2024-08-05T10:27:58-05:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2022-10-01 814446403 REHAB JV LLC DBA SHELTERING ARMS INSTITUTE REHA 8048774000 2000 WILKES RIDGE DR RICHMOND VA 23233 JAMES S LITSINGER CFO 8048774000 2024-08-02 1 1 JOHN NORMAN P01506766 7049985200 2024-07-31 2022 2024-08-08 14:25:15Z ALAN LOMARDO 2000 WILKES RIDGE DR RICHMOND VA 23233 81599451 0 X HTTPS://SHELTERINGARMSINSTITUTE.COM X LLC 2016 VA SHELTERING ARMS INSTITUTE (SAI) WAS CREATED AS A COLLABORATION BY SHELTERING ARMS HOSPITAL AND VCU HEALTH TO REINVENT REHABILITATION FOR LIFE BEYOND LIMITS.AS A NATIONAL LEADER IN REHABILITATION MEDICINE, SAI DELIVERS PERSONALIZED CARE IN AN ENVIRONMENT THAT SUPPORTS RECOVERY AND RESTORES POSSIBILITY THROUGH THE INTEGRATION OF COLLABORATIVE SCIENCE AND RESEARCH, INTER-PROFESSIONAL EDUCATION, COMMUNITY ENGAGEMENT, AND STEWARDSHIP. ACROSS THE DISCIPLINES, THERE IS A CONSISTENT AND INTENTIONAL ORGANIZATIONAL CULTURE FOCUSED ON PROPELLING PATIENT OUTCOMES AND TRANSFORMING THE COURSE OF REHABILITATION MEDICINE. 13 13 819 0 0 0 4019418 979251 67239154 80620200 0 0 0 0 71258572 81599451 0 0 0 0 34775921 53424050 0 0 0 32803512 30433854 67579433 83857904 3679139 -2258453 27439914 79285380 22912924 77016843 4526990 2268537 X SHELTERING ARMS INSTITUTE (SAI) WAS CREATED AS A COLLABORATION BY SHELTERING ARMS HOSPITAL AND VCU HEALTH TO REINVENT REHABILITATION FOR LIFE BEYOND LIMITS.AS A NATIONAL LEADER IN REHABILITATION MEDICINE, SAI DELIVERS PERSONALIZED CARE IN AN ENVIRONMENT THAT SUPPORTS RECOVERY AND RESTORES POSSIBILITY THROUGH THE INTEGRATION OF COLLABORATIVE SCIENCE AND RESEARCH, INTER-PROFESSIONAL EDUCATION, COMMUNITY ENGAGEMENT, AND STEWARDSHIP. ACROSS THE DISCIPLINES, THERE IS A CONSISTENT AND INTENTIONAL ORGANIZATIONAL CULTURE FOCUSED ON PROPELLING PATIENT OUTCOMES AND TRANSFORMING THE COURSE OF REHABILITATION MEDICINE. 0 0 70658753 80620200 IN JUNE 2020, SAI OPENED A 114-BED REHABILITATION HOSPITAL IN RICHMOND, VIRGINIA. THE HOSPITAL AND ITS CLINICIANS PROVIDE EXCEPTIONAL CARE IN ONE PLACE FOR INDIVIDUALS WHO HAVE SURVIVED STROKES, SPINAL CORD INJURIES, BRAIN INJURIES, AS WELL AS THOSE IN NEED OF GENERAL REHABILITATION FOR A VARIETY OF ILLNESSES AND INJURIES. AT THE HOSPITAL, PATIENTS HAVE ACCESS TO ADVANCED THERAPEUTIC TECHNOLOGIES IN A 9,251 SQUARE FOOT MAIN GYM, AS WELL AS OTHER SATELLITE GYMS. DURING FISCAL YEAR 2022-2023, THE HOSPITAL SERVED 2,362 PATIENTS FROM AROUND VIRGINIA AND THE MID-ATLANTIC REGION.(CONTINUED ON SCHEDULE O)IN JULY 2022, SAH DONATED ITS SEVEN OUTPATIENT PHYSICAL REHABILITATION CENTERS TO SAI, PROVIDING PATIENTS ACCESS TO A SEAMLESS CONTINUUM OF CARE. SINCE THEN, SAI HAS OPENED AN OUTPATIENT PHYSICAL REHABILITATION CENTER IN THE HOSPITAL, BRINGING THEIR TOTAL NUMBER OF OUTPATIENT PHYSICAL REHABILITATION CENTERS TO EIGHT. THE OUTPATIENT CENTERS ARE LOCATED THROUGHOUT THE METRO RICHMOND AREA AND SERVE PATIENTS FROM ACROSS