2017-07-10T09:44:13-05:00 2016-08-31 990 2015-09-01 521988421 Bon Secours - Richmond Health System Inc BONS 8042818413 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi Treasurer (BSR-VP Finance) 8042818316 2017-07-10 0 2015 2021-01-29 14:40:06Z Bon Secours Virginia Bon Secours Virginia Health System Toni R Ardabell 8580 Magellan Parkway Building IV Richmond VA 23227 22225733 0 X www.bonsecours.com X 1996 VA Provides support services to related not-for-profit entities within the System. 19 17 332 120 0 0 20041543 802929 22844457 22207050 0 50000 235587 -834246 43121587 22225733 0 10345313 0 0 16634022 18492998 0 0 0 6393029 8952020 23027051 37790331 20094536 -15564598 35301223 21737551 13460555 15461481 21840668 6276070 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 10345313 10345313 0 Supports the subsidiary members of the Bon Secours Richmond Health System in their effort to provide compassionate, quality healthcare services to those in need, including the poor and dying, for the purpose of alleviating human suffering and bringing people to wholeness in the midst of pain and loss. 22367498 0 19877121 Bon Secours Home Care, LLC: In 1824, the Sisters of Bon Secours began to care for the sick in their own homes in Paris, France. Today, compassionate care at home remains a fundamental part of the mission of Bon Secours. Bon Secours Home Care provides care to patients in the home setting and offers a comprehensive suite of services to patients, from infants to seniors, which address their physical, emotional and spiritual needs. Such services include: - Skilled Nursing (diabetic teaching, medication management, post-operative care) - Certified Wound and Ostomy Nurse - Heart Failure Disease Management Program - Home Telehealth Monitoring - Physical, Occupational and Speech Therapy - Medical Social Workers - Pediatric Services - Orthopedic Rehab Services - Home Health Aides (activities of daily living assistance in conjunction with patient's rehabilitative plan of care)Additionally, Bon Secours Home Care provides hospice services which is the continuation of medical care for end-of-life patients. It allows people to live comfortably and with dignity during their remaining days. Hospice care addresses the physical, emotional and spiritual needs and wishes of patients and their families.Bon Secours Home Care, LLC is a single-member limited liability company. As such, the activity of the entity is disregarded for tax purposes and consolidated into the Form 990 of its member Bon Secours Richmond Health System. 2552655 0 2329929 Bon Secours Ambulatory Services, LLC (dba Bon Secours Good Health Express) serves as an urgent care center for the community of Henrico County. Families have access to board-certified physicians and medical professionals trained in adult and pediatric life support. The organization provides quality urgent care without an emergency room visit. Bon Secours Ambulatory Services, LLC follows the same Financial Assistance Policy of its related tax exempt hospitals within Bon Secours Richmond Health System. Patients are never turned away due to their inability to pay. Services provided, but not excluded to:- Onsite diagnostic laboratory and imaging services- Treatment of broken bones- Treatment of minor injuries like the flu or sore throat 35265466 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 14 0 1 332 1 0 0 0 0 0 0 0 0 0 0 0 X 19 17 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Jeff Brown MD Board Member 2.00 0.00 X 0 0 0 Janice Burnett Board Member 2.00 48.00 X 0 994803 127505 Elizabeth Crowther Board Member 2.00 0.00 X 0 0 0 B Keith Fulton Board Member 2.00 0.00 X 0 0 0 Thomas Gayner Board Member 2.00 0.00 X 0 0 0 Reginald Gordon Board Member 2.00 0.00 X 0 0 0 Sr Rose Jasinski CBS Board Member 2.00 2.00 X 0 0 0 Jon King Board Member 2.00 0.00 X 0 0 0 Mary Malone Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Linda Rigsby Board Member (Jan-Aug) 2.00 1.00 X 0 0 0 Pamela Royal MD Board Member 2.00 0.00 X 0 0 0 Joe Schilling Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Irvin Seeman MD Board Member 2.00 0.00 X 0 0 0 Robert Sledd Board Member 2.00 0.00 X 0 0 0 Harry Turton Jr Board Member 2.00 0.00 X 0 0 0 Jane Watkins Board Member 2.00 0.00 X 0 0 0 Michel Zajur Board Member 2.00 0.00 X 0 0 0 Toni Ardabell CEO-BSR/CEO-BSV 2.50 47.50 X 0 1046319 74999 Sr Anne Mack CBS President 3.00 47.00 X 0 0 0 Pamela Schutz Chairman 3.00 0.00 X 0 0 0 Allen Goolsby III Secretary 2.00 2.00 X 0 0 0 Stephan Quiriconi Treasurer 2.00 48.00 X 0 360869 