2018-07-03T06:33:58-05:00 2017-08-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2016-09-01 540548200 Mary Immaculate Hospital MARY 7578866000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Darlene Stephenson Chief Executive Officer 7578866000 2018-07-03 1 John W Sadoff Jr P00540589 4042201500 2016 2022-09-23 18:48:47Z Bon Secours Mary Immaculate Hospital Darlene Stephenson 7007 Harbour View Blvd No 108 Suffolk VA 23435 180821434 0 0928 X bonsecours.com X 1956 VA Acute Care Hospital 19 17 1065 136 101568 -34287 835837 555093 181714333 176111949 892900 2000678 2443033 2115360 185886103 180783080 74710 17250 0 0 54965533 54889564 0 0 0 114659640 110362954 169699883 165269768 16186220 15513312 242150281 258942792 20619993 21519918 221530288 237422874 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 155074307 17250 177788355 Mary Immaculate Hospital provides medical care to patients without regard to their ability to pay. Among the major services provided to the residents of Hampton Roads, three major areas of focus are orthopedics, general surgery and women's health. In addition, Mary Immaculate provides support for community services. Please see Schedule H for additional information regarding programs, community benefit programs and Charity Care. 155074307 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 84 0 1 1065 1 1 1 0 0 0 0 1 1 0 0 0 0 X 19 17 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Susan Anthony Board Member 2.00 0.00 X 0 0 0 James Bento Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Robert Bray Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Brother Arthur Caliman President - BSHR/DMC/MMC/MNCC 3.50 46.50 X 0 0 0 Arthur Collins Chairman (Jan-Aug) 3.00 0.00 X X 0 0 0 Sister Elaine Davia Board Member 2.00 48.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 953293 35876 Debra Deihl Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Charlette Fairchild PhD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Gabriel Franco Board Member 2.00 0.00 X 0 0 0 Rev Ivan Harris Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Deborah Jones Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Dr Vincent Joseph Board Member 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 14.00 36.00 X X 0 842080 126937 Sister Sandra Lyons Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Sister Shaun Malone Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Helena Mock Secretary (Sep-Dec) 2.00 0.00 X X 0 0 0 Jeffrey Morrison DO Board Member (Sep-Dec) 2.00 0.00 X 0 20750 0 Sister David Niski President - MIH/SFNC 3.50 0.00 X X 0 0 0 William Pile Chair (Sep-Dec)/BM (Jan-Aug) 3.00 0.00 X X 0 0 0 Cynthia Romero MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Rodrigo Romulo MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Stephanie Short Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Douglas Ziegenfuss PhD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 15.00 35.00 X 0 275200 16870 Darlene Stephenson CEO - MIH 47.50 2.50 X 0 322337 34367 Michael Dooley Int VP Fin(Apr-Aug)/Treas (Jul-Aug) 12.00 38.00 X 0 0 0 Jeffrey Doucette VP Patient Care Services (Sep-Dec) 50.00 0.00 X 0 244395 42687 Vickie Humphries VP of Human Resources 15.00 35.00 X 0 228779 24073 James McNamara VP of Ortho 7.00 43.00 X 0 272959 21760 Terri Spence VP & Regional CIO 15.00 35.00 X 0 253014 32322 Anthony Terracina MD General Surgeon 50.00 0.00 X 1086584 0 42210 Jason Andre MD Vascular Surgeon 50.00 0.00 X 209811 179515 35093 Edward Pak Internist 50.00 0.00 X 371729 0 10600 Thomas Hoffmier MD Cardiologist 50.00 0.00 X 283922 0 30186 Michael Mangano Pharmacist 50.00 0.00 X 169439 0 26436 2121485 3592322 479417 40 0 1 0 Tidewater Physicians Multispecialty Grou 860 Omni Blvd Suite 401 Newport News VA 23606 Physician Services 2788304 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 303682289 Dietary Services 2730993 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 2566510 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction 1709399 Anesthesia Assoc of Hampton 110 Three Point Ct Yorktown VA 23692 Physician Services 1403875 31 36461 302896 8978 206758 555093 Patient Service Rev. 622110 176111949 176010381 101568 176111949 1076598 1076598 34151 1820 2765 2163 31386 -343 31043 31043 789594 134486 0 0 789594 134486 924080 924080 13309 36461 33426 -20117 -20117 Joint Venture Income 900099 1004560 1004560 Outpatient Pharmacy 446110 542787 542787 Physical Therapy Svcs 900099 230627 230627 326460 326460 2104434 180783080 177788355 101568 2338064 17250 17250 43338954 39005059 4333895 1882998 1694698 188300 5908562 5317706 590856 3759050 3383145 375905 