2014-07-15T18:11:46-05:00 2013-08-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2012-09-01 540548200 Mary Immaculate Hospital MARY 7578866000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner 7578866000 2014-07-15 1 David A Craig P00542227 4042201500 2012 2015-11-30 17:44:51Z Bon Secours Mary Immaculate Hospital Patricia Robertson 2 Bernardine Drive Newport News VA 23602 189752872 0 0928 X www.bonsecourshamptonroads.org X 1956 VA Acute Care Hospital 20 18 1106 130 200542 -111202 2721787 1867229 179297332 182521964 966129 2635548 2170737 2580032 185155985 189604773 29302 16439 0 0 51703452 53016555 0 0 0 115925849 115928392 167658603 168961386 17497382 20643387 179981353 198131332 39468341 26582203 140513012 171549129 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 54033277 71297451 Orthopedics is center of choice for orthopedic care in the greater Hampton Roads area, with 1 of every 5 orthopedic surgeries in the region performed at Mary Immaculate. It includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-of-the-art technology, including a Mako robot and nationally renowned expert physicians, as well as a comprehensive outpatient rehab network and community outreach events. Bon Secours skilled surgeons perform minimally invasive and traditional orthopaedic and spine procedures. Bon Secours respond to the needs of all orthopaedic patients - from the young athlete to the adult sports medicine patient (weekend warrior or sports enthusiast) to the patient needing significant repair and possibly replacement of joints. 21697135 14174480 Women and children services provided added capacity and resources so that the needs of the community for OB care would continue to be met. Mary Immaculate also offers advanced nursery services through a neonatal specialty care nursery. Bon Secours also offers the largest curriculum of family and parenting classes through its Love & Learn program. Mary Immaculate expanded its gynecology offering by introducing gynecological oncology services (board certified and fellowship trained surgeon) and an infusion center for women suffering from such cancers. 8983050 9270109 Mary Immaculate has committed significant resources to the care of cardiac patients. The comprehensive Early Detection Center, aimed at identifying cardiac disease early and referring patients to primary care, cardiology, vascular surgery, and cardiothoracic surgery as necessary for prompt and effective treatment - continues to serve area residents. The outreach has expanded to area businesses and community churches as well. In addition, the introduction of the One-Call Transfer center (for cardiac and other patients) and relationships with transport services make it easier to transfer patients in need of more advanced procedures to Bon Secours Maryview, which serves as the Bon Secours regional referral center for advanced cardiac services. In addition, a strong focus also exists on community education through seminars, classes, screenings, special events and a brand new community outreach program aimed at middle school students called The Heart Health Academy at Bon Secours. Mary Immaculate recently installed a state-of-the-art, fully digital cardiac catheterization laboratory. 