2019-07-11T07:53:00-05:00 2018-08-31 861065772 Deloitte Tax LLP 695 Town Center Drive Suite 1000 Costa Mesa CA 92626 990 2017-09-01 540793767 Bon Secours - St Mary's Hospital of Richmond Inc BONS 8042818413 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi Treasurer (BSR-VP Finance) 8042818316 2019-07-11 1 John W Sadoff Jr P00540589 4042201500 168.250.63.1 2019-07-11 07:00:42 ED P 0EB4CE1ACD44DB279B6C2D9A8476B20948576B96 F6D944725D87E8D67D75795748B251B00643F0AC 2017 2019-02-21 02:37:17Z St Mary's Hospital Francine Barr 5801 Bremo Road Richmond VA 23226 776323041 0 X www.bonsecours.com X 1961 VA Acute Care Hospital 21 19 5342 715 433953 0 1788284 2769855 711818603 741475338 14744650 24307257 8476135 6990375 736827672 775542825 7114620 7157695 0 0 306743569 327492900 0 0 0 373961191 382519245 687819380 717169840 49008292 58372985 1038396475 1103110014 355131635 319430117 683264840 783679897 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 589770849 7157695 604220418 St. Mary's Hospital provides medical care to patients without regard to their ability to pay. As the major community not for profit hospital in Richmond, St. Mary's is the access for under-insured and financially disadvantaged who will not be treated at the for profit hospitals. In addition, St. Mary's provides support for community services. Please refer to the Community Benefit information on Schedule H. 140563064 St. Mary's Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 761292 120539 The Bon Secours St. Mary's Hospital School of Medical Imaging offers an accredited 18-month radiography program designed to prepare individuals to enter the workforce as Diagnostic Radiologic Technologists. This new and innovative curriculum will allow students to enter the workforce more quickly while maintaining high standards of education. The Radiography program quality and depth has remained the same and continues to meet requirements established by the American Society of Radiologic Technologists. 590532141 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 239 0 1 5342 1 1 1 0 0 0 0 0 0 0 0 0 X 21 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 VA X Travis Crum 5139525000 1701 Mercy Health Place Cincinnati OH 45237 X Toni Ardabell CEO-BSV 20.00 30.00 X X 0 1550046 107752 Jean Ann Bolling Board Member (End 12/17) 2.00 0.00 X 0 0 0 Jeffrey Brown MD Board Member 2.00 0.00 X 0 0 0 Stuart Bunting Board Member (Beg 01/18) 2.00 0.00 X 0 0 0 Janice Burnett Board Member 2.00 48.00 X 0 1343437 143169 Chandrashekar Challa Board Member 2.00 0.00 X 0 0 0 Elizabeth Crowther Board Member 2.00 0.00 X 0 0 0 John Daniel III MD Board Member 2.00 0.00 X 0 0 0 Thomas Gayner Board Member (End 12/17) 2.00 0.00 X 0 0 0 Chris Hairston-White Board Member 2.00 0.00 X 0 0 0 Morris Henderson D Min Board Member (Beg 01/18) 2.00 0.00 X 0 0 0 BHB Hubbard III Board Member (End 05/18) 2.00 0.00 X 0 0 0 Birdie Jamison Board Member (Beg 01/18) 2.00 0.00 X 0 0 0 Sr Rose Marie Jasinski CBS Board Member (End 12/17) 2.00 0.00 X 0 0 0 Joyce Lanier Board Member (Beg 01/18) 2.00 0.00 X 0 0 0 Sr Anne Marie Mack CBS President 3.50 46.50 X X 0 0 0 Linda Rigsby Board Member 2.00 0.50 X 0 0 0 Pamela Royal MD Board Member 2.00 0.00 X 0 0 0 Joseph Schilling Board Member 2.00 0.00 X 0 0 0 Sr Victoria Segura MD CBS Board Member (Beg 01/18) 2.00 48.00 X 0 0 0 Shannon Sinclair Board Member 2.00 0.00 X 0 0 0 Nancy Thomas Chairman 2.00 0.00 X X 0 0 0 Harry Turton Jr Board Member (End 12/17) 2.00 0.00 X 0 0 0 Deborah Ulmer PhD RN Board Member 2.00 0.00 X 0 0 0 Jane Watkins Board Member 2.00 0.00 X 0 0 0 BK Fulton Board Member 2.00 0.00 X 0 0 0 Francine Barr CEO-SMH 50.00 0.00 X 451408 0 38427 Allen Goolsby III Secretary 2.00 0.00 X 0 0 0 Stephan Quiriconi Treasurer 10.00 40.00 X 460619 0 16253 Jim Godwin VP HR 20.00 30.00 X 233850 0 39796 Eleanor League VP CNE 50.00 0.00 X 258301 0 29774 James McNamara VP Orthopedics 10.00 40.00 X 0 278394 22630 Leigh Sewell VP Service Line Strategy 14.00 36.00 X 245646 0 49370 Thomas Auer CEO (End 10/17) 10.00 40.00 X 0 907927 16610 Herbert Cummings COO (Beg 11/17) 10.00 40.00 X 0 312192 38067 Kevin Sheppard VP - Integration 40.00 10.00 X 266245 0 31773 Matthew Ngo MD Cardiologist 50.00 0.00 X 1002975 0 37962 Omar Shams MD Cardiologist 50.00 0.00 X 821960 0 33895 Mark Bladergroen MD Cardiologist 50.00 0.00 X 779363 0 22908 Julia Padgett MD Dermatologic Surgeon 50.00 0.00 X 779232 0 13500 Steven Fiser MD Cardiac Surgeon 50.00 0.00 X 758088 0 14432 6057687 4391996 656318 333 0 1 0 Aramark CTS Inc 12483 Collections Ctr Drive Chicago IL 60693 Medical Equipment Maintenance 7373241 Morrison Mgt Specialists P O Box 102289 Atlanta GA 303682289 Dietary Management 6297522 Envera Health Inc 1001 Haxall Pt - Suite 1B Richmond VA 23219 Manage Healthcare 4183879 WM Jordan Co Inc P O Box 1337 Newport News VA 236010337 Construction 4097143 Sheltering Arms Ther Solutions 8254 Atlee Road Mechanicsville VA 23116 Rehab Therapy 2587798 219 2701855 68000 2769855 Patient Service Rev. 621300 600194518 600167506 27012 Shared Services 561499 140563064 140563064 Other Rev - Misc JV In 621999 597217 597217 Sch. of Imag. Tuition 611310 120539 120539 741475338 5924563 5924563 777972 780216 -2244 -2244 -2244 18382000 694 0 0 18382000 694 18382694 18382694 Child Care 900099 2644434 2644434 Care Coordination 900099 929897 929897 Clinical Drug Trials 900099 784249 784249 2634039 406941 2227098 6992619 775542825 744877009 433953 27462008 X 7130267 7130267 27428 27428 1631627 1468464 163163 253781503 228403353 25378150 16602308 14942077 1660231 36058718 32452846 3605872 19418744 17476870 1941874 1013065 1013065 46587 46587 44005 39605 4400 164325705 78703357 85622348 5006584 4505926 500658 8641955 7777760 864195 4466718 4020046 446672 20715826 18644243 2071583 1087715 978943 108772 843076 758768 84308 6038847 6038847 24689448 22220503 2468945 2773027 2495724 277303 Medical Supplies 115202576 115202576 Bad Debt Expense 20430804 20430804 Medical Equip. Repairs 1916368 1916368 Medical Equip. Rental 1481204 1481204 3795735 3416162 379573 717169840 590532141 126637699 0 3787 3031 382854025 391252330 68463451 72556506 9912195 10197416 3585155 4328074 477109062 322869058 135814929 154240004 419848652 447432564 163984 378387 17750297 22721702 1038396475 1103110014 87885434 101881891 10404642 10230334 35034125 30296254 221807434 177021638 355131635 319430117 X 683264840 783679897 683264840 783679897 1038396475 1103110014 X 58372985 8326073 33715999 X 0 1 X 1 1 1 X 0 1 0 0 1 1000 0 1 25225 0 1 44005 70230 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. 5497311 5497311 173810421 92934786 80875635 23342305 16647145 6695160 247017124 210219243 36797881 27441901 3067884 24374017 154240004 LT Pension Liability 97026006 Due to Affiliates 37755681 Other Liabilities (MOB Reynolds lease from 2008) 23058841 HPL/GL Liability 14572841 Patient Credit Balances 1788366 Deferred Rent 1044977 Medicare/Medicaid Settlement 1452404 FIN47 LT Asbestos Liab 322522 177021638 X Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 by Bon Secours Mercy Health, Inc. on September 1, 2007 did not have a material impact on BSMH'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 Mercy Health, 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. Their related income is exempt from federal income tax under Section 501(A). The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of August 31, 2018 or 2017. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present, and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2013. As of August 31, 2018 and 2017, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $97,815 and $106,393 of net operating loss carryforwards as of August 31, 2018 and 2017, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The System accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The System's deferred tax assets are fully reserved at August 31, 2018 and 2017 as the System considers it more likely than not that these amounts will not be recognized. On December 22, 2017, the President signed into law H.R. 1, originally known as the Tax Cuts and Jobs Act. The Act significantly revises the U.S. corporate income tax by, lowering the statutory corporate tax rate from 35% to 21% and eliminating certain deductions. The new law also includes several provisions that result in substantial changes to the tax treatment of tax-exempt organizations and their donors. The System has reviewed these provisions and the potential impact and concluded the enactment of H.R. 1 will not have a material effect on the operations of the organization. 1 1 X 1 X 1 X 1 1 1 0 1 1 20553599 396247 20157352 0.02890 50914280 33249551 17664729 0.02540 71467879 33645798 37822081 0.05430 13 28375 6487078 0 6487078 0.00930 1 32 2697004 1101424 1595580 0.00230 1 314 0 314 0.00000 2 11 962488 0 962488 0.00140 17 28418 10146884 1101424 9045460 0.01300 17 28418 81614763 34747222 46867541 0.06730 1 20430804 0 130997523 145757484 -14759961 X 1 1 1 1 St Mary's Hospital of Richmond Inc 5801 Bremo Road Richmond VA 23226 bonsecours.com H1833 X X X X X St Mary's Hospital of Richmond Inc 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Section C X See Section C X 1 15 1 See Section C 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X http://www.fa.bonsecours.com/ X http://www.fa.bonsecours.com/ X http://www.fa.bonsecours.com/ X X X X X X X 1 X 0 X X X X 1 X 0 0 St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 5: 2015 CHNA: Community SurveyAn electronic survey using Survey Monkey was developed and administered to 759 community members and partners. The survey was offered in Spanish and English. 65 individuals completed the survey in Spanish and 694 completed the survey in English. Individuals were invited to participate based on their ability to represent: underserved, low-income and minority population needs; needs of chronically ill patients; and awareness of healthcare needs in their respective communities. Participants were asked to share their viewpoints on: Important health concerns in the community; Significant service gaps in the community; Ideas for addressing concerns and service gaps.To gauge the importance of various health concerns, respondents were asked to "Choose the top 5 priorities you think should be addressed in your community" from a list of 34 health concerns. Respondents were then asked to rate their overall health, the health of the community, and the quality of life of the community. Other questions included reviewing lists of services typically important to addressing health concerns and how strong the community was in providing those services. Respondents were then asked to indicate services that needed to be strengthened in terms of availability, access, and quality. Open-ended response items were provided for participants to indicate additional service gaps in the community and ideas for addressing concerns and service gaps. Community ConversationsFive Community Conversations were held as part of the CHNA process in which 78 individuals participated from all of the core jurisdictions of Hanover, Henrico, Chesterfield, and Richmond City. Overall, the racial and geographical diversity of the participants represented a healthy mix of the region's residents. The purpose of the conversation was to elicit feedback from community members about publicly available health data describing health conditions in the services area, and to review the online survey results to further explore findings. Attendees were asked to 1) rank the health issues identified in the Community Survey according to the issues that impact them and the people close to them the most and 2) rank the issues needing to be addressed to improve the overall health of the region from a community view.Priority Needs Bon Secours Richmond convened a CHNA Advisory Board to support the process by engaging community members and providing feedback on the findings. The CHNA Advisory Board included individuals with special knowledge of public health and underserved populations and included the following: Directors from the Richmond City Health Department and the Chickahominy Health District, an Executive Director of a Free Clinic, a Vice President from VCU Health, Vice Presidents from the Better Housing Coalition and United Methodist Family Services, and the Executive Director of the Richmond Academy of Medicine. A group conversation was facilitated by Becky Clay Christensen and included a review of all qualitative and quantitative data gathered from the Community Survey, Community Conversations, and publicly available secondary health data. Advisory Board members were asked to categorize issues as high or low need in the community using a Strategy Grid. They were also asked to determine the feasibility of the community's ability to make an impact on the issues. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 6a: St. Mary's Hospital, Memorial Regional Medical Center, St. Francis Medical Center, Richmond Community Hospital St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 11: The Implementation Plan focuses on 4 broad areas including Access to Care for the Uninsured with Chronic Disease, Mental Health, Transportation, and Education. Goals and objectives were created for each area and were based on Healthy People 2020 objectives, Virginia's Plan for Well-Being 2016-2020 goals, and other evidence-based sources.The overarching goal for Access to Care for the Uninsured with Chronic Disease is to improve access to high quality health care services. This will be achieved in part by supporting the many community partners who work with the uninsured population to include: the Free Clinic Network, the Capital Region Collaborative, and the two other hospital systems in the region. Additionally, Bon Secours Mercy Health will provide services to the uninsured through the Care-A-Van, St. Joseph's Outreach Clinic, and the Community Nutrition program. Partnerships to achieve this objective include Churches, nutrition and healthy food providers, St. Joseph's Villa and The Daily Planet (FQHC).The goal in addressing Mental Health is to improve mental health status by ensuring access to appropriate, quality mental health services. We aim to achieve this by increasing the proportion of people who receive appropriate treatment for mental health disorders. Increasing the use of depression screenings and integrating behavioral health with primary care are two strategies to impact this goal. Partners in this work include The Daily Planet, the National Alliance on Mental Health, United Methodist Family Services, Childsavers, Stop Child Abuse Now, and the Bon Secours Bereavement Center. Additionally, Henrico Area Mental Health and Development Services, Chesterfield Department of Mental Health Support Services, the City of Richmond Department of Health, and the two other health systems in the region will be influential partners to impact Mental Health.Transportation is being addressed by increasing safe, healthy, and reliable transportation options for residents in the Richmond service area. Bon Secours Mercy Health promotes active transportation through advocacy for and provision of place making in the neighborhoods we serve. Additionally, we are an advocate for the expansion of public transportation options to increase access for those in underserved areas and improve ridership through a community-based design. One place making activity included opening the Sarah Garland Jones Center for