186706 168035 18671 29661 26695 2966 8883730 8883730 5267 4740 527 1894987 1705488 189499 174156 156740 17416 2912480 2621232 291248 83516 75164 8352 20851 18766 2085 1604838 1604838 6935823 6242241 693582 800549 720494 80055 Medical Supplies 42915417 42915417 Purchased Services 30579909 27521918 3057991 Bad Debt Expense 9893936 9893936 BSHSI Allocation 2612652 2351387 261265 828476 745628 82848 165269768 155074307 10195461 0 3205 3206 138467253 155855703 119067 87955 18774088 16697675 50000 3784652 3760210 855946 877098 106114265 71072370 35078863 35041895 33757493 36740915 77030 74079 11232684 9754056 242150281 258942792 10585815 11217812 1122358 1090972 8911820 9211134 20619993 21519918 X 220408597 236455666 1062772 913358 58919 53850 221530288 237422874 242150281 258942792 X 15513312 1876400 -1497126 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 15635 0 1 14026 29661 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. The filing organization also conducted advocacy relating to education of legislative body regarding hospital and healthcare reform and how it impacts communities. The lobbying expense related to this activity is included on Line 1g. 58919 -140 -4929 53850 56357 451 2111 58919 59700 -3024 318 1 56357 56878 4213 1391 59700 44871 521 11749 263 56878 0.00000 1.00000 0.00000 0 0 3352921 3352921 723312 40614077 21830412 19506977 390703 385189 5514 32485 59621460 47614518 12039427 348295 1031012 1242251 137056 35041895 HPL/GL Liability 4322273 Fin 47 LT Asbestos Liab 1841373 Due to Affiliates 1486554 Patient Credit Balances 1183350 Medicare/Medicaid Liabilities 235069 Deferred Rent 118611 Other Misc Liabilities 23904 9211134 X Part V, Line 4: Earnings are used to assist the needy. 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. Golf 39431 31834 7597 22857 Holiday Brunch 10339 4627 5712 10257 312 49770 36461 13309 33114 312 33426 -20117 1 1 X 1 X 1 X 1 1 1 0 1 1 3653532 175312 3478220 0.02240 14031311 10579355 3451956 0.02220 17684843 10754667 6930176 0.04460 35 17887 1152917 2115 1150802 0.00740 2 497 225267 225267 0.00140 10 7995 293764 293764 0.00190 47 26379 1671948 2115 1669833 0.01070 47 26379 19356791 10756782 8600009 0.05530 1 37 370 370 0.00000 1 3922 3922 0.00000 2 2088 13882 13882 0.00010 4 2125 18174 18174 0.00010 1 9893936 0 39767383 45465294 -5697911 X 1 1 1 1 Mary Immaculate Hospital 2 Bernardine Dr Newport News VA 23602 bonsecours.com H1873 X X X X Mary Immaculate Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Section C X X 1 15 0 1 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X www.fa.bonsecours.com X www.fa.bonsecours.com X www.fa.bonsecours.com X X X X X X X 1 X 0 X X X X 1 X 0 0 Mary Immaculate Hospital Part V, Section B, Line 5: Mary Immaculate Hospital (MIH) contracted with ToXcel to conduct an electronic survey of key stakeholders to determine the top healthcare needs of the community. MIH developed a list of key stakeholders who were asked to provide their viewpoints on important healthcare concerns in the community, significant gaps in the community, and ideas for addressing health concerns and service gaps. Stakeholders included individuals who have special knowledge and expertise in public health, as well as the deans of area colleges and universities with medical degree programs. In addition, MIH surveyed representatives of medically underserved, minority populations, and those with chronic conditions. MIH also conducted community forums to gather additional input from residents. Upon receipt of all information, MIH convened a community advisory board made up of 36 representatives from 40 organizations focused on community health, including Sentara and Riverside health systems and the Peninsula Health Department to review the list of key needs and gaps identified to prioritize the needs and make recommendations to MIH leadership. Mary Immaculate Hospital Part V, Section B, Line 7d: The MIH CHNA was posted on the Bon Secours Hampton Roads website (https://bonsecours.com/hampton-roads), as well as distributed to community advisory board members. In addition, copies of the CHNA are located in the emergency departments at MIH and Administration Office. Mary Immaculate Hospital Part V, Section B, Line 11: Through development of an implementation plan from the CHNA, Mary Immaculate Hospital (MIH) identified the health priorities in the related service areas. MIH has an open medical staff with privileges available to all qualified physicians. The MIH emergency department provides service 24 hours/day, 7 days/week to ensure access for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located.MIH strives