2011-07-11T07:47:35-05:00 2010-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2009-09-01 540647482 Richmond Community Hospital Inc RICH 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 Peter F Gallagher 8047646102 2011-07-08 1 7032511000 2009 2016-02-24 21:20:13Z Michael Robinson 8260 Atlee Road Mechanicsville VA 23116 53604476 0 X www.bonsecours.com X 1922 VA Acute Care Hospital 20 16 389 52 0 0 40669 79136 49163487 53186883 942 28 350026 332991 49555124 53599038 0 0 17608578 18646589 0 0 35152665 35191121 52761243 53837710 -3206119 -238672 16987458 17691003 45313270 46100452 -28325812 -28409449 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 49003262 53186883 Richmond Community Hospital provides medical care to patients without regard to their ability to pay. As a community not-for-profit hospital in Richmond, Richmond Community Hospital is an access point for under insured and financially disadvantaged who will not be treated at the for profit hospitals. In addition, Richmond Community Hospital provides support for community services. Please refer to the Community Benefit information on Schedule H. 49003262 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 50 0 1 389 1 0 0 0 0 0 0 0 0 0 20 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X Peter F Gallagher 8046275400 5801 Bremo Road Richmond VA 23227 X William T Patrick Jr 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 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 John Muldowney 4.00 X 0 0 0 Joanne Nattrass 4.00 X 0 0 0 Michael Williams 4.00 X 0 0 0 Jean Ann Bolling 4.00 X 0 0 0 Mark Gordon 50.00 X 0 681718 59405 Toni Ardabell 50.00 X 0 396984 17938 Nancy Thomas 4.00 X 0 0 0 Jane Watkins 4.00 X 0 0 0 Tom Winfree 4.00 X 0 0 0 Thom Morris PhD 50.00 X 0 417659 45481 Michael Robinson 50.00 X X 0 603955 71609 Peter B Cleal 6.00 X X 0 0 0 Sr Victoria V Segura MD CBS 50.00 X X 0 0 0 Allen Goolsby 6.00 X 0 0 0 Peter F Gallagher 50.00 X 0 479986 72617 Peter J Bernard 50.00 X 0 1248815 174770 Charles F Malloy 50.00 X 0 217668 11546 Michael Spine 50.00 X 0 400284 43214 Bonnie M Shelor 50.00 X 0 332400 44799 Jill Kennedy 50.00 X 0 220242 31915 Virginia J Stephens 50.00 X 159951 0 22859 Betty Edloe-Drummond 50.00 X 145578 0 22201 Katina Fletcher 50.00 X 130191 0 25585 Carl M Scott 50.00 X 126756 0 7150 Stacy Coleman 50.00 X 119253 0 14779 Teresa Edwards 0.00 X 0 25357 0 Michael Kerner 0.00 X 0 940681 126469 681729 5965749 792337 11 1 1 0 Professional Emergency Care Inc 38935 Ann Arbor Road Livonia MI 48150 Emergency Room physicians 1355447 Alliance Recruiting Resources 2708 Halifax Court McKinney TX 75070 Temporary physician staffing 912604 Aramark CTS Inc 12483 Collections Center Drive Chicago IL 60693 Clinical technology services 550018 Colonial Orthopaedics Inc 131 Jennick Drive Colonial Heights VA 23834 Physicians 443625 Linas & Associates 9014 Norwick Road Richmond VA 23229 Anesthesia physicians 358599 16 26796 52340 79136 Patient Svc Revenue 622110 53186883 53186883 53186883 28 28 133731 5438 128293 128293 128293 Cafe & vending 722212 167477 167477 Joint Venture 900099 21823 21823 Purchased Discounts 900099 5064 5064 10334 10334 204698 53599038 53186883 0 333019 15396202 13856582 1539620 2178484 1960636 217848 1071903 964713 107190 199889 179900 19989 5893 5304 589 2782060 2503854 278206 10581 9523 1058 154123 138711 15412 825611 743050 82561 48814 43933 4881 9122 8209 913 133636 120272 13364 1539628 1385665 153963 543106 488795 54311 Purchased Services 11184966 10066470 1118496 Supplies - medical exp. 9026275 8123648 902627 Bad Debt 5493229 5493229 Rental Equipment 802855 722570 80285 BSHSI Corporate Dues 780120 702108 78012 1651213 1486090 165123 53837710 49003262 4834448 0 5595169 6751208 824490 979112 746233 189656 35429422 26207084 9100010 9222338 93512 13749 614295 548689 16987458 17691003 1478690 2059106 103587 43730993 44041346 45313270 46100452 X -28339562 -28409449 13750 0 -28325812 -28409449 16987458 17691003 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 5893 5893 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Richmond Community Hospital paid dues to the American Hospital Association (AHA), the Virginia Healthcare and Hospital 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 for AHA ($2,891 or 23.76%), VHHA ($2,665 or 23.07%) and CHA ($337 or 4.68%) for a total of $5,893. 463022 463022 10813897 5657752 5156145 162706 49221 113485 22932142 20102234 2829908 1057655 397877 659778 9222338 Due to Affiliates 2584429 Other Liabilities 312374 Due to BSHSI 41144543 44041346 Part X: Description of Uncertain Tax Positions Under FIN 48: 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. As the organization does not conduct a separate audit of its financial statement, 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 $98,300 and $117,200 of net operating loss carryforwards as of August 31, 2010 and 2009, respectively, which expire in varying periods through 2030 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2010 and 2009. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of change. 1 1 1 X 1 X 1 1 1 0 1 1 4871269 260348 4610921 0.09540 12595175 9328224 3266951 0.06760 0.00000 17466444 9588572 7877872 0.16300 0.00000 0.00000 0.00000 0.00000 0.00000 17466444 9588572 7877872 0.16300 2 800 311057 311057 0.00640 2 800 311057 311057 0.00640 1 1325484 10096262 11233051 -1136789 X 1 1 NA Richmond Community Hospital Inc