Health Communities. Additionally, advocacy efforts include the expansion of safe walking and biking opportunities and the redesign of the public bus system to ensure timely access for all those we serve. Bon Secours Mercy Health also provides transportation to and from Richmond Community Hospital.The goal for Education is to promote student success in schools to improve health and quality of life for the Richmond community and future generations. Our efforts have focused on kindergarten readiness, 3rd grade Standards of Learning (SOL) reading test scores, and high school graduation rates. The Care-A-Van provides no cost vaccines and school physicals to children to ensure school readiness as well as enrolls eligible children in FAMIS Medicaid. Partners to support this work include, Commonwealth Parenting, Excel VCU, Faison School for Autism, Friends Association, Richmond Cycling Corps, First Things First, Reach Out and Read, Sacred Heart Center, Virginia Literacy Foundation, YMCA, YWCA, Peter Paul Development Center, Armstrong Priorities Freshman Academy, Anna Julie Cooper School, Church Hill Activities and Tutoring, Great Aspirations Scholarship Program, United Way, Higher Achievement, Salvation Army Boys and Girls Club, and many others providing direct education and workforce readiness training.Needs Not AddressedAccess to care for Medicaid and Medicare beneficiaries, adult and childhood obesity, jobs with fair wages, families living in poverty and seniors were identified as high needs in the community. The CHNA Advisory Board also identified these needs as having high feasibility meaning there was sufficient community support to make an impact.During the Community Conversations, older adults with Medicare shared they had challenges finding community physicians who accepted Medicare patients. This is being addressed by Bon Secours Richmond Health System that includes Bon Secours Medical Group and VCU Health in that they accept Medicaid and Medicare patients.Adult and childhood obesity are being addressed in the community by multiple organizations including Active RVA, City of Richmond's Corner Store initiative, Faces of Hope, Fit 4 Kids, the Seventh District Health and Wellness Initiative, Shalom Farms, Sports Backers/Richmond Strikers, Tricycle Gardens, Virginia Recreation and Parks and the YMCA.Jobs with Fair Wages is being addressed by the City of Richmond Community Wealth Building, Goodwill, Richmond Technical Center, Chesterfield Career and Technical Center, The Hanover Center for Trades and Technology, Henrico County Public Schools Career and Technical Education, United Way of Greater Richmond & Petersburg and the Virginia Interfaith Center.A family living in poverty is a multi-factorial issue which may be impacted through enhanced education and transportation, both areas of focus for the 2016 CHNA. Organizations presently engaged in breaking the cycle of poverty include Area Congregations Together in Service, Better Housing Coalition, Capital Region Collaboration, City of Richmond Community Wealth Building, Commonwealth Catholic Charities, Local Initiative Support Corporation (LISC), Peter Paul Development Center, Richmond Cycling Corps, Richmond Hill, Richmond Redevelopment and Housing Authority, Salvation Army Boys and Girls Club.The needs of the older adult population in the greater metro Richmond area or seniors are being addressed by Circle Center Adult Day Services, Old Dominion Partnership, Peter Paul Development Center, Rebuilding Together Richmond, Senior Connections, Senior Navigator and Shepherd's Center of Chesterfield. St. Mary's Hospital of Richmond, Inc. Part V, Section B, Line 16j: Information regarding the FAP is available on our websites, brochures are available at time of registration. We have on-site Financial Counselors who assist patients. We also have eligibility vendors who work with the patients and our statements indicate we have an FAP. We also provided local clinics in each market brochures regarding our FA program. Form 990, Schedule H, Part V, Section B, Line 14: Charges for patients who are eligible for financial assistance shall be limited to no more than amounts generally billed ("AGB") for such services. These charges are based on the average allowed amounts from Medicare and commercial payers for emergency and other medically necessary care. The allowed amounts include both the amount the insurer will pay and the amount, if any, the individual is personally responsible for paying. The AGB is calculated using a look back method. Form 990, Schedule H, Part V, Section B, Line 7a: https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment Form 990, Schedule H, Part V, Section B, Line 10a: https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment Form 990, Schedule H, Part V, Section B, Line 7b: www.behealthyrva.org; https://bonsecours.com/richmond/community-commitment/community-health-needs-assessment 39 1 - Cardiovascular Associates of VA 7001 Forest Avenue Suite 200 Richmond VA 232301727 Physician Practice 2 - Women's Imaging Center 5875 Bremo Road MOB South Suite 105 Richmond VA 23226 Imaging 3 - PTOTSPLymphedema 5875 Bremo Road MOB South Suite 611 Richmond VA 23226 Physical Therapy, Outpatient Care, Etc. 4 - Patterson Avenue Family Practice 9600 Patterson Avenue Richmond VA 23229 Physician Practice 5 - Sleep Lab (located at St Mary's) 5875 Bremo Rd Suite 709 Richmond VA 23226 Sleep Lab 6 - Cardiac Surgery Specialists 5875 Bremo Road MOB South Suite G-5 Richmond VA 231226234 Physician Practice 7 - West End Internal Medicine 7001 Forest Avenue Suite 2500 Richmond VA 23230 Physician Practice 8 - Surgical Dermatology Center 5207 Hickory Park Drive Suite A Glen Allen VA 230592624 Physician Practice 9 - Bon Sec Sports Med and Fam Pra 2401 W Leigh Street Richmond VA 23226 Physician Practice 10 - Perinatal Center 5855 Bremo Road MOB North Suite 306 Richmond VA 232261926 Physician Practice 11 - Sports Medicine 9600 Patterson Avenue Richmond VA 232296053 Sports Medicine Rehab 12 - Senior Care Services 7001 Forest Avenue Suite 100 Richmond VA 23230 Physician Practice 13 - OP Wound Care 6900 Forest Avenue Suite 115 Richmond VA 23230 OP Wound Care 14 - Sleep Center - Chesterfield 13520 Hull St Midlothian VA 23112 Sleep Lab 15 - Neurology Clinic at St Mary's 5801 Bremo Road Richmond VA 23226 Physician Practice 16 - Associated Internists 5855 Bremo Road MOB North Suite 207 Richmond VA 232261930 Physician Practice 17 - Redskins Sports Performance 2401 W Leigh Street Richmond VA 23226 Sports Medicine Rehab 18 - Monument Internal Medicine 5855 Bremo Road MOB North Suite 102 Richmond VA 23226 Physician Practice 19 - Commonwealth Internal Medicine 9220 Forest Avenue Suite 1-A Richmond VA 23235 Physician Practice 20 - Pediatric Gastroenterology 5875 Bremo Road MOB South Suite 303 Richmond VA 23175 Physician Practice 21 - Arthritis & Osteoporosis Center 9600 Patterson Avenue Richmond VA 232296053 Physician Practice 22 - Pediatric Lung Care 5875 Bremo Road MOB South Suite 104 Richmond VA 232261930 Physician Practice 23 - Glen Allen Internal Medicine 5207 Hickory Park Drive Suite A Glen Allen VA 23059 Physician Practice 24 - Pediatric Endo & Diabetes Assoc 5875 Bremo Road MOB South Suite 207 Richmond VA 232261926 Physician Practice 25 - Advan Heart Fail Cntr-LVAD program 7001 Forest Avenue Suite 103 Richmond VA 23230 Cardiac Rehabilitation 26 - Cardiac Rehab 7001 Forest Avenue Suite 101 Richmond VA 23230 Cardiac Rehabilitation 27 - Palliative Care Clinic 2366 Colony Crossing Midlothian VA 231124280 Physician Practice 28 - Pediatric Dental 6900 Forest Avenue Suite 110 Richmond VA 23141 Physician Practice 29 - BS Canal Crossing Internal Med 5801 Bremo Road Richmond VA 23226 Physician Practice 