Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 09-01-2012 , 2012, and ending 08-31-2013
BCheck if applicable:
CName of organization
Bon Secours Health System Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
8990 Old Annapolis Road
 
Room/suite
City or town, state or country, and ZIP + 4
Columbia, MD21045
D Employer identification number

52-1301088
E Telephone number

G Gross receipts $ 255,235,748
F Name and address of principal officer:
Richard Statuto
8990 Old Annapolis Road
Columbia,MD21045
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.bshsi.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1983
M State of legal domicile: MD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Provide admin/mgmt services to hospitals, nursing homes, & other related healthcare orgs.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 20
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 18
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 845
6 Total number of volunteers (estimate if necessary) ............. 6 18
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 603,186
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 29,434 8,379
9 Program service revenue (Part VIII, line 2g) ......... 165,204,936 182,231,617
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 19,486,120 30,770,006
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 29,825,308 42,225,746
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 214,545,798 255,235,748
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,605,030 6,662,628
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 101,216,300 103,790,709
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 114,107,717 126,575,957
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 216,929,047 237,029,294
19 Revenue less expenses. Subtract line 18 from line 12....... -2,383,249 18,206,454
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,140,476,498 1,213,757,145
21 Total liabilities (Part X, line 26)............. 1,245,642,024 1,203,308,235
22 Net assets or fund balances. Subtract line 21 from line 20..... -105,165,526 10,448,910
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 215,191,115 including grants of $ 6,662,628 ) (Revenue $ 213,536,267 )
The Bon Secours Health System provides a wide range of corporate support services to the facilities it owns or has affiliations. The system's mission services ensure that all Bon Secours facilities support the ministry of the Sisters of Bon Secours and the Catholic Church, and are driven by the system's mission and values. The system's financial, operational and business development services provide essential centralized support to improve operations, financial performance, and the delivery of patient care. With expertise in all areas of acute, long-term care and assisted living facility and home care management and operations, the corporate staff also serves as an invaluable corporate consulting resource.See Schedule O. Mission Services:-Direction, support and consultation for the local and corporate staff and boards of directors-Policy development in areas such as sponsorship, business relationships, moral investments, bioethics, organizational ethics, social justice and community commitment services-Education to promote the Bon Secours mission, philosophy and values to key staff-Coordination of teams charged with addressing health care issues and ethical concernsFinancial & Treasury Services:-Negotiation of access to capital-Oversight, coordination and control of external audits-Coordination of and assistance in maximizing third-party reimbursement and filing related appeals-Monitoring of federal health care policy-Monitoring of System's master pension trust encompassing the pooled investment of all defined benefit pension plan assets of System members, including the selection of master pension trust investment advisor and managers and evaluation of their performance-Management of System members' trustee-held funds and System-wide investment program encompassing the vast majority of System members' investments, including funded depreciation accounts and centralized cash management program, in accordance with uniform System investment guidelines-Management of centralized cash management program-Maintenance of System-wide common financial data base providing statusof key financial indicators and operating statistics-Long range capital and financial planning and annual operating and capital budgeting support-Preparation of monthly and year-end consolidating System-wide financial statements, including budget variation reporting and statistical analysis-Development, implementation and monitoring of standardized accounting policies and educates senior leaders on financial literacy and contemporary financial practices.-Development of external financial disclosures to investors and the public at large-Primary contact with rating agencies, bond insurers and for investors questions-Oversight of System consulting in the areas of tax returns,cost reporting, A-133 filings, CDM compliance and third party appeals-Organization of meetings of Chief Financial Officers to better coordinate implementation of System-wide goals, strategies, tactics and objectives and to monitor facility operations and corporate compliance Operational Services:-Actuarial, accounting and investment functions for self insurance funding of System members' general and professional liability and workers compensation claims and for a System-wide self-funded plan for employee health benefits-Coordination of functions for a System-wide standard hospital information system and other systems for use throughout the System and support functions for implementing and maintaining the information system-Standardized purchasing function, material management, Lawson ERP system, and other standard IS-Knowledge Transfer of best practices and successes on revenue enhancement and cost reduction initiatives.Strategic Planning, Marketing, and Business Development Services:-Coordination of System strategic planning including coordination of development of the System's vision, goals, and 3-year strategic plan and annual planning processes.-Market assessment and strategy development for improved local market positioning-Strategic planning support for acute, long-term and home care operations-New product/service research and development-Emerging technology research & assessment; knowledge transfer of technology and implications for system-Coordination and consultative assistance in service line planning & profitability analyses-Implementation of strategic growth initiatives in new and existing communities-Coordination of Planning & Business Development leaders, Customer Satisfaction, and Marketing & Communications leaders networksOther Corporate Services:-Corporate Communications and Public Relations-Internal auditing-Corporate Responsibility-Risk management-Governance-Coordination and control of System-wide benefit testing-Administration of System-wide health benefit plans-Placement and renewal of various System-wide welfare benefit plans-Coordination and management of legal services provided to System members-Regulatory compliance and insurance functions-System-wide employee, patient, resident and physician satisfactionProgram
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet215,191,115
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
639
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
845
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
20
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
18
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletLaura Ellison8990 Old Annapolis RoadColumbiaMD21045 (410) 442-5511
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Sister Elaine Davia........................................................................
Board Member
 3.00
.......................2.00 		X           0 0 0
(2) Marcia Dush........................................................................
Board Member
 3.00
.......................0.00 		X           0 0 0
(3) Stephanie Ferguson PhD........................................................................
Board Member (Jan-Aug)
 3.00
.......................0.00 		X           0 0 0
(4) Elder Granger MD........................................................................
Board Member (Sep-May)
 3.00
.......................0.00 		X           0 0 0
(5) Roger Huang........................................................................
Board Member (Sep-Dec)
 3.00
.......................0.00 		X           0 0 0
(6) Gerard Kells........................................................................
Board Member
 3.00
.......................0.00 		X           0 0 0
(7) Peter F Maddox........................................................................
Board Member (Jan-Aug)
 3.00
.......................0.00 		X           0 0 0
(8) Lucretia McClenney........................................................................
Board Member (Sep-Dec)
 3.00
.......................0.00 		X           0 0 0
(9) Jennifer O'Brien Esq........................................................................
Board Member (Jan-Aug)
 3.00
.......................0.00 		X           0 0 0
(10) Richard Serafini........................................................................
Board Member
 4.00
.......................0.00 		X           0 0 0
(11) Rev Myles Sheehan MD........................................................................
Board Member (Sep-May)
 3.00
.......................0.00 		X           0 0 0
(12) Sister Mary Shimo........................................................................
Board Member
 3.00
.......................0.00 		X           0 0 0
(13) Sister Alice Talone........................................................................
Board Member
 3.00
.......................0.00 		X           0 0 0
(14) Chris Allen........................................................................
Board Member
 4.00
.......................0.00 		X           0 0 0
(15) Richard Blair........................................................................
Board Member
 4.00
.......................0.00 		X           0 0 0
(16) David Jimenez........................................................................
Board Member
 4.00
.......................0.00 		X           0 0 0
(17) Laurie Lafontaine........................................................................
Board Member
 4.00
.......................0.00 		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Susan Sandlund PhD........................................................................
Board Member
 5.00
.......................0.00 		X           0 0 0
(19) Donald G Seitz MD........................................................................
Chairman
 12.00
.......................0.00 		X   X       87,481 0 0
(20) Richard Statuto........................................................................
CEO/President
 50.00
.......................0.00 		X   X       2,187,270 0 171,522
(21) Janice E Burnett........................................................................
CFO/Treasurer
 48.00
.......................2.00 		    X       559,191 0 72,090
(22) Martha Riva........................................................................
SVP Governance/Secretary
 50.00
.......................0.00 		    X       582,458 0 80,518
(23) Timothy Davis........................................................................
EVP-CHRAO
 50.00
.......................0.00 		      X     1,122,284 0 134,895
(24) Lawrence Skip Hubbard........................................................................
SVP-CIO
 48.00
.......................2.00 		      X     767,237 0 33,748
(25) Marlon Priest MD........................................................................
EVP-CMO
 49.00
.......................1.00 		      X     1,039,465 0 158,468
(26) Peter Bernard........................................................................
EVP - CEO VA Health System
 .10
.......................49.90 		        X   1,438,081 0 192,966
(27) Matthew Toddy........................................................................
EVP & General Counsel
 50.00
.......................0.00 		        X   1,014,148 0 116,512
(28) Mark Nantz........................................................................
CEO-BS St. Francis Health System
 .10
.......................49.90 		        X   952,104 0 80,530
(29) Samuel Ross MD........................................................................
CEO-BS Baltimore Health System
 12.50
.......................37.50 		        X   938,123 0 76,328
(30) Michael Kerner........................................................................
CEO-BS Hampton Roads Health System
 .10
.......................49.90 		        X   936,925 0 132,770
(31) Katherine Arbuckle........................................................................
Former CFO/Treasurer
 0.00
.......................0.00 		          X 233,666 0 16,969
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 11,858,433 0 1,267,316
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet245
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Deloitte Consulting LLP200 Berkley StreetBostonMA20116 General Advisory Services 9,190,765
Towers Watson Pennsylvania IncLockbox 7482 PO Box 8500PhiladelphiaPA19178 Pension Consulting Services 3,130,532
Crowell & Moring LLPPO Box 75509BaltimoreMD21275 Professional Services 2,329,061
Med Assets Inc200 N Point Center E Ste 600AlpharettaGA30022 Revenue Solutions 2,032,007
Gallup OrgPO Box 30111OmahaNE68103 Engagement Survey Services 1,901,717
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet69
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		8,379
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 8,379
Program Service Revenue Business Code
2a Corp Mgmt & IS Fees 900099 182,231,617 182,231,617    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 182,231,617
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,760,182     6,760,182
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 184,404  
b Less: rental expenses 0  
c Rental income or (loss) 184,404  
d Net rental income or (loss).......MediumBullet 184,404     184,404
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 24,009,824  
b Less: cost or other basis and sales expenses 0  
c Gain or (loss) 24,009,824  
d Net gain or (loss)..........MediumBullet 24,009,824     24,009,824
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a Investment in JV - Rop 900099 19,479,407 19,479,407    
b Premier & Other Pships 900099 8,958,633 8,196,394 399,602 362,637
c Rebates 900099 6,464,461     6,464,461
d All other revenue .... 7,138,841 3,628,849 203,584 3,306,408
e Total. Add lines 11a–11d ...... MediumBullet 42,041,342
12 Total revenue. See Instructions......MediumBullet 255,235,748 213,536,267 603,186 41,087,916
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 6,657,628 6,657,628
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 5,000 5,000
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 6,760,134 6,084,118 676,016  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 79,559,044 71,510,352 8,048,692  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,602,257 3,242,031 360,226  
9 Other employee benefits ....... 9,236,456 8,311,465 924,991  
10 Payroll taxes ........... 4,632,818 4,162,830 469,988  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 586,713 526,675 60,038  
c Accounting ........... 134,857 121,371 13,486  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 7,620 6,858 762  
12 Advertising and promotion .... 372,487 335,238 37,249  
13 Office expenses ....... 1,227,132 1,076,316 150,816  
14 Information technology ...... 29,125,667 26,213,100 2,912,567  
15 Royalties ..        
16 Occupancy ........... 6,476,145 5,780,353 695,792  
17 Travel ............ 4,120,167 3,707,260 412,907  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 1,419,811 1,277,830 141,981  
20 Interest ........... 15,863,261 15,863,261    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 40,292,920 36,133,015 4,159,905  
23 Insurance .............. 83,724 51,664 32,060  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Purchased services 17,390,189 15,610,263 1,779,926  
b Loss-Defeasance of Debt 7,843,633 7,059,270 784,363  
c Recruitment/Relocation 477,710 429,939 47,771  
d Dues and Subscriptions 422,313 380,082 42,231  
e All other expenses 731,608 645,196 86,412  
25 Total functional expenses. Add lines 1 through 24e 237,029,294 215,191,115 21,838,179 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 34,156,512 2 34,844,993
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 3,560,094 4 4,805,172
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 17,543,453 9 22,611,917
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 330,747,476
b Less: accumulated depreciation ..... 10b 157,196,914 179,210,038 10c 173,550,562
11 Investments—publicly traded securities .......... 214,946,643 11 292,346,014
12 Investments—other securities. See Part IV, line 11 ..... 42,089,841 12  
13 Investments—program-related. See Part IV, line 11 ..... 13,968,310 13 143,769,186
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 635,001,607 15 541,829,301
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 1,140,476,498 16 1,213,757,145
Liabilities 17 Accounts payable and accrued expenses ......... 54,180,118 17 89,131,838
18 Grants payable .................   18  
19 Deferred revenue ................ 16,570,284 19 80,723,883
20 Tax-exempt bond liabilities ............. 854,473,162 20 856,619,461
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 2,753,885 23 3,414,975
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 317,664,575 25 173,418,078
26 Total liabilities. Add lines 17 through 25......... 1,245,642,024 26 1,203,308,235
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. -112,425,526 27 10,448,910
28 Temporarily restricted net assets ........... 7,260,000 28 0
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... -105,165,526 33 10,448,910
34 Total liabilities and net assets/fund balances ........ 1,140,476,498 34 1,213,757,145
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
255,235,748
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
237,029,294
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
18,206,454
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-105,165,526
5
Net unrealized gains (losses) on investments ...............
5
30,560,538
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
66,847,444
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
10,448,910
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
No
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
(A) The Sisters of Bon Secours in the United States Inc
  		520715237 1 Yes   Yes   Yes   6,790,892
(B) Listed on supplemental information-Bon Secours Health System Inc is forme
  		521301088 9 Yes   Yes   Yes   0
Total                 6,790,892

