2015-07-13T14:55:38-05:00 2014-08-31 861065772 Deloitte Tax LLP 191 Peachtree St Suite 2000 Atlanta GA 303031749 990 2013-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Richard Jones Chief Financial Officer-BSBHS 4103624477 2015-07-13 1 David A Craig P00542227 4042201500 2013 2016-02-25 16:41:14Z BS Hospital Specialty Center New Hope BS Renal Dialysis Center Samuel L Ross MD 2000 West Baltimore Street Baltimore MD 212231558 130687080 0 0928 X www.bonsecoursbaltimore.com X 1920 MD Acute Care Hospital 13 11 1058 100 28111 22573 3268385 5874116 123541704 123313094 1473124 804198 808303 590358 129091516 130581766 150425 252706 0 0 64049993 60034081 0 0 0 73655506 67338603 137855924 127625390 -8764408 2956376 71145793 75014730 155818768 157282734 -84672975 -82268004 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 118101003 252706 123313094 Bon Secours Baltimore Hospital provides both inpatient and outpatient services. Such services include:Inpatient Services - 151 licensed beds for critical care, medical, psychiatric and surgical needs. The Hospital provides a full range of srvices & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care; Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; Employment Services; Family Support Center; Financial Education; Infectious Disease Care; Lab Services; Mammography; Neurology; Nuclear Medicine; Ophthalmology; Orthopedics; Faith Community Nurse Services; Pastoral Care; Pharmacy; Physical Therapy; Podiatry; Psychiatry; Pulmonary Services and Primary Care.Outpatient Services include: renal dialysis, HIV/AIDS services, mental health, substance abuse treatment, health education, cardiac rehabilitation and wellness programs and tele-health program for patients with congestive heart disease. The Hospital operates an emergency room that is open 24 hours per day, seven days per week, serving persons regardless of their ability to pay. See Sch H for additional information. 118101003 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 110 0 1 1058 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Ackneil Muldrow Chair 3.00 0.50 X X 0 0 0 Samuel Ross MD CEO - BSBHS 21.00 29.00 X X 0 691072 84352 Sr Anne Lutz President 3.00 47.00 X X 0 0 0 Martha Riva Board Member 2.00 48.00 X 0 444872 78818 Mary Beachley Board Member 2.00 0.00 X 0 0 0 Patricia Scipio Board Member 2.00 0.00 X 0 0 0 Sr Mary Shimo Board Member 2.00 48.00 X 0 0 0 Matthew Hemelt Board Member 2.00 0.00 X 0 0 0 Jeffrey Richardson Board Member 2.00 0.00 X 0 0 0 Anthony Stanowski Board Member 2.00 0.00 X 0 0 0 Keshia Pollack Board Member 2.00 0.00 X 0 0 0 Theodore Wimberly Board Member 2.00 0.00 X 0 0 0 Br Art Caliman President (Sep-Dec) 3.00 47.00 X X 0 0 0 Glendora Hughes Esq Chair (Sep-Dec) 2.00 0.00 X X 0 0 0 Lisa Williams Board Member 2.00 0.00 X 0 0 0 Richard Jones Treasurer/CFO - BSBHS 33.50 16.50 X 99155 354183 22596 Matthew Ansel Interim CNE 50.00 0.00 X 171049 0 15912 Arsalan Sheikh MD Chief Medical Officer 50.00 0.00 X 194862 0 15418 Sidney Mir MD VP - Medical Affairs 50.00 0.00 X 299762 0 14460 Madhu Bhasin Staff Nurse 50.00 0.00 X 218527 0 4055 Aliya Jones Psychiatrist 50.00 0.00 X 212133 0 23940 Lesia Douglas MD CNE/VP - Patient Care (Sep) 50.00 0.00 X 200817 0 18201 Usha Jain MD Chief Pathologist 49.50 0.50 X 284576 0 23968 1680881 1490127 301720 69 0 1 0 University of Maryland 110 South Paca St Baltimore MD 21201 ED Physician Services 4044933 Cardinal Health PO Box 905867 Charlotte NC 28290 Pharmacy Mgmt Services 2140463 Johnson Controls Inc PO Box 423 Milwaukee WI 53201 Maintenance Services 1857778 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 1742400 MDICS Management LLC 6934 Aviation Blvd Suite B Glen Burnie MD 21061 Physician Services 1651885 70 676239 5182877 15000 5874116 Net Patient Service Re 621110 123313094 123313094 123313094 117359 117359 290145 0 290145 290145 290145 344145 448008 0 105314 344145 342694 686839 686839 Parking 812930 138699 138699 Rebates 900099 46528 46528 Cafe and Vending 722212 36413 36413 78573 28111 50462 300213 130581766 123313094 28111 1366445 135996 135996 116710 116710 530587 477528 53059 46953967 42258570 4695397 2814860 2533374 281486 5796193 5216574 579619 3938474 3544627 393847 366390 329751 36639 237796 214016 23780 11526 10373 1153 12177267 12177267 337412 303671 33741 1786844 1608160 178684 3157510 2841759 315751 2571927 2314734 257193 257850 232065 25785 198407 178566 19841 1352004 1352004 4561631 4105468 456163 1131588 1018429 113159 Purchased Services 16513619 14862257 1651362 Medical Supplies 9471450 9471450 Bad Debt Expense 9168388 9168388 Federal Taxes for UBI 4476 4476 4032518 3629266 403252 127625390 118101003 9524387 0 X 6328 2163 472182 360056 914728 895663 18155331 19616127 1414394 1314763 1287756 1271530 99739959 68962851 28555969 30777108 10829311 12085794 9509794 8691526 71145793 75014730 16088660 16555558 40086 36852 139690022 140690324 155818768 157282734 X -85327413 -82588778 654438 320774 -84672975 -82268004 71145793 75014730 X 2956376 804690 -1356095 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 11526 11526 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. 