30 - Parham Road Internal Medicine 2600 E Parham Road Richmond VA 23228 Physician Practice 31 - Cure and Care 5875 Bremo Road MOB South Suite 110 Richmond VA 232261926 Physician Practice 32 - BS Developme & Special Needs Peds 5875 Bremo Road MOB South Suite 104 Richmond VA 232261934 Physician Practice 33 - Neurointerventional Surg Serv 5875 Bremo Road MOB South Suite 208 Richmond VA 232261926 Physician Practice 34 - Good Health Clinic 5875 Bremo Road MOB South Suite 204 Richmond VA 232261926 Physician Practice 35 - BS Infectious Disease Specialists 5855 Bremo Road MOB North Suite 102 Richmond VA 23225 Physician Practice 36 - Diabetes Treatment Center 5875 Bremo Road MOB South Suite 712 Richmond VA 23226 Diabetes Treatment 37 - Lactation Center (A Woman's Place) 4121 Cox Road Suite 110 Glen Allen VA 23059 Physician Practice 38 - Pediatric Neurology Clinic 5875 Bremo Road MOB South Suite 207 Richmond VA 232261926 Physician Practice 39 - BS Pediatric Hematology-Oncology 5875 Bremo Road MOB South Suite 303 Richmond VA 23226 Physician Practice Part I, Line 6a: Annually, Bon Secours Richmond Health System (BSRHS) publishes a report for the community on the community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around January 24, commemorating Founding Day of the Sisters of Bon Secours. This report is available online at https://bonsecours.com/richmond/about-us. 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.For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $20,430,804. Part III, Line 2: Bad debt expense on the general ledger includes: 1) actual write offs of discounted gross charges where it is determined an uninsured patient can pay and does not pay; and 2) the estimated write offs for uninsured patient accounts with outstanding balances after discount. Estimates are based on historical collection rates.When an uninsured patient is billed for patient care services, the charges are automatically discounted and the patient is requested to only pay the amount after discount. The discount is recorded as an adjustment to gross revenue and is not recorded in bad debt expense. If the balance after discount is not paid or not paid in full, the unpaid amount will be written off to bad debt expense. When a patient remits a payment on an account that has already been written off to bad debt expense, the payment is recorded as a recovery of bad debt, which reduces bad debt expense. Part III, Line 3: The organization does not report an estimate for the portion of bad debt expense that may have been likely to qualify for financial assistance under the hospital's charity care policy. The organization takes the position that ample opportunity and assistance is provided to the patient to qualify under the financial assistance policy. If sufficient information is not provided, the organization must assume the patient does not qualify. Part III, Line 4: Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on page 10 in the attached BSMH consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 37-38 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in- and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost.The organization feels the total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients who qualify for financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is approved, 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 exists 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 eight months from the date of the application. This eligibility is identified by hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of the eight months, the patient is responsible for reapplying for FAP eligibility. Part VI, Line 2: The 2015 CHNA was conducted during Fiscal Year 2016 (September 1, 2015 to August 31, 2016) by the Community Health Services team in order to prepare documents by the end of the fiscal year. It was determined that existing quantitative data, augmented by a community survey, and community conversations would be used to identify and prioritize health indicators. All identified needs were reported to the Community Advisory Board to prioritize based on need and feasibility. An executive summary and report was then presented to system leadership from Mission. Findings were then presented to the Executive Management Team for further review and comment. Finally, a presentation was made to the Bon Secours Richmond Health System Board for final approval prior to being made available to the public.Quantitative DataData was gathered and compiled via publicly available data sources such as County Health Rankings, the Census Bureau, and the Virginia Department of Health. The data presented in the CHNA reflects how the area served by Bon Secours Richmond Health System compares to Virginia overall and/or the nation. Health issues and conditions were either identified by the community during qualitative community conversations or are issues which deviated from the state or national findings.Community Input Input from community members was included in assessing health care needs as described in Part V, Line 5. Part VI, Line 3: The Patient Financial Assistance program is communicated to patients verbally upon scheduling, registration, visible postings of the program are in common areas throughout the hospital, along with brochures and the program is detailed on our Bon Secours Mercy Health website. In addition, patient billing statements and letters inform patients regarding our financial assistance program. Bon Secours Mercy Health proactively screens patients to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Mercy Health 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. Bon Secours Mercy Health is also 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 Mercy Health 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 assistance process. Based on market need, our financial assistance policy and application are translated into multiple languages and placed on our Bon Secours Mercy Health website for patients to access. Part VI, Line 4: St Mary's Hospital opened in 1966 with a unique vision for the time, allowing patients of all colors and religions to receive treatment there. Fifty years later, St. Mary's has grown into an acute care facility licensed for 391 beds. St. Mary's has over 3,000 full and part-time employees and more than 1,000 associated physicians. The St. Mary's Hospital serves residents primarily from the counties of Chesterfield, Goochland, Hanover, Henrico, and Richmond City. While its core is based in the Richmond metropolitan area, its services reach into the surrounding rural counties.Bon Secours Richmond Health System serves the larger Richmond, Virginia metropolitan area and includes four hospital facilities whose service areas largely overlap. While the hospitals serve patients from many cities and counties, the majority of patients fall within the counties of Chesterfield, Henrico, Hanover and the City of Richmond totaling approximately 1,067,000 residents. For the purpose of this CHNA, we refer to these as the "Richmond Core Service Area."The Richmond Core Service Area is 53% Caucasian and 30.7% African American. When the demographics of the City of Richmond are viewed alone, we find a much lower percentage of Caucasians (40%) and a much higher percentage of African Americans (49%) than the community overall.The population age distribution for the Richmond Core Service Area is similar to Virginia overall with the exception of the City of Richmond, which has a higher percentage of 19-64 year olds (70%) and lower percentages of children (18%) and older adults (12%).Median household incomes in the United States are less than those found in Virginia overall. The Richmond Core