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 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 2018-07-03 1 John W Sadoff Jr P00540589 4042201500 2016 2022-09-23 18:48:47Z St Mary's Hospital Toni R Ardabell 5801 Bremo Road Richmond VA 23226 737615241 0 X www.bonsecours.com X 1961 VA Acute Care Hospital 21 19 5247 770 3003565 0 13254325 1788284 701577573 711818603 5265129 14744650 5246025 8476135 725343052 736827672 9266336 7114620 0 0 299411871 306743569 0 0 0 367130041 373961191 675808248 687819380 49534804 49008292 965437268 1038396475 377666525 355131635 587770743 683264840 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 634200328 7114620 577930006 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. 135559369 St. Mary's Hospital provides shared services to related organizations to assist with furthering its mission of providing help to those in need. 822047 132100 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. 635022375 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 1 262 0 1 5247 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 0 VA X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Toni Ardabell CEO-BSV 20.00 30.00 X X 0 880538 127406 Francine Barr BM (Sep-Dec)/CEO-SMH (Full FY) 50.00 0.00 X X 0 442530 34364 Jean Bolling Board Member 2.00 0.00 X 0 0 0 Jeff Brown MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Janice Burnett Board Member (Jan-Aug) 2.00 48.00 X 0 883722 138217 Chandrashekar Challa Board Member 2.00 0.00 X 0 0 0 Elizabeth Crowther Board Member (Jan-Aug) 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 (Jan-Aug) 2.00 0.00 X 0 0 0 Thomas Gayner Board Member (Jan-Aug) 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 (Jan-Aug) 2.00 1.00 X 0 0 0 Sr Anne 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 (Jan-Aug) 2.00 0.50 X 0 0 0 Pamela Royal MD Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Joseph Schilling Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Sr Victoria Segura CBS Board Member (Sep-Dec) 10.00 40.00 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 Chairman 2.00 0.00 X X 0 0 0 Harry Turton Jr Board Member (Jan-Aug) 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 (Jan-Aug) 2.00 0.00 X 0 0 0 Michael Williams 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 9.00 41.00 X 314286 0 16732 Jim Godwin VP HR 20.00 30.00 X 236288 0 37935 Eleanor League VP CNE 50.00 0.00 X 235368 0 30480 James McNamara VP Orthopedics 10.00 40.00 X 0 272959 21760 Leigh Sewell VP Service Line Strategy 14.00 36.00 X 237791 0 47723 Thomas Auer CEO 10.00 40.00 X 0 698055 16405 Kevin Sheppard VP - Integration 40.00 10.00 X 283187 0 32098 Matthew Ngo MD Cardiologist 50.00 0.00 X 929873 0 36503 Bruce Stevens MD Psychiatrist 50.00 0.00 X 773103 0 41690 Omar Shams MD Cardiologist 50.00 0.00 X 766356 0 33165 Julia Padgett MD Dermatologist 50.00 0.00 X 750381 0 13250 Mark Bladergroen MD Dermatologist 50.00 0.00 X 727680 0 18401 John Turner Former Key Employee 0.00 0.00 X 309841 0 17307 Marc Katz MD Former Highest Paid 0.00 0.00 X 918169 0 29453 6482323 3177804 692889 347 1 1 0 Aramark CTS Inc 12483 Collections Ctr Drive Chicago IL 60693 Medical Equipment Maintenance 9511568 Morrison Mgt Specialists P O Box 102289 Atlanta GA 303682289 Dietary Management 6236374 Free Agents Marketing 4800 Cox Road - Ste 100 Glen Allen VA 23060 Marketing/Advertising 3332011 Siemens Healthcare Diagnostics P O Box 121102 Dallas TX 753121102 Medical Technology 3281026 Sheltering Arms Ther Solutions 8254 Atlee Road Mechanicsville VA 23116 Rehab Therapy 3178287 203 1610054 178230 1788284 Patient Service Rev. 621300 573126504 573126504 Shared Services 561499 138559999 135559369 3000630 Sch. of Imag. Tuition 611310 132100 132100 711818603 5266325 5266325 783801 783377 424 424 940 -516 9300517 182000 0 4192 9300517 177808 9478325 9478325 Child Care 900099 2677084 2677084 Clinical Drug Trials 900099 2126418 2126418 