2013-07-15T00:09:58-05:00 2012-08-31 861065772 Deloitte Tax LLP 1750 Tysons Blvd McLean VA 221024219 990 2011-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Richard Jones 4103624477 2013-07-15 1 David A Craig P00542227 7032511000 2011 2016-02-24 21:20:13Z Richard Jones 2000 West Baltimore Street Baltimore MD 212231558 138792340 0 0928 X www.bonsecoursbaltimore.com X 1920 MD Acute Care Hospital 15 13 1158 91 16741 0 7992836 1017085 132055347 136083583 -770937 904165 866227 787507 140143473 138792340 58575 197872 0 0 64595492 61919999 0 0 0 72460871 76163514 137114938 138281385 3028535 510955 83049970 72332787 142266042 157340732 -59216072 -85007945 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 126249133 197872 136083583 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. BSBHS provides a full range of services & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; 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; Primary Care; Senior & Family Housing; Smoking Cessation; Social Work; Substance Abuse Treatment; Surgery; a Wellness & Fitness Center; Vascular Services; & the Women's Resource Center. Outpatient Services - including 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. BSBHS 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. 126249133 1 1 0 1 0 0 0 0 0 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 0 1 183 0 1 1158 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X Richard Jones 4103623000 2000 W Baltimore St Baltimore MD 212231558 X Mary Lenore Beachley 4.00 X 0 0 0 Matthew Hemelt 4.00 X 0 0 0 J Howard Henderson 4.00 X 0 0 0 Keshia Pollack 4.00 X 0 0 0 Martha Riva 50.00 X 0 342569 128325 Sr Mary Shimo 50.00 X 0 0 0 Alan Siegfried 4.00 X 0 0 0 Anthony Stanowski 4.00 X 0 0 0 Lisa Williams 4.00 X 0 0 0 Theodore Wimberly 4.00 X 0 0 0 Patricia Scipio 4.00 X 0 0 0 Bro Art Caliman 50.00 X X 0 0 0 Glendora Hughes Esq 6.00 X X 0 0 0 Ackneil Muldrow 6.00 X X 0 0 0 Samuel L Ross MD 50.00 X X 0 592063 77713 Richard Jones 50.00 X 333070 0 22593 Fabienne Larkins 50.00 X 278096 0 19581 Rosita R Cruz MD 50.00 X 203379 0 18429 Usha Jain MD 50.00 X 306576 0 37503 Kwang Kim MD 50.00 X 203221 0 14660 Shivani Myer MD 50.00 X 204088 0 15465 Donovan Parkes MD 50.00 X 409898 0 57660 1938328 934632 391929 74 0 1 0 Cardinal Health 1330 Enclave Parkway Houston TX 77077 Pharmacy Mgmt Services 2319104 Shiftwise PO Box 70870 St Paul MN 55170 Nursing Services 2088010 University of Maryland 110 South Paca St Baltimore MD 21201 Physician Services 1907409 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 1623520 Broadway Services Inc 3709 E Monument St Baltimore MD 21205 Security 1221252 78 30590 973843 12652 1017085 Net Patient Rev. 621110 136083583 136083583 136083583 200047 200047 1646 1646 199937 0 199937 199937 199937 137867 564605 0 0 137867 564605 702472 702472 Cafe and Vending 722212 403597 403597 Parking 812930 149109 149109 Purchase Discounts 900099 18123 18123 16741 16741 587570 138792340 136083583 16741 1674931 175706 175706 22166 22166 678506 610655 