Service Area counties of Henrico, Hanover and Chesterfield all have higher median household incomes than the U.S. overall. In contrast, the City of Richmond has a much lower median household income ($39,249) as compared to the U.S. ($53,046) and Virginia overall ($63,907).Compared to Virginia, the percentage of uninsured adults is highest in the City of Richmond (20%) and lowest in Hanover County (10%). The percentages of uninsured children show a much lower degree of variance. Part VI, Line 5: St. Mary's Hospital has an open medical staff with privileges available to all qualified physicians in the area. St. Mary's Hospital through the Bon Secours Richmond Health System is governed by a board of directors whose composition is representative of the community. St. Mary's Hospital engages in medical research. Inpatient and outpatient research-related activities are conducted by St. Mary's with oversight from the Bon Secours Richmond Health System Institutional Review Board. St. Mary's Hospital provides training and education of health care professionals. The Bon Secours St. Mary's School of Imaging, sponsored by St. Mary's Hospital had enrolled 32 students in fiscal year 2018.Community Programs Noah's Children, located at St. Mary's Hospital, is Central Virginia's only pediatric hospice and palliative care program. It is a specialized program of comprehensive care serving infants, children and adolescents who have been diagnosed with a life-threatening illness, and their families. This holistic program ensures compassionate care at the most difficult time for a family by addressing their physical, emotional, social, spiritual and practical needs, so that they can focus on making sure their child's remaining time is as rich and meaningful as possible. In the year ended August 31, 2018, 435 individuals were served.The Care-A-Vans are mobile health care clinics, which travel throughout the Richmond Metro area to provide free primary, urgent and preventive care to uninsured patients. Patients on these vans speak many different languages. Approximately 40% of the Care-A-Van's staff are bilingual in English and Spanish. Each van is a self-contained mobile clinic with examining rooms, storage, bathroom, and waiting area. Services include health screenings, childhood immunizations, flu shots for adults, school physicals for uninsured children and examination and treatment of sick patients who are uninsured. Patients who need health care from specialists are referred to volunteer physicians within the community including Bon Secours Medical Group physicians. The vans make regular stops six days a week at churches providing 12,440 patient visits in the year ended August 31, 2018. Bon Secours Richmond Health System partnered with the Daily Planet, a federally qualified health center and St. Joseph's Villa for Children, a not-for-profit organization serving children with special needs, at risk youth, and adults with disabilities to create St. Joseph's Outreach Clinic. The clinic provides primary care services to both the insured and the uninsured and serves a large Hispanic population. In the year ended August 31, 2018, 5,318 patient visits were provided. Every Women's Life (EWL), Virginia Breast and Cervical Cancer Early Detection Program is a partnership with the Virginia Department of Health, with funding through the Centers for Disease Control and Prevention. This program provides breast and cervical cancer screenings and diagnostic testing if needed for low income, uninsured women who are 40 to 64 years old. If cancer is found, women are enrolled in Medicaid for treatment. BSRHS holds clinics seven days per month in Bon Secours facilities in the Richmond Metro area. Additionally, BSRHS provides case management, follow-up and patient education for these women. In the year ended August 31, 2018, 937 screenings were provided.BSRHS assists low to moderate-income families whose children may qualify for state-sponsored insurance programs (Medicaid and FAMIS). Partnerships have developed with other agencies that have enrollers to identify and refer uninsured children, avoid duplication of effort, and to share responsibilities for case managing to complete the enrollment process. Two BSRHS outreach specialists enrolled or re-enrolled over 25 children in FAMIS or Medicaid in the year ended August 31, 2018.The nationally recognized Reach Out and Read (ROR) program provides books for young children when they visit the Care-A-Van. Volunteers transform the sites into literary rich areas for children and parents while helping families learn the joys and techniques of reading aloud. Volunteers distributed 544 books in the year ended August 31, 2018 to children at Care-A-Van sites. Part VI, Line 6: Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), 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 BSMH, 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 BSMH 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. As a member of the Catholic health ministry and a member of Bon Secours Mercy Health, Inc. (BSMH), this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is "to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSMH Vision. BSMH's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2016-2018). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that teh struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression.- Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSMH and the SQP (Strategic Quality Plan). Part VI, Line 7, Reports Filed With States VA 1 Bon Secours Richmond Healthcare Foundation 7229 Forest Avenue Suite 200 Richmond VA 23226 541201346 501(C)(3) 3373380 General Support Access Now 2821 Emerywood Parkway-Suite 200 Richmond VA 23294 261695468 501(C)(3) 75000 Prescriptions Area Congregations Together in Service 1 N 5th Street-Suite 400 Richmond VA 23219 453020788 501(C)(3) 15000 Housing Stability to Complement a Healthier Lifestyle Center for Healthy Hearts 1200 West Cary Street Richmond VA 23220 521303481 501(C)(3) 10000 Diabetes Program Cristo Rey Richmond 7800 Carousel Lane Richmond VA 23294 812742073 501(C)(3) 450000 Launch Year: Planning and Formative Development Phase ChildSavers 200 North 22nd Street Richmond VA 23223 540505927 501(C)(3) 37500 Richmond Public Schools Resiliency Partnership CrossOver Healthcare Ministry 8600 Quioccasin Road-Suite 102 Richmond VA 23229 541371067 501(C)(3) 118000 Operations Free Clinic of Powhatan 3908 Old Buckingham Road Powhatan VA 23139 261275136 501(C)(3) 34000 Providing healthcare services to patients FRIENDS Association for Children Saint John Street Richmond VA 23220 540505899 501(C)(3) 85000 Early Childhood Education Goochland Cares PO Box 116 2999 River Road West Goochland VA 23103 541967650 501(C)(3) 50000 Staff Health Brigade (Formerly Fan Free Clinic) 1010 North Thompson St Richmond VA 23230 540927792 501(C)(3) 60000 Operations Higher Achievement 4009 Fitzhugh Avenue-Suite 200 Richmond VA 23230 521383374 501(C)(3) 30000 Achieving Higher in the East End and Henrico Housing Families First 3900 Nine Mile Road Henrico VA 23223 541995917 501(C)(3) 50000 Building Neighbors: A Solution that Works Metro Richmond SportsBackers 100 Avenue of Champions Richmond VA 23230 541592267 501(C)(3) 150000 Biking and Walking programs NextUp RVA 7501 Boulders View Dr -Suite 110 Richmond VA 23225 463607727 501(C)(3) 75000 The Path to Success: Richmond's Out-of-School Time Network Peter Paul Development Center 1708 N 22nd Street Richmond VA 232234431 541137164 501(C)(3) 75000 Community Engagement for Youth and Family Success ProjectHOMES 88 Carnarion Street Richmond VA 23225 541595851 501(C)(3) 237887 Volunteer Ministry House Richmond Cycling Corps 1717 Summit Avenue Richmond VA 