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Our Lady of Bellefonte Hospital Inc: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
Our Lady of Bellefonte Hospital Inc (EIN 61-1356023)
Tax period
2013-09-01 to 2014-08-31
Filed
2015-07-13
IRS object ID
201531949349300838
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-07-13T14:29:46-05:00ReturnTs
Tax Period End2014-08-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN861065772PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1191 Peachtree St Suite 2000AddressLine1
CityAtlantaCity
StateGAState
ZIP Code303031749ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-09-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN611356023EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Our Lady of Bellefonte Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlOURLBusinessNameControlTxt
Phone6068333333PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1St Christopher DriveAddressLine1
CityAshlandCity
StateKYState
ZIP Code41101ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJoe BuchheitPersonNm
Person TitleChief Financial Officer-BSKHSPersonTitleTxt
Phone6068333600PhoneNum
Signature2015-07-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDavid A CraigPreparerPersonNm
PTINP00542227PTIN
Phone4042201500PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKevin HalterPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1St Christopher DriveAddressLine1
CityAshlandCity
StateKYState
ZIP Code41101ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$161,324,654GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.olbh.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1999FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionAcute Care HospitalActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee1166TotalEmployeeCnt
Total Volunteers175TotalVolunteersCnt
Total Gross UBI$2,352,120TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,226,497PYContributionsGrantsAmt
CY Contributions Grants$819,164CYContributionsGrantsAmt
PY Program Service Revenue$154,224,825PYProgramServiceRevenueAmt
CY Program Service Revenue$158,821,195CYProgramServiceRevenueAmt
PY Investment Income$1,039,437PYInvestmentIncomeAmt
CY Investment Income$536,553CYInvestmentIncomeAmt
PY Other Revenue$3,594,480PYOtherRevenueAmt
CY Other Revenue$1,109,367CYOtherRevenueAmt
PY Total Revenue$161,085,239PYTotalRevenueAmt
CY Total Revenue$161,286,279CYTotalRevenueAmt
PY Grants And Similar Paid$398,990PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$505,633CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$62,560,342PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$57,560,684CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$93,531,062PYOtherExpensesAmt
CY Other Expenses$90,484,793CYOtherExpensesAmt
PY Total Expenses$156,490,394PYTotalExpensesAmt
CY Total Expenses$148,551,110CYTotalExpensesAmt
PY Revenues Less Expenses$4,594,845PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$12,735,169CYRevenuesLessExpensesAmt
Total Assets BOY$117,497,443TotalAssetsBOYAmt
Total Assets EOY$130,194,416TotalAssetsEOYAmt
Total Liabilities BOY$56,898,322TotalLiabilitiesBOYAmt
Total Liabilities EOY$62,831,488TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$60,599,121NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$67,362,928NetAssetsOrFundBalancesEOYAmt
MissionThe 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$138,009,935ExpenseAmt
Grant$505,633GrantAmt
Revenue$156,651,840RevenueAmt
DescTo bring compassion to healthcare and to be good help to those in need by providing healthcare services. Please see community benefit disclosures in Sch H.Desc
Total Program Service Expenses$138,009,935TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document110IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1166EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldKYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Aaron AkersBusinessNameLine1
FieldValueIRS element (for citing)
Phone6068334136PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1St Christopher DriveAddressLine1
CityAshlandCity
StateKYState
ZIP Code41101ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Carol Allen
Board Member2.000.00Yes (X)$0$0$0
Gregory Bausch PharmD
Board Member2.000.00Yes (X)$0$0$0
Mary Carter
Board Member2.000.00Yes (X)$0$0$0
William Dickens
Board Member (Sep-Dec)2.000.00Yes (X)$0$0$0
Mary Flath PhD
Board Member2.000.00Yes (X)$0$0$0
Kevin Halter FACHE
CEO - BSKY20.0030.00Yes (X)$0$397,047$50,246Yes (X)
Lawrence Hubbard CHCIO
Board Member2.0048.00Yes (X)$0$567,216$35,405
Daniel Huffman
Chairman3.000.00Yes (X)$0$0$0Yes (X)
Gregory Jackson
Board Member (Jan-Aug)2.000.50Yes (X)$0$0$0
Connie Johnson
Board Member2.000.00Yes (X)$0$0$0
Larry Jones
Board Member2.000.00Yes (X)$0$0$0
Elizabeth Keith
Board Member2.0048.00Yes (X)$0$251,584$21,389
Phillip Leslie Esq
Board Member2.000.00Yes (X)$0$0$0
James Martin Jr MD
Board Member2.000.00Yes (X)$0$0$0
Jason McCloud OD
Board Member2.000.00Yes (X)$0$0$0
Thomas Morris PhD
President (Jan-Aug)3.0047.00Yes (X)$0$404,206$56,063Yes (X)
Laura Timberlake
Board Member (Jan-Aug)2.000.00Yes (X)$0$0$0
EW Unnikrishnan MD
Board Member2.000.00Yes (X)$0$0$0
John Wallenhorst PhD
President (Sep-Dec)3.0047.00Yes (X)$0$337,082$24,753Yes (X)
