2014-07-15T14:42:23-05:00 2013-08-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2012-09-01 540506463 Maryview Hospital MARY 7573982200 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner 7576735920 2014-07-15 1 Jennifer E Ernteman P00693666 4042201500 2012 2015-11-30 17:44:51Z Bon Secours Maryview Medical Center Bon Secours Home Oxygen Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 385713475 0 0928 X www.bonsecourshamptonroads.org X 1944 VA Acute Care Hospital 19 17 2760 217 1704434 0 1792137 3981894 349750492 366448470 2613278 8468819 4873181 5466656 359029088 384365839 234495 275086 0 0 155494499 164158878 0 0 0 197418395 215582636 353147389 380016600 5881699 4349239 253707979 262143562 124848980 122001001 128858999 140142561 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 29158304 28586798 Maryview continues to commit 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 been 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 operate Maryview as a regional referral center for advanced cardiac services. Maryview offers the broadest continuum of cardiac services - from diagnosis to treatment to surgery to inpatient/outpatient rehabilitation to wellness. Maryview continues strong relationships with other Bon Secours hospitals and serves as a regional referral center for the delivery of advanced cardiac interventions, such as cardiac surgery and electrophysiology. A 64-slice CT scanners at both Maryview and its Harbour View ambulatory campus are used to perform calcium scoring heart studies, service Bon Secours re-initiated in late 2013. 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. Bon Secours Maryview Medical Center has been recognized as UnitedHealth Premium cardiac specialty center for Interventional Cardiac Care. Maryview is certified as a Primary Stroke Center and is accredited as a Chest Pain Center with PCI. Maryview's ambulatory campus receievd Chest Pain Center accreditation. 21815583 26232579 Maryview continues a strong focus on orthopaedic care for residents of Western Hampton Roads. Maryview was recently recognized as a Blue Distinction Center of Excellence to attest to the excellence of care. This service includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-if-the-art technology and expert physicians, as well as a comprehensive inpatient and outpatient rehabilitation network. In addition, a strong focus exists on community education through seminars and classes. Bon Secours skilled surgeons perform minimally invasive and traditional orthopaedic and spine procedures, and are complemented by a strong physiatry network. Bon Secours respond to the needs of all orthopaedic patients - from the young athlete to the adults sports medicine patient (weekend warrior or sports enthusiast) to the patient needing significant repair and possibly replacement of joints. 19821753 18582995 For the seventh year in a row, Maryview was named the top hospital for bariatric surgery in Virginia by Healthgrades, and among the top 5% in the nation. A special focus on this service include a comprehensive program, expert physicians, and a commitment to patient support for the duration of their weight loss journey. Bon Secours is the only weight loss surgery program that does not charge a fee to participants. Bon Secours also offers a medically managed weight loss program as part of its Weight Loss Institute and an exercise-nutrition program for those who may choose this more traditional approach. Maryview also operates a Center of Excellence for colorectal surgery as a result of significant physician and staff expertise with colon & rectal diseases. In 2013, Maryview renovated its surgical suite, renovating some rooms with state-of-the-art technology. As a result, new general surgeons have lined the staff and are offering the community more options for minimally invasive surgery. Finally, as with other services and part of our mission, a strong focus exists on community education through seminars, classes and support groups. 275013245 275086 293671951 Other major services offered by Maryview include a Birthing Center, Cancer Center, Neuroscience Center, Behavioral Medicine, Gastroenterology and Pulmonary services. In addition, Maryview offers a full service 24 hour Emergency Room, Surgical Weight Loss Center, Home Care and Hospice services. 275013245 275086 293671951 345808885 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 200 0 1 2760 1 1 1 0 0 0 0 0 0 0 0 0 0 X 19 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 VA X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Michael D Blount 2.00 0.00 X 0 0 0 Bruce Britton MD 2.00 0.00 X 0 0 0 Arthur L Collins 2.00 0.00 X 0 0 0 Sr Elaine Davia 2.00 0.00 X 0 0 0 Timothy J Davis 2.00 48.00 X 0 1122284 134895 William H Kline 2.00 0.00 X 0 0 0 Michael S LaRock 2.00 0.00 X 0 0 0 Carol Ormond 2.00 0.00 X 0 0 0 P Ward Robinett Jr 2.00 0.00 X 0 0 0 RB Seal MD 2.00 0.00 X 0 0 0 Stephanie Short 2.00 0.00 X 0 0 0 Robert Squatrito MD 2.00 0.00 X 0 0 0 Deborah K Stearns 2.00 0.00 X 0 0 0 Sister Rita Thomas 2.00 1.00 X 0 0 0 Douglas Ziegenfuss 2.00 0.00 X 0 0 0 J Robert Bray 3.00 0.00 X X 0 0 0 Sr Patricia Heath 3.00 47.00 X X 0 0 0 Linwood E Howard 3.00 0.00 X X 0 0 0 Michael K Kerner 15.50 34.50 X X 0 936925 132770 Melinda Hancock 3.00 47.00 X 0 343941 27968 Joseph M Oddis 49.50 0.50 X 0 503723 37475 Charmaine Rochester 15.50 34.50 X 135417 0 13585 Barbara H Lynch 50.00 0.00 X 164426 0 10813 Devin T McKeever 30.00 20.00 X 199350 0 12010 James B Sherwood 25.00 25.00 X 285249 0 38182 Steven C Blasdell MD 50.00 0.00 X 931105 0 34789 Jun K Chung MD 50.00 0.00 X 614163 0 37130 Mark B Kerner MD 49.50 0.50 X 1148006 0 36611 Ernesto Luciano-Perez MD 50.00 0.00 X 748395 0 34499 Aaron L Marlow MD 50.00 0.00 X 740210 0 20484 Joe Buchheit 0.00 50.00 X 0 326400 25031 Ernie Padden 0.00 0.00 X 201500 0 3120 5167821 3233273 599362 137 1 1 0 Rehabcare Group East Incorporated PO Box 502096 St Louis MO 631502096 Rehabilitation Services 9331432 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering Services 2270854 Eastern VA Med School PO Box 1980 Norfolk VA 235011980 Residency Fees 2083696 WM Jordan Co Inc PO Box 1337 Newport News VA 236010337 Construction Services 1425523 SE Emergency Physicians PO Box 634706 Cincinnati OH 452634760 Physician Services 1220632 62 243436 3738357 101 3981894 Patient Service Rev. 622110 325973731 325911588 62143 Shared Services 561499 40474739 40474739 366448470 1324564 1324564 39 39 1288755 1001 1226402 0 62353 1001 63354 47742 15612 7265450 0 121234 7265450 -121234 7144216 7144216 CBO Billing Fees 900099 1540713 1540713 Joint Venture Income 900099 818022 818022 Outpatient Pharmacy 900099 759968 759968 2284599 687996 53836 1542767 5403302 384365839 367074323 1704434 11605188 275086 275086 804912 724420 80492 131671430 118504287 13167143 6323821 5691439 632382 15198553 13678698 1519855 10160162 9144146 1016016 748476 673628 74848 90549 81494 9055 44784 40306 4478 14085981 12677383 1408598 4302473 3872226 430247 8315890 7484301 831589 17058839 15352955 1705884 13069018 11762116 1306902 1425160 1282644 142516 210608 189547 21061 2497754 2497754 14238632 12814769 1423863 3221873 2899686 322187 Medical Supplies 47873018 43085716 4787302 Purchase services 41428358 37285522 4142836 Bad Debt 35166613 35166613 BSHSI Allocation 6131737 5518563 613174 5672873 5105586 567287 380016600 345808885 34207715 0 9094 9745 3212185 1914354 24000 25612 36986079 37903063 87516 83333 5566202 7320658 2743093 5511805 224481820 164225731 59505501 60256089 85087790 94164898 603213 0 907012 2703179 2703179 57180127 51343814 253707979 262143562 32616401 37470658 0 3297619 24445548 23045548 67787031 58187176 124848980 122001001 X 128737701 140019550 121298 123011 128858999 140142561 253707979 262143562 X 4349239 472066 6462257 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 24159 0 1 20625 44784 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. 4636569 4636569 83287370 55567547 27719823 11533688 7136084 4397604 82327626 67563539 14764087 42696567 33958561 8738006 60256089 Due from BSHSI-LT 25662564 LT Non-Cash Inv-HPL/GL 12279374 Due to Affiliates 5387437 Deferred Medicare Rec 4180224 Non Patient AR 2050609 Other Accrued Rec 761507 Other LT Receivables 568062 Medicare Settlement Rec 264944 Other Non-acute Liabilities 189093 51343814 Due to BSHSI 13720329 Due to Affiliates 10322535 HPL/GL Liability 12279374 LT Pension Liability 11603325 Other Long-Term Deferred Rent 3410168 Fin 47 LT Asbestos Liability 3284606 Medicare Liability 3275309 Other LT Liability 282320 Unclaimed Property 9210 58187176 X 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 derecognition 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. 1 1 1 X 1 X 1 1 1 0 1 1 13181080 518088 12662992 0.03670 29438725 18958867 10479858 0.03040 2856416 1396309 1460107 0.00420 45476221 20873264 24602957 0.07130 19 18271 860793 3498 857295 0.00250 3 1082 1933508 1933508 0.00560 2 9171 1221690 1221690 0.00350 9 17365 573372 573372 0.00170 33 45889 4589363 3498 4585865 0.01330 33 45889 50065584 20876762 29188822 0.08460 1 186 2980 2980 0.00000 1 1194 7142 7142 0.00000 1 662 5597 5597 0.00000 1 755 755 0.00000 4 2042 16474 16474 1 9589025 81916739 74933465 6983274 X 1 1 1 3 BS Surg Ctr at Harbourview LLC Outpatient Surgery 0.42640 0.12060 1 1 Maryview Hospital

3636 High St Portsmouth VA 23707

http://bshr.com/ X X X X Maryview 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 33 Bon Secours Health Ctr at Harbourview

5818D Harbour View Blvd Suffolk VA 23435

Imaging, ER, Physical Therapy & Other OP Services BS Health Ctr at Harbourview MAB

5838 Harbourview Blvd Chesapeake VA 23321

OP Cardiology & Physical Therapy Services VA Orthopedic & Spine Specialists

5838 Harbourview Blvd Suite 100 Portsmouth VA 23707

Physician Practice Cardiovascular Specialists

5838 Harbour View Blvd Suite 270 Suffolk VA 23435

Physician Practice Tidewater Surgical Specialists

5838 Harbour View Blvd Suite 240 Suffolk VA 23435

Physician Practice In Motion at Chesapeake Square

4300 Portsmouth Blvd Suite 200 Chesapeake VA 23321

Physical Therapy The Center for Pain Management

3315 High St Portsmouth VA 23707

Physician Practice Chenault-Ostroff Urology

4037 Taylor Road Suite A Chesapeake VA 23321

Physician Practice In Motion PT Suffolk

2012 Meade Parkway Suffolk VA 23434

Physical Therapy Western Branch OBGYN

4057 Taylor Road Suite R Chesapeake VA 23321

Physician Practice In Motion PT High Street

3300 High Street Portsmouth VA 23707

Physical Therapy In Motion PT Portsmouth Blvd

5553 Portsmouth Blvd Portsmouth VA 23701

Physical Therapy Harbour View Family Practice

5818 Harbour View Blvd Suite B2 Suffolk VA 23435

Physician Practice In Motion PT Portsmouth YMCA

4900 High St West Portsmouth VA 23703

Physical Therapy Internists of Churchland

4041 Taylor Road Suite G Chesapeake VA 23321

Physician Practice Nansemond Suffolk Family Practice

2897 Bridge Road Suffolk VA 23435

Physician Practice Western Branch Family Practice

3253 Taylor Road Suite 200 Chesapeake VA 23321

Physician Practice Internists at Western Branch

4020 Raintree Road Suite B Chesapeake VA 23321

Physician Practice Bon Secours Pulmonary Specialists

4053 Taylor Road Suite N Chesapeake VA 23321

Physician Practice Bon Secours Neuroscience Center

3640 High St Suite 1A Portsmouth VA 23707

Physician Practice Eagle Harbor Medical Associates

13609 Carrollton Blvd Suite 11 Carrollton VA 23314

Physician Practice In Motion PT Eagle Harbor

13609 Carrollton Blvd Suite 115 Carrollton VA 23314

Physical Therapy In Motion PT Chilled Ponds

1416 Stephanie Way Chesapeake VA 23320

Physical Therapy Portsmouth Medical Associates

3520 High Street Suite 100 Portsmouth VA 23707

Physician Practice Cardiology Associates

301 Goode Way Suite 102 Portsmouth VA 23704

Physician Practice Cardiology Associates

1030 Hillpoint Blvd N Suffolk VA 23434

Physician Practice VA Orthopedic & Spine Specialists

3300 High Street Suite 1 Portsmouth VA 23707

Physician Practice VA Orthopedic & Spine Specialists

2012 Meade Parkway Suffolk VA 23434

Physician Practice The Spine Center of Hampton Roads

Mast One 1040 University Blvd Suite 20 Portsmouth VA 23703

Physician Practice Cardiovascular & Thoracic Specialists (C

3636 High Street Portsmouth VA 23737

Physician Practice Delta Oncology Associates

104 Palmyra Drive Suffolk VA 23434

Physician Practice Delta Oncology Associates

612 Kingsborough Square Suite 300 Chesapeake VA 23320

Physician Practice Delta Oncology Associates

355 Crawford Street Suite 300 Portsmouth VA 23704

Physician Practice 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): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $35,166,613. Part II: Bon Secours Maryview Medical Center provided staff and resources in support of the Healthy Community Initiative of Bon Secours Health System, and advocated for local and state policies that would improve health across its communities. Bon Secours Hampton Roads Health System is working to engage and empower the members of the East Ocean View neighborhood to support them in improving their quality of life and holistic health. East Ocean View has historically been one of the roughest neighborhoods in the community. Among the 6,000 residents, more than 25% of the households are at or below the poverty level and over 20% are single parent households. Family violence, gangs, addictions, housing affordability, access to healthcare, and a lack of educational opportunities affect the health of the individuals living in the neighborhood. In addition, Maryview Medical Center reached out to the homeless community with continuing support of Oasis, a shelter for the homeless in the City of Portsmouth. Maryview Medical Center donated staff time and resources in support of these efforts. 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 BSHSIconsolidated audited financial statements ("AFS"). "Allowance for doubtfulaccounts" is discussed in the second paragraph in Footnote "(10) NetPatient 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, Section B, Line 7: While Maryview Hospital shows a Medicare surplus on this Schedule H, it is due to the unique composition of the hospital, the high percent of uncompensated care and the Medicare cost report allocation of indirect costs which is used in this tax schedule computation. Compared to other hospitals, Maryview Hospital is unique in that it has several non-provider based physician practices residing on the hospital company rather than on a separate company. Using the Medicare cost report as the basis for reporting Medicare allowable costs, the predetermined step-down statistical bases are allocating significant overhead costs to the nonallowable physician practices, artificially lowering allowable costs to the Medicare centers. Similar hospitals that do not include physician practices in the same company, these same overhead costs are included as allowable Medicare costs. Maryview also receives significant Medicare disproportionate share (DSH) payments, which are intended to partially compensate hospitals for the uncompensated care that arises from serving an usually large percentage of uninsured, low-income patients in their area. While these payments are a component of Medicare reimbursement, they do not relate to the Medicare allowable costs reported in line 6, but are more closely related to the Medicaid shortfall reported in Part I, Line 7 b, column (e). 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.Part IV, Column (E), Management Companies and Joint Ventures: Maryview Hospital participates in a joint venture with physicians in the Bon Secours Surgery Center at Harbourview, LLC. The 12.0636% reported in Column (E) represents the Physician's ownership percentage not the Physician's profit percentage. Maryview Hospital Part V, Section B, Line 3: Maryview Medical Center (MMC) contracted with Community Health Solutions (CHS) to conduct an electronic survey of key stakeholder to determine the top healthcare needs of the community. MMC 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, MMC surveyed representatives of medically underserved, minority populations, and those with chronic conditions. MMC also met with representatives from the Portsmouth Health Department to review the key findings from the survey and seek additional input. Upon receipt of all information, MMC 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. Maryview Hospital Part V, Section B, Line 7: Within the community, there are other providers and organizations addressing dental care/oral health and tobacco use with specialized programs and services and it would result in duplication of services if Maryview Medical Center (MMC) were to address the need. MMC currently provides comprehensive diabetes education with weekly education sessions covering understanding diabetes, nutrition, foot care, exercise, and medication. The Maryview Behavioral Medicine Center, located on the MMC campus, provides inpatient and outpatient programs for treatment of substance abuse and psychiatric medicine. MMC 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. Maryview Hospital Part V, Section B, Line 12h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Maryview Hospital Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Maryview 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, Maryview Medical Center 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 Maryview Medical Center. 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 53% of the population in Portsmouth, 30% in Chesapeake, 43% in Suffolk, 25% in Isle of Wight, 38% in Southampton County, 43% in Norfolk, and 20% of Virginia Beach, which far exceeds the national average of 31.5 % and the state average of 19%. Seniors currently account for 13% of the populations. The population served by Bon Secours Maryview Medical Center (MMC), Portsmouth, VA is estimated to change from 793,898 to 855,730, resulting in a growth of 7.8% between 2000 and the current year. Over the next five years, the population is projected to grow by 2.2%. Currently the largest populations are white (57.4%), Black or African American (37.8%), Hispanic or Latino (2.6%) and Asian (1.75%). 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 (28.6%), high cholesterol (35.2%), arthritis (22.2%), diabetes (11.6%), and asthma (7.8%). Morbidity rates per 10,000: heart disease (285), cerebrovascular disease (66.3), chronic obstructive pulmonary disease (36.8), diabetes (25.6), and asthma (17.5). Mortality rates (age-adjusted per 100,000) for this area are cancer (195.9), ischemic heart disease (193.6), cerebrovascular disease (48.7), and chronic obstructive pulmonary disease (43.8). Part VI, Line 5: Maryview Medical Center (MMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at MMC and Harbour View provide service 24 hours/day, 7 days/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.MMC, through BSHR, offers Home Health and Hospice Care. One-on-one care is provided to help patients recover from an illness or injury or to assist with daily living activities and pain management. Services include care coordination, physical therapies, diet education, intravenous therapy, medical/surgical care, nursing instruction, skilled clinical evaluation and wound care. MMC, through BSHR, offers health services via the CARE-A-VAN. The Care-A-Van (CAV), initiated on the peninsula in 2009 at two sites, has expanded in the past year to twelves sites, three in Norfolk, three in Portsmouth, three in Suffolk, 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 childrens' health insurance. The Care-A-Van 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 organizations which collaborate with CAV staff. The CAV has a staff of 10 FTEs and annual expenses of approximately $700,000.MMC, through BSHR, 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 at our 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 members. Seniors 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. MMC supports the Faith Community Health Ministry which builds on the skills of registered nurses 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. The Let's Get Real (LGR) Program was created by BSHRHS in response to alarming data revealing an excessively high death rate from heart disease among African Americans in Hampton Roads. LGR is a heart health community outreach and education campaign specifically designed to bring valuable information to African-American women and their families. The goal is to raise awareness and lower risk factors for heart disease through culturally sensitive education, healthy cooking demonstrations, baseline and follow-up health screenings & risk-factor assessments and physical activity with an ethnic flair. Program components are centered on Cooking Light nutrition seminars and Tree of Life family history/genealogy research. FY 11 saw service expansion to one additional faith community on the Peninsula and an underserved housing community in Norfolk.The Maryview Foundation Healthcare Center is located adjacent to BSMMC's emergency department, the Center had 7,753 patient visits in 2013. The Center provides primary and preventive care for Portsmouth residents who are uninsured and meet the financial guidelines of 200% of the federal poverty level and below. The center provides prescription assistance, a wellness program, blood pressure checks and other services. MMC is dedicated to promoting the health and the quality of life for the women of Hampton Roads the women health service lines. MMC provides community health education seminars in cardiac, orthopedics, weight loss, acupuncture, sports performance, oncology, and stroke through the Bon Secours for Women program.MMC offers free Community Education programs open to the public throughout Hampton Roads on health topics such as heart disease, diabetes, bone and joint conditions, women's health and other chronic diseases. Several seminars on clinical ethics were also offered to professionals in the area. The MMC staff are dedicated to promoting the health and welfare of community through many including the United Way campaign, support of Oasis a homeless shelter in Portsmouth, and the FoodBank of Southeastern Virginia. 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 Health.As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and its 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 Bon Secours Maryview Foundation 7007 Harbour View Blvd No 108 Suffolk VA 221024219 521694731 501(c)(3) 171311 Foundation Administrative Expenses Eastern Virginia Medical School 721 Fairfax Ave Suite 512 Norfolk VA 235011980 546055378 103775 Joint Academic Program Support 1 1 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. 0 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 Joseph M Oddis 0 313302 0 148515 0 41906 0 11475 0 26000 0 541198 0 0 Barbara H Lynch 143054 0 20902 0 470 0 10301 0 512 0 175239 0 0 0 Devin T McKeever 172445 0 25986 0 919 0 4277 0 7733 0 211360 0 0 0 James B Sherwood 201852 0 44561 0 38836 0 11002 0 27180 0 323431 0 0 0 Steven C Blasdell MD 460013 0 468254 0 2838 0 12583 0 22206 0 965894 0 0 0 Jun K Chung MD 541897 0 70595 0 1671 0 11937 0 25193 0 651293 0 0 0 Mark B Kerner MD 491967 0 654460 0 1579 0 13750 0 22861 0 1184617 0 0 0 Ernesto Luciano-Perez MD 300096 0 446840 0 1459 0 11698 0 22801 0 782894 0 0 0 Aaron L Marlow MD 304409 0 435357 0 444 0 11698 0 8786 0 760694 0 0 0 Joe Buchheit 0 215606 0 55955 0 54839 0 8035 0 16996 0 351431 0 9225 Ernie Padden 201500 0 0 0 0 0 3120 0 0 0 204620 0 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 contracts Compensation survey or study Approval by the board/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 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. Doing Business As Form 990, Part I, Item C DBA: Bon Secours Maryview Medical Center in Affiliation with Delta Oncology; Bon Secours Home Oxygen.. Form 990, Part VI, Section A, line 2 Board Members P. Ward Robinett, Jr. and Deborah K. Sterns have a business relationship. 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 Maryview Hospital. Form 990, Part VI, Section A, line 7a The governing body of Maryview Hospital is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to the approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Maryview Hospital 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 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors' and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization provides any documents open to public inspection upon request. Avg hours devoted to related org(s) when related comp is reported: 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. 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: I/Co Debt/Principal Payments - BSHSI -1,889,004. Additional Minimum Pension Liability 8,351,272. Error Suspense -11. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsvile MD 21104 521301088 Parent Org. - Mgmt Services MD 501(c)(3) 11b Bon Secours Inc 0 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 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 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) 11b Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 540548200 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) N/A Bon Secours DePaul Medical Center 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 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 Bon Secours DePaul Medical Center 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 541820093 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 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 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 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 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0