2016-07-15T11:47:50-05:00 2015-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2014-09-01 521301088 Bon Secours Health System Inc BONS 4104425511 8990 Old Annapolis Road Columbia MD 21045 Janice E Burnett Chief Financial Officer 4433672218 2016-07-15 1 John W Sadoff Jr P00540589 4042201500 2014 2016-09-27 15:27:22Z Richard Statuto 8990 Old Annapolis Road Columbia MD 21045 297246183 0 0928 X www.bshsi.org X 1983 MD Provide admin/mgmt services to hospitals, nursing homes & other related healthcare orgs. 17 15 924 15 551234 344192 51432 3663 187349741 229681336 16116615 15125550 55650211 48435200 259167999 293245749 3988076 16727350 0 0 119400030 143438041 0 0 0 133582208 232070856 256970314 392236247 2197685 -98990498 1301862465 1299722360 1234971162 1293179357 66891303 6543003 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 351314511 16727350 244993994 The Bon Secours Health System provides a wide range of corporate support services to the facilities it owns or has affiliations. The system's mission services ensure that all Bon Secours facilities support the ministry of the Sisters of Bon Secours and the Catholic Church, and are driven by the system's mission and values. The system's financial, operational and business development services provide essential centralized support to improve operations, financial performance, and the delivery of patient care. With expertise in all areas of acute, long-term care and assisted living facility and home care management and operations, the corporate staff also serves as an invaluable corporate consulting resource. Mission Services:-Direction, support and consultation for the local and corporate staffand boards of directors-Policy development in areas such as sponsorship, businessrelationships, moral investments, bioethics, organizational ethics,social justice and community commitment services-Education to promote the Bon Secours mission, philosophy and values tokey staff-Coordination of teams charged with addressing health care issues andethical concernsFinancial & Treasury Services:-Negotiation of access to capital-Oversight, coordination and control of external audits-Coordination of and assistance in maximizing third-party reimbursementand filing related appeals-Monitoring of federal health care policy-Monitoring of System's master pension trust encompassing the pooledinvestment of all defined benefit pension plan assets of System members, including the selection of master pension trust investment advisor and managers and evaluation of their performance-Management of System members' trustee-held funds and System-wideinvestment program encompassing the vast majority of System members'investments, including funded depreciation accounts and centralized cash management program, in accordance with uniform System investmentguidelines-Management of centralized cash management program-Maintenance of System-wide common financial data base providing statusof key financial indicators and operating statistics-Long range capital and financial planning and annual operating andcapital budgeting support-Preparation of monthly and year-end consolidating System-widefinancial statements, including budget variation reporting andstatistical analysis-Development, implementation and monitoring of standardized accountingpolicies and educates senior leaders on financial literacy andcontemporary financial practices.-Development of external financial disclosures to investors and thepublic at large-Primary contact with rating agencies, bond insurers and for investorsquestions Oversight of System consulting in the areas of tax returns,cost reporting, A-133 filings, CDM compliance and third party appeals-Organization of meetings of Chief Financial Officers to bettercoordinate implementation of System-wide goals, strategies, tactics andobjectives and to monitor facility operations and corporate complianceOperational Services:-Actuarial, accounting and investment functions for self insurancefunding of System members' general and professional liability andworkers compensation claims and for a System-wide self-funded plan for employee health benefits-Coordination of functions for a System-wide standard hospitalinformation system and other systems for use throughout the System andsupport functions for implementing and maintaining the informationsystem-Standardized purchasing function, material management, Lawson ERPsystem, and other standard IS-Knowledge Transfer of best practices and successes on revenueenhancement and cost reduction initiatives.Strategic Planning, Marketing, and Business Development Services:-Coordination of System strategic planning including coordination ofdevelopment of the System's vision, goals, and 3-year strategic planand annual planning processes.-Market assessment and strategy development for improved local marketpositioning-Strategic planning support for acute, long-term and home careoperations-New product/service research and development-Emerging technology research & assessment; knowledge transfer oftechnology and implications for system-Coordination and consultative assistance in service line planning &profitability analyses-Implementation of strategic growth initiatives in new and existingcommunities-Coordination of Planning & Business Development leaders, Customer Satisfaction, and Marketing & Communications leaders networksOther Corporate Services:-Corporate Communications and Public Relations-Internal auditing-Corporate Responsibility-Risk management-Governance-Coordination and control of System-wide benefit testing-Administration of System-wide health benefit plans-Placement and renewal of various System-wide welfare benefit plans-Coordination and management of legal services provided to Systemmembers-Regulatory compliance and insurance functions-System-wide employee, patient, resident and physician satisfactionProgram 4013579 125000 Bon Secours Good Helpcare, LLC d.b.a Good Help ACO, is an Accountable Care Organization (ACO) that received approval from the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Shared Savings Program (MSSP), effective January 1, 2013. Part of the Affordable Care Act of 2010, the MSSP is intended to facilitate cooperation among health care providers for the coordination of care for Medicare Fee-for-Service beneficiaries. The goal of coordinated care is to ensure the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Good Help ACO is designed to allow participating providers to provide appropriate coordinated care at a time when it is needed and in a setting that is both convenient and appropriate. 355328090 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 324 0 1 924 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Chris Allen Board Member 4.00 2.00 X 400 0 0 Richard Blair Board Member 4.00 0.00 X 400 0 0 Charles Brown III Chairman (Jan-Aug) 12.00 2.00 X X 0 0 0 Sr Elaine Davia Board Member 3.00 4.00 X 0 0 0 Marcia Dush Board Member 3.00 0.00 X 400 0 0 Stephanie Ferguson PhD Board Member 3.00 0.00 X 400 0 0 David Jimenez Board Member 4.00 0.00 X 400 0 0 Gerard Kells Board Member 3.00 0.00 X 400 0 0 Robert Kuramoto MD Board Member 3.00 0.00 X 400 0 0 Peter Maddox Board Member 3.00 0.00 X 400 0 0 Jennifer O'Brien Esq Board Member 4.00 0.00 X 0 0 0 Susan Sandlund PhD Board Member 5.00 0.00 X 400 0 0 Donald Seitz MD Chairman (Sep-Dec)/BM (Jan-Aug) 12.00 2.00 X X 50400 0 0 Richard Serafini Board Member (Sep-Dec) 4.00 0.00 X 400 0 0 Sr Mary Shimo Board Member 3.00 3.00 X 400 0 0 Richard Statuto President/CEO 50.00 0.00 X X 1971280 0 527923 Sr Alice Talone Board Member 3.00 0.50 X 400 0 0 Carol Taylor Board Member 3.00 0.00 X 1400 0 0 Janice Burnett Treasurer/CFO 48.00 2.00 X 704655 0 127038 Martha Riva Secretary/SVP Governance 47.50 2.50 X 544786 0 81951 Timothy Davis EVP, CHRAO 46.00 4.00 X 1019679 0 151683 Marlon Priest MD EVP, CMO 50.00 0.00 X 1359194 0 37144 Laishy Williams-Carlson SVP, CIO 50.00 0.00 X 423986 0 36396 Peter Bernard EVP, CEO - BSV 0.10 49.90 X 1489553 0 205165 Michael Kerner CEO - HRHS 0.10 49.90 X 958311 0 131925 Mark Nantz EVP, CEO - MKT LDR GRNVL 0.10 49.90 X 898579 0 117360 Matthew Toddy EVP, Legal Affairs 50.00 0.00 X 885520 0 113474 Samuel Ross MD EVP, CEO - BHS 12.50 37.50 X 832778 0 87464 Lawrence Hubbard Former SVP/CIO 0.00 0.00 X 647371 0 36753 11792292 0 1654276 289 1 1 0 Divurgent 4445 Corporation Lane Ste 228 Virginia Beach VA 23462 Management & Support Staff 3808318 Shiftwise PO Box 70870 St Paul MN 55170 Staffing Support 3654960 Towers Watson PO Box 8500 Philadelphia PA 19178 Advisory Services 2680915 Benefit Focus PO Box 123383 Dallas TX 75312 Customer Support 2500060 Infor PO Box 1450 Minneapolis MN 55485 Consulting Services 2286009 125 3663 3663 Corp Mgmt & IS Fees 900099 223849270 223849270 Charity Service Fees 900099 5707066 5707066 Acc. Care Org - Reimb. 900099 125000 125000 229681336 3762701 3762701 10780040 3665257 7114783 7114783 7114783 6834101 4863925 0 335177 6834101 4528748 11362849 11362849 Premier & Other Pships 900099 15749414 15437658 311756 Rebates 900099 6924090 6924090 JV Income 900099 5899693 5899693 12747220 239478 12507742 41320417 293245749 245118994 551234 47571858 16727350 16727350 6019626 5417663 601963 111958611 100667883 11290728 10748910 9670270 1078640 10258190 9219567 1038623 4452704 4000561 452143 1248299 1115902 132397 3994283 3594855 399428 3250 2925 325 342233 308010 34223 2929180 2632753 296427 36156327 32540694 3615633 8112458 7233681 878777 5017141 4514455 502686 3324334 2991901 332433 10774471 10774471 6500000 5850000 650000 44489771 39914638 4575133 152935 108239 44696 Forgiveness of Debt 78181466 70363319 7818147 Purchased Services 29407965 26426308 2981657 Membership/Subscription 838544 754690 83854 UBIT 10847 10847 587352 497955 89397 392236247 355328090 36908157 0 1287491 1448457 39267293 67909390 12842529 14035760 49601 51700 21492733 20277519 429352306 235700261 252368048 193652045 261691056 161508160 156839833 231760761 556023881 609078568 1301862465 1299722360 107432902 111575016 84289186 74822407 836086914 822224366 15584773 15564069 191577387 268993499 1234971162 1293179357 X 66891303 6543003 66891303 6543003 1301862465 1299722360 X -98990498 -9474974 120001 47997171 X 0 1 X 1 1 1 X X 38 Bon Secours Hospital Baltimore Inc 521909599 3 1 9867953 0 Bon Secours Housing Inc 521442707 9 1 0 0 Bon Secours Housing II Inc 521543174 9 1 0 0 Bon Secours of Maryland Foundation Inc 521732800 7 1 774450 0 Unity Properties Inc 521857768 7 1 278598 0 Bon Secours Charity Health System Medical Group PC 223636986 9 1 501208 0 Bon Secours Community Hospital 141340100 3 1 3875553 0 Good Samaritan Foundation For Better Health Inc 133400353 7 1 90000 0 Good Samaritan Hospital of Suffern NY 131740104 3 1 11739247 0 St Anthony Community Hospital Warwick New York 141340100 3 1 2386106 0 St Francis Center at the Knolls Inc dba Mt Alverno Center 061370576 9 1 325081 0 The Bon Secours Warwick Health Foundation 141972807 7 1 0 0 Villa Frances at the Knolls Inc dba Schervier Pavilion 061381994 9 1 294510 0 Bon Secours DePaul Health Foundation 541843876 7 1 157721 0 Bon Secours DePaul Medical Center Inc 541820093 3 1 25823104 0 Bon Secours Maryview Foundation 521694731 7 1 923779 0 Bon Secours Maryview Nursing Care Center 521578169 9 1 157317 0 Maryview Hospital 540506463 3 1 35054212 0 Mary Immaculate Hospital Incorporated 540548200 3 1 5553784 0 Mary Immaculate Nursing Center Inc 541516476 9 1 131344 0 Bellefonte Physician Services Inc 352320780 9 1 15722550 0 Bon Secours Kentucky Health System Foundation Inc 611381952 7 1 213000 0 Our Lady of Bellefonte Hospital Inc 611356023 3 1 14941817 0 Frances Schervier Home and Hospital 131740397 9 1 7329846 0 Schervier Housing Development Fund Corporation 133098867 9 1 0 0 Bon Secours Memorial Regional Medical Center Inc 541744931 3 1 36779774 0 Bon Secours Richmond Community Hospital Incorporated 540647482 3 1 2746136 0 Bon Secours Richmond Health Care Foundation 541201346 7 1 327000 0 Bon Secours St Francis Medical Center Inc 311716973 3 1 9691930 0 Bon Secours St Marys Hospital of Richmond Inc 540793767 3 1 61767666 0 Bon Secours St Francis Health System Foundation Inc 260012031 7 1 0 0 St Francis Hospital Inc 582504530 3 1 75477480 0 Bon Secours Maria Manor Nursing Care Center Inc 650061820 9 1 1297010 0 Bon Secours St Petersburg Home Care Services Inc 134334363 9 1 0 0 Congregation of Bon Secours of Paris Incorporated 453662533 1 1 0 0 Sisters of Bon Secours of the US Incorporated 520715234 1 1 775409 0 Chesapeake Hospital Corporation 237424835 3 1 6484424 0 Rappahannock General Hospital Foundation 541210450 7 1 0 0 38 331488009 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 X X 1 1 1 1 Part IV, Section A, Line 5a: The following organizations were added to the listing of supported organizations as newly acquired organizations. The organizing documents of each organization were amended to reflect the authority of the filing organization. These actions were accomplished through the applicable Board of Directors' approvals. Chesapeake Hospital Corporation: 23-7424835 Rappahannock General Hospital Foundation: 54-1210450 Part IV, Section A, Line 6: The filing organization did provide support in the form of grants and other assistance to organizations other than their supported organizations. The organization regularly provides financial support to charitable and religious organizations with similar tax exempt purposes. Part IV, Section D, Line 3: The filing organization maintains a close and continuous working relationship with the Sisters of Bon Secours in the United States because members of the order serve on its board and because the Congregation is the founding and participating entity in the filing organization's canonical sponsor. The filing organization maintains a close and continuous working relationship with its other supported organizations through the Governance Steering Committee, which is comprised of the BSHSI Board Chair, BSHSI President/CEO, and the Board Chairs, Board Presidents, and CEOs of each local system. The committee meets quarterly to bring together governance leadership throughout the system for education, sharing and working toward governance best practices. The local board chairs and presidents also meet with the BSHSI Board Chair in executive session at each meeting. The supported organizations have a significant voice in the use of the filing organization's income and assets. Representatives of the supported organizations have clear channels of communication to relay to the filing organization's staff and leadership the resources they want and need in order to carry out their operations in furtherance of their shared health care mission. Supported organizations communicate their needs through the annual budget approval process and through ad hoc requests as needs arise. The filing organization's staff and leadership take account of the information they receive from the supported organizations in developing budgets and proposed allocations of resources to be presented to the filing organization's Board for debate and approval. Part IV, Section E, Line 2a: Substantially all of the filing organization's activities directly furthered the exempt purposes of the Sisters of Bon Secours in the United States and the other supported organizations because the activities were all carrying out the shared health care mission of the Bon Secours Health System. The filing organization developed system-wide policies, provided services such as electronic health records system maintenance, procurement, accounting, and legal to support the delivery of health care to the communities served and to enable the Sisters of Bon Secours to carry out their faith-based health care mission consistently and effectively across the system. Part IV, Section E, Line 2b: The filing organization's supported organizations would have engaged in the filing organization's activities but for the filing organization's involvement because the functions and services performed by the filing organization are all important to sound operations that deliver quality health care that is compliant with legal and regulatory requirements and the faith-based mission of the Bon Secours Health System. Part IV, Section E, Line 3a: The filing organization had the power to appoint or elect a majority of the officers and directors of its supported organizations, other than the Sisters of Bon Secours of the United States, which has the authority, through its relationship with the filing organization's sole member, to appoint the board of the filing organization. The filing organization exercises this power through its control over the parent entities of the local health systems which in turn have control over the supported organizations. Part IV, Section E, Line 3b: The supported organizations are subject to the general supervision or control of filing organization. Per the governing documents of each of the supported organizations, the filing organization has the power to approve strategic plans, capital budgets, operating budgets, as well as change the philosophy, objectives or purposes of the organizations. Schedule A, Part VI, Additional Disclosure: The following five organizations were supported organizations of the filing organizations from the beginning of the taxable year through May 19, 2015 when WMC Health Network Rockland, Inc., acquired a membership interest in Bon Secours Charity Health System, a nonprofit corporation which is the parent that controls the selection of directors of these organizations: Good Samaritan Hospital of Suffern, Bon Secours Community Hospital, St. Anthony Community Hospital, Villa Frances at the Knolls, St. Francis Center at the Knolls, Bon Secours Charity Health System Medical Group, P.C., Good Samaritan Hospital for Better Health, Inc., and the Bon Secours Warwick Health Foundation. 11241726 11241726 61314120 6846727 54467393 2101535 1297120 804415 332301764 227156414 105145350 22393161 400000 21993161 193652045 Inv in Roper St. Francis 98021340 C Inv in Charity Health System 56995228 C Community Programs Loans 23935410 C Inv in Premier 22223413 C Inv in Innovation Institute 12144804 C Inv in Memorial Regional Med Center 9238222 C Inv in Mary Immaculate Hospital JV 9202344 C 231760761 Due from Affiliates 526325753 HPL/GL Asset 45466770 Ground Lease & Amortization 19147259 Actuarial Value of Excess Recoverables 13321263 Capital Accumulation 4629893 BSAS Inv in Shannon Health 120000 Misc A/R 67630 609078568 Pension Liability 127198479 Worker's Comp Liability 52657333 HPL/GL Liability 45694215 Due to Affiliates 36879880 MOB Deferred Costs & Other 3859596 Capital Lease 2703996 268993499 X 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. The System's taxable subsidiaries have approximately $84,748 and $61,513 of net operating loss carryforwards as of August 31, 2015 and 2014, respectively, which expire in varying periods through 2035 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2015 and 2014 as the System considers it more likely than not that these amounts will not be recognized. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Central America & the Caribbean 0 1 Program services Off Shore Captive Management 16084365 Europe (Including Iceland & Greenland) - Albania, Andorra, Austria, Belgium 0 3 Program Services Travel expenses relating to accounting systems upgrade - Sisters of Bon Secours in Ireland. 9291 0 4 0 0 0 4 16093656 0 16093656 1 0 1 0 0 0 1 Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 15800 Jordan Park Community Gardens Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 10000 St. Petersburg Free Clinic Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 30000 Fruit & Vegetable Prescription Pilot Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 25000 Wrap Around Family Service Program Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 15000 200 in 2015 Campaign Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 7500 Fresh & Healthy Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 10000 Connecting Community With Community Orchards Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 13500 Anytown Grant Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 20000 Employee Hardship Assistance Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 650061820 501(C)(3) 5000 Working Families Initiative Bon Secours of Maryland Foundation 26 North Fulton Avenue Baltimore MD 21223 521732800 501(C)(3) 90000 Bon Secours Re-Entry Success Program Bon Secours of Maryland Foundation 26 North Fulton Avenue Baltimore MD 21223 521732800 501(C)(3) 42000 Aide for Baltimore Riot Relief Bon Secours of Maryland Foundation 26 North Fulton Avenue Baltimore MD 21223 521732800 501(C)(3) 102000 Baltimore Early Childhood program- infant support Bon Secours of Maryland Foundation 26 North Fulton Avenue Baltimore MD 21223 521732800 501(C)(3) 550 Overcoming Lack of Transportation as a Barrier to Healthcare Bon Secours Kentucky Health System Foundation Inc 1000 Ashland Drive Ashland KY 41101 611381952 501(C)(3) 45000 Ironton Community Project Bon Secours Kentucky Health System Foundation Inc 1000 Ashland Drive Ashland KY 41101 611381952 501(C)(3) 45000 Charles and Betty Russell Hiking Trail Phase II Bon Secours Kentucky Health System Foundation Inc 1000 Ashland Drive Ashland KY 41101 611381952 501(C)(3) 43000 Community Based Palliative Care Program Bon Secours Kentucky Health System Foundation Inc 1000 Ashland Drive Ashland KY 41101 611381952 501(C)(3) 80000 Richmond Hope Therapy Center Expansion Bon Secours Richmond Healthcare Foundation 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 90000 The Community Kitchen Bon Secours Richmond Healthcare Foundation 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 125000 Employee Hardship (Crisis Fund) for RGH Bon Secours Richmond Healthcare Foundation 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 75000 Health and Wellness Improvement Intiative Bon Secours Richmond Healthcare Foundation 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 37000 Employee Cultural Assessment Bon Secours Hospital Baltimore 2000 West Baltimore Street Baltimore MD 21223 521909599 501(C)(3) 76000 Book Value Medical Equipment Medical Equipment/Pyxis Bon Secours Hospital Baltimore 2000 West Baltimore Street Baltimore MD 21223 521909599 501(C)(3) 20000 Employee Focus Group Bon Secours Hospital Baltimore 2000 West Baltimore Street Baltimore MD 21223 521909599 501(C)(3) 3000 Live Near Your Work Program Bon Secours Hospital Baltimore 2000 West Baltimore Street Baltimore MD 21223 521909599 501(C)(3) 200000 Growing the BSCHS Garden Ministry at Four Sites Good Samaritan Hospital Foundation for Better Health 255 Lafayette Ave Suffern NY 10901 133400353 501(C)(3) 90000 General Support Bon Secours DePaul Foundation 3636 High St Portsmouth VA 23707 541820093 501(C)(3) 30000 Bereavement Center Bon Secours DePaul Foundation 3636 High St Portsmouth VA 23707 541820093 501(C)(3) 60000 East Ocean View Healthy Communities Bon Secours DePaul Foundation 3636 High St Portsmouth VA 23707 541820093 501(C)(3) 13360 Passport to Health Mary Immaculate Hospital 2 Bernardine Drive Newport News VA 23602 540548200 501(C)(3) 85022 Walking Trail and Landscape at Mary Immaculate Bon Secours - St Mary's Hospital of Richmond Inc 5801 Bremo Road Richmond VA 23226 540793767 501(C)(3) 343000 Cash for Capital Lease Buyout/Olympus Bon Secours - St Mary's Hospital of Richmond Inc 5801 Bremo Road Richmond VA 23226 540793767 501(C)(3) 2544862 Book Value Medical Equipment Medical Equipment/Pyxis Bon Secours - St Mary's Hospital of Richmond Inc 5801 Bremo Road Richmond VA 23226 540793767 501(C)(3) 260000 Cash for Capital Lease Buyout/Olympus Frances Schervier Home and Hospital 2975 Independence Ave Bronx NY 10463 131740397 501(C)(3) 89600 Healthy Communities Bronx Mission Fund Grant Frances Schervier Home and Hospital 2975 Independence Ave Bronx NY 10463 131740397 501(C)(3) 40000 Community Garden Project Manager Frances Schervier Home and Hospital 2975 Independence Ave Bronx NY 10463 131740397 501(C)(3) 47200 Onsite Wellness and Fitness Center Frances Schervier Home and Hospital 2975 Independence Ave Bronx NY 10463 131740397 501(C)(3) 2800 Employee Focus Group Frances Schervier Home and Hospital 2975 Independence Ave Bronx NY 10463 131740397 501(C)(3) 10000 Employee Focus Group St Francis Hospital One St Francis Drive Greenville SC 29601 582504530 501(C)(3) 135000 Federally Qualified Health Clinic Look Alike St Francis Hospital One St Francis Drive Greenville SC 29601 582504530 501(C)(3) 2334747 Book Value Medical Equipment Medical Equipment/Pyxis St Francis Hospital One St Francis Drive Greenville SC 29601 582504530 501(C)(3) 75000 Employee Hardship Assistance St Francis Hospital Inc One St Francis Drive Greenville SC 29601 582504530 501(C)(3) 990040 Cash for Capital Lease Buyout/Olympus Water Missions International 1150 Kinzler St Bld 1605 N Charleston SC 29405 571116978 501(C)(3) 50000 Ebola Donation Benedictine Sisters of Kaunas 602 20th Street Belleville KS 669352101 020495272 501(C)(3) 6000 Donation Renovate Bathroom Archdiocese of Baltimore Annual GALA 320 Cathedral St 4th CL Baltimore MD 21201 520591535 501(C)(3) 5000 Gala Sponsorship Sisters of Bon Secours USA Inc 1505 Marriottsville Road Marriottsville MD 21104 520715237 501(C)(3) 644500 Peru Construction Sisters of Bon Secours USA Inc 1505 Marriottsville Road Marriottsville MD 21104 520715237 501(C)(3) 1000 Our Lady of Mt Carmel High School Donation in Honor of Bishop Rozanski Sisters of Bon Secours USA Inc 1505 Marriottsville Road Marriottsville MD 21104 520715237 501(C)(3) 2750 Jovan Hatian Donation Sisters of Bon Secours USA Inc 1505 Marriottsville Road Marriottsville MD 21104 520715237 501(C)(3) 127159 FY15 Volunteer Ministry Program Bread for the World Institute 425 3rd Street SW Washington DC 20024 510175510 501(C)(3) 5000 Support US Food and Farm Policy Catholic Medical Mission Board 1129 20th Street NW Washington DC 20036 135602319 501(C)(3) 399000 Championing Work In Peru Catholic Medical Mission Board 1129 20th Street NW Washington DC 20036 135602319 501(C)(3) 12500 CMMB Partnerships Event March 2015 Catholic Medical Mission Board 1129 20th Street NW Washington DC 20036 135602319 501(C)(3) 175000 Donations Catholic Relief Service 228 W Lexington Street Baltimore MD 21201 135563422 501(C)(3) 83001 Haiti Project;Rebuilding of St.Francis de Sales Hospital&Hospital Network Strengthening Doctors Without Borders USA Inc 333 Seventh Ace 2nd Fl New York NY 10001 133433452 501(C)(3) 48528 Ebola Donation Doctors Without Borders USA Inc 333 Seventh Ave 2nd Fl New York NY 10001 133433452 501(C)(3) 70000 Napal Earthquake Doctors Without Borders USA Inc 333 Seventh Ave 2nd Fl New York NY 10001 133433452 501(C)(3) 25067 Napal Earthquake Disaster Mercy Housing 1999 Broadway Denver CO 80202 470646706 501(C)(3) 100000 Strategic Healthcare Partnership Pledge Midwives for Haiti 7130 Glen Forest Drive Richmond VA 23226 272368581 501(C)(3) 100000 Midwives for Haiti Pledge Sisters Academy of Baltimore 139 First Avenue Baltimore MD 21227 341975939 501(C)(3) 25000 Class Sponorship; annual pledge Crossover Ministries 8600 Quioccasin Rd Ste 102 Richmond VA 23229 541371067 501(C)(3) 5000 Crossover Healthcare Ministry Donation The Health Wagon Inc 119 Number Ten Street Clinchco VA 24226 043739083 501(C)(3) 25000 Donation Immaculate Heart of Mary 610 West Elm Ave Monroe MI 48162 381359581 501(C)(3) 34933 Nepal Earthquake Disaster Roper St Francis Foundation 2095 Hentry Tecklenburg dr Charleston SC 29414 571068509 501(C)(3) 5000 2015 Spirt of Caring Golf Outing Roper St Francis Health System 315 Calhoun St Charleston SC 29601 571068509 501(C)(3) 40000 Expanding Access to Breast Health Education and Screening Diversity Inc 163 Bayard Lane Princeton NJ 08540 542077792 501(C)(3) 15000 General Support Bonnier DBA Mother Media 2 Park Avenue New York NY 10016 800256860 501(C)(3) 5000 General Support Leadership Conference of Women Religious of the USA Inc 8808 Cameron St Silver Spring MD 20910 436033728 501(C)(3) 10000 General Support Bon Secours Inc 1505 Marriottsville Road Marriottsville MD 21104 521301091 501(C)(3) 50000 General Support Bon Secours DePaul Medical Center Inc One St Francis Drive Greenville SC 29601 541820093 501(C)(3) 13000 Cash for Capital Lease Buyout/Olympus Our Lady of Bellefonte 1000 St Christopher Dr Ashland KY 41101 611356023 501(C)(3) 306048 Cash for Capital Lease Buyout/Olympus Our Lady of Bellefonte 1000 St Christopher Dr Ashland KY 41101 611356023 501(C)(3) 1158614 Book Value Medical Equipment Medical Equipment/Pyxis Our Lady of Bellefonte Hospital Auxiliary 1000 St Christopher Dr Ashland KY 41101 610488859 501(C)(3) 5000 OLBH Auxiliary Golf Benefit Bon Secours - Memorial Regional Medical Center Inc 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 299000 Cash for Capital Lease Buyout/Olympus Bon Secours - Memorial Regional Medical Center Inc 8580 Magellan Pkwy Richmond VA 23227 541744931 501(C)(3) 1825000 Book Value Medical Equipment Medical Equipment/Pyxis Bon Secours - Richmond Community Hospital Incorporated 1500 North 28th Street Richmond VA 23223 540647482 501(C)(3) 107000 Cash for Capital Lease Buyout/Olympus Bon Secours - Richmond Community Hospital Incorporated 1500 North 28th Street Richmond VA 23223 540647482 501(C)(3) 607141 Book Value Medical Equipment Medical Equipment/Pyxis Bon Secours - St Francis Medical Center Inc 1 Park West Circle Midlothian VA 23114 311716973 501(C)(3) 475000 Cash for Capital Lease Buyout/Olympus Bon Secours - St Francis Medical Center Inc 1 Park West Circle Midlothian VA 23114 311716973 501(C)(3) 1397117 Book Value Medical Equipment Medical Equipment/Pyxis Good Samaritan Hospital of Suffern NY 255 Lafayette Ave Suffern NY 10901 131740104 501(C)(3) 76000 Cash for Capital Lease Buyout/Olympus 81 0 Part I, Line 2: Per 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. In other cases, grantees submit progress reports on the anniversary date on which the grant was received. The evaluation report includes: 1) progress toward the deployment of the stated goals and objectives, 2) progress towards the achievement of desired outcome as demonstrated by Project Work Plan, 3) an accurate accounting of the revenue and expenses and the amount of the mission fund award expensed, and 4) a summary past, current and future funding sources and efforts to secure sustaining sources of funding. Description of the Bon Secours Health System Mission Fund: Bon Secours Health System, Inc. performs its philanthropic work through its mission department. This initiative, called the Bon Secours Health System Mission Fund ("Mission Fund"), was developed to promote the Catholic Health Ministry and the BSHSI Mission. This purpose is realized through the funding of initiatives that improve the health and well being of communities, particularly for disenfranchised and marginalized people, served by BSHSI Local Systems ("Local Systems"), Cosponsors and the Congregation of the Sisters of Bon Secours. The scope of its purpose and use of funds would be to: -promote healthy community coalition initiatives in conjunction with local system efforts, -develop local system and community excellence for a specific health condition and preventive need, and -improve access for uninsured populations and reduce health disparities among populations in the community. The Strategic Quality Plan of the health system calls for focused efforts to Build Healthier Communities. The health system understands "health" to include social and communal dimensions and has adopted the following articulation of a healthy community. The conditions of communities and individuals served by BSHSI reflect the interaction of significant factors and complex behaviors at the individual, communal, and societal level. It is not likely that interventions by any one organization will result in substantial improvement or benefit to the community. Rather, increased participation by stakeholders and greater cooperation among entities with appropriate skills and resources is necessary for systemic change and improved outcomes. Mission Fund grants place emphasis on increased collaboration among community based members (Healthy Community Initiative), public health officials and other providers of services. The Mission Fund anticipates that most endeavors that seek to bring meaningful improvement require time and commitment. Consequently, local system grant recipients may expect continuity of support (several years) to establish and track outcomes. At the same time, grant applicants need to cultivate and achieve a wide array of financial resources necessary to sustain promising projects and service programs. X 0 0 X X X X X 0 1 0 0 0 0 0 0 0 Richard Statuto President/CEO 1149495 0 422742 0 399043 0 497443 0 30480 0 2499203 0 226534 0 Janice Burnett Treasurer/CFO 494045 0 154275 0 56335 0 107690 0 19348 0 831693 0 23971 0 Martha Riva Secretary/SVP Governance 327426 0 106341 0 111019 0 51427 0 30524 0 626737 0 61584 0 Timothy Davis EVP, CHRAO 617514 0 191208 0 210957 0 132084 0 19599 0 1171362 0 135985 0 Marlon Priest MD EVP, CMO 678544 0 223596 0 457054 0 15600 0 21544 0 1396338 0 243440 0 Laishy Williams-Carlson SVP, CIO 274777 0 90628 0 58581 0 15600 0 20796 0 460382 0 0 0 Peter Bernard EVP, CEO - BSV 789743 0 326469 0 373341 0 174403 0 30762 0 1694718 0 186126 0 Michael Kerner CEO - HRHS 527082 0 221442 0 209787 0 101956 0 29969 0 1090236 0 125798 0 Mark Nantz EVP, CEO - MKT LDR GRNVL 619520 0 178094 0 100965 0 94520 0 22840 0 1015939 0 46250 0 Matthew Toddy EVP, Legal Affairs 553802 0 172028 0 159690 0 90326 0 23148 0 998994 0 83961 0 Samuel Ross MD EVP, CEO - BHS 559362 0 191202 0 82214 0 68261 0 19203 0 920242 0 21657 0 Lawrence Hubbard Former SVP/CIO 387377 0 123245 0 136749 0 15600 0 21153 0 684124 0 0 0 Part I, Line 1a Board members, Committee Members and Members of the Executive Management Team received gift cards in the amount of $400. Those members who were also paid employees of the filing organization (10 individuals) received tax gross-ups to offset the tax impact of this gift. The organization paid a tax gross-up to a single executive in connection with an expense reimbursement that was reported as additional taxable compensation. Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans available to officers and certain 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: Richard Statuto, $343,506; Janice Burnett, $31,461; Martha Riva, $67,623; Timothy Davis, $181,617; Peter Bernard, $241,741; Michael Kerner, $164,862; Mark Nantz, $57,876; Matthew Toddy, $115,243; Samuel Ross, MD, $34,046; Marlon Priest, MD, $311,118. A South Carolina Jobs-Economic Development Authority 576000286 837031QH9 2008-01-15 69925000 Construct and equip facility 0 0 0 B Economic Development Authority of Henrico County Virginia 541197472 42605PBV6 2010-10-19 80412256 Refund bonds issued 01-15-08 (2008B Henrico) 0 0 0 C Economic Development Authority of the County of Chesterfield 521279622 16639EAY0 2010-10-19 93627897 Refund bonds issued 01-15-08 (2008C Ches.) 0 0 0 D South Carolina Jobs-Economic Development Authority 570960018 837031RA3 2008-10-17 30365000 Refund bonds issued 12-30-02 (2002B SC) 0 0 0 A 69973023 729108 1694518 67549397 2008 0 0 1 1 B 80412256 80412256 1 0 1 1 C 93627897 967897 92660000 1 0 1 1 D 9795000 30365000 255675 7500 30101825 1 0 1 1 A 0 1 1 1 1 1 0.00520 0.00000 0.00520 0 0 1 B 0 1 1 1 1 1 0.00010 0.00000 0.00010 0 0 1 C 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 PNC Bank 33.000000000000 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 D 0 0 0 1 1 0 0 0 1 A 1 B 1 C 1 D 1 Part I, Column (f): 2008D Hanover Bonds - D1 refund bonds issued on 12-30-02 (2002B Econ. Dev. Auth. Hanover Co, VA) and D2 refund bonds issued on 9-28-05 (2005 Econ. Dev. Auth. Hanover Co, VA). 2013 South Carolina Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A South Carolina JEDA). 2013 Norfolk Bonds - construct & equip facility and refund bonds issued on 08-01-97 (1997 Peninsula Ports Auth. of VA). 2013 Henrico Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A Econ. Dev. Auth. of Henrico Co., VA). 2013 Russell Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A City of Russell, KY). Part II, Line 3: The difference in Issue Price listed in Part I, section E is different from Total Proceeds of Issue listed in Part II, row 3 for Column A - 2008A South Carolina bonds because of investment earnings on the Project Fund. Part III: Part III has not been completed with respect to bonds that refinance projects where the original debt was issued prior to 2003. Part IV, Line 2c: Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 04/08/2013. Issuer Name: Economic Development Authority of Henrico County, Virginia Date the Rebate Computation was Performed: 04/08/2013. Issuer Name: Economic Development Authority of the County of Chesterfield Date the Rebate Computation was Performed: 04/08/2013. Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 06/17/2014. Issuer Name: Economic Development Authority of Hanover County, Virginia Date the Rebate Computation was Performed: 06/17/2014. A Economic Development Authority of Hanover County 541228097 41077RAC6 2008-10-17 124715000 Refund bonds* 0 0 0 B South Carolina Jobs-Economic Development Authority 570960018 837031SL8 2013-01-11 200846700 Construct/Equip facility and refund bonds* 0 0 0 C Economic Dev Auth of the City of Norfolk 521375010 65588QAM7 2013-01-11 21635500 Construct/Equip facility and refund bonds* 0 0 0 D Economic Development Authority of Henrico County Virginia 541197472 42605PDJ1 2013-01-11 62929133 Construct/Equip facility and refund bonds* 0 0 0 A 21840000 124715000 1131056 157532 123426412 1 0 1 1 B 200846700 8266938 192579763 2013 1 0 1 1 C 21635500 11767093 9868407 2013 1 0 1 1 D 62929133 20730675 42198458 2013 1 0 1 1 B 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 D 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A City of Russell Kentucky 782563AY6 2013-01-11 42941199 Construct/Equip facility and refund bonds* 0 0 0 B Economic Development Authority of Henrico County Virginia 541197472 NoCUSIPno 2013-07-11 26505000 Refund bonds issued 10-17-08 (2008D Henrico) 0 0 0 C Virginia Small Business Financing Authority 541300845 NoCUSIPno 2013-07-11 40740000 Refund bonds issued 10-19-10 (2010 VSBFA) 0 0 0 D Economic Development Authority of the City of Norfolk 521375010 NoCUSIPno 2014-10-31 58260000 Refund bonds issued 12-08-11 (2011 Norfolk) 0 0 0 A 42941199 4094261 38846938 2013 1 0 1 1 B 8790000 26505000 26505000 1 0 1 1 C 40740000 40740000 1 0 1 1 D 58260000 58260000 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 1 1 Merrill Lynch Capital Services 11.000000000000 0 0 0 0 1 A 1 B 1 C 1 D 1 Form 990, Part VI, Section A, line 6 Bon Secours, Inc. is the sole member of Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Health System, Inc. is appointed by its member Bon Secours, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Health System, Inc. are reserved to its Member, Bon Secours, 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 organization's Audit and Compliance Committee and providing the form to the Board of Directors to allow for a thorough review by both prior to the filing date. The organization'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 was 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 15 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 the 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. Form 990, Part VI, Section B, Line 15b - 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 BSHSI provides any documents open to public inspection 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. As the parent organization of nine local systems, Bon Secours Health System, Inc.'s officers, directors, key employees and highly compensated employees have duties and responsibilities which encompass the activities of many of the related organizations within those local systems. Part VII, Section B: Five Highest Paid Independent Contractors Providing Services: Independent contractors and vendors paid/invoiced to Bon Secours Health System, Inc. are generally for services covering a majority of the related organizations, if not all. Form 990, Part XI, line 9: Transfers To/From Affiliates 22,755,881. Add'l Minimum Pension Liability -30,375,294. Changes in Minority Interest JVs 3,283,876. Health and Wellness Reported in Prior Years 508,322. Establishment of Minority Interest in Charity & Other Changes in Net Assets 52,063,864. Subpart F Income Reported on 990 - Book/Tax Difference -239,478. Bon Secours Associates Services LLC 1505 Marriottsville Road Marriottsville MD 21104 522321591 Healthcare MD 0 3020557 Bon Secours Health System Inc Townley IV Farm LLC 1402 Stapleton Road Gladstone VA 245533138 541833386 Farm VA -80544 6437910 Bon Secours Health System Inc Bon Secours Good Helpcare LLC 1505 Marriottsville Road Marriottsville MD 21104 460889532 Accountable Care Organization MD 125000 4527391 Bon Secours Health System Inc Bon Secours Richmond LLC 8580 Magellan Parkway Richmond VA 23227 541570244 Richmond Health System Parent Org VA 7539 7357989 Bon Secours Health System Inc Shannon HealthMOB 3 Richland Medical Park Suite 120 Columbia SC 29203 571127828 Rental Activity SC 929614 24361247 Bon Secours Health System Inc Bon Secours New York Health System 2975 Independence Avenue Bronx NY 10463 912135196 Local System Parent Org. NY 501(c)(3) Line 11a, I Bon Secours Health System Inc 1 Bon Secours Charity Health System Inc 255 Lafayette Avenue Suffern NY 10901 912135195 Local System Parent Org. NY 501(c)(3) Line 11a, I Bon Secours Health System Inc 1 Bon Secours Kentucky Health System Inc St Christopher Dr Ashland KY 41101 611356024 Local System Parent Org. KY 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 1 Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health 2000 West Baltimore Street Baltimore MD 21223 800728893 Local System Parent Org. MD 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 1 Bon Secours St Francis Health System Inc 1 St Francis Drive Greenville SC 29601 582504528 Local System Parent Org. SC 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 1 Bon Secours Hampton Roads Health System 7007 Harbour View Blvd Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 1 Bon Secours Baltimore Health System Foundation Inc 26 North Fulton Avenue Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) Line 11c, III-FI Bon Secours Baltimore Health System 1 The Bon Secours of Maryland Foundation Inc (dba Bon Secours Community Work 26 North Fulton Avenue Baltimore MD 21223 521732800 Grant Making Foundation MD 501(c)(3) Line 11c, III-FI Bon Secours Baltimore Health System 1 Mary Immaculate Foundation 7007 Harbour View Blvd Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 11c, III-FI Mary Immaculate Hospital 1 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours DePaul Medical Center 1 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 1 Our Lady of Bellefonte Hospital Inc 1000 St Christopher Dr Ashland KY 41101 611356023 Acute Care Hospital KY 501(c)(3) Line 3 Bon Secours Kentucky Health System 1 Bon Secours Baltimore Hospital 2000 West Baltimore Street Baltimore MD 21223 521909599 Health Care MD 501(c)(3) Line 3 Bon Secours Baltimore Health System 1 Frances Schervier Home and Hospital 2975 Independence Avenue Bronx NY 10463 131740397 Long term nursing care NY 501(c)(3) Line 9 Bon Secours NY Health System 1 Bon Secours Community Hospital 160 E Main Street Port Jervis NY 12771 141347717 Health Care NY 501(c)(3) Line 3 Bon Secours Charity Health System 1 Good Samaritan Hospital of Suffern NY 255 Lafayette Avenue Suffern NY 10901 131740104 Acute Care Hospital NY 501(c)(3) Line 3 Bon Secours Charity Health System 1 St Anthony Community Hospital 15-19 Maple Ave Warwick NY 10990 141340100 Hospital NY 501(c)(3) Line 3 Bon Secours Charity Health System 1 St Francis Hospital Inc One St Francis Drive Greenville SC 29601 582504530 Health Care SC 501(c)(3) Line 3 Bon Secours St Francis Health System Inc 1 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suffolk VA 23435 540548200 Health Care VA 501(c)(3) Line 3 Bon Secours Health System Inc 1 Bon Secours DePaul Medical Center Inc 7007 Harbour View Blvd Suffolk VA 23435 541820093 Health Care VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 1 Maryview Hospital 7007 Harbour View Blvd Portsmouth VA 23707 540506463 Health Care VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 1 Bon Secours Memorial Regional Medical Center Inc 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours St Mary's Hospital 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Our Lady of Bellefonte Hospital Foundation St Christopher Dr Ashland KY 41101 611381952 Grant Making Foundation KY 501(c)(3) Line 7 Bon Secours Kentucky Health System 1 Bon Secours Baltimore Development 26 North Fulton Avenue Baltimore MD 21223 760785344 Community Housing MD 501(c)(3) Line 7 Unity Properties Inc 1 Unity Properties Inc 26 North Fulton Avenue Baltimore MD 21223 521857768 Low Income Housing MD 501(c)(3) Line 7 Bon Secours of Maryland Foundation 1 Bon Secours Community Hospital Foundation 160 E Main Street Port Jervis NY 12771 810667395 Grant Making Foundation NY 501(c)(3) Line 7 Bon Secours Community Hospital 1 Good Samaritan Foundation for Better Health Inc 255 Lafayette Avenue Suffern NY 10901 133400353 Grant Making Foundation NY 501(c)(3) Line 7 Bon Secours Charity Health System 1 The Bon Secours Warwick Health Foundation 20 Grand Street Warwick NY 10990 141972807 Grant Making Foundation NY 501(c)(3) Line 7 St Anthony Community Hospital 1 Bon Secours St Francis Health System Foundation One St Francis Drive Greenville SC 29601 260012031 Grant Making Foundation SC 501(c)(3) Line 7 St Francis Hospital Inc 1 Bon Secours Richmond Health Care Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) Line 7 Bon Secours Richmond Health Corp 1 Bon Secours St Petersburg Home Care Services Inc 10300 Fourth Street North St Petersburg FL 33716 134334363 Home Care Services FL 501(c)(3) Line 9 Maria Manor Nursing Care Center 1 Bon Secours Maria Manor Nursing Care Center 10300 Fourth Street North St Petersburg FL 33716 134334363 Nursing Home FL 501(c)(3) Line 9 Bon Secours Health System Inc 1 Bellefonte Physician Services Inc St Christopher Dr Ashland KY 41101 352320780 Physician Practices KY 501(c)(3) Line 9 Bon Secours Kentucky Health System 1 Bon Secours Housing 26 North Fulton Avenue Baltimore MD 21223 521442707 Low Income Housing MD 501(c)(3) Line 9 Bon Secours of Maryland Foundation 1 Bon Secours Housing II 26 North Fulton Avenue Baltimore MD 21223 521543174 Low Income Housing MD 501(c)(3) Line 9 Bon Secours of Maryland Foundation 1 Schervier Housing Development Fund Corporation 2975 Independence Avenue Bronx NY 10463 133098867 Housing NY 501(c)(3) Line 9 Bon Secours NY Health System 1 St Francis Center at the Knolls Inc(dba Mount Alverno Center) 20 Grand Street Warwick NY 10990 061370576 Long term Care NY 501(c)(3) Line 9 Bon Secours Charity Health System 1 Villa Francis at the Knolls (dba Schervier Pavilion) 20 Grand Street Warwick NY 10990 061381994 Skilled Nursing NY 501(c)(3) Line 9 Bon Secours Charity Health System 1 Bon Secours Charity Health System Medical Group PC 255 Lafayette Avenue Suffern NY 10901 223636986 Physician Practices NY 501(c)(3) Line 9 Bon Secours Charity Health System 1 St Francis Physician Services Inc One St Francis Drive Greenville SC 29601 134290167 Physician Services SC 501(c)(3) Line 9 St Francis Health System Inc 1 Mary Immaculate Nursing Center Inc 7007 Harbour View Blvd Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 9 Mary Immaculate Hospital 1 Bon Secours - Maryview Nursing Care Center 7007 Harbour View Blvd Suffolk VA 23435 521578169 Nursing Care Center VA 501(c)(3) Line 9 Bon Secours Hampton Roads Health System 1 Bayley Properties 7007 Harbour View Blvd Suffolk VA 23435 541424748 Title Holding Company VA 501(c)(2) Bon Secours DePaul Medical Center 1 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 1 Bon Secours Health System Foundation Inc 8990 Old Annapolis Road Columbia MD 21045 474765376 Fundraising MD 501(c)(3) Line 7 Bon Secours Health System Inc 1 Rappahanock General Hospital Foundation 101 Harris Road Kilmarnock VA 22482 541210450 Supporting Organization VA 501(c)(3) Line 7 Bon Secours Richmond Health System 1 Chesapeake Medical Group 101 Harris Road Kilmarnock VA 22482 541857174 Healthcare Services VA 501(c)(3) Line 9 Bon Secours Richmond Health System 1 Chesapeake Hospital Corporation 101 Harris Road Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours Place at St Petersburg LLP 10300 Fourth Street North St Petersburg FL 33716 593589729 Assisted Living/Senior Care FL N/A Bon Secours Apartments LP 1800 West Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD N/A Bon Secours Apartments II LP 1800 West Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD N/A Liberty Senior Housing LP 1800 West Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD N/A Bon Secours Apartments III LP 1800 West Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD N/A Bon Secours Smallwood Summit LP 26 North Fulton Ave Baltimore MD 21223 522280175 Low Income Housing MD N/A Bon Secours Chesapeake Apartments LP 26 North Fulton Ave Baltimore MD 21223 200107034 Low Income Housing MD N/A Bon Secours Shiloh LP 26 North Fulton Ave Baltimore MD 21223 203965243 Low Income Housing MD N/A Bon Secours Wayland LP 26 North Fulton Ave Baltimore MD 21223 270468688 Low Income Housing MD N/A Bon Secours Gibbons Apartments LP 26 North Fulton Ave Baltimore MD 21223 472322323 Low Income Housing MD N/A Upstate Surgery Center LLC One St Francis Drive Greenville SC 29601 562186977 Ambulatory Surgery Center SC N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Living Facilities VA N/A Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA N/A Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Bon Secours Benet House LP 26 North Fulton Ave Baltimore MD 21223 364765400 Low Income Housing MD N/A Bon Secours Benet House LLC 26 North Fulton Ave Baltimore MD 21223 463055312 Low Income Housing MD N/A N/A Bon Secours Assurance Company Ltd PO Box 69 CJ KY1-1102 980152147 Offshore Captive Management CJ Bon Secours Health System Inc C 16084365 112239090 1.00000 0 Bon Secours-Florida Integrated Health Services Inc 10300 Fourth Street North St Petersburg FL 33716 650779777 Holding Company/Assisted Living FL Bon Secours Maria Manor Nursing Care C 181030 1873600 1.00000 0 Unity Housing Inc 26 North Fulton Avenue Baltimore MD 21223 521952507 Low Income Housing MD Unity Properties Inc C -103 350100 1.00000 0 Bon Secours Wayland LLC 26 North Fulton Avenue Baltimore MD 21223 270468561 Low Income Housing MD Unity Properties Inc C -64 1.00000 0 Professional Health Care Management Inc & Subs 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA Bon Secours Hampton Roads Health System Inc C 341127 7456115 1.00000 0 OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA Mary Immaculate Hospital Inc C 78082 1128615 1.00000 0 Bon Secours Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA Bon Secours DePaul Medical Center Inc C 234504 2312842 1.00000 0 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 4255 256001 0.83000 0 Bon Secours-Virginia Healthsource Inc & Subs 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 29376061 31358906 0.83000 0 RHS Management Corp 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System Inc C 536384 59330 0.83000 0 Schervier Apartments LLC 2975 Independence Avenue Bronx NY 10463 471364217 Low Income Housing NY Bon Secours New York Health System C 1.00000 0 Bon Secours New York Housing Development Corporation 2975 Independence Avenue Bronx NY 10463 472224316 Low Income Housing NY Bon Secours New York Health System C 1.00000 0 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Medical Services VA Bon Secours Richmond Health System Inc C 1004386 267677 0.83000 0 Good Help Connections 8990 Old Annapolis Road Columbia MD 21045 472345223 IT Consulting MD Bon Secours Health System Inc C 1741105 991492 1.00000 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 Bon Secours DePaul Medical Center Inc B 13000 Cost Bon Secours Maria Manor Nursing Care Center Inc B 151800 Cost Bon Secours Memorial Regional Medical Center Inc B 2124000 Cost Bon Secours Richmond Community Hospital Incorporated B 714141 Cost Bon Secours St Marys Hospital of Richmond Inc B 3147862 Cost Bon Secours Hospital Baltimore Inc B 299000 Cost Bon Secours Kentucky Health System Foundation Inc B 213000 Cost Bon Secours Richmond Health Care Foundation B 327000 Cost Bon Secours DePaul Health Foundation B 103360 Cost Mary Immaculate Hospital Incorporated B 85022 Cost Bon Secours of Maryland Foundation Inc B 234550 Cost Frances Schervier Home and Hospital B 189600 Cost Good Samaritan Foundation For Better Health Inc B 90000 Cost Good Samaritan Hospital of Suffern NY B 76000 Cost Our Lady of Bellefonte Hospital Inc B 1464662 Cost St Francis Hospital Inc B 3534787 Cost St Francis Medical Center - Richmond B 1872117 Cost Bellefonte Physician Services Inc D 14515201 Cost Bon Secours DePaul Health Foundation D 54361 Cost Bon Secours DePaul Medical Center Inc D 18437976 Cost Bon Secours Maryview Foundation D 923779 Cost Bon Secours St Marys Hospital of Richmond Inc D 2295580 Cost Bon Secours Ambulatory Services LLC D 218858 Cost Bon Secours Baltimore Health System Foundation Inc D 514842 Cost Bon Secours of Maryland Foundation Inc D 539900 Cost Bon Secours Richmond Health System Inc D 5713664 Cost Bon Secours Virginia Healthsource D 10812338 Cost Chesapeake Hospital Corporation D 6484424 Cost Chesapeake Medical Group D 1899012 Cost Frances Schervier Home and Hospital D 5121353 Cost Laburnum Properties Inc D 333405 Cost RHS Management D 215493 Cost Schervier Apartments LLC D 279996 Cost St Francis Physician Services D 46075243 Cost St Francis Upstate Surgery Center D 805430 Cost Unity Properties Inc D 278598 Cost Bon Secours Place at St Pete D 326488 Cost Providence Place of Maryview D 266600 Cost Providence Place of Depaul D 376802 Cost Maryview Hospital J 3323211 Fair Market Value Bellefonte Physician Services Inc L 388182 Cost Bon Secours DePaul Medical Center Inc L 2529521 Cost Bon Secours Maria Manor Nursing Care Center Inc L 385622 Cost Bon Secours Memorial Regional Medical Center Inc L 250706 Cost Bon Secours St Francis Medical Center Inc L 183767 Cost Bon Secours St Marys Hospital of Richmond Inc L 44883546 Cost Bon Secours Community Hospital L 2445859 Cost Bon Secours Hospital Baltimore Inc L 5550072 Cost St Francis Center at the Knolls Inc dba Mt Alverno Center L 256089 Cost Good Samaritan Hospital of Suffern NY L 7104006 Cost Bon Secours Virginia Healthsource L 125920 Cost Frances Schervier Home and Hospital L 728432 Cost Maryview Hospital L 23160882 Cost Mary Immaculate Hospital Incorporated L 2101625 Cost Our Lady of Bellefonte Hospital Inc L 6639243 Cost Bon Secours Richmond Community Hospital Incorporated L 5708 Cost St Francis Physician Services L 695794 Cost St Anthony Community Hospital Warwick New York L 1530280 Cost St Francis Hospital Inc L 15024926 Cost Professional Health Care Management Services Inc Q 62086 Cost RHS Management Q 96402 Cost Chesapeake Medical Group Q 105833 Cost Bon Secours St Petersburg Home Care Services Q 152254 Cost St Mary's MRI Inc Q 154478 Cost Broad 64 Imaging LLC Q 155264 Cost Upstate Surgery Center Q 166326 Cost Bon Secours Baltimore Health System Foundation Inc Q 190127 Cost Richmond Radiation Oncology Center I LLC Q 201402 Cost RI LP Q 259617 Cost St Francis Center at the Knolls Inc dba Mt Alverno Center Q 444813 Cost Providence Place of Maryview Q 585072 Cost Bon Secours Place at St Pete Q 411981 Cost Providence Place of Depaul Q 744998 Cost Mary Immaculate Nursing Center Inc Q 808845 Cost Bon Secours Maryview Nursing Care Center Q 1053853 Cost Villa Frances at the Knolls Inc dba Schervier Pavilion Q 1588707 Cost Frances Schervier Home and Hospital Q 3097047 Cost Bon Secour Richmond Health Service Inc Q 1813889 Cost Bon Secours Maria Manor Nursing Care Center Inc Q 3277727 Cost St Anthony Community Hospital Warwick New York Q 3590291 Cost Bon Secours Charity Health System Medical Group PC Q 3612266 Cost Bellefonte Physician Services Inc Q 3649548 Cost Bon Secours Richmond Community Hospital Incorporated Q 4295180 Cost Bon Secours Community Hospital Q 4662181 Cost Bon Secours Virginia Healthsource Q 6016908 Cost Bon Secours Hospital Baltimore Inc Q 11064642 Cost Mary Immaculate Hospital Incorporated Q 11589195 Cost St Francis Physician Services Q 12788455 Cost Bon Secours DePaul Medical Center Q 14840475 Cost Our Lady of Bellefonte Hospital Inc Q 19169140 Cost Bon Secours St Francis Medical Center Inc Q 25751573 Cost Bon Secours Maryview Hospital Q 33163571 Cost Good Samaritan Hospital of Suffern NY Q 29379430 Cost Bon Secours Memorial Regional Medical Center Inc Q 31328243 Cost St Francis Hospital Inc Q 58345838 Cost Bon Secours St Marys Hospital of Richmond Inc Q 73684650 Cost Schedule R, Part VII, Additional Disclosure: The following five organizations were supported organizations of the filing organizations from the beginning of the taxable year through May 19, 2015 when WMC Health Network Rockland, Inc., acquired a membership interest in Bon Secours Charity Health System, a nonprofit corporation which is the parent that controls the selection of directors of these organizations: Good Samaritan Hospital of Suffern, Bon Secours Community Hospital, St. Anthony Community Hospital, Villa Frances at the Knolls, St. Francis Center at the Knolls, Bon Secours Community Hospital Foundation, Bon Secours Charity Health System Medical Group, P.C., Good Samaritan Hospital for Better Health, Inc., and the Bon Secours Warwick Health Foundation.