2024-05-13T17:22:28-05:00 2023-06-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-07-01 521164513 FREDERICK HEALTH HOSPICE INC FRED 2405663030 400 WEST SEVENTH STREET FREDERICK MD 21701 HANNAH R JACOBS SR VP, CFO 2405663300 2024-05-13 1 HANNAH JACOBS 999009999 1 AMY BIBBY P00445891 8282542254 2024-05-13 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z HANNAH R JACOBS 1919256 0 X WWW.FREDERICKHEALTHHOSPICE.ORG X 1981 MD TO POSITIVELY IMPACT THE WELL-BEING OF EVERY INDIVIDUAL IN OUR COMMUNITY. 11 8 0 185 0 0 1626241 1193381 0 0 486779 514695 197723 178208 2310743 1886284 0 0 0 0 0 0 0 0 21354 474546 1554466 474546 1554466 1836197 331818 11736591 13517328 55050 384032 11681541 13133296 TO POSITIVELY IMPACT THE WELL-BEING OF EVERY INDIVIDUAL IN OUR COMMUNITY 0 0 1470873 THE PURPOSE OF FREDERICK HEALTH HOSPICE, INC. IS TO PROVIDE AND PROMOTE HOSPICE CARE FOR INDIVIDUALS WHO ARE TERMINALLY ILL AND FOR THEIR FAMILIES. FREDERICK HEALTH HOSPICE, INC. OPERATES AS A FUNDRAISING ORGANIZATION FOR THE BENEFIT OF HOSPICE SERVICES AND OWNERSHIP OF THE KLINE HOSPICE HOUSE. 1470873 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 3 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MD X HANNAH R JACOBS 2405663030 400 WEST SEVENTH STREET FREDERICK MD 21701 X THOMAS A KLEINHANZL PRESIDENT AND CEO FHH 2.00 49.00 X X 0 1134727 366456 MICHELLE K MAHAN SR. VP & CFO THROUGH 8/6/22 2.00 48.00 X 0 643631 44464 PATRICK J MANSKY DIRECTOR THROUGH 6/23 2.00 40.00 X 0 508923 20102 HANNAH R JACOBS SR. VP & CFO START 4/4/22 2.00 49.00 X 0 391111 46751 HEATHER R KIRBY VP INTEGRATED CARE & CPHO 4.00 36.00 X 0 311495 24277 CARLOS GRAVERAN DIRECTOR-HOSPICE 16.00 24.00 X 0 214243 27723 REV TIMOTHY MAY PRESIDENT 2.00 0.00 X X 0 0 0 CATHY S ALEXANDER VICE PRESIDENT 2.00 0.00 X X 0 0 0 JOHN VERBUS VICE PRESIDENT 2.00 0.00 X X 0 0 0 ARTHUR ANDERSON SECRETARY 2.00 0.00 X X 0 0 0 TEJAL GANDHI DIRECTOR THROUGH 10/22 2.00 0.00 X 0 0 0 WILLIAM HAUGH DIRECTOR 2.00 0.00 X 0 0 0 ALLISON ZERR DIRECTOR THROUGH 8/22 1.00 0.00 X 0 0 0 DOUGLAS BROWN DIRECTOR 1.00 0.00 X 0 0 0 SHANE WEEKS DIRECTOR 1.00 0.00 X 0 0 0 DAN TIPSORD DIRECTOR 1.00 0.00 X 0 0 0 CHARLES SMITH III DIRECTOR 1.00 0.00 X 0 0 0 0 3204130 529773 0 0 1 0 0 1193381 1193381 514695 514695 211180 32972 178208 178208 1886284 0 0 692903 X 12738 12738 1190406 1153667 36739 193183 177195 5137 10851 19815 19428 275 112 59612 59612 SUPPLIES 78191 60450 7350 10391 COST OF GOODS SOLD 521 521 1554466 1470873 62239 21354 2893012 473763 1910464 1445021 525055 465443 8318524 12334372 243750 11736591 13517328 19706 282512 35344 101520 55050 384032 X 11681541 12889546 243750 11681541 13133296 11736591 13517328 X 331818 876187 243750 X X 0 1 X 1 0 X 1197599 2816445 3066067 1626241 1193381 9899733 304187 377519 681706 232128 234900 247120 232120 211180 1157448 1733914 3428864 3313187 1858361 1404561 11738887 0 0 0 11738887 328429 27096 876558 413826 514695 2160604 328429 27096 876558 413826 514695 2160604 2062343 3455960 4189745 2272187 1919256 13899491 0.84460 0.55930 0.15540 0.13000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 145000 145000 1334057 1039244 294813 227798 227182 616 203609 178595 25014 465443 INTERCOMPANY LIABILITIES 101520 101520 GOLF TOURNEY 211180 211180 600 8879 21672 1821 211180 211180 600 8879 21672 1821 32972 178208 0 1 0 0 0 0 0 0 0 THOMAS A KLEINHANZL PRESIDENT AND CEO FHH 0 870555 0 260818 0 3354 0 351433 0 15023 0 1501183 0 0 MICHELLE K MAHAN SR. VP & CFO THROUGH 8/6/22 0 431445 0 206090 0 6096 0 36107 0 8357 0 688095 0 0 PATRICK J MANSKY DIRECTOR THROUGH 6/23 0 463245 0 44094 0 1584 0 13541 0 6561 0 529025 0 0 HANNAH R JACOBS SR. VP & CFO START 4/4/22 0 344255 0 45062 0 1794 0 34126 0 12625 0 437862 0 0 HEATHER R KIRBY VP INTEGRATED CARE & CPHO 0 261278 0 48423 0 1794 0 9254 0 15023 0 335772 0 0 CARLOS GRAVERAN DIRECTOR-HOSPICE 0 192433 0 21018 0 792 0 11011 0 16712 0 241966 0 0 PART I, LINE 3 THE EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO CARRY OUT THE HEALTH SYSTEM MISSION, TO ACHIEVE THE CHARITABLE PURPOSE, TO ATTRACT, RETAIN, MOTIVATE, AND REWARD EXECUTIVE MANAGEMENT, AND TO MAINTAIN A COMPETITIVE POSITION WITH PEER ORGANIZATIONS IN THE REGION. OVERSIGHT OF THE EXECUTIVE COMPENSATION PROGRAM IS PROVIDED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD, COMPOSED OF THE BOARD CHAIRMAN, VICE CHAIRMAN, IMMEDIATE PRECEDING CHAIRMAN, CHAIRMAN OF THE FINANCE COMMITTEE, AND THE CHAIRMAN OF THE GOVERNANCE COMMITTEE. IN ADDITION TO THE BOARD'S COMPENSATION COMMITTEE, WE UTILIZED AN EXTERNAL INDEPENDENT CONSULTANT AND MARKET SURVEYS FOR ALL EXECUTIVE MANAGEMENT COMPENSATION. THE PRESIDENT AND CEO HAS A WRITTEN EMPLOYMENT CONTRACT. PART I, LINE 4B FREDERICK HEALTH HOSPITAL HAS ONE 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR MANAGEMENT. UNDER THE PLAN, THEY MAY CONTRIBUTE AMOUNTS FROM THEIR COMPENSATION TO THE PLAN AND MAY RECEIVE A DISCRETIONARY EMPLOYER CONTRIBUTION. EMPLOYEES ARE FULLY VESTED IN ALL EMPLOYEE CONTRIBUTIONS TO THE PLAN. VESTING IN EMPLOYER CONTRIBUTIONS OCCURS IN ACCORDANCE WITH THE UNDERLYING PLAN DOCUMENTS. ALL ASSETS OF THE PLAN ARE HELD IN A SEPERATE TRUST. TOTAL HOSPITAL CONTRIBUTIONS TO THIS PLAN WERE AS FOLLOWS: MICHELLE K MAHAN - $2,052 THOMAS A KLEINHANZL - $315,683 HANNAH JACOBS - $21,000 FORM 990, PART VI, SECTION A, LINE 6 FREDERICK HEALTH HOSPITAL, INC IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER (FHH, INC.) SHALL TAKE THE FOLLOWING ACTIONS ON BEHALF OF THE CORPORATION: - APPOINT, AND AS NECESSARY, REMOVE THE EXECUTIVE DIRECTOR OF THE CORPORATION; PROVIDED, HOWEVER, THAT THE MEMBER SHALL TAKE NO SUCH ACTION WITHOUT PRIOR CONSULTATION WITH THE BOARD OF DIRECTORS; - FORMULATE, COMMUNICATE AND IMPLEMENT STRATEGIC PLANNING AND FINANCIAL MANAGEMENT; AND - SELECT A FISCAL AUDITOR. THE CORPORATION MAY TAKE THE FOLLOWING ACTIONS ONLY WITH THE PRIOR APPROVAL OF THE MEMBER: - DISOLVE OR LIQUIDATE; AND - CREATE, DISSOLVE OR DIVEST ANY SUBSIDIARY, PARTNERSHIP OR LLC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING SHALL NOT BE DEEMED TO HAVE TAKEN PLACE ABSENT SUBSEQUENT RATIFICATION BY THE MEMBER: - ELECTION OR REPLACEMENT OF A DIRECTOR OR THE FILLING OF A VACANCY ON THE BOARD OF DIRECTORS; OR - AT SUCH TIMES AS THE MEMBER DEEMS NECESSARY, AND PURSUANT TO THE VOTE OF AT LEAST TWO-THIRDS OF THE MEMBER'S DIRECTORS, REMOVE A DIRECTOR OF THE CORPORATION; OR - CHANGE THE MISSION OF THE CORPORATION, OR - AMEND THE ARTICLES OF INCORPORATION AND/OR BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED IN CONJUNCTION WITH OUTSIDE TAX ACCOUNTANTS AND IS REVIEWED BY UPPER MANAGEMENT PRIOR TO PROVIDING A COPY TO THE BOARD. A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE FREDERICK HEALTH HOSPICE, INC. BOARD OF DIRECTORS IS COMMITTED TO MEETING ITS FIDUCIARY RESPONSIBILITIES AND MAINTAINING ITS DUTY OF LOYALTY TO THE HOSPITAL AND THE COMMUNITY IT SERVES. TO THIS END, THE BOARD WILL EXERCISE VIGILANCE IN IDENTIFYING ANY CONFLICTS OF INTEREST. THE BOARD WILL ALSO MAINTAIN TRANSPARENCY AND OBJECTIVITY IN MAKING DECISIONS ABOUT CONFLICTS OF INTEREST SO THAT THE ORGANIZATION'S MISSION IS ALWAYS THE FIRST PRIORITY. THE CHAIRPERSON (OR VICE CHAIRPERSON IF THE CHAIR IS INVOLVED) WILL NOTIFY ALL DIRECTORS OF A REPORTED CONFLICT OF INTEREST AND WILL DECIDE WHETHER TO TAKE THE MATTER TO THE FULL BOARD TO DECIDE WHETHER A CONFLICT EXISTS AND, IF SO, TO DECIDE WHAT ACTION TO TAKE. ALTERNATIVELY, THE CHAIR PERSON WILL REFER THE MATTER TO THE GOVERNANCE COMMITTEE FOR AN IN-DEPTH EXAMINATION, SUMMARY, AND RECOMMENDATION PRIOR TO A FULL BOARD DISCUSSION AND DECISION. IF TIME IS OF THE ESSENCE, THE CHAIRPERSON WILL TAKE THE MATTER TO THE EXECUTIVE COMMITTEE, AND THE CHAIRPERSON WILL NOTIFY THE FULL BOARD OF SUCH ACTION. WHERE A CONFLICT OF INTEREST HAS BEEN IDENTIFIED THE BOARD MEMBER SHALL NOT VOTE OR BE PRESENT FOR THE DISCUSSION OR THE VOTE REGARDING THE TRANSACTION AT EITHER THE FULL BOARD, EXECUTIVE COMMITTEE, OR GOVERNANCE COMMITTEE MEETINGS EXCEPT TO ANSWER QUESTIONS THAT MAY BE ASKED OF HIM OR HER. TO PREVENT ACTUAL OR PERCEIVED INFLUENCE ON THE BOARD'S DECISION, THE CONFLICTED MEMBER IS PROHIBITED, AFTER INITIAL DISCLOSURE, FROM DISCUSSING THE CONFLICT OF INTEREST EITHER FORMALLY OR INFORMALLY WITH FELLOW DIRECTORS OR WITH MEMBERS OF THE MANAGEMENT. THERE WILL BE AN ANNUAL REVIEW OF ALL BOARD MEMBERS AND OFFICERS' TRANSACTIONS PREPARED BY THE ADMINISTRATION AND REVIEWED BY THE GOVERNANCE COMMITTEE AND THE FULL BOARD OF DIRECTORS. AT THAT TIME, ALL DIRECTORS WILL BE REMINDED OF THE IRS INTERMEDIATE SANCTIONS REGULATION THAT ESTABLISHES EXCISE TAXES AS A SANCTION AGAINST ADMINISTRATORS AND DIRECTORS OF TAX-EXEMPT ORGANIZATIONS WHO PARTICIPATE IN 'EXCESS BENEFIT TRANSACTIONS' (E.G., UNREASONABLE HIGH EMPLOYMENT COMPENSATION OR BUSINESS DEALS). FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND THE CONFLICT-OF-INTEREST POLICY ARE AVAILABLE UPON REQUEST. FREDERICK HEALTH, INC'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE AT WWW.FREDERICKHEALTH.ORG FORM 990, PART VII, SECTION A DIRECTOR PATRICK J. MANSKY RECEIVED COMPENSATION FROM FREDERICK MEDICAL GROUP, LLC FOR PHYSICIAN SERVICES. DIRECTOR THOMAS A. KLEINHANZL RECEIVED COMPENSATION FROM FREDERICK HEALTH HOSPITAL, INC. FOR EMPLOYMENT AS PRESIDENT AND CEO. DIRECTOR HEATHER R. KIRBY RECEIVED COMPENSATION FROM FREDERICK HEALTH HOSPITAL, INC. FOR EMPLOYMENT AS VP INTEGRATED CARE CPHO. HANNAH JACOBS AND MICHELLE MAHAN RECEIVED COMPENSATION FROM FREDERICK HEALTH HOSPITAL, INC. FOR EMPLOYMENT AS SVP AND CFO. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,153,667. MANAGEMENT AND GENERAL EXPENSES 36,739. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,190,406. FORM 990, PART XI, LINE 9: OTHER CHANGE IN RESTRICTED NET ASSET 243,750. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FREDERICK HEALTH HOSPITAL INC 400 WEST SEVENTH STREET FREDERICK MD 21701 520591612 HOSPITAL MD 501(C)(3) LINE 3 FREDERICK HEALTH INC 1 FREDERICK HEALTH INC 400 WEST SEVENTH STREET FREDERICK MD 21701 454133096 HEALTH SYSTEM MD 501(C)(3) TYPE II N/A 0 FREDERICK HEALTH MEDICAL GROUP LLC 400 WEST SEVENTH STREET FREDERICK MD 21701 453001639 PHYSICIAN ORG MD 501(C)(3) LINE 7 FREDERICK HEALTH INC 1 FREDERICK HEALTH SERVICES CORPORATION 400 WEST SEVENTH STREET FREDERICK MD 21701 521851661 HEALTH CARE MD N/A C 1 MONOCACY INSURANCE LTD PO BOX 1159 GRAND CAYMAN KY11 CJ 981011570 SELF INSURANCE CJ N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 FREDERICK HEALTH HOSPITAL INC O 327339 DIRECT COSTING FREDERICK HEALTH HOSPITAL INC R 330000 CASH