Frank Warnock Esq
Board Member (Sep-Dec)2.000.50Yes (X)$0$0$0
William Willan PhD
Board Member2.000.00Yes (X)$0$0$0
Joe Buchheit
Treasurer/CFO-BSKY37.0013.00$294,689$0$22,721Yes (X)
Rodney Hieneman
Secretary (Feb-Aug)2.0048.00$151,235$0$29,810Yes (X)
Jennifer Moore
Secretary (Sep-Dec)2.0048.00$245,758$0$16,013Yes (X)
Daniel Goulson
Chief Medical Officer50.000.00$309,103$0$36,044Yes (X)
Kurt Jaenicke MD
Obstetrician50.000.00$702,880$0$29,991Yes (X)
Yogendra Prasad MD
Cardiologist50.000.00$615,211$0$31,565Yes (X)
Michele Friday MD
Cardiologist49.500.50$574,651$0$29,273Yes (X)
Phillip Lackey MD
Plastic Surgeon50.000.00$395,368$0$29,170Yes (X)
Jason Ford MD
Pediatrician50.000.00$320,901$0$28,844Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,609,796TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,957,135TotReportableCompRltdOrgAmt
Total Other Compensation$441,287TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K44IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
Ashland Anesthesia PSC
PO Box 1377AshlandKY411051377Anesthesia$2,873,513
Morrison Management Specialists Inc
PO Box 102289AtlantaGA303682289Cafeteria/Food Services$2,713,904
Aramark Healthcare
24863 Network PlaceChicagoIL606731248Housekeeping/Laundry and Linen/Lift Team$2,047,255
Biomet
75 Remittance Dr Ste 3283ChicagoIL606753273Equipment Maintenance$1,668,946
Aramark Cts
12483 Collections Center DrChicagoIL60693Equipment Maintenance$1,589,069
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K27CntrctRcvdGreaterThan100KCnt
Related Organizations$194,161RelatedOrganizationsAmt
Government Grants$625,003GovernmentGrantsAmt
Noncash Contributions$10,000NoncashContributionsAmt
Total Contributions$819,164TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPatient Service Rev.Desc
Business622110BusinessCd
Total Revenue Column$158,821,195TotalRevenueColumnAmt
Related Or Exempt Func Income$156,469,075RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,352,120UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$158,821,195TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$254,732TotalRevenueColumnAmt
Exclusion$254,732ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$479,052RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$479,052RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$479,052TotalRevenueColumnAmt
Exclusion$479,052ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$261,826SecuritiesAmt
Other$58,370OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$38,375SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$223,451SecuritiesAmt
Other$58,370OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$281,821TotalRevenueColumnAmt
Exclusion$281,821ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Comm. Health & Fitness621610$291,435$291,435
Retail Pharmacy Rev.446110$182,765$182,765
Cafeteria/Vending531120$78,861$78,861

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$77,254TotalRevenueColumnAmt
Exclusion$77,254ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$630,315OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$161,286,279TotalRevenueColumnAmt
Related Or Exempt Func Income$156,651,840RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,352,120UnrelatedBusinessRevenueAmt
Exclusion$1,463,155ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$505,633TotalAmt
Program Services$505,633ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,125,174TotalAmt
Program Services$1,012,656ProgramServicesAmt
Management And General$112,518ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$42,293,454TotalAmt
Program Services$38,064,109ProgramServicesAmt
Management And General$4,229,345ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$4,205,574TotalAmt
Program Services$3,785,016ProgramServicesAmt
Management And General$420,558ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$6,697,569TotalAmt
Program Services$6,027,812ProgramServicesAmt
Management And General$669,757ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,238,913TotalAmt
Program Services$2,915,022ProgramServicesAmt
Management And General$323,891ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$459,517TotalAmt
Program Services$413,565ProgramServicesAmt
Management And General$45,952ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$103,957TotalAmt
Program Services$93,561ProgramServicesAmt
Management And General$10,396ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$14,969TotalAmt
Program Services$13,472ProgramServicesAmt
Management And General$1,497ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,882,907TotalAmt
Program Services$5,882,907ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$656,149TotalAmt
Program Services$590,534ProgramServicesAmt
Management And General$65,615ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,179,411TotalAmt
Program Services$1,961,470ProgramServicesAmt
Management And General$217,941ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,221,773TotalAmt
Program Services$3,799,596ProgramServicesAmt
Management And General$422,177ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,343,661TotalAmt
Program Services$4,809,295ProgramServicesAmt
Management And General$534,366ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$475,052TotalAmt
Program Services$427,547ProgramServicesAmt
