2011-07-12T20:08:10-05:00 2010-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2009-09-01 541820093 Bon Secours DePaul Medical Center Inc BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael Kerner 7578895000 2011-07-12 1 Emily Hayes Smith 7032511000 2009 2016-02-24 21:20:13Z X Michael Kerner 150 Kingsley Lane Norfolk VA 23505 170396410 0 0928 X www.bonsecourshamptonroads.com X 1996 VA Acute Care Hospital 22 19 1013 148 3961899 -386290 233637 160247 144190514 168064618 -838745 -1445812 4738865 1502699 148324271 168281752 0 0 56426799 58612863 0 0 93196843 112601609 149623642 171214472 -1299371 -2932720 76833398 79304838 107517950 113455426 -30684552 -34150588 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 32460444 34684994 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 neurosurgeons. DePaul was also 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-of-the-art technology and expert physicians, as well as a comprehensive rehab network. In addition, a strong focus exists on community education through seminars and classes. 15443019 14391061 DePaul recently established a bariatric surgery program, modeled on the successful program already in place at sister facility Maryview. 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 in expanding this part of the surgery service. New services added in 2010 include craniotomy surgery, deep brain stimulation, advanced spinal surgeries, and other neurosurgical procedures. As with other services and part of our mission, a strong focus exists on community education through seminars and classes. 12164272 12656631 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. In FY10, Bon Secours DePaul began operating 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, such as Day of Dance. 96061024 102490040 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 Emgency Room and as well as a innovative Senior Assessment Program. 96061024 102490040 156128759 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 96 0 1 1013 1 1 1 0 0 0 0 0 0 0 0 22 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 1 VA X James Pirtle 7572152709 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 Michael D Blount 4.00 X 0 0 0 Rise Faith E Dajao 4.00 X 0 0 0 William H Kline 4.00 X 0 0 0 Robert W Knapp 4.00 X 0 0 0 Michael S LaRock 4.00 X 0 0 0 Bennie L Marshall 4.00 X 0 0 0 Margaret U Moser 4.00 X 0 0 0 Mary Jane Nero 4.00 X 0 0 0 R B Seal 4.00 X 0 0 0 Deborah K Stearns 4.00 X 0 0 0 Alfred E Abiouness 4.00 X 0 0 0 Sr Rita Thomas 4.00 X 0 0 0 Timothy J Davis 50.00 X 0 1223989 129362 Sr Anne Lutz 50.00 X 0 0 0 J Robert Bray 4.00 X 0 0 0 Arthur Collins 4.00 X 0 0 0 Sr Elaine Davia 4.00 X 0 0 0 Carol Ormond 4.00 X 0 0 0 Wayne K Sawyer 6.00 X X 0 0 0 Linwood E Howard 6.00 X X 0 0 0 Michael Kerner 50.00 X X 0 940681 126469 Sr Patricia Heath 50.00 X X 0 0 0 Daniel Duggan 50.00 X 0 424024 63036 Gregory Simia 50.00 X 0 404075 51557 Theresa Nero 50.00 X 141923 0 20592 David Setchel 50.00 X 211937 0 36345 James Mosure MD 50.00 X 395951 0 15072 Harikrishanan Damodarannair MD 50.00 X 336638 0 27281 Kochicheril N Moni MD 50.00 X 317899 0 17542 Ray Marling MD 50.00 X 288375 0 11911 Nena G Aceveda 50.00 X 232051 0 10173 Edward Boyer 0.00 X 0 938417 17317 Richard Hanson 0.00 X 0 772746 108243 Joseph Buccheit 0.00 X 0 354134 44775 1782851 5058066 659083 7 1 1 0 Rehabcare Group Inc PO Box 502096 St Louis MO 631502096 Rehab 3710758 Wellspring Valuation Partners 123 North Wacker Drive Ste 900 Chicago IL 60606 Operations Consulting 1468476 Eastern Virginia Medical School 721 Fairfax Ave Norfolk VA 23507 Residence/ Director Fees 1251162 Staff Care Inc 5001 Statesman Dr Irving TX 750632414 Anesthesia Staffing 1219970 Alliance Healthcare Svcs Inc PO Box 96485 Chicago IL 606936485 MRI Services 1023149 34 103179 56968 100 160247 Patient Service Rev. 621500 168064618 164222726 3841892 168064618 201430 201430 511243 467416 43827 43827 43827 111490 1535752 -111490 -1535752 -1647242 -1647242 Tuition - Nurses Aide 900099 197773 197773 Joint venture income 621999 166394 166394 Answering Service 517000 120007 120007 974698 974698 1458872 168281752 164222726 3961899 -63120 375694 338125 37569 45654495 41089045 4565450 1532121 1378909 153212 7868155 7081340 786815 3182398 2864158 318240 87263 78537 8726 5084 4576 508 28013 25212 2801 3666293 3299664 366629 400526 360473 40053 705274 634747 70527 3587504 3228754 358750 235001 211501 23500 12717 11445 1272 2167313 2167313 6615799 5954219 661580 1594635 1435171 159464 Purchased Services 40587830 36529046 4058784 Supplies 28781884 25903696 2878188 Bad Debt 18190016 18190016 0 Equipment Rental 3152113 2836902 315211 Repairs 1443121 1298809 144312 1341223 1207101 134122 171214472 156128759 15085713 0 4500 4800 19217220 20006909 2280963 2538596 190392 287132 103635109 65948841 36586198 37686268 8815996 9487193 9738129 9293940 76833398 79304838 9057473 11732058 98460477 101723368 107517950 113455426 X -30661808 -34130581 -22744 -20007 -30684552 -34150588 76833398 79304838 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 16200 0 1 11813 28013 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The organization paid dues to the Virginia Healthcare and Hospital Association (VHHA) and American Hospital Association (AHA), 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: These organizations disclosed that 23.07% ($6,856) and 23.76% ($4,957)respectively, of their dues were used for lobbying purposes. 3750384 3750384 30354217 17500071 12854146 4112485 1373018 2739467 65418023 47075752 18342271 37686268 Goodwill 5247764 Inv in Bed Licenses, net of amortization 2057699 Organizational Costs 496400 Other 1492077 9293940 Other Current Liabilities 1808425 Due to affiliates 91787613 Pension Liability 5125758 Deferred Rent 2204421 FIN 48 LT Asbestos Liability 797151 101723368 Part X: Description of Uncertain Tax Positions Under FIN 48: 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. As the organization does not conduct a separate audit of its financial statement, 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 $98,300 and $117,200 of net operating loss carryforwards as of August 31, 2010 and 2009, respectively, which expire in varying periods through 2030 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2010 and 2009. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 X 1 X 1 X 1 1 1 0 1 1 3463733 3463733 0.02260 14730135 12487401 2242734 0.01470 18193868 12487401 5706467 0.03730 13547 503433 300 503133 0.00330 2031359 1014626 1016733 0.00660 381211 381211 0.00250 137102 137102 0.00090 13547 3053105 1014926 2038179 0.01330 13547 21246973 13502327 7744646 0.05060 457 8702 8702 0.00010 1011 30058 30058 0.00020 1143 50859 50859 0.00030 2611 89619 89619 0.00060 1 4791003 37989122 37699586 289536 X 1 1 Radiology Svcs-Hampton Rds Radiology Services 0.25000 Management Services LLC Management Services 0.20000 Posit Emiss Tomography Operate PET Scanner 0.13750 0.45000 Peninsula Hospital Svcs Laundry Services 0.13500 VA Health Network Inc Insurance Networks 0.07000 VA Beach Surgery Ctr LLC Outpatient Surgery 0.46880 0.24500 DePaul Medical Center

150 Kingsley Lane Norfolk VA 23505

X X X X Bon Secours Health Center VA Beach

828 Healthy Way Virginia Beach VA 23462

Imaging & Other OP Svcs DePaul In-Motion Physical Ther - Norfolk

7300 Newport Ave Ste 300 Norfolk VA 23505

Physical, Occupational & Speech Therapy Bon Secours In-Motion at Hilltop

1817 Laskin Rd Ste 100 Virginia Beach VA 23454

Physical Therapy & Sports Rehab Hampton Roads OBGYN

100 Kingsley Lane Ste 100 Norfolk VA 23505

Physician Practice Towne Center Medical Associates

4445 Corporation Lane Ste 100 Virginia Beach VA 23562

Physician Practice Cardiovascular Specialists

160 Kingsley Lane Ste 100A Norfolk VA 23505

Physician Practice Tidewater Surgical Specialists DePaul

160 Kingsley Lane Ste 400 Norfolk VA 23505

Physician Practice DePaul Medical Associates

100 Kingsley Lane Norfolk VA 23505

Physician Practice Bon Secours Medical Associates

828 Healthy Way Ste 220 Virginia Beach VA 23462

Physician Practice Amelia Medical Associates

855 Kempsville Rd Ste 320 Norfolk VA 23502

Physician Practice Patient Choice Ghent

957 W 21st St Ste E Norfolk VA 23517

Physician Practice Patient Choice Oceana

1232 Perimeter Parkway Ste 101 Virginia Beach VA 23464

Physician Practice Part I, Line 6a: Community benefit information is included in the Bon Secours Hampton Roads Health System newsletter which is published and mailed out three times each year. The report contains a summary of outreach activities, community benefits, uncompensated care, and accomplishments. The newsletters are distributed to approximately 90,000 households. 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 non patient 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, Line 7g: DePaul Medical Center provides financial and in-kind support to Park Place Medical Center, a federally qualified health clinic in Norfolk that serves uninsured and underinsured individuals. Part I, Line 7f: The bad debt expense included in Part IX, line 25 and excluded from the "percent of total expense" calculation is $18,190,016. 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 hospitals 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 non reimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and non reimburseable 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 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 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 approval. 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. Partnership with Federally Qualified Health Clinic in Norfolk - BSDMC 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. BSDMC makes financial and/or in-kind donations to Park Place that includes equipment, services, and cash assistance for patient administration support, clinical staffing, case management, and patient outreach. The Life Coach model of Care was implemented in March 30, 2007 at Bon Secours DePaul Medical Center. Through partnerships with Park Place Healthcare Medical Center and The Southeastern Tidewater Opportunity Project, Inc. (STOP) organization, the uninsured, underinsured and those without a medical home who present at the Bon Secours DePaul Emergency Department (ED) are referred after treatment for evaluation by the Life Coaches who arrange a follow-up appointment at Park Place Medical Center where the patient receives a medical home with their own a primary care physician. The patient also receives follow-up phone calls from the life coach to educate the patient related to their primary care diagnosis and to offer assistance for any social needs such as emergency assistance or help with obtaining affordable medications. The goal of the Life Coach Model of Care is to develop and implement community partnerships to better serve the economically poor with respect and dignity and to improve access to primary care. In 2010, the DePaul life coaches helped 1000 patients, of those, only 12 patients returned to the emergency department for a non-emergent reason. In the summer, Bon Secours Maryview Medical Center partnered with Catholic Charities to place two life coaches in their emergency room to assist patients who are uninsured and do not have a primary care physician. Faith Community Health Ministries builds on the skills of the registered nurse through additional 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 500-750 vaccines for select covenanted partners to host annual vaccine clinics. BSHRHS employs a Director and Coordinator to provide education and support to more than 108 faith communities and 208 registered nurses and lay health promoters. The Lets 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. Part VI, Line 2: Bon Secours Hampton Roads Health System (BSHR) utilizes multiple approaches when assessing community health needs. Typically, BSHR conducts a comprehensive needs assessment every three to five years, looking at the needs for residents of the greater Hampton Roads area, and more specifically for our three hospitals' distinct service areas. Most recently, a comprehensive meta analysis was conducted in partnership with Old Dominion University's School of Community Health Sciences, utilizing national data (Health People 2010, Thomson Reuters Health Status surveys, etc.), state-wide data (infant mortality, etc), local/county data, as well as discussions with leaders of community services organizations such as Consortium for the Immunization on Norfolk's Children (CINCH), Peninsula Institute for Community Health (PICH), Catholic Charities of Eastern Virginia, etc. The compilation identified geographic communities that performed poorly on the majority of health status indicators. Further analysis was then conducted to narrow to some demographic group. As a result, children and adolescents, especially African American, were identified as those with the most health disparity. Combining with the geographic areas of need helped narrow services BSHR could offer to improve the health needs of the communities it serves. Community need assessments are updated using a variety of informational sources including Virginia Health Information (VHI) for state-based performance data, Hammes Company for market and geographic data, Thomson-Reuters Market Expert to retrieve demographic information and trends for the service areas of the various entities within BSHR, patient statistics from our own facilities, etc. While needs may vary by service areas, BSHR always looks for ways to synergize existing services and best practices and deploying them as appropriate to other markets if the identified need is present in another community. This was successfully achieved recently with the Care-a-Van service serving on the Peninsula with plans of expansion to sections of Norfolk and Portsmouth, and the Life Coach program expanding from DePaul to Maryview, thanks to a partnership with Catholic Charities. Part VI, Line 3: BSHRHS is committed to ensuring access to health care services for all. As a health care provider, BSHRHS treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. BSHRHS addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with Medicaid and State Child Health Insurance Program enrollment, and free community-based preventive and primary care services. BSHRHS 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). Potentially eligible patients are referred to the Patient Financial Assistance Department for assistance in completing the documentation required to establish eligibility in, and apply for, government insurance programs or the FAP. 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).For uninsured and underinsured patients with annual family incomes greater than 200% of the Adjusted FPG, the FAP offers 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 communitys relative cost of living. All patients are eligible for a Prompt Pay Discount. In addition, a variety of other potential payment options are available. This patient financial assistance policy is communicated to patients verbally upon registration, visible postings of the policy and brochures in common areas throughout the hospital. The information is also made available in writing to all patients and is promoted on the BSHRHS website at http://bonsecourshamptonroads.com/about/payment_assistance.html. Part VI, Line 4: Bon Secours DePaul Medical Center's primary service area has a population of 364,569 in 2010. The overall population is expected to decline by 0.9 percent to a total of 361,289 by 2015. Demographic data indicates that 52.3 percent of the population is white, 34.5 percent black, and a Hispanic population of 18,909, or 5.2 percent. The largest ethnic population growth is expected to be among the Hispanic population which will increase by 16.6% percent by 2015. [Data Source: Census data for the state of Virginia for 1990. New projections will be released later this year.] Among age cohorts, the largest growth is expected to be in the 55 - 64 age group, which is expected to increase by 4,909 people, or 11.9 percent of the population by 2015. [Data Source: 2010 Claritas, 2010 Thomson Reuters/Market Expert]The median household income in 2010 was $52,285, compared to the Virginia average of $61,210 (CY 2008) and the national average of $52,029 (CY 2008). 20.17 percent of the population has a household income of less than $25,000, compared to the Virginia average of 17.47 percent and the national average of 22.28 percent. [Data Sources: Census and 2010 Claritas/SiteReports.com]Health Conditions - the most prevalent health conditions impacting the primary service area are hypertension, pain/aching of joints and low back pain. The incidence rate for hypertension is 21.32 per 1,000 population, which is 0.8 percent less than the state wide rate of 21.48 per 1,000. As for pain/aching of joints, the incidence rate is 21.07 per 1,000 which is 1,221.19 per 100,000 less than the state wide rate of 22.29. [Data Source: 2010 Thomson Reuters/Market Expert.] In addition, the top five DRGs based on actual inpatient discharges from the defined service area are for major joint replacement, psychoses, chest pain, severe sepsis, and heart failure. [Data Source: 2009 & 2010 VA inpatient data.] For minority populations, incidence and death rates are even greater. For example, "In 2006 the death rates per 100,000 population from high blood pressure were 15.6 for white males, 51.1 for black males, 14.3 for white females and 37.7 for black females." [Data Source: American Heart Association.]In addition, the service area incidence for these diseases is impacted by risk factors, among them smoking and being overweight. 18.1 percent of residents living in Virginia smoke, and 31.7 percent of residents living in eastern Virginia are considered obese.In fiscal year 2010, Bon Secours DePaul Medical Center cared for 6,938 inpatients, and treated 45,186 patients through the Emergency Department. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. Bon Secours DePaul Medical Center participates in Medicare, Medicaid, CHAMPUS, and other government sponsored health care programs including the state SCHIP/FAMIS program for children. Part VI, Line 5: BSHRHS 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. In FY 10, the BSHRHS Administrative Director of Building Healthy Communities worked to coordinate efforts and to unite the community. The Director has assessed the needs of the community by conducting resident interviews, and community forums. Through this process, working with East Ocean View residents, businesses and faith communities along with other interested organizations, several priority improvement initiatives have been identified. The local food pantry has been renovated and expanded. BSHRHS and the City implemented an Earn-and-Learn program where BSHRHS provided employment to four teens and the City paid their wages via stimulus money. BSHRHS and the City are also pursuing the development of an Intel Computer Clubhouse to provide computer-training and technology opportunities for the community. Habitat for Humanity has been approved to build a Habitat home in the neighborhood with a tentative build time the Summer of 2011. Habitat and the community are considering opportunities for a building blitz in East Ocean View in 2011 where 10-20 homes would be built in improved the neighborhood. As a start to the desired community beautification efforts, a BSHRHS Board member donated over 1,200 bushes that were planted by residents and BSHRHS volunteers last summer. In addition, the groundwork has been laid for the BSHRHS to bring the Care-A-Van program to provide primary care to the uninsured and underinsured of the community. On a longer term basis, discussions are underway with a local organization who is interested in building a health center in the neighborhood. Talks are underway for the development of a playground and park system as well. Part VI, Line 6: BSHRHS operates an emergency room at BSMMC, the Bon Secours Health Center at Harbour View, BSDMC, and MIH that are open 24 hours per day, 7 days per week. In accordance with the bylaws of each of the medical staffs, BSHRHS has an open medical staff with privileges available to all qualified physicians in the region. Board of Directors - The BSHRHS Board of Directors governs facilities located on the Southside of the service area. The BSHRHS Board of Directors is comprised of 17 members. One member, the president of the board, is appointed by Bon Secours Ministries, the Catholic Church sponsor of the health system. The board membership represent expertise in various areas, including finance, real estate, clinical quality, human resources, community outreach, management, representatives from BSHSI and administration. BSDMC's Board of Directors is comprised of 15 members. Three members are appointed by BSHSI, two are members appointed by the Bernardine Franciscan Sisters, and the others represent expertise in various areas, including finance, real estate, clinical quality, human resources, management, representatives from BSHSI and administration. BSHRHS participates in select investigational research studies by external IRB's that are in compliance with the Catholic Health Care Ethical and Religious Directives. Training and Education of Health Care Professionals is provided through regular CME teaching sessions are provided and open to the entire medical staff. BSHRHS hospitals are training sites for Eastern Virginia Medical School residents in Family Practice. In addition, training for residents specializing in Internal Medicine, Diagnostic Radiology, OB GYN (GYN Surgery), Surgery, Ophthalmology and Emergency Medicine are provided in collaboration with area universities without reimbursement to BSHRHS. BSHRHS sponsors a Certified Nurse Aide training program at BSDMC. Nursing students from area schools as well as North Carolina are provided clinical experience as are EVMS/ODU Physician Assistant students, Surgical Assistant students, Radiology and Respiratory Therapy Students. Pharmacy students from Hampton University also receive clinical experiences. Our Wound and Skin Nurse precepts RN's going through college sponsored programs to qualify to sit for the National exams. All BSHRHS facilities participate in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs to also include the Medallion (Medicaid HMO), Medicare Advantage, and the State and Local Hospitalization (SLH) programs. Part VI, Line 7: Bon Secours Health System, Inc., a Maryland nonprofit, non stock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, non stock 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. Activities directly associated with this purpose are considered operating activities. Operating activities also include other incidental services that are closely related to healthcare. VA X X X X X 0 1 0 0 0 0 0 0 0 Timothy J Davis 0 536658 0 665880 0 21451 0 110185 0 19177 0 1353351 0 0 Michael Kerner 0 467646 0 290947 0 182088 0 99435 0 27034 0 1067150 0 0 Daniel Duggan 0 264490 0 141461 0 18073 0 44178 0 18858 0 487060 0 0 Gregory Simia 0 287470 0 69599 0 47006 0 24464 0 27093 0 455632 0 0 David Setchel 178399 0 33052 0 486 0 10198 0 26147 0 248282 0 0 0 James Mosure MD 394972 0 0 0 979 0 0 0 15072 0 411023 0 0 0 Harikrishanan Damodarannair MD 336340 0 0 0 298 0 0 0 27281 0 363919 0 0 0 Kochicheril N Moni MD 313729 0 0 0 4170 0 319 0 17223 0 335441 0 0 0 Ray Marling MD 257031 0 30000 0 1344 0 0 0 11911 0 300286 0 0 0 Nena G Aceveda 212337 0 19624 0 90 0 3233 0 6940 0 242224 0 0 0 Edward Boyer 0 428865 0 416683 0 92869 0 8188 0 9129 0 955734 0 0 Richard Hanson 0 407990 0 335679 0 29077 0 80844 0 27399 0 880989 0 0 Joseph Buccheit 0 224034 0 47590 0 82510 0 28800 0 15975 0 398909 0 0 Part I, Line 4b: Bon Secours DePaul Medical Center, Inc. participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting deposits are made into this plan. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours DePaul Medical Center, 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 Meridian Group Deborah Stearn's (board member) husband is a VP with the Meridian Group 250000 Independent contractor for advertising services 0 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 Bon Secours DePaul Medical Center, Inc.'s audit and compliance board committee and providing the form to the Bon Secours DePaul Medical Center, Inc.'s board of directors to allow for a thorough review by both before the filing date of July 15, 2011. Bon Secours DePaul Medical Center's audit and compliance board committee and Bon Secours DePaul Medical Center, Inc.'s board of directors will review the Form 990 and ask any additional questions regarding the Form 990 before the return is filed July 15, 2011. Form 990, Part VI, Section B, line 12c Bon Secours DePaul Medical Center, Inc. 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 Bon Secours DePaul Medical Center, Inc. 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 participates 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). Part VI, Section B, Line 14: Document Retention and Destruction Policy While Bon Secours Health System, Inc. does not have a written organization-wide document retention and destruction policy, individual department policies and practices are in place to ensure that each department of the organization maintains their documentation in compliance with state and federal requirements. In addition, any areas responsible for medical records have department policies in compliance with Medicare and HIPAA requirements. An organization-wide policy is currently in place for fiscal year ending August 31, 2011. Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of Bon Secours DePaul Medical Center, Inc. The compensation committee consists of a group of independent board members and engages external counsel 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. 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 Bon Secours DePaul Medical Center 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. 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. Michael 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. Greg Simia's compensation is paid by Maryview Hospital, a related organization. The compensation he receives is for his role as the Chief Financial Officer of Bon Secours Hampton Roads Health System. Daniel Duggan's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Executive Vice President of DePaul Medical Center. Sr. Pat Heath and Sr. Anne Lutz do not receive payroll distributions as they have taken vows of poverty. Mary Immaculate Nursing Center 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 9: 509(a)(2) N/A Mary Immaculate Hospital Inc 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) Line 3: 170(b)(1)(A) N/A Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Suffolk VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11, Type II: 50 N/A Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) Line 9: 509(a)(2) N/A Maryview Hospital 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 540506463 Healthcare VA 501(c)(3) Line 3: 170(b)(1)(A) N/A Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) N/A N/A Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11, Type II: 50 N/A Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 11, Type III-FI N/A Bon Secours Maryview Foundation 7007 Harbour View Blvd Ste 108 Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) Line 11, Type III-FI N/A Mary Immaculate Foundation 150 Kingsley Lane Norfolk VA 23505 311644734 Fundraising VA 501(c)(3) Line 11, Type III-FI N/A Province Place of Maryview LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541842697 Assisted Living VA N/A Related 0 0 Province Place of DePaul LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541950880 Assisted Living VA N/A Related 0 0 Western Tidewater Diagnostic Imaging LLC c/o Roberts Dean PLC 150 Bousch St Norfolk VA 23510 383655545 Healthcare VA N/A Excluded-Investment 0 0 Professional Health Care Mgmt Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541241031 Administrative VA N/A C Tidewater Diversified Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541431826 Pharmacy VA N/A C 1.00000 OSF Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541369919 Rental VA N/A C 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 None