16123 Jim Godwin VP HR 1.00 49.00 X 0 249400 27407 Leigh Sewell VP Service Line Strategy 2.00 48.00 X 0 207236 39837 Shailendra Kapoor MD Family Physician 50.00 0.00 X 369626 0 29809 Victor Agbeibor MD Family Physician 50.00 0.00 X 313022 0 41508 Tushar Shah MD Family Physician 50.00 0.00 X 251080 0 39352 William Anderson Medical Director 50.00 0.00 X 206144 0 28415 Ismat Asad Family Physician 50.00 0.00 X 200296 0 22372 Peter Bernard Former Officer 0.00 0.00 X 0 2257034 121913 1340168 5115661 569240 20 1 1 0 Loughridge & Company LLC 5711 Staples Mill Road Suite 100 Richmond VA 23228 Construction Services 3525352 Kathy Helm & Associates Inc 1205 E Washington St Suite 110 Louisville KY 40206 Interior Design 407821 Action Landscape Inc 10638 Watterson Trail Louisville KY 40299 Landscaping 337833 Autumn Corporation 3610 Winchester Drive Portsmouth VA 23707 Room/Board for Hospice Patients 216289 NetMD Business Inc 38935 Ann Arbor Road Livonia MI 48150 Billing Fees 159817 9 802929 802929 Home Care & Hospice 621610 19877121 19877121 Urgent Care 611600 2329929 2329929 22207050 50000 0 50000 50000 50000 JV Income 621610 25491 25491 3rd Party Remittance I 900099 695 695 Medical Records 900099 382 382 -860814 -860814 -834246 22225733 22207050 0 -784246 10345313 10345313 14842196 13357976 1484220 391322 352190 39132 2099337 1889403 209934 1160143 1044129 116014 18600 16740 1860 229807 229807 6867 6180 687 739706 665737 73969 2000 1800 200 608570 547713 60857 883937 795543 88394 9389 8450 939 41499 41499 570140 513126 57014 24032 21629 2403 Purchased Services 3828126 3445313 382813 Medical Supplies 1327047 1327047 Medical Equip. Rental 332518 332518 Bad Debt 265495 265495 64287 57858 6429 37790331 35265466 2524865 0 100 100 5376678 3042871 31772 30401 18807731 2838497 16496229 15969234 1855670 524853 11540774 2170092 35301223 21737551 827819 533548 360842 266585 12271894 14661348 13460555 15461481 X 21840668 6276070 21840668 6276070 35301223 21737551 -15564598 0 X 0 1 X 1 0 X 1805982 3202700 3280206 20041543 802929 29133360 15594847 14260222 18888119 22844457 22207050 93794695 17400829 17462922 22168325 42886000 23009979 122928055 0 0 0 122928055 1294 195128 314964 235587 26749 773722 17402123 17658050 22483289 43121587 23036728 123701777 0.99370 0.99360 0.00000 X Schedule A, Part III, Line 12, Explanation of Other Income: Medical Records - 2011 Amount: $ 598. 2012 Amount: $ 514. 2013 Amount: $ 718. 2014 Amount: $ 597. 2015 Amount: $ 383. 3rd Party Remittances - 2011 Amount: $ 696. 2012 Amount: $ 502. 2013 Amount: $ 439. 2014 Amount: $ 415. 2015 Amount: $ 695. Misc JV Rev - 2012 Amount: $ 194,112. 2013 Amount: $ 313,807. 2014 Amount: $ 167,908. 2015 Amount: $ 25,491. Int Inc from Related Org - 2014 Amount: $ 66,667. All Other Revenue - 2015 Amount: $ 180. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6960091 6960091 7055136 259993 6795143 1265757 315724 950033 3477190 2260125 1217065 49557 2655 46902 15969234 Due from Affiliates 1735243 MedMal & Gen Liab 418049 Misc A/R 14283 Deferred Fin Costs & Other Assets 2517 2170092 Due to Affiliates 14211759 MedMal & Gen Liab 418049 Patient Credit Balances 25522 Misc A/R 6018 14661348 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. The System's taxable subsidiaries had approximately $89,895 and $84,748 of net operating loss carryforwards as of August 31, 2016 and 2015, respectively, which expire in varying periods through 2036 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. Income tax liabilities are recorded for the impact of positions taken on income tax returns, which management believes are not more likely than not to be sustained on tax audit. 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, 2016 and 2015 as the System considers it more likely than not that these amounts will not be recognized. 1 Bon Secours St Mary's Hospital Inc 8580 Magellan Parkway Richmond VA 23227 540793767 501(C)(3) 10345313 General Support 1 0 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. 