2016-07-12T13:24:51-05:00 2015-08-31 861065772 Deloitte Tax LLP Deloitte Tax LLP 191 Peachtree St Atlanta GA 303031749 990 2014-09-01 540506463 Maryview Hospital MARY 7573982200 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner CEO - BSHRHS 7576735920 2016-07-12 1 John W Sadoff Jr P00540589 4042201500 2014 2016-09-27 15:27:22Z Bon Secours Maryview Medical Center with Delta Oncology Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 404159401 0 0928 X http://bshr.com/ X 1944 VA Acute Care Hospital 16 14 3039 160 220944 0 2295437 2321000 382955554 394391798 3856874 2464718 4262503 3778344 393370368 402955860 73606 175678 0 0 178211227 182136062 0 0 0 205571162 217973290 383855995 400285030 9514373 2670830 275550114 276976822 111658035 120377204 163892079 156599618 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 326268830 175678 350380183 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 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 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. 43980126 0 43980126 Maryview Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 370248956 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 0 0 0 0 0 1 0 0 0 1 188 0 1 3039 1 1 1 0 0 0 0 0 0 0 0 0 X 16 14 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 0.50 X 0 0 0 Michael Blount Board Member 2.00 0.00 X 0 0 0 Robert Bray Board Member 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member 2.00 0.00 X 0 0 0 Brother Arthur Caliman CFX President 3.00 47.00 X X 0 0 0 Arthur Collins Board Chair 3.00 0.00 X X 0 0 0 Sister Elaine Davia CBS Board Member 2.00 5.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 1019679 151683 Barbara Hamm Lee Board Member (Sep-May) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 15.00 35.00 X X 0 958311 131925 Michael LaRock Board Member 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member 2.00 0.00 X 0 0 0 Carol Ormond Board Member 2.00 0.00 X 0 0 0 Ward Robinett Jr Board Member 2.00 0.00 X 0 0 0 Stephanie Short Board Member 2.00 0.00 X 0 0 0 Robert Sqautrito MD Board Member 2.00 0.00 X 0 0 0 Sister Rita Thomas Board Member (Sep-Dec) 2.00 1.00 X 0 0 0 Douglas Ziegenfuss Board Member 2.00 0.00 X 0 0 0 Joseph Oddis CEO - MVH 49.50 0.50 X 0 483553 40433 Charmaine Rochester Treasurer/VP Finance 15.00 35.00 X 243142 0 16388 Herbert Cummings COO - BSMG 30.00 20.00 X 0 213251 35277 Barbara Lynch VP - Ambulatory Services (Sep-Dec) 50.00 0.00 X 183949 0 1731 Leana Fox VP - Patient Care Services 50.00 0.00 X 216820 0 10181 Mark Kerner MD Orthopedic Surgeon 49.00 1.00 X 1008510 0 40846 Steven Blasdell MD Orthopedic Surgeon 50.00 0.00 X 826295 0 38185 Ernesto Luciano-Perez MD Orthopedic Surgeon 50.00 0.00 X 763731 0 39670 Aaron Marlow MD Orthopedic Surgeon 50.00 0.00 X 759096 0 22616 Apurva Patel MD Cardiologist 50.00 0.00 X 739234 0 13000 James Sherwood Former Key Employee 0.00 0.00 X 102699 0 11743 4843476 2674794 553678 181 1 1 0 Aramark CTS Inc 12483 Collections Ctr Chicago IL 60693 Biomedical Engineering 5620219 Free Agents Marketing 4800 Cox Rd Ste 100 Glen Allen VA 23060 Marketing Services 3647137 AthenaHealth Inc 311 Arsenal Ct Watertown MA 02472 Physician Billing 3050428 Morrison Mgt Specialists PO Box 102289 Atlanta GA 303682289 Dietary Services 2946902 Eastern VA Med School PO Box 1980 Norfolk VA 235011980 Residency Fees 2039062 72 1103161 1160109 57730 2321000 Patient Service Rev. 561000 350411672 350380183 31489 Shared Services 561499 43980126 43980126 394391798 887088 887088 1270029 3963 1203541 0 66488 3963 70451 51302 19149 1577630 0 1577630 1577630 1577630 Outpatient Pharmacy 900099 1166647 1166647 Joint Venture Income 900099 637027 637027 Employee Assis. Prog. 900099 428344 428344 1475875 138153 1337722 3707893 402955860 394360309 220944 6053607 175678 175678 697978 628180 69798 146843274 132158947 14684327 6419934 5777941 641993 17157558 15441802 1715756 11017318 9915586 1101732 1254418 1128976 125442 64758 58282 6476 54632 49169 5463 13927684 13927684 3788590 3409731 378859 7371299 6634169 737130 19503423 17553081 1950342 16849106 15164195 1684911 1576669 1419002 157667 161839 145655 16184 2641530 2641530 15584496 14026046 1558450 2850374 2565337 285037 Medical Supplies 58726665 58726665 Purchased Services 35322214 31789993 3532221 