2016-07-15T09:46:27-05:00 2015-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2014-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Laura Ellison CFO-BSBHS 4103624477 2016-07-15 1 John W Sadoff Jr P00540589 4042201500 2014 2016-09-27 15:27:22Z BS Hospital Specialty Center New Hope BS Renal Dialysis Center Samuel L Ross MD 2000 West Baltimore Street Baltimore MD 212231558 128524648 0 0928 X www.bonsecoursbaltimore.com X 1920 MD Acute Care Hospital 12 10 1017 100 37870 30699 5874116 4765721 123313094 121625518 804198 1443074 590358 592270 130581766 128426583 252706 271472 0 0 60034081 58567273 0 0 0 67338603 59668755 127625390 118507500 2956376 9919083 75014730 70127016 157282734 147743944 -82268004 -77616928 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 109316529 271472 121625518 Bon Secours Baltimore Hospital provides both inpatient and outpatient services. Such services include:Inpatient Services - 151 licensed beds for critical care, medical, psychiatric and surgical needs. The Hospital provides a full range of srvices & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care; Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; Employment Services; Family Support Center; Financial 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. 109316529 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 1 117 0 1 1017 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 MD X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Ackneil Muldrow Esq Chairman 3.00 0.00 X X 0 0 0 Samuel Ross MD CEO 21.00 29.00 X X 0 832778 87464 Sr Anne Lutz CBS President 3.00 47.00 X X 0 0 0 Martha Riva Esq Board Member 2.00 48.00 X 0 544786 81951 Mary Beachley Board Member 2.00 0.00 X 0 0 0 Patricia Scipio BM (Sep-Apr)/Treasurer (May-Aug) 2.00 0.50 X X 0 0 0 Sr Mary Shimo CBS Board Member 2.00 4.00 X 0 0 0 Matthew Hemelt Board Member 2.00 0.00 X 0 0 0 Jeffrey Richardson Board Member 2.00 0.00 X 0 0 0 Anthony Stanowski Board Member 2.00 0.00 X 0 0 0 Keshia Pollack Board Member 2.00 0.00 X 0 0 0 Theodore Wimberly Board Member 2.00 0.00 X 0 0 0 Richard Jones Treasurer/CFO - BSBHS (Sep-Jul) 30.00 20.00 X 0 473500 24575 Laura Ellison CFO-BSBHS (Jul-Aug)/BSHSI Sys VP Fin 30.00 20.00 X 0 371037 42931 Matthew Ansel Interim CNE (Sep-Mar) 50.00 0.00 X 193088 0 26826 Shelly Buck CNE/COO (Mar-Aug) 50.00 0.00 X 0 212781 38974 Arsalan Sheikh MD Chair of Medicine 50.00 0.00 X 293234 0 33806 Ibrahim Hanna MD Chair of Surgery 50.00 0.00 X 321688 0 17029 Usha Jain MD Chief Pathologist 49.50 0.50 X 292839 0 22803 Aliya Jones MD Chair of Psychiatry 50.00 0.00 X 258022 0 38046 Rhonda Allen MD Medical Director 50.00 0.00 X 252411 0 8495 Yasmeen Ahmed MD Primary Care Physician 50.00 0.00 X 218842 0 34176 1830124 2434882 457076 72 0 1 0 University of Maryland 110 South Paca St Baltimore MD 21201 ED Physician Services 5720856 Johnson Controls Inc PO Box 423 Milwaukee WI 53201 Maintenance Services 2735878 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 2468640 MDICS Management LLC 6934 Aviation Blvd Suite B Glen Burnie MD 21061 Physician Services 2406250 Aramark CTS Inc 12483 Collections Ctr Dr Chicago IL 60693 Medical Equip Maint 1257483 86 362765 3956890 446066 4765721 Patient Service Reve. 622110 121625518 121625518 121625518 145667 145667 212793 0 212793 212793 212793 181433 1214039 0 98065 181433 1115974 1297407 1297407 Rebates & Discounts 900099 138543 138543 Parking 812930 128538 128538 Reference Lab 621500 37870 37870 74526 74526 379477 128426583 121625518 37870 1997474 137227 137227 134245 134245 555279 499751 55528 46300488 41670439 4630049 2539198 2285278 253920 5201559 4681403 520156 3970749 3573674 397075 477892 430103 47789 169107 152196 16911 9250 8325 925 11100140 11100140 14406 12965 1441 441097 396987 44110 4174896 3757406 417490 1884199 1695779 188420 218350 196515 21835 1376165 1376165 5855748 5270173 585575 1349144 1214230 134914 Purchased Services 13883986 12495587 1388399 Medical Supplies 7138998 7138998 Bad Debt Expense 6798359 6798359 Federal Taxes for UBI 9705 9705 4767313 4290584 476729 118507500 109316529 9190971 0 2163 1553 360056 360923 895663 689657 19616127 16076580 1314763 1092964 1271530 541052 101157918 71358455 30777108 29799463 12085794 12159372 4106 8691526 9401346 75014730 70127016 16555558 11261295 5629432 36852 42530 140690324 130810687 157282734 147743944 X -82588778 -77888486 320774 271558 -82268004 -77616928 75014730 70127016 X 9919083 -210410 -5057597 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 9250 9250 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 49986535 32125398 17861137 47649696 36968063 10681633 2921687 2264994 656693 29799463 HPL/GL Asset 6557498 Due from Affiliates 1835356 Accrued Revenue 450000 Due from BSHSI 371395 Staff Loans 81698 Resident Trust 42530 LT Noncash Investment 13150 Miscellaneous A/R 10611 Other Misc Assets 39108 9401346 Due to BSHSI 90864644 Pension Liability 24407546 Liability - HPL/GL 6557498 Medicaid and Insurance Advances 3083408 Capital Leases 1913644 Liability - FIN 47 1548097 Patient Credit Balances 1417496 Medicare Reserve 486097 Other Misc Liabilities 532257 130810687 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. 