2014-07-15T15:43:30-05:00 2013-08-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2012-09-01 540793767 St Mary's Hospital of Richmond Inc STMA 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi 8042818316 2014-07-15 1 David A Craig P00542227 4042201500 2012 2016-02-25 16:41:14Z St Mary's Hospital Toni R Ardabell 5801 Bremo Road Richmond VA 23226 666376103 0 X www.bonsecours.com X 1961 VA Acute Care Hospital 20 16 4173 735 1232658 0 3914038 3185652 584881420 628957004 10685788 29998138 4487822 3011463 603969068 665152257 2064057 5606327 0 0 253726390 285190413 0 0 0 303028475 316295160 558818922 607091900 45150146 58060357 764227632 839161866 327812920 294443709 436414712 544718157 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 548289981 5606327 518466095 St. Mary's Hospital provides medical care to patients without regard to their ability to pay. As the major community not for profit hospital in Richmond, St. Mary's is the access for under-insured and financially disadvantaged who will not be treated at the for profit hospitals. In addition, St. Mary's provides support for community services. Please refer to the Community Benefit information on Schedule H. 109076657 St. Mary's Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 786266 182658 The Bon Secours St. Mary's Hospital School of Medical Imaging offers anaccredited 18-month radiography program designed to prepare individualsto enter the workforce as Diagnostic Radiologic Technologists. This newand innovative curriculum will allow students to enter the workforcemore quickly while maintaining high standards of education. TheRadiography program quality and depth has remained the same andcontinues to meet requirements established by the American Society ofRadiologic Technologists. 549076247 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 254 0 1 4173 1 1 1 0 0 0 0 0 0 0 0 0 X 20 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X David Larkin 4433672204 8990 Old Annapolis Road Columbia MD 21045 X Nalia Townes Ahmed 2.00 0.00 X 0 0 0 Jean Ann Bolling 2.00 0.00 X 0 0 0 John Bowman MD 2.00 0.00 X 0 0 0 Barry Case 2.00 0.50 X 0 0 0 Pete Cleal 2.00 0.00 X 0 0 0 John Daniel III MD 2.00 0.00 X 0 0 0 Mark Gordon 48.00 2.00 X 0 609630 56092 Richard Jackson MD 2.00 0.00 X 0 0 0 Kenneth J Jones 2.00 0.00 X 0 0 0 Sr Anne Marie Mack CBS 2.00 48.00 X 0 0 0 Joanne Nattrass 2.00 0.00 X 0 0 0 Michael Robinson 2.00 48.00 X 0 827818 32855 William Stallings MD 2.00 0.00 X 0 0 0 William Shewmake 2.00 0.00 X 0 0 0 Nancy Thomas 2.00 0.00 X 0 0 0 Jane Watkins 2.00 0.00 X 0 0 0 Michael Williams 2.00 0.00 X 0 0 0 Toni Ardabell 47.50 2.50 X X 0 596709 39743 Sr Victoria Segura CBS MD 9.90 40.10 X X 0 0 0 Thomas Winfree 3.00 0.00 X X 0 0 0 Peter J Bernard 8.00 42.00 X 0 1438081 192966 Alan Goolsby 2.00 2.00 X 0 0 0 Melinda S Hancock 8.00 42.00 X 343941 0 27968 Francine Barr 50.00 0.00 X 244122 0 6474 Kathleen Santini 12.50 37.50 X 252661 0 23724 Bonnie M Shelor 24.00 26.00 X 374068 0 31278 Stephan F Quiriconi 50.00 0.00 X 199093 0 12111 Mark R Bladergroen MD 50.00 0.00 X 683787 0 21028 Matthew L Brengman MD 50.00 0.00 X 746732 0 31934 Christine M Browning MD 50.00 0.00 X 786842 0 29998 Marc R Katz MD 50.00 0.00 X 907676 0 33821 Gregory L Schroder MD 50.00 0.00 X 697597 0 24901 Peter F Gallagher 0.00 0.50 X 0 250236 11760 Michael Kerner 0.00 50.00 X 0 936925 132770 5236519 4659399 709423 242 1 1 0 Taylor & Parrish Inc 710 Perry Street Richmond VA 23224 Architectural & Engineering 8379603 Central VA Health Network 2201 West Broad Street 202 Richmond