Care Coordination 900099 1293766 1293766 2378443 1995 2376448 8475711 736827672 713621475 3003565 18414348 7087682 7087682 26938 26938 1560952 1404857 156095 232905072 209614565 23290507 18533774 16680397 1853377 35252658 31727392 3525266 18491113 16642002 1849111 887543 798789 88754 1032 929 103 36792 33113 3679 15956397 15956397 6203183 5582865 620318 7464716 6718244 746472 4530544 4077490 453054 20391938 18352744 2039194 1172541 1055287 117254 764838 688354 76484 6911590 6911590 31377483 28239735 3137748 2249818 2024836 224982 Purchased Services 136404418 122763976 13640442 Medical Supplies 106555148 106555148 Bad Debt Expense 23311560 23311560 Medical Equipment Renta 2017623 1815861 201762 7724027 6951624 772403 687819380 635022375 52797005 0 2727 3787 343972113 382854025 15459 67798553 68463451 490840 9310028 9912195 3981162 3585155 445618507 309803578 132444052 135814929 383920199 419848652 50000 163984 23452135 17750297 965437268 1038396475 80884006 87885434 10581819 10404642 36498619 35034125 249702081 221807434 377666525 355131635 X 587770743 683264840 587770743 683264840 965437268 1038396475 X 49008292 21650013 24835792 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 36792 36792 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. 4746565 4746565 172357266 89302578 83054688 21719129 14074685 7644444 235433194 203452039 31981155 11362353 2974276 8388077 135814929 LT Pension Liability 139474148 Due to Affiliates 39607544 Other Liabilities (MOB Reynolds lease from 2008) 23065882 HPL/GL Liability 13905351 Patient Credit Balances 2940838 Deferred Rent 1329860 Medicare/Medicaid Settlement 1168289 FIN47 LT Asbestos Liab 315522 221807434 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 15944622 408708 15535914 0.02340 51285920 33923977 17361943 0.02610 67230542 34332685 32897857 0.04950 6 15373 6061689 6061689 0.00910 1 55 3476153 1281568 2194585 0.00330 1 314 314 0.00000 1 706889 706889 0.00110 9 15428 10245045 1281568 8963477 0.01350 9 15428 77475587 35614253 41861334 0.06300 1 23311560 0 117373755 129391877 -12018122 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 gather 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 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 will be addressed by increasing safe, healthy, and reliable transportation options for residents in the Richmond service area. Bon Secours will promote active transportation through advocacy for and provision of place making in the neighborhoods we serve. Additionally, we will be 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. Place making activities include opening the Sarah Garland Jones Center for Health Communities and a local market with fresh produce in the East End of Richmond. Additionally, advocacy efforts will 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 will also provide 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 will focus on kindergarten readiness, 3rd grade SOL reading test scores, and high school graduation rates. The Care-A-Van will provide no cost vaccines and school physicals to children to ensure school readiness as well as enroll 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.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. 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 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.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: $23,311,560. 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 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 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 on translated into multiple languages and placed on our Bon Secours 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 55 enrolled students in fiscal year 2017.