2014-11-14T15:17:37-06:00 2013-12-31 861065772 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 303031749 990 2013-01-01 452964467 Bon Secours Charity Health System Affiliated Group BONS 8453685000 255 Lafayette Avenue Suffern NY 10901 Mary Leahy MD Chief Executive Officer 8453685000 2014-11-14 1 David A Craig P00542227 4042201500 2013 2015-11-30 17:44:51Z Mary Leahy MD 255 Lafayette Avenue Suffern NY 10901 473866542 1 1 5747 X charity.bonsecours.com X Acute care hospitals, physician services and long-term care facilities 21 15 3542 445 0 0 10266805 9816195 444769571 458143916 -253847 395047 3135778 5465277 457918307 473820435 0 0 0 0 253284803 252694520 0 0 0 219549437 229076816 472834240 481771336 -14915933 -7950901 251954297 260737781 298567414 314851929 -46613117 -54114148 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 people and communities to health and wholeness. 0 0 443734028 462277765 Bon Secours Charity Health System Affiliated Group is composed of three acute care hospitals, primary and specialty medical care practices and two long-term care and residential facilities: Good Samaritan Hospital of Suffern, NY; Bon Secours Community Hospital; St. Anthony Community Hospital; Bon Secours Charity Health System Medical Group, PC; St. Francis Center at the Knolls (dba Mount Alverno Center); and Villas Francis at the Knolls (dba Schervier Pavilion).Good Samaritan Hospital of Suffern, New York, is a non-profit, 326-bed hospital providing emergency, medical, surgical, obstetrical / gynecological and acute care services to residents of Rockland and southern Orange Counties in New York; and northern Bergen County, New Jersey. The hospital also serves these communities as an Area Level II Trauma Center. Good Samaritan Regional Medical Center provides regional specialty services, including comprehensive cancer treatment services and the first and only cardiovascular program in the lower Hudson Valley area which includes, open heart surgery, cardiac catheterization laboratory, emergency angioplasty, electrophysiology studies, and a pacemaker clinic. Good Samaritan offers a brand new Wound Care Center, and we also offer maternal/child services, including a high level II special care nursery and the Children's Diagnostic Center, which utilizes the services of pediatric subspecialists from Westchester County Medical Center. The hospital also provides social, psychiatric and substance abuse services for the area and kidney dialysis services through its Frank and Fannie Weiss Renal Center. Good Samaritan Regional Medical Center's Certified Home Care Agency provides home health care service to the residents of Rockland and Orange Counties, New York.Bon Secours Community Hospital is a non-profit, 122-bed hospital providing acute care and medical/surgical services, including long-term care and behavioral health services. The Emergency Department features highly trained physicians, nurses and technicians, providing the Tri-State community with a vital, life-saving service. Bon Secours Community Hospital offers the Bariatric Surgery Center of Excellence, a complete program dedicated to weight loss surgery, dietary counseling and support groups to help the morbidly obese patients turn their life around.St. Anthony Community Hospital is a non-profit, 60-bed hospital serving the residents of Orange County, NY, Sussex and Passaic Counties in NJ. The hospital has been a primary resource for emergency, quality medical and wellness care since 1939. Among the services provided are comprehensive women's health programs, which include the Kennedy Birthing Center. The new Center for Ambulatory Services offers the clinical and support services needed - all in one location. These include admitting, pre-admission screening, endoscopy, minor surgery and same-day surgery. Patients seeking comfortable and convenient infusion therapy can now utilize the Outpatient Infusion Center within the hospital. Bon Secours Charity Health System Medical Group, PC provides medical services to Suffern, NY and sounding communities. Their services include primary care and various pseicalty profesional services. The organization seeks to locate its physician practice sites in areas that most effectively meet the needs of a community.Mount Alverno Center is a New York State-licensed Adult Home with an Assisted Living Program serving 85 residents. The goal of the organization is for residents to maintain a maximum level of independence. Individualized care plans are designed to help residents reach their utmost daily potential. Services are based on a team approach and are provided by highly competent professionals dedicated to the comfort and safety of our residents.Schervier Pavilion is a 120-bed skilled nursing facility. The goal of the organization is to help each resident maintain the highest level of daily independence possible. Residents participate in a broad range of therapeutic and social activities designed to enhance their physical and mental capabilities providing healthcare services to acute care patients. 