Our Lady of Bellefonte Hospital Inc: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: Our Lady of Bellefonte Hospital Inc (EIN 61-1356023)
Tax period: 2010-09-01 to 2011-08-31
Filed: 2012-07-13
IRS object ID: 201201959349300220
Schema version: 2010v3.4
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-07-13T11:00:32-05:00	Timestamp
Tax Period End Date	2011-08-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DELOITTE TAX LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1750 TYSONS BLVD	AddressLine1
City	MCLEAN	City
State	VA	State
ZIP Code	221024219	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-09-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	611356023	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Our Lady of Bellefonte Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	OURL	NameControl
Phone	6068333333	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	St Christopher Drive	AddressLine1
City	Ashland	City
State	KY	State
ZIP Code	41101	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Joe Buchheit	Name
Title	Chief Financial Officer	Title
Phone	6068333600	Phone
Date Signed	2012-07-13	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Laura L Catlett	Name
Phone	7032511000	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Kevin Halter	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	St Christopher Drive	AddressLine1
City	Ashland	City
State	KY	State
ZIP Code	41101	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	155655404	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	www.olbh.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1999	YearFormation
State Legal Domicile	KY	StateLegalDomicile
Activity Or Mission Description	Acute Care Hospital	ActivityOrMissionDescription
Nbr Voting Members Governing Body	19	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	1635	TotalNbrEmployees
Total Nbr Volunteers	150	TotalNbrVolunteers
Total Gross UBI	1574546	TotalGrossUBI
Net Unrelated Business Txbl Income	-93238	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	941431	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	148921164	ProgramServiceRevenuePriorYear
Program Service Revenue CY	150022362	ProgramServiceRevenueCY
Investment Income Prior Year	325050	InvestmentIncomePriorYear
Investment Income Current Year	426499	InvestmentIncomeCurrentYear
Other Revenue Prior Year	4297822	OtherRevenuePriorYear
Other Revenue Current Year	4064403	OtherRevenueCurrentYear
Total Revenue Prior Year	153544036	TotalRevenuePriorYear
Total Revenue Current Year	155454695	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	372800	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	56546781	SalariesEtcPriorYear
Salaries Etc Current Year	59461273	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	89177766	OtherExpensePriorYear
Other Expenses Current Year	87228960	OtherExpensesCurrentYear
Total Expenses Prior Year	145724547	TotalExpensesPriorYear
Total Expenses Current Year	147063033	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	7819489	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	8391662	RevenuesLessExpensesCY
Total Assets BOY	91664809	TotalAssetsBOY
Total Assets EOY	98205634	TotalAssetsEOY
Total Liabilities BOY	55485081	TotalLiabilitiesBOY
Total Liabilities EOY	50715835	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	36179728	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	47489799	NetAssetsOrFundBalancesEOY
Mission Description	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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	133793625	Expense
Grants	372800	Grants
Revenue	150286493	Revenue
Description	To 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.	Description
Total Program Service Expense	133793625	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	105	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	1635	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	19	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Aaron Akers	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6068334136	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	OLBH St Christopher Drive	AddressLine1
City	Ashland	City
State	KY	State
ZIP Code	41101	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
Gregory Bausch
Board Member	4.00	X	0	0	0
Danny BentleyPharmD FACA
Board Member (Sept-Dec)	4.00	X	0	0	0
Mary Carolyn Carter
Board Member	4.00	X	0	0	0
William Dickens
Board Member	4.00	X	0	0	0
Larry Fields MD
Board Member	4.00	X	9066	0	0
Mary Catherine Flath PhD
Board Member	4.00	X	0	0	0
John Gross III
Board Member	4.00	X	0	0	0
Daniel Huffman
Board Member	4.00	X	0	0	0
Connie Johnson
Board Member	4.00	X	0	0	0
Larry Jones
Board Member	4.00	X	0	0	0
Phillip Bruce Leslie Esq
Board Member	4.00	X	0	0	0
James Martin MD
Board Member (Jan-Aug)	4.00	X	0	0	0
EW Unnikrishnan MD
Board Member	4.00	X	0	0	0
William Willan
Board Member	4.00	X	0	0	0
Elizabeth Keith
Board Member	50.00	X	0	219843	25709
Lawrence Skip Hubbard CHCIO
Board Member	50.00	X	0	474728	118294
Kevin Halter
CEO - BSKY	50.00	X	0	413436	47041	X
John Wallenhorst
President	50.00	X	0	294258	25314	X
Frank Warnock Esq
Chairman	4.00	X	0	0	0	X
Joe Buchheit
CFO/ Treasurer	50.00		292884	0	41939	X
