2013-07-15T19:08:16-05:00 2012-08-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-09-01 541820093 Bon Secours DePaul Medical Center Inc BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Sr Patricia Heath 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 169237828 0 0928 X www.bonsecourshamptonroads.com X 1996 VA Acute Care Hospital 18 16 1238 310 1598687 0 319950 838204 166743301 163892701 16478035 207236 2440050 3606199 185981336 168544340 663012 611514 0 0 62958438 64723048 0 0 0 120893503 117750031 184514953 183084593 1466383 -14540253 105618626 118571919 138402753 167384136 -32784127 -48812217 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 33048729 36883760 DePaul continues a strong focus on orthopaedic care for residents of Norfolk and Virginia Beach. A special expertise exists in the treatment of spine disorders, with a significant cadre of spine and neurological surgeons. This service includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-of-the-art technology and expert physicians, as well as a comprehensive outpatient rehab network and community outreach events for area residents suffering from joint pain. 13692633 12478139 DePaul operates a bariatric surgery program, modeled on the successful program already in place at sister facility Maryview. The program has met the requirements to seek Center of Excellence designation and we have submitted all the necessary documentation. DePaul has long been known for its premier gynecological oncology program, treating women from a 5-state area. Specialized or, diagnostic, therapeutic, and nursing services are available to treat this disease, alongside specialty-trained expert physicians. Finally, DePaul is working extensively with neurosurgeons and neuroendovascualr specialists to expand this part of the surgery service. New services added include craniotomy surgery, deep brain stimulation, advanced spinal surgeries, and other neuroendovascular surgical procedures. Finally, DePaul now operates the busiest daVinci surgical robot in all of Virginia, used for gynecological, gynoncological, and urological minimally invasive surgical procedures. 12601578 11466211 DePaul has committed significant resources to the care of cardiac patients. The comprehensive Early Detection Center is aimed at identifying cardiac disease early and referring patients to physicians as necessary for prompt and effective treatment. DePaul also upgraded equipment and nursing services to better support the service line. Bon Secours DePaul operates a state-of-the art, fully digital cardiac catheterization laboratory. In addition, DePaul's CT was upgraded to a 64-slice unit, enabling "beating heart" scans. DePaul continues strong relationships with other Bon Secours hospitals for the delivery of advanced cardiac interventions, such as cardiac surgery. In addition, a strong focus also exists on community education through seminars, classes, screenings, and special events. 107464108 611514 101568328 Other major services offered by Bon Secours DePaul Medical Center include a Birthing Center, Sleep, Gastroenterology and Pulmonary services. In addition, Bon Secours DePaul Medical Center offers a full service 24 hour Emergency Room. 107464108 611514 101568328 166807048 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 83 0 1 1238 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 1 1 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 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 John Barrett 50.00 X 0 282689 12837 Melinda Hancock 50.00 X 0 292838 33668 Ernie Padden 50.00 X 0 195000 0 David Setchel 50.00 X 186298 0 39039 Gregory F Adams 50.00 X 330453 0 44701 John R Baker 50.00 X 553126 0 18302 Robert B Hansen 50.00 X 302204 0 42931 Saumil V Patel 50.00 X 354874 0 53764 Elizabeth Z Salzberg 50.00 X 276594 0 44400 Joseph Buchheit 50.00 X 0 268350 40227 2003549 2131939 702554 65 1 1 0 Rehabcare Group East Incorporated PO Box 502096 St Louis MD 631502096 Rehabilitation Services 4498175 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction Services 1844011 Eastern Virginia Medical School PO Box 1980 Norfolk VA 235011980 Residence/Director Fees 1720625 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 1194924 Inpatient Medical Services PO Box 41367 Houston TX 77241 Hospitalist Services 1055234 30 134372 703732 100 838204 Patient Service Rev. 622110 163815280 162319017 1496263 Nursing Asst Prgm Tuit 900099 77421 77421 163892701 199964 199964 621520 4069 521876 0 99644 4069 103713 28324 75389 163027 15857 0 171612 163027 -155755 7272 7272 Joint venture income 621999 2035890 2035890 Cafe and Vending 722320 444487 444487 Ret Sales-Met Rev 446199 226481 226481 795628 74100 721528 3502486 168544340 162396438 1598687 3711011 611514 611514 231578 208420 23158 51707479 46536731 5170748 2466434 2219791 246643 6110616 5499554 611062 4206941 3786247 420694 407419 366677 40742 131154 118039 13115 33190 29871 3319 12878739 11590865 1287874 248746 223871 24875 1497825 1348043 149782 20097 18088 2009 4647466 4182720 464746 87336 78602 8734 144321 129889 14432 2195924 2195924 7165248 6448723 716525 1817168 1635451 181717 Medical Expenses 32881816 29593634 3288182 Purchased Services 30166098 27149488 3016610 Bad Debt 17501709 17501709 BSHSI Allocation 3594936 3235442 359494 2330839 2097755 233084 183084593 166807048 16277545 0 5373 5173 64152 28253 49513 20322818 21530873 2862661 3309094 988059 1179995 115920973 75509775 38637722 40411198 10692467 11571220 20942460 22478728 5263864 5263864 5874949 12708109 105618626 118571919 12177851 11803086 8960 126215942 155581050 138402753 167384136 X -32793348 -48839252 9221 27035 -32784127 -48812217 105618626 118571919 X -14540253 -1487837 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 16822 0 1 16368 33190 0 Explanation of Lobbying Activities: Part II-B, Line 1: Bon Secours DePaul Medical Center 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 $4,959 or 24.6%, VHHA $10,132 or 24.37% and CHA $1,276 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. 3750384 3750384 30127793 18144174 11983619 3921760 1961869 1959891 78121036 55403732 22717304 40411198 Inv in Sentara Princess Anne Hosp 22478728 C 22478728 Inv in Bed Licenses, net of amortization 1142699 Organizational Costs 458462 Due from affiliates 863525 Due from BSHSI 522842 Other investments and deferred financing costs 2488834 Third Party Settlements 1061618 Inv- HPL/GL 6170129 12708109 Other Current Liabilities 2162442 Due to affiliates 3695790 Pension Liability 4347969 Deferred Rent 1917403 FIN 47 LT Asbestos Liability 742603 Due to BSHSI 134883822 Inv - HPL/GL 6170129 Third Party Settlements 1660892 155581050 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. 1 1 1 X 1 X 1 1 1 0 1 1 8502607 8502607 0.05130 15081731 10182299 4899432 0.02960 162380 117710 44670 0.00030 23746718 10300009 13446709 0.08120 6 1723 319664 319664 0.00190 3 224 1871970 678343 1193627 0.00720 1 24 5370 5370 0.00000 11 8875 781610 781610 0.00470 21 10846 2978614 678343 2300271 0.01380 21 10846 26725332 10978352 15746980 0.09500 1 15 32945 32945 0.00020 1 15 32945 32945 0.00020 1 4583922 39763274 47689021 -7925747 X 1 1 3 Positron Emission Tomography Institute of Hampton Roads LLC PET Scanner 0.13750 0.45000 6 BS Surg Ctr at VA Beach LLC Outpatient Surgery 0.46880 0.24500 1 1 DePaul Medical Center

150 Kingsley Lane Norfolk VA 23505

X X X X Bon Secours DePaul Medical Center Inc 1 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 22 Bon Secours Health Center

828 Healthy Way Virginia Beach VA 23462

Rehabilitation & Physician Practice DePaul InMotion Phys Ther-Norfolk

7300 Newport Ave Suite 300 Norfolk VA 23505

Physical, Occupational & Speech Therapy Tidewater Surg Specialists DePaul

160 Kingsley Lane Suite 400 Norfolk VA 23505

Physician Practice Bon Secours In-Motion at Hilltop

1817 Laskin Rd Suite 100 Virginia Beach VA 23454

Physical Therapy & Sports Rehab Tidewater Surgical Spect DePaul

160 Kingsley Lane Suite 400 Norfolk VA 23505

Physician Practice Amelia Medical Associates

885 Kempsville Rd Ste 300303305313 Norfolk VA 23502

Physician Practices, Physical Therapy Patient Choice Oceana

1232 Perimeter Pkwy Suite 101 Virginia Beach VA 23454

Physician Practice Hampton Roads OBGYN

100 Kingsley Lane Suite 100 Norfolk VA 23505

Physician Practice Ghent Family Practice & Internal Med

957 W 21st St Suite E Norfolk VA 23517

Physician Practice Bon Secours Neuroscience Ctr for Pain

4445 Corporation Lane Suite 120 Virginia Beach VA 23562

Physician Practice DePaul Medical Associates

100 Kingsley Lane Suite 100 Norfolk VA 23505

Physician Practice Cardiovascular Specialists

160 Kingsley Lane Suite 100A Norfolk VA 23505

Physician Practice InMotion Phy Ther Redmill Landing

1253 Nimmo Parkway Suite 105 Virginia Beach VA 23456

Physical Therapy InMotion Phy Ther Healthy Way

828 Healthy Way Suite 105 Virginia Beach VA 23462

Physical Therapy & Sports Rehab Bon Secours Neurovascular Center

110 Kingsley Lane Suite 411 Norfolk VA 23505

Physician Practice Bon Secours Pulmonary Specialists

150 Kingsley Lane Norfolk VA 23505

Physician Practice Bon Secours Medical Associates

828 Healthy Way Suite 220 Virginia Beach VA 23462

Physician Practice Norma O Mafpoc MD

1020 Independence Blvd Suite 206 Virginia Beach VA 23455

Physician Practice Saghana B Chakrabortty MD

1020 Independence Blvd Suite 305 Virginia Beach VA 23455

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): Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $17,501,709 Part II: Bon Secours DePaul Medical Center 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. The community building activities reported in Part II reflect the donated administrative support to facilitate health and community building in the neighborhood of East Ocean View. 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, DePaul Medical Center uses multiple approaches to assess the health needs of the communities it serves. Health care needs of the community are assessed and updated using a variety of informational sources including Virginia Health Information for state-based performance data, Health Group West and Hammes Company for market and geographic data. Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to DePaul Medical Center. National Research Corporation (NRC) 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 DePaul Medical Center (DMC), Norfolk, VA is estimated to change from 828,728 to 867,988, resulting in a growth of 4.7% between 2000 and the current year. Over the next five years, the population is projected to grow by 1.0%. The current year estimated population represents white (61.3%), Black or African American (28.7%), Hispanic or Latino (5.4%) and small percentages other small groups. The current year median age for this area is 34.3, while the average age is 36.0. Five years from now, the median age is projected to be 35.2.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: DePaul Medical Center (DMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/ day, 7days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located .DMC, through BSHR, offers CARE-A-VAN services. 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 childrens' 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.DMC, 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 DMC's advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP). DMC supports the BSHR 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. Partnership with Federally Qualified Health Clinic in Norfolk - DMC and Park Place Medical Center work together to provide uninsured and underinsured individuals with a medical home and receive a full range of primary care services. DMC lab services to Park Place. 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 the local community in addressing unmet need include: - A monthly contribution to Park Place Clinic to help subsidize medical care for those who are uninsured or underinsured. - For Kids organization which works to break the cycle of homelessness and poverty for families and children- Help and Emergency Response to provide shelter and to engage in dedicated efforts to eliminate domestic violence- Access Partnership to support an oral health initiative for adults with no access to dental care- PIN Organization to support their work of providing food, clothing, shelter, and free medical care for people who are either homeless or extremely poorDMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. DMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.DMC offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Several seminars on clinical ethics were also offered to professionals in the area. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, 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 Portsmouth Community Health Center Inc 664 Lincoln St Portsmouth VA 23704 541626757 501(c)(3) 396818 0 General Support Bon Secours DePaul Health Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 541843876 501(c)(3) 214696 0 General Support 2 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. 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 John Barrett 0 162947 0 15000 0 104742 0 0 0 12837 0 295526 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 David Setchel 182027 0 3746 0 525 0 10128 0 28911 0 225337 0 0 0 Gregory F Adams 329846 0 0 0 607 0 12789 0 31912 0 375154 0 0 0 John R Baker 517104 0 35000 0 1022 0 0 0 18302 0 571428 0 0 0 Robert B Hansen 253845 0 46973 0 1386 0 12016 0 30915 0 345135 0 0 0 Saumil V Patel 342629 0 11643 0 602 0 24686 0 29078 0 408638 0 0 0 Elizabeth Z Salzberg 276594 0 0 0 0 0 11620 0 32780 0 320994 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, 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. 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 Bon Secours DePaul Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board of Directors of Bon Secours DePaul Medical Center, Inc. is appointed by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Any decision which is subject to a reserved power is subject to approval by members. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc.(BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 Bon Secours DePaul Medical Center, Inc. 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. John Barrett'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 DePaul Medical Center, which includes direct management, monitoring and oversight of the Hospital. 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. 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: 515,761. Add'l Minimum Pension Liability -435,742. BSHSI - I/Co Debt Principal Payment -1,567,856. Total to Form 990, Part XI, Line 5: -1,487,837. Mary Immaculate Foundation 150 Kingsley Lane Norfolk VA 23505 311644734 Fundraising VA 501(c)(3) 11c Mary Immaculate Hospital 0 Mary Immaculate Nursing Center 4 Ridgewood Parkway Newport News VA 23602 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 2 Bernadine Drive Newport News VA 23602 540548200 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Health Systems Inc 0 Bon Secours Maryview Nursing Care Center 4775 Bridge Road Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) 9 Bon Secours Hampton Roads Health System 0 Maryview Hospital 3636 High Street Portsmouth VA 23707 540506463 Healthcare VA 501(c)(3) 3 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 1 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfolk VA 23505 541843876 Fundraising VA 501(c)(3) 11c Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 150 Kingsley Lane Norfolk VA 23505 521694731 Fundraising VA 501(c)(3) 11c 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 Ste 108 Suffolk VA 23435 541241031 Administrative VA Bon Secours Hampton Roads Health System Inc C Tidewater Diversified Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C 818334 2263317 1.00000 OSF Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541369919 Rental VA Mary Immaculate Hospital Inc C 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0