to reduce barriers to accessing behavioral health services to improve the mental health of the community. Nearly 120 patients were referred to the Peninsula CSB by the MIH ED and Life Coaches. Bereavement and grief counseling is a significant need in the service area and MIH has been able to provide many services to meet the need of the community. The Bereavement Center and Family Focus are addressing bereavement issues in English and Spanish to provide additional support to Hispanic families in Newport News. Collaboration with Jim's Local Market continues to provide community space for grief education and support in the community. Nearly 400 families are involved with the Kidz'N'Grief support group and Mikey's Camp had 140 participants. The partnership between Kidz'N'Grief and the Mason School of Business at the College of William & Mary was enhanced through a variety of fundraising and awareness events. Children of Incarcerated Parents (CHIPs) Program served 14 7-12 year olds in its inaugural year. Collaboration with community partners continues to address the opioid epidemic.MIH offers health services via the Care-A-Van (CAV). The CAV is a free mobile medical service that provides general medical care to uninsured adults and children in Newport News, as well as Norfolk, Portsmouth, and Suffolk. Services provided include urgent and primary care (including examination, diagnosis, lab, pharmacy, and follow-up), immunizations for school, pregnancy tests, blood pressure measurement, health education, referrals for specialty care, opportunity to enroll eligible children in children's health insurance. While the CAV primarily serves adults, some sites provide care and referral services for children aged 12 and older. Community partners include free clinics, local health agencies, physicians, and numerous faith-based organizations which collaborate with CAV staff. Over 900 patient visits were rendered by the CAV in Newport News and over $4,000 in lab services were provided at no cost to the patient. Eight patients were referred to area CSBs for follow-up.MIH offers support to qualified patients though the Life Coach Program. The Life Coach Program connects patients with no insurance, little resources, or no personal doctor with primary care resources to minimize their trips to the emergency room. These coaches work closely with the emergency department staff and care managers to find medical homes for patients who regularly use emergency rooms for non-emergency issues. Life Coaches help patients overcome social barriers to care, make follow up appointments, and obtain medications. MIH Life Coaches had 1,213 patient contacts, of which 120 were referred to areas CSBs for follow-up.Prevention and treatment of obesity with an emphasis on diabetes and nutrition was identified as one of the top health concerns in the MIH service area. MIH offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Monthly nutrition program held at Jim's Local Market reached 88 participants. Nutrition education programs were held with the Hampton Police Department student and trainees. A community health and safety fair was held at Jim's Local Market and provided nutrition advice and resources to approximately 40 participants. 175 glucose screens were provided through seven community events. The total attendance of those events was over 1,200. The Heart Health Academy was held and attended by 141 students. In partnership with other area health systems and organizations, MIH is addressing the issue of healthy lifestyles through the Peninsula Community Health Collaborative.MIH partners with several organizations to address the needs of the homeless. MIH was an active participant at the first Newport News Project Homeless Connect. Over 100 homeless clients were seen. Collaborating with LINK of Hampton Roads has led to a partnership with St. Francis Nursing Center to provide hospice beds to homeless patients if the need arises. MIH also has many staff volunteers that support LINK of Hampton Roads' winter shelter initiative PORT. Crime and community violence were identified as a community need. Although they are not addressed in the MMC Implementation Plan, human trafficking and gun control/violence are two of the Bon Secours Health System advocacy resolutions. MIH is very involved in the human trafficking effort.Although Bon Secours Mary Immaculate Hospital recognizes the importance of all the needs identified by the community including education, jobs with fair wages, community violence, transportation services, dental health, alcohol/drugs, and housing resources are limited within the organization