2013-07-14T01:28:28-05:00 2012-08-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-09-01 311716973 Bon Secours - St Francis Medical Center BONS 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 Melinda S Hancock 8045947400 2013-07-14 1 David A Craig P00542227 7032511000 2011 2016-02-24 21:20:13Z Mark Gordon 8580 Magellan Parkway Building IV Richmond VA 23227 238142575 0 X www.bonsecours.com X 1999 VA Acute Care Hospital 19 16 1201 275 0 0 2012916 2208673 215300734 232931716 25743 1415 2168627 2452344 219508020 237594148 72000 73250 0 0 67514944 75947053 0 0 0 139228429 146002578 206815373 222022881 12692647 15571267 144937947 152599457 135497325 131941039 9440622 20658418 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 198819722 73250 233492206 Patient Service in order to bring compassion to healthcare and to be good help to those in need by providing healthcare services. Please refer to the Community Benefit information on Schedule H. 2794691 634632 Bon Secours St. Francis Family Medicine Residency Program: The Virginia Commonwealth University (VCU) affiliated Bon Secours St. Francis Family Medicine Residency Program opened its doors in August 2005 and is fully accredited by the Accreditation Council for Graduate Medical Education.Bon Secours has built a program that creates family physicians and serves western Chesterfield county and surrounding areas in suburban Richmond, Virginia. The faculty includes a mixture of rural and suburban-based academicians and clinicians. Subspecialty preceptors are drawn from a premier network of Bon Secours affiliated physicians. The residency program is housed in a building designed specifically for the needs of resident education and efficient clinical care. In addition to rotating through Bon Secours St. Francis Medical Center, residents use many of the award-winning systems through our practice, the four hospitals of Bon Secours Richmond Health System, and our community outreach including Care-A-Van, our free mobile health clinic. 201614413 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 66 0 1 1201 1 0 0 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X Melinda S Hancock 8046275400 8580 Magellan Parkway Building IV Richmond VA 23227 X Nalia Towners Ahmed 4.00 X 0 0 0 Toni Ardabell 50.00 X 0 390990 68190 Jean Ann Bolling 4.00 X 0 0 0 John Bowman MD 4.00 X 0 0 0 Pete Cleal 4.00 X 0 0 0 Robert J Cohen MD 4.00 X 0 0 0 Alexander J Corbett PhD 4.00 X 0 0 0 Richard Jackson MD 4.00 X 0 0 0 Kenneth J Jones 4.00 X 0 0 0 Sr Anne Marie Mack CBS 50.00 X 0 0 0 Joanne Nattrass 4.00 X 0 0 0 Michael Robinson 50.00 X 0 438084 105755 William Shewmake 4.00 X 0 0 0 Nancy Thomas 4.00 X 0 0 0 Jane Watkins 4.00 X 0 0 0 Michael Williams 4.00 X 0 0 0 Mark Gordon 50.00 X X 0 360340 72092 Sr Victoria Segura CBS MD 50.00 X X 0 0 0 Thomas Winfree 6.00 X X 0 0 0 Peter J Bernard 50.00 X 0 790976 236221 Peter F Gallagher 50.00 X 0 370109 61386 Alan Goolsby 6.00 X 0 0 0 Melinda Hancock 50.00 X 0 292838 33668 Shelly A Buck-Turner 50.00 X 0 150029 33346 Stacey L Epps 50.00 X 350653 0 40826 Chi-Kin Ng 50.00 X 340587 0 31819 James Pellicane 50.00 X 487284 0 41366 Gregory Sorensen 50.00 X 298650 0 21521 Polly Stephens 50.00 X 368622 0 35597 Michael Kerner 50.00 X 0 492621 187822 Thomas Morris PhD 50.00 X 0 303520 67515 1845796 3589507 1037124 47 1 1 0 Whiting Turner Contracting Company PO Box 17596 Baltimore MD 21297 Construction Services 2765518 Commonwealth