23230 582508155 501(C)(3) 50000 Richmond Cycling Corps Cycling Team Richmond Hill Inc 2209 East Grace Street Richmond VA 23223 541360535 501(C)(3) 25000 Armstrong Leadership Program Richmond Metropolitan Habitat for Humanity (RMHFH) 2281 Dabney Road -Suite A Richmond VA 23230 541385198 501(C)(3) 100000 Revitalizing Randolph into a Thriving, Mixed-Income Neighborhood Rx Partnership 2924 Emerywood Parkway-Suite 300 Richmond VA 23294 571186937 501(C)(3) 20000 Prescriptions Sacred Heart Center 1400 Perry Street Richmond VA 23224 541590419 501(C)(3) 50000 Sustaining the Impact of the Sacred Heart Center (SHC) Safe Harbor PO Box 17996 Richmond VA 23226 541950038 501(C)(3) 115000 Counseling Services for Immigrant and Human Trafficking Survivors and Motivational Interviewing Training for Staff The Faces of HOPE of Virginia Inc 8014 Midlothian Turnpike-Suite 200-A Richmond VA 23235 562616080 501(C)(3) 50000 Faces of Hope/Care-A-Van Pediatric Wellness Collaboration Tricycle Gardens 2314 Jefferson Avenue Richmond VA 23223 753253795 501(C)(3) 100000 Cultivating Certified Urban Agriculturists Virginia Community Development Fund 1840 West Broad Street-Suite 200 Richmond VA 23220 541914519 501(C)(3) 350000 Economic Development in East End Virginia LISC 413 Stuart Circle Suite 300 Richmond VA 23220 133030229 501(C)(3) 119500 Supporting East End Entrepreneur Development (SEED) Program Virginia Supportive Housing PO Box 8585 Richmond VA 23226 541444564 501(C)(3) 50000 Permanent Solutions to End Homelessness - Richmond Supportive Services 2018 YMCA of Greater Richmond 2 West Franklin Street Richmond VA 23220 540505986 501(C)(3) 50000 Youth Development in the East End Benedictine High School 12829 River Road Richmond VA 23238 453960058 501(C)(3) 190000 Student Intern Program Commonwealth Catholic Charities 1601 Rolling Hills Drive Richmond VA 23229 540505877 501(C)(3) 200000 ISAD Program Enrichmond Foundation 100 North 17th Street Richmond VA 23219 541610700 501(C)(3) 75000 RVA East End Festival 2018 Greater Richmond ARC 3600 Saunders Ave Richmond VA 23227 540629691 501(C)(3) 50000 Startup Initiative - Staples Mill Road Greater Richmond SCAN 103 East Grace Street Richmond VA 23219 541584969 501(C)(3) 50000 Greater Richmond Trauma Informed Community Network (TICN) Honoring Choices Virginia (an initiative of the RAM trust) 2821 Emerywood Parkway-Suite 200 Richmond VA 23294 510160045 501(C)(3) 65000 Honoring Choices Virginia Medical Society of Virginia Foundation 2924 Emerywood Parkway Suite 300 Richmond VA 23294 521394768 501(C)(3) 25000 Doc Rx Northern Neck - Middlesex Free Health Clinic PO Box 1694 51 William B Graham Court Kilmarnock VA 22482 541679279 501(C)(3) 10000 Operations Richmond City Health District 400 East Cary Street Richmond VA 23219 546001775 501(C)(3) 160000 Improving Patient Health Outcomes through Community Health Worker Support & Epidemiologist Smart Beginnings Greater Richmond 919 East Main Street Suite 1700 Richmond VA 23219 474362313 25000 Pathways to Quality The Maggie Walker Community Land Trust 203 N Robinson Street Richmond VA 23220 475629011 501(C)(3) 250000 Targeted Land Acquisition Ensures Permanent Affordable Homeownership in Richmond YMCA Richmond 6 N 5th St Richmond VA 23219 540506493 501(C)(3) 25000 Regional Hospital Accompaniment Team (RHART) 41 0 Indigent Cab Fare 777 19428 Colleges for Student Tuition 8 8000 Part I, Line 2: Per Bon Secours Mercy Health's system-wide financial and accounting policies, contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. In other cases, grantees submit progress reports on the anniversary date on which the grant was received. The evaluation report includes: 1) progress toward the deployment of the stated goals and objectives, 2) progress towards the achievement of desired outcome as demonstrated by Project Work Plan, 3) an accurate accounting of the revenue and expenses and the amount of the mission fund award expensed, and 4) a summary past, current and future funding sources and efforts to secure sustaining sources of funding. Description of the Bon Secours Mercy Health Mission Fund: Bon Secours Mercy Health performs its philanthropic work through its mission department. This initiative, called the Bon Secours Health System Mission Fund ("Mission Fund"), was developed to promote the Catholic Health Ministry and the Bon Secours Mercy Health, Inc. Mission. This purpose is realized through the funding of initiatives that improve the health and well-being of communities, particularly for disenfranchised and marginalized people, served by Bon Secours Mercy Health Local Systems ("Local Systems"), Cosponsors and the Congregation of the Sisters of Bon Secours. The scope of its purpose and use of funds would be to: -promote healthy community coalition initiatives in conjunction with local system efforts, -develop local system and community excellence for a specific health condition and preventive need, and -improve access for uninsured populations and reduce health disparities among populations in the community. The Strategic Quality Plan of the health system calls for focused efforts to Build Healthier Communities. The health system understands "health" to include social and communal dimensions and has adopted the following articulation of a healthy community. The conditions of communities and individuals served by Bon Secours Mercy Health reflect the interaction of significant factors and complex behaviors at the individual, communal, and societal level. It is not likely that interventions by any one organization will result in substantial improvement or benefit to the community. Rather, increased participation by stakeholders and greater cooperation among entities with appropriate skills and resources is necessary for systemic change and improved outcomes. Mission Fund grants place emphasis on increased collaboration among community based members (Healthy Community Initiative), public health officials and other providers of services. The Mission Fund anticipates that most endeavors that seek to bring meaningful improvement require time and commitment. Consequently, local system grant recipients may expect continuity of support (several years) to establish and track outcomes. At the same time, grant applicants need to cultivate and achieve a wide array of financial resources necessary to sustain promising projects and service programs. Form 990, Schedule I, Part III: Cab fares are estimated at $25/round-trip X 1 1 0 1 0 0 0 0 0 1 0 Toni Ardabell CEO-BSV 0 677035 0 130351 0 742660 0 105750 0 2002 0 1657798 0 196397 Janice Burnett Board Member 0 667595 0 240070 0 435772 0 129000 0 14169 0 1486606 0 92090 Francine Barr CEO-SMH 329795 0 78298 0 43315 0 16588 0 21839 0 489835 0 0 0 Stephan Quiriconi Treasurer 349584 0 69669 0 41366 0 5300 0 10953 0 476872 0 0 0 Jim Godwin VP HR 199313 0 13959 0 20578 0 18746 0 21050 0 273646 0 0 0 Eleanor League VP CNE 242093 0 14653 0 1555 0 7264 0 22510 0 288075 0 0 0 James McNamara VP Orthopedics 0 260455 0 16853 0 1086 0 12444 0 10186 0 301024 0 0 Leigh Sewell VP Service Line Strategy 223604 0 15153 0 6889 0 12704 0 36666 0 295016 0 0 0 Thomas Auer CEO (End 10/17) 0 439234 0 57599 0 411094 0 16200 0 410 0 924537 0 0 Herbert Cummings COO (Beg 11/17) 0 269439 0 42358 0 395 0 10800 0 27267 0 350259 0 0 Kevin Sheppard VP - Integration 249332 0 16355 0 558 0 4621 0 27152 0 298018 0 0 0 Matthew Ngo MD Cardiologist 631849 0 369508 0 1618 0 3475 0 34487 0 1040937 0 0 0 Omar Shams MD Cardiologist 610503 0 211241 0 216 0 10800 0 23095 0 855855 0 0 0 Mark Bladergroen MD Cardiologist 769520 0 0 0 9843 0 4017 0 18891 0 802271 0 0 0 Julia Padgett MD Dermatologic Surgeon 609619 0 164253 0 5360 0 13500 0 0 0 792732 0 0 0 Steven Fiser MD Cardiac Surgeon 