2012-07-12T12:42:02-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 540793767 St Mary's Hospital of Richmond Inc STMA 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 Peter F Gallagher 8042818316 2012-07-12 1 Laura L Catlett 7032511000 2010 2016-02-24 21:20:13Z St Mary's Hospital Toni R Ardabell 5801 Bremo Road Richmond VA 23226 660513631 0 X www.bonsecours.com X 1961 VA Acute Care Hospital 17 12 4122 700 2657717 -86898 264325 3400539 603624335 634418015 2741987 18985311 2116387 2993627 608747034 659797492 0 0 0 0 237986855 244951409 0 0 0 338284793 369492771 576271648 614444180 32475386 45353312 647150444 711581073 253275729 252626501 393874715 458954572 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 396173167 457096292 St. Mary's Hospital provides medical care to patients without regard to their ability to pay. As the major community not for profit hospital in Richmond, St. Mary's is the access for under-insured and financially disadvantaged who will not be treated at the for profit hospitals. In addition, St. Mary's provides support for community services. Please refer to the Community Benefit information on Schedule H. 159432798 174395511 St. Mary's Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 14360 181608 The Bon Secours St. Mary's Hospital School of Medical Imaging offers an accredited 18-month radiography program designed to prepare individuals to enter the workforce as Diagnostic Radiologic Technologists. This new and innovative curriculum will allow students to enter the workforce more quickly while maintaining high standards of education. The Radiography program quality and depth has remained the same and continues to meet requirements established by the American Society of Radiologic Technologists. 555620325 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 286 0 1 4122 1 1 1 0 0 0 0 0 0 0 0 0 X 17 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X Melinda S Hancock 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 X Jean Ann Bolling 4.00 X 0 0 0 John Bowman MD 4.00 X 0 0 0 Robert J Cohen MD 4.00 X 0 0 0 Alexander J Corbett PhD 4.00 X 0 0 0 Mark Gordon 50.00 X 0 459644 57923 Richard Jackson MD 4.00 X 0 0 0 Kenneth J Jones 4.00 X 0 0 0 Sr Anne Marie Mack CBS 50.00 X 0 0 0 Joanne Nattrass 4.00 X 0 0 0 Michael Robinson 50.00 X 0 520898 78018 Nancy Thomas 4.00 X 0 0 0 Jane Watkins 4.00 X 0 0 0 Michael Williams 4.00 X 0 0 0 Peter B Cleal 6.00 X X 0 0 0 Thomas Winfree 6.00 X X 0 0 0 Sr Victoria V Segura MD CBS 50.00 X X 0 0 0 Toni Ardabell 50.00 X X 0 473594 35077 Allen Goolsby 6.00 X 0 0 0 Peter J Bernard 50.00 X 0 965548 188973 Peter F Gallagher 50.00 X 0 476340 58283 Marc R Katz 50.00 X 743640 0 35727 Matthew L Brengman 50.00 X 731162 0 35502 Gregory L Schroder 50.00 X 715809 0 32893 Mark R Bladergroen 50.00 X 630347 0 22419 Mark F Warner 50.00 X 598476 0 27738 Michael Kerner 50.00 X 0 606241 145769 Thomas Morris PhD 50.00 X 0 351566 40989 Thomas Koenig 0.00 X 204267 0 0 3623701 3853831 759311 193 1 1 0 Amerisource Bergen PO Box 5195 New York NY 100875195 Pharmaceutical Services 8737426 Free Agents Marketing 10124 West Broad Street Suite N Glen Allen VA 23060 Marketing Services 7331058 Central VA Health Network 2201 West Broad Street 202 Richmond VA 232202022 Care Management 4889052 Synthes USA PO Box 