to prioritize these specific needs. There are other providers and organizations addressing these needs with specialized programs and services. BSMIH is prepared to collaborate or assist with these efforts beyond the current set of services we provide. Mary Immaculate Hospital Part V, Section B, Line 16j: Information regarding the FAP is available on our websites, brochures are available at time of registration. We have on-site Financial Counselors who assist patients. We also have eligibility vendors who work with the patients and our statements indicate we have an FAP. We also provided local clinics in each market brochures regarding our FA program. Form 990, Schedule H, Part V, Section B, Line 14: Charges for patients who are eligible for financial assistance shall be limited to no more than amounts generally billed ("AGB") for such services. These charges are based on the average allowed amounts from Medicare and commercial payers for emergency and other medically necessary care. The allowed amounts include both the amount the insurer will pay and the amount, if any, the individual is personally responsible for paying. The AGB is calculated using a look back method. Because both Maryland law and Federal tax law limit the amounts that may be charged to patients, an FAP eligible individual or an uninsured individual will not be charged more than the lesser of the AGB or the regulated charge set by the Maryland Health Services Cost Review Commission for emergency or other medically necessary care. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/hampton-roads/community-commitment/community-health-needs-assessment 9 1 - In-Motion Boo Williams Sportsplex 5 Armistead Pointe Parkway Hampton VA 23666 Physical Therapy 2 - PT Outpatient Rehab 2 Bernardine Dr Newport News VA 23602 Physical Therapy 3 - Mary Immaculate Phys Therapy Victory 101-A Long Green Blvd Yorktown VA 23693 Physical Therapy 4 - Mary Immaculate Phys Therapy Denbigh 14703 Warwick Blvd Suite B Newport News VA 23608 Physical Therapy 5 - Bon Secours Surgical Specialists 12720 McManus Blvd Ste 311 Newport News VA 23602 Physician Practice 6 - Bon Secours Occumed 14703 Warwick Blvd Suite A Newport News VA 23608 Occupational Medicine 7 - Bon Secours Vein and Vascular-MIH 12720 McManus Blvd Suite 303 Newport News VA 23602 Physician Practice 8 - Bon Secours Palliative Medicine 12720 McManus Blvd Suite 301 Newport News VA 23602 Physician Practice 9 - Bon Secours Pulmonary Specialists 12720 McManus Blvd Ste 303 Newport News VA 23602 Physician Practice Part I, Line 6a: Annually, Bon Secours Hampton Roads Health System (BSHRHS) publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. This report is available online at https://bonsecours.com/hampton-roads. Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $9,893,936. Part II, Community Building Activities: Bon Secours Mary Immaculate Hospital provided staff and resources in support of the Healthy Community Initiative of Bon Secours Health System, and advocated for local and state policies that would improve health across its communities. MIH has partnered with LINK of Hampton Roads to address socioeconomic and health disparities among the homeless population throughout the service area. Bon Secours Hampton Roads has partnered with the Peninsula Health Department, Sentara Healthcare, and Riverside Health System to form the Peninsula Community Health Collaborative to address issues affecting the health of the community. Bon Secours Hampton Roads also partnered with the Southeast Virginia United Way, Sentara Healthcare, and Virginia Department of Health to develop the Greater Hampton Roads Connects website, a community dashboard that aggregates data for use in the CHNA and CHA processes. MIH donated staff time and resources in support of these efforts. Part III, Line 2: Bad debt expense on the general ledger includes: 1) actual write offs of discounted gross charges where it is determined an uninsured patient can pay and does not pay; and 2) the estimated write offs for uninsured patient accounts with outstanding balances after discount. Estimates are based on historical collection rates.When an uninsured patient is billed for patient care services, the charges are automatically discounted and the patient is requested to only pay the amount after discount. The discount is recorded as an adjustment to gross revenue and is not recorded in bad debt expense. If the balance after discount is not paid or not paid in full, the unpaid amount will be written off to bad debt expense. When a patient remits a payment on an account that has already been written off to bad debt