727468 0 29700 0 920 0 3552 0 10880 0 772520 0 0 0 Part I, Line 1a A tax indemnification benefit to cover the income tax incurred on physician insurance was paid to one highest compensated employee. The entire benefit was treated as taxable compensation. Part I, Line 3 Bon Secours Mercy Health, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSMH 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: Toni Ardabell, $381,880; Janice Burnett, $106,552; Stephan Quiriconi, $0; James Godwin, $0. Part I, Line 7 The organization provides annual incentive compensation for listed individuals. The organization's Board of Trustees establishes objective thresholds which must be achieved for incentives to be awarded. The Board also establishes threshold, target and maximum levels for incentive awards. Within these established parameters, the Board determines the CEO's incentive award and incentive awards for other listed individuals are determined by the listed individual's supervisor and disclosed to the Board. The Board may authorize modified incentive awards when appropriate in its judgment. Martha E Merchent Married to Officer Stephan Quiriconi 171523 Employment 0 Form 990, Part VI, Section A, line 6 Bon Secours Mercy Health, Inc. is the sole member of Bon Secours Richmond LLC which was formerly Bon Secours Richmond Health Corp, a nonprofit tax exempt organization prior to conversion. Bon Secours Richmond LLC holds the majority interest in Bon Secours - Richmond Health System, which in turn is the sole member of St. Mary's Hospital of Richmond, Inc. Form 990, Part VI, Section A, line 7a The governing body of St. Mary's Hospital of Richmond, Inc. is appointed by its member Bon Secours - Richmond Health System and subject to approval by Bon Secours Mercy Health, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of St. Mary's Hospital of Richmond, Inc. are reserved to its member or to Bon Secours Mercy Health, Inc. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by BSMH's tax department and reviewed by management. Upon review, the Form 990 is then forwarded to the local system's independent Audit and Compliance Committee for review and approval. Once the Form 990 is reviewed by all applicable parties a copy of the final version is provided to all members of the governing body prior to filing. 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 BSMH CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15b The compensation committee of the board of Bon Secours Mercy Health, Inc. (BSMH) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of BSMH. 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 BSMH board of directors and compensation committee minutes. Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSMH compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization makes all documents available to the general public upon request. Form 990, Part VII - Additional Disclosure: The governing bodies of the following entities are comprised of the same board members and board officers (Chairman, President, Secretary and Treasurer): - Bon Secours St. Mary's Hospital - Bon Secours St. Francis Medical Center - Bon Secours Memorial Regional Medical Center - Richmond Community Hospital - Chesapeake Hospital Corporation - Chesapeake Medical Group The entities listed above and the parent organization to these entities, Bon Secours Richmond Health System, Inc. (RHS), established a mirror board. The action aligned the board members and board officers of RHS and the listed entities. Hours reported on Form 990, Part VII represents total hours worked per week. These hours may include time spent as an employee of the organization and any hours spent serving as a volunteer board member. Any compensation paid to these individuals is payment for their employment with the filing organization or related organization. Volunteers are not paid for their time. Sr. Anne Marie Mack, Sr. Rose Marie Jasinski, and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Form 990, Part IX, line 11g Purchased Services - Intercompany: Program service expenses 3,770,985. Management and general expenses 418,998. Fundraising expenses 0. Total expenses 4,189,983. Physician Fees: Program service expenses 19,109,530. Management and general expenses 0. Fundraising expenses 0. Total expenses 19,109,530. Billing and Collections: Program service expenses 5,122,831. Management and general expenses 569,203. Fundraising expenses 0. Total expenses 5,692,034. Security Services: Program service expenses 2,338. Management and general expenses 260. Fundraising expenses 0. Total expenses 2,598. Other Purchased Services: Program service expenses 33,742,162. Management and general expenses 3,749,128. Fundraising expenses 0. Total expenses 37,491,290. Maintenance and Service Agreements: Program service expenses 5,840,366. Management and general expenses 648,930. Fundraising expenses 0. Total expenses 6,489,296. Consulting: Program service expenses 4,592,311. Management and general expenses 510,257. Fundraising expenses 0. Total expenses 5,102,568. Contracted Nursing and Ancillary Tech Staff: Program service expenses 5,704,041. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,704,041. Dues - Physicians: Program service expenses 818,793. Management and general expenses 0. Fundraising expenses 0. Total expenses 818,793. Dues - Mgt - Non Ops: Program service expenses 0. Management and general expenses 79,725,572. Fundraising expenses 0. Total expenses 79,725,572. Form 990, Part XI, line 9: Minimun Pension Liability 38,406,160. Transfers to Affiliates - Pension -4,690,161. Bon Secours Mercy Health Inc 1701 Mercy Health Place Cincinnati OH 45237 521301088 Healthcare system parent OH 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 Bon Secours New York Health System Inc 2975 Independence Avenue Bronx NY 10463 912135196 Local System Parent Org. NY 501(c)(3) Line 12a, I Bon Secours Mercy Health Inc 0 Bon Secours Kentucky Health System Inc St Christopher Dr Ashland KY 41101 611356024 Local System Parent Org. KY 501(c)(3) Line 12c, III-FI Bon Secours Mercy Health Inc 0 Bon Secours Baltimore Health Corporation 2000 West Baltimore Street Baltimore MD 21223 800728893 Local System Parent Org. MD 501(c)(3) Line 12c, III-FI Bon Secours Mercy Health Inc 0 Bon Secours St Francis Health System Inc 1 St Francis Drive Greenville SC 29601 582504528 Local System Parent Org. SC 501(c)(3) Line 12c, III-FI Bon Secours Mercy Health Inc 0 Bon Secours Hampton Roads Health System 7007 Harbour View Blvd Portsmouth VA 23435 521538513 Local System Parent Org. VA 501(c)(3) Line 12c, III-FI Bon Secours Mercy Health Inc 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) Line 12c, III-FI Bon Secours Mercy Health Inc 0 Bon Secours Baltimore Health System Foundation Inc 26 North Fulton Avenue Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) Line 12c, III-FI Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health 0 The Bon Secours of Maryland Foundation Inc 26 North Fulton Avenue Baltimore MD 21223 521732800 Grant Making Foundation MD 501(c)(3) Line 12c, III-FI Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health 0 Mary Immaculate Foundation 7007 Harbour View Blvd Suffolk VA 23435 311644734 Fundraising VA 501(c)(3) Line 12c, III-FI Mary Immaculate Hospital 0 Bon Secours DePaul Health Foundation 7007 Harbour View Blvd Suffolk VA 23435 541843876 Fundraising VA 501(c)(3) Line 7 Bon Secours DePaul Medical Center 0 Bon Secours Maryview Foundation 7007 Harbour View Blvd Suffolk VA 23435 521694731 Fundraising VA 501(c)(3) Line 7 Bon Secours Hampton Roads Health System 0 Our Lady of Bellefonte Hospital Inc 1000 St Christopher Dr Ashland KY 41101 611356023 Health Care KY 501(c)(3) Line 3 Bon Secours