2016-02-15T00:00:00-06:00 2015-03-31 990 2014-04-01 541857174 Chesapeake Medical Group Inc CHES 8044358661 101 Harris Drive Kilmarnock VA 22482 Steve Quiriconi Treasurer 8044358661 2016-02-16 2014 2016-08-17 19:52:53Z Steve Quiriconi 101 Harris Drive Kilmarnock VA 22482 7126822 0 X N/A X 1994 VA Not-for-Profit primary medical care services. 21 17 95 0 4618098 0 0 201650 6194294 4618098 200 0 -967 2295729 6193527 7115477 0 0 0 0 5145986 4170030 0 0 0 2356642 2250874 7502628 6420904 -1309101 694573 1690493 1968940 8884692 8440573 -7194199 -6471633 X The mission of Chesapeake Medical Group, Inc. (CMG) is to provide quality, compassionate, cost effective primary medical care services to the community as a whole in a defined geographic area of the northern neck and middle peninsula of Virginia. The company will pursue its mission through the development and management of one group medical practice operating at multiple locations which are reasonably equipped and efficiently staffed by competent clinical and administrative individuals. The corporation is committed to providing medical services without regard to the patients' race, color, creed, national origin, religion or disability and will provide primary medical care to any individual with an acute injury or illness without regard to their ability to pay. 0 0 5741490 0 4618098 During the fiscal year, Chesapeake Medical Group employed 9 physicians and 3 nurse practitioners who provided either family practice, pediatric or surgical medical care at 7 offices located in three counties. CMG providers treated a total of 42,000 patients during the fiscal year. Chesapeake Medical Group policy is to provide care to any patient regardless of their ability to pay and accepts both current and new patients regardless of available insurance coverage. 147384 During the year, CMG physicians and nurse practitioners provided numerous services for the community which included: a. Providing admission services and coverage to area nursing homes.b. Providing free health care to indigent patients in CMG locations and through participation with the Northern Neck Free Health Clinic.c. Providing free community education through speaking and teaching engagements on numerous topics. d. Participation in discount sports physicals for secondary school students of Lancaster, Middlesex, Northumberland, Richmond, Westmoreland and Essex Counties.e. Participation in free health screening events in service area. The health screenings included free blood glucose testing; cholesterol testing; and blood pressure testing. Additionally, preventative health care information was provided at each screening event.f. Our policy remains to provide care to any patient regardless of their ability to pay. 5888874 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 95 1 0 0 0 0 0 0 0 0 0 0 X 21 17 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X John Headley 8044358000 101 Harris Road Kilmarnock VA 22482 X Bonnie Abbott Secretary (Apr-Dec) 1.00 0.00 X X 0 0 0 David Antonio MD Board Member (Apr-Dec) 1.00 0.00 X 0 0 0 James Bryant MD Board Member (Apr-Dec) 1.00 39.00 X 0 212602 12942 James Holmes Jr President/Treasurer (Apr-Dec)/BD (Jan-Mar) 6.00 34.00 X X 0 233879 29009 Stephen Whiteway Board Member (Apr-Dec) 1.00 0.00 X 0 0 0 Marian Walker Board Member (Apr-Dec) 1.00 0.00 X 0 0 0 Jean Bolling Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 John Bowman MD Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Barry Case Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Chandrashekar Challa Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 John Daniel III MD Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Anup Gokli MD Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Mark Gordon Board Member (Jan-Mar) 2.00 48.00 X 0 546935 49326 Pamela Hacker Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 BH Hubbard Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Sr Anne Mack CBS President (Jan-Mar) 3.00 48.00 X X 0 0 0 Joanne Nattrass Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Fr Jack Podsiadlo Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Michael Robinson Board Member (Jan-Mar) 2.00 48.00 X 0 730851 25808 Sr Victoria Segura CBS Board Member (Jan-Mar) 2.00 48.00 X 0 0 0 William Shewmake Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Shannon Sinclair Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 William Stallings MD Board Member (Jan-Mar) 2.00 38.00 X X 0 224680 16206 Nancy Thomas Chair (Jan-Mar) 3.00 0.00 X X 0 0 0 Michael Williams Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Thomas Winfree Board Member (Jan-Mar) 2.00 0.00 X 0 0 0 Norman Tingle Jr Board Member ( Apr-Jan) 40.00 0.00 X 229855 0 3400 Marvene Ruit Vice President Operations (Apr-Dec) 39.00 1.00 X 0 113005 18030 Toni Ardabell CEO-SMH / CEO-Richmond (Jan-Mar) 1.00 49.00 X 0 734625 39627 Peter Bernard CEO - Virginia (Jan-Mar) 1.00 49.00 X 0 1489553 197160 Allen Goolsby III Secretary (Jan-Mar) 2.00 2.00 X 0 0 0 Stephan Quiriconi Treasurer (Jan-Mar) 2.00 48.00 X 0 307530 13955 Jim Godwin VP HR 1.00 49.00 X 254827 0 28849 Darlene Stibal Physician 40.00 0.00 X 277437 0 7088 Barbara Kahler Physician 40.00 0.00 X 191140 0 10388 Bridgitte Wolf-Small Physician 40.00 0.00 X 158189 0 12668 Carlos Martinez Physician 40.00 0.00 X 146392 0 13860 Steven Oltermann Physician 40.00 0.00 X 144204 0 8721 1402044 4593660 487037 8 0 1 0 CompHealth PO Box 972651 Dallas TX 75397 Surgical locum coverage 147978 1 201650 201650 Patient Service Rev. 621110 4618098 4618098 4618098 11200 11345 -145 -145 -145 Forgiveness of Debt 900099 2222269 2222269 Billing Ser.to Related 900099 73605 73605 2295874 7115477 0 4618098 2295729 233256 209930 23326 3329947 2996952 332995 48182 43364 4818 321301 289171 32130 237344 213610 23734 572019 572019 3904 3514 390 66321 59689 6632 652 587 65 296396 266756 29640 12232 11009 1223 19101 17191 1910 27745 27745 231114 208003 23111 166497 149847 16650 Medical Supplies 297568 297568 Bad Debt Expense 203309 203309 Purchased Services 189686 170717 18969 Mgmt Fee Allocation 136683 123015 13668 27647 24878 2769 6420904 5888874 532030 0 0 0 46063 339236 295735 487135 117697 26388 143258 1057160 57849 1202591 999311 2019 1690493 1968940 570893 1423027 524188 7789611 7017546 8884692 8440573 X -7194199 -6471633 -7194199 -6471633 1690493 1968940 X 694573 27993 X 0 0 0 X 201650 201650 6244651 6903242 6672691 6194294 4618098 30632976 6244651 6903242 6672691 6194294 4819748 30834626 0 0 0 30834626 14182 14298 14091 13760 11300 67631 14182 14298 14091 13760 11300 67631 2468953 2468953 6258833 6917540 6686782 6208054 7300001 33371210 0.92400 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34000 34000 368167 9375 358792 79604 2923 76681 554809 45551 509258 20580 20580 999311 Due to Affiliates 6579430 Due to BSHSI 435507 Other Debt General Curr Portion 1678 Fin/Issue Costs & Misc 931 7017546 X X X X X 0 1 0 0 0 0 0 0 0 James Bryant MD Board Member (Apr-Dec) 0 212602 0 0 0 0 0 5850 0 7092 0 225544 0 0 James Holmes Jr President/Treasurer (Apr-Dec)/BD (Ja 0 233879 0 0 0 0 0 7939 0 21070 0 262888 0 0 Mark Gordon Board Member (Jan-Mar) 0 336416 0 144733 0 65786 0 21206 0 28120 0 596261 0 17280 Michael Robinson Board Member (Jan-Mar) 0 464732 0 154883 0 111236 0 15600 0 10208 0 756659 0 0 William Stallings MD Board Member (Jan-Mar) 0 224680 0 0 0 0 0 5850 0 10356 0 240886 0 0 Norman Tingle Jr Board Member ( Apr-Jan) 229855 0 0 0 0 0 0 0 3400 0 233255 0 0 0 Toni Ardabell CEO-SMH / CEO-Richmond (Jan-Mar) 0 493876 0 159372 0 81377 0 37127 0 2500 0 774252 0 25794 Peter Bernard CEO - Virginia (Jan-Mar) 0 789743 0 326469 0 373341 0 166398 0 30762 0 1686713 0 186126 Stephan Quiriconi Treasurer (Jan-Mar) 0 248452 0 57920 0 1158 0 3672 0 10283 0 321485 0 0 Jim Godwin VP HR 206334 0 47086 0 1407 0 6792 0 22057 0 283676 0 0 0 Darlene Stibal Physician 277437 0 0 0 0 0 0 0 7088 0 284525 0 0 0 Barbara Kahler Physician 191140 0 0 0 0 0 3300 0 7088 0 201528 0 0 0 Bridgitte Wolf-Small Physician 158189 0 0 0 0 0 4590 0 8078 0 170857 0 0 0 Carlos Martinez Physician 146392 0 0 0 0 0 1500 0 12360 0 160252 0 0 0 Steven Oltermann Physician 144204 0 0 0 0 0 4235 0 4486 0 152925 0 0 0 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 officers and 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: Peter Bernard, 241,741; Toni Ardabell, 37,602; Mark Gordon, 25,011. Form 990, Part VI, Section A, line 4 On December 31, 2014, the articles and bylaws of both of these entities were amended and restated in their entirety to reflect that as a result of the Rappahannock transaction, Bon Secours-Richmond Health System acquired the sole membership interest in each entity. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Richmond LLC. Bon Secours Richmond LLC holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of the filing organization. Form 990, Part VI, Section A, line 7a The governing body of the filing organization is appointed by it's member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of the filing organization are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The Form 990 for the filing organization will be provided to the Board after filing. Any material changes to the return will be reflected in an amended return, as necessary. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages 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 directors and compensation committee minutes. Form 990, Part VI, Section b, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of 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: 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 Richmond Health System, including Bon Secours St. Mary's Hospital, Bon Secours St. Francis Medical Center, Bon Secours Memorial Regional Medical Center and Richmond Community Hospital, Chesapeake Hospital Corporation, as well as the Chesapeake Medical Group, are comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer). These governing bodies are referred to as the Richmond Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for all four hospitals. Sr. Anne Marie Mack and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Form 990, Part XI, line 9: Misc adj to net assets 27,993. Chesapeake Hospital Corporation PO Box 1449 Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Chesapeake Health Services Inc PO Box 1449 Kilmarnock VA 22482 541513371 Management Services VA 501(c)(3) Line 11a, I N/A 0 Rappahannock General Hospital Foundation PO Box 1449 Kilmarnock VA 22482 541210450 Fundraising VA 501(c)(3) Line 7 Bon Secours Richmond Health System 0 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 Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) Line 7 Bon Secours Richmond LLC 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Richmond LLC 0 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 St Mary's Hospital of Richmond Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 0 St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental - Medical Office Building VA N/A Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA N/A C 0 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA N/A C 0 Bon Secours - Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA N/A C 0 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA N/A C 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1