Chesapeake Hospital Corporation: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- Chesapeake Hospital Corporation (EIN 23-7424835)
- Tax period
- 2016-09-01 to 2017-08-31
- Filed
- 2018-07-03
- IRS object ID
- 201831849349300213
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-07-03T08:52:40-05:00 | ReturnTs |
| Tax Period End | 2017-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 861065772 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 191 Peachtree Street Suite 2000 | AddressLine1Txt |
| City | Atlanta | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 303031749 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237424835 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chesapeake Hospital Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHES | BusinessNameControlTxt |
| Phone | 8044358582 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Harris Road | AddressLine1Txt |
| City | Kilmarnock | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22482 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Stephan Quiriconi | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 8044358582 | PhoneNum |
| Signature | 2018-07-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | John W Sadoff Jr | PreparerPersonNm |
| PTIN | P00540589 | PTIN |
| Phone | 4042201500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rappahannock General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Toni Ardabell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Harris Road | AddressLine1Txt |
| City | Kilmarnock | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22482 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,488,351 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.bonsecours.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | Not-for-profit Acute Care Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 22 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 19 | VotingMembersIndependentCnt |
| Total Employee | 374 | TotalEmployeeCnt |
| Total Volunteers | 110 | TotalVolunteersCnt |
| Total Gross UBI | $694 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $369,213 | PYContributionsGrantsAmt |
| CY Contributions Grants | $839,433 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,432,771 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,283,905 | CYProgramServiceRevenueAmt |
| PY Investment Income | $14,855 | PYInvestmentIncomeAmt |
| CY Investment Income | $17,456 | CYInvestmentIncomeAmt |
| PY Other Revenue | $169,703 | PYOtherRevenueAmt |
| CY Other Revenue | $347,557 | CYOtherRevenueAmt |
| PY Total Revenue | $14,986,542 | PYTotalRevenueAmt |
| CY Total Revenue | $36,488,351 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,902,900 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $250 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,305,927 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,000,790 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,882,458 | PYOtherExpensesAmt |
| CY Other Expenses | $20,806,329 | CYOtherExpensesAmt |
| PY Total Expenses | $17,091,285 | PYTotalExpensesAmt |
| CY Total Expenses | $37,807,369 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,104,743 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,319,018 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,038,847 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,209,969 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,256,097 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,170,783 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$217,250 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,960,814 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The organization operates an acute care general hospital. The hospital has a community based Board of Directors, has an open medical staff, operates an emergency room providing care to all regardless of ability to pay, and provides non-emergency services to any with the ability to pay including Medicare and Medicaid covered individuals. The organization is dedicated to the provision of quality, compassionate care to all patients in the most cost effective manner. This will be accomplished through the most effective use of available resources and will reflect ethical decisions, including the effective management of pain, made jointly by the patients, the family, and health care professionals involved in its care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $35,569,898 | ExpenseAmt |
| Grant | $250 | GrantAmt |
| Revenue | $35,348,661 | RevenueAmt |
| Desc | Rappahannock General Hospital, which is the only provider of inpatient and outpatient acute care services within a five county area, provides medical care to patients without regard to their ability to pay. Please refer to the Community Benefit information on Schedule H. | Desc |
| Total Program Service Expenses | $35,569,898 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 374 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 22 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 19 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laura Ellison | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4433673835 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8990 Old Annapolis Rd | AddressLine1Txt |
| City | Columbia | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21045 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (41 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Christopher Accashian | ||||||||||
| BM (Sep-Jul)/CEO-CHC (Aug) | 12.50 | 37.50 | Yes (X) | Yes (X) | $0 | $319,430 | $18,582 | |||
| Toni Ardabell | ||||||||||
| CEO-BSV | 6.00 | 44.00 | Yes (X) | Yes (X) | $0 | $880,538 | $127,406 | |||
