2012-07-16T15:09:24-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 541820093 Bon Secours DePaul Medical Center Inc BONS 7578895000 7007 Harbour View Blvd No 108 Suffolk VA 23435 Michael Kerner 7578895000 2012-07-16 1 Laura L Catlett 7032511000 2010 2016-02-24 21:20:13Z Michael K Kerner 7007 Harbour View Blvd No 108 Suffolk VA 23435 187402332 0 0928 X www.bonsecourshamptonroads.com X 1996 VA Acute Care Hospital 19 16 1132 148 1299835 -215679 160247 319950 168064618 166743301 -1445812 16478035 1502699 2440050 168281752 185981336 0 663012 0 0 58612863 62958438 0 0 0 112601609 120893503 171214472 184514953 -2932720 1466383 79304838 105618626 113455426 138402753 -34150588 -32784127 X The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. 0 0 31588027 35730306 DePaul continues a strong focus on orthopedic care for residents of Norfolk and Virginia Beach. A special expertise exists in the treatment of spine disorders, with a significant cadre of spine and neurosurgeons. DePaul was also recently recognized as a Blue Distinction Center of Excellence to attest to the excellence of care. This service includes a continuum of care from pre-operative education through post-op recovery, and is supported by state-of-the-art technology and expert physicians, as well as a comprehensive rehab network. In addition, a strong focus exists on community education through seminars and classes. 17152973 14131941 DePaul recently established a bariatric surgery program, modeled on the successful program already in place at sister facility Maryview. DePaul has long been known for its premier gynecological oncology program, treating women from a 5-state area. Specialized OR, diagnostic, therapeutic, and nursing services are available to treat this disease, alongside specialty-trained expert physicians. Finally, DePaul is working extensively with neurosurgeons in expanding this part of the surgery service. New services added in 2010 include craniotomy surgery, deep brain stimulation, advanced spinal surgeries, and other neurosurgical procedures. As with other services and part of our mission, a strong focus exists on community education through seminars and classes. 13782456 12256924 DePaul has committed significant resources to the care of cardiac patients. The comprehensive Early Detection Center is aimed at identifying cardiac disease early and referring patients to physicians as necessary for prompt and effective treatment. DePaul also upgraded equipment and nursing services to better support the service line. In FY10, Bon Secours DePaul began operating a state-of-the art, fully digital cardiac catheterization laboratory. In addition, DePaul's CT was upgraded to a 64-slice unit, enabling "beating heart" scans. DePaul continues strong relationships with other Bon Secours hospitals for the delivery of advanced cardiac interventions, such as cardiac surgery. In addition, a strong focus also exists on community education through seminars, classes, screenings, and special events, such as Day of Dance. 105694768 663013 104435986 Other major services offered by Bon Secours DePaul Medical Center include a Birthing Center, Sleep, Gastroenterology and Pulmonary services. In addition, Bon Secours DePaul Medical Center offers a full service 24 hour Emergency Room. 105694768 663013 104435986 168218224 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 92 0 1 1132 1 1 1 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 1 1 1 1 0 VA 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 Robinette Jr 4.00 X 0 0 0 R B Seal 4.00 X 0 0 0 Robert Squatrito MD 4.00 X 1320 0 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 743478 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 0 606241 145769 Daniel Duggan 50.00 X 0 364633 38702 John Barrett 50.00 X 0 0 0 Gregory Simia 50.00 X 0 438573 55734 Ernie Padden 50.00 X 0 0 0 David Setchel 50.00 X 214987 0 39471 Kochicheril N Moni 50.00 X 412521 0 37040 