2016-07-12T13:26:34-05:00 2015-08-31 990 2014-09-01 521578169 Bon Secours-Maryview Nursing Care Center BONS 7576860488 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner CEO - BSHRHS 7576860488 2016-07-12 0 2014 2016-09-27 15:27:22Z Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 10594408 0 0928 X http://bshr.com/ X 1988 VA Skilled Nursing Center 16 14 173 57 0 0 0 600 9954964 10533396 22078 34830 24027 25582 10001069 10594408 0 0 0 0 6098476 6389426 0 0 0 3887301 3480086 9985777 9869512 15292 724896 18413751 18937731 4582712 4418566 13831039 14519165 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 7465326 0 7792070 Skilled Nursing Care provided to patients to include assessment of cognitive and physical status, personal hygiene care, nutrition and maintenance of a clean and comfortable environment. 1082179 0 2233191 Rehabilitation Therapies to include physical therapy, respiratory therapy and occupational therapy so as to maintain each patient's optimal quality of life. 495891 0 508135 Medication & Diagnostic Treatments to include the administration of medication, ongoing assessment of potential interactions and negative side effects, wound care and facilitation of diagnostic testing as needed. 9043396 1 0 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 1 173 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X James Bento Board Member 2.00 0.50 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 Board Chair 3.00 0.00 X X 0 0 0 Sister Elaine Davia CBS Board Member 2.00 2.00 X 0 0 0 Timothy Davis Board Member 2.00 48.00 X 0 1019679 151683 Barbara Hamm Lee Board Member (Sep-May) 2.00 0.00 X 0 0 0 Michael Kerner Secretary/CEO-BSHR 1.00 49.00 X X 0 958311 131925 Michael LaRock Board Member 2.00 0.00 X 0 0 0 Shelley Mishoe Board Member 2.00 0.00 X 0 0 0 Carol Ormond Board Member 2.00 0.00 X 0 0 0 Ward Robinett Jr Board Member 2.00 0.00 X 0 0 0 Stephanie Short Board Member 2.00 0.00 X 0 0 0 Robert Sqautrito MD Board Member 2.00 0.00 X 0 0 0 Sister Rita Thomas Board Member (Sep-Dec) 2.00 1.00 X 0 0 0 Douglas Ziegenfuss Board Member 2.00 0.00 X 0 0 0 Patricia Robertson CEO - MIH & Ext Care 2.00 48.00 X 0 442986 27267 Charmaine Rochester Treasurer/VP Finance 1.00 49.00 X 0 243142 16388 Teresa Cooper Director - Nursing CC 50.00 0.00 X 113053 0 35322 Donald Chastang Physical Therapist 50.00 0.00 X 103581 0 28027 216634 2664118 390612 2 0 1 0 Shiftwise PO Box70870 St Paul MN 551709705 Contract Nursing 242116 1 600 600 Patient Service Rev. 623110 10533396 10533396 10533396 34830 34830 Resident Laundry Svcs 812320 8735 8735 Cafe/Vending/Gift Shop 722212 6511 6511 Beauty & Barber Shop 812112 4239 4239 6097 6097 25582 10594408 10533396 0 60412 4998417 4498575 499842 128413 115572 12841 783848 705463 78385 478748 430873 47875 43699 39329 4370 866 779 87 106204 106204 121 109 12 156496 140846 15650 12623 11361 1262 461282 415154 46128 3039 2735 304 60642 60642 148656 133790 14866 38076 34268 3808 Medical Supplies 933619 933619 0 Purchased Services 801549 721394 80155 Bad Debt 507904 507904 0 Corporate Dues 157318 141586 15732 47992 43193 4799 9869512 9043396 826116 0 550 550 15239717 16098769 1276865 1157088 50581 47090 7561876 6435186 1210837 1126690 100004 19917 535197 487627 18413751 18937731 404913 459987 3700000 3500000 14589 6680 463210 451899 4582712 4418566 X 13831039 14519165 13831039 14519165 18413751 18937731 X 724896 -36770 X 0 1 X 1 0 X 5740 600 6340 9919187 10027169 9779506 9954964 10533396 50214222 9919187 10032909 9779506 9954964 10533996 50220562 0 0 0 50220562 23132 25394 26347 22078 16098 113049 23132 25394 26347 22078 16098 113049 30310 31969 31017 24027 25582 142905 9972629 10090272 9836870 10001069 10575676 50476516 0.99490 0.99500 0.00220 0.00260 X Schedule A, Part III, Line 12, Explanation of Other Income: Beauty Barber Shop - 2010 Amount: $ 11,165. 2011 Amount: $ 7,861. 2012 Amount: $ 8,351. 2013 Amount: $ 5,630. 2014 Amount: $ 4,239. Cafe/Vending/Gift Shop - 2010 Amount: $ 6,709. 2011 Amount: $ 8,811. 2012 Amount: $ 8,645. 2013 Amount: $ 4,369. 2014 Amount: $ 6,511. Resident Laundry Service - 2010 Amount: $ 12,233. 2011 Amount: $ 14,482. 2012 Amount: $ 10,268. 2013 Amount: $ 11,090. 2014 Amount: $ 8,735. All other - 2010 Amount: $ 203. 2011 Amount: $ 815. 2012 Amount: $ 3,753. 2013 Amount: $ 2,938. 2014 Amount: $ 6,097. 0 0 0 0 0 0 0 0 1 866 866 0 Part II-B, Line 1: The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. 0 1 X 2087243 1384168 703075 20357 6193 14164 4581687 4182420 399267 872589 862405 10184 1126690 MedMal & Gen Liab 377860 Due to BSHSI 63010 Medicare Settlement 5459 Due to Affiliates 4844 Unclaimed Property Accrual 726 451899 X Part IV, Line 2b: The filing organization holds, safeguards, manages and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents. Written requests for $50 or more are honored within 3 business days. All excess custodial funds are held in interest bearing accounts separate from that of the organization. Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The system accounts for uncertain tax positions in accordance with ASC Topic 740. The System's taxable subsidiaries have approximately $84,748 and $61,513 of net operating loss carryforwards as of August 31, 2015 and 2014, respectively, which expire in varying periods through 2035 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2015 and 2014 as the System considers it more likely than not that these amounts will not be recognized. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 0 1 0 0 0 0 0 0 0 Timothy Davis Board Member 0 617514 0 191208 0 210957 0 132084 0 19599 0 1171362 0 135985 Michael Kerner Secretary/CEO-BSHR 0 527082 0 221442 0 209787 0 101956 0 29969 0 1090236 0 125798 Patricia Robertson CEO - MIH & Ext Care 0 291541 0 100199 0 51246 0 15600 0 11667 0 470253 0 0 Charmaine Rochester Treasurer/VP Finance 0 195153 0 47816 0 173 0 12271 0 4117 0 259530 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 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: Timothy Davis, $181,617; Michael Kerner, $164,862. 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 - Maryview Nursing Care Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours - Maryview Nursing Care Center is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours - Maryview Nursing Care Center are reserved to its member or to Bon Secours Health System, Inc. 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 the BSHSI. The compensation committee consists of a group of independent board members and engages 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 related organizations within Bon Secours Hampton Roads Health System, including Maryview Hospital dba Maryview Medical Center, Bon Secours DePaul Medical Center, 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 all listed entities). Br. Arthur Caliman does not receive payroll distributions as he has taken a vow of poverty. Form 990, Part XI, line 9: BSHSI Principal Debt & Swap Payments -36,770. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsvile MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Ste A Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 0 Mary Immaculate Nursing Center 7007 Harbour View Blvd Newport News VA 23602 541516476 Nursing Care Center VA 501(c)(3) Line 9 Mary Immaculate Hospital 0 Mary Immaculate Foundation 2 Bernadine Drive Newport News VA 23602 311644734 Fundraising VA 501(c)(3) Line 11c, III-FI Mary Immaculate Hospital 0 Mary Immaculate Hospital 4 Ridgewood Parkway Newport News VA 23602 540548200 Healthcare VA 501(c)(3) Line 3 Bon Secours Health System Inc 0 Bon Secours Maryview Foundation 3520 High Street Ste 100 Portsmouth VA 23707 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Maryview Hospital 3636 High Street Portsmouth VA 23707 540506463 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center 150 Kingsley Lane Norfolk VA 23505 541820093 Healthcare VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfolk VA 23505 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) Bon Secours DePaul Medical Center 0 Province Place of Maryview LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541842697 Assisted Living VA N/A Province Place of DePaul LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541950880 Assisted Living VA N/A Professional Health Care Mgmt Inc 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA N/A C 0 Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA N/A C 0 OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA N/A C 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0