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
Schedule A, Part IV, Supplemental Information: Part I, Line 11 H (i) - Supported Organizations: Bon Secours Health System, Inc. is formed exclusively for the benefit of, to perform the functions of, and to carry out the purposes of the Sisters of Bon Secours in the United States, Inc. and all other publicly supported organizations (within the meaning of section 509(a)(1) or 509(a)(2) of the Internal Revenue Code of 1986) in, or operating for the benefit of, the Bon Secours Health System, Inc. Additionally, Bon Secours Health System, Inc. is formed: (1) To participate in the charitable health care system sponsored by Bon Secours Ministries throughout the United States, and globally, through which the health care mission of The Sisters of Bon Secours in the United States, Incorporated (the "Congregation"), the founding participating entity of Bon Secours Ministries, is furthered; (2) To fulfill and to participate in, the charitable health care mission sponsored by Bon Secours Ministries throughout the United States, and globally, as it carries out its health care mission in accordance with the philosophy, mission and policies of Bon Secours Ministries and the directives and teachings of the Roman Catholic Church; (3) To participate in the activities and implement the operational policies and procedures pertaining to health care facilities and other enterprises sponsored by Bon Secours Ministries, or associated or affiliated with, BSHSI, a Maryland nonstock, nonprofit corporation; (4) To benefit the Congregation and all other publicly supported organizations (within the meaning of Section 509(a)(1) or 509(a)(2) of the Code) in, or operating for the benefit of, the Bon Secours Health System in the United States by carrying out the health care mission of the Congregation in accordance with the philosophy, mission and policies of the Congregation, and in accordance with, and subject to, the directives and teachings of the Roman Catholic Church or in concert with one or more other publicly supported organizations which provide health care services in a manner that is consistent with the teachings of the Roman Catholic Church; (5) To perform all activities permitted corporations under the laws of the State of Maryland, to the extent such activities are permitted by organizations which are exempt from Federal income tax under Section 501(c)(3) of the Code and contributions to which are deductible under Sections 170(c)(2), 2055(a)(2) and 2522(a)(2) of the Code and to the extent such activities are not inconsistent with the Corporation's non-private foundation status under Section 509(a) of the Code, including the making of distributions for charitable, religious, educational, and scientific purposes to organizations which are exempt from Federal income tax under Section 501(c)(3) of the Code and contributions to which are deductible under Sections 170(c)(2), 2055(a)(2) and 2522(a)(2) of the Code (a "Charity").
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,566,082 11,566,082
b Buildings ................   8,620,951 3,484,830 5,136,121
c Leasehold improvements ............   1,537,289 1,024,366 512,923
d Equipment ................   4,291,155 2,375,420 1,915,735
e Other .................   304,731,999 150,312,298 154,419,701
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 173,550,562
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Community Program Loans 18,917,792 C
(2) Inv in Memorial Region Med Ctr 9,238,222 C
(3) Inv in Mary Immaculate Hospital JV 9,202,344 C
(4) Inv in Roper St. Francis 97,626,330 C
(5) Other mission related JV Partnerships 8,784,498 C




Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 143,769,186
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Due from Affiliates 518,669,672
(2) Actuarial Value of Excess Recoverables 10,161,242
(3) Misc A/R 4,898,438
(4) Capital Accumulation 4,871,290
(5) Health Plan Asset/Liability 290,598
(6) Other misc investments 1,217,504
(7) BSAS Investment in Shannon Health Ptsp 1,720,557


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 541,829,301
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Worker's Comp Liability 45,892,177
Health Plan Liability 790,382
Pension Liability 100,571,418
Due to Affiliates 25,749,723
MOB Deferred Costs & Other 414,378




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 173,418,078
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740 (formerly FIN48). ASC 740 (formerly FIN48) addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 (formerly FIN48) by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The system accounts for uncertain tax positions in accordance with ASC Topic 740. Income taxes of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $95,733 and $89,500 of net operating loss carryforwards as of August 31, 2012 and 2011, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2012 and 2011. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
Central America & the Caribbean 0 1 Program services Off Shore Captive Management 29,115,690
South America 0 0 Grant-making N/A 5,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 1 29,120,690
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 1 29,120,690
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
Procedure for Monitoring Grants Outside the U.S.:   Schedule F, Part I, Line 2: Grantees submit progress reports on the anniversary date on which the grant was received. Includes status of goals and objectives and progress towards achievement of desired outcomes. An accurate accounting of revenues and expenses must be submitted.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


Software ID:  
Software Version:  



Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number
52-1301088
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Mellon Employee Hardship Fund
919 E Main St
Richmond,VA23219 		95-3571558 501(c)(3) 5,000,000       To provide financial support for employees during hardship
(2) Archdioces of Baltimore
320 Cathedral Street
Baltimore,MD21201 		52-0591535 501(c)(3) 5,000       Annual Pledge for Gala
(3) Archdiocese of Oklahoma City
PO Box 32180
Oklahoma City,OK73123 		73-0636561 501(c)(3) 5,000       Diaster Relief
(4) Baltimore Basilica
408 N Charles Street
Baltimore,MD21201 		52-1065433 501(c)(3) 20,000       Pope John Paul II Prayer Garden
(5) Benedictine Sisters of Kaunas
100 Elm St PO Box 3701
Manchester,NH031053701 		02-0495272 501(c)(3) 6,000       Srs of Kaunas bathroom renovation
(6) Bread for the World Institute
425 3rd Street SW
Washington,DC20024 		51-0175510 501(c)(3) 5,000       Support US Food and Farm Policy
(7) Catholic Medical Mission Board
1129 20th Street NW
Washington,DC20036 		13-5602319 501(c)(3) 153,000       General Support
(8) Catholic Relief Service
228 W Lexington Street
Baltimore,MD21201 		13-5563422 501(c)(3) 166,666       Haiti Project;Rebuilding of St.Francis de Sales Hospital&Hospital Network Strengthening
(9) Crossover Health Care Ministry
8600 Quioccasin Rd STE 102
Richmond,VA23229 		54-1371067 501(c)(3) 5,000       Support Health Care for people in need
(10) Bon Secours Richmond Healthcare Foundation
5875 Bremo Road
Richmond,VA23226 		54-1201346 501(c)(3) 20,000       Haitian Outreach Foundation
(11) The Health Wagon Inc
119 Number Ten Street
Clinchco,VA24226 		04-3739083 501(c)(3) 25,000       Annual Pledge for Lung Clinic
(12) Hero Health Donation
55 Nod Rd
Avon,CT06001 		46-0730555 501(c)(3) 20,000       Sponsorship
(13) Institute of the Blessed
PO Box 508
Wheaton,IL601870508 		36-2179797 501(c)(3) 5,000       Solidarity for South Sudan
(14) International Rescue
122 East 42nd St
New York,NY10168 		13-5660870 501(c)(3) 76,744       Ongoing efforts in Central African Republic
(15) Bon Secours Maria Manor Nursing Care Center
10300 4th Street North
St Petersburg,FL33716 		65-0051820 501(c)(3) 10,000       Annual Gala Sponsorship
(16) Mercy Housing
1999 Broadway
Denver,CO80202 		47-0646706 501(c)(3) 100,000       Strategic Healthcare Partnership Pledge
(17) Midwives for Haiti
7130 Glen Forest Drive
Richmond,VA23226 		27-2368581 501(c)(3) 75,000       Midwives for Haiti Pledge
(18) NJ Relief Fund
PO Box 6200
Merrifield,VA22116 		36-4745729 501(c)(3) 17,378       Hurrican Sandy Relief Efforts
(19) Our Lady of Bellefonte HS
100 St Christopher Dr
Ashland,KY41101 		61-1356023 501(c)(3) 5,000       Golf Tournament Sponsorship
(20) Roper St Francis Foundation
315 Calhoun St
Charleston,SC29401 		57-1068509 501(c)(3) 5,000       Golf Tournament Sponsorship
(21) The Rose Foundation
6008 College Avenue
Oakland,CA94618 		94-3179772 501(c)(3) 5,000       Environmental Health Network
(22) Sisters of Bon Secours USA Inc
1505 Marriottsville Road
Marriottsville,MD21104 		52-0715237 501(c)(3) 133,239       Ministry Program for FY13
(23) Virginia Commonwealth University School of Nursing
821 W Franklin St
Richmond,VA23284 		54-6001758 501(c)(3) 5,000       Bon Secours Nurses Recognition
(24) Tunnel to Towers
2361 Hyland Blvd
Staten Island,NY10305 		02-0554654 501(c)(3) 17,378       Hurrican Sandy Relief Efforts
(25) Virginia Community Capital Inc
930 Cambira St NE
Christiansburg,VA24073 		54-1754009 501(c)(3) 20,000       Virginia Fresh Food Initiative
(26) Sisters Academy of Baltimore
139 First Avenue
Baltimore,MD21227 		34-1975939 501(c)(3) 25,000       Class Sponorship; annual pledge
(27) Good Samaritan Foundation for Better Health Inc
255 Lafayette Avenue
Suffern,NY10901 		13-1740104 501(c)(3) 67,500       Community Gardens, Phase 4
(28) Bon Secours Richmond Healthcare Foundation
5875 Bremo Road
Richmond,VA23226 		54-1201346 501(c)(3) 85,000       The Learning Kitchen
(29) Bon Secours Community Works
26 North Fulton Avenue
Baltimore,MD21223 		53-1732800 501(c)(3) 85,000       Working Families Initiative
(30) Bon Secours - Maria Manor Nursing Care Center Inc
10401 Roosevelt Blvd N
St Petersburg,FL33716 		65-0061820 501(c)(3) 85,000       HCI Collaboration Grants
(31) BS OLBH Foundation
1000 Ashland Drive
Ashland,KY41101 		61-1381952 501(c)(3) 43,000       Ironton Community Project
(32) BS OLBH Foundation
1000 Ashland Drive
Ashland,KY41101 		61-1381952 501(c)(3) 42,000       Healthy Choices Kentucky
(33) Frances Schervier Home and Hospital
255 Lafayette Avenue
Suffern,NY10901 		13-1740397 501(c)(3) 85,000       Healthy Living, Healthy Communities
(34) Mary Immaculate Hospital Inc
3636 High Street
Portsmouth,VA23737 		54-0548200 501(c)(3) 30,075       Hope City Newport News Healthy Communities
(35) Bon Secours Maryview Foundation
3636 High Street
Portsmouth,VA23737 		52-1694731 501(c)(3) 20,550       CHF 12 Step Program
(36) Bon Secours DePaul Health Foundation
3636 High Street
Portsmouth,VA23737 		54-1843876 501(c)(3) 30,000       Lets Get Real
(37) BS St Francis Health System Foundation
One St Francis Drive
Greenville,SC29601 		26-0012031 501(c)(3) 25,350       Bilingual RN for Community Outreach
(38) BS St Francis Health System Foundation
One St Francis Drive
Greenville,SC29601 		26-0012031 501(c)(3) 50,000       Nurse Practitioner for Free Clinic
(39) BS St Francis Health System Foundation
315 Calhoun St
Greenville,SC29302 		26-0012031 501(c)(3) 20,000       Hope Housing
(40) Bon Secours Inc
1505 Marriottsville Road
Marriottsville,MD21104 		52-1301091 501(c)(3) 50,000       General Program Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
40
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Per Bon Secours Health System, Inc's system-wide financial and accounting policies, contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. In other cases, grantees submit progress reports on the anniversary date on which the grant was received. The evaluation report includes: 1) progress toward the deployment of the stated goals and objectives, 2) progress towards the achievement of desired outcome as demonstrated by Project Work Plan, 3) an accurate accounting of the revenue and expenses and the amount of the mission fund award expensed, and 4) a summary past, current and future funding sources and efforts to secure sustaining sources of funding.
    Description of the Bon Secours Health System Mission Fund: Bon Secours Health System, Inc. performs its philanthropic work through its mission department. This initiative, called the Bon Secours Health System Mission Fund ("Mission Fund"), was developed to promote the Catholic Health Ministry and the BSHSI Mission. This purpose is realized through the funding of initiatives that improve the health and well being of communities, particularly for disenfranchised and marginalized people, served by BSHSI Local Systems ("Local Systems"), Cosponsors and the Congregation of the Sisters of Bon Secours. The scope of its purpose and use of funds would be to: -promote healthy community coalition initiatives in conjunction with local system efforts, -develop local system and community excellence for a specific health condition and preventive need, and -improve access for uninsured populations and reduce health disparities among populations in the community. The Strategic Quality Plan of the health system calls for focused efforts to Build Healthier Communities. The health system understands "health" to include social and communal dimensions and has adopted the following articulation of a healthy community. The conditions of communities and individuals served by BSHSI reflect the interaction of significant factors and complex behaviors at the individual, communal, and societal level. It is not likely that interventions by any one organization will result in substantial improvement or benefit to the community. Rather, increased participation by stakeholders and greater cooperation among entities with appropriate skills and resources is necessary for systemic change and improved outcomes. Mission Fund grants place emphasis on increased collaboration among community based members (Healthy Community Initiative), public health officials and other providers of services. The Mission Fund anticipates that most endeavors that seek to bring meaningful improvement require time and commitment. Consequently, local system grant recipients may expect continuity of support (several years) to establish and track outcomes. At the same time, grant applicants need to cultivate and achieve a wide array of financial resources necessary to sustain promising projects and service programs.
Schedule I (Form 990) 2012


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Richard StatutoCEO/President (i)
(ii)		 1,076,516
0 		849,317
0 		261,437
0 		141,590
0 		29,932
0 		2,358,792
0 		121,088
0
(2)Janice E BurnettCFO/Treasurer (i)
(ii)		 355,312
0 		141,412
0 		62,467
0 		53,116
0 		18,974
0 		631,281
0 		11,109
0
(3)Martha RivaSVP Governance/Secretary (i)
(ii)		 301,586
0 		239,025
0 		41,847
0 		49,277
0 		31,241
0 		662,976
0 		0
0
(4)Timothy DavisEVP-CHRAO (i)
(ii)		 576,344
0 		419,077
0 		126,863
0 		115,800
0 		19,095
0 		1,257,179
0 		69,776
0
(5)Lawrence Skip HubbardSVP-CIO (i)
(ii)		 368,632
0 		277,018
0 		121,587
0 		15,000
0 		18,748
0 		800,985
0 		0
0
(6)Marlon Priest MDEVP-CMO (i)
(ii)		 570,835
0 		397,444
0 		71,186
0 		130,955
0 		27,513
0 		1,197,933
0 		43,734
0
(7)Peter BernardEVP - CEO VA Health System (i)
(ii)		 748,358
0 		507,898
0 		181,825
0 		166,098
0 		26,868
0 		1,631,047
0 		108,845
0
(8)Matthew ToddyEVP & General Counsel (i)
(ii)		 517,588
0 		378,920
0 		117,640
0 		90,844
0 		25,668
0 		1,130,660
0 		50,063
0
(9)Mark NantzCEO-BS St. Francis Health System (i)
(ii)		 546,573
0 		364,503
0 		41,028
0 		61,960
0 		18,570
0 		1,032,634
0 		0
0
(10)Samuel Ross MDCEO-BS Baltimore Health System (i)
(ii)		 510,782
0 		345,326
0 		82,015
0 		57,512
0 		18,816
0 		1,014,451
0 		22,472
0
(11)Michael KernerCEO-BS Hampton Roads Health System (i)
(ii)		 475,717
0 		336,924
0 		124,284
0 		106,467
0 		26,303
0 		1,069,695
0 		67,422
0
(12)Katherine ArbuckleFormer CFO/Treasurer (i)
(ii)		 159,942
0 		0
0 		73,724
0 		11,086
0 		5,883
0 		250,635
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
  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 officers and to certain key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Richard Statuto, $211,910; Janice E. Burnett, $16,030; Timothy Davis, $101,207; Marlon Priest, MD, $43,581; Peter Bernard, $134,024; Matthew Toddy, $75,564; Samuel Ross, MD, $37,738; Michael Kerner, $80,925.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number
52-1301088
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A South Carolina Jobs-Economic Development Authority
  		57-6000286 837031QH9 01-15-2008 69,925,000 Construct and equip facility   X   X   X
B Economic Development Authority of Henrico County VA
  		54-1197472 42605PBV6 10-19-2010 80,412,256 Refund bonds issued 01/15/08 (2008B Henrico)   X   X   X
C Economic Development Authority of the County of Chesterfield
  		52-1279622 16639EAY0 10-19-2010 93,627,897 Refund bonds issued 01/15/08 (2008C Chest.)   X   X   X
D South Carolina Jobs-Economic Development Authority
  		57-0960018 837031RA3 10-17-2008 30,365,000 Refund bonds issued 12/30/02 (2002B SC)   X   X   X
Economic Development Authority of Henrico County VA
  		54-1197472 42605PBK0 10-17-2008 53,890,000 Refund bonds issued 12/30/02 (2002B Henrico)   X   X   X
Economic Development Authority of Hanover County VA
  		54-1228097 41077RAC6 10-17-2008 124,715,000 Refund bonds*   X   X   X
Economic Dev Auth of the City of Norfolk
  		52-1375010 NOCUSIPno 12-08-2011 72,460,000 Refund bonds issued 10/17/08 (2008D Nofolk)   X   X   X
South Carolina Jobs Econ Dev Auth
  		57-0960018 837031SL8 01-11-2013 200,846,700 Contruct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of the City of Norfolk
  		52-1375010 65588QAM7 01-11-2013 21,635,500 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 42605PDJ1 01-11-2013 62,929,133 Construct/Equip facility and refund bonds*   X   X   X
City of Russell Kentucky
  		782563AY6 01-11-2013 42,941,199 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 NOCUSIPno 07-11-2013 26,505,000 Refund bonds issued 10/17/08 (2008D Henrio)   X   X   X
Virginia Small Business Financing Authority
  		54-1300845 NOCUSIPno 07-11-2013 40,740,000 Refund bonds issed 10/19/10 (2010 VSBFA)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 6,775,000 13,855,000 4,860,000 6,775,000
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 69,973,023 80,412,256 93,627,987 30,365,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 729,108 1,131,056 967,897 255,675
8 Credit enhancement from proceeds . . . . . . . . . . . 1,694,518 157,532   7,500
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 67,549,397 20,730,675 1,100,000 8,266,938
11 Other spent proceeds . . . . . . . . . . . . . . 80,412,256 80,412,256 92,660,000 30,101,825
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2008 2013 2011 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X     X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X   X   X      
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X   X   X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X   X   X
b Exception to rebate? . . . . . . . .   X   X   X   X
c No rebate due? . . . . . . . . . .
X   X   X   X  
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X   X   X   X  
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X   X   X
b Name of provider . . . . . . . . . PNC Bank
  		 
  		Goldman Sachs
  		 
 
c Term of hedge . . . . . . . . . . 33.000000000000   13.000000000000  
d Was the hedge superintegrated? . . . . . .   X       X    
e Was a hedge terminated? . . . . . . .   X       X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X   X
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X   X  
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of the County of Chesterfield Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Hanover County, VA Date the Rebate Computation was Performed: 06/23/2014
Part I, Column (f)   2008D Hanover Bonds - D-1 refund bonds issued on 12-30-02 (2002B Econ. Dev. Auth. Hanover Co, VA) and D-2 refund bonds issued on 09-28-05 (2005 Econ. Dev. Auth. Hanover Co, VA). 2013A South Carolina Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A South Carolina JEDA). 2013A Norfolk Bonds - construct & equip facility and refund bonds issued on 08-01-97 (1997 Peninsula Ports Auth. Of VA). 2013A Henrico - construct & equip facility and refund bonds issued on 11-15-02 (2002A Econ. Dev. Auth. of Henrico, County, VA). 2013A Russell Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A City of Russell, KY).
Part II, Line 3   Differences between the Issue Price (Part I) and Total Proceeds (Part II, Line 3) are due to investment earnings.
Part III   Part III has not been completed with respect to bonds that refinance projects where the original debt was issued prior to 2003.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number
52-1301088
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A South Carolina Jobs-Economic Development Authority
  		57-6000286 837031QH9 01-15-2008 69,925,000 Construct and equip facility   X   X   X
B Economic Development Authority of Henrico County VA
  		54-1197472 42605PBV6 10-19-2010 80,412,256 Refund bonds issued 01/15/08 (2008B Henrico)   X   X   X
C Economic Development Authority of the County of Chesterfield
  		52-1279622 16639EAY0 10-19-2010 93,627,897 Refund bonds issued 01/15/08 (2008C Chest.)   X   X   X
D South Carolina Jobs-Economic Development Authority
  		57-0960018 837031RA3 10-17-2008 30,365,000 Refund bonds issued 12/30/02 (2002B SC)   X   X   X
Economic Development Authority of Henrico County VA
  		54-1197472 42605PBK0 10-17-2008 53,890,000 Refund bonds issued 12/30/02 (2002B Henrico)   X   X   X
Economic Development Authority of Hanover County VA
  		54-1228097 41077RAC6 10-17-2008 124,715,000 Refund bonds*   X   X   X
Economic Dev Auth of the City of Norfolk
  		52-1375010 NOCUSIPno 12-08-2011 72,460,000 Refund bonds issued 10/17/08 (2008D Nofolk)   X   X   X
South Carolina Jobs Econ Dev Auth
  		57-0960018 837031SL8 01-11-2013 200,846,700 Contruct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of the City of Norfolk
  		52-1375010 65588QAM7 01-11-2013 21,635,500 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 42605PDJ1 01-11-2013 62,929,133 Construct/Equip facility and refund bonds*   X   X   X
City of Russell Kentucky
  		782563AY6 01-11-2013 42,941,199 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 NOCUSIPno 07-11-2013 26,505,000 Refund bonds issued 10/17/08 (2008D Henrio)   X   X   X
Virginia Small Business Financing Authority
  		54-1300845 NOCUSIPno 07-11-2013 40,740,000 Refund bonds issed 10/19/10 (2010 VSBFA)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 6,775,000 13,855,000 4,860,000 6,775,000
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 69,973,023 80,412,256 93,627,987 30,365,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 729,108 1,131,056 967,897 255,675
8 Credit enhancement from proceeds . . . . . . . . . . . 1,694,518 157,532   7,500
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 67,549,397 20,730,675 1,100,000 8,266,938
11 Other spent proceeds . . . . . . . . . . . . . . 80,412,256 80,412,256 92,660,000 30,101,825
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2008 2013 2011 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X     X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X   X   X      
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X   X   X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X   X   X
b Exception to rebate? . . . . . . . .   X   X   X   X
c No rebate due? . . . . . . . . . .
X   X   X   X  
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X   X   X   X  
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X   X   X
b Name of provider . . . . . . . . . PNC Bank
  		 
  		Goldman Sachs
  		 
 
c Term of hedge . . . . . . . . . . 33.000000000000   13.000000000000  
d Was the hedge superintegrated? . . . . . .   X       X    
e Was a hedge terminated? . . . . . . .   X       X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X   X
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X   X  
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of the County of Chesterfield Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Hanover County, VA Date the Rebate Computation was Performed: 06/23/2014
Part I, Column (f)   2008D Hanover Bonds - D-1 refund bonds issued on 12-30-02 (2002B Econ. Dev. Auth. Hanover Co, VA) and D-2 refund bonds issued on 09-28-05 (2005 Econ. Dev. Auth. Hanover Co, VA). 2013A South Carolina Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A South Carolina JEDA). 2013A Norfolk Bonds - construct & equip facility and refund bonds issued on 08-01-97 (1997 Peninsula Ports Auth. Of VA). 2013A Henrico - construct & equip facility and refund bonds issued on 11-15-02 (2002A Econ. Dev. Auth. of Henrico, County, VA). 2013A Russell Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A City of Russell, KY).
Part II, Line 3   Differences between the Issue Price (Part I) and Total Proceeds (Part II, Line 3) are due to investment earnings.
Part III   Part III has not been completed with respect to bonds that refinance projects where the original debt was issued prior to 2003.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number
52-1301088
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A South Carolina Jobs-Economic Development Authority
  		57-6000286 837031QH9 01-15-2008 69,925,000 Construct and equip facility   X   X   X
B Economic Development Authority of Henrico County VA
  		54-1197472 42605PBV6 10-19-2010 80,412,256 Refund bonds issued 01/15/08 (2008B Henrico)   X   X   X
C Economic Development Authority of the County of Chesterfield
  		52-1279622 16639EAY0 10-19-2010 93,627,897 Refund bonds issued 01/15/08 (2008C Chest.)   X   X   X
D South Carolina Jobs-Economic Development Authority
  		57-0960018 837031RA3 10-17-2008 30,365,000 Refund bonds issued 12/30/02 (2002B SC)   X   X   X
Economic Development Authority of Henrico County VA
  		54-1197472 42605PBK0 10-17-2008 53,890,000 Refund bonds issued 12/30/02 (2002B Henrico)   X   X   X
Economic Development Authority of Hanover County VA
  		54-1228097 41077RAC6 10-17-2008 124,715,000 Refund bonds*   X   X   X
Economic Dev Auth of the City of Norfolk
  		52-1375010 NOCUSIPno 12-08-2011 72,460,000 Refund bonds issued 10/17/08 (2008D Nofolk)   X   X   X
South Carolina Jobs Econ Dev Auth
  		57-0960018 837031SL8 01-11-2013 200,846,700 Contruct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of the City of Norfolk
  		52-1375010 65588QAM7 01-11-2013 21,635,500 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 42605PDJ1 01-11-2013 62,929,133 Construct/Equip facility and refund bonds*   X   X   X
City of Russell Kentucky
  		782563AY6 01-11-2013 42,941,199 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 NOCUSIPno 07-11-2013 26,505,000 Refund bonds issued 10/17/08 (2008D Henrio)   X   X   X
Virginia Small Business Financing Authority
  		54-1300845 NOCUSIPno 07-11-2013 40,740,000 Refund bonds issed 10/19/10 (2010 VSBFA)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 6,775,000 13,855,000 4,860,000 6,775,000
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 69,973,023 80,412,256 93,627,987 30,365,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 729,108 1,131,056 967,897 255,675
8 Credit enhancement from proceeds . . . . . . . . . . . 1,694,518 157,532   7,500
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 67,549,397 20,730,675 1,100,000 8,266,938
11 Other spent proceeds . . . . . . . . . . . . . . 80,412,256 80,412,256 92,660,000 30,101,825
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2008 2013 2011 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X     X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X   X   X      
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X   X   X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X   X   X
b Exception to rebate? . . . . . . . .   X   X   X   X
c No rebate due? . . . . . . . . . .
X   X   X   X  
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X   X   X   X  
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X   X   X
b Name of provider . . . . . . . . . PNC Bank
  		 
  		Goldman Sachs
  		 
 
c Term of hedge . . . . . . . . . . 33.000000000000   13.000000000000  
d Was the hedge superintegrated? . . . . . .   X       X    
e Was a hedge terminated? . . . . . . .   X       X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X   X
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X   X  
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of the County of Chesterfield Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Hanover County, VA Date the Rebate Computation was Performed: 06/23/2014
Part I, Column (f)   2008D Hanover Bonds - D-1 refund bonds issued on 12-30-02 (2002B Econ. Dev. Auth. Hanover Co, VA) and D-2 refund bonds issued on 09-28-05 (2005 Econ. Dev. Auth. Hanover Co, VA). 2013A South Carolina Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A South Carolina JEDA). 2013A Norfolk Bonds - construct & equip facility and refund bonds issued on 08-01-97 (1997 Peninsula Ports Auth. Of VA). 2013A Henrico - construct & equip facility and refund bonds issued on 11-15-02 (2002A Econ. Dev. Auth. of Henrico, County, VA). 2013A Russell Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A City of Russell, KY).
Part II, Line 3   Differences between the Issue Price (Part I) and Total Proceeds (Part II, Line 3) are due to investment earnings.
Part III   Part III has not been completed with respect to bonds that refinance projects where the original debt was issued prior to 2003.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number
52-1301088
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A South Carolina Jobs-Economic Development Authority
  		57-6000286 837031QH9 01-15-2008 69,925,000 Construct and equip facility   X   X   X
B Economic Development Authority of Henrico County VA
  		54-1197472 42605PBV6 10-19-2010 80,412,256 Refund bonds issued 01/15/08 (2008B Henrico)   X   X   X
C Economic Development Authority of the County of Chesterfield
  		52-1279622 16639EAY0 10-19-2010 93,627,897 Refund bonds issued 01/15/08 (2008C Chest.)   X   X   X
D South Carolina Jobs-Economic Development Authority
  		57-0960018 837031RA3 10-17-2008 30,365,000 Refund bonds issued 12/30/02 (2002B SC)   X   X   X
Economic Development Authority of Henrico County VA
  		54-1197472 42605PBK0 10-17-2008 53,890,000 Refund bonds issued 12/30/02 (2002B Henrico)   X   X   X
Economic Development Authority of Hanover County VA
  		54-1228097 41077RAC6 10-17-2008 124,715,000 Refund bonds*   X   X   X
Economic Dev Auth of the City of Norfolk
  		52-1375010 NOCUSIPno 12-08-2011 72,460,000 Refund bonds issued 10/17/08 (2008D Nofolk)   X   X   X
South Carolina Jobs Econ Dev Auth
  		57-0960018 837031SL8 01-11-2013 200,846,700 Contruct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of the City of Norfolk
  		52-1375010 65588QAM7 01-11-2013 21,635,500 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 42605PDJ1 01-11-2013 62,929,133 Construct/Equip facility and refund bonds*   X   X   X
City of Russell Kentucky
  		782563AY6 01-11-2013 42,941,199 Construct/Equip facility and refund bonds*   X   X   X
Econ Dev Auth Of Henrico County VA
  		54-1197472 NOCUSIPno 07-11-2013 26,505,000 Refund bonds issued 10/17/08 (2008D Henrio)   X   X   X
Virginia Small Business Financing Authority
  		54-1300845 NOCUSIPno 07-11-2013 40,740,000 Refund bonds issed 10/19/10 (2010 VSBFA)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 6,775,000 13,855,000 4,860,000 6,775,000
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 69,973,023 80,412,256 93,627,987 30,365,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 729,108 1,131,056 967,897 255,675
8 Credit enhancement from proceeds . . . . . . . . . . . 1,694,518 157,532   7,500
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 67,549,397 20,730,675 1,100,000 8,266,938
11 Other spent proceeds . . . . . . . . . . . . . . 80,412,256 80,412,256 92,660,000 30,101,825
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2008 2013 2011 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X     X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . . X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X   X   X      
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X      
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0% 0% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X   X   X   X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X   X   X   X
b Exception to rebate? . . . . . . . .   X   X   X   X
c No rebate due? . . . . . . . . . .
X   X   X   X  
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X   X   X   X  
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X   X   X
b Name of provider . . . . . . . . . PNC Bank
  		 
  		Goldman Sachs
  		 
 
c Term of hedge . . . . . . . . . . 33.000000000000   13.000000000000  
d Was the hedge superintegrated? . . . . . .   X       X    
e Was a hedge terminated? . . . . . . .   X       X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X   X
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X   X  
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: Economic Development Authority of the County of Chesterfield Date the Rebate Computation was Performed: 04/08/2013 Issuer Name: South Carolina Jobs-Economic Development Authority Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Henrico County, VA Date the Rebate Computation was Performed: 06/23/2014 Issuer Name: Economic Development Authority of Hanover County, VA Date the Rebate Computation was Performed: 06/23/2014
Part I, Column (f)   2008D Hanover Bonds - D-1 refund bonds issued on 12-30-02 (2002B Econ. Dev. Auth. Hanover Co, VA) and D-2 refund bonds issued on 09-28-05 (2005 Econ. Dev. Auth. Hanover Co, VA). 2013A South Carolina Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A South Carolina JEDA). 2013A Norfolk Bonds - construct & equip facility and refund bonds issued on 08-01-97 (1997 Peninsula Ports Auth. Of VA). 2013A Henrico - construct & equip facility and refund bonds issued on 11-15-02 (2002A Econ. Dev. Auth. of Henrico, County, VA). 2013A Russell Bonds - construct & equip facility and refund bonds issued on 11-15-02 (2002A City of Russell, KY).
Part II, Line 3   Differences between the Issue Price (Part I) and Total Proceeds (Part II, Line 3) are due to investment earnings.
Part III   Part III has not been completed with respect to bonds that refinance projects where the original debt was issued prior to 2003.
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Identifier Return Reference Explanation
  Form 990, Part VI, Section A, line 6 Bon Secours, Inc. is the sole member of Bon Secours Health System, Inc.
  Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Health System, Inc. is appointed by its member Bon Secours, Inc.
  Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Health System, Inc. are reserved to its Member, Bon Secours, Inc.
  Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed.
  Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members).
  Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Form 990, Part VI, Section B, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources.
  Form 990, Part VI, Section C, line 19 BSHSI provides any documents open to public inspection upon request.
Reclassification of assets Form 990, Part X, Lines 11,12,13,15,17,19,25,27,28 Certain balance sheet items, included in the referenced lines above, on the current year Form 990 (Column B - End of Year) have been reported differently than in the prior year. Total assets, liabilities and net assets reported for the beginning of the year (Column A) are reported accurately and consistently with the prior year Form 990 filing. In an effort to report & classify assets similarly across Bon Secours Health System and related organizations, certain general ledger accounts have been grouped differently than as previously reported. These changes are only presentational in nature.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Refi of 97 Bonds - Transferred to Hampton Roads -12,755,000. Transfers to/from affiliates 23,201,375. Add'l Minimum Pension Liability 49,497,769. Change in investment in JV Partnership 985,675. Addition of net assets of consolidated entities 5,442,679. Other changes in net assets 474,946.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Bon Secours Health System Inc
 
Employer identification number

52-1301088
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) Bon Secours Associated Services LLC
1505 Marriottsville Road
Marriottsville,MD211041301
52-2321591 		Healthcare MD 0 1,720,557 Bon Secours Health System Inc
 
(2) Townley IV Farm LLC
1402 Stapleton Road
Gladstone,VA245533138
54-1833386 		Farm VA 1,800 6,982,554 Bon Secours Health System Inc
 
(3) Bon Secours Good Helpcare LLC
1505 Marriottsville Road
Marriottsville,MD211041301
46-0889532 		Accountable Care Organization MD 0 0 Bon Secours Health System Inc
 
(4) Bon Secours Richmond LLC
8580 Magellan Parkway Building IV
Richmond,VA23227
54-1570244 		LS Parent Organization VA 12,846 7,402,641 Bon Secours Health System Inc
 




Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Bon Secours St Petersburg Home Care Services Inc

10300 Fourth Street North

St Petersburg,FL33716
13-4334363 		Home Care Services FL 501(c)3 Line 9 Maria Manor Nursing Care Center
 
Yes
 
(2) Bon Secours Maria Manor Nursing Care Center

10300 Fourth Street North

St Petersburg,FL33716
13-4334363 		Nursing Home FL 501(c)3 Line 9 Bon Secours Health System Inc
 
Yes
 
(3) Our Lady of Bellefonte Hospital Inc

1000 St Christopher Dr

Ashland,KY41101
61-1356023 		Acute Care Hospital KY 501(c)3 Line 3 Bon Secours Kentucky Health System
 
Yes
 
(4) Bon Secours Kentucky Health System Inc

St Christopher Dr

Ashland,KY41101
61-1356024 		Local System Parent Org. KY 501(c)3 Line 11b, II Bon Secours Health System Inc
 
Yes
 
(5) Our Lady of Bellefonte Hospital Foundation

St Christopher Dr

Ashland,KY41101
61-1381952 		Grant Making Foundation KY 501(c)3 Line 7 Bon Secours Kentucky Health System
 
Yes
 
(6) Bellefonte Physician Services Inc

St Christopher Dr

Ashland,KY41101
35-2320780 		Physician Practices KY 501(c)3 Line 9 Bon Secours Kentucky Health System
 
Yes
 
(7) Bon Secours Baltimore Hospital

2000 West Baltimore Street

Baltimore,MD21223
52-1909599 		Health Care MD 501(c)3 Line 3 Bon Secours Baltimore Health System
 
Yes
 
(8) Bon Secours Baltimore Development

26 North Fulton Avenue

Baltimore,MD21223
76-0785344 		Community Housing MD 501(c)3 Line 7 Unity Properties Inc
 
Yes
 
(9) Bon Secours Baltimore Health System Foundation Inc

26 North Fulton Avenue

Baltimore,MD21223
38-3843816 		Grant Making Foundation MD 501(c)3 Line 11c, III-FI Bon Secours Baltimore Health System
 
Yes
 
(10) The Bon Secours of Maryland Foundation Inc (dba Bon Secours Community Work

26 North Fulton Avenue

Baltimore,MD21223
52-1732800 		Grant Making Foundation MD 501(c)3 Line 11c, III-FI Bon Secours Baltimore Health System
 
Yes
 
(11) Unity Properties Inc

26 North Fulton Avenue

Baltimore,MD21223
52-1857768 		Low Income Housing MD 501(c)3 Line 7 Bon Secours of Maryland Foundation
 
Yes
 
(12) Bon Secours Housing

26 North Fulton Avenue

Baltimore,MD21223
52-1442707 		Low Income Housing MD 501(c)3 Line 9 Bon Secours of Maryland Foundation
 
Yes
 
(13) Bon Secours Housing II

26 North Fulton Avenue

Baltimore,MD21223
52-1543174 		Low Income Housing MD 501(c)3 Line 9 Bon Secours of Maryland Foundation
 
Yes
 
(14) Bon Secours Baltimore Health Corporation (dba Bon Secours Baltimore Health

2000 West Baltimore Street

Baltimore,MD21223
80-0728893 		Local System Parent Org. MD 501(c)3 Line 11b, II Bon Secours Health System Inc
 
Yes
 
(15) Bon Secours Inc

1505 Marriottsville Road

Marriottsville,MD21104
52-1301091 		Supporting Org. to Bon Secours Health System, Inc. MD 501(c)3 Line 11a, I N/A
 
No
(16) Bon Secours New York Health System

2975 Independence Avenue

Bronx,NY10463
91-2135196 		Local System Parent Org. NY 501(c)3 Line 11a, I Bon Secours Health System Inc
 
Yes
 
(17) Frances Schervier Home and Hospital

2975 Independence Avenue

Bronx,NY10463
13-1740397 		Long term nursing care NY 501(c)3 Line 3 Bon Secours NY Health System
 
Yes
 
(18) Schervier Housing Development Fund Corporation

2975 Independence Avenue

Bronx,NY10463
13-3098867 		Housing NY 501(c)3 Line 9 Bon Secours NY Health System
 
Yes
 
(19) Bon Secours Community Hospital

160 E Main Street

Port Jervis,NY12771
14-1347717 		Health Care NY 501(c)3 Line 3 Bon Secours Charity Health System
 
Yes
 
(20) Bon Secours Community Hospital Foundation

160 E Main Street

Port Jervis,NY12771
81-0667395 		Grant Making Foundation NY 501(c)3 Line 7 Bon Secours Community Hospital
 
Yes
 
(21) Good Samaritan Hospital of Suffern NY

255 Lafayette Avenue

Suffern,NY10901
13-1740104 		Acute Care Hospital NY 501(c)3 Line 3 Bon Secours Charity Health System
 
Yes
 
(22) Good Samaritan Foundation for Better Health Inc

255 Lafayette Avenue

Suffern,NY10901
13-3400353 		Grant Making Foundation NY 501(c)3 Line 7 Bon Secours Charity Health System
 
Yes
 
(23) Bon Secours Charity Health System Inc

255 Lafayette Avenue

Suffern,NY10901
91-2135195 		Local System Parent Org. NY 501(c)3 Line 11a, I Bon Secours Health System Inc
 
Yes
 
(24) St Francis Center at the Knolls Inc (dba Mount Alverno Center)

20 Grand Street

Warwick,NY10990
06-1370576 		Long term Care NY 501(c)3 Line 9 Bon Secours Charity Health System
 
Yes
 
(25) Villa Francis at the Knolls (dba Schervier Pavilion)

20 Grand Street

Warwick,NY10990
06-1381994 		Skilled Nursing NY 501(c)3 Line 9 Bon Secours Charity Health System
 
Yes
 
(26) St Anthony Community Hospital

15-19 Maple Ave

Warwick,NY10990
14-1340100 		Hospital NY 501(c)3 Line 3 Bon Secours Charity Health System
 
Yes
 
(27) The Bon Secours Warwick Health Foundation

20 Grand Street

Warwick,NY10990
14-1972807 		Grant Making Foundation NY 501(c)3 Line 7 St Anthony Community Hospital
 
Yes
 
(28) Bon Secours Charity Health System Medical Group PC

255 Lafayette Avenue

Suffern,NY10901
22-3636986 		Physician Practices NY 501(c)3 Line 9 Bon Secours Charity Health System
 
Yes
 
(29) Bon Secour St Francis Health System Foundation

One St Francis Drive

Greenville,SC29601
26-0012031 		Grant Making Foundation SC 501(c)3 Line 7 SFH Inc
 
Yes
 
(30) SFH Inc

One St Francis Drive

Greenville,SC29601
58-2504530 		Health Care SC 501(c)3 Line 3 St Francis Health System Inc
 
Yes
 
(31) Bon Secours St Francis Health System Inc

1 St Francis Drive

Greenville,SC29601
58-2504528 		Local System Parent Org. SC 501(c)3 Line 11b, II Bon Secours Health System Inc
 
Yes
 
(32) St Francis Physician Services Inc

One St Francis Drive

Greenville,SC29601
13-4290167 		Physician Services SC 501(c)3 Line 9 St Francis Health System Inc
 
Yes
 
(33) Mary Immaculate Hospital Inc

7007 Harbour View Blvd

Suffolk,VA23435
54-0548200 		Health Care VA 501(c)3 Line 3 Bon Secours Hampton Roads Health System
 
Yes
 
(34) Mary Immaculate Nursing Center Inc

7007 Harbour View Blvd

Suffolk,VA23435
54-1516476 		Nursing Care Center VA 501(c)3 Line 9 Mary Immaculate Hospital
 
Yes
 
(35) Mary Immaculate Foundation

7007 Harbour View Blvd

Suffolk,VA23435
31-1644734 		Fundraising VA 501(c)3 Line 11c, III-FI Mary Immaculate Hospital
 
Yes
 
(36) Bon Secours - Maryview Nursing Care Center

7007 Harbour View Blvd

Suffolk,VA23435
52-1578169 		Nursing Care Center VA 501(c)3 Line 9 Bon Secours Hampton Roads Health System
 
Yes
 
(37) Bon Secours Maryview Foundation

7007 Harbour View Blvd

Suffolk,VA23435
52-1694731 		Fundraising VA 501(c)3 Line 7 Bon Secours Hampton Roads Health System
 
Yes
 
(38) Bayley Properties

7007 Harbour View Blvd

Suffolk,VA23435
54-1424748 		Title Holding Company VA 501(c)2   Bon Secours DePaul Medical Center
 
Yes
 
(39) Bon Secours DePaul Medical Center Inc

7007 Harbour View Blvd

Suffolk,VA23435
54-1820093 		Health Care VA 501(c)3 Line 3 Bon Secours Hampton Roads Health System
 
Yes
 
(40) Bon Secours DePaul Health Foundation

7007 Harbour View Blvd

Suffolk,VA23435
54-1843876 		Fundraising VA 501(c)3 Line 7 Bon Secours Depaul Medical Center
 
Yes
 
(41) Bon Secours Hampton Roads Health System

7007 Harbour View Blvd

Portsmouth,VA23435
52-1538513 		Local System Parent Org. VA 501(c)3 Line 11b, II Bon Secours Health System Inc
 
Yes
 
(42) Maryview Hospital

7007 Harbour View Blvd

Portsmouth,VA23707
54-0506463 		Health Care VA 501(c)3 Line 3 Bon Secours Hampton Roads Health System
 
Yes
 
(43) Bon Secours Richmond Health Care Foundation

8580 Magellan Parkway

Richmond,VA23227
54-1201346 		Grant Making Foundation VA 501(c)3 Line 7 Bon Secours Richmond Health Corp
 
Yes
 
(44) Bon Secours Richmond Health Corporation

8580 Magellan Parkway

Richmond,VA23227
54-1356155 		Supporting Org. to Bon Secours Richmond Health System VA 501(c)3 Line 11b, II Bon Secours Health System Inc
 
Yes
 
(45) Bon Secours Stuart Circle Hospital

8580 Magellan Parkway

Richmond,VA23227
54-1740128 		Health Care VA 501(c)3 Line 3 Bon Secours Richmond Health System
 
Yes
 
(46) Bon Secours Memorial Regional Medical Center Inc

8580 Magellan Parkway

Richmond,VA23227
54-1744931 		Health Care VA 501(c)3 Line 3 Bon Secours Richmond Health System
 
Yes
 
(47) Bon Secours Richmond Health System

8580 Magellan Parkway

Richmond,VA23227
52-1988421 		Supporting Org. to Bon Secours Richmond Health System VA 501(c)3 Line 11b, II Bon Secours Richmond Health Corp
 
Yes
 
(48) Bon Secours St Mary's Hospital

8580 Magellan Parkway

Richmond,VA23227
54-0793767 		Health Care VA 501(c)3 Line 3 Bon Secours Richmond Health System
 
Yes
 
(49) Bon Secours Richmond Community Hospital

8580 Magellan Parkway

Richmond,VA23227
54-0647482 		Health Care VA 501(c)3 Line 3 Bon Secours Richmond Health System
 
Yes
 
(50) Bon Secours St Francis Medical Center

8580 Magellan Parkway

Richmond,VA23227
31-1716973 		Health Care VA 501(c)3 Line 3 Bon Secours Richmond Health System
 
Yes
 
(51) Laburnum Properties

8580 Magellan Parkway

Richmond,VA23227
52-1260700 		Title Holding Company VA 501(c)2   Bon Secours Richmond Health System
 
Yes
 
(52) Bon Secours Grosse Pointe

1505 Marriottsville Road

Marriottsville,MD211041301
38-3404533 		Health Care MI 501(c)3 Line 3 Bon Secours Health System Inc
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Bon Secours Place at St Petersburg LLP

10300 Fourth Street North
St Petersburg,FL33716
59-3589729 		Assisted Living/Senior Care FL N/A
                  
(2) Bon Secours Apartments LP

1800 West Baltimore St
Baltimore,MD21223
52-1952505 		Low Income Housing MD N/A
                  
(3) Bon Secours Apartments II LP

1800 West Baltimore St
Baltimore,MD21223
52-2063512 		Low Income Housing MD N/A
                  
(4) Liberty Senior Housing LP

1800 West Baltimore St
Baltimore,MD21223
52-2134447 		Low Income Housing MD N/A
                  
(5) Bon Secours Apartments III LP

1800 West Baltimore St
Baltimore,MD21223
52-2134444 		Low Income Housing MD N/A
                  
(6) Bon Secours Smallwood Summit LP

26 North Fulton Ave
Baltimore,MD21223
52-2280175 		Low Income Housing MD N/A
                  
(7) Bon Secours Chesapeake Apartments LP

26 North Fulton Ave
Baltimore,MD21223
20-0107034 		Low Income Housing MD N/A
                  
(8) Bon Secours Shiloh LP

26 North Fulton Ave
Baltimore,MD21223
20-3965243 		Low Income Housing MD N/A
                  
(9) Bon Secours Wayland LP

26 North Fulton Ave
Baltimore,MD21223
27-0468688 		Low Income Housing MD N/A
                  
(10) Upstate Surgery Center LLC

One St Francis Drive
Greenville,SC29601
56-2186977 		Ambulatory Surgery Center SC N/