2021-05-20T11:31:28-05:00 2020-06-30 205991824 SC&H GROUP INC 910 RIDGEBROOK ROAD SPARKS MD 21152 990 2019-09-10 843355332 WEST BALTIMORE RENAISSANCE FOUNDATION INC WEST 4106015653 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 DAVID KRAJEWSKI EXECUTIVE VP/CFO 4106015653 2021-05-20 1 LORI S BURGHAUSER P00370694 4104031500 2021-05-20 2019 2022-09-23 18:48:47Z X KURT SOMMER 2401 W BELVEDERE AVENUE BALTIMORE MD 21215 2758118 0 X N/A X 501(C)(3) 2019 MD TO EMPOWER WEST BALTIMORE RESIDENTS AND COMMUNITIES THROUGH STRATEGIC INVESTMENTS THAT EXPAND SERVICES, AMENITIES, AND OPPORTUNITIES THAT LEAD TO A LASTING IMPACT ON HEALTH AND QUALITY OF LIFE. 7 4 0 4 0 0 2758118 0 0 0 2758118 0 0 39946 0 0 0 39946 2718172 2960372 0 2960372 WE TAKE RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR COMMUNITY THROUGH CARE MANAGEMENT, ENHANCING WORKFORCE DEVELOPMENT, PROVIDING ACCESS TO HEALTHY FOOD AND PROVIDING FAMILY SUPPORT. 0 0 0 0 0 WE TAKE RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR COMMUNITY THROUGH CARE MANAGEMENT, ENHANCING WORKFORCE DEVELOPMENT, PROVIDING ACCESS TO HEALTHY FOOD AND PROVIDING FAMILY SUPPORT. BEING THAT THE ORGANIZATION WAS FORMED ON SEPTEMBER 10, 2019, MORE SIGNIFICANT ACTIVITIES WILL BE PRESENT IN THE FISCAL YEAR ENDING JUNE 30, 2021. 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 X NANCY KANE 4106015653 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 NEIL MELTZER CHAIRMAN 1.00 40.00 X X 0 2328138 409143 LETITIA DZIRASA DIRECTOR 1.00 0.00 X 0 0 0 EDITH GILLIARD-CANTY DIRECTOR 1.00 0.00 X 0 0 0 SUSAN MANI MD DIRECTOR 1.00 40.00 X 0 461247 69374 MARK MARTIN PHD DIRECTOR 1.00 0.00 X 0 0 0 SISTER MARY SHIMO DIRECTOR 1.00 0.00 X 0 0 0 LESLIE SIMMONS DIRECTOR/EVP & COO OF LBH 1.00 40.00 X 0 1179170 285431 DAVID KRAJEWSKI TREASURER 1.00 40.00 X 0 1261959 390457 JASON WEINER SECRETARY 1.00 40.00 X 0 591819 107297 DWAYNE RICHARDSON COO 40.00 1.00 X 31001 310418 54066 31001 6132751 1315768 0 0 1 0 0 2758118 2758118 2758118 0 0 0 39940 39940 6 6 39946 0 39946 0 241683 0 549707 2168982 0 0 2168982 0 2960372 0 0 X 0 2960372 0 2960372 0 2960372 X 2718172 242200 X X 0 1 X 1 0 X 2758118 2758118 2758118 2758118 2758118 2758118 X 5-YEAR COMPUTATION PERIOD THE 2019 TAX PERIOD ON SCH A, PART II REPRESENTS A SHORT YEAR FROM 9/10/19 TO 6/30/20 AS THAT WAS THE ORGANIZATION'S YEAR OF FORMATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2168982 2168982 2168982 0 1 0 0 0 0 0 0 0 NEIL MELTZER CHAIRMAN 0 999827 0 842880 0 485431 0 388916 0 20227 0 2737281 0 357770 SUSAN MANI MD DIRECTOR 0 354552 0 100592 0 6103 0 45303 0 24071 0 530621 0 0 LESLIE SIMMONS DIRECTOR/EVP & COO OF LBH 0 704152 0 318661 0 156357 0 265490 0 19941 0 1464601 0 100342 DAVID KRAJEWSKI TREASURER 0 763808 0 350836 0 147315 0 364121 0 26336 0 1652416 0 90169 JASON WEINER SECRETARY 0 382090 0 198002 0 11727 0 87237 0 20060 0 699116 0 0 DWAYNE RICHARDSON COO 23099 231296 7402 74120 500 5002 2702 27056 2207 22101 35910 359575 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS DETERMINED BY THE CEO'S DIRECT REPORT SUPERVISOR AND HUMAN RESOURCES LOCATED AT A RELATED ORGANIZATION WITHIN THE LIFEBRIDGE HEALTH INC SYSTEM. PART I, LINE 4B DURING THE YEAR, THE FOLLOWING DIRECTORS AND OFFICERS PARTICIPATED IN A LIFEBRIDGE HEALTH SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DAVID KRAJEWSKI $ 337,265 NEIL MELTZER $ 361,442 JASON WEINER $ 68,318 DWAYNE RICHARDSON $ 28,561 SUSAN MANI $ 43,907 LESLIE SIMMONS $ 241,199 DURING THE YEAR, THE FOLLOWING DIRECTORS AND OFFICERS RECEIVED PAYMENTS AS PART OF THEIR PARTICIPATION IN A LIFEBRIDGE HEALTH SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DAVID KRAJEWSKI $ 105,878 NEIL MELTZER $ 428,403 LESLIE SIMMONS $ 115,877 COMPENSATION PROVIDED BY RELATED ORGANIZATIONS: MR. KRAJEWSKI RECEIVED COMPENSATION AS EXECUTIVE VP AND CHIEF FINANCIAL OFFICER OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF WEST BALTIMORE RENAISSANCE FOUNDATION, INC. MR. MELTZER RECEIVED COMPENSATION AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF WEST BALTIMORE RENAISSANCE FOUNDATION, INC. MR. WEINER RECEIVED COMPENSATION AS SENIOR VICE PRESIDENT AND GENERAL COUNSEL OF LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF WEST BALTIMORE RENAISSANCE FOUNDATION, INC. MS. MANI RECEIVED COMPENSATION AS VICE PRESIDENT OF CLINCIAL TRANSFORMATION AT LIFEBRIDGE HEALTH, INC., NOT AS AN OFFICER OF WEST BALTIMORE RENAISSANCE FOUNDATION, INC. MS. SIMMONS RECEIVED COMPENSATION AS EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER OF LIFEBRIDGE HEALTH, INC., NOT AS A DIRECTOR. MR. RICHARDSON RECEIVED COMPENSATION FROM A RELATED ORGANIZATION ON ACCOUNT OF HIS EMPLOYMENT AT THE RELATED ORGANIZATION, NOT AS AN OFFICER OF WEST BALTIMORE RENAISSANCE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE ONE MEMBER: LIFEBRIDGE HEALTH, INC. (THE "MEMBER") A MARYLAND NONSTOCK CORPORATION. MEMBERSHIP IN THE CORPORATION SHALL NOT BE TRANSFERABLE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION SHALL HAVE EIGHT DIRECTORS, EACH WITH FULL VOTING RIGHTS, AS FOLLOWS: A. THREE DIRECTORS DESIGNATED BY THE MEMBER (EACH, A "LIFEBRIDGE DIRECTOR, AND COLLECTIVELY, THE "LIFEBRIDGE DIRECTORS"). B. ONE DIRECTOR DESIGNATED BY BON SECOURS BALTIMORE HEALTH CORPORATION. C. ONE DIRECTOR DESIGNATED BY THE BALTIMORE CITY MAYOR'S OFFICE. D. ONE DIRECTOR DESIGNATED BY THE MARYLAND DEPARTMENT OF HEALTH. E. ONE DIRECTOR DESIGNATED BY EITHER THE HSCRC OR ANOTHER ORGANIZATION SELECTED BY THE HSCRC (EACH DIRECTOR UNDER (B) THROUGH (E), A "DESIGNATED DIRECTOR"). F. ONE COMMUNITY DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER SHALL HAVE EXCLUSIVE AND COMPLETE AUTHORITY AND DISCRETION TO MANAGE THE OPERATIONS AND AFFAIRS OF THE CORPORATION AND TO MAKE ALL DECISIONS REGARDING THE BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 10A: THE POLICIES DESCRIBED IN PART VI, SECTION B, LINES 10A-16B APPLY TO WEST BALTIMORE RENAISSANCE FOUNDATION, INC. AND ITS AFFILIATES AS LISTED BELOW: CALHOUN STREET INVESTMENTS, LLC CALHOUN STREET INVESTMENTS II, LLC FORM 990, PART VI, SECTION B, LINE 11B THE LIFEBRIDGE EXEMPT ENTITIES 990'S ARE INITIALLY REVIEWED BY THE ASSISTANT VICE PRESIDENT OF FINANCIAL REPORTING. IN ADDITION, AN INDEPENDENT ACCOUNTING FIRM ALSO REVIEWS ALL THE 990 RETURNS. A FORMAL MEETING IS THEN SCHEDULED WITH THE CHIEF FINANCIAL OFFICER, VICE PRESIDENT OF FINANCIAL REPORTING, GENERAL COUNSEL, AND THE ASSISTANT VICE PRESIDENT OF FINANCIAL REPORTING TO REVIEW IN THEIR ENTIRETY ALL THE LIFEBRIDGE EXEMPT ENTITIES 990'S. MANAGEMENT THEN PROVIDES A COPY OF THE 990'S TO EACH INDIVIDUAL BOARD DIRECTOR PRIOR TO THE FILING DATE FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS, EMPLOYEES, MEDICAL STAFF MEMBERS, AND VOLUNTEERS ARE EXPECTED TO RECOGNIZE AND DISCLOSE AT THE EARLIEST POSSIBLE TIME ACTUAL AND POTENTIAL CONFLICTS OF INTEREST. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL OR A FAMILY MEMBER OF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE HEALTH. ADDITIONAL INFORMATION REGARDING WHAT CONSTITUTES A CONFLICT OF INTEREST AND HOW TO DISCLOSE A CONFLICT IS OUTLINED BELOW. LIFEBRIDGE AND ALL OF ITS SUBSIDIARIES SHALL REQUIRE ALL EMPLOYEES, MEDICAL STAFF, AND MEMBERS OF THE BOARD TO DISCLOSE ANY ACTIVITIES THAT COULD RESULT IN A POSSIBLE CONFLICT OF INTEREST. IF A CONFLICT IS IDENTIFIED, THE PERSON INVOLVED WOULD RECUSE HIM/HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTIONS. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES. AN INDIVIDUAL IS CONSIDERED TO HAVE A "PERSONAL INTEREST" IN A MATTER IF IT IS LIKELY TO HAVE A DIRECT AND MATERIAL IMPACT ON THE INDIVIDUAL'S RELATIONSHIP WITH LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES (E.G., THE INDIVIDUAL'S CONTINUED MEMBERSHIP ON A SUBSIDIARY HOSPITAL'S MEDICAL STAFF), OR ON THE INDIVIDUAL'S OWN HEALTH CARE, OR THE INDIVIDUAL IS PERSONALLY INVOLVED IN A SUBSTANTIAL WAY (E.G., SERVES AS AN OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE) WITH ANOTHER ORGANIZATION THAT HAS A SIGNIFICANT INTEREST IN THE MATTER. AN INDIVIDUAL IS CONSIDERED TO HAVE A "FINANCIAL INTEREST" IN A TRANSACTION IF THE INDIVIDUAL, OR THEIR FAMILY MEMBER, (I) IS A PARTY TO THE TRANSACTION, (II) WILL BENEFIT PERSONALLY FROM THE TRANSACTION, OR (III) HAS, DIRECTLY OR INDIRECTLY, A CURRENT OR ANTICIPATED OWNERSHIP OR INVESTMENT IN, OR COMPENSATION ARRANGEMENT WITH, A PARTY TO THE TRANSACTION. AN OWNERSHIP INTEREST OF LESS THAN 5% IN AN ENTITY WILL NOT, IN AND OF ITSELF, GENERALLY BE CONSIDERED A FINANCIAL INTEREST; HOWEVER, TO THE EXTENT THE INDIVIDUAL'S COMPENSATION FROM THE ENTITY IS DIRECTLY LINKED TO THE ENTITY'S BUSINESS WITH LIFEBRIDGE HEALTH, SUCH COMPENSATION WILL CONSTITUTE A FINANCIAL INTEREST. FOR THE PURPOSES OF THIS POLICY, A "FAMILY MEMBER" INCLUDES SPOUSE OR DOMESTIC PARTNER, PARENTS, BROTHERS AND SISTERS, CHILDREN (WHETHER NATURAL OR ADOPTED), GRANDPARENTS, GRANDCHILDREN, GREAT-GRANDCHILDREN, AND IN-LAWS, SPOUSES OF BROTHERS, SISTERS, CHILDREN, GRANDCHILDREN, AND GREAT-GRANDCHILDREN, AND ANY OTHER MEMBER OF A HOUSEHOLD OF THE INDIVIDUAL. CONFLICTS OF INTEREST ARE TO BE REPORTED BY EMPLOYEES TO THEIR SUPERVISOR, WHO WILL BE RESPONSIBLE FOR DETERMINING WHETHER FURTHER DISSEMINATION IS NECESSARY. MEMBERS OF THE MEDICAL STAFF SHOULD REPORT CONFLICTS TO THE CHIEF OF THEIR DEPARTMENT, AND MEMBERS OF THE BOARD SHOULD REPORT THEM TO THE CHIEF COMPLIANCE OFFICER. QUESTIONNAIRES ARE SENT OUT TO MEMBERS OF THE BOARD ON AN ANNUAL BASIS. IF QUESTIONS ARISE OR FURTHER GUIDANCE IS SOUGHT, INDIVIDUALS CAN CONTACT THE CHIEF COMPLIANCE OFFICER (410-601-4832) OR CONFIDENTIAL COMPLIANCE HOTLINE (1-844-732-6233). NOTHING IN THIS DEFINITION IS INTENDED TO RELIEVE ANY PERSON OF ANY ADDITIONAL OBLIGATIONS THAT MAY BE IMPOSED BY STATE OR FEDERAL LAW. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE POLICY OF LIFEBRIDGE HEALTH INC. AND ITS SUBSIDIARIES TO MAKE AVAILABLE UPON REQUEST THE AUDITED FINANCIAL STATEMENTS TO THE GENERAL PUBLIC. THE LIFEBRIDGE HEALTH INC. AND SUBSIDIARY GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST OR VIA A WEBSITE. THE CONFLICT OF INTEREST POLICY IS INCLUDED ON SCHEDULE O. FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATE 242,200. FORM 990, PART XII, LINE 2C: DURING FY20, LIFEBRIDGE HEALTH, INC. ESTABLISHED WEST BALTIMORE RENAISSANCE FOUNDATION, INC. THE AUDIT COMMITTEE REVIEW PROCESS FOR WEST BALTIMORE RENAISSANCE FOUNDATION, INC. WILL FOLLOW LIFEBRIDGE HEALTH, INC.'S AUDIT COMMITTEE REVIEW PROCESS. 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