2017-08-15T11:42:35-05:00 2016-09-30 560574444 CHERRY BEKAERT LLP 828 Main St Ste 1801 Lynchburg VA 24504 990 2015-10-01 540505955 Sheltering Arms Hospital SHEL 8043424340 8254 Atlee Road Mechanicsville VA 23116 Mary Zweifel President & CEO 8043424340 2017-08-15 1 Samuel Johnson P00019699 4348476643 2015 2021-01-29 14:40:06Z Mary Zweifel 8254 Atlee Road Mechanicsville VA 23116 50707280 0 X WWW.SHELTERINGARMS.COM X 1941 VA TO PROVIDE PHYSICAL REHABILITATION AND TO ENHANCE THE QUALITY OF LIFE TO THOSE WITH DISABILITIES, AND TO OFFER FINANCIAL ASSISTANCE TO THOSE IN NEED. 17 17 766 17 0 0 17891406 19737000 51153593 30321095 3112 18552 -30495 113012 69017616 50189659 200712 162052 0 0 25409754 27152141 0 0 0 41893992 20664536 67504458 47978729 1513158 2210930 33322851 32515705 17038981 14216633 16283870 18299072 X THE MISSION OF SHELTERING ARMS HOSPITAL IS TO PROVIDE COMPREHENSIVE PHYSICAL REHABILITATION OF THE HIGHEST CALIBER WITH COMPASSION AND RESPECT, TO ENHANCE THE QUALITY OF LIFE TO THOSE PERSONS EXPERIENCING DISABILITIES, AND TO OFFER FINANCIAL ASSISTANCE TO THOSE IN NEED. 0 0 41232029 74938146 INPATIENT PHYSICAL REHABILITATION SERVICES:Sheltering Arms Hospital operates a 40 bed acute physical rehabilitation inpatient hospital in Mechanicsville, Virginia. The primary service area is central Virginia although patients are admitted from Virginia and surrounding states. During fiscal year 2016, 864 patients were admitted resulting in 13,126 patient days. OUTPATIENT PHYSICAL REHABILITAITON SERVICES:Sheltering Arms Hospital provides outpatient physical rehabilitation services at the hospital campus and nine additional locations in the Richmond area. The outpatient continuum of services included Orthopedic Rehabilitation Services, Neurological Rehabilitation Services, Physicians and Psychology Rehabilitation Services, and Outpatient Rehabilitation Therapies. During fiscal year 2016, Sheltering Arms Hospital provided outpatient therapy resulting in 82,756 therapy visits. For fiscal year 2016 Physician and Psychology services resulted in 40,017 patient visits. 1295808 162052 CHARITY CARE AND COMMUNITY SUPPORT:Sheltering Arms Hospital accepts patients regardless of their ability to pay and provides financial assistance for medical bills to qualified patients lacking adequate financial resources. Financial assistance is also offered for the Partners for Life program. During fiscal year 2016, charity care and/or financial assistance resulted in total discounted charges foregone by Sheltering Arms Hospital of $760,709.01. In FY 2016, Sheltering Arms Hospital also transported patients participating in patient therapy at an unreimbursed cost of $3,934.50. Sheltering Arms Hospital also provided free mobility and therapy equipment and pharmacy assistance to those patients who qualified, for use during their recovery at home. The cost of providing this assistance was $18,908.50. In addition, Sheltering Arms Hospital contributed $143,142.87 to support other community organizations and events. 1603659 487016 PARTNER FOR L.I.F.E.:The benefits of physical and recreational activity participation highlight a need for individuals with physical disabilities, the aging population, and individuals managing chronic conditions to access services that can positively impact quality of life and physical activity level. Sheltering Arms is dedicated to helping people find within themselves the power to overcome serious setbacks following illness, injury, or accident through internationally recognized physical rehabilitation programs. The Sheltering Arms commitment does not end when therapy or physician services are complete. Sheltering Arms provides a comprehensive portfolio of unique, community-based recreation and health and wellness services to meet the needs of the community. These services make up the Partner for L.I.F.E. program (Leisure, Interaction, Fitness, and Enjoyment), empowering individuals to embrace a lifetime of recreation and wellness. Our unique programming provides an opportunity for people to re-engage in activities they once enjoyed and maintain an active social and physical lifestyle despite their limitations. The services provided are open to the public and do not require a physician referral. Services offered include group recreation and social events, Adaptive Bowling League, Accessible Travel Program, therapeutic pool and fitness center memberships, personal training services, group exercise classes, educational seminars, chronic disease self-management classes, diabetes self-management classes, NeruoFit and our Club Rec Program. Club Rec is a non-medically based social, recreation program providing opportunities for fitness, wellness, socialization, and community reintegration for members up to five days per week. Certified Therapeutic Recreation and Fitness Specialists organize daily programs, community outings, group and individual exercise sessions, social programs, cognitive activities, adaptive leisure activities, educational programs, and an array of weekly leisure activities. Club Rec focuses on enhancing quality of life for those recovering from injury or illness. Members enrolled in Club Rec have opportunities to utilize the onsite fitness center, participate in Spirituality Group , the computer lab, weekly trips to our therapeutic pool, intergenerational programs, community services opportunities, as well as community outings. Financial Assistance was provided to those who qualified in this program at a discounted amount of $142,813. In fiscal year 2016 the Club Rec those programs enrolled 7,350 visits from individuals with disabilities.Partner for L.I.F.E. special event programs (including Adaptive Golf & Adaptive Bowling League) provide opportunities for individuals with disabilities to participate in organized recreation activities with the support of Recreational Therapists, and necessary adaptive recreation equipment, to ensure successful participation regardless of their physical limitations. In fiscal year 2016 there were 16 events with a total of 448 participants. Chronic disease Self-Management and Diabetes Self-Management classes were offered free to the community through partnership with local senior and health care agencies. The goal of the program is for participants to learn strategies to implement healthy lifestyle changes to successfully manage their chronic condition. In addition to recreation events, Partner for L.I.F.E. services believe in the necessity of maintaining physical activity to continue an active lifestyle, maintain progress achieved in skilled therapy, as well as prevent future injury or illness. We have a warm water therapeutic pool and fitness center offering pool and fitness memberships, aquatic and land group exercise classes, and personal training services to the community. Our warm water therapeutic pool provides a ramp for wheelchair entry into the water, submerged parallel bars, and lap lane swimming for those who find less pain and increased range of motion in a warm water environment. Pool and fitness memberships provide a transition plan for patients being discharged from inpatient hospital and outpatient therapy clinics by providing the opportunity to continue to engage in physical activity. Fitness Specialists provide fitness members with personalized attention, as well as personal training services for those who are interested in individualized goal setting and exercise programs designed to meet their needs. During fiscal year 2016 there were 29,643 community membership visits to the pools fitness centers. Sheltering Arms lead 1,111 group exercise classes and wellness education classes with a total of 5,603 class participants. Fitness Specialists conducted 2,795 personal training and 1,824 NeuroFit personal training visits. On our Hanover and South Hospital campuses the Fitness Specialists utilize advanced technologies to provide unique personal training services for the neurologically impaired in our NeuroFit program. The goal is to ensure lifelong physical activity after a catastrophic injury or illness. Fitness Specialists at our Bon Air and Reynolds locations provide personal training services to those transitioning from outpatient therapy services, while also providing personal training service to the community for prevention and wellness. Our Parkinson's Wellness Recovery bi-weekly group exercise at Bon Air has seen significant growth in class participants. Sheltering Arms fitness centers have seen significant growth in Silver Sneaker members. This community program provides financial fitness membership support for those with a Silver Sneaker wellness option through their private insurance financial fitness membership support for those with a Silver Sneaker wellness option through their private insurance company. Specific Silver Sneaker group exercise classes are offered at our Bon Air location weekly.As we continue to face the transition of health care in our community the focus of health, wellness, and prevention continue to emerge as a critical component in life long care. Sheltering Arms Partner for L.I.F.E. services provide a unique niche for individuals with physical disabilities, as well as the community, to maintain an active and healthy lifestyle. 44131496 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 100 0 1 766 1 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 VA X James S Litsinger CFO 8043424340 8254 ATLEE RD MECHANICSVILLE VA 23116 TERESA Reynolds DIMARCO DIRECTOR 2.00 3.00 X 0 0 0 HOLLY ANTRIM DIRECTOR 2.00 3.00 X 0 0 0 Lawrence E Gibson DIRECTOR 2.00 3.00 X 0 0 0 WILLIAM E HARDY DIRECTOR 2.00 3.00 X 0 0 0 SUSAN J RAWLES DIRECTOR 2.00 3.00 X 0 0 0 JAMES A SLABAUGH SR DIRECTOR 2.00 3.00 X 0 0 0 KATHRYN M BARLEY DIRECTOR 2.00 3.00 X 0 0 0 ANNE H BENNETT DIRECTOR 2.00 3.00 X 0 0 0 PETER H BOWLES DIRECTOR 1.00 4.00 X 0 0 0 DAVID E CONSTINE III DIRECTOR 2.00 3.00 X 0 0 0 Sandra M Douglas DIRECTOR 2.00 3.00 X 0 0 0 ASHBY R HACKNEY DIRECTOR 2.00 3.00 X 0 0 0 AMES J RUSSELL DIRECTOR 2.00 3.00 X 0 0 0 THEODORE W PRICE DIRECTOR 1.00 4.00 X 0 0 0 PATRICIA B CUSHNIE Immediate Past Chair 1.00 4.00 X X 0 0 0 J WAVERLY PULLEY III Chairman 2.00 3.00 X X 0 0 0 DIANNE V JEWELL VICE CHAIRMAN 2.00 3.00 X X 0 0 0 James S Litsinger VP of Finance & CFO/Treasurer 8.00 32.00 X 0 0 0 MARY ZWEIFEL Interim President/ CEO as of 1/16 24.00 16.00 X 288358 0 17576 CHRISTOPHER P SORENSON VP OF INFORMATION TECHNOLO 10.00 30.00 X 200055 0 23061 Michael Dacus VP of finance until 4/16 24.00 16.00 X 309069 0 21947 James E Sok President/CEO until 12/31/16 24.00 16.00 X 934440 0 98664 ELLEN VANCE Chief Human Resource Officer 10.00 30.00 X 220881 0 24772 SANDY EYLER Chief Nursing Officer 10.00 30.00 X 183787 0 14478 TIMOTHY M SILVER MEDICAL DIRECTOR 40.00 40.00 X 405524 0 24905 HILLARY S HAWKINS MEDICAL DIRECTOR 40.00 0.00 X 469506 0 16102 GREGORY LEGHART PHYSICIAN 40.00 0.00 X 310237 0 26583 CHARLES MATTHEW GIBELLATO PHYSICIAN 40.00 0.00 X 229854 0 13791 ALBERT M JONES PHYSICIAN 40.00 0.00 X 264154 0 21045 MARIA C LITTAUA PHYSICIAN 40.00 0.00 X 227925 0 25894 AARON M JONES PHYSICIAN 40.00 0.00 X 224886 0 22236 James Braith Former VP of business development 40.00 X 218982 0 24729 4487658 0 375783 37 1 1 0 MEMORIAL REGIONAL MEDICAL 8260 ATLEE ROAD MECHANICSVILLE VA 23116 HOSPITAL ANCILLARY & SUPPORT 2340163 CROTHALL 1500 Liberty Ridge Drive Ste 210 WAYNE PA 19087 HOUSEKEEPING 494409 Emerald Construction Company 2219 Dabney Road RichMOND VA 23230 Construction services 458900 TROUTMAN SANDERS LLP 1001 HAXALL POINT RICHMOND VA 23219 LEGAL ADVICE 341371 BE Smith Inc 9777 Ridge Drive Suite 300 Lanexa KS 66219 Employment services 299717 11 18815968 921032 19737000 PATIENT REVENUE 621400 29794006 29794006 THERAPEUTIC RECREATION 621400 527089 527089 30321095 19175 19175 144108 0 144108 144108 144108 623 -623 -623 -623 486335 516998 -30663 -30663 MISCELLANEOUS 621400 -433 -433 -433 50189659 30464770 0 -12111 143143 143143 18909 18909 3496836 1777489 1719347 17800213 17800213 1098403 933643 164760 2362909 2126766 236143 2393780 1921172 472608 432262 225234 207028 149361 112021 37340 87616 77602 10014 141301 125437 15864 186824 184812 2012 2341679 1991143 350536 2737774 2586372 151402 57880 50855 7025 142784 110582 32202 166882 166882 8117974 8117974 2171329 1870140 301189 246925 210447 36478 PURCHASED SERVICES 3099855 3043668 56187 BAD DEBT EXPENSE 469442 469442 MEMBERSHIPS 114648 67550 47098 47978729 44131496 3847233 0 237654 126849 12521045 8788664 3736093 3851989 60348 70545 1302491 1021198 39872361 27987873 12204655 11884488 100000 495647 492314 2664918 6279658 33322851 32515705 4185490 4702233 12853491 9514400 17038981 14216633 X 16180832 18296034 3038 3038 100000 0 16283870 18299072 33322851 32515705 X 2210930 -15728 -80000 -100000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 416370 416370 11135716 6255729 4879987 3965448 2656730 1308718 19306300 16070510 3235790 5048527 3004904 2043623 11884488 INVESTMENT IN OTHER ENTITIES 83398 Internal Use software 6196260 6279658 X Part X, Line 2: The Corporation has been recognized by the Internal Revenue Service as a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code ("IRC") and is exempt from federal income taxes pursuant to Section 501(a) of the IRC. GAAP requires the Corporation's management to evaluate tax positions taken by the Corporation and recognize a tax liability (or asset) if the Corporation has taken an uncertain tax position that more than likely would not be sustained upon examination by the IRS. The Corporation's management has analyzed the tax positions taken by the Corporation and has concluded that as of September 30, 2016, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or an asset) or disclosure in the consolidated financial statements. The Corporation is subject to audit by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. BAL-DU-BOIS 486335 486335 157132 359866 486335 486335 157132 359866 516998 -30663 1 1 X 1 X 1 X 1 1 0 1 1 926365 0 926365 0.01930 741739 0 741739 0.01550 0 0 1668104 1668104 0.03480 1603659 487016 1116643 0.02330 166666 0 166666 0.00350 142212 0 142212 0.00300 1912537 487016 1425521 0.02980 3580641 487016 3093625 0.06460 1 469442 23472 11636770 9806884 1829886 X 1 1 1 1 SHELTERING ARMS HOSPITAL 8254 ATLEE ROAD MECHANICSVILLE VA 23116 www.shelteringarms.com h-1899 X PHYSICAL REHABILITATION HOSPITAL SHELTERING ARMS HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.shelteringarms.com X 1 15 1 www.shelteringarms.com 0 0 1 X 200.000000000000 250.000000000000 X X X X X X 1 1 X X X X X 1 X www.shelteringarms.com X X X X X 1 X 0 X X X X 0 X X X 0 0 SHELTERING ARMS HOSPITAL Part V, Section B, Line 5: Line 5: The content of the survey was based on broad community health data. On a national level, Sheltering Arms looked at Healthy People 2020 for improving health of all Americans and specific objectives related to Disability and Health. At the state level Sheltering Arms looked at The Virginia health Promotion for People with Disabilities at Virginia Commonwealth University whose mission is to promote the health of people with disabilities, prevent secondary conditions, and eliminate disparity between people with and without disabilities. At the local level Sheltering Arms looked to the Virginia Department of Health-Office of minority Health and health Equity to determine the many factors determining health including community walkability, food accessibility, affordability, income inequality and access to care. There were two surveys conducted: One for clients and patients and then another for agencies and persons who represent the broad interest of the community including those with special knowledge of or expertise in public health and assess the needs of the medically underserved, low-income and minority populations. Sheltering Arms Hospital cares for patients in the central and eastern Virginia region covering 16 counties. SHELTERING ARMS HOSPITAL Part V, Section B, Line 11: Sheltering arms hospital is addressing the chna 2016 assessment using chip. The chna identified and then prioritized the significant health needs of the community identified in the two surveys conducted. The survey results were grouped in to four major areas: access to healthcare, access to education and support, access resources, and access to fitness and wellness. Sheltering arms leadership reviewed the results and prioritized them based on the number of responses and grouped the responses in to four top community health needs. The health need priorities are: healthy lifestyle which includes nutrition, health, wellness, fitness and mobility; care navigation; caregiver support; medical devices-ramps since the survey determined that they are difficult to obtain and make a difference in patients going home versus long term care facilities. SHELTERING ARMS HOSPITAL Part V, Section B, Line 15e: The cfo will review applications that do not meet the program guidelines but for which extraordinary circumstances may exist. Also, applications by patients/families who disagree with the program determination may request reconsideration through this process. 10 1 - SHELTERING ARMS HANOVER REHABILITATION C 8226 MEADOWBRIDGE ROAD MECHANICSVILLE VA 23116 OUTPATIENT THERAPY AND PHYSICIANS CLINIC 2 - SHELTERING ARMS SOUTH PHYSICIANS CLINIC 13700 ST FRANCES BLVD MIDLOTHIAN VA 23114 OUTPATIENT THERAPY AND PHYSICIANS CLINIC 3 - SHELTERING ARMS BON AIR CENTER 206 TWINRIDGE LANE RICHMOND VA 23235 OUTPATIENT THERAPY AND PHYSICIANS CLINIC 6 - SHELTERING ARMS Reynolds CENTER 6627 W Broad Street RICHMOND VA 23226 OUTPATIENT THERAPY AND PHYSICIANS CLINIC 9 - SHELTERING ARMS HANOVER NEURO CTR 8254 ATLEE ROAD MECHANICSVILLE VA 23116 OUTPATIENT THERAPY AND PHYSICIANS CLINIC 10 - Sheltering ARms Chester Center 12220 Ironbridge Road Chester VA 23831 OuTPATIENT THERAPY AND PHYSICIANS CLINIC 11 - Sheltering ARms Midtown Club Rec 2805 West Broad Street RICHMOND VA 23230 Outpatient therapy, outpatient day program and fitness center 12 - PT Works Center 2296 John Rolfe Parkway RICHMOND VA 23233 outpatient therapy and physicians clINIC 13 - Sheltering Arms Hull Street Center 13530 Hull Street Road MiDLOTHIAN VA 23114 outpatient therAPY AND PHYSICIANS CLINIC 14 - Sheltering Arms Laburnum Center 4730 S Laburnum Avenue RichMOND VA 23231 OUTPATIENT THERAPY AND PHYSICIANS CLINIC Part I, Line 3c: Part I, Line 6a: The fy 2015 community benefit report was published in the sheltering arms hospital annual report and is available on the website at www.shelteringarms.com. The fy 2016 community benefit report will be published in fy 2017 in the sheltering arms annual report and will be available on the website at www.shelteringarms.comPart I, Line 7: Column f reflects the charity and financial assistance at cost and other community benefits as a percentage of the total functional expenses in part ix, column a, line 25 of the form 990. A complete list of the cash grants to others can be found on schedule i of the form 990. Part III, Line 2: Bad debt represents the uncollectible amounts written off during the fiscal year. Part III, Line 3: Bad debt attributable to patients under the organization's financial assistance policy is estimate based on a patient's inability to pay and who fail to complete the application and/or submit the required documents within the 60 day grace period allowed to apply for assistance. Part III, Line 4: See page 11 of the audited financial statements - Note 1- nature of organization and summary of significant accounting policies "paitent accounts receivable." Part III, Line 8: The Medicare gain was obtained directly from the FY 2016 Medicare cost report. Part III, Line 9b: PATIENTS MAY APPLY RETROACTIVELY FOR FINANCIAL ASSISTANCE FOR SERVICES UP TO 60 DAYS OLD. IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE AND ALL OTHER PROGRAMS HAVE BEEN EXHAUSTED FOR PAYMENT ASSISTANCE, A SHELTERING ARMS HOSPITAL 54-0505955 PAYMENT PLAN ARRANGEMENT MAY BE MADE. BALANCES DESIGNATED BY 3RD PARTY PAYERS AS PATIENT RESPONSIBILITY WILL BE ASSIGNED TO THE PATIENT BALANCE SEGMENT IN THE SAH BILLING SYSTEM. QUALIFYING PATIENT RESPONSIBLE BALANCES WILL BE BILLED DIRECTLY TO THE PATIENT BY SHELTERING ARMS. IF PAYMENT IS NOT RECEIVED WITHIN 60 DAYS ANY UNPAID BALANCES WILL BE FORWARDED TO OUR FIRST OUT VENDOR FOR CONTINUING COLLECTION EFFORTS TO iNCLUDE PATIENT PAYMENT PLANS. ANY UNSETTLED BALANCES REMAINING AFTER A TOTAL OF 120 DAYS AFTER THE FIRST ASSIGNMENT OF BALANCES AS PATIENT PAY the balances will be sent to our collection agency and removed from our active accounts receivable as bad debt. If the collection agency successfully collects the balances the patient account will be reactivated in our AR system and the bad debt will be reversed and coded as recovery. If the collection agency is unsuccessful with collections and has no payment arrangement, or a broken payment arrangement, then the account can be pulled back from the collection vendor, the bad debt status will remain and collection efforts will cease. Part VI, Line 2: Sheltering Arms Hospital assesses the service gaps and health care needs of the communities we serve to identify needed programs and events. The new CHNA and corresponding CHIP can be accessed at www.Shelteringarms.com. The 1st identified significant health need is Healthy Lifestyle. It encompasses nutrition, health, wellness, fitness, recreation and mobility. The CHIP plan calls for follow-up phone calls from inpatient dietician two weeks post-discharge from the inpatient rehabilitation hospital; partnering with local groups on nutritional education twice a year to include Bon Secours, Relay Foods, and VCU Health System; compiling resource list for patients to access food services in the community and developing a process for connecting patients to these services; adding nutrition screening question at discharge from inpatient hospital; adding nutrition screening question for outpatient therapy; and expanding fitness/wellness programs for persons with neurologic disorders. Currently we have added a new Parkinson's boxing program and expanded the Neuro-fit program. In addition our plan includes short screening tools for inpatient and outpatient regarding need for health, wellness, and education classes. We are adding nutrition education an Sheltering Arms channel in inpatient, adding nutrition training/specialization for fitness staff, a series of healthy cooking and meal planning for patients and caregivers, a nutrition support group in inpatient for patients and caregivers, an outpatient dietician to address post-inpatient nutrition needs as part of a comprehensive health/wellness care model and inpatient and outpatient therapeutic recreation as part of the comprehensive care model. The second significant health need identified is Care Navigation, we have mapped in Cerner (our EHR) for touch points to build and foster care navigation. Also as a standard of care at discharge, refer appropriate and interested patients to Senior Connections. We have improved internal and external education of what Sheltering Arms offers for continuum of care through internal education provided to nurse liaisons and the community liaison teams. We are implementing screensaver tips on Sheltering Arms computers to educate clinicians on resources available for patients/families. In addition we are developing a strategy for high risk patients and we plan to add a social worker as part of the comprehensive health and wellness care model. The 3rd significant health need identified is Caregiver support. This plan includes developing education materials and references for caregivers needing support and a screening tool for all sites that asks about the need for caregiver support. The 4th significant health care need is Medical Devices-Ramps. We are partnering with local organizations that provide ramps to identify how we can support them. We are currently in discussions with project Homes to develop a process. The Sheltering Arms Foundation currently provides support to projectHomes and Ramps Made possible by Students. As part of this initiative we are actively looking to identify other ramp building resources in the communities Sheltering Arms serves. Part VI, Line 3: Financial assistance information and applications will be provided to patients/families who express concern about their ability to pay for Sheltering Arms services. Applications with instructions may be obtained from the patient access staff, case managers, or a patient financial services representative. The complete policy and application are also available on the Sheltering Arms Hospital website at www.shelteringarms.com. All completed applications must be submitted to the patient information department, as per the instructions, for review and verification of information. The utilization manager may be consulted as needed. New patient admissions receive a form upon arrival disclosing the financial agreement to pay which includes offering monthly payment arrangements or application for financial assistance. The form requires signature. Outpatient and physician services appointment verification letters for new patients discloses availability of financial assistance if the patient wishes to apply. Part VI, Line 4: Sheltering Arms Hospital Serves the Greater Central Virginia Community. Based on the recent Community Health Needs Assessment the study region is based on the Sheltering Arms Hanover campus service area which includes urban and rural areas. The counties included are Caroline, Charles City, Essex, Hanover, Henrico, King and Queen, King William, Lancaster, Louisa, Middlesex, New Kent, Northumberland, Richmond and Richmond City. Part VI, Line 5: Our Community Support initiatives include participation in the DSCR employee health fair promoting the necessity of fitness and wellness; The Richmond Diabetes Walk which in which Sheltering Arms employees, patients, and members participated to share fitness and wellness information and resources; the Richmond Health expo promoting necessity of fitness and wellness participation; the Virginia Home Walk and Roll; the Chesterfield Triad senior health fair for Chesterfield County promoting necessity of fitness and wellness in living a healthy lifestyle; provided staff speakers at the local Multiple Sclerosis support group meeting which included three session focusing on physical therapy, fitness and recreation activities; provided staff speakers at the area Amputee Support group meeting for 2 sessions focusing on physical therapy fitness and recreational activities. Sheltering Arms Hospital grants supported 12 organizations through The Community Foundation. Those recipients were Circle Center Adult Day services, Crossover Ministry, F.R.E.E. Foundation for Rehabilitation Equipment and Endowment, Goochland Free Clinic and Family Services, Positive Vibe Foundation, project:Homes, Ramp Access Made Possible by Students, REACH Cycles, South Richmond Adult Day Care Center, Sportable, The Doorways, and United Spinal Association of VA, In addition, Sheltering Arms Nurse Liaisons provide information to local acute care hospitals with regard to appropriate services, and sites of service, for seniors who require rehabilitative care and a wide portfolio of unique, community-based services intended largely to meet the needs of individuals who are transitioning from a medical treatment regimen to an emphasis on self-management.The benefits of physical and recreational activity participation highlight a need for individuals with physical disabilities, the aging population, and individuals managing chronic conditions to access services that can positively impact quality of life and physical activity level. Sheltering Arms is dedicated to helping people find within themselves the power to overcome serious setbacks following illness, injury, or accident through internationally recognized physical rehabilitation programs. The Sheltering Arms commitment does not end when therapy or physician services are complete. Sheltering Arms provides a comprehensive portfolio of unique, community-based recreation and health and wellness services to meet the needs of the community. These services make up the Partner for L.I.F.E. program (Leisure, Interaction, Fitness, and Enjoyment), empowering individuals to embrace a lifetime of recreation and wellness. Our unique programming provides an opportunity for people to re-engage in activities they once enjoyed and maintain an active social and physical lifestyle despite their limitations. The services provided are open to the public and the majority of the services do not require a physician referral. Services offered include group recreation and social events, Adaptive Golf Program, Adaptive Bowling League, Accessible Travel Program, therapeutic pool and fitness center memberships, personal training services, group exercise classes, educational seminars, chronic disease self-management classes, diabetes self-management classes, PowerEx, NeuroFit, and our Club Rec program. Club Rec is a non- medically based social, recreation program providing opportunities for fitness, wellness, socialization, and community reintegration for members up to five days per week. Certified Therapeutic Recreation and Fitness Specialists organize daily programs, community outings, group and individual exercise sessions, social programs, cognitive activities, adaptive leisure activities, educational programs, and an array of weekly recreation programs. Club Rec focuses on enhancing quality of life for those recovering from injury or illness. Members enrolled in Club Rec have opportunities to utilize the on -site fitness center, participate in Spirituality Group , the computer lab, weekly trips to our therapeutic pool, intergenerational programs, community services opportunities, as well as community outings. In FY 2016 the Club Rec program enrolled 7,350 visits from individuals with disabilities. Partner for L.I.F.E. special event programs (including Adaptive Golf & Adaptive Bowling League) provide opportunities for individuals with disabilities to participate in organized recreation activities with the support of Recreational Therapists, and necessary adaptive recreation equipment, to ensure successful participation regardless of their physical limitations. In fiscal year 2016 there were 16 events totaling 448 participants. Chronic Disease Self-Management and Diabetes Self Management classes were offered free to the community through partnership with local senior and health care agencies. The goal of the program is for participants to learn strategies to implement healthy lifestyle changes to successfully manage their chronic condition. In addition to recreation events, Partner for L.I.F.E. services believe in the necessity of maintaining physical activity to continue an active lifestyle, maintain progress achieved in skilled therapy, as well as prevent future injury or illness. We have a warm water therapeutic pool and fitness center offering pool and fitness memberships, aquatic and land group exercise classes, and personal training services to the community. Our warm water therapeutic pool provides a ramp for wheelchair entry into the water, submerged parallel bars, and lap lane swimming for those who find less pain and increased range of motion in a warm water environment. Pool and fitness memberships provide a transition plan for patients being discharged from inpatient hospital and outpatient therapy clinics the opportunity to continue to engage in physical activity. Fitness Specialists provide fitness members with personalized attention, as well as personal training services for those who are interested in individualized goal setting and exercise programs designed to meet their needs. During fiscal year 2016 there were 29,643 community membership visits to the pools and fitness centers. Sheltering Arms lead 1,111 group exercise classes and wellness education classes totaling 5,603 class participants. Fitness Specialists conducted 2,795 personal training visits and 1,824 NeuroFit personal training visits. On our Hanover and South hospital campus the Fitness Specialists utilize advanced technologies to provide unique personal training services for the neurologically impaired in our NeuroFit program. The goal is to ensure lifelong physical activity after a catastrophic injury or illness. Fitness Specialists at our Bon Air and Reynolds location provide personal training services to those transitioning from outpatient therapy services, while also providing personal training service to the community for prevention and wellness. Our Parkinson's Wellness Recovery bi-weekly group exercise class at Bon Air has seen significant growth in class participants. Sheltering Arms fitness centers have seen significant growth in Silver Sneaker members. This community program provides financial fitness membership support for those with a Silver Sneaker wellness option through their private insurance company. Specific Silver Sneaker group exercise classes are offered at our Bon Air location weekly.As we continue to face the transition of health care in our community the focus of health, wellness, and prevention continue to emerge as a critical component in life long care. Sheltering Arms Partner for LIFE services provide a unique niche for individuals with physical disabilities, as well as the community, to maintain an active and healthy lifestyle. 1 THE COMMUNITY FOUNDATION SERVING RICHMOND AND CENTRAL VIRGINIA 7501 BOULDERS VIEW DRIVE SUITE 110 RICHMOND VA 23225 541201346 501(C)(3) 114938 TO SUPPORT eleven PROGRAMS IDENTIFIED IN THE COMMUNITY SERVING POPULATIONS Chesterfield Quarterback League PO Box 1792 Chesterfield VA 23832 541717639 501(c)(6) 11212 To support prevention, management, and treatment of orthopedic and sports injuries National Multiple Sclerosis Society - Central Virginia Chapter 4200 Innslake Drive Suite 301 Glen Allen VA 23060 540633474 501(c)(3) 9343 Support of the local initiatives of the national MS Society 2 1 EQUIPMENT AND PHARMACY ASSISTANCE 70 18909 FMV COST OF SUPPLIES GRANTED Part I, Line 2: THE ORGANIZATION MAINTAINS RECORDS OF ALL GRANTS GIVEN. THE DONATIONS WERE MADE TO COMMUNITY PROGRAMS IDENTIFIED BY THE INDEPENDENT BOARD AND MANAGEMENT AS SERVING THE HOSPITAL'S MISSION AND POPULATIONS IN NEED OF ASSISTANCE. X X X X X 0 0 0 0 0 0 0 0 0 MARY ZWEIFEL Interim President/ CEO as of 1/16 245619 0 42739 0 0 0 12000 0 5576 0 305934 0 0 0 CHRISTOPHER P SORENSON VP OF INFORMATION TECHNOLO 166308 0 33747 0 0 0 9000 0 14061 0 223116 0 0 0 Michael Dacus VP of finance until 4/16 248559 0 60510 0 0 0 7457 0 14490 0 331016 0 0 0 James E Sok President/CEO until 12/31/16 810600 0 123840 0 0 0 88112 0 10552 0 1033104 0 0 0 ELLEN VANCE Chief Human Resource Officer 184100 0 36781 0 0 0 10640 0 14132 0 245653 0 0 0 SANDY EYLER Chief Nursing Officer 153525 0 30262 0 0 0 4606 0 9872 0 198265 0 0 0 TIMOTHY M SILVER MEDICAL DIRECTOR 332982 0 72542 0 0 0 9990 0 14915 0 430429 0 0 0 HILLARY S HAWKINS MEDICAL DIRECTOR 338672 0 130834 0 0 0 1163 0 14939 0 485608 0 0 0 GREGORY LEGHART PHYSICIAN 276542 0 33695 0 0 0 12000 0 14583 0 336820 0 0 0 CHARLES MATTHEW GIBELLATO PHYSICIAN 140233 0 89621 0 0 0 4909 0 8882 0 243645 0 0 0 ALBERT M JONES PHYSICIAN 250907 0 13247 0 0 0 9000 0 12045 0 285199 0 0 0 MARIA C LITTAUA PHYSICIAN 227925 0 0 0 0 0 11500 0 14394 0 253819 0 0 0 AARON M JONES PHYSICIAN 220190 0 4696 0 0 0 7876 0 14360 0 247122 0 0 0 James Braith Former VP of business development 218982 0 0 0 0 0 10615 0 14114 0 243711 0 0 0 Schedule J, Part 1, Line 4: For any executive or other employee who has substantial influence over the affairs of the organization the compensation arrangement must be approved by the organizations governing body or a committee of the governing body comprised of individuals who do not have a conflict of interest with respect to the arrangement. The governing body or its committee obtains and relies upon appropriate data as to comparability prior to making its decision and the governing body or its committee adequately documents the basis for its decision. TROUTMAN SANDERS LLP DAVID CONSTINE, A BOARD MEMBER, IS A PARTNER IN THIS LAW FIRM. 341371 LEGAL THE SERVICES ARE NEGOTIATED AT ARM'S LENGTH AND ARE AT FAIr market value 0 Form 990, Part VI, Section A, line 6 THE ORGANIZATION HAS ONE MEMBER, THE RELATED ORGANIZATION SHELTERING ARMS CORPORATION, EIN 54-1615598. Form 990, Part VI, Section A, line 7a SHELTERING ARMS CORPORATION, AS SOLE MEMBER HAS THE POWER TO APPOINT THE BOARD OF SHELTERING ARMS HOSPITAL INC. PER THE ORGANIZATION BYLAWS. Form 990, Part VI, Section B, line 11 Form 990 and applicable attachments were provided to the finance committee of the board of directors of sheltering arms hospital and to all other board members, either in electronic format or by mail. An open comment and question period was welcomed to direct any questions or comments before filing the Form 990 and its related attachments. Form 990, Part VI, Section B, line 12c BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. ANY CONFLICTS ARE DISCLOSED AT THAT TIME, AND THE SIGNED POLICY IS KEPT ON FILE BY THE ORGANIZATION. IN THE EVENT A POTENTIAL CONFLICT ARISES DURING THE YEAR, THE DIRECTOR WITH SUCH CONFLICT MUST RECUSE HIM/HERSELF FROM ALL DISCUSSIONS AND VOTE ON THE MATTER. Form 990, Part VI, Section B, line 15 SHELTERING ARMS HOSPITAL UTILIZED THE SERVICES OF AN INDEPENDENT, EXTERNAL COMPENSATION FIRM TO CONDUCT A REVIEW OF ITS EXECUTIVE COMPENSATION PROGRAM TO ENSURE THE EXECUTIVE COMPENSATION LEVELS ARE COMPETITIVE AND REASONABLE. SHELTERING ARMS' COMPENSATION WAS MEASURED AGAINST HEALTHCARE ORGANIZATIONS SIMILAR IN SCOPE AND SCALE USING DATA FROM SIX EXTERNAL MARKET SURVEY SOURCES AS THE COMPARATIVE BASIS; BOTH BASE SALARY AND TOTAL CASH COMPENSATION WERE EVALUATED. THE COMPETITIVE ANALYSIS FINDINGS WERE PRESENTED TO THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS WHO EXAMINED AND APPROVED THEM. IN ADDITION, THE COMPENSATION COMMITTEE EVALUATES PERFORMANCE, COMPENSATION SURVEYS, AND CONTRACT TERMS AND CONDITIONS ANNUALLY BEFORE DETERMINING AND RECOMMENDING COMPENSATION. ALL COMPENSATION COMMITTEE DISCUSSIONS ARE DOCUMENTED IN FORMAL MINUTES. Form 990, Part VI, Section C, line 19 UPON REQUEST, SHELTERING ARMS HOSPITAL WILL MAKE AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, WHISTLEBLOWER POLICIES, RELATED POLICIES, AND FINANCIAL STATEMENTS. Form 990, Part XI, line 9: Permanently restricted assets released -100,000. PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SHELTERING ARMS PHYSICAL REHABILITATION ASSOCIATES LLC 8254 ATLEE ROAD MECHANICSVILLE VA 23116 260402064 PHYSICAL REHABILITATION VA -3238199 573898 SHELTERING ARMS HOSPITAL SHELTERING ARMS THERAPY CLINICS LLC DBA PT WORKS 8254 ATLEE ROAD MECHANICSVILLE VA 23116 271939022 PHYSICAL REHABILITATION VA 0 0 SHELTERING ARMS HOSPITAL SHELTERING ARMS FOUNDATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615599 PHYSICAL REHABILITATION VA 501(C)(3) Line 11b, II SHELTERING ARMS CORPORATION 0 SHELTERING ARMS HOSPITAL SOUTH 8254 ATLEE ROAD MECHANICSVILLE VA 23116 352258075 PHYSICAL REHABILITATION VA 501(C)(3) Line 3 SHELTERING ARMS CORPORATION 0 PALMYRA REHABILITATION CORPORATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615601 PHYSICAL REHABILITATION VA 501(C)(3) Line 11a, I SHELTERING ARMS CORPORATION 0 SHELTERING ARMS CORPORATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615598 PHYSICAL REHABILITATION VA 501(C)(3) Line 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 SHELTERING ARMS HOSPITAL SOUTH C 4862906 AMOUNT TRANSFERRED SHELTERING ARMS FOUNDATION C 10844648 AMOUNT TRANSFERRED PALMYRA REHABILITATION CORPORATION C 2108414 AMOUNT TRANSFERRED SHELTERING ARMS HOSPITAL SOUTH B 4693740 AMOUNT TRANSFERRED PALMYRA REHABILITATION CORPORATION B 2275687 AMOUNT TRANSFERRED SHELTERING ARMS FOUNDATION B 1148546 AMOUNT TRANSFERRED