2012-07-10T14:37:23-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 650061820 Bon Secours Maria Manor Nursing Care Center BONS 7275761025 10300 Fourth Street N St Petersburg FL 337163814 Karen Reich 7275761025 2012-07-10 1 7032511000 2010 2016-02-24 21:20:13Z Karen Reich 10300 Fourth Street N St Petersburg FL 337163814 22219661 0 X www.bonsecoursstpete.org X 1988 FL Nursing care to the elderly 18 15 536 30 107875 -60450 154474 326637 21421656 21700518 -1879 -3295 588897 175039 22163148 22198899 0 83589 0 0 12963873 12462803 0 0 0 9258325 8990795 22222198 21537187 -59050 661712 8608335 9146237 13349336 13741956 -4741001 -4595719 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 19479515 83589 21700518 Bon Secours Maria Manor Nursing Care Center, Inc. is a freestanding, 274-resident nursing care center offering skilled and long-term nursing care for the Tampa Bay area as well as short-term rehabilitiation unit. The Center for Rehabilitation at Maria Manor is designated for those with short-term rehabilitation needs. This 32-bed, dedicated short-term unit mirrors the rehabilitation programs offered at many hospital and rehabilitation centers. For those with orthopedic injuries or surgeries, the CORE, or Center for Orthopedic Excellence, has been designed specifically for those rehabilitating from a fractured hip or hip or knee replacement surgery. Services at Maria Manor include, dental and podiatry services, physcial occupational and speech therapy, physician visits on site, interdisciplinary team approach to care, specialized end of life care programs, activities programming for each unit, mass or communion services offered daily, and pastoral care. 19479515 1 1 0 1 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 536 1 1 1 0 0 0 0 0 0 0 0 0 X 18 15 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X Karen Reich 7275761025 10300 4th Street North St Petersburg FL 33716 X Karen Bigby MD 4.00 X 0 0 0 Teresa Bradley MD 4.00 X 0 0 0 Regina Clifton 4.00 X 0 0 0 William R DiMarino 4.00 X 0 0 0 Sr Frances McCabe 4.00 X 0 0 0 Terence McCarthy 4.00 X 0 0 0 Emily E Morgan 4.00 X 0 0 0 Donna Potter 4.00 X 0 0 0 Janice M Russell 4.00 X 0 0 0 Fr John Tapp 4.00 X 0 0 0 John R Thomas 4.00 X 0 0 0 Lawrence Skip Hubbard 50.00 X 0 474728 118294 James Higgins 50.00 X X 0 391474 38676 Brother Arthur Caliman 50.00 X X 0 0 0 Joseph Mark Waterbury 6.00 X X 0 0 0 Harry B Jones 6.00 X X 0 0 0 Robert Sherman 6.00 X X 0 0 0 Karen Reich 50.00 X X 0 218434 42262 Kity Khundkar 50.00 X 0 302784 17400 Vicki Ackerman 50.00 X 171461 0 8623 Jennifer Craddock 50.00 X 100372 0 7266 271833 1387420 232521 2 0 1 0 Rehabcare Group PO Box 502096 St Louis MO 631502096 Rehab therapy 1046911 Nurse Staffing PO Box 4729 Winter Park FL 327934729 Contract labor 233117 Arbor Temporary PO Box 354526 Palm Coast FL 321354526 Contract labor 207901 Extended Care Respiratory Services 8452 118th Ave B Largo FL 33773 Respiratory therapy 107061 4 2779 130000 193858 326637 Patient Service Rev. 621110 21700518 21700518 21700518 3295 -3295 -3295 -3295 20246 2779 17467 2779 2779 Management Fee 900099 107875 107875 Beauty & Barber 900099 41004 41004 Gift Shop 900099 11304 11304 12077 12077 172260 22198899 21700518 107875 63869 83589 83589 169467 152520 16947 9674326 8706893 967433 193452 174107 19345 1612747 1451472 161275 812811 731530 81281 44236 39812 4424 25066 22559 2507 881 793 88 1055982 950384 105598 16104 14494 1610 338703 304833 33870 57856 52070 5786 559524 503572 55952 53583 48225 5358 473 426 47 543613 543613 540723 486651 54072 463647 417282 46365 Purchased Services 2112056 1900850 211206 Medical Suppies 1698146 1528331 169815 BSHSI Mgmt Allocation 523688 471319 52369 Quality Assessment Fee 371019 333917 37102 Bad Debt 333285 333285 252210 226988 25222 21537187 19479515 2057672 0 -85715 823743 2625815 1801465 82710 88574 26283 27425 17788902 12371366 5289052 5417536 670190 987494 8608335 9146237 904446 2008086 68387 12444890 11665483 13349336 13741956 X -4754300 -4830238 0 234519 13299 0 -4741001 -4595719 8608335 9146237 X 661712 -516431 X 0 1 1 X 1 1 X 21514 3683 2269 154474 326637 508577 19824086 21349437 22334259 21421656 21700518 106629956 19845600 21353120 22336528 21576130 22027155 107138533 0 0 0 107138533 37898 18305 1765 57968 107875 107875 37898 18305 1765 107875 165843 273421 310005 375174 588897 84631 1632128 20156919 21681430 22713467 22165027 22219661 108936504 0.98350 0.98170 0.00150 0.00150 X Schedule A, Part IV, Supplemental Information: Part III, Section B, Line 12: Beauty&Barber, Gift Shop and Other. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 881 881 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The filing organization paid dues to the Florida Association of Homes and Services for the Aging, Inc. (FAHSA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities was as follows: 5.3% ($881). 0 0 68387 68387 1 1828977 1828977 2464997 1151300 1313697 4171256 3857281 313975 9323672 7362785 1960887 5417536 Due from short term affiliates 721926 Assets Held in Trust 68387 Due from BSHSI 197181 987494 Due to BSHSI 10716524 Long term Pension Liability 150000 FIN47- Asbestos 430609 Third party liability 368350 11665483 Part IV, Line 2b: Bon Secours Maria Manor Nursing Care Center holds, safeguards, manages and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests up to $25 are available for immediate distribution to residents. Written requests for greater than $25 are processed through the Accounts Payable Clerk. All excess custodial funds are held in interest bearing accounts separate from that of the organization. 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 FIN 48. FIN 48 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 FIN 48 by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The system accounts for uncertain tax positions in accordance with ASC Topic 740. Income taxes of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $89,500 and $98,300 of net operating loss carryforwards as of August 31, 2011 and 2010, respectively, which expire in varying periods through 2031 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2011 and 2010. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Chihuly Event 23025 2779 20246 4196 8331 2110 2830 23025 2779 20246 4196 8331 2110 2830 17467 2779 1 Friends of the Sunshine Center 330 5th St N StPetersburg FL 33701 161780444 501(c)(3) 1000 10000 FMV Exercise Equipment Specialized machine for seniors DayStar Life Center Inc 226 6th St StPetersburg FL 33713 650523539 501(c)(3) 20000 Funds for replacement Id's for homeless St Petersburg Free Clinic Inc 863 3rd Ave N StPetersburg FL 33701 237208280 501(c)(3) 50000 Equipment and materials to supply new dental clinic 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization actively partners with all community groups which receive funding. Donees/grantees submit written reports regarding their expenditure of such funds. X X X X X 0 1 0 0 0 0 0 0 0 Lawrence Skip Hubbard 0 365557 0 102880 0 6291 0 96117 0 22177 0 593022 0 0 James Higgins 0 318905 0 45156 0 27413 0 27333 0 11343 0 430150 0 0 Karen Reich 0 168833 0 26614 0 22987 0 12420 0 29842 0 260696 0 0 Kity Khundkar 0 252209 0 28484 0 22091 0 1003 0 16397 0 320184 0 0 Vicki Ackerman 135544 0 35654 0 263 0 0 0 8623 0 180084 0 0 0 Part I, Line 4b Bon Secours Health System, Inc. and Frances Schervier Home and Hospital participate in a BSHSI sponsored executive retirement program that allows for deposits into additional retirements 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 are made into this plan. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours St. Petersburg Home Care Services, 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 Form 990, Part VI, Section A, line 2 The Chairman of the Board, Mark Waterbury and another Board Member, Terence McCarthy, have a business relationship. Form 990, Part VI, Section A, line 4 The articles and bylaws were amended and restated in their entirety (effective 2/14/2011) to reflect current operational realities and governance best practices, and to reflect the transfer of sponsorship of the Bon Secours Health System from the Sisters of Bon Secours to Bon Secours Ministries. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Maria Manor Nursing Care Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Maria Manor Nursing Care Center is appointed by its member Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Maria Manor Nursing Care Center, Inc. are reserved to its Members. 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 of July 16, 2012. 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 July 16, 2012. 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 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 directors and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the 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 Bon Secours Maria Manor Nursing Care Center provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officers' and directors' 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. James Higgin's compensation is paid by Bon Secours Health System, Inc., a related organization. The calendar year 2010 compensation reported on Form 990, Part VII was reflective of his role as the CEO of both Bon Secours New York Health System, Inc. and Bon Secours St. Petersburg Health System. This role included direct management, monitoring and oversight of all related entities within both systems. As of March 2011, in FY11, Karen Reich (as described below), assumed the role of CEO at Bon Secours St. Petersburg Health System. Karen Reich's compensation is paid by Bon Secours Health System, Inc., a related organization. The calendar year 2010 compensation reported on Form 990, Part VII was reflective of her role as EVP and Administrator of Bon Secours Maria Manor Nursing Care Center and Bon Secours St. Petersburg Home Care Services, respectively. During FY11, starting in March of 2011, she transitioned into the role of CEO for Bon Secours St. Petersburg Health System. This role includes direct management, monitoring and oversight of all related entities within the system. Kity Khundkar's compensation is paid by Frances Schervier Home and Hospital, a related organization of Bon Secours Health System, Inc. During FYII, Ms. Khundkar continued to serve as the CFO of both Bon Secours New York Health System, Inc. and Bon Secours St. Petersburg Health System. The compensation she received was for her role as the CFO of both local systems which included direct financial management, monitoring and oversight of all related entities within the systems. Lawrence "Skip" Hubbard's compensation is from Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as a SVP and the Chief Information Officer of Bon Secours Health System, Inc. Brother Art Caliman does not receive payroll distributions as he has taken a vow of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfers to Affiliates -503,132. Other changes in net assets 43,208. Amounts Reported as Rev in PY -57,000. Other misc 493. Total to Form 990, Part XI, Line 5: -516,431. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org - Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours St Petersburg Home Care Services 10300 Fourth Street North St Petersburg FL 33716 134334363 Home Care Services FL 501(c)(3) 9 Bon Secours Maria Manor Nursing Care Center 1 Bon Secours Place at St Petersburg 10300 4th Street North St Petersburg FL 33716 593589729 Assisted Living/Senior Care FL Bon Secours - Florida Integrated Services Inc Related 0 0 Bon Secours - Florida Integrated Services Inc 10300 4th Street North St Petersburg FL 33716 650779777 Holding Company/Assisted Living FL Bon Secours Maria Manor Nursing Care Center C 0.80000 0 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 Bon Secours St Petersburg Home Health Care P 1252098 Actual Cost