Management And General$47,505ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$46,831TotalAmt
Program Services$42,148ProgramServicesAmt
Management And General$4,683ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,202,100TotalAmt
Program Services$2,202,100ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$8,110,899TotalAmt
Program Services$7,299,809ProgramServicesAmt
Management And General$811,090ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$913,009TotalAmt
Program Services$821,708ProgramServicesAmt
Management And General$91,301ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$24,706,822$24,706,822
Purchased Services$15,424,287$13,881,858$1,542,429
Bad Debt$9,854,494$9,854,494
UBI Tax$1,398$1,398

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$9,887,557TotalAmt
Program Services$8,898,801ProgramServicesAmt
Management And General$988,756ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$148,551,110TotalAmt
Program Services$138,009,935ProgramServicesAmt
Management And General$10,541,175ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,514BOYAmt
EOY$873EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$24,007,552BOYAmt
EOY$38,782,744EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$25,000BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$15,063,673BOYAmt
EOY$17,273,772EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$547,507BOYAmt
EOY$636,277EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,412,570BOYAmt
EOY$3,335,481EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,308,471BOYAmt
EOY$1,532,048EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$127,974,561LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$80,292,500LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$52,241,137BOYAmt
EOY$47,682,061EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$8,419,434BOYAmt
EOY$9,396,308EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$386,930BOYAmt
EOY$308,715EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$265,985BOYAmt
EOY$265,985EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$11,816,670BOYAmt
EOY$10,980,152EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$117,497,443BOYAmt
EOY$130,194,416EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$10,347,979BOYAmt
EOY$12,774,454EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$5,060,840BOYAmt
EOY$4,960,737EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$41,489,503BOYAmt
EOY$45,096,297EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$56,898,322BOYAmt
EOY$62,831,488EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$60,598,561BOYAmt
EOY$67,362,368EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$560BOYAmt
EOY$560EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$60,599,121BOYAmt
EOY$67,362,928EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$117,497,443BOYAmt
EOY$130,194,416EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$12,735,169ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$625,620NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$6,596,982OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$14,969OtherActivitiesAmt
Total Lobbying Expenditures$14,969TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationThe 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.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,557,950OtherCostOrOtherBasisAmt
Book Value$4,557,950BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$57,560,245OtherCostOrOtherBasisAmt
Depreciation$27,408,921DepreciationAmt
Book Value$30,151,324BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,563,271OtherCostOrOtherBasisAmt
Depreciation$2,069,307DepreciationAmt
Book Value$493,964BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$59,723,377OtherCostOrOtherBasisAmt
Depreciation$47,861,905DepreciationAmt
Book Value$11,861,472BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,569,718OtherCostOrOtherBasisAmt
Depreciation$2,952,367DepreciationAmt
Book Value$617,351BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$47,682,061TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDescBook ValueBookValueAmt
HPL/GL$8,197,328
Other Patient and 3rd Party Payers$1,628,576
Due From Affiliates$461,810
Medicare and Medicaid Settlement$359,154
Pharm A/R$241,236
Kentucky Hospital Care Program A/R$80,403
Lifeline A/R/Accrued Int/Misc Clearing$11,645
FieldValueIRS element (for citing)
Total Book Value Other Assets$10,980,152TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
LT Liab - Pension Liability$35,924,813
HPL/GL Liability$8,197,328
Reserves for Medicare and Medicaid$660,743
Medicare and Medicaid Settlements$226,667
Other Misc LT Liability$58,635
Unclaimed Prop Accrual$28,111
FieldValueIRS element (for citing)
Total Liability$45,096,297TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationSchedule 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.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,365,573TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$460,462DirectOffsettingRevenueAmt
Net Community Benefit Expns$905,111NetCommunityBenefitExpnsAmt
Total Expense0.00650TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$27,545,220TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$15,913,453DirectOffsettingRevenueAmt
