2012-11-15T07:16:46-06:00 2011-12-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-01-01 452964467 Bon Secours Charity Health System Affiliated Group BONS 255 Lafayette Avenue Suffern NY 10901 Philip A Patterson 8453685000 2012-11-15 1 Laura L Catlett P00873861 7032511000 2011 2016-02-24 21:20:13Z 436150071 1 1 5747 X X Acute care hospitals and long-term care facilities 18 15 3438 247 53700 53700 1452980 3734392 423486129 430113011 224165 102207 4257487 1926861 429420761 435876471 0 0 0 0 214734781 221857508 0 0 0 225874646 231301691 440609427 453159199 -11188666 -17282728 202303494 251943636 199683678 266142156 2619816 -14198520 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 people and communities to health and wholeness. 0 0 411584774 430113011 Bon Secours Charity Health System Affiliated Group is composed of three acute care hospitals and two long-term care and residential facilities: Good Samaritan Hospital of Suffern, NY; Bon Secours Community Hospital; St. Anthony Community Hospital; St. Francis Center at the Knolls (dba Mount Alverno Center); and Villas Francis at the Knolls (dba Schervier Pavilion).Good Samaritan Hospital, Suffern, New York, is a non-profit, 370-bed hospital providing emergency, medical, surgical, obstetrical/gynecological and acute care services to residents of Rockland and Orange Counties in New York and northern Bergen County, New Jersey. The hospital also serves these communities as an Area Level II Trauma Center and Level II Neonatal Intensive Care Unit. Good Samaritan Hospital is home of the Active International Cardiovascular Institute providing open heart surgery and advanced cardiac services to the region. See Schedule H for additional information relating to activities of the hospitals.Bon Secours Community Hospital's primary program service is to provide inpatient and outpatient acute care hospital services. Additional community programs are provided to bring wellness to the community served.St. Anthony Community Hospital is an acute care facility with 78 licensed beds.Mt. Alverno Center is the adult home/assisted living complex serving approximately 79 residents.Villa Francis at the Knolls, Inc. is a 120-bed skilled nursing facility providing healthcare services to acute care patients. 411584774 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 262 0 1 3438 1 1 1 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Julie Owen 8458567215 20 Grand Street Warwick NY 10990 X Maureen Creegan 4.00 X 0 0 0 Stephen Dormer 4.00 X 0 0 0 Joseph Ingrassia MD 4.00 X 0 0 0 Sylvain Klein 4.00 X 0 0 0 Sr Roseann Mazzeo 4.00 X 0 0 0 Sr Mary Eillen O'Brien 4.00 X 0 0 0 John O'Reilly 4.00 X 0 0 0 Robert Porr 4.00 X 0 0 0 Jerome Quint MD 4.00 X 0 0 0 Sr Rosemary Smith 4.00 X 0 0 0 Kenneth Steinglass MD 4.00 X 0 0 0 Bernard Weinstein 4.00 X 0 0 0 Andrea Schmid-Mazzoccoli 50.00 X 0 356293 62145 John Wallenhorst PhD 50.00 X 0 250446 27611 Fred Kelly 6.00 X X 0 0 0 Sr Anne Lutz 50.00 X X 0 0 0 Sr Ellen Dauwer 6.00 X X 0 0 0 Philip Patterson 50.00 X X 0 493724 113614 Melinda Hancock Jan-Aug 50.00 X 0 292838 33668 David Capone Aug-Dec 50.00 X 149888 0 5282 Rodney Williams MD Apr-Dec 50.00 X 266970 0 9196 Gerry Durney 50.00 X 305340 0 38766 Jeffrey Reilly 50.00 X 235720 0 8159 Elizabeth Ponte 50.00 X 185569 0 26197 Pam Tarulli 50.00 X 281011 0 30893 Richard Fenton 50.00 X 271971 0 16563 Toni Clark 50.00 X 198080 0 20287 Edward Lundy MD 50.00 X 1442274 0 36434 Rawn Salenger MD 50.00 X 789892 0 38317 Sushil Bhardwaj MD 50.00 X 541831 0 13426 Leon S Harris MD 50.00 X 417782 0 21947 Peter Kaye MD 50.00 X 299006 0 29789 Terence O'Brien 0.00 X 0 568025 8215 Leah Cerkvenik Jan-Oct 0.00 X 0 263688 11309 5385334 2225014 551818 250 1 1 0 Crothall Services Group 13028 Collections Center Chicago IL 60693 Engineering 7734139 Morrison Mgt Specialists PO Box 102289 Atlanta GA 30368 Dietary 5501183 Hospital Attending Physicians 484 Temple Hill Rd Suite 102 New Windsor NY 12553 Physician Fees 4185000 Holt Construction 50 East Washington Avenue Pearl River NY 10965 Construction Capital Projects 3935194 GE Healthcare PO Box 640944 Pittsburg PA 15264 Med Equip Service Contracts 2809762 243 1299997 2431065 3330 3734392 Patient Service Rev. 623000 430113011 430113011 430113011 247751 247751 358373 0 358373 358373 53700 304673 128056 0 273600 128056 -273600 -145544 -145544 Other Misc. Rev. 900099 834270 834270 Home Care Rev 900099 332162 332162 Pathology Lab Rev 900099 171000 171000 231056 