Elizabeth Z Salzberg 50.00 X 263417 0 39881 James Mosure 50.00 X 262917 0 7343 Charles E Ives 50.00 X 255862 0 21572 Gregory Adams 50.00 X 318371 0 41640 Richard Hanson 0.00 X 0 100022 8651 Joseph Buchheit 50.00 X 0 292884 41939 1729395 2545831 610532 71 1 1 0 Rehabcare Group Inc PO Box 502096 St Louis MO 631502096 Rehabilitation Services 4332521 Eastern Virginia Medical School 721 Fairfax Ave Norfolk VA 23507 Residence/Director Fees 1568183 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Biomedical Engineering 1084975 Shiftwise 1800 SW 1st Avenue Portland OR 97201 Contract nursing 1018634 Alliance Healthcare Services Inc PO Box 96485 Chicago IL 606936485 MRI Services 1015782 36 147745 172205 319950 Patient Service Rev. 722320 166555157 165440261 1114896 Nursing Asst Pgrm Tuit 900099 188144 188144 166743301 212343 212343 627688 1795 545754 81934 1795 83729 31168 52561 512139 16628795 875242 512139 15753553 16265692 16265692 Joint venture income 621999 975377 975377 Cafe and Vending 722320 504360 504360 Physician Phone Svcs 900099 153771 153771 722813 722813 2356321 185981336 165628405 1299835 18733146 663012 663012 252338 227104 25234 49686751 44718076 4968675 2340353 2106318 234035 6582304 5924074 658230 4096692 3687023 409669 391766 352589 39177 102592 92333 10259 22384 20146 2238 1701063 1530956 170107 20019917 18017925 2001992 87707 78936 8771 3341872 3007685 334187 141739 127565 14174 2432943 2189649 243294 78154 70339 7815 175962 158366 17596 1856572 1856572 6340115 5706104 634011 1139477 1025529 113948 Medical Expenses 32751197 29476077 3275120 Purchased Services 24288124 21859312 2428812 Bad Debt 19028072 19028072 BSHSI Allocation 3126856 2814170 312686 Repairs & Maintenance 2205201 1984681 220520 1661790 1495611 166179 184514953 168218224 16296729 0 4800 5373 28253 20006909 20322818 2538596 2862661 287132 988059 107001216 68363494 37686268 38637722 9487193 10692467 20942460 5263864 9293940 5874949 79304838 105618626 11732058 12177851 8960 101723368 126215942 113455426 138402753 X -34130581 -32793348 -20007 9221 -34150588 -32784127 79304838 105618626 X 1466383 -99922 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 12521 0 1 9863 22384 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: DePaul Medical Center paid dues to the American Hospital Association (AHA), the Virginia Hospital and Healthcare Association (VHHA) and the Catholic Health Association (CHA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations are as follows: AHA $4,844 or 24.2%, VHHA $3,756 or 9.7% and CHA $1,263 or 4.68%. 3750384 3750384 27302183 16777495 10524688 3623067 1455874 2167193 72325582 50130125 22195457 38637722 Inv in Sentara Princess Anne Hosp 20942460 C 20942460 Inv in Bed Licenses, net of amortization 1142699 Organizational Costs 477431 Other investments and deferred finance costs 2854118 Due from affiliates 778217 Due from BSHSI 622484 5874949 Other Current Liabilities 1293605 Due to affiliates 47489561 Due to BSHSI 70969061 Pension Liability 3919400 Deferred Rent 1853416 FIN 47 LT Asbestos Liability 690899 126215942 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 6579195 6579195 0.03950 16719321 12500487 4218834 0.02540 175832 89142 86690 0.00050 23474348 12589629 10884719 0.06540 8 8412 204347 0 204347 0.00120 2 130 2243601 800468 1443133 0.00870 157980 157980 0.00090 2 613 448910 448910 0.00270 12 9155 3054838 800468 2254370 0.01350 12 9155 26529186 13390097 13139089 0.07890 1 586 8498 8498 0.00000 1 225 959 959 0.00000 1 544 6094 6094 0.00000 3 1355 15551 15551 1 4983696 40501127 46790972 -6289845 X 1 1 1 Radiology Svcs-Hampton Rds Radiology Services 0.25000 2 Management Services LLC Management Services 0.20000 3 Posit Emiss Tomography Operate PET Scanner 0.13750 0.45000 4 Peninsula Hospital Svcs Laundry Services 0.13500 5 VA Health Network Inc Insurance Networks 0.07000 6 VA Beach Surgery Ctr LLC Outpatient Surgery 0.46880 0.24500 1 1 DePaul Medical Center

