2015-07-13T10:57:01-05:00 2014-08-31 990 2013-09-01 521988421 Bon Secours - Richmond Health System Inc BONS 8042818413 8580 Magellan Parkway Building IV Richmond VA 23227 Stephan F Quiriconi Treasurer BSR - VP Finance 8046275400 2015-07-13 0 2013 2016-03-07 17:11:31Z Bon Secours Virginia Bon Secours Virginia Health System Peter J Bernard 8580 Magellan Parkway Building IV Richmond VA 23227 22483289 0 X www.bonsecours.com X 1996 VA Provides support services to related not-for-profit entities within the System. 17 14 189 120 0 0 3202700 3280206 14260222 18888119 0 0 195128 314964 17658050 22483289 0 0 0 0 11701267 13729673 0 0 0 3925797 5419989 15627064 19149662 2030986 3333627 8849497 17284316 3399021 8500213 5450476 8784103 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 78000 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. 15955468 18150463 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)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. 1422011 737656 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 qualify 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 (St. Mary's Hospital, Memorial Regional Medical Center, Richmond Community Hospital, and St. Francis Medical Center). 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 17455479 1 1 0 0 0 0 0 0 0 0 1 0 1 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 1 1 1 1 0 0 1 19 0 1 189 1 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Peter Bernard CEO - Bon Secours Virginia 2.00 48.00 X X 0 1217905 194176 Jeff Brown MD Board Member 2.00 0.00 X 0 0 0 Janice Burnett Board Member 2.00 48.00 X 0 647765 111554 B Keith Fulton Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Reginald Gordon Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Sr Rose Marie Jasinski CBS Board Member 2.00 0.30 X 0 0 0 Jon King Board Member 2.00 0.00 X 0 0 0 Sr Anne Marie Mack CBS President 3.00 47.00 X X 0 0 0 Claudia MacSwain Board Member (Sep-Dec) 2.00 0.00 X 0 0 0 Mary Malone Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Stephan Quiriconi Treasurer/VP Finance (Jan-Aug) 2.00 48.00 X X 0 209652 12819 Pamela Royal MD Board Member 2.00 0.00 X 0 0 0 Pamela Schutz Board Member 2.00 0.00 X 0 0 0 Irvin Seeman MD Board Member 2.00 0.00 X 0 0 0 Robert Sledd Chair 3.00 0.00 X X 0 0 0 Harry Turton Jr Board Member 2.00 0.00 X 0 0 0 Jane Watkins Board Member (Jan-Aug) 2.00 0.00 X 0 0 0 Michel Zajur Board Member 2.00 0.00 X 0 0 0 Allen Goolsby III Secretary 2.00 2.00 X 0 0 0 Melinda Hancock Treasurer/CFO (Sep-Dec) 2.00 48.00 X 0 365950 30891 Jim Godwin VP - Human Resources 1.00 49.00 X 0 218134 33654 Kimberly Kothe RPT 50.00 0.00 X 159850 0 26827 Jennifer Howerton RPT 50.00 0.00 X 151540 0 26440 Lydia Frye RN 50.00 0.00 X 134248 0 29539 Margaret Trent Physical Therapist 50.00 0.00 X 125673 0 26922 Michelle Hafner RN 50.00 0.00 X 124525 0 13965 695836 2659406 506787 9 0 1 0 Balzer and Associates Inc 1208 Corporate Circle Roanoke VA 24018 Engineering/architectural services 152426 1 3280206 3280206 Home Care & Hospice 621610 18150462 18150462 Bon Secours Ambulatory 621990 737657 737657 18888119 JV Income from CVHN 621610 313807 313807 Medical Records 621610 718 718 3rd Party Remittance 622110 439 439 314964 22483289 18888119 0 314964 11186092 10067483 1118609 208647 187782 20865 1445506 1300955 144551 889428 800485 88943 38744 34870 3874 517733 517733 30774 27697 3077 142336 128103 14233 1340 1206 134 460041 414037 46004 636214 572593 63621 10590 9531 1059 3506 3506 244311 219880 24431 30222 27200 3022 Medical Supplies 1056148 1056148 Purchased Services 1022589 920330 102259 Bad Debt 318801 318801 Medical Equip Rental 311643 311643 594997 