Bad Debt 24452732 24452732 BSHSI Allocation 10703329 9632996 1070333 3139532 2825579 313953 400285030 370248956 30036074 0 5960 5961 5712470 10093053 21758 21758 40598059 39434554 33333 463333 6424381 6330801 2844853 2693734 235262399 181996991 57698229 53265408 105890480 105851499 1110457 1406631 2703179 2568513 52506955 54841577 275550114 276976822 33621834 34570016 3535702 3276682 23045548 21345548 51454951 61184958 111658035 120377204 X 163748612 156456151 143467 143467 163892079 156599618 275550114 276976822 X 2670830 -1829589 -8133702 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 31272 0 1 23361 54633 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 84428054 59172032 25256022 14121504 9330913 4790591 126965680 109521076 17444604 5110592 3972970 1137622 53265408 Due from BSHSI 25365385 LT Non-Cash Inv - HPL/GL 14024676 Due from Affiliates 9133619 Deferred Medicare Rec 3979713 Other Accrued Rec 979533 Other LT Receivables 554719 Medicare Settlement Rec 520395 Non-Patient A/R 142882 Other Misc. Assets 140655 54841577 HPL/GL Liab 14024676 Due to BSHSI 13424552 Pension Liability 13382238 Due to Affiliates 12630740 FIN 47 Liab 3575622 Deferred Rent 3114707 Deposits 400031 Other LT Liab 282320 Other Misc. Liabilities 350072 61184958 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. The System's taxable subsidiaries have approximately $84,748 and $61,513 of net operating loss carryforwards as of August 31, 2015 and 2014, respectively, which expire in varying periods through 2035 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2015 and 2014 as the System considers it more likely than not that these amounts will not be recognized. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 X 1 X 0 1 1 0 1 1 0 0 9801694 992528 8809166 0.02340 0 0 34112647 26280250 7832397 0.02080 0 0 0 0 43914341 27272778 16641563 0.04420 18 10412 1088142 2742 1085400 0.00290 3 871 2851417 1124158 1727259 0.00460 4 13473 1959572 0 1959572 0.00520 0 0 0 0 9 11606 606130 0 606130 0.00160 34 36362 6505261 1126900 5378361 0.01430 34 36362 50419602 28399678 22019924 0.05850 0 0 0 0 1 700 2551 0 2551 0.00000 1 100 156 0 156 0.00000 0 0 0 0 0 0 0 0 1 214 9132 0 9132 0.00000 0 0 0 0 1 139 89936 0 89936 0.00020 0 0 0 0 4 1153 101775 101775 0.00020 1 24452732 0 96562951 167484732 -70921781 X 1 1 1 1 Maryview Hospital 3636 High Street Portsmouth VA 23707 http://bshr.com H1830 X X X X Maryview Hospital 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X http://bshr.com X 1 12 0 1 0 1 X 200.000000000000 1 1 X X X 1 X http://bshr.com X http://bshr.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 Community Health Solutions (CHS) to conduct an electronic survey of key stakeholder 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. MMC also met with representatives from the Portsmouth Health Department to review the key findings from the survey and seek additional input. Upon receipt of all information, MMC convened a small group to review the list of key needs and gaps identified to prioritize the needs using criteria developed against which to evaluate each need. 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 childrens' 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. 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. 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 BSHRHS for the Portsmouth area. MMC Life Coaches had 1,672 patient contacts, scheduled 1,372 appointments with primary care physicians, assisted 74 patients with medication needs, and connected 223 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 1,845 patients.Within the community, there are other providers and organizations addressing dental care/oral health and tobacco use with specialized programs and services and it would result in duplication of services if Maryview Medical Center (MMC) were to address the need. 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. 