67851 47200329 42480296 4720033 2267044 2040340 226704 8270453 7443408 827045 3503667 3153300 350367 320210 288189 32021 277276 249548 27728 14491 13042 1449 12273726 11046353 1227373 501996 451796 50200 913087 821778 91309 173418 156076 17342 5127967 4615170 512797 128627 115764 12863 2045010 2045010 3331597 2998437 333160 1711918 1540726 171192 Bad Debt Expense 15715983 15715983 0 0 Purchased Services 14151131 12736018 1415113 0 Medical Supplies 12848081 11563273 1284808 0 BSHSI Mgmt Allocation 5421376 4879238 542138 0 1207620 1086861 120759 138281385 126249133 12032252 0 532485 362260 1795634 464881 19775321 19426325 1179262 1344093 14854 1384077 91234260 61749453 28472159 29484807 9608249 10352296 21672006 9514048 83049970 72332787 14404431 14196890 1452192 2822759 5007955 4737030 121401464 135584053 142266042 157340732 X -59815241 -84867001 599169 -140944 0 -59216072 -85007945 83049970 72332787 X 510955 -26302828 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14491 14491 0 Explanation of Lobbying Activities: Part II-B, Line 1: Bon Secours Hospital Baltimore, Inc. paid dues to the American Hospital Association (AHA), the Maryland Hospital Association (MHA) and the Catholic Hospital Association (CHA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations is as follows: Lobbying activity for AHA ($4,623 or 24.6%), MHA ($8,731 or 8.65%), CHA ($1,137 or 5.15%) for a total of $14,491. 600000 600000 29936934 17345943 12590991 18163178 12514718 5648460 30771788 24036083 6735705 11762360 7852709 3909651 29484807 Due from Afilliates 1859157 Due from HSO 20 HPL/GL Asset 7602179 Other LT Investments 13150 Social Security Assets 39542 9514048 Due to BSHSI 92062921 Pension Liability 28094654 Capital Leases 412339 Advances from Medicaid 4503795 Advances from Carefirst 639862 HPL/GL Liability 7602179 Due to Affiliates 919351 FIN 47 Liability 1348952 135584053 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 (formerly FIN48). ASC 740 (formerly FIN48) 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 de-recognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 (formerly FIN48) 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 (formerly FIN48). Income taxes of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $95,733 and $89,500 of net operating loss carryforwards as of August 31, 2012 and 2011, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2012 and 2011. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 1 X 1 X 1 1 1 0 1 1 5925739 0 5925739 0.04830 0 0 0.00000 0.00000 5925739 5925739 0.04830 4 2892 2362457 2362457 0.01930 1 224 108862 0 108862 0.00090 3 26983 15108674 111889 14996785 0.12240 0.00000 0.00000 8 30099 17579993 111889 17468104 0.14260 8 30099 23505732 111889 23393843 0.19090 12 2193 4686952 2779792 1907160 0.01560 0.00000 3 1788 1484931 1484931 0.01210 0.00000 0.00000 0.00000 0.00000 3 26923 940851 940851 0.00770 0.00000 18 30904 7112734 2779792 4332942 0.03540 1 8860170 33066259 29220251 3846008 X 1 1 1 1 Bon Secours Hospital Baltimore Inc