Anesthesia Assoc PO Box 35808 Richmond VA 23235 Anesthesia Physicians 2083007 Aramark CTS Inc 12483 Collections Center Drive Chicago IL 60693 Clinical Services 1559245 Sheltering Arms Hospital 8254 Atlee Road Mechanicsville VA 23116 Physical Therapy 1488189 OB Hospitalists 1754 Woodruff Road Greenville SC 29607 Obstetric Hospitalists 1387661 136 290219 1918454 2208673 Net Patient Serv. Rev. 622110 232297084 232297084 Fmly Prac Res Prg Tuit 622110 634632 634632 232931716 418492 499409 -80917 -80917 -80917 50433 49018 1415 1415 1415 Sheltering Arms Rev. 900099 1195122 1195122 Cafe/Vending/Gift Shop 722212 1051906 1051906 Purchase Discounts 900099 47033 47033 239200 239200 2533261 237594148 234126838 0 1258637 73250 73250 184696 166226 18470 61320389 55188351 6132038 1318300 1186470 131830 8855437 7969893 885544 4268231 3841408 426823 442738 398464 44274 18332 16499 1833 30553500 27498150 3055350 173254 155929 17325 664259 597833 66426 6599993 5939994 659999 234719 211247 23472 4113430 4113430 7678406 6910565 767841 1624676 1462208 162468 Medical Supplies 40592178 36532960 4059218 Purchased Services 28265586 25439027 2826559 Bad Debt 13751523 13751523 BSHSI Mgmt allocations 5631491 5068342 563149 5658493 5092644 565849 222022881 201614413 20408468 0 61091 128029 4032 39200 21868977 23871622 3634673 3921335 881629 1336242 178188613 67020581 110145338 111168032 8342207 12134997 144937947 152599457 12773258 10686074 3765443 3725458 118958624 117529507 135497325 131941039 X 9436139 20615735 4483 42683 9440622 20658418 144937947 152599457 X 15571267 -4353471 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18332 18332 0 Explanation of Lobbying Activities: Part II-B, Line 1: St. Francis Medical Center paid dues to the American Hospital Association (AHA), the Virginia Hospital Healthcare Association (VHHA) and the Catholic Hospital Association (CHA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations is as follows: AHA ($4,446 or 24.6%), VHHA ($12,041 or 24.37%), CHA ($1,845 or 5.15%) for a total of $18,332. 21097936 21097936 75217916 14897537 60320379 9223761 3324586 5899175 59873497 44356695 15516802 12775503 4441763 8333740 111168032 LT Non Cash Inv - HPL/GL 7076491 Accrued Revenue 1736335 Cost Report Settlements Receivable 1369110 Physician Loan Receivable 984994 Ground Lease Rent Receivable 59588 Developer Receivable 596565 Sheltering Arms Receivable 296448 Dietary Rebate Receivable 12300 Employee Cafeteria Receivable 3166 12134997 Due to BSHSI 28538920 Due to Affiliates 80000000 HP/GL Liability 7076491 LT Deferred Rent 786284 Medicare Settlement Receivable 667177 Accrued Physicians Income Guarantee 458333 Rent Deposit 1720 Unclaimed Property Tax Accrual 582 117529507 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 derecognition 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 (formerly FIN48). 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 $95,733 and $89,500 of net operating loss carryforwards as of August 31, 2012 and 2011, 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, 2012 and 2011. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 1 1 1 X 1 X 1 1 0 1 1 7375256 7375256 0.03540 16305223 10746607 5558616 0.02670 23680479 10746607 12933872 0.06210 617699 617699 0.00300 3869428 937569 2931859 0.01410 116196 116196 0.00060 4603323 937569 3665754 0.01770 28283802 11684176 16599626 0.07980 1 3236145 45937897 75668766 -29730869 X 1 1 1 1 St Francis Medical Center

13710 St Francis Blvd Midlothian VA 23114

X X X X Bon Secours - St Francis Medical Center 1 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 13 St Francis Family Medical Practice

13540 Hull Street Road Midlothian VA 23112

Physician Practice Neurology Clinic Bon Secours Med Group

11601 Ironbridge Road Suite 207 Chester VA 23831

Physician Practice Virginia Breast Center

610 Watkins Centre Parkway Midlothian VA 23114

Physician Practice Internal Medicine of Chesterfield

611 Watkins Centre Parkway Ste 250 Midlothian VA 23114

Physician Practice Ironbridge Family Practice

11601 Ironbridge Road Suite 117 Chester VA 23831

Physician Practice St Francis Medical Women's Center

13700 St Francis Blvd Suite 510 Midlothian VA 23114

Physician Practice Powhatan Medical Associates

3452 Anderson Highway Suite D Powhatan VA 231395845

Physician Practice Charter Colony Family Practice

13700 St Francis Blvd Suite 302 Midlothian VA 23114

Physician Practice St Joseph Outreach Clinic

8000 Brook Road Richmond VA 23227

Physician Practice Diabetes Treatment Center

2372 Colony Crossing Midlothian VA 23114

Outpatient Diabetic Clinic CARE Diabetes & Endocrinology

3660 Boulevard Suite G Colonial Heights VA 23834

Physician Practice Commonwealth Fertility & Women's Care

13700 St Francis Blvd Suite 502 Midlothian VA 23114

Physician Practice Bon Secours Oncology Assoc at SFMC

14051 St Francis Blvd Suite 2210 Midlothian VA 23114

Physician Practice Part I, Line 6a: Annually, Bon Secours Richmond Health System (BSRHS) 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 January 24, commemorating Foundation Day of the Sisters of Bon Secours. 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 recorded in the 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, L7 Col(f): Bad debt expense included in Part IX: line 25 and excluded from the "percent of total expense" calculation is: $13,751,523 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'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 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 8: 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 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 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: In partnership with Bon Secours Richmond Health System, St. Francis Medical Center (SFMC) uses multiple approaches to assess the health needs of the communities it serves. In October 2009, the Central Virginia Health Planning Agency released an Immigrant Needs Assessment commissioned by Bon Secours Richmond Health System in collaboration with Saint Francis Medical Center. This work documented the growth of the immigrant population in the metropolitan Richmond area and made multiple recommendations including the need for interpretation and translation services, health resource information in other languages, preventive services, health screenings including vision and dental, affordable health insurance for immigrants and their families and access to behavioral health services. Bon Secours Richmond has initiated many of the recommendations.Community need assessments are updated using a variety of informational sources including Virginia Health Information for state-based performance data, Health Group West and Hammes Company for market and geographic data. Thomson-Reuter's Market Expert is used to retrieve demographic information and trends for the primary and secondary service areas pertaining to Saint Francis Medical Center. National Research Corporation (NRC) is also utilized. 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"), 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: SFMC serves the greater Richmond, Virginia area. Projections indicate that the population will grow by 5.2% from 1,089,918 in 2012 to 1,146,394 in 2017, with 9.9% of the service area having a household income of less than $15,000 per year, compared to the national average of 13.0%. Similarly, 18.8% of the service area's populace maintains a household income less than $25,000 per year, compared to the national average of 23.8%. Demographic data shows that 57.0% of the population is white and 31.6% is black, compared to the national averages of 62.8% and 12.3% respectively. Demographics of the service area indicate that the age cohort of 64 to 75 will increase by 20.7% between 2012 and 2017. SFMC is a disproportionate share hospital (DSH). In fiscal year 2012, it served 9,339 inpatients and provided outpatient services for 46,214. Additionally, SFMC provided 43,902 emergency room visits. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. SFMC participates in Medicare, Medicaid, CHAMPUS, Tricare and other government sponsored health care programs such as the State/Local Hospitalization program and the SCHIP/FAMIS program for children. Part VI, Line 5: SFMC has an open medical staff with privileges available to all qualified physicians in the area. SFMC, through the BSRHS is governed by a board of directors whose composition is representative of the community. SFMC also engages in medical research. Inpatient and outpatient research-related activities are conducted by SFMC with oversight from the BSRHS Institutional Review Board. 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 four goal areas for the current three year period (2010-2012). One of those goals was to partner with communities to co-create a more humane world, improve health and model social justice. To accomplish this, two key strategies are to: - Engage communities to identify needs and assets and building partnerships to improve health and quality of life of a specific population.- Demonstrate sustainable stewardship for healing the earth as a way to improve health and life quality.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 VA 1 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Building IV Richmond VA 23227 541201346 501(c)(3) 73000 General Support Chesterfield Public Education Foundation Inc 1911 Huguenot Rd Ste 100 Richmond VA 23235 541595479 501(c)(3) 250 General Support 2 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Bon Secours Richmond - St. Francis Medical Center complies with Bon Secours Health System Inc.'s system wide financial accounting policies. 