443734028 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 305 0 1 3542 1 0 0 0 0 0 0 0 0 0 0 X 21 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X David Larkin 4433672204 8990 Old Annapolis Road Columbia MD 21045 X Steve Albanese Board Member 2.00 0.00 X 0 0 0 Maureen Creegan Board Member 2.00 0.00 X 0 0 0 Tamer El-Rayess Board Member 2.00 0.00 X 0 0 0 Sandra Grannum Board Member 2.00 0.00 X 0 0 0 Steve Kent Board Member 2.00 0.00 X 0 0 0 Sylvain Klein Board Member 2.00 0.00 X 0 0 0 Sr Roseann Mazzeo Board Member 2.00 0.00 X 0 0 0 Sr Mary Eilleen O'Brien Board Member 2.00 0.00 X 0 0 0 Robert Porr Board Member 2.00 0.00 X 0 0 0 Clement Osei MD Board Member 24.00 0.00 X 185926 0 26393 Daniel Rifkin Board Member 2.00 0.00 X 0 0 0 Kenneth Steinglass MD Board Member 2.00 0.00 X 0 0 0 Andrea Schmid-Mazzoccoli Board Member 2.00 48.00 X 0 497282 67346 Fred Kelly Board Member 2.00 0.00 X 0 0 0 John Wallenhorst PhD Board Member 2.00 48.00 X 0 337082 24753 Stephen Dormer Chairman 3.00 0.00 X X 0 0 0 Sr Anne Lutz President - BSCHS 3.00 47.00 X X 0 0 0 Sr Ellen Dauwer Secretary - BSCHS 2.00 0.00 X X 0 0 0 Philip Patterson CEO - BSCHS (Jan-Sept) 49.00 1.00 X X 0 600007 72532 Mary Leahy MD CEO - BSCHS (Sept-Dec) 49.00 1.00 X X 506375 0 43233 Martin Evers MD President - BSCHS MedPC 50.00 0.00 X X 323097 0 36715 Rodney Williams MD CMO - BSCHS 50.00 0.00 X 536471 0 29340 Eileen Dobbing CNO - BSCHS 50.00 0.00 X 384036 0 20478 Pam Tarulli SVP HR - BSCHS 49.00 1.00 X 370763 0 32779 Jeffrey Reilly SVP OPS - CH & SACH 50.00 0.00 X 322317 0 7573 Sophie Crawford-Rosso VP PCS - CH 50.00 0.00 X 156301 0 16915 Judith Lindberg VP PCS - SACH 50.00 0.00 X 165091 0 18936 John Fiore Medical Director - SACH 50.00 0.00 X 353222 0 36716 Toni Clark EVP Sr Services - MA&SP 50.00 0.00 X 232680 0 22473 Edward Lundy MD Dir of Cardiac Surgery 50.00 0.00 X 1018083 0 34374 Cary Hirsch MD Physician 50.00 0.00 X 996664 0 20037 Thomas Facelle MD Dir of Surgery 50.00 0.00 X 815346 0 20574 Anuj Shah MD Cardiologist 50.00 0.00 X 692935 0 28326 Seth Hurwitz MD Cardiologist 50.00 0.00 X 626719 0 40030 David Capone Former CFO 0.00 0.00 X 261699 0 9284 Melinda Hancock Former Interim CFO 0.00 0.00 X 0 365950 30891 7947725 1800321 639698 337 1 1 0 Holt Construction Corp 50 East Washington Avenue Pearl River NY 10965 Construction Capital Projects 9607756 Crothall Services Group 13028 Collections Center Chicago IL 60693 Engineering 5046978 Hunter Partners PO Box 919359 Orlando FL 32891 Consulting 2894971 Morrison Management Specialists PO Box 102289 Atlanta GA 30368 Dietary 2319432 Shiftwise 1800 SW 1st Avenue Suite 510 St Paul MN 97201 Temp Services 2043271 55 191019 9622711 2465 9816195 Patient Service Rev. 623000 458143916 458143916 458143916 170767 170767 438978 9628 0 0 438978 9628 448606 448606 270387 0 46107 270387 -46107 224280 224280 Capitation Rev/Incent. 900099 1685526 1685526 Self-Ins Trust Distrib 900099 1558741 1558741 Med. Readings & Educ 900099 862041 862041 910363 27541 882822 5016671 473820435 462277765 0 1726475 3829222 3446299 382923 184452317 166007085 18445232 7954850 7159365 795485 38955012 35059511 3895501 17503119 15752807 1750312 819652 737687 81965 442339 398105 44234 100506 90455 10051 22878379 22878379 1756322 1580690 175632 8267577 7440819 826758 12672203 11404983 1267220 8727433 7854690 872743 934253 840828 93425 2427560 2184804 242756 5141231 5141231 16216316 14594684 1621632 8288819 7459937 828882 Medical Supplies 55568355 55568355 Purchased Services 50079139 45071225 5007914 Bad Debt 17810292 17810292 BSHSI Mgmt Dues 8560731 7704658 856073 8385709 7547139 838570 481771336 443734028 38037308 0 395012 165997 306537 306621 1500 1504671 60445243 57384930 1262557 2862274 6032302 6582029 1819888 3517389 271126014 148205450 118828330 122920564 4786131 5314515 1285437 1007310 56791360 59171481 251954297 260737781 53730917 54094273 4903465 2555455 103390 121751 334553 239829642 257745897 298567414 314851929 X -47386207 -54888198 773090 774050 -46613117 -54114148 251954297 260737781 X -7950901 211674 238196 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 100506 100506 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 4589780 4589780 133726567 58669651 75056916 1401361 272157 1129204 110618420 83780997 26837423 20789886 5482645 15307241 122920564 LT Non-Cash Inv - HPL/GL 52113392 