2000 W Baltimore St Baltimore MD 212231558

X X X X Bon Secours Hospital Baltimore Inc 1 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 3 Bon Secours CIBS

3101 Towanda Ave Baltimore MD 212150000

Behavioral Health Services New Hope

2401 W Baltimore Street Baltimore MD 212231558

Behavioral Health Services Druid Park Facility

2901 Druid Park Drive Suite A103 Baltimore MD 212150000

Behavioral Health Services Part I, Line 7: Part I, Lines 7a-7c: 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.For Part I, Lines 7a-7c 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, L7 Col(f): Current year bad debt expense not included in the calculation for line 7, column f: $15,715,983 Part II: 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 2012:Our Money Place (OMP) Financial Services 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 Earn Benefits. Over 2,260 persons utilized these services in FY 12. 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. Over 340 area youth participated in YEEP activities in FY 12.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 maintained over 400 lots in FY 12. In addition eight individuals completed a six month training program.Career Development Program offers job readiness, GED instruction, placement and retention services where, after a five-week intensive classroom experience, clients are followed for three years and helped to move up the company ladder, obtain more education as needed, get out of debt and learn basic money management skills. The ultimate goal is financial self-sufficiency. A total of 21 individuals completed our job readiness training and 53 community residents were placed in employment in FY 2012. Family Support Center helps young parents obtain a GED and get into college 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. One-thousand two hundred thirty four parents and children were served during FY 12.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. Over 510 women were served in FY 12.Housing: BSBHS also renovates row houses and constructs apartment buildings where low-income families and seniors can find safe and affordable housing. Over 648 families and seniors were housed in FY 12. Part III, Line 4: Part III, Line 2: Bad Debt Expense at cost is computed by applying the cost-to-charge ratio computed on Worksheet 2 to the aggregate bad debt expense for patient accounts recorded in the general ledger. 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 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 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, 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 Financial Assistance Program (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 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 V, Section B, line 11h:Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy.Part V, Section B, line 13g:Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy.Part V, Section B, line 19d:Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part VI, Line 2: In FY13 BSBHS will complete its current Community Health Needs Assessment which began in November 2009 with a community health engagement process with an objective to develop:- An agreed-upon vision of an improved healthcare system which would lead to a healthier community and would be financially sustainable- A plan to achieve our visionWe hosted meetings involving 9 community associations, churches - such as Central Baptist Church and Greater Church of the Risen Savior - schools, service providers and seniors, gathering input from more than 100 community members. We also consulted other hospitals, our local health department, federally qualified health centers, physicians, and philanthropic organizations, institutions of higher education, and elected officials.This planning process led to recommendations and strategies under three major areas of focus: Healthy People, Healthy Environment and Healthy Economy.The next step taken in our current effort was a West Baltimore Health Care Summit which brought together 100 participants representing various stakeholders - hospitals, federally qualified health centers, physicians, philanthropic organizations, institutions of higher education, community members, and elected officials - to focus on improving access to primary care in Central and Southwest Baltimore City.Following the 2010 West Baltimore Health Care Summit, three workgroups were formed to focus on various aspects of improving access to primary care: Prevention, Education, and Outreach; Healthcare Workforce and Service Delivery. Understanding that central and southwest Baltimore exhibit some of the poorest health status indicators in the state, and understanding that the passage of the Patient Protection and Affordable Care Act now provides us with a unique opportunity to create new models of care that better meet the needs of our community, Bon Secours and the Mid Atlantic Association of Community Health Centers then launched a West Baltimore Primary Care Access Assessment and Strategic Planning project. A primary goal of that project is to ensure that our community members have access to quality primary care. We also now have a New Vision and corresponding strategic plan designed to expand our role as a trusted resource for healthcare, education, community, social and housing services. As we look to implement a new patient-centered "Medical Neighborhood," we are sharpening our focus on creating even more programs to address the needs 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 200% of the Federal Poverty Guidelines ("FPG"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain States, where applicable. 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. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. 