8580 Magellan Parkway Building IV Richmond VA 23227

X X X Part I, Line 6a: Bon Secours Richmond Health System (BSRHS) annually develops a report to 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 published 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. Line 7, Column F: Current year bad debt expense not included in the calculation for line 7, column f: $5,493,229. 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 hospitals 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 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 patients ability to pay or the hospitals ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publically insured patients where reimbursement is less than cost of providing the service. 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 patients 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 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 approval. 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 Virginia Health System, Richmond Community Hospital uses multiple approaches to assess the health needs of the community 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 Richmond Community Hospital (RCH). 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.Understanding that dental issues were a major health concern for the uninsured, Bon Secours Richmond Health System entered into a partnership with Richmond City Health District to provide dental care through its Richmond Smiles Mobile Dental Van. Beginning in December 2009, the van provides free dental services to uninsured patients on the campus of Richmond Community Hospital. During FY 10, 216 patient visits were provided on the campus of RCH.In June 2010, Bon Secours Virginia Health System in collaboration with Richmond Community Hospital partnered with 12 providers including a federally qualified health clinic, four free clinics, five private physician practices, a home-health program and the Richmond Health Department to submit a letter of intent for the Beacon Community Cooperative Agreement Program. The proposed project is titled East End Beacon Community Project. The purpose of the grant is to reduce health disparities in the area specifically in the areas of infant mortality, childhood obesity and diabetes. Part VI, Line 3: Richmond Community Hospital is committed to ensuring access to health care services for all. As a health care provider, Richmond Community treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout scheduling, admission, delivery of services, discharge, billing and collection processes. Richmond Community addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with Medicaid and State Child Health Insurance Program (SCHIP) enrollment, and free community-based preventive and primary care services. Richmond Community Hospital proactively screens and assists in enrollment activities for individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program (FAP). Potentially eligible patients are referred to the Patient Financial Assistance Department for assistance in completing the documentation required to establish eligibility in, and apply for, government insurance programs or the FAP. Patients who qualify for the Bon Secours Financial Assistance Program receive a CareCard which allows them to seek healthcare services with ease and dignity. The CareCard is good for one year.The public receives education on the financial assistance program at the point of registration, from brochures, in patient letters, on the Bon Secours Richmond website, via Free Clinics in the Richmond Metropolitan area and through community presentations. Information is available in English and Spanish. Collection practices incorporate opportunities for eligible patients to apply for financial assistance. Any collection attorneys or agencies used by Richmond Community Hospital commit to follow Bon Secours Richmond Health Systems value-based procedures, including, without limitation, the Bon Secours Health System Inc./Bon Secours Richmond Health System Code of Conduct, in pursuit of estates, garnishments and judgments for non-payment. Part VI, Line 4: Bon Secours Richmond Community Hospital serves the greater Richmond area. Projections indicate that the population will grow by 5.6% from 877,389 in 2009 to 926,752 in 2014, with 9.7% of the service area having a household income of less than $15,000 per year, compared to the national average of 12.4%. Similarly, 18.2% of the service areas populace maintains a household income less than $25,000 per year, compared to the national average of 22.8%. Demographic data shows that 59.1% of the population is white and 31.4% is black, compared to the national averages of 65.0% and 12.2% respectively. Demographics of the service area indicate that the age cohort of 64 to 75 will increase by 31% between 2009 and 2014. Richmond Community Hospital is located in a medically underserved area, a health professional shortage area and is a disproportionate share hospital.In fiscal year 2010, Richmond Community Hospital served 2,784 inpatients and provided outpatient services for 18,549 visits. Additionally, RCH provided 31,921 emergency room visits. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. RCH 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 5: BSRHS is working to engage and empower the members of Church Hill/East District, which is the community where Bon Secours Richmond Community Hospital is located. Church Hill is an historic part of the Richmond City landscape, however, the East District of Church Hill has fallen victim to many socio-economic challenges. Four of the city's largest Section VIII housing complexes are located in the East District. The community does not have access to healthy food or fitness options and it is common to see youth loitering without any positive extracurricular outlets.A Bon Secours Richmond Community Hospital Liaison of Healthy Communities has been working in the neighborhood since 2009 to coordinate efforts, to unite the community as well as to aid in health and social issues. The liaison was instrumental in relationship building to generate interest and participation the East End Transformation Charrette.In June 2010, Bon Secours Virginia Health System and the Richmond Community Hospital leadership in collaboration with Dunany Plater Zyberk & Company (DPZ), a leading proponent of traditional town planning and New Urbanism hosted an East End Transformation Charrette. Beginning with the public/private partnership of the City of Richmond, Bon Secours Virginia Health System and the Richmond Redevelopment and Housing Authority and extending to more than 800 people who participated in the opening and closing sessions, the hundreds of citizens who joined sessions throughout the week, representatives from neighborhood residential associations, business owners, foundations and corporations, as well the families and students who participated in the youth charrette, many points of view were shared. Designers worked throughout the week to illustrate the historic integrity of the neighborhood and current best practices in neighborhood planning. The leading projects that emerged through the charrette include new learning centers along 25th Street, a supermarket, hospital services expansion, a new gateway to the city along Nine Mile Road, improved pedestrian and bicycle access to downtown Richmond, and enhanced streetscapes throughout. Part VI, Line 6: Richmond Community Hospital has an open medical staff with privileges available to all qualified physicians in the area. Richmond Community Hospital through the Bon Secours Richmond Health System is governed by a board of directors whose composition is representative of the community with 75% comprised of independent members of the community. Richmond Community Hospital engages in medical research. Inpatient and outpatient research-related activities are conducted by Richmond Community with oversight from the Bon Secours Richmond Health System Institutional Review Board. The Care-A-Vans are mobile health care clinics, which travel throughout the Richmond Metro area to provide free primary, urgent and preventive care to patients. Patients on these vans speak many different languages. Approximately one-third of the Care-A-Vans staff are bilingual in English and Spanish. Each van is a self-contained mobile clinic with examining rooms, storage, bathroom, and waiting area. Services include health screenings, childhood immunizations, flu shots for adults, school physicals for uninsured children and examination and treatment of sick patients who are uninsured. 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 9,340 patient visits in FY 10 of which approximately 5,083 were in the Richmond Community Hospitals primary service area. Bon Secours Richmond Health System partnered with the Daily Planet, a federally qualified health center and St. Josephs Villa for Children, a not-for-profit organization serving children with special needs, at risk youth, and adults with disabilities to create St. Josephs Outreach Clinic. The clinic provides primary care services to both the insured and the uninsured and serves a large Hispanic population. In FY 10, 5,099 patient visits were provided. St. Josephs Outreach Clinic resides in the primary service area of Richmond Community Hospital. The Asthma & Allergy Foundation of America designated Richmond, Virginia as the 2010 Asthma Capital of the United States. 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 10 over 2,332 children, parents, teachers and physicians were directly served through CARMAs services. Every Womens 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. BSRHS holds clinics in three facilities in the Richmond Metro area. Additionally, BSRHS provides case management, follow-up and patient education for these women. In FY10, 704 screenings were provided of which 136 were provided at Richmond Community Hospital and 251 at Laburnum Diagnostic Center which is affiliated with RCH. To address the issue of high infant mortality in the Richmond Community Hospital service area, Healthy Beginnings was initiated. Healthy Beginnings is a resource center located on the campus of Richmond Community Hospital. The program targets teenage and young adults who are pregnant or considering pregnancy. BSRHS 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. Two BSRHS outreach specialists enrolled or re-enrolled over 455 children in FAMIS or Medicaid in FY 10.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 209 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 Richmond Community Hospital Emergency Department. 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 461 books in FY 2010 to children at Richmond Community Hospital Emergency Department. Part VI, Line 7: 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. The community benefit contribution of BSRHS, which is comprised of Bon Secours Memorial Regional Medical Center, Bon Secours St. Francis Medical Center, Bon Secours Richmond Community Hospital, and St. Mary's Hospital of Richmond, includes programs and partnerships working to improve access to health care, the quality of life and holistic health of the BSRHS communities. The mission of BSRHS is to provide compassionate quality healthcare services to those in need including the poor and dying for the purpose of alleviating human suffering and bringing people to wholeness in the midst of pain and loss. This ambition is embraced not only by the doctors and nurses providing exceptional quality care in the acute care facilities, but also by all of the employees working to improve the access to care and quality of life for those in need who live in the BSRHS community.BSRHS is comprised of four acute care hospitals with a total of 850 licensed beds. Bon Secours St. Mary's Hospital is a 391 licensed bed facility located in the West End. Bon Secours Memorial Regional Medical Center is a 225 licensed bed facility located north of the city and is the only acute care facility in Hanover County. Bon Secours Richmond Community Hospital is a 104 bed acute care facility located in the East End, a medically underserved area. Both Bon Secours Richmond Community Hospital and Bon Secours St. Mary's Hospital are disproportionate share hospitals. Bon Secours St. Francis Medical Center, a 130 bed facility, is BSRHS only hospital south of the James River. Transforming the delivery of healthcare through the development of an innovative delivery system and through partnerships with community resources, physicians and payers, BSRHS seeks to improve community health and access to care for those in need. BSRHS mission and vision are implemented through the daily work of thousands of employees, physicians, and volunteers. BSRHS has numerous staff dedicated specifically to assist in the community benefit effort. As of August 31, 2010, BSRHS employed over 15 full time employees specifically dedicated to community benefit programs and community building activities. Bon Secours Richmond Health System is a prophetic voice for just and equitable public policies that ensure access to basic human goods for all people. The hospital system continues to lead the fight for a fair/living wage by insisting that the lowest paid workers be paid at $8.50 an hour instead of the minimum wage of $7.25 an hour. VA X X X X X 0 1 0 0 0 0 0 0 0 Mark Gordon 0 335043 0 235710 0 110965 0 33893 0 25512 0 741123 0 0 Toni Ardabell 0 262501 0 42000 0 92483 0 16500 0 1438 0 414922 0 0 Thom Morris PhD 0 225765 0 157345 0 34549 0 35338 0 10143 0 463140 0 0 Michael Robinson 0 369198 0 207071 0 27686 0 47385 0 24224 0 675564 0 0 Peter F Gallagher 0 350924 0 127502 0 1560 0 47344 0 25273 0 552603 0 0 Peter J Bernard 0 696077 0 547034 0 5704 0 146706 0 28064 0 1423585 0 0 Charles F Malloy 0 173756 0 43580 0 332 0 3060 0 8486 0 229214 0 0 Michael Spine 0 296808 0 90338 0 13138 0 17351 0 25863 0 443498 0 0 Bonnie M Shelor 0 246321 0 84334 0 1745 0 37141 0 7658 0 377199 0 0 Jill Kennedy 0 172979 0 46909 0 354 0 9204 0 22711 0 252157 0 0 Virginia J Stephens 150651 0 9163 0 137 0 0 0 22859 0 182810 0 0 0 Betty Edloe-Drummond 140843 0 3002 0 1733 0 4238 0 17963 0 167779 0 0 0 Katina Fletcher 128978 0 906 0 307 0 2834 0 22751 0 155776 0 0 0 Teresa Edwards 0 0 0 25357 0 0 0 0 0 0 0 25357 0 0 Michael Kerner 0 467646 0 290947 0 182088 0 99435 0 27034 0 1067150 0 0 Part I, Line 4b: Richmond Community Hospital 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 on deposits are made into this plan. Supplemental Information Part III Part I, line 3: Bon Secours Health System, Inc., a related organization of Richmond Community Hospital, 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 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 Richmond Community Hospital, Inc. Form 990, Part VI, Section A, line 7a The governing body of Richmond Community Hospital, Inc. is appointed by its 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 Richmond Community Hospital, 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 Bon Secours Richmond Health System's audit and compliance board committee and providing the form to the Richmond Community Hospital board of directors to allow for a thorough review by both before the filing date of July 15, 2011. Bon Secours Richmond Health System's audit and compliance board committee and Richmond Community Hospital's board of directors will review the Form 990 and ask any additional questions regarding the Form 990 before the return is filed July 15, 2011. Form 990, Part VI, Section B, line 12c Richmond Community Hospital 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 Richmond Community Hospital. 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 participates 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. engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of Richmond Community Hospital, as well as other officers, key employees and highest paid employees. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure the reasonableness of compensation paid to executives and disqualified parties. The committee maintains a Board-approved 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 reported to the BSHSI Board of Directors and documented in the BSHSI compensation committee minutes. Form 990, Part VI, Section B , Line 15b - Compensation Process Other Officers/ Key Employees: For those officers, 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 other officers or key employees of Ricmond Community Hospital were compared to other hospitals' employees in the area that hold the same title. 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 Richmond Community 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 officer's and director's 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. 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 of Richmond Health System and related organizations and includes the monitoring and oversight of all of Bon Secours Virginia Health System in total. Peter F. Gallagher's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization. The compensation he receives is for his role as CFO of Bon Secours Virginia Health System. Toni Arabell's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the CEO of St. Mary's Hospital of Richmond, Inc. Thom Morris, Phd's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Director, Mission and Sponsorship of Bon Secours Health System, 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 CEO of Bon Secours - St. Francis Medical Center. 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 CEO of Richmond Community Hospital, Inc. and Memorial Regional Medical Center, Inc. Michael Spine's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization. The compensation he receives is for his role as the Bon Secours Richmond Health System Senior Vice President Business Development. Bonnie Shelor's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization. The compensation she receives is for her role as the Bon Secours Virginia Health System Senior Vice President Human Resources. Jill Kennedy's compensation is paid by Memorial Regional Medical Center, Inc., a related organization. The compensation she receives is for her role as the Chief Nursing Executive of Memorial Regional Medical Center, Inc. and Richmond Community Hospital, Inc. Charles F. Malloy's compensation is paid by Memorial Regional Medical Center, Inc., a related organization. The compensation he receives is for his role as the Chief Operating Officer of Memorial Regional Medical Center, Inc. and Richmond Community Hospital, Inc. Sr. Victoria V. Segura and Sr. Anne Marie Mack do not receive payroll distributions as they have taken vows of poverty. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11, Type II: 50 N/A Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) Line 11, Type II: 50 N/A Bon Secours Richmond Health Corporation 8580 Magellan Parkway Richmond VA 23227 541356155 Management Services VA 501(c)(3) Line 11, Type II: 50 N/A Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3: 170(b)(1)(a) N/A Bon Secours - St Mary's Hospital of Richmond Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3: 170(b)(1)(a) N/A Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) Line 7: 170(b)(1)(a) N/A Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3: 170(b)(1)(a) N/A Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) N/A N/A Bon Secours Stuart Circle Hospital 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) Line 3: 170(b)(1)(a) N/A Community Health Alliance 2201 West Broad Street No 202 Richmond VA 23220 113671164 Providing for the health care needs of the underserved VA 501(c)(3) Line 7: 170(b)(1)(a) N/A Richmond Community Hospital Foundation 5875 Bremo Road Richmond VA 23226 541780854 Grant Making Foundation VA 501(c)(3) Line 11, Type III: 5 N/A St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA N/A Related 0 0 RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Related 0 0 Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Related 0 0 Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A Related 0 0 CCHC Ironbridge Realty LLC 8580 Magellan Parkway Richmond VA 23227 300181909 Rental - Land VA N/A Related 0 0 Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental - Medical Office Building VA N/A Related 0 0 Mental HealthSource LLC 8580 Magellan Parkway Richmond VA 23227 541785409 Behavioral Health Services VA N/A Related 0 0 Richmond Community Hospital MOB I LLC 435 Southlake Blvd Richmond VA 23236 541848514 Rental - Land VA N/A Related 0 0 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA N/A C RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA N/A C Bon Secours - Virginia Healthsource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA N/A C Ironbridge Assisted Living Retirement Community 8580 Magellan Parkway Richmond VA 23227 541807857 Assisted Living Facility VA N/A C Richmond Radiation Oncology Center Inc 8580 Magellan Parkway Richmond VA 23227 541570244 Oncology Services VA N/A C Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA N/A C Central Virginia Health Network Inc 2201 West Broad Street Richmond VA 23220 541806281 Healthcare Support Services VA N/A C Bon Secours at Wellesley Owners Assocation Inc 8580 Magellan Parkway Richmond VA 23227 541938077 Real Estate VA N/A C 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 NONE