Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
Carroll Hospital Center Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 Memorial Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Westminster, MD21157
D Employer identification number

52-1452024
E Telephone number

G Gross receipts $ 206,214,157
F Name and address of principal officer:
John Sernulka
200 MEMORIAL AVE
WESTMINSTER,MD21774
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.carrollhospitalcenter.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1957
M State of legal domicile: MD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: OUR COMMUNITIES EXPECT AND DESERVE SUPERIOR MEDICAL TREATMENT, COMPASSIONATE CARE, AND EXPERT GUIDANCE IN MAINTAINING THEIR HEALTH AND WELL-BEING.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,958
6 Total number of volunteers (estimate if necessary) .... 6  
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 3,692,824
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,176,242 1,090,000
9 Program service revenue (Part VIII, line 2g) ......... 190,619,219 201,412,609
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,311,044 3,179,446
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 773,491 532,102
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 196,879,996 206,214,157
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 115,000 115,000
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 96,985,712 97,467,463
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 100,640,157 91,916,180
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 197,740,869 189,498,643
19 Revenue less expenses. Subtract line 18 from line 12...... -860,873 16,715,514
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 300,967,431 313,981,970
21 Total liabilities (Part X, line 26)............ 206,812,673 195,306,839
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 94,154,758 118,675,131
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 160,054,843 including grants of $ 115,000 ) (Revenue $ 198,252,757 )
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. Carroll County's population alone is currently estimated to be 204,400. 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 over 54,000 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 2011, Carroll Hospital Center recorded 15,833 inpatient admissions and observation stay cases, 1,119 births and approximately 9,200 surgical procedures, all contributing to a total of 330,000 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 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 Form 990's. While we have attempted to summarize our program service accomplishments below, we urge those interested to access more detailed and complete information at www.CarrolHospitalCenter.org. In cooperation with our many community partners, including The Partnership, we seek to make measurable and sustainable progress in improving the health of the communities we serve. We gauge our progress by how effectively we identify and positively impact the underlying root causes associated with poor community health. To track and trend our progress as a community, The Partnership has organized Healthy Carroll Vital Signs - Measures of Community Health. This data is provided by various sources and is updated each year. When combined with our newly-acquired Healthy Communities Institute data, the hospital has access to the most up-to-date, comprehensive information on our community's health. Through The Partnership, Carroll Hospital Center has been involved in numerous health status assessment projects specific to our community and is in the process of conducting a comprehensive Community Health Needs Assessment. Once completed in June 2012, the assessment will provide the hospital with the important and current needs and opinions of members of our community as well as more in-depth information from key community leaders. Collectively the data will provide the hospital with the crucial information it needs to continue to make well informed decisions when it comes to effectuating positive change in the health status of our communities. Previous health needs assessments have sparked the hospital to develop key services such as Access Carroll (in coordination with the Carroll County Health Department and The Partnership), a clinic for uninsured patients and The Women's Place, a center for health and wellness for women that provides a full range of educational, complementary health and patient navigation services, a breast center and cancer boutique. Hospital staff also have helped to develop and participate in numerous committees and work groups to address age, gender and ethnic-specific living and health care issues. In addition, the hospital's focus on wellness is one that provides our community with hundreds of free education programs, screenings and support groups each year for everything from childbirth and disease prevention to nutrition and breast, prostate and skin cancers. The hospital also has committed significant resources to make certain there is an adequate supply of primary care and specialty physicians in our service area. Ensuring our communities have access to quality and medical expertise is a priority for our organization. That's why we continue to develop Carroll Health Group, our hospital-owned network of medical providers, which currently includes 32 Physicians and 11 Other Providers (PA, NP) in 19 office locations throughout Carroll and surrounding counties. During the most recent reporting period the organization provided a total of $3,011,868, $2,463,708 at cost, in charity/uncompensated care to the community. Additionally the organization expended approximately $19,147,524 (Net of Revenues) on programs and activities benefitting the communities we serve. These programs and activities included hospice services, physician support, education programs, screenings, support groups, health professional education and community contributions and required approximately 492,000 staff hours.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 160,054,843
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
233
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,958
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA , MD
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DAVID MCCORMICK
200 MEMORIAL AVE
Westminster,MD21157
(410) 871-6859
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) CHARLES O FISHER JR
DIRECTOR
 1.0 X           0 0 0
(2) CHARLES FISHER SR
DIRECTOR
 1.0 X           0 0 0
(3) MIRIAM BECK
DIRECTOR
 1.0 X           0 0 0
(4) PAULA LANGMEAD
DIRECTOR
 1.0 X           0 0 0
(5) ETHAN SEIDEL
DIRECTOR
 1.0 X           0 0 0
(6) JOHN SERNULKA
PRESIDENT
 35.0 X   X       291,984 0 292,083
(7) STEPHAN HOCHULI MD
BOARD MEMBER
 1.0 X           0 0 0
(8) KIMBERLY JOHNSTON MD
BOARD MEMBER
 1.0 X           0 0 0
(9) STANLEY H TEVIS III
BOARD MEMBER
 1.0 X           0 0 0
(10) HAROLD WALSH
BOARD MEMBER
 1.0 X           0 0 0
(11) HELEN W WHITEHEAD
BOARD MEMBER
 1.0 X           0 0 0
(12) CHRISTOS BALLAS MD
BOARD MEMBER
 1.0 X           0 0 0
(13) THOMAS WELLIVER
BOARD MEMBER
 1.0 X           0 0 0
(14) JEFFREY A WOTHERS
BOARD MEMBER
 1.0 X           0   0
(15) DENNIS THOMAS
BOARD MEMBER
 1.0 X           0 0 0
(16) LESLIE SIMMONS
CHIEF OPERATING OFFICER
 38.0     X       278,385 0 24,101
(17) KEVIN KELBLY
SR VP FINANCE CFO
 34.0     X       303,120 0 29,988
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) KEVIN SMOTHERS
CHIEF MEDICAL OFFICER
 40.0     X       366,121 0 22,772
(19) STEPHANIE REID
ASSISTANT VICE PRESIDENT
 40.0     X       155,779 0 7,033
(20) DAVID HORN
VICE PRESIDENT
 40.0       X     188,775 0 23,172
(21) M ELLEN FINNERTY MYERS
VICE PRESIDENT
 40.0       X     192,915 0 4,949
(22) JOYCE ROMANS
VICE PRESIDENT
 40.0       X     198,223 0 14,976
(23) TRACEY ELLISON
VICE PRESIDENT
 40.0       X     172,101 0 19,892
(24) DANILO PERUNOVICH
VICE PRESIDENT
 40.0       X     184,371 0 13,876
(25) CYNTHIA ROLDAN
PHYSICIAN
 40.0         X   174,445 0 3,078
(26) JEROME MARAVE
PHYSICIAN
 40.0         X   210,263 0 19,753
(27) DANILO V SANTOS
PHYSICIAN
 40.0         X   187,300 0 13,932
(28) EDYTA OSWIECIMKA
nurse
 40.0         X   163,532 0 18,620
(29) KIMBERLY MOREAU
asst vice president
 40.0         X   150,193 0 24,520