Medicare Settlements 2332111 Due from Affiliate 1843782 Deferred Medicare 1243148 LT 3rd Party Reserves 725213 Organizational Costs 284492 Deposits 125044 Assets Held in Trust for Others 107215 Physician Loans 41926 All Other 355158 59171481 Due to BSHSI 108874746 Other Debt LT General 76510000 HPL/GL Liability 52113392 LT Building Development Liab 4390000 Medicare Settlements 4155641 FIN47 LT Asbestos Liab 3864675 Capital Leases LT General 3654799 LT Liab - Post Retirement Benefits 2936765 Due to Affiliates 348529 Other Misc LT Liabilities 897350 257745897 Part IV, Line 2b: Certain facilities hold, safeguard, manage and account for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents and written requests for $50 or more are honored, by check, within a reasonable time frame. Generally, all custodial funds in excess of $50 are held in interest bearing accounts separate from that of the organization. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 0 2480092 516885 1963207 0.00420 67916694 48525494 19391200 0.04150 662550 556087 106463 0.00020 71059336 49598466 21460870 0.04590 33 197463 735279 735279 0.00160 5 6508 3809763 3809763 0.00810 6 3678 41882 41882 0.00010 44 207649 4586924 4586924 0.00980 44 207649 75646260 49598466 26047794 0.05570 4 1612 129281 129281 0.00030 1 159 2823 2823 0.00000 6 2715 256160 256160 0.00050 11 4486 388264 388264 0.00080 1 13993515 0 137217056 137136664 80392 X 1 1 3 1 Good Samaritan Hospital of Suffern NY 255 Lafayette Avenue Suffern NY 10901 goodsamhosp.org 4329000H X X X A 2 St Anthony Community Hospital 15 Maple Avenue Warwick NY 10990 stanthonycommunityhosp.org 3529000H X X X A 3 Bon Secours Community Hospital 160 East Main Street Port Jervis NY 12771 bonsecourscommunityhosp.org 3535001H X X X A Facility Reporting Group - A 1 X X X X X X X X X 13 1 1 1 X bschs.org/about-us-community-health-needs X X X X X X X X X 0 0 1 1 250.000000000000 1 250.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Good Samaritan Hospital of Suffern, NY, - Facility 2: St. Anthony Community Hospital, - Facility 3: Bon Secours Community Hospital Facility Reporting Group - A Part V, Section B, line 3: The Rockland County DOH, led by E. Oscar Alleyne, D.Ph., MPH, and Director of Epidemiology & Public Health Planning, was the lead agency to coordinate the data collection and direct the focus group interviews. Other agencies with knowledge of vulnerable populations that participated in the county's process were Nyack Hospital, Hudson River HealthCare, Refuah Health Center, Dominican College, Northern Services Group, the Rockland County Office for the Aging, ARC of Rockland, the Haitian American Cultural and Social Organization (HACSO) of Rockland and the Lower Hudson Valley Perinatal Network. Each of these agencies has special knowledge of the population sector that they serve. Specifically, Hudson River HealthCare and Refuah Health Center are federally qualified health centers that provide health care for a largely medically underserved population and HACSO of Rockland exclusively serves the Haitian minority population in Rockland County. Facility Reporting Group - A Part V, Section B, line 4: The following hospitals within Bon Secours Charity Health System, conducted a joint CHNA: Good Samaritan Hospital of Suffern, NY; St. Anthony Community Hospital;Bon Secours Community Hospital. Facility Reporting Group - A Part V, Section B, line 7: Based on data from the community assessment and the NYS Prevention Agenda priorities, the most significant health needs of the service area are as follows: Chronic Disease prevention Healthy and Safe environments Healthy Women, Infants and Children Mental Health and Substance Abuse Communicable Diseases Both priorities BS Charity will address are components of Chronic Disease prevention. BS Charity has identified other participant organizations and community resources that will focus on and provide responses to the needs of the community for the remaining significant health needs on the NYS Prevention Agenda priorities. Facility Reporting Group - A Part V, Section B, line 12i: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Facility Reporting Group - A Part V, Section B, line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Facility Reporting Group - A Part V, Section B, line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. 