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. 1 1 X 1 X 200.000000000000 0 1 1 0 1 0 1375350 0 1375350 0.01230 1375350 1375350 0.01230 16 25102 7639214 45677 7593537 0.06800 2 391 248975 0 248975 0.00220 2 17417 11247641 5656892 5590749 0.05000 1 0 125177 0 125177 0.00110 21 42910 19261007 5702569 13558438 0.12130 21 42910 20636357 5702569 14933788 0.13360 4 1686 3770346 2094996 1675350 0.01500 4 1686 3770346 2094996 1675350 0.01500 1 6798359 28507383 24620320 3887063 X 1 1 1 1 Bon Secours Hospital Baltimore Inc 2000 W Baltimore St Baltimore MD 212231558 http://bonsecoursbaltimore.com/ 30-007 X X X X Bon Secours Hospital Baltimore Inc 1 0 0 1 X X X X X X X X 12 1 0 0 1 X http://baltimore.bonsecours.com X 1 12 1 http://bonsecoursbaltimore.com 1 0 1 X 200.000000000000 X 1 1 X X X 1 X http://www.bonsecoursbaltimore.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: The organization utilized several methods for gathering input including a series of community meetings where issues were identified and prioritized; review and analysis of previous community engagement activities; convening a health care summit to launch a primary care access study; one on one interviews and a community needs/desires survey.The organization consulted with the following third parties for their input and expertise while completing the CHNA:- University of Maryland Social Work Community Outreach Service: Community Organizing/Academic Organization- Joyce Smith: Community Activitist/Organic Master Gardener/Health & Wellness Expert- John Snow, Inc: Public Health Research and Consulting Firm-Michelle Gourdine & Associations: Community Health Expert/PractionerAdditional information can be found in the CHNA. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 11: Over the period of 2009-2012 Bon Secours Baltimore Health System (BSBHS) conducted a Community Health Needs Assessment that included meetings, interviews, community summits, literature studies and the engagement of those representatives of our community with a knowledge of public health, the broad interests of the communities we serve, special knowledge of the medically underserved, low-income and vulnerable populations and people with chronic diseases.The assessment resulted in the identification of the most important and pressing issues affecting the community served by BSBHS as well as recommendations of initiatives for Bon Secours to undertake to address those issues. After compiling and reviewing the key findings and recommendations regarding these issues, we prioritized the results based upon the following criteria:- Supported by Data- Identified by more than one constituency- Bon Secours' ability to respond effectively; including with partners- Consistency with Baltimore City Health Department and other regional/city-wide goals.This implementation plan positioned 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 visits.The 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 2015, 112,358 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.CHW Community Outreach Outcomes October 2014 August 2015:- 352 community members partnered with CHWs- 8,018 total encounters - 53 Health Education events with 1,348 participants (2,160 encounters)- 11 regular fitness classes with 348 regular participants- Held 34 nutrition and cooking classesFor additional information, please see the attached Implementation Plan and Update. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 13h: The facility approved free care for patients at or below 200% of the FPL. For patients above 200% of the FPL we utilize a sliding scale with no cap. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 16i: Information regarding the FAP is available on our websites and 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. 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Bon Secours Hospital Baltimore, Inc. Part V, Section B, line 16b website: http://www.bonsecoursbaltimore.com 3 Bon Secours CIBSNew Passage 3101 Towanda Ave Baltimore MD 21215 Behavioral Health Servies New Hope 2401 W Baltimore St Baltimore MD 21223 Behavioral Health Servies Bon Secours Washington Village 700 Washington Blvd Baltimore MD 21230 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 7b: Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient.For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit.Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $6,798,359. Part II, 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 offered the following Community Building programs and services in FY 2015:The Financial Services Program (formerly Working Families Initiative) offers group and individual financial education, debt remediation, free and low-cost tax preparation and retirement planning to help residents reduce non-asset building debt and increase personal wealth. Residents can also be screened for and access public and private benefits through EarnBenefits. Eviction prevention counseling and funding is also provided. In FY 15, 440 participants received tax preparation services and 237 participants avoided homelessness through eviction prevention. 406 persons were screened for EarnBenefits.Youth Employment and Entrepreneurship Program (YEEP) helps high school age youth learn job readiness, financial literacy and leadership skills and then access part time and summer jobs. YEEP also helps youth develop career plans and get into post-secondary education. The program follows alumni who attend college. 35 area youth participated in YEEP activities in FY 15.Clean & Green turns vacant lots into attractive green spaces and consistently maintains them at a community-wide scale. Also provides paid internships in landscaping and other job skills. The program improved 52 lots in FY 15. In addition six individuals completed a six month training program.Career Development Program offers job readiness, placement and retention services. A total of 70 individuals were assisted in job searches and 18participants obtained employment. Family Support Center helps young parents obtain a GED and/or secure employment while providing developmental childcare and parenting classes. Children (birth to age 4) receive developmental childcare while their parents are in class or in training. In addition, the Family Support Center staff provides In-Home-Intervention services. During FY 15 4,447 center based and home visits were made by families. 57 families made center visits; 12 participants received their GED, 15 babies were born full term and 13 babies were born with normal birth weight.Women's Resource Center is a drop-in center that provides crisis intervention, hospitality services and domestic violence counseling for homeless women or women at risk for becoming homeless. In FY 15, 147 women visited the Center; 61 received health screenings, 40 were screened for Earn Benefits, and 83 developed individual "My Journey Through Life" plans.Housing: BSBHS also renovates row houses and constructs apartment buildings where low-income families and seniors can find safe and affordable housing. Over 119 families and 530 seniors were housed in FY 15 at seven locations. Resident services were provided at each senior living facility through grants and direct subsidy. An additional 115 individuals attended homeownership training classes and 15 persons purchased homes for the first time. Part III, Line 2: Bad debt expense on the general ledger includes: 1) actual write offs of discounted gross charges where it is determined an uninsured patient can pay and does not pay; and 2) the estimated write offs for uninsured patient accounts with outstanding balances after discount. Estimates are based on historical collection rates.When an uninsured patient is billed for patient care services, the charges are automatically discounted and the patient is requested to only pay the amount after discount. The discount is recorded as an adjustment to gross revenue and is not recorded in bad debt expense. If the balance after discount is not paid or not paid in full, the unpaid amount will be written off to bad debt expense. When a patient remits a payment on an account that has already been written off to bad debt expense, the payment is recorded as a recovery of bad debt, which reduces bad debt expense. Part III, Line 3: The organization does not report an estimate for the portion of bad debt expense that may have been likely to qualify for financial assistance under the hospital's charity care policy. The organization takes the position that ample opportunity and assistance is provided to the patient to qualify under the financial assistance policy. If sufficient information is not provided, the organization must assume the patient does not qualify. Part III, Line 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on pages 11-12 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 45 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in- and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients 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 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 Baltimore Health System primarily serves four zip codes in West Baltimore: 21223, 21229, 21216 & 21217. Bon Secours Baltimore Health System's