expense, the payment is recorded as a recovery of bad debt, which reduces bad debt expense. Part III, Line 3: The organization does not report an estimate for the portion of bad debt expense that may have been likely to qualify for financial assistance under the hospital's charity care policy. The organization takes the position that ample opportunity and assistance is provided to the patient to qualify under the financial assistance policy. If sufficient information is not provided, the organization must assume the patient does not qualify. Part III, Line 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accountsreceivable" on page 10 in the attached BSHSI consolidated auditedfinancial statements ("AFS"). "Allowance for uncollectible accounts" isdiscussed in the second paragraph in Footnote "(10) Net Patient ServiceRevenue" on page 38-39 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and non-reimbursable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and non-reimbursable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in- and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost.The organization feels the total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service.In addition to the costs reported above, the organization incurred additional costs relating to Medicare support that are not includable in the Medicare Cost Report in the amount of: $439,260. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients who qualify for financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is approved, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending FAP account.Specific criteria exists for how much financial assistance, partial or total, will be provided to the patient based on the assessed need. Criteria is based on Federal Poverty Guidelines and is reviewed and updated annually. Once a patient has been deemed eligible for the Patient Financial Assistance Program (FAP), the patient is notified by letter within 60 days after receipt of the application and supporting documentation. The patient retains eligibility for a period of eight months from the date of the application. This eligibility is identified by hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of the eight months, the patient is responsible for reapplying for FAP eligibility. Part VI, Line 2: In partnership with Bon Secours Virginia Health System, Mary Immaculate Hospital uses multiple approaches to assess the health needs of the communities it serves. Health care needs of the community are assessed and updated using a variety of informational sources including Virginia Health Information for state-based performance data, and Claritas and Sg2 for market and geographic data. The Sg2 strategic planning tools are used to retrieve demographic information and trends for the primary and secondary service areas pertaining to Maryview Medical Center. National Research Corporation (NRC), and other strategic market intelligence are also utilized. Part VI, Line 3: The Patient Financial Assistance program is communicated to patients verbally upon scheduling, registration, visible postings of the program are in common areas throughout the hospital, along with brochures and the program is detailed on our Bon Secours website. In addition, patient billing statements and letters inform patients regarding our financial assistance program. Bon Secours proactively screens patients to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assist the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Bon Secours is also dedicated to meeting the needs of non-English speaking patients by having on-site Spanish translators, and other language translation services. In addition, Bon Secours employs a telephone language service which assists in meeting any language needs that arise. The translation services are offered to non-English speaking patients from admission to discharge, including the financial assistance process. Based on market need, our financial assistance policy and application are translated into multiple languages and placed on our Bon Secours website for patients to access. Part VI, Line 4: As of 2017, Hampton Roads is a very diverse community within an MSA of over 1.7 million people residing in 16 cities and counties, stretching from northeastern North Carolina to Williamsburg. The area is characterized by racial diversity, a significant military population and a growing elderly population.The primary service area population served by Mary Immaculate Hospital (MIH), encompasses Newport News, Hampton, Williamsburg, and York County. The largest populations for the MIH service area are