Kentucky Health System 0 Bon Secours Hospital Baltimore Inc 2000 West Baltimore Street Baltimore MD 21223 520591555 Health Care MD 501(c)(3) Line 3 Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health 0 St Francis Hospital Inc One St Francis Drive Greenville SC 29601 582504530 Health Care SC 501(c)(3) Line 3 Bon Secours St Francis Health System Inc 0 Mary Immaculate Hospital Inc 7007 Harbour View Blvd Suffolk VA 23435 540548200 Health Care VA 501(c)(3) Line 3 Bon Secours Mercy Health Inc 0 Bon Secours - DePaul Medical Center Inc 7007 Harbour View Blvd Suffolk VA 23435 541820093 Health Care VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Maryview Hospital 7007 Harbour View Blvd Portsmouth VA 23707 540506463 Health Care VA 501(c)(3) Line 3 Bon Secours Hampton Roads Health System 0 Bon Secours - Memorial Regional Medical Center Inc 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours - St Mary's Hospital of Richmond Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours - Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours - St Francis Medical Center Inc 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Bon Secours Kentucky Health System Foundation Inc St Christopher Dr Ashland KY 41101 611381952 Grant Making Foundation KY 501(c)(3) Line 7 Bon Secours Kentucky Health System 0 Bon Secours Baltimore Development Inc 26 North Fulton Avenue Baltimore MD 21223 760785344 Community Housing MD 501(c)(3) Line 7 Unity Properties Inc 0 Unity Properties Inc 26 North Fulton Avenue Baltimore MD 21223 521857768 Low Income Housing MD 501(c)(3) Line 7 Bon Secours of Maryland Foundation 0 Bon Secours - St Francis Health System Foundation Inc One St Francis Drive Greenville SC 29601 260012031 Grant Making Foundation SC 501(c)(3) Line 7 St Francis Hospital Inc 0 Bon Secours Richmond Health Care Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) Line 7 Bon Secours Richmond LLC 0 Bon Secours St Petersburg Home Care Services Inc 10300 Fourth Street North St Petersburg FL 33716 134334363 Home Care Services FL 501(c)(3) Line 10 Maria Manor Nursing Care Center 0 Bon Secours - Maria Manor Nursing Care Center Inc 10300 Fourth Street North St Petersburg FL 33716 650061820 Nursing Home FL 501(c)(3) Line 10 Bon Secours Mercy Health Inc 0 Bellefonte Physician Services Inc St Christopher Dr Ashland KY 41101 352320780 Physician Practices KY 501(c)(3) Line 10 Bon Secours Kentucky Health System 0 Bon Secours Housing Inc 26 North Fulton Avenue Baltimore MD 21223 521442707 Low Income Housing MD 501(c)(3) Line 10 Bon Secours of Maryland Foundation 0 Bon Secours Housing II Inc 26 North Fulton Avenue Baltimore MD 21223 521543174 Low Income Housing MD 501(c)(3) Line 10 Bon Secours of Maryland Foundation 0 Schervier Housing Development Fund Corporation 2975 Independence Avenue Bronx NY 10463 133098867 Housing NY 501(c)(3) Line 10 Bon Secours NY Health System 0 St Francis Physician Services Inc One St Francis Drive Greenville SC 29601 134290167 Physician Services SC 501(c)(3) Line 10 St Francis Health System Inc 0 Mary Immaculate Nursing Center Inc 7007 Harbour View Blvd Suffolk VA 23435 541516476 Nursing Care Center VA 501(c)(3) Line 10 Mary Immaculate Hospital 0 Bon Secours - 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PA 501(c)(3) Bon Secours Mercy Health Inc 0 Pennsylvania Health Choice Plan 1505 Marriottsville Road Marriottsville MD 27104 Health Care PA 501(c)(3) Mercy Health Services 0 Liberty Medical Center 1505 Marriottsville Road Marriottsville MD 27104 521466304 Health Care MD 501(c)(3) Line 3 Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health 0 Bon Secours - Stuart Circle Hospital Inc 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Post Office Plaza Owners Association Inc 1703 Laurel Street Columbia SC 29201 Health Care SC 501(c)(3) Bon Secours St Francis Health System Inc 0 Bon Secours Place at St Petersburg LLP 10300 Fourth Street North St Petersburg FL 33716 593589729 Assisted Living/Senior Care FL N/A Bon Secours Apartments LP 1800 West Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD N/A Bon Secours Apartments II LP 1800 West Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD N/A Liberty Senior Housing LP 1800 West Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD N/A Bon Secours Apartments III LP 1800 West Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD N/A Bon Secours Smallwood Summit LP 26 North Fulton Ave Baltimore MD 21223 522280175 Low Income Housing MD N/A Bon Secours Chesapeake Apartments LP 26 North Fulton Ave Baltimore MD 21223 200107034 Low Income Housing MD N/A Bon Secours Shiloh LP 26 North Fulton Ave Baltimore MD 21223 203965243 Low Income Housing MD N/A Bon Secours New Shiloh II Limited Partnership 26 North Fulton Ave Baltimore MD 21223 820655142 Low Income Housing MD N/A Bon Secours Wayland LP 26 North Fulton Ave Baltimore MD 21223 270468688 Low Income Housing MD N/A Bon Secours Gibbons Apartments LP 26 North Fulton Ave Baltimore MD 21223 472322323 Low Income Housing MD N/A Upstate Surgery Center LLC One St Francis Drive Greenville SC 29601 562186977 Ambulatory Surgery Center SC N/A Province Place of DePaul LLC 6403 Granby Street Norfolk VA 23505 541950880 Assisted Living Facilities VA N/A Province Place of Maryview LLC One Bon Secours Way Portsmouth VA 23703 541842697 Assisted Living VA N/A Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Bon Secours Benet House LP 26 North Fulton Ave Baltimore MD 21223 364765400 Low Income Housing MD N/A Bon Secours Benet House LLC 26 North Fulton Ave Baltimore MD 21223 463055312 Low Income Housing MD N/A Southeastern Health PartnersLLC One St Francis Drive Greenville SC 29601 813264385 Coordinated Care SC N/A Harbour View MOB 2 LLC 5818 Harbour View Blvd Suite A1 Suffolk VA 23435 822484997 Real Estate VA N/A Memorial Ambulatory Surgery Center LLC 8580 Magellan Parkway Richmond VA 23227 593813233 Ambulatory Surgery Center VA N/A Bon Secours-Florida Integrated Services Inc 10300 Fourth Street North St Petersburg FL 33716 650779777 Holding Company/Assisted Living FL N/A C 0 Professional Health Care Management Services Inc 150 Kingsley Lane Norfolk VA 23505 541241031 Administrative VA N/A C 0 Bon Secours - Tidewater Diversified Inc 160 Kingsley Lane Norfolk VA 23505 541431826 Pharmacy VA N/A C 0 OSF Inc 2 Bernadine Drive Newport News VA 23602 541369919 Rental VA N/A C 0 Unity Housing Inc 26 North Fulton Avenue Baltimore MD 21223 521952507 Low Income Housing MD N/A C 0 Bon Secours Wayland LLC 26 North Fulton Avenue Baltimore MD 21223 270468561 Low Income Housing MD N/A C 0 Bon Secours New Shiloh II LLC 26 North Fulton Avenue Baltimore MD 21223 820631206 Low Income Housing MD N/A C 0 Bon Secours New York Housing Development Fund Corporation 2975 Independence Avenue Bronx NY 10463 472224316 Low Income Housing NY N/A C 0 Maryview Building Corporation 3636 High Street Portsmouth VA 23707 541306612 Administrative VA N/A C 0 Bon Secours-Virginia Healthsource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA N/A C 0 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA N/A C 0 Richmond Radiation Oncology Center Inc 8580 Magellan Parkway Richmond VA 23227 541570244 Ambulatory Healthcare Services VA N/A C 0 RHS Management Corp 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA N/A C 0 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Medical Services VA N/A C 0 Good Help Connections LLC 8990 Old Annapolis Road Columbia MD 21045 472345223 IT Consulting MD N/A C 0 Optimum Health Network Inc One St Francis Drive Greenville SC 29601 570973524 Healthcare Services SC N/A C 0 Bon Secours Assurance Company Ltd PO Box 69 CJ KY1-1102 980152147 Offshore Captive Management CJ N/A C 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1