Net Community Benefit Expns$11,631,767NetCommunityBenefitExpnsAmt
Total Expense0.08390TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$28,910,793TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$16,373,915DirectOffsettingRevenueAmt
Net Community Benefit Expns$12,536,878NetCommunityBenefitExpnsAmt
Total Expense0.09040TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs26ActivitiesOrProgramsCnt
Persons Served16271PersonsServedCnt
Total Community Benefit Expns$195,284TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$640DirectOffsettingRevenueAmt
Net Community Benefit Expns$194,644NetCommunityBenefitExpnsAmt
Total Expense0.00140TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served800PersonsServedCnt
Total Community Benefit Expns$1,047,081TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$247,819DirectOffsettingRevenueAmt
Net Community Benefit Expns$799,262NetCommunityBenefitExpnsAmt
Total Expense0.00580TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served8897PersonsServedCnt
Total Community Benefit Expns$130,170TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$130,170NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs41ActivitiesOrProgramsCnt
Persons Served25968PersonsServedCnt
Total Community Benefit Expns$1,372,535TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$248,459DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,124,076NetCommunityBenefitExpnsAmt
Total Expense0.00810TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs41ActivitiesOrProgramsCnt
Persons Served25968PersonsServedCnt
Total Community Benefit Expns$30,283,328TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$16,622,374DirectOffsettingRevenueAmt
Net Community Benefit Expns$13,660,954NetCommunityBenefitExpnsAmt
Total Expense0.09850TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs4ActivitiesOrProgramsCnt
Persons Served3232PersonsServedCnt
Total Community Benefit Expns$7,440TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,440NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served254PersonsServedCnt
Total Community Benefit Expns$1,801TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,801NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served118PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served1263PersonsServedCnt
Total Community Benefit Expns$2,368TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,368NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs15ActivitiesOrProgramsCnt
Persons Served5110PersonsServedCnt
Total Community Benefit Expns$22,280TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,280NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served14427PersonsServedCnt
Total Community Benefit Expns$33,398TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$33,398NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served74PersonsServedCnt
Total Community Benefit Expns$628TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$628NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs29ActivitiesOrProgramsCnt
Persons Served24478PersonsServedCnt
Total Community Benefit Expns$67,915TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$67,915NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$9,854,494BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$42,543,938ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$44,438,576CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$1,894,638MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Our Lady of Bellefonte Hospital IncBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1St Christopher DriveAddressLine1
CityAshlandCity
StateKYState
ZIP Code41101ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.OLBH.comWebsiteAddressTxt
State License100154StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Teaching HospitalYes (X)TeachingHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Our Lady of Bellefonte Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://www.olbh.comOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Other FactorsYes (X)OtherFactorsInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On Nonpayment0FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Our Lady of Bellefonte Hospital, Inc.Part V, Section B, Line 3: In preparing the OLBH CHNA the hospital collaborated with community service organizations to provide feedback on the questions to be included in the survey. Local Health Dept., local police officers, fire dept., school districts, community based service org, local businesses and representatives from local faith communities, local residents and organizations. Interviews were conducted with several individuals with special knowledge and expertise in public health, representatives of medically underserved and those with chronic disease - Chris Crum, Director of Greenup Co. Health Dept., Maria Hardy, Director Boyd Co. Health Dept., Laura Brown, Director Ironton OH Health Dept. , Debbie Fisher Director Lawrence Co. Ohio Health Dept., Kelli Prater, Director Boyd Co. Head Start, Mary Crowley, NEKCC Free clinic, Debbie Sivis, Director at Shelter of Hope, Alfreda Moore, Director Ashland Community Kitchen, Debbie Blevins, Director of Helping Hands of Greenup KY, Ann Perkins, Director of Safe Harbor, Trish Hall Director of CARES, Eve Greene Nurse at Greenup co. health dept.