Jennifer Moore
Sec/VP Pat Care/CNO	50.00		250001	0	16810	X
Emilio A Punzal MD
Physician	50.00		257526	0	28740		X
Kevin D Howard MD
Physician	50.00		229400	0	19493		X
Chuck D Charles
VP Foundation	50.00		183337	0	2856		X
Rodney N Hieneman
VP Operations	50.00		153603	0	7704		X
Thomas G Lyons
Director of Pharmacy	50.00		147675	0	2518		X
Mark Gordon
Former CEO - BSKHS	50.00		0	459644	57923			X
Charles Rhodes MD
Former Board Member			0	0	0			X
Mark Neff
Former Board Member			0	0	0			X
Thomas Wolf
Former Board Member			0	0	0			X
Angela Foltz
Board Member			0	0	0			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1523492	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1861909	TotalReportableCompFrmRltdOrgs
Total Other Compensation	394341	TotalOtherCompensation
Number Individuals GT100 K	28	NumberIndividualsGT100K
Formers Listed	1	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Morrison Management Specialists Inc
PO Box 102289	Atlanta	GA	303682289	Cafeteria/Food Services	3248200
Ashland Anesthesia PSC
PO Box 1377	Ashland	KY	411051377	Anesthesia	2829169
Aramark CTS Inc
12483 Collections Center Dr	Chicago	IL	60693	Equipment maintenance	1703451
Aramark Refreshment Services
1301 Oliver Hill Way	Richmond	VA	23219	Lift Team Services	1399454
Medical Doctor Association
PO Box 277185	Atlanta	GA	303847185	Hospitalists Services	1089334

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	35	NumberOfContractorsGT100K
Related Organizations	256354	RelatedOrganizations
Government Grants	685077	GovernmentGrants
Total Contributions	941431	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Patient Service Rev.	Description
Business Code	622110	BusinessCode
Total Revenue Column	150022362	TotalRevenueColumn
Related Or Exempt Function Income	149630462	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	391900	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	150022362	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	239418	TotalRevenueColumn
Related Or Exempt Function Income	239418	RelatedOrExemptFunctionIncome

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	416613	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	416613	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	416613	TotalRevenueColumn
Related Or Exempt Function Income	416613	RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	387790	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	200709	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	187081	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	187081	TotalRevenueColumn
Exclusion	$187,081	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Unrelated Business RevenueUnrelatedBusinessRevenue	ExclusionExclusionAmount
Retail Pharmacy Rev.	446110	2439523	1182646	$1,256,877
Cafeteria/Vending	531120	753611		$753,611
Comm. Health & Fitness	621610	281841		$281,841

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	172815	TotalRevenueColumn
Exclusion	$172,815	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	3647790	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	155454695	TotalRevenueColumn
Related Or Exempt Function Income	150286493	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	1574546	UnrelatedBusinessRevenue
Exclusion	$2,652,225	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	372800	Total
Program Services	372800	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	596328	Total
Program Services	536695	ProgramServices
Management And General	59633	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	42519092	Total
Program Services	38267183	ProgramServices
Management And General	4251909	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	5291874	Total
Program Services	4762687	ProgramServices
Management And General	529187	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	7998776	Total
Program Services	7198898	ProgramServices
Management And General	799878	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	3055203	Total
Program Services	2749683	ProgramServices
Management And General	305520	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	568402	Total
Program Services	511562	ProgramServices
Management And General	56840	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	12423	Total
Program Services	11181	ProgramServices
Management And General	1242	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	10281704	Total
Program Services	9253534	ProgramServices
Management And General	1028170	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1373871	Total
Program Services	1236484	ProgramServices
Management And General	137387	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1783504	Total
Program Services	1605154	ProgramServices
Management And General	178350	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	5950213	Total
Program Services	5355192	ProgramServices
Management And General	595021	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	443524	Total
Program Services	399172	ProgramServices
Management And General	44352	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	4268174	Total
Program Services	4268174	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	7470544	Total
Program Services	6723490	ProgramServices