9 Regional Kidney Center 33-1 Route 17M Harriman NY 10926 Output Dialysis Center Women's Imaging Center 55 Ronald Regan Blvd Warwick NY 10990 Outpatient Women's Imaging Center The Ambulatory Surgery Center 257 Lafayette Avenue Suffern NY 10901 Ambulatory Surgery Center Monsignor Patrick J Frawley Mental 3 Campbell Avenue Suffern NY 10901 Mental Health Center for Physical Rehabilitation 153 South Route 94 Warwick NY 10990 Out Patient Rehab Good Samaritan Home Care 1 Crosfield Ave Ste 202 West Nyack NY 10994 Home Care Good Samaritan Home Care 15 Matthew St Suite 302 Goshen NY 10924 Home Care St Anthony Sleep Disorder Institute 74 North Main Street Florida NY 10921 Sleep Lab Center For Physical Rehabilitation 70 Hatfield Lane Goshen NY 10924 Outpatient Physical Therapy Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 13,993,515. Part II, Community Building Activities: Bon Secours is actively engaged in improving community health in the Port Jervis area through its Building Healthy Communities initiative. The BSCHS Director of Building Healthy Communities is focused on improving community health in the Port Jervis area. Building Healthy Communities has partnered with local residents, business owners, and government officials to bring opportunities for physical activity into the community and improve access to health screenings for low income residents. This initiative, along with related educational programs on healthy cooking and eating, are a step forward in addressing a major community-identified barrier to health. Part III, Line 4: Part III, line 2: Bad debt expense reported on line 2 is consistent with the expense reported in the audited financial statements. Bad debt expense per the audited financial statements and 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. Please note that in prior years, the bad debt expense reported on Line 2 reflected bad debt expense at cost which was computed by applying the cost-to-charge ratio computed on Worksheet 2, of the Schedule H instructions, to the aggregate bad debt expense for patient accounts recorded in the general ledger.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 9-10 in the attached BSCHS consolidated audited financial statements ("AFS"). "Allowance for doubtful accounts" is discussed in the second paragraph in Footnote "(8) Net Patient Service Revenue" on page 25 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Part III, Line 6: 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, Section B, Line 7-8: Good Samaritan Hospital and Bon Secours Community Hospital both receives significant Medicare disproportionate share (DSH) payments, which are intended to partially compensate hospitals for the uncompensated care that arises from serving an usually large percentage of uninsured, low-income patients in their area. While these payments are a component of Medicare reimbursement, they do not relate to the Medicare allowable costs reported in line 6, but are more closely related to the Medicaid shortfall reported in Part I, Line 7 b, column (e). 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: Over the period of nine months, Bon Secours Charity Health System worked collaboratively with the Rockland County and Orange County Departments of Health on individual Community Health Needs Assessments for Bon Secours Community Hospital located in Port Jervis, NY, St. Anthony Community Hospital located in Warwick, NY, and Good Samaritan Hospital located in Suffern, NY. This process included community surveys and interviews with representatives of our community with a knowledge of public health. Additionally, the New York State Department of Health (NYSDOH) Indicators for Tracking Public Health Priority Areas, 2013-2017 helped form the foundation for the needs assessment process. In addition to performing a Community Health Needs Assessment, all hospitals in New York State (NYS) are required to submit a three year Community Service Plan to the NYS Department of Health by November 2013. NYS mandates that each Community Service Plan is based on the NYS Prevention Agenda 2013-17. This Prevention Agenda is the blueprint for state and local action to improve the health of New Yorkers in five priority areas and to reduce health disparities for racial, ethnic, disability, socioeconomic and other groups who experience them. Based on data from the above mentioned community assessment activities and the NYS Prevention Agenda priorities, the most significant health needs of our service area are as follows: Chronic Disease prevention, Healthy and Safe environments, Healthy Women, Infants and Children, Mental Health and Substance Abuse, and Communicable Diseases. In this report we have identified community wide resources that can assist in addressing the health needs of our community. We will work with many of these health facilities and organizations to develop plans and programs to improve the health of our community. 