150 Kingsley Lane Norfolk VA 23505

X X X X Not Applicable 1 14 Bon Secours Health Center VA Beach

828 Healthy Way Virginia Beach VA 23462

Imaging, Rehabilitation & Physician Practice DePaul InMotion Phys Ther-Norfolk

7300 Newport Ave Suite 300 Norfolk VA 23505

Physical, Occupational & Speech Therapy Tidewater Surg Specialists DePaul

160 Kingsley Lane Suite 400 Norfolk VA 23505

Physician Practice Bon Secours In-Motion at Hilltop

1817 Laskin Rd Suite 100 Virginia Beach VA 23454

Physical Therapy & Sports Rehab Tidewater Surgical Spect DePaul

160 Kingsley Lane Suite 400 Norfolk VA 23505

Physician Practice Amelia Medical Associates

885 Kempsville Rd Ste 300303305313 Norfolk VA 23502

Physician Practices, Physical Therapy Patient Choice Oceana

1232 Perimeter Pkwy Suite 101 Virginia Beach VA 23454

Physician Practice Hampton Roads OBGYN

100 Kingsley Lane Suite 100 Norfolk VA 23505

Physician Practice Patient Choice Ghent

957 W 21st St Suite E Norfolk VA 23517

Physician Practice Internal Medicine Specialists

142 W York St Suite 508 Norfolk VA 23510

Physician Practice Bon Secours Neuroscience Ctr for Pain

4445 Corporation Lane Suite 120 Virginia Beach VA 23562

Physician Practice DePaul Medical Associates

100 Kingsley Lane Suite 100 Norfolk VA 23505

Physician Practice Cardiovascular Specialists

160 Kingsley Lane Suite 100A Norfolk VA 23505

Physician Practice InMotion Phy Ther Redmill Landing

1253 Nimmo Parkway Suite 105 Virginia Beach VA 23456

Physical Therapy 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 non-patient 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: $19,028,072. Part II: DePaul Medical Center (DMC), through BSHR, offers Care-A-Van services. The Care-A-Van (CAV), initiated on the peninsula in 2009 at two sites, has expanded in the past year to seven sites, two in Norfolk, two in Portsmouth and three in Newport News. This is a mobile health unit that provides healthcare services to those most in need-the uninsured. Services provided include urgent and primary care (including examination, diagnosis, lab, pharmacy, and follow-up), immunizations for school, pregnancy tests, blood pressure measurement, health education, referrals for specialty care, opportunity to enroll eligible children in children's health insurance. The Care-A-Van also offers sports physicals, children's health insurance enrollment, and health education services. While the CAV primarily serves adults, some sites do provide care and referral services for children aged 12 and older. Community partners include free clinics, local health agencies, and numerous Faith-based community organizations which collaborate with the Care-A-Van staff. The CAV has a staff of 10 FTEs and annual expenses of approximately $700,000.DMC, through BSHR, offers Bon Secours Senior Health Program which offers a free membership program to over 75,000 individuals 65 years and older. A key component is the Successful Aging Forum, which brings national speakers to the community to discuss the latest health and wellness topics for senior citizens. The annual HealthFest provides a seniors-focused health festival with health screenings, health information and social interaction for seniors of all socio-economic backgrounds. Friday Night Dinners, held at area hospitals, serve seniors who need low cost meals and socialization. A transportation program offers transportation to medical appointments, without charge to those who are financially challenged. A quarterly publication Good Health provides information to 75,000 members in Hampton Roads.Seniors play a vital role in DMC's advocacy efforts against reductions in Medicaid payments and to support continued funding for the State Children Health Insurance Program (SCHIP). DMC supports the BSHR Faith Community Health Ministry which builds on the skills of the registered nurse through additional, structured training in holistic (body, mind and spirit) health services; the faith community nurse partners with the congregational leadership to promote good health by serving as an educator, counselor, referral agent and advocate. Specialized training has also been developed to prepare non-licensed persons to serve in congregational health ministry. Additionally, the Influenza Vaccination Administration program provided 600 vaccines for select covenanted partners to host annual vaccine clinics. BSHRHS employs a sole Director to provide education, mentoring and support to more than 130 faith communities and 232 registered nurses and lay health promoters. Partnership with Federally Qualified Health Clinic in Norfolk - DMC and Park Place Medical Center work together to provide uninsured and underinsured individuals with a medical home and receive a full range of primary care services. DMC makes financial and/or in-kind donations to Park Place that includes equipment, services and cash assistance for patient administration support, clinical staffing, case management and patient outreach. BSHRHS' Community Sponsorship Committee reviews and financially sponsors community events that support our mission and values. Some of the contributions in FY 11 that support the work of the local community in addressing unmet need include: -A monthly contribution to Park Place Clinic to help subsidize medical care for those who are uninsured or underinsured. -For Kids organization which works to break the cycle of homelessness and poverty for families and children-Help and Emergency Response to provide shelter and to engage in dedicated efforts to eliminate domestic violence-Access Partnership to support an oral health initiative for adults with no access to dental care-PIN Organization to support their work of providing food, clothing, shelter, and free medical care for people who are either homeless 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 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: Hampton Roads is a very diverse community within an MSA of nearly 1.6 million people residing in 16 cities and counties, stretching from northeastern North Carolina to Williamsburg. The area is characterized by racial diversity, a significant military population and a growing elderly population. African Americans comprise 52.2% of the population in Portsmouth, 41.6% in Newport News, and 43.4 % of Norfolk and 19.3% of Virginia Beach, which far exceeds the national average of 31.5 %. Seniors currently account for 11.2% of the population, growing to 13% in the next five years. The population served by Bon Secours DePaul Medical Center (DMC), Norfolk, VA is estimated to change from 828,728 to 867,988, resulting in a growth of 4.7% between 2000 and the current year. Over the next five years, the population is projected to grow by 1.0%. The current year estimated population represents white (61.3%), Black or African American (28.7%), Hispanic or Latino (5.4%) and small percentages other small groups. The current year median age for this area is 34.3, while the average age is 36.0. Five years from now, the median age is projected to be 35.2.The most prevalent chronic conditions among adults include high blood pressure (26,400 or 40.1%), high cholesterol (20,900 or 33.3%), arthritis (22,000 or 33.3%), diabetes (8,700 or 12.9%), and asthma (7,000 or 10.3%). Morbidity rates per 10,000: heart disease (159.5), cerebrovascular disease (33.4), chronic obstructive pulmonary disease (29.4), diabetes (26.3), and asthma (17.5). Mortality rates (age-adjusted per 100,000) for this area are cancer (205.2), ischemic heart disease (150.5), cerebrovascular disease (66.9), and chronic obstructive pulmonary disease (43.9). Part VI, Line 6: DePaul Medical Center (DMC) has an open medical staff with privileges available to all qualified physicians. Emergency departments at the three hospitals provide service 24 hours/day, 7 days/week to ensure access for emergency care for all individuals in need of emergency care. Hospital board members are diverse, inclusive and representative of the broader community in which the facilities are located. Reports Filed With States Part VI, Line 7 VA 1 Portsmouth Community Health Center Inc 664 Lincoln St Portsmouth VA 23704 541626757 501(c)(3) 435775 Patient Transfer Support Agreement Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfok VA 23505 541843876 501(c)(3) 225737 Administrative Costs 2 0 X X X X X 0 1 0 0 0 0 0 0 0 Timothy J Davis 0 568101 0 168422 0 6955 0 111800 