2015-07-13T10:57:01-05:00 2014-08-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2013-09-01 541820093 Bon Secours DePaul Medical Center Inc BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner Secretary & CEO - BSHRHS 7578895000 2015-07-13 1 David A Craig P00542227 4042201500 2013 2016-02-25 16:41:14Z Michael K Kerner 150 Kingsley Lane Norfolk VA 23505 183355609 0 0928 X www.bonsecourshamptonroads.com X 1996 VA Acute Care Hospital 18 16 1421 254 1135209 0 2617955 1630125 174322547 174009515 1133964 534248 9266099 6617150 187340565 182791038 371664 132521 0 0 69455880 76385657 0 0 0 125304006 116867558 195131550 193385736 -7790985 -10594698 125980704 124856316 182124543 192253305 -56143839 -67396989 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 179752823 132521 178119715 DePaul Medical Center provides medical care to patients without regard to their ability to pay. Among the major services provided to the residents of Hampton Roads, three major areas of focus are orthopedics, general surgery and neurology.Orthopedics - DePaul continues a strong focus on orthopaedic care for residents of Norfolk and Virginia Beach. Bon Secours respond to the needs of all orthopaedic patients. 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 rehabilitation network. In addition, a strong focus exists on community education through seminars and classes. A special expertise exists in the treatment of spine disorders, with a significant cadre of spine and neurological surgeons performing advanced spine surgeries. In addition, a particular focus exists on foot & ankle surgery, with a few fellowship-trained surgeons practicing at DePaul.A strong focus exists on community education through seminars and classes, as well as innovative electronic risk assessments SpineAware and JointAware.General Surgery - DePaul has a special focus on bariatric surgery, including a comprehensive program, expert physicians, and a commitment to patient support for the duration of their weight loss journey. Bon Secours is the only weight loss surgery program that does not charge a fee to participants. 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. In 2014, DePaul also added dedicated colorectal surgery services on campus. DePaul is also home to a daVinci S surgical robotic system. The robot is being used by general surgeons, colorectal surgeons, gynecological surgeons as well as gynecological oncology surgeons. As a result, the robot has become the most heavily used system in the Commonwealth. Patients travel from all over the region to receive specialized gynecological (and gynecological oncology) surgery at DePaul with our specially trained physicians. As with other services and part of our mission, a strong focus exists on community education through seminars, classes, support groups, and innovative electronic risk assessment tools for breast and colorectal cancers (BreastAware and ColonAware).Neurology - DePaul has recently invested significantly in this service line. A state-of-the-art neuroendovascular laboratory and a skilled surgeon offer services unique in the area. In addition, DePaul is supported by an extensive network of neurologists and neurosurgeons, many with such sub-specialty as sleep medicine, motion disorders, pain management, etc. DePaul's board-certified team of neurology, neurosurgical, neurointerventional, neuroradiology, and neuropsychology specialists offers the latest and most effective treatments in the management of a complete spectrum of nervous system disorders. The comprehensive neuroscience services offered at DePaul includes: a full continuum of care from diagnostics to treatment to physical therapy; specialized, Joint Commission certified Primary Stroke Centers, part of the largest Joint Commission Certified stroke network in Virginia; Emergency Room teleneurology for rapid and more efficient acute stroke treatment; dedicated inpatient acute care and intensive care neuroscience units, one for stroke and neurology and another for neurosurgery, with specialized nurses and clinical staff; spine treatments performed with the latest technological advancements and procedures; the largest outpatient comprehensive pain management center in Hampton Roads; a team of emergency room, acute nurses trained to assess and care for patients with disorders of the nervous system and spinal injury; collaboration with the fully-accredited Bon Secours Sleep Disorder Centers staffed by neurologists that are board certified in sleep medicine; and Long-term video-EEG