2014-07-14T21:26:23-05:00 2013-08-31 861065772 Deloitte Tax LLP 191 Peachtree St SUITE 2000 ATLANTA GA 303031749 990 2012-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Richard Jones 4103624477 2014-07-14 1 David A Craig P00542227 4042201500 2012 2015-11-30 17:44:51Z BS Hospital Specialty Center New Hope BS Renal Dialysis Center Samuel L Ross MD 2000 West Baltimore Street Baltimore MD 212231558 129091516 0 0928 X www.bonsecoursbaltimore.com X 1920 MD Acute Care Hospital 15 13 1130 100 22357 10411 1017085 3268385 136083583 123541704 904165 1473124 787507 808303 138792340 129091516 197872 150425 0 0 61919999 64049993 0 0 0 76163514 73655506 138281385 137855924 510955 -8764408 72332787 71145793 157340732 155818768 -85007945 -84672975 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 125548197 150425 123541704 Bon Secours Baltimore Hospital provides both inpatient and outpatient services. Such services include:Inpatient Services - 151 licensed beds for critical care, medical, psychiatric and surgical needs. BSBHS provides a full range of services & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; Employment Services; Family Support Center; Financial Education; Infectious Disease Care; Lab Services; Mammography; Neurology; Nuclear Medicine; Ophthalmology; Orthopedics; Faith Community Nurse Services; Pastoral Care; Pharmacy; Physical Therapy; Podiatry; Psychiatry; Pulmonary Services; Primary Care; Senior & Family Housing; Smoking Cessation; Social Work; Substance Abuse Treatment; Surgery; a Wellness & Fitness Center; Vascular Services; & the Women's Resource Center. Outpatient Services - including renal dialysis, HIV/AIDS services, mental health, substance abuse treatment, health education, cardiac rehabilitation and wellness programs and tele-health program for patients with congestive heart disease. BSBSH operates an emergency room that is open 24 hours per day, seven days per week, serving persons regardless of their ability to pay. See Sch H for additional information. 125548197 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 98 0 1 1130 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X Laura Ellison 4433672212 8990 Old Annapolis Road Columbia MD 21045 X Mary Lenore Beachley 2.00 0.00 X 0 0 0 Matthew Hemelt 2.00 0.00 X 0 0 0 Keshia Pollack 2.00 0.00 X 0 0 0 Jeffrey Richardson 2.00 0.00 X 0 0 0 Martha Riva 2.00 48.00 X 0 582458 80518 Patricia Scipio 2.00 0.00 X 0 0 0 Sr Mary Shimo 2.00 48.00 X 0 0 0 Alan Siegfried 2.00 0.00 X 0 0 0 Anthony Stanowski 2.00 0.00 X 0 0 0 Lisa Williams 2.00 0.00 X 0 0 0 Theodore Wimberly 2.00 0.00 X 0 0 0 Bro Art Caliman 3.00 47.00 X X 0 0 0 Glendora Hughes Esq 3.00 0.00 X X 0 0 0 Ackneil Muldrow 2.00 1.00 X X 0 0 0 Samuel L Ross MD 21.00 29.00 X X 0 938123 76328 Richard Jones 33.50 16.50 X 350744 0 21792 Matthew Ansel 50.00 0.00 X 176845 0 13803 Leroy Bell 50.00 0.00 X 234673 0 7221 Lesia Douglas 50.00 0.00 X 209302 0 24778 Usha Jain MD 50.00 0.00 X 289282 0 21732 Sidney Mir 50.00 0.00 X 286497 0 18453 Shivani Myer MD 50.00 0.00 X 236694 0 18910 Fabienne Larkins 0.00 0.00 X 246932 0 7905 2030969 1520581 291440 77 1 1 0 University of Maryland 110 South Paca St Baltimore MD 21201 Emergency Dept. Physicians 3661424 Cardinal Health 1330 Enclave Parkway Houston TX 77077 Pharmacy Mgmt Services 2190738 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 1662960 Johnson Controls Inc PO Box 423 Milwaukee WI 532010423 Maintenance Services 1455219 MDICS Management LLC 6934 Aviation Blvd Ste B Glen Burnie MD 21061 Physician Services 1445118 85 121341 3085176 61868 3268385 Net Patient Rev. 621110 123541704 123541704 123541704 192343 192343 993 993 286882 0 286882 286882 286882 619288 660500 0 0 619288 660500 1279788 1279788 Rebate 900099 162722 162722 Cafe and Vending 722212 155770 155770 Parking 812930 137013 137013 65916 22357 43559 521421 129091516 123541704 22357 2259070 120775 120775 29650 29650 635398 571858 63540 47359376 42623438 4735938 4750191 4275172 475019 7156107 6440496 715611 4148921 3734029 414892 433984 390586 43398 348343 313509 34834 26004 23404 2600 13537337 12183603 1353734 309062 278155 30907 1993043 1793739 199304 3267990 2941191 326799 2718542 2446688 271854 132441 119197 13244 129690 116721 12969 1428347 1428347 3814849 3433364 381485 1488375 1339537 148838 Purchased Services 14929193 13436274 1492919 Bad Debt Expense 13199880 13199880 Medical Supplies 11557501 10401751 1155750 BSHSI Mgmt Allocations 2651962 2386766 265196 1688963 1520067 168896 137855924 125548197 12307727 0 0 6328 362260 472182 464881 914728 19426325 18155331 1344093 1414394 1384077 1287756 93831041 65275072 29484807 28555969 10352296 