2012-07-16T11:40:49-05:00 2011-08-31 Deloitte Tax LLP 1750 Tysons Blvd McLean VA 221024219 990 2010-09-01 520591555 Bon Secours Hospital Baltimore Inc BONS 4103623000 2000 West Baltimore Street Baltimore MD 212231558 Richard Jones 4103624477 2012-07-16 1 Laura L Catlett 7032511000 2010 2016-02-24 21:20:13Z Richard Jones 2000 West Baltimore Street Baltimore MD 212231558 141585095 0 0928 X www.bonsecoursbaltimore.com X 1920 MD Acute Care Hospital 14 12 1106 100 0 0 9804493 7992836 126819087 132055347 114690 -770937 825607 866227 137563877 140143473 0 58575 0 0 58743311 64595492 0 0 0 77459547 72460871 136202858 137114938 1361019 3028535 76327534 83049970 142322917 142266042 -65995383 -59216072 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 124665635 58575 132055347 Bon Secours Baltimore Hospital provides both inpatient and outpatient services. Such services include:Inpatient Services - 151 licensed beds for critical care, medical, psychiatric and surgical needs. BSBHS provides a full range of services & programs in response to community needs & interests including: Acute Care; Cardiology; Case Management; Wound Care Community Health Screenings; Critical Care; Emergency Care; Diagnostic Services; Employment Services; Family Support Center; Financial Education; Infectious Disease Care; Lab Services; Mammography; Neurology; Nuclear Medicine; Ophthalmology; Orthopedics; Faith Community Nurse Services; Pastoral Care; Pharmacy; Physical Therapy; Podiatry; Psychiatry; Pulmonary Services; Primary Care; Senior & Family Housing; Smoking Cessation; Social Work; Substance Abuse Treatment; Surgery; a Wellness & Fitness Center; Vascular Services; & the Women's Resource Center.Outpatient Services - including renal dialysis, HIV/AIDS services, mental health, substance abuse treatment, health education, cardiac rehabilitation and wellness programs and tele-health program for patients with congestive heart disease. BSBSH operates an emergency room that is open 24 hours per day, seven days per week, serving persons regardless of their ability to pay. See Sch. H for additional information. 124665635 1 1 0 1 0 0 0 0 0 1 1 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 1 144 0 1 1106 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MD X Richard Jones 4103623000 2000 W Baltimore St Baltimore MD 212231558 X Mary Lenore Beachley 4.00 X 0 0 0 Matthew Hemelt 4.00 X 0 0 0 J Howard Henderson 4.00 X 0 0 0 Martha Riva 50.00 X 0 401841 97433 Sr Mary Shimo 50.00 X 0 0 0 Alan Siegfried 4.00 X 0 0 0 Anthony Stanowski 4.00 X 0 0 0 Don A Waite 4.00 X 0 0 0 Lisa Williams 4.00 X 0 0 0 Theodore Wimberly 4.00 X 0 0 0 Glendora Hughes Esq 6.00 X X 0 0 0 Bro Art Caliman 50.00 X X 0 0 0 Ackneil Muldrow 6.00 X X 0 0 0 Samuel L Ross MD 50.00 X X 0 935425 47941 Richard Jones 50.00 X 360752 0 16406 Scott Furniss 0.00 X 0 0 0 Becky Colker 0.00 X 0 0 0 Richard Braam 0.00 X 0 0 0 Cathy Newhouse 50.00 X 0 377257 27267 Fabienne Larkins 50.00 X 282808 0 15887 Lu Ann Brady 0.00 X 0 0 0 Donovan Parkes 50.00 X 472099 0 33667 Usha Jain 50.00 X 295191 0 13999 Sudhir D Patel 50.00 X 287513 0 22413 Rosita R Cruz 50.00 X 285925 0 11127 Pelayo E Correa 50.00 X 284412 0 26987 2268700 1714523 313127 76 0 1 0 Shiftwise PO Box 70870 St Paul MN 55170 Nursing Services 1979392 Cardinal Health 1330 Enclave Parkway Houston TX 77077 Pharmacy Mgmt Services 1790238 University of Maryland 22 South Greene St Baltimore MD 21201 Physician Services 1672429 West Baltimore Anesthesia LLC 2000 W Baltimore St Baltimore MD 21223 Anesthesiologists 1623240 University of MD Emergency Medicine Asso 110 South Paca St Baltimore MD 21201 Physician Services 1173605 83 3429123 4429797 133916 7992836 Net Patient Rev. 621110 132055347 132055347 132055347 204418 204418 815 815 133991 133991 133991 133991 465452 1441622 465452 -1441622 -976170 -976170 Cafe and Vending 722212 387898 387898 MD Federal Entitlement 900099 174580 174580 Parking 812930 154353 154353 15405 15405 732236 140143473 132055347 0 95290 58575 58575 708831 637948 70883 49192373 44273136 4919237 3661790 3295611 366179 7479393 6731454 747939 3553105 3197794 355311 373755 336379 37376 348714 313843 34871 14426 12983 1443 11243249 10118924 1124325 685774 617197 68577 834219 750797 83422 344724 310252 34472 5737402 5163662 573740 181826 163643 18183 1407548 1407548 3260700 2934630 326070 1480799 1332719 148080 Purchased Services 14240403 12816363 1424040 0 Medical Supplies 12125521 10912969 1212552 0 Bad Debt Expense 11155779 11155779 0 0 BSHSI Allocation 7698806 6928925 769881 0 Business License & Fees 177874 160087 17787 0 1149352 1034417 114935 137114938 124665635 12449303 0 531585 532485 1554907 1795634 14919797 19775321 947884 1179262 1241466 14854 85790983 57318824 31066556 28472159 8589746 9608249 0 17475593 21672006 76327534 83049970 14512810 14404431 9295 1452192 5263880 5007955 122536932 121401464 142322917 142266042 X -66064929 -59815241 69546 599169 -65995383 -59216072 76327534 83049970 X 3028535 3750776 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 14425 14425 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Bon Secours Hospital Baltimore, Inc. paid dues to the American Hospital Association (AHA), the Maryland Hospital Association (MHA) 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: Lobbying activity for AHA ($4,825 or 24.2%), MHA ($8,450 or 8.65%), CHA ($1,150 or 4.68%) for a total of $14,425. 600000 600000 29048784 15860401 13188383 16517871 11718359 4799512 24709386 21604926 3104460 14914942 8135138 6779804 28472159 Due from Afilliates 21658856 Other LT Investment 13150 21672006 Due to Affiliates 21106366 Due to Bon Secours Health System, Inc. 71112494 Patient Credit Balances 1825593 Capital Leases 3616912 Pension Liability 20322261 Advances Mcaid/Blue Cross 2134969 Asbestos Liability 1282869 121401464 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 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. 1 1 1 X 1 X 1 1 1 0 1 1 7082269 7082269 0.05640 0.00000 0.00000 7082269 7082269 0.05640 1 977342 977342 0.00780 1 129 77080 77080 0.00060 2 83362 19096562 48812 19047750 0.15160 4 83491 20150984 48812 20102172 0.16000 4 83491 27233253 48812 27184441 0.21640 4 2162 6265725 2371554 3894171 0.00030 1 2172 602742 602742 0.00000 3 2040 2076007 2076007 0.00020 3 26318 1021075 1021075 0.00010 11 32692 9965549 2371554 7593995 0.00060 1 6289272 34826227 30508847 4317380 X 1 1 1 1 Bon Secours Hospital Baltimore Inc

2000 W Baltimore St Baltimore MD 212231558

X X X X NA 1 3 Bon Secours CIBS

3101 Towanda Ave Baltimore MD 21215

Behavioral Health Services New Hope

2401 W Baltimore Street Baltimore MD 212231558

Behavioral Health Services Druid Park Facility

2901 Druid Park Drive Suite A103 Baltimore MD 21215

Behavioral Health Services 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. Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.Part I, Line 7b: Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care.Part I, line 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. Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, L7 Col(f): Current year bad debt expense not included in the calculation for line 7, Column (f): $11,155,779 Part II: For BSBHS, creating an option for the poor and disadvantaged cannot be simply providing free or discounted services to those who come to our health care facilities in crisis without financial means to pay. Our call to live the teachings and promises of Jesus requires that we nurture the growth of individual and community capacities and create opportunities for each individual to assume a meaningful role in defining and pursuing holistic well being, peace, and hope. Our call requires that we be a prophetic voice for just and equitable public policies that ensure access to basic human goods for all people. As part of BSHSI, BSBHS' 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."Community Based Clinical Services BSBHS community-based clinical services include the Community Institute of Behavioral Services which provides a variety of clinical and community based behavioral health services; the Imani Center which provides primary and specialty care to persons affected by HIV/AIDS; health screenings at no charge at various sites throughout the community; and free transportation to and from medical appointments for the elderly and disabled. These programs served nearly 102,000 persons during FY 11.Health Care Support ServicesTele-Heart is a disease management program for persons diagnosed with congestive heart failure and hypertension that served over 5,000 persons in FY 11. Community Benefit Operations/Financial and In-Kind ContributionsBon Secours Community Works (formerly known as Bon Secours of Maryland Foundation) provides oversight and administration of BSBHS Community Benefit operations as well as contributions to local community groups."Community Benefit" is not just a program within BSBHS, but rather a constitutive dimension of its mission and history. From its beginnings in 1881 providing health care and support in neighbors' homes, to the establishment of its first hospital in 1919, to its comprehensive neighborhood revitalization initiative in the 21st Century - BSBHS has been an integral part of the community life of West Baltimore. This encompasses long term, collaborative relationships in which service organizations engage and empower the members of a defined geographic community to support them in improving their quality of life and holistic health. Since 1995, BSBHS has worked closely with the Operation ReachOut Southwest (OROSW) community to create projects, programs and work plans that are leading to the realization of OROSW's vision: to make southwest Baltimore a community of choice for current and new residents.Over the past few years, OROSW and BSBHS have collaborated to make tremendous strides in building programs and projects that are improving the quality of life for the residents of southwest Baltimore. The improvements have been accomplished by building off the strengths of the community, listening and responding to what residents say is needed, and hiring talented people to implement the projects. Our Money Place (OMP) - combines the services of the Security Plus Federal Credit Union, a local check casher, OROSW and BSBHS. Since opening in 2003, OMP has offered savings accounts, market rate loans, low cost check cashing, debt remediation free and low-cost tax preparation and retirement planning to help residents reduce non-asset building debt and increase personal wealth. Over 2,170 persons utilized these services in FY 11. Youth Employment and Entrepreneurship Program (YEEP) helps high school age youth learn job readiness, financial literacy and leadership skills and then access part time and summer jobs. YEEP also helps youth develop career plans and get into post-secondary education. The program follows alumni who attend college. Over 650 area youth participated in YEEP activities in FY 11.Clean & Green turns vacant lots into attractive green spaces and consistently maintains them at a community-wide scale. The program maintained over 400 lots in FY 11.Career Development Program offers job readiness, GED instruction, placement and retention services where, after a five-week intensive classroom experience, clients are followed for three years and helped to move up the company ladder, obtain more education as needed, get out of debt and learn basic money management skills. The ultimate goal is financial self-sufficiency. A total of 55 individuals completed our job readiness training and 120 community residents were placed in employment in FY 2011. We also screened 682 individuals for public benefits with 157 individuals receiving benefits. Family Support Center helps young parents obtain a GED and get into college while providing developmental childcare and parenting classes. Children (birth to age 4) receive developmental childcare while their parents are in class or in training. In addition, the Family Support Center staff provides In-Home-Intervention services. Eight hundred thirty-six parents and children were served during FY 11.Women's Resource Center is a drop-in center that provides crisis intervention, hospitality services and domestic violence counseling for homeless women or women at risk for becoming homeless. Over 540 women were served in FY 11.Housing - BSBHS also renovates row houses and constructs apartment buildings where low-income families and seniors can find safe and affordable housing in what had been dangerous, abandoned and drug-ridden properties. Over 648 families and seniors were housed in FY 11. 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 9b: 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 Hospital ("BSB" for Bon Secours Baltimore, or the "Hospital") is a 125 bed facility with 7,390 discharges for the fiscal year ended August 31, 2011. Bon Secours Hospital serves west, north and southwest Baltimore where almost one third of the city's total population reside. Predominately comprised of elderly, women and children, BSB's service area includes some stable neighborhoods as well as many neighborhoods facing significant social challenges in the areas of housing, employment education and health. Slightly more than half of BSB' admission's are either Self-Pay or Medicaid patients. The main focus of the community efforts by Bon Secours Hospital is the immediate area around the Hospital's campus. Represented by Operation Reach Out Southwest (a neighborhood community organization, "OROSW"), this area contains a community of approximately 21,000 persons containing 13 distinct neighborhoods surrounding Bon Secours Hospital. Although the community is located in close proximity to the hospital it meets the federal guidelines of a medically underserved population. Not surprisingly, the residents of these neighborhoods have some of the worst indicators of poor health status in the State. Our residents have some of the highest rates in the State for childhood diseases, breast and cervical cancer, poor nutrition, cardiovascular disease and diabetes. The community has been challenged by a host of social and economic ills including, vacant housing, high unemployment, illicit drug activity and drug related crime. Bon Secours approach to needs assessment is a collaborative one. Bon Secours works very closely with OROSW to develop, implement and monitor community benefit programs. OROSW, in partnership with Bon Secours, has developed and is implementing a 20 year revitalization plan in which Bon Secours has and will continue to serve as an anchor of stability and hope.Decision making ultimately rests with the BSB board. The board works closely with the Executive Leadership Team of Bon Secours Hospital, the Executive Director of the Bon Secours of Maryland Foundation (BSMF), the Bon Secours of Maryland Foundation board and the national Bon Secours Health System, Inc. ("BSHSI") board to insure the most effective use of the resources available. Ongoing needs assessment is done by BSMF staff and OROSW. With participation from over 200 residents and local stakeholders, BSB and OROSW completed a comprehensive revitalization plan in 1998. This plan includes a vision statement and desired outcomes and strategies in each of six issue areas: economic development, education, health, physical planning, public safety, and enriching activities for youth and seniors. Programs have been launched and many positive outcomes have been achieved in each of these areas see section 6 "Description of Community Building Activities"). The plan was updated in 2002 and approved by the Baltimore City Planning Commission.Much of the coalition's work has moved from a planning and implementation focus to one of managing programs and services. The Coalition's current leadership has aged and there is an effort underway to engage younger community residents into leadership roles. A major challenge is maintaining participation and related momentum at all levels (coalition, neighborhood, and block). This is critical because much remains to be done and we have learned that the most successful initiatives are resident led and community driven. Through the OROSW coalition, we have set up a decision making infrastructure that ensures meaningful resident participation in planning and implementation. We have also learned that success is more certain when you reverse thinking from addressing deficits in the community to building upon assets. We have also learned that success is more likely when we implement strategies and initiatives that are consistent with the communities' plans and appropriate to our organizational resources and skills. In November 2009, we launched a community health engagement process in partnership with the Operation ReachOut Southwest coalition and with assistance from the University of Maryland at Baltimore Social Work Community Outreach Service who are providing the staff organizing and outreach aspects of the process. The goal of the project was to engage the community around the hospital in a process that should culminate with:- an agreed-upon vision of an improved healthcare system which leads to a healthier community and is financially sustainable- a plan to achieve our visionThis planning process led to recommendations and strategies under three major areas of focus: Healthy People, Healthy Environment and Healthy Economy.The next step taken in our current effort was the West Baltimore Health Care Summit convened by Senator Verna Jones-Rodwell in January 2010 in collaboration with Bon Secours Baltimore Health System. The Summit Brought together 100 participants representing various stakeholders - hospitals, federally qualified health centers, physicians, philanthropic organizations, institutions of higher education, community members, and elected officials- to focus on improving access to primary care in Central and Southwest Baltimore City. Following the 2010 West Baltimore Health Care Summit, three workgroups were formed to focus on various aspects of improving access to Primary Care. The three workgroups focused on:a. Prevention, Education, and Outreach - a group which engaged community members through surveys and focus groups to identify recommendations to improve prevention, education and outreach efforts - and potential barriers that we may encounter as we move forward in our work.b. Healthcare Workforce - a group which developed recommendations to address the anticipated shortages in physicians, physician extenders, nurses and other clinicians that we expect to experience as the demand for health care services continues to increase.c. Service Delivery - a group, chaired by Miguel McInnis of the Mid Atlantic Association of Community Health Centers, which developed recommendations for improvements to the health care service delivery system - including the recommendation to complete a Primary Care Access Study. Understanding that Central and Southwest Baltimore exhibit some of the poorest health status indicators in the State of Maryland, and understanding that the passage of the Patient Protection and Affordable Care Act now provide us with a unique opportunity to create new models of care that better meet the needs of our community, Bon Secours and the Mid Atlantic Association of Community Health Centers have launched a Primary Care Access study as the next phase in our work. We expect this to be completed in February 2012. 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: BSBHS exists to benefit the people living in west Baltimore, where nearly one-third of the city's total population resides. Dominated by the elderly, women and children, BSBHS' service area includes stable, thriving neighborhoods as well as many neighborhoods facing basic social challenges in the areas of housing, employment, education and health. BSBHS' service area is comprised of African American population predominately (83%).BSBHS' service area is primarily lower income families with an annual average per capita income of $9,508 and unemployment of 21%. Seniors over 65 years of age comprise 14% of the population and 37% of the children under the age of 18 live in poverty. Sixty four % of the patients that BSBHS serves are malnourished at the time of admission, which is twice the national average.Bon Secours Baltimore Health System's primary service area had a population of 147,787 in 2009. The population is expected to decrease by 3.3 percent to a total of 142,924 by 2014. Demographic data indicates that 14 percent of the population is white, 82.2 percent is black, and a Hispanic population of 2,249, or 1.5 percent. Twenty-three percent of the population is under the age of 16 and 12.6 percent is over the age of 65. The median household income in 2009 was $32,451, compared to the median state income of $70,050. 39.9 percent of the population has a household income of below $25,000, compared to the state average of 17.8 percent. 22.6 percent of family households had income below the federal poverty level.Health Conditions - the most prevalent health conditions impacting the primary service area are high blood pressure, high cholesterol, and smoking. In 2008, the incidence of heart disease for the City of Baltimore is 256.3 per 100,000 residents, which is 35 percent greater than the state wide rate of 189.8 per 100,000, excluding Baltimore. The incidence rate for all cancers is 216.3 per 100,000 residents which is 40 per 100,000 residents (23 percent) greater than the state wide rate. For minority populations, the prevalence of all health conditions, from heart disease to cancer to HIV/AIDS ranges from 15 percent to as much as seven times more prevalent across health conditions. (City of Baltimore Health Department, 2010 Health Disparities Report Card).In addition, the service area incidence for these diseases is impacted by risk factors, among them smoking and being overweight. Thirty-two and a half percent of the service area residents smoke, and 23.4 percent of residents are considered overweight or obese.In fiscal year 2011, Bon Secours Baltimore hospital cared for 7,390 discharged patients, and treated 26,680 patients through in Emergency Department. The Emergency Department is open 24 hours a day and available to all persons regardless of ability to pay. Bon Secours Baltimore participates in Medicare, Medicaid, CHAMPUS, and other government sponsored health care programs including the state SCHIP/FAMIS program for children. Part VI, Line 6: BSB has an open medical staff with privileges available to all qualified physicians in the area. BSB is governed by a board of directors whose composition is representative of the community. 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 Baltimore Health Corporation dba Bon Secours Baltimore Health System, Inc. (BSBHS) is called to continue the healing ministry of Jesus. BSBHS 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." BSBHS 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 BSBHS. Reports Filed With States Part VI, Line 7 MD 0 Friends of MD State Archives 350 Rowe Blvd Annapolis MD 214011686 510547173 501(c)(3) 9000 General support American Diabetes Association 2002 Clipper Park Road Suite 110 Baltimore MD 212111465 131623888 501(c)(3) 10000 Charitable contrib. to help improve health in our community American Heart Association 415 N Charles Street Baltimore MD 212014405 135613797 501(c)(3) 7500 Charitable contrib. to help improve health in our community 3 0 X X X X X 0 1 0 0 0 0 0 0 0 Martha Riva 0 309435 0 88768 0 3638 0 63141 0 34292 0 499274 0 0 Samuel L Ross MD 0 464477 0 445726 0 25222 0 27112 0 20829 0 983366 0 0 Richard Jones 256891 0 80999 0 22862 0 3181 0 13225 0 377158 0 0 0 Cathy Newhouse 0 229474 0 51866 0 95917 0 16208 0 11059 0 404524 0 0 Fabienne Larkins 242664 0 38711 0 1433 0 5688 0 10199 0 298695 0 0 0 Donovan Parkes 471749 0 0 0 350 0 2886 0 30781 0 505766 0 0 0 Usha Jain 291701 0 0 0 3490 0 2785 0 11214 0 309190 0 0 0 Sudhir D Patel 286507 0 0 0 1006 0 2238 0 20175 0 309926 0 0 0 Rosita R Cruz 278655 0 0 0 7270 0 1172 0 9955 0 297052 0 0 0 Pelayo E Correa 282477 0 0 0 1935 0 8271 0 18716 0 311399 0 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 are made into this plan. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Hospital Baltimore, Inc., 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 Baltimore Health Systems, Inc., which in turn is the sole member of Bon Secours Hospital Baltimore, Inc. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Hospital Baltimore, Inc. is appointed by its member Bon Secours Baltimore Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Hospital Baltimore, Inc. are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date 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. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy, reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the 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 C, line 19 Bon Secours Hospital Baltimore, Inc. 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 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. Voluntary Board Members are not compensated for their time. Samuel L. Ross, M.D.'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 Baltimore Health System, Inc. which includes direct management , monitoring and oversight of Bon Secours Baltimore Health System and its related organizations. Martha Riva's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Chief Executive Officer of Bon Secours Health System, Inc. Brother Art Caliman and Sr. Mary Shimo do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 405,665. Amounts released from restriction -193,640. Transfers to BSHSI - Reimbursement and Swap/Principal -1,790,615. Add'l Minimum Pension Liability 3,612,502. Revenue deferred per financial stmts, recognized for tax 1,716,864. Total to Form 990, Part XI, Line 5: 3,750,776. Bon Secours Health System Inc 1505 Marriottsville Rd Marriottsville MD 211041301 521301088 Parent Org. Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Community Health Services Inc 2600 Liberty Heights Ave Baltimore MD 212157804 521909599 Medical Services Center MD 501(c)(3) 9 Bon Secours Baltimore Health System Inc 0 The Bon Secours of Maryland Foundation Inc 26 N Fulton Ave Baltimore MD 212231624 521732800 Community Foundation MD 501(c)(3) 11b Bon Secours Baltimore Health System Inc 0 Unity Properties Inc 26 N Fulton Ave Baltimore MD 212231624 521857768 Low Income Housing MD 501(c)(3) 7 Bon Secours of Maryland Foundation 0 Urban Medical Institute Inc 2600 Liberty Heights Ave Baltimore MD 212157804 521905869 Medical Services Center MD 501(c)(3) 3 Liberty Medical Center Inc 0 Bon Secours Baltimore Development Inc 26 N Fulton Ave Baltimore MD 212231624 760785344 Low Income Housing MD 501(c)(3) 7 Unity Properties Inc 0 Washington Village Community Medical Center Inc 2600 Liberty Heights Ave Baltimore MD 212231624 521138191 Healthcare MD 501(c)(3) 9 Bon Secours Baltimore Health Services Inc 0 Bon Secours Baltimore Health System Foundation Inc 2000 W Baltimore Street Baltimore MD 21223 383843816 Grant Making Foundation MD 501(c)(3) 11a Bon Secours Baltimore Health System Inc 0 Bon Secours Housing 26 N Fulton Ave Baltimore MD 212231624 521442707 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Housing II 26 N Fulton Ave Baltimore MD 212231624 521543174 Low Income Housing MD 501(c)(3) 9 Bon Secours of Maryland Foundation 0 Bon Secours Baltimore Health Corps (dba Bon Secours Baltimore Health System 2000 W Baltimore Street Baltimore MD 212231558 800728893 Local System Parent Org MD 501(c)(3) 11b Bon Secours Health System Inc 0 Bon Secours Apartments LP 1800 W Baltimore St Baltimore MD 21223 521952505 Low Income Housing MD Unity Housing Inc Related 0 0 0.00000 Bon Secours Apartments II LP 1800 W Baltimore St Baltimore MD 21223 522063512 Low Income Housing MD Unity Housing Inc Related 0 0 0.00000 Liberty Senior Housing LP 1800 W Baltimore St Baltimore MD 21223 522134447 Low Income Housing MD Unity Housing Inc Related 0 0 0.00000 Bon Secours Apartments III LP 1800 W Baltimore St Baltimore MD 21223 522134444 Low Income Housing MD Unity Housing Inc Related 0 0 0.00000 Bon Secours Smallwood Summit 26 N Fulton Avenue Baltimore MD 212231624 522280175 Low Income Housing MD Unity Housing Inc Related 0 0 0.00000 Bon Secours Chesapeake Apartments LP 26 N Fulton Avenue Baltimore MD 212231624 200107034 Low Income Housing MD Chesapeake Housing LLC Related 0 0 0.00000 Bon Secours Shiloh LP 26 N Fulton Avenue Baltimore MD 212231624 203965243 Low Income Housing MD Bon Secours Shiloh LLC Related 0 0 0.00000 Bon Secours Wayland LP 26 N Fulton Avenue Baltimore MD 212231624 270468688 Low Income Housing MD Bon Secours Wayland LLC Related 0 0 0.00000 Unity Housing Inc 26 N Fulton Avenue Baltimore MD 212231624 521952507 Low Income Housing MD Unity Properties Inc C Bon Secours Wayland LLC 26 N Fulton Avenue Baltimore MD 212231624 270468561 Low Income Housing MD Unity Properties Inc C 0 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0