2012-08-15T10:48:35-05:00 2011-09-30 CHERRY BEKAERT & HOLLAND LLP P O BOX 1119 LYNCHBURG VA 245051119 990 2010-10-01 540505955 SHELTERING ARMS HOSPITAL SHEL 8043424340 8254 ATLEE ROAD MECHANICSVILLE VA 23116 JAMES E SOK 8043424340 2012-08-10 1 SAMUEL E JOHNSON 4348476643 2012-08-10 2010 2016-02-24 21:20:13Z JAMES E SOK 8254 ATLEE ROAD MECHANICSVILLE VA 23116 66562326 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. 20 19 780 20 111667 -55912 8824327 11152461 46771750 49598719 -56512 3718121 634869 688148 56174434 65157449 241250 388561 0 0 28725064 31077037 0 0 100000 25243812 35476891 54210126 66942489 1964308 -1785040 24500064 22514027 3482021 3281024 21018043 19233003 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 52890722 53328912 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 2011, 999 PATIENTS WERE ADMITTED RESULTING IN 13,466 PATIENT DAYS. IN ADDITION, SHELTERING ARMS HOSPITAL PROVIDES INPATIENT THERAPY SERVICES TO LOCAL ACUTE CARE HOSPITALS ON A CONTRACT BASIS.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 2011, SHELTERING ARMS HOSPITAL PROVIDED OUTPATIENT THERAPY AND PHYSICIAN SERVICES RESULTING IN 128,230 PATIENT VISITS. 1790456 388561 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 2011, 839 OCCURRENCES RESULTED IN CHARITY CARE AND/OR FINANCIAL ASSISTANCE BEING ACCEPTED. THE DISCOUNTED CHARGES FOREGONE BY SHELTERING ARMS HOSPITAL FOR THIS ASSISTANCE WAS $1,282,021. IN FISCAL YEAR 2011, SHELTERING ARMS ALSO TRANSPORTED 120 PATIENTS PARTICIPATING IN THE OUTPATIENT THERAPY DAY REHAB PROGRAM AT AN UNREIMBURSED COST OF $72,609. 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 $47,238. SHELTERING ARMS ALSO CONTRIBUTED $388,561 TO SUPPORT COMMUNITY ORGANIZATIONS. 1612798 443514 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 7,375 VISITS IN FY 2011 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 1,495 SPECIAL EVENTS WHICH INCLUDED EXERCISE CLASSES, EDUCATIONAL PROGRAMS, AND SPECIAL RECREATION WITH A TOTAL OF 8,304 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 FACILITITIES TO CONTINUE THEIR FITNESS PROGRAMS AFTER DISCHARGE FROM THE HOSPITAL OR OUTPATIENT CLINICS.DURING FISCAL YEAR 2011, THERE WERE 34,352 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 2011, THE COST UNDERWRITTEN WAS $1,169,284. 56293976 1 1 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 0 780 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 0 0 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 CHARLES M CARAVATI III 4.00 X X 0 0 0 LISA T POWELL 4.00 X X 0 0 0 LAWRENCE E GIBSON 4.00 X X 0 0 0 JOHN L MCELROY 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 THEODORE W PRICE 4.00 X 0 0 0 CORBIN K RANKIN 4.00 X 0 0 0 SUSAN J RAWLES 4.00 X 0 0 0 AMES 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 JAMES E SOK 40.00 X 439878 0 66566 MICHAEL A BOEMMEL 40.00 X 344709 0 13660 JAMES A BRAITH 40.00 X 215933 0 28509 HILLARY S HAWKINS 40.00 X 372438 0 20722 TIMOTHY M SILVER 40.00 X 385083 0 27832 MICHAEL J MCDONNELL 40.00 X 233232 0 0 CHERYL LEE 40.00 X 186935 0 0 ELLEN VANCE 40.00 X 163687 0 0 JOHN E GIBBS II 40.00 X 242552 0 13451 CHARLES M GIBELLATO 40.00 X 218980 0 23785 ALBERT M JONES 40.00 X 274227 0 25062 GREGORY LEGHART 40.00 X 299185 0 26357 SCOTT N SCHIMPFF 40.00 X 464343 0 26392 3841182 0 272336 24 0 1 0 BON SECOURS MEMORIAL REGIONAL MEDICAL CE 8260 ATLEE ROAD MECHANICSVILLE VA 23116 HOSPITAL ANCILLARY & SUPPORT 1562844 FREE AGENTS MARKETING LLC 10124 WEST BROAD STREET SUITE N GLEN ALLEN VA 23059 ADVERTISING & MARKETING 481799 LAWSON SOFTWARE AMERICAS C/O CITIBANK PO BOX 2395 CAROL STREAM IL 60132 PAYROLL SYSTEM & SUPPORT 384092 CROTHALL 955 CHESTERBROOK BLVD SUITE 800 WAYNE PA 19087 HOUSEKEEPING 345981 INTERACTIVE DATA SYSTEMS 203 BURNING LAMP LANE FOREST VA 24551 IT EQUIPMENT AND SUPPORT 288503 11 10333218 819243 11152461 PATIENT SERVICE REVENU 621400 42173921 42173921 THERAPY SERVICE - CONT 621400 6981284 6981284 THERAPEUTIC RECREATION 621400 443514 443514 49598719 3166 3166 108191 108191 108191 108191 4780850 1065895 3714955 3714955 3714955 456711 338982 117729 117729 MISC REAL ESTATE INCOM 621400 343383 343383 SPORTS ACCELERATION PR 713940 111667 111667 MISCELLANEOUS 621400 7178 7178 462228 65157449 49949280 111667 3944041 388561 388561 2547317 1069873 1477444 23790604 22375902 1414702 869069 851563 17506 1658932 1590873 68059 2211115 2056337 154778 276568 13246 263322 88584 14547 74037 1024909 616181 408728 389801 69154 320647 1353904 1003624 250280 100000 671659 335898 335761 14759 14759 1986661 1800201 186460 179808 100919 78889 58862 43540 15322 8833929 4054079 4779850 1904450 1558936 345514 197619 177857 19762 CONTRACTUAL ADJUSTMENTS 15086845 15086845 PURCHASED SERVICES 2993497 2993497 BAD DEBT 265572 265572 MEMBERSHIPS 149464 77584 71880 66942489 56293976 10548513 100000 1830957 322909 1582173 1789720 5586539 5593975 48074 44816 390727 411581 32405849 18660511 13451475 13745338 446480 1610119 159208 24500064 22514027 3462021 3281024 20000 3482021 3281024 X 20900960 19116531 17083 16472 100000 100000 21018043 19233003 24500064 22514027 -1785040 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 416370 416370 11688079 5493917 6194162 2081641 576192 1505449 16007355 12202283 3805072 2212404 388119 1824285 13745338 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, 2011, 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, 2008. 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1501 MAPLE AVENUE SUITE 100 RICHMOND VA 23226

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS MIDTOWN CLUB REC

2805 WEST BROAD STREET RICHMOND VA 23230

OUTPATIENT DAY PROGRAM AND FITNESS CENTER PT WORKS CENTER

2296 JOHN ROLFE PARKWAY RICHMOND VA 23233

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS HANOVER NEURO CTR

8254 ATLEE ROAD MECHANICSVILLE VA 23116

OUTPATIENT THERAPY AND PHYSICIANS CLINIC SHELTERING ARMS HULL STREET CENTER

13530 HULL STREET ROAD MIDLOTHIAN VA 23114

OUTPATIENT THERAPY AND PHYSICIANS CLINIC PART 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 III, LINE 9B: ANY PATIENT WHO QUALIFIES FOR CHARITY CARE AND/OR FINANCIAL ASSISTANCE MUST FOLLOW THE GUIDELINES INCORPORATED IN THE CHARITY CARE AND FINANCIAL ASSISTANCE SIGNED DOCUMENTS. LEGAL ACTION MAY ONLY BE PURSUED IF IT IS DETERMINED THAT THE PATIENT HAS ASSETS OR INCOME NOT REPORTED ON THE APPLICATION FOR CHARITY AND FINANCIAL ASSISTANCE, HAS FAILED TO COMPLETE THE REQUIRED FINANCIAL ASSISTANCE OR CHARITY APPLICATION, OR IF THE PATIENT FAILS TO COMPLY WITH THE PREVIOUS AGREED UPON TERMS AND HAS FAILED TO NOTIFY SHELTERING ARMS OF A CHANGE IN THEIR FINANCIAL STATUS. ALL PATIENTS MAY RE-APPLY FOR FINANCIAL ASSISTANCE OR CHARITY IF THEIR FINANCIAL CONDITION WORSENS AT WHICH TIME NEW PAYMENT ARRANGEMENTS OR FULL CHARITY OR FINANCIAL ASSISTANCE MAY BE GRANTED. ONLY WHEN THE PATIENT FAILS TO NOTIFY SHELTERING ARMS OF THE HARDSHIP OR REFUSES TO COOPERATE WITH THE WRITTEN AGREEMENTS WILL SHELTERING ARMS TURN UNPAID PATIENT BALANCES OVER TO A COLLECTION AGENCY. PART 1, LINE 6A:SHELTERING ARMS PRODUCES AN ANNUAL REPORT SUMMARIZING THE ACCOMPLISHMNETS 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. 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 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. 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. PATIENT ACCESS STAFF VERBALLY DISCLOSE THIS INFORMATION TO PATIENTS IN PERSON AND/OR OVER THE PHONE, AND IT IS ALSO DISCLOSED ON OUR WEBSITE. 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 6: 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 7: N/A 0 BON SECOURS RICHMOND FOUNDATION 5875 BREMO ROAD SUITE 305 RICHMOND VA 23226 541201346 501(C)(3) 203728 TO SUPPORT THE BON SECOUR CHARITABLE INITIATIVES. THE COMMUNITY FOUNDATION SERVING RICHMOND AND CENTRAL VIRGINIA 7501 BOULDERS VIEW DRIVE SUITE 110 RICHMOND VA 23225 237009135 501(C)(3) 137280 TO SUPPORT EIGHT PROGRAMS IDENTIFIED IN THE COMMUNITY SERVING POPULATIONS IN NEED OF ASSISTANCE. AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 10000 TO SUPPORT THE FUNDRAISING INITIATIVE FOR THE AMERICAN HEART ASSOCIATION IN RAISING AWARENESS OF HEART RELATED CONDITIONS AND PREVENTATIVE AWARENESS. NATIONAL MULTIPLE SCLEROSIS SOCIETY - CENTRAL VIRGINIA CHAPTER 4200 INNSLAKE DRIVE SUITE 301 GLEN ALLEN VA 23060 540633474 501(C)(3) 37553 SPONSORSHIP OF THE RICHMOND MS WALK AND RECOGNITION CEREMONY IN 2011. 4 0 X X X X 0 1 0 0 0 0 0 0 0 JAMES E SOK 316128 0 123750 0 0 0 47862 0 18704 0 506444 0 0 0 MICHAEL A BOEMMEL 256909 0 87800 0 0 0 7900 0 5760 0 358369 0 0 0 JAMES A BRAITH 166293 0 49640 0 0 0 10795 0 17714 0 244442 0 0 0 HILLARY S HAWKINS 265077 0 107361 0 0 0 4900 0 15822 0 393160 0 0 0 TIMOTHY M SILVER 297478 0 87605 0 0 0 4900 0 22932 0 412915 0 0 0 MICHAEL J MCDONNELL 182232 0 51000 0 0 0 0 0 0 0 233232 0 0 0 CHERYL LEE 140650 0 46285 0 0 0 0 0 0 0 186935 0 0 0 ELLEN VANCE 137877 0 25810 0 0 0 0 0 0 0 163687 0 0 0 JOHN E GIBBS II 193489 0 49063 0 0 0 4881 0 8570 0 256003 0 0 0 CHARLES M GIBELLATO 205307 0 13673 0 0 0 4466 0 19319 0 242765 0 0 0 ALBERT M JONES 254677 0 19550 0 0 0 4900 0 20162 0 299289 0 0 0 GREGORY LEGHART 205332 0 93853 0 0 0 7940 0 18417 0 325542 0 0 0 SCOTT N SCHIMPFF 272027 0 192316 0 0 0 4900 0 21492 0 490735 0 0 0 PART I, LINE 4B JAMES E. SOK - $40,295 TROUTMAN SANDERS LLP DAVID CONSTINE, A BOARD MEMBER, IS A PARTNER IN THIS LAW FIRM. 348975 LEGAL SERVICES. THE SERVICES ARE NEGOTIATED AT ARM'S LENGTH AND ARE AT FAIR MARKET VALUE. 0 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, AND FINANCIAL STATEMENTS. SUCH REQUESTS MUST BE PRESENTED TO EITHER THE PRESIDENT/CEO AND/OR THE VICE PRESIDENT OF FINANCE/CFO. SHELTERING ARMS PHYSICAL REHABILITATION ASSOCIATES LLC 8254 ATLEE ROAD MECHANICSVILLE VA 23116 260402064 PHYSICAL REHABILITATION VA 9419176 562834 SHELTERING ARMS HOSPITAL SHELTERING ARMS THERAPY CLINICS LLC DBA PT WORKS 8254 ATLEE ROAD MECHANICSVILLE VA 23116 271939022 PHYSICAL REHABILITATION VA 1629840 742689 SHELTERING ARMS HOSPITAL SHELTERING ARMS FOUNDATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615599 PHYSICAL REHABILITATION VA 501(C)(3) 509(A)(2) SHELTERING ARMS CORPORATION 0 SHELTERING ARMS HOSPITAL SOUTH 8254 ATLEE ROAD MECHANICSVILLE VA 23116 352258075 PHYSICAL REHABILITATION VA 501(C)(3) 170(B)(1)(A)(III) SHELTERING ARMS CORPORATION 0 PALMYRA REHABILITATION CORPORATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615601 PHYSICAL REHABILITATION VA 501(C)(3) 509(A)(3) SHELTERING ARMS CORPORATION 0 SHELTERING ARMS CORPORATION 8254 ATLEE ROAD MECHANICSVILLE VA 23116 541615598 PHYSICAL REHABILITATION VA 501(C)(3) 170(B)(1)(A)(III) N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SHELTERING ARMS FOUNDATION C 6260695 ACTUAL DOLLAR VALUE SHELTERING ARMS HOSPITAL SOUTH C 3848237 ACTUAL DOLLAR VALUE PALMYRA REHABILITATION CORPORATION C 224285 ACTUAL DOLLAR VALUE SHELTERING ARMS HOSPITAL SOUTH B 3543492 ACTUAL DOLLAR VALUE PALMYRA REHABILITATION CORPORATION B 510588 ACTUAL DOLLAR VALUE SHELTERING ARMS FOUNDATION B 4779850 ACTUAL DOLLAR VALUE