2017-07-10T09:44:13-05:00 2016-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2015-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Laura Ellison CFO-BSBHS 4103624477 2017-07-10 1 John W Sadoff Jr P00540589 4042201500 2015 2021-01-29 14:40:06Z BS Hospital Specialty Center New Hope BS Renal Dialysis Center Samuel L Ross MD 2000 West Baltimore Street Baltimore MD 212231558 120658280 0 0928 X www.bonsecours.com X 1920 MD Acute Care Hospital 14 12 1008 100 101684 83831 4765721 4959054 121625518 114827825 1443074 209653 592270 661748 128426583 120658280 271472 393933 0 0 58567273 54983397 0 0 0 59668755 66310424 118507500 121687754 9919083 -1029474 70127016 65899696 147743944 153506599 -77616928 -87606903 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 112360407 393933 114827825 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 services & 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. 112360407 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 1 126 0 1 1008 1 1 1 0 0 0 0 0 0 0 0 0 X 14 12 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 1153509 95732 Sr Anne Lutz CBS President 3.00 47.00 X X 0 0 0 Matthew Hemelt BM (Sep-Dec)/Chairman (Jan-Aug) 3.00 2.00 X X 0 0 0 Keshia Pollack BM (Sep-Dec)/Secretary (Jan-Aug) 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 (Jan-Aug) 2.00 0.00 X 0 0 0 Lawrence Hubbard Board Member (Jan-Aug) 2.00 3.00 X 0 0 0 Kevin Hutt Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Br Frank O'Donnell Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Jeffrey Richardson Board Member (Sep-Feb) 2.00 0.00 X 0 0 0 Martha Riva Esq Board Member 2.00 48.00 X 0 730674 85632 Sr Mary Shimo CBS Board Member 2.00 4.00 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 (Jan-Aug) 2.00 0.00 X 0 0 0 Ackneil Muldrow Esq Chairman (Sep-Dec) 3.00 0.00 X X 0 0 0 Mary Beachley Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Laura Ellison CFO-BSBHS/BSHSI Sys VP Fin 30.00 20.00 X 0 463622 45402 Shelly Buck CNE/COO 50.00 0.00 X 240342 0 40438 Arsalan Sheikh MD Chair of Medicine 50.00 0.00 X 303888 0 37169 Ibrahim Hanna MD Chair of Surgery 50.00 0.00 X 333420 0 22741 Usha Jain MD Chief Pathologist 49.50 0.50 X 303924 0 22714 Aliya Jones MD Chair of Psychiatry 50.00 0.00 X 301316 0 41515 Rhonda Allen MD Medical Director 50.00 0.00 X 258250 0 15256 Maurice Jeter Psychiatrist (Sep-Oct) 50.00 0.00 X 234013 0 4590 Richard Jones Former Officer 0.00 0.00 X 0 235094 24061 1975153 2582899 435250 81 1 1 0 University of Maryland 110 South Paca St Baltimore MD 21201 ED Physician Services 4611910 Johnson Controls Inc PO Box 423 Milwaukee WI 53201 Maintenance Services 1849041 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 1606250 MDICS Management LLC 6934 Aviation Blvd Suite B Glen Burnie MD 21061 Physician Services 1597440 Allied Barton Security PO Box 828854 Philadelphia PA 191828854 Security 1434910 69 404123 4510928 44003 4959054 Patient Service Reve. 622110 114827825 114827825 114827825 108362 108362 204978 0 204978 204978 204978 65791 35500 0 0 65791 35500 101291 101291 Parking 812930 128926 128926 Rebates 900099 122612 122612 Med Student Program 900099 72600 72600 132632 101684 30948 456770 120658280 114827825 101684 769717 140192 140192 253741 253741 679047 611142 67905 43099994 38789995 4309999 2422316 2180084 242232 4982968 4484671 498297 3799072 3419165 379907 264191 237772 26419 17011 15310 1701 10123 9111 1012 12005291 12005291 105708 95137 10571 1517954 1366159 151795 4111967 3700770 411197 2756339 2480705 275634 187547 168792 18755 140493 126444 14049 1609070 1609070 5866479 5279831 586648 761114 685003 76111 Purchased Services 17602218 15841996 1760222 Medical Supplies 7672210 7672210 Bad Debt Expense 6852560 6852560 Unrelated Business Inco 13198 13198 4816951 4335256 481695 121687754 112360407 9327347 0 1553 1834 360923 361790 689657 919803 16076580 10587497 1092964 1026842 541052 607316 103876949 75419048 29799463 28457901 12159372 12518938 4106 9401346 11417775 70127016 65899696 11261295 10818483 5629432 3310146 42530 55352 130810687 139322618 147743944 153506599 X -77888486 -87826694 271558 219791 -77616928 -87606903 70127016 65899696 X -1029474 194816 -9155317 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 10123 10123 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 50555928 33224505 17331423 49600345 39881083 9719262 3120676 2313460 807216 28457901 HPL/GL Asset 6652585 Due from Affiliates 3598938 Accrued Revenue 981470 Staff Loans 85391 Resident Trust 55351 Security Deposits 22200 LT Noncash Investment 13150 Other Misc Assets 8690 11417775 Due to Affiliates 90558450 Pension Liability 33147015 Liability - HPL/GL 6652036 Medicaid and Insurance Advances 3673422 Liability - FIN 47 1623382 Capital Leases 1420206 Patient Credit Balances 1295833 Other Misc Liabilities 952274 139322618 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. The System's taxable subsidiaries had approximately $89,895 and $84,748 of net operating loss carryforwards as of August 31, 2016 and 2015, respectively, which expire in varying periods through 2036 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. Income tax liabilities are recorded for the impact of positions taken on income tax returns, which management believes are not more likely than not to be sustained on tax audit. 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, 2016 and 2015 as the System considers it more likely than not that these amounts will not be recognized. 1 1 X 1 X 0 1 1 0 1 1 350065 0 350065 0.00300 350065 350065 0.00300 0 42511 2729686 1221202 1508484 0.01310 4 654 370513 19791 350722 0.00310 2 17659 12387387 7694380 4693007 0.04090 2 0 189536 116701 72835 0.00060 8 60824 15677122 9052074 6625048 0.05770 8 60824 16027187 9052074 6975113 0.06070 1 6852560 0 27228117 24382191 2845926 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 1 15 1 See Section C 1 0 1 X 200.000000000000 0.000000000000 0 1 X X X 1 X http://www.fa.bonsecours.com/ X X X X X 1 X 1 X 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 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 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 Priority Need:Southwest Baltimore residents have evolving needs for comprehensive and integrated health services, including behavioral health. Bon Secours has expanded its service line over the last several years to become one of the most extensive in the City of Baltimore as it relates to behavioral health services and is an invaluable asset to the Southwest Baltimore community. The Department of Behavioral Health provides the following outpatient mental health and substance abuse programs: Assertive Community Treatment (ACT) Specialized Case Management (SCMP) Homeless Outreach Adult Day Psychiatric Rehabilitation Program (PRP) Residential (RRP) Outpatient Mental Health (OMHC) Partial Hospitalization Programs for Adults and Children (PHEP) A.D.A.P.T Cares (Anti-Drug Abuse Program With Therapy) New Hope Treatment Center counseling Next Passage Substance Abuse Treatment Center Psychiatric Rehabilitation Services (New Phases)The combined West Baltimore zip codes of 21216, 21217, 21223, and 21229 have the highest disease burden and worst indicators of social determinants of health than most 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.Our Community Health Needs Assessment identified expansion of Primary Care and capacity along with expanded access to case/care management services as priorities in order 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 visitsThe Health Enterprise Zone (HEZ) takes a two-part approach: 1) increased care coordination through the patient-centered medical home for patients with cardiovascular disease at high risk of hospitalization and emergency department (ED) use; and 2) community-based risk factor reduction for patients at risk of developing cardiovascular disease. These strategies are designed to be mutually reinforcing to improve cardiovascular outcomes. There are an estimated 86,000 West Baltimore residents who have or are at risk for cardiovascular disease (CVD) in zip codes of 21216, 21217, 21223, and 21229. Through FY 2016, 151,440 West Baltimore residents had participated in HEZ activities 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). Community Health Workers (CHWs) are also deployed across the HEZ and are embedded in the community. CHWs are responsible for care coordination, staffing health fairs, and registering Passport to Health participants during events (including fitness and nutrition classes). The Passport to Health program incentivizes activities that reduce CVD risk. Participants receive a registration card that is scanned at each staffed activity. Attendance is tracked using an online system developed by the Delmarva Foundation and points are assigned for attendance. At the end of a session, points are tallied and healthy incentives are distributed.The CHWs are deployed across the HEZ and are embedded in the community. CHW Community Outreach Encounters SEPTEMBER 2015 AUGUST 2016:Total Encounters To date: 3,231Home visits: 913Educational : 1,290Phone visits: 5,416Clinic visits: 44We held 528 fitness classes (about 11 free fitness classes per week) with an average of 178 participants per month. We held 15 nutrition and cooking classes with 88 participants.The HEZ awarded 39 scholarships to West Baltimore residents who are pursuing degrees/certificates in health careers. To date, $172,300 in scholarships has been committed to these 39 HEZ scholars.For additional information, please see the attached Implementation Plan and Update.Community Building Activities: Bon Secours Baltimore Health System works closely with the community it serves to create projects, programs and services that are leading to the realization of a vision towards making southwest Baltimore a healthier community of choice for current and new residents. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 16i: Information regarding the FAP is available on our websites; brochures are available at the time of registration. We have on site Counselors who can assist the patients. We have eligibility vendors who work with the patients and our statements indicate we have an FAP. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 22d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy (FAP). The FAP provides information relating to the assistance provided to individuals that are eligible for free or discounted care. 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 3c: For patients with income above 200% of the FPG, the organization utilizes a sliding scale with no cap. 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 non-patient 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: $6,852,560. 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 "accountsreceivable" on pages 12-13 in the attached BSHSI consolidated auditedfinancial statements ("AFS"). "Allowance for uncollectible accounts" isdiscussed in the second paragraph in Footnote "(10) Net Patient ServiceRevenue" on pages 42-43 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 non-reimbursable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and non-reimbursable 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 that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending FAP account.Specific criteria exist for how much 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 twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve months, the patient is responsible for reapplying for FAP eligibility. Part VI, Line 2: We utilize several methods for gathering input including community association meetings where issues are identified and prioritized by residents; review and analysis of previous community engagement activities; quarterly community forums convened by Bon Secours and one on one interviews. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens 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. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 200% of the Federal Poverty Guidelines ("FPG"), A sliding scale assistance policy is afforded to patients that exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self-pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family suffers a catastrophic financial burden to receive necessary health care services. Based on research conducted by the Tax Foundation, a non-partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. In addition, a variety of other potential payment options are available. Bon Secours is 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 process. Part VI, Line 4: Bon Secours' Community Benefit Service Area (CBSA) includes the following zip codes: 21223, 21216, 21217, 21229, 21230, 21201, and 21215. Bon Secours has maintained a constant presence in this part of Baltimore for over 130 years. Bon Secours' CBSA includes 40.5% of Baltimore City's population. Bon Secours' CBSA is similar to Baltimore City and Maryland in regards to age and gender, but is different in terms of race/ethnicity and income. Bon Secours' CBSA has a lower household income and a larger proportion of African Americans than Baltimore City and Maryland. The CBSA also experiences a higher rate of public insurance than Maryland. Within Bon Secours' CBSA 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 CBSA zip codes. There is also wide variation in race/ethnicity and insurance coverage within the CBSA. Overall, the CBSA is a majority African American, low income, and in most zip codes publicly insured. According to the American Community Survey of 2010 - 2014, the following demographic estimates are provided for the Bon CBSA:Population40.5% of Baltimore City's residents are within Bon Secours' CBSA. Zip codes 21215, 21229, and 21217 comprise the largest segments of the CBSA, and represent 59.6% of the residents in the CBSA. AgeOn average, Bon Secours' CBSA is comparable to Baltimore and Maryland by age across all age sub-groups, but the CBSA average does not capture the wide variation between zip codes.-10.9% of people living in 21201 are under 14, the lowest in the CBSA.-40.1% of 21201 residents are between 15-30, which is over a 20% difference to Baltimore City and Maryland. -21215 and 21216 have a 65+ population that is greater than the average for Baltimore and Maryland. Bon Secours' CBSA race/ethnicity is starkly different than Maryland's, and more comparable to Baltimore City's race/ethnicity, with some key exceptions. -69.5% of the CBSA is African American, which is greater than Baltimore City and Maryland's (62.5% and 29%, respectively).-The White population in Bon Secours' CBSA differs by 5.5% to Baltimore City and 32% to Maryland. -5.5% of the CBSA is not African American or White, whereas it is 7.3% and 14.8% in Baltimore City and Maryland, respectively. Bon Secours' CBSA household incomes are much lower that the state of Maryland and Baltimore City.-29.9% Bon Secours' CBSA households have an income under $25,000. -55.1% of CBSA 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 CBSA households have an income of $75,000 or over.The CBSA has a higher percent of individuals that have public insurance compared to Maryland. All CBSA zip codes have more than 30% of their population enrolled in public insurance. The CBSA has a higher proportion of uninsured persons compared to Baltimore and Maryland. Four of 7 zip codes within the CBSA have 50% or more of their population enrolled in public insurance.The CBSA has worse health outcomes compared to Baltimore City and Maryland in both length of life and quality of life. Significant findings are that CBSA residents are more likely to report feeling that their health is poor or fair compared to Baltimore City and Maryland, and CBSA residents report more bad mental health days than physical health days. Health problems in the community are exacerbated by inadequate insurance coverage. Approximately 11% of neighborhood residents are covered by Medicare, and 31% receive Medicaid. Seventeen percent are without any form of health insurance. Part VI, Line 5: BS Baltimore has an open medical staff with privileges available to all qualified physicians in the area. BS Baltimore 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, non-stock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, non-stock 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 plays a role in achieving the vision of BSHSI and the SQP (Strategic Quality Plan). Part VI, Line 7, Reports Filed With States MD 1 Bon Secours of Maryland Foundation Inc 26 N Fulton Ave Baltimore MD 21223 521732800 501(C)(3) 18620 General Support United Way of Central Maryland 1800 Washington Blvd Suite 340 Baltimore MD 21230 520591543 501(C)(3) 10000 General Support American Diabetes Association 2002 Clipper Park Rd 110 Baltimore MD 21211 131623888 501(C)(3) 10000 General Support Reading Partners 916 N Charles St 250 Baltimore MD 21201 770568469 501(C)(3) 20000 General Support American Heart Association 216 E Redwood St Baltimore MD 21202 135613797 501(C)(3) 7500 General Support 5 0 Indigent Cab/Bus Fare 396 106132 Emergency Assistance Funds for Patients, Volunteers, & Employees 63 55858 Community Scholarships (HEZ Grant) 39 76751 "Live Near Your Work" Program 3 15000 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 611251 0 423522 0 118736 0 75234 0 20498 0 1249241 0 47512 Martha Riva Esq Board Member 0 359450 0 283433 0 87791 0 53340 0 32292 0 816306 0 34277 Laura Ellison CFO-BSBHS/BSHSI Sys VP Fin 0 306898 0 113464 0 43260 0 15900 0 29502 0 509024 0 0 Shelly Buck CNE/COO 195128 0 40358 0 4856 0 9931 0 30507 0 280780 0 0 0 Arsalan Sheikh MD Chair of Medicine 303576 0 0 0 312 0 10600 0 26569 0 341057 0 0 0 Ibrahim Hanna MD Chair of Surgery 333077 0 0 0 343 0 10600 0 12141 0 356161 0 0 0 Usha Jain MD Chief Pathologist 300407 0 0 0 3517 0 10600 0 12114 0 326638 0 0 0 Aliya Jones MD Chair of Psychiatry 285772 0 15250 0 294 0 7950 0 33565 0 342831 0 0 0 Rhonda Allen MD Medical Director 257725 0 0 0 525 0 7798 0 7458 0 273506 0 0 0 Maurice Jeter Psychiatrist (Sep-Oct) 217283 0 0 0 16730 0 4590 0 0 0 238603 0 0 0 Richard Jones Former Officer 0 100266 0 97949 0 36879 0 12186 0 11875 0 259155 0 1300 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: Samuel Ross, MD., $68,934; Martha Riva, Esq., $42,772; Richard Jones, $4,945. 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 11 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 XI, line 9: Transfer to BSHSI for Debt Principal, Swaps and Pension -1,065,802. Minimum Pension Liability -8,069,903. Other changes in net assets -1,016. Reversed accrual for unrealized grant -18,596. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, 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 9 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 9 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 11c, 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 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 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0