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 540506463 Maryview Hospital MARY 7573982200 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner CEO - BSHRHS 7576735920 2017-07-10 1 John W Sadoff Jr P00540589 4042201500 2015 2021-01-29 14:40:06Z Bon Secours Maryview Medical Center with Delta Oncology Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 418481200 0 0928 X bonsecours.com X 1944 VA Acute Care Hospital 17 15 3167 126 277585 0 2321000 1083908 394391798 406629857 2464718 1404704 3778344 8833351 402955860 417951820 175678 865847 0 0 182136062 186454534 0 0 0 217973290 231797360 400285030 419117741 2670830 -1165921 276976822 277516917 120377204 127151515 156599618 150365402 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 337757454 865847 356414176 Maryview 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, cardiology and general surgery.Orthopedics- Maryview continues a strong focus on orthopaedic care for residents of Western Hampton Roads. Maryview was recognized as a Blue Distinction Center of Excellence to attest to the excellence of care. Bon Secours responds to the needs of all orthopaedic patients - from the young athlete to the adult sports medicine patient (weekend warrior or sports enthusiast) to the patient needing significant repair and possibly replacement of joints. Bon Secours skilled surgeons perform minimally invasive and traditional orthopaedic and spine procedures, and are complemented by a strong psychiatry 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 and expert physicians, as well as a comprehensive inpatient and outpatient rehabilitation network. Community education is available through seminars and classes, as well as innovative electronic risk assessments SpineAware and JointAware.Cardiology -Maryview commits significant resources to the care of cardiac patients. In fact, the Bon Secours Heart & Vascular Institute has a special focus on prevention and early detection. The outreach has been expanded to area businesses and community churches as well. In addition, the introduction of the One-Call Transfer center and relationships with transport services make it easier to operate Maryview as a regional referral center for advanced cardiac services. Maryview offers the broadest continuum of cardiac services. Maryview continues strong relationships with other Bon Secours hospitals and serves as a regional referral center for the delivery of advanced cardiac interventions, such as cardiac surgery and electrophysiology. This was recently enhanced with the addition of two robotic systems deployed at other facilities, which facilitate communications between Maryview cardiac specialists and referring physicians and their patients at other Bon Secours facilities. 64-slice CT scanners located both at Maryview and its Harbour View ambulatory campus are used to perform calcium scoring heart studies, service Bon Secours re-initiated in late 2013. Community education is available through seminars, classes, screenings, special events and a brand new community outreach program aimed at middle school students called The Heart Health Academy at Bon Secours. Bon Secours Maryview Medical Center has been recognized as UnitedHealth Premium cardiac specialty center for Interventional Cardiac Care. Maryview is certified as a Primary Stroke Center and is accredited as a Chest Pain Center with PCI. Maryview's ambulatory campus - Harbour View - received Chest Pain Center accreditation.General Surgery - Maryview continues to be a top hospital for bariatric surgery in Virginia by Healthgrades, and among the top 5% in the nation. Bon Secours is the only weight loss surgery program that does not charge a fee to participants in this 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. Maryview also operates a Center of Excellence for colorectal surgery as a result of significant physician and staff expertise with colon & rectal diseases. In 2013, Maryview renovated its surgical suite, renovating some rooms with state-of-the-art technology, including a daVinci surgical robotic system. In 2014, Maryview and three of its GYN surgeons earned