8538-662 Philadelphia PA 191710662 Medical Devices Supplier 4854845 Depuy Orthopaedics Inc 5972 Collections Ctr Dr Chicago IL 60693 Medical Devices Supplier 4507868 287 114244 2968828 317467 3400539 Patient Service Rev. 621300 457096292 457096292 Shared Services 561499 177140115 174395511 2744604 Sch. of Med. Imag Tut. 611310 181608 181608 634418015 5518194 5518194 259429 259429 910026 707931 202095 202095 -86887 288982 13215896 8208 13215896 -8208 13207688 13207688 272607 272607 272607 Cafe & Vending 722210 1539667 1539667 Joint Venture 900099 414893 414893 Clinical Trials 900099 265287 265287 299078 299078 2518925 659797492 631938698 2657717 21800538 186641834 167977651 18664183 14714473 13243026 1471447 31104472 27994025 3110447 12490630 11241567 1249063 1381460 1243314 138146 702453 632208 70245 19330 17397 1933 72732868 65459581 7273287 9083920 8175528 908392 5783539 5205185 578354 3040852 2736767 304085 10471787 9424608 1047179 1698081 1528273 169808 193686 174317 19369 6839231 6839231 26914886 24223397 2691489 3113841 2802457 311384 Medical Supplies 92626085 83363477 9262608 Purchased Services 89038283 80134455 8903828 Bad Debt 19366384 19366384 BSHSI Mgt Allocation 6798112 6118301 679811 Medical Equip Rental 5381344 4843210 538134 14306629 12875966 1430663 614444180 555620325 58823855 0 200116573 221073232 0 3065 51824049 53864362 273353 7358970 7669607 3007626 3503676 355601337 219162906 128642991 136438431 251271530 277911647 127572 4801133 10843700 647150444 711581073 68620358 71528267 0 10818056 49227882 48101258 135427489 122178920 253275729 252626501 X 393802335 458920622 72380 33950 393874715 458954572 647150444 711581073 X 45353312 19726545 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19330 19330 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: St. Mary's Hospital paid dues to the American Hospital Association (AHA), the Virginia Hospital Healthcare Association (VHHA) and the Catholic Hospital Association (CHA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations is as follows: Lobbying activity for AHA ($10,041 or 24.2%), VHHA ($8,904 or 9.7%), CHA ($385 or 4.68%) for a total of $19,330. 4346148 4346148 136320183 67452382 68867801 11829989 2356193 9473796 156280159 123698566 32581593 46824858 25655765 21169093 136438431 Other Liabilities 107315294 Current installment of LT Debt 1126624 Due to affiliates 11247491 Due to BSHSI 2489511 122178920 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 FIN 48. FIN 48 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 FIN 48 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 $89,500 and $98,300 of net operating loss carryforwards as of August 31, 2011 and 2010, respectively, which expire in varying periods through 2031 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2011 and 2010. 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 12685515 12685515 0.03080 46017637 31751267 14266370 0.03470 58703152 31751267 26951885 0.06550 20 37598 10584021 0 10584021 0.02570 1 48 1509598 410634 1098964 0.00270 6 1260 156938 156938 0.00040 27 38906 12250557 410634 11839923 0.02880 27 38906 70953709 32161901 38791808 0.09430 1 886 1 5000 5000 0.00000 1 8 4110 4110 0.00000 3 894 9110 9110 1 4702950 95034265 115231198 -20196933 X 1 1 1 1 St Mary's Hospital of Richmond Inc

5801 Bremo Road Richmond VA 23226

X X X X NA 1 25 Cardiovascular Associates of VA

7001 Forest Ave Suite 200 Richmond Cardiology VA 23230

Physician Practice Women's Imaging Center

5875 Bremo Road MOB South Suite 105 Richmond VA 23226

Imaging Perinatal Center

5855 Bremo Road MOB North Suite 306 Richmond VA 23226

Physician Practice Dominion Surgical Associates

5855 Bremo Road MOB North Suite 406 Richmond VA 23226

Physician Practice Cardiac Surgery Specialists

5875 Bremo Road MOB South Suite G-5 Richmond Cardiology VA 23226

Physician Practice Commonwealth Gynecologic Oncology

5875 Bremo Road MOB South Suite G-7 Richmond VA 23226

Physician Practice Richmond Cardiology

7001 Forest Ave Suite 100 Richmond Cardiology VA 23230

Physician Practice PTOTSPLymphedema

5875 Bremo Road MOB South Suite 611 Richmond VA 23226

Physical Therapy Monument Internal Medicine

5855 Bremo Road MOB North Suite 102 Richmond VA 23226

Physician Practice Associated Internists

5855 Bremo Road MOB North Suite 207 Richmond Cardiology VA 23226

Physician Practice Diagnostic Radiology 4

2201 Grove Avenue Titus Hendrix Richmond VA 23220

Radiology Pediatric Endo & Diabetes Assoc

5875 Bremo Road MOB South Suite 207 Richmond VA 23226

Physician Practice Liver Institute of Virginia-MIH

5855 Bremo Road MOB North Suite 509 Richmond Cardiology VA 23226

Physician Practice Sports Medicine

9600 Patterson Avenue Richmond VA 23229

Sports Medicine Pediatric Lung Care

5875 Bremo Road MOB South Suite 104 Richmond VA 23226

Physician Practice Cardiac Rehab

7001 Forest Avenue Suite 101 Richmond VA 23230

Rehab Diabetes Treatment Center

5875 Bremo Road MOB South Suite 712 Richmond VA 23226

Diabetes Treatment Arthritis & Osteroporosis Center

9600 Patterson Avenue Richmond Cardiology VA 23229

Physician Practice Surgical Dermatology Center

5207 Hickory Park Drive Suite A Glen Allen VA 23059

Physician Practice Palliative Care Clinic

2366 Colony Crossing Midlothian VA 23112

Physician Practice Pediatric Neurology Clinic

5875 Bremo Road MOB South Suite 207 Richmond VA 23226

Physician Practice Lactation Center (A Woman's Place)

4121 Cox Road Suite 110 Glen Allen VA 23059

Lactation Center Developmental Assessment Clinic

5875 Bremo Road MOB South Suite 104 Richmond VA 23226

Physician Practice Liver Institute of Virginia

5855 Bremo Road MOB North Suite 509 Richmond Cardiology VA 23226

Physician Practice OP Radiology

5855 Bremo Rd MOB North Ground Floor Richmond VA 23226

Radiology Part I, Line 6a: Annually, Bon Secours Richmond Health System (BSRHS) 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. 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: $19,380,876 Part II: SMH's Project SEARCH is a workforce development program for students with Autism Spectrum Disorders (ASD). Students spend their entire final year of high school at the hospital rotating through three internships, each lasting 10 to 12 weeks. Internships are based on the skills and interests of each student and are held in a variety of locations including: Cardiac Care, Care Management, Pharmacy, Diabetes Treatment Center, Main Operating Room, Central Sterile, Materials Management, and Durable Medical Equipment. The goal for each student is competitive employment somewhere in the community using the skills they have acquired at Bon Secours. In fiscal year 2011, 8 students participated in Project SEARCH.Advancing the Bon Secours mission "to bring people and communities to health and wholeness," the Bon Secours Richmond Health System and SMH leadership in collaboration with Dunany Plater Zyberk & Company (DPZ) a leading proponent of traditional town planning and New Urbanism sponsored a weeklong charrette in fiscal year 2010. The purpose of the charrette was to engage hospital staff, administration and supporters along with neighbors, municipal officials and a team of design consultants to develop a vision for the next 40 years. Completion of the final charrette report occurred in fiscal year 2011. 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 8: Part III, Line 6: Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost.Part III, Line 8: The organization feels the total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service. Part III, Line 9b: 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 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 Financial Assistance Program (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 VI, Line 2: In partnership with Bon Secours Richmond Health System, SMH uses multiple approaches to assess the health needs of the communities it serves. In October 2009, the Central Virginia Health Planning Agency released an Immigrant Needs Assessment commissioned by Bon Secours Richmond Health System in collaboration with SMH. This work documented the growth of the immigrant population in the metropolitan Richmond area and made multiple recommendations including the need for interpretation and translation services, health resource information in other languages, preventive services, health screenings including vision and dental, affordable health insurance for immigrants and their families and access to behavioral health services. Bon Secours Richmond has initiated many of the recommendations.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 SMH. 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: SMH serves the greater Richmond, Virginia area. Projections indicate that the population will grow by 5.0% from 1,242,918 in 2010 to 1,304,689 in 2015, with 9.2% of the service area having a household income of less than $15,000 per year, compared to the national average of 12.1%. Similarly, 17.3% of the service area's populace maintains a household income less than $25,000 per year, compared to the national average of 22.3%. Demographic data shows that 61.6% of the population is white and 29.4% is black, compared to the national averages of 64.7% and 12.1% respectively. Demographics of the service area indicate that the age cohort of 64 to 75 will increase by 29.5% between 2010 and 2015. SMH is a disproportionate share hospital (DSH). In fiscal year 2011, it served 21,583 inpatients and provided outpatient services for 81,607 visits. Additionally, Bon Secours SMH provided 65,757 emergency room visits. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. Bon Secours SMH participates in Medicare, Medicaid, CHAMPUS, Tricare and other government sponsored health care programs such as the State/Local Hospitalization program and the SCHIP/FAMIS program for children. Part VI, Line 6: SMH has an open medical staff with privileges available to all qualified physicians in the area. SMH, through the BSRHS is governed by a board of directors whose composition is representative of the community. SMH also engages in medical research. Inpatient and outpatient research-related activities are conducted by SMH with oversight from the BSRHS Institutional Review Board. BSRHS' commitment to the poor and disadvantaged is more than providing free or discounted services to those who come to the health care facilities in crisis without financial means to pay. The call to live a healing ministry requires that BSRHS nurture the growth of individual and community capacities and create opportunities for each individual to assume a meaningful role in defining and pursuing holistic wellbeing, peace, and hope. BSRHS is a prophetic voice for just and equitable public policies that ensure access to basic human goods for all people. BSRHS participates in collaborative partnerships throughout the metropolitan area to support improving the quality of life for individuals and the community. The following are illustrative examples of numerous community benefit programs impacting St Mary's Hospital (SMH).Noah's Children, located at SMH, is Central Virginia's only pediatric hospice and palliative care program. It is a specialized program of comprehensive care serving infants, children and adolescents who have been diagnosed with a life-threatening illness. This holistic program ensures compassionate care at the most difficult time for a family by addressing their physical, emotional, social, spiritual and practical needs, so that they can focus on making sure their child's remaining time is as rich and meaningful as possible. In FY 11, 68 families were served.SMH provides lab services free of charge to eight area free clinics as well as to patients of the Bon Secours Care-A-Van and St. Joseph's Outreach Clinic. The cost of these services is $368,914.Bon Secours SMH owns twelve physician practices. They provided free or reduced fee services to patients in FY 11 at a cost of $426,514.SMH provides training and education of health care professionals. The Bon Secours SMH's School of Imaging, sponsored by SMH had 48 enrolled students in fiscal year 2011. For the second year in a row, Richmond, VA, has been named the "Asthma Capital" in the research and ranking by the Asthma and Allergy Foundation of America (AAFA). The annual Asthma Capitals report is a list of the 100 most challenging places to live with asthma. Controlling Asthma in the Richmond Metropolitan Area (CARMA) works to improve the management of pediatric asthma through collaborative partnerships with multiple health care systems, schools, American Lung Association, community physicians and schools, case management organizations, and universities. In FY 11 over 2,888 children, parents, teachers and physicians were directly served through CARMA's services. Every Women's Life (EWL), Virginia Breast and Cervical Cancer Early Detection Program is a partnership with the Virginia Department of Health, with funding through the Centers for Disease Control and Prevention. This program provides breast and cervical cancer screenings and diagnostic testing if needed for low income, uninsured women who are 40 to 64 years old. If cancer is found, women are enrolled in Medicaid for treatment. Bon Secours Richmond Health System holds clinics in three facilities in the Richmond Metro area. Additionally, Bon Secours Richmond provides case management, follow-up and patient education for these women. In FY 11, 742 screenings were provided.Bon Secours' mobile health outreach program is called Care-A-Van. Mobile vans travel throughout the metropolitan Richmond area to provide free care to the uninsured including health screenings, childhood immunizations, flu shots for adults, school physicals for children and examination and treatment of sick patients. Each van is a self-contained clinic with examining rooms, storage, bathroom, and waiting area. Patients who need health care from specialists are referred to volunteer physicians within the community including Bon Secours Medical Group physicians. The vans make regular stops six days a week at churches, apartments and schools, providing 9,492 patient visits in FY 11. Bon Secours Richmond Health System partners with the Daily Planet, a federally qualified health center and Saint Joseph's Villa for Children, a not-for-profit organization serving children with special needs, at risk youth, and adults with disabilities to create Saint Joseph's Outreach Clinic. The clinic provides primary care services to both the insured and the uninsured and serves a large Hispanic population. In FY 11, 5,955 patient visits were provided. Bon Secours Richmond Health System assists low to moderate-income families whose children may qualify for state-sponsored insurance programs (Medicaid and FAMIS). Partnerships have developed with other agencies that have enrollers to identify and refer uninsured children, avoid duplication of effort, and to share responsibilities for case managing to complete the enrollment process. Three Bon Secours Richmond outreach specialists enrolled or re-enrolled over 921 children in FAMIS or Medicaid in FY 11.Founded over ten years ago, the Faith Community Health Ministry Network partners with churches to recruit and train volunteer nurses and other health ministers who in turn work to promote physical, social, emotional and spiritual growth within the congregation. BSRHS trains and supports 196 congregational promoters, faith community nurses and other health ministers.The nationally recognized Reach Out and Read (ROR) program provides books for young children when they visit the SMH's and Richmond Community Hospital Emergency Departments and the Care-A-Van. Volunteers transform the sites into literary rich areas for children and parents while helping families learn the joys and techniques of reading aloud. Volunteers distributed 2,105 books in FY 2011. Part VI, Line 7: 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 four goal areas for the current three year period (2010-2012). One of those goals is to partner with communities to co-create a more humane world, improve health and model social justice. To accomplish this, two key strategies are to: - Engage communities to identify needs and assets and building partnerships to improve health and quality of life of a specific population.- Demonstrate sustainable stewardship for healing the earth as a way to improve health and life quality.As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), Bon Secours Richmond Health System (BSRHS) is called to continue the healing ministry of Jesus. BSRHS exists 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." BSRHS shares 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 within BSRHS. Reports Filed With States Part VI, Line 7 VA X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 Mark Gordon 0 334541 0 101237 0 23866 0 30227 0 27696 0 517567 0 0 Michael Robinson 0 395596 0 94735 0 30567 0 58409 0 19609 0 598916 0 0 Toni Ardabell 0 355805 0 84183 0 33606 0 32375 0 2702 0 508671 0 0 Peter J Bernard 0 733983 0 222954 0 8611 0 158275 0 30698 0 1154521 0 0 Peter F Gallagher 0 387134 0 86236 0 2970 0 27746 0 30537 0 534623 0 0 Marc R Katz 740013 0 0 0 3627 0 3180 0 32547 0 779367 0 0 0 Matthew L Brengman 464451 0 266185 0 526 0 3072 0 32430 0 766664 0 0 0 Gregory L Schroder 432725 0 281990 0 1094 0 3132 0 29761 0 748702 0 0 0 Mark R Bladergroen 627484 0 0 0 2863 0 3216 0 19203 0 652766 0 0 0 Mark F Warner 496392 0 100000 0 2084 0 3228 0 24510 0 626214 0 0 0 Michael Kerner 0 463467 0 138768 0 4006 0 116245 0 29524 0 752010 0 0 Thomas Morris PhD 0 258451 0 70978 0 22137 0 28541 0 12448 0 392555 0 0 Thomas Koenig 0 0 0 0 204267 0 0 0 0 0 204267 0 0 0 Part I, Line 1a One executive received a country club membership for business use. A receipt was required to substantiate the amount eligible for reimbursement. The value of the country club membership was not included in compensation as St. Mary's Hospital of Richmond, Inc. considers the membership a business necessity. Part I, Lines 4a-b Part I, Line 4a: Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: Thomas Koenig, $204,267. 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 are made into this plan. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of St. Mary's Hospital of Richmond, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Neurological Associates BD. Member R. Cohen has more than 5% int. in Neurological Assoc. 155490 Independent Contractor 0 David Cleal Child of BD. Member P. Cleal 64744 Employment 0 Whitney Robinson Child of BD. Member M. Robinson 17455 Employment 0 Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours - Richmond Health Corp, which in turn holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of St. Mary's Hospital of Richmond, Inc. Form 990, Part VI, Section A, line 7a The governing body of St. Mary's Hospital of Richmond, Inc. is appointed by it's member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of St. Mary's Hospital of Richmond, Inc. 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 of July 16, 2012. 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 July 16, 2012. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy, reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of director's 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 positions of other officers or key employees of the organization were compared to similar position market data in comparably situated organizations taking into consideration geographic location and organization size where appropriate. 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 Bon Secours - St. Mary's Hospital provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officers' and directors' hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Voluntary Board Members are not compensated for their time. Peter J. Bernard's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the CEO of Bon Secours Virginia Health System which includes direct management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Peter F. Gallagher's compensation is paid by Memorial Regional Medical Center, a related organization. The compensation he receives is for his role as the CFO of Bon Secours Virginia Health System which includes direct financial management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Toni Ardabell's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Chief Executive Officer of St. Mary's Hospital of Richmond, Inc. Mark Gordon's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of St. Francis Medical Center, a related organization. Michael Robinson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of Memorial Regional Medical Center and Richmond Community Hospital. Sr. Anne Marie Mack and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 12,404,914. Grants & Contributions 81,638. Transfers - PPE -75,941. Transfers to Affiliates -5,528,291. Net assets released from restrictions used for operations -44,127. Minimum Pension Liability 12,888,352. Total to Form 990, Part XI, Line 5: 19,726,545. Community Ambulatory Surgery Center LLC 8580 Magellan Parkway Richmond VA 23227 Ambulatory Surgery Center VA 0 0 St Mary's Hospital of Richmond Bon Secours Health System Inc 1505 Marriotsville Road Marriotsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Richmond Health Corporation 8580 Magellan Parkway Richmond VA 23227 541356155 Management Services VA 501(c)(3) 11b Bon Secours Health Sysytem Inc 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Richmond Health Corporation 0 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 0 Bon Secours Stuart Circle Hospital 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) 7 Bon Secours Richmond Health Corporation 0 St Mary's Hospital Auxiliary of Richmond 5801 Bremo Road Richmond VA 23226 540742852 Health Care VA 501(c)(3) 11b N/A 0 St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA Bon Secours Virginia Healthsource Inc Related 0 0 0.00000 RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA Bon Secours Virginia Healthsource Inc Related 0 0 0.00000 Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA Bon Secours Virginia Healthsource Inc Related 0 0 0.00000 Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA Richmond Radiation Oncology Center Inc Related 0 0 0.00000 Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA Bon Secours Virginia Healthsource Inc Related 0 0 0.00000 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Bon Secours Richmond Health System C RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System C Bon Secours -Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Bon Secours Richmond Health System C Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Bon Secours Virginia Healthsource Inc C 1 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0