2018-07-03T08:42:14-05:00 2017-08-31 990 2016-09-01 521578169 Bon Secours-Maryview Nursing Care Center BONS 7576860488 7007 Harbour View Blvd No 108 Suffolk VA 23435 Karen Reich CEO Extended Senior Care 7576860488 2018-07-03 0 2016 2022-09-23 18:48:47Z Karen Reich 7007 Harbour View Blvd No 108 Suffolk VA 23435 10201952 0 0928 X bonsecours.com X 1988 VA Skilled Nursing Center 20 17 199 8 0 0 0 0 10701540 10102333 54115 83059 22198 16560 10777853 10201952 0 0 0 0 6484688 5939137 0 0 0 3702112 5071394 10186800 11010531 591053 -808579 19242918 18706208 4169058 4491613 15073860 14214595 The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. 0 0 8566253 7438724 Skilled Nursing Care provided to patients to include assessment of cognitive and physical status, personal hygiene care, nutrition and maintenance of a clean and comfortable environment. 1125676 2021679 Rehabilitation Therapies to include physical therapy, respiratory therapy and occupational therapy so as to maintain each patient's optimal quality of life. 510299 641930 Medication & Diagnostic Treatments to include the administration of medication, ongoing assessment of potential interactions and negative side effects, wound care and facilitation of diagnostic testing as needed. 10202228 1 0 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 199 1 0 0 0 0 0 0 0 0 0 0 X 20 17 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Susan Anthony Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 James Bento Board Member 2.00 0.00 X 0 0 0 Michael Blount Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Robert Bray Board Member 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member 2.00 0.00 X 0 0 0 Brother Arthur Caliman CFX President - BSHR/DMC/MMC/MNCC 3.50 46.50 X X 0 0 0 Arthur Collins Chairman 3.00 0.00 X X 0 0 0 Sister Elaine Davia CBS Board Member 2.00 48.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 953293 35876 Charlette Fairchild PhD Board Member 2.00 0.00 X 0 0 0 Gabriel Franco Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Vincent Joseph Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 1.00 49.00 X X 0 842080 126937 Shelley Mishoe Board Member 2.00 0.00 X 0 0 0 Jeffrey Morrison DO Board Member (Jan-Aug) 2.00 0.00 X 0 20750 0 Sister David Niski President - MIH/SFNC (Jan-Aug) 3.50 0.00 X X 0 0 0 William Pile Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Ward Robinett Jr Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Cynthia Romero MD Board Member 2.00 0.00 X 0 0 0 Rodrigo Romulo MD Board Member 2.00 0.00 X 0 0 0 Stephanie Short Board Member 2.00 0.00 X 0 0 0 Robert Sqautrito MD Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Douglas Ziegenfuss CPA Board Member 2.00 0.00 X 0 0 0 Michael Dooley Int VP Fin(Apr-Aug)/Treas (Jul-Aug) 5.00 45.00 X 0 0 0 Patricia Robertson CAO/BSV Administration (Sep-Dec) 25.00 25.00 X 0 431220 27585 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 1.00 49.00 X 0 275200 16870 Karen Reich CEO Extended Senior Care (Jan-Aug) 3.00 47.00 X 0 331895 45868 Donald Chastang Physical Therapist 50.00 0.00 X 106119 0 30462 106119 2854438 283598 1 0 1 0 Shiftwise PO Box 70870 St Paul MN 551709705 Contract Nursing 231450 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction 155795 2 Patient Service Rev. 623110 10102333 10102333 10102333 83059 83059 Resident Laundry Svcs 812320 6720 6720 Cafe/Vending/Gift Shop 722212 3960 3960 Beauty & Barber Shop 812112 2302 2302 3578 3578 16560 10201952 10102333 0 99619 X 4517738 4065964 451774 111901 100711 11190 829447 746502 82945 480051 432046 48005 89676 80708 8968 1074 967 107 1463311 1463311 210 189 21 208184 187366 20818 10741 9667 1074 512731 461458 51273 1400 1260 140 212 191 21 56910 56910 154610 139149 15461 34694 31225 3469 Purchased Services 1006792 906113 100679 Medical Supplies 1001665 1001665 Bad Debt 405601 405601 Corporate Dues 86549 77894 8655 37034 33331 3703 11010531 10202228 808303 0 550 550 16489776 15339702 1249414 1264432 4410 3380 8177894 6738695 1063185 1439199 119 201405 435464 457540 19242918 18706208 530613 737081 3260184 3264313 25307 12528 352954 477691 4169058 4491613 X 15073860 14214595 15073860 14214595 19242918 18706208 X -808579 -50686 X 0 1 X 1 0 X 600 600 9779506 9954964 10533396 10701540 10102333 51071739 9779506 9954964 10533996 10701540 10102333 51072339 0 0 0 51072339 26347 22078 16098 54115 83059 201697 26347 22078 16098 54115 83059 201697 31017 24027 25582 22198 16560 119384 9836870 10001069 10575676 10777853 10201952 51393420 0.99380 0.99460 0.00390 0.00280 X Schedule A, Part III, Line 12, Explanation of Other Income: Beauty Barber Shop - 2012 Amount: $ 8,351. 2013 Amount: $ 5,630. 2014 Amount: $ 4,239. 2015 Amount: $ 5,002. 2016 Amount: $ 2,302. Cafe/Vending/Gift Shop - 2012 Amount: $ 8,645. 2013 Amount: $ 4,369. 2014 Amount: $ 6,511. 2015 Amount: $ 4,988. 2016 Amount: $ 3,960. Resident Laundry Service - 2012 Amount: $ 10,268. 2013 Amount: $ 11,090. 2014 Amount: $ 8,735. 2015 Amount: $ 8,330. 2016 Amount: $ 6,720. All other - 2012 Amount: $ 3,753. 2013 Amount: $ 2,938. 2014 Amount: $ 6,097. 2015 Amount: $ 3,878. 2016 Amount: $ 3,578. 0 0 0 0 0 0 0 0 1 1074 1074 0 Part II-B, Line 1: The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. 0 1 X 2499739 1527632 972107 20357 10263 10094 4701552 4338393 363159 956246 862407 93839 1439199 HPL/GL Liability 371071 Due to Affiliates 55789 Medicare Settlement 50831 477691 X Part IV, Line 2b: The filing organization holds, safeguards, manages and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents. Written requests for $50 or more are honored within 3 business days. All excess custodial funds are held in interest bearing accounts separate from that of the organization. Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The System accounts for uncertain tax positions in accordance with ASC Topic 740, Income Taxes. Their related income is exempt from federal income tax under Section 501(A). The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of August 31, 2017 or 2016. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present, and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2013. As of August 31, 2017 and 2016, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $106,393 and $89,895 of net operating loss carryforwards as of August 31, 2017 and 2016, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The System accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The System's deferred tax assets are fully reserved at August 31, 2017 and 2016 as the System considers it more likely than not that these amounts will not be recognized. 0 1 0 0 0 0 0 0 0 Timothy Davis Board Member 0 648505 0 151613 0 153175 0 15900 0 19976 0 989169 0 0 Michael Kerner Secretary/CEO-BSHR 0 555514 0 156883 0 129683 0 106277 0 20660 0 969017 0 73667 Patricia Robertson CAO/BSV Administration (Sep-Dec) 0 305277 0 73944 0 51999 0 15900 0 11685 0 458805 0 0 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 0 205465 0 30621 0 39114 0 12879 0 3991 0 292070 0 0 Karen Reich CEO Extended Senior Care (Jan-Aug) 0 227513 0 64506 0 39876 0 15176 0 30692 0 377763 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Michael Kerner, $82,150. Form 990, Part VI, Section A, line 4 On January 1, 2017, the bylaws of (i) Bon Secours Hampton Roads Health System, Inc., Bon Secours-DePaul Medical Center, Inc., Maryview Hospital, and Bon Secours-Maryview Nursing Care Center (collectively the "Hampton Roads Entities"); and (ii) Mary Immaculate Hospital, Incorporated and Mary Immaculate Nursing Center, Inc. (collectively, the "Mary Immaculate Entities") were amended and restated in their entirety to implement a single mirror board structure for the Hampton Roads and Mary Immaculate Entities, as well as to otherwise bring the documents up to date with current templates. No changes in corporate or sponsorship structure occurred as a result of the bylaws revisions. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Hampton Roads Health System, Inc., which in turn is the sole member of Bon Secours - Maryview Nursing Care Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours - Maryview Nursing Care Center is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours - Maryview Nursing Care Center are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11b The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15b The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization makes all documents available to the general public upon request. Form 990, Part VII - Additional Disclosure: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. The governing bodies of the related organizations of Bon Secours Hampton Roads Health System, including DePaul Medical Center, Maryview Hospital, Mary Immaculate Hospital, Bon Secours Maryview Nursing Care Center, and Mary Immaculate Nursing Center are comprised of the same board members and board officers (Chairman, Secretary and Treasurer), with the exception of President. These governing bodies are referred to as the Hampton Roads Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for the applicable entities. Br. Arthur Caliman and Sr. Elaine Davia do not receive payroll distributions as they have taken a vow of poverty. Form 990, Part IX, line 11g Other Fees-for-Services: Program service expenses 1,463,311. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,463,311. Form 990, Part XI, line 9: Principal Payments and Swaps -50,682. Rounding -4. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsvile MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Ste A Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 12c, III-FI Bon Secours Health System Inc 0 Bon Secours Maryview Foundation 3520 High Street Ste 100 Portsmouth VA 23707 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Maryview Hospital 3636 High Street Portsmouth VA 23707 540506463 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center 150 Kingsley Lane Norfolk VA 23505 541820093 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfolk VA 23505 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 0 Province Place of Maryview LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541842697 Assisted Living VA N/A Province Place of DePaul LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541950880 Assisted Living VA N/A Harbour View MOB 2 LLC 5818 Harbourview Blvd Suite A1 Suffolk VA 23435 822484997 Medical Office Building VA N/A Professional Health Care Mgmt Inc 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA N/A C 0 Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0