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. Maryview Hospital Part V, Section B, Line 13b: 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 and 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 out 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Maryview Hospital Part V, Section B, line 16a website: http://bshr.com Maryview Hospital Part V, Section B, line 16b website: http://bshr.com 40 Bon Secours Health Ctr at Harbourview 5818D Harbourview Blvd Suffolk VA 23435 Imaging, ER, Physical Therapy & Other OP Services BS Health Ctr at Harbourview MAB 5838 Harbourview Blvd Chesapeake VA 23321 OP Cardiology & Physical Therapy Services VA Orthopedic & Spine Specialists 5838 Harbourview Blvd Suite 100 Portsmouth VA 23707 Physician Practice Cardiovascular Specialists 5838 Harbourview Blvd Suite 270 Suffolk VA 23435 Physician Practice Bon Secours Surgical Specialists 5838 Harbourview Blvd Suite 240 Suffolk VA 23435 Physician Practice In Motion at Chesapeake Square 4300 Portsmouth Blvd Suite 200 Chesapeake VA 23321 Physical Therapy The Center for Pain Management 3315 High St Portsmouth VA 23707 Physician Practice Chenault-Ostroff Urology 4037 Taylor Rd Suite A Chesapeake VA 23321 Physician Practice In Motion PT Suffolk 2012 Meade Parkway Suffolk VA 23434 Physical Therapy Western Branch OBGYN 4057 Taylor Rd Suite R Chesapeake VA 23321 Physician Practice In Motion PT High Street 3300 High Street Portsmouth VA 23707 Physical Therapy In Motion PT Portsmouth Blvd 5553 Portsmouth Blvd Portsmouth VA 23701 Physical Therapy Harbour View Family Practice 5818 Harbourview Blvd Suite B2 Suffolk VA 23435 Physician Practice In Motion PT Portsmouth YMCA 4900 High St West Portsmouth VA 23703 Physical Therapy Internists of Churchland 4041 Taylor Rd Suite G Chesapeake VA 23321 Physician Practice Nansemond Suffolk Family Practice 2897 Bridge Rd Suffolk VA 23435 Physician Practice Western Branch Family Practice 3253 Taylor Rd Suite 200 Chesapeake VA 23321 Physician Practice Internists at Western Branch 4020 Raintree Rd Suite B Chesapeake VA 23321 Physician Practice Bon Secours Pulmonary Specialists 4053 Taylor Rd Suite N Chesapeake VA 23321 Physician Practice Bon Secours Neuroscience Center 3640 High St Suite 1A Portsmouth VA 23707 Physician Practice Eagle Harbor Medical Associates 13609 Carrollton Blvd Suite 11 Carrollton VA 23314 Physician Practice In Motion PT Eagle Harbor 13609 Carrollton Blvd Suite 115 Carrollton VA 23314 Physical Therapy In Motion PT Chilled Ponds 1416 Stephanie Way Chesapeake VA 23320 Physical Therapy Portsmouth Medical Associates 3520 High Street Suite 100 Portsmouth VA 23707 Physician Practice Cardiology Associates 301 Goode Way Suite 102 Portsmouth VA 23704 Physician Practice Cardiology Associates 1030 Hillpoint Blvd N Suffolk VA 23434 Physician Practice VA Orthopedic & Spine Specialists 3300 High Street Suite 1 Portsmouth VA 23707 Physician Practice VA Orthopedic & Spine Specialists 2012 Meade Parkway Suffolk VA 23434 Physician Practice The Spine Center of Hampton Roads Mast One 1040 University Blvd Portsmouth VA 23703 Physician Practice Cardiovascular & Thoracic Specialists 3636 High Street Portsmouth VA 23737 Physician Practice Delta Oncology Associates 104 Palmyra Drive Suffolk VA 23434 Physician Practice Delta Oncology Associates 612 Kingsborough Square Suite 300 Chesapeake VA 23320 Physician Practice Delta Oncology Associates 355 Crawford Street Suite 300 Portsmouth VA 23704 Physician Practice Bon Secours Oncology Specialists 3640 High St Suite 1E Portsmouth VA 23707 Physician Practice Airline Boulevard Medical Associates 3537 Airline Boulevard Suite 1 Portsmouth VA 23701 Physician Practice In Motion at Harbor View 5838 Harbourview Blvd Suffolk VA 23435 Physical Therapy Bon Secours In-Motion 1417 N Main St Suffolk VA 23434 Physical Therapy Bon Secours Grassfield Medical Assoc 648 Grassfield Parkway Suite 1 Chesapeake VA 23322 Physician Practice Bon Secours Surgical Specialist 3640 High Street Suite 2E Portsmouth VA 23707 Physician Practice Internist of Portsmouth 3300 High Street 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 www.bshr.org. Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $24,452,732. 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. 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 "accounts receivable" on pages 11-12 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 page 45 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 nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable 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: $995,766. 