Our Lady of Bellefonte Hospital, Inc.Part V, Section B, Line 7: There were 9 health needs identified within the community health needs assessment. Although our efforts focus on obesity the other needs identified are not ignored. Diabetes, (certain) cancer, heart disease, stroke, respiratory problems, and some mental illnesses are all addressed through the obesity focus. This is being done in conjunction with area wide partners. The remaining health issues, some of which are likely to improve with reduction in obesity, have health resources available across the community. Many are being addressed by the larger health system in our community, Kings Daughters Medical Center. There are several other local services addressing these three issues.
Our Lady of Bellefonte Hospital, Inc.Part V, Section B, Line 12i: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy.
Our Lady of Bellefonte Hospital, Inc.Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy.
Our Lady of Bellefonte Hospital, Inc.Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy.
FieldValueIRS element (for citing)
Facility13FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
Med Plaza Pharmacy
700 St Christopher DriveAshlandKY41101Pharmacy
Bellefonte Sleep Lab
118 St Christopher DriveAshlandKY41101Sleep Lab
Ironton MRI
1015 East Ring RoadIrontonOH45638Imaging Center
Vitality Center
1100 St Christopher DriveAshlandKY41101Cardio/Vascular Rehab
Same Day Surgery Center
1101 St Christopher DriveAshlandKY41101Surgery Center
Bellefonte Home Health Care Agency
1819 Ashland RoadGreenupKY41144Home Health
OLBH Pediatric Rehabilitation Clinic
1100 St Christopher DriveAshlandKY41101Pediatric Rehab
Bellefonte Behavioral Health
1000 St Christoopher DriveAshlandKY41101Behavioral Health
Bellefonte Center
1000 Ashland DriveAshlandKY41101Womens Health, Pre-testing, Various physician Offices
Ashland Infusion Center
2930 Carter AveAshlandKY41101Infusion Therapy
Ashland Lab
1816 Carter AveAshlandKY41101Lab Services
Ashland Imaging
1816 Carter AveAshlandKY41101Imaging Center
Ashland Sleep Lab
2920 Winchester AveAshlandKY41101Sleep Lab

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 6a:Annually, Bon Secours Kentucky Health System/Our Lady of Bellefonte Hospital through its Foundation publishes a report for the community, explaining the various community benefit services and programs that exist. This report also includes the annual financial commitment of the local system to the community, detailing monetary contributions for government sponsored healthcare shortfall, community benefit programs and charity care at cost. This report is available to the public each year on or around March 15. This report is avaliable online at http://kentucky.bonsecours.com/about-us-foundation.html
Part I, Line 7:Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program.
Part I, Ln 7 Col(f):The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $9,854,494.
Part II, Community Building Activities:BSKHS is working to engage and empower the members of the Argillite Community located in Greenup County. The Director of Healthy community initiatives is coordinating efforts to unite the communities and aid in health and social issues to support them in improving their quality of life and health. Argillite is a rural community with approximately 1,000 residents; 47% make less than $25,000 per year, 69% of students receive free and reduced lunches. School gardens and walking trails have been built to address nutrition and opportunities for fresh vegetables to help fight obesity. Distribution of free books, backpack program and weekend snack sack program supplying food to students most a risk of going hungry during the weekend. The Ironton, Ohio community is a small urban area of approximately 25,000 residents. The 9th street community is home to subsidize housing for low income seniors and families. Initiatives include computers for community center and senior housing rec rooms used by residents and families, funding after-school programs for low income students needing assistance with homework and providing a safe environment for students. Students participate in summer youth activities at the community center provides the opportunity to go on field trips, safe summer day camp activities and mentors to work with on the various topics. Community garden opened in the spring of 2013, the garden provides community residents with space to grow fresh vegetables to use in family meals. Work with a local farmers market resulted in availability of fresh fruit and vegetables in an area that is labeled a food dessert. Healthy Community Services conducted 127 health fairs, providing approximately 8,696 health screenings for chronic conditions such as heart disease, diabetes, osteoporosis, anemia, glaucoma, and peripheral vascular disease. All participants in our health fairs received personal health counseling and those with abnormal results received educational materials and the offer of assistance in finding a health care provider if they had none. Information about the Northeast KY care center (NEKCC), the local "Free Clinic" was also given to participants who were uninsured or could not afford a health care provider. Three of our BPS physician staff volunteer at least once a month at the NEKCC. Additionally Healthy Community services conducted 17 community CPR classes in 2014 resulting in 87 individuals being certified in adult, infant and child CPR. We offered 3 safe sitter classes and certified 20 young people as safe sitters. With grant funding from the Paula Nye foundations, we were able to offer an expanded bicycle safety camp in 2014 with 91 children and their families in attendance. We currently have faith ministry or faith community nurse partnerships with 54 local churches with 27 additional congregations on our mailing list. Our Healthy Community Services Van Ministry provided free non-emergency medical transportation for outpatient services on the OLBH campus and to patients who had appointments with campus or BPS-affiliated physicians. We operate three vans --one of which is equipped with a wheelchair lift. In an area which has very limited public transportation, our van ministry provides an option for our patients who need treatment but have no means of affordable non-emergency medical transportation. In FY14 our van ministry provided over 2,479 round trips and traveled over 64,000 miles. We served over 403 individuals in FY14 transporting most of these individuals multiple times. This represents 103 more individuals served than in 2013. Our Meals on Wheels programs serve 212 home-bound seniors in 10 communities for an average of 4,664 meals delivered each month. We provide approximately $1,150 in free or reduced price meals each month. BSKHS provides a women's services mobile health clinic that offers mammography screening monthly. In FY14 we provided 912 mobile mammography screenings and 210 in house screenings through grant funding to individuals that are uninsured or underinsured.