10829311 9514048 9509794 72332787 71145793 14196890 16088660 2822759 2198889 4737030 0 0 40086 135584053 137491133 157340732 155818768 X -84867001 -85327413 -140944 654438 -85007945 -84672975 72332787 71145793 X -8764408 53693 9045685 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 26004 26004 0 Explanation of Lobbying Activities: Part II-B, Line 1: The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i. 0 1 X 637500 637500 29936934 17943991 11992943 19251908 13043752 6208156 33915296 25955708 7959588 10089403 8331621 1757782 28555969 HPL/GL Asset 7359140 Due from Affiliates 1835356 Miscellaneous AR 199811 Staff loans 62251 Resident Trust 40086 LT Noncash Investment 13150 9509794 Due to BSHSI 103117028 Pension Liability 19182427 Liability - HPL/GL 7359140 Capital leases 2816188 Medicaid and Insurance Advances 2773353 Liability - FIN 47 1416300 Due to Affiliates 646697 Medicare Reserve 180000 137491133 X Part IV, Line 2b: Bon Secours Hospital Baltimore holds, safeguards, manages and accounts for the Social Security refunds of certain patients. These funds are held in an FDIC insured banking institution. With the assistance of hospital personnel, funds are generally accessed by the patient through the use of ATM cards or Visa gift cards which are purchased on their behalf. Description of Uncertain Tax Positions Under FIN 48: 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 (Formerly FIN48). ASC 740 (Formerly FIN48) 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 de-recognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 (Formerly FIN48) 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 $66,681 and $95,733 of net operating loss carryforwards as of August 31, 2013 and 2012, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2013 and 2012. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 1 X 250.000000000000 1 X 1 1 1 0 1 1 8493744 8493744 0.06810 8493744 8493744 0.06810 11 32620 4291322 4291322 0.03440 1 337 140330 140330 0.00120 3 27734 14185587 5072853 9112734 0.07310 15 60691 18617239 5072853 13544386 0.10870 15 60691 27110983 5072853 22038130 0.17680 3 2168 4544725 2690749 1853976 0.01490 3 2168 4544725 2690749 1853976 0.01490 1 8074210 29261727 21488744 7772983 X 1 1 1 1 Bon Secours Hospital Baltimore Inc

2000 W Baltimore St Baltimore MD 212231558

http://bonsecoursbaltimore.com/ X X X X Bon Secours Hospital Baltimore Inc 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 250.000000000000 1 250.000000000000 1 X X 1 1 X X X X X 0 0 1 X 0 0 2 Bon Secours CIBSNew Passage

3101 Towanda Ave Baltimore MD 212150000

Behavioral Health Services New Hope

2401 W Baltimore Street Baltimore MD 212231558

Behavioral Health Services Part I, Line 7: Part I, line 7a: Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.Part I, Line 7b: Maryland's regulatory system creates a unique process forhospital payment that differs from the rest of the nation. The HealthServices Cost Review Commission, (HSCRC) determines payment through a ratesetting process and all payors, including governmental payors, pay thesame amount for the same services delivered at the same hospital.Maryland's unique all payor system includes a method for referencingUncompensated Care in each payors rates, which does not enable Marylandhospitals to breakout any offsetting revenue related to UncompensatedCare.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, L7 Col(f): Current year bad debt expense not included in the calculation for line 7, column f: $13,199,880. Part II: Bon Secours Baltimore Health System works closely with the community it serves to create projects, programs and services that are leading to the realization of a vision towards making southwest Baltimore a healthier community of choice for current and new residents.Bon Secours offered the following Community Building programs and services in FY 2013:The Working Families Initiative offers group and individual financial education, debt remediation, free and low-cost tax preparation and retirement planning to help residents reduce non-asset building debt and increase personal wealth. Residents can also be screened for and access public and private benefits through Earn Benefits. Over 1,920 persons utilized these services in FY 13. Youth Employment and Entrepreneurship Program (YEEP) helps high school age youth learn job readiness, financial literacy and leadership skills and then access part time and summer jobs. YEEP also helps youth develop career plans and get into post-secondary education. The program follows alumni who attend college. Over 65 area youth participated in YEEP activities in FY 13.Clean & Green turns vacant lots into attractive green spaces and consistently maintains them at a community-wide scale. Also provides paid internships in landscaping and other job skills. The program improved 52 lots in FY 13. In addition eight individuals completed a six month training program.Career Development Program offers job readiness, GED instruction, placement and retention services where, after a five-week intensive classroom experience, clients are followed for three years and helped to move up the company ladder, obtain more education as needed, get out of debt and learn basic money management skills. The ultimate goal is financial self-sufficiency. A total of 23 individuals completed our job readiness training and 257 community residents were provided assistance in computer access and/or employment related activities. Family Support Center helps young parents obtain a GED and/or secure employment while providing developmental childcare and parenting classes. Children (birth to age 4) receive developmental childcare while their parents are in class or in training. In addition, the Family Support Center staff provides In-Home-Intervention services. During FY 13 1,805 home visits were made to families, 891 parenting education sessions were provided to 91 participants, 110 children were immunized, 38 persons participated in GED training (5 of which received their GED and 9 received an external high school diploma), 40 participants secured part-time employment and 9 secured full-time employment.Women's Resource Center is a drop-in center that provides crisis intervention, hospitality services and domestic violence counseling for homeless women or women at risk for becoming homeless. Over 640 women were served in FY 13.Housing: BSBHS also renovates row houses and constructs apartment buildings where low-income families and seniors can find safe and affordable housing. Over 648 families and seniors were housed in FY 13. Part III, Line 4: Part III, Line 2: Bad Debt Expense at cost is computed by applying the cost-to-charge ratio computed on Worksheet 2 to the aggregate bad debt expense for patient accounts recorded in the general ledger. 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 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 pages 10-11 in the attached BSHSI consolidated audited financial statements ("AFS"). "Allowance for doubtful accounts" is discussed in the second paragraph in Footnote "(10) Net Patient Service Revenue" on page 41 of the attached AFS. There is not a separate "bad debt expense" footnote in the AFS. Part III, Line 8: Part III, Line 6: Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in- and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending Financial Assistance Program (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 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. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 3: We utilized several methods for gathering input including a series of community meetings where issues were identified and prioritized; review and analysis of previous community engagement activities; convening a health care summit to launch a primary care access study; one on one interviews and a community needs/desires survey. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 12h: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 14g: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy. Bon Secours Hospital Baltimore, Inc. Part V, Section B, Line 20d: Please see the narrative for Part VI, Line 3regarding the Financial Assistance Policy. Part VI, Line 2: Bon Secours Baltimore Hospital conducted a Community Health Needs Assessment that included meetings, interviews, community summits and literature studies and the engagement of those representatives of our community with a knowledge of public health, the broad interests of the communities we serve, as well as individuals with special knowledge of the medically underserved, as well as low-income and vulnerable populations and people with chronic diseases.This Assessment determined that to address the most significant health needs of our service area we must develop a plan of action:- To help make Southwest Baltimore a place where residents live long, satisfying lives, are proactive about their health and wellness, understand the importance of healthful eating and have access to healthful foods in a variety of locations and outlets, including at the hospital.- To help make Southwest Baltimore a community where residents are ready to work,are self-sufficient and have access to jobs that enable them to support themselves and their families.- To help make Southwest Baltimore a more environmentally-friendly community, lush with nature and green, open spaces, lead-free and with air that is safe to breathe and water that is safe to drink. - To develop a coalition to be made up of senior leaders from the organizations which comprise the core of West Baltimore's health care safety net. - To focus on primary care engagement, expanding primary care capacity, and preparing for the Affordable Care Act. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assist the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 250% of the Federal Poverty Guidelines ("FPG"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain States, where applicable. 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. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. In addition, a variety of other potential payment options are available. Bon Secours is dedicated to meeting the needs of non-English speaking patients by having on-site Spanish translators, and other language translation services. In addition, Bon Secours employs a telephone language service which assists in meeting any language needs that arise. The translation services are offered to non-English speaking patients from admission to discharge, including the financial process. Part VI, Line 4: Bon Secours Baltimore Health System primarily serves four zip codes in West Baltimore: 21223, 21229, 21216 & 21217. Bon Secours Baltimore Health System's Community Health Needs Assessment has taken into account challenges and conditions in its primary service area as described above with a special emphasis on the surrounding BSB, known as "Old Southwest Baltimore." Bon Secours has maintained a constant presence in this part of Baltimore for over 130 years and it is the community where most of BSBHS's services are located. The conditions and social determinants of health in the direct area serviced by BSBHS also are of concern in the broader service area and the health and socioeconomic status of the direct area mirrors that of the broader service area. Old Southwest Baltimore has a population of more than 17,885 (2010 Census) people, many of whom are medically and economically underserved. The socioeconomic status, ethnic diversity and health status of residents, according to the Baltimore City Health Department, indicates that 27% of the population is between 0-17 years; 76% are African American; 36% have a high school diploma equivalent; 43% of those ages 16-64 are not employed; 44% of households make less than $25,000; and the leading causes of health-related deaths are heart disease, HIV/AIDS, substance abuse and diabetes. In fact, in the neighborhoods served by BSB, residents die from heart disease at a rate that is 35% higher than the city as a whole. Deaths from diabetes and HIV/AIDS are also substantially higher than in the entire city. And residents of certain areas along the West Baltimore Street corridor have a life expectancy of 64.2 years, compared to almost 71 years for the entire city. Health problems in the community are exacerbated by inadequate insurance coverage. Approximately 11% of neighborhood residents are covered by Medicare, and 31% receive Medicaid. Seventeen percent are without any form of health insurance.Designated as a federal medically-underserved community, Southwest Baltimore also suffers from a high rate of foreclosures as many residents do not have the financial capacity to maintain their homes. Many of the streets are lined with neglected and vacant houses, many boarded up and hazardous to the health and safety of children and adults. Part VI, Line 5: BS Baltimore has an open medical staff with privileges available to all qualified physicians in the area. BS Baltimore is governed by a board of directors whose composition is representative of the community it serves. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, 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. Reports Filed With States Part VI, Line 7 MD 1 Baltimore Mental Health Systems Inc 201 E Baltimore Street Suite 1340 Baltimore MD 21202 521519025 501(c)(3) 10000 Cardiovascular Health Grant University of Maryland Medical Center 22 S Greene Street Baltimore MD 21201 521362793 501(c)(3) 10000 Patient Centered Medical Home Grant St Agnes Hospital 900 S Caton Avenue Baltimore MD 21229 520591657 501(c)(3) 10000 Cardiovascular Health Grant American Heart Association 4217 Park Place Court Gen Allen VA 23060 135613797 501(c)(3) 47500 Patient Centered Medical Home Grant Bon Secours Baltimore Health System Foundation 2000 W Baltimore Street Baltimore MD 21104 383843816 501(c)(3) 7845 Program Service Support American Diabetes Association 4335 Cox Road Glen Allen VA 23060 131623888 501(c)(3) 5000 Program Service Support Associated Black Charities 1114 Cathedral Street Baltimore MD 21202 521427774 501(c)(3) 6030 Program Service Support 7 0 Emergency Assistance Funds for Patients, Volunteers, & Employees 54 29650 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization complies with Bon Secours Health System, Inc.'s system-wide financial and accounting policies. Contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. 1 1 0 0 0 0 0 0 0 Martha Riva 0 301586 0 239025 0 41847 0 49277 0 31241 0 662976 0 0 Samuel L Ross MD 0 510782 0 345326 0 82015 0 57512 0 18816 0 1014451 0 22472 Richard Jones 268450 0 31065 0 51229 0 10000 0 11792 0 372536 0 0 0 Matthew Ansel 160060 0 15810 0 975 0 1626 0 12177 0 190648 0 0 0 Leroy Bell 149419 0 49911 0 35343 0 7031 0 190 0 241894 0 0 0 Lesia Douglas 161156 0 36695 0 11451 0 7646 0 17132 0 234080 0 0 0 Usha Jain MD 279643 0 0 0 9639 0 10000 0 11732 0 311014 0 0 0 Sidney Mir 260788 0 21663 0 4046 0 7435 0 11018 0 304950 0 0 0 Shivani Myer MD 201046 0 10000 0 25648 0 9232 0 9678 0 255604 0 0 0 Fabienne Larkins 68009 0 16096 0 162827 0 783 0 7122 0 254837 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 Supplemental Information Part III Part I, Line 4a: Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: Fabienne Larkins, $119,818. Supplemental Information Part III Part I, Line 4b: The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Samuel L. Ross, M.D., $37,738. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours Baltimore Health Systems, Inc., which in turn is the sole member of Bon Secours Hospital Baltimore, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Hospital Baltimore, Inc. is appointed by its member Bon Secours Baltimore Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Hospital Baltimore, Inc. are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages 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 provides any documents open to public inspection upon request. Form 990, Part VII: Brother Art Caliman and Sr. Mary Shimo do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Minimum Pension Liability 10,671,015. Transfers to BSHSI for Debt and Swaps -1,766,172. Prior period adjustments 140,842. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 211041301 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 The Bon Secours of Maryland Foundation Inc dba Community Works 26 N Fulton Avenue Baltimore MD 212231624 521732800 Community Foundation MD 501(c)(3) 7 Bon Secours Baltimore Health System Inc 0 Unity Properties Inc 26 N Fulton Avenue Baltimore MD 212231624 521857768 Low Income Housing MD 501(c)(3) 7 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Development Inc 26 N Fulton Avenue Baltimore MD 212231624 760785344 Low Income Housing MD 501(c)(3) 7 Unity Properties Inc 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) 7 Bon Secours Baltimore Health System Inc 0 Bon Secours Housing 26 N Fulton Avenue Baltimore MD 212231624 521442707 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Housing II 26 N Fulton Avenue Baltimore MD 212231624 521543174 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Health Corps (dba Bon Secours Baltimore Health System 2000 W Baltimore Street Baltimore MD 212231558 800728893 Local System Parent Org MD 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Apartments LP 1800 W Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD N/A Bon Secours Apartments II LP 1800 W Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD N/A Liberty Senior Housing LP 1800 W Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD N/A Bon Secours Apartments III LP 1800 W Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD N/A Bon Secours Smallwood Summit 26 N Fulton Avenue Baltimore MD 212231624 522280175 Low Income Housing MD N/A Bon Secours Chesapeake Apartments LP 26 N Fulton Avenue Baltimore MD 212231624 200107034 Low Income Housing MD N/A Bon Secours Shiloh LP 26 N Fulton Avenue Baltimore MD 212231624 203965243 Low Income Housing MD N/A Bon Secours Wayland LP 26 N Fulton Avenue Baltimore MD 212231624 270468688 Low Income Housing MD N/A Bon Secours Benet House LP 26 N Fulton Avenue Baltimore MD 21223 364765400 Low Income Housing MD N/A Bon Secours Benet House LLC 26 N Fulton Avenue Baltimore MD 21223 463055312 Low Income Housing MD N/A Unity Housing Inc 26 N Fulton Avenue Baltimore MD 212231624 521952507 Low Income Housing MD N/A C 0 Bon Secours Wayland LLC 26 N Fulton Avenue Baltimore MD 212231624 270468561 Low Income Housing MD N/A C 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0