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 250% 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: BSCHS facilities operate and serve populations of lower New York State, principally Rockland and Orange counties. Rockland County is located approximately 30 miles north of Manhattan on the West side of the Hudson River. The County is a popular residence for people who commute to work in nearby Westchester and Bergen Counties, as well as Manhattan. The County comprises approximately 115,000 acres and contains more than 35,000 acres of preserved open space and park land. Rockland continues to experience steady population growth in its five towns and 19 villages. The most recent Census Department estimates indicate that Rockland County grew 8.7% from 2000 to 2010, and now includes 311,687 residents. Orange County is located in the Hudson River Valley, bordering New Jersey. The County comprises approximately 816 square miles. Orange County continues to experience steady population growth, with the 2010 Census indicating that Orange County grew 9.2% from 2000 to 2010, and now includes 372,813 residents. In Rockland County, there was substantial growth in all age cohorts 65 and older, a consistent trend nationally. Gender among the age groups is roughly equal from the early age cohorts through the 40s, but after age 65, women continue to outnumber men. Population projections - Preliminary population projections through 2035 show that Rockland County's older population may double in size in the next three decades, while those ages 30 to 44 may shrink in size. While projections are based on historical data and do not always predict accurate trends, the dramatic possible increase in the elderly population is a trend that should be of importance to County service providers and planners. Based on 2010 U.S. Census population estimates, the median age in Orange County has increased by more than 2 years since 2007, to 36.6 years; the largest cohort of residents is age 45-49. The number of residents ages 65-69 is forecasted to more than double from 2000-2020 primarily due to the entry of 'baby boomers' into these age ranges.Twenty-one percent of Rockland County's population was estimated to be foreign-born in 2010. Among the 63,058 Rockland county residents estimated to be foreign born in 2007, the largest group was born in the Latin America and the Caribbean (48%). One quarter of foreign-born residents (25%) originated from Asia. Approximately another quarter (23%) came from Europe and 3% from Africa. Countywide, 32.9% of persons over age 5 speak a language other than English at home.According to the U.S. Census, 11.1% of residents in Orange County were foreign born, with 22.3% of persons over the age of five speaking a language other than English at home. Rockland County's rate of poverty for children under 18 increased to 16.9% in 2009 when compared to (15%) in 2000. Poverty rates in Orange County vary greatly based on municipality. Poverty rates exceeding 25% for families with related children under 18 are found in Orange County's three cities (Middletown, Newburgh, and Port Jervis), as well as in the town of Monroe, largely due to the impact of the village of Kiryas Joel, where the poverty rate is more than 4 times the county average. Part VI, Line 5: All BSCHS facilities have an open medical staff with privileges available to all qualified physicians in the area and are governed by a System board of directors whose composition is representative of the community, with a majority being independent members of the community. BSCHS has a dedicated Community Outreach department responsible for planning, implementing and evaluating all community health and education programs. In 2013, over 20 support groups met monthly in our facilities. The Community Outreach department managed the BSCHS Speakers' Bureau which connected our medical professionals directly with the community on topics such as Cardiac, Orthopedics, Women's health, Obesity, Stroke, Diabetes, Wound Care, Safety, Asthma, Senior Services, etc. The Community Outreach department also managed 2 live radio interview broadcasts each month for a combined listening audience of 16,000/month. In addition to this, the Outreach department also managed service line specific programs such as Breast and Cervical Cancer screenings, Hearing testing, Sleep Disturbances seminars and others. Access to Care: Bon Secours Charity Health System is committed to responding to and participating in addressing the health care needs of the communities in its service area. This is accomplished through several means such as providing charity care; improving access to health care services especially for the underserved population; and offering various opportunities for community