0 1 0 0 0 0 0 0 0 Toni Ardabell 0 368180 0 0 0 22810 0 64266 0 3924 0 459180 0 0 Michael Robinson 0 410571 0 0 0 27513 0 91606 0 14149 0 543839 0 0 Mark Gordon 0 338075 0 0 0 22265 0 38340 0 33752 0 432432 0 0 Peter J Bernard 0 761416 0 0 0 29560 0 201853 0 34368 0 1027197 0 0 Peter F Gallagher 0 366724 0 0 0 3385 0 27022 0 34364 0 431495 0 0 Melinda Hancock 0 254357 0 5017 0 33464 0 4898 0 28770 0 326506 0 0 Shelly A Buck-Turner 0 149629 0 0 0 400 0 2640 0 30706 0 183375 0 0 Stacey L Epps 349256 0 750 0 647 0 7255 0 33571 0 391479 0 0 0 Chi-Kin Ng 337974 0 0 0 2613 0 8077 0 23742 0 372406 0 0 0 James Pellicane 462797 0 23850 0 637 0 4788 0 36578 0 528650 0 0 0 Gregory Sorensen 279009 0 15000 0 4641 0 5924 0 15597 0 320171 0 0 0 Polly Stephens 367985 0 0 0 637 0 4824 0 30773 0 404219 0 0 0 Michael Kerner 0 487110 0 0 0 5511 0 154116 0 33706 0 680443 0 0 Thomas Morris PhD 0 277485 0 0 0 26035 0 49847 0 17668 0 371035 0 0 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. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours - St. Francis Medical Center, 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 Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours - Richmond Health Corp, which in turn holds the majority interest in Bon Secours- Richmond Health System, which in turn is the sole member of Bon Secours - St. Francis Medical Center. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours - St. Francis Medical Center is appointed by it's member Bon Secours - Richmond Health System and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours - St. Francis Medical Center 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 director's 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 Bon Secours - St. Francis Medical Center provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officer's and director's hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Voluntary Board Members are not compensated for their time. Peter J. Bernard's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the CEO of Bon Secours Virginia Health System which includes direct management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Melinda Hancock's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization. The compensation she receives is for her role as the CFO of Bon Secours Virginia Health System which includes direct financial management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organizations. Peter F. Gallagher's compensation was paid by Memorial Regional Medical Center, a related organization. The compensation he received was for his role as the CFO of Bon Secours Richmond Health System which includes direct financial management, monitoring and oversight of Bon Secours Richmond Health System and its related organizations. Toni Ardabell's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of St. Mary's Hospital of Richmond, Inc., a related organization. Mark Gordon's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of St. Francis Medical Center, a related organization. Michael Robinson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Executive Officer of Memorial Regional Medical Center and Richmond Community Hospital. Sr. Anne Marie Mack and Sr. Victoria Segura do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfers to Affiliates -4,353,471. Total to Form 990, Part XI, Line 5: -4,353,471. Bon Secours Health System Inc 1505 Marriotsville Road Marriotsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Richmond Health Corporation 8580 Magellan Parkway Richmond VA 23227 541356155 Management Services VA 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Richmond Health System 8580 Magellan Parkway Richmond VA 23227 521988421 Local System Parent Org. VA 501(c)(3) 11b Bon Secours Richmond Health Corporation 0 Bon Secours Memorial Regional Medical Center 8580 Magellan Parkway Richmond VA 23227 541744931 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours St Mary's Hospital Inc 8580 Magellan Parkway Richmond VA 23227 540793767 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Community Hospital Inc 8580 Magellan Parkway Richmond VA 23227 540647482 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Laburnum Properties 8580 Magellan Parkway Richmond VA 23227 521260700 Title Holding Company VA 501(c)(2) Bon Secours Richmond Health System 0 Bon Secours Stuart Circle Hospital 8580 Magellan Parkway Richmond VA 23227 541740128 Health Care VA 501(c)(3) 3 Bon Secours Richmond Health System 0 Bon Secours Richmond Healthcare Foundation 8580 Magellan Parkway Richmond VA 23227 541201346 Grant Making Foundation VA 501(c)(3) 7 Bon Secours Richmond Health Corporation 0 St Mary's MRI LP 8580 Magellan Parkway Richmond VA 23227 541568022 Imaging Services VA Virginia Healthsource Inc Related 0 0 RI LP 8580 Magellan Parkway Richmond VA 23227 541708835 Imaging Services VA Virginia Healthsource Inc Related 0 0 Broad64 Imaging LLC 8580 Magellan Parkway Richmond VA 23227 205886018 Imaging Services VA Virginia Healthsource Inc Related 0 0 Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond VA 23227 208444551 Radiation Oncology Services VA Radiation Oncology Center Inc Related 0 0 Chesterfield Community Healthcare Center MOB I LLC 435 Southlake Blvd Richmond VA 23236 541745670 Rental- Medical Office Building VA Virginia Healthsource Inc Related 0 0 Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond VA 23227 541812738 Ambulatory Healthcare Services VA Richmond Health System Inc C RHS Management Corporation 8580 Magellan Parkway Richmond VA 23227 541313425 Independent Living Facility VA Richmond Health System Inc C Bon Secours - Virginia Healthsource Inc 8580 Magellan Parkway Richmond VA 23227 541417686 Ambulatory Healthcare Services VA Richmond Health System Inc C Richmond MRI Inc 8580 Magellan Parkway Richmond VA 23227 541568452 Imaging Services VA Virginia HealthSource Inc C 0 0 1 0 1 0 1 0 0 0 0 1 0 1 1 0 0 0