2018-07-03T08:42:14-05:00 2017-08-31 990 2016-09-01 541516476 Mary Immaculate Nursing Center MARY 7576865000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Karen Reich CEO Extended Senior Care 7576865000 2018-07-03 0 2016 2022-09-23 18:48:47Z St Francis Nursing Center Karen Reich 7007 Harbour View Blvd No 108 Suffolk VA 23435 8263291 0 0928 X bonsecours.com X 1989 VA Skilled Nursing Facility 19 17 167 21 0 0 0 0 9171098 8225566 23504 30463 14872 7262 9209474 8263291 0 0 0 0 5028680 4538662 0 0 0 4515920 4647503 9544600 9186165 -335126 -922874 9011061 8018495 4502050 4475424 4509011 3543071 The mission is to bring compassion to skilled nursing care and to be good help to those in need, especially those who are elderly, poor and dying. 0 0 7396530 6722264 Skilled Nursing Care provided to patients to include assessment of cognitive and physical status, personal hygeine care, nutrition and maintenance of a clean and comfortable environment. 864021 1167930 Rehabilitation Therapies to include physical therapy, speech therapy and occupational therapy so as to maintain each patient's optimal quality of life. 247899 335372 Medication & Diagnostic Treatments to include the administration of medication, ongoing assessment of potential interactions and negative side effects, wound care and facilitation of diagnostic testing as needed. 8508450 1 0 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 1 167 1 0 0 0 0 0 0 0 0 0 0 X 19 17 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Susan Anthony Board Member 2.00 0.00 X 0 0 0 James Bento Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Robert Bray Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Brother Arthur Caliman President - BSHR/DMC/MMC/MNCC 3.50 46.50 X 0 0 0 Arthur Collins Chairman (Jan-Aug) 3.00 0.00 X X 0 0 0 Sister Elaine Davia Board Member 2.00 48.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 953293 35876 Debra Deihl Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Charlette Fairchild PhD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Gabriel Franco Board Member 2.00 0.00 X 0 0 0 Rev Ivan Harris Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Deborah Jones Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Dr Vincent Joseph Board Member 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 1.00 49.00 X X 0 842080 126937 Sister Sandra Lyons Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Sister Shaun Malone Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Helena Mock Secretary (Sep-Dec) 2.00 0.00 X X 0 0 0 Jeffrey Morrison DO Board Member (Sep-Dec) 2.00 0.00 X 0 0 20750 Sister David Niski President - MIH/SFNC 3.50 0.00 X X 0 0 0 William Pile Chair (Sep-Dec)/BM (Jan-Aug) 3.00 0.00 X X 0 0 0 Cynthia Romero MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Rodrigo Romulo MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Stephanie Short Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Douglas Ziegenfuss CPA Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 1.00 49.00 X 0 275200 16870 Darlene Stephenson CEO - MIH 2.00 48.00 X 0 322337 34367 Michael Dooley Int VP Fin(Apr-Aug)/Treas (Jul-Aug) 5.00 45.00 X 0 0 0 Patricia Robertson CAO/BSV Administration (Sep-Dec) 25.00 25.00 X 0 431220 27585 Karen Reich CEO Extended Senior Care (Jan-Aug) 3.00 47.00 X 0 331895 45868 Tamara Waller Physical Therapist 50.00 0.00 X 0 106553 7084 0 3262578 315337 1 0 1 0 Tidewater Physicians Multispecialty Gro 860 Omni Blvd Suite 401 Newport News VA 23606 Physician Services 305705 First Choice Nurses Of Eastern Virginia 5520 Greenwich Rd Suite 100 Virginia Beach VA 23462 Nursing Services 282669 Shiftwise PO Box 70870 St Paul MN 551709705 Contract Nursing 207267 Shared Hospital Services 3530 Elmhurst Lane Portsmouth VA 23701 Maintenance & Linen Services 116794 GC Commercial Inc 3 Pennington Avenue Newport News VA 236062631 Construction 113493 5 Patient Service Rev. 623110 8225566 8225566 8225566 30463 30463 Beauty & Barber Shop 812112 4071 4071 Purchase Discounts 900099 3191 3191 7262 8263291 8225566 0 37725 X 3429930 3086937 342993 79507 71556 7951 654931 589438 65493 374294 336865 37429 5867 5280 587 1031 928 103 1343108 1343108 362 326 36 77612 69851 7761 11474 10327 1147 455357 409821 45536 4021 3619 402 368 331 37 46217 46217 135976 122378 13598 25412 22871 2541 Purchased Services 1225271 1102744 122527 Medical Supplies 718661 718661 Bad Debt 301020 301020 Medical Equip. Rental 149983 134985 14998 145763 131187 14576 9186165 8508450 677715 0 1000 1000 6379652 5449720 1181509 1117053 29115 22626 5021398 4050271 954095 971127 465690 456969 9011061 8018495 584830 498169 13191 17438 3904029 3959817 4502050 4475424 X 4489965 3524025 19046 19046 4509011 3543071 9011061 8018495 X -922874 -43066 X 0 1 X 1 0 X 8600177 8925434 9171971 9171098 8225566 44094246 8600177 8925434 9171971 9171098 8225566 44094246 0 0 0 44094246 10851 8979 6953 22004 30463 79250 10851 8979 6953 22004 30463 79250 24038 12560 10935 14872 7262 69667 8635066 8946973 9189859 9207974 8263291 44243163 0.99660 0.99670 0.00180 0.00140 X Schedule A, Part III, Line 12, Explanation of Other Income: Beauty Barber - 2012 Amount: $ 13,675. 2013 Amount: $ 10,690. 2014 Amount: $ 7,665. 2015 Amount: $ 5,188. 2016 Amount: $ 4,071. Other - 2012 Amount: $ 10,363. 2014 Amount: $ 523. 2015 Amount: $ 5,378. Purchase Discounts - 2013 Amount: $ 1,870. 2014 Amount: $ 2,747. 2015 Amount: $ 4,306. 2016 Amount: $ 3,191. 0 0 0 0 0 0 0 0 1 1031 1031 0 Part II-B, Line 1: The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. 0 1 X 3367230 2960938 406292 1650168 1088354 561814 4000 979 3021 971127 MedMal & Gen Liab 412905 Due From Affiliates 26007 Assets HIT for Others 18057 456969 Due to Affiliates 3540864 MedMal & Gen Liab 412905 Medicare Settlement 5922 Miscellaneous A/R 126 3959817 X Part IV, Line 2b: Resident Trust Fund Account - The filing organization holds, safeguards, manages, and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Any redsudent may deposit money in to a personal resident fund account. Deposits may not exceed $2,000 for residents receiving Medicaid. Withdrawal requests greater than $50 must be made prior to 4 pm to allow time to obtain funds from the banking institution if necessary. All excess custodial funds are held in interest bearing accounts separate from that of the organization. Part X, Line 2: 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. ASC 740 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 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. Their related income is exempt from federal income tax under Section 501(A). The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of August 31, 2017 or 2016. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present, and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2013. As of August 31, 2017 and 2016, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $106,393 and $89,895 of net operating loss carryforwards as of August 31, 2017 and 2016, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The System accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The System's deferred tax assets are fully reserved at August 31, 2017 and 2016 as the System considers it more likely than not that these amounts will not be recognized. 0 1 0 0 0 0 0 0 0 Timothy Davis Board Member 0 648505 0 151613 0 153175 0 15900 0 19976 0 989169 0 0 Michael Kerner Secretary/CEO-BSHR 0 555514 0 156883 0 129683 0 106277 0 20660 0 969017 0 73667 Charmaine Rochester PhD Treasurer/VP Finance (Sep-Apr) 0 205465 0 30621 0 39114 0 12879 0 3991 0 292070 0 0 Darlene Stephenson CEO - MIH 0 227405 0 54452 0 40480 0 14917 0 19450 0 356704 0 0 Patricia Robertson CAO/BSV Administration (Sep-Dec) 0 305277 0 73944 0 51999 0 15900 0 11685 0 458805 0 0 Karen Reich CEO Extended Senior Care (Jan-Aug) 0 227513 0 64506 0 39876 0 15176 0 30692 0 377763 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, 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 Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Michael Kerner, $82,150. Form 990, Part VI, Section A, line 4 On January 1, 2017, the bylaws of (i) Bon Secours Hampton Roads Health System, Inc., Bon Secours-DePaul Medical Center, Inc., Maryview Hospital, and Bon Secours-Maryview Nursing Care Center (collectively the "Hampton Roads Entities"); and (ii) Mary Immaculate Hospital, Incorporated and Mary Immaculate Nursing Center, Inc. (collectively, the "Mary Immaculate Entities") were amended and restated in their entirety to implement a single mirror board structure for the Hampton Roads and Mary Immaculate Entities, as well as to otherwise bring the documents up to date with current templates. No changes in corporate or sponsorship structure occurred as a result of the bylaws revisions. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc., and the General Minister and General Council of the Bernardine Sisters of the Third Order of St. Francis are the members of Mary Immaculate Hospital, Inc., which in turn is the sole member of Mary Immaculate Nursing Center. Form 990, Part VI, Section A, line 7a The governing body of Mary Immaculate Nursing Center is appointed by its member Mary Immaculate Hospital, Inc., and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Mary Immaculate Nursing Center are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11b 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 15b The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS's rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. 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 The filing organization makes all documents available to the general public upon request. Form 990, Part VII Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. The governing bodies of the related organizations of Bon Secours Hampton Roads Health System, including DePaul Medical Center, Maryview Hospital, Mary Immaculate Hospital, Bon Secours Maryview Nursing Care Center, and Mary Immaculate Nursing Center are comprised of the same board members and board officers (Chairman, Secretary and Treasurer), with the exception of President. These governing bodies are referred to as the Hampton Roads Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for the applicable entities. Br. Art Caliman and Sr. Elaine Davia do not receive payroll distributions as they have taken a vow of poverty. Form 990, Part IX, line 11g Contract Nursing: Program service expenses 1,045,772. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,045,772. Physician Services: Program service expenses 297,336. Management and general expenses 0. Fundraising expenses 0. Total expenses 297,336. Form 990, Part XI, line 9: BSHSI Principal Debt & Swap Payments -43,066. Bon Secours Health System Inc 8990 Old Annapolis Road Columbia MD 21045 521301088 Parent Org. - Mgmt Services MD 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 12c, III-FI Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) Line 3 Bon Secours Health System Inc 0 Mary Immaculate Hospital Auxiliary 7007 Harbourview Blvd Suffolk VA 23435 546040266 Auxiliary VA 501(c)(3) Line 10 N/A 0 OSF Inc 7007 Harbourview Blvd Suite 108 Suffolk VA 23435 541369919 Rental VA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0