members to enroll in governmental and/or community health plans. All three BSCHS hospitals have partnered with local Federally Qualified Health Centers (FQHC) to increase public awareness of the available services that are either free of charge or based on a sliding scale payment. BSCHS also continues to increase the size of its employed Medical Group and, in accordance with our mission, these practitioners are required to accept Medicaid and to participate in programs to provide charity care. Chronic Disease:The goal of our Heart Disease strategies is to increase the public's awareness of the risk factors for heart disease and to give them information on how to diminish their risk. In 2013, BSCHS hosted or participated in free cardiac awareness and prevention programs that were attended by over 8000 people. Specific programs focused on prevention, signs and symptoms, cholesterol, blood pressure screenings, obesity and women and heart disease. In addition, BSCHS also participated in the American Heart Walk which was attended by over 1000 people. The Lower Hudson Valley Mended Hearts Chapter #368 meets monthly at Good Samaritan Hospital offering support and education for cardiac patients and their family members. Through the trained volunteer visitor program, both pre and post cardiac surgery patients are visited by a former heart surgery patient. The BSCHS cancer services provide the community with excellent cancer treatment and support opportunities as well as increase the public's awareness of risk factors and cancer prevention. 2013 BSCHS had two cancer treatment programs, one located at Good Samaritan Hospital and one at Bon Secours Community Hospital. Both programs are accredited by the Commission on Cancer by the American College of Surgeons and Good Samaritan Hospital's Radiation Oncology Services are accredited by the American College of Radiology. BSCHS leadership and cancer program staff work diligently to maintain these accreditations to ensure that the community is receiving the best care available. Additionally, partnerships with the American Cancer Society have helped to develop new community screening programs and to improve patient support offerings.In 2013, BSCHS hosted numerous cancer awareness, early detection, prevention and support programs that reached a total of 7709 people. These programs focused on a wide variety of cancer related illnesses and many of them offered the community the opportunity to meet oncology specialists on a one-to-one basis. In addition, BSCHS participated in the American Cancer Society's Making Strides Against Breast Cancer walk which was attended by 1500 people. A partnership with the Cancer Services Program of Rockland County helped BSCHS to develop ongoing breast and cervical cancer screenings for uninsured and underinsured community members. Through this partnership, 9 free screenings were held in 2013 and 299 people received early detection services. Important to note is that, if a person has a positive finding from any of these free screenings, BSCHS works with the Cancer Services Program to provide all necessary follow up treatment including surgery, chemotherapy and radiation. BSCHS employs a board certified breast surgeon and a board certified colorectal surgeon. Additionally, BSCHS employs a Certified Genetics Counselor who provides patient and family consultations and speaks at free community education programs. A patient navigator assists breast cancer patients to coordinate their care and access available services. BSCHS continues to financially support the American Cancer Society's Making Strides Against Breast Cancer annual fundraising walk. Our restricted donation helps to produce prevention and early detection educational materials for the communities we serve. 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 it's 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 NY 1 1 0 0 0 0 0 0 0 Clement Osei MD Board Member 165462 0 0 0 20464 0 12694 0 13699 0 212319 0 0 0 Andrea Schmid-Mazzoccoli Board Member 0 342352 0 91905 0 63025 0 47154 0 20192 0 564628 0 20219 John Wallenhorst PhD Board Member 0 225989 0 63875 0 47218 0 14568 0 10185 0 361835 0 801 Philip Patterson CEO - BSCHS (Jan-Sept) 0 336904 0 205912 0 57191 0 45612 0 26920 0 672539 0 3750 Mary Leahy MD CEO - BSCHS (Sept-Dec) 300114 0 115252 0 91009 0 21289 0 21944 0 549608 0 0 0 Martin Evers MD President - BSCHS MedPC 150257 0 172287 0 553 0 16573 0 20142 0 359812 0 0 0 Rodney Williams MD CMO - BSCHS 357040 0 132747 0 46684 0 19539 0 9801 0 565811 0 0 0 Eileen Dobbing CNO - BSCHS 221679 0 95000 0 67357 0 11889 0 8589 0 404514 0 0 0 Pam Tarulli SVP HR - BSCHS 226005 0 105070 0 39688 0 17621 0 15158 0 