2018-07-10T06:49:37-05:00 2017-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2016-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Laura Ellison CFO-BSBHS 4103624477 2018-07-10 1 John W Sadoff Jr P00540589 4042201500 2016 2022-09-23 18:48:47Z BS Hospital Specialty Center New Hope BS Renal Dialysis Center Samuel L Ross MD 2000 West Baltimore Street Baltimore MD 212231558 114941824 0 0928 X www.bonsecours.com X 1920 MD Acute Care Hospital 12 10 965 30 89683 73840 4959054 3334087 114827825 110547571 209653 445749 661748 614417 120658280 114941824 393933 394482 0 0 54983397 53832125 0 0 0 66310424 63813391 121687754 118039998 -1029474 -3098174 65899696 68505669 153506599 153884340 -87606903 -85378671 X The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. 0 0 108779726 394482 110547571 Bon Secours Baltimore Hospital provides both inpatient and outpatient services. Such services include:Inpatient Services - 151 bed capacity, 72 licensed beds for critical care, medical, psychiatric and surgical needs. The Hospital provides a full range of srvices & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care; Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; Patient Education; Infectious Disease Care; Lab Services; Mammography; Neurology; Nuclear Medicine; Ophthalmology; Orthopedics; Faith Community Nurse Services; Pastoral Care; Pharmacy; Physical Therapy; Podiatry; Psychiatry; Pulmonary Services and Primary Care.Outpatient Services include: renal dialysis, HIV/AIDS services, mental health, substance abuse treatment, health education, cardiac rehabilitation and wellness programs and tele-health program for patients with congestive heart disease. The Hospital operates an emergency room that is open 24 hours per day, seven days per week, serving persons regardless of their ability to pay. See Sch H for additional information. 108779726 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 121 0 1 965 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 MD X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Samuel Ross MD CEO 21.00 29.00 X X 0 1000544 54934 Sr Anne Lutz CBS President 3.50 46.50 X X 0 0 0 Matthew Hemelt Chairman 3.00 0.00 X X 0 0 0 Keshia Pollack Secretary 2.00 0.00 X X 0 0 0 Patricia Scipio Treasurer 2.00 0.50 X X 0 0 0 Sonja Hines Board Member (Sep-Mar) 2.00 0.00 X 0 0 0 Lawrence Hubbard Board Member 2.00 0.00 X 0 0 0 Kevin Hutt Board Member 2.00 0.00 X 0 0 0 Br Frank O'Donnell Board Member 2.00 0.00 X 0 0 0 Martha Riva Esq Board Member (Sep-Dec) 2.00 48.00 X 0 800176 44996 Sr Mary Shimo CBS Board Member 2.00 3.50 X 0 0 0 Anthony Stanowski Board Member 2.00 0.00 X 0 0 0 Theodore Wimberly Board Member 2.00 0.00 X 0 0 0 Cecelia Wright Brown Board Member (Sep-Jul) 2.00 0.00 X 0 0 0 Christine Lay Board Member (Jan-Aug) 2.00 48.00 X 0 355490 28071 Laura Ellison CFO-BSBHS/BSHSI Sys VP Fin 30.00 20.00 X 0 450849 45410 Shelly Buck CNE/COO 50.00 0.00 X 265776 0 41375 Arsalan Sheikh MD Chair of Medicine 50.00 0.00 X 351871 0 37292 Ibrahim Hanna MD Chair of Surgery 50.00 0.00 X 320981 0 22353 Usha Jain MD Chief Pathologist 49.50 0.50 X 295471 0 23827 Aliya Jones MD Chair of Psychiatry 50.00 0.00 X 291826 0 41515 Shanta Powell Psychiatrist 50.00 0.00 X 232389 0 26426 Joseph Griffin Psychiatrist 50.00 0.00 X 231648 0 15063 1989962 2607059 381262 65 0 1 0 University of Maryland 110 South Paca Street Baltimore MD 21201 ED Physician Services 4406035 Johnson Controls Inc PO Box 423 Milwaukee WI 53201 Maintenance Services 2051890 Allied Universal PO Box 828854 Philadelphia PA 191828854 Security Services 1946911 Crothall Healthcare Inc 13028 Collection Center Drive Chicago IL 60693 Housekeeping Services 1917804 Cardinal Health Pharmacy 21377 Network Place Chicago IL 60673 Pharmacy Services 1817864 54 130748 1869294 1334045 3334087 Patient Service Reve. 622110 110547571 110547571 110547571 138807 138807 202570 0 202570 202570 202570 304788 2154 0 0 304788 2154 306942 306942 Parking 812930 108211 108211 Rebates 900099 106019 106019 Med Student Program 900099 105900 105900 91717 89683 2034 411847 114941824 110547571 89683 970483 X 147725 147725 246757 246757 699739 629765 69974 40847523 36762771 4084752 3133017 2819715 313302 5609637 5048673 560964 3542209 3187988 354221 164940 148446 16494 42243 38019 4224 10247 9222 1025 12871785 12871785 142128 127915 14213 1038469 934622 103847 3217531 2895778 321753 2622796 2360516 262280 160700 144630 16070 111836 100652 11184 1457159 1457159 6327131 5694418 632713 1669614 1502653 166961 Purchased Services 18070679 16263611 1807068 Medical Supplies 7992469 7992469 Bad Debt Expense 3359401 3359401 Unrelated Bus Inc. Tax 70890 70890 4483373 4035036 448337 118039998 108779726 9260272 0 1834 1100 361790 362667 919803 439994 10587497 10660343 1026842 1028483 607316 543685 107679827 79818641 28457901 27861186 12518938 13646337 11417775 13961874 65899696 68505669 10818483 13372527 3310146 4374402 55352 70893 139322618 136066518 153506599 153884340 X -87826694 -85601469 219791 222798 -87606903 -85378671 65899696 68505669 X -3098174 709592 4616814 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10247 10247 0 Part II-B, Line 1: 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. 