Management And General	747054	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1544536	Total
Program Services	1390082	ProgramServices
Management And General	154454	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medical Supplies	20110323	18099291	2011032
Purchased Services	13185867	11867280	1318587
Bad Debt	9727959	9727959
Corporate Dues	3563989	3207590	356399
Taxes & Bus. Licenses	2591070	2331963	259107

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4352857	Total
Program Services	3917571	ProgramServices
Management And General	435286	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	147063033	Total
Program Services	133793625	ProgramServices
Management And General	13269408	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	4894049	BOY
EOY	9071874	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	14879379	BOY
EOY	17698609	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	802885	BOY
EOY	1290667	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	3535658	BOY
EOY	3669259	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	966986	BOY
EOY	453826	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	119375204	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	64005141	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	57748486	BOY
EOY	55370063	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
EOY	7030076	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	6686874	BOY
EOY	388320	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	2150492	BOY
EOY	3232940	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	91664809	BOY
EOY	98205634	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	12878637	BOY
EOY	14344504	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	4114833	BOY
EOY	3999967	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	38491611	BOY
EOY	32371364	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	55485081	BOY
EOY	50715835	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	36179728	BOY
EOY	47489799	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	36179728	BOY
EOY	47489799	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	91664809	BOY
EOY	98205634	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	8391662	ReconcilationRevenueExpenses
Reconcilation Other Changes	2918408	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$14,892	OtherActivitiesAmount
Total Lobbying Expenditures IIB	14892	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Other Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1i:	ReturnReference
Explanation	Our Lady of Bellefonte Hospital paid dues to the Kentucky Hospital Association (KHA), Catholic Health Association (CHA), and American Hospital Association (AHA) 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: 16.2% ($8468) to the KHA, 4.7% ($1367) CHA, and 24.4%($5057) AHA.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4533456	OtherCostOrOtherBasis
Book Value	4533456	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	56918738	OtherCostOrOtherBasis
Depreciation	21431983	Depreciation
Book Value	35486755	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2528936	OtherCostOrOtherBasis
Depreciation	1303317	Depreciation
Book Value	1225619	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	50927155	OtherCostOrOtherBasis
Depreciation	38095457	Depreciation
Book Value	12831698	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4466919	OtherCostOrOtherBasis
Depreciation	3174384	Depreciation
Book Value	1292535	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	55370063	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescription	AmountAmount
Pension Liability	$30,017,514
Mcare/Mcaid Liability	$1,851,165
Other Miscellaneous	$502,350
Unclaimed Properties	$160
Due to Affiliates	$175

Field	Value	IRS element (for citing)
Total Of Amounts	32371364	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Description of Uncertain Tax Positions Under FIN 48:	Identifier
Return Reference	Part X:	ReturnReference
Explanation	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 FIN 48. FIN 48 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 FIN 48 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 $89,500 and $98,300 of net operating loss carryforwards as of August 31, 2011 and 2010, respectively, which expire in varying periods through 2031 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2011 and 2010. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2963463	TotalCommunityBenefitExpense
Direct Offsetting Revenue	742250	DirectOffsettingRevenue
Net Community Benefit Expense	2221213	NetCommunityBenefitExpense
Percent Of Total Expense	0.02150	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	22563414	TotalCommunityBenefitExpense
Direct Offsetting Revenue	18495047	DirectOffsettingRevenue
Net Community Benefit Expense	4068367	NetCommunityBenefitExpense
Percent Of Total Expense	0.04160	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	25526877	TotalCommunityBenefitExpense
Direct Offsetting Revenue	19237297	DirectOffsettingRevenue
Net Community Benefit Expense	6289580	NetCommunityBenefitExpense
Percent Of Total Expense	0.06310	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	32	NumberOfActivitiesOrPrograms
Persons Served	141120	PersonsServed
Total Community Benefit Expense	786478	TotalCommunityBenefitExpense
Direct Offsetting Revenue	11581	DirectOffsettingRevenue
Net Community Benefit Expense	774897	NetCommunityBenefitExpense
Percent Of Total Expense	0.00360	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Persons Served	254	PersonsServed
Total Community Benefit Expense	1403228	TotalCommunityBenefitExpense
Direct Offsetting Revenue	166520	DirectOffsettingRevenue
Net Community Benefit Expense	1236708	NetCommunityBenefitExpense
Percent Of Total Expense	0.00750	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	787337	TotalCommunityBenefitExpense
Net Community Benefit Expense	787337	NetCommunityBenefitExpense
Percent Of Total Expense	0.00690	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	10	NumberOfActivitiesOrPrograms
Persons Served	5702	PersonsServed
Total Community Benefit Expense	19416	TotalCommunityBenefitExpense
Net Community Benefit Expense	19416	NetCommunityBenefitExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	47	NumberOfActivitiesOrPrograms
Persons Served	147076	PersonsServed
Total Community Benefit Expense	2996459	TotalCommunityBenefitExpense
Direct Offsetting Revenue	178101	DirectOffsettingRevenue
Net Community Benefit Expense	2818358	NetCommunityBenefitExpense
Percent Of Total Expense	0.01830	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	47	NumberOfActivitiesOrPrograms
Persons Served	147076	PersonsServed
Total Community Benefit Expense	28523336	TotalCommunityBenefitExpense
Direct Offsetting Revenue	19415398	DirectOffsettingRevenue
Net Community Benefit Expense	9107938	NetCommunityBenefitExpense
Percent Of Total Expense	0.08140	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	1270	PersonsServed
Total Community Building Expense	9299	TotalCommunityBuildingExpense
Net Community Building Expense	9299	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	205	PersonsServed
Total Community Building Expense	231143	TotalCommunityBuildingExpense
Net Community Building Expense	231143	NetCommunityBuildingExpense
Percent Of Total Expense	0.00170	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Persons Served	1222	PersonsServed
Total Community Building Expense	6265	TotalCommunityBuildingExpense
Net Community Building Expense	6265	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	7	NumberOfActivitiesOrPrograms
Persons Served	21382	PersonsServed
Total Community Building Expense	202499	TotalCommunityBuildingExpense
Net Community Building Expense	202499	NetCommunityBuildingExpense
Percent Of Total Expense	0.00150	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	13722	PersonsServed
Total Community Building Expense	69345	TotalCommunityBuildingExpense
Net Community Building Expense	69345	NetCommunityBuildingExpense
Percent Of Total Expense	0.00050	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	250	PersonsServed
Total Community Building Expense	1427	TotalCommunityBuildingExpense
Net Community Building Expense	1427	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Building Expense	603	TotalCommunityBuildingExpense
Net Community Building Expense	603	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	20	NumberOfActivitiesOrPrograms
Persons Served	38051	PersonsServed
Total Community Building Expense	520581	TotalCommunityBuildingExpense
Net Community Building Expense	520581	NetCommunityBuildingExpense
Percent Of Total Expense	0.00380	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$2,460,981	BadDebtExpenseAmount
Amount Reimbursed By Medicare	41032642	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	42666709	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-1634067	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Our Lady of Bellefonte Hospital Inc	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	St Christopher Dr	AddressLine1
City	Ashland	City
State	KY	State
ZIP Code	41101	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	10	NumberOfOtherFacilities

Other Facilities OtherFacilities (10 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
Bellefonte Home Health Care Agency
1819 Ashland Road	Greenup	KY	41144	Home Health
OLBH Pediatric Rehabilitation Clinic
1629 Ashland Road Unit 2	Greenup	KY	41144	Pediatric Rehab
Sleep Lab
118 St Christopher Drive	Ashland	KY	41101	Sleep Lab
Bellefonte Behavioral Health
St Christopher Drive	Ashland	KY	41101	Behavioral Health
Bellefonte Center
1000 Ashland Drive	Ashland	KY	41101	Holds Med. Records, Registration, Billing, Finance, HR, Physician Prac. Admi
Renaissance Sleep Lab
2920 Winchester Avenue	Ashland	KY	41101	Sleep Lab
Ironton MRI
1015 East Ring Road	Ironton	OH	45638	Imaging Center
Vitality Center
St Christopher Drive	Ashland	KY	41101	Cardio/Vascular Rehab
Same Day Surgery Center
1101 St Christopher Drive	Ashland	KY	41101	Surgery Center
Med Plaza Pharmacy
700 St Christopher Drive	Ashland	KY	41101	Pharmacy

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
Part I, Line 6a: Bon Secours Kentucky Health System annually develops a report to 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 published each year and posted on the web at http://www.olbhfoundation.com.