403542 0 0 0 Jeffrey Reilly SVP OPS - CH & SACH 196461 0 85647 0 40209 0 6602 0 971 0 329890 0 0 0 Sophie Crawford-Rosso VP PCS - CH 134285 0 20941 0 1075 0 3181 0 13734 0 173216 0 0 0 Judith Lindberg VP PCS - SACH 141337 0 22160 0 1594 0 4514 0 14422 0 184027 0 0 0 John Fiore Medical Director - SACH 238581 0 112561 0 2080 0 19086 0 17630 0 389938 0 0 0 Toni Clark EVP Sr Services - MA&SP 156635 0 35720 0 40325 0 14742 0 7731 0 255153 0 0 0 Edward Lundy MD Dir of Cardiac Surgery 854954 0 159375 0 3754 0 19539 0 14835 0 1052457 0 0 0 Cary Hirsch MD Physician 942308 0 50000 0 4356 0 19539 0 498 0 1016701 0 0 0 Thomas Facelle MD Dir of Surgery 603078 0 209337 0 2931 0 19539 0 1035 0 835920 0 0 0 Anuj Shah MD Cardiologist 432660 0 259385 0 890 0 15198 0 13128 0 721261 0 0 0 Seth Hurwitz MD Cardiologist 343292 0 282549 0 878 0 18909 0 21121 0 666749 0 0 0 David Capone Former CFO 0 0 0 0 261699 0 0 0 9284 0 270983 0 0 0 Melinda Hancock Former Interim CFO 0 270243 0 56597 0 39110 0 5235 0 25656 0 396841 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, Lines 4a-b Line 4a: Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: David Capone, $256,154. Line 4b: The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Andrea Mazzoccoli, $20,139; Philip Patterson, $4,902; John Wallenhorst, PhD, $903. Form 990, Part VI, Section A, line 2 Board Members Steve Alabanese and Daniel Rifkin have a business relationship. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. ("BSHSI") is one of two corporate members of Bon Secours Charity Health System, Inc. ("BSCHSI") along with the Sisters of Charity of Saint Elizabeth of Convent Station. BSCHSI is in turn the sole member of each of the members within Bon Secours Charity Health System Affiliated Group ("Group"). Pursuant New York State Law, as an organization engaged in the profession of medicine, Bon Secours Charity Health System Medical Group, PC has a sole shareholder of the organization who is engaged in the practice of medicine and licensed to practice in the state of New York. Form 990, Part VI, Section A, line 7a The governing bodies of the members within the Group, but for Bon Secours Charity Healthy System Medical Group, PC, are appointed by its Member, BSCHSI, and subject to approval by BSHSI, one of two corporate members of BSCHSI along with the Sisters of Charity of Saint Elizabeth of Convent Station. The governing body of Bon Secours Charity Healthy System Medical Group, PC is appointed by its shareholder with the approval of Bon Secours Charity Health System. The board of directors is comprised of individuals, each of whom is a shareholder of the organization or engaged in the practice of medicine in the organization and licensed to practice medicine in the state of New York. Form 990, Part VI, Section A, line 7b Certain authorities of the members of the Group, but for Bon Secours Charity Healthy System Medical Group, PC, are reserved to its member or to Bon Secours Health System, Inc. or are jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station. Certain authorities of Bon Secours Charity Healthy System Medical Group, PC are reserved to the shareholder, Bon Secours Charity Health System 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 and questions by both before the extended filing date. The local system's audit and compliance committee members review the Form 990, schedules time on their meeting agenda, and provide comments 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 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's 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 positions of other officers or key employees of the organization were compared to similar position market data in comparably situated organizations taking into consideration geographic location and organization size where appropriate. 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 organizations provide any documents open to public inspection upon request. Form 990, Part VII: 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: Pension Related Changes 237,113. Other Misc Changes in Net Assets 1,083. Bon Secours Health System Inc (BSHSI) 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org - Management Services MD 501(c)(3) Line 11b, II Bon Secours Inc 0 Good Samaritan Foundation for Better Health 255 Lafayette Avenue Suffern NY 10901 133400353 Foundation NY 501(c)(3) Line 7 BSCHSI 0 Bon Secours Community Hospital Foundation 255 Lafayette Avenue Suffern NY 10901 810667395 Foundation NY 501(c)(3) Line 7 BSCHSI 0 Bon Secours Warwick Health Foundation 255 Lafayette Avenue Suffern NY 10901 141972807 Foundation NY 501(c)(3) Line 7 BSCHSI 0 0 1 1 1 1 0 0 0 1 0 0 0 1 0 0 1 1 0 0