monitoring to help diagnose and treat seizure disorders such as epilepsy.Finally, as with other services and part of our mission, a strong focus exists on community education and outreach, in partnership with Heart&StrokeAware.Please see Schedule H for additional information regarding programs, community benefit programs and Charity Care. 179752823 1 1 0 1 0 0 0 0 0 0 1 0 1 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 1 0 0 0 1 76 0 1 1421 1 1 1 0 0 0 0 0 0 0 0 0 X 18 16 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X James Bento Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Blount Board Member 2.00 0.00 X 0 0 0 J Robert Bray Chair 3.00 0.00 X X 0 0 0 Bruce Britton MD Board Member 2.00 0.00 X 0 0 0 Br Arthur Caliman CFX President (Jan-Aug) 3.00 47.00 X X 0 0 0 Arthur Collins Board Member 2.00 0.00 X 0 0 0 Sr Elaine Davia CBS Board Member 2.00 2.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 1332288 147578 Barbara Hamm Lee Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 15.00 35.00 X X 0 824158 116563 Michael LaRock Board Member 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Carol Ormond Board Member 2.00 0.00 X 0 0 0 P 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 Sr Rita Thomas Board Member 2.00 1.00 X 0 0 0 Douglas Ziegenfuss Board Member 2.00 0.00 X 0 0 0 Sr Patricia Heath President (Sep) 3.00 47.00 X X 0 0 0 Linwood Howard Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 William Kline Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 R B Seal MD Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Charmaine Rochester Treasurer/VP Finance 15.00 35.00 X 0 186402 13688 Melinda Hancock CFO - Bon Secours Virginia (Sep-Dec) 3.00 47.00 X 0 365950 30891 John Barrett CEO - DePaul Medical Center 49.50 0.50 X 0 361497 36555 James Sherwood Chief Admin Officer (Sep-Apr) 15.00 35.00 X 0 289523 40315 Herbert Cummings COO - BSMG 15.00 35.00 X 0 214769 31567 Michael Bratton VP of Patient Care Services 50.00 0.00 X 218425 0 21994 John Baker MD Neurologist 50.00 0.00 X 989236 0 39268 George Sarris MD Cardiologist 50.00 0.00 X 600237 0 39169 Gregory Adams MD Surgeon 50.00 0.00 X 484706 0 39192 Saumil Patel MD Cardiologist 50.00 0.00 X 452326 0 36537 Robert Hansen MD Neurologist (Sep-May) 50.00 0.00 X 411251 0 37188 3156181 3574587 630505 82 0 1 0 Shiftwise 1800 SW 1st Ave Suite 510 Portland OR 97201 Contract Nursing Services 3144123 Rehabcare Group East Inc 7733 Forsyth Blvd Ste 1700 St Louis MO 63105 Rehabilitation Services 3008588 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 2489140 Eastern VA Med School PO Box 1980 Norfolk VA 235011980 Residency Fees/Physician Services 2028638 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 303682289 Dietary Services 1634435 48 40098 1583707 6320 1630125 Patient Service Rev. 622110 174009515 173105548 903967 174009515 127297 127297 642037 85273 557978 6593 84059 78680 162739 29662 133077 406951 0 406951 406951 406951 JV Inc.- SPAH & Other 621999 5416090 5014167 401923 Physical Therapy Servi 446199 250373 250373 Gift Shop Revenue 900099 221412 221412 566536 201580 364956 6454411 182791038 178119715 1135209 1905989 132521 132521 244919 220427 24492 61902811 55712530 6190281 2697163 2427447 269716 6618291 5956462 661829 4922473 4430226 492247 509967 458971 50996 164953 148458 16495 30282 27254 3028 8674298 8674298 34099 30689 3410 2502586 2252327 250259 97409 87668 9741 6686729 6018056 668673 212384 191146 21238 54807 49326 5481 1919038 1919038 9497638 8547874 949764 1191934 1072741 119193 Purchased Services 33901542 30511388 3390154 Medical Expenses 28724168 28724168 Bad Debt Expense 17606564 17606564 BSHSI Mgmt Allocation 3888282 3499454 388828 1170878 1053790 117088 193385736 179752823 13632913 0 5381 3853 409620 80575 4313 2956 21203700 20926458 3521208 3412339 1318096 981897 126392574 89631412 37767072 36761162 12805625 14291412 32143009 31287734 5263864 5263864 11538816 11844066 125980704 124856316 9849749 9964861 3023677 3270304 169251117 179018140 182124543 192253305 X -56127674 -67384537 -16165 -12452 -56143839 -67396989 125980704 124856316 X -10594698 951543 -1609995 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 20346 0 1 9936 30282 0 Part II-B, Line 1: 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. 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. 3750384 3750384 31179828 20912510 10267318 5121676 3207100 1914576 80036330 63186664 16849666 6304356 2325138 3979218 36761162 Inv. in Sentara Princess Anne Hosp. 28282665 C Inv. in Bed Licenses 1142699 C Inv. in Rad Svc of Hampton Roads 948952 C Inv. in Surgery Center 434767 C Inv. in Peninsula Hospital Service 265423 C Inv. in MRI 108228 C Inv. - Positrom Emission Tom. 55000 C Inv. in VHN 50000 C 31287734 LT Non-Cash Inv - HPL/GL 7299526 Other & Third Party Payor 1866537 Due from Champus 952499 Other Accrued Revenue 901459 Organizational Costs 420524 Due from Affiliates 363472 Other Nonacute Rec 37264 Non-Patient A/R 2785 11844066 Due to BSHSI 167770706 HPL/GL Liability 7299526 Due to Affiliates 2887911 FIN 47 LT Asbestos Liab 824587 Medicare Liability 159635 Other Misc. LT Liabilities 75616 Unclaimed Property 159 179018140 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 of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $61,513 and $66,681 of net operating loss carryforwards as of August 31, 2014 and 2013, respectively, which expire in varying periods through 2034 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2014 and 2013. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 1 X 1 X 1 1 0 1 1 3403017 0 3403017 0.01940 15617945 10110832 5507113 0.03130 19020962 10110832 8910130 0.05070 19 15211 1059254 1400 1057854 0.00600 3 168 1353526 773807 579719 0.00330 2 1247 26829 60 26769 0.00020 10 23781 553391 0 553391 0.00310 34 40407 2993000 775267 2217733 0.01260 34 40407 22013962 10886099 11127863 0.06330 1 1752 130229 8389 121840 0.00070 1 928 5988 0 5988 0.00000 1 22 758 0 758 0.00000 3 2702 136975 8389 128586 0.00070 1 17606564 0 39535439 49150678 -9615239 X 1 1 1 1 DePaul Medical Center 150 Kingsley Lane Norfolk VA 23505 http://bshr.com H1829 X X X X Bon Secours DePaul Medical Center Inc 1 1 X X X X X X X X X 12 1 0 1 X http://bshr.com/ X X X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X X X X 0 0 1 X 0 0 Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 3: DePaul Medical Center (DMC) contracted with Community Health Solutions (CHS) to conduct an electronic survey of key stakeholder to determine the top healthcare needs of the community. DMC 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, DMC surveyed representatives of medically underserved, minority populations, and those with chronic conditions. DMC also met with representatives from the Norfolk Health Department to review the key findings from the survey and seek additional input. Upon receipt of all information, DMC 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. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 7: While DePaul Medical Center (DMC) recognizes the importance of all the needs identified, there are other providers and organizations within the community addressing mental illness, dental/oral health, tobacco use, arthritis, domestic violence, sexually transmitted diseases, teen pregnancy, and Alzheimer's disease with specialized programs and services and it would result in duplication of services if DMC were to address those needs. DMC currently provides comprehensive diabetes education with weekly education sessions covering understanding diabetes, nutrition, foot care, exercise, and medication. DMC also has a comprehensive program in place to address prenatal and pregnancy care. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 12i: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. 21 Bon Secours Health Center 828 Healthy Way Virginia Beach VA 23462 Rehabilitation & Physician Practice DePaul InMotion Phys Ther-Norfolk 7300 Newport Ave Suite 300 Norfolk VA 23505 Physical, Occupational & Speech Therapy Bon Secours In-Motion at Hilltop 1817 Laskin Rd Suite 100 Virginia Beach VA 23454 Physical Therapy & Sports Rehab Bon Secours Surg Specialists DePaul 160 Kingsley Lane Suite 400 Norfolk VA 23505 Physician Practice Amelia Medical Associates 885 Kempsville Rd Suites 3003033053 Norfolk VA 23502 Physician Practices, Physical Therapy Patient Choice Oceana 1232 Perimeter Pkwy Suite 101 Virginia Beach VA 23454 Physician Practice Hampton Roads OBGYN 100 Kingsley Lane Suite 100 Norfolk VA 23505 Physician Practice Ghent Family Practice & Internal Med 957 W 21st St Suite E Norfolk VA 23517 Physician Practice InMotion Phy Ther Healthy Way 828 Healthy Way Suite 105 Virginia Beach VA 23462 Physicial Therapy & Sports Rehab Bon Secours Neuroscience Ctr for Pain 4445 Corporation Lane Suite 120 Virginia Beach VA 23562 Physician Practice DePaul Medical Associates 100 Kingsley Lane Suite 100 Norfolk VA 23505 Physician Practice Cardiovascular Specialists 160 Kingsley Lane Suite 100A Norfolk VA 23505 Physician Practice InMotion Phy Ther Redmill Landing 1253 Nimmo Parkway Suite 105 Virginia Beach VA 23456 Physical Therapy Bon Secours Neurovascular Center 110 Kingsley Lane Suite 411 Norfolk VA 23505 Physician Practice Bon Secours Pulmonary Specialists 150 Kingsley Lane Norfolk VA 23505 Physician Practice Bon Secours Medical Associates 828 Healthy Way Suite 220 Virginia Beach VA 23462 Physician Practice East Beach Medical Associates 4039 E Little Creek Rd Norfolk VA 23518 Physician Practice Bon Secours Oncology Specialists 150 Kingsley Lane Norfolk VA 23505 Physician Practice Town Center Medical Associates 4421 Virginia Beach Blvd Suite 114 Virginia Beach VA 23462 Physician Practice Monarch Medical Associates 4211 Monarch Way Suite 100 Norfolk VA 23508 Physician Practice Greenbrier Medical Associates 908 Eden Way North Suite 101 Chesapeake VA 23320 Physician Practice Part I, Line 6a: Annually, Bon Secours Hampton Roads Health System (BSHRHS) publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs, and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. This report is available online at http://bshr.com/about-us-mission-and-outreach.html. Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $17,606,564. Part II, Community Building Activities: Bon Secours DePaul 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. East Ocean View has historically been one of the roughest neighborhoods in the community. Among the 6,000 residents, more than 25% of the households are at or below the poverty level and over 20% are single parent households. Family violence, gangs, addictions, housing affordability, access to healthcare, and a lack of educational opportunities affect the health of the individuals living in the neighborhood. 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 page 10 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 40 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. 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, DePaul 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 DePaul 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 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. In Bon Secours DePaul Medical Center's (DePaul) regional market, African Americans comprise 41% of Norfolk, 30% of Chesapeake, and 20% of Virginia Beach. Seniors in DePaul's service area currently account for 17.0% of the population, increasing by 17.1% within the next five years. The primary service area population served by DePaul, Norfolk, VA is estimated to change from 445,445 to 461,523, with a projected growth of 3.6% over the next five years. The current year estimated population represents White (53%), Black or African American (31%), Hispanic or Latino (8%), Asian (5%) and small percentages of other groups. The current year median age for this area is 34.1. The most prevalent chronic conditions among adults in the DePaul Medical Center service area include high blood pressure (34%), high cholesterol (29%), depression/anxiety disorder (22.7%), arthritis (20.6%), asthma (20.4%), and smokers (29.9%). 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: DePaul Medical Center (DMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/ day, 7days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located.DMC 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 Norfolk, as well as Newport News, Portsmouth, and Suffolk. Services provided include urgent and primary care (including examination, diagnosis, lab, pharmacy, and follow-up), immunizations for school, pregnancy tests, blood pressure measurement, health education, referrals for specialty care, opportunity to enroll eligible children in childrens' health insurance, sports physicals and health education services. 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 990 patients. Over 1,328 patient visits were rendered by the CAV in Norfolk and over $49,000 in lab services were provided at no cost to the patient. The CAV has a staff of 11 FTEs and annual expenses of approximately $600,000.DMC offers support to 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. Coaches work closely with 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. They also help set up ongoing care with primary care physicians or the Care-A-Van, a mobile clinic operated by BSHRHS for the Norfolk area. DMC Life Coaches had 4,779 patient contacts, scheduled 2,719 appointments with primary care physicians, assisted 188 patients with medication needs, and connected 3,268 patients with other community resources.Building healthier communities requires a systemic, ecological, multi-sector approach that acknowledges all of the social determinants of health such as housing, education, employment, public safety and social justice.In 2009, DMC partnered with the City of Norfolk on an initiative called Neighbors Building Neighborhoods. DMC chose to focus on the Pretty Lake area of East Ocean View (EOV), historically one of the roughest neighborhoods in Norfolk. With over 6,000 residents of which more than 25% are below the poverty level, over 20% are single parent households, and with a per-capita income of only $14,658 leaves families in extreme difficulty. Family violence, gangs, addictions, housing affordability, access to healthcare, and a lack of educational opportunities all affect the health of residents. DMC assisted in a neighborhood beautification project, the renovation and expansion of the local Storehouse Food Pantry, the development of the 'Future CEOs' young entrepreneurs program. The "Passport to Health" program, which encourages living a healthier lifestyle by providing healthy cooking & education classes, exercise program and fresh weekly produce bags, led 18 families to realize an overall 4% loss in body fat over an eight week period. Working with the Norfolk Farmer's Market, Passport to Health Families received 5,760 pounds of fresh produce. The EOV Community Garden, which now includes 10 raised, accessible garden boxes, a solar-powered hydroponics system, flowerbeds, fruit trees and grapevines, continues to thrive and plans are in process for a second community garden. Seventy-five attended the annual Youth Survival Night where a cardiologist engaged participants in the Bon Secours Heart Heath Academy. The donation of playground equipment at the East Ocean View recreation center, the renovation of the 4th Bay basketball court and playground area, and the addition of the Care-A-Van to the community are helping DMC to build a healthier community in Norfolk.DMC supports the Faith Community Health Ministry which builds on the skills of registered nurses through additional, structured training in holistic (body, mind and spirit) health services; faith community nurses partner with congregational leadership to promote good health by serving as an educator, counselor, referral agent and advocate. Specialized training prepares non-licensed persons to serve in congregational health ministry. Additionally, the Influenza Vaccination Administration program provided 600 vaccines for select covenanted partners to host annual vaccine clinics. BSHR provides education, mentoring and support to more than 136 faith communities and 199 registered nurses and lay health promoters. The Let's Get Real (LGR) program was created in response to alarming data revealing an excessively high death rate from heart disease among African Americans in Hampton Roads. LGR is a community outreach campaign specifically designed to bring valuable information to African-American women and their families, whose goal is to raise awareness and lower risk factors for heart disease through culturally sensitive education, healthy cooking demonstrations, baseline and follow-up health screenings & risk-factor assessments and physical activity with an ethnic flair. Program components are centered on Cookin' Light nutrition seminars and Tree of Life family history/genealogy research. LGR was introduced to the East Ocean View community in September 2013 with health screenings, and a Zumba dance program. In March 2014, a second Zumba class was added to accommodate the increasing number of participants (average of 35 per session). Eight LGR sessions were presented to the Norfolk Alumnae Chapter civic organization (average of 20 participants per session). In response to the increase in childhood obesity, DMC implemented the Heart E Heart Children's program for first and second grade students. Children in the program meet twice monthly with a Bon Secours registered dietician and receive education about healthy eating, being active, and making changes for a more positive healthy lifestyle. Sixty students participated in the program. At the end of the program, the students' knowledge assessment score increased five percentage points (77%) better than the baseline of 72%.DMC offers the Bon Secours SeniorHealth Program which provides a free membership program to over individuals 55 years and older. Lunch & Learn educational programs bring professionals from healthcare, the government, and the private sector in front of members for presentations and question/answer sessions 6 times a year. The annual Successful Aging Forum brings national speakers to discuss the latest health and wellness topics. A quarterly publication, Good Health, provides information to 48,000 members in Hampton Roads area. Seniors also play a vital role in BSHRHS' advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP) through the Bon Secours Advocates program. DMC 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. DMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. DMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.DMC offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Several seminars on clinical ethics were also offered to professionals in the area. 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, 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 Bon Secours DePaul Health Foundation 100 Kinglsey Lane Suie 204 Norfolk VA 23505 541843876 501(c)(3) 132521 Foundation Administrative Expenses 1 0 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 0 1 0 0 0 0 0 0 0 Timothy Davis Board Member 0 599174 0 155672 0 577442 0 127775 0 19803 0 1479866 0 94650 Michael Kerner Secretary/CEO-BSHR 0 518825 0 136519 0 168814 0 88967 0 27596 0 940721 0 99095 Charmaine Rochester Treasurer/VP Finance 0 155056 0 31215 0 131 0 9226 0 4462 0 200090 0 0 Melinda Hancock CFO - Bon Secours Virginia (Sep-Dec) 0 270243 0 56597 0 39110 0 5235 0 25656 0 396841 0 0 John Barrett CEO - DePaul Medical Center 0 280831 0 57961 0 22705 0 15300 0 21255 0 398052 0 0 James Sherwood Chief Admin Officer (Sep-Apr) 0 203584 0 46439 0 39500 0 11201 0 29114 0 329838 0 0 Herbert Cummings COO - BSMG 0 152532 0 43368 0 18869 0 5056 0 26511 0 246336 0 0 Michael Bratton VP of Patient Care Services 188059 0 28891 0 1475 0 11100 0 10894 0 240419 0 0 0 John Baker MD Neurologist 985645 0 300 0 3291 0 12750 0 26518 0 1028504 0 0 0 George Sarris MD Cardiologist 541143 0 58100 0 994 0 12375 0 26794 0 639406 0 0 0 Gregory Adams MD Surgeon 316323 0 167156 0 1227 0 12750 0 26442 0 523898 0 0 0 Saumil Patel MD Cardiologist 341746 0 109516 0 1064 0 12750 0 23787 0 488863 0 0 0 Robert Hansen MD Neurologist (Sep-May) 253444 0 155550 0 2257 0 12750 0 24438 0 448439 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, $122,307; Michael Kerner, $124,395. Form 990, Part VI, Section A, line 4 The articles and bylaws were amended and restated in their entirety (effective August 14, 2014) to bring the documents up to date with current templates for hospital entities (which reflect current operational realities and governance best practices, as well as the transfer of canonical sponsorship of the Bon Secours Health System from the Sisters of Bon Secours to Bon Secours Ministries). Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Hampton Roads Health System, Inc., which in turn is the sole member of Bon Secours DePaul Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board of Directors of Bon Secours DePaul Medical Center, Inc. is appointed by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Any decision which is subject to a reserved power is subject to approval by members. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 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 director's 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). Sr. Patricia Heath and Br. Art Caliman do not receive payroll distributions as they have taken a vow of poverty. Form 990, Part XI, line 9: Clinical Sys Pat Trns Suspense 942. BSHSI Principal & Swap Payments -1,610,937. Mary Immaculate Foundation 7007 Harbour View Blvd Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 11c, III-FI Mary Immaculate Hospital 0 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 9 Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) Line 3 Bon Secours Health Systems Inc 0 Bon Secours Hampton Roads Health System Inc 7007 Harbour View Blvd Suffolk VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Health Systems Inc 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) Line 9 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Suffolk VA 23435 540506463 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bayley Properties 7007 Harbour View Blvd Suffolk VA 23435 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 1 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suffolk VA 23435 521694731 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 Bon Secours DePaul Medical Center Inc C 731465 2425991 1.00000 1 OSF Inc 2 Bernadine Dr Newport News VA 23602 541369919 Rental VA N/A C 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0