2018-07-03T12:51:23-05:00 2017-08-31 990 2016-09-01 352320780 Bellefonte Physician Services Inc BELL 6068334235 1000 St Christopher Drive Ashland KY 41101 Kevin Halter CEO 6068364002 2018-07-03 0 2016 2022-09-23 18:48:47Z Kevin Halter 1000 St Christopher Drive Ashland KY 41101 26214585 0 X bonsecours.com X 2008 KY Primary, urgent and specialty care 6 1 361 1 0 0 376500 430257 27100834 25680398 641 28 130140 103902 27608115 26214585 1700 0 0 0 30767067 30796522 0 0 0 13031111 12950452 43799878 43746974 -16191763 -17532389 5357581 4796276 92637283 109608365 -87279702 -104812089 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 39813508 0 25680398 Charity & Indigent Care - Bellefonte Physician Services (BPS) utilizes an affiliate model to provide residents of the tri-state with a variety of services, from primary care to pediatric, urgent and specialty care. A member of the Bon Secours Kentucky Health System, BPS continues to expand to meet the needs of community residents, especially those in charily and indigent need. The various practices that comprise BPS are strategically located throughout the region to bring the highest quality health care close to home with convenient locations. 39813508 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 47 0 1 361 1 0 0 0 0 0 0 0 0 0 0 X 6 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X John Darnell MD Board Member 0.00 50.00 X 0 285348 17880 Kevin Halter FACHE Chairman/CEO-BSKY 10.00 40.00 X X 0 452561 56406 Augustinus Lobach MD Board Member (Sep-Dec) 0.00 50.00 X 0 228880 11515 Thomas Morris PhD President 1.00 49.00 X X 0 464396 82259 James Payne PhD Board Member 0.00 2.00 X 0 0 0 Samuel Ross MD Board Member 0.00 50.00 X 0 1000544 54934 Melinda Elkins-Smith MD Board Member (Dec-Aug) 0.00 50.00 X 0 223135 8239 Joe Buchheit CFO-BSKY 10.00 40.00 X 0 307585 22742 Troy Connett Secretary 50.00 0.00 X 63197 0 11542 Tyler Walters Treasurer 0.00 50.00 X 0 142440 28456 Charles Rhodes MD Cardiologist 50.00 0.00 X 832717 35700 31901 Richard Mailloux MD Gastroenterologist 50.00 0.00 X 544958 0 38566 Diane Settles MD Internist 50.00 0.00 X 526232 0 37624 John Brandenburg Gastroenterologist 50.00 0.00 X 519834 0 33203 Harry Bell Rehabilitation Specialist 50.00 0.00 X 426991 0 30352 John Wallenhorst PhD Former Board Officer 0.00 50.00 X 0 454099 35488 2913929 3594688 501107 49 1 1 0 AthenaHealth Inc 311 Arsenal Court Watertown MA 02472 Billing Agent 1124100 Roland Benton PSC 413 Country Club Drive Ashland KY 41101 Contract Physician 466194 McBrayer McGinnis Leslie & Kirkland L 201 E Main St Ste 1000 Lexington KY 405072003 Professional Services 289250 Envera Health Inc 4900 Cox Rd Ste 200 Glen Allen VA 23060 Health Management Services 151368 Dirtbusters Janitorial Services 6433 Route 60 Suite 100 Barboursville WV 25504 Cleaning Services 128833 6 430257 430257 Patient Service Rev. 621110 25680398 25680398 25680398 28 28 Retail Sales 900099 57478 57478 Nursing Services 900099 32320 32320 Medical Records 900099 12748 12748 1356 1356 103902 26214585 25680398 0 103930 76697 69027 7670 25202574 22682317 2520257 805900 725310 80590 2996993 2697294 299699 1714358 1542922 171436 37641 33877 3764 1046038 1046038 12840 11556 1284 410076 369068 41008 202031 181828 20203 2995036 2695532 299504 177800 160020 17780 47710 42939 4771 165941 165941 695217 625695 69522 534034 480631 53403 Purchased Services 2932480 2639232 293248 Medical Supplies 1994240 1994240 Bad Debt 1206102 1206102 Physician Recruitment 250396 225356 25040 242870 218583 24287 43746974 39813508 3933466 0 5940 6022 220791 223607 1764960 1412907 315315 272732 1596148 1718169 4482784 3320801 1128238 1161983 326189 856 5357581 4796276 914381 924234 91722902 108684131 92637283 109608365 X -87279702 -104812089 -87279702 -104812089 5357581 4796276 X -17532389 2 X 0 1 X 1 0 X 516619 268902 376500 430257 1592278 26171523 26114218 26804512 27100834 25680398 131871485 26171523 26630837 27073414 27477334 26110655 133463763 0 0 0 133463763 30 27 25 193 28 303 30 27 25 193 28 303 37805 163724 209362 130140 103902 644933 26209358 26794588 27282801 27607667 26214585 134108999 0.99520 0.99570 0.00000 X Schedule A, Part III, Line 12, Explanation of Other Income: Skin Care Products - 2012 Amount: $ 31,606. 2013 Amount: $ 16,585. 2014 Amount: $ 54,180. 2015 Amount: $ 71,809. Purchase Discounts - 2012 Amount: $ 6,199. EKG Reading Fees - 2013 Amount: $ 108,659. 2014 Amount: $ 113,201. Gift Shop - 2013 Amount: $ 21,537. Retail Sales - 2016 Amount: $ 57,478. Nursing Services - 2016 Amount: $ 32,320. Medical Records - 2016 Amount: $ 12,748. All Other Revenue - 2013 Amount: $ 16,943. 2014 Amount: $ 41,981. 2015 Amount: $ 58,331. 2016 Amount: $ 1,356. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 143588 41443 102145 301907 239688 62219 3948995 3002893 946102 88294 36777 51517 1161983 Due to Affiliates 108660692 Deferred Rent 23439 108684131 X Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The System accounts for uncertain tax positions in accordance with ASC Topic 740, Income Taxes. Their related income is exempt from federal income tax under Section 501(A). The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of August 31, 2017 or 2016. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present, and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The System is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2013. As of August 31, 2017 and 2016, the System has no uncertain tax positions. The System's taxable subsidiaries had approximately $106,393 and $89,895 of net operating loss carryforwards as of August 31, 2017 and 2016, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The System accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The System's deferred tax assets are fully reserved at August 31, 2017 and 2016 as the System considers it more likely than not that these amounts will not be recognized. 0 1 0 0 0 0 0 0 0 John Darnell MD Board Member 0 250884 0 32819 0 1645 0 6090 0 11790 0 303228 0 0 Kevin Halter FACHE Chairman/CEO-BSKY 0 358895 0 41539 0 52127 0 29714 0 26692 0 508967 0 8326 Augustinus Lobach MD Board Member (Sep-Dec) 0 178127 0 28313 0 22440 0 3771 0 7744 0 240395 0 0 Thomas Morris PhD President 0 336400 0 81600 0 46396 0 61346 0 20913 0 546655 0 21104 Samuel Ross MD Board Member 0 601809 0 90308 0 308427 0 34958 0 19976 0 1055478 0 171858 Melinda Elkins-Smith MD Board Member (Dec-Aug) 0 133007 0 90000 0 128 0 0 0 8239 0 231374 0 0 Joe Buchheit CFO-BSKY 0 236843 0 28648 0 42094 0 4681 0 18061 0 330327 0 0 Tyler Walters Treasurer 0 133088 0 9190 0 162 0 3589 0 24867 0 170896 0 0 Charles Rhodes MD Cardiologist 692672 0 51374 0 88671 35700 11925 0 19976 0 864618 35700 0 0 Richard Mailloux MD Gastroenterologist 542053 0 1500 0 1405 0 11925 0 26641 0 583524 0 0 0 Diane Settles MD Internist 515194 0 500 0 10538 0 8859 0 28765 0 563856 0 0 0 John Brandenburg Gastroenterologist 392065 0 70923 0 56846 0 6562 0 26641 0 553037 0 0 0 Harry Bell Rehabilitation Specialist 392132 0 29500 0 5359 0 10376 0 19976 0 457343 0 0 0 John Wallenhorst PhD Former Board Officer 0 300576 0 72652 0 80871 0 24843 0 10645 0 489587 0 24034 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Kevin Halter, FACHE, $9,610; Thomas Morris, PhD, $22,519; Samuel Ross, MD, $201,434; John Wallenhorst, PhD, $34,685. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc is the sole member of Bon Secours Kentucky Health System, which in turn is the sole member of Bellefonte Physician Services, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bellefonte Physician Services, Inc. is appointed by its Member, Bon Secours Kentucky Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bellefonte Physician Services, 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 the 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 provides any documents open to public inspection upon request. Form 990, Part VII - Additional Disclosure: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. Form 990, Part XI, line 9: 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 Our Lady of Bellefonte Hospital Inc 1000 St Christopher Drive Ashland KY 41101 611356023 Healthcare KY 501(c)(3) Line 3 Bon Secours Kentucky Health System 0 Our Lady of Bellefonte Hospital Foundation 1000 St Christopher Drive Ashland KY 41101 611381952 Grant Making Foundation KY 501(c)(3) Line 7 Bon Secours Kentucky Health System 0 Bon Secours Kentucky Health System 1000 St Christopher Drive Ashland KY 41101 611356024 Local System Parent Org. KY 501(c)(3) Line 12c, III-FI Bon Secours Health System Inc 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0