2017-07-10T09:44:13-05:00 2016-08-31 861065772 Deloitte Tax LLP Deloitte Tax LLP 191 Peachtree St Atlanta GA 303031749 990 2015-09-01 540548200 Mary Immaculate Hospital MARY 7578866000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner CEO - BSHRHS 7578866000 2017-07-10 1 John W Sadoff Jr P00540589 4042201500 2015 2021-01-29 14:40:06Z Bon Secours Mary Immaculate Hospital Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 185917254 0 0928 X bonsecours.com X 1956 VA Acute Care Hospital 16 13 1080 120 84916 -17577 1158457 835837 181634071 181714333 918732 892900 2555403 2443033 186266663 185886103 25184 74710 0 0 54062489 54965533 0 0 0 113744164 114659640 167831837 169699883 18434826 16186220 228432529 242150281 22396578 20619993 206035951 221530288 X 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 159328713 74710 181629417 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.Orthopedics -Mary Immaculate continues a strong focus on orthopaedic care for residents of the greater Hampton Roads area. Bon Secours skilled surgeons perform minimally invasive and traditional orthopaedic and spine procedures, and are complemented by a strong physiatry network. The orthopaedic service includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-of-the-art technology, including a Mako surgical robot to assist in orthopaedic surgeries, and expert physicians, some with a national reputation, as well as a comprehensive inpatient and outpatient rehabilitation network. In addition, a strong focus exists on community education through seminars and classes, as well as innovative electronic risk assessments SpineAware and JointAware.General Surgery - Mary Immaculate has a special focus on bariatric surgery, including a comprehensive program, expert physicians, and a commitment to patient support for the duration of their weight loss journey. Bon Secours is part of the only weight loss surgery program that does not charge a fee to participants in the region. Bon Secours also offers a medically-managed weight loss program as part of its Weight Loss Institute and an exercise-nutrition program for those who may choose this more traditional approach. Mary Immaculate surgeons perform bariatric surgery using a variety of techniques, including the traditional roux-en-y approach, the gastric sleeve, and also the lap band. As a result, Mary Immaculate is now the market leader in bariatric surgery, with more than a quarter of all bariatric inpatient surgeries in Hampton Roads now performed at the hospital. Since 2013, Mary Immaculate added gynecological oncologists on its staff, and this surgical expertise has helped grow the hospital's market share in the service, especially from Peninsula residents. Women's Services - Mary Immaculate's Women's and Children's services provided added capacity and resources so that the needs of the community for obstetrical care would continue to be met after another facility closed its doors recently. Mary Immaculate's strong service legacy and its comprehensive service has led it to have higher birth rate amongst the Bon Secours hospitals in Hampton Roads. Bon Secours also offers the largest curriculum of family and parenting classes through its Love & Learn program. Mary Immaculate renovated its nursery to better meet the needs of babies and moms. In addition, Mary Immaculate also expanded its gynecology offering by introducing gynecological oncology services (board certified and fellowship trained surgeons) and an infusion center for women suffering from such cancers. Finally, as with other services and part of our mission, a strong focus exists on community education through seminars, classes, support groups, and innovative electronic risk assessment tools for various female cancers (BreastAware, LungAware, and ColonAware).Please see Schedule H for additional information regarding programs, community benefit programs and Charity Care. 159328713 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 1 0 0 0 0 1 1 0 0 0 1 80 0 1 1080 1 1 1 0 0 0 0 1 1 0 0 0 0 X 16 13 0 0 0 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 (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Archuleta Board Member (Sep) 2.00 0.00 X 0 0 0 Brother Arthur Caliman Board Member 2.00 48.00 X 0 0 0 Sister Elaine Davia Board Member 2.00 48.00 X 0 400 0 Timothy Davis Board Member 2.00 48.00 X 0 1652431 96308 Debra Deihl Board Member 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 2.00 0.00 X 0 0 0 Dr Vincent Joseph Board Member 2.00 0.00 X 0 0 0 Deborah Jones Board Member 2.00 0.00 X 0 0 0 Michael Kerner CEO - BSHR 14.00 36.00 X X 0 1121910 124973 Sister Sandra Lyons Board Member 2.00 0.00 X 0 0 0 Sister Shaun Malone Board Member 2.00 0.00 X 0 0 0 Helena Mock Secretary 2.00 0.00 X X 0 0 0 Jeffrey Morrison DO Board Member 2.00 0.00 X 23000 0 0 Sister David Niski President 3.00 0.00 X X 0 0 0 William Pile Chairman 3.00 0.00 X X 0 0 0 Joseph Ritchie Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Caroline Sorokos Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Charmaine Rochester PhD Treasurer/VP Finance 15.00 35.00 X 0 277873 16234 Darlene Stephenson CEO - MIH 47.50 2.50 X 0 326350 33466 Herbert Cummings COO - BSMG 25.00 25.00 X 0 302100 38105 Jeffrey Doucette VP Patient Care Services 50.00 0.00 X 244849 0 43781 Vickie Humphries VP of Human Resources 25.00 25.00 X 0 228417 12312 James McNamara VP of Ortho 25.00 25.00 X 0 275726 22121 Terri