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 FY 17, 492 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 12,558 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 7229 Forest Avenue Suite 200 Richmond VA 23226 541201346 501(C)(3) 4152517 General Support Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 501(C)(3) 435000 Support for connect care expenses - CMG; Support for RHS Access Now 2821 Emerywood Parkway-Suite 200 Richmond VA 23294 261695468 501(C)(3) 75000 Access Now Program - Coordination of Specialty Care for qualified uninsured patients Area Congregations Together in Service 1 N 5th Street-Suite 400 Richmond VA 23219 453020788 501(C)(3) 10000 East End Homeless Prevention Center for Healthy Hearts 1200 West Cary Street Richmond VA 23220 521303481 501(C)(3) 10000 Program Support Cristo Rey 7800 Carousel Lane Richmond VA 23294 812742073 501(C)(3) 100000 Cristo Rey High School Challenge Discovery Projects 1503 Santa Rosa Road Suite 211 Richmond VA 23229 510250681 501(C)(3) 25000 Virginia Health Center Satellite Counseling Locations Children's Museum of Richmond 2626 West Broad Richmond VA 23220 510220694 501(C)(3) 25000 Children's Health Display ChildSavers 200 North 22nd Street Richmond VA 23223 540505927 501(C)(3) 75000 Mental Health Services (MHS) Church Hill Activities and Tutoring 3015 North Street Richmond VA 23223 200220263 501(C)(3) 127915 Front Porch Cafe' CrossOver Healthcare Ministry 8600 Quioccasin Road-Suite 102 Richmond VA 23229 541371067 501(C)(3) 118000 CrossOver Healthcare Ministry West End Clinic Operations Free Clinic of Powhatan 3908 Old Buckingham Road Powhatan VA 23139 261275136 501(C)(3) 34000 Providing Health Services to Patients FRIENDS Association for Children Saint John Street Richmond VA 23220 540505899 501(C)(3) 50000 Early Childhood Education Programs Full Circle Grief Center 10611 Patterson Avenue 201 Richmond VA 23238 263324192 501(C)(3) 40000 Community Outreach: Groups and Education Goochland Free Clinic and Family Services PO Box 116 3001 River Road West Goochland VA 23103 541967650 501(C)(3) 50000 Provider position for medical program and electronic medical record system Greater Richmond Fit4Kids 2500 W Broad Street Richmond VA 23220 272817718 501(C)(3) 75000 Fit4Kids East End Wellness Integration Health Brigade (Formerly Fan Free Clinic) 1010 North Thompson St Richmond VA 23230 540927792 501(C)(3) 60000 Clinic Operations Higher Achievement 4009 Fitzhugh Avenue-Suite 200 Richmond VA 23230 521383374 501(C)(3) 30000 Closing the Middle School Opportunity Gap 2016 Homeward 1125 Commerce Road Richmond VA 23224 050606153 501(C)(3) 25000 Collective impact to end homelessness Housing Families First 3900 Nine Mile Road Richmond VA 23223 541995917 501(C)(3) 50000 Building Neighbors Rapid Re-Housing Program Metro Richmond SportsBackers 100 Avenue of Champions Richmond VA 23230 541592267 501(C)(3) 100000 Program Support NextUp RVA 7501 Boulders View Dr -Suite 110 Richmond VA 23225 474933093 501(C)(3) 75000 Out of School Programs Peter Paul Development Center 1708 N 22nd Street Richmond VA 23223 541137164 501(C)(3) 25000 Community Engagement Program ProjectHOMES 88 Carnarion Street Richmond VA 23225 541595851 501(C)(3) 140000 Land Acq. With Maggie Walker Land Trust Richmond Cycling Corps 1717 Summit Avenue Richmond VA 23230 582508155 501(C)(3) 75000 Richmond Cycling Corps 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) 75000 Neighborhood Revitalization Richmond Public Schools Education Foundation Inc 301 N 9th Street - 17th floor Richmond VA 23219 542025186 501(C)(3) 75000 RVA East End Festival 2015: Giving the Gift of Music Robinson Theater Community Arts Center 2903 Q Street Richmond VA 23223 264176813 501(C)(3) 25000 Robinson Theater 2016 Programs and Community Engagement Rx Partnership 2924 Emerywood Parkway-Suite 300 Richmond VA 23294 571186937 501(C)(3) 20000 Rx Partnership-Medication Access for the Uninsured Sacred Heart Center 1400 Perry Street Richmond VA 23224 541590419 501(C)(3) 50000 Pathways to Success (Year 2) Safe Harbor PO Box 17996 Richmond VA 23226 541950038 501(C)(3) 80000 Safe Harbor Community Counseling Program The Faces of HOPE of Virginia Inc 8014 Midlothian Turnpike-Suite 200-1 Richmond VA 23235 562616080 501(C)(3) 35000 Support Faces of HOPE's expanded childhood obesity program Tricycle Gardens 2314 Jefferson Avenue Richmond VA 23223 753253795 501(C)(3) 120000 Cultivating Urban Agriculture in RVA Virginia Community Development Fund 1840 West Broad Street-Suite 200 Richmond VA 23220 541914519 501(C)(3) 350000 Richmond East End Grocery Equipment Virginia LISC 413 Stuart Circle Suite 300 Richmond VA 23220 133030229 501(C)(3) 150000 2015 Church Hill Corridor Program SEED & Metro Edge Market Assesment Virginia Supportive Housing PO Box 8585 Richmond VA 23226 541444564 501(C)(3) 50000 Reducing Hospital Costs by Housing the Homeless YMCA of Greater Richmond 2 West Franklin Street Richmond VA 23220 540505986 501(C)(3) 50000 Year Round Out of School Time Programming at Woodville and Oak Grove Elementary 38 0 Employee Hardship Grant 2 2500 Indigent Cab Fare 498 12438 Next Generation Scholarships 12 12000 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. Form 990, Schedule I, Part III: Cab fares are estimated at $25/round-trip 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 BM (Sep-Dec)/CEO-SMH (Full FY) 0 321886 0 77824 0 42820 0 15900 0 18464 0 476894 0 0 Janice Burnett Board Member (Jan-Aug) 0 624566 0 146250 0 112906 0 118316 0 19901 0 1021939 0 76390 Stephan Quiriconi Treasurer 241335 0 35201 0 37750 0 6061 0 10671 0 331018 0 0 0 Jim Godwin VP HR 187612 0 28229 0 20447 0 17779 0 20156 0 274223 0 0 0 Eleanor League VP CNE 204311 0 29776 0 1281 0 8524 0 21956 0 265848 0 0 0 James McNamara VP Orthopedics 0 237568 0 34415 0 976 0 12205 0 9555 0 294719 0 0 Leigh Sewell VP Service Line Strategy 206935 0 30644 0 212 0 11723 0 36000 0 285514 0 0 0 Thomas Auer CEO 0 504452 0 117618 0 75985 0 15900 0 505 0 714460 0 0 Kevin Sheppard VP - Integration 239578 0 43075 0 534 0 5937 0 26161 0 315285 0 0 0 Matthew Ngo MD Cardiologist 548964 0 380549 0 360 0 3642 0 32861 0 966376 0 0 0 Bruce Stevens MD Psychiatrist 260123 0 512361 0 619 0 13250 0 28440 0 814793 0 0 0 Omar Shams MD Cardiologist 444579 0 321561 0 216 0 10600 0 22565 0 799521 0 0 0 Julia Padgett MD Dermatologist 574424 0 175717 0 240 0 13250 0 0 0 763631 0 0 0 Mark Bladergroen MD Dermatologist 699858 0 15788 0 12034 0 0 0 18401 0 746081 0 0 0 John Turner Former Key Employee 120199 0 48527 0 141115 0 3160 0 14147 0 327148 0 0 0 Marc Katz MD Former Highest Paid 795436 0 0 0 122733 0 3906 0 25547 0 947622 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, 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 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. Martha E Merchent Married to Officer Stephan Quiriconi 186558 Employment 0 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 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 Health System, 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 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 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: 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 - HSO Bond related -6,325,696. Minimun Pension Liability 28,941,582. Transfers to Affiliates - Pension 2,219,908. Rounding -2. Bon Secours Health System Inc 1505 Marriottsville 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 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 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 8580 Magellan Parkway Richmond VA 23227 311716973 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 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 Chesapeake Hospital Corporation PO Box 1449 Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 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 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 Richmond CIN LLC 8580 Magellan Parkway Richmond VA 23236 814161677 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 1 0 1