0 1 0 0 0 0 0 0 0 Janice Burnett Board Member 0 552081 0 370190 0 72532 0 106777 0 20728 0 1122308 0 38116 Stephan Quiriconi Treasurer 0 289751 0 50368 0 20750 0 5516 0 10607 0 376992 0 0 Jim Godwin VP HR 0 200215 0 40105 0 9080 0 7417 0 19990 0 276807 0 0 Leigh Sewell VP Service Line Strategy 0 163246 0 43634 0 356 0 10263 0 29574 0 247073 0 0 Shailendra Kapoor MD Family Physician 200634 0 168776 0 216 0 11267 0 18542 0 399435 0 0 0 Victor Agbeibor MD Family Physician 256907 0 55655 0 460 0 13250 0 28258 0 354530 0 0 0 Tushar Shah MD Family Physician 250810 0 0 0 270 0 11390 0 27962 0 290432 0 0 0 William Anderson Medical Director 204872 0 0 0 1272 0 10419 0 17996 0 234559 0 0 0 Ismat Asad Family Physician 193796 0 6260 0 240 0 3956 0 18416 0 222668 0 0 0 Peter Bernard Former Officer 0 594915 0 907922 0 754197 0 97765 0 24148 0 2378947 0 460681 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: Peter Bernard, $617,982; Toni Ardabell, $28,228; Janice Burnett, $46,841. Form 990, Part VI, Section A, line 4 On December 22, 2015, the articles and bylaws of each of these entities were amended and restated in their entirety to bring the documents up to date with current templates for local system parent and hospital entities, respectively. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Richmond, LLC a single member limited liability company. Bon Secours Richmond, LLC was formerly Bon Secours Richmond Health Corp, a nonprofit tax exempt organization prior to conversion. Bon Secours Richmond LLC holds the majority interest in Bon Secours-Richmond Health System. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours-Richmond Health System is appointed by the Class B Member, Bon Secours Richmond, LLC, subject to the approval of Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours-Richmond Health System are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15b The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization makes all documents available to the general public upon request. Form 990, Part VII - Additional Disclosure: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment and do not receive additional compensation for their board responsibilities. Sr. Anne Marie Mack does not receive payroll distributions as she has taken a vow of poverty. Bon Secours Ambulatory Services LLC 8580 Magellan Parkway Richmond VA 23227 271672951 All Other Outpatient Care Centers VA 2329929 1573937 Bon Secours Richmond Health System Inc Bon Secours Home Care LLC 8580 Magellan Parkway Richmond VA 23227 271672759 Home Health Care Services VA 19877121 11160155 Bon Secours Richmond Health System Inc Bon Secours VA Medical Group I LLC 8580 Magellan Parkway Richmond VA 23227 271908136 Offices of Physicians VA 0 0 Bon Secours Ambulatory Services LLC Richmond Good Help ACO LLC 8580 Magellan Parkway Richmond VA 23227 813119802 Accountable Care Organization VA 0 0 Bon Secours Richmond Health System Inc Bon Secours Health System Inc 1505 Marriotsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) Line 7 Bon Secours Richmond LLC 0 Bon Secours St Mary's Hospital Richmond Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours Richmond Community Hospital 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Bon Secours St Francis Medical Center 8580 Magellan Parkway Richmond VA 23227 311716973 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 1 Rappahanock General Hospital Foundation 101 Harris Road Kilmarnock VA 22482 541210450 Supporting Organization VA 501(c)(3) Line 7 Bon Secours Richmond Health System 1 Chesapeake Medical Group 101 Harris Road Kilmarnock VA 22482 541857174 Healthcare Services VA 501(c)(3) Line 9 Bon Secours Richmond Health System 1 Chesapeake Hospital Corporation PO Box 1449 Kilmarnock VA 22482 237424835 Health Care VA 501(c)(3) Line 3 Bon Secours Richmond Health System 1 IVNA Health Services 5008 Monument Avenue Richmond VA 23230 541479847 Healthcare Services VA 501(c)(3) Line 9 Bon Secours Home Care LLC 1 St Mary's MRI Center LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA N/A RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA N/A Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA N/A Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA N/A Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA N/A CCHC Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 5805 302631 1.00000 1 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System Inc C 629677 124998 1.00000 1 Bon Secours - Virginia HealthSource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc C 28754127 37486703 1.00000 1 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Bon Secours - Virginia HealthSource Inc C 1332243 55658 1.00000 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 Bon Secours St Mary's Hospital Q 180686 FMV Bon Secours St Mary's Hospital R 10345313 FMV Rappahannock General Hospital Foundation A 58333 FMV Bon Secours Richmond Healthcare Foundation C 623079 FMV St Mary's Hospital of Richmond Inc P 3035583 FMV St Mary's Hospital of Richmond Inc C 169999 FMV Bon Secours Richmond Healthcare Foundation B 574596 FMV