68778096 16439 87828894 Major services offered by Mary Immaculate include the Hernia Center which is a comprehensive program dedicated to treating hernias. The program specializes in developing treatments based on each patient's individual needs. The program uses the latest innovations and performs many of it's procedures using state-of-the-art, minimally invasive techniques. In addition, Mary Immaculate offers Neuroscience, Gastroenterology and Pulmonary services as well as a full service 24 hour Emergency Room. See Sch H for additional information. 68778096 16439 87828894 153491558 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 58 0 1 1106 1 1 1 0 0 0 0 1 1 0 0 0 0 X 20 18 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Sr Elaine Davia 2.00 2.00 X 0 0 0 Timothy J Davis 2.00 48.00 X 0 1122284 134895 Debra Deihl 2.00 0.00 X 0 0 0 Paul W Garman 2.00 0.00 X 0 0 0 Pastor Ivan T Harris 2.00 0.00 X 0 0 0 Sr Patricia Heath 2.00 48.00 X 0 0 0 Steven B Hopson MD 2.00 0.00 X 0 0 0 Sr Mary Margaret Jackson 2.00 0.00 X 0 0 0 Matthew James 2.00 0.00 X 0 0 0 Sr Shaun Malone 2.00 0.00 X 0 0 0 Helena Mock 2.00 0.00 X 0 0 0 Jeffrey Morrison DO 2.00 0.00 X 0 0 0 William F Pile 2.00 0.00 X 0 0 0 Sr Christen Shukwit 2.00 0.00 X 0 0 0 Robert M Yacobi 2.00 0.00 X 0 0 0 Susan B Anthony FNP 2.00 0.00 X X 0 0 0 John H Garrett 3.00 0.00 X X 0 0 0 Michael K Kerner 15.50 34.50 X X 0 936925 132770 Sr David Ann Niski 3.00 0.00 X X 0 0 0 Jon A Nystrom 3.00 0.00 X X 0 0 0 Melinda Hancock 3.00 47.00 X 0 343941 27968 Patricia Robertson 45.00 5.00 X 0 475822 27272 Charmaine Rochester 15.50 34.50 X 0 135417 13585 Jeffrey N Doucette 50.00 0.00 X 203823 0 38131 Devin T McKeever 5.00 45.00 X 0 199350 12010 James B Sherwood 10.00 40.00 X 0 285249 38182 Darlene Stephenson 50.00 0.00 X 170120 0 41195 Thomas J Hoffmier MD 50.00 0.00 X 468041 0 25614 Nauman Naseer MD 50.00 0.00 X 440410 0 40273 Allen B Nichols MD 50.00 0.00 X 629493 0 42733 Anthony D Terracina MD 50.00 0.00 X 913430 0 39550 Leslie A Webb MD 50.00 0.00 X 197139 0 3123 Joe Buchheit 0.00 50.00 X 0 326400 25031 Ernie Padden 0.00 0.00 X 0 201500 3120 James H Sammons 0.00 0.00 X 224590 0 18095 3247046 4026888 663547 33 1 1 0 Rehabcare Group East Incorporated PO Box 502096 St Louis MO 631502096 Rehabilitative Services 2701370 Tidewater Physicians Multispecialty Grou 860 Omni Blvd 304 Newport News VA 23606 Physician Services 1915627 Anesthesia Associates of Hampton 110 Three Point Ct Yorktown VA 23692 Physician Services 1500000 Aramark CTS Inc 12483 Collections Center Dr Chicago IL 60693 Biomedical Engineering 929599 Shared Hospital Svcs 3530 Elmhurst Lane Portsmouth VA 23701 Linen/Laundry Service 561700 35 54762 83742 1541664 187061 439 1867229 Patient Service Rev. 622110 182521964 182383231 138733 182521964 573848 573848 2049 2049 68805 3550 14377 3550 54428 0 54428 21510 32918 2164612 0 104961 2164612 -104961 2059651 2059651 29607 54762 25211 4396 4396 Joint venture income 900099 1680316 1680316 Rehab Services 900099 187703 187703 Cafe/Vending/Dietary 722514 184076 184076 469113 40299 428814 2521208 189604773 182570934 200542 4966068 13063 13063 3376 3376 447600 402840 44760 41541862 37387676 4154186 2195831 1976248 219583 5002260 4502034 500226 3829002 3446102 382900 117080 105372 11708 90248 81223 9025 28992 26093 2899 7986464 7187818 798646 120008 108007 12001 2669327 2402394 266933 105952 95357 10595 2562802 2306522 256280 167664 150898 16766 82590 74331 8259 1390896 1390896 6406274 5765647 640627 1250262 1125236 125026 Medical Supplies 46738863 42064977 4673886 Purchased Services 28664517 25798065 2866452 Bad Debt Expense 12855765 12855765 BSHSI Mgmt Allocation 2611909 2350718 261191 2078779 1870900 207879 168961386 153491558 15469828 0 2955 3480 79452701 97528313 95782 109516 21741465 18777276 3947664 4291144 408341 791812 90792108 55380471 33589287 35411637 26428069 29243495 1738260 0 81069 81069 12495760 11893590 179981353 198131332 14035856 12896199 1471122 2515904 11361907 0 12599456 11170100 39468341 26582203 X 139822964 170644225 645178 848027 44870 56877 140513012 171549129 179981353 198131332 X 20643387 218244 10174486 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 16465 0 1 12527 28992 0 Explanation of Lobbying Activities: 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. 44871 521 11749 263 56878 48147 384 3660 44871 50349 2202 48147 28574 22025 250 50349 112350 -83276 500 28574 1.00000 0 0 3352921 3352921 34885973 18098812 16787161 390703 187160 203543 50357372 36167609 14189763 1805139 926890 878249 35411637 LT Non-Cash Inv - HPL/GL 5723878 Due from Affiliates 2801893 Accrued Revenue 2000212 Deferred Fin Costs 437754 3rd Party Payors 117681 Inv in Surgery centers 812172 11893590 HPL/GL Liability 5723878 LT Liab-Pension Liability 2486427 Fin 47 LT Asbestos Liab 1729546 Medicare/Medicaid Liabilities 855969 Deferred Rent and other 242898 Due to Affiliates 110178 Due to BSHSI 19864 Unclaimed Property Liabilities 1340 11170100 X Description of Intended Use of Endowment Funds: Part V, Line 4: Earnings are to used to assist the needy. Description of Uncertain Tax Positions Under FIN 48: 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 (Formerly FIN48). ASC 740 (Formerly FIN48) 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 de-recognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 (Formerly FIN48) 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 of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $66,681 and $95,733 of net operating loss carryforwards as of August 31, 2013 and 2012, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2013 and 2012. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Golf 48466 26866 21600 25211 Gala 35903 27896 8007 84369 54762 29607 25211 25211 4396 1 1 1 X 1 X 1 1 0 1 1 2591893 2591893 0.01660 13136803 9161051 3975752 0.02550 2957686 1637459 1320227 0.00840 18686382 10798510 7887872 0.05050 21 12279 829002 5508 823494 0.00530 2 615 182619 182619 0.00120 12 6243 284586 284586 0.00180 35 19137 1296207 5508 1290699 0.00830 35 19137 19982589 10804018 9178571 0.05880 5455 5455 0.00000 1 399 9358 9358 0.00010 1 399 14813 14813 0.00010 1 3011130 44798386 48099989 -3301603 X 1 1 1 1 Mary Immaculate Hospital

2 Bernardine Dr Newport News VA 23602

http://bshr.com/ X X X X Mary Immaculate Hospital 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X X X X 0 0 1 X 0 0 7 Mary Immaculate Phys Therapy Denbigh

14703 Warwick Blvd Suite B Newport News VA 23608

Physical Therapy In-Motion Boo Williams Sportsplex

5 Armistead Pointe Parkway Hampton VA 23666

Physical Therapy Mary Immaculate Phys Therapy Victory

101-A Long Green Blvd Yorktown VA 23693

Physical Therapy Cardiovascular Specialists

12720 McManus Blvd Ste 201 Newport News VA 23602

Physician Practice Tidewater Surgical Specialists

12720 McManus Blvd Ste 311 Newport News VA 23602

Physician Practice Bon Secours Pulmonary Specialists

12720 McManus Blvd Ste 303 Newport News VA 23602

Physician Practice Bon Secours Occumed

14703 Warwick Blvd Suite A Newport News VA 23608

Occupational Medicine 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 www.bshr.org. 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 recorded in the 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, L7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $12,855,765 Part II: Bon Secours Mary Immaculate Hospital provided facility space, dietary contributions and staff support to local community boards, coalitions, and civic groups to discuss and address health and social concerns across the community. These meetings enabled various community groups to plan programs and activities to improve the health of community residents across different health and social conditions. In addition, Mary Immaculate is working with other community organizations to address the homeless issue in the Newport News area. Part III, Line 4: Part III, line 2: Bad Debt Expense at cost is computed by applying the cost-to-charge ratio computed on Worksheet 2 to the aggregate bad debt expense for patient accounts recorded in the general ledger. 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 10-11 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for doubtful accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 41 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Part III, Line 6: 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 nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable 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.Part III, Line 8: 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. 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 Financial Assistance Program (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 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. Mary Immaculate Hospital Part V, Section B, Line 3: Mary Immaculate Hospital (MIH) contracted with Community Health Solutions (CHS) to conduct an electronic survey of key stakeholder to determine the top healthcare needs of the community. MIH 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, MIH surveyed representatives of medically underserved, minority populations, and those with chronic conditions. MIH also met with representatives from the Peninsula Health Center to review the key findings from the survey and seek additional input. Upon receipt of all information, MIH convened a small group to review the list of key needs and gaps identified to prioritize the needs using criteria developed against which to evaluate each need. Mary Immaculate Hospital Part V, Section B, Line 7: While Mary Immaculate Hospital (MIH) recognizes the importance of all the needs identified, there are other providers and organizations within the community addressing mental illness, dental/oral health, tobacco use, substance abuse, prenatal and pregnancy care, sexually transmitted diseases, teen pregnancy, and Alzheimer's disease with specialized programs and services and it would result in duplication of services if MIH were to address those needs. MIH currently provides comprehensive diabetes education with weekly education sessions covering understanding diabetes, nutrition, foot care, exercise, and medication. MIH also has a comprehensive community-based program in place to address domestic violence through parenting education programs that offer positive learning opportunities for parents, child development, age-appropriate expectations, and health and safety issues as it relates to children from birth through the teenage years. Mary Immaculate Hospital Part V, Section B, Line 12h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Mary Immaculate Hospital Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Mary Immaculate Hospital Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part VI, Line 2: In partnership with Bon Secours Virginia Health System, Mary Immaculate Hospital 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 Mary Immaculate Hospital. National Research Corporation (NRC) is 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"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain States, where applicable. 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. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. 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: As of 2011, Hampton Roads is a very diverse community within an MSA of nearly 1.6 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. African Americans comprise 50% of the population in Hampton, 41% in Newport News, 1% in Poquoson, 14% in Williamsburg, 14% in York County and James City County. Seniors currently in the Mary Immaculate service area account for 17.5% of the population. The population served by Bon Secours Mary Immaculate Hospital (MIH), Newport News, VA is estimated to change from 463,658 to 503,313, resulting in a growth of 8.6%. Over the next five years, the population is projected to grow by 2.4%. Currently the largest populations are white (57%), Black or African American (34%), Hispanic or Latino (6%) and Asian (6%). The current year median age for this area is 35.0, while the average age is 36.2. Five years from now, the median age is projected to be 35.8.The most prevalent chronic conditions among adults include high blood pressure (29%), high cholesterol (36%), arthritis (24%), diabetes (10%), and asthma (7%). Morbidity rates per 10,000: heart disease (92.0), cerebrovascular disease (25.3), chronic obstructive pulmonary disease (10.1), diabetes (12.0) and asthma (10.0). Mortality rates (age-adjusted per 100,000) for this area are cancer (173.6), ischemic heart disease (164.5), cerebrovascular disease (43.9) and chronic obstructive pulmonary disease (33.3). Part VI, Line 5: Mary Immaculate Hospital (MIH) has an open medical staff with privileges available to all qualified physicians. Emergency departments at the hospital provide service 24 hours/ day, 7days/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. MIH, through Bon Secours Hampton Roads Health System (BSHRHS), offers Care-A-Van (CAV) services to the community. The CAV, initiated on the peninsula in 2009 at two sites, has expanded in the past year to twelve sites, three in Norfolk, three in Portsmouth and three in Newport News. This is a mobile health unit that provides healthcare services to those most in need--the uninsured. 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, opportunity to enroll eligible children in children's health insurance. The CAV also offers sports physicals, children's health insurance enrollment, and health education services. While the CAV primarily serves adults, some sites do provide care and referral services for children aged 12 and older. Community partners include free clinics, local health agencies, physicians, and numerous faith-based community organizations which collaborate with the Care-A-Van staff. The CAV has a staff of 10 FTEs and annual expenses of approximately $700,000.MIH, through BSHRHS, offers the Bon Secours Senior Health Program which offers a free membership program to over 54,000 individuals 65 years and older. A key component is the Successful Aging Forum, which brings national speakers to the community to discuss the latest health and wellness topics for senior citizens. The annual HealthFest provides a seniors-focused health festival with health screenings, health information and social interaction for seniors of all socio-economic backgrounds. Friday Night Dinners, held all three BSHR hospitals, serve seniors who need low cost meals and socialization. A transportation program offers transportation to medical appointments, without charge to those who are financially challenged. A quarterly publication, Good Health, provides information to 54,000 members in Hampton Roads. Seniors also play a vital role in BSHRHS advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP) through the Capital Hill Club. MIH supports and provides staffing for the BSHRHS Faith Community Health Ministry which builds on the skills of the registered nurse through additional, structured training in holistic (body, mind and spirit) health services; the faith community nurse partners with the congregational leadership to promote good health by serving as an educator, counselor, referral agent and advocate. Specialized training has also been developed to prepare non-licensed persons to serve in congregational health ministry. Additionally, the Influenza Vaccination Administration program provided 600 vaccines for select covenanted partners to host annual vaccine clinics. BSHRHS employs a sole Director to provide education, mentoring and support to more than 130 faith communities and 232 registered nurses and lay health promoters. MIH Family Focus is a child abuse prevention program of MIH, which targets at-risk families for child abuse and helps teach positive parenting skills. MIH employs the director for the program and provides operating funds for two locations. Family Focus, founded by BSHSI and the Bernardine Sisters of the Third Order of St. Francis, is a broad coalition of private and public organizations that provide a continuum of education, prevention and support programming for over 500 families to encourage healthy child development and nurturing environments in the home and community. In FY11 the program was expanded to include services for Spanish-speaking families.As part of the Virginia Framework for Building a Successful Regional Plan to End Homelessness, MIH is partnering with other organizations in Hampton Roads to build Hope City, a day shelter with shower and laundry facilities for the homeless. Another aspect of the plan is for a New Creation Farm where homeless and other disadvantaged individuals can get out of their current environment to work and be retooled to become independent and prosperous members of the community. MIH is currently establishing long-term relationship to move this project forward. BSHRHS' Community Sponsorship Committee reviews and financially sponsors community events that support our mission and values. Some of the contributions in FY13 that support the work of MIH in addressing unmet need include: - H.E.L.P. Free Dental Clinic to partially subsidize the cost of dental supplies to provide services to uninsured adults- American Heart Association heart healthy initiatives- American Cancer Society Relay for LifeMIH provides in-kind support to the community through its community garden. In 2013, The garden provided 453 pounds of fresh vegetables to Union Baptist Church, New Mount Zion Baptist Church, Natasha House, and Menchville House. MIH also works with other community organizations to address the homeless issue in Newport News.MIH is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. We provide community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock 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. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to:- Improve Health Locally and Globally- Build Partnerships for Population HealthAs a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and it's 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. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world."Please see Schedule R for listings of the related organizations. Reports Filed With States Part VI, Line 7 VA 1 Makemie Woods Camp PO Box 39 Barhamsville VA 23011 540636036 501(c)(3) 12913 Kidz N Grief Camp for Children 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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. 1 1 0 0 0 0 0 0 0 Timothy J Davis 0 576344 0 419077 0 126863 0 115800 0 19095 0 1257179 0 69776 Michael K Kerner 0 475717 0 336924 0 124284 0 106467 0 26303 0 1069695 0 67422 Melinda Hancock 0 251908 0 53362 0 38671 0 3924 0 24044 0 371909 0 0 Patricia Robertson 0 278391 0 146397 0 51034 0 15000 0 12272 0 503094 0 0 Jeffrey N Doucette 169117 0 33795 0 911 0 10278 0 27853 0 241954 0 0 0 Devin T McKeever 0 172445 0 25986 0 919 0 4277 0 7733 0 211360 0 0 James B Sherwood 0 201852 0 44561 0 38836 0 11002 0 27180 0 323431 0 0 Darlene Stephenson 146454 0 22613 0 1053 0 18797 0 22398 0 211315 0 0 0 Thomas J Hoffmier MD 267725 0 196118 0 4198 0 10000 0 15614 0 493655 0 0 0 Nauman Naseer MD 439209 0 0 0 1201 0 12500 0 27773 0 480683 0 0 0 Allen B Nichols MD 412418 0 103137 0 113938 0 17659 0 25074 0 672226 0 0 0 Anthony D Terracina MD 486310 0 425584 0 1536 0 13750 0 25800 0 952980 0 0 0 Leslie A Webb MD 176990 0 20000 0 149 0 913 0 2210 0 200262 0 0 0 Joe Buchheit 0 215606 0 55955 0 54839 0 8035 0 16996 0 351431 0 9225 Ernie Padden 0 201500 0 0 0 0 0 3120 0 0 0 204620 0 0 James H Sammons 127439 0 0 0 97151 0 7955 0 10140 0 242685 0 0 0 Supplemental Information Part III 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 Supplemental Information Part III Part I, Line 4a: Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: James H. Sammons, $73,440; Allen B. Nichols, M.D., $107,310. Supplemental Information Part III Part I, Line 4b: The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and 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 J. Davis, $101,207; Michael K. Kerner, $80,925; Joe Buchheit, $14,445. Form 990, Part VI, Section A, line 4 The articles and bylaws were amended and restated in their entirety (effective November 13, 2012) to reflect current operational realities and governance best practices, and to reflect the transfer of canonical sponsorship of the Bon Secours Health System from the Sisters of Bon Secours to Bon Secours Ministries. Form 990, Part VI, Section A, line 6 The General Minister and General Council of the Bernardine Sisters of the Third order of St. Francis and Bon Secours Health System, Inc. are the members of Mary Immaculate Hospital. Form 990, Part VI, Section A, line 7a The governing body of Mary Immaculate Hospital is appointed by both members, with Bon Secours Health System, Inc. having the majority vote. Form 990, Part VI, Section A, line 7b Certain authorities of Mary Immaculate Hospital are reserved to its 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 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 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 provides any documents open to public inspection upon request. Form 990, Part VII: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. The governing bodies of Mary Immaculate Hospital and Mary Immaculate 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 Mary Immaculate Joint Board. Hours reported for these voluntary board positions represent total hours worked per week, which include responsibilities for both entities). Sr. Patricia Heath does not receive payroll distributions as she has taken a vow of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: BSHSI Principal debt & swaps 8,380,305. Add'l Minimum Pension Plan Liability 1,789,558. Other misc changes 4,623. Mary Immaculate Hospital Auxiliary 2 Bernadine Drive Newport News VA 23602 546040266 Auxiliary VA 501(c)(3) 11c-FI N/A 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) 11c-FI Mary Immaculate Hospital 1 Mary Immaculate Nursing Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 1 Bon Secours Hampton Roads Health System Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521538513 Local System Parent Org VA 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Maryview Nursing Care Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) 9 Bon Secours Hampton Roads Health System 0 Bayley Properties 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541424748 Rental VA 501(c)(2) N/A Bon Secours DePaul Medical Center 0 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) 7 Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) 7 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Suite 108 Suffolk VA 23707 540506463 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Livivng VA N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Livivng 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 Mary Immaculate Hospital Inc C 86316 1257217 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0