2013-08-15T13:39:25-05:00 2012-09-30 560574444 CHERRY BEKAERT LLP P O BOX 1119 LYNCHBURG VA 245051119 990 2011-10-01 540505955 SHELTERING ARMS HOSPITAL SHEL 8043424340 8254 ATLEE ROAD MECHANICSVILLE VA 23116 MICHAEL E DACUS 8043424340 2013-08-13 1 SAMUEL E JOHNSON P00019699 4348476643 2013-08-13 2011 2016-02-24 21:20:13Z MICHAEL E DACUS 8254 ATLEE ROAD MECHANICSVILLE VA 23116 63996815 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. 19 18 780 19 115858 -56155 11152461 11499503 49598719 50582724 3718121 688311 688148 808892 65157449 63579430 388561 204593 0 0 31077037 32171751 0 0 125000 35476891 32531172 66942489 64907516 -1785040 -1328086 22514027 21712605 3281024 3807688 19233003 17904917 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 57291799 50165617 PHYSICAL REHABILITATION SERVICES:INPATIENT 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 2012, 940 PATIENTS WERE ADMITTED RESULTING IN 13,161 PATIENT DAYS. IN ADDITION, SHELTERING ARMS HOSPITAL PROVIDES INPATIENT THERAPY SERVICES TO LOCAL ACUTE CARE HOSPITALS ON A CONTRACT BASIS.THERE WERE 20,500 LIVES TOUCHED BY CONTRACT SERVICES IN FISCAL YEAR 2012.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 A DAY REHABILITATION PROGRAM, ORTHOPEDIC REHABILITATION SERVICES, NEUROLOGICAL REHABILITATION SERVICES, PHYSICIANS' REHABILITATION SERVICES, AND OUTPATIENT REHABILITATION THERAPIES. DURING FISCAL YEAR 2012, SHELTERING ARMS HOSPITAL PROVIDED OUTPATIENT THERAPY SERVICES RESULTING IN 117,259 PATIENT THERAPY SESSIONS.FOR FISCAL YEAR 2012,PHYSICIAN AND PSYCHOLOGY SERVICES RESULTED IN 44,527 PATIENT VISITS. 1472532 417107 PARTNERS 4 LIFE/COMMUNITY REC PROGRAM:SHELTERING ARMS HOSPITAL OPERATES A PARTNERS 4 LIFE PROGRAM WHICH ENCOMPASSES THE SPECIALIZED COMMUNITY RECREATIONAL PROGRAM TO ADDRESS THE LEISURE AND RECREATIONAL NEEDS OF INDIVIDUALS WITH DISABILITIES ON A DAILY BASIS. THE COMMUNITY REC PROGRAM WAS DESIGNED AS AN EXTENSION OF THE REHABILITATION CONTINUUM OF SERVICES OFFERED BY SHELTERING ARMS HOSPITAL. THE PROGRAM PROMOTES WELLNESS AND COMMUNITY INTEGRATION THAT DIRECTLY IMPACTS THE QUALITY OF LIFE FOR INDIVIDUALS WITH DISABILITIES. SERVICES OFFERED ARE GROUP CLINICS, CLASSES, TOURNAMENTS, AND SEMINARS PROMOTING LEISURE SKILL DEVELOPMENT, COMMUNITY INTEGRATION, AND SOCIALIZATION.ALL CLUB REC PROGRAMS ARE PLANNED AND IMPLEMENTED BY A CERTIFIED THERAPEUTIC RECREATION SPECIALIST WHO IS AVAILABLE TO PROVIDE AND ASSIST THE PARTICIPANTS WITH RESOURCES, INSTRUCTION ON THE USE OF ADAPTIVE LEISURE EQUIPMENT, INSTRUCTION ON MODIFICATIONS/ADAPTIVE TECHNIQUES TO PARTICIPATE IN THE ACTIVITY, PROVIDE ENCOURAGEMENT AND FOSTER SOCIALIZATION. THE CLUB RECREATION PROGRAM OFFERS MEMBERS ACCESS TO VARIOUS RESOURCES INCLUDING A SPIRITUALITY GROUP, A COMPUTER LAB, LIBRARY RESOURCES AND A FITNESS CENTER. THIS PROGRAM ENJOYED 7,085 VISITS IN FY 2012 FROM INDIVIDUALS WITH DISABILITIES.PARTNERS 4 LIFE ALSO FOCUSES ON THERAPEUTIC RECOVERY AND MAINTAINING PHYSICAL WELLNESS AFTER DISCHARGE ON A BROADER SPECTRUM. THIS PROGRAM HELD 1,383 SPECIAL EVENTS WHICH INCLUDED EXERCISE CLASSES, EDUCATIONAL PROGRAMS, AND SPECIAL RECREATION WITH A TOTAL OF 6,877 PARTICIPANTS.THERE ARE TWO WARM WATER THERAPEUTIC POOLS FOR THERAPHY AND THERAPEUTIC CLASSES. THESE POOLS ALLOW PATIENTS WITH DISABILITIES TO PERFORM THERAPEUTIC EXERCISE AND IMPROVE AND MAINTAIN THEIR MOBILITY. INDIVIDUALS MAY PURCHASE POOL MEMBERSHIPS THAT ALLOW THEM TO UTILIZE THE POOL FACILITIES TO CONTINUE THEIR FITNESS PROGRAMS AFTER DISCHARGE FROM THE HOSPITAL OR OUTPATIENT CLINICS.DURING FISCAL YEAR 2012, THERE WERE 33,012 VISITS TO THE POOL AND FITNESS CENTERS. SHELTERING ARMS HOSPITAL PROVIDES THESE PROGRAMS TO THE COMMUNITY FOR FEES AND UNDERWRITES THE REMAINING COST. FOR FY 2012, THE COST UNDERWRITTEN WAS $1,055,243. 1223886 204593 CHARITY CARE/FINANCIAL ASSISTANCE: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 2012, THE DISCOUNTED CHARGES FOREGONE BY SHELTERING ARMS HOSPITAL FOR THIS CHARITY CARE AND/OR FINANCIAL ASSISTANCE WAS $971,516. IN FISCAL YEAR 2012, SHELTERING ARMS ALSO TRANSPORTED 131 PATIENTS PARTICIPATING IN THE OUTPATIENT THERAPY DAY REHAB PROGRAM AT AN UNREIMBURSED COST OF $51,734. 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 $30,205. 431788 431788 59988217 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 91 0 1 780 1 1 1 0 0 0 0 0 0 0 0 0 X 19 18 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 JOHN L MCELROY III 4.00 X 0 0 0 CHARLES M CARAVATI III 4.00 X 0 0 0 WILLIAM T CLARKE JR 4.00 X 0 0 0 JOYCE F NASH 4.00 X 0 0 0 EVANS B BRASFIELD 4.00 X 0 0 0 BARBARA H DUNN 4.00 X 0 0 0 WILLIAM E HARDY 4.00 X 0 0 0 DIANNE V JEWELL 4.00 X 0 0 0 SUSAN J RAWLES 4.00 X 0 0 0 JAMES RUSSELL 4.00 X 0 0 0 JAMES A SLABAUGH SR 4.00 X 0 0 0 KATHRYN M BARLEY 4.00 X 0 0 0 ANNE H BENNETT 4.00 X 0 0 0 PETER BOWLES 4.00 X 0 0 0 DAVID CONSTINE 4.00 X 0 0 0 W BATES CHAPPELL 4.00 X 0 0 0 PATRICIA B CUSHNIE 4.00 X 0 0 0 LISA T POWELL 4.00 X X 0 0 0 LAWRENCE E GIBSON 4.00 X X 0 0 0 JAMES E SOK 40.00 X 587790 0 84824 MICHAEL A BOEMMEL 40.00 X 319187 0 7687 JAMES A BRAITH 40.00 X 210846 0 27113 MCDONNELL MICHAEL J 40.00 X 229769 0 23504 CHERYL LEE 40.00 X 188190 0 14666 ELLEN VANCE 40.00 X 178590 0 20748 MICHAEL E DACUS 40.00 X 0 0 0 HILLARY S HAWKINS 40.00 X 387658 0 21541 TIMOTHY M SILVER 40.00 X 366653 0 25447 JOHN E GIBBS II 40.00 X 255115 0 12600 CHARLES MATTHEW GIBELLATO 40.00 X 237032 0 23523 ALBERT M JONES 40.00 X 257249 0 23686 GREGORY LEGHART 40.00 X 319456 0 25031 SCOTT N SCHIMPFF 40.00 X 703810 0 24578 4241345 0 334948 25 0 1 0 MEMORIAL REGIONAL MEDICAL 8260 ATLEE ROAD MECHANICSVILLE VA 23116 HOSPITAL ANCILLARY & SUPPORT 2140309 TROUTMAN SANDERS LLP 1001 HAXALL POINT RICHMOND VA 23219 LEGAL ADVICE 551844 CROTHALL 955 CHESTERBROOK BLVD SUITE 800 WAYNE PA 19087 HOUSEKEEPING 377434 MEDISERVE INFORMATION SYSTEM 585 N JUPITER DR SUITE 100 CHANDLER AZ 85226 LICENSING, SERVICE, AND SUPPORT 360968 FREE AGENTS MARKETING LLC 10124 WEST BROAD ST SUITE N GLEN ALLEN VA 23060 ADVERTISING & MARKETING 334357 18 10844418 655085 25 11499503 PATIENT SERVICE REVENU 621400 42910645 42910645 THERAPY SERVICE - CONT 621400 7235109 7235109 THERAPEUTIC RECREATION 621400 436970 436970 50582724 3785 3785 131384 0 131384 131384 101384 30000 684526 0 684526 684526 684526 547247 417385 129862 129862 MISCELLANEOUS 621400 338306 338306 SPORTS ACCELERATION PR 713940 115858 115858 MOB RENTAL INCOME 621400 93482 93482 547646 63579430 51115896 115858 848173 204593 204593 2694213 1596324 1097889 24105674 22679181 1426493 1168006 1086246 81760 1937263 1801655 135608 2266595 2107933 158662 319103 31910 287193 92469 9247 83222 1834191 975576 858615 420662 333286 87376 1138678 1041716 -28038 125000 888772 624548 264224 11807 11807 2198310 2151863 46447 112255 83546 28709 119111 109961 9150 3960910 3960910 2014093 1871901 142192 217986 196187 21799 CONTRACTUAL ADJUSTMENTS 15674640 15674640 PURCHASED SERVICES 3182394 3173033 9361 BAD DEBT 186146 186146 MEMBERSHIPS 159645 76008 83637 64907516 59988217 4794299 125000 322909 140621 1789720 1471919 5593975 6078689 44816 49049 411581 722496 33135473 20521328 13745338 12614145 446480 505647 159208 130039 22514027 21712605 3281024 3807688 3281024 3807688 X 19116531 17729917 16472 75000 100000 100000 19233003 17904917 22514027 21712605 -1328086 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 416370 416370 11135716 5052761 6082955 2827984 1617274 1210710 13710196 8903509 4806687 5045207 4947784 97423 12614145 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, 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, 2009. 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OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS SOUTH PHYSICIANS CLINIC

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OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS LABURNAM CENTER

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8254 ATLEE ROAD MECHANICSVILLE VA 23116

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS HULL STREET CENTER

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OUTPATIENT THERAPY AND PHYSICIANS CLINIC PART 1, LINE 6A:SHELTERING ARMS PRODUCES AN ANNUAL REPORT SUMMARIZING THE ACCOMPLISHMENTS OF THE ORGANIZATION OVER THE CURRENT FISCAL YEAR. IT IS MAILED TO THE BOARD OF DIRECTORS, AND ALL EMPLOYEES AND COPIES ARE LEFT IN THE WAITING ROOMS OF ALL INPATIENT AND OUTPATIENT FACILITIES. HIGHLIGHTS INCLUDE OUR COMMUNITY INVOLVEMENT WITH ASSOCIATIONS DEDICATED TO COMMUNITY HEALTH AND FITNESS AWARENESS, ADVANCED CERTIFICATIONS OF OUR STAFF TO PROVIDE OUR SERVICE AREA WITH THE MOST ADVANCED PHYSICAL THERAPY BEST PRACTICES, INFORMATION REGARDING OUR EXPANSION THROUGHOUT THE AREA TO SERVE MORE PEOPLE, REPORTING THE NUMBER OF LIVES TOUCHED THROUGHOUT THE YEAR THROUGH INPATIENT AND OUTPATIENT REHABILITATION SERVICES, AND TO ACKNOWLEDGE THE COMMUNITY PUBLIC SUPPORT SO IMPORTANT TO OUR MISSION. IT ALSO DISCLOSES THE OUTREACH EFFORTS WHICH INCLUDE STROKE RECOVERY SEMINARS, HEALTH SCREENINGS, PARTICIPATION IN HEALTH FAIRS, AND PARTICIPATION AND SPONSORSHIP IN LOCAL FUNDRAISING EVENTS SUCH AS THE MS WALK, ARTHRITIS FOUNDATION, AND THE VIRGINIA HOME. SHELTERING ARMS ALSO PRESENTED A SEMINAR AT THE 9TH WORLD CONGRESS OF THE INTERNATIONAL BRAIN INJURY ASSOCIATION IN EDINBURGH, SCOTLAND. THE ORGANIZATION'S ANNUAL REPORT CAN BE FOUND ON THE WEBSITE AT WWW.SHELTERINGARMS.COM. PART 1, LINE 7, COLUMN F: 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 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,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: THE MEDICARE GAIN WAS OBTAINED FROM THE MEDICARE COST REPORT. PART VI, LINE 2: SHELTERING ARMS,THROUGH THE RESEARCH OF THE COMMUNITY FOUNDATION AND RECOMMENDED ASSISTANCE TO THOSE COMMUNITY PROGRAMS IN NEED OF SUPPORT, OUR INVOLVEMENT WITH THE VIRGINIA INJURY COMMUNITY PLANNING GROUP, THE AMERICAN HEART ASSOCIATION, THE DISABILITY TASKFORCE, THE VIRGINIA ARTHRITIS ACTION COALITION, THE SPINAL CORD INJURY ASSOCIATION OF VIRGINIA, AND THE VARIOUS SPEAKING ENGAGEMENTS WE PARTICIPATE IN SUCH AS THE AMERICAN PHYSICAL THERAPY ASSOCIATION, AND THE AMERICAN OCCUPATIONAL ASSOCIATION, AND THROUGH OUR STRATEGIC PARTNERSHIPS FOR RESEARCH, WE STRIVE TO PROVIDE THE MOST INNOVATIVE AND BROAD SPECTRUM OF SERVICES AND SUPPORT POSSIBLE TO OUR COMMUNITY.THE COMMUNITY FOUNDATION IDENTIFIED NINE PROGRAMS IN NEED OF THEIR ASSISTANCE IN FY 2012. PART VI, LINE 3: 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. THE FORM REQUIRES SIGNATURE. OUTPATIENT AND PHYSICIANS SERVICES APPOINTMENT VERIFICATION LETTERS FOR NEW PATIENTS DISCLOSES AVAILABLITY OF FINANCIAL ASSISTANCE IF THE PATIENT WISHES TO APPLY. THE APPLICATION AND POLICY DISCLOSURE IS AVAILABLE ON THE WEBSITE AT WWW.SHELTERINGARMS.COM. PART VI, LINE 4: SHELTERING ARMS SERVES THE RICHMOND METROPOLITAN AREA AND SURROUNDING COUNTIES. THE REGION IS ALSO KNOWN AS REGION IV OF CENTRAL VIRGINIA AND SOME POINTS IN OTHER ADJOINING REGIONS. OVER THE LAST 10 YEARS THE POPULATION HAS GROWN IN THIS AREA AN AVERAGE OF 12%. SHELTERING ARMS SERVES THE CITY OF RICHMOND WITH A POPULATION OF 204,214, CHESTERFIELD COUNTY WITH A POPULATION OF 316,236, HENRICO COUNTY WITH A POPULATION OF 306,935, HANOVER COUNTY WITH A POPULATION OF 99,863, PETERSBURG CITY WITH A POPULATION OF 32,420 AND 7-10 OTHER SURROUNDING COUNTIES WITH A MORE RURAL GEOGRAPHIC. REGION IV HAS A POPULATION ESTIMATE OVER AGE 65 OF 167,972. 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. PART VI, LINE 6: N/A 1 BIRKDALE GOLF CLUB 8511 ROYAL BIRKDALE DR CHESTERFIELD VA 23838 542195785 501(C)(6) 11559 DONATED A PARAGOLFER TO ASSIST WOUNDED VETERANS AND OTHERS UNABLE TO STAND TO PLAY GOLF. THE COMMUNITY FOUNDATION SERVING RICHMOND AND CENTRAL VIRGINIA 7501 BOULDERS VIEW DRIVE SUITE 110 RICHMOND VA 23225 237009135 501(C)(3) 149363 TO SUPPORT EIGHT PROGRAMS IDENTIFIED IN THE COMMUNITY SERVING POPULATIONS IN NEED OF ASSISTANCE. 1 1 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 335695 0 252095 0 0 0 76242 0 8582 0 672614 0 0 0 MICHAEL A BOEMMEL 263406 0 55781 0 0 0 6500 0 1187 0 326874 0 0 0 JAMES A BRAITH 171471 0 39375 0 0 0 15397 0 11716 0 237959 0 0 0 MCDONNELL MICHAEL J 187758 0 42011 0 0 0 15656 0 7848 0 253273 0 0 0 CHERYL LEE 152295 0 35895 0 0 0 7007 0 7659 0 202856 0 0 0 ELLEN VANCE 147590 0 31000 0 0 0 9115 0 11633 0 199338 0 0 0 HILLARY S HAWKINS 274648 0 113010 0 0 0 9313 0 12228 0 409199 0 0 0 TIMOTHY M SILVER 303080 0 63573 0 0 0 13050 0 12397 0 392100 0 0 0 JOHN E GIBBS II 193438 0 61677 0 0 0 7900 0 4700 0 267715 0 0 0 CHARLES MATTHEW GIBELLATO 220110 0 16922 0 0 0 11511 0 12012 0 260555 0 0 0 ALBERT M JONES 236503 0 20746 0 0 0 11366 0 12320 0 280935 0 0 0 GREGORY LEGHART 241871 0 77585 0 0 0 13050 0 11981 0 344487 0 0 0 SCOTT N SCHIMPFF 275082 0 428728 0 0 0 12300 0 12278 0 728388 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 2011 WAS $60,442. TROUTMAN SANDERS LLP DAVID CONSTINE, A BOARD MEMBER, IS A PARTNER IN THIS LAW FIRM. 422923 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. THE DIRECTOR WITH THE CONFLICT MUST ABSTAIN FROM VOTING ON ANY MATTER THAT RELATES TO THE IDENTIFIED CONFLICT. 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 EXECUTIVE 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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