COEMIG designation (Center of Excellence in Minimally Invasive Gynecology). Community education is available through seminars, classes, support groups, and innovative electronic risk assessment tools for breast and colorectal cancers (BreastAware and ColonAware).Please see Schedule H for additional information regarding programs, community benefit programs and Charity Care. 50189598 50189598 Maryview Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 387947052 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 193 0 1 3167 1 1 1 0 0 0 0 0 0 0 0 0 X 17 15 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 James Bento Board Member 2.00 0.00 X 0 0 0 Michael Blount Board Member 2.00 0.00 X 0 0 0 J Robert Bray Board Member 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member 2.00 0.00 X 0 0 0 Brother Arthur Caliman CFX President 3.00 47.00 X X 0 0 0 Arthur Collins Chairman 3.00 0.00 X X 0 0 0 Sister Elaine Davia CBS Board Member 2.00 48.00 X 0 400 0 Timothy Davis Board Member 2.00 48.00 X 0 1652431 96308 Charlette Fairchild PhD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 14.00 36.00 X X 0 1121910 124973 Michael LaRock Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member 2.00 0.00 X 0 0 0 Carol Ormond Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 P Ward Robinett Jr Board Member 2.00 0.00 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 2.00 0.00 X 0 0 0 Robert Sqautrito MD Board Member 2.00 0.00 X 0 0 0 Douglas Ziegenfuss CPA Board Member 2.00 0.00 X 0 0 0 Joseph Oddis CEO - MVH 49.50 0.50 X 0 590317 48165 Charmaine Rochester PhD Treasurer/VP Finance 15.00 35.00 X 277873 0 16234 Herbert Cummings COO - BSMG 25.00 25.00 X 302100 0 38105 Vickie Humphries VP of Human Resources 25.00 25.00 X 228417 0 12312 James McNamara VP of Ortho 25.00 25.00 X 275726 0 22121 Terri Spence VP & Regional CIO 25.00 25.00 X 269054 0 14451 Leana Fox VP - Patient Care Services 50.00 0.00 X 219139 0 9756 Mark Kerner MD Orthopedic Surgeon 49.00 1.00 X 1094233 0 43105 Steven Blasdell MD Orthopedic Surgeon 50.00 0.00 X 993198 0 37326 Aaron Marlow MD Orthopedic Surgeon 50.00 0.00 X 807548 0 23480 Ernesto Luciano-Perez MD Orthopedic Surgeon 50.00 0.00 X 800889 0 42578 Apurva Patel MD Cardiologist 49.50 0.50 X 649334 0 13250 5917511 3365058 542164 214 0 1 0 Aramark CTS Inc 12483 Collections Ctr Chicago IL 60693 Biomedical Engineering 4642575 Free Agents Marketing 4800 Cox Rd Ste 100 Glen Allen VA 23060 Marketing Services 3063882 Morrison Mgt Specialists PO Box 102289 Atlanta GA 303682289 Dietary Services 2801226 AthenaHealth Inc 311 Arsenal Ct Watertown MA 02472 Physician Billing 2414959 Deloitte Consulting LLP 200 Berkeley St Boston MA 02116 Consulting 2347170 68 369150 605482 109276 48000 1083908 Patient Service Rev. 561000 356440259 356414176 26083 Shared Services 561499 50189598 50189598 406629857 831128 831128 623181 741 529380 0 93801 741 94542 76142 18400 572076 1500 0 0 572076 1500 573576 573576 Outpatient Pharmacy 900099 5957079 5957079 Joint Venture Income 900099 1097224 1097224 Employee Assistance Pr 900099 309395 309395 1375111 175360 1199751 8738809 417951820 406603774 277585 9986553 865847 865847 1688876 1519989 168887 152201262 136981136 15220126 4897604 4407844 489760 16312459 14681213 1631246 11354333 10218900 1135433 1436219 1292597 143622 68396 61556 6840 51239 46115 5124 13294887 13294887 2952050 2656845 295205 4779837 4301852 477985 20225912 18203321 2022591 16769979 15092981 1676998 1502029 1351826 150203 56049 50444 5605 3078255 3078255 15511864 13960678 1551186 1926580 1733922 192658 Medical Supplies 63905025 63905025 Purchased Services 34783147 31304832 3478315 Bad Debt 26266837 26266837 BSHSI Corporate Dues 21403451 19263106 2140345 3785604 3407044 378560 419117741 387947052 31170689 0 5961 12035 10093053 331801 21758 21758 39434554 34765550 463333 0 6330801 7574927 2693734 4590261 255492813 191327146 53265408 64165667 105851499 108857388 1406631 1207377 2568513 2568513 54841577 53421640 276976822 277516917 34570016 37111761 3276682 2735452 21345548 20345549 61184958 66958753 120377204 127151515 X 156456151 150221835 143467 143567 156599618 150365402 276976822 277516917 X -1165921 1693998 -6762293 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 29487 0 1 21752 51239 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. 