VA 232202022 Care Management 5550663 Free Agents Marketing 10124 West Broad Street Glen Allen VA 23060 Marketing/Advertising 5424823 Aramark CTS Inc 12483 Collections Center Chicago IL 60693 Medical Equipment Maintenance/Rental 4477731 Inhealth 2201 West Broad Street 202 Richmond VA 232202022 Care Management 3661033 145 114383 3071269 3185652 Patient Service Rev. 621300 518466095 518466095 Shared Services 561499 110308251 109076657 1231594 Sch. of Med. Imag Tut. 611310 182658 182658 628957004 5100854 5100854 8923 8923 724407 615527 108880 108880 1064 107816 25496680 0 608319 25496680 -608319 24888361 24888361 Clinical Drug Trials 900099 1133269 1133269 Joint Venture Revenue 900099 691638 691638 Mgmt & Consulting 900099 253946 253946 823730 823730 2902583 665152257 627725410 1232658 33008537 5606327 5606327 1307448 1176703 130745 213649249 192284324 21364925 22185192 19966673 2218519 31523573 28371216 3152357 16524951 14872456 1652495 1556754 1401079 155675 552260 497034 55226 31642 28478 3164 8126427 7313784 812643 10326796 9294116 1032680 3452818 3107536 345282 28209357 25388421 2820936 17081853 15373668 1708185 2163991 1947592 216399 976233 878610 97623 4936924 4936924 32345692 29111123 3234569 2656697 2391027 265670 Medical Supplies 94606897 85146207 9460690 Purchased Services 65015413 58513872 6501541 Bad Debt 16392116 16392116 BSHSI Mgmt Allocation 12294051 11064646 1229405 15569239 14012315 1556924 607091900 549076247 58015653 0 0 2324 235050792 267942820 44120 42450 50391042 59417779 1255736 895305 7741607 7504754 4091832 4617620 390610507 248703640 142109028 141906867 301326594 332370168 0 50000 22216881 24411779 764227632 839161866 63545906 74738281 11168418 13428078 44904634 44883010 208193962 161394340 327812920 294443709 X 436341377 544644822 73335 73335 436414712 544718157 764227632 839161866 X 58060357 1646209 48596879 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 31642 31642 0 Explanation of Lobbying Activities: Part II-B, Line 1: The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. 4346148 4346148 163637639 74348623 89289016 16299798 5645359 10654439 171248379 142593673 28654706 35078543 26115985 8962558 141906867 LT Pension Liability 76390122 HPL/GL Liability 17368856 Due to BSHSI 37688901 Other Liabilities (Mob Reynolds lease from 2008) 23010735 Deferred Rent 3557362 Medicare Liabilities 1501029 Medicare/Medicare Settlement Liability 1473409 Fin 47 LT Asbestos Liability 380117 Unamortized Disc. Liability 21624 Unclaimed Property 2185 161394340 X Description of Uncertain Tax Positions Under FIN 48: 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 (Formerly FIN48). ASC 740 (Formerly FIN48) 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 (Formerly FIN48) 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 $66,681 and $95,733 of net operating loss carryforwards as of August 31, 2013 and 2012, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2013 and 2012. 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 20699372 20699372 0.03500 50084309 32035779 18048530 0.03060 2847165 1624449 1222716 0.00210 73630846 33660228 39970618 0.06770 10 15139 5677395 5677395 0.00960 1 580 2037127 515087 1522040 0.00260 2 3 71510 71510 0.00010 2 949274 949274 0.00160 15 15722 8735306 515087 8220219 0.01390 15 15722 82366152 34175315 48190837 0.08160 1 20500 20500 0.00010 0.00000 1 10250 10250 0.00000 0.00000 0.00000 0.00000 1 4100 4100 0.00000 0.00000 0.00000 3 34850 34850 0.00010 1 16396122 4128654 105744553 121293063 -15548510 X 1 1 1 1 St Mary's Hospital of Richmond Inc

5801 Bremo Road Richmond VA 23226

http://richmond.bonsecours.com/ X X X X X St Mary's Hospital of Richmond Inc 1 1 X X X X X X X X X 12 1 0 1 X X X 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 41 Cardiovascular Associates of VA

7001 Forest Avenue Suite 200 Richmond Cardiology VA 232301727

Physician Practice Women's Imaging Center

5875 Bremo Road MOB South Suite 105 Richmond VA 23226

Imaging Patterson Avenue Family Practice

9600 Patterson Avenue Richmond VA 23229

Physician Practice PTOTSPLymphedema

5875 Bremo Road MOB South Suite 611 Richmond VA 23226

Physicial Therapy, Outpatient Care, Etc. Perinatal Center

5855 Bremo Road MOB North Suite 306 Richmond VA 232261926

Physician Practice Cardiac Surgery Specialists

5875 Bremo Road MOB South Suite G-5 Richmond VA 231226234

Physician Practice West End Internal Medicine

7001 Forest Avenue Suite 2500 Richmond VA 23230

Physician Practice Commonwealth Gynecologic Oncology

5875 Bremo Road MOB South Suite G-7 Richmond VA 232261934

Physician Practice Associated Internists

5855 Bremo Road MOB North Suite 207 Richmond VA 232261930

Physician Practice Surgical Dermatology Center

5207 Hickory Park Drive Suite A Glen Allen VA 230592624

Physician Practice Sports Medicine

9600 Patterson Avenue Richmond VA 232296053

Sports Medicine Rehab Commonwealth Internal Medicine

9220 Forest Avenue Suite 1-A Richmond VA 23235

Physician Practice Monument Internal Medicine

5855 Bremo Road MOB North Suite 102 Richmond VA 23226

Physician Practice Pediatric Gastreonterology

5875 Bremo Road MOB South Suite 303 Richmond VA 23175

Physician Practice Senior Care Services

7001 Forest Avenue Suite 100 Richmond VA 23230

Physician Practice Parham Road Internal Medicine

2600 E Parham Road Richmond VA 23228

Physician Practice Oncology Associates

5875 Bremo Road Richmond VA 23226

Physician Practice Arthritis & Osteroporosis Center

9600 Patterson Avenue Richmond Cardiology VA 232296053

Physician Practice Liver Institute of Virginia-MIH

5855 Bremo Road MOB North Suite 509 Richmond Cardiology VA 232261926

Physician Practice Diagnostic Radiology 4

2201 Grove Avenue Titus Hendrix Richmond VA 23226

Radiology Pediatric Lung Care

5875 Bremo Road MOB South Suite 104 Richmond VA 232261930

Physician Practice Pediatric Endo & Diabetes Assoc

5875 Bremo Road MOB South Suite 207 Richmond VA 232261926

Physician Practice Palliative Care Clinic

2366 Colony Crossing Midlothian VA 231124280

Physician Practice OP Wound Care

6900 Forest Avenue Suite 115 Richmond VA 23230

OP Wound Care Diabetes Treatment Center

5875 Bremo Road MOB South Suite 712 Richmond VA 23226

Diabetes Treatment Cardiac Rehab

7001 Forest Avenue Suite 101 Richmond VA 23230

Cardiac Rehabilitation Glen Allen Internal Medicine

5207 Hickory Park Drive Suite A Glen Allen VA 23059

Physician Practice Cure and Care

5875 Bremo Road MOB South Suite 110 Richmond Cardiology VA 232261926

Physician Practice Good Health Clinic

5875 Bremo Road MOB South Suite 204 Richmond Cardiology VA 232261926

Physician Practice Advan Heart Fail Cntr-LVAD program

7001 Forest Avenue Suite 103 Richmond VA 23230

Cardiac Rehabilitation Liver Institute of Virginia

5855 Bremo Road MOB North Suite 509 Richmond VA 232261926

Physician Practice BS Behavioral Hth Group at SMH

5855 Bremo Road MOB North Suite 104 Richmond VA 23226

Physician Practice BS Infectious Disease

5855 Bremo Road MOB North Suite 102 Richmond VA 23225

Physician Practice Pediatric Neurology Clinic

5875 Bremo Road MOB South Suite 207 Richmond VA 232261926

Physician Practice Pediatric Dental

6900 Forest Avenue Suite 110 Richmond VA 23141

Physician Practice Lactation Center (A Woman's Place)

4121 Cox Road Suite 110 Glen Allen VA 23059

Physician Practice Dr Sura Edmond

5875 Bremo Road MOB South Suite 304 Richmond VA 23226

Physician Practice Surgical Oncology

5855 Bremo Rd MOB N Ste 406 506 Richmond VA 23226

Physician Practice Developmental Assessment Clinic

5875 Bremo Road MOB South Suite 104 Richmond VA 232261934

Physician Practice Pediatric Infectious Disease

5875 Bremo Road MOB South Suite 303 Richmond VA 232261934

Physician Practice BS Pediatric Hematology-Oncology

5875 Bremo Road MOB South Suite 303 Richmond VA 23226

Physician Practice Part I, Line 6a: Bon Secours Richmond Health System (BSRHS) publishes an annual report for the community, explaining the various community benefit services and programs that exist. This report also includes the financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. This report is available online at www.bonsecours.org. Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges recorded in the 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, L7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $16,392,116. Part II: A healthy community liaison (HCL) was employed by St. Mary's Hospital during FY 2013. The purpose of the HCL is to improve community health in targeted neighborhoods by engaging stakeholders and residents to identify and prioritize community needs. Part III, Line 4: Part III, line 2: Bad Debt Expense at cost is computed by applying the cost-to-charge ratio computed on Worksheet 2 to the aggregate bad debt expense for patient accounts recorded in the general ledger. Bad debt expense on the general ledger includes: 1) actual write offs of discounted gross charges where it is determined an uninsured patient can pay and does not pay; and 2) the estimated write offs for uninsured patient accounts with outstanding balances after discount. Estimates are based on historical collection rates.When an uninsured patient is billed for patient care services, the charges are automatically discounted and the patient is requested to only pay the amount after discount. The discount is recorded as an adjustment to gross revenue and is not recorded in bad debt expense. If the balance after discount is not paid or not paid in full, the unpaid amount will be written off to bad debt expense. When a patient remits a payment on an account that has already been written off to bad debt expense, the payment is recorded as a recovery of bad debt, which reduces bad debt expense.Part III, line 3: The organization does not report an estimate for the portion of bad debt expense that may have been likely to qualify for financial assistance under the hospital's charity care policy. The organization takes the position that ample opportunity and assistance is provided to the patient to qualify under the financial assistance policy. If sufficient information is not provided, the organization must assume the patient does not qualify.Part III, Line 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on pages 10-11 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for doubtful accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 41 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Part III, Line 6: 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.Part III, Line 8: 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 Patient Financial Assistance Program (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 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. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 3: Community Survey:An electronic survey using Survey Monkey was developed and administered to 488 community members and partners by Community Health Solutions (CHS). Individuals were invited to participate based on their ability to represent: underserved, low-income and minority population needs; needs of chronically ill patients; and awareness of healthcare needs in their respective communities. A total of 152 (31%) responded, though not all participants completed each question. Participants represented over 60 agencies from across the primary service area, including concerned citizens, faith community leaders, free clinics, physicians, elected officials and governmental servants. Participants were asked to share their viewpoints on:- Important health concerns in the community;- Significant service gaps in the community; - Ideas for addressing concerns and service gaps.To gauge the importance of various health concerns, respondents were asked to identify issues of community concern from a list modified from topics in Healthy People 2010. Respondents were able to enter additional concerns in an open-ended response item. Participants were also asked to review a list of services typically important to addressing health concerns. Respondents were then asked to indicate services that needed to be strengthened in terms of availability, access, or quality. Open-ended response items were provided for participants to indicate additional service gaps in the community and ideas for addressing concerns and service gaps. Priority Needs:The Bon Secours CHNA Community review session facilitated by Becky Clay Christensen of the Clay Christensen Group, separately covered each of the four hospitals within Bon Secours Richmond Health System. This review included: Medical Directors and Associate Medical Directors covering Health Departments for four jurisdictions; Health Department Registered Nurses from two jurisdictions; Chief Operating Officer of a Free Clinic; Executive Director of a Federally Qualified Health Center; Executive Director for Community Health Services; Director of Richmond Promise Neighborhoods. In addition to these community health leaders, the following internal leaders also participated: Senior Vice President of Sponsorship for Bon Secours Richmond; Administrative Director for Community Health Services; Administrative Director for Advocacy; Manager for Evaluation and Sustainability; Manager for Community Nutrition; Two Healthy Community Liaisons. After hearing a presentation on initial findings, which included secondary and survey data, this group discussed and made "dot choices" to help prioritize issues by distributing dots on issues from the report and raised by the group. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 7: Dental Care/Oral Health:Dental Care was identified in the CHNA community survey as a gap. Oral health is important because it can impact general health. Multiple community organizations are engaged in providing dental care services to the uninsured. They include Virginia Commonwealth University's School of Dentistry, Daily Planet, FQHC, Vernon J. Harris FQHC Dental Clinic, CrossOver Ministry and Goochland Free Clinic and Family Services. As such Bon Secours will not be addressing dental needs at this time.Transportation:Other community organizations are better positioned to provide transportation. The Greater Richmond Transit Authority (GRTC) serves the City of Richmond and Henrico County. They have 186 buses and 40 routes. Each bus is equipped with a wheel chair lift. GRTC serves the Richmond Community Hospital campus.GRTC CARE service provides curb-to-curb public transportation to disabled individuals who may not be reasonably able to use the GRTC fixed route bus. It is also available for persons aged 80 or older. Richmond Community Hospital provides limited patient transportation. Patients who reside within a 10-mile radius of the hospital may utilize the patient transport van to reach the hospital campus. This service includes behavioral health patients.Lack of adequate transportation can be a barrier to accessing health care services. The Bon Secours Care-A-Van is a mobile health outreach program providing primary care services in local neighborhoods in the Richmond Community Hospital service area. The Care-A-Van contributes to the elimination of transportation as a barrier to care for uninsured patients. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 12h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part VI, Line 2: BSR contracted with Community Health Solutions (CHS), a local Healthcare Consultant who was recommended by the Virginia Hospital and Healthcare Association (VHHA) to assist with data collection and analysis. Becky Clay Christenson, of The Clay Christensen Group, facilitated conversation to prioritize and vet findings from the initial data collection. Jason W. Smith, PhD, consulted on the CHNA and implementation strategy process, documenting method, analyzing data, and synthesizing components into a public document. The CHNA was conducted during Fiscal Year 2013 (September 1, 2012 to August 31, 2013) in order to prepare documents by the end of the fiscal year. It was determined that existing secondary data, augmented by a key informant survey, would be used to identify and prioritize health indicators. An executive summary and report was then presented to system leadership from Mission and Business Development. Findings were then presented to the St. Mary's Hospital Senior Operations Team for further review and comment. Finally, a presentation was made to the Bon Secours Richmond Health System Board for final approval prior to being made available to the public.Secondary Data:The core of the secondary data analysis was conducted by CHS in order to develop a Community Health Indicator Profile. The analysis intentionally did not include every possible indicator, but instead focused on key metrics that provide a broad insight into community health. Availability of data sources was also considered in selection of content. In many cases, results can be considered in comparison to Virginia averages. Foundational source of data include: Alteryx, Inc.; Virginia Department of Health; hospital discharge data from Virginia Health Information, Inc.; Health Resources and Administration data. In other cases, data was only readily available at the state or national levels and synthetic estimates were created by CHS in order to further develop the community profile. CHS developed statistical models to produce estimates where local data was not available. This analysis was based on the CDC's Behavioral Risk Factor Surveillance Survey; the Virginia Foundation for Youth's Market Decisions' 2010 Obesity Survey; a report produced for Virginia Healthcare Foundation by Urban Institute; and local demographic characteristics obtained by Alteryx, Inc. Because the data is extrapolated, meaningful comparisons to state and national averages cannot be made. Community Input: Input from community members was included in assessing health care needs as described in Part V, Section B, above. 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"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain States, where applicable. 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. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. 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: SMH service area consists of sixty-one zip codes that fall primarily within the countries of Chesterfield, Goochland, Hanover, Henrico and Louisa; and the cities of Petersburg and Richmond. The community of the St. Mary's Hospital primary service area contained 1,230,852 people as of 2010, of which 52% are female and 48% male a population that is expected to grow to 1,293,100 by 2015. Compared to the Commonwealth of Virginia as a whole, this region is more densely populated (329.6 people per sq. mile) and is proportionately more Black/African American (29%). The median income of the community is $58,538, just under the median household income in Virginia of $60,034. The study region also has higher rates of low-income households (28% are Low Income Households with income less than $35,000) and slightly more adults age 25+ with a high school education. Part VI, Line 5: SMH has an open medical staff with privileges available to all qualified physicians in the area. SMH, through the BSRHS is governed by a board of directors whose composition is representative of the community with a majority being comprised of independent members of the community. SMH also engages in medical research. Inpatient and outpatient research-related activities are conducted by SMH with oversight from the BSRHS Institutional Review Board. SMH provides training and education of health care professionals. The Bon Secours SMH's School of Imaging, sponsored by SMH had 30 enrolled students in fiscal year 2013. Noah's Children, located at SMH, is Central Virginia's only pediatric hospice and palliative care program. It is a specialized program of comprehensive care serving infants, children and adolescents who have been diagnosed with a life-threatening illness, and their families. This holistic program ensures compassionate care at the most difficult time for a family by addressing their physical, emotional, social, spiritual and practical needs, so that they can focus on making sure their child's remaining time is as rich and meaningful as possible. In FY 13, 1,041 people were served.The Care-A-Vans are mobile health care clinics, which travel throughout the Richmond Metro area to provide free primary, urgent and preventive care to patients. Patients on these vans speak many different languages. Approximately one-third of the Care-A-Van's staff are bilingual in English and Spanish. Each van is a self-contained mobile clinic with examining rooms, storage, bathroom, and waiting area. Services include health screenings, childhood immunizations, flu shots for adults, school physicals for uninsured children and examination and treatment of sick patients who are uninsured. Patients who need health care from specialists are referred to volunteer physicians within the community including Bon Secours Medical Group physicians. The vans make regular stops six days a week at churches providing 9,578 patient visits in FY 13. Bon Secours Richmond Health System partnered with the Daily Planet, a federally qualified health center and Saint Joseph's Villa for Children, a not-for-profit organization serving children with special needs, at risk youth, and adults with disabilities to create Saint Joseph's Outreach Clinic. The clinic provides primary care services to both the insured and the uninsured and serves a large Hispanic population. In FY 13, 5,469 patient visits were provided. Controlling Asthma in the Richmond Metropolitan Area (CARMA) works to improve the management of pediatric asthma through collaborative partnerships with multiple health care systems, schools, American Lung Association, community physicians and schools, case management organizations, and universities. In FY 13 over 3,911 children, parents, teachers and physicians were directly served through CARMA's services. Every Women's Life (EWL), Virginia Breast and Cervical Cancer Early Detection Program is a partnership with the Virginia Department of Health, with funding through the Centers for Disease Control and Prevention. This program provides breast and cervical cancer screenings and diagnostic testing if needed for low income, uninsured women who are 40 to 64 years old. If cancer is found, women are enrolled in Medicaid for treatment. BSRHS holds clinics in six facilities in the Richmond Metro area. Additionally, BSRHS provides case management, follow-up and patient education for these women. In FY13, 1,007 screenings were provided. BSRHS assists low to moderate-income families whose children may qualify for state-sponsored insurance programs (Medicaid and FAMIS). Partnerships have developed with other agencies that have enrollers to identify and refer uninsured children, avoid duplication of effort, and to share responsibilities for case managing to complete the enrollment process. Three BSRHS outreach specialists enrolled or re-enrolled over 816 children in FAMIS or Medicaid in FY 13.Founded over ten years ago, the Faith Community Health Ministry Network partners with churches to recruit and train volunteer nurses and other health ministers who in turn work to promote physical, social, emotional and spiritual growth within the congregation. BSRHS trains and supports 153 congregational promoters, faith community nurses and other health ministers.The nationally recognized Reach Out and Read (ROR) program provides books for young children when they visit the Care-A-Van. Volunteers transform the sites into literary rich areas for children and parents while helping families learn the joys and techniques of reading aloud. Volunteers distributed 453 books in FY 2013 to children at Care-A-Van sites. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to: - Improve Health Locally and Globally.- Build Partnerships for Population Health. As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and it's related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is "to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSHSI Vision. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world." Please see Schedule R for listings of the related organizations. Reports Filed With States Part VI, Line 7 VA 1 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Building IV Richmond VA 23227 541201346 501(c)(3) 2561600 General Support St Christophers School Foundation 711 St Christopher Road Richmond VA 23226 541727301 501(c)(3) 5000 General Support Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 501(c)(3) 3039727 General Support 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: St. Mary's Hospital of Richmond, Inc. 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. X 1 1 0 1 0 0 0 0 0 0 0 Mark Gordon 0 322518 0 244532 0 42580 0 28121 0 27971 0 665722 0 2450 Michael Robinson 0 403284 0 197269 0 227265 0 15000 0 17855 0 860673 0 112599 Toni Ardabell 0 355659 0 182851 0 58199 0 35226 0 4517 0 636452 0 16500 Peter J Bernard 0 748358 0 507898 0 181825 0 166098 0 26868 0 1631047 0 108845 Melinda S Hancock 251908 0 53362 0 38671 0 3924 0 24044 0 371909 0 0 0 Francine Barr 211898 0 31388 0 836 0 5832 0 642 0 250596 0 0 0 Kathleen Santini 217270 0 32785 0 2606 0 5532 0 18192 0 276385 0 0 0 Bonnie M Shelor 202053 0 55112 0 116903 0 22625 0 8653 0 405346 0 47451 0 Stephan F Quiriconi 172036 0 25943 0 1114 0 3408 0 8703 0 211204 0 0 0 Mark R Bladergroen MD 679893 0 0 0 3894 0 3528 0 17500 0 704815 0 0 0 Matthew L Brengman MD 459498 0 286225 0 1009 0 0 0 31934 0 778666 0 0 0 Christine M Browning MD 418965 0 366703 0 1174 0 12500 0 17498 0 816840 0 0 0 Marc R Katz MD 902774 0 0 0 4902 0 3492 0 30329 0 941497 0 0 0 Gregory L Schroder MD 464433 0 232089 0 1075 0 0 0 24901 0 722498 0 0 0 Peter F Gallagher 0 11452 0 0 0 238784 0 0 0 11760 0 261996 0 0 Michael Kerner 0 475717 0 336924 0 124284 0 106467 0 26303 0 1069695 0 67422 Part I, Line 1a Select executives receive country club memberships primarily for business use and certain business related expenses are reimbursed. Receipts are required to substantiate the amounts elidgible for reimbursement. Part I, Line 3 Bon Secours Health System, Inc., a related organization of St. Mary's Hospital of Richmond, Inc., 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: Peter J. Bernard, $134,024; Michael Robinson, $134,840; Melinda S. Hancock, $3,432; Toni Ardabell, $16,673; Mark Gordon, $2,655; Bonnie M. Shelor, $71,620; Michael Kerner, $80,925. David Cleal Child of Board Member Pete Cleal 70826 Employment 0 Martha E Merchant Married to Key Employee Stephan F. Quiriconi 125000 Employment 0 Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours - Richmond Health, LLC, which in turn holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of St. Mary's Hospital of Richmond, Inc. Form 990, Part VI, Section A, line 7a The governing body of St. Mary's Hospital of Richmond, Inc. is appointed by it's member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of St. Mary's Hospital of Richmond, Inc. 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 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 provides any documents open to public inspection upon request. Avg. hours devoted to related org(s) when related comp is reported: Form 990, Part VII: 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 Richmond Health System, including Bon Secours St. Mary's Hospital, Bon Secours St. Francis Medical Center, Bon Secours Memorial Regional Medical Center and Richmond Community Hospital, are comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer). These governing bodies are referred to as the Richmond Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for all four hospitals). Sr. Anne Marie Mack and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers to Affiliates -3,956,532. Net assets released from restrictions -7,380. Minimum Pension Liability 52,560,791. Bon Secours Health System Inc 1505 Marriotsville Road Marriotsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) 7 Bon Secours Richmond LLC 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Richmond Health System 0 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 0 Bon Secours Stuart Circle Hospital 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Health Corporation 8580 Magellan Parkway Richmond VA 23227 541356155 Management Services VA 501(c)(3) 11b Bon Secours Health System Inc 0 St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA N/A Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA N/A C 0 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA N/A C 0 Bon Secours - Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA N/A C 0 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0