white (59.1%), Black or African American (29.3%), and small percentages of other groups. The median income for the MIH service area is $59,346. The City of Newport News has the highest rate of children living in poverty (26.0%) compared to Virginia (15.0%). York County has 7% of children living in poverty. The percentage of children living in single parent households (39.8%) is higher compared to Virginia (30%) and 38.8% of students are eligible for free lunch.The most prevalent chronic conditions among adults in the service area include high blood pressure (30.7%), asthma (15%), diabetes (10.4%), and smoking (17%). The leading causes of mortality in the MIH service area per 100,000 are heart disease (168.5), cerebrovascular disease (43.1) cancer (172.2), chronic lower respiratory diseases (35.8), diabetes (24.8), kidney disease (17.9) and septicemia (13.0). The infant mortality rate (per 1,000 live births) in the MIH service area is 12.4% compared to 6.2% in Virginia. Part VI, Line 5: Bon Secours Hampton Roads has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/day, 7days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, 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 as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSHSI Vision. BSHSI's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2016-2018). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that teh struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression.- Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSHSI and the SQP (Strategic Quality Plan). Part VI, Line 7, Reports Filed With States VA 1 Literacy For Life PO Box 8795 Williamsburg VA 23185 541085026 501(C)(3) 17250 HEAL Program 1 0 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 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 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 0 205465 0 30621 0 39114 0 12879 0 3991 0 292070 0 0 Darlene Stephenson CEO - MIH 0 227405 0 54452 0 40480 0 14917 0 19450 0 356704 0 0 Jeffrey Doucette VP Patient Care Services (Sep-Dec) 0 193710 0 44700 0 5985 0 12258 0 30429 0 287082 0 0 Vickie Humphries VP of Human Resources 0 159662 0 24632 0 44485 0 14231 0 9842 0 252852 0 0 James McNamara VP of Ortho 0 237568 0 34415 0 976 0 12205 0 9555 0 294719 0 0 Terri Spence VP & Regional CIO 0 221664 0 30442 0 908 0 22171 0 10151 0 285336 0 0 Anthony Terracina MD General Surgeon 485661 0 599747 0 1176 0 13250 0 28960 0 1128794 0 0 0 Jason Andre MD Vascular Surgeon 208876 178714 754 646 181 155 3233 2767 15679 13414 228723 195696 0 0 Edward Pak Internist 348567 0 22755 0 407 0 10600 0 0 0 382329 0 0 0 Thomas Hoffmier MD Cardiologist 240991 0 38542 0 4389 0 10600 0 19586 0 314108 0 0 0 Michael Mangano Pharmacist 168809 0 150 0 480 0 8122 0 18314 0 195875 0 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. Additionally, on December 28, 2016, the articles of Mary Immaculate Hospital, Incorporated were amended to ensure that the board appointment provisions mirrored the new bylaws provisions. Form 990, Part VI, Section A, line 6 The General Minister and General Council of the Bernardine Sisters of the Third order of St. Francis and Bon Secours Health System, Inc. are the members of Mary Immaculate Hospital. Form 990, Part VI, Section A, line 7a The governing body of Mary Immaculate Hospital is appointed by both members, with Bon Secours Health System, Inc. having the majority vote. Form 990, Part VI, Section A, line 7b Certain authorities of Mary Immaculate Hospital are reserved to its members. 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 BSHSI. The compensation committee consists of a group of independent board members and engages an 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. 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 hospitals 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. Art Caliman and Sr. Elaine Davia do not receive payroll distributions as they have taken a vow of poverty. Form 990, Part XI, line 9: BSHSI Principal Debt & Swaps -1,494,175. Writedown of Goodwill - Sale of BSNY -2,951. Mary Immaculate Hospital Auxiliary 7007 Harbourview Blvd Suffolk VA 23435 546040266 Auxiliary VA 501(c)(3) Line 10 N/A 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 12c, III-FI Mary Immaculate Hospital 1 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 10 Mary Immaculate Hospital 1 Bon Secours Health System Inc 8990 Old Annapolis Road Columbia MD 21045 521301088 Parent Org. - Mgmt. Services MD 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA Mary Immaculate Hospital Inc C 740436 1008921 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0