2018-07-03T08:52:40-05:00 2017-08-31 990 2016-09-01 521988421 Bon Secours - Richmond Health System Inc BONS 8042818413 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi Treasurer (BSR-VP Finance) 8042818316 2018-07-03 0 2016 2022-09-23 18:48:47Z Bon Secours Virginia Bon Secours Virginia Health System Toni R Ardabell 8580 Magellan Parkway Building IV Richmond VA 23227 22909372 0 X www.bonsecours.com X 1996 VA Provides support services to related not-for-profit entities within the System. 21 19 390 131 0 0 802929 3567068 22207050 19333096 50000 0 -834246 9208 22225733 22909372 10345313 0 0 0 18492998 20128122 0 0 0 8952020 8669069 37790331 28797191 -15564598 -5887819 21737551 21769562 15461481 21389018 6276070 380544 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 3302606 Supports the subsidiary members of the Bon Secours Richmond Health System in their effort to provide compassionate, quality healthcare services to those in need, including the poor and dying, for the purpose of alleviating human suffering and bringing people to wholeness in the midst of pain and loss. 19961441 16625158 Bon Secours Home Care, LLC: In 1824, the Sisters of Bon Secours began to care for the sick in their own homes in Paris, France. Today, compassionate care at home remains a fundamental part of the mission of Bon Secours. Bon Secours Home Care provides care to patients in the home setting and offers a comprehensive suite of services to patients, from infants to seniors, which address their physical, emotional and spiritual needs. Such services include: - Skilled Nursing (diabetic teaching, medication management, post-operative care) - Certified Wound and Ostomy Nurse - Heart Failure Disease Management Program - Home Telehealth Monitoring - Physical, Occupational and Speech Therapy - Medical Social Workers - Pediatric Services - Orthopedic Rehab Services - Home Health Aides (activities of daily living assistance in conjunction with patient's rehabilitative plan of care)Additionally, Bon Secours Home Care provides hospice services which is the continuation of medical care for end-of-life patients. It allows people to live comfortably and with dignity during their remaining days. Hospice care addresses the physical, emotional and spiritual needs and wishes of patients and their families.Bon Secours Home Care, LLC is a single-member limited liability company. As such, the activity of the entity is disregarded for tax purposes and consolidated into the Form 990 of its member Bon Secours Richmond Health System. 2941983 2707938 Bon Secours Ambulatory Services, LLC (dba Bon Secours Good Health Express) serves as an urgent care center for the community of Henrico County. Families have access to board-certified physicians and medical professionals trained in adult and pediatric life support. The organization provides quality urgent care without an emergency room visit. Bon Secours Ambulatory Services, LLC follows the same Financial Assistance Policy of its related tax exempt hospitals within Bon Secours Richmond Health System. Patients are never turned away due to their inability to pay. Services provided, but not excluded to:- Onsite diagnostic laboratory and imaging services- Treatment of broken bones- Treatment of minor injuries like the flu or sore throat 230 Richmond GoodHelp ACO is a patient-centered organization where the patient and providers are true partners of care. Our group of Medicare providers and suppliers (hospitals, physicians, and others involved in patient care) work together to better coordinate care for the Medicare Fee-For- Service patients we serve. The goal of our ACO is to deliver seamless, high-quality care for Medicare beneficiaries. 230 26206260 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 24 0 1 390 1 0 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 0 X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Toni Ardabell CEO-BSV 2.50 47.50 X X 0 880538 127406 Jean Ann Bolling Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Jeff Brown MD Board Member 2.00 0.00 X 0 0 0 Janice Burnett Board Member 2.00 48.00 X 0 883722 138217 Chandrashekar Challa Board Member (Jan-Aug) 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 (Jan-Aug) 2.00 0.00 X 0 0 0 BK Fulton Board Member 2.00 0.00 X 0 0 0 Thomas Gayner Board Member 2.00 0.00 X 0 0 0 Reginald Gordon Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Chris Hairston-White Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 