231056 1568488 435876471 430113011 53700 1975368 2264488 2038039 226449 162552773 146297496 16255277 5751092 5175983 575109 37767058 33990352 3776706 13522097 12169887 1352210 1823374 1641036 182338 648248 583423 64825 258355 232520 25835 21642488 19478239 2164249 2255339 2029805 225534 7612958 6851662 761296 7678014 6910213 767801 1033552 930197 103355 7560042 7560042 18782598 16904338 1878260 6558273 5902446 655827 Medical Supplies 57767976 51991178 5776798 0 Purchased Services 49836419 44852777 4983642 0 Bad Debt 29854921 29854921 0 0 Corporate Dues 8103928 7293535 810393 0 9885206 8896685 988521 453159199 411584774 41574425 0 290450 111180 471686 56574653 62441733 2580735 6460181 6177611 5757457 1372089 226809412 117596884 109153628 109212528 18929711 19543788 4523337 50646363 202303494 251943636 46013399 44518426 51157 60710 153619122 221563020 199683678 266142156 X 1261699 -14966847 1358117 768327 0 2619816 -14198520 202303494 251943636 X -17282728 464392 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 80257 0 1 178098 258355 0 Explanation of Lobbying Activities: Part II-B, Line 1: Direct lobbying was conducted for budget, regulatory, and legislative issues pertaining to healthcare. Association dues were paid to the following organizations, a portion of which is used for lobbying activities: Health Association of New York 30.3%, North Metropolitan Hospital Association 28.9%, HEP 1199/SEIU project 100%, American Hospital Association 24.6% (2011), American Hospital Association 24.6% estimated (2012 dues accrued in 2011) and Catholic Health Association 5.15%. 0 1 4639780 4639780 118551698 50369651 68182047 1401361 208221 1193140 94633006 67019012 27613994 7583567 7583567 109212528 Current Other Receivables 1501980 Assets held in trust for others 54761 Deposits 330810 Medicare/Medicaid Settlements 4125921 Insurance Claims Receivable 44632891 50646363 Other Debt Long Term Liability 75068347 Due to BSHSI 79399270 Fin 47 LT Abestos Liability 4793514 Capital Leases LT Investment 4618831 Insurance Claims Payable 44632892 LT Building Development Liability 4390000 LT Liability Post Retirement Benefits 3152076 Medicare/Medicaid Settlements 5508090 221563020 Part IV, Line 2b: Certain facilities hold, safeguard, manage and account for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents and written requests for $50 or more are honored, by check, within a reasonable time frame. Generally, all custodial funds in excess of $50 are held in interest bearing accounts separate from that of the organization. 1 1 X 1 X 1 X 1 1 0 1 1 2431310 761892 1669418 0.00390 76194892 51888061 24306831 0.05710 1109136 1042803 66333 0.00020 79735338 53692756 26042582 0.06120 51 367755 1248251 0 1248251 0.00290 8 7383 1235964 0 1235964 0.00290 0 0 0 0 0.00000 0 0 0 0 0.00000 13 9274 78290 0 78290 0.00020 72 384412 2562505 2562505 0.00600 72 384412 82297843 53692756 28605087 0.06720 0 0 0 0 0.00000 0 0 0 0 0.00000 6 2739 167845 0 167845 0.00040 0 0 0 0 0.00000 0 0 0 0 0.00000 2 227 4065 0 4065 0.00000 1 37 817 0 817 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 9 3003 172727 172727 0.00040 1 5977343 0 140046099 147432984 -7386885 X 1 1 3 1 Good Samaritan Hospital of Suffern NY

255 Lafayette Avenue Suffern NY 10901

X X X 2 St Anthony Community Hospital

15 Maple Avenue Warwick NY 10990

X X X 3 Bon Secours Community Hospital

160 East Main Street Port Jervis NY 12771

X X X GOOD SAMARITAN HOSPITAL 1 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 ST ANTHONY COMMUNITY HOSPITAL 2 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 BON SECOURS COMMUNITY HOSPITAL 3 1 1 200.000000000000 1 200.000000000000 1 X X 1 1 X X 0 0 1 X 0 0 3 Regional Kidney Center

33-1 Route 17M Harriman NY 10926

Outpatient Dialysis Center Women's Imaging Center

55 Ronald Regan Blvd Warwick NY 10990

Outpatient Women's Imaging Center Bon Secours Care Center

510 Rt6209 Ste102105106 2nd Fl Milford PA 18337