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,217,507 0 532,745
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet70
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CENTRAL MD REHABILITATION
4259 HARNEY RD
TANEYTOWN,MD21787 		REHAB 3,005,060
CARROLL COUNTY ANES ASSOCIATION
PO BOX 75193
BALTIMORE,MD21275 		ANESTHESIA 1,802,745
carroll county radiology
7253 ambassador rd
BALTIMORE,MD21244 		mri 783,960
DIGITRACE CARE SERVICES
200 CORPORATE PLACE
PEABODY,MA01960 		Sleep Studies 666,550
university of md physicians
419 w redwood st ste 660
BALTIMORE,MD21201 		physicians 658,333
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet30
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,090,000
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,090,000
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE   194,771,483 194,771,483    
b CAFETERIA/VEND.   798,131 798,131    
c LAB 621,500 3,569,383   3,569,383  
d OTHER OPERATING REVENUE   2,273,612 2,273,612    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 201,412,609
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 3,179,446   870 3,178,576
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 442,102  
b Less: rental expenses    
c Rental income or (loss) 442,102  
d Net rental income or (loss).......MediumBullet 442,102 409,531 32,571 0
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CARROLL COUNTY MED SERVICES MGMT FEE 541,610 90,000   90,000  
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 90,000
12 Total revenue. See Instructions....MediumBullet 206,214,157 198,252,757 3,692,824 3,178,576
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 115,000 115,000
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,403,976 0 2,403,976 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 78,355,992 69,652,245 8,703,747 0
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 4,342,488 3,857,380 485,108 0
9 Other employee benefits ....... 6,551,084 5,819,249 731,835 0
10 Payroll taxes ........... 5,813,923 5,164,438 649,485 0
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 519,862 1,565 518,297 0
c Accounting ........... 247,500 0 247,500 0
d Lobbying ........... 7,858 0 7,858 0
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 231,741 0 231,741 0
g Other .......... 8,337,408 7,833,641 503,767 0
12 Advertising and promotion .... 621,820 8,237 613,583 0
13 Office expenses ....... 855,882 538,583 317,299 0
14 Information technology ...... 5,090,673 0 5,090,673 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 3,751,339 2,634,079 1,117,260 0
17 Travel ............ 441,163 167,876 273,287 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 92,613 69,954 22,659 0
20 Interest ........... 6,889,101 6,889,101 0 0
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 13,233,722 10,848,419 2,385,303 0
23 Insurance .............. 2,332,579 1,341,964 990,615 0
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 22,333,959 22,331,531 2,428 0
b FOOD 946,953 882,083 64,870  
c OTHER 619,270 400,320 218,950  
d MINOR EQUIPMENT 593,864 543,116 50,748  
e SUPPLIES 719,270 694,739 24,531  
f All other expenses 24,049,603 20,261,323 3,788,280 0
25 Total functional expenses. Add lines 1 through 24f 189,498,643 160,054,843 29,443,800 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,300 1 2,300
2 Savings and temporary cash investments ....... 44,351,604 2 28,013,039
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 18,272,362 4 16,873,397
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 50,000 7 50,000
8 Inventories for sale or use .............. 2,920,302 8 2,637,299
9 Prepaid expenses and deferred charges ............ 2,589,854 9 2,405,896
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 255,012,044
b Less: accumulated depreciation. ..... 10b 122,955,606 133,056,141 10c 132,056,438
11 Investments—publicly traded securities .......... 34,915,453 11 46,469,198
12 Investments—other securities. See Part IV, line 11 ...... 20,018,231 12 35,388,415
13 Investments—program-related. See Part IV, line 11 .. 27,685,775 13 28,600,900
14 Intangible assets ......... 0 14 4,400,000
15 Other assets. See Part IV, line 11 ........... 17,105,409 15 17,085,088
16 Total assets. Add lines 1 through 15 (must equal line 34)... 300,967,431 16 313,981,970
Liabilities 17 Accounts payable and accrued expenses . 25,006,392 17 20,358,923
18 Grants payable ..........   18  
19 Deferred revenue .......... 1,695,861 19 1,264,732
20 Tax-exempt bond liabilities .......... 135,147,684 20 135,424,555
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 44,962,736 25 38,258,629
26 Total liabilities. Add lines 17 through 25..... 206,812,673 26 195,306,839
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 94,154,758 27 118,675,131
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 94,154,758 33 118,675,131
34 Total liabilities and net assets/fund balances ..... 300,967,431 34 313,981,970
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
206,214,157
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
189,498,643
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
16,715,514
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
94,154,758
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
7,804,859
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
118,675,131
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Carroll Hospital Center Inc
  		Employer identification number

52-1452024
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Carroll Hospital Center Inc
  		Employer identification number

52-1452024
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Carroll Hospital Center Inc
  		Employer identification number

52-1452024
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
7,858
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
 