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 7: The organization feels the total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publically insured patients where reimbursement is less than cost of providing the service.
Part III, Line 9b:The hospital has a written policy that describes collection practices applying to patients 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:Bon Secours Kentucky Health System / Our Lady of Bellefonte Hospital uses multiple approaches to assess the health needs of the communities it serves. We have a community based Board of Directors that provides the hospital with guidance and input on services needed in the local community through contacts with local business and government leaders. Community health screening data is gathered through the year and analyzed for use in planning. Community need assessments are updated using a variety of informational sources including Kentucky Health Information for state-based performance data, Kentucky Hospital Association info site for market and geographic data bases, third party data bases, US Census Bureau data and Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to Our Lady of Bellefonte Hospital. We have also developed regional alignment plans using this data and tying it to our underserved areas to plan for future growth in the communities we serve by providing more access points for patients in our service areas.The community health care needs assessment was open to the public through a web based survey and available as a print copy, working with local health departments we participated in health needs assessments through these organizations, conversations with local residents and health professionals, public forums and community meetings and coalitions all contribute to the assessment of the community health care needs.
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 200% 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 Kentucky Health System, Our Lady of Bellefonte Hospital serves a region of approximately 400,000 people in northeastern Kentucky, southern Ohio, and western West Virginia, The service areas includes six counties in northern Kentucky (Greenup, Boyd, Lawrence, Carter, and Elliott) which comprises the FIVCO Area Development District as well as Lewis County, two counties in southern Ohio (Lawrence, Scioto) and Wayne and Cabell counties in western West Virginia. Due to our growing aging population services for our community residents aged 55 and older are needed, particularly women's health, orthopedics, diabetes, cardiopulmonary services, cancer, drug rehab and wound care. The 55 and older population is expected to increase by 14% over the next five years. The high poverty and high unemployment rate in the area result in a low social economic status. It is a very industrialized region which creates carcinogens and unhealthy life styles especially in eastern Kentucky, which has some of the highest incidence in the country of smoking, diabetes, obesity and carcinogens. These demographic characteristics create a high demand for chronic disease health care, including diabetes, cancer and heart disease among others.OLBH conducted a demographic analysis of the hospitals service. OLBH is located in Greenup County, KY, with approximately 14,000 households about 14 percent are living in poverty and 15 percent are age 65 and older. In adjacent counties, the poverty rate is 15 percent in Boyd County; 22 percent in Carter County; 29 percent in Lewis County; and approximately 19 percent in Lawrence County, Ohio. Lack of well-paying jobs has contributed to the rate of poverty in this area. According the U.S. Census gathered in 2010, Hispanics make up less than one percent of the hospital's service area. However, there are marked increases of the Hispanic population at OLBH's primary care centers in Carter County KY, in particular, where many residents still make a living through tobacco and other farm crops.According to the County Health rankings data 2011, the counties in OLBH primary service area rank among the highest in the state at risk for poor health outcomes and poor Health factors. Consistent with the state and national trends five chronic diseases account for most of the spending on health care: diabetes, heart disease, hypertension, asthma and depression. Prescription drug abuse and adduction is a growing problem in the area as is illegal drug use including methamphetamine, cocaine and marijuana. Access to quality preventative care and disease management education is critical in minimizing future hospitalizations as well as the seriousness of these diseases. Health insurance coverage is also a factor in determining whether patients will seek preventative care or wait for symptoms to become more severe, thus requiring more extensive treatments, including hospitalization.The area's growing drug addiction problems puts these individuals more at risk for depression, suicides and kidney failure. The area's population of drug abuse by all ages is growing at a relatively fast pace and will necessitate planning of and access to health care services unique to this population. There are few exceptions to our local community versus state averages with regard to health impacts. Our service area has higher overall cancer rates in Lung Cancer than the state average. Other cancers that are prevalent in our primary and secondary service areas are breast, colon, bladder, prostate and lymphoma.
