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 540506463 Maryview Hospital MARY 7573982200 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner Chief Executive Officer - BSHR 7576735920 2015-07-13 1 David A Craig P00542227 4042201500 2013 2016-02-25 16:41:14Z Bon Secours Maryview Medical Center with Delta Oncology Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 394573109 0 0928 X www.bonsecourshamptonroads.org X 1944 VA Acute Care Hospital 18 16 3052 165 587909 0 3981894 2295437 366448470 382955554 8468819 3856874 5466656 4262503 384365839 393370368 275086 73606 0 0 164158878 178211227 0 0 0 215582636 205571162 380016600 383855995 4349239 9514373 262143562 275550114 122001001 111658035 140142561 163892079 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 313574866 73606 341423498 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 respond 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 - For the eighth year in a row, Maryview was named the 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. 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. 41494510 41494510 Maryview Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 355069376 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 1 197 0 1 3052 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 186402 0 13688 Melinda Hancock CFO - Bon Secours Virginia (Sep-Dec) 3.00 47.00 X 0 365950 30891 Joseph Oddis CEO - Maryview Hospital 49.50 0.50 X 0 431309 39163 James Sherwood Chief Admin Officer (Sep-Apr) 25.00 25.00 X 289523 0 40315 Herbert Cummings COO - BSMG 25.00 25.00 X 0 214769 31567 Barbara Lynch VP -Ambulatory Services 50.00 0.00 X 166650 0 11016 Mark Kerner MD Orthopedic Surgeon 49.00 1.00 X 1164703 0 39413 Steven Blasdell MD Orthopedic Surgeon 50.00 0.00 X 930995 0 37285 Aaron Marlow MD Orthopedic Surgeon 50.00 0.00 X 752197 0 21461 Apurva Patel MD Cardiologist 50.00 0.00 X 721308 0 23425 Ernesto Luciano-Perez MD Orthopedic Surgeon 50.00 0.00 X 711710 0 36887 4923488 3168474 589252 158 0 1 0 Rehabcare Group East Inc 7733 Forsyth Blvd Ste 1700 St Louis MO 63105 Rehabilitation Services 6080582 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering Services 4289051 Athenahealth Inc 311 Arsenal Ct Watertown MA 02472 Physician Billing Service 3543925 Free Agents Marketing 4800 Cox Rd Ste 100 Glen Allen VA 23060 Marketing Services 2699060 Morrison Mgt Specialists Inc PO Box 102289 Atlanta GA 30368 Dietary Services 2532443 80 179073 2083708 32656 2295437 Patient Service Rev. 622110 341461044 341423498 37546 Shared Services 561499 41494510 41494510 382955554 901375 901375 1231989 711 1156771 0 75218 711 75929 56696 19233 2992469 9000 -744 46714 2993213 -37714 2955499 2955499 Outpatient Pharmacy 900099 1335507 1335507 Joint Venture Income 900099 736783 736783 Employee Assis. Prog. 900099 527452 527452 1586832 493667 1093165 4186574 393370368 382918008 587909 7569014 73606 73606 641958 577762 64196 145606793 131046114 14560679 6320358 5688322 632036 14985233 13486710 1498523 10656885 9591196 1065689 1379607 1241647 137960 135750 122175 13575 46002 41402 4600 12165062 12165062 4569023 4112121 456902 6547850 5893065 654785 16097082 14487374 1609708 15444756 13900280 1544476 1610161 1449145 161016 157466 141719 15747 2328753 2328753 13595408 12235867 1359541 2424902 2182412 242490 Medical Supplies 54104306 54104306 Purchase Services 37232057 33508851 3723206 Bad Debt 27318081 27318081 BSHSI Allocation 6670756 6003680 667076 3744140 3369726 374414 383855995 355069376 28786619 0 9745 5960 1914354 5712470 25612 21758 37903063 40598059 83333 33333 7320658 6424381 5511805 2844853 230304137 172605908 60256089 57698229 94164898 105890480 907012 1110457 2703179 2703179 51343814 52506955 262143562 275550114 37470658 33621834 3297619 3535702 23045548 23045548 58187176 51454951 122001001 111658035 X 140019550 163748612 123011 143467 140142561 163892079 262143562 275550114 X 9514373 6997077 7238068 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 33517 0 1 12485 46002 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. 4636569 4636569 83775717 57323299 26452418 12093753 8117143 3976610 123390627 103259718 20130909 6407471 3905748 2501723 57698229 Due from BSHSI 25365385 LT Non-Cash Inv - HPL/GL 13092736 Due from Affiliates 7028075 Deferred Medicare Rec 4804285 Medicare Settlement Rec 673362 Other Accrued Rec 619088 Other LT Receivables 553747 Non-Patient A/R 188071 Other Misc. Assets 182206 52506955 Due to BSHSI 13424677 HPL/GL Liab 13092736 Due to Affiliates 10465388 Pension Liability 6222333 FIN47 Liab 3419424 Deferred Rent 3165110 Medicare Liability 849823 Deposits 529358 Other LT Liabilities 282321 Unclaimed Property 3781 51454951 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 1 0 1 1 10198876 518088 9680788 0.02720 32488465 23109228 9379237 0.02630 42687341 23627316 19060025 0.05350 18 13380 845850 5628 840222 0.00240 3 1200 2680524 1081248 1599276 0.00450 4 10334 2387088 2387088 0.00670 8 35444 606314 0 606314 0.00170 33 60358 6519776 1086876 5432900 0.01530 33 60358 49207117 24714192 24492925 0.06880 1 0 2093 0 2093 0.00000 1 548 3897 0 3897 0.00000 1 137 10447 0 10447 0.00000 1 76 39607 0 39607 0.00010 4 761 56044 56044 0.00010 1 27318081 0 86147039 76857278 9289761 X 1 1 1 BS Surg Ctr at Harbour View LLC Outpatient Surgery 0.42200 0.10890 1 1 Maryview Hospital 3636 High Street Portsmouth VA 23707 http://bshr.com H1830 X X X X Maryview Hospital 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 Maryview Hospital Part V, Section B, Line 3: Maryview Medical Center (MMC) contracted with Community Health Solutions (CHS) to conduct an electronic survey of key stakeholders to determine the top healthcare needs of the community. MMC developed a list of key stakeholders who were asked to provide their viewpoints on important healthcare concerns in the community, significant gaps in the community, and ideas for addressing health concerns and service gaps. Stakeholders included individuals who have special knowledge and expertise in public health, as well as the deans of area colleges and universities with medical degree programs. In addition, MMC surveyed representatives of medically underserved, minority populations, and those with chronic conditions. 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 7: 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 12i: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Maryview Hospital Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Maryview Hospital Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. 36 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 Tidewater 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 Ste 2 Portsmouth VA 23703 Physician Practice Cardiovascular & Thoracic Specialists (C 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 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): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $27,318,081. 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. 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. 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 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.While Maryview Hospital shows a Medicare surplus on this Schedule H, it is due to the unique composition of the hospital, the high percent of uncompensated care and the Medicare cost report allocation of indirect costs which is used in this tax schedule computation. Compared to other hospitals, Maryview Hospital is unique in that it has several non-provider based physician practices residing on the hospital company rather than on a separate company. Using the Medicare cost report as the basis for reporting Medicare allowable costs, the predetermined step-down statistical bases are allocating significant overhead costs to the nonallowable physician practices, artificially lowering allowable costs to the Medicare centers. Similar hospitals that do not include physician practices in the same company, these same overhead costs are included as allowable Medicare costs. Maryview also receives significant Medicare disproportionate share (DSH) payments, which are intended to partially compensate hospitals for the uncompensated care that arises from serving an usually large percentage of uninsured, low-income patients in their area. While these payments are a component of Medicare reimbursement, they do not relate to the Medicare allowable costs reported in line 6, but are more closely related to the Medicaid shortfall reported in Part I, Line 7 b, column (e). 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.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, 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 1,891 patient contacts in Portsmouth and Suffolk with over $19,795 in lab services provided at no cost to the patient. The CAV has a staff of 11 FTEs and annual expenses of approximately $600,000.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 1,936 patient contacts, scheduled 1,427 appointments with primary care physicians, assisted 148 patients with medication needs, and connected 778 patients with other community resources.MMC 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; the faith community nurse partners with the congregational leadership to promote good health by serving as an educator, counselor, referral agent and advocate. Specialized training has also been developed to prepare 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 employs a sole Director to provide 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 by BSHRHS in response to alarming data revealing an excessively high death rate from heart disease among African Americans in Hampton Roads. LGR is a heart health community outreach and education campaign specifically designed to bring valuable information to African-American women and their families. The 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. The Maryview Foundation Healthcare Center is located adjacent to MMC's emergency department. The Center had 7,903 patient visits in 2014 and received over 9,800 requests for medication assistance (value = $6,385,233). The Center provides primary and preventive care for Portsmouth residents who are uninsured and meet the financial guidelines of 200% of the federal poverty level and below. The center provides prescription assistance, a wellness program, blood pressure checks and other services. The Center expanded their services by providing GYN exams in April 2014. MMC offers the Bon Secours SeniorHealth Program which provides a free membership program to individuals 55 years and older. Lunch & Learn educational programs bring professionals from healthcare, the government, and the private sector in front of members for presentations and question/answer sessions six times a year. The annual Successful Aging Forum brings national speakers to discuss the latest health and wellness topics for senior citizens. The MMC SeniorHealth transportation program provided transportation for 1,223 patients to medical appointments. 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. MMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads through the women health service lines. MMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.MMC 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. MMC staff are dedicated to promoting the health and welfare of community through a variety of avenues including the United Way campaign, support of Oasis (a homeless shelter in Portsmouth), the FoodBank of Southeastern Virginia, and participation in the Healthy Portsmouth and Healthy Suffolk initiatives. 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 Maryview Foundation 100 Kingley Lane Suite 204 Norfolk VA 23505 521694731 501(c)(3) 73606 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 155056 0 31215 0 131 0 9226 0 4462 0 200090 0 0 0 Melinda Hancock CFO - Bon Secours Virginia (Sep-Dec) 0 270243 0 56597 0 39110 0 5235 0 25656 0 396841 0 0 Joseph Oddis CEO - Maryview Hospital 0 319497 0 69293 0 42519 0 10875 0 28288 0 470472 0 0 James Sherwood Chief Admin Officer (Sep-Apr) 203584 0 46439 0 39500 0 11201 0 29114 0 329838 0 0 0 Herbert Cummings COO - BSMG 0 152532 0 43368 0 18869 0 5056 0 26511 0 246336 0 0 Barbara Lynch VP -Ambulatory Services 144269 0 21640 0 741 0 10638 0 378 0 177666 0 0 0 Mark Kerner MD Orthopedic Surgeon 491214 0 671617 0 1872 0 12750 0 26663 0 1204116 0 0 0 Steven Blasdell MD Orthopedic Surgeon 460873 0 467222 0 2900 0 12792 0 24493 0 968280 0 0 0 Aaron Marlow MD Orthopedic Surgeon 295623 0 456124 0 450 0 12136 0 9325 0 773658 0 0 0 Apurva Patel MD Cardiologist 499990 0 220076 0 1242 0 22750 0 675 0 744733 0 0 0 Ernesto Luciano-Perez MD Orthopedic Surgeon 290127 0 420062 0 1521 0 12136 0 24751 0 748597 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 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 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 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 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 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). 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: Minimum Pension Plan Liability 9,422,027. BSHSI Principal & Swap Payments -2,183,005. Misc 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 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 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