BHB Hubbard III Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Sr Rose Jasinski CBS Board Member 2.00 1.00 X 0 0 0 Jon King Board Member (Sep-Jan) 2.00 0.00 X 0 0 0 Sr Anne 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 Joe Schilling Board Member 2.00 0.00 X 0 0 0 Pamela Schutz Chairman (Sep-Dec) 3.00 0.00 X X 0 0 0 Irvin Seeman MD Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shannon Sinclair Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Robert Sledd Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Nancy Thomas Chair (Jan-Aug) 2.00 0.00 X X 0 0 0 Harry Turton Jr Board Member 2.00 0.00 X 0 0 0 Deborah Ulmer PhD RN Board Member (Feb-Aug) 2.00 0.00 X 0 0 0 Jane Watkins Board Member 2.00 0.00 X 0 0 0 Michel Zajur Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Allen Goolsby III Secretary 2.00 0.00 X 0 0 0 Stephan Quiriconi Treasurer 2.00 48.00 X 0 314286 16732 Jim Godwin VP HR 1.00 49.00 X 0 236288 37935 Thomas Auer CEO 5.00 45.00 X 0 698055 16405 Kevin Sheppard VP - Integration 10.00 40.00 X 0 283187 32098 Shailendra Kapoor MD Family Physician (Sep-Nov) 50.00 0.00 X 285825 0 27861 Victor Agbeibor MD Family Physician 50.00 0.00 X 356738 0 41690 Tushar Shah MD Family Physician 50.00 0.00 X 267227 0 40818 Nermine Saleh Medical Director 50.00 0.00 X 220592 0 37708 Ismat Asad Family Physician 50.00 0.00 X 217410 0 37775 1347792 3296076 554645 23 0 1 0 NetMD Business Inc 38935 Ann Arbor Road Livonia MI 48150 Billing Fees 160177 Care Advantage Inc 10041 Midlothian Turnpike Richmond VA 23235 Contract Nursing 113443 2 3567068 3567068 Home Care & Hospice 621610 16625158 16625158 Urgent Care 611600 2707938 2707938 19333096 CVHN Investment 900099 7706 7706 Medical Records 900099 772 772 3rd Party Remittance I 900099 672 672 58 58 9208 22909372 19333096 0 9208 15856384 14270746 1585638 506277 455649 50628 2513307 2261976 251331 1252154 1126939 125215 75863 68277 7586 996 896 100 203446 203446 582 524 58 561276 505148 56128 242879 218591 24288 634858 571372 63486 850498 765448 85050 19462 17516 1946 86418 86418 660951 594856 66095 24774 22297 2477 Purchased Services 1660857 1494771 166086 Medical Supplies 1588101 1588101 Bad Debt 1009916 1009916 Corporate Dues 374889 337400 37489 673303 605973 67330 28797191 26206260 2590931 0 100 99 3042871 4038378 30401 31432 18896680 3496539 15969234 15400141 524853 524854 2170092 1774658 21737551 21769562 533548 841686 266585 429033 14661348 20118299 15461481 21389018 X 6276070 380544 6276070 380544 21737551 21769562 X -5887819 -7707 X 0 1 X 1 0 X 3202700 3280206 20041543 802929 3567068 30894446 14260222 18888119 22844457 22207050 19333096 97532944 17462922 22168325 42886000 23009979 22900164 128427390 0 0 0 128427390 195128 314964 235587 26749 9208 781636 17658050 22483289 43121587 23036728 22909372 129209026 0.99400 0.99370 0.00000 X Schedule A, Part III, Line 12, Explanation of Other Income: Medical Records - 2012 Amount: $ 514. 2013 Amount: $ 718. 2014 Amount: $ 597. 2015 Amount: $ 383. 2016 Amount: $ 772. 3rd Party Remittances - 2012 Amount: $ 502. 2013 Amount: $ 439. 2014 Amount: $ 415. 2015 Amount: $ 695. 2016 Amount: $ 672. Misc JV Rev - 2012 Amount: $ 194,112. 2013 Amount: $ 313,807. 2014 Amount: $ 167,908. 2015 Amount: $ 25,491. Int Inc from Related Org - 2014 Amount: $ 66,667. All Other Revenue - 2015 Amount: $ 180. 2016 Amount: $ 7,764. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 995 995 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. 6960091 6960091 7064822 589292 6475530 1265757 444542 821215 3559053 2456695 1102358 46957 6010 40947 15400141 Due from Affiliates 1331412 MedMal & Gen Liab 433171 Misc A/R 7558 Deposits - Utilities 2517 1774658 Due to Affiliates 19445169 MedMal & Gen Liab 433171 Misc A/R 206559 Patient Credit Balances 33400 20118299 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 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. 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, 2017 or 2016. 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, 2017 and 2016, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $106,393 and $89,895 of net operating loss carryforwards as of August 31, 2017 and 2016, 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, 2017 and 2016 as the System considers it more likely than not that these amounts will not be recognized. 0 1 0 0 0 0 0 0 0 Toni Ardabell CEO-BSV 0 643063 0 184069 0 53406 0 124906 0 2500 0 1007944 0 21527 Janice Burnett Board Member 0 624566 0 146250 0 112906 0 118316 0 19901 0 1021939 0 76390 Stephan Quiriconi Treasurer 0 241335 0 35201 0 37750 0 6061 0 10671 0 331018 0 0 Jim Godwin VP HR 0 187612 0 28229 0 20447 0 17779 0 20156 0 274223 0 0 Thomas Auer CEO 0 504452 0 117618 0 75985 0 15900 0 505 0 714460 0 0 Kevin Sheppard VP - Integration 0 239578 0 43075 0 534 0 5937 0 26161 0 315285 0 0 Shailendra Kapoor MD Family Physician (Sep-Nov) 157680 0 115636 0 12509 0 11257 0 16604 0 313686 0 0 0 Victor Agbeibor MD Family Physician 281025 0 75367 0 346 0 13250 0 28440 0 398428 0 0 0 Tushar Shah MD Family Physician 266957 0 0 0 270 0 12898 0 27920 0 308045 0 0 0 Nermine Saleh Medical Director 213262 0 7141 0 189 0 6730 0 30978 0 258300 0 0 0 Ismat Asad Family Physician 196625 0 20545 0 240 0 11134 0 26641 0 255185 0 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and 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, $24,015; Janice Burnett, $86,966. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Richmond, LLC a single member limited liability company. Bon Secours Richmond, LLC 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. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours-Richmond Health System is appointed by the Class B Member, Bon Secours Richmond, LLC, subject to the approval of Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours-Richmond Health System are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11b The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15b The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of 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' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization makes all documents available to the general public upon request. Form 990, Part VII - Additional Disclosure: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. Sr. Anne Marie Mack does not receive payroll distributions as she has taken a vow of poverty. Form 990, Part XI, line 9: CHA equity distribution -7,707. Bon Secours Ambulatory Services LLC 8580 Magellan Parkway Richmond VA 23227 271672951 All Other Outpatient Care Centers VA 2707938 1301075 Bon Secours Richmond Health System Inc Bon Secours Home Care LLC 8580 Magellan Parkway Richmond VA 23227 271672759 Home Health Care Services VA 16626660 11471519 Bon Secours Richmond Health System Inc Bon Secours VA Medical Group I LLC 8580 Magellan Parkway Richmond VA 23227 271908136 Offices of Physicians VA 0 0 Bon Secours Ambulatory Services LLC Richmond Good Help ACO LLC 8580 Magellan Parkway Richmond VA 23227 813119802 Accountable Care Organization VA 7 349751 Bon Secours Richmond Health System Inc Bon Secours Health System Inc 1505 Marriotsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 Bon Secours Richmond Healthcare 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 Mary's Hospital Richmond Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 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 1 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 1 Rappahanock General Hospital Foundation 101 Harris Road Kilmarnock VA 22482 541210450 Supporting Organization VA 501(c)(3) Line 7 Bon Secours Richmond Health System 1 Chesapeake Medical Group 101 Harris Road Kilmarnock VA 22482 541857174 Healthcare Services VA 501(c)(3) Line 10 Bon Secours Richmond Health System 1 Chesapeake Hospital Corporation PO Box 1449 Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 IVNA Health Services 5008 Monument Avenue Richmond VA 23230 541479847 Healthcare Services VA 501(c)(3) Line 10 Bon Secours Home Care LLC 1 St Mary's MRI Center LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services 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 Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA N/A CCHC Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 9102 297561 1.00000 1 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System Inc C 625969 161797 1.00000 1 Bon Secours - Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 29011251 40476469 1.00000 1 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Bon Secours - Virginia HealthSource Inc C 1168505 170398 1.00000 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 Rappahannock General Hospital Foundation A 58333 FMV Bon Secours Richmond Healthcare Foundation C 3141664 FMV St Mary's Hospital of Richmond Inc P 3035583 FMV St Mary's Hospital of Richmond Inc C 425404 FMV