CENTRAL VIRGINIA. SERVICES OFFERED AT THESE CENTERS INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY, AS WELL AS ACCESS TO ADVANCED THERAPEUTIC TECHNOLOGIES. DURING FISCAL YEAR 2022 2023, THE OUTPATIENT CENTERS SERVED 10,284 PATIENTS, WHO RECEIVED A COMBINED TOTAL OF 115,346 OUTPATIENT VISITS.IN AUGUST 2023, SAI WAS RECOGNIZED BY U.S. NEWS & WORLD REPORT IN ITS 2023-2024 BEST HOSPITALS. THE RANKINGS ASSIST PATIENTS AND THEIR DOCTORS IN CHOOSING THE RIGHT HOSPITAL FOR THEM. IN ITS FIRST YEAR ELIGIBLE AND OF THE 1,041 PHYSICAL REHABILITATION HOSPITALS THAT WERE EVALUATED, SHELTERING ARMS INSTITUTE RANKED 29TH IN THE COUNTRY IN THE PHYSICAL REHABILITATION SPECIALTY AND IS THE TOP REHABILITATION HOSPITAL IN THE STATE OF VIRGINIA.THROUGH EDUCATIONAL AFFILIATIONS, INCLUDING A PHYSICIAN RESIDENCY PROGRAM WITH THE DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION AT VCU HEALTH, SAI IS INFLUENCING THE PRACTICES AND DIVERSITY OF THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS IN REHABILITATION MEDICINE. A COLLABORATIVE APPROACH TO RESEARCH, INCLUDING ACTIVE PARTNERSHIPS WITH VCU HEALTH'S CENTER FOR REHABILITATION SCIENCE AND ENGINEERING AND THE CENTRAL VIRGINIA VETERANS HEALTHCARE SYSTEM, CREATES A RESOURCE-RICH ENVIRONMENT THAT CAN SUPPORT PROGRAMS LIKE THE TRAUMATIC BRAIN INJURY (TBI) AND SPINAL CORD INJURY (SCI) MODEL SYSTEMS, WHICH ARE FUNDED BY FEDERAL GRANTS. THE PURSUIT OF BETTER PATIENT OUTCOMES INCLUDES PRODUCING CLINICAL RESEARCH, AS WELL AS TRANSLATING RESEARCH KNOWLEDGE INTO CLINICAL PRACTICE GUIDELINES USED BY OUR CLINICIANS. AS AN EXAMPLE OF KNOWLEDGE TRANSLATION, RESEARCH SHOWS THAT LONG-TERM PATIENT OUTCOMES IMPROVE THROUGH SUPPORTIVE RELATIONSHIPS WITH COMMUNITY PARTNER ORGANIZATIONS. TO FACILITATE THE DEVELOPMENT OF THOSE RELATIONSHIPS, COMMUNITY PARTNER GROUPS ARE REGULARLY ON-SITE AS A RESOURCE FOR PATIENTS AND THEIR FAMILIES. THE RESOURCES INCLUDE PEER MENTORING, ADAPTIVE SPORTS CLINICS, ADAPTIVE TECHNOLOGIES AS WELL AS DONATED MOBILITY EQUIPMENT FOR PATIENTS WHO QUALIFY. THE ORGANIZATION IS ALSO FOCUSED ON IMPROVING PATIENT OUTCOMES THROUGH DIVERSITY, EQUITY, AND INCLUSION (DEI) INITIATIVES. THIS INCLUDES CREATING AND MAINTAINING A WORK ENVIRONMENT THAT ATTRACTS AND RETAINS CLINICIANS AND LEADERS FROM DIVERSE BACKGROUNDS THAT REPRESENT OUR PATIENT BASE. WITH PARTNERS LIKE VIRGINIA COMMONWEALTH UNIVERSITY AND HAMPTON UNIVERSITY, AN HBCU LOCATED IN HAMPTON, VIRGINIA, SAI PARTICIPATES IN WORKFORCE DEVELOPMENT PROGRAMS TO IMPROVE MINORITY REPRESENTATION IN THE RANKS OF REHABILITATION PROFESSIONALS. THE INSTITUTE IS ALSO COMMITTED TO BETTER UNDERSTANDING THE LONG-TERM OUTCOMES FOR ALL REHABILITATION PATIENTS. BY ANALYZING DATA COLLECTED BY RESEARCH PARTNERS, THE INSTITUTE SEEKS TO UNDERSTAND AND REMOVE BARRIERS SO PATIENTS CAN ACHIEVE THE BEST POSSIBLE OUTCOMES. SAI HAS MORE THAN 500 CLINICAL TEAM MEMBERS, WHICH INCLUDES PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, RECREATION THERAPISTS, SPEECH-LANGUAGE PATHOLOGISTS, AND NURSES, AS WELL AS A TEAM OF PHYSICIANS. THERE IS ALSO A FULL COMPLEMENT OF SUPPORT SERVICES AT THE HOSPITAL, SUCH AS LABORATORY, RADIOLOGY, RESPIRATORY THERAPY, AND PHARMACY. 70658753 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 42 0 1 819 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X JAMES S LITSINGER 8043424340 8226 MEADOWBRIDGE ROAD MECHANICSVILLE VA 23116 LAWRENCE GIBSON CHAIRMAN 1.00 4.00 X 0 0 0 DAVID CIFU DIRECTOR 1.00 4.00 X 0 0 0 ILVY COTTERRELL DIRECTOR 1.00 4.00 X 0 0 0 ASHBY HACKENY DIRECTOR 1.00 4.00 X 0 0 0 MICHAEL RYAN RAISIG DIRECTOR 1.00 4.00 X 0 0 0 MICHAEL ROUSSOS DIRECTOR 1.00 4.00 X 0 0 0 PAUL WESOLOWSKI DIRECTOR 1.00 4.00 X 0 0 0 LESLIE WYATT DIRECTOR 1.00 4.00 X 0 0 0 PETER ZEDLER DIRECTOR 1.00 4.00 X 0 0 0 KARAH GUNTHER VICE CHAIR 1.00 4.00 X 0 0 0 DIANNE V JEWELL PRESIDENT & CEO SAH 8.00 32.00 X 0 0 0 JAMES S LITSINGER CFO & TREASURER 30.00 10.00 X 232922 0 14776 ALAN LOMBARDO PRESIDENT & CEO SAI 40.00 8.00 X 475978 0 101624 MISTY WOODWARD CNO 40.00 0.00 X 242981 0 28345 MATTHEW WILKS CRO 40.00 0.00 X 237085 0 29403 LINDA TIEMENS VP OF QUALITY 35.00 5.00 X 206749 0 14817 TANZA WESTRY AVP OF OPERATIONS 40.00 0.00 X 155313 0 14965 MELISSA BANTA DIRECTOR OF THERAPY 40.00 0.00 X 134106 0 16889 WAYNE CAMPBELL NURSE 40.00 0.00 X 132004 0 25792 SUSAN HAMILTON DIRECTOR OF NURSING 40.00 0.00 X 131879 0 14728 JOANNA MOORE DIRECTOR OF THERAPY 40.00 0.00 X 130514 0 22824 PAMELA MCGEE NURSE MANAGER 40.00 0.00 X 130414 0 6742 2209945 0 290905 37 0 1 0 VCU HEALTH SYSTEM 57 N 11TH STREET RICHMOND VA 23298 ANCILLARY & PHYSICIAN SERVICES 4461612 LINCOLN RETIREMENT SERVICES CO 325 HOPPING BROOK ROAD HOLLISTON MA 01746 EMPLOYEE BENEFITS 3357394 SHELTERING ARMS CORPORATION 8226 MEADOWBRIDGE RD MECHANICSVILLE VA 23116 ADMINISTRATIVE/ IT 2663857 ABM HEALTH INC 711 MOOREFIELD PARK DR RICHMOND VA 23236 FNS/EVS MANAGEMENT 2363492 CERNER CORPORATION 8779 HILLCREST RD KANSAS CITY MO 64138 IT SERVICES 1251349 16 114787 864464 574685 979251 NET PATIENT SERVICE REVENUE 621400 79804318 79804318 SHARED SERVICES 541900 532455 532455 FOOD SERVICE REVENUE 722514 144334 144334 MEDICARE COST REPORT REVENUE 621400 139093 139093 80620200 81599451 80620200 0 0 992739 992739 43270259 37234589 6035670 1308771 1225883 82888 4676134 3947563 728571 3176147 2699725 476422 114395 65566 48829 162378 93067 69311 641544 367702 273842 420276 348958 71318 1290620 1212780 77840 4075976 3384312 691664 6980132 5795653 1184479 63608 52814 10794 645421 528781 116640 2302034 1868211 433823 355351 295050 60301 PURCHASED SERVICES 7025458 6260118 765340 PATIENT SUPPLIES 5974105 4960342 1013763 EQUIPMENT 313297 260133 53164 69259 57506 11753 83857904 70658753 13199151 0 5669593 3482060 9412781 11930627 307997 255996 979942 1154577 15578016 6233808 10917047 9344208 152554 53117912 27439914 79285380 6367045 7453422 11300000 11300000 5245879 58263421 22912924 77016843 X 4526990 2268537 4526990 2268537 27439914 79285380 -2258453 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 568307 210890 357417 14643869 5847149 8796720 365840 175769 190071 9344208 RIGHT OF USE ASSET 53017542 INTERCOMPANY 100370 53117912 RIGHT OF USE LIABILITY 53017542 ESTIMATED THIRD PARTY PAYMENTS 5245879 58263421 X 81599451 0 81599451 0 81599451 83857904 0 83857904 0 83857904 PART X, LINE 2: U.S. GAAP REQUIRES SAI'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY SAI AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF SAI HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE THAN LIKELY WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. SAI'S MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY SAI AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR AN ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. SAI IS SUBJECT TO AUDIT BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS 1 1 X 1 X 1 X 1 1 0 0 2340086 2340086 0.02790 11768305 11158052 610253 0.00730 14108391 11158052 2950339 0.03520 732560 732560 0.00870 298660 298660 0.00360 1031220 1031220 0.01230 15139611 11158052 3981559 0.04750 1 524258 27288328 27584192 -295864 X 1 1 1 1 SHELTERING ARMS INSTITUTE 2000 WILKES RIDGE DRIVE RICHMOND VA 23233 HTTPS://SHELTERINGARMSINSTITUTE.COM H0201 X PHYSICAL REHABILITATION HOSPITAL SHELTERING ARMS INSTITUTE 1 0 0 1 X X X X X X 21 1 0 0 1 X SEE PART V X 1 21 1 SEE PART V 0 1 X 200.000000000000 250.000000000000 X X X X X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 X 0 X X X X 0 X X 0 0 SCHEDULE H, PART V, SECTION B, LINES 7B AND 10A HTTPS://SHELTERINGARMSINSTITUTE.COM/SHELTERING-ARMS-INSTITUTE-BROCHURE SCHEDULE H, PART V, SECTION B, LINES 16A-C HTTPS://SHELTERINGARMSINSTITUTE.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-FEES PART I, LINE 7: COLUMN F REFLECTS THE CHARITY AND FINANCIAL ASSISTANCE AT COST AND OTHER COMMUNITY BENEFITS AS A PERCENTAGE OF THE TOTAL FUNCTIONAL EXPENSES IN PART IX, COLUMN A, LINE 25 OF THE FORM 990. PART II, COMMUNITY BUILDING ACTIVITIES: AS PART OF OUR COMMITMENT TO LIFELONG CARE, OUR OUTPATIENT PHYSICAL REHABILITATION CENTERS PROVIDE A SEAMLESS STREAM OF CARE AFTER PATIENTS ARE DISCHARGED FROM OUR HOSPITAL. PART III, LINE 2: THE AMOUNT REPORTED HERE REPRESENTS AMOUNTS DEEMED TO BE UNCOLLECTIBLE THAT WERE WRITTEN OFF DURING THE FISCAL YEAR. PART III, LINE 4: SAI PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT FROM STANDARD CHARGES. PATIENTS WHO ARE COVERED BY THIRD PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE. SAI ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS FIGURE WAS OBTAINED FROM THE FISCAL YEAR 2022-2023 MEDICARE COST REPORTY PART III, LINE 9B: PATIENTS MAY APPLY RETROACTIVELY FOR FINANCIAL ASSISTANCE FOR SERVICES UP TO 60 DAYS PRIOR. IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE AND ALL OTHER PROGRAMS HAVE BEEN EXHAUSTED FOR PAYMENT ASSISTANCE, A PAYMENT PLAN ARRANGEMENT MAY BE MADE. BALANCES DESIGNATED BY THIRD-PARTY PAYERS AS PATIENT RESPONSIBILITY WILL BE ASSIGNED TO THE PATIENT BALANCE SEGMENT IN THE SHELTERING ARMS HOSPITAL BILLING SYSTEM. QUALIFYING PATIENT RESPONSIBLE BALANCES WILL BE BILLED DIRECTLY TO THE PATIENT BY SHELTERING ARMS. IF PAYMENT IS NOT RECEIVED WITHIN 60 DAYS, ANY UNPAID BALANCES WILL BE FORWARDED TO OUR FIRST-OUT VENDOR FOR CONTINUING COLLECTION EFFORTS TO INCLUDE PATIENT PAYMENT PLANS. ANY UNSETTLED BALANCES REMAINING AFTER A TOTAL OF 120 DAYS AFTER THE FIRST ASSIGNMENT OF BALANCES WILL BE SENT TO OUR COLLECTION AGENCY AND REMOVED FROM OUR ACTIVE ACCOUNTS RECEIVABLE AS BAD DEBT. IF THE COLLECTION AGENCY SUCCESSFULLY COLLECTS THE BALANCES, THE PATIENT ACCOUNT WILL BE REACTIVATED IN OUR ACCOUNTS RECEIVABLE SYSTEM AND THE BAD DEBT WILL BE REVERSED AND CODED AS RECOVERY. IF THE COLLECTION AGENCY IS UNSUCCESSFUL WITH COLLECTIONS AND HAS NO PAYMENT ARRANGEMENT OR A BROKEN PAYMENT ARRANGEMENT, THE ACCOUNT CAN BE PULLED BACK FROM THE COLLECTION VENDOR, THE BAD DEBT STATUS WILL REMAIN, AND COLLECTION EFFORTS WILL CEASE. PART VI, LINE 2: A HOSPITAL ORGANIZATION MUST MEET THE REQUIREMENTS OF SECTION 501(R)WITH RESPECT TO A NEW HOSPITAL FACILITY IT OPERATES BY THE LAST DAY OF THE SECOND TAXABLE YEAR BEGINNING AFTER THE DATE THE FACILITY WAS LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY ITS STATE AS A HOSPITAL. SINCE THE INSTITUTE'S NEW FACILITY WAS LICENSED IN JUNE OF 2020, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN ITS TAXABLE YEAR ENDING SEPTEMBER 30, 2022.THERE WERE TWO VERSIONS OF SURVEYS DISTRIBUTED: ONE SPECIFIC TO CONSUMERS AND ONE SPECIFIC TO HEALTH PROFESSIONALS/COMMUNITY LEADERS. THE HOSPITAL FACILITY DISTRIBUTED THE ELECTRONIC SURVEY FOR HEALTH PROFESSIONALS/COMMUNITY LEADERS VIA EMAIL TO INDIVIDUALS WHO WORK FOR LOCAL PUBLIC HEALTH DEPARTMENTS, COMMUNITY FREE CLINICS, DISEASE-SPECIFIC ASSOCIATIONS, AND TEAM MEMBERS OF THE FACILITY. IN TOTAL, 141 HEALTHCARE PROFESSIONALS WERE SURVEYED FROM ORGANIZATIONS INCLUDING: CHESTERFIELD HEALTH DISTRICT, CHICKAHOMINY HEALTH DISTRICT, RICHMOND CITY HEALTH DISTRICT, VIRGINIA DEPARTMENT OF HEALTH, BON SECOURS, BRAIN INJURY ASSOCIATION OF VIRGINIA, CENTRAL VIRGINIA VA HEALTH CARE SYSTEM, COMMONWEALTH PAIN SPECIALISTS, DEPARTMENT FOR AGING & REHABILITATIVE SERVICES, GOOCHLANDCARES, HEALING INTO POSSIBILITY, OASISSENIOR ADVISORS, PRIMARY HEALTH GROUP - HENRICO, SENIOR CONNECTIONS, UVA MEDICAL CENTER, VCU HEALTH, VIRGINIA ASSISTIVE TECHNOLOGY SYSTEM, VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES, SHELTERING ARMS, AND SHELTERING ARMS INSTITUTE. PART VI, LINE 3: SHELTERING ARMS INSTITUTE WILL WIDELY PUBLICIZE THE SHELTERING ARMS INSTITUTE FINANCIAL ASSISTANCE POLICY. INFORMATION ON FINANCIAL ASSISTANCE WILL BE PROVIDED TO PATIENTS AND THE COMMUNITY SERVED BY SHELTERING ARMS INSTITUTE. THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY WILL BE AVAILABLEON THE SHELTERING ARMS INSTITUTE' WEBSITE. SHELTERING ARMS INSTITUTE WILL PROVIDE HARD COPIES OF THE FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE POLICY TO PATIENT UPON REQUEST, IN PERSON OR BY MAIL, AND FREE OF CHARGE. FINANCIAL ASSISTANCE INFORMATION WILL BE MADE AVAILABLE IN THE PATIENT ADMISSION INFORMATION PACKAGE AND DISCHARGE PROCESS FOR ALL PATIENTS. INFORMATION ON THE POLICY AND INSTRUCTIONS ON HOW TO CONTACT SHELTERING ARMS INSTITUTE FOR ASSISTANCE WILL BE POSTED IN AREAS THAT INCLUDE, BUT ARE NOT LIMITED TO, ADMITTING AND REGISTRATION. PATIENT STATEMENTS WILL INCLUDEINFORMATION ON THE SHELTERING ARMS INSTITUTE FINANCIAL ASSISTANCE POLICY AND ON HOW AN APPLICATION FORM MAY BE OBTAINED. SHELTERING ARMS INSTITUTE WILL PROVIDE PUBLIC NOTICES YEARLY IN LOCAL NEWSPAPERS SERVING THE HOSPITAL'S TARGET POPULATION. PART VI, LINE 4: SHELTERING ARMS INSTITUTE SERVES A REGIONAL AREA INCLUDING BUT NOT LIMITED TO VIRGINIA AND SURROUNDING STATES. PRIMARY COUNTIES IN VIRGINIA SERVED INCLUDE CAROLINE, CHARLES CITY, ESSEX, HANOVER, HENRICO, KING AND QUEEN, KING WILLIAM, LANCASTER, LOUISA, MIDDLESEX, NEW KENT, NORTHUMBERLAND, RICHMOND, AND RICHMOND CITY. PART VI, LINE 7, REPORTS FILED WITH STATES VA X X X 0 0 0 0 0 0 0 1 0 ALAN LOMBARDO PRESIDENT & CEO SAI 368664 0 106504 0 810 0 82270 0 19354 0 577602 0 0 0 MISTY WOODWARD CNO 197742 0 44619 0 620 0 9585 0 18760 0 271326 0 0 0 MATTHEW WILKS CRO 192633 0 43880 0 572 0 10691 0 18712 0 266488 0 0 0 JAMES S LITSINGER CFO & TREASURER 140515 0 91335 0 1072 0 6231 0 8545 0 247698 0 0 0 LINDA TIEMENS VP OF QUALITY 163336 0 39153 0 4260 0 8426 0 6391 0 221566 0 0 0 TANZA WESTRY AVP OF OPERATIONS 139297 0 15391 0 625 0 3448 0 11517 0 170278 0 0 0 WAYNE CAMPBELL NURSE 129251 0 2500 0 253 0 7509 0 18283 0 157796 0 0 0 JOANNA MOORE DIRECTOR OF THERAPY 118965 0 11325 0 224 0 4360 0 18464 0 153338 0 0 0 MELISSA BANTA DIRECTOR OF THERAPY 121830 0 12045 0 231 0 5154 0 11735 0 150995 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON ACHIEVING PRE-ESTABLISHED PERFORMANCE OBJECTIVES FOLLOWING SAI'S COMPENSATION POLICY. X MEDICAL EQUIPMENT AND SIGNAGE 1 574685 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS, SHELTERING ARMS HOSPITAL AND VIRGINIA COMMONWEALTH UNIVERSITY HOSPITAL SYSTEM AUTHORUTY. FORM 990, PART VI, SECTION A, LINE 7A THE TWO MEMBERS EACH APPOINT 5 OF 10 BOARD MANAGERS. EACH MEMBER ALSO HAS THE POWER TO REMOVE ANY BOARD MANAGER WHICH THEY APPOINTED. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS ARE SUBJECT TO APPROVAL BY THE MEMBERS: (A) AMEND THE ARTICLES OF ORGANIZATION OR THE JOINT VENTURE OPERATING AGREEMENT; (B) APPROVE ANY MERGER, CONSOLIDATION, OR CONVERSION; SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE COMPANY; OR ACQUISITION OF ANOTHER BUSINESS OR ENTRY INTO A NEW LINE OF BUSINESS; (C) APPROVE THE CREATION OF ANY SUBSIDIARY OF THE COMPANY; (D) APPROVE ANY VOLUNTARY BANKRUPTCY OR INSOLVENCY PROCEEDING; (E) APPROVE THE VOLUNTARY DISSOLUTION OF THE COMPANY; (F) APPROVE THE TRANSFER OF UNITS BY ANY MEMBER OR AUTHORIZE OR ISSUE ADDITIONAL UNITS EXCEPT AS PERMITTED BY THE JOINT VENTURE OPERATING AGREEMENT; (G) APPROVE THE ADMISSION OF NEW MEMBER(S) AND THE SPECIFIC TERMS AND CONDITIONS UPON WHICH NEW MEMBER(S) WILL BE ADMITTED; (H) APPROVE THE ENTRY INTO ANY NEW CONTRACT WITH A MEMBER OR ITS AFFILIATES; (I) APPROVE THE NEW FACILITY LEASE; (J) APPROVE ANY ADDITIONAL CAPITAL CONTRIBUTION, OTHER THAN THOSE DESCRIBED IN THE PARTICIPATION AGREEMENT; (K) INCUR ANY INDEBTEDNESS OR GUARANTEE ANY INDEBTEDNESS IN EXCESS OF $500,000 IN THE AGGREGATE FOR A SINGLE EXPENDITURE OR ANY SERIES OF RELATED EXPENDITURES; (L) APPROVE ANY GUARANTEES OF THE DEBT OF THE COMPANY BY THE MEMBERS: (M) TAKE OR AUTHORIZE ANY ACTION THAT WOULD CAUSE THE COMPANY, THE NEW HOSPITAL, OR ANY MEMBER TO OPERATE IN A MANNER INCONSISTENT WITH THE COMMUNITY BENEFIT STANDARD ARTICULATED BY THE INTERNAL REVENUE SERVICE, CAUSE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM (VCUHS) TO ACT IN A MANNER THAT WOULD VIOLATE OR THAT WOULD BE REASONABLY LIKELY TO VIOLATE THE FINDINGS, MISSION, OR PURPOSE FOR WHICH VCUHS WAS CREATED UNDER THE VCUHS ACT, OR OTHERWISE CAUSE THE COMPANY, THE NEW HOSPITAL, OR ANY MEMBER TO ACT IN VIOLATION OF ITS FEDERAL, STATE, OR LOCAL TAX-EXEMPTION AND/OR CHARITABLE PURPOSE; OR (N) ENTER INTO ANY NEW AFFILIATION OR SIMILAR AGREEMENT FOR THE TRAINING OF STUDENTS, RESIDENTS, OR FELLOWS OTHER THAN WITH VCUHS OR VIRGINIA COMMONWEALTH UNIVERSITY WITHOUT THE CONSENT OF VCUHS, WHICH SHALL NOT BE UNREASONABLY WITHHELD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 AND APPLICABLE ATTACHMENTS ARE PROVIDED TO THE BOARD OF MANAGERS 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 MANAGERS 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. IN THE EVENT A POTENTIAL CONFLICT ARISES DURING THE YEAR, THE MANAQGER WITH SUCH CONFLICT MUST RECUSE HIM/HERSELF FROM ALL DISCUSSIONS AND VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE CEO HAS A WRITTEN EMPLOYMENT CONTRACT APPROVED BY THE BOARD. THE BOARD USED LEGAL COUNSEL TO DRAFT THE AGREEMENT AND GUIDE THEM ON THE COMPENSATION AMOUNT, INCLUDING THE USE OF A COMPENSATION SPECIALIST. CERTAIN OTHER OFFICERS OF SAI ARE EMPLOYED BY SAC. DEPENDING ON THE INDIVIDUAL, EITHER SAC OR SAI UTILIZES 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 COMPENSATION 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 INSTITUTE WILL MAKE AVAILABLE FOR PUBLIC INSPECTION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, RELATED POLICIES, AND FINANCIAL STATEMENTS. SHELTERING ARMS PHYSICAL REHABILITATION ASSOCIATES LLC 8226 MEADOWBRIDGE ROAD MECHANICSVILLE VA 23116 260402064 PHYSICAL REHABILITATION VA REHAB JV LLC