0 1 X 637500 637500 50318639 32196681 18121958 45514462 34553253 10961209 3269358 2212917 1056441 30777108 HPL/GL Asset 6251758 Due from Affiliates 1835356 Due from BSHSI 346318 Miscellaneous A/R 138355 Staff Loans 66479 Resident Trust 36852 LT Noncash Investment 13150 Rent Receivable 3258 8691526 Due to BSHSI 105168575 Pension Liability 19575831 Liability - HPL/GL 6251758 Medicaid and Insurance Advances 3319608 Capital Leases 2378417 Patient Credit Balances 1753891 Liability - FIN 47 1486411 Medicare Reserve 232340 Other Misc Liabilities 523493 140690324 X Part IV, Line 2b: Bon Secours Hospital Baltimore holds, safeguards, manages and accounts for the Social Security funds of certain patients. These funds are held in an FDIC insured banking institution. With the assistance of hospital personnel, funds are generally accessed by the patient through the use of ATM cards or Visa gift cards which are purchased on their behalf. 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 of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $61,513 and $66,681 of net operating loss carryforwards as of August 31, 2014 and 2013, respectively, which expire in varying periods through 2034 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2014 and 2013. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 7587392 7587392 0.06410 7587392 7587392 0.06410 14 21960 5120203 5120203 0.04320 2 524 353342 353342 0.00300 2 16803 9610026 4109484 5500542 0.04640 1 0 103863 103863 0.00090 19 39287 15187434 4109484 11077950 0.09350 19 39287 22774826 4109484 18665342 0.15760 1 9168388 0 33323290 26071416 7251874 X 1 1 1 1 Bon Secours Hospital Baltimore Inc 2000 W Baltimore St Baltimore MD 212231558 http://bonsecoursbaltimore.com/ 30-007 X X X X Bon Secours Hospital Baltimore Inc 1 1 X X X X X X X X 12 1 0 1 X http://baltimore.bonsecours.com X X X X X X X X X 1 0 1 1 250.000000000000 1 250.000000000000 1 X X 1 1 X X X X X X 0 0 1 X 0 0 Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 3: We utilized several methods for gathering input including a series of community meetings where issues were identified and prioritized; review and analysis of previous community engagement activities; convening a health care summit to launch a primary care access study; one on one interviews and a community needs/desires survey. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 12i: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. 3 Bon Secours CIBSNew Passage 3101 Towanda Ave Baltimore MD 21215 Behavioral Health Servies New Hope 2401 W Baltimore St Baltimore MD 21223 Behavioral Health Servies Bon Secours Washington Village 700 Washington Blvd Baltimore MD 21230 Community Medical Center Part I, Line 7: Part I, Line 7b: Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.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: $9,168,388. 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 40 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. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, 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 exist 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 twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve months, the patient is responsible for reapplying for FAP eligibility. Part VI, Line 2: Over the period of 2009-2012 Bon Secours Baltimore Hospital conducted a Community Health Needs Assessment that included meetings, interviews, community summits and literature studies and the engagement of those representatives of our community with a knowledge of public health, the broad interests of the communities we serve, as well as individuals with special knowledge of the medically underserved, as well as low-income and vulnerable populations and people with chronic diseases.This Assessment determined that to address the most significant health needs of our service area we must develop a plan of action:- To help make Southwest Baltimore a place where residents live long, satisfying lives, are proactive about their health and wellness, understand the importance of healthful eating and have access to healthful foods in a variety of locations and outlets, including at the hospital.- To help make Southwest Baltimore a community where residents are ready to work, are self-sufficient and have access to jobs that enable them to support themselves and their families.- To help make Southwest Baltimore a more environmentally-friendly community, lush with nature and green, open spaces, lead-free and with air that is safe to breathe and water that is safe to drink. - To develop a coalition to be made up of senior leaders from the organizations which comprise the core of West Baltimore's health care safety net. - To focus on primary care engagement, expanding primary care capacity, and preparing for the Affordable Care Act. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens 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. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 250% of the Federal Poverty Guidelines ("FPG"), A sliding scale assistance policy is afforded patients that exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family suffers a catastrophic financial burden to receive necessary health care services. Based on research conducted by the Tax Foundation, a non partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. In addition, a variety of other potential payment options are available. Bon Secours is 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 process. Part VI, Line 4: Bon Secours Baltimore Health System primarily serves four zip codes in West Baltimore: 21223, 21229, 21216 & 21217. Bon Secours Baltimore Health System's Community Health Needs Assessment has taken into account challenges and conditions in its primary service area as described above with a special emphasis on the surrounding the hospital, known as "Old Southwest Baltimore." Bon Secours has maintained a constant presence in this part of Baltimore for over 130 years and it is the community where most of BSBHS's services are located. The conditions and social determinants of health in the direct area serviced by BSBHS also are of concern in the broader service area and the health and socioeconomic status of the direct area mirrors that of the broader service area. Old Southwest Baltimore has a population of more than 17,885 (2010 Census) people, many of whom are medically and economically underserved. The socioeconomic status, ethnic diversity and health status of residents, according to the Baltimore City Health Department, indicates that 27% of the population is between 0-17 years; 76% are African American; 31% do not have a high school diploma or equivalent; 43% of those ages 16-64 are not employed; 44% of households make less than $25,000; and the leading causes of health-related deaths are heart disease, HIV/AIDS, substance abuse and diabetes. In fact, in the neighborhoods served by the hospital, residents die from heart disease at a rate that is 35% higher than the city as a whole. Deaths from diabetes and HIV/AIDS are also substantially higher than in the entire city. And residents of certain areas along the West Baltimore Street corridor have a life expectancy of 64.2 years, compared to almost 71 years for the entire city. Part VI, Line 5: BS Baltimore has an open medical staff with privileges available to all qualified physicians in the area. BS Baltimore is governed by a board of directors whose composition is representative of the community it serves. 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, 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. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to: - Improve Health Locally and Globally- Build Partnerships for Population Health As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and it's 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. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world." Please see Schedule R for listings of the related organizations. Part VI, Line 7, Reports Filed With States MD 1 Uptown Ventures Group 113 East 125th St New York NY 10035 461422024 Other 5000 General Support Center for Urban Families 2201 N Monroe St Baltimore MD 21217 522142708 501(C)(3) 5000 General Support BLK Maryland African American Museum Corporation 830 E Pratt St Baltimore MD 21202 522107879 501(C)(3) 5000 General Support American Heart Association 216 E Redwood St Baltimore MD 21202 135613797 501(C)(3) 15000 Patient Centered Medical Home Grant American Diabetes Association 1701 North Beauregard St Alexandria VA 22311 131623888 501(C)(3) 10000 Program Service Support Baltimore Medical System Inc 3501 Sinclair Lane Baltimore MD 21213 521358241 501(C)(3) 10000 General Support Saint Agnes Foundation 900 Caton Ave Baltimore MD 21229 521415083 501(C)(3) 10000 General Support Health Freedom Inc 2901 Druid Park Dr Baltimore MD 21215 202797813 501(C)(3) 10000 General Support Chesapeake Center for Youth Development 301 East Patapsco Ave Baltimore MD 21225 521004559 501(C)(3) 10000 General Support Coppin State University 2500 West North Ave Baltimore MD 21216 526002033 Other 20000 General Support Ames Shalom Community Inc 613 Baker Street Baltimore MD 21217 522224538 501(C)(3) 10000 General Support Thomas Jefferson Elementary School 605 Dryden Drive