0 1 X 600000 600000 52230886 34383949 17846937 51623357 43072667 8550690 3225584 2362025 863559 27861186 HPL/GL Asset 9322963 Due from Affiliates 4118737 Accrued Revenue 298949 Staff Loans 110877 Resident Trust 70893 Security Deposits 22200 LT Noncash Investment 13150 Rent Receivable 1010 Other Misc Assets 3095 13961874 Due to Affiliates 94381402 Pension Liability 24116676 Liability - HPL/GL 9322414 Medicaid and Insurance Advances 4406651 Liability - FIN 47 1707117 Patient Credit Balances 1113516 Capital Leases 896334 Other Misc Liabilities 122408 136066518 X Part IV, Line 2b: Bon Secours Hospital Baltimore holds, safeguards, manages and accounts for the Social Security funds of certain patients. These funds are held in an FDIC insured banking institution. With the assistance of hospital personnel, funds are generally accessed by the patient through the use of ATM cards or Visa gift cards which are purchased on their behalf. Part X, Line 2: 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. 1 1 X 1 X 1 X 1 1 0 1 1 385851 385851 0.00340 385851 385851 0.00340 8 37483 2631022 887144 1743878 0.01520 2 776 484296 484296 0.00420 2 18560 12206742 7663053 4543689 0.03960 2 199089 102094 96995 0.00080 344565 344565 0.00300 14 56819 15865714 8652291 7213423 0.06280 14 56819 16251565 8652291 7599274 0.06620 1 3359401 0 36292822 21321182 14971640 X 1 1 1 1 Bon Secours Hospital Baltimore Inc 2000 W Baltimore St Baltimore MD 212231558 www.bonsecours.com 30-007 X X X X Bon Secours Hospital Baltimore Inc 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Section C X X 1 15 1 See Section C 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X http://www.fa.bonsecours.com/ X http://www.fa.bonsecours.com/ X http://www.fa.bonsecours.com/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 5: In FY2016 Bon Secours Baltimore Health System (BSBHS) used a team approach to complete its Community Health Needs Assessment (CHNA). The CHNA team used a multi-pronged approach to solicit input from the West Baltimore community regarding their health needs. Data collection methodologies included surveys, stakeholder interviews, focus groups, and community conversations. We engaged with representatives of our community with a knowledge of public health (e.g., Maryland Department of Health and Mental Hygiene and the Baltimore City Health Department), the broad interests of the communities we serve, individuals with special knowledge of the medically underserved, as well as low-income and vulnerable populations and people with chronic diseases. We met with seniors, youth, re-entry residents, hospital patients, faith-based stakeholders, community leaders, health care providers, neighborhood associations, representatives from community-based organizations and other key community stakeholders with an intimate knowledge of the West Baltimore community and their health needs. Four hundred and twenty-five (425) surveys were collected (296 within the defined service area), and nine (9) stakeholder interviews, six (6) focus groups and one (1) community discussion were conducted between November 2015 through June 2016. The survey, interviews, focus groups and community discussion focused on community health needs, community assets and resources available to respond to the community health needs, barriers and challenges to accessing the community assets and resources, and ways in which Bon Secours could help address the health needs. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 7d: Hard copies were distributed to our Healthy Community Advisory Board members and are also available upon request to Hospital Administration, Marketing or CommunityWorks. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 11: BSBHS's CHNA Implementation Plan positions BSBHS to take on the entwined roles of convener, catalyst and contributor in partnering with the communities we serve and helps us to move towards the realization of a vision of: Healthy People, Healthy Economy & Healthy Environment.Healthy People:Bon Secours Women's Resource Center (WRC) serves as a day-time center addressing the needs to women who are in crisis and need immediate access to services. Bon Secours Family Support Center serves pregnant mothers and families with children up to age three. The Center offers non-traditional Early Head Start services, teen parent services, and in-home support. Early Head Start (EHS) -121 children and 12 pregnant mothers enrolled in and received EHS in-center developmental care throughout the fiscal year. -In addition to EHS, parents/guardians participated in a wide variety of "Nurturing Parent Workshops" held throughout the year.Teen Parent Program-24 parenting or pregnant teens enrolled and received health, social, psychological, and academic support to encourage educational success as well as prevent subsequent pregnancies. -1 teen participated in our eight-week summer Youth Employment Entrepreneurship Program (YEEP).Home Visiting Program -41 young mothers with children under three years of age received ongoing in-home parenting skills training and education about supporting their child's developmental milestones. Women, Infant, & Children Although not operated by Bon Secours, the Baltimore City Women, Infants & Children (WIC) Program is located at Bon Secours Community Works, so we enabled an additional 917 clients to access to WIC benefits by providing a facility. Of those 86 clients were connected with additional services at Community Works.Health Enterprise Zone (HEZ) works to improve and expand access to primary care and preventive services, improve the health of the community by increasing the number of people connected to a primary care medical home and increasing annual primary care visits. 37,087 West Baltimore residents have participated in HEZ activities throughout the program by the following mechanisms: 1) health fairs, 2) care coordination, 3) primary care services, and 4) community based activities (i.e. fitness, cooking and nutrition classes).The Community Health Workers Encounters :SEPTEMBER 2016 - MARCH 2017-Total Encounters: 5,722 -Home visits: 399 -Educational: 2,628-Phone visits: 2,686-Clinic visits: 9We held 220 fitness classes (about 11 free fitness classes per week) with an average of 116 participants per month. We held 2 nutrition and cooking classes with 23 participants.Awarded 25 scholarships to West Baltimore residents who are pursuing degrees/certificates in health careers. To date, $80,476 in scholarships has been committed to these 25 HEZ scholars.SEPTEMBER 2016 - MARCH 2017Total # of unduplicated patients seen in reporting period: 17,754 Total # of patient visits in reporting period: 28,042 Bon Secours Hospital Screening Brief Intervention Referral to Treatment ("SBIRT") is designed so that all patients that enter the hospital through the Emergency Department or through a direct admission are screened by hospital nursing staff as part of the nursing assessment. Nurses and other members of the health care team refer patients at high risk to Peer Recovery Coaches (PRC) to provide brief interventions and referrals to treatment, as appropriate.For the July 1, 2016 through June 30, 2017 period: -97.6% of Emergency Department patients were screened by ED Nurse-34% of patient screened were positive-32.1% with positive screen receive brief intervention-14.07% referred to treatment from brief intervention-44.06% confirmed attendance at treatmentThe Department of Behavioral Health provides the following outpatient mental health and substance abuse programs:Assertive Community Treatment (ACT) Mobile Treatment Services served 96 different clients, average # enroll 94 clients for FY17. Specialized Case Management Program (SCMP): served 255 clients during FY17.Vocational Services (SEP): Averages 28 clients continuously employed. 60 referrals received during FY17.Psychiatric Day Program (PRP): 1,260 client visits 152 different clients enrolled. Outpatient Mental Health (OMHC): -The OMHC Walk-in Program was initiated during FY 17 in an effort to meet a community need for on-demand treatment services. -Number of people signed in for walk-in: 415-Number of People Screened: 415-Number of Admissions to OMHC: 282Partial Hospitalization Programs for Adults and Children (PHEP): Average Daily Census 7.00Opioid Maintenance Treatment with Methadone (OTP): -New Hope- (189 Admissions; 315 Census)-Adapt Cares- (107 Admissions; 255 Census)Opioid Maintenance Treatment with Methadone with Suboxone (OTP): (123 Admissions; 35 daily Census) Crisis Stabilization: 2141 Crisis AssessmentsCommunity Disease Management Nurse Ministry addresses a critical need for patients to have access to services and education to assist in management as well as improve outcomes in their physical and mental health and well-beingTELE-HEART PROGRAM - SEPTEMBER 2016 THROUGH AUGUST 2017-Total Occurrence- 10,140-Total Encounters- 9,909PARISH NURSE MINISTRY - SEPTEMBER 2016 THROUGH AUGUST 2017-Total Occurrence - 2,142-Encounters - 2,873Healthy Economy:Bon Secours Career Development works to create jobs and prepare residents for these jobs by providing job readiness programs and ongoing adult education; participating in the creation of jobs in areas which we have the most expertise and influence. Job Placement167 clients gained one or more paid employment opportunities using our job search and placement support obtaining 204 jobs averaging $13.17. 8 additional clients received paid urban landscaping training and job readiness skills training through our six-month Clean and Green Neighborhood Revitalization program. Trainees improved more than 50 vacant lots. CNA/GNA Training 105 clients enrolled in our CNA/GNA training program, with 88 clients graduating, and 87 receiving CNA/GNA certification. 83 clients have gained employment in a health-care field and of those 3 clients were placed at Bon Secours Hospital. Youth Employment Entrepreneurship Program (YEEP) 30 youth from low-income households participated in this eight-week summer work and career prep program, which included paid work experience throughout 16 departments in Bon Secours Baltimore and Community Works Re-entry Success Program296 clients enrolled in the "TYRO" life skills training program for men and women to help break the cycle of incarceration. 96 participants graduated over 8 cohorts. Some clients enrolled in the program and were unable to complete for the following reasons 1) behind the walls and moved to new jail; 2) obtain job which conflict with TYRO class times; 3) or did not complete all 12 classes to graduate. -Hosted two expungement workshops (89 persons served; 471 charges expunged).Bon Secours Financial Services offers services to help residents become more financially aware, begin building assets, and create stronger financial futures for their families.Eviction Prevention -643 individuals/families were screened for eviction prevention assistance and benefited from a one-on-one assessment of their financial situation. -Of those, 205 individuals/families prevented imminent eviction through a one-time eviction prevention cash grant after completing our mandatory "Budget & Credit Workshop." This is intended to prevent first-time homelessness and increase clients' capacity for sustained financial stability.Total of $184,818 in eviction prevention assistance distributed. EarnBenefits Screening (i.e. public benefits) -647 clients were screened through the EarnBenefits software system for eligibility for public benefits to increase economic stability. Benefits include SNAP (aka food stamps), utilities assistance, health insurance, and WIC. Of those, 433 clients were eligible for one or more public benefits.Income Tax Preparation -395 clients received low-cost tax preparation. -Total Federal Refunds generated: $666,268.-Total State Refunds generated: $180,802.Healthy Environment:Community Housing develops and manages safe/affordable housing; connects residents of housing to needed services - and to one another. A total of 729 units are in service; service coordination at each senior housing site; construction on an additional 73 unit family apartment building begun June 2016. Housing occupancy for FY17 was 97.9% for 729 units. Bon Secours Hospital Baltimore, Inc. 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 14: The FAP provides information relating to the assistance provided to individuals that are eligible for free or discounted care. However, the Community Service Adjustment, which is available in our other markets, is not available in Maryland. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/baltimore/community-commitment/healthy-community-initiative Form 990, Schedule H, Part V, Section B, Line 10a: https://bonsecours.com/baltimore/community-commitment/healthy-community-initiative 4 1 - Bon Secours CIBSADAPT 3101 Towanda Ave Baltimore MD 21215 Behavioral Health Services 2 - Bon Secours CIBSNew PassageNew Hope 2401 W Baltimore St Baltimore MD 21223 Behavioral Health Services 3 - Bon Secours CIBSSCMPACTNew Phases 6000 Metro Drive Baltimore MD 21215 Behavioral Health Services 4 - Family Health & Wellness 1940 W Baltimore St Baltimore MD 21223 Community Medical Center Part I, Line 6a: Annually, Bon Secours Baltimore Health System (BSBHS) publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Foundation Day of the Sisters of Bon Secours. This report is available online at https://bonsecours.com/baltimore/community-commitment. 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: Part I, Line 7b: Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.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: $3,359,401. 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. 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: As a part of Bon Secours Health System, Bon Secours Baltimore Health System conducts strategic planning on a three-year cycle. The product of this process, the "Strategic Quality Plan" serves as the driver for strategic initiatives at both the national and local system level. Fiscal year 2016 was the first year in the cycle (2016-2018) that had the following priorities: Co-Create Healthy Communities Be Person Centric Serve Those Who Are Less Vulnerable Strengthen Our Culture And CapabilitiesAll strategic initiatives, including community benefit, must address one or more of these priorities, the development of which are informed in part by local system community benefit reports, the most recent community health needs assessment and other community engagement activities.Community engagement activities include regular meetings with advisory groups (Anchor Work Group, Crime & Grime committee, CHNA Advisory Board, local Community Associations and the Southwest Partnership coalition) and events such as quarterly community forums, neighborhood cleanups, charrettes and various other single-purpose activities that inform our needs assessment and program development. 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 are translated into multiple languages and placed on our Bon Secours website for patients to access. Part VI, Line 4: Bon Secours' service area includes 40.5% of Baltimore City's population. Bon Secours' service area is similar to Baltimore City and Maryland in regards to age and gender, but is different in terms of race/ethnicity and income. The area has a lower household income and a larger proportion of African Americans than Baltimore City and Maryland. The area also experiences a higher rate of public insurance than Maryland. Within Bon Secours' service area seven zip codes there is wide variation. Zip codes 21217 and 21223 have a population that is younger than the other CBSA zip codes, while 21215 and 21216 have a population that is older than the other zip codes. There is also wide variation in race/ethnicity and insurance coverage within the area. Overall, the area is a majority African American, low income, and in most zip codes publicly insured. 40.5% of Baltimore City's residents are within Bon Secours' service area. Zip codes 21215, 21229, and 21217 comprise the largest segments of the area, and represent 59.6% of the total residents in the area.Household incomes are much lower in the area on average than the state of Maryland and Baltimore City. 29.9% have an income under $25,000. 55.1% of household incomes are below $50,000, whereas 50.3% of Baltimore City and 26.3% of Maryland household incomes are below $50,000. 57.3% of Maryland household incomes are $75,000 or over, while 27.6% of Bon Secours service area households have an income of $75,000 or over.The area has a higher percent of individuals that have public insurance compared to Maryland. More than 30% of their population is enrolled in public insurance. There is also a higher proportion of uninsured persons compared to Baltimore and Maryland. Four of 7 zip codes within the Bon Secours service area have 50% or more of their population enrolled in public insurance.The Bon Secours service area also has one of the highest disease burden and some of the worst indicators of social determinants of health than any other community in Maryland. These neighborhoods establish the lower extremes for health disparities in the City and the State across all major chronic illnesses. Families in the Zone experience poverty (20%) at higher rates than those in Maryland (6%) and in Baltimore City (17%). Life expectancy can be up to 12 years shorter in these zip codes than in other parts of Maryland. Part VI, Line 5: BSBHS has an open medical staff with privileges available to all qualified physicians in the area. BSBHS is governed by a board of directors whose composition is representative of the community it serves. 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 MD 1 Coppin State University 2500 West North Avenue Baltimore MD 21216 526002033 501(C)(3) 10000 General Support NAACP Baltimore City Branch 8 W 26th Street Baltimore MD 21218 520576923 501(C)(4) 5000 General Support National Association of Health Service Executives 1050 Connecticut Ave NW Washington DC 20036 621312239 501(C)(3) 5000 General Support American Diabetes Association 2002 Clipper Park Rd 110 Baltimore MD 21211 131623888 501(C)(3) 5000 General Support 3 1 Indigent Cab/Bus Fare 396 80560 Emergency Assistance Funds for Patients, Volunteers, & Employees 44 37765 Community Scholarships (HEZ Grant) 42 77432 "Live Near Your Work" Program 4 50000 Next Generation Scholarship 1 1000 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 0 1 0 0 0 0 0 0 0 Samuel Ross MD CEO 0 601809 0 90308 0 308427 0 34958 0 19976 0 1055478 0 171858 Martha Riva Esq Board Member (Sep-Dec) 0 386142 0 89482 0 324552 0 15900 0 29096 0 845172 0 106744 Christine Lay Board Member (Jan-Aug) 0 259003 0 51734 0 44753 0 15900 0 12171 0 383561 0 0 Laura Ellison CFO-BSBHS/BSHSI Sys VP Fin 0 341191 0 68847 0 40811 0 18718 0 26692 0 496259 0 0 Shelly Buck CNE/COO 230005 0 33538 0 2233 0 9911 0 31464 0 307151 0 0 0 Arsalan Sheikh MD Chair of Medicine 321539 0 30000 0 332 0 10600 0 26692 0 389163 0 0 0 Ibrahim Hanna MD Chair of Surgery 320651 0 0 0 330 0 10600 0 11753 0 343334 0 0 0 Usha Jain MD Chief Pathologist 292084 0 0 0 3387 0 10600 0 13227 0 319298 0 0 0 Aliya Jones MD Chair of Psychiatry 279543 0 12000 0 283 0 7950 0 33565 0 333341 0 0 0 Shanta Powell Psychiatrist 185695 0 46551 0 143 0 0 0 26426 0 258815 0 0 0 Joseph Griffin Psychiatrist 230234 0 0 0 1414 0 3404 0 11659 0 246711 0 0 0 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, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Martha Riva, $ 297,476; Samuel Ross MD, $201,434. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Baltimore Health Systems, Inc., which in turn is the sole member of Bon Secours Hospital Baltimore, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Hospital Baltimore, Inc. is appointed by its member Bon Secours Baltimore Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Hospital Baltimore, Inc. 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: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. Sr. Anne Lutz does not receive payroll distributions as she has taken a vow of poverty. Form 990, Part IX, line 11g Physician Fees: Program service expenses 11,975,979. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,975,979. Contracted Labor: Program service expenses 895,806. Management and general expenses 0. Fundraising expenses 0. Total expenses 895,806. Form 990, Part XI, line 9: Transfer to BSHSI for Debt Principal, Swaps and Pension -929,504. Minimum Pension Liability 5,546,318. 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 The Bon Secours of Maryland Foundation Inc dba Community Works 26 N Fulton Avenue Baltimore MD 21223 521732800 Community Foundation MD 501(c)(3) Line 7 Bon Secours Baltimore Health System Inc 0 Unity Properties Inc 26 N Fulton Avenue Baltimore MD 21223 521857768 Low Income Housing MD 501(c)(3) Line 7 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Development Inc 26 N Fulton Avenue Baltimore MD 21223 760785344 Low Income Housing MD 501(c)(3) Line 7 Unity Properties Inc 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) Line 7 Bon Secours Baltimore Health System Inc 0 Bon Secours Housing 26 N Fulton Avenue Baltimore MD 21223 521442707 Low Income Housing MD 501(c)(3) Line 10 Bon Secours of Maryland Foundation 0 Bon Secours Housing II 26 N Fulton Avenue Baltimore MD 21223 521543174 Low Income Housing MD 501(c)(3) Line 10 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Health Corp(dba Bon Secours Baltimore Health System) 2000 W Baltimore Street Baltimore MD 21223 800728893 Local System Parent Org MD 501(c)(3) Line 12c, III-FI Bon Secours Health System Inc 0 Bon Secours Apartments LP 1800 W Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD N/A Bon Secours Apartments II LP 1800 W Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD N/A Liberty Senior Housing LP 1800 W Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD N/A Bon Secours Apartments III LP 1800 W Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD N/A Bon Secours Smallwood Summit 26 N Fulton Avenue Baltimore MD 21223 522280175 Low Income Housing MD N/A Bon Secours Chesapeake Apartments LP 26 N Fulton Avenue Baltimore MD 21223 200107034 Low Income Housing MD N/A Bon Secours Shiloh LP 26 N Fulton Avenue Baltimore MD 21223 203965243 Low Income Housing MD N/A Bon Secours Wayland LP 26 N Fulton Avenue Baltimore MD 21223 270468688 Low Income Housing MD N/A Bon Secours Benet House LP 26 N Fulton Avenue Baltimore MD 21223 364765400 Low Income Housing MD N/A Bon Secours Benet House LLC 26 N Fulton Avenue Baltimore MD 21223 463055312 Low Income Housing MD N/A Bon Secours Gibbons Apartments LP 26 N Fulton Avenue Baltimore MD 21223 472322323 Low Income Housing MD N/A Bon Secours New Shiloh II LP 26 N Fulton Avenue Baltimore MD 21223 820655142 Low Income Housing MD N/A Unity Housing Inc 26 N Fulton Avenue Baltimore MD 212231624 521952507 Low Income Housing MD N/A C 0 Bon Secours Wayland LLC 26 N Fulton Avenue Baltimore MD 212231624 270468561 Low Income Housing MD N/A C 0 Bon Secours New Shiloh II LLC 26 N Fulton Avenue Baltimore MD 21223 820631206 Low Income Housing MD N/A C 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0