535496 59501 19149662 17455479 1694183 0 100 1792877 4230069 6886 335251 5456514 2031433 298110 3425081 6440968 8754775 86667 223989 539040 8849497 17284316 708902 1427937 417918 430050 2272201 6642226 3399021 8500213 X 5450476 8784103 5450476 8784103 8849497 17284316 3333627 0 X 0 1 X 1 1 1 X X X 0 0 0 St Mary's Hosp of Richmond Inc 540628017 3 1 1 1 0 Memorial Regional Medical Cntr Inc 541744931 3 1 1 1 0 Richmond Community Hospital Inc 540647482 3 1 1 1 0 St Francis Medical Cntr Inc 311716973 3 1 1 1 0 4 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1258671 58667 1200004 2564235 1972766 591469 1633608 1633608 3425081 Investment in Rappahannock General Hospital 7056184 C Investment in Central Virginia Health Network, Inc. 1698591 F 8754775 Due to BSHSI 5976875 HPL/GL Liability 378070 RGH EHR Liability 287281 6642226 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 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. 0 1 0 0 0 0 0 0 0 Peter Bernard CEO - Bon Secours Virginia 0 785237 0 199179 0 233489 0 166098 0 28078 0 1412081 0 145125 Janice Burnett Board Member 0 475901 0 124998 0 46866 0 91690 0 19864 0 759319 0 18660 Stephan Quiriconi Treasurer/VP Finance (Jan-Aug) 0 181069 0 27384 0 1199 0 3672 0 9147 0 222471 0 0 Melinda Hancock Treasurer/CFO (Sep-Dec) 0 270243 0 56597 0 39110 0 5235 0 25656 0 396841 0 0 Jim Godwin VP - Human Resources 0 187388 0 29001 0 1745 0 6792 0 26862 0 251788 0 0 Kimberly Kothe RPT 158365 0 600 0 885 0 2184 0 24643 0 186677 0 0 0 Jennifer Howerton RPT 150157 0 600 0 783 0 1668 0 24772 0 177980 0 0 0 Lydia Frye RN 133253 0 300 0 695 0 2388 0 27151 0 163787 0 0 0 Margaret Trent Physical Therapist 123879 0 600 0 1194 0 2892 0 24030 0 152595 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, 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 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: Janice Burnett, $22,770; Peter Bernard, $183,101. 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 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 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. Sr. Rose Marie Jasinski and Sr. Anne Marie Mack do not receive payroll distributions as they have each taken a vow of poverty. Bon Secours Ambulatory Services LLC 8580 Magellan Parkway Richmond VA 23227 271672951 All Other Outpatient Care Centers VA 0 0 Bon Secours Richmond Health System Inc Bon Secours Home Care LLC 8580 Magellan Parkway Richmond VA 23227 271672759 Home Health Care Services VA 3333627 1249269 Bon Secours Richmond Health System Inc Bon Secours VA Medical Group I LLC 8580 Magellan Parkway Richmond VA 23227 271908136 Offices of Physicians (Except Mental Health Specialists) VA 0 0 Bon Secours Ambulatory Services LLC Bon Secours VA Medical Group II LLC 8580 Magellan Parkway Richmond VA 23227 271908193 Offices of Physicians (Except Mental Health Specialists) VA 0 0 Bon Secours - Virginia HealthSource Inc Bon Secours Health System Inc 1505 Marriotsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11b, II 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 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 7763 312877 1.00000 1 RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Bon Secours Richmond Health System Inc C 642891 75848 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 30111495 35258911 1.00000 1 Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Bon Secours - Virginia HealthSource Inc C 1231066 294811 1.00000 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 Bon Secours Richmond Healthcare Foundation P 565319 FMV St Mary's Hospital of Richmond Inc S 330011 FMV St Mary's Hospital of Richmond Inc C 2687251 FMV