Part I, Line 7: 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, Line 7g: Primary Care Clinic Subsidy: Bellefonte Physician Services, Inc. ("BPS"), in conjunction with Our Lady of Bellefonte Hospital, employs 49 providers in order to offer quality healthcare to the residents of Eastern Kentucky, more specifically Boyd, Greenup, and Carter Counties. BPS providers offer healthcare services to patients who are either uninsured or are covered by Medicaid, which equals approximately 12% and 23% of our overall patient population, respectively.
Part I, L7 Col(f): The bad debt expense included in Part IX; line 25 and excluded from the "percent of total expense" calculation is: $9,727,959
Part II: Healthy Community Initiative: BSKHS commitment to social and economic justice is integrated into the fabric of the organization through its Strategic Quality Plan and its common vision of a healthy community. Our vision of a healthy community is embodied in the following statements. A healthy community is a good place to live for all residents. The rich diversity of cultures and capacities of the community are celebrated and mobilized, with a particular concern for the poor, marginalized and dying, to create physical and social environments that promote families, nurture youth and support senior citizens. Individuals have the opportunity to fully participate in defining holistic well-being and assuming responsibility for the development of their innate potential.BSKHS is working to engage and empower the members of the Argillite community located in Greenup County to support them in improving their quality of life and holistic health. The Director of Healthy Community Initiatives is coordinating efforts to unite the communities and aid in health and social issues. The Director is assessing the needs and assets of the communities through resident interviews, community forums, surveys and focus groups. With this data, the community members will choose the priority improvement initiatives that residents and supporting organizations want to address.Argillite is a rural community with approximately 1,000 residents. Single-family homes and trailers prevail. 47% of the households make less than $25,000 per year with 17% of that number making less than $15,000 annually. Forty-three percent of residents have no high school diploma; 16% of that number have less than a 9th grade education. Argillite Elementary has 68% of students receiving free and reduced lunch. One of the first initiatives was a summer feeding and reading program for children in collaboration with the Greenup County Schools Family Resource and Youth Service Center. Other community projects include distribution of free dictionaries and books to students and Thanksgiving food baskets to needy families; a Back pack program to assist low income students with school supplies and clothes and funding for a weekend snack sack program that provides students most at risk of going hungry with food during the weekend. A walking track was built in the community to provide a safe area for residents to exercise in close proximity to where they live.The Ironton, Ohio community is a small urban area of approximately 25,000 residents. The once thriving city with abundant jobs in the steel and industrial areas is now in a situation of high unemployment, low job opportunities and a strapped city budget with an aging infrastructure. The 9th street community is home to subsidize housing for seniors and families; high crime rates and drug abuse are taking a toll on the residents. One of the first initiatives was the purchase of computers for senior housing recreation rooms and a community center used by students and families. Financial support for a cash strapped after school program allowed services to be provided three days a week to low income students needing assistance with homework and providing a safe environment for students. Students participating in summer youth activities at the community center will have the opportunity to go on fieldtrips, safe summer day camp activities and mentors to work with on various topics.
