2018-07-03T08:52:40-05:00 2017-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2016-09-01 311716973 Bon Secours - St Francis Medical Center Inc BONS 8042818413 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi Chief Executive Officer 8042818413 2018-07-03 1 John W Sadoff Jr P00540589 4042201500 2016 2022-09-23 18:48:47Z Christopher Accashian 8580 Magellan Parkway Building IV Richmond VA 23227 272731261 0 X bonsecours.com X 1999 VA Acute Care Hospital 21 19 1700 330 1995 0 1331447 1070318 276730977 268801662 105343 -216438 2518116 2421280 280685883 272076822 62000 62893 0 0 100854425 101301138 0 0 0 164478509 164026682 265394934 265390713 15290949 6686109 174317586 181096862 103149927 108027565 71167659 73069297 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 241041804 62893 269830265 Patient Service in order to bring compassion to healthcare and to be good help to those in need by providing healthcare services. Please refer to the Community Benefit information on Schedule H. 4465215 650491 Bon Secours St. Francis Family Medicine Residency Program: The Virginia Commonwealth University (VCU) affiliated Bon Secours St. Francis Family Medicine Residency Program opened its doors in August 2005 and is fully accredited by the Accreditation Council for Graduate Medical Education. Bon Secours has built a program that creates family physicians and serves western Chesterfield county and surrounding areas in suburban Richmond, Virginia. The faculty includes a mixture of rural and suburban-based academicians and clinicians. Subspecialty preceptors are drawn from a premier network of Bon Secours affiliated physicians. The residency program is housed in a building designed specifically for the needs of resident education and efficient clinical care. In addition to rotating through Bon Secours St. Francis Medical Center, residents use many of the award-winning systems through our practice, the four hospitals of Bon Secours Richmond Health System, and our community outreach including Care-A-Van, our free mobile health clinic. 245507019 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 79 0 1 1700 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 0 VA X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Toni Ardabell CEO-BSV 6.00 44.00 X X 0 880538 127406 Francine Barr Board Member (Sep-Dec) 2.00 48.00 X 0 442530 34364 Jean Ann Bolling Board Member 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 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 BK Fulton Board Member 2.00 0.00 X 0 0 0 Thomas Gayner Board Member 2.00 0.00 X 0 0 0 Anup Gokli MD Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Pamela Hacker Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Chris Hairston-White Board Member 2.00 0.00 X 0 0 0 BHB Hubbard III Board Member 2.00 0.00 X 0 0 0 Sr Rose Marie Jasinski CBS Board Member 2.00 1.00 X 0 0 0 Sr Anne Marie Mack CBS President 3.50 46.50 X X 0 0 0 Joanne Nattrass Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Paula Peaden Board Member (Sep-Dec) 2.00 0.50 X 0 0 0 Fr John Podsiadlo Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Linda Rigsby Board Member 2.00 0.50 X 0 0 0 Pamela Royal Board Member 2.00 0.00 X 0 0 0 Sr Victoria Segura CBS Board Member (Sep-Dec) 10.00 40.00 X 0 0 0 Joseph Schilling Board Member 2.00 0.00 X 0 0 0 William Shewmake Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Shannon Sinclair Board Member 2.00 0.00 X 0 0 0 Nancy Thomas Chair 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 Michael Williams Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Christopher Accashian CEO-SFMC 37.50 12.50 X 0 319430 18582 Allen Goolsby III Secretary 2.00 2.00 X 0 0 0 Stephan Quiriconi Treasurer 9.00 41.00 X 0 314286 16732 Jim Godwin VP HR 8.00 42.00 X 0 236288 37935 James McNamara VP Orthopedics 8.00 42.00 X 0 272959 21760 Barbara Gesme VP - Patient Care 50.00 0.00 X 183865 0 28931 Leigh Sewell VP Service Line Strategy 12.00 38.00 X 0 237791 47723 Thomas Auer CEO - BSMG 7.00 43.00 X 0 698055 16405 Howard Wiles MD Obstetrician 50.00 0.00 X 463138 0 33871 Tracy Hicks MD Obstetrician 50.00 0.00 X 491739 0 43564 James Pellicane MD General Surgeon 50.00 0.00 X 653786 0 35230 Tamara Pringle MD Obstetrician 50.00 0.00 X 470545 0 12413 Stacey Epps MD Neurologist 50.00 0.00 X 458323 0 41730 John Turner Former Key Employee 0.00 0.00 X 0 309841 17307 