4636569 4636569 86594920 60991541 25603379 15552658 10678581 4874077 130793465 115618251 15175214 17915201 4038773 13876428 64165667 Due from BSHSI 28284206 LT Non-Cash Inv - HPL/GL 10747113 Due from Affiliates 9316249 Deferred Medicare Rec 2983244 Non-Patient A/R 677515 Other LT Receivables 524179 Other Accrued Revenue 319695 Medicare Settlement Rec 319439 Other Misc Assets 250000 53421640 Pension Liability 18598535 Due to BSHSI 17987747 Due to Affiliates 12057323 HPL/GL Liab 10747113 FIN 47 Liab 3668138 Deferred Rent 2400000 Medicare Settlement/Resrvs 1167088 Other Misc. Liabilities 332809 66958753 X 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. 1 1 X 1 X 0 1 1 1 0 1 1 0 0 10419008 907697 9511311 0.02420 0 0 33717614 24093157 9624457 0.02450 0 0 0 0 44136622 25000854 19135768 0.04870 19 9283 1088220 2590 1085630 0.00280 3 897 2673800 1124929 1548871 0.00390 4 18167 1644974 210 1644764 0.00420 0 0 0 0 7 9988 768610 0 768610 0.00200 33 38335 6175604 1127729 5047875 0.01290 33 38335 50312226 26128583 24183643 0.06160 0 0 0 0 1 0 1213 0 1213 0.00000 1 367 20004 0 20004 0.00010 0 0 0 0 0 0 0 0 2 363 15203 0 15203 0.00000 0 0 0 0 1 118 116002 0 116002 0.00030 0 0 0 0 5 848 152422 152422 0.00040 1 26266837 0 90636547 85609837 5026710 X 1 1 1 1 Maryview Hospital 3636 High Street Portsmouth VA 23707 bonsecours.com H1830 X X X X Maryview 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 Maryview Hospital Part V, Section B, Line 5: Maryview Medical Center (MMC) contracted with ToXcel to conduct an electronic survey of key stakeholders to determine the top healthcare needs of the community. MMC 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, MMC surveyed representatives of medically underserved, minority populations, and those with chronic conditions. In addition, MMC conducted community forums to gather additional input from residents. Upon receipt of all information, MMC 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 Portsmouth Health Department to review the list of key needs and gaps identified to prioritize the needs and make recommendations to MMC leadership. Maryview Hospital Part V, Section B, Line 11: Through development of an implementation plan from the CHNA, MMC identified the health priorities in the related service areas. Maryview Medical Center (MMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at MMC and Harbour View provide 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.MMC 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. MMC 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 Portsmouth and Suffolk, as well as Norfolk and Newport News. 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. Community partners include free clinics, local health agencies, CSBs, physicians, and numerous faith-based organizations which collaborate with CAV staff. Medicaid/FAMIS eligibility questionnaires were provided to 684 patients. CAV staff had 1,441 patient contacts in Portsmouth and Suffolk with over $12,231 in lab services provided at no cost to the patient. The CAV has a staff of 11 FTEs and annual expenses of approximately $245,000.MMC 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. In FY16, the Life Coaches began working with inpatient discharge nurses to assist qualified inpatients as part of the discharge process. 