2014-08-15T08:48:01-05:00 2013-09-30 560574444 CHERRY BEKAERT LLP P O BOX 1119 LYNCHBURG VA 245051119 990 2012-10-01 540505955 SHELTERING ARMS HOSPITAL SHEL 8043424340 8254 ATLEE ROAD MECHANICSVILLE VA 23116 MICHAEL E DACUS 8043424340 2014-08-14 1 SAMUEL E JOHNSON P00019699 4348476643 2014-08-14 2012 2015-11-30 17:44:51Z MICHAEL E DACUS 8254 ATLEE ROAD MECHANICSVILLE VA 23116 52792996 0 X WWW.SHELTERINGARMS.COM X 1941 VA TO PROVIDE COMPREHENSIVE PHYSICAL REHABILIATION 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. 22 21 757 22 102587 -56934 11499503 9950677 50582724 41914846 688311 -1268 808892 595647 63579430 52459902 204593 246763 0 0 32171751 23815906 0 0 100000 32531172 31386455 64907516 55449124 -1328086 -2989222 21712605 18332170 3807688 3416475 17904917 14915695 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 49702066 41756061 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 2013, 970 PATIENTS WERE ADMITTED RESULTING IN 13,402 PATIENT DAYS.OUTPATIENT PHYSICAL REHABILITATION 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 INCLUDES ORTHOPEDIC REHABILITATION SERVICES, NEUROLOGICAL REHABILITATION SERVICES, PHYSICIANS' REHABILITATION SERVICES, AND OUTPATIENT REHABILITATION THERAPIES. DURING FISCAL YEAR 2013, SHELTERING ARMS HOSPITAL PROVIDED OUTPATIENT THERAPY SERVICES RESULTING IN 72,542 THERAPY VISITS. FOR FISCAL YEAR 2013, PHYSICIAN AND PSYCHOLOGY SERVICES RESULTED IN 42,427 PATIENT VISITS. 1645672 449146 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 GOLF PROGRAM, ADAPTIVE BOWLING LEAGUE, ACCESSIBLE TRAVEL PROGRAM, THERAPEUTIC POOL AND FITNESS CENTER MEMBERSHIPS, PERSONAL TRAINING SERVICES, GROUP EXERCISE CLASSES, EDUCATIONAL SEMINARS, 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 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 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 ACOMMUNITY OUTINGS. IN FY 2013 CLUB REC ENJOYED 7,780 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. EDUCATIONAL SESSIONS ON WELLNESS AND LEARNING TO LIVE LIFE AFTER A DISABILITY ARE ORGANIZED AND OFFERED TO THE COMMUNITY. IN FISCAL YEAR 2013 THERE WERE 58 EVENTS TOTALING 754 PARTICIPANTS.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 TWO WARM WATER THERAPEUTIC POOLS AND FITNESS CENTERS OFFERING POOL AND FITNESS MEMBERSHIPS, AQUATIC AND LAND GROUP EXERCISE CLASSES, AND PERSONAL TRAINNING SERVICES TO THE COMMUNITY. ONE 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 THE INPATIENT HOSPITAL AND OUTPATIENT THERAPY CLINICS THE OPPORTUNITY TO CONTINUE TO ENGAGE IN PHYSICAL ACTIVITY. FITNESS SPECIALISTS WORK WITH INDIVIDUASL PROVIDING PERSONALIZED ATTENTION TO THE MEMBERS, AS WELL AS PERSONAL TRAINING SERVICES FOR THOSE WHO ARE INTERESTEED IN INDIVIDUALIZED GOAL SETTING AND EXERCISE POGRAMS DESIGNED TO MEET THEIR NEEDS. DURING FISCAL YEAR 2013 THERE WERE 26,591 VISITS TO THE POOLS AND FITNESS CENTERS. SHELTERING ARMS LEAD 1,410 GROUP EXERCISE CLASSES TOTALING 6,225 PARTICPANTS. FITNESS SPECIALISTS CONDUCTED 3,147 NEUROFIT, PERSONAL TRAINING UTILIZING ADVANCED TECHNOLOGIES FOR THE NEUROGLOGICALLY IMPAIRED, AND PERSONAL TRAINING SESSIONS TO THE COMMUNITY. 1529603 246763 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 2013, CHARITY CARE AND/OR FINANCIAL ASSISTANCE RESULTED IN TOTAL DISCOUNTED CHARGES FOREGONE BY SHELTERING ARMS HOSPITAL OF $1,274,836. IN FISCAL YEAR 2013, SHELTERING ARMS ALSO TRANSPORTED PATIENTS PARTICIPATING IN PATIENT THERAPY SERVICES AT AN UNREIMBURSED COST OF $8,004. SHELTERING ARMS 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 $33,924. IN ADDITION, SHELTERING ARMS HOSPITAL CONTRIBUTED $212,839 TO SUPPORT OTHER COMMUNITY ORGANIZATIONS AND EVENTS. 52877341 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 87 0 1 757 1 1 1 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 VA X MICHAEL E DACUS VP OF FINANCE AND CFO 8043424340 8254 ATLEE RD MECHANICSVILLE VA 23116 TERESA REYNOLDS DIMARCO 2.00 1.00 X 0 0 0 CHARLES M CARAVATI III 2.00 3.00 X 0 0 0 WILLIAM T CLARKE JR 2.00 2.00 X 0 0 0 JOYCE F NASH 2.00 2.00 X 0 0 0 DONNAN O'KEEFE 2.00 1.00 X 0 0 0 BARBARA H DUNN 2.00 1.00 X 0 0 0 WILLIAM E HARDY 2.00 2.00 X 0 0 0 DIANNE V JEWELL 2.00 2.00 X 0 0 0 SUSAN J RAWLES 2.00 1.00 X 0 0 0 JAMES RUSSELL 2.00 1.00 X 0 0 0 JAMES A SLABAUGH SR 2.00 1.00 X 0 0 0 KATHRYN M BARLEY 2.00 1.00 X 0 0 0 ANNE H BENNETT 2.00 1.00 X 0 0 0 PETER BOWLES 2.00 2.00 X 0 0 0 DAVID CONSTINE 2.00 1.00 X 0 0 0 W BATES CHAPPELL 2.00 2.00 X 0 0 0 PATRICIA B CUSHNIE 2.00 1.00 X 0 0 0 THEODORE PRICE 2.00 3.00 X 0 0 0 WAVERLY J PULLEY 2.00 1.00 X 0 0 0 ABRAHAM SEGRES 2.00 1.00 X 0 0 0 LISA T POWELL 2.00 3.00 X X 0 0 0 JOHN L MCELROY III 2.00 3.00 X X 0 0 0 JAMES E SOK 24.00 16.00 X 466065 0 88198 JAMES A BRAITH 24.00 16.00 X 280064 0 22043 ELLEN VANCE 30.00 10.00 X 219290 0 20998 MICHAEL E DACUS 24.00 16.00 X 152039 0 10046 MARY ZWEIFEL 40.00 0.00 X 59597 0 894 HILLARY S HAWKINS 40.00 0.00 X 379469 0 16984 TIMOTHY M SILVER 1.00 40.00 X 361802 0 26382 JOHN E GIBBS II 40.00 0.00 X 270082 0 16288 CHARLES MATTHEW GIBELLATO 40.00 0.00 X 253224 0 24083 ALBERT M JONES 40.00 0.00 X 261793 0 24217 GREGORY LEGHART 40.00 0.00 X 315940 0 23727 SCOTT N SCHIMPFF 40.00 0.00 X 605106 0 25105 3624471 0 298965 24 0 1 0 MEMORIAL REGIONAL MEDICAL 8260 ATLEE ROAD MECHANICSVILLE VA 23116 HOSPITAL ANCILLARY & SUPPORT 2008194 TROUTMAN SANDERS LLP 1001 HAXALL POINT RICHMOND VA 23219 LEGAL ADVICE 607746 OWENS & MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 PATIENT SUPPLIES 430952 CROTHALL 955 CHESTERBROOK BLVD SUITE 800 WAYNE PA 19087 HOUSEKEEPING 417490 FREE AGENTS MARKETING LLC 10124 WEST BROAD ST SUITE N GLEN ALLEN VA 23060 ADVERTISING & MARKETING 334206 19 9606968 343709 9950677 PATIENT SERVICE REVENU 621400 41390053 41390053 THERAPEUTIC RECREATION 621400 524793 524793 41914846 1649 1649 131878 0 131878 131878 101878 30000 2917 -2917 -2917 -2917 502876 330177 172699 172699 MISCELLANEOUS 621400 182121 182121 SPORTS ACCELERATION PR 713940 102587 102587 MOB RENTAL INCOME 621400 6362 6362 291070 52459902 42205207 102587 201431 246763 246763 2103873 1312332 791541 17513131 17332576 180555 1017832 644655 373177 1033505 1051473 -17968 2147565 2040187 107378 408644 -523 409167 84986 58193 26793 1162958 937892 225066 184364 165915 18449 732442 722312 -89870 100000 1012533 872531 140002 11807 11807 2273157 2203361 69796 101125 92582 8543 122517 110002 12515 5913010 5913010 1988608 1809936 178672 181792 148591 33201 CONTRACTUAL ADJUSTMENTS 13706033 13706033 PURCHASED SERVICES 3090860 3090857 3 BAD DEBT EXPENSE 324715 324715 MEMBERSHIPS 86904 82141 4763 55449124 52877341 2471783 100000 140621 222219 1471919 1203079 6078689 3265557 49049 42857 722496 893060 34348286 22363985 12614145 11984301 100000 505647 502313 130039 118784 21712605 18332170 3807688 3416475 3807688 3416475 X 17729917 14763913 75000 51782 100000 100000 17904917 14915695 21712605 18332170 -2989222 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 416370 416370 11135716 5388297 5747419 3123578 1890432 1233146 14337028 9411092 4925936 5335594 5674164 -338570 11984301 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR 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. THE CORPORATION'S MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR TAX YEARS PRIOR TO THE FISCAL YEAR ENDED SEPTEMBER 30, 2010. BAL-DU-BOIS 502876 502876 141012 189165 502876 502876 141012 189165 330177 172699 1 1 X 1 X 1 X 1 1 1 0 1 1 1274836 1274836 0.02300 238257 238257 0.00430 1513093 1513093 0.02730 4 1645672 449146 1196526 0.02160 2 128473 128473 0.00230 20 246763 246763 0.00450 24 2 2020908 449146 1571762 0.02840 24 2 3534001 449146 3084855 0.05570 2 1050 252 252 0.00000 12 114 700 700 0.00000 14 1164 952 952 1 324715 16236 12110660 9086928 3023732 X 1 1 1 1 SHELTERING ARMS HOSPITAL

8254 ATLEE ROAD MECHANICSVILLE VA 23116

X PHYSICAL REHABILITATION HOSPITAL SHELTERING ARMS HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X X X 0 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X X X X X 1 X 0 X X X X 0 X X 0 0 10 SHELTERING ARMS HANOVER REHABILITATION C

8226 MEADOWBRIDGE ROAD MECHANICSVILLE VA 23116

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS SOUTH PHYSICIANS CLINIC

13700 ST FRANCES BLVD MIDLOTHIAN VA 23114

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS BON AIR CENTER

206 TWINRIDGE LANE RICHMOND VA 23235

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS CHESTER CENTER

12220 IRONBRIDGE ROAD CHESTER VA 23831

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS LABURNAM CENTER

4730 S LABURNUM AVENUE RICHMOND VA 23231

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS MAPLE CENTER

1501 MAPLE AVENUE SUITE 100 RICHMOND VA 23226

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS MIDTOWN CLUB REC

2805 WEST BROAD STREET RICHMOND VA 23230

OUTPATIENT DAY PROGRAM AND FITNESS CENTER PT WORKS CENTER

2296 JOHN ROLFE PARKWAY RICHMOND VA 23233

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS HANOVER NEURO CTR

8254 ATLEE ROAD MECHANICSVILLE VA 23116

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS HULL STREET CENTER

13530 HULL STREET ROAD MIDLOTHIAN VA 23114

OUTPATIENT THERAPY AND PHYSICIANS CLINIC PART I: LINE 3C: VICE PRESIDENT FINANCE/CFO WILL REVIEW APPLICATIONS THAT DO NOT MEET THE PROGRAM GUIDELINES BUT FOR WHICH EXTRAORDINARY CIRCUMSTANCES MAY EXIST; AND APPLICATIONS BY PATIENTS/FAMILIES WHO DISAGREE WITH THE PROGRAM DETERMINATION AND WHO REQUEST RECONSIDERATION.PART I: LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT BEGAN IN FY 2012 AND WAS PUBLISHED IN FY 2013.PART I: LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC AT WWW.SHELTERINGARMS.COM.PART I: LINE 7: COLUMN F REFLECTS THE CHARITY AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF THE TOTAL FUNCTIONAL EXPENSES IN COLUMN A, LINE 25 OF PART IX OF THE FORM 990.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 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 BY SHELTERING ARMS EVERY WEDNESDAY. PATIENT BALANCES WILL BE BILLED FOR 2 CYCLES (60 DAYS) UPON WHICH ANY UNPAID BALANCES WILL BE FORWARDED TO OUR FIRST OUT VENDOR FOR RESOLUTION OF THE REMAINING DEBT BEGINNING ON DAY 61. THE FIRST OUT VENDOR WILL WORK IN AN ATTEMPT TO COLLECT THE OUTSTANDING BALANCE OR ESTABLISH PAYMENT PLAN ARRANGEMENTS WITH THE PATIENT OR THEIR ESTATE. ANY ACCOUNTS WITH: UNSETTLED BALANCES REMAINING, NO PAYMENT ARRANGEMENTS, OR BROKEN PAYMENT ARRANGEMENTS AFTER 60 DAYS (120 DAYS SINCE DESIGNATION AS PATIENT RESPONSIBILITY), WILL BE RETURNED SYSTEMATICALLY FROM THE VENDOR AND SHELTERING ARMS WILL DESIGNATE THE BALANCES AS OUTSOURCED TO COLLECTION VENDOR AS COLLECTION BALANCES. THE COLLECTION VENDOR WILL RECEIVE AND PROCESS DESIGNATED ACCOUNTS FOR BALANCES AND WORK ACCOUNTS DESIGNATED AS BAD DEBT FOR AN ADDITIONAL 120 DAYS (240 DAYS SINCE DESIGNATION AS A PATIENT RESPONSIBLE BALANCE) AT WHICH TIME ANY ACCOUNTS WITH UNSETTLED BALANCES REMAINING, NO PAYMENT ARRANGEMENTS, OR BROKEN PAYMENT ARRANGEMENTS WILL BE RETRACTED FROM THE VENDOR AND ASSOCIATED COLLECTION EFFORTS WILL CEASE. PART V, SECTION B, LINE 3: BEGINNING IN 2012, THE SHELTERING ARMS HOSPITAL (SAH) DEVELOPED AND CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY THROUGH COLLABORATION WITH COMMUNITY HEALTH SOLUTIONS, A RICHMOND, VIRGINIA-BASED HEALTH RESEARCH AND CONSULTING COMPANY. THE PROCESS BEGAN BY DEFINING THE TARGET COMMUNITY AND THEN ASSESSING THE CONCERNS AND NEEDS OF THE COMMUNITY USING HEALTH DATA AND INPUT FROM KEY COMMUNITY STAKEHOLDERS. THE CONTENT OF THE SURVEY WAS FOCUSED ON THE FOLLOWING:1) IMPORTANT HEALTH CONCERNS IN THE COMMUNITY (NON-SPECIFIC TO REHABILITATION);2) SIGNIFICANT SERVICE GAPS IN THE COMMUNITY; AND3) IDEAS AND SUGGESTIONS FOR IMPROVING COMMUNITY HEALTHTHE SURVEY WAS SENT TO A GROUP OF 162 COMMUNITY STAKEHOLDERS IDENTIFIED BY THE SHELTERING ARMS HOSPITAL IN COLLABORATION WITH COMMUNITY HEALTH SOLUTIONS. RESPONDENTS TO THE SURVEY, INCLUDING TWO PUBLIC HEALTH ENTITIES, IDENTIFIED MORE THAN TWENTY IMPORTANT HEALTH CONCERNS; AND MORE THAN TWO DOZEN GAPS IN SPECIFIC COMMUNITY SERVICES (SEE "A COMMUNITY HEALTH NEEDS ASSESSMENT - SHELTERING ARMS HOSPITAL-HANOVER"). RESPONDENTS ALSO OFFERED, THROUGH A WRITE-IN OPTION, IDEAS AND SUGGESTIONS FOR IMPROVING COMMUNITY HEALTH; THE MOST COMMON SUGGESTION BEING THAT THE SHELTERING ARMS HOSPITALPURSUE ADDITIONAL BEDS FOR INPATIENT REHABILITATION. THE STUDY POPULATION FOR THE SHELTERING ARMS HOSPITAL CHNA SURVEY WAS ADULT RESIDENTS (18+) RESIDING IN THE PRIMARY SERVICE AREA OF 47 ZIP CODES - FALLING LARGELY IN THE COUNTIES OF CAROLINE, CHARLES CITY, ESSEX, HANOVER, HENRICO, KING WILLIAM, LANCASTER, NEW KENT, NORTHUMBERLAND AND RICHMOND; AND THE CITY OF RICHMOND. AS OF 2012, THAT STUDY AREA INCLUDED AN ESTIMATED 459,123 INDIVIDUALS AGES 18 AND OVER.PART V, SECTION B: LINE 7: SHELTERING ARMS WILL FOLLOW THE IMPLEMENTATION PLAN IN PLACE TO FURTHER ADDRESS SERVICE GAPS IN FY 2014 - FY 2016 BY EXPANDING SERVICES ALREADY IN PLACE WHICH ADDRESS THESE GAPS. THOSE IDENTIFIED GAPS WERE AGING SERVICES, BEHAVIORAL HEALTH SERVICES, PATIENT SELF MANAGEMENT SERVICES (FOR EXAMPLE, EXERCISE & EDUCATION) & HEALTH PROMOTION AND PREVENTION SERVICES, CHRONIC PAIN MANAGEMENT SERVICES, HEALTH CARE COVERAGE, DIABETES, CARE COORDINATION SERVICES, CHRONIC DISEASE SERVICES, JOB/VOCATIONAL REHABILITATION. PART II: THE COMMUNITY BUILDING ACTIVITIES INCLUDE COALITION BUILDING THROUGH PARTICIPATION IN TASK FORCES SUCH AS THE VIRGINIA ARTHRITIS ACTION COALITION AND THE HEALTH PROMOTIONS FOR PEOPLE WITH DISABILITIES PROJECT RUN THROUGH THE VIRGINIA COMMONWEALTH UNIVERSITY PARTNERSHIP FOR PEOPLE WITH DISABILITIES. THESE TASK FORCES WORK WITH AGENCIES AND ORGANIZATIONS ACROSS THE STATE TO PROMOTE HEALTHY LIFESTYLES, EDUCATIONAL OPPORTUNITIES, AND TRAINING PROGRAMS IN AN EFFORT TO DECREASE FUTURE LONG TERM DISABILITIES BY OFFERING WORKSHOPS AND TRAINING COURSES. THE COMMUNITY HEALTH IMPROVEMENT ADVOCACY IS ACCOMPLISHED BY PARTICIPATION IN CENTRALLY ACCESSIBLE LOCATIONS TO PROVIDE STROKE SCREENINGS, SEMINARS ON LIVING WITH FIBROMYALGA, DIABETES EDUCATION,FALL PREVENTION, AS WELL AS HEALTH FAIRS SPONSORED BY OTHER LOCAL HOSPITALS. THIS EDUCATION AND SEMINAR PARTICIPATION FOLLOWS THE GOAL OF PROVIDING THE GREATER PUBLIC WITH THE INFORMATION THEY NEED TO IMPROVE THEIR FITNESS AND AWARENESS OF DEBILITATING ILLNESSES. PART III, LINE 4: DOUBTFUL ACCOUNTS GENERALLY ARISE BASED UPON A PATIENT'S INABILITY TO PAY THEIR PORTION OF THE AMOUNT BILLED FOR SERVICES. MANAGEMENT'S ESTIMATES ARE BASED UPON AN ANALYSIS OF HISTORICAL COLLECTION TRENDS, CURRENT PAYER MIX, INDUSTRY FACTORS, CURRENT ANTICIPATED ECONOMIC CONDITIONS. AND OTHER RISKS INHERENT IN THE ACCOUNTS RECEIVABLE BALANCE. PART III, LINE 8: PART III: LINE 8: THE MEDICARE GAIN WAS OBTAINED FROM THE MEDICARE COST REPORT FILED FOR FY 2013. PART VI, LINE 2: SHELTERING ARMS HOSPITAL HAS DEVELOPED A HOME HEALTH AGENCY, SPECIALIZING IN REHABILITATION SERVICES, TO PROVIDE SERVICES TO A LARGELY SENIOR POPULATION TO SUPPORT AGING IN PLACE IN THE COMMUNITY SETTING; HOSTS AN EDUCATIONAL SERIES AND EVENTS SUCH AS THE CHRONIC DISEASE SELF- MANAGEMENT CLASS, SPONSORED BY SENIOR CONNECTIONS; SEMINARS ON HEALTHY LIVING PROVIDED TO LONG TERM CARE FACILITIES; AND SEMINARS ON FALL PREVENTION, NUTRITION, AND SO ON; HOLDS A SIX-WEEK STROKE EDUCATION SERIES PROVIDED AT THE SHELTERING ARMS HOSPITAL; A LOW-VISION PROGRAM TO PROVIDE SPECIALIZED SCREENING AND TREATMENT SERVICES; REFERRAL RELATIONSHIPS WITH COMMUNITY AGENCIES AND ORGANIZATIONS TO ASSIST PATIENTS AND FAMILIES IN LOCATING NEEDED SERVICES; HOSTS AN ANNUAL POSTER DAY ON ADVANCED DIRECTIVES; SHELTERING ARMS FOUNDATION GRANT SUPPORT OF ENTITIES SUCH AS CIRCLE CENTER ADULT DAY SERVICES, HANOVER ADULT CENTER, IVNA, JEWISH FAMILY SERVICES, RAMP ACCESS MADE POSSIBLE BY STUDENTS, RICHMOND AREA HIGH BLOOD PRESSURE CENTER, AND SOUTH RICHMOND ADULT DAY CARE CENTER. IN ADDITION, SHELTERING ARMS PROVIDES FITNESS / EXERCISE PROGRAMS AND CLASSES FOCUSED SPECIFICALLY ON SENIORS, INCLUDING PROGRAMS FOR SENIORS WITH ARTHRITIS AND ONGOING EDUCATION PROVIDED BY SHELTERING ARMS NURSE LIAISONS TO THE STAFF OF 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. SHELTERING ARMS PARTNER FOR LIFE PROGRAMS (LEISURE; INTERACTION; FITNESS; AND ENJOYMENT) PROVIDE A VARIETY OF SOCIAL AND WELLNESS OPPORTUNITIES TO EXTEND THE SHELTERING ARMS CONTINUUM WHILE ALSO SERVING INDIVIDUALS FROM THE COMMUNITY - OR THOSE REFERRED BY OTHER HEALTHCARE PROVIDERS - WHO ARE INTERESTED IN PREVENTION, WELLNESS AND SELF-MANAGEMENT ACTIVITIES. THE PARTNERS FOR LIFE PROGRAMS INCLUDE NEUROFIT - A COMPREHENSIVE "AFTER-CARE" EXERCISE PROGRAM - BASED ON A FITNESS MODEL - FOR INDIVIDUALS WHO HAVE NEUROLOGICAL CONDITIONS BUT NO LONGER REQUIRE FORMAL THERAPY. PROGRAM EMPHASES INCLUDE IMPROVED OR MAINTAINED STRENGTH, RANGE OF MOTION, BALANCE AND FUNCTIONAL MOVEMENT - COMPLEMENTING THE PROGRESS MADE IN PHYSICAL THERAPY AND OTHER CLINICAL VENUES. POOL AND FITNESS MEMBERSHIPS - SHELTERING ARMS PROVIDES TWO FITNESS CENTERS AND TWO THERAPEUTIC (WARM WATER) POOLS TO MEMBERS WHO MAY BE FORMER PATIENTS OR MAY SIMPLY RESIDE IN THE COMMUNITY. FITNESS CENTERS FEATURE HIGH QUALITY EQUIPMENT AND THE AVAILABILITY OF CERTIFIED PERSONAL TRAINERS TO PROVIDE INDIVIDUALIZED FITNESS PLANS AND SERVICES. THE FITNESS ENVIRONMENT IS COMFORTABLE AND NON-INTIMIDATING TO SERVE AN AGING AND/OR CHALLENGED COMMUNITY POPULATION. POOLS PROVIDE A NEEDED EXERCISE MODALITY FOR THOSE STRUGGLING WITH PAIN CONDITIONS AND/OR MOBILITY RESTRICTIONS. AQUATIC AND FITNESS CLASSES - IN WATER OR ON LAND, EXERCISE CLASSES INCLUDE STRENGTH & CONDITIONING; SENIORLITE (LIMITED INDIVIDUALS CAN TOLERATE EXERCISE), CORE STRENGTHENING, CARDIO BLAST, YOGA, AND AQUATIC FITNESS. CLUB REC - A DAY RECREATION PROGRAM FOR INDIVIDUALS WITH DISABILITY OR PHYSICAL LIMITATIONS WHO CAN BENEFIT FROM A SUPERVISED SOCIAL AND WELLNESS PROGRAM. THE MODEL IS HOLISTIC, ANCHORED IN SELF-MANAGEMENT CONCEPTS, AND INCLUDES: ORGANIZED PROGRAMS AND MODULES IN HEALTH, EDUCATION AND LEISURE - PROVIDED BY RECREATION THERAPISTS AND FITNESS SPECIALISTS; COPING SKILLS GROUP (LED BY A LICENSED CLINICAL SOCIAL WORKER); USE OF SPECIALIZED RECREATION/ADAPTIVE EQUIPMENT; A COMPUTER LAB; ACCESS TO A FITNESS CENTER AND POOL; SPORTING EVENTS; AND COMMUNITY SERVICE PROJECTS. TO FURTHER SERVE THE NEEDS OF THE - LARGELY - AGING POPULATION OF CLUB REC MEMBERS, SHELTERING ARMS ADDEDOUTPATIENT PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY SERVICES TO THE CLUB REC FACILITY TO CREATE AN EFFICIENT AND HIGHLY COORDINATED EXPERIENCE FOR THOSE INDIVIDUALS WHO REQUIRE FORMAL TREATMENT SERVICES. CHRONIC DISEASE SELF-MANAGEMENT CLASS - A SIX-WEEK PROGRAM DESIGNED TO TEACH CRITICAL PREVENTION AND HEALTH SELF-MANAGEMENT SKILLS. CLASS TOPICS INCLUDE: NUTRITION; EXERCISE; MANAGEMENT OF PAIN AND FATIGUE; EFFECTIVE COMMUNICATION ABOUT HEALTH MATTERS; MANAGING FEAR, ANGER & FRUSTRATION; AND ACTION PLANS FOR LIFESTYLE CHANGES. FITNESS & WELLNESS EDUCATION SERIES - FREE MONTHLY EDUCATION SESSIONS FOCUSED ON HEART HEALTH, FALL PREVENTION, NUTRITION, GENERAL EXERCISE, AND OTHER TOPICS AS REQUESTED BY ATTENDEES. SHAREGIVER PROGRAM - A SIX-WEEK EDUCATIONAL PROGRAM, DESIGNED BY THE AMERICAN HEART & STROKE ASSOCIATION, FOR STROKE SURVIVORS AND THEIR CAREGIVERS. TOPICS INCLUDE: PREVENTING RECURRENCE; EMOTIONAL WELLNESS; SAFETY IN THE HOME; AND ACCESSING COMMUNITY RESOURCES. SPECIAL ADAPTIVE SPORTING AND TRAVEL EVENTS - INCLUDING BOWLING CLINICS; ADAPTIVE GOLF CLINICS AND TOURNAMENTS; FISHING TRIPS; ADAPTIVE SKI TRIPS; AND AN ACCESSIBLE TRAVEL PROGRAM. COLLABORATIVE EVENTS - SHELTERING ARMS PARTNERS WITH LOCAL AGENCIES TO PROVIDE HEALTH AND WELLNESS EDUCATION EVENTS TO THE COMMUNITY. PARTNER AGENCIES AND ORGANIZATIONS INCLUDE: ARTHRITIS FOUNDATION; VCU PARTNERSHIPS FOR PEOPLE WITH DISABILITIES; VIRGINIA ARTHRITIS ACTION COALITION; SENIOR NAVIGATOR; AMERICAN HEART & STROKE ASSOCIATION; NATIONAL MULTIPLE SCLEROSIS SOCIETY; VIRGINIA BRAIN INJURY ASSOCIATION; VIRGINIA DEPARTMENT OF HEALTH; AND VIRGINIA DEPARTMENT ON AGING. GRANTMAKING - SUPPORT FROM THE SHELTERING ARMS FOUNDATION TO ENTITIES SUCH AS CIRCLE CENTER ADULT DAY SERVICES, COMMUNITY BRAIN INJURY SERVICES, HANOVER ADULT CENTER, SOUTH RICHMOND ADULT DAY CARE CENTER, AND SPORTABLE RICHMOND ADAPTIVE SPORT & RECREATION. 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 MANAGER OR PATIENT FINANCIAL SERVICES REPRESENTATIVE AND ARE AVAILABLE ON THE SHELTERING ARMS WEBSITE AT WWW.SHELTERINGARMS.COM WITH THE COMPLETE POLICY AND APPLICATION. ALL COMPLETED APPLICATIONS MUST BE SUBMITTED TO THE PATIENT INFORMATION DEPARTMENT, AS PER PRINTED INSTRUCTIONS, FOR REVIEW AND VERIFICATION OF INFORMATION. THE UTILIZATION MANAGER MAY BE CONSULTED AS NEEDED. NEW INPATIENT ADMISSIONS RECEIVE A FORM UPON ARRIVAL DISCLOSING THE FINANCIAL AGREEMENT TO PAY WHICH INCLUDES OFFERING MONTHLY PAYMENT ARRANGEMENTS OR APPLICATION FOR FINANCIAL ASSISTANCE. THIS 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: BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT PATIENT POPULATION IS LARGELY COMPRISED OF ADULT RESIDENTS IN CENTRAL AND EASTERN VIRGINIA. THE STUDY POPULATION FOR THIS CHNA IS ADULT RESIDENTS AGE 18+. THE STUDY REGION IS BASED ON THE SA HANOVER SERVICE AREA OF 47 ZIP CODES. MOST OF THESE ZIP CODES FALL WITHIN THE COUNTIES OF CAROLINE, CHARLES CITY, ESSEX, HANOVER, HENRICO, KING WILLIAM, LANCASTER, NEW KENT, NORTHUMBERLAND, AND RICHMOND; AND THE CITY OF RICHMOND. DEMOGRAPHIC PROFILE. AS OF 2012, THE STUDY REGION INCLUDED AN ESTIMATED 459,123 PERSONS AGE 18+. COMPARED TO THE COMMONWEALTH OF VIRGINIA AS A WHOLE, THE STUDY REGION IS MORE DENSELY POPULATED, AND PROPORTIONALLY MORE BLACK/AFRICAN AMERICAN. THE REGION HAS SLIGHTLY LOWER INCOME LEVELS THAN VIRGINIA AS A WHOLE.- MORTALITY PROFILE. THE STUDY REGION HAD 4,959 TOTAL DEATHS FOR ADULTS AGE 18+ IN 2011. THE TWO LEADING CAUSES OF DEATH WERE MALIGNANT NEOPLASMS (CANCER) AND HEART DISEASE. THE STUDY REGION DEATH RATE PER 100,000 POPULATION WAS HIGHER THAN THE STATEWIDE RATE FOR ALL AGE GROUPS.- ADULT HEALTH RISK PROFILE. THE STUDY INCLUDED A PROFILE OF SELECTED HEALTH RISKS FOR ADULTS AGE 18+. THE ESTIMATES INDICATE THAT SUBSTANTIAL NUMBERS OF ADULTS IN THE STUDY REGION HAVE HEALTH RISKS RELATED TO NUTRITION,WEIGHT, PHYSICAL INACTIVITY, ALCOHOL AND TOBACCO. IN ADDITION, SUBSTANTIAL NUMBERS OF ADULTS MAY HAVE CHRONIC CONDITIONS SUCH AS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, ARTHRITIS, DIABETES AND ASTHMA.- UNINSURED PROFILE. AN ESTIMATED 57,462 (16%) ADULTS AGE 19-64 IN THE STUDY REGION WERE UNINSURED AT ANY POINT IN TIME. THE MAJORITY OF UNINSURED ADULTS WERE ESTIMATED TO HAVE INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL).- MEDICALLY UNDERSERVED PROFILE. MEDICALLY UNDERSERVED AREAS (MUAS) AND MEDICALLY UNDERSERVED POPULATIONS (MUPS) ARE DESIGNATED BY THE U.S. HEALTH RESOURCES AND SERVICES ADMINISTRATION AS BEING AT RISK FOR HEALTH CARE ACCESS PROBLEMS. THE DESIGNATIONS ARE BASED ON SEVERAL FACTORS INCLUDING PRIMARY CARE PROVIDER SUPPLY, INFANT MORTALITY, PREVALENCE OF POVERTY, AND THE PREVALENCE OF SENIORS AGE 65+. TEN OF THE 11 LOCALITIES THAT ENCOMPASS THE STUDY REGION HAVE BEEN FULLY OR PARTIALLY DESIGNATED AS MUAS/MUPS.- PREVENTABLE HOSPITALIZATION DISCHARGE PROFILE. THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) IDENTIFIES A DEFINED SET OF CONDITIONS (CALLED PREVENTION QUALITY INDICATORS, OR "PQIS") FOR WHICH HOSPITALIZATION SHOULD BE AVOIDABLE WITH PROPER OUTPATIENT HEALTH CARE. HIGH RATES OF HOSPITALIZATION FOR THESE CONDITIONS INDICATE POTENTIAL GAPS IN ACCESS TO QUALITY OUTPATIENT SERVICES FOR COMMUNITY RESIDENTS. STUDY REGION RESIDENTS AGE 18+ HAD 5,695 PQI HOSPITAL DISCHARGES IN 2011. THE STUDY REGION PQI DISCHARGE RATE PER 100,000 POPULATION WAS HIGHER THAN THE STATEWIDE RATE OVERALL, AND FOR ADULTS AGE 18-44.- BEHAVIORAL HEALTH HOSPITALIZATION DISCHARGE PROFILE. BEHAVIORAL HEALTH HOSPITALIZATIONS PROVIDE ANOTHER IMPORTANT INDICATOR OF COMMUNITY HEALTH STATUS. STUDY REGION RESIDENTS AGE 18+ HAD 5,220 HOSPITAL DISCHARGES FROM VIRGINIA COMMUNITY HOSPITALS FOR BEHAVIORAL HEALTH CONDITIONS IN 2011.1 THE LEADING DIAGNOSES FOR THESE DISCHARGES WERE AFFECTIVE PSYCHOSES AND SCHIZOPHRENIC DISORDERS. THE STUDY REGION BEHAVIORAL HEALTH HOSPITALIZATION DISCHARGE RATE PER 100,000 POPULATION WAS HIGHER THAN THE STATEWIDE RATE FOR ALL AGE GROUPS EXCEPT THE 65+ AGE GROUP. PART VI, LINE 5: SHELTERING ARMS REPRESENTATIVES HAVE BEEN APPOINTED TO THE AMERICAN PHYSICAL THERAPY ASSOCIATION, THE RICHMOND ACADEMY OF MEDICINE, THE MULTIPLE SCLEROSIS SOCIETY AS WELL AS FACULTY APPOINTMENTS TO THE VCU PHYSICAL THERAPY AND MEDICAL SCHOOLS. WE ALSO HAVE MADE PRESENTATIONS AND SPEAKING ENGAGEMENTS TO THE AMERICAN PHYSICAL THERAPY ASSOCIATION, THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION, AND THE VIRGINIA OCCUPATIONAL THERAPY ASSOCIATION. 1 BON SECOURS RICHMOND HEALTHCARE FOUNDATION 5875 BREMO ROAD SUITE 305 RICHMOND VA 23226 541201346 501(C)(3) 33225 ANNUAL PLEDGE THE COMMUNITY FOUNDATION SERVING RICHMOND AND CENTRAL VIRGINIA 7501 BOULDERS VIEW DRIVE SUITE 110 RICHMOND VA 23225 237009135 501(C)(3) 136223 TO SUPPORT NINE PROGRAMS IDENTIFIED IN THE COMMUNITY SERVING POPULATIONS IN NEED OF ASSISTANCE. WASHINGTON REDSKINS CHARITABLE FOUNDATION 21300 REDSKINS PARK DRIVE ASHBURN VA 20147 541982366 501(C)(3) 16613 IN SUPPORT OF MAKING A POSITIVE AND MEASURABLE IMPACT ON YOUTH DEVELOPMENT IN THE AREAS OF EDUCATION, COMMUNITY OUTREACH, AND HEALTH AND WELLNESS. SENIOR NAVIGATOR 7501 BOULDERS VIEW DRIVE SUITE 201 RICHMOND VA 23225 541977334 501(C)(3) 9968 SUPPORT OF ONLINE SEARCH WEBSITE TO ASSIST SENIORS AND CAREGIVERS TO FIND COMMUNITY PROGRAMS AND SERVICES. NATIONAL MULTIPLE SCLEROSIS SOCIETY - CENTRAL VIRGINIA CHAPTER 4200 INNSLAKE DRIVE SUITE 301 GLEN ALLEN VA 23060 540633474 501(C)(3) 8639 SUPPORT OF THE LOCAL INITIATIVES OF THE AMERICAN HEART ASSOCIATION. 5 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 1 0 0 0 0 0 0 0 JAMES E SOK 338849 0 127216 0 0 0 79736 0 8462 0 554263 0 0 0 JAMES A BRAITH 187050 0 93014 0 0 0 10169 0 11874 0 302107 0 0 0 ELLEN VANCE 155071 0 64219 0 0 0 9608 0 11390 0 240288 0 0 0 MICHAEL E DACUS 133012 0 19027 0 0 0 2992 0 7054 0 162085 0 0 0 HILLARY S HAWKINS 280218 0 99251 0 0 0 5000 0 11984 0 396453 0 0 0 TIMOTHY M SILVER 308716 0 53086 0 0 0 14229 0 12153 0 388184 0 0 0 JOHN E GIBBS II 199580 0 70502 0 0 0 8806 0 7482 0 286370 0 0 0 CHARLES MATTHEW GIBELLATO 220764 0 32460 0 0 0 11912 0 12171 0 277307 0 0 0 ALBERT M JONES 238805 0 22988 0 0 0 11738 0 12479 0 286010 0 0 0 GREGORY LEGHART 250603 0 65337 0 0 0 11990 0 11737 0 339667 0 0 0 SCOTT N SCHIMPFF 275106 0 330000 0 0 0 13071 0 12034 0 630211 0 0 0 PART I, LINE 4B THE ORGANIZATION HAS A 457B PLAN FOR JAMES E. SOK. THE AGGREGATE EARNED PORTION OF THE EMPLOYER PAID CONTRIBUTION FOR THE CALENDAR YEAR 2012 WAS $166,223. SUPPLEMENTAL INFORMATION PART III 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. 607746 LEGAL SERVICES. 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. AUDIT COMMITTEE PROCESS: PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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