Shelly Buck-Turner Former Key Employee 0.00 50.00 X 0 265776 41375 2721396 4861216 713545 91 1 1 0 Aramark Cts Inc 12483 Collections Ctr Dr Chicago IL 60693 Medical Equipment Maintenance/Rental 4127620 Morrison Management Specialists Inc PO Box 102289 Atlanta GA 303682289 Dietary Management 3520372 Intuitive Surgical Inc PO Box 39000 - Dept 33629 San Francisco CA 94139 Medical Equipment Maintenance 3048248 Richmond Emergency Physicians 5855 Bremo Road - Suite 210 Richmond VA 23226 Emergency Physicians 2469589 OBHG Virginia LLC 10 Centimeters Dr Mauldin SC 29662 OB Services 1851744 67 900235 170083 1070318 Patient Service Rev. 622110 268151171 268151171 Residency Program 622110 650491 650491 268801662 187120 187120 209223 235881 -26658 -26658 -26658 15000 418558 -403558 -403558 -403558 Sheltering Arms Rev. 900099 1111791 1111791 Care Coordination Fees 900099 567303 567303 Cafe/Vending/Gift Shop 900099 379216 379216 389628 1995 387633 2447938 272076822 270480756 1995 523753 50000 50000 12893 12893 207954 187159 20795 78948201 71053381 7894820 4282103 3853893 428210 11693207 10523886 1169321 6169673 5552706 616967 170892 153803 17089 19793 17814 1979 7804254 7804254 42604 38344 4260 2189210 1970289 218921 264924 238432 26492 9380858 8442772 938086 226479 203831 22648 103356 93020 10336 5121214 5121214 7476126 6728513 747613 1451333 1306200 145133 Purchased Services 68246464 61421818 6824646 Medical Supplies 36749358 36749358 Bad Debt 16816039 16816039 BSHSI Mgmt Allocations 5976398 5378758 597640 1987380 1788642 198738 265390713 245507019 19883694 0 1152 1794 32309473 38579244 28676251 28256795 30632 2902604 3104911 1259007 1382712 202697783 103923425 97021341 98774358 12117126 10997048 174317586 181096862 9452901 12032929 3473673 3435431 90223353 92559205 103149927 108027565 X 71167659 73069297 71167659 73069297 174317586 181096862 X 6686109 -4784471 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19793 19793 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. 21097936 21097936 75673314 23654189 52019125 15954770 11569456 4385314 75580934 61820637 13760297 14390829 6879143 7511686 98774358 LT Non Cash Inv - HPL/GL 8377175 Due from Affiliates 1160645 Medicare/Medicaid Settlement 954982 Miscellaneous A/R 365407 Ground Lease Rent Receivable 92827 Deposits 46012 10997048 Due to Affiliates 80952308 HPL/GL Liability 8377175 Patient Credit Balances 1470455 Deferred Rent 1274353 Medicare/Medicaid Settlement 251435 Other LT Liabilities 108895 Medicare Reserves 97447 Other Misc Liabilities 27137 92559205 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 8707242 100040 8607202 0.03460 17838326 12573108 5265218 0.02120 26545568 12673148 13872420 0.05580 2 2498797 2498797 0.01010 6063258 1342997 4720261 0.01900 1 350630 350630 0.00140 3 8912685 1342997 7569688 0.03050 3 35458253 14016145 21442108 0.08630 1 16816039 0 52660320 66551485 -13891165 X 1 1 1 1 Bon Secours - St Francis Medical Center Inc 13710 St Francis Blvd Midlothian VA 23114 bonsecours.com H1924 X X X X X Bon Secours - St Francis Medical Center 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Section C X www.behealthyrva.org 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 Bon Secours - St. Francis Medical Center 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. Bon Secours - St. Francis Medical Center Part V, Section B, Line 6a: St. Mary's Hospital, Memorial Regional Medical Center, St. Francis Medical Center, Richmond Community Hospital Bon Secours - St. Francis Medical Center 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 has been 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 provides 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 that have been implemented 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 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 the opening of 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 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 2015 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. Bon Secours - St. Francis Medical Center 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. Because both Maryland law and Federal tax law limit the amounts that may be charged to patients, an FAP eligible individual or an uninsured individual will not be charged more than the lesser of the AGB or the regulated charge set by the Maryland Health Services Cost Review Commission for emergency or other medically necessary care. 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 18 1 - Bon Secours Richmond OBGYN 13700 St Francis Blvd Suite 305 Midlothian VA 23114 Physician Practice 2 - St Francis Family Medical Practice 13540 Hull Street Road Midlothian VA 23112 Physician Practice 3 - Internal Medicine of Chesterfield 611 Watkins Centre Parkway Ste 250 Midlothian VA 23114 Physician Practice 4 - Neurology Clinic Bon Secours Med Group 11601 Ironbridge Road Suite 207 Chester VA 23831 Physician Practice 5 - Ironbridge Family Practice 11601 Ironbridge Road Suite 117 Chester VA 23831 Physician Practice 6 - PT OT SP Lymphedema 13700 St Francis Blvd Midlothian VA 23114 Physical Therapy, Outpatient Care, Etc. 7 - Virginia Breast Center 610 Watkins Centre Parkway Midlothian VA 23114 Physician Practice 8 - OP Wound Care 13700 St Francis Blvd Midlothian VA 23114 OP Wound Care 9 - CARE Diabetes & Endocrinology 3660 Boulevard Suite G Colonial Heights VA 23834 Physician Practice 10 - Powhatan Medical Associates 3452 Anderson Highway Suite D Powhatan VA 23139 Physician Practice 11 - Blackstone Family Practice 213 N Main Street Blackstone VA 23824 Physician Practice 12 - St Francis Medical Women's Center 13700 St Francis Blvd Suite 510 Midlothian VA 23114 Physician Practice 13 - BS-Bermuda Crossroads Prm Care 12340 Bermuda Crossroads Lane Chester VA 23831 Physician Practice 14 - Charter Colony Family Practice 13700 St Francis Blvd Suite 302 Midlothian VA 23114 Physician Practice 15 - St Joseph Outreach Clinic 8000 Brook Road Richmond VA 23227 Physician Practice 16 - Diabetes Treatment Center 2372 Colony Crossing Midlothian VA 23114 Outpatient Diabetic Clinic 17 - Bon Sec Freedom Healthcr Assoc 32 West Washington Street Suite B Petersburg VA 23803 Physician Practice 18 - Bon Secours FastCare 200 Charter Colony Parkway Midlothian VA 23114 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/newsroom. Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, Ln 7 Col(f): Bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $16,816,039. 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 BSHSI consolidated audited financial statements ("AFS"). "Allowance for uncollectible accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 38-39 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 InputInput 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 website. In addition, patient billing statements and letters inform patients regarding our financial assistance program. Bon Secours proactively screens patients to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assist the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Bon Secours 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 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 website for patients to access. Part VI, Line 4: St. Francis Medical Center was completed in 2005 and is a state-of-the-art acute care facility licensed for 130 beds, serving residents primarily from the counties of Amelia, Chesterfield, Hanover, Henrico, Powhatan, and Richmond City. The St. Francis Medical Center service area extends across much of central Virginia, including downtown Richmond, suburban communities of Chesterfield and Henrico counties and rural counties such as Powhatan and Amelia.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 narrative, 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. Francis Medical Center has an open medical staff with privileges available to all qualified physicians in the area. St. Francis Medical Center through the Bon Secours Richmond Health System is governed by a board of directors whose composition is representative of the community.St. Francis Medical Center engages in medical research. Inpatient and outpatient research-related activities are conducted by St. Francis Medical Center with oversight from the Bon Secours Richmond Health System Institutional Review Board.Community Programs 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 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 12,558 patient visits in FY 17. 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 FY 17, 5,857 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 FY 17, 818 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 74 children in FAMIS or Medicaid in FY 17.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 FY 2017 to children at Care-A-Van sites. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), 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 BSHSI Vision. BSHSI'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 BSHSI and the SQP (Strategic Quality Plan). Part VI, Line 7, Reports Filed With States VA 1 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Building IV Richmond VA 23227 541201346 501(c)(3) 50000 General Support 1 0 Indigent Cab Fare 516 12893 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'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. 1 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 Francine Barr Board Member (Sep-Dec) 0 321886 0 77824 0 42820 0 15900 0 18464 0 476894 0 0 Janice Burnett Board Member 0 624566 0 146250 0 112906 0 118316 0 19901 0 1021939 0 76390 Christopher Accashian CEO-SFMC 0 205413 0 81877 0 32140 0 1569 0 17013 0 338012 0 0 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 James McNamara VP Orthopedics 0 237568 0 34415 0 976 0 12205 0 9555 0 294719 0 0 Barbara Gesme VP - Patient Care 160601 0 22655 0 609 0 9039 0 19892 0 212796 0 0 0 Leigh Sewell VP Service Line Strategy 0 206935 0 30644 0 212 0 11723 0 36000 0 285514 0 0 Thomas Auer CEO - BSMG 0 504452 0 117618 0 75985 0 15900 0 505 0 714460 0 0 Howard Wiles MD Obstetrician 276724 0 184830 0 1584 0 13250 0 20621 0 497009 0 0 0 Tracy Hicks MD Obstetrician 288561 0 202626 0 552 0 13250 0 30314 0 535303 0 0 0 James Pellicane MD General Surgeon 457036 0 196198 0 552 0 3710 0 31520 0 689016 0 0 0 Tamara Pringle MD Obstetrician 305475 0 164830 0 240 0 12219 0 194 0 482958 0 0 0 Stacey Epps MD Neurologist 215818 0 242145 0 360 0 13250 0 28480 0 500053 0 0 0 John Turner Former Key Employee 0 120199 0 48527 0 141115 0 3160 0 14147 0 327148 0 0 Shelly Buck-Turner Former Key Employee 0 230005 0 33538 0 2233 0 9911 0 31464 0 307151 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Lines 4a-b Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: John Turner, $116,058. The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. 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 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 Bon Secours - St. Francis Medical Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours - St. Francis Medical Center is appointed by its member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours - St. Francis Medical Center 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 BSHSI. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of director's 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: From September 1, 2016 - December 31, 2016, the governing bodies of the following entities were 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 As of January 1, 2017, 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 and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Form 990, Part XI, line 9: Transfers to Affiliates - Bond related -4,727,011. Transfers to Affiliates - Blackstone Family Practice fixed assets -57,460. Bon Secours Health System Inc 1505 Marriotsville Road Marriotsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 12c, III-FI Bon Secours Inc 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) Line 10 Bon Secours Richmond LLC 0 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 0 Bon Secours St Mary's Hospital 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 Inc 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 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 Rappahanock General Hospital Foundation 101 Harris Road Kilmarnock VA 22482 541210450 Supporting Organization VA 501(c)(3) Line 7 Bon Secours Richmond Health System 0 Chesapeake Medical Group 101 Harris Road Kilmarnock VA 22482 541857174 Healthcare Services VA 501(c)(3) Line 10 Bon Secours Richmond Health System 0 IVNA Health Services 5008 Monument Ave Richmond VA 23230 541479847 Healthcare Services VA 501(c)(3) Line 10 Bon Secours Home Care LLC 0 Chesapeake Hospital Corporation PO Box 1449 Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 0 St Mary's MRI 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 N/A C 0 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility 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 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA N/A C 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0