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 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: As of 2014, 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. African Americans comprise 51% of the population in Portsmouth, 42% in Suffolk, 30% in Chesapeake, and 24% in Isle of Wight County. Seniors currently in Bon Secours Maryview Medical Center's (Maryview) service area account for 18.2% of the population, increasing by 19.7% within the next five years. The primary service area population served by Maryview, Portsmouth, VA, is estimated to change from 198,699 to 208,191, with a projected growth of 4.8% over the next five years. Currently the largest populations are white (48%), Black or African American (42%), Hispanic or Latino (4%), Asian (2%), and small percentages of other groups. The current year median age for this area is 36.7. The most prevalent chronic conditions among adults in the Maryview service area include high blood pressure (42.7%), high cholesterol (29.8%), smokers (26.1%), arthritis (23.7%), depression/anxiety disorder (21.2%), and obesity/weight problems (20.2%). Morbidity rates per 10,000: heart disease (159.5), cerebrovascular disease (33.4), chronic obstructive pulmonary disease (29.4), diabetes (26.3), and asthma (17.5). Mortality rates (age-adjusted per 100,000) for the state of Virginia are cancer (169.5), ischemic heart disease (161.3), cerebrovascular disease (41.4) and chronic obstructive pulmonary disease (38.4). 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, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc, a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to: - Improve Health Locally and Globally- Build Partnerships for Population Health As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and it's 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. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world." Please see Schedule R for listings of the related organizations. Part VI, Line 7, Reports Filed With States VA 1 Old Dominion University Educational Foundation 4417 Monarch Way 4th Floor Norfolk VA 23529 546052014 501(C)(3) 30000 Endowed Scholarship Operation Blessing Relief and Development Corporation 977 Centerville Turnpike Virginia Beach VA 23463 541382657 501(C)(3) 5000 Disaster Relief Bon Secours Maryview Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 521694731 501(C)(3) 139678 Foundation Administrative Expenses 3 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 617514 0 191208 0 210957 0 132084 0 19599 0 1171362 0 135985 Michael Kerner Secretary/CEO-BSHR 0 527082 0 221442 0 209787 0 101956 0 29969 0 1090236 0 125798 Joseph Oddis CEO - MVH 0 327823 0 113194 0 42536 0 11947 0 28486 0 523986 0 0 Charmaine Rochester Treasurer/VP Finance 195153 0 47816 0 173 0 12271 0 4117 0 259530 0 0 0 Herbert Cummings COO - BSMG 0 170417 0 42266 0 568 0 8878 0 26399 0 248528 0 0 Barbara Lynch VP - Ambulatory Services (Sep-Dec) 148708 0 34489 0 752 0 1731 0 0 0 185680 0 0 0 Leana Fox VP - Patient Care Services 174735 0 41446 0 639 0 10181 0 0 0 227001 0 0 0 Mark Kerner MD Orthopedic Surgeon 489226 0 517834 0 1450 0 13000 0 27846 0 1049356 0 0 0 Steven Blasdell MD Orthopedic Surgeon 463976 0 359627 0 2692 0 13617 0 24568 0 864480 0 0 0 Ernesto Luciano-Perez MD Orthopedic Surgeon 308028 0 454390 0 1313 0 12917 0 26753 0 803401 0 0 0 Aaron Marlow MD Orthopedic Surgeon 295740 0 462906 0 450 0 12917 0 9699 0 781712 0 0 0 Apurva Patel MD Cardiologist 515129 0 222863 0 1242 0 13000 0 0 0 752234 0 0 0 James Sherwood Former Key Employee 60330 0 0 0 42369 0 1485 0 10258 0 114442 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 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, $181,617; Michael Kerner, $164,862. 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 the 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. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization makes all documents available to the general public upon request. Form 990, Part VII - Additional Disclosure: 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 -6,162,603. BSHSI Principal & Swap Payments -1,612,261. Goodwill Impairment Transfer -134,666. Pension Defined Benefit Transaction -225,126. Miscellaneous Changes to Net Assets 954. 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