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 help set up ongoing care at Maryview Foundation Health Care Center, a free clinic located on the Maryview hospital grounds, or with the Care-A-Van, a mobile clinic operated by BSMMC for the Portsmouth service area. MMC Life Coaches had 1,119 patient contacts, scheduled 931 appointments with primary care physicians, assisted 85 patients with medication needs, and connected 978 patients with other community resources. Oncology nurse navigators guide patients from a cancer diagnosis through treatment and follow-up care. Nurse navigators educate patients on what to expect about treatment and side effects, make calls to insurance companies, schedule and track medical appointments. Nurse navigators at MMC and Harbour View worked with 1,901 patients.MMC currently provides comprehensive diabetes education with weekly education sessions covering understanding diabetes, nutrition, foot care, exercise, and medication. The Maryview Behavioral Medicine Center, located on the MMC campus, provides inpatient and outpatient programs for treatment of substance abuse and psychiatric medicine. The Maryview Behavioral Medicine Center also partners with the Portsmouth judicial system to conduct court sessions for inpatients brought to MMC by the police department. MMC also has a comprehensive community-based program in place to address domestic violence through parenting education programs that offer positive learning opportunities for parents, child development, age-appropriate expectations, and health and safety issues as it relates to children from birth through the teenage years. MMC also partners with Virginia Supportive Housing to address the needs of the homeless.Within the community, there are other providers and organizations addressing employment, education, crime, alcohol/drug abuse, community violence, transportation, child abuse, people with disabilities, and places to play with specialized programs and services and it would result in duplication of services if Maryview Medical Center (MMC) were to address the need. Maryview 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. Maryview 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. Maryview 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 our New York Market. Form 990, Schedule H, Part V, Section B, Line 14: The Community Service Adjustment was based on the average amounts paidby our insurance companies. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/hampton-roads/community-commitment/community-health-needs-assessment 33 1 - In Motion at Harbor View 5838 Harbourview Blvd Suffolk VA 23435 Physical Therapy 2 - In Motion PT Portsmouth Blvd 5553 Portsmouth Blvd Portsmouth VA 23701 Physical Therapy 3 - In Motion PT Suffolk 2012 Meade Parkway Suffolk VA 23434 Physical Therapy 4 - VA Orthopedic & Spine Specialists - Spec 2012 Meade Parkway Suffolk VA 23434 Physician Practice 5 - In Motion at Chesapeake Square 4300 Portsmouth Blvd Suite 200 Chesapeake VA 23321 Physical Therapy 6 - In Motion PT Portsmouth YMCA 4900 High St West Portsmouth VA 23703 Physical Therapy 7 - In Motion PT Chilled Ponds 1416 Stephanie Way Chesapeake VA 23320 Physical Therapy 8 - In Motion PT High Street 3300 High Street Portsmouth VA 23707 Physical Therapy 9 - The Center for Pain Management 3315 High St Portsmouth VA 23707 Physician Practice 10 - Cardiovascular Specialists - Portsmouth 5838 Harbourview Blvd Suite 270 Suffolk VA 23435 Physician Practice 11 - The Spine Center of Hampton Roads Mast One 1040 University Blvd Portsmouth VA 23703 Physician Practice 12 - Bon Secours Surgical Specialist HBV 3640 High Street Suite 2E Portsmouth VA 23707 Physician Practice 13 - Cardiology Associates 301 Goode Way Suite 102 Portsmouth VA 23704 Physician Practice 14 - Bon Secours Pulmonary Specialists 4053 Taylor Rd Suite N Chesapeake VA 23321 Physician Practice 15 - Internists of Churchland 2185 Harbour Townse Parkway Suite 206 Suffolk VA 23435 Physician Practice 16 - Western Branch Family Practice 3253 Taylor Rd Suite 200 Chesapeake VA 23321 Physician Practice 17 - In Motion PT Eagle Harbor 13609 Carrollton Blvd Suite 115 Carrollton VA 23314 Physical Therapy 18 - Nansemond Suffolk Family Practice 2897 Bridge Rd Suffolk VA 23435 Physician Practice 19 - Harbour View Family Practice 5818 Harbourview Blvd Suite B2 Suffolk VA 23435 Physician Practice 20 - Chenault-Ostroff Urology 4037 Taylor Rd Suite A Chesapeake VA 23321 Physician Practice 21 - Western Branch OBGYN 4057 Taylor Rd Suite R Chesapeake VA 23321 Physician Practice 22 - Internists at Western Branch 4020 Raintree Rd Suite B Chesapeake VA 23321 Physician Practice 23 - Bon Secours Neuroscience Center 3640 High St Suite 1A Portsmouth VA 23707 Physician