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 hospitals 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 patients ability to pay or the hospitals 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 patients 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, Our Lady of Bellefonte Hospital (OLBH) 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-Reuters 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.Our primary service area consists of Boyd, Greenup, and Carter Counties in Kentucky and Lawrence County in Ohio. Our secondary service area consists of Lewis County, Kentucky and Scioto County, Ohio. We continually update our information for our market share and physician planning to offer services in underserved areas of our region utilizing hospital data including emergency department visits for our uninsured adult population that needs primary care services. 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 52 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. The most recent comprehensive community needs assessment for our tri-state area was a collaborative effort by the Lewis College of Business at Marshall University in Huntington, WV, and the River Cities Community Health Coalition. Conducted in 2002, a survey questionnaire of 88 questions was jointly developed and then administered by telephone to a random sample of households in the 12-county, tri-state area that comprises the River Cities (Ashland, KY; Huntington, WV; and Portsmouth, OH). Significant findings include:-Nearly 30% of respondents did not participate in any kind of physical activity.-Nearly 50% of respondents were trying to lose weight.-It had been more than one year since 20% of respondents had had their blood pressure checked.-Slightly over 25% of the survey respondents smoked cigarettes and over 80% of these respondents said they would like to quit smoking if they could.-33% of male respondents had not had prostate or testicular cancer screening.-36% of female respondents over the age of 40 had never had a mammogram.-52% of respondents had not had a tetanus shot in the past 10 years.-Nearly 24% of respondents said they had never had their cholesterol checked by a health professional.-Almost 43% of the overall survey respondents said they had needed medical care but did not seek it because of a lack of money, lack of insurance or lack of transportation.OLBH is currently partners with the Greenup County Health Department in its MAPP (Mobilize for Action through Planning & Partnerships) project which is a state mandated program that will result in a comprehensive community health plan for each county in Kentucky. OLBH is conducting a community needs assessment conducted on Survey Monkey is being distributed to local organizations, business leaders, non-profit organizations and other community organizations. OLBH staff members are being ask to participate as community members and the survey will be offered to local community residents in the spring by internet or through a paper version by mail, plans to reach local residents is an ongoing effort to receive feedback from a wide range of individuals in our local service area.
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 patients 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 Kentucky Health System (BSKHS) serves a region of approximately to 400,000 people in northeastern Kentucky, southern Ohio, and western West Virginia. The service areas includes six counties in northeastern Kentucky (Greenup, Boyd, Lawrence, Carter and Elliott which comprise the FIVCO Area Development District as well as Lewis County); two counties in southern Ohio (Lawrence and Scioto counties); 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 womens health, orthopedics, diabetes, cardiopulmonary services and wound care. Major trends in the service area indicate a stable population that is aging. The 55 and older population is expected to increase by 14% over the next five years. The younger population tends to leave the area to find jobs. The high poverty and high unemployment rate in the area result in a low socioeconomic status. It is a very industrialized region which creates carcinogens and unhealthy life styles especially in eastern Kentucky which has some of the highest incidences 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.
Part VI, Line 6: BSKHS' hospital, Our Lady of Bellefonte Hospital, operates an emergency room that is open 24 hours 7 days a week to all persons regardless of ability to pay. Three years ago, the hospital implemented the 30-minute guarantee that patients will be evaluated within 30 minutes of their arrival. This access to care guarantee continues to be the benchmark of performance. Our Lady of Bellefonte Hospital has an open medical staff with privileges available to all qualified physicians in the area.In FY11, Healthy Community Services conducted 94 health fairs and screenings. All participants in our health fairs received personal health counseling and those with abnormal results received appropriate educational materials and the offer of assistance in finding a health care provider if they had none. Participants were given a copy of their screening results and encouraged to share these results with their health care provider. Additionally, the services of our Diabetes Center, Firm Fitness and the Human Motion Vitality Center, and nutrition services were recommended when appropriate. Information about the Northeast Kentucky Care Center, our local "free" clinic was also given to participants who were uninsured or couldn't afford a health care provider.Faith Community Health Ministry: We currently partner with 50 local