2013-07-15T18:38:34-05:00 2012-08-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-09-01 540548200 Mary Immaculate Hospital MARY 7576866000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner 7578895000 2013-07-15 1 David A Craig P00542227 7032511000 2011 2016-02-24 21:20:13Z Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 185178965 0 0928 X www.bonsecourshamptonroads.org X 1956 VA Acute Care Hospital 18 16 1077 155 298585 48003 314579 2721787 177100093 179297332 2206357 966129 2279877 2170737 181900906 185155985 11928 29302 0 0 49881851 51703452 0 0 0 113839736 115925849 163733515 167658603 18167391 17497382 154385895 179981353 30951982 39468341 123433913 140513012 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 38594248 42515992 Orthopedics is center of choice for orthopedic care in the Virginia Peninsula and beyond. It includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-if-the-art technology and expert physicians, as well as a comprehensive rehab network. 9171029 10472961 Cardiovascular services - a comprehensive Early Detection Center, aimed at identifying cardiac disease early and referring patients to physicians as necessary for prompt and effective treatment, strong relationships with other Bon Secours hospitals for the delivery of advanced cardiac interventions, such as cardiac surgery, and a large community outreach program. A new state-of-the-art cardiac catheterization laboratory will be installed at Mary Immaculate in mid-2013, enhancing physicians' ability to better manage and treat cardiac disease in area patients. 12806725 9718927 Women and children services provided added capacity and resources so that the needs of the community for OB care would continue to be met. Mary Immaculate also offers advanced nursery services through a neonatal specialty care nursery. Bon Secours also offers the largest curriculum of family and parenting classes through its Love & Learn program. In the last year, Mary Immaculate expanded its gynecology offering by introducing gynecological oncology services (board certified and fellowship trained surgeon) and an infusion center for women suffering from such cancers. 92242574 29302 116345510 Major services offered by Mary Immaculate include the Hernia Center which is a comprehensive program dedicated to treating hernias. The program specializes in developing treatments based on each patient's individual needs. The program uses the latest innovations and performs many of it's procedurws using state-of-the-art, minimally invasive techniques. In addition, Mary Immaculate offers Neuroscience, Gastroenterology and Pulmonary services as well as a full service 24 hour Emergency Room. See Sch H for additional information. 92242574 29302 116345510 152814576 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 71 0 1 1077 1 1 1 0 0 0 0 1 1 0 0 0 0 X 18 16 0 0 0 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 Susan B Anthony FNP 4.00 X 0 0 0 Alejandra Arnold 4.00 X 0 0 0 Sr Elaine Davia 4.00 X 0 0 0 Timothy J Davis 50.00 X 0 600441 184863 Pastor Ivan T Harris 4.00 X 0 0 0 Sr Patricia Heath 50.00 X 0 0 0 Steven B Hopson MD 4.00 X 0 1375 0 Sr M Margaret Jackson 4.00 X 0 0 0 Matthew James 4.00 X 0 0 0 Sr Lynn Rachelle Pascoe 4.00 X 0 0 0 William F Pile 4.00 X 0 0 0 Sr Christen Shukwit 4.00 X 0 0 0 Robert M Yacobi 4.00 X 0 0 0 Paul W Garman 6.00 X X 0 0 0 John H Garrett 4.00 X X 0 0 0 Michael K Kerner 50.00 X X 0 492621 187822 Sr David Ann Niski 6.00 X X 0 0 0 Jon A Nystrom 6.00 X X 0 0 0 Melinda Hancock 50.00 X 0 292838 33668 Ernie Padden 50.00 X 0 195000 0 Patricia Robertson 50.00 X 0 327698 39138 Thomas J Hoffmier 50.00 X 332005 0 28628 Nauman Naseer 50.00 X 441397 0 63249 Allen B Nichols 50.00 X 505657 0 34259 James H Sammons 50.00 X 291205 0 46891 Anthony D Terracina 50.00 X 910191 0 61323 Joseph Buchheit 50.00 X 0 268350 40227 2480455 2178323 720068 28 1 1 0 Rehabcare Group Inc PO Box 502096 St Louis MO 631502096 Rehabilitation Services 2908592 Tidewater Physicians Multispecialty Grou 860 Omni Blvd 304 Newport News VA 23606 Physician Services 1674043 Anesthesia Associates of Hampton 110 Three Point Ct Yorktown VA 23692 Physician Services 1500000 Origin Inc dba Shiftwise PO Box 70870 St Paul MN 551709705 Contract Nursing 1037071 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 962164 22 18766 54890 2523635 124496 2721787 Patient Service Rev. 622110 179297332 179053390 243942 179297332 575498 575498 7028 7028 77153 3553 12098 0 65055 3553 68608 20345 48263 357163 26440 0 0 357163 26440 383603 383603 33239 18766 10882 22357 22357 Joint Venture Income 900099 1351247 1351247 Cafe/Vending/Dietary 900099 292737 292737 Managed Care/Rehab Svc 900099 212745 212745 223043 34298 188745 2079772 185155985 179053390 298585 3082223 17725 17725 11577 11577 181612 163588 18024 41227832 37105049 4122783 1843083 1658775 184308 4758538 4282684 475854 3692387 3323148 369239 185540 166986 18554 138333 124500 13833 32185 28967 3218 9409551 8468458 941093 201834 181651 20183 1651899 1486709 165190 210758 189682 21076 3145628 2831065 314563 78157 70341 7816 28321 25489 2832 1561144 1561144 2752233 2477010 275223 1213591 1092232 121359 Medical Supplies 46811408 42130267 4681141 Purchased Services 25884123 23295711 2588412 Bad Debt 17627891 17627891 BSHSI Allocation 2627136 2364422 262714 2366117 2129505 236612 167658603 152814576 14844027 0 2855 2955 70436974 79452701 0 95782 20081011 21741465 3481390 3947664 279916 408341 85125505 51536218 29391652 33589287 26248865 26428069 0 1738260 0 81069 4463232 12495760 154385895 179981353 11181409 14035856 1479106 1471122 12213380 11361907 6078087 12599456 30951982 39468341 X 122861414 139822964 524352 645178 48147 44870 123433913 140513012 154385895 179981353 X 17497382 -418283 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 17266 0 1 14919 32185 0 Explanation of Lobbying Activities: Part II-B, Line 1: Mary Immaculate Hospital paid dues to the American Hospital Association (AHA), the Virginia Hospital and Healthcare Association (VHHA) and the Catholic Health Association (CHA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations is as follows: AHA $4,463 or 24.6%, VHHA $9,213 or 24.37% and CHA $1,243 or 4.68%. The filing organization also conducted advocacy relating to education of legislative body regarding hospital and healthcare reform and how it impacts communities. 48147 384 3660 44871 50349 2202 48147 28574 22025 250 50349 112350 -83276 500 28574 1.00000 0 0 3352921 3352921 33915772 17146100 16769672 390703 134268 256435 42703495 33341559 9361936 4762614 914291 3848323 33589287 Deferred Fin Costs 706247 Due from Affiliates 226323 3rd Party Payors 729366 Accrued Revenue 2422396 LT Rec - Mary Immaculate Medical Pavillion 2691432 LT Non-Cash Inv - HPL/GL 5719996 12495760 LT Liab-Pension Liability 4347969 Fin 47 LT Asbestos Liab 1675062 Other Gen 3rd Party Rsvs LT 412169 Due to Affiliates 76273 Due to BSHSI 19864 HPL/GL Liability 5719996 Other Liabilities 348123 12599456 Description of Intended Use of Endowment Funds: Part V, Line 4: Earnings are to used to assist the needy. Description of Uncertain Tax Positions Under FIN 48: Part X: 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 FIN 48). ASC 740 (formerly FIN 48) 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 FIN 48) 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 (formerly FIN 48). 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 $95,733 and $89,500 of net operating loss carryforwards as of August 31, 2012 and 2011, 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, 2012 and 2011. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Gala 29558 4766 24792 1312 Golf 22447 14000 8447 6300 3270 52005 18766 33239 6300 1312 3270 10882 22357 1 1 1 X 1 X 1 1 1 0 1 1 2169127 2169127 0.01450 12939963 9946290 2993673 0.02000 1283923 958496 325427 0.00220 16393013 10904786 5488227 0.03670 10 5177 288749 5547 283202 0.00190 2 391 74583 74583 0.00050 9 5758 112522 112522 0.00070 21 11326 475854 5547 470307 0.00310 21 11326 16868867 10910333 5958534 0.03980 1 4758 4758 0.00000 1 35 393 393 0.00000 1 23 11495 11495 0.00010 3 58 16646 16646 0.00010 1 4012167 46801661 50812674 -4011013 X 1 1 1 Mary Immaculate ASC LLC Outpatient Surgery 0.34140 0.49340 1 1 Mary Immaculate Hospital

2 Bernardine Dr Newport News VA 23602

X X X X Mary Immaculate Hospital 1 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 7 Mary Immaculate Phys Therapy Denbigh

14703 Warwick Blvd Suite B Newport News VA 23608

Physical Theraphy In-Motion Boo Williams Sportsplex

5 Armistead Pointe Parkway Hampton VA 23666

Physical Theraphy Mary Immaculate Phys Therapy Victory

101-A Long Green Blvd Yorktown VA 23693

Physical Theraphy Cardiovascular Speciallists

12720 McManus Blvd Ste 201 Newport News VA 23602

Physician Practice Tidewater Surgical Specialists

12720 McManus Blvd Ste 311 Newport News VA 23602

Physician Practice Bon Secours Pulmonary Specialists

12720 McManus Blvd Ste 303 Newport News VA 23602

Physician Practice Bon Secours Occumed

14703 Warwick Blvd Suite A Newport News VA 23608

Occupational Medicine 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 will available to the public each year at www.bshr.com on or about February 15, 2013. 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: $17,627,891 Part II: Mary Immaculate Hospital provided facility space, dietary contributions and staff support to local community boards, coalitions, and civic groups to discuss and address health and social concerns across the community. These meetings enabled various community groups to plan programs and activities to improve the health of community residents across different health and social conditions. 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 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 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 Patient 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 V,Line 11h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part V, Line 13g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part V, Line 19d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part VI, Line 2: In partnership with Bon Secours Virginia Health System, Mary Immaculate Hospital 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 Mary Immaculate Hospital. National Research Corporation (NRC) is 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"), 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: As of 2010, Hampton Roads is a very diverse community within an MSA of nearly 1.6 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 52.2% of the population in Portsmouth, 41.6% in Newport News, and 43.4% of Norfolk and 19.3% of Virginia Beach, which far exceeds the national average of 31.5%. Seniors currently account for 11.2% of the population, growing to 13% in the next five years.The population served by Mary Immaculate Hospital (MIH), Newport News, VA is estimated to change from 463,658 to 503,313, resulting in a growth of 8.6% between 2000 and the current year. Over the next five years, the population is projected to grow by 2.4%. Of this area's current year estimated population, 59.2% are White, 33.3% are Black or African American, and 4.5% are Hispanic or Latino and small percentages of other ethnicities. The current year median age for this area is 37.1, while the average age is 37.8. Five years from now, the median age is projected to be 38.0.The most prevalent chronic conditions among adults include high cholesterol (71,100 or 33.2%), high blood pressure (67,000 or 26.9%), arthritis (61,000 or 23.4%), asthma (29,800 or 11.9%), and diabetes (16,000 or 6.3%). Morbidity rates per 10,000: heart disease (92.0), cerebrovascular disease (25.3), chronic obstructive pulmonary disease (10.1), diabetes (12.0) and asthma (10.0). Mortality rates (age-adjusted per 100,000) for this area are cancer (166.4), ischemic heart disease (110.6), cerebrovascular disease (41.8) and chronic obstructive pulmonary disease (33.2). Part VI, Line 5: MIH has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/day, 7days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located. MIH, through BSHR, offers CARE-A-VAN services to the community. The Care-A-Van (CAV), initiated on the peninsula in 2009 at two sites, has expanded in the past year to seven sites, two in Norfolk, two in Portsmouth and three in Newport News. This is a mobile health unit that provides healthcare services to those most in need-the uninsured. 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 children's health insurance. The Care-A-Van also offers sports physicals, children's health insurance enrollment, and health education services. While the CAV primarily serves adults, some sites do provide care and referral services for children aged 12 and older. Community partners include free clinics, local health agencies, and numerous Faith-based community organizations which collaborate with the Care-A-Van staff. The CAV has a staff of 10 FTEs and annual expenses of approximately $700,000.MIH, through BSHR, offers Bon Secours Senior Health Program which offers a free membership program to over 75,000 individuals 65 years and older. A key component is the Successful Aging Forum, which brings national speakers to the community to discuss the latest health and wellness topics for senior citizens. The annual HealthFest provides a seniors-focused health festival with health screenings, health information and social interaction for seniors of all socio-economic backgrounds. Friday Night Dinners, held at area hospitals, serve seniors who need low cost meals and socialization. A transportation program offers transportation to medical appointments, without charge to those who are financially challenged. A quarterly publication Good Health provides information to 75,000 members in Hampton Roads. Seniors 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). MIH supports and provides staffing for the BSHRHS Faith Community Health Ministry which builds on the skills of the registered nurse 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. BSHRHS employs a sole Director to provide education, mentoring and support to more than 130 faith communities and 232 registered nurses and lay health promoters.MIH Family Focus is a child abuse prevention program of MIH, which targets at-risk families for child abuse and helps teach positive parenting skills. MIH employs the director for the program and provides operating funds for two locations. Family Focus, founded by BSHSI and the Bernardine Sisters of the Third Order of St. Francis, is a broad coalition of private and public organizations that provide a continuum of education, prevention and support programming for over 500 families to encourage healthy child development and nurturing environments in the home and community. In FY 11 the program was expanded to include services for Spanish-speaking families.BSHRHS' Community Sponsorship Committee reviews and financially sponsors community events that support our mission and values. Some of the contributions in FY 11 that support the work of MIH in addressing unmet need include:- H.E.L.P. Free Dental Clinic to partially subsidize the cost of dental supplies to provide services to uninsured adults- The Arc of the Virginia Peninsula to continue serving individuals with developmental and other disabilities and their families- American Heart Association heart healthy initiatives- American Cancer Society Relay for LifeMIH is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. We provide community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.MIH offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Several seminars on clinical ethics were also offered to professionals in the area. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, 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 four goal areas for the current three year period (2010-2012). One of those goals was to partner with communities to co-create a more humane world, improve health and model social justice. To accomplish this, two key strategies are to: - Engage communities to identify needs and assets and building partnerships to improve health and quality of life of a specific population.- Demonstrate sustainable stewardship for healing the earth as a way to improve health and life quality.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 Project Care of the Greater Virginia Peninsula Inc 416 J Clyde Morris Boulevard Newport News VA 23601 273518508 501(c)(3) 8475 General Support 1 0 Benevolence Fund 71 11577 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: 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 J Davis 0 592854 0 0 0 7587 0 160480 0 24383 0 785304 0 0 Michael K Kerner 0 487110 0 0 0 5511 0 154116 0 33706 0 680443 0 0 Melinda Hancock 0 254357 0 5017 0 33464 0 4898 0 28770 0 326506 0 0 Ernie Padden 0 195000 0 0 0 0 0 0 0 0 0 195000 0 0 Patricia Robertson 0 292448 0 0 0 35250 0 25253 0 13885 0 366836 0 9750 Thomas J Hoffmier 269549 0 58750 0 3706 0 8314 0 20314 0 360633 0 0 0 Nauman Naseer 440688 0 0 0 709 0 30519 0 32730 0 504646 0 0 0 Allen B Nichols 443469 0 55800 0 6388 0 8314 0 25945 0 539916 0 0 0 James H Sammons 289670 0 0 0 1535 0 28250 0 18641 0 338096 0 0 0 Anthony D Terracina 468164 0 440983 0 1044 0 30990 0 30333 0 971514 0 0 0 Joseph Buchheit 0 232474 0 13123 0 22753 0 18475 0 21752 0 308577 0 0 Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Maryview Hospital, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent compensation consultant Written employment contracts Compensation survey or study Approval by the board/compensation committee Supplemental Information Part III Part I, Line4b: 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: Patricia Robertson, $9,923 Form 990, Part VI, Section A, line 6 The General Minister and General Council of the Bernardine Sisters of the Third order of St. Francis and Bon Secours Health System, Inc. are the members of Mary Immaculate Hospital. Form 990, Part VI, Section A, line 7a The governing body of Mary Immaculate Hospital is appointed by both members, with Bon Secours Health System, Inc. having the majority vote. Form 990, Part VI, Section A, line 7b Certain authorities of Mary Immaculate Hospital are reserved to its members. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS's rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of director's and compensation committee minutes. Form 990, Part VI, Section b, Line 15b - Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 Mary Immaculate Hospital provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officer's and director's hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Volunteer Board Members are not compensated for their time. Michael K. Kerner's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of Bon Secours Hampton Roads Health System which includes direct management, monitoring and oversight of Bon Secours Hampton Roads Health System and its related organizations. Melinda Hancock's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization of Bon Secours Health System, Inc. The compensation she receives is for her role as the Chief Financial Officer of Bon Secours Virginia Health System which includes direct financial management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Ernie Padden's compensation was paid by Maryview Hospital, a related organization. The compensation he received was for his role as the Chief Financial Officer of Bon Secours Hampton Roads Health System which includes direct financial management, monitoring and oversight of Bon Secours Hampton Roads Health System and its related organizations. Timothy J. Davis' compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as Executive Vice President and Chief Administrative Officer of Bon Secours Health System, Inc. Patricia Robertson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Executive Vice President of Mary Immaculate Hospital and both nursing care facilities in the Hampton Roads Health System. Sr. Patricia Heath does not receive payroll distributions as she has taken a vow of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,148,891. BSHSI - Debt/Principal Payment: -1,127,982. Add'l Minimun Pension Liability: -435,742. Error Suspense -3,450. Total to Form 990, Part XI, Line 5: -418,283. Mary Immaculate Hospital Auxiliary 2 Bernadine Drive Newport News VA 23602 546040266 Auxiliary VA 501(c)(3) 11c-FI N/A 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) 11c-FI Mary Immaculate Hospital 1 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 1 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) 11b Bon Secours Health System Inc 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) 9 Bon Secours Hampton Roads Health System 0 Bayley Properties 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541424748 Rental VA 501(c)(2) N/A Bon Secours DePaul Medical Center 1 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 1b Bon Secours Inc 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) 11c-FI Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) 11c-FI Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Suite 108 Suffolk VA 23707 540506463 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Livivng VA Professional Health Care Mgmt Related 0 0 Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Livivng VA Professional Health Care Mgmt Related 0 0 Professional Health Care Mgmt Inc 7007 Harbourview Blvd Suite 108 Suffolk VA 23435 541241031 Administrative VA Hampton Roads Health System Inc C Tidewater Diversified Inc 7007 Harbourview Blvd Suite 108 Suffolk VA 23435 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C OSF Inc 7007 Harbourview Blvd Suite 108 Suffolk VA 23435 541369919 Rental VA Mary Immaculate Hospital Inc C 1.00000 0 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0