Practice 24 - Cardiovascular & Thoracic Specialists 3636 High Street Portsmouth VA 23737 Physician Practice 25 - Portsmouth Medical Associates 3520 High Street Suite 100 Portsmouth VA 23707 Physician Practice 26 - Eagle Harbor Medical Associates 13609 Carrollton Blvd Suite 11 Carrollton VA 23314 Physician Practice 27 - Delta Oncology Associates - Chesapeake 612 Kingsborough Square Suite 300 Chesapeake VA 23320 Physician Practice 28 - Bon Secours Oncology Specialists 3640 High St Suite 1E Portsmouth VA 23707 Physician Practice 29 - Airline Boulevard Medical Associates 3537 Airline Boulevard Suite 1 Portsmouth VA 23701 Physician Practice 30 - Delta Oncology Associates - Portsmouth 355 Crawford Street Suite 300 Portsmouth VA 23704 Physician Practice 31 - Delta Oncology Associates - Suffolk 104 Palmyra Drive Suffolk VA 23434 Physician Practice 32 - Bon Secours Grassfield Medical Associate 648 Grassfield Parkway Suite 1 Chesapeake VA 23322 Physician Practice 33 - VA Orthopedic & Spine Specialists 3300 High Street Suite 1 Portsmouth VA 23707 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): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $26,266,837. Part II, Community Building Activities: Bon Secours Maryview Medical Center 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 Health System is working to engage and empower the members of the East Ocean View neighborhood to support them in improving their quality of life and holistic health. Maryview Medical Center also reached out to the homeless community with continuing support of Oasis, a shelter for the homeless in the City of Portsmouth. Maryview Medical Center donated staff time and resources in support of these efforts. In addition, Bon Secours Hampton Roads has partnered with Healthy Portsmouth 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. Form 990, Schedule H, Part II, Line 2, Column b: Persons served: 2,170,000 Part III, Line 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on pages 12-13 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on pages 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.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: $613,231. 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, Maryview Medical Center 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 Maryview Medical Center. 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 nonpartisan 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 Maryview, Portsmouth, VA, encompasses Portsmouth, Chesapeake, and Suffolk, and has an anticipated projected growth of 4.4% over the next five years. Currently the largest populations for the Maryview service area are white (49.4%), Black or African American (41.3%), non-white Hispanics (4%), Asian (2%), and small percentages of other groups. The current year median age for this area is 36.6. Seniors currently in Maryview's service area account for 18.2% of the population, which is anticipated to increase to 19.7% within the next five years. The median income for the Maryview service area is $56,767. The City of Portsmouth has the highest rate of children living in poverty (28.5%) compared to Virginia (14.6%). Suffolk follows with 17.2% and Chesapeake with 13.5% children living in poverty. The percentage of children living in single parent households (41.6%) is higher compared to Virginia (30%) and 38.7% of students are eligible for free lunch.The most prevalent chronic conditions among adults in the Maryview service area include smoking (18.3%), depression/anxiety disorder (14.6%), sexually transmitted infections (747.7 cases of newly diagnosed clamydia cases per 100,000), and obesity/weight problems (32.3%). The leading causes of mortality in the Maryview service area per 100,000 are heart disease (253), cerebrovascular disease (47.3), cancer (263.3), chronic lower respiratory diseases (52.3), diabetes (39), and septicemia (29.7). Mortality rates (age-adjusted per 100,000) for the state of Virginia are cancer (195.4), ischemic heart disease (190.7), cerebrovascular disease (41.4) and chronic obstructive pulmonary disease (38.7). The infant mortality rate (per 1,000 live births) in the Maryview service area is 20.9% compared to 14.4% in Virginia. Part VI, Line 5: Maryview Medical Center (MMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at MMC and Harbour View provide 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. 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 (Strategic Quality Plan). Part VI, Line 7, Reports Filed With States VA 1 Old Dominion Universty Educational Foundation 4417 Monarch Way 4th Floor Norfolk VA 23529 546052014 501(C)(3) 30000 Endowed Scholarship Bon Secours Maryview Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 521694731 501(C)(3) 22114 Friends Of Maryview Fund Bon Secours Maryview Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 521694731 501(C)(3) 350689 Foundation Admin Expenses Mary Immaculate Hospital 100 Kingsley Lane Suite 204 Norfolk VA 23505 540548200 501(C)(3) 81861 Foundation Admin Expenses Bon Secours DePaul Health Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 541843876 501(C)(3) 381183 Foundation Admin Expenses 5 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 Secretary/CEO-BSHR 0 559739 0 403723 0 158448 0 93156 0 31817 0 1246883 0 91467 Joseph Oddis CEO - MVH 0 349828 0 195518 0 44971 0 17512 0 30653 0 638482 0 1475 Charmaine Rochester PhD Treasurer/VP Finance 207596 0 41583 0 28694 0 12118 0 4116 0 294107 0 0 0 Herbert Cummings COO - BSMG 237395 0 64499 0 206 0 10600 0 27505 0 340205 0 0 0 Vickie Humphries VP of Human Resources 165089 0 35245 0 28083 0 3054 0 9258 0 240729 0 0 0 James McNamara VP of Ortho 230605 0 44615 0 506 0 12247 0 9874 0 297847 0 0 0 Terri Spence VP & Regional CIO 225003 0 43560 0 491 0 3975 0 10476 0 283505 0 0 0 Leana Fox VP - Patient Care Services 183529 0 34928 0 682 0 9756 0 0 0 228895 0 0 0 Mark Kerner MD Orthopedic Surgeon 509146 0 583797 0 1290 0 13250 0 29855 0 1137338 0 0 0 Steven Blasdell MD Orthopedic Surgeon 486462 0 503481 0 3255 0 13784 0 23542 0 1030524 0 0 0 Aaron Marlow MD Orthopedic Surgeon 307114 0 499967 0 467 0 13066 0 10414 0 831028 0 0 0 Ernesto Luciano-Perez MD Orthopedic Surgeon 300662 0 498910 0 1317 0 13728 0 28850 0 843467 0 0 0 Apurva Patel MD Cardiologist 536047 0 111997 0 1290 0 13250 0 0 0 662584 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: Timothy Davis, $406,381; Michael Kerner, $112,117; Joseph Oddis, $1,820. X 15 48000 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 I, Item C DBA: Bon Secours Maryview Medical Center in Affiliation with Delta Oncology. DBA: Bon Secours Home Oxygen Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Hampton Roads Health System, Inc. which in turn is the sole member of Maryview Hospital. Form 990, Part VI, Section A, line 7a The governing body of Maryview Hospital is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to the approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Maryview Hospital are reserved to its member or to Bon Secours Health System, Inc. 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: Avg hours devoted to related org(s) when related comp is reported: 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, and Bon Secours Maryview 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 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 does not receive payroll distributions as he has taken a vow of poverty. Form 990, Part XI, line 9: Minimum Pension Plan Liability -4,436,194. BSHSI Principal & Swap Payments -2,326,099. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. - Mgmt. Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 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 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 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 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 0 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 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 Bon Secours DePaul Medical Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 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 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 N/A C 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0