churches in health ministry and about 19 additional congregations are on our mailing list. A significant number of our health fairs and community flu shot clinics were held in our partnering congregations. Additionally, our congregational partners receive a monthly mailing that provides an article suitable for their church newsletter that blends scripture with timely health education. Information about health issues and events at the local, state and national levels is also included in the mailing. This includes information about advocacy and resources that might benefit members of the congregation. We also provide weekly Wellness Tips for Body, Mind and Spirit that can be used in church bulletins. Our mailing is also shared with the Kentucky Parish Nurse Network and the BSHI Parish Nurse Network which significantly increases the number of congregations we reach. We are planning our first Basic Parish Nurse Education course for summer of 2012. This will consist of three 1 1/2 day sessions scheduled one month apart. Transportation Services: Our Healthy Community Services Van Ministry provides free non-emergency medical transportation to patients who are receiving outpatient services at our campus or who have appointments with campus or Bellefonte Physician Services-affiliated physicians. We also provide transportation to our primary care centers. The program is staffed with one full-time and two part-time drivers. We have two vans including one that is equipped with a wheelchair lift. This has been an invaluable service to our community as there is severely limited public transportation to our campus. There are virtually no options, other than ambulance transport, for patients who require transport in a wheelchair. In FY11, the number of "round trips" we provided increased from 1,704 in FY10 to 2,013 and we traveled nearly 9,000 more miles in FY11 than in FY10.Community Health Education programs: Healthy Community Services provides our community CPR classes. In FY11 we provided 14 classes and certified 91 individuals in CPR. We provided one Safe Sitter class in FY11 resulting in 15 certified Safe Sitters. We also offered a parish nurse conference and retreat with 13 nurses in attendance and a diabetes education program to the Salvation Army's Home League. The Salvation Army is one of our health ministry partners and 15 ladies attended this program.BSKHS provides a Women's Services mobile clinic that offers mammography screening Additionally, Healthy Community Services provides bone density screening monthly at the Greenup County Health Department. In FY2011, we served 74 women at the health department identifying 16 in the pre-osteoporosis or osteoporosis range. One of our primary care physicians volunteered two times a month at Northeast Kentucky Care Center, our local free clinic, throughout FY2011. He supervises our medical students and they were also involved in the clinic experience. Our Healthy Community Services director also volunteers monthly at the clinic and serves on their board.Children and Youth Services: Healthy Community Services participated in our 13th Annual Bicycle Safety Camp in FY 2011 serving 50 children. We also provided educational programs at both end-of-school activities and back-to-school events such as Ready fest in both Greenup and Boyd Counties. We trained 15 young people to be Safe Sitters in FY2011. Primary Care Clinic Subsidy: Bellefonte Physician Services, Inc. ("BPS"), in conjunction with Our Lady of Bellefonte Hospital, employs 49 providers in order to offer quality healthcare to the residents of Eastern Kentucky, more specifically Boyd, Greenup, and Carter Counties. BPS providers offer healthcare services to patients who are either uninsured or are covered by Medicaid, which equals approximately 12% and 23% of our overall patient population, respectively.
Part VI, Line 7: 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 is 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), Bon Secours Kentucky Health System (BSKHS) is called to continue the healing ministry of Jesus. BSKHS exists 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." BSKHS shares 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 within BSKHS.
KY	Reports Filed With States	Part VI, Line 7

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	OLBH Foundation	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	St Christopher Drive	AddressLine1
City	Ashland	City
State	KY	State
ZIP Code	41101	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	521301088	EINOfRecipient
IRC Section	501(c)(3)	IRCSection
Amount Of Cash Grant	372800	AmountOfCashGrant
Purpose Of Grant	General and Administrative Support	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Elizabeth Keith
0	158496	0	59911	0	1436	0	17705	0	8004	0	245552	0	0
Lawrence Skip Hubbard CHCIO
0	365557	0	102880	0	6291	0	96117	0	22177	0	593022	0	0
Kevin Halter
0	299973	0	90885	0	22578	0	18675	0	28366	0	460477	0	0
John Wallenhorst
0	222021	0	49904	0	22333	0	15504	0	9810	0	319572	0	0
Joe Buchheit
229525	0	41221	0	22138	0	19617	0	22322	0	334823	0	0	0
Jennifer Moore
184313	0	42734	0	22954	0	7380	0	9430	0	266811	0	0	0
Emilio A Punzal MD
193302	0	63968	0	256	0	3972	0	24768	0	286266	0	0	0
Kevin D Howard MD
154232	0	37570	0	37598	0	4296	0	15197	0	248893	0	0	0
Chuck D Charles
154647	0	26543	0	2147	0	2856	0	0	0	186193	0	0	0
Rodney N Hieneman
130348	0	23159	0	96	0	7704	0	0	0	161307	0	0	0
Thomas G Lyons
137250	0	9732	0	693	0	2304	0	214	0	150193	0	0	0
Mark Gordon
0	334541	0	101237	0	23866	0	30227	0	27696	0	517567	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 4b	The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits are made into this plan.