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's Community Benefit Service Area is southwest Baltimore, which 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; 33% have a high school diploma 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 BSBHS, residents die from heart disease at a rate that is 26% higher than the city as a whole. Deaths from diabetes and HIV/AIDS are also substantially higher than in the entire city. And 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. Part VI, Line 5: BSB has an open medical staff with privileges available to all qualified physicians in the area. BSB 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 four goal areas for the current three year period (2010-2012). One of those goals was to partner with communities to co-create a more humane world, improve health and model social justice. To accomplish this, two key strategies are to: - Engage communities to identify needs and assets and building partnerships to improve health and quality of life of a specific population.- Demonstrate sustainable stewardship for healing the earth as a way to improve health and life quality.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. Reports Filed With States Part VI, Line 7 MD 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 501(c)(3) 175706 General Support to start up organization 1 0 Emergency Assistance Funds for Patients, Volunteers & Employees 22 22166 0 1 0 0 0 0 0 0 0 Martha Riva 0 318505 0 0 0 24064 0 89783 0 38542 0 470894 0 0 Samuel L Ross MD 0 491059 0 45844 0 55160 0 53709 0 24004 0 669776 0 0 Richard Jones 260932 0 35000 0 37138 0 5137 0 17456 0 355663 0 0 0 Fabienne Larkins 239637 0 15462 0 22997 0 6435 0 13146 0 297677 0 0 0 Rosita R Cruz MD 172768 0 0 0 30611 0 11610 0 6819 0 221808 0 0 0 Usha Jain MD 286741 0 0 0 19835 0 23365 0 14138 0 344079 0 0 0 Kwang Kim MD 170300 0 0 0 32921 0 1247 0 13413 0 217881 0 0 0 Shivani Myer MD 203541 0 0 0 547 0 3400 0 12065 0 219553 0 0 0 Donovan Parkes MD 371175 0 0 0 38723 0 23326 0 34334 0 467558 0 0 0 Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Hospital Baltimore, Inc., 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 Supplemental Information Part III 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. 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 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's 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 director's and compensation committee minutes. Form 990, Part VI, Section b, Line 15b - Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 Bon Secours Hospital Baltimore, Inc. provides any documents open to public inspection upon request. Avg hours devoted to related org(s) when related comp is reported: Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officer's and director's hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Voluntary Board Members are not compensated for their time. Dr. Samuel Ross' compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the CEO of Bon Secours Baltimore Health System which includes direct management, monitoring and oversight of Bon Secours Baltimore Health System and its related organizations. Martha Riva's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the SPV of Governance of Bon Secours Health System, Inc. Brother Art Caliman and Sr. Mary Shimo do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 437,624. Amounts released from restriction -115,253. Transfers to BSHSI - Reimbursement and Swap/Principal -1,337,422. Add'l Minimum Pension Liability -8,246,070. Forgiveness of debt to LMC and UMI -16,900,826. Other Changes -140,881. Total to Form 990, Part XI, Line 5: -26,302,828. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 211041301 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Community Health Services Inc 2600 Liberty Heights Avenue Baltimore MD 212157804 521909599 Medical Services Center MD 501(c)(3) 9 Bon Secours Baltimore Health System Inc 0 The Bon Secours of Maryland Foundation Inc dba Community Works 26 N Fulton Avenue Baltimore MD 212231624 521732800 Community Foundation MD 501(c)(3) 11b Bon Secours Baltimore Health System Inc 0 Unity Properties Inc 26 N Fulton Avenue Baltimore MD 212231624 521857768 Low Income Housing MD 501(c)(3) 7 Bon Secours of Maryland Foundation 0 Urban Medical Institute Inc 2600 Liberty Heights Avenue Baltimore MD 212157804 521905869 Medical Services Center MD 501(c)(3) 3 Liberty Medical Center Inc 0 Bon Secours Baltimore Development Inc 26 N Fulton Avenue Baltimore MD 212231624 760785344 Low Income Housing MD 501(c)(3) 7 Unity Properties Inc 0 Washington Village Community Medical Center Inc 700 Washington Blvd Baltimore MD 212231624 520591555 Healthcare MD 501(c)(3) 9 Bon Secours Baltimore Health System Inc 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) 11a Bon Secours Baltimore Health System Inc 0 Bon Secours Housing 26 N Fulton Avenue Baltimore MD 212231624 521442707 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Housing II 26 N Fulton Avenue Baltimore MD 212231624 521543174 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Health Corps (dba Bon Secours Baltimore Health System 2000 W Baltimore Street Baltimore MD 212231558 800728893 Local System Parent Org MD 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Apartments LP 1800 W Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD Unity Housing Inc Related 0 0 Bon Secours Apartments II LP 1800 W Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD Unity Housing Inc Related 0 0 Liberty Senior Housing LP 1800 W Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD Unity Housing Inc Related 0 0 Bon Secours Apartments III LP 1800 W Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD Unity Housing Inc Related 0 0 Bon Secours Smallwood Summit 26 N Fulton Avenue Baltimore MD 212231624 522280175 Low Income Housing MD Unity Housing Inc Related 0 0 Bon Secours Chesapeake Apartments LP 26 N Fulton Avenue Baltimore MD 212231624 200107034 Low Income Housing MD Chesapeake Housing LLC Related 0 0 Bon Secours Shiloh LP 26 N Fulton Avenue Baltimore MD 212231624 203965243 Low Income Housing MD Bon Secours Shiloh LLC Related 0 0 Bon Secours Wayland LP 26 N Fulton Avenue Baltimore MD 212231624 270468688 Low Income Housing MD Bon Secours Wayland LLC Related 0 0 Unity Housing Inc 26 N Fulton Avenue Baltimore MD 212231624 521952507 Low Income Housing MD Unity Properties Inc C Bon Secours Wayland LLC 26 N Fulton Avenue Baltimore MD 212231624 270468561 Low Income Housing MD Unity Properties Inc C 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0