2020-11-16T20:06:54-06:00 2019-12-31 ERNST & YOUNG US LLP 221 E 4TH ST SUITE 2900 CINCINNATI OH 45202 990 2019-01-01 901000718 Riverside Healthcare Association Inc Group % DIRECTOR-TAX RIVE 7578757545 608 Denbigh Blvd Suite 800 Newport News VA 23608 W WILLIAM AUSTIN JR SR VP AND CFO 7578757545 2020-11-16 true ABBEY E LEIBEL P01517527 5136121400 108.41.174.160 31499120203215000012 2020-11-16 P 7561E913104CC6280560885735C77FB5BBD04937 FFB0EFF293EA09521C0540EE725FAC39CBD1764F 2019 2021-01-29 14:40:06Z WILLIAM DOWNEY CEOPRESIDENT 608 DENBIGH BLVD STE 800 NEWPORT NEWS VA 23608 1711332669 true true 5701 X RIVERSIDEONLINE.COM X PROVIDE GENERAL MEDICAL SERVICES TO THE COMMUNITY. 186 149 10617 664 500065 0 12519798 7157691 1165924710 1258603102 12751267 12661651 394437974 424327804 1585633749 1702750248 9190240 550060 0 0 664831576 720777075 0 0 94135 912934696 968646372 1586956512 1689973507 -1322763 12776741 987607407 955792442 547891755 498263539 439715652 457528903 TO CARE FOR OTHERS AS WE WOULD CARE FOR THOSE WE LOVE - TO ENHANCE THEIR WELL-BEING AND IMPROVE THEIR HEALTH. false false 1306907161 550060 1668315269 General hospital, Long-Term Care and physician services provided to the community: 2,417,299 persons were benefited in 2019 with quantifiable community benefits of $90,127,927. 1306907161 true true false true false false false false false true true false false false true false false true false false false false false false false false true true true true true false false false false false false false true false false false false true true true true false false true 839 0 true 10617 true true true false false false false false false false false false false false false X 186 149 true false false false true true true true true false false false true true true true true false false true true VA X DIRECTOR-TAX 7578757545 608 DENBIGH BLVD 800 NEWPORT NEWS VA 23608 DEAN KOSTOV PHYSICIAN 40.0 0.0 X 2344807 0 52600 WILLIAM H MCALLISTER M BOARD MEMBER 40.0 0.0 X 1650236 0 58136 WILLIAM BURNS DOWNEY PRESIDENT,CEO RHS 40.0 0.0 X X 1397015 0 49302 ROMNEY ANDERSEN PHYSICIAN 40.0 0.0 X 1395044 0 13285 ROBERT CULLOM PHYSICIAN 39.0 0.0 X 1299204 0 31563 BRIAN KEEL PHYSICIAN 40.0 0.0 X 1231701 0 31727 ANTHONY FARAH PHYSICIAN 40.0 0.0 X 1216596 0 46197 MICHAEL DACEY MD EVP/CCOO 40.0 0.0 X X 868519 0 22185 PAUL J MICALE MD BOARD MEMBER 40.0 0.0 X 777670 0 58720 MICHAEL JOSEPH DOUCETT VP RRMC OPERATIONS 40.0 0.0 X 617967 0 69012 WALTER WILLIAM AUSTIN SR VP, CFO & TREASURER 40.0 0.0 X 650462 0 33628 CHARLES FRAZIER VP MD 40.0 0.0 X 526011 0 62247 SALLY HARTMAN SENIOR VP 40.0 0.0 X 539582 0 46798 NANCY WICK LITTLEFIELD EVP/CNO 40.0 0.0 X X 525888 0 27235 PETER GALANTICH MD PRESIDENT MEDICAL STAFF 40.0 0.0 X 483325 0 63861 MELVIN D SCHURSKY JR Board member 40.0 0.0 X 523178 0 18756 JASON O HOUSER VP, LEGAL AFFAIRS & SECRETARY 40.0 0.0 X 473589 0 59740 CHRISTOPHER PATRICK ST VP MEDICAL AFFAIRS 40.0 0.0 X 494200 0 36484 ROSS YOUNGER SENIOR VP 40.0 0.0 X 451023 0 67705 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40.0 0.0 X 185038 0 46431 LINDA MCKEE ASSOCIATE VICE PRESIDENT SERVI 40.0 0.0 X 213657 0 17260 EILEEN VARNSON VP 40.0 0.0 X 201044 0 28431 DAVID INABINET CHIEF INFORMATION SECURITY OFF 40.0 0.0 X 204840 0 20260 CHERYL ANGE DIRECTOR SR SPECIALITIES 40.0 0.0 X 191584 0 28034 LISA SHANNON DIRECTOR SYSTEM 40.0 0.0 X 189308 0 23217 ERIC STONE FORMER VP CLINICAL OPERATIONS 32.0 0.0 X 199335 0 9125 ANTOINETTE WATKINS DIRECTOR SYSTEM 40.0 0.0 X 188373 0 17498 JAMES LESNICK VP/MEDICAL DIRECTOR RMG 7.0 0.0 X 162449 0 24432 ELISABETH WILLIAMS VP 24.0 0.0 X 167149 0 19190 JESSICA MACALINO ASSOCIATE VICE PRESIDENT SERVI 40.0 0.0 X 169783 0 16129 KELLY COOPER DIRECTOR SR RMG 40.0 0.0 X 162676 0 22745 JUDITH MATTHEWS EXECUTIVE NURSE 40.0 0.0 X 157315 0 21770 ANDREA STASKIEL EXECUTIVE DIRECTOR 40.0 0.0 X 160694 0 8241 DEBRA CAMPBELL ADMINISTRATOR RBHC 40.0 0.0 X 140545 0 21290 TERESA K THOMPSON NP BOARD MEMBER 32.0 0.0 X 103598 0 13268 ALAN STEVEN WITT Chairman 1.0 0.0 X X 0 0 0 ALEXANDER FLEET DILLAR 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REBECCA ELLEN MCCOY CP BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD A FARMAR III CHAIRMAN 1.0 0.0 X X 0 0 0 RICHARD FREDERICK CROW CHAIRMAN 1.0 0.0 X X 0 0 0 RICHARD JOEL PEARCE BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT J COURTER JR BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT THOMAS DAVIS MD BOARD MEMBER 1.0 0.0 X 0 0 0 RONALD MURRAY BOARD MEMBER 1.0 0.0 X 0 0 0 RONALD LEE SAUNDERS BOARD MEMBER 1.0 0.0 X 0 0 0 STEPHEN SILVASY JR BOARD MEMBER 1.0 0.0 X 0 0 0 STEPHEN C ADAMS VICE CHAIRMAN 1.0 0.0 X X 0 0 0 STEVE SPAIN BOARD MEMBER 1.0 0.0 X 0 0 0 SUSAN S JACOBS BOARD MEMBER 1.0 0.0 X 0 0 0 SUSANNA B HICKMAN BOARD MEMBER 1.0 0.0 X 0 0 0 THERESA EMORY MD BOARD MEMBER 1.0 0.0 X 0 0 0 VICKI MILES HAUSER BOARD MEMBER 1.0 0.0 X 0 0 0 WALTER R CLEMONS PHD BOARD MEMBER 1.0 0.0 X 0 0 0 WANDA M AUSTIN BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM L BRAUER CHAIRMAN 1.0 0.0 X X 0 0 0 WILLIAM M GRACE BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM P HEATH JR BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM S MASSEY BOARD MEMBER 1.0 0.0 X 0 0 0 20037611 0 1120459 889 true true false DPR CONSTRUCTION 1450 VETERANS BLVD REDWOOD CITY CA 94063 PROFESSIONAL SVCS 3059998 CHANGE HEALTHCARE LLC PO BOX 98347 CHICAGO IL 606938347 PROFESSIONAL SVCS 2091681 ENCORE MEDICAL LP PO BOX 660126 DALLAS TX 752660126 PROFESSIONAL SVCS 1277779 EAGLE TELEMED HOLDINGS LLC 280 INTERSTATE N CIRCLE SE STE 150 ATLANTA GA 30339 PROFESSIONAL SVCS 1269980 SCRIBEAMERICA LLC PO BOX 417756 BOSTON MA 022417756 PROFESSIONAL SVCS 1036115 44 X 2456367 4701324 20383 7157691 PROGRAM SERVICE REVENUE 900099 1231126332 1231126332 AFFILIATE RENTAL INCOME C(3) 532000 27476770 27476770 1258603102 826232 826232 0 0 2815830 2815830 0 2815830 2815830 19900190 517650 8579614 2807 11320576 514843 11835419 11835419 0 0 0 0 0 0 0 0 0 SVCS TO AFFILIATES 900099 360304784 360304784 PHARMACY SALES 446110 38152420 31051888 7100532 OPTICAL SALES 446130 6413209 6413209 16641561 11942286 500065 4199210 421511974 1702750248 1668315269 500065 26777223 X 465660 465660 84400 84400 0 0 26944878 26944878 636434 636434 580143089 509743486 70399603 27405145 12101289 15303856 50607814 45017011 5590803 35039715 31023366 4016349 36728680 36728680 2067206 2067206 5804297 5804297 58106 58106 0 86520 86520 81420371 32008387 49411984 7391444 232938 7158506 55334930 39712109 15534949 87872 47742864 5474630 42268234 0 107706585 107706585 1961779 1630189 331590 0 93741 19775 73966 10944991 112585 10832406 0 53235509 43978405 9250841 6263 87808497 7076686 80731811 PROFESSIONAL SERVICES 178086795 178086795 0 MEDICAL SUPPLIES 220549360 220549360 0 BAD DEBT EXPENSES 37547797 37547797 0 MEDICAID ASSESSMENT 23703647 23703647 0 10373253 9937521 435732 1689973507 1306907161 382972211 94135 9200375 16091059 348122612 373720398 0 0 44192046 40538584 0 0 0 0 0 0 18823521 23517421 155517341 17162381 1008617825 607294310 365446981 401323515 0 0 0 0 5821219 42955772 40483312 40483312 0 0 987607407 955792442 198556028 232772097 0 0 5125132 6181255 0 0 0 0 0 0 0 0 0 0 344210595 259310187 547891755 498263539 X 424442509 439155636 15273143 18373267 439715652 457528903 987607407 955792442 X 12776741 21900173 56567 -355 -16919875 X false true X true false X 3 RIVERSIDE HOSPITAL INC 521245746 3 true 0 0 RIVERSIDE MIDDLE PENINSULA HOSPITAL INC 521241836 3 true 0 0 RIVERSIDE REHABILITATION INSTITUTE 521432269 3 true 0 0 3 880659 2004962 3327791 3265075 1605113 11083600 0 0 880659 2004962 3327791 3265075 1605113 11083600 0 11083600 8362 10944 11996 283370 93 314765 0 1291676 3233478 157475 89009 1744442 6516080 17914445 154453978 0.61870 0.59327 X 0 0 29493 31543 0 61036 100546480 110067150 162557613 148919430 154453978 676544651 0 0 0 100546480 110067150 162587106 148950973 154453978 676605687 0 88414861 88414861 88414861 88414861 588190826 3539270 36502 -1095619 -3719539 1298816 59430 0 3539270 36502 -1095619 -3719539 1298816 59430 0 8851203 13785249 18170944 30662630 692452 72162478 112936953 123888901 179632938 175862521 156445246 748766558 0.78555 0.88072 0.00008 0.00130 X true true false false false 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 2 Riverside Healthcare Foundation, which is controlled by Riverside Healthcare Association, Inc., has determined that its hospital supported organizations, which qualify under 170(b)(1)(A)(iii), also qualify as public charities under section 509(a)(2)). PART IV, SECTION B, LINE 2 Riverside Healthcare Foundation also supported its other supported organizations within the Riverside Health System. That support carried out the purposes of Riverside Healthcare Association, Inc. (RHA) by strengthening the ability of the Foundations supported organizations to provide quality health care and improve the health of citizens in RHAs community. PART I, LINES 12 and 12a RIVERSIDE HEALTHCARE FOUNDATION IS A SUBORDINATE WITHIN THE GROUP THAT IS RECOGNIZED BY THE IRS AS A 509(a)(3) TYPE I SUPPORTING ORGANIZATION. ACCORDINGLY, PART IV, SECTIONS A AND B HAVE BEEN COMPLETED. SCHEDULE A, PART 1 Public Charity Status of Subordinates Name of Subordinate EIN Type Center for Excellence in Aging/Geriatric Health 06-1544517 7 Riverside Middle Peninsula Hospital, Inc. 52-1241836 3 Riverside Healthcare Services, Inc. 52-1241839 10 Riverside Management Services, Inc. 52-1241840 10 Riverside Healthcare Foundation, Inc. 52-1241989 12 I Riverside Hospital, Inc. 52-1245746 3 Riverside Convalescent Centers, Inc. 52-1276323 3 The Rehabilitation Institute of Virginia, Inc. 52-1432269 3 Sanders Common,LTD 52-4233030 10 Patrick Henry Hospital, Inc. 54-0601803 3 Francis N. Sanders Nursing Home, Inc. 54-0683174 10 Riverside Wellness and Fitness Centers, Inc. 54-1318861 10 Riverside Retirement Services, Inc. 54-1348674 10 Riverside Tappahannock Hospital, Inc. 54-1489410 3 Riverside Physician Services, Inc. 54-1519724 3 Patriots Colony, Inc. 54-1680163 10 Riverside Health System Foundation, Inc. 54-1994013 7 Doctors Hospital of Williamsburg 27-1540267 3 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false false false true 170630 170630 false Other Advocacy Activities Salary and Expenses $112,524 Dues $ 58,106 ---------------------------- Total $170,630 Advocates on issues related to certificates of public need and all issues affecting healthcare such as hospitals, patients, physicians, and health insurance. 1223034 146702 84400 1285336 1385267 -26248 1359019 1241004 144263 1385267 1175020 65984 1241004 1186469 -11449 1175020 1.00000 false false 14003371 14003371 439661245 210120464 229540779 522155595 379856679 142298916 32797614 17317165 15480449 401323515 0 OTHER CURRENT LIABILITIES 1375494 OBLIGATION UNDER CAPITAL LEASE 28695824 NOTE PAYABLE-CURRENT 1806706 CONTINGENT LIABILITY 455873 OTHER NON-CURRENT LIABILITIES 226976290 259310187 Schedule D Part V Line 4 Endowment funds are used for scholarships true true X true X true X true true true false true true 32144169 0 32144169 0.01940 124131471 131056313 0 0.00000 156275640 131056313 32144169 0.01940 1950661 1950661 0.00120 24646037 13228631 11417406 0.00690 2467403 1418012 1049392 0.00060 2247963 2247963 0.00140 31312064 14646643 16665422 0.01010 187587704 145702956 48809591 0.02950 false 37609578 0 297535709 301244469 -3708760 X true true 6 1 Riverside Regional Medical Center 500 J CLYDE MORRIS BLVD NEWPORT NEWS VA 23601 www.riversideonline.com/rrmc/ H 1887 Riverside Hospital Inc 521245746 X X X X X Inpat Psychiatric A 2 Riverside Walter Reed Hospital 7519 HOSPITAL DRIVE GLOUCESTER VA 23061 www.riversideonline.com/rwrh/ H 1890 Riverside Middle Peninsula H 521241836 X X X A 3 Riverside Tappahannock Hospital 618 HOSPITAL ROAD TAPPAHANNOCK VA 22560 www.riversideonline.com/rth/ H 1889 Riverside Tapahannock Hospit 541489410 X X X A 4 Riverside Doctors Hosp Williamsburg 1500 Commonwealth Avenue Williamsburg VA 23185 www.riversideonline.com/rdhw/ H 1937 Doctors' Hospital of William 271540267 X X X A 5 Riverside Rehabilitation Hospital 250 Josephs Drive Yorktown VA 23693 www.riverside-rehabilitation.com H 1888 Coastal Virginia Rehabilitat 821270202 X inpat rehabilitation 6 Select Specialty Hospital-Hampton Rds 500 J Clyde Morris Blvd Newport News VA 23601 hamptonroads.selectspecialtyhospitals.co H 1925 LTACH Riverside LLC 743135196 X Long Term Acute Care Riverside Rehabilitation Hospital 5 false false true X X X X X X X X X 19 true false false true X See Part V, Section C X X true 19 true See Part V, Section C false true X 200. 400. X X X true true X X X true X See Part V, Sect. C X See Part V, Sect. C X See Part V, Sect. C X X X X X true X false X X false X X false false Select Specialty Hospital-Hampton Rds 6 false false true X X X X X X X X X 19 true false false true X See Part V, Section C X X true 19 true See Part V, Section C false true X 200. 400. X X X true true X X X true X See Part V, Sect. C X See Part V, Sect. C X See Part V, Sect. C X X X X X true X false X X true X false false A 14 false false true X X X X X X X X X 19 true false false true X See Part V, Section C X X true 19 true See Part V, Section C false true X 200. 400. X X X true true X X X true X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X true X false X X X X true X false false Riverside Rehabilitation Hospital Line 3E. The significant health needs of the community identified in the CNHA are prioritized according to the community needs. Line 5: As described in the CHNA, Riverside conducted a community survey between June 2018 and May 2019 to obtain input for the Community Health Needs Assessment. In partnership with other regional healthcare systems, the Peninsula Community Health Collaborative, non-profit organizations and the Virginia Department of Health conducted a joint survey utilizing SurveyMonkey. There were two versions of the survey: one for community members which was distributed on each systems website, social media outlets and community meetings; and one for community, medical and public health leaders which was emailed to an identified list of key stakeholders jointly from all of the health systems under the signature of the Medical Director of the Peninsula Health District of the Virginia Department of Health. The specific list of organization affiliations can be found in Appendix A of the CHNA. In addition to the survey, multiple public health sources were consulted in the assembly of the needs assessment. These included CDCs WONDER database, Virginia Department of Health statistics, Virginia Health Information, Urban Institute for the Virginia Health Care Foundation, American Community Survey and the US Health Resources and Service Administration. Line 7 a: www.riverside-rehabilitation.com/about/community-health-needs-assessment Line 7D: In addition to the website and the hardcopy available at the facility the report was also mailed to several community leaders. Line 10a: www.riverside-rehabilitation.com/about/community-health-needs-assessment Line 11: As explained in the CHNA, the significant needs to be addressed include: Behavioral/Mental Health and Substance Abuse In 2019 the ligature-resistant Riverside Behavioral Health Center opened up the Adolescent Care Unit. The facility also participates in the Medicaid ARTS program (Addiction and Recovery Treatment Services). RRMC has also implemented a Clinical Opiate Withdrawal Scale (COWS) protocol, and RRMC is attempting to minimize opioid exposure through responsible and appropriate prescribing tactics, multi-modal pain management education to patients and providers. Food Insecurities: Riverside will continue the Riverside Brentwood Diabetic Food Insecurity Program, which was established off of the 2013 CHNA. This program identifies patients with diabetes who are food insecure and invites them to participate by getting healthy food boxes every two weeks (whole grain pasta, brown rice, low sodium canned vegetables, etc) along with education and recipes. The small pilot program demonstrated the positive impact through lowered BMI and A1C, so the program will continue and look for opportunities to expand. Health Insurance Coverage / Access to Care: Riverside provides support to the Lackey Free Clinic and participates in Change Healthcare, which is a program dedicated to increasing the number of community members who are signed up for Medicaid. Neoplasms of the Lung: Riverside offers low dose CT screenings to patients who may have an increased risk of developing lung cancer. While Riverside was only initially able to offer these screening to patients with commercial insurance or who could pay out of pocket, Riverside now participates with the PenLung registry, allowing us to offer these services to Medicaid and Medicare patients as well. Maternal and Infant Care: Riverside offers multiple community education courses and groups, including: breastfeeding, baby care, infant CPR, expectant parents, expectant siblings, grandparents class and rookie dads. Riverside also offers bereavement and post partum support groups and has a partnership with Healthy Families of Newport News and Hampton for free services including a personal parenting coach and home visits. Colon Cancer: Riverside plans to roll out awareness campaigns in March 2020, particularly focusing on minority groups. Aging Services focused on Alzheimers and Dementia Riversides Center for Excellence in Aging and Lifelong Health (CEALH) offers multiple services for memory care patients and their caregivers. These include access to the Benjamin Rose Institute on Aging Care Consultation program, a Memory Caf and the Caring for You / Caring for me program. The items determined to not be the highest priorities included for the CHNA are noted below, due to the limitation of resources, the size of the issue and the capacity of existing organizations to impact the problem (which is currently noted). Items on the list may be already being addressed through other Riverside programs, such as heart disease, smoking cessation programs, chronic pain, smoking, respiratory care, domestic violence and reproductive health. Some issues were outside of the area of expertise of the health system, such as the foster care system. Items such as infant mortality are important, but not necessarily an item that could be impacted significantly by the health system in a three year period and instead will be addressed through our continued pre and post-natal care programs. Other items not ranked as top health problems through either the qualitative or quantitative data assessments included: environmental health, drowning/water safety, autism, HIV/AIDS, dental/oral care, neurological problems, arthritis, renal disease, orthopedic problems, sexually transmitted infections, physical disabilities and bullying. Line 16 a: www.riverside-rehabilitation.com/referral-sources/financial-assistance Line 16 b: www.riverside-rehabilitation.com/referral-sources/financial-assistance Line 16 c: www.riverside-rehabilitation.com/referral-sources/financial-assistance Line 20b. While the hospital facility made reasonable efforts to orally notify all individuals about the FAP and FAP application process, this may not have been uniformly performed for 100% of the patients receiving treatment despite the hospitals best efforts. Line 20 d: Presumptive eligibility is not used. Due to the limited number of patients and applicants for Financial Assistance, personnel work with patients to complete the application. Presumptive models are not used. Select Specialty Hospital-Hampton Roads Line 3E. The significant health needs of the community identified in the CNHA are prioritized according to the community needs. Line 5: As described in the CHNA, Riverside conducted a community survey between June 2018 and May 2019 to obtain input for the Community Health Needs Assessment. In partnership with other regional healthcare systems, the Peninsula Community Health Collaborative, non-profit organizations and the Virginia Department of Health conducted a joint survey utilizing SurveyMonkey. There were two versions of the survey: one for community members which was distributed on each systems website, social media outlets and community meetings; and one for community, medical and public health leaders which was emailed to an identified list of key stakeholders jointly from all of the health systems under the signature of the Medical Director of the Peninsula Health District of the Virginia Department of Health. The specific list of organization affiliations can be found in Appendix A of the CHNA. In addition to the survey, multiple public health sources were consulted in the assembly of the needs assessment. These included CDCs WONDER database, Virginia Department of Health statistics, Virginia Health Information, Urban Institute for the Virginia Health Care Foundation, American Community Survey and the US Health Resources and Service Administration. Line 7A: https://hamptonroads.selectspecialtyhospitals.com/uploadedfiles/content/sh ared/patients_and_families/admissions/2019-chna-ssh-hampton-roads.pdf Line 7D: In addition to the website and the hardcopy available at the facility the report was also mailed to several community leaders. Line 10A: https://hamptonroads.selectspecialtyhospitals.com/uploadedfiles/content/sh ared/patients_and_families/admissions/2019-chna-ssh-hampton-roads.pdf Line 11: As explained in the CHNA, the significant needs to be addressed include: Behavioral/Mental Health and Substance Abuse In 2019 the ligature-resistant Riverside Behavioral Health Center opened up the Adolescent Care Unit. The facility also participates in the Medicaid ARTS program (Addiction and Recovery Treatment Services). RRMC has also implemented a Clinical Opiate Withdrawal Scale (COWS) protocol, and RRMC is attempting to minimize opioid exposure through responsible and appropriate prescribing tactics, multi-modal pain management education to patients and providers. Food Insecurities: Riverside will continue the Riverside Brentwood Diabetic Food Insecurity Program, which was established off of the 2013 CHNA. This program identifies patients with diabetes who are food insecure and invites them to participate by getting healthy food boxes every two weeks (whole grain pasta, brown rice, low sodium canned vegetables, etc) along with education and recipes. The small pilot program demonstrated the positive impact through lowered BMI and A1C, so the program will continue and look for opportunities to expand. Health Insurance Coverage / Access to Care: Riverside provides support to the Lackey Free Clinic and participates in Change Healthcare, which is a program dedicated to increasing the number of community members who are signed up for Medicaid. Neoplasms of the Lung: Riverside offers low dose CT screenings to patients who may have an increased risk of developing lung cancer. While Riverside was only initially able to offer these screening to patients with commercial insurance or who could pay out of pocket, Riverside now participates with the PenLung registry, allowing us to offer these services to Medicaid and Medicare patients as well. Maternal and Infant Care: Riverside offers multiple community education courses and groups, including: breastfeeding, baby care, infant CPR, expectant parents, expectant siblings, grandparents class and rookie dads. Riverside also offers bereavement and post partum support groups and has a partnership with Healthy Families of Newport News and Hampton for free services including a personal parenting coach and home visits. Colon Cancer: Riverside plans to roll out awareness campaigns in March 2020, particularly focusing on minority groups. Aging Services focused on Alzheimers and Dementia Riversides Center for Excellence in Aging and Lifelong Health (CEALH) offers multiple services for memory care patients and their caregivers. These include access to the Benjamin Rose Institute on Aging Care Consultation program, a Memory Caf and the Caring for You / Caring for me program. The items determined to not be the highest priorities included for the CHNA are noted below, due to the limitation of resources, the size of the issue and the capacity of existing organizations to impact the problem (which is currently noted). Items on the list may be already being addressed through other Riverside programs, such as heart disease, smoking cessation programs, chronic pain, smoking, respiratory care, domestic violence and reproductive health. Some issues were outside of the area of expertise of the health system, such as the foster care system. Items such as infant mortality are important, but not necessarily an item that could be impacted significantly by the health system in a three year period and instead will be addressed through our continued pre and post-natal care programs. Other items not ranked as top health problems through either the qualitative or quantitative data assessments included: environmental health, drowning/water safety, autism, HIV/AIDS, dental/oral care, neurological problems, arthritis, renal disease, orthopedic problems, sexually transmitted infections, physical disabilities and bullying. Line 16A: https://hamptonroads.selectspecialtyhospitals.com/uploadedfiles/content/sh ared/patients_and_families/admissions/ssh-hampton-roads-financial-assistan ce-policy.pdf Line 16B: https://hamptonroads.selectspecialtyhospitals.com/uploadedfiles/content/sh ared/patients_and_families/admissions/select-specialty-hospital-financial- assistance-policy-application.pdf Line 16C: https://hamptonroads.selectspecialtyhospitals.com/uploadedfiles/content/sh ared/patients_and_families/admissions/ssh-hampton-roads-plain-language-sum mary-of-financial-assistance.pdf Line 20b. While the hospital facility made reasonable efforts to orally notify all individuals about the FAP and FAP application process, this may not have been uniformly performed for 100% of the patients receiving treatment despite the hospitals best efforts. Line 20D: Presumptive eligibility methods are not used. A Line 3E. The significant health needs of the community identified in the CNHA are prioritized according to the community needs. Line 5: As described in the CHNA, Riverside conducted a community survey between June 2018 and may 2019 to obtain input for the Community Health Needs Assessment. In partnership with other regional healthcare systems, the Peninsula Community Health Collaborative, non-profit organizations and the Virginia Department of Health conducted a joint survey utilizing SurveyMonkey. There were two versions of the survey: one for community members which was distributed on each systems website, social media outlets and community meetings; and one for community, medical and public health leaders which was emailed to an identified list of key stakeholders jointly from all of the health systems under the signature of the Medical Director of the Peninsula Health District of the Virginia Department of Health. The specific list of organization affiliations can be found in Appendix A of the CHNA. In addition to the survey, multiple public health sources were consulted in the assembly of the needs assessment. These included CDCs WONDER database, Virginia Department of Health statistics, Virginia Health Information, Urban Institute for the Virginia Health Care Foundation, American Community Survey and the US Health Resources and Service Administration. Line 7A: https://riversideonline.com/about_riverside/Community/community-health-nee ds.cfm Line 7D: In addition to the website and the hardcopy available at the facility the report was also mailed to several community leaders. Line 10A: https://riversideonline.com/about_riverside/Community/community-health-nee ds.cfm Line 11: Riverside Regional Medical Center As explained in the CHNA, the significant needs to be addressed include: Behavioral/Mental Health and Substance Abuse In 2019 the ligature-resistant Riverside Behavioral Health Center opened up the Adolescent Care Unit. The facility also participates in the Medicaid ARTS program (Addiction and Recovery Treatment Services). RRMC has also implemented a Clinical Opiate Withdrawal Scale (COWS) protocol, and RRMC is attempting to minimize opioid exposure through responsible and appropriate prescribing tactics, multi-modal pain management education to patients and providers. Food Insecurities: Riverside will continue the Riverside Brentwood Diabetic Food Insecurity Program, which was established off of the 2013 CHNA. This program identifies patients with diabetes who are food insecure and invites them to participate by getting healthy food boxes every two weeks (whole grain pasta, brown rice, low sodium canned vegetables, etc) along with education and recipes. The small pilot program demonstrated the positive impact through lowered BMI and A1C, so the program will continue and look for opportunities to expand. Health Insurance Coverage / Access to Care: Riverside provides support to the Lackey Free Clinic and participates in Change Healthcare, which is a program dedicated to increasing the number of community members who are signed up for Medicaid. Neoplasms of the Lung: Riverside offers low dose CT screenings to patients who may have an increased risk of developing lung cancer. While Riverside was only initially able to offer these screening to patients with commercial insurance or who could pay out of pocket, Riverside now participates with the PenLung registry, allowing us to offer these services to Medicaid and Medicare patients as well. Maternal and Infant Care: Riverside offers multiple community education courses and groups, including: breastfeeding, baby care, infant CPR, expectant parents, expectant siblings, grandparents class and rookie dads. Riverside also offers bereavement and post partum support groups and has a partnership with Healthy Families of Newport News and Hampton for free services including a personal parenting coach and home visits. Colon Cancer: Riverside plans to roll out awareness campaigns in March 2020, particularly focusing on minority groups. Aging Services focused on Alzheimers and Dementia Riversides Center for Excellence in Aging and Lifelong Health (CEALH) offers multiple services for memory care patients and their caregivers. These include access to the Benjamin Rose Institute on Aging Care Consultation program, a Memory Caf and the Caring for You / Caring for me program. The items determined to not be the highest priorities included for the CHNA are noted below, due to the limitation of resources, the size of the issue and the capacity of existing organizations to impact the problem (which is currently noted). Items on the list may be already being addressed through other Riverside programs, such as heart disease, smoking cessation programs, chronic pain, smoking, respiratory care, domestic violence and reproductive health. Some issues were outside of the area of expertise of the health system, such as the foster care system. Items such as infant mortality are important, but not necessarily an item that could be impacted significantly by the health system in a three year period and instead will be addressed through our continued pre and post-natal care programs. Other items not ranked as top health problems through either the qualitative or quantitative data assessments included: environmental health, drowning/water safety, autism, HIV/AIDS, dental/oral care, neurological problems, arthritis, renal disease, orthopedic problems, sexually transmitted infections, physical disabilities and bullying. Line 11: Walter Reed Hospital As explained in the CHNA, the significant needs to be addressed include: Aging Services: Through Riversides Center for Excellence in Aging and Lifelong Health (CEALH and the Riverside Wellness Center, there will be multiple courses available to the community, including Riversides Introduction to Supervised Exercise (RISE) program, FAMILIES, Advance Care Planning and Memory Caf Transportation: Riverside will approach Bay Transit to build a covered bus stop and will contribute the financial resources to erect the structure and include appropriate safety, such as lights. Cardiovascular Health and Heart Disease: Riverside will be looking to expand access to cardiology specialists in the region and bring vascular surgery to the hospital. Additionally they will work to expand programs through cardiac rehab and provide community education. Chronic Diseases: RWRH will establish an outpatient destination to accommodate rheumatology, GO, antibodies and other non-chemotherapy infusions. This will assist multiple sclerosis, Crohns disease, lupus, rheumatoid arthritis, ulcerative colitis and chronic inflammatory demyelinating polyneuritis patients. Lung Cancer Now that Riverside is participating with the PenLung registry it will expand access to a broader population to the low-dose screening CT scans. Substance Abuse: Riverside will continue its Crisis Intervention Program in collaboration with the CSB and other organizations to appropriately address psychiatric needs in the hospital. Additionally, Riverside continues to attempt to minimize opioid exposure through responsible and appropriate prescribing tactics such as multi-modal pain management and education to patients and providers. The items determined to not be the highest priorities included for the CHNA are noted below. Items on the list may be already being addressed through other Riverside programs, COPD, stroke, violent crime rate, psychoses and food insecurities. Other items not ranked as top health problems through either the qualitative or quantitative data assessments included: smoking / tobacco use, violence in the home / child abuse, dental / oral care, health insurance coverage, autism, chronic pain, foster care and social services. Line 11: Doctors' Hospital Williamsburg As explained in the CHNA, the significant needs to be addressed include: Heart Disease: Continue the collaboration with Riverside Doctors Hospital of Williamsburg, Sentara Williamsburg Regional Medical Center, Williamsburg Health Foundation, Fire and EMS services in Williamsburg, James City County and York County, The College of William and Mary, Greater Williamsburg Chamber of Commerce and the community to advance the Heart Safe Community. Other aspects of this effort will include ongoing CPR classes, distributing AEDs and screening for blood pressure, implementing the Pulse Point app and working with cardiologists to create pathways for uninsured and underinsured patients access to specialty care. Diabetes / Obesity / Improved Nutrition / Physical Activity: Riverside Doctors Hospital of Williamsburg and Sentara Williamsburg Regional Medical Center will coordinate with various local non-profits to promote wellness in the community at large. Opportunities identified include: workshops on wellness and nutrition, diabetes partnership program, sponsoring walks and other physical activities for the community and continue the Doc Is In lecture series 33 Oyster Point Diagnostic 895 City Center Blvd Newport News VA 23606 Diagnostic Center Patriots Colony 6000 Patriots Colony Dr Williamsburg VA 23188 Retirement Center Peninsula Surgery Center 12000 Warwick Blvd Newport News VA 23601 Surgery Center Riverside Rehabilitation at Williamsburg 120 Monticello Avenue Williamsburg VA 23185 Rehabiliation Services Radiation Therapy Williamsburg 3901 Treyburn Drive Williamsburg VA 23185 Radiation Oncology Center Warwick Forest Retirement 866 Old Denbigh Blvd Newport News VA 23602 Retirement Center Williamsburg Healthcare Center 120 Kings Way Williamsburg VA 23185 Diagnostic Center Infusion Therapy Center RHS-Hampton Project 850 Enterprise Pkwy Hampton VA 23666 Surgery Center Diagnostic Center Riverside Walter Reed Professional Ctr Route 17 - Hospital Drive Gloucester VA 23061 Medical Office Building Gloucester Cancer Care 7544 Medical Drive Gloucester VA 23061 Radiation Oncology Infusion Therapy Services Riverside Rehab-Shoreview 225 Chesapeake Ave Newport News VA 23607 Rehabiliation Services Tappahannock Hospice 289 Hospital Road Tappahannock VA 22560 Hospice Services Cancer Specialists TW- Bayview 1200 Colonial Road Virginia Beach VA 23454 Cancer Care Services RDC - Smithfield 202 Gumwood Drive Smithfield VA 23434 Diagnostic Center Tappahannock Professional Office Bldg A 659 Hospital Road Tappahannock VA 22560 Medical Office Building Mount Clement Medical 300 Mount Clement Park Tappahannock VA 22560 Diagnostic Center Therapy Services Riverside Convalescent - Mathews 603 Main Street Mathews VA 23109 Convalescent Services Nursing Home Riverside Convalescent - Saluda 672 Gloucester Road Saluda VA 23149 Convalescent Services Nursing Home Riverside Convalescent - West Point 2960 Chelsea Road West Point VA 23181 Convalescent Services Nursing Home Riverside Wellness - Peninsula 12650 Jefferson Ave Newport News VA 23602 Fitness Center Physical Therapy Tappahannock Hospital Home Health 658 Hospital Road Tappahannock VA 22560 Home Health Services Cancer Specialists TW- Suffolk (Stark) 5835 Harbor View Blvd Suffolk VA 23435 Cancer Care Services Brentwood - Med Ed 10510 Jefferson Avenue Newport News VA 23601 Physician Clinic RCC-Smithfield Conv-Magnolia 200 Lumar Road Smithfield VA 23430 Convalescent Center Nursing Home Riverside Convalescent - Hampton 414 Algonquin Rd Hampton VA 23661 Convalescent Services Nursing Home The Orchard-Magnolia Manor 20 Delfae Drive Warsaw VA 22572 Convalescent Services Nursing Home Sanders Retirement Village 7385 Walker Ave Gloucester VA 23061 Retirement Services Cancer Specialists TW- Chspke 110 Wimbledon Square Chesapeake VA 23320 Infusion Therapy Center MDExpress-Hampton 3321 West Mercury Blvd Hampton VA 23666 Urgent Care Services MDExpress - Newport News 12997 Warwick Blvd Newport News VA 23602 Urgent Care Services The Gardens at Warwick Forest 1000 Old Denbigh Blvd Newport News VA 23602 Convalescent Services Nursing Home Cancer Care Center 12100 Warwick Blvd Newport News VA 23601 Radiation Oncology Infusion Therapy Center Newport Square Professional Center 856 J Clyde Morris Blvd Newport News VA 23601 Physician Services Part VI Line 1: Part I Line 3c: Free care uses 200% and discounted care uses 400% of the FPG. Line 1: Part I Line 7, column F: Bad debt expense removed from total expense in line 7, column F is $37,547,796. Line 1: Part I Line 7A: The cost to charge ratio calculated on worksheet 2 was used for the charity expense. Line 1: Part I Line 7B: Medicaid cost and net revenue are directly from the Medicaid cost report. Line 1: Part I Line 7E: Community health improvement is actual cost accumulated by the individuals participating in the activities. Line 1: Part I Line 7F: Health Professions Education cost is from the 2019 Medicare Cost Report plus overhead calculated from the Medicare Cost 2019 Report. Line 1: Part I Line 7H: Research costs are expenses less any funding received. Line 1: Part I Line 7I: Cash and in kind contributions are the actual 2019 dollar value of the cash or items given. Line 1: Part III Line 2: (Riverside Health System) Bad debt is the amount remaining on a patient's account after cash payments, third party payer contractual adjustments and hospital discounts have been taken. Before the amount is written off to bad debt, the account is sent to a collection agency which returns the account when they have exhausted all possible effort. Upon return the account balance is written off to bad debt. Line 1: Part III Line 2: (Select Specialty Hospital) Hospital records uncollectible accounts that are not a result of credit worthiness as a direct offset to revenue in accordance with current GAAP revenue recognition standards. Hospitals methodology to record a reserve for uncollectible accounts is based on recording, on a monthly basis, a reserve which is equal to the % of write-offs to net patient revenue for the prior twelve calendar months multiplied by the current months recorded patient revenue. Line 1: Part III Line 3: If the patient was uninsured and had a household income at or below 200% of the Federal Poverty Level or was insured and had a household income at or below 400% of the Federal Poverty Level the patient would qualify for 100% financial assistance write off and would not be included in bad debt. The only population that may fall into the bad debt is if the patient was uninsured with a household income between 201% and 400% of the Federal Poverty Level which received a 75% financial assistance write off of eligible billed charges. The patient would have a liability of 25% of the billed amount. If the patient did not pay the 25% amount, that liability could be sent to bad debt. The financial assistance write off of 75% is not applied to bad debt. However, our procedures for identifying FAP-eligible individuals are thorough, therefore we do not estimate any amount of bad debt to be attributable to FAP-eligible patients. Line 1: Part III Line 4: Footnote 3 of the Audited Financial Statements states: If the System identifies subsequent adjustments to the transaction price that would cause adverse changes in a patient or payor's ability to pay, the amounts are recorded as bad debt expense. Bad debt expense is included in operating expenses in the consolidated statement of operations. The amount included as bad debt expense for the year ended December 31, 2019 was not material to the System. Line 1: Part III Line 8: The organization uses CMS cost reporting guidelines and methodology to determine allowable Medicare costs. The shortfall from Medicare should be recognized as a community benefit, since the patients are provided services at a loss for the facility. The Health System is assuring that these essential emergency and acute care services are provided for the population's health. Not included in this shortfall are costs that Medicare considers non allowable. Line 1: Part III Line 9b: Reasonable efforts will be made to determine whether a patient is eligible for financial assistance prior to sending an account to collections. If the patient qualifies for financial assistance the account is adjudicated based on their FAP eligibility. Patients may need to complete a financial assistance application to determine eligibility or may request reconsideration under this financial assistance policy by submitting a financial assistance application. Upon receipt of an application for financial assistance, collection actions are suspended until a final eligibility determination is made. If the patient is deemed eligible for financial assistance, the account will be returned from collections and all collection efforts will be reversed. Line 2: Riverside Health System has embraced the Community Health Needs Assessment process as the way to best assess the health care needs of the communities it serves. To supplement this data, Riverside also utilizes resources such as the Virginia Atlas of Community Health, demographic data, as well as observing utilization and diagnoses trends across the Riverside service areas and nationally. Finally, Riverside works closely with other community leaders to identify and respond to local needs. Having community-based boards also allows for continuous feedback from individuals living and working in the service area. Line 3: Notification about the financial assistance program include, but are not limited to, the publication of notices in patient bills, providing the Plain Language Summary of the Financial Assistance Policy in emergency rooms, admitting and registration departments, hospital business offices, patient financial services offices, and at other public places as Riverside Health System may elect. Riverside Health System also publishes and widely publicizes this financial assistance policy on the facility website. The plain language summary is also included with the billing statement 30 days prior to referring a patient's account to collections. Patients may obtain additional information and/or paper copies of any financial assistance policy, PLS or application in person by visiting any Riverside Hospital Department, by mail, via our website, or by calling our Customer Service Center. Line 4: The service area for Riverside Healthcare Association, dba Riverside Health System, covers a wide geographic area, from the Potomac River to south of the James River in southeastern Virginia. The entire Peninsula region, including James City County, Williamsburg (where RDHW is located), Newport News (where RRMC is located), Hampton, York and Poquoson has a 2020 forecasted population of approximately 555,000 people. The Virginia Peninsula is bordered on the east by the Chesapeake Bay, on the south by the James River and the north by the York River. Access to health care facilities not located on the Peninsula is restricted by tunnels and bridges, with three connections to various points across the James and the Bay, and one bridge north across the York. Numerous waterways, inlets and marshlands are prominent in the landscape and restrict traffic in certain areas, requiring a system of bridges or circuitous routes for local travel. Interstate 64 runs the length of the Peninsula, providing access some 75 miles from Newport News to downtown Richmond and 40 miles to downtown Norfolk (via Hampton Roads Bridge Tunnel). The 2016 Virginia Department of Transportation study reports Average Annual Weekday Traffic counts of 163,000 along this corridor. The Virginia Peninsula region, per 2020 Census Projections, is approximately 52% White, 38% Black, and the remaining 10% a combination of Asian, Native American, Other and Two or More Races. While still a small overall percentage, the Hispanic community is growing, with 13% growth projected from 2015 to 2020. Median household income is projected to be $59,562 in 2020, with Per Capita Income projected to be at $30,503. The median age is projected to be 35.9 in 2020. The communitys population of people over age 65 is growing quickly, and that aging population points to even stronger hospital utilization in the coming years. The age group of 65 and older comprises 14 percent of the population. Within the market, all of the localities with the exception of the city of Poquoson qualify for full or partial designation as Medically Underserved Service Areas. While the military only accounts for 10% of the direct employment in the region, the impact of the armed forces is much larger. With the largest private employer being Huntington Ingalls Newport News Shipbuilding (maker of nuclear powered aircraft carriers and submarines) with more than 20,000 local workers, and the many smaller contracting companies that support the Newport News Shipyard, local Navy bases and Langley AFB / NASA Langley, more than 50% of the regional economy is connected to the defense industry. It is also a popular destination for military retirees. In terms of demographics and occupations, the Riverside service area is primarily what has traditionally been defined as a blue-collar community. More than one third of adults over age 25 have high school or less as the highest level of educational attai true American Cancer Society 2730 Ellsmere Avenue Norfolk VA 23513 131788491 501(c)(3) 22000 Make Strides March of Dimes 4191 Innslake Drive Ste 201 Glenn Allen VA 23060 131846366 501(c)(3) 6300 2019 Spon-Chef American Heart Association Inc PO Box 4002906 Des Moines IA 50340 135613797 501(c)(3) 25000 Heart Ball Here For The Girls 1309 Jamestown Rd Williamsburg VA 23185 260606190 501(c)(3) 22000 Pink Carpet; Run for Hill & Gala Flat-Out Events LLC 744 City Center Blvd Suite 800 Newport News VA 23606 271675755 20000 Community Partnership Community Free Clinic of Newport News 727 25th Street Suite 100 Newport News VA 23607 273510814 501(c)(3) 114583 Free Clinic Fear 2 Freedom Inc PO Box 6104 Newport News VA 23606 452143034 501(c)(3) 10000 Edu & Sexual Assault Survival Kits Hospice Support Care 4445 Powhatan Pkwy Suite 800 Williamsburg VA 23188 521289657 501(c)(3) 6000 2019 Sponsorship Williamsburg Area Chamber of Commerce 421 N Boundary St Williamsburg VA 23185 540482313 501(c)(6) 7500 2019 Sponsorship Christopher Newport University 1 Avenue of the Arts Suite 800 Newport News VA 23606 540701501 501(c)(3) 130000 Lifelong Learning Society; Insider's Breakfast; Athletics Sponsorship; Ferguson Ctr Dance Series; Riverside Medical Group Leadership Peninsula EMS Council Inc PO Box 3648 Williamsburg VA 23187 541064500 501(c)(3) 15000 2019 Sponsorship CNU Educational Foundation 1 Avenue of the Arts Newport News VA 23606 541156248 501(c)(3) 12500 2019-Sponsorship An Achievable Dream Foundation Inc 10858 Warwick Blvd Suite 800 Newport News VA 23601 541621932 501(c)(3) 25000 Tennis Ball VA Health Care Foundation 707 East Main Street Ste A Richmond VA 23219 541639924 501(c)(3) 25000 2019 Sponsorship Virginia Nurses Foundation 2819 N Parham Road Suite 1350 Richmond VA 23294 541788059 501(c)(3) 6500 2019 Spon-Gala VNF Awards Lackey Free Clinic 1620 Old Williamsburg Road Suite 230 Yorktown VA 23690 541850915 501(c)(3) 30000 Indig Pt Support Williamsburg Area Chamber of Commerce Foundation 421 N Boundary St Williamsburg VA 23187 541945838 501(c)(6) 15780 2019 Sponsorship Williamsburg Indoor Sports Complex 5700 Warhill Trail Williamsburg VA 23188 541966400 10000 2019 Sponsorship Virginia Symphony Orchestra 150 Boush Street Suite 800 Norfolk VA 23510 546000598 501(c)(3) 7500 2019-Sponsorship City of Newport News 2400 Washington Avenue Ste 201 Newport News VA 23607 546022059 Government 16700 Marathon Health & Wellness Expo Silent Children's Garden Annual Senior Amateur Golf Classic Annual Senior Amateur Golf Classic Virginia Living Museum Inc 524 J Clyde Morris Blvd Newport News VA 23601 546055922 501(c)(3) 18000 2019 Spon-Otter Ball 2019 Commemoration Inc PO Box 1607 Williamsburg VA 23187 810703911 501(c)(3) 25000 Edu Programs & Commemorative Projects Lionsbridge Football Club LLC 701 Town Center Drive Newport News VA 23606 823032870 35000 2020 Sponsorship-Partnership RIV Sports Medicine Team 18 5 Scholarships 108 84400 Grant Explanation A fund distribution form is completed and signed by an authorized administrator of the benefiting facility. Requests are approved according to the specifics of the requestor's governing charter. If a request doesn't comply the money is not distributed. Scholarship Eligibility and Requirements: Students must be enrolled or be an application to the nursing Program at the Riverside College of Health Careers. Applicants must demonstrate a cumulative GPA of 2.75 in prerequisite courses and enrolled students must have 3.0 in completed coursework. 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185912 0 0 0 JOHN MINCKS MEDICAL STAFF PRESIDENT 275609 0 40500 0 21389 0 33242 0 16395 0 387135 0 0 0 JUDITH MATTHEWS EXECUTIVE NURSE 136940 0 19023 0 1352 0 5747 0 16023 0 179085 0 0 0 KARL J GEDDES MD BOARD MEMBER 254167 0 22675 0 11057 0 27642 0 30303 0 345844 0 0 0 KEITH PERCIC VP 264817 0 48916 0 46537 0 35954 0 25140 0 421364 0 0 0 KELLY COOPER DIRECTOR SR RMG 152019 0 10091 0 566 0 19624 0 3121 0 185421 0 0 0 LINDA MCKEE ASSOCIATE VICE PRESIDENT SERVI 183341 0 26460 0 3856 0 9707 0 7553 0 230917 0 0 0 LINWOOD NELSON CHIEF FINANCIAL OFFICER/AVP 163286 0 31431 0 2944 0 20219 0 25724 0 243604 0 0 0 LISA SALSBERRY DIRECTOR 243536 0 3000 0 36444 0 26641 0 39277 0 348898 0 0 0 LISA SHANNON DIRECTOR SYSTEM 162028 0 26662 0 618 0 8726 0 14491 0 212525 0 0 0 LISA A CASANOVA MD BOARD MEMBER 193186 0 21953 0 14016 0 27459 0 24749 0 281363 0 0 0 MELVIN D SCHURSKY JR MD Board member 282975 0 49246 0 190957 0 8140 0 10616 0 541934 0 0 0 MICHAEL DACEY MD EVP/CCOO 616433 0 139799 0 112287 0 12600 0 9585 0 890704 0 0 0 MICHAEL FRANCIS PRESIDENT, MEDICAL STAFF 319609 0 0 2065 0 8654 0 15850 0 346178 0 0 0 MICHAEL JOSEPH DOUCETTE VP RRMC OPERATIONS 467316 0 71561 0 79090 0 33242 0 35770 0 686979 0 0 0 NANCY WICK LITTLEFIELD EVP/CNO 371892 0 82334 0 71662 0 10932 0 16303 0 553123 0 0 0 NEHEMIAH THRASH MD BOARD MEMBER 323915 0 51900 0 26256 0 12600 0 39637 0 454308 0 0 0 PAUL J MICALE MD BOARD MEMBER 568537 0 181034 0 28099 0 27642 0 31078 0 836390 0 0 0 PETER GALANTICH MD PRESIDENT MEDICAL STAFF 395222 0 18250 0 69853 0 27642 0 36219 0 547186 0 0 0 RICHARD K DUNN MD BOARD MEMBER 158258 0 0 84524 0 14087 0 40291 0 297160 0 0 0 ROBERT CULLOM PHYSICIAN 712817 0 582698 0 3689 0 600 0 30963 0 1330767 0 0 0 ROBERT R HARDING MD CHAIRMAN 167784 0 21875 0 69094 0 33304 0 1171 0 293228 0 0 0 ROMNEY ANDERSEN PHYSICIAN 470018 0 841337 0 83689 0 12600 0 685 0 1408329 0 0 0 ROSS YOUNGER SENIOR VP 337871 0 61503 0 51649 0 25235 0 42470 0 518728 0 0 0 SADIE THURMAN VP RN 186819 0 23614 0 6999 0 17722 0 1453 0 236607 0 0 0 SALLY HARTMAN SENIOR VP 396783 0 76074 0 66725 0 33242 0 13556 0 586380 0 0 0 SALLY RYAN VP PHYSICIAN SERVICES 262307 0 50517 0 44504 0 11938 0 13742 0 383008 0 0 0 SANDRA SNAPP ASSOCIATE VICE PRESIDENT SERVI 194545 0 27781 0 3923 0 25889 0 648 0 252786 0 0 0 SHEBA MOHSIN MD BOARD MEMBER 167315 0 108799 0 10480 0 25732 0 21984 0 334310 0 0 0 THERESA SIEVERS SENIOR VP 258857 0 0 14768 0 6341 0 1992 0 281958 0 0 0 VERNEETA L WILLIAMS MD BOARD MEMBER 217473 0 2500 0 861 0 22272 0 20465 0 263571 0 0 0 WALTER WILLIAM AUSTIN JR SR VP, CFO & TREASURER 478839 0 91463 0 80160 0 12600 0 21028 0 684090 0 0 0 WILLIAM BURNS DOWNEY PRESIDENT,CEO RHS 919559 0 264600 0 212856 0 33242 0 16060 0 1446317 0 0 0 WILLIAM H MCALLISTER MD BOARD MEMBER 968436 0 669791 0 12009 0 27642 0 30494 0 1708372 0 0 0 ANTOINETTE WATKINS DIRECTOR SYSTEM 159722 0 27593 0 1058 0 8657 0 8841 0 205871 0 0 0 Schedule J, Part I, Line 3 The compensation committee of the parent corporation, Riverside Healthcare Association, Inc. reviews and approves the compensation for top management using independent consultants and surveys. Schedule J, Part I, Line 4b ADRIA VANHOOZIER $26,200 CHARLES FRAZIER $52,128 CHARLES GRAHAM $42,404 CHRISTOPHER STOLLE $50,449 CYNTHIA WILLIAMS $32,621 DENNIS LOFTUS $45,772 EDWARD HECKLER $28,447 ELIZABETH MARTIN $39,846 ESTHER DESIMINI $29,653 JASON HOUSER $43,616 JESSE GOODRICH $13,495 KEITH PERCIC $32,855 LISA SALSBERRY $24,178 MICHAEL DACEY $93,600 MICHAEL DOUCETTE $63,687 NANCY LITTLEFIElD $52,944 ROSS YOUNGER $38,437 SALLY HARTMAN $53,184 SALLY RYAN $32,190 WALTER AUSTIN $64,700 WILLIAM DOWNEY $189,000 --------------------------- TOTAL $1,049,406 Riverside has established this SERP to provide retirement benefits to certain executive employees to supplement the retirement benefits to be received from Riverside and Social Security. Although the employee is fully vested in these funds, he/she will not have the right to withdraw these funds until the later of the employee reaching age 62 or separation from service with Riverside. PHILLIPS ENERGY INC SEE PART V 271894 SEE PART V false SANDY SANPP SEE PART V 70681 EMPLOYMENT false RICHARD DUNN SEE PART V 293859 EMPLOYMENT false LINDA PHILLIPS Schedule L, Part IV Linda Phillips' family members own Phillips Energy Inc. that contracts with Riverside. SANDY SNAPP Schedule L, Part IV Sandy Snapp's family member is employed by Riverside Hospital, Inc. RICHARD DUNN Schedule L, Part IV Richard Dunn's family member is employed by Riverside Physician Services, Inc. SCHEDULE O Part I, Lines 3 and 4/Part VI Lines 1a and 1b The number of voting members and independent voting members reported in Part I line 3 and 4/Part VI lines 1a and 1b is higher than the total count of board members reported in Part VII as several of the board members sit on several of the entities included within the Group return but have only been listed once. Part V, Line 3A Riverside Hospital, Inc. EIN 52-1245746, a subordinate company, had unrelated business income greater than $1,000 and 990-T was filed. Part VI, Section A, Line 2 Alan Witt and William Downey serve together on a regional advisory board for a local community bank. Part VI, Section A, Line 6 The Organization is a not for profit corporation with members. The members have the right to participate in the Organization's governance, including electing members of the governing body and to approve significant decisions of the governing body. Part VI, Section A, Line 7a Members of the governing body are subject to approval by the Member. Part VI, Section A, Line 7b Significant items such as merger, amendment of charter documents, and appointment of Board members requires the approval of the member corporation. Part VI, Section B, Line 11B Part I, Lines 3 and 4/Part VI Lines 1a and 1b The number of voting members and independent voting members reported in Part I line 3 and 4/Part VI lines 1a and 1b is higher than the total count of board members reported in Part VII as several of the board members sit on several of the entities included within the Group return but have only been listed once. Part V, Line 3A Riverside Hospital, Inc. EIN 52-1245746, a subordinate company, had unrelated business income greater than $1,000 and 990-T was filed. Part VI, Section A, Line 2 William Downey and Alan Witt serve together on a Board of Directors of a local entity. Part VI, Section A, Line 6 The Organization is a not for profit corporation with members. The members have the right to participate in the Organization's governance, including electing members of the governing body and to approve significant decisions of the governing body. Part VI, Section A, Line 7a Members of the governing body are subject to approval by the Member. Part VI, Section A, Line 7b Significant items such as merger, amendment of charter documents, and appointment of Board members requires the approval of the member corporation. Part VI, Section B, Line 11B On behalf of the Organization's governing body, the Riverside Healthcare Association, Inc. Board of Directors Salary and Pension Committee reviews key data from the Form 990. The entire Form 990 was reviewed by an independent accounting firm before filing. Part VI, Section B, line 12c All Board Members, Officers, Directors and Key Employees complete an annual Conflict of Interest questionnaire. A report of potential Conflicts of Interest is reviewed by the Compliance Officer. Further concern, as reflected in the Conflict of Interest, Financial Disclosure, and Compliance Certification Questionnaire is reviewed by the Riverside Health System President to determine if additional follow-up is necessary. If a conflict presents, Board Members are required by the By-Laws, to disclose the conflict to the full Board and recuse themselves from voting on a case by case basis. Part VI,Section B, Line 15 A&B The Riverside Healthcare Association, Inc. Board of Directors Salary and Pension Committee determines the compensation of the President and Senior Executives. The Committee relies on market comparative information provided by a reputable independent third party expert to establish the reasonableness of compensation levels. Part VI, Section C, Line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the general public upon request. Part VIII Line 11d $7,057,759 of the amount reported on Line 11d is a reclass of certain funds to cover specific program costs for related organizations. Part IX Line 24g $7,057,759 of the amount reported on Line 24g is a reclass of certain funds to cover specific program costs for related organizations. Part XI Line 9 Pension Adjustment $-43,072,941 Equity Adjustment $ 20,175,000 Equity Adjustment/true up related to Charlottesville Area Retirement Svcs $ 7,728,066 Distribution of Equity $ -1,750,000 ------------------------------------------------------------------------ Total $ -16,919,875 Virginia Surgical Management LLC 608 Denbigh Blvd Ste 800 Newport News VA 23608 542057012 Management VA 0 2515472 RivHosp Peninsula Cancer Institute LLC 608 Denbigh Blvd Ste 800 Newport News VA 23608 201872200 PT Services VA 13172790 93329567 RivPhysSv PENINSULA RADIOSURGERY ASSOCIATES LLC 608 Denbigh Blvd Ste 800 NEWPORT NEWS VA 23608 030596051 PT Services VA 1184140 7513040 RivHosp Michumi LLC 608 Denbigh Blvd Ste 800 Newport News VA 23608 200318732 PT Services VA 13680332 1852428 RivPhysSv Shore Health Services Inc 608 Denbigh Blvd Ste 800 Newport News VA 23608 540560500 Hospital VA 501(c)(3) 3 RivHCAssc true Shore Life Care inc 608 Denbigh Blvd Ste 800 Newport News VA 23608 541876370 Nursing Care VA 501(c)(3) 10 ShoreHSvc true Newport News General & Nonsectarian 608 Denbigh Blvd Ste 800 Newport News VA 23608 540505934 Holding Corp VA 501(c)(2) N/A RivHCAssc true Riverside Healthcare Assocation Inc 608 Denbigh Blvd Ste 800 Newport News VA 23608 521241835 Parent Comp. 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