| Francine Barr | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 48.00 | Yes (X) | $0 | $442,530 | $34,364 | ||||
| Jean Ann Bolling | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jeff Brown MD | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Janice Burnett | ||||||||||
| Board Member | 2.00 | 48.00 | Yes (X) | $0 | $883,722 | $138,217 | ||||
| Chandrashekar Challa | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Elizabeth Crowther | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| John Daniel III MD | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| BK Fulton | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas Gayner | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Anup Gokli MD | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mark Gordon | ||||||||||
| CEO-MRMC&RCH&CHC | 10.00 | 40.00 | Yes (X) | Yes (X) | $0 | $534,362 | $52,832 | |||
| Pamela Hacker | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Chris Hairston-White | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| BHB Hubbard III | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Rose Marie Jasinski CBS | ||||||||||
| Board Member | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Anne Marie Mack CBS | ||||||||||
| President | 3.50 | 46.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Joanne Nattrass | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Paula Peaden | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Fr John Podsiadlo | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Linda Rigsby | ||||||||||
| Board Member | 2.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| Pamela Royal MD | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joseph Schilling | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Victoria Segura CBS | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 48.00 | Yes (X) | $0 | $0 | $0 | ||||
| William Shewmake | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Shannon Sinclair | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Nancy Thomas | ||||||||||
| Chairman | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Harry Turton Jr | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Deborah Ulmer PhD RN | ||||||||||
| Board Member (Feb-Aug) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jane Watkins | ||||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Michael Williams | ||||||||||
| Board Member (Sep-Dec) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Allen Goolsby III | ||||||||||
| Secretary | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Stephan Quiriconi | ||||||||||
| Treasurer | 3.00 | 47.00 | Yes (X) | $0 | $314,286 | $16,732 | ||||
| Jim Godwin | ||||||||||
| VP HR | 2.00 | 48.00 | $0 | $236,288 | $37,935 | Yes (X) | ||||
| Randall Scott | ||||||||||
| Psychiatrist | 50.00 | 0.00 | $245,622 | $0 | $14,046 | Yes (X) | ||||
| William Stallings | ||||||||||
| Primary Care Physician | 50.00 | 0.00 | $205,519 | $0 | $13,016 | Yes (X) | ||||
| James Bryant | ||||||||||
| Internist | 50.00 | 0.00 | $197,211 | $0 | $5,897 | Yes (X) | ||||
| Paul Olson | ||||||||||
| Internist | 50.00 | 0.00 | $195,169 | $0 | $18,581 | Yes (X) | ||||
| Maxine Luxton | ||||||||||
| Pharmacist/OM | 50.00 | 0.00 | $162,198 | $0 | $1,859 | Yes (X) | ||||
| James Holmes | ||||||||||
| Former CEO | 0.00 | 0.00 | $493,103 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,498,822 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,611,156 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $479,467 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Linde Health Care Staffing Inc | |||||
| PO Box 915241 | Dallas | TX | 75391 | Physician Fee | $873,291 |
| VA Anesthesia & Perioperative | |||||
| 760 McGuire Place 1st Floor | Newport News | VA | 23601 | Anesthesia & Perioperative | $800,004 |
| Aramark CTS Inc | |||||
| 12483 Collections Center Drive | Chicago | IL | 60693 | Biomedical Equipment Maintenance | $698,018 |
| Emergency Medical Associates | |||||
| 20010 Century Boulevard Suite 200 | Germantown | MD | 20874 | Physician Fee | $541,528 |
| Ortho VA Inc | |||||
| 7858 Shrader Road | Henrico | VA | 23294 | Physician Fee | $235,421 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $832,933 | RelatedOrganizationsAmt |
| Government Grants | $6,500 | GovernmentGrantsAmt |
| Total Contributions | $839,433 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Re | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $35,283,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,283,905 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,283,905 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,486 | TotalRevenueColumnAmt |
| Exclusion | $9,486 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $76,884 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $76,884 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,884 | TotalRevenueColumnAmt |
| Exclusion | $76,884 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,970 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,970 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,970 | TotalRevenueColumnAmt |
| Exclusion | $7,970 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Cafeteria and Vending | 900099 | $205,223 | $205,223 | |
| Rehab Payments | 900099 | $10,892 | $10,892 | |
| Reference Lab | 900099 | $10,659 | $10,659 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,899 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,205 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $694 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $270,673 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,488,351 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,348,661 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $694 | UnrelatedBusinessRevenueAmt |
| Exclusion | $299,563 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250 | TotalAmt |
| Program Services | $250 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,328,674 | TotalAmt |
| Program Services | $11,995,807 | ProgramServicesAmt |
| Management And General | $1,332,867 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,790 | TotalAmt |
| Program Services | $242,811 | ProgramServicesAmt |
| Management And General | $26,979 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,402,077 | TotalAmt |
| Program Services | $2,161,869 | ProgramServicesAmt |
| Management And General | $240,208 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000,249 | TotalAmt |
| Program Services | $900,224 | ProgramServicesAmt |
| Management And General | $100,025 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,007 | TotalAmt |
| Program Services | $65,706 | ProgramServicesAmt |
| Management And General | $7,301 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,254 | TotalAmt |
| Program Services | $4,729 | ProgramServicesAmt |
| Management And General | $525 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,732 | TotalAmt |
| Program Services | $2,459 | ProgramServicesAmt |
| Management And General | $273 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,797,682 | TotalAmt |
| Program Services | $4,797,682 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,466 | TotalAmt |
| Program Services | $11,219 | ProgramServicesAmt |
| Management And General | $1,247 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $435,002 | TotalAmt |
| Program Services | $391,502 | ProgramServicesAmt |
| Management And General | $43,500 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,138 | TotalAmt |
| Program Services | $80,224 | ProgramServicesAmt |
| Management And General | $8,914 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $654,450 | TotalAmt |
| Program Services | $589,005 | ProgramServicesAmt |
| Management And General | $65,445 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,634 | TotalAmt |
| Program Services | $170,671 | ProgramServicesAmt |
| Management And General | $18,963 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,426 | TotalAmt |
| Program Services | $2,183 | ProgramServicesAmt |
| Management And General | $243 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $833,285 | TotalAmt |
| Program Services | $833,285 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100,941 | TotalAmt |
| Program Services | $990,847 | ProgramServicesAmt |
| Management And General | $110,094 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,469 | TotalAmt |
| Program Services | $196,622 | ProgramServicesAmt |
| Management And General | $21,847 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $7,299,978 | $7,299,978 | |
| Bad Debt Expense | $2,501,460 | $2,501,460 | |
| Purchased Services | $1,890,814 | $1,701,733 | $189,081 |
| Repairs | $264,942 | $238,448 | $26,494 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $434,649 | TotalAmt |
| Program Services | $391,184 | ProgramServicesAmt |
| Management And General | $43,465 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,807,369 | TotalAmt |
| Program Services | $35,569,898 | ProgramServicesAmt |
| Management And General | $2,237,471 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $864 | BOYAmt |
| EOY | $909 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,417,380 | BOYAmt |
| EOY | $182,095 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,201,889 | BOYAmt |
| EOY | $3,407,765 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $903,823 | BOYAmt |
| EOY | $979,919 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,833 | BOYAmt |
| EOY | $405,263 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,247,992 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,799,723 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,126,260 | BOYAmt |
| EOY | $14,448,269 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,109 | BOYAmt |
| EOY | $17,109 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,000,689 | BOYAmt |
| EOY | $5,768,640 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,038,847 | BOYAmt |
| EOY | $25,209,969 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,737,817 | BOYAmt |
| EOY | $1,659,622 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,518,280 | BOYAmt |
| EOY | $25,511,161 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,256,097 | BOYAmt |
| EOY | $27,170,783 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$399,295 | BOYAmt |
| EOY | -$2,142,936 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,045 | BOYAmt |
| EOY | $182,122 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$217,250 | BOYAmt |
| EOY | -$1,960,814 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,038,847 | BOYAmt |
| EOY | $25,209,969 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,319,018 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$424,546 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,732 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,732 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,672,060 | OtherCostOrOtherBasisAmt |
| Book Value | $1,672,060 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,190,269 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,012,494 | DepreciationAmt |
| Book Value | $9,177,775 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,436,209 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,749,767 | DepreciationAmt |
| Book Value | $2,686,442 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $949,454 | OtherCostOrOtherBasisAmt |
| Depreciation | $37,462 | DepreciationAmt |
| Book Value | $911,992 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,448,269 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Medicare Settlement | $5,021,519 |
| LT Non-Cash Inv - HPL/GL | $443,279 |
| Organizational Costs | $190,000 |
| Due from Affiliates | $113,842 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,768,640 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Affiliates | $24,489,579 |
| HPL/GL Liability | $443,279 |
| Medicare Settlement | $264,117 |
| Patient Credit Balances | $260,887 |
| Unclaimed Property Accrual | $53,299 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $25,511,161 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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 ASC 740. ASC 740 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 ASC 740 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. Their related income is exempt from federal income tax under Section 501(A). The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of August 31, 2017 or 2016. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present, and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2013. As of August 31, 2017 and 2016, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $106,393 and $89,895 of net operating loss carryforwards as of August 31, 2017 and 2016, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The System accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The System's deferred tax assets are fully reserved at August 31, 2017 and 2016 as the System considers it more likely than not that these amounts will not be recognized. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $615,830 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $615,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01740 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,873,725 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,725,983 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,147,742 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03250 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,489,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,725,983 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,763,572 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04990 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1269 | PersonsServedCnt |
| Total Community Benefit Expns | $45,690 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1269 | PersonsServedCnt |
| Total Community Benefit Expns | $45,690 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1269 | PersonsServedCnt |
| Total Community Benefit Expns | $3,535,245 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,725,983 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,809,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,501,460 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $20,209,386 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $20,269,929 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$60,543 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chesapeake Hospital Corporation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Harris Drive | AddressLine1Txt |
| City | Kilmarnock | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22482 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | bonsecours.com | WebsiteAddressTxt |
| State License | H1885 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Chesapeake Hospital Corp | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Section C | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Section C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Section C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.fa.bonsecours.com/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.fa.bonsecours.com/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.fa.bonsecours.com/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Chesapeake Hospital Corp | Part V, Section B, Line 5: 2016 (FY2017) CHNA: Community SurveyAn electronic survey using Survey Monkey was developed and administered to 215 community members and partners of whom 184 completed the full survey. Individuals were invited to participate based on their ability to represent: underserved, low-income and minority population needs; needs of chronically ill patients; and awareness of healthcare needs in their respective communities. Participants were asked to share their viewpoints on: Important health concerns in the community; Significant service gaps in the community; Ideas for addressing concerns and service gaps.To gauge the importance of various health concerns, respondents were asked to "Choose the top 5 priorities you think should be addressed in your community" from a list of 34 health concerns. Respondents were then asked to rate their overall health, the health of the community, and the quality of life of the community. Other questions included reviewing lists of services typically important to addressing health concerns and how strong the community was in providing those services. Respondents were then asked to indicate services that needed to be strengthened in terms of availability, access, and quality. Open-ended response items were provided for participants to indicate additional service gaps in the community and ideas for addressing concerns and service gaps. Community ConversationsTwo Community Conversations were held as part of the CHNA process in which 22 individuals participated from all of the core jurisdictions of Lancaster, Middlesex, and Northumberland. Overall, the racial and geographical diversity of the participants represented a healthy mix of the region's residents. The purpose of the conversation was to elicit feedback from community members about publicly available health data describing health conditions in the services area, and to review the online survey results to further explore findings. Attendees were asked to 1) rank the health issues identified in the Community Survey according to the issues that impact them and the people close to them the most and 2) rank the issues needing to be addressed to improve the overall health of the region from a community view.Priority Needs Bon Secours Rappahannock General Hospital convened a CHNA Advisory Board to support the process by engaging community members and providing feedback on the findings. The CHNA Advisory Board included individuals with special knowledge of public health and underserved populations and included the following: Director of the Three Rivers Health Department, Executive Director of the Northern Neck Free Clinic, Mayor of Kilmarnock, Executive Director of the Middle Peninsula Northern Neck Community Services Board, Board Member from Peninsula EMS Council, and President and CEO of Bay Aging.A group conversation was facilitated by Becky Clay Christensen and included a review of all qualitative and quantitative data gather from the Community Survey, Community Conversations, and publicly available secondary health data. Advisory Board members were asked to categorize issues as high or low need in the community using a Strategy Grid. They were also asked to determine the feasibility of the community's ability to make an impact on the issues. |
| Chesapeake Hospital Corp | Part V, Section B, Line 11: The Implementation Plan focuses on 3 broad areas including Access to Care for the Uninsured, Health Education, and Behavioral Health. Goals and objectives were created for each area and were based on Healthy People 2020 objectives, Virginia's Plan for Well-Being 2016-2020 goals, and other evidence-based sources.The overarching goal for Access to Care for the Uninsured is to improve access to comprehensive, quality health care services. This has been achieved in part by recruiting primary care physicians and mid-level providers to the service area. We are also coordinating strategies with the Northern Neck Free Clinic, current primary care providers, and Lively and Hartfield Medical Centers to identify resources for the provision of care and to enhance service coverage.The goal in addressing Health Education is to increase the quality, availability, and effectiveness of educational and community-based programs designed to prevent disease and injury, improve health, and enhance quality of life. We provide health education on Diabetes, Hypertension, and the Continuum of Care as well as provide our Senior University to promote health and wellness among older adults. Additional partners in this work include the Northern Neck YMCA and Lancaster, Northumberland, and Middlesex School systems.The goal for Behavioral Health is to increase access to behavioral health services to improve mental health of the community. This has been achieved by conducting support groups around the topics of Women's Cancer, Grief Counseling, Alzheimer's Care Givers, and Stroke. We are also working closely with the Northern Neck Community Service Board and primary care providers to promote bridges between behavioral health and primary care.Needs Not AddressedAdditional areas of need identified in the community survey include: Jobs with fair wages, Adult and Childhood Obesity, Alcohol and Drug Use, Transportation, and Diabetes. While these needs will not be directly addressed, we recognize that activities in Access to Care for the Uninsured, Health Education, and Behavioral Health will also impact these areas of need. Additionally, the following resources are available in the community and are addressing these needs: Three Rivers Health Department, Northern Neck Family YMCA, Northern Neck Free Health Clinic, American Cancer Society, Bay Aging, American Heart Association, Middle Peninsula/Northern Neck Community Services Board, Bay Transit, Virginia Women's Center, Eastern Virginia Care Transition Partnerships, Lancaster County High School, Northumberland High School, and Middlesex High School. |
| Chesapeake Hospital Corp | Part V, Section B, Line 16j: Information regarding the FAP is available on our websites, brochures are available at time of registration. We have on-site Financial Counselors who assist patients. We also have eligibility vendors who work with the patients and our statements indicate we have an FAP. We also provided local clinics in each market brochures regarding our FA program. |
| Form 990, Schedule H, Part V, Section B, Line 7a: | https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment |
| Form 990, Schedule H, Part V, Section B, Line 10a: | https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment |
| Form 990, Schedule H, Part V, Section B, Line 7b: | www.behealthyrva.org; https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment |
| Form 990, Schedule H, Part V, Section B, Line 14: | Charges for patients who are eligible for financial assistance shall be limited to no more than amounts generally billed ("AGB") for such services. These charges are based on the average allowed amounts from Medicare and commercial payers for emergency and other medically necessary care. The allowed amounts include both the amount the insurer will pay and the amount, if any, the individual is personally responsible for paying. The AGB is calculated using a look back method. Because both Maryland law and Federal tax law limit the amounts that may be charged to patients, an FAP eligible individual or an uninsured individual will not be charged more than the lesser of the AGB or the regulated charge set by the Maryland Health Services Cost Review Commission for emergency or other medically necessary care. |
| Form 990, Schedule H, Part V, Section B, Line 3i: | Rappahannock General Hospital (RGH) was acquired by Bon Secours Health System on December 31, 2014. A Community Health Needs Assessment was conducted for RGH in FY2016 (tax year 2015). In order to align the tax years of the two organizations, a second CHNA was prepared for RGH in FY2017 (tax year 2016). The FY2017 CHNA document provides updated publicly available health data. Community input was obtained from an online survey conducted between September 2015 and February 2016 and two community conversations conducted in November 2015. The initiatives contained in the FY2016 Implementation Plan will continue to be advanced under the FY2017 CHNA Implementation Plan. This approach was approved by the CHNA Advisory Board on March 24, 2017. CHNAs for Bon Secours Health System hospitals, including Rappahannock General Hospital will be conducted again in tax year 2018 during FY2019 and will include a description of the impact of any actions taken to address the significant health needs identified in the prior CHNA. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | Annually, Bon Secours Richmond Health System (BSRHS) publishes a report for the community on the 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 available to the public each year on or around January 24, commemorating Founding Day of the Sisters of Bon Secours. This report is available online at https://bonsecours.com/richmond/about-us. |
| 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 captured in the patient accounting system and 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, Ln 7 Col(f): | Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $2,501,460. |
| Part III, Line 2: | 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 4: | Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on page 10 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 38-39 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. |
| Part III, Line 8: | 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.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 III, Line 9b: | The hospital has a written policy that describes collection practices applying to patients who qualify for financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is approved, 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 exists for how much financial 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 eight months from the date of the application. This eligibility is identified by hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of the eight months, the patient is responsible for reapplying for FAP eligibility. |
| Part VI, Line 2: | The 2016 CHNA was conducted during Fiscal Year 2017 by the Community Health Services team in order to prepare documents by the end of the fiscal year. It was determined that existing quantitative data, augmented by a community survey, and community conversations would be used to identify and prioritize health indicators. All identified needs were reported to the Community Advisory Board to prioritize based on need and feasibility. An executive summary and report was then presented to system leadership from Mission. Findings were then presented to the Executive Management Team for further review and comment. Finally, a presentation was made to the Bon Secours Richmond Health System Board for final approval prior to being made available to the public.Quantitative DataData was gathered and compiled via publicly available data sources such as County Health Rankings, the Census Bureau, and the Virginia Department of Health. The data presented in the CHNA reflects how the area served by Bon Secours Rappahannock General Hospital compares to Virginia overall and/or the nation. Health issues and conditions were either identified by the community during qualitative community conversations or are issues which deviated from the state or national findings.Community Input Input from community members was included in assessing health care needs as described in Part V, Line 5. |
| Part VI, Line 3: | The Patient Financial Assistance program is communicated to patients verbally upon scheduling, registration, visible postings of the program are in common areas throughout the hospital, along with brochures and the program is detailed on our Bon Secours website. In addition, patient billing statements and letters inform patients regarding our financial assistance program. Bon Secours proactively screens patients 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. Bon Secours is also 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 assistance process. Based on market need, our financial assistance policy and application is translated into multiple languages and placed on our Bon Secours website for patients to access. |
| Part VI, Line 4: | Rappahannock General Hospital was founded in 1977. The hospital is located in the eastern central section of Lancaster County. The Bon Secours Health System, a faith based, not-for-profit healthcare system acquired Rappahannock General Hospital in 2014. For purposes of the CHNA, RGH defines the three counties of Lancaster, Middlesex and Northumberland as the community it serves as many secondary data sources are county specific and enable comparison to data for the state of Virginia and the United States. Approximately 35,000 residents reside in Lancaster, Northumberland, and Middlesex Counties. For the purpose of this CHNA, the residents of these three counties will represent the primary service area for Rappahannock General Hospital. The population is relatively evenly distributed among the three counties. The actual population served by the hospital is closer to 40,000. Approximately 88% of RGH's patient population resides in one of these 3 counties.The RGH community is predominantly White (73%), with a large African American population (24%). Compared to Virginia as a whole, RGH has a larger percentage of African Americans but has less ethnic diversity, due to a lower percentage of Hispanics, Asians, and Native Americans.The RGH community is comprised of approximately 20% more older adults (65+) than Virginia and the nation, and a comparatively lower percentage of children (age <18). Middlesex has a greater percentage of adults (19-64) residing in the community and fewer older adults (65+) compared to Lancaster and Northumberland.The median household incomes for Lancaster, Middlesex and Northumberland are lower than the Virginia state average of $65,015 and the national average of $53,889. While Middlesex has lower rates of unemployment than Virginia, the median household income is lower than Virginia and consistent with Lancaster and Northumberland. The median household incomes for the three RGH counties are as follows: Lancaster County; $50,374, Middlesex County; $54,654 and Northumberland County; $51,885.Compared to Virginia, the percentage of uninsured adults is higher in Lancaster and Northumberland. The percentage of uninsured children is higher in all three counties, with the highest percentage of uninsured residing in Northumberland County (20% of adults and 11% of children). |
| Part VI, Line 5: | Rappahannock General Hospital provides numerous services to the community including health fairs, free health screenings and education on cholesterol, blood pressure and glucose. Cancer screenings are available as well as support groups for cancer patients and their families. The Rappahannock General Hospital Emergency Department offers CPR training, heart saver courses and pediatric basic life support. Free sports physicals are provided to area secondary students. |
| Part VI, Line 6: | Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, 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 as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSHSI Vision. BSHSI's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2016-2018). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that the struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression.- Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSHSI and the SQP (Strategic Quality Plan). |
| Part VI, Line 7, Reports Filed With States | VA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Christopher Accashian | ||||||||||||||
| BM (Sep-Jul)/CEO-CHC (Aug) | $0 | $205,413 | $0 | $81,877 | $0 | $32,140 | $0 | $1,569 | $0 | $17,013 | $0 | $338,012 | $0 | $0 |
| Toni Ardabell | ||||||||||||||
| CEO-BSV | $0 | $643,063 | $0 | $184,069 | $0 | $53,406 | $0 | $124,906 | $0 | $2,500 | $0 | $1,007,944 | $0 | $21,527 |
| Francine Barr | ||||||||||||||
| Board Member (Sep-Dec) | $0 | $321,886 | $0 | $77,824 | $0 | $42,820 | $0 | $15,900 | $0 | $18,464 | $0 | $476,894 | $0 | $0 |
| Janice Burnett | ||||||||||||||
| Board Member | $0 | $624,566 | $0 | $146,250 | $0 | $112,906 | $0 | $118,316 | $0 | $19,901 | $0 | $1,021,939 | $0 | $76,390 |
| Mark Gordon | ||||||||||||||
| CEO-MRMC&RCH&CHC | $0 | $392,515 | $0 | $94,091 | $0 | $47,756 | $0 | $26,462 | $0 | $26,370 | $0 | $587,194 | $0 | $5,606 |
| Stephan Quiriconi | ||||||||||||||
| Treasurer | $0 | $241,335 | $0 | $35,201 | $0 | $37,750 | $0 | $6,061 | $0 | $10,671 | $0 | $331,018 | $0 | $0 |
| Jim Godwin | ||||||||||||||
| VP HR | $0 | $187,612 | $0 | $28,229 | $0 | $20,447 | $0 | $17,779 | $0 | $20,156 | $0 | $274,223 | $0 | $0 |
| Randall Scott | ||||||||||||||
| Psychiatrist | $244,772 | $0 | $0 | $0 | $850 | $0 | $3,825 | $0 | $10,221 | $0 | $259,668 | $0 | $0 | $0 |
| William Stallings | ||||||||||||||
| Primary Care Physician | $186,228 | $0 | $8,258 | $0 | $11,033 | $0 | $2,939 | $0 | $10,077 | $0 | $218,535 | $0 | $0 | $0 |
| James Bryant | ||||||||||||||
| Internist | $193,047 | $0 | $1,306 | $0 | $2,858 | $0 | $2,475 | $0 | $3,422 | $0 | $203,108 | $0 | $0 | $0 |
| Paul Olson | ||||||||||||||
| Internist | $174,415 | $0 | $7,478 | $0 | $13,276 | $0 | $14,700 | $0 | $3,881 | $0 | $213,750 | $0 | $0 | $0 |
| Maxine Luxton | ||||||||||||||
| Pharmacist/OM | $161,815 | $0 | $250 | $0 | $133 | $0 | $1,520 | $0 | $339 | $0 | $164,057 | $0 | $0 | $0 |
| James Holmes | ||||||||||||||
| Former CEO | $40,740 | $0 | $0 | $0 | $452,363 | $0 | $0 | $0 | $0 | $0 | $493,103 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Bon Secours Health System, Inc., a related organization of the filing organization, 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 |
| Part I, Lines 4a-b | Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: James Holmes, $452,234. The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is 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 made into this plan. Individuals that received a distribution include: Toni Ardabell, $24,015; Janice Burnett, $86,966; Mark Gordon, $6,590. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Bon Secours Health System, Inc. is the sole member of Bon Secours Richmond LLC. Bon Secours Richmond LLC holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of the filing organization. |
| Form 990, Part VI, Section A, line 7a | The governing body of the filing organization 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 the filing organization are reserved to its member or to Bon Secours Health System, Inc. |
| Form 990, Part VI, Section B, line 11b | 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. 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. |
| 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 15b | 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 BSHSI. The compensation committee consists of a group of independent board members and engages an 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. 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 other officers or key employees of the organization 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 | The filing organization makes all documents available to the general public upon request. |
| Form 990, Part VII - Additional Disclosure: | From September 1, 2016 - December 31, 2016, the governing bodies of the following entities were comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer): - Bon Secours St. Mary's Hospital - Bon Secours St. Francis Medical Center - Bon Secours Memorial Regional Medical Center - Richmond Community Hospital - Chesapeake Hospital Corporation - Chesapeake Medical Group As of January 1, 2017, the entities listed above and the parent organization to these entities, Bon Secours Richmond Health System, Inc. (RHS), established a mirror board. The action aligned the board members and board officers of RHS and the listed entities. Hours reported on Form 990, Part VII represents total hours worked per week. These hours may include time spent as an employee of the organization and any hours spent serving as a volunteer board member. Any compensation paid to these individuals is payment for their employment with the filing organization or related organization. Volunteers are not paid for their time. Sr. Anne Marie Mack and Sr Victoria Segura do not receive payroll distributions as they have taken vows of poverty. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 4,797,682. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,797,682. |
| Form 990, Part XI, line 9: | Intercompany Transfers Relating to Debt -424,546. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Rappahannock General Hospital Foundation | ||||||||||
| 101 Harris Road | Kilmarnock | VA | 22482 | 541210450 | Supporting Organization | VA | 501(c)(3) | Line 7 | Bon Secours Richmond Health System | 0 |
| Chesapeake Medical Group | ||||||||||
| 101 Harris Road | Kilmarnock | VA | 22482 | 541857174 | Healthcare Services | VA | 501(c)(3) | Line 10 | Bon Secours Richmond Health System | 0 |
| Bon Secours Health System Inc | ||||||||||
| 1505 Marriottsville Road | Marriottsville | MD | 21104 | 521301088 | Parent Org. Management Services | MD | 501(c)(3) | Line 12c, III-FI | Bon Secours Inc | 0 |
| Bon Secours Richmond Healthcare Foundation | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541201346 | Grant Making Foundation | VA | 501(c)(3) | Line 7 | Bon Secours Richmond LLC | 0 |
| Bon Secours Richmond Health System | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 521988421 | Local System Parent Org. | VA | 501(c)(3) | Line 12c, III-FI | Bon Secours Richmond LLC | 0 |
| Bon Secours Memorial Regional Medical Center | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541744931 | Health Care | VA | 501(c)(3) | Line 3 | Bon Secours Richmond Health System | 0 |
| Bon Secours Richmond Community Hospital | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 540647482 | Health Care | VA | 501(c)(3) | Line 3 | Bon Secours Richmond Health System | 0 |
| Bon Secours St Francis Medical Center | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 311716973 | Health Care | VA | 501(c)(3) | Line 3 | Bon Secours Richmond Health System | 0 |
| St Mary's Hospital of Richmond Inc | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 540793767 | Health Care | VA | 501(c)(3) | Line 3 | Bon Secours Richmond Health System | 0 |
| Laburnum Properties | ||||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 521260700 | Title Holding Company | VA | 501(c)(2) | Bon Secours Richmond Health System | 0 | |
| IVNA Health Services | ||||||||||
| 5008 Monument Ave | Richmond | VA | 23230 | 541479847 | Healthcare Services | VA | 501(c)(3) | Line 10 | Bon Secours Home Care LLC | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| St Mary's MRI LP | |||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541568022 | Imaging Services | VA | N/A |
| RI LP | |||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541708835 | Imaging Services | VA | N/A |
| Broad64 Imaging LLC | |||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 205886018 | Imaging Services | VA | N/A |
| Richmond Radiation Oncology Center I LLC | |||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 208444551 | Radiation Oncology Services | VA | N/A |
| Chesterfield Community Healthcare Center MOB I LLC | |||||||
| 435 Southlake Blvd | Richmond | VA | 23236 | 541745670 | Rental - Medical Office Building | VA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Chesterfield Community Healthcare Center Inc | |||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541812738 | Ambulatory Healthcare Services | VA | N/A | C | 0 |
| RHS Management Corporation | |||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541313425 | Independent Living Facility | VA | N/A | C | 0 |
| Bon Secours - Virginia HealthSource Inc | |||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541417686 | Ambulatory Healthcare Services | VA | N/A | C | 0 |
| Richmond MRI Inc | |||||||||
| 8580 Magellan Parkway | Richmond | VA | 23227 | 541568452 | Imaging Services | VA | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |