2012-07-12T12:21:43-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 540647482 Richmond Community Hospital Inc RICH 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 Peter F Gallagher 8047646102 2012-07-12 1 7032511000 2010 2016-02-24 21:20:13Z Michael Robinson 8260 Atlee Road Mechanicsville VA 23116 62906509 0 X www.bonsecours.com X 1922 VA Acute Care Hospital 17 14 331 52 0 0 79136 3266480 53186883 59083549 28 49753 332991 501212 53599038 62900994 0 0 0 0 18646589 19799404 0 0 0 35191121 40446991 53837710 60246395 -238672 2654599 17691003 20282493 46100452 46212635 -28409449 -25930142 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 55139129 59083549 Richmond Community Hospital provides medical care to patients without regard to their ability to pay. As a community not-for-profit hospital in Richmond, Richmond Community Hospital is an access point for under insured and financially disadvantaged who will not be treated at the for profit hospitals. In addition, Richmond Community Hospital provides support for community services. Please refer to the Community Benefit Information on Schedule H. 55139129 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 39 0 1 331 1 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X Melinda S Hancock 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 X Jean Ann Bolling 4.00 X 0 0 0 John Bowman MD 4.00 X 0 0 0 Robert J Cohen MD 4.00 X 0 0 0 Alexander J Corbett PhD 4.00 X 0 0 0 Mark Gordon 50.00 X 0 459644 57923 Richard Jackson MD 4.00 X 0 0 0 Kenneth J Jones 4.00 X 0 0 0 Sr Anne Marie Mack CBS 50.00 X 0 0 0 Joanne Nattrass 4.00 X 0 0 0 Toni Ardabell 50.00 X 0 473594 35077 Nancy Thomas 4.00 X 0 0 0 Jane Watkins 4.00 X 0 0 0 Michael Williams 4.00 X 0 0 0 Pete B Cleal 6.00 X X 0 0 0 Thomas Winfree 6.00 X X 0 0 0 Sr Victoria V Segura MD CBS 50.00 X X 0 0 0 Michael Robinson 50.00 X X 0 520898 78018 Allen Goolsby 6.00 X 0 0 0 Peter J Bernard 50.00 X 0 965548 188973 Peter F Gallagher 50.00 X 0 476340 58283 Charles F Malloy 50.00 X 0 222195 7384 Jill Kennedy 50.00 X 0 229941 34423 Bruce R Stevens 50.00 X 452756 0 24229 Charles E Welander 50.00 X 293476 0 0 Virginia J Stephens 50.00 X 189380 0 23844 Karen Allen 50.00 X 161663 0 0 Katina Fletcher 50.00 X 150785 0 22654 Michael Kerner 50.00 X 0 606241 145769 Thomas Morris PhD 50.00 X 0 351566 40989 1248060 4305967 717566 22 1 1 0 Professional Emergency Care Inc 38935 Ann Arbor Road Livonia MI 48150 Emergency Room physicians 1414172 Aramark CTS Inc PO Box 640944 Pittsburgh PA 152640944 Clinical technology services 584472 Sheltering Arms Hospital 8254 Atlee Road Mechanicsville VA 23116 Rehabilitation Services 441358 Linas & Associates PC 9014 Norwick Road Richmond VA 23229 Anesthesia physicians 401485 PrimeDoc of Richmond PC 1 West Pack Sq BBT Bldg Ste 300 Ashville NC 28801 Med/Surg physicians 290335 14 2320162 946318 3266480 Patient Service Rev. 622110 59083549 59083549 59083549 3 3 264947 5515 259432 259432 259432 49750 49750 49750 49750 Cafe & Vending 722212 184974 184974 Joint Venture Income 900099 42953 42953 Purchase Discounts 900099 6384 6384 7469 7469 241780 62900994 59083549 0 550965 16380953 14742858 1638095 96369 86732 9637 2200467 1980420 220047 1121615 1009454 112161 93058 83752 9306 5432 4889 543 8182331 7364098 818233 12533 11280 1253 254842 229358 25484 667647 600882 66765 32435 29191 3244 18627 16764 1863 66388 66388 1586122 1427509 158613 448123 403311 44812 Medical Supplies 10706391 9635752 1070639 Bad Debt 9107346 9107346 Purchased Services 7092067 6382860 709207 BSHSI Management Alloc. 811322 730190 81132 Repairs and Maintenance 480991 432892 48099 881336 793203 88133 60246395 55139129 5107266 0 0 977 6751208 5872008 979112 922198 189656 307261 39803233 27986514 9222338 11816719 548689 1363330 17691003 20282493 2059106 1896148 0 35639 44041346 44280848 46100452 46212635 X -28409449 -25932025 0 1883 -28409449 -25930142 17691003 20282493 X 2654599 -175292 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5432 5432 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Richmond Community Hospital, Inc. paid dues to the American Hospital Association (AHA), the Virginia Hospital and Healthcare Association (VHHA) and the Catholic Hospital 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 24.20% or $2,848, VHHA 9.70% or $1,282 and CHA 4.68% or $1,302 for a total of $5,432. 11028711 6029655 4999056 162706 66503 96203 21481688 17283433 4198255 7130128 4606923 2523205 11816719 Other Pat & 3rd Party Payor 135196 Accrued Revenue 929822 LT Non-Cash Inv-General 85501 Due to Affiliates 211907 Investments 904 1363330 Due to Affiliates 2584429 Other Liabilities 692535 Due to BSHSI 41003884 44280848 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 FIN 48. 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 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. 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 $89,500 and $98,300 of net operating loss carryforwards as of August 31, 2011 and 2010, respectively, which expire in varying periods through 2031 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2011 and 2010. 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 4370884 4370884 0.08730 12080586 9704868 2375718 0.04750 16451470 9704868 6746602 0.13480 2 297 10859 10859 0.00020 2 297 10859 10859 0.00020 2 297 16462329 9704868 6757461 0.13500 112762 112762 0.00220 7021 7021 0.00010 119783 119783 0.00230 1 1889521 11702702 14177690 -2474988 X 1 1 1 NA 1 1 Richmond Community Hospital Inc

8580 Magellan Parkway Building IV Richmond VA 23227

X X X NA 1 3 Infusion Center - Bremo

5875 Bremo Road MOB South Suite G-2 Richmond VA 23226

Patient Drug Infusion Center Infusion Center - Hanover

8260 Atlee Road MOB III Suite 206 Mechanicsville VA 23116

Patient Drug Infusion Center Laburnum Diagnostic Imaging

4630 S Laburnum Avenue Suite C Richmond VA 23231

Radiology Services Part I, Line 6a: Annually, Bon Secours Richmond Health System (BSRHS) publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. 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: $9,107,346 Part II: Richmond Community Hospital partnered with the City of Richmond and the Richmond Redevelopment and Housing Authority to celebrate the one-year anniversary of the community health planning charrette. A large number of residents, including children turned out to participate. Childhood obesity, a leading health indicator identified by the residents and the needs assessments for the neighborhood, is being addressed with a three-fold approach - increased number of community gardens, nutrition education by a Bon Secours community dietitian, and an incentive program for area pediatricians to help obese children lose weight using community resources. Additional avenues to improve sidewalk walkability, improved street lighting and additional afterschool programs for children are being pursued.The nationally recognized Reach Out and Read (ROR) program provides books for young children when they visit the SMH and RCH Emergency Departments and the Care-A-Van. Volunteers transform the sites into literary rich areas for children and parents while helping families learn the joys and techniques of reading aloud. Volunteers distributed 2,105 books in FY 2011. 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 publicly insured patients where reimbursement is less than cost of providing the service. Part III, Line 9b: Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending FAP account.Specific criteria exist for how much financial assistance, partial or total, will be provided to the patient based on the assessed need. Criteria is based on Federal Poverty Guidelines and is reviewed and updated annually. Once a patient has been deemed eligible for the Patient Financial Assistance Program (FAP), the patient is notified by letter within 60 days after receipt of the application and supporting documentation. The patient retains eligibility for a period of twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve months, the patient is responsible for reapplying for FAP eligibility. Part VI, Line 2: In partnership with Bon Secours Virginia Health System, Richmond Community Hospital uses multiple approaches to assess the health needs of the community it serves.In October 2009, the Central Virginia Health Planning Agency released an Immigrant Needs Assessment commissioned by Bon Secours Richmond Health System in collaboration with Richmond Community Hospital (RCH). This work documented the growth of the immigrant population in the metropolitan Richmond area and made multiple recommendations including the need for interpretation and translation services, health resource information in other languages, preventive services, health screenings including vision and dental, affordable health insurance for immigrants and their families and access to behavioral health services.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 Richmond Community Hospital. National Research Corporation (NRC) is also utilized. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assist the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 200% of the Federal Poverty Guidelines ("FPG"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain States, where applicable. A sliding scale assistance policy is afforded patients that exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family suffers a catastrophic financial burden to receive necessary health care services. Based on research conducted by the Tax Foundation, a non partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. In addition, a variety of other potential payment options are available. Bon Secours is dedicated to meeting the needs of non-English speaking patients by having on-site Spanish translators, and other language translation services. In addition, Bon Secours employs a telephone language service which assists in meeting any language needs that arise. The translation services are offered to non-English speaking patients from admission to discharge, including the financial process. Part VI, Line 4: RCH serves the greater Richmond, Virginia area. Projections indicate that the population will grow by 5.0% from 1,242,918 in 2010 to 1,304,689 in 2015, with 9.2% of the service area having a household income of less than $15,000 per year, compared to the national average of 12.1%. Similarly, 17.3% of the service area's populace maintains a household income less than $25,000 per year, compared to the national average of 22.3%. Demographic data shows that 61.6% of the population is white and 29.4% is black, compared to the national averages of 64.7% and 12.1% respectively. Demographics of the service area indicate that the age cohort of 64 to 75 will increase by 29.5% between 2010 and 2015. RCH is a disproportionate share hospital (DSH) and is located in a health professional shortage area (HPSA). In fiscal year 2011, it served 2,854 inpatients and provided outpatient services for 16,305 visits. Additionally, RCH provided 31,919 emergency room visits. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. RCH participates in Medicare, Medicaid, CHAMPUS, Tricare and other government sponsored health care programs such as the State/Local Hospitalization program and the SCHIP/FAMIS program for children. Part VI, Line 6: RCH has an open medical staff with privileges available to all qualified physicians in the area. RCH, through the BSRHS is governed by a board of directors whose composition is representative of the community. RCH also engages in medical research. Inpatient and outpatient research-related activities are conducted by RCH with oversight from the BSRHS Institutional Review Board. Part VI, Line 7: 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 is 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), Bon Secours Richmond Health System (BSRHS) is called to continue the healing ministry of Jesus. BSRHS exists 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." BSRHS shares 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 within BSRHS. Reports Filed With States Part VI, Line 7 VA X X X X X 1 1 0 0 0 0 0 0 0 Mark Gordon 0 334541 0 101237 0 23866 0 30227 0 27696 0 517567 0 0 Toni Ardabell 0 355805 0 84183 0 33606 0 32375 0 2702 0 508671 0 0 Michael Robinson 0 395596 0 94735 0 30567 0 58409 0 19609 0 598916 0 0 Peter J Bernard 0 733983 0 222954 0 8611 0 158275 0 30698 0 1154521 0 0 Peter F Gallagher 0 387134 0 86236 0 2970 0 27746 0 30537 0 534623 0 0 Charles F Malloy 0 146019 0 28952 0 47224 0 0 0 7384 0 229579 0 0 Jill Kennedy 0 195232 0 34451 0 258 0 10476 0 23947 0 264364 0 0 Bruce R Stevens 231417 0 221000 0 339 0 285 0 23944 0 476985 0 0 0 Charles E Welander 289567 0 0 0 3909 0 0 0 0 0 293476 0 0 0 Virginia J Stephens 174474 0 14855 0 51 0 2370 0 21474 0 213224 0 0 0 Karen Allen 155844 0 5743 0 76 0 0 0 0 0 161663 0 0 0 Katina Fletcher 145167 0 5601 0 17 0 1843 0 20811 0 173439 0 0 0 Michael Kerner 0 463467 0 138768 0 4006 0 116245 0 29524 0 752010 0 0 Thomas Morris PhD 0 258451 0 70978 0 22137 0 28541 0 12448 0 392555 0 0 Part I, Lines 4a-b 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: Charles Malloy, $47,064. 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 are made into this plan. Supplemental Information Part III Part I, line 3: Bon Secours Health System, Inc., a related organization of Richmond Community Hospital, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours - Richmond Health Corp, which in turn holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of Richmond Community Hospital, Inc. Form 990, Part VI, Section A, line 7a The governing body of Richmond Community Hospital, Inc. is appointed by its member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Richmond Community Hospital, Inc. are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date of July 16, 2012. 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 July 16, 2012. 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 director's and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the positions of other officers or key employees of the organization were compared to similar position market data in comparably situated organizations taking into consideration geographic location and organization size where appropriate. 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 Richmond Community 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 officers' and directors' 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. Voluntary Board Members are not compensated for their time. Peter J. Bernard's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the CEO of Bon Secours Virginia Health System which includes direct management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Peter F. Gallagher's compensation is paid by Memorial Regional Medical Center, a related organization. The compensation he receives is for his 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. Toni Ardabell's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Chief Executive Officer of St. Mary's Hospital of Richmond, Inc., a related organization. Mark Gordon'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 St. Francis Medical Center, a related organization. Michael Robinson'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 Memorial Regional Medical Center and Richmond Community Hospital. Charles Malloy's compensation is paid by Memorial Regional Medical Center, a related organization. The compensation he receives is for his role as the Chief Operating Officer of Memorial Regional Medical Center and Richmond Community Hospital. Jill Kennedy's compensation is paid by Memorial Regional Medical Center, a related organization. The compensation she receives is for her role as the VP of Patient Care/Chief Nursing Executive of Memorial Regional Medical Center and Richmond Community Hospital. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Grants & Contributions 23,258. Transfers - PPE -21,375. Transfers to Affiliates -177,175. Total to Form 990, Part XI, Line 5: -175,292. Bon Secours Health System Inc 1505 Marriotsville Road Marriotsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Richmond Health Corporation 8580 Magellan Parkway Richmond VA 23227 541356155 Management Services VA 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Richmond Health Corporation 0 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours St Mary's Hospital Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 0 Bon Secours Stuart Circle Hospital 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) 7 Bon Secours Richmond Health Corporation 0 Richmond Community Hospital Foundation 5875 Bremo Road Richmond VA 23226 541780854 Grant Making Foundation VA 501(c)(3) 11b N/A 0 St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA Bon Secours Virginia Health Source Inc Related 0 0 0.00000 RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA Bon Secours Virginia Health Source Inc Related 0 0 0.00000 Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA Bon Secours Virginia Health Source Inc Related 0 0 0.00000 Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA Richmond Radiation Oncology Center Inc Related 0 0 0.00000 Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA Bon Secours Virginia Health Source Inc Related 0 0 0.00000 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Bon Secours Richmond Health System C RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System C Bon Secours - Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Bon Secours Richmond Health System C Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Bon Secours Virginia Health Source Inc C 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1