Baltimore MD 21229 522064235 Other 10000 General Support 9 3 Emergency Assistance Funds for Patients, Volunteers, & Employees 94 46603 Cab Fare for the Indigent 274 70107 Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 1 1 0 0 0 0 0 0 0 Samuel Ross MD CEO - BSBHS 0 544818 0 78880 0 67374 0 64863 0 19489 0 775424 0 9962 Martha Riva Board Member 0 316103 0 86159 0 42610 0 48777 0 30041 0 523690 0 0 Richard Jones Treasurer/CFO - BSBHS 93133 252535 0 73000 6022 28648 3778 7367 3813 7638 106746 369188 0 0 Matthew Ansel Interim CNE 162101 0 7905 0 1043 0 3059 0 12853 0 186961 0 0 0 Arsalan Sheikh MD Chief Medical Officer 184330 0 10000 0 532 0 1500 0 13918 0 210280 0 0 0 Sidney Mir MD VP - Medical Affairs 52396 0 0 0 247366 0 3080 0 11380 0 314222 0 0 0 Madhu Bhasin Staff Nurse 217529 0 0 0 998 0 3171 0 884 0 222582 0 0 0 Aliya Jones Psychiatrist 211574 0 0 0 559 0 0 0 23940 0 236073 0 0 0 Lesia Douglas MD CNE/VP - Patient Care (Sep) 130577 0 13483 0 56757 0 4839 0 13362 0 219018 0 0 0 Usha Jain MD Chief Pathologist 280133 0 0 0 4443 0 10200 0 13768 0 308544 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: Sidney Mir, MD, $212,068; Lesia Douglas, MD, $42,178. The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Samuel Ross, MD, $21,465. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Baltimore Health Systems, Inc., which in turn is the sole member of Bon Secours Hospital Baltimore, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Hospital Baltimore, Inc. is appointed by its member Bon Secours Baltimore Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Hospital Baltimore, Inc. 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 15 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. Form 990, Part VI, Section B, Line 15b - 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. Br. Art Caliman, Sr. Mary Shimo, and Sr. Anne Lutz do not receive payroll distributions as they have taken vows of poverty. Form 990, Part X, Lines 19 & 25 On the prior year return, amounts were reported on Line 19 as deferred revenues when in fact the amounts should have been reported on Line 25 as other liabilities. We have updated the prior year balance on this return as the change is presentational in nature and does not have an effect on the overall balance sheet. Form 990, Part XI, line 9: Minimum Pension Liability -64,800. Transfers to BSHSI for Debt Principal, Swaps and Pension -1,291,296. Rounding 1. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 The Bon Secours of Maryland Foundation Inc dba Community Works 26 N Fulton Avenue Baltimore MD 21223 521732800 Community Foundation MD 501(c)(3) Line 7 Bon Secours Baltimore Health System Inc 0 Unity Properties Inc 26 N Fulton Avenue Baltimore MD 21223 521857768 Low Income Housing MD 501(c)(3) Line 7 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Development Inc 26 N Fulton Avenue Baltimore MD 21223 760785344 Low Income Housing MD 501(c)(3) Line 7 Unity Properties Inc 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) Line 7 Bon Secours Baltimore Health System Inc 0 Bon Secours Housing 26 N Fulton Avenue Baltimore MD 21223 521442707 Low Income Housing MD 501(c)(3) Line 9 Bon Secours of Maryland Foundation 0 Bon Secours Housing II 26 N Fulton Avenue Baltimore MD 21223 521543174 Low Income Housing MD 501(c)(3) Line 9 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Health Corp(dba Bon Secours Baltimore Health System) 2000 W Baltimore Street Baltimore MD 21223 800728893 Local System Parent Org MD 501(c)(3) Line 11c, III-FI Bon Secours Health System Inc 0 Bon Secours Apartments LP 1800 W Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD N/A Bon Secours Apartments II LP 1800 W Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD N/A Liberty Senior Housing LP 1800 W Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD N/A Bon Secours Apartments III LP 1800 W Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD N/A Bon Secours Smallwood Summit 26 N Fulton Avenue Baltimore MD 21223 522280175 Low Income Housing MD N/A Bon Secours Chesapeake Apartments LP 26 N Fulton Avenue Baltimore MD 21223 200107034 Low Income Housing MD N/A Bon Secours Shiloh LP 26 N Fulton Avenue Baltimore MD 21223 203965243 Low Income Housing MD N/A Bon Secours Wayland LP 26 N Fulton Avenue Baltimore MD 21223 270468688 Low Income Housing MD N/A Bon Secours Benet House LP 26 N Fulton Avenue Baltimore MD 21223 364765400 Low Income Housing MD N/A Bon Secours Benet House LLC 26 N Fulton Avenue Baltimore MD 21223 463055312 Low Income Housing MD N/A Unity Housing Inc 26 N Fulton Avenue Baltimore MD 212231624 521952507 Low Income Housing MD N/A C 0 Bon Secours Wayland LLC 26 N Fulton Avenue Baltimore MD 212231624 270468561 Low Income Housing MD N/A C 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0