Radiology and Lab Part I, Line 7: Part I, line 7a: Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger. Part I, line 7b: Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges recorded in the general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.Part I, line 7c: Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient. For Part I, Line 7 a-c computations: The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger. Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit. Part I, line 7e: Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.Part I, line 7f: Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program. Part I, L7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 29,818,052. Part II: Bon Secours is actively engaged in improving community health in the Port Jervis area through its Building Healthy Communities initiative. The Bon Secours Charity Health System (BSCHS) Director of Building Healthy Communities is focused on improving community health in the Port Jervis area. Building Healthy Communities has partnered with local residents, business owners, and government officials to bring fresh, local produce into the community and improve access to health screenings for low income residents. This initiative, along with related educational programs on healthy cooking and eating, is a step forward in addressing a major community-identified barrier to health. 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 total shortfall of Medicare reimbursement compared to computed Medicare allowable costs should be treated as community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service. Part III, Line 9b: The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending FAP account.Specific criteria exist for how much financial assistance, partial or total, will be provided to the patient based on the assessed need. Criteria is based on Federal Poverty Guidelines and is reviewed and updated annually. Once a patient has been deemed eligible for the Patient Financial Assistance Program (FAP), the patient is notified by letter within 60 days after receipt of the application and supporting documentation. The patient retains eligibility for a period of twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve months, the patient is responsible for reapplying for FAP eligibility. GOOD SAMARITAN HOSPITAL Part V, Section B, Line 11h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. ST. ANTHONY COMMUNITY HOSPITAL Part V, Section B, Line 11h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. BON SECOURS COMMUNITY HOSPITAL Part V, Section B, Line 11h: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. GOOD SAMARITAN HOSPITAL Part V, Section B, Line 13g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. ST. ANTHONY COMMUNITY HOSPITAL Part V, Section B, Line 13g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. BON SECOURS COMMUNITY HOSPITAL Part V, Section B, Line 13g: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. GOOD SAMARITAN HOSPITAL Part V, Section B, Line 19d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. ST. ANTHONY COMMUNITY HOSPITAL Part V, Section B, Line 19d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. BON SECOURS COMMUNITY HOSPITAL Part V, Section B, Line 19d: Please see the narrative for Part VI, Line 3 regarding the Financial Assistance Policy. Part VI, Line 2: Consistent with New York State Public Health Law 2803-L, Bon Secours Charity Health System participates in a Community Service Plan process on an annual basis. Working with the Rockland County Department of Health, the Orange County Department of Health, and other health care providers in the community, we gathered and analyzed the following information in selecting the public health priorities to be focused on in our community service plan: demographics of the population we serve, health status of the population, availability, accessibility, and acceptability of needed resources, and studies and surveys of local health issues. The framework/criteria we used in selecting the public health care priorities included: alignment with the health care priorities in the New York State Prevention Agenda, alignment with the local health priorities and concerns identified in interaction with key health care partners/providers, community leaders, organizations and interested residents in the communities we serve, and the opportunity to develop plans and programs to improve the health status of our community as well as access to care. Based on the above, in our Comprehensive Community Service Plan submitted in September 2009, Bon Secours Charity Health Care Systems identified two Prevention Agenda priorities as our focus from 2009-2012: Access to Quality Health Care and Chronic Disease and Cancer. Part VI, Line 3: Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance, if needed, once any patient financial obligation is determined.Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services, community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assist the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 200% of the Federal Poverty Guidelines ("FPG"), as adjusted by the Medicare geographic wage index for each community served to reflect that community's relative cost of living ("Adjusted FPG"). Adjustments to these guidelines are made in certain states, where applicable. A sliding scale assistance policy is afforded patients that exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family suffers a catastrophic financial burden to receive necessary health care services. Based on research conducted by the Tax Foundation, a non partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. The standard sliding scale is adjusted by the Medicare geographic wage index of each community served to reflect that community's relative cost of living. All patients are also eligible for a Prompt Pay Discount. In addition, a variety of other potential payment options are available. Bon Secours is dedicated to meeting the needs of non-English speaking patients by having on-site Spanish translators, and other language translation services. In addition, Bon Secours employs a telephone language service which assists in meeting any language needs that arise. The translation services are offered to non-English speaking patients from admission to discharge, including the financial process. Part VI, Line 4: BSCHS facilities operate and serve populations of lower New York State, principally Rockland and Orange counties. Rockland County is located approximately 30 miles north of Manhattan on the West side of the Hudson River. The County is a popular residence for people who commute to work in nearby Westchester and Bergen Counties, as well as Manhattan. The County comprises approximately 115,000 acres and contains more than 35,000 acres of preserved open space and park land. Rockland continues to experience steady population growth in its 5 towns and 19 villages. The most recent Census Department estimates indicate that Rockland County grew 8.7% from 2000 to 2010, and now includes 311,687 residents. Orange County is located in the Hudson River Valley, bordering New Jersey. The County comprises approximately 816 square miles. Orange County continues to experience steady population growth, with the 2010 Census indicating that Orange County grew 9.2% from 2000 to 2010, and now includes 372,813 residents. In Rockland County, there was substantial growth in all age cohorts 65 and older, a consistent trend nationally. Gender among the age groups is roughly equal from the early age cohorts through the 40s, but after age 65, women continue to outnumber men. Population projections-Preliminary population projections through 2035 show that Rockland County's older population may double in size in the next three decades, while those ages 30 to 44 may shrink in size. While projections are based on historical data and do not always predict accurate trends, the dramatic possible increase in the elderly population is a trend that should be of importance to County service providers and planners. Based on 2010 U.S. Census population estimates, the median age in Orange County has increased by more than 2 years since 2007, to 36.6 years; the largest cohort of residents is age 45-49. The number of residents ages 65-69 is forecasted to more than double from 2000-2020 primarily due to the entry of 'baby boomers' into these age ranges.Twenty-one percent of Rockland County's population was estimated to be foreign-born in 2010. Among the 63,058 Rockland county residents estimated to be foreign born in 2007, the largest group was born in the Latin America and the Caribbean (48%). One quarter of foreign-born residents (25%) originated from Asia. Approximately another quarter (23%) came from Europe and 3% from Africa. Countywide, 32.9% of persons over age 5 speak a language other than English at home.According to the U.S. Census, 11.1% of residents in Orange County were foreign born, with 22.3% of persons over the age of 5 speaking a language other than English at home. Rockland County's rate of poverty for children under 18 increased to 16.9% in 2009 when compared to (15%) in 2000. Poverty rates in Orange County vary greatly based on municipality. Poverty rates exceeding 25% for families with related children under 18 are found in Orange County's three cities (Middletown, Newburgh, and Port Jervis), as well as in the town of Monroe, largely due to the impact of the village of Kiryas Joel, where the poverty rate is more than 4 times the county average. Part VI, Line 5: All BSCHS facilities have an open medical staff with privileges available to all qualified physicians in the area and are governed by a System board of directors whose composition is representative of the community, with a majority being independent members of the community. BSCHS has a dedicated Community Outreach department responsible for planning, implementing and evaluating all community health and education programs. In 2011, over 20 support groups met monthly in our facilities. The Community Outreach department managed the BSCHS Speakers' Bureau which connected our medical professionals directly with the community on topics such as Cardiac, Orthopedics, Women's Health, Obesity, Stroke, Diabetes, Wound Care, Safety, Asthma, Senior Services, etc. The Community Outreach department also managed 3 live radio interview broadcasts each month for a combined listening audience of 23,000/month. In addition to this, the Outreach department also managed service line specific programs such as Breast and Cervical Cancer screenings, Vein screenings, Colon Cancer screenings, Better Hearing seminars, Sleep Disturbances seminars and others. Access to Care: Bon Secours Charity Health System is committed to responding to and participating in addressing the health care needs of the communities in its service area. This is accomplished through several means such as providing charity care; improving access to health care services especially for the underserved population; and offering various opportunities for community members to enroll in governmental and/or community health plans. Two of the three BSCHS hospitals give space to several different health insurance providers to allow the public the opportunity to apply for health insurance coverage. Additionally, all three BSCHS hospitals have partnered with local Federally Qualified Health Centers (FQHC) to increase public awareness of the available services that are either free of charge or based on a sliding scale payment.In 2011, Bon Secours Charity Health System assisted 851 patients in applying for Medicaid, Family Health Plus and Child Health Plus. While this has helped many people, the challenge to keep the health consumer engaged through the often tedious application process is something that BSCHS continues to work to improve. BSCHS also continues to increase the size of its employed Medical Group and, in accordance with our mission, these practitioners are required to accept Medicaid and to participate in programs to provide charity care. Chronic Disease:The health risk analysis completed in partnership with area Health Departments indicated the communities served by BSCHS have high incidence of chronic disease (particularly heart disease and cancer). BSCHS has dedicated full time resources, including a Community Education Coordinator and Cardiac Liaison whose primary role involves educating the community about health issues including chronic disease and cancer. The goal of our Heart Disease strategies is to increase the public's awareness of the risk factors for heart disease and to give them information on how to diminish their risk. In 2011, BSCHS hosted 45 free cardiac awareness and prevention programs that were attended by a total of 1,345 people. Specific programs focused on prevention, signs and symptoms, cholesterol, blood pressure screenings, obesity and women and heart disease. BSCHS also participated in the American Heart Walk which was attended by over 800 people. The Lower Hudson Valley Mended Hearts Chapter #368 meets monthly at Good Samaritan Hospital offering support and education for cardiac patients and their family members. Through the trained volunteer visitor program, both pre and post cardiac surgery patients are visited by a former heart surgery patient. In 2011, 7 trained Mended Hearts volunteer visitors made 56 visits to cardiac patients before and after surgery. A new offering of the Heart Disease awareness program was the addition of free cardiac screenings. These screenings are managed by nurse practitioners and laboratory technicians. Cholesterol, blood pressure, BMI, and glucose levels are tested and each person has a private consultation about their results with a cardiac nurse or nurse practitioner. In 2011, BSCHS hosted 6 such screenings and reached 241 people. In addition, BSCHS hosted 45 free cardiac awareness and prevention programs that were attended by a total of 1,345 people.The BSCHS cancer services provide the community with excellent cancer treatment and support opportunities as well as increase the public's awareness of risk factors and cancer prevention. BSCHS has two cancer treatment programs, one located at Good Samaritan Hospital and one at Bon Secours Community Hospital. Both programs are accredited by the Commission on Cancer by the American College of Surgeons and Good Samaritan Hospital's Radiation Oncology Services are accredited by the American College of Radiology. BSCHS leadership and cancer program staff work diligently to maintain these accreditations to ensure that the community is receiving the best care available. Additionally, partnerships with the American Cancer Society have helped to develop new community screening programs and to improve patient support offerings.In 2011, BSCHS hosted 56 cancer awareness, early detection, prevention and support programs that reached a total of 1,397 people. These programs focused on a wide variety of cancer related illnesses and many of them offered the community the opportunity to meet oncology specialists on a one-to-one basis. A partnership with the Cancer Services Program of Rockland County helped BSCHS to develop ongoing breast, cervical and colon cancer screenings for uninsured and underinsured community members. These free screenings began late in 2011, and through the 2 screenings held that year, 42 people received early detection services. Important to note is that, if a person has a positive finding from any of these free screenings, BSCHS works with the Cancer Services Program to provide all necessary follow up treatment including surgery, chemotherapy and radiation. BSCHS recruited a board certified breast surgeon and a board certified colorectal surgeon who both joined our medical staff in 2011. Additionally, BSCHS now employs a Certified Genetics Counselor who provides patient and family consultations and speaks at free community education programs. A patient navigator assists breast cancer patients to coordinate their care and access available services. BSCHS continues to financially support the American Cancer Society's Making Strides Against Breast Cancer annual fundraising walk. Our restricted donation helps to produce prevention and early detection educational materials for the communities we serve. Part VI, Line 6: Bon Secours Health System, Inc., a Maryland nonprofit, nonstock membership corporation (BSHSI), and all of the other entities that are controlled directly or indirectly by Bon Secours, Inc., a Maryland nonprofit, nonstock membership corporation (BSI) are described collectively as the System. BSI, which is the sole corporate member of BSHSI, has no healthcare operations. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2010-2012). One of those goals 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 Charity Health System (BSCHS) is called to continue the healing ministry of Jesus. BSCHS 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". BSCHS 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 BSCHS. Reports Filed With States Part VI, Line 7 NY X X X X X 1 1 0 0 0 0 0 0 0 Andrea Schmid-Mazzoccoli 0 333338 0 0 0 22955 0 35568 0 26577 0 418438 0 0 John Wallenhorst PhD 0 227839 0 0 0 22607 0 16142 0 11469 0 278057 0 0 Philip Patterson 0 442839 0 0 0 50885 0 73079 0 40535 0 607338 0 0 Melinda Hancock Jan-Aug 0 254357 0 5017 0 33464 0 4898 0 28770 0 326506 0 0 David Capone Aug-Dec 130405 0 0 0 19483 0 0 0 5282 0 155170 0 0 0 Rodney Williams MD Apr-Dec 264249 0 0 0 2721 0 0 0 9196 0 276166 0 0 0 Gerry Durney 280537 0 0 0 24803 0 7903 0 30863 0 344106 0 0 0 Jeffrey Reilly 213157 0 0 0 22563 0 6395 0 1764 0 243879 0 0 0 Elizabeth Ponte 158619 0 25000 0 1950 0 10606 0 15591 0 211766 0 0 0 Pam Tarulli 238996 0 20000 0 22015 0 15876 0 15017 0 311904 0 0 0 Richard Fenton 154994 0 0 0 116977 0 0 0 16563 0 288534 0 0 0 Toni Clark 175937 0 0 0 22143 0 11095 0 9192 0 218367 0 0 0 Edward Lundy MD 1244351 0 192500 0 5423 0 11000 0 25434 0 1478708 0 0 0 Rawn Salenger MD 788793 0 0 0 1099 0 8250 0 30067 0 828209 0 0 0 Sushil Bhardwaj MD 538299 0 0 0 3532 0 11227 0 2199 0 555257 0 0 0 Leon S Harris MD 286619 0 129542 0 1621 0 17708 0 4239 0 439729 0 0 0 Peter Kaye MD 253790 0 45000 0 216 0 5685 0 24104 0 328795 0 0 0 Terence O'Brien 0 0 0 0 0 568025 0 0 0 8215 0 576240 0 0 Leah Cerkvenik Jan-Oct 0 0 0 0 0 263688 0 0 0 11309 0 274997 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Lines 4a-b Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: Terence O'Brien,$568,025;Richard Fenton, $103,062;Leah Cerkvenik, $263,688. Part I, Lines 4a-b 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. Daniel Cerkvenik Family member of 42566 Employment 0 Sch L, Part IV, Business Transactions Involving Interested Persons: (a) Name of Person: Daniel Cerkvenik(b) Relationship Between Interested Person and Organization:Family member of Former EVP - Leah Cerkvenik Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. ("BSHSI") is one of two corporate members of Bon Secours Charity Health System, Inc. ("BSCHSI") along with the Sisters of Charity of Saint Elizabeth of Convent Station. BSCHSI is in turn the sole member of each of the members within Bon Secours Charity Health System Affiliated Group ("Group"). Form 990, Part VI, Section A, line 7a The governing bodies of the members within the Group are appointed by its Member, BSCHSI, and subject to approval by BSHSI, one of two corporate members of BSCHSI along with the Sisters of Charity of Saint Elizabeth of Convent Station. Form 990, Part VI, Section A, line 7b Certain authorities of the members of the Group are reserved to its member or to Bon Secours Health System, Inc. or are jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station. Form 990, Part VI, Section B, line 11 The process the Group uses to review the Form 990 consists of a review by Bon Secours Charity Health System, Inc.'s compliance board committee and provide the form to the board of directors of the Group to allow for a thorough review and questions by both before the extended filing date. BSCHS's audit and compliance committee members review the Form 990, schedules time on their meeting agenda, and provide comments before the return is filed. Form 990, Part VI, Section B, line 12c The members of this Group 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 BSCHS. 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's 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 The Group provides any documents open to public inspection upon request. Avg hours devoted to related org(s) when related comp is reported: 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. Volunteer Board Members are not compensated for their time. Philip Patterson'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 Charity Health System, Inc., which includes direct management, monitoring and oversight over the System and its related organizations. Melinda Hancock's compensation is paid by St. Mary's Hospital of Richmond (SMH). The compensation she received during calendar year ended 12/31/11 was for her role as the Interim CFO of Bon Secours Charity Health System (BSCHS)(Jan-Aug) and as the CFO of Bon Secours Virginia (BSV)(Aug-Dec). Her duties included direct financial management, monitoring and oversight over the respective systems and their related organizations. SMH was reimbursed for salary expenses from Jan-Aug by BSCHS. John Wallenhorst, PhD's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the VP of Missions & Ethics of Bon Secours Health System, Inc. Andrea Schmid-Mazzoccoli's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the VP-Chief Nursing Officer of Bon Secours Health System, Inc. Sr. Anne Lutz does not receive payroll distributions as she has taken a vow of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -238,485. Transfers to/from Affiliates 656,499. Add'l Minimum Pension Liability 660,848. Other -40. Reversal of PY adj -614,430. Total to Form 990, Part XI, Line 5: 464,392. Bon Secours Health System Inc (BSHSI) 1505 Marriottville Road Marriottsville MD 21104 521301088 Parent Org - Management Services MD 501(c)(3) Line 11, Type II: 50 N/A 0 Good Samaritan Foundation for Better Health 255 Lafayette Avenue Suffern NY 10901 133400353 Foundation NY 501(c)(3) Line 7: 170(b)(1)(a) BSCHSI 0 Bon Secours Community Hospital Foundation 255 Lafayette Avenue Suffern NY 10901 810667395 Foundation NY 501(c)(3) Line 7: 170(b)(1)(a) BSCHSI 0 Bon Secours Warwick Health Foundation 255 Lafayette Avenue Suffern NY 10901 141972807 Foundation NY 501(c)(3) Line 7: 170(b)(1)(a) BSCHSI 0 Bon Secours Charity Health System Medical Group PC 255 Lafayette Avenue Suffern NY 10901 223636986 Physician Services NY 501(c)(3) Line 3: 170(b)(1)(a) BSCHSI 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 1 1 0 0