Part III	Part I, Line 3: Bon Secours Health System, Inc., a related organization of Our Lady of Bellefonte Hospital, Inc., uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent compensation consultant Written employment contracts Compensation survey or study Approval by the board/compensation committee	Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Form 990, Part VI, Section A, line 2	Board members Philip B. Leslie and Frank Warnock have a business relationship.
Form 990, Part VI, Section A, line 6	Bon Secours Health System, Inc. is the sole member of Bon Secours Kentucky Health System, which in turn is the sole member of Our Lady of Bellefonte Hospital, Inc.
Form 990, Part VI, Section A, line 7a	The 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 7b	Certain 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 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 of July 16, 2012. 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 July 16, 2012.
	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 12c
	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 positions of other officers or key employees of the organization were compared to similar position market data in comparably situated organizations taking into consideration geographic location and organization size where appropriate. During the review and approval of the compensation, documentation of the decision was recorded in human resources.	Form 990, Part VI, Section B, line 15
	Our Lady of Bellefonte Hospital, Inc. provides any documents open to public inspection upon request.	Form 990, Part VI, Section C, line 19
	Hours worked are not tracked on an entity by entity basis. All officers' and directors' 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. Volunteer Board Members are not compensated for their time. Voluntary Board Members are not compensated for their time. Kevin Halter'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 Kentucky Health System, which includes direct management, monitoring and oversight of Bon Secours Kentucky Health System and its related organizations. John Wallenhorst's compensation is paid by Bon Secours Health Systems, Inc., a related organization. The compensation he receives is for his role as the VP of Mission & Ethics at Bon Secours Health Systems, Inc. Elizabeth Keith's compensation is paid by SFH, Inc., a related organization of Bon Secours Health System, Inc. The compensation she receives is for her role as the SVP, Mission Services at SFH, Inc. Lawrence "Skip" Hubbard's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Information Officer of Bon Secours Health System, Inc. 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.	Form 990, Part VII:
Changes in Net Assets or Fund Balances:	Net unrealized gains on investments: 316,112. Minimum Pension Liability 6,748,545. Other Changes in Unrestricted Net Assets -84,081. Transfers to affiliates -4,062,168. Total to Form 990, Part XI, Line 5: 2,918,408.	Form 990, Part XI, line 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg	Direct Controlling Entity NADirectControllingEntityNA
Bon Secours Health Systems Inc
1505 Marriottsville Rd	Marriottsville	MD	21104	521301088	Parent Org. Management Services	MD	501(c)(3)	11b	Bon Secours Inc	0
Bellefonte Physician Services Inc
1000 St Christopher Drive	Ashland	KY	41101	352320780	Physician Practices	KY	501(c)(3)	3	Bon Secours Kentucky Health System	0
Our Lady of Bellefonte Hospital Foundation
1000 St Christopher Drive	Ashland	KY	41101	611381952	Grant Making Foundation	KY	501(c)(3)	9	Bon Secours Kentucky Health System	0
Bon Secours Kentucky Health System
1000 St Christopher Drive	Ashland	KY	41101	611356024	Local System Parent Org.	KY	501(c)(3)	11b	Bon Secours Health System Inc	0
Our Lady of Bellefonte Hospital Auxiliary
1000 St Christopher Drive	Ashland	KY	41101	610488859	Fundraising for Our Lady of Bellefonte Hospital	KY	501(c)(3)			0	N/A

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg