2012-07-20T08:36:09-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 521578169 Bon Secours - Maryview Nursing Care Center BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael K Kerner 7576865000 2012-07-20 1 Laura L Catlett 7032511000 2010 2016-02-24 21:20:13Z Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 9972629 0 0928 X www.bonsecourshamptonroads.com X 1988 VA Skilled Nursing Center 19 16 163 39 0 0 0 0 9796655 9919187 33219 23132 37589 30310 9867463 9972629 0 0 0 0 4797427 5005918 0 0 0 3586551 3724988 8383978 8730906 1483485 1241723 16416661 17646817 5218553 5206986 11198108 12439831 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 6541107 7374869 Skilled Nursing Care provided to patients to include assessment of cognitive and physical status, personal hygiene care, nutrition and maintenance of a clean and comfortable environment. 367370 671457 Medication & Diagnostic Treatments to include the administration of medication, ongoing assessment of potential interactions and negative side effects, wound care and facilitation of diagnostic testing as needed. 992022 1872861 Rehabilitation Therapies to include physical therapy, respiratory therapy and occupational therapy so as to maintain each patient's optimal quality of life. 7900499 1 0 0 1 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 19 0 1 163 1 0 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X James Pirtle 7572152709 7007 Harbour View Blvd Suite 108 Suffolk VA 23435 X Michael D Blount 4.00 X 0 0 0 J Robert Bray 4.00 X 0 0 0 Bruce Britton MD 4.00 X 0 0 0 Arthur L Collins 4.00 X 0 0 0 William H Kline 4.00 X 0 0 0 Michael S LaRock 4.00 X 0 0 0 Margaret U Moser 4.00 X 0 0 0 Mary Jane Nero 4.00 X 0 0 0 Carol Ormond 4.00 X 0 0 0 P Ward Robinett Jr 4.00 X 0 0 0 R B Seal MD 4.00 X 0 0 0 Robert Squatrito MD 4.00 X 0 1320 0 Deborah K Stearns 4.00 X 0 0 0 Sr Rita Thomas 4.00 X 0 0 0 Sr Elaine Davia 4.00 X 0 0 0 Timothy J Davis 50.00 X 0 743518 132790 Linwood E Howard 6.00 X X 0 0 0 Sr Patricia Heath 50.00 X X 0 0 0 Michael K Kerner 50.00 X X 0 606241 145769 Gregory Simia 50.00 X 0 438573 55734 Ernie Padden 50.00 X 0 0 0 Patricia Robertson 50.00 X 0 376824 28833 Diana L Jarrett 50.00 X 0 162553 13852 Richard Hanson 0.00 X 0 100022 8651 Joseph Buchheit 50.00 X 0 292884 41939 Eileen Malo 50.00 X 0 222341 7777 0 2944276 435345 0 1 1 0 Rehabcare Group Inc PO Box 502096 St Louis MO 631502096 Rehabilitation Services 973171 ShiftWise Corporate 1800 SW 1st Avenue Portland OR 97201 Contract Nursing Services 114976 2 Patient Service Rev. 621110 9919187 9919187 9919187 21630 21630 1502 1502 Resident Laundry Ser. 812300 12233 12233 Beauty & Barber Shop 812900 11165 11165 Cafe and Vending 722320 6709 6709 203 203 30310 9972629 9919187 0 53442 3851984 3466786 385198 82778 74500 8278 794138 714724 79414 277018 249316 27702 2188 1969 219 821 739 82 1266868 1140181 126687 292 263 29 57211 51490 5721 9677 8709 968 229272 206345 22927 10659 9593 1066 227212 227212 232281 209053 23228 44081 39673 4408 Medical Expenses 980008 882007 98001 Bad Debt 199629 199629 Purchased Services 182750 164475 18275 Repairs & Equip Rental 120517 108465 12052 BSHSI allocation 75220 67698 7522 86302 77672 8630 8730906 7900499 830407 0 12989095 78277 0 14889529 933878 847470 5434 65281 7369817 5726413 1877293 1643404 31778 11632 488179 0 91004 111224 16416661 17646817 708320 1298581 3900000 3900000 5700 610233 2705 5218553 5206986 X 11198108 12439831 11198108 12439831 16416661 17646817 1241723 0 X 0 1 1 X 1 1 X 7671247 8298190 10032865 9796655 9919187 45718144 7671247 8298190 10032865 9796655 9919187 45718144 0 0 0 45718144 508222 298047 212923 33219 23132 1075543 508222 298047 212923 33219 23132 1075543 30310 30310 8179469 8596237 10245788 9829874 9972629 46823997 0.97640 0.96840 0.02300 0.03160 X 0 0 0 0 0 0 0 0 1 821 821 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Maryview Nursing Care Center paid dues to the Virginia Health Care Association, a portion of which is used for lobbying activities. The portion of the dues allocated to lobbying activities is $821 or 11.71%. 0 1 2087243 1033692 1053551 4418769 3810294 608475 863805 882427 -18622 1643404 Bond Fund 1992 - Debt Service 460 ST Payable - Maryview 2194 ST Payable - MRMC 51 2705 Part IV, Line 2b: The filing organization holds, safeguards, manages and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Any resident may deposit money into a personal Resident Fund Account. Deposits may not exceed $2,000 for residents receiving Medicaid. Withdrawal requests greater than $50 must be made prior to 4PM to allow time to obtain funds from the banking institution if necessary. All excess custodial funds are held in interest bearing accounts separate from that of the organization. 