Community Health Needs Assessment has taken into account challenges and conditions in its primary service area as described above with a special emphasis on the surrounding BSB, known as "Old Southwest Baltimore." Bon Secours has maintained a constant presence in this part of Baltimore for over 130 years and it is the community where most of BSBHS's services are located. The conditions and social determinants of health in the direct area serviced by BSBHS also are of concern in the broader service area and the health and socioeconomic status of the direct area mirrors that of the broader service area. Old Southwest Baltimore has a population of more than 17,885 (2010 Census) people, many of whom are medically and economically underserved. The socioeconomic status, ethnic diversity and health status of residents, according to the Baltimore City Health Department, indicates that 27% of the population is between 0-17 years; 76% are African American; 31% do not have a high school diploma or equivalent; 43% of those ages 16-64 are not employed; 44% of households make less than $25,000; and the leading causes of health-related deaths are heart disease, HIV/AIDS, substance abuse and diabetes. In fact, in the neighborhoods served by BSB, residents die from heart disease at a rate that is 35% higher than the city as a whole. Deaths from diabetes and HIV/AIDS are also substantially higher than in the entire city. Residents of certain areas along the West Baltimore Street corridor have a life expectancy of 64.2 years, compared to almost 71 years for the entire city. 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.Designated as a federal medically-underserved community, Southwest Baltimore also suffers from a high rate of foreclosures as many residents do not have the financial capacity to maintain their homes. Many of the streets are lined with neglected and vacant houses, many boarded up and hazardous to the health and safety of children and adults. 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, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc, a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to: - Improve Health Locally and Globally- Build Partnerships for Population Health 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. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world." Please see Schedule R for listings of the related organizations. Part VI, Line 7, Reports Filed With States MD 1 American Heart Association 216 E Redwood St Baltimore MD 21202 135613797 501(C)(3) 20000 Patient Centered Medical Home Grant Coppin State University 2500 West North Ave Baltimore MD 21216 526002033 Other 14000 General Support Chase Brexton Health Care 1111 North Charles St Baltimore MD 21201 521638592 501(C)(3) 10000 General Support American Diabetes Association 1701 North Beauregard St Alexandria VA 22311 131623888 501(C)(3) 10000 General Support Healthcare Access Maryland Inc 201 East Baltimore Street Suite 1200 Baltimore MD 21202 522017098 501(C)(3) 12430 General Support United Way of Central Maryland 100 South Charles St 5th Floor Baltimore MD 21201 520591543 501(C)(3) 21300 General Support Gamma Boule 2 Hamill Rd West Quadrangle 241 Baltimore MD 21210 272876914 501(C)(3) 5000 General Support 6 1 Indigent Cab/Bus Fare 440 112277 Emergency Assistance Funds for Patients, Volunteers, & Employees 30 21968 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 559362 0 191202 0 82214 0 68261 0 19203 0 920242 0 21657 Martha Riva Esq Board Member 0 327426 0 106341 0 111019 0 51427 0 30524 0 626737 0 61584 Richard Jones Treasurer/CFO - BSBHS (Sep-Jul) 0 295094 0 139230 0 39176 0 11700 0 12875 0 498075 0 0 Laura Ellison CFO-BSBHS (Jul-Aug)/BSHSI Sys VP Fin 0 262108 0 68925 0 40004 0 15600 0 27331 0 413968 0 0 Matthew Ansel Interim CNE (Sep-Mar) 170035 0 22282 0 771 0 4141 0 22685 0 219914 0 0 0 Shelly Buck CNE/COO (Mar-Aug) 0 173026 0 39332 0 423 0 10966 0 28008 0 251755 0 0 Arsalan Sheikh MD Chair of Medicine 291365 0 0 0 1869 0 8485 0 25321 0 327040 0 0 0 Ibrahim Hanna MD Chair of Surgery 318235 0 0 0 3453 0 5600 0 11429 0 338717 0 0 0 Usha Jain MD Chief Pathologist 287150 0 0 0 5689 0 10400 0 12403 0 315642 0 0 0 Aliya Jones MD Chair of Psychiatry 245295 0 12500 0 227 0 7197 0 30849 0 296068 0 0 0 Rhonda Allen MD Medical Director 251306 0 0 0 1105 0 537 0 7958 0 260906 0 0 0 Yasmeen Ahmed MD Primary Care Physician 217352 0 0 0 1490 0 7226 0 26950 0 253018 0 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Samuel Ross, MD., $34,046; Martha Riva, Esq., $67,623. 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: Minimum Pension Liability -4,245,975. Transfers to BSHSI for Debt Principal, Swaps and Pension -811,622. 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 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0