 
 
j
Total. lines 1c through 1i ...................................
7,858
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 7,900,509 7,009,809  
b Contributions ........ 690,978 251,338  
c Investment earnings or losses ... 1,503,183 639,362  
d Grants or scholarships ..... 8,500    
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ...... 10,086,170 7,900,509  
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet84.000 %
b
Permanent endowment: SchDMd Bullet15.000 %
c
Term endowment: SchDMd Bullet1.000 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,217,860 1,217,860
b Buildings ................   116,937,179 34,672,871 82,264,308
c Leasehold improvements ............   9,494,934 9,476,596 18,338
d Equipment ................   98,137,291 72,406,132 25,731,159
e Other .................   29,224,780 6,400,007 22,824,773
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 132,056,438
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) LONG-TERM INVESTMENTS OTHER 		17,109,570 C

(B) LONG TERM INVESTMENTS 		3,789,611 F

(C) CD 		155,960 C

(D) SHORT TERM INVESTMENTS 		14,167,332 F

(E) MONEY MARKET ACCT 		165,942 F




Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 35,388,415
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) INVESTMENT IN SUBSIDIARIES 25,873,672 C
(2) INVESTMENT IN PREMIER 275,818 C
(3) INVESTMENT IN ONCOLOGY CTR 0 C
(4) INVESTMENT IN MT AIRY HLTH SER 435,989 C
(5) INVESTMENT IN CMOA 2,015,421 C




Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet 28,600,900
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 1,067,195
(2) UMAMORTIZED BOND ISSUANCE COST 1,867,734
(3) OTHER RECEIVABLES 643,446
(4) FUNDS HELD BY TRUSTEE 13,441,518
(5) ASSETS LIMITED TO USE 65,195




Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 17,085,088
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
ADVANCES FROM THIRD PARTY 6,723,511
ACCRUED PENSION 6,873,504
OTHER LIABILITIES 181,248
MERRILL LYNCH SWAP RATE 3,586,214
CAPITAL LEASE 698,981
MOB 16,224,312
DEF COMPENSATION 3,970,859


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 38,258,629
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean     Investments   1,944,679
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     1,944,679
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     1,944,679
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
 
No
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    2,463,708   2,463,708 1.360 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		           
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    2,463,708   2,463,708 1.360 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    1,383,532 33,585 1,349,947 0.750 %
f Health professions education
(from Worksheet 5) .. 		    625,578   625,578 0.350 %
g Subsidized health services
(from Worksheet 6) .. 		    31,629,284 17,825,678 13,803,606 7.620 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    207,586   207,586 0.110 %
jTotal Other Benefits ...     33,845,980 17,859,263 15,986,717 8.830 %
kTotal. Add lines 7d and 7j. ..     36,309,688 17,859,263 18,450,425 10.190 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     406,772 103,863 302,909 0.170 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     448,930   448,930 0.250 %
8 Workforce development            
9 Other            
10 Total     855,702 103,863 751,839 0.420 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
6,861,384
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
686,138
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
83,961,449
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
62,855,055
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
21,106,394
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1cc radiology llc
  		imaging center 60.000 %   40.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 CARROLL HOSPITAL CENTER INC
200 MEMORIAL AVE
WESTMINSTER,MD21157 		X                
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CARROLL HOSPITAL CENTER INC
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?5
Name and address Type of Facility (Describe)
1 carroll county radiology
7253 ambassador road
baltimore,MD21244 		imaging center
2 carroll county radiology
7253 ambassador road
baltimore,MD21244 		imaging center
3 carroll county radiology
7253 ambassador road
baltimore,MD21244 		imaging center
4 carroll county radiology
7253 ambassador road
baltimore,MD21244 		imaging center
5 carroll county radiology
7253 ambassador road
baltimore,MD21244 		imaging center
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 3B   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.
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 2010 CARROLL HOSPITAL CENTER'S MEDICAID BUDGET DEFICIT UNFUNDED ASSESSMENT AMOUNTED TO $504,659.
PART I, LINE 3C   N/A
PART I, LINE 6A   MARYLAND HOSPITAL'S 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 PROVIDED $13,803,606 OF NET COMMUNITY BENEFIT THROUGH SUBSIDIZED HEALTH SERVICES. THIS INCLUDES PHYSICIAN SUPPORT SPENDING INCURRED BY THE HOSPITAL ($4.2 MILLION) TO PROVIDE ON-SITE PHYSICIAN COVERAGE TO HOSPITAL OBSTETRICAL, PEDIATRIC, CRITICAL CARE, AND MEDICAL/SURGICAL PATIENTS, AS WELL AS EMERGENCY DEPARTMENT ON-CALL COVERAGE. ADDITIONALLY, CARROLL HOSPITAL CENTER INDIRECTLY SUBSIDIZES THE OPERATING LOSSES ASSOCIATED WITH ITS WHOLLY-OWNED CORPORATE SUBSIDIARY'S (CARROLL COUNTY MED-SERVICES) EMPLOYED PHYSICIAN ENTERPRISES (ELEVEN WHOLLY-OWNED PHYSICIAN PRACTICE LIMITED COMPANIES DISREGARDED FOR TAX PURPOSES). CARROLL HOSPITAL CENTER FUNDS THE OPERATING LOSSES ($9.6 MILLION) THAT ARE INCURRED DIRECTLY BY CARROLL COUNTY MED-SERVICES. AS A RESULT, CARROLL HOSPITAL CENTER HAS INCLUDED THE $9.6 MILLION OPERATING LOSS ASSOCIATED WITH THE FUNDING OF THE PHYSCIAN ENTERPRISES AS A COMMUNITY BENEFIT ON SCHEDULE H. 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. THERE IS NOT ANY OTHER ORGANIZATION OR INDIVIDUAL IN THE COUNTY THAT WOULD BE ABLE TO PROVIDE ALL OF THESE COMPREHENSIVE SERVICES IN ALL OF THE AREAS That THE HOSPITAL DOES.
PART I LINE 7   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 $6,861,384 BAD DEBT EXPENSE DURING THE TAX YEAR 2010. THIS REFLECTS THE AMOUNT OF GROSS PATIENT CHARGES ($8,388,000) UNCOLLECTED FROM PATIENTS THAT DID NOT QUALIFY FOR FINANCIAL ASSISTANCE DISCOUNTED BY CHC'S COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PER AUDIT REPORT (1M): "NET PATIENT SERVICE FOR THE HOSPITAL REFLECTS ACTUAL CHARGES TO PATIENTS BASED ON RATES ESTABLISHED BY THE STATE OF MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) IN EFFECT DURING THE PERIODS IN WHICH SERVICES ARE RENDERED, NET OF CONTRACTUAL ADJUSTMENTS. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED BY THE HOSPITAL AND AMOUNTS PAID BY THIRD-PARTY PAYORS. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE". BAD DEBT EXPENSE 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 ($686,138 AT COST) MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE.
PART III, LINE 8   CARROLL HOSPITAL CENTER'S TAX YEAR 2010 (FISCAL YEAR 2011) MEDICARE COST REPORT SUBMISSION WAS UTILIZED AS THE SOURCE DOCUMENT TO REPORT MEDICARE ALLOWABLE COSTS OF CARE (PART III, LINE 6) RELATING TO PAYMENTS ON (PART III, LINE 5)
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 charity care. Collection efforts will be stopped immediately once the patient is found to qualify for charity care under the organization's financial assistance policy.
NEEDS ASSESSMENT PART VI, LINE 2 THROUGH OUR COMMUNITY ADVOCACY ARM, THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, CHC HAS BEEN INVOLVED IN NUMEROUS HEALTH STATUS ASSESSMENT PROJECTS SPECIFIC TO OUR COMMUNITY. AN ORIGINAL CARROLL COMMUNITY HEALTH ASSESSMENT IN 1997 PRIORITIZED EIGHT BROAD AREAS WHERE IMPROVEMENT OPPORTUNITIES EXISTED. THAT NUMBER WAS EXPANDED TO 11, FOLLOWING SUCCESSIVE ASSESSMENTS. UPDATED TO THE ORIGINAL ASSESSMENT WERE ALSO COMPLETED IN 2005 AND INCLUDED TWO UPDATES, ONE SPECIFIC TO HOUSEHOLDS WITHOUT CHILDREN UNDER THE AGE OF 18 AND THOSE WITH CHILDREN UNDER THE AGE OF 18. OUR RESULTS WERE STRIKINGLY SIMILAR TO THE LEADING INDICATORS IN THE US GOVERNMENT'S HEALTHY PEOPLE 2010 PROJECT. OPERATING UNDER THE GUIDANCE OF THE SURGEON GENERAL'S OFFICE AND THE SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTHY PEOPLE 2010 IS THE PREVENTION AGENDA FOR THE NATION. ALL IDENTIFIED IMPROVEMENT AREAS HAVE BEEN UPDATED TO PROVIDE HEALTHY PEOPLE 2010 OBJECTIVES. ALL IDENTIFIED IMPROVEMENT AREAS WILL BE REVIEWED AND INCORPORATED INTO OUR COMMUNITY BENEFIT PLAN AS FEASIBLE AND APPROPRIATE. IN COOPERATION WITH OUR COMMUNITY PARTNERS. WE SEEK TO MAKE MEASURABLE, SUSTAINABLE, LONG-TERM PROCESS. WE GAUGE OUR PROGRESS RELATED TO OUR EFFORTS ON THE UNDERLYING ROOT CAUSES ASSOCIATED WITH THESE ISSUES, AND AGAIN, WITH AND THROUGH OUR MANY PARTNERS, WE STRIVE TO ADDRESS ROOT CAUSES. TO TRACK AND TREND OUR PROGRESS AS A COMMUNITY, THE PARTNERSHIP HAS ORGANIZED HEALTHY CARROLL VITAL SIGNS - MEASURES OF COMMUNITY HEALTH. THIS DATA IS PROVIDED BY VARIOUS SOURCES INCLUDING THE CARROLL COUNTY HEALTH DEPARTMENT AND OTHER BRANCHES OF THE CARROLL COUNTY GOVERNMENT AS WELL AS THROUGH HOSPITAL-BASED COMMUNITY OUTREACH ACTIVITIES AND EDUCATION (DATA CHARTS AVAILABLE ON-LINE AT WWW.HEALTHYCARROLL.ORG). SINCE NOT ALL OF THE DATA CHARTS ARE UPDATED EACH YEAR, DATA CHARTS ARE REVIEWED ANNUALLY AND UPDATED AS DATA IS AVAILABLE. THE PARTNERSHIP DEVELOPED A DASHBOARD REPORT TO TRACK PROGRESS AND OUTCOMES OF KEY INDICATORS (DASHBOARD AVAILABLE ON-LINE AT WWW.HEALTHYCARROLL.ORG AND PROVIDED AS SUPPORT IN QUESTION 5). OTHER ASSESSMENTS USED INCLUDE: ELDER NEEDS HEALTH ASSESSMENT: COMPLETED IN FEBRUARY 2008, (REPORT AVAILABLE IN ITS ENTIRETY ON-LINE AT WWW.HEALTHYCARROLL.ORG). COMMUNITY BENEFIT PROGRAM INITIATIVES ARE DECIDED UPON PRIMARILY BY THE INPUT, WORK AND ANNUAL STRATEGY PLANNING OF THE FOLLOWING: 1. PATIENTS 2. THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY (WITH OUR COMMUNITY PARTNERS INCLUDING THE CARROLL COUNTY HEALTH DEPARTMENT) 3. THE LEARNING CENTER 4. THE WOMEN'S PLACE 5. THE HOSPITAL'S MULTIDISCIPLINARY COMMUNITY BENEFIT PLANNING AND REVIEW TEAM 6. THE HOSPITAL'S EXECUTIVE TEAM AND BOARD OF DIRECTORS IN ADDITION, TO KEEP OUR FINGER ON THE PULSE OF PERTINENT ISSUES AND CONTINUE TO BE PROACTIVE IN INDENTIFYING AND CREATIVELY MEETING THE UNIQUE NEEDS OF OUR COMMUNITY ON AN ONGOING BASIS, THE PARTNERSHIP HAS DEVELOPED AND FACILITATES THE FOLLOWING LEADERSHIP TEAMS FOCUSED ON THE 11 CORE HEALTH IMPROVEMENT AREAS IDENTIFIED IN OUR ORIGINAL COMMUNITY HEALTH ASSESSMENT: 1. ACCESS TO HEALTH CARE - COLLABORATES WITH COMMUNITY PARTNERS TO IMPROVE ACCESS TO HEALTH CARE FOR THE UNINSURED AND UNDERINSURED. 2. CANCER: AMERICAN CANCER SOCIETY LEADERSHIP COUNCIL - WORKS TO REDUCE CANCER INCIDENCE AND MORTALITY IN CARROLL COUNTY. 3. INTERPERSONAL VIOLENCE: DOMESTIC VIOLENCE COORDINATING COUNCIL - FOCUSES ON ISSUES OF DOMESTIC VIOLENCE IN COUNTY. AFFILIATED WITH FAMILY AND CHILDREN'S SERVICES OF CENTRAL MARYLAND, CARROLL COUNTY. 4. ELDER HEALTH - SEEKS TO INCREASE QUALITY AND YEARS OF HEALTHY LIFE FOR CARROLL COUNTIANS OVER AGE 65. 5. HEART HEALTH IMPROVEMENT - SEEKS TO IMPROVE THE CARDIOVASCULAR HEALTH AND QUALITY OF LIFE OF ADULTS AND CHILDREN THROUGH PREVENTION, DETECTION, AND TREATMENT OF RISK FACTORS. 6. L.E.A.N. CARROLL - MULTI-DISIPLINARY HOSPITAL/COMMUNITY GROUP WORKING TO ADDRESS CHILDHOOD OBESITY IN CARROLL COUNTY THROUGH LIFESTYLE, EDUCATION, ACTIVITY AND NUTRITION. 7. MENTAL HEALTH: SUBCOMMITTEE OF THE BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - SUPPORTS EFFORTS TO IMPROVE THE MENTAL HEALTH OF CARROLL COUNTY RESIDENTS. A MENTALLY HEALTHY COMMUNITY IS INDICATED BY MANY FACTORS INCLUDING: LOW SUICIDE ATTEMPT RATES, AND INCREASED NUMBER OF COUNTY RESIDENTS WHOSE INSURANCE COVERS MENTAL HEALTH SERVICES, AN ADEQUATE NUMBER OF OUTPATIENT SERVICES, AND A DECREASE IN THE STIGMA ASSOCIATED WITH MENTAL ILLNESS AND EMOTIONAL DISTURBANCES. 8. PREVENTION & WELLNESS PARTNERS - COORDINATES PROJECTS TO IMPROVE HEALTH OUTCOMES FOR PEOPLE IN CARROLL COUNTY AS MEASURED BY IMPROVEMENT IN LIFESTYLE/BEHAVIOR INDICATORS. 9. RESOURCE CONSERVATION COALITION - WORK GROUP FORMED TO PROMOTE HEALTH AND QUALITY OF LIFE FOR ALL COUNTY RESIDENTS THROUGH A HEALTHIER ENVIORMENT AND MANAGED GROWTH AND DEVELOPMENT AND WATER QUALITY STANDARDS. 10.POSITIVE YOUTH & FAMILY DEVELOPMENT - SCHOOL READINESS PROVIDES INFORMATION TO PARENTS AND COMMUNITY ON WAYS TO ENSURE THAT CHILDREN ENTER SCHOOL WITH THE SKILLS NEEDED FOR LEARNING. 11.SUBSTANCE ABUSE: SUB-COMMITTEE OF THE BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - FOCUSES ON ALL ISSUES OF SUBSTANCE ABUSE IN CARROLL COUNTY. PRODUCES SUBSTANCE ABUSE DIRECTORY (2008 VERSION). WORKS TOWARDS GAPS IN SERVICE THAT HAVE BEEN IDENTIFIED, INCLUDING NEED FOR A LONG-TERM TREATMENT FACILITY FOR HEROIN USERS, LACK OF SPACE/CAPACITY FOR CURRENT RESIDENTAL PROGRAMS, INSUFFICIENT DETOX SERVICES, INADEQUATE SERVICES FOR ADOLESCENTS WITH CO-OCCURING DISORDERS, AND A NEED FOR MORE PREVENTION SERVICES. THE ADDTIONAL PARTNERS UTILIZED IN COMMUNITY NEEDS ASSESSMENTS WERE: 1. BEHAVIORAL HEALTH AND ADDICTIONS ADVISORY COUNCIL - STATE APPOINTED LOCAL GROUP TO EVALUATE CONTINUUM OF CARE IN SUBSTANCE ABUSE AND MENTAL HEALTH FIELDS IN THE COUNTY. SERVES AS QUASI-BOARD OF DIRECTORS FOR THE CARROLL COUNTY CORE SERVICES AGENCY. ALSO COORDINATES TRAINING PROGRAMS, PROGRAMS DESIGNED TO REDUCE THE STIGMA ASSOCIATED WITH PSYCHIATRIC DISORDERS, AND PUBLIC AWARENESS PROGRAMS. 2. CARING CARROLL, INC. - OPERATES CARING CARROLL, A FAITH IN ACTION VOLUNTEER CARE GIVING PROGRAM. HELPS TO MEET THE NON-MEDICAL NEEDS OF ISOLATED ELDERLY, ILL, DISABLED, OR FRAIL CARROLL COUNTY RESIDENTS STRIVING TO REMAIN INDEPENDENT IN THEIR OWN HOMES. 3. CARROLL COUNTY LOCAL MANAGEMENT BOARD - WORKS TO IMPROVE THE LIVES OF CHILDREN AND FAMILIES IN CARROLL COUNTY. DEVELOPS AND MANAGES COMMUNITY-BASED FAMILY SERVICES. 4. MID-WESTERN REGION HIGHWAY SAFETY TASK FORCE - CARROLL COUNTY COMPREHENSIVE HIGHWAY TRAFFIC SAFETY TASK FORCE. FUNDS LAW ENFORCEMENT, INCLUDING OVERTIME FOR DUI ENFORCEMENT, AGGRESSIVE DRIVING, MOTORCYCLE, AND PEDESTRIAN ENFORCEMENT. EDUCATION AND AWARENESS PROGRAMS ON YOUNG/OLDER DRIVER ISSUES, OCCUPANT PROTECTION, CHILD PASSENGER SAFETY, BICYCLE, ALCOHOL, AGGRESSIVE DRIVING AND MORE. 5. RISKY BUSINESS PLANNING COMMITTEE - PLANS ANNUAL TRAINING/ AWARENESS-RAISING CONFERENCE IN JUNE FOR PROVIDERS REGARDING ISSUES OF TEEN RISKY BEHAVIORS, SUCH AS PREGNANCY, DRUG USE, AND SUICIDE. 6. TOBACCO COALITION (CARROLL COMMUNITY HEALTH TOBACCO COALITION) LOCAL HEALTH COALITION THAT SEEKS TO DECREASE TOBACCO USE AND EXPOSURE TO SECONDHAND SMOKE IN CARROLL COUNTY.
PATIENT EDUCATION AND 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 FO 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 FO 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 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 2010: 167,134 POPULATION PERCENT CHANGE 2000 TO 2010: 10.8% POPULATION 2000: 150,897 PERSONS UNDER 5 YEARS PERCENT 2010: 5.4% PERSONS UNDER 18 YEARS PERCENT 2010: 24.7% PERSONS 65 YEARS AND OVER PERCENT 2010: 13.0% FEMALE PERSONS, PERCENT 2010: 50.6% RACE WHITE PERSONS: 92.9% BLACK PERSONS: 3.2% AMERICAN INDIAN AND ALASKA NATIVE PERSONS: 0.2% ASIAN PERSONS: 1.4% NATIVE AMERICAN AND OTHER PACIFIC ISLANDER: 0 PERSONS REPORTING TWO OR MORE RACES: 1.5% PERSONS OF HISPANIC OR LATINO ORIGIN: 2.6% WHITE PERSONS NOT HISPANIC: 91.2% SOURCE: SOURCE US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. FAMILY TOTAL NUMBER OF HOUSEHOLDS (2009): 59,915 AVERAGE HOUSEHOLD SIZE (2009): 2.77 PERSONS SOURCE: 2009 AMERICAN COMMUNITY SURVEY 1-YEAR ESTIMATES. ECONOMICS MEDIAN HOUSEHOLD INCOME (2007/2008): $78,653 PERSONS BELOW POVERTY LEVEL, PERCENT, 2009: 5.9% SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THE MD BRFSS (MARYLAND BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY) (AVERAGE 2008-2010 DATA) THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 7.4%. IN FY 2011, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS), 7.2% WERE MEDICAID ADMISSIONS.
PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 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. Carroll County's population alone is currently estimated to be 204,400. 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 over 54,000 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 2011, Carroll Hospital Center recorded 15,833 inpatient admissions and observation stay cases, 1,119 births and approximately 9,200 surgical procedures, all contributing to a total of 330,000 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 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 Form 990's. While we have attempted to summarize our program service accomplishments below, we urge those interested to access more detailed and complete information at www.CarrolHospitalCenter.org. In cooperation with our many community partners, including The Partnership, we seek to make measurable and sustainable progress in improving the health of the communities we serve. We gauge our progress by how effectively we identify and positively impact the underlying root causes associated with poor community health. To track and trend our progress as a community, The Partnership has organized Healthy Carroll Vital Signs - Measures of Community Health. This data is provided by various sources and is updated each year. When combined with our newly-acquired Healthy Communities Institute data, the hospital has access to the most up-to-date, comprehensive information on our community's health. Through The Partnership, Carroll Hospital Center has been involved in numerous health status assessment projects specific to our community and is in the process of conducting a comprehensive Community Health Needs Assessment. Once completed in June 2012, the assessment will provide the hospital with the important and current needs and opinions of members of our community as well as more in-depth information from key community leaders. Collectively the data will provide the hospital with the crucial information it needs to continue to make well informed decisions when it comes to effectuating positive change in the health status of our communities. Previous health needs assessments have sparked the hospital to develop key services such as Access Carroll (in coordination with the Carroll County Health Department and The Partnership), a clinic for uninsured patients and The Women's Place, a center for health and wellness for women that provides a full range of educational, complementary health and patient navigation services, a breast center and cancer boutique. Hospital staff also have helped to develop and participate in numerous committees and work groups to address age, gender and ethnic-specific living and health care issues. In addition, the hospital's focus on wellness is one that provides our community with hundreds of free education programs, screenings and support groups each year for everything from childbirth and disease prevention to nutrition and breast, prostate and skin cancers. The hospital also has committed significant resources to make certain there is an adequate supply of primary care and specialty physicians in our service area. Ensuring our communities have access to quality and medical expertise is a priority for our organization. That's why we continue to develop Carroll Health Group, our hospital-owned network of medical providers, which currently includes 32 Physicians and 11 Other Providers (PA, NP) in 19 office locations throughout Carroll and surrounding counties. During the most recent reporting period the organization provided a total of $3,011,868, $2,463,708 at cost, in charity/uncompensated care to the community. Additionally the organization expended approximately $19,147,524 (Net of Revenues) on programs and activities benefitting the communities we serve. These programs and activities included hospice services, physician support, education programs, screenings, support groups, health professional education and community contributions and required approximately 492,000 staff hours. THE HOSPITAL'S EDUCATION AND WELLNESS INITIATIVES ARE DRIVEN BY THE WOMEN'S PLACE, THE LEARNING CENTER AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY. THESE EDUCATION ARMS OF THE HOSPITAL WORK COLLABORATIVELY TO ADDRESS THE LARGEST NUMBER OF COMMUNITY HEALTH CARE NEEDS AND WELLNESS INITIATIVES WITHOUT DUPLICATING SERVICES OR PROGRAMS. TOGETHER, IN FY11, THE HOSPITAL HAD 7,997 ENCOUNTERS FOR COMMUNITY HEATLH EDUCATION, 2,364 ENCOUNTERS FOR SUPPORT GROUPS, 1,734 ENCOUNTERS FOR FREE AND LOW-COST SCREENINGS AND 214 ENCOUNTERS FOR SELF-HELP PROGRAMS. THESE PROGRAMS, SUPPORT GROUPS AND SCREENINGS ARE NOT ONLY DIRECTED TO PATIENTS WITH A VARIETY OF CHRONIC AND ACUTE MEDIAL ISSUES RANGING FROM CANCER AND DIABETES TO HEART DISEASE AND ARTHRITIS BUT MANY ARE FOCUSED ON PREVENTION AND EDUCATION TO KEEP OUR POPULATION WELL. FIVE EXAMPLES OF PROGRAMS WITH MEASURABLE OUTCOMES ARE OUTLINED BELOW: A. LOSE to Win: Wellness Challenge DESCRIPTION:12-week collaborative community program to promote weight loss and wellness. This innovative and rigorous 12-week program features: 1. Unlimited access to exercise sessions at Merritt Athletic Club 2. Weekly group nutritional classes at Martin's Food Market 3. Weekly weigh-ins and regular blood pressure checks 4. Prize incentives 5. Pre- and post-program comprehensive blood profiles EVALUATION DATES: Fall 2010: September 2 - November 18, 2010 Spring 2011: February 24 - May 12, 2011 RESULTS/EVALUATION: AS A RESULT OF A HEALTHY COLLABORATION BETWEEN CARROLL HOSPITAL CENTER AND ITS PARTNERS IN THE SOUTH CARROLL (ELDERSBURG) AREA, MARTIN'S FOOD MARKET, MERRITT ATHLETIC CLUB AND LOCAL BEAUTY SALONS, THE LOSE TO WIN WELLNESS CHALLENGE HAS MARKED THE END TO ANOTHER SUCCESSFUL YEAR. RESULTS FOR ALL PROGRAMS ARE LISTED BELOW. FALL 2010 Total pounds lost - 383 lbs Percentage lost - 7.3% Number of participants who lost 10 pounds or more - 15 Number of participants who lost 20 pounds or more - 8 Number of participants who lost 30 pounds or more - 3 Percentage of weight lost by winner - 14.3% Pounds lost by winner - 59.6 lbs SPRING 2011 Total pounds lost - 272 lbs Percentage lost - 7.4% Number of participants who lost 10 pounds or more - 11 Number of participants who lost 20 pounds or more - 6 Number of participants who lost 30 pounds or more - 2 Percentage of weight lost by winner - 16.4% Pounds lost by winner - 29 lbs People saw significant reductions in blood sugar and blood sugar control (based on fasting Blood Sugar) during each of the three programs. B. TOTAL HEALTH EXPO: THE HEALTH & WELLNESS EVENT FOR THE ENTIRE FAMILY DESCRIPTION:The free event included: Free and low-cost Screenings Health information booths Kids activities Interactive educational displays Physical activities Adult CPR class Complementary health mini-treatments Medical assistance enrollment & information Healthy lunch free for all attendees And more! DATE OF EVENT: October 30, 20
AFFILIATED HEALTH CARE SYSTEMS   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 the sole member and employer of eleven physician practices, which provide primary and specialty care services to the community. The provision of these physician services helps meet an identified community health need for additional primary and specialty care physicians in the community. The eleven physician practices run at a substantial operating loss ($6.6 million in 2010), which is funded by contributions from Carroll Hospital Center. 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,
Schedule H (Form 990) 2010
Additional Data


Software ID:  
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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number
52-1452024
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) PARTNERSHIP FOR HEALTHIER CARROLL COUNTY95 CARROLL ST
WESTMINSTER,MD21157 		  115,000       Hospital contribution to support the programs of the Partnership






















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
1
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
part i, line 2   The grant provided is to a related organization that is controlled by the organization 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.
Schedule I (Form 990) 2010


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JOHN SERNULKA (i)
(ii)		 228,722
0 		33,110
0 		30,152
0 		274,095
0 		17,988
0 		584,067
0 		 
 
(2) LESLIE SIMMONS (i)
(ii)		 238,846
0 		16,699
0 		22,840
0 		6,689
0 		17,412
0 		302,486
0 		 
 
(3) KEVIN KELBLY (i)
(ii)		 261,419
0 		16,233
0 		25,468
0 		12,576
0 		17,412
0 		333,108
0 		 
 
(4) DAVID HORN (i)
(ii)		 169,643
0 		8,044
0 		11,088
0 		5,760
0 		17,412
0 		211,947
0 		 
 
(5) M ELLEN FINNERTY MYERS (i)
(ii)		 173,239
0 		8,880
0 		10,796
0 		4,440
0 		509
0 		197,864
0 		 
 
(6) KEVIN SMOTHERS (i)
(ii)		 319,846
0 		21,061
0 		25,214
0 		5,361
0 		17,411
0 		388,893
0 		 
 
(7) JOYCE ROMANS (i)
(ii)		 177,795
0 		8,597
0 		11,831
0 		2,984
0 		11,992
0 		213,199
0 		 
 
(8) TRACEY ELLISON (i)
(ii)		 154,649
0 		7,541
0 		9,911
0 		2,616
0 		17,276
0 		191,993
0 		 
 
(9) CYNTHIA ROLDAN (i)
(ii)		 174,283
0 		0
0 		162
0 		2,216
0 		862
0 		177,523
0 		 
 
(10) JEROME MARAVE (i)
(ii)		 209,075
0 		0
0 		1,188
0 		8,927
0 		10,826
0 		230,016
0 		 
 
(11) DANILO V SANTOS (i)
(ii)		 183,592
0 		0
0 		3,708
0 		1,973
0 		11,959
0 		201,232
0 		 
 
(12) EDYTA OSWIECIMKA (i)
(ii)		 163,274
0 		0
0 		258
0 		6,940
0 		11,680
0 		182,152
0 		 
 
(13) STEPHANIE REID (i)
(ii)		 143,978
0 		5,339
0 		6,462
0 		6,229
0 		804
0 		162,812
0 		 
 
(14) KIMBERLY MOREAU (i)
(ii)		 137,939
0 		5,796
0 		6,458
0 		7,198
0 		17,322
0 		174,713
0 		 
 
(15) DANILO PERUNOVICH (i)
(ii)		 166,614
0 		6,732
0 		11,025
0 		1,767
0 		12,109
0 		198,247
0 		 
 

Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
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 2010, 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 - 260,900
Schedule J (Form 990) 2010

Additional Data


Software ID:  
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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number
52-1452024
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A maryland health and higher education fac authority
  		52-0936091 574217b53 12-07-2006 36,179,115 HOSPITAL RENOVATIONS AND EQUIP   X   X   X
B MARYLAND HEALTH AND HIGHER EDUCATION FAC AUTHORITY
  		52-0936091 000000000 06-30-2010 15,000,000 HOSPITAL RENOVATIONS AND EQUIP   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 312,040 312,040    
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 37,718,099 15,000,000    
4 Gross proceeds in reserve funds . . 2,023,640      
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 683,750 255,500    
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 35,012,068 14,100,077    
11 Other spent proceeds . .        
12 Other unspent proceeds. . . 644,423 644,423    
13 Year of substantial completion . . . 2009 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X   X        
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . . X     X        
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X   X          
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X        
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 1.000 %    
6 Total of lines 4 and 5 . . .. . . . . . 0 % 1.000 %    
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X X          
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X        
6 Did the bond issue qualify for an exception to rebate? . . .   X   X        
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
DIFFERENCE BETWEEN AMOUNT ON PART I, COLUMN E AND PART II, LINE 3   THE DIFFERENCE IS DUE TO INVESTMENT EARNINGS.
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) KATHLEEN PALAIA SISTER/DAUGHTER DIRECTOR 81,354 EMPLOYEE OF THE HOSPITAL   No
(2) HEATHER SIMMONS DAUGHTER OF AN OFFICER 71,810 EMPLOYEE OF THE HOSPITAL   No
(3) CHELSEY SIMMONS DAUGHTER OF AN OFFICER 11,155 EMPLOYEE OF THE HOSPITAL   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Identifier Return Reference Explanation
FAMILY OR BUSINESS RELATIONSHIP PART VI LINE 2 CHARLES FISHER SR AND CHARLES FISHER JR HAVE A FATHER/SON RELATIONSHIP. CHARLES FISHER SR AND CHARLES FISHER JR HAVE A BUSINESS RELATIONSHIP. 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, YAFFE & COMPANY, 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. THE COMMITTEE CONTEMORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES.
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 UNREALIZED GAIN $ 4,498,951 BOOK/TAX DIFFERENCE K-1 (1,013,121) INTEREST RATE ADJUST ON INVEST 4,319,029 ----------- TOTAL $7,804,859
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES O FISHER JR TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES FISHER SR TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIRIAM BECK TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAULA LANGMEAD TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ETHAN SEIDEL TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN SERNULKA TITLE:PRESIDENT HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHAN HOCHULI MD TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY JOHNSTON MD TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STANLEY H TEVIS III TITLE:BOARD MEMBER HOURS:9
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HAROLD WALSH TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HELEN W WHITEHEAD TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTOS BALLAS MD TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS WELLIVER TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY A WOTHERS TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENNIS THOMAS TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LESLIE SIMMONS TITLE:CHIEF OPERATING OFFICER HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN KELBLY TITLE:SR VP FINANCE CFO HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN SMOTHERS TITLE:CHIEF MEDICAL OFFICER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEPHANIE REID TITLE:ASSISTANT VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID HORN TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M ELLEN FINNERTY MYERS TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOYCE ROMANS TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TRACEY ELLISON TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANILO PERUNOVICH TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CYNTHIA ROLDAN TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEROME MARAVE TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANILO V SANTOS TITLE:PHYSICIAN HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EDYTA OSWIECIMKA TITLE:nurse HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY MOREAU TITLE:asst vice president HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Carroll Hospital Center Inc
 
Employer identification number

52-1452024
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) CARROLL HOSPITAL CENTER MOB INVEST LLC
200 MEMORIAL AVENUE
WESTMINSTER,MD21157
27-1528355 		INVESTMENTS MD 0 2,015,421 CHC
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CARROLL COUNTY HEALTH SERVICES INC

200 MEMORIAL AVE

WESTMINSTER,MD21157
52-0691413 		SUPPORT ORG MD 501(c)(3) 509(A)(3) N/A
 
 
(2) CARROLL HOSPITAL CENTER FOUNDATION INC

200 MEMORIAL AVE

WESTMINSTER,MD21157
52-1115038 		FOUNDATION MD 501(c)(3) 503(A)(3) CHC
 
 
 
(3) CARROLL HOSPICE INC

292 STONER AVE

WESTMINSTER,MD21157
52-1565870 		HOSPICE MD 501(c)(3) 170(B)(1A) CHC
 
 
 








For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) cc radiology llc

7253 AMBASSADOR RD
BALTIMORE,MD21244
52-2190849 		RADIOLOGY MD CARROLL HOSP CT
  		  1,345,003     No     No 60.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) CARROLL COUNTY MED SERVICES INC
200 MEMORIAL AVE
WESTMINSTER,MD21157
52-1891102 		MEDICAL SERVI MD CHC
  		C CORP 13,109,103 16,319,122 100.000 %
(2) CEN-MAR ASSURANCE CO
po box 1085
grand cayman   ky1-1102
CJ
98-6011607 		insurance CJ CHC
  		C CORP 2,046,200 9,443,919 100.000 %










Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CARROLL HOSPITAL CENTER FOUNDATION

 C 1,090,000  
(2) cen-mar

 p 75,576  
(3) carroll county med services

 a,n,p 562,047  
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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