Part VI, Line 5:OLBH has been instrumental in developing programs to meet the needs of uninsured and low income families. A free health care clinic Northeast Kentucky Care Center (NEKCC), serves uninsured adult residents of Boyd and Greenup Counties. OLBH has provided the clinic with financial support, volunteer personnel, and supplies. A van ministry that provides free non-emergency medical transportation for outpatient services at our campus and primary care centers; developing the Greenup County Interagency Council; a county drug task force, Greenup Residents Ending Addiction Together (GREAT); church partnerships with 54 churches to develop health ministry and/or faith community nursing programs; and our support of the previously mentioned Northeast Kentucky Care Center and Greenup County Health Department MAPP project.-Healthy Choices Kentucky: This coalition is tackling the obesity problem in our communities. HCK has focused on providing more opportunities for increasing physical activity and on improving nutrition. Some of the successes of the Coalition in 2014 include the development of some new walking trails in the city of Ashland, implementing a geocaching program in both Boyd and Greenup counties, and partnering with local restaurants and grocers to improve community access to healthy foods.-OLBH Homeless Care Initiative: This coalition of nurses and other OLBH personnel has provided health screening and flu shots to the homeless population of our community. Many of them volunteer at Church Without Walls, a worship service in Central Park on Saturday mornings that also provides breakfast. This initiative has collected coats, toiletries and food throughout the year to meet the needs of the homeless population.-OLBH Green Team: The OLBH Green Team has implemented recycling programs (plastic, aluminum, electronics, printer cartridges and toners, cardboard, batteries, etc.) that offer the opportunity for our community residents to be better stewards of our earth and live in a healthier environment. In 2014, the team took on the project of renovating a walking trail on our campus that provides an opportunity for employees and community residents to walk, garden (adopt-a-flower-bed program) or just enjoy nature. The team also operates a clothing closet, has regular clean-up days for our campus and participates in Cell Phones for Soldiers by donating old cell phones to provide talk time for American military personnel around the world.-Greenup County Interagency Council: OLBH provides leadership for this council that provides an opportunity for service agencies in Greenup County to meet monthly for networking and collaboration. These meetings have resulted in multiple partnerships and projects that benefit the community including a volunteer mentoring program that matches trained mentors from local congregations with students and/or families dealing with substance abuse issues; a nutrition education program that included cooking and canning classes by the cooperative extension agency, provision of fresh produce by the county farmers' markets and a celebratory health fair at the conclusion of the program that provided health screenings and information; and a Greenup County diabetes coalition. We work with companies to assist them in identifying needs for care for their employees by providing a health screening and analysis tool and help develop programming to address those needs. We also provide a free program to local business community to provide employee health assessments and DOT physicals as well as drug screenings for their employees.