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. X X X X X 1 1 0 0 0 0 0 0 0 Timothy J Davis 0 568101 0 168422 0 6995 0 111800 0 20990 0 876308 0 0 Michael K Kerner 0 463467 0 138768 0 4006 0 116245 0 29524 0 752010 0 0 Gregory Simia 0 303064 0 69986 0 65523 0 25631 0 30103 0 494307 0 0 Patricia Robertson 0 282666 0 67407 0 26751 0 17150 0 11683 0 405657 0 0 Diana L Jarrett 0 137365 0 24932 0 256 0 13638 0 214 0 176405 0 0 Richard Hanson 0 91580 0 680 0 7762 0 6444 0 2207 0 108673 0 69611 Joseph Buchheit 0 229525 0 41221 0 22138 0 19617 0 22322 0 334823 0 0 Eileen Malo 0 46769 0 39414 0 136158 0 3842 0 3935 0 230118 0 0 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: Eileen Malo, $136,016. Part I, Line 4b: Maryview Nursing Care Center participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting deposits are made into this plan. The following individuals received payments in 2011: Richard Hanson - $71,180. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Maryview Nursing Care Center, 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 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 Bon Secours - Maryview Nursing Care Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours - Maryview Nursing Care Center is appointed by its Member, Bon Secours Hampton Roads Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours - Maryview Nursing Care Center 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 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 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-Maryview Nursing Care Center 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. Michael K. Kerner'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 Bon Secours Hampton Roads Health System which includes direct management, monitoring and oversight of Bon Secours Hampton Roads Health System and its related organizations. Greg Simia's compensation is paid by Maryview Hospital, a related organization. The compensation he receives is for his role as the Chief Financial Officer of Bon Secours Hampton Roads Health System and all related organizations. Patricia Robertson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Executive Vice President of Mary Immaculate Hospital and both nursing care facilities in the Hampton Roads Health System. Diana L. Jarret's compensation is paid by Maryview Hospital, a related organization. The compensation she receives is for her role as the Executive Director, Extended Care. This position includes responsibilities over both nursing care facilities in the Hampton Roads Health System. Timothy J. Davis's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as Executive Vice President and Chief Administrative Officer of Bon Secours Health System, Inc. Sr. Patricia Heath does not receive payroll distributions as she has taken a vow of poverty. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsvile MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Ste A Portsmouth 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 Newport News VA 23602 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 0 Mary Immaculate Foundation 2 Bernadine Drive Newport News VA 23602 311644734 Fundraising VA 501(c)(3) 11c Mary Immaculate Hospital 0 Mary Immaculate Hospital 4 Ridgewood Parkway Newport News VA 23602 540548200 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Scours Maryview Foundation 3520 High Street Ste 100 Portsmouth VA 23707 521694731 Fundraising VA 501(c)(3) 11c Bon Secours Hampton Roads Health System 0 Maryview Hospital 3636 High Street Portsmouth VA 23707 540506463 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Medical Center 150 Kingsley Lane Norfolk VA 23505 541820093 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfolk VA 23505 541843876 Fundraising VA 501(c)(3) 11c 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 Province Place of Maryview LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541842697 Assisted Living VA Professional Health Care Mgmt Related 0 0 Province Place of DePaul LLC 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541950880 Assisted Living VA Professional Health Care Mgmt Related 0 0 Professional Health Care Mgmt Inc 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA Bon Secours Hampton Roads Health System Inc C Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA Mary Immaculate Hospital Inc C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0