0 20990 0 876268 0 0 Michael K Kerner 0 463467 0 138768 0 4006 0 116245 0 29524 0 752010 0 0 Daniel Duggan 0 276156 0 64882 0 23595 0 17831 0 20871 0 403335 0 0 Gregory Simia 0 303064 0 69986 0 65523 0 25631 0 30103 0 494307 0 0 David Setchel 181545 0 33237 0 205 0 10683 0 28788 0 254458 0 0 0 Kochicheril N Moni 407004 0 0 0 5517 0 17190 0 19850 0 449561 0 0 0 Elizabeth Z Salzberg 263186 0 0 0 231 0 6346 0 33535 0 303298 0 0 0 James Mosure 113753 0 122500 0 26664 0 0 0 7343 0 270260 0 69789 0 Charles E Ives 239315 0 15000 0 1547 0 11817 0 9755 0 277434 0 0 0 Gregory Adams 318026 0 0 0 345 0 12457 0 29183 0 360011 0 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 Part I, Line 4b Bon Secours DePaul Medical Center, Inc. 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 deposits are made into this plan. The following individuals received payments in 2011: Richard Hanson - $71,180 James Mosure - $112,931 Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Maryview Hospital, 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 DePaul Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board of Directors of Bon Secours DePaul Medical Center, Inc. is appointed by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Any decision which is subject to a reserved power is subject to approval by members. 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 DePaul Medical Center, Inc 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. Volunteer 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. Gregory 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 which includes direct financial management, monitoring and oversight of Bon Secours Hampton Roads Health System and its related organizations. Timothy J. Davis' 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. Daniel Duggan'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 of Depaul Medical Center. Sr. Patricia Heath does not receive payroll distributions as she has taken a vow of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 480,793. Prior period adjustments: 21,549. Add'l Minimun Pension Liability 1,021,781. BSHSI - I/Co Debt Principal Payment -1,782,706. Grants and Restricted Contributions 64,152. Use of Grant Funds for Ops -34,925. Contribution to Foundation for Expenses 129,434. Total to Form 990, Part XI, Line 5: -99,922. Mary Immaculate Foundation 150 Kingsley Lane Norfolk VA 23505 311644734 Fundraising VA 501(c)(3) 11(c) Mary Immaculate Hospital 0 Mary Immaculate Nursing Center 4 Ridgewood Parkway Newport News VA 23602 541516476 Nursing Care Center VA 501(c)(3) 9 Mary Immaculate Hospital 0 Mary Immaculate Hospital Inc 2 Bernadine Drive Newport News VA 23602 540548200 Healthcare VA 501(c)(3) 3 Bon Secours Hampton Roads Health System 0 Bon Secours Hampton Roads Health System Inc 5818 Harborview Blvd Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) 11(b) Bon Secours Health Systems Inc 0 Bon Secours Maryview Nursing Care Center 4775 Bridge Road Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) 9 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 Bayley Properties 150 Kingsley Lane Norfolk VA 23505 541424748 Rental VA 501(c)(2) N/A Bon Secours DePaul Medical Center 1 Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11(b) Bon Secours Inc 0 Bon Secours DePaul Health Foundation 150 Kingsley Lane Norfolk VA 23505 541843876 Fundraising VA 501(c)(3) 11(c) Bon Secours Hampton Roads Health System 0 Bon Secours Maryview Foundation 150 Kingsley Lane Norfolk VA 23505 521694731 Fundraising VA 501(c)(3) 11(c) Bon Secours Hampton Roads Health System 0 Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Livivng VA Professional Health Care Mgmt Related 0 0 0.00000 Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Livivng VA Professional Health Care Mgmt Related 0 0 0.00000 Professional Health Care Mgmt Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541241031 Administrative VA Bon Secours Hampton Roads Health System Inc Tidewater Diversified Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc 1.00000 OSF Inc 7007 Harbourview Blvd Ste 108 Suffolk VA 23435 541369919 Rental VA Mary Immaculate Hospital Inc 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0