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 StatesKY

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Bon Secours Kentucky Health System Foundation IncBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1St Christopher DriveAddressLine1
CityAshlandCity
StateKYState
ZIP Code41101ZIPCode
FieldValueIRS element (for citing)
Recipient EIN611381952RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$505,633CashGrantAmt
Purpose Of GrantGeneral and Administrative SupportPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationThe 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E Expnss0WrittenPolicyRefTAndEExpnssInd
Substantiation Required0SubstantiationRequiredInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Kevin Halter FACHE
CEO - BSKY$0$302,354$0$49,988$0$44,705$0$23,626$0$26,620$0$447,293$0$1,525
Lawrence Hubbard CHCIO
Board Member$0$374,924$0$99,856$0$92,436$0$15,300$0$20,105$0$602,621$0$0
Elizabeth Keith
Board Member$0$148,792$0$42,396$0$60,396$0$10,185$0$11,204$0$272,973$0$11,022
Thomas Morris PhD
President (Jan-Aug)$0$286,607$0$77,693$0$39,906$0$36,404$0$19,659$0$460,269$0$11,391
John Wallenhorst PhD
President (Sep-Dec)$0$225,989$0$63,875$0$47,218$0$14,568$0$10,185$0$361,835$0$801
Joe Buchheit
Treasurer/CFO-BSKY$220,097$0$29,649$0$44,943$0$4,536$0$18,185$0$317,410$0$3,075$0
Rodney Hieneman
Secretary (Feb-Aug)$137,150$0$13,178$0$907$0$6,036$0$23,774$0$181,045$0$0$0
Jennifer Moore
Secretary (Sep-Dec)$179,795$0$24,067$0$41,896$0$6,672$0$9,341$0$261,771$0$0$0
Daniel Goulson
Chief Medical Officer$281,069$0$26,395$0$1,639$0$11,475$0$24,569$0$345,147$0$0$0
Kurt Jaenicke MD
Obstetrician$342,349$0$358,828$0$1,703$0$4,512$0$25,479$0$732,871$0$0$0
Yogendra Prasad MD
Cardiologist$440,358$0$173,150$0$1,703$0$4,188$0$27,377$0$646,776$0$0$0
Michele Friday MD
Cardiologist$492,942$0$80,241$0$1,468$0$4,404$0$24,869$0$603,924$0$0$0
Phillip Lackey MD
Plastic Surgeon$393,853$0$0$0$1,515$0$4,200$0$24,970$0$424,538$0$0$0
Jason Ford MD
Pediatrician$128,899$0$191,022$0$980$0$5,076$0$23,768$0$349,745$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aTax indemnification and gross-up: Certain full time individuals (7) listed on Form 990, Part VII received gift cards valued at $100. The value of the gift cards were reported as taxable compensation. In an effort to reduce the tax impact of these gifts, each recipient received additional taxable compensation of $50 which was added to their paycheck.
Part I, Line 3Bon 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 4bThe 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: Elizabeth Keith, $20,272; Kevin Halter, FACHE, $3,706; John Wallenhorst, PhD, $903; Joe Buchheit, $3,956; Thomas Morris, PhD, $17,448.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2Board members Philip B. Leslie and Frank Warnock have a business relationship.
Form 990, Part VI, Section A, line 6Bon Secours Health System, Inc. is the sole member of Bon Secours Kentucky Health System, Inc. which in turn is the sole member of Our Lady of Bellefonte Hospital, Inc.
Form 990, Part VI, Section A, line 7aThe governing body of Our Lady of Bellefonte Hospital, 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 7bCertain authorities of Our Lady of Bellefonte Hospital, Inc. are reserved to its member or to Bon Secours Health System, Inc.
Form 990, Part VI, Section B, line 11The 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 12cThe 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 15The 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's 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 19Our Lady of Bellefonte Hospital, Inc. 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:Minimum Pension Liability -4,570,231. Transfer to BSHSI for Swaps & Debt -2,026,751.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
Bon Secours Health System Inc
1505 Marriottsville RoadMarriottsvilleMD21104521301088Parent Org. Management ServicesMD501(c)(3)Line 11c, III-FIBon Secours Inc0
Bellefonte Physician Services Inc
1000 St Christopher DriveAshlandKY41101352320780Physician PracticesKY501(c)(3)Line 9Bon Secours Kentucky Health System Inc0
Our Lady of Bellefonte Hospital Foundation
1000 St Christopher DriveAshlandKY41101611381952Grant Making FoundationKY501(c)(3)Line 7Bon Secours Kentucky Health System Inc0
Bon Secours Kentucky Health System Inc
1000 St Christopher DriveAshlandKY41101611356024Local System Parent Org.KY501(c)(3)Line 11c, III-FIBon Secours Health System Inc0
Our Lady of Bellefonte Hospital Auxiliary
1000 St Christopher DriveAshlandKY41101610488859Fundraising for Our Lady of Bellefonte HospitalKY501(c)(3)0N/A
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd