2017-07-10T09:44:13-05:00 2016-08-31 861065772 Deloitte Tax LLP Deloitte Tax LLP 191 Peachtree St Atlanta GA 303031749 990 2015-09-01 541820093 Bon Secours DePaul Medical Center Inc BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner Secretary & CEO - BSHRHS 7578895000 2017-07-10 1 John W Sadoff Jr P00540589 4042201500 2015 2021-01-29 14:40:06Z Michael K Kerner 150 Kingsley Lane Norfolk VA 23505 204549681 0 0928 X bonsecours.com X 1996 VA Acute Care Hospital 17 15 1530 107 597359 -12405 1168016 501597 182446680 191870863 367153 -292967 11378370 11860038 195360219 203939531 78386 138600 0 0 79875930 84110801 0 0 0 124352619 132912415 204306935 217161816 -8946716 -13222285 135028278 127918866 213054011 220327522 -78025733 -92408656 X The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. 0 0 201624941 138600 200861111 DePaul Medical Center provides medical care to patients without regard to their ability to pay. Among the major services provided to the residents of Hampton Roads, three major areas of focus are orthopedics, general surgery and neurology.Orthopedics - DePaul continues a strong focus on orthopedic care for residents of Norfolk and Virginia Beach. Bon Secours responds to the needs of all orthopedic patients. Bon Secours skilled surgeons perform minimally invasive and traditional orthopedic and spine procedures, and are complemented by a strong physiatry network. The orthopedic 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 rehabilitation network. In addition, a strong focus exists on community education through seminars and classes. A special expertise exists in the treatment of spine disorders, with a significant cadre of spine and neurological surgeons performing advanced spine surgeries. In addition, a particular focus exists on foot & ankle surgery, with a few fellowship-trained surgeons practicing at DePaul.A strong focus exists on community education through seminars and classes, as well as innovative electronic risk assessments SpineAware and JointAware.General Surgery - DePaul has a special focus on bariatric surgery, including a comprehensive program, expert physicians, and a commitment to patient support for the duration of their weight loss journey. Bon Secours is part of the only weight loss surgery program that does not charge a fee to participants in Hampton Roads. Bon Secours also offers a medically-managed weight loss program as part of its Weight Loss Institute and an exercise-nutrition program for those who may choose this more traditional approach. In 2014, DePaul also added dedicated colorectal surgery services on campus. DePaul is also home to two daVinci (s and si) surgical robotic systems. The robots are being used by general surgeons, colorectal surgeons, gynecological surgeons as well as gynecological oncology surgeons. As a result, the robotic program is one of the busiest in the Commonwealth. Patients travel from all over the region to receive specialized gynecological (and gynecological oncology) surgery at DePaul with our specially trained physicians. As with other services and part of our mission, a strong focus exists on community education through seminars, classes, support groups, and innovative electronic risk assessment tools for breast and colorectal cancers (BreastAware and ColonAware).Neurology - DePaul has recently invested significantly in this service line. A state-of-the-art neuroendovascular laboratory and a skilled surgeon offer services unique in the area. In addition, DePaul is supported by an extensive network of neurologists and neurosurgeons, many with such sub-specialty as sleep medicine, motion disorders, pain management, etc. DePaul's board-certified team of neurology, neurosurgical, neurointerventional, neuroradiology, and neuropsychology specialists offers the latest and most effective treatments in the management of a complete spectrum of nervous system disorders. The comprehensive neuroscience services offered at DePaul includes: a full continuum of care from diagnostics to treatment to physical therapy; specialized, Joint Commission certified Primary Stroke Centers, part of the largest Joint Commission Certified stroke network in Virginia; Emergency Room teleneurology for rapid and more efficient acute stroke treatment; dedicated inpatient acute care and intensive care neuroscience units, one for stroke and neurology and another for neurosurgery, with specialized nurses and clinical staff; spine treatments performed with the latest technological advancements and procedures; the largest outpatient comprehensive pain management center in Hampton Roads; a team of emergency room, acute nurses trained to assess and care for patients with disorders of the nervous system and spinal injury; collaboration with the fully-accredited Bon Secours Sleep Disorder Centers staffed by neurologists that are board certified in sleep medicine; and Long-term video-EEG monitoring to help diagnose and treat seizure disorders such as epilepsy.Finally, as with other services and part of our mission, a strong focus exists on community education and outreach, in partnership with Heart&StrokeAware.See Schedule H for additional information. 201624941 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 81 0 1 1530 1 1 1 0 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X James Bento Board Member 2.00 0.00 X 0 0 0 Michael Blount Board Member 2.00 0.00 X 0 0 0 Robert Bray Board Member 2.00 0.00 X 0 0 0 Bruce Britton MD Board Member 2.00 0.00 X 0 0 0 Brother Arthur Caliman CFX President 3.00 47.00 X X 0 0 0 Arthur Collins Chairman 3.00 0.00 X X 0 0 0 Sister Elaine Davia CBS Board Member 2.00 48.00 X 0 400 0 Timothy Davis Board Member 2.00 48.00 X 0 1652431 96308 Charlette Fairchild Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 14.00 36.00 X X 0 1121910 124973 Michael LaRock Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member 2.00 0.00 X 0 0 0 Carol Ormond Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Ward Robinett Jr Board Member 2.00 0.00 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 2.00 0.00 X 0 0 0 Robert Squatrito MD Board Member 2.00 0.00 X 0 0 0 Douglas Ziegenfuss CPA Board Member 2.00 0.00 X 0 0 0 John Barrett CEO - DMC 49.50 0.50 X 0 494178 28716 Charmaine Rochester PhD Treasurer/VP Finance 15.00 35.00 X 0 277873 16234 Herbert Cummings COO - BSMG 15.00 35.00 X 0 302100 38105 Michael Bratton VP of Patient Care Services 50.00 0.00 X 244188 0 23810 Vickie Humphries VP of Human Resources 15.00 35.00 X 0 228417 12312 James McNamara VP of Ortho 15.00 35.00 X 0 275726 22121 Terri Spence VP & Regional CIO 15.00 35.00 X 0 269054 14451 John Baker MD Neurointerventionalist 50.00 0.00 X 1017441 0 42265 Bradley Prestidge MD Oncologist 50.00 0.00 X 795769 0 45996 George Sarris MD Cardiologist 50.00 0.00 X 596915 0 43170 Saumil Patel MD Cardiologist 50.00 0.00 X 588619 0 41300 William Callaghan Cardiologist 50.00 0.00 X 487233 0 26542 3730165 4622089 576303 104 0 1 0 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 3267156 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction 3002283 PG Hariis Construction Co 1501 Technology DR Ste 101 Chesapeake VA 23320 Construction 1962585 US Bank Corporate Trust (Shiftwise) CM 9705 Acct XXX-XX-XXXX PO Box 70870 St Paul MN 551709705 Contract Nursing 1873088 Morrison Mgt Specialists PO Box 102289 Atlanta GA 303682289 Dietary Services 1487623 39 158254 342743 600 501597 Patient Service Rev. 621500 191870863 191374564 496299 191870863 -370964 -370964 806631 10826 605283 4867 201348 5959 207307 5959 31181 170167 77797 200 0 0 77797 200 77997 77997 JV Inc.- SPAH & Other 621999 10092047 9480588 611459 Physical Therapy Serv. 446199 423173 423173 Insurance Proceeds 900099 325137 325137 812374 69879 742495 11652731 203939531 200861111 597359 1979464 138600 138600 263982 237584 26398 68827901 61945111 6882790 2280102 2052092 228010 7337160 6603444 733716 5401656 4861490 540166 510352 459317 51035 550 495 55 29450 26505 2945 9974563 9974563 14312 12881 1431 2489996 2240996 249000 284094 255685 28409 8487454 7638709 848745 254728 229255 25473 13386 12047 1339 2055331 2055331 11869618 10682656 1186962 839667 755700 83967 Purchased Services 41215529 37093976 4121553 Medical Expenses 31160909 31160909 Bad Debt Expense 18463659 18463659 BSHSI Mgmt Allocation 4391044 3951940 439104 857773 771996 85777 217161816 201624941 15536875 0 3848 3851 48642 137933 2956 2956 22460084 19739665 3613812 3666265 1005222 1430816 152460715 107883518 47663389 44577197 14378418 14803602 29896932 28315354 5001631 5001631 10953344 10239596 135028278 127918866 10155485 10578646 6456868 5910621 196441658 203838255 213054011 220327522 X -78018041 -92401564 -7692 -7092 -78025733 -92408656 135028278 127918866 X -13222285 230371 -1391009 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 18042 0 1 11408 29450 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. The filing organization also conducted advocacy relating to education of legislative body regarding hospital and healthcare reform and how it impacts communities. The lobbying expense related to this activity is included on Line 1g. 3750384 3750384 32929797 23808143 9121654 16908585 6732857 10175728 94688214 74622979 20065235 4183735 2719539 1464196 44577197 Inv. in Sentara Princess Anne Hosp. 26055300 C Inv. in Rad Svc of Hampton Roads 1018460 C Inv. in Surgery Center 654555 C Inv. in Peninsula Hospital Service 265423 C Inv. in MRI 141687 C Inv. in Bed Licenses 74929 C Inv in PET 55000 C Inv. in VHN 50000 C 28315354 Inv - HPL/GL 5621008 Due from Medicare/Medicaid 1316217 Due From Affiliates 1236592 Due from Champus 1201532 Organizational Costs 382586 Other Accrued Revenue 243004 Other Non-Acute Revenue 238657 10239596 Due to Affiliates 196815878 HPL/GL Liability 5621008 FIN 47 LT Asbestos Liab 896839 Due to Medicare 424142 Other LT Liabilities 80388 203838255 X 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. The System's taxable subsidiaries had approximately $89,895 and $84,748 of net operating loss carryforwards as of August 31, 2016 and 2015, respectively, which expire in varying periods through 2036 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. Income tax liabilities are recorded for the impact of positions taken on income tax returns, which management believes are not more likely than not to be sustained on tax audit. 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, 2016 and 2015 as the System considers it more likely than not that these amounts will not be recognized. 1 1 X 1 X 0 1 1 1 0 1 1 4845473 31867 4813606 0.02420 20189920 14801912 5388008 0.02710 0 0 25035393 14833779 10201614 0.05130 22 23652 1564940 1000 1563940 0.00790 3 302 1307006 650124 656882 0.00330 3 2262 202622 135 202487 0.00100 0 0 0 0 7 0 544299 0 544299 0.00270 35 26216 3618867 651259 2967608 0.01490 35 26216 28654260 15485038 13169222 0.06620 1 3125 176006 0 176006 0.00090 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2412 32260 0 32260 0.00020 0 0 0 0 1 8 14803 0 14803 0.00010 0 0 0 0 4 5545 223069 223069 0.00120 1 18463659 0 37849819 49917185 -12067366 X 1 1 1 1 DePaul Medical Center 150 Kingsley Lane Norfolk VA 23505 bonsecours.com H1829 X X X X Bon Secours DePaul Medical Center Inc 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Section C X 1 15 0 1 0 1 X 200.000000000000 0.000000000000 X 1 1 X X X 1 X www.fa.bonsecours.com X X X X X 1 X 1 X X X X X 1 X 0 0 Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 5: DePaul Medical Center (DMC) contracted with ToXcel to conduct an electronic survey of key stakeholders to determine the top healthcare needs of the community. DMC developed a list of key stakeholders who were asked to provide their viewpoints on important healthcare concerns in the community, significant gaps in the community, and ideas for addressing health concerns and service gaps. Stakeholders included individuals who have special knowledge and expertise in public health, as well as the deans of area colleges and universities with medical degree programs. In addition, DMC surveyed representatives of medically underserved, minority populations, and those with chronic conditions. In addition, DMC conducted community forums to gather additional input from residents. Upon receipt of all information, DMC convened a community advisory board made up of 36 representatives from 40 organizations focused on community health, including Sentara and Riverside health systems and the Norfolk Public Health Department to review the list of key needs and gaps identified to prioritize the needs and make recommendations to DMC leadership. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 11: Through development of an implementation plan from the CHNA, DePaul Medical Center identified the health priorities in the related service areas. DMC has an open medical staff with privileges available to all qualified physicians. The DMC emergency department provides service 24 hours/day, 7 days/week to ensure access for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located.DMC offers health services via the Care-A-Van (CAV). The CAV is a free mobile medical service that provides general medical care to uninsured adults and children in Norfolk, as well as Newport News, Portsmouth, and Suffolk. Services provided include urgent and primary care (including examination, diagnosis, lab, pharmacy, and follow-up), immunizations for school, pregnancy tests, blood pressure measurement, health education, referrals for specialty care, and opportunity to enroll eligible children in children's health insurance. The Care-A-Van also offers sports physicals and health education services. While the CAV primarily serves adults, some sites provide care and referral services for children aged 12 and older. Community partners include free clinics, local health agencies, physicians, and numerous faith-based organizations which collaborate with CAV staff. Over 1,550 patient visits were rendered by the CAV in Norfolk and over $206,700 in lab services were provided at no cost to the patient. The CAV has a staff of 11 FTEs and annual expenses of approximately $385,934.DMC offers support to qualified patients though the Life Coach Program. The Life Coach Program connects patients with no insurance, little resources, or no personal doctor with primary care resources to minimize their trips to the emergency room. These coaches work closely with the emergency department staff to find medical homes for patients who regularly use emergency rooms for non-emergency issues. Life Coaches help patients overcome social barriers to care, make follow up appointments, and obtain medications. If any patient meets the criteria for life coach services - low-income, lack of insurance and no regular source of primary care - life coaches call that person to provide information and offer assistance. They also help set up ongoing care with primary care physicians or the Care-A-Van, a mobile clinic operated by BSHR for the Norfolk area. DMC Life Coaches had 9,230 patient contacts, scheduled 4,943 appointments with primary care physicians, connected 1,403 patients with the Care-A-Van, assisted 46 patients with medication needs, and connected 5,631 patients with other community resources.Building healthier communities requires a systemic, ecological, multi-sector approach that acknowledges all of the social determinants of health such as housing, education, employment, public safety and social justice. In 2009, DMC partnered with the City of Norfolk on an initiative called Neighbors Building Neighborhoods. DMC chose to focus on the Pretty Lake area of East Ocean View (EOV), historically one of the roughest neighborhoods in Norfolk. With over 6,000 residents of which more than 25% are below the poverty level, over 20% are single parent households, and with a per-capita income of only $14,658 leaves families in extreme difficulty. In this neighborhood family violence, gangs, addictions, housing affordability, access to healthcare, and a lack of educational opportunities all affect the health of the individuals living there. Working with residents and city officials, DMC assisted in a neighborhood beautification project and the renovation and expansion of the local Storehouse Food Pantry, which feeds 80-100 families a month. The "Passport to Health" program, which encourages living a healthier lifestyle by providing healthy cooking & education classes, exercise program and fresh weekly produce bags, led 42 families (110 individuals) to lose approximately 200 pounds over a five month period. To encourage physical activity, "Move It Thursdays" was added to programming and includes Zumba classes, weight-training, education on the use of exercise equipment, walking, running, basketball, and other activities. Working with the Norfolk Farmer's Market, Passport to Health Families received approximately 5,700 pounds of fresh produce. The EOV Community Garden, which includes 10 raised, accessible garden boxes, a solar-powered hydroponics system, flowerbeds, fruit trees and grapevines, continues to thrive and plans are in process for a second community garden. The annual Youth Survival Night was attended by 60 youth (ages 10 - 17). DMC offers the Bon Secours SeniorHealth Program which provides a free membership program to over 40,000 individuals 55 years and older. Lunch & Learn educational programs bring professionals from healthcare, the government, and the private sector in front of members for presentations and question/answer sessions six times a year. The annual Successful Aging Forum brings national speakers to discuss the latest health and wellness topics for senior citizens (over 500 people attended the event). A quarterly publication, Good Health, provides information to members in the Hampton Roads area. Seniors also play a vital role in BSHR's advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP) through the Bon Secours Advocates program. BSHR partnered with "As You Wish" Advanced Care Planning" to provide programming to seniors. DMC offers Home Health and Hospice Care. One-on-one care through the H2H (Hospital-to-Home) is provided to help patients recover from an illness or injury or to assist with daily living activities and pain management. Services include care coordination, physical therapies, diet education, intravenous therapy, medical/surgical care, nursing instruction, skilled clinical evaluation and wound care.DMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads through the the women's health service line. DMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program. The Oncology Nurse Navigator at DMC provided education and support services to 781 patients diagnosed with cancer. DMC Oncology Services also partnered with Eastern Virginia Medical School to provide skin cancer screenings - 128 participants with 63 advised to have follow-up/biopsies. DMC offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. DMC currently provides comprehensive diabetes education with weekly education sessions covering understanding diabetes, nutrition, foot care, exercise, and medication. Several seminars on clinical ethics were also offered to professionals in the area. DMC staff are dedicated to promoting the health and welfare of community through a variety of avenues including the United Way campaign and The Storehouse Food Bank (serves 80-100 residents per month). Bon Secours InMotion provided health screenings and presentations to approximately 1,700 people. DMC also partners with Virginia Supportive Housing to address the needs of the homeless. Within the community, there are other providers and organizations addressing homelessness, mental health, crime, education, community violence, employment, alcohol/drugs, child abuse/neglect, access to social services, and dental health with specialized programs and services and it would result in duplication of services if DMC were to address the need. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 13h: The facility approved free care for patients at or below 200% of the FPL. For patients above 200% of the FPL we utilize a sliding scale with no cap. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 16i: Information regarding the FAP is available on our websites, brochures are available at the time of registration. We have on site Counselors who can assist the patients. We have eligibility vendors who work with the patients and our statements indicate we have an FAP. Bon Secours DePaul Medical Center, Inc. Part V, Section B, Line 22d: Bon Secours offers 75% discounts to all self pay patients in the following markets: Virginia, South Carolina and Kentucky. We also offer an 80% discount to our patients in our New York Market. Form 990, Schedule H, Part V, Section B, Line 14: The Community Service Adjustment was based on the average amounts paid by our insurance companies. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/hampton-roads/community-commitment/community-health-needs-assessment 22 1 - InMotion Phy Ther Healthy Way 828 Healthy Way Suite 105 Virginia Beach VA 23462 Physicial Therapy & Sports Rehab 2 - DePaul InMotion Phys Ther-Norfolk 7300 Newport Ave Suite 300 Norfolk VA 23505 Physical, Occupational & Speech Therapy 3 - Bon Secours In-Motion at Hilltop 1817 Laskin Rd Suite 100 Virginia Beach VA 23454 Physical Therapy & Sports Rehab 4 - InMotion Phy Ther Redmill Landing 1253 Nimmo Parkway Suite 105 Virginia Beach VA 23456 Physical Therapy 5 - Bon Secours In Motion Amelia 885 Kempsville Road Suite 300 Norfolk VA 23502 Physical Therapy 6 - Bon Secours Medical Associates 828 Healthy Way Suite 220 Virginia Beach VA 23462 Physician Practice 7 - Bon Secours In Motion Ghent Station 930 W 21st St Norfolk VA 23517 Physical Therapy 8 - DePaul Medical Associates 100 Kingsley Lane Suite 100 Norfolk VA 23505 Physician Practice 9 - Bon Secours Surg Specialists DePaul 160 Kingsley Lane Suite 400 Norfolk VA 23505 Physician Practice 10 - Ghent Family Practice & Internal Med 957 W 21st St Suite E Norfolk VA 23517 Physician Practice 11 - Hampton Roads OBGYN 100 Kingsley Lane Suite 100 Norfolk VA 23505 Physician Practice 12 - Amelia Medical Associates 885 Kempsville Road Norfolk VA 23502 Physician Practices, Physical Therapy 13 - Cardiovascular Specialists 160 Kingsley Lane Suite 100A Norfolk VA 23505 Physician Practice 14 - Town Center Medical Associates 4421 Virginia Beach Blvd Suite 114 Virginia Beach VA 23462 Physician Practice 15 - East Beach Medical Associates 4039 E Little Creek Rd Norfolk VA 23518 Physician Practice 16 - Bon Secours Oncology Specialists 150 Kingsley Lane Norfolk VA 23505 Physician Practice 17 - Patient Choice Oceana 1232 Perimeter Pkwy Suite 101 Virginia Beach VA 23454 Physician Practice 18 - Bon Secours Pulmonary Spec - Norfolk 100 Kingsley Lane Suite 400 Norfolk VA 23505 Physician Practice 19 - Bon Secours Neurovascular Center 110 Kingsley Lane Suite 411 Norfolk VA 23505 Physician Practice 20 - Monarch Medical Associates 4211 Monarch Way Suite 100 Norfolk VA 23508 Physician Practice 21 - Greenbrier Medical Associates 908 Eden Way North Suite 101 Chesapeake VA 23320 Physician Practice 22 - Bon Secours Fastcare - Battlefield 309 Battlefield Blvd Chesapeake VA 23322 Physician Practice Part I, Line 6a: Annually, Bon Secours Hampton Roads Health System (BSHRHS) publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. This report is available online at https://bonsecours.com/hampton-roads. 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 captured in the patient accounting system and 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, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $18,463,659. Form 990, Schedule H, Part I, Line 7i, Column b: Number of persons served: 3,610,352 Part II, Community Building Activities: Bon Secours DePaul Medical Center provided staff and resources in support of the Healthy Community Initiative of Bon Secours Health System, and advocated for local and state policies that would improve health across its communities. Bon Secours Hampton Roads Health System is working to engage and empower the members of the East Ocean View neighborhood to support them in improving their quality of life and holistic health. DePaul Medical Center donated staff time and resources in support of these efforts. In addition, Bon Secours Hampton Roads has partnered with Norfolk Health Collaborative to address issues affecting the health of the community. Bon Secours Hampton Roads also partnered with the Greater Hampton Roads Coalition to develop a community dashboard that aggregates data for use in the CHNA and CHA processes. Part III, Line 2: 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 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on pages 12-13 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 42-43 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: 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-reimbursable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and non-reimbursable 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.The organization feels the total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publically insured patients where reimbursement is less than cost of providing the service.In addition to the costs reported above, the organization incurred additional costs relating to Medicare support that are not includable in the Medicare Cost Report in the amount of: $414,311. 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, DePaul Medical Center (DMC) uses multiple approaches to assess the health needs of the communities it serves.Health care needs of the community are assessed and updated using a variety of informational sources including Virginia Health Information for state-based performance data, Health Group West and Hammes Company for market and geographic data. Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to DMC. National Research Corporation (NRC), Sg2 Analytics, and strategic market intelligence are 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"), 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. 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: Hampton Roads is a very diverse community within an MSA of over 1.7 million people residing in 16 cities and counties, stretching from northeastern North Carolina to Williamsburg. The area is characterized by racial diversity, a significant military population and a growing elderly population.The primary service area population served by DePaul Medical Center (DMC), encompasses Norfolk and Virginia Beach. The largest populations for the DMC service area are white (53.5%), Black or African American (30.2%), non-white Hispanic (53.5%), and small percentages of other groups. The median income for the DMC service area is $55,150. The City of Norfolk has the highest rate of children living in poverty (31.7%) compared to Virginia (15.9%). Virginia Beach follows with 12.4% of children living in poverty. The percentage of children living in single parent households (41.5%) is higher compared to Virginia (30%) and 40% of students are eligible for free lunch.The most prevalent chronic conditions among adults in the service area include high blood pressure (29.4%), asthma (8.5%), diabetes (8.3%), depression (15.8%) and smoking (21.5%). The leading causes of mortality in the DMC service area per 100,000 are heart disease (518.5), cerebrovascular disease (126), cancer (555.5), chronic lower respiratory diseases (113.5), diabetes (65), kidney disease (67) and septicemia (58). The infant mortality rate (per 1,000 live births) in the DMC service area is 9.9% compared to 6.2% in Virginia. Part VI, Line 5: DePaul Medical Center (DMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/day, 7 days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located. Part VI, Line 6: 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. As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is "to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSHSI Vision. BSHSI's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2016-2018). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents.- Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that the struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression.- Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSHSI and the SQP. Part VI, Line 7, Reports Filed With States VA 1 Bon Secours DePaul Health Foundation 100 Kinglsey Lane Suite 204 Norfolk VA 23505 541843876 501(c)(3) 120134 Foundation Administrative Expense Bon Secours DePaul Health Foundation 100 Kingsley Lane Suite 204 Norfolk VA 23505 541843876 501(C)(3) 18466 Gift Shop Proceeds 2 0 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 0 1 0 0 0 0 0 0 0 Timothy Davis Board Member 0 658643 0 496834 0 496954 0 75673 0 20635 0 1748739 0 329759 Michael Kerner Secretary/CEO-BSHR 0 559739 0 403723 0 158448 0 93156 0 31817 0 1246883 0 91467 John Barrett CEO - DMC 0 290687 0 163153 0 40338 0 15900 0 12816 0 522894 0 0 Charmaine Rochester PhD Treasurer/VP Finance 0 207596 0 41583 0 28694 0 12118 0 4116 0 294107 0 0 Herbert Cummings COO - BSMG 0 237395 0 64499 0 206 0 10600 0 27505 0 340205 0 0 Michael Bratton VP of Patient Care Services 203684 0 39693 0 811 0 12334 0 11476 0 267998 0 0 0 Vickie Humphries VP of Human Resources 0 165089 0 35245 0 28083 0 3054 0 9258 0 240729 0 0 James McNamara VP of Ortho 0 230605 0 44615 0 506 0 12247 0 9874 0 297847 0 0 Terri Spence VP & Regional CIO 0 225003 0 43560 0 491 0 3975 0 10476 0 283505 0 0 John Baker MD Neurointerventionalist 1014790 0 0 0 2651 0 13250 0 29015 0 1059706 0 0 0 Bradley Prestidge MD Oncologist 611682 0 162784 0 21303 0 13250 0 32746 0 841765 0 0 0 George Sarris MD Cardiologist 561094 0 34885 0 936 0 13315 0 29855 0 640085 0 0 0 Saumil Patel MD Cardiologist 381431 0 206822 0 366 0 13250 0 28050 0 629919 0 0 0 William Callaghan Cardiologist 459226 0 25000 0 3007 0 0 0 26542 0 513775 0 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: Timothy Davis, $406,381; Michael Kerner, $112,117. Elizabeth Barrett Spouse-John Barrett, CEO 430687 Employment 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 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 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' 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. 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 - Additional Disclosure: Avg hours devoted to related org(s) when related comp is reported: 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 hospitals of Bon Secours Hampton Roads Health System, including DePaul Medical Center, Maryview Hospital, and Bon Secours Maryview Nursing Care Center, are comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer). 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 does not receive payroll distributions as he has taken a vow of poverty. Form 990, Part XI, line 9: BSHSI Principal and Swap Payments -1,391,009. Mary Immaculate Foundation 7007 Harbour View Blvd Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 11c, III-FI Mary Immaculate Hospital 0 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 9 Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) Line 3 Bon Secours Health System Inc 0 Bon Secours Hampton Roads Health System Inc 7007 Harbour View Blvd Suffolk VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) Line 9 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Suffolk VA 23435 540506463 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bayley Properties 7007 Harbour View Blvd Suffolk VA 23435 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 1 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Living VA N/A Professional Health Care Mgmt Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541241031 Administrative VA N/A C 0 Tidewater Diversified Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C 684081 2420239 1.00000 1 OSF Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541369919 Rental VA N/A C 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0