Spence VP & Regional CIO 25.00 25.00 X 0 269054 14451 Anthony Terracina MD General Surgeon 50.00 0.00 X 1063431 0 45605 Edward Pak Internist 50.00 0.00 X 372318 0 10600 Thomas Hoffmier MD Cardiologist 50.00 0.00 X 370440 0 33433 Nathanael Tilghman Preventative Medicine 50.00 0.00 X 224421 0 17745 John Austin Pharmacist 50.00 0.00 X 383258 0 41148 Patricia Robertson Former Officer 0.00 50.00 X 0 533486 28189 2681717 4987747 578471 48 1 1 0 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction 3739885 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 303682289 Dietary Services 2674777 Tidewater Physicians Multispecialty Grou 860 Omni Blvd Suite 401 Newport News VA 23606 Physician Services 2394014 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 2281885 Anesthesia Assoc of Hampton 110 Three Point Ct Yorktown VA 23692 Physician Services 1314375 33 11750 177441 37168 609478 25600 835837 Patient Service Rev. 622110 181714333 181629417 84916 181714333 719164 719164 40123 2635 8541 1880 31582 755 32337 32337 170440 3296 0 0 170440 3296 173736 173736 20415 11750 20730 -315 -315 Joint Venture Income 900099 1263957 1263957 Outpatient Pharmacy 446110 564978 564978 Physical Therapy Svcs 900099 275774 275774 306302 306302 2411011 185886103 181629417 84916 3335933 74710 74710 291247 262122 29125 43977504 39579754 4397750 1523749 1371374 152375 5222336 4700102 522234 3950697 3555627 395070 286539 257885 28654 28550 25695 2855 9287425 9287425 10749 9674 1075 2418675 2176809 241866 187119 168407 18712 3304123 2973711 330412 157464 141718 15746 6342 5708 634 1782096 1782096 6593028 5933725 659303 609308 548377 60931 Medical Supplies 44540957 44540957 Purchased Services 31113979 28002581 3111398 Bad Debt Expense 10302991 10302991 BSHSI Allocation 3197887 2878098 319789 832408 749167 83241 169699883 159328713 10371170 0 3205 3205 125894712 138467253 95689 119067 19591336 18774088 4111482 3784652 462509 855946 101661682 66582819 34257177 35078863 32738938 33757493 77030 77030 11200451 11232684 228432529 242150281 11811861 10585815 1153800 1122358 9430917 8911820 22396578 20619993 X 205069587 220408597 910007 1062772 56357 58919 206035951 221530288 228432529 242150281 X 16186220 559856 -1251739 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 17071 0 1 11479 28550 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. 56357 451 2111 58919 59700 -3024 -318 -1 56357 56878 4213 -1391 59700 44871 521 11749 -263 56878 48147 384 0 -3660 44871 0.00000 1.00000 0.00000 0 0 3352921 3352921 40777413 20998334 19779079 390703 345837 44866 55902833 44285672 11617161 1237812 952976 284836 35078863 HPL/GL Liability 4940256 Fin 47 LT Asbestos Liab 1752540 Patient Credit Balances 934556 Medicare/Medicaid Liabilities 396533 Due to Affiliates 363047 Due to BSHSI 362555 Deferred Rent 138397 Other Misc Liabilities 23936 8911820 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. The System's taxable subsidiaries had approximately $89,895 and $84,748 of net operating loss carryforwards as of August 31, 2016 and 2015, respectively, which expire in varying periods through 2036 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. Income tax liabilities are recorded for the impact of positions taken on income tax returns, which management believes are not more likely than not to be sustained on tax audit. 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, 2016 and 2015 as the System considers it more likely than not that these amounts will not be recognized. Golf 25195 11750 13445 17834 Holiday Brunch 6970 6970 2896 32165 11750 20415 17834 2896 20730 -315 1 1 X 1 X 0 1 1 0 1 1 1664157 137960 1526197 0.00960 14959213 10936579 4022634 0.02520 0 0 16623370 11074539 5548831 0.03480 18 16305 1216015 2695 1213320 0.00760 2 519 336554 0 336554 0.00210 1 1988 42325 510 41815 0.00030 0 0 0 0 7 8595 318172 0 318172 0.00200 28 27407 1913066 3205 1909861 0.01200 28 27407 18536436 11077744 7458692 0.04680 0 0 0 0 1 25 220 0 220 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 2 816 15414 0 15414 0.00010 0 0 0 0 0 0 0 0 0 0 0 0 3 841 15634 15634 0.00010 1 10302991 0 42841820 49289606 -6447786 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 1 15 0 1 0 1 X 200.000000000000 0.000000000000 X 1 1 X X X 1 X www.fa.bonsecours.com X X X X X 1 X 1 X 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 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 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, and opportunity to enroll eligible children in children's health insurance. The Care-A-Van also offers sports physicals and health education services. 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 $9,000 in lab services were provided at no cost to the patient. The CAV has a staff of 11 FTEs and annual expenses of approximately $385,934.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 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. If any patient meets the criteria for life coach services - low-income, lack of insurance and no regular source of primary care - life coaches call that person to provide information and offer assistance. They also help set up ongoing care with primary care physicians and the Care-A-Van, a mobile clinic operated by BSHR for the Norfolk area. MIH Life Coaches had 571 patient contacts, scheduled 246 appointments with primary care physicians, connected 136 patients with the Care-A-Van, assisted 46 patients with medication needs, and connected 280 patients with other community resources.Building healthier communities requires a systemic, ecological, multi-sector approach that acknowledges all of the social determinants of health such as housing, education, employment, public safety and social justice. MIH developed a partnership with Jim's Local Market, a restaurant in a Newport News/Hampton food desert, to provide nutritional education to residents. MIH offers the Bon Secours SeniorHealth Program which provides a free membership program to over 40,000 individuals 55 years and older. Lunch & Learn educational programs bring professionals from healthcare, the government, and the private sector in front of members for presentations and question/answer sessions six times a year. The annual Successful Aging Forum brings national speakers to discuss the latest health and wellness topics for senior citizens (over 500 people attended the event). A quarterly publication, Good Health, provides information to members in the Hampton Roads area. Seniors also play a vital role in BSHR's advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP) through the Bon Secours Advocates program. BSHR partnered with "As You Wish" Advanced Care Planning" to provide programming to seniors. MIH offers Home Health and Hospice Care. One-on-one care through the H2H (Hospital-to-Home) is provided to help patients recover from an illness or injury or to assist with daily living activities and pain management. Services include care coordination, physical therapies, diet education, intravenous therapy, medical/surgical care, nursing instruction, skilled clinical evaluation, and wound care. MIH is dedicated to promoting the health and the quality of life for the women of Hampton Roads through the women health service lines. MIH provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.MIH also 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. Several seminars on clinical ethics were also offered to professionals in the area. MIH staff are dedicated to promoting the health and welfare of community through a variety of avenues including the United Way campaign. Bon Secours InMotion provided health screenings and presentations to approximately 1,700 people. Bon Secours Hampton Roads also partners with Virginia Supportive Housing to address the needs of the homeless. Within the community, there are other providers and organizations addressing mental health, employment, crime, transportation, community violence, education, dental health, alcohol/drugs, and access to social services with specialized programs and services and it would result in duplication of services if MIH were to address the need. Mary Immaculate Hospital Part V, Section B, Line 13h: The facility approved free care for patients at or below 200% of the FPL. For patients above 200% of the FPL we utilize a sliding scale with no cap. Mary Immaculate Hospital Part V, Section B, Line 16i: Information regarding the FAP is available on our websites, brochures are available at the time of registration. We have on site Counselors who can assist the patients. We have eligibility vendors who work with the patients and our statements indicate we have an FAP. Mary Immaculate Hospital Part V, Section B, Line 22d: Bon Secours offers 75% discounts to all self-pay patients in the following markets: Virginia, South Carolina and Kentucky. We also offer an 80% discount to our patients in out New York Market. Form 990, Schedule H, Part V, Section B, Line 14: The Community Service Adjustment was based on the average amounts paid by our insurance companies. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/hampton-roads/community-commitment/community-health-needs-assessment 6 1 - In-Motion Boo Williams Sportsplex 5 Armistead Pointe Parkway Hampton VA 23666 Physical Therapy 2 - Mary Immaculate Phys Therapy Victory 101-A Long Green Blvd Yorktown VA 23693 Physical Therapy 3 - Mary Immaculate Phys Therapy Denbigh 14703 Warwick Blvd Suite B Newport News VA 23608 Physical Therapy 4 - Bon Secours Surgical Specialists 12720 McManus Blvd Ste 311 Newport News VA 23602 Physician Practice 5 - Bon Secours Occumed 14703 Warwick Blvd Suite A Newport News VA 23608 Occupational Medicine 6 - Bon Secours Pulmonary Specialists 12720 McManus Blvd Ste 303 Newport News VA 23602 Physician Practice Part I, Line 3c: For patients with income above 200% of the FPG, the organization utilizes a sliding scale with no cap. 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 non-patient 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: $10,302,991. 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. Bon Secours Hampton Roads has partnered with the Peninsula Health Department and the Peninsula Health Collaborative to address issues affecting the health of the community. Bon Secours Hampton Roads also partnered with the Greater Hampton Roads Coalition to develop a community dashboard that aggregates data for use in the CHNA and CHA processes. 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 pages 12-13 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 42-43 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 publically 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: $349,529. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, 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 exist 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 twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve 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 (MIH) 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, Health Group West and Hammes Company for market and geographic data. Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to MIH. National Research Corporation (NRC), Sg2 Analytics, and strategic market intelligence are also utilized. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens 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. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 200% of the Federal Poverty Guidelines ("FPG"), A sliding scale assistance policy is afforded patients that exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self-pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family suffers a catastrophic financial burden to receive necessary health care services. Based on research conducted by the Tax Foundation, a non-partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. In addition, a variety of other potential payment options are available. Bon Secours is 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 process. Part VI, Line 4: 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 (68.1%), Black or African American (23.3%), and small percentages of other groups. The median income for the MIH service area is $64,900. The City of Newport News has the highest rate of children living in poverty (25.8%) compared to Virginia (15.9%). York County has 7% of children living in poverty. The percentage of children living in single parent households (40.3%) is higher compared to Virginia (30%) and 35.8% 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 (7.9%), diabetes (8.3%), and smoking (20.5%). The leading causes of mortality in the MIH service area per 100,000 are heart disease (155), cerebrovascular disease (37.5), cancer (185.5), chronic lower respiratory diseases (65), diabetes (27.5), kidney disease (19) and septicemia (24.3). The infant mortality rate (per 1,000 live births) in the DMC service area is 10.8% compared to 6.4% in Virginia. Part VI, Line 5: Mary Immaculate Hospital has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/day, 7 days/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, non-stock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, non-stock 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 the 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. Part VI, Line 7, Reports Filed With States VA 1 Literacy For Life PO Box 8795 Williamsburg VA 23185 541085026 501(C)(3) 74430 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 658643 0 496834 0 496954 0 75673 0 20635 0 1748739 0 329759 Michael Kerner CEO - BSHR 0 559739 0 403723 0 158448 0 93156 0 31817 0 1246883 0 91467 Charmaine Rochester PhD Treasurer/VP Finance 0 207596 0 41583 0 28694 0 12118 0 4116 0 294107 0 0 Darlene Stephenson CEO - MIH 0 204970 0 81112 0 40268 0 13268 0 20198 0 359816 0 0 Herbert Cummings COO - BSMG 0 237395 0 64499 0 206 0 10600 0 27505 0 340205 0 0 Jeffrey Doucette VP Patient Care Services 190869 0 53799 0 181 0 12578 0 31203 0 288630 0 0 0 Vickie Humphries VP of Human Resources 0 165089 0 35245 0 28083 0 3054 0 9258 0 240729 0 0 James McNamara VP of Ortho 0 230605 0 44615 0 506 0 12247 0 9874 0 297847 0 0 Terri Spence VP & Regional CIO 0 225003 0 43560 0 491 0 3975 0 10476 0 283505 0 0 Anthony Terracina MD General Surgeon 498974 0 563236 0 1221 0 13250 0 32355 0 1109036 0 0 0 Edward Pak Internist 327696 0 44213 0 409 0 10600 0 0 0 382918 0 0 0 Thomas Hoffmier MD Cardiologist 275388 0 91491 0 3561 0 10600 0 22833 0 403873 0 0 0 Nathanael Tilghman Preventative Medicine 224274 0 0 0 147 0 0 0 17745 0 242166 0 0 0 John Austin Pharmacist 320659 0 62105 0 494 0 13250 0 27898 0 424406 0 0 0 Patricia Robertson Former Officer 0 309884 0 172647 0 50955 0 15900 0 12289 0 561675 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: Timothy Davis, $406,381; Michael Kerner, $112,117. X 8 25600 Cost or selling price 0 0 1 0 Part I, Column (b): The amount reported in Column (b) refers to the number of contributions. 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 11 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 Mary Immaculate Hospital and Mary Immaculate Nursing Care Center are comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer). These governing bodies are referred to as the Mary Immaculate Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for both entities. Br. Art Caliman does not receive payroll distributions as he has taken a vow of poverty. Form 990, Part XI, line 9: BSHSI Principal Debt & Swaps -1,206,089. Accrual Write-off -45,650. Mary Immaculate Hospital Auxiliary 7007 Harbourview Blvd Suffolk VA 23435 546040266 Auxiliary VA 501(c)(3) Line 9 N/A 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 11c, 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 9 Mary Immaculate Hospital 1 Bon Secours Hampton Roads Health System Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) Line 9 Bon Secours Hampton Roads Health System 0 Bayley Properties 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 0 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 540506463 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Living 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 OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA Mary Immaculate Hospital Inc C 818343 1076390 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0