2013-07-15T18:17:33-05:00 2012-08-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-09-01 540506463 Maryview Hospital MARY 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Sr Patricia Heath 7576735920 2013-07-15 1 David A Craig P00542227 7032511000 2011 2016-02-24 21:20:13Z Maryview Medical Center Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 360500385 0 0928 X www.bonsecourshamptonroads.org X 1944 VA Acute Care Hospital 18 16 2171 165 1309962 0 937247 1792137 310769214 349750492 12258808 2613278 4480057 4873181 328445326 359029088 270655 234495 0 0 117143948 155494499 0 0 0 200888115 197418395 318302718 353147389 10142608 5881699 238577278 253707979 115419109 124848980 123158169 128858999 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 32166870 37757342 Maryview continues a strong focus on orthopaedic care for residents of Western Hampton Roads. Maryview was recently recognized as a Blue Distinction Center of Excellence to attest to the excellence of care. This service 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 outpatient rehab network. Maryview also offers Bon Secours' only inpatient acute rehab services for those who need that extra level of care before being discharged gome. In addition, a strong focus exists on community education through seminars and classes. 33510843 34765815 Maryview continues to commit significant resources to the care of cardiac patients. The comprehensive Early Detection Center, aimed at identifying cardiac disease early and referring patients to physicians as necessary for prompt and effective treatment, continues to serve area residents. In addition, the introduction of the One-Call Transfer center (for cardiac and other patients) and relationships with transport services make it easier to operate Maryview as a regional referral center for advanced cardiac services. Maryview offers the broadest continuum of cardiac services - from diagnosis to treatment to surgery (including open heart) to rehab to wellness. Maryview continues strong relationships with other Bon Secours hospitals and serves as a regional referral center for the delivery of advanced cardiac interventions, such as cardiac surgery. Maryview is the only Bon Secours facility with a dedicated electrophysiology laboratory. A 64-slice CT at Maryview's ambulatory campus rounds up cardiac services. In addition, a strong focus also exists on community education through seminars, classes, screenings, and special events. Bon Secours Maryview Medical Center has been reconized as UnitedHealth Premium cardiac specialty center for Interventional Cardiac Care and has received a three out of three star rating. This past year, Maryview was re-certified as a Primary Stroke Center and also earned Chest Pain Center with PCI deisgnation. Maryview's ambulatory campus receievd Chest Pain Center accreditation. 21872387 20246810 For the sixth year in a row, Maryview was named the top hospital for bariatric surgery in Virginia by Healthgrades, and among the top 5% in the nation. Maryview also operates a Center of Excellence for colorectal surgery as a result of significant physician and staff expertise with colon & rectal diseases. Maryview also uses the daVinci surgical robot to perform minimally invasive surgical procedures in several specialties including urology, gynecology, gynecology oncology and general surgery. 233435424 234495 256827599 Other major services offered by Maryview include a Birthing Center, Cancer Center, Neuroscience Center, Behavioral Medicine, Gastroenterology and Pulmonary services. In addition, Maryview offers a full service 24 hour Emergency Room, Surgical Weight Loss Center, Home Care and Hospice services. 233435424 234495 256827599 320985524 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 240 0 1 2171 1 1 1 0 0 0 0 0 0 0 0 0 X 18 16 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Michael D Blount 4.00 X 0 0 0 J Robert Bray 4.00 X 0 0 0 Bruce Britton MD 4.00 X 0 0 0 Arthur L Collins 4.00 X 0 0 0 Sr Elaine Davia 4.00 X 0 0 0 Timothy J Davis 50.00 X 0 600441 184863 William H Kline 4.00 X 0 0 0 Michael S LaRock 4.00 X 0 0 0 Mary Jane Nero 4.00 X 0 0 0 Carol Ormond 4.00 X 0 0 0 P Ward Robinette Jr 4.00 X 0 0 0 R B Seal MD 4.00 X 0 0 0 Robert Squatrito MD 4.00 X 0 0 0 Deborah K Stearns 4.00 X 0 0 0 Sr Rita Thomas 4.00 X 0 0 0 Sr Patricia Heath 50.00 X X 0 0 0 Linwood E Howard 6.00 X X 0 0 0 Michael K Kerner 50.00 X X 0 492621 187822 Melinda Hancock 50.00 X 0 292838 33668 Joseph M Oddis 50.00 X 0 378950 52515 Ernie Padden 50.00 X 195000 0 0 Steven C Blasdell 50.00 X 673068 0 42480 Jun K Chung MD 50.00 X 689979 0 47870 Mark B Kerner MD 50.00 X 1260594 0 42557 Ernesto Luciano-Perez 50.00 X 798743 0 48595 Aaron L Marlow MD 50.00 X 870676 0 28257 Joseph Buccheit 50.00 X 0 268350 40227 Susan MacLeod 0.00 X 0 127534 11231 4488060 2160734 720085 137 1 1 0 Rehabcare Group East Incorprated PO Box 502096 St Louis MO 631502096 Rehabilitation Services 9748212 Free Agents Marketing 10124 West Broad St Ste N Glen Allen VA 23060 Advertising Services 3898784 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering Services 2375910 Origin Inc dba Shiftwise PO Box 70870 St Paul MN 551709705 Contract Nursing Services 1919091 Virginia Anesthesia & Perioperative Care 760 Pilot House Dr Newport News VA 23606 Cardiac Anesthesia Coverage 1349752 52 209023 1583114 1792137 Patient Service Rev. 622110 349750492 349597566 152926 349750492 1472019 1472019 45 45 1437869 1375297 62572 62572 45903 16669 1199105 38109 0 96000 1199105 -57891 1141214 1141214 CBO Billing Fees 900099 1057297 1057297 Misc JV Income 900099 1020411 1020411 O/P Pharmacy 900099 759055 759055 1973846 53836 1920010 4810609 359029088 349597566 1309962 6329423 234495 234495 314964 283468 31496 125324908 112792417 12532491 5703608 5133247 570361 14786111 13307500 1478611 9364908 8428417 936491 1056746 951071 105675 150517 135465 15052 53424 48082 5342 25148758 22633882 2514876 3432528 3089275 343253 4316522 3884870 431652 16332161 14698945 1633216 9464810 8518329 946481 970707 873636 97071 362921 326629 36292 2811308 2811308 10264603 9238143 1026460 3380113 3042102 338011 Supplies 47854221 43068799 4785422 Bad debt 28482939 28482939 Purchase Services 27634407 24870966 2763441 Equipment Rental 3713476 3342128 371348 11988234 10789411 1198823 353147389 320985524 32161865 0 0 9094 21277267 3212185 0 24000 34490077 36986079 276242 87516 4630984 5566202 2381524 2743093 214787669 155282168 51518196 59505501 78625973 85087790 92172 603213 2703179 2703179 42581664 57180127 238577278 253707979 40358720 32616401 23845548 24445548 51214841 67787031 115419109 124848980 X 123072707 128737701 85462 121298 123158169 128858999 238577278 253707979 X 5881699 -180869 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 27577 0 1 25847 53424 0 Explanation of Lobbying Activities: Part II-B, Line 1: Maryview 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 $7,480 or 24.6%, VHHA $15,592 or 24.37%, CHA $2,038 or 4.68%, National Association for Home Care & Hospice (NAHC), $343 or 10% and Virginia Association for Home Care & Hospice (VAHC) $394 or 9.2%. The filing organization also conducted advocacy relating to education of legislative body regarding hospital and healthcare reform and how it impacts communities. 0 0 4636569 4636569 81991641 53741406 28250235 10618486 6067656 4550830 78281040 63187782 15093258 39259933 32285324 6974609 59505501 Due from BSHSI-LT 25358440 Due from BSHSI-ST 9363 Due from Affiliates ST 15078346 Fin/Issue Costs 223211 Inv in VHN 647832 LT Non-Cash Inv-HP/GL 11214177 Misc AR Clearing Account 818014 Accrued Revenue 1152918 Due from Third Party 2559179 Other Current Assets 118647 57180127 Due to Affiliates 12167140 Due to BSHSI 13425566 Other Accrued Expense 4577514 LT Pension Liability 20290521 Other Long-Term Deferred Rent 2719316 Fin 47 LT Asbestos Liability 3110478 HPL/GL Liability 11214177 Other Liabilities 282319 67787031 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 to FIN 48). ASC 740 (formerly to 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 to 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 to 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. 1 1 1 X 1 X 1 1 1 0 1 1 12283778 504960 11778818 0.03630 27887945 18996125 8891820 0.02740 658649 420708 237941 0.00070 40830372 19921793 20908579 0.06440 21 17435 1350091 1295 1348796 0.00420 3 584 2328901 892923 1435978 0.00440 2 10177 954355 954355 0.00290 0.00000 14 6368 456571 456571 0.00140 40 34564 5089918 894218 4195700 0.01290 40 34564 45920290 20816011 25104279 0.07730 0.00000 1 3220 3220 0.00000 1 478 6555 6555 0.00000 1 2275 142082 142082 0.00040 0.00000 1 37 567 567 0.00000 0.00000 1 10 2704 2704 0.00000 0.00000 5 2800 155128 155128 0.00040 1 7741451 81580758 78128773 3451985 X 1 1 3 BS Surg Ctr at Harbourview LLC Outpatient Surgery 0.41830 0.37100 1 1 Maryview Hospital

3636 High St Portsmouth VA 23707

X X X X Maryview Hospital 1 0 0 0 0 0 0 0 0 0 0 0 33 Bon Secours Health Ctr at Harbourview

5818D Harbour View Blvd Suffolk VA 23435

Imaging, ER, Physical Therapy & Other OP Services BS Health Ctr at Harbourview MAB

5838 Harbourview Blvd Chesapeake VA 23321

OP Cardiology & Physical Therapy Services VA Orthopedic & Spine Specialists

5838 Harbourview Blvd Suite 100 Portsmouth VA 23707

Physician Practice Cardiovascular Specialists

5838 Harbour View Blvd Suite 270 Suffolk VA 23435

Physician Practice Tidewater Surgical Specialists

5838 Harbour View Blvd Suite 240 Suffolk VA 23435

Physician Practice In Motion at Chesapeake Square

4300 Portsmouth Blvd Suite 200 Chesapeake VA 23321

Physical Therapy The Center for Pain Management

3315 High St Portsmouth VA 23707

Physician Practice Chenault-Ostroff Urology

4037 Taylor Road Suite A Chesapeake VA 23321

Physician Practice In Motion PT Suffolk

2012 Meade Parkway Suffolk VA 23434

Physical Therapy Western Branch OBGYN

4057 Taylor Road Suite R Chesapeake VA 23321

Physician Practice In Motion PT High Street

3300 High Street Portsmouth VA 23707

Physical Therapy In Motion PT Portsmouth Blvd

5553 Portsmouth Blvd Portsmouth VA 23701

Physical Therapy Harbour View Family Practice

5818 Harbour View Blvd Suite B2 Suffolk VA 23435

Physician Practice In Motion PT Portsmouth YMCA

4900 High St West Portsmouth VA 23703

Physical Therapy Internists of Churchland

4041 Taylor Road Suite G Chesapeake VA 23321

Physician Practice Nansemond Suffolk Family Practice

2897 Bridge Road Suffolk VA 23435

Physician Practice Western Branch Family Practice

3253 Taylor Road Suite 200 Chesapeake VA 23321

Physician Practice Internists at Western Branch

4020 Raintree Road Suite B Chesapeake VA 23321

Physician Practice Bon Secours Pulmonary Specialists

4053 Taylor Road Suite N Chesapeake VA 23321

Physician Practice Bon Secours Neuroscience Center

3640 High St Suite 1A Portsmouth VA 23707

Physician Practice Eagle Harbor Medical Associates

13609 Carrollton Blvd Suite 11 Carrollton VA 23314

Physician Practice In Motion PT Eagle Harbor

13609 Carrollton Blvd Suite 115 Carrollton VA 23314

Physical Therapy In Motion PT Chilled Ponds

1416 Stephanie Way Chesapeake VA 23320

Physical Therapy Portsmouth Medical Associates

3520 High Street Suite 100 Portsmouth VA 23707

Physician Practice Cardiology Associates

301 Goode Way Suite 102 Portsmouth VA 23704

Physician Practice Cardiology Associates

1030 Hillpoint Blvd N Suffolk VA 23434

Physician Practice Virginia Orthopedic & Spine Specialists

3300 High Street Suite 1 Portsmouth VA 23707

Physician Practice Virginia Orthopedic & Spine Specialists

2012 Meade Parkway Suffolk VA 23434

Physician Practice The Spine Center of Hampton Roads

Mast One 1040 University Blvd Suite 20 Portsmouth VA 23703

Physician Practice Cardiovascular & Thoracic Specialists

3636 High Street Portsmouth VA 23737

Physician Practice Delta Oncology Associates

104 Palmyra Drive Suffolk VA 23434

Physician Practice Delta Oncology Associates

612 Kingsborough Square Suite 300 Chesapeake VA 23320

Physician Practice Delta Oncology Associates

355 Crawford Street Suite 300 Portsmouth VA 23704

Physician Practice 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): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $28,482,939. Part II: Bon Secours Maryview Medical Center provided staff and resources in support of the Healthy Community Initiative of Bon Secours Health System, and advocated for local and state policies that would improve health across its communities. Bon Secours Hampton Roads Health System is working to engage and empower the members of the East Ocean View neighborhood to support them in improving their quality of life and holistic health. East Ocean View has historically been one of the roughest neighborhoods in the community. Among the 6,000 residents, more than 25% of the households are at or below the poverty level and over 20% are single parent households. Family violence, gangs, addictions, housing affordability, access to healthcare, and a lack of educational opportunities affect the health of the individuals living in the neighborhood. Maryview Medical Center donated staff time and resources in support of these efforts. 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, Section B, Line 7: While Maryview Hospital shows a Medicaresurplus on this Schedule H, it is due to the unique composition of thehospital, the high percent of uncompensated care and the Medicare costreport allocation of indirect costs which is used in this tax schedulecomputation. Compared to other hospitals, Maryview Hospital is unique inthat it has several non-provider based physician practices residing on thehospital company rather than on a separate company. Using the Medicarecost report as the basis for reporting Medicare allowable costs, thepredetermined step-down statistical bases are allocating significantoverhead costs to the nonallowable physician practices, artificiallylowering allowable costs to the Medicare centers. Similar hospitals thatdo not include physician practices in the same company, these sameoverhead costs are included as allowable Medicare costs. Maryview alsoreceives significant Medicare disproportionate share (DSH) payments, whichare intended to partially compensate hospitals for the uncompensated carethat arises from serving an usually large percentage of uninsured,low-income patients in their area. While these payments are a componentof Medicare reimbursement, they do not relate to the Medicare allowablecosts reported in line 6, but are more closely related to the Medicaidshortfall reported in Part I, Line 7 b, column (e). Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending 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, Section B, Line 11h: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy.Part V, Section B, Line 11h: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy.Part V, Section B, Line 19d: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy. Part VI, Line 2: In partnership with Bon Secours Virginia Health System, Maryview Medical Center uses multiple approaches to assess the health needs of the communities it serves.Health care needs of the community are assessed and updated using a variety of informational sources including Virginia Health Information for state-based performance data, Health Group West and Hammes Company for market and geographic data. Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to Maryview Medical Center. National Research Corporation (NRC) 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 Bon Secours Maryview Medical Center (MMC), Portsmouth, VA is estimated to change from 793,898 to 855,730, resulting in a growth of 7.8% between 2000 and the current year. Over the next five years, the population is projected to grow by 2.2%. Currently the largest populations are white (58.8%), Black or African American (32.6%), Hispanic or Latino (4.7%) and Asian (3.5%). The current year median age for this area is 35.0, while the average age is 36.2. Five years from now, the median age is projected to be 35.8.The most prevalent chronic conditions among adults include high blood pressure (26,400 or 40.1%), high cholesterol (20,900 or 33.3%), arthritis (22,000 or 33.3%), diabetes (8,700 or 12.9%), and asthma (7,000 or 10.3%). Morbidity rates per 10,000: heart disease (159.5), cerebrovascular disease (33.4), chronic obstructive pulmonary disease (29.4), diabetes (26.3), and asthma (17.5). Mortality rates (age-adjusted per 100,000) for this area are cancer (205.2), ischemic heart disease (150.5), cerebrovascular disease (66.9), and chronic obstructive pulmonary disease (43.9). Part VI, Line 5: Maryview Medical Center (MMC) 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.MMC, through BSHR, offers Home Health and Hospice Care. One-on-one care is provided to help patients recover from an illness or injury or to assist with daily living activities and pain management. Services include care coordination, physical therapies, diet education, intravenous therapy, medical/surgical care, nursing instruction, skilled clinical evaluation and wound care. MMC, through BSHR, offers health services via the CARE-A-VAN. 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.MMC, 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). MMC supports the 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. The Let's Get Real (LGR) Program was created by BSHRHS in response to alarming data revealing an excessively high death rate from heart disease among African Americans in Hampton Roads. LGR is a heart health community outreach and education campaign specifically designed to bring valuable information to African-American women and their families. The goal is to raise awareness and lower risk factors for heart disease through culturally sensitive education, healthy cooking demonstrations, baseline and follow-up health screenings & risk-factor assessments and physical activity with an ethnic flair. Program components are centered on Cooking Light nutrition seminars and Tree of Life family history/genealogy research. The Maryview Foundation Healthcare Center is located adjacent to BSMMC's emergency department. The Center provides primary and preventive care for Portsmouth residents who are uninsured and meet the financial guidelines of 200% of the federal poverty level and below. The center provides prescription assistance; a wellness program, blood pressure checks and other services. MMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. MMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.MMC offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Several seminars on clinical ethics were also offered to professionals in the area. 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 Bon Secours Maryview Foundation 7007 Harbour View Blvd No 108 Suffolk VA 221024219 521694731 501(c)(3) 234495 Foundation Administrative expense paid by the Hospital 1 0 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. 1 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 Joseph M Oddis 0 324070 0 0 0 54880 0 16223 0 36292 0 431465 0 0 Ernie Padden 195000 0 0 0 0 0 0 0 0 0 195000 0 0 0 Steven C Blasdell 444038 0 226684 0 2346 0 14755 0 27725 0 715548 0 0 0 Jun K Chung MD 542311 0 146520 0 1148 0 15561 0 32309 0 737849 0 0 0 Mark B Kerner MD 490176 0 769331 0 1087 0 11535 0 31022 0 1303151 0 0 0 Ernesto Luciano-Perez 300432 0 497344 0 967 0 16737 0 31858 0 847338 0 0 0 Aaron L Marlow MD 300762 0 569614 0 300 0 16061 0 12196 0 898933 0 0 0 Joseph Buccheit 0 232474 0 13123 0 22753 0 18475 0 21752 0 308577 0 0 Susan MacLeod 0 0 0 0 0 127534 0 0 0 11231 0 138765 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, Line 4a: Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: Susan MacLeod, $127,534 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. Doing Business As Form 990, Part I, Item C DBA: Bon Secours Oxygen Form 990, Part VI, Section A, line 2 Board Members P. Ward Robinett, Jr. and Deborah K. Sterns have a business relationship. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Hampton Roads Health System, Inc. which in turn is the sole member of Maryview Hospital. Form 990, Part VI, Section A, line 7a The governing body of Maryview Hospital is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to the approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Maryview Hospital are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS'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 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 Maryview 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 CFO 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. 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. Joseph Oddis' compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as CEO of Maryview Hospital. 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: 3,792,593. I/Co Debt/Principal Payments - BSHSI -1,940,009. Additional Minimum Pension Liability -2,033,464. Error Suspense 11. Total to Form 990, Part XI, Line 5: -180,869. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsvile MD 21104 521301088 Parent Org. - Mgmt Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Hampton Roads Health System Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521538513 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Health System Inc 0 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) 11b Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) 3 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 Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) 9 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) 11c Bon Secours Hampton Roads Health System 0 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) N/A Bon Secours Depaul Medical Center 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA Professional Health Care Mgmt Related 0 0 Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Living VA Professional Health Care Mgmt Related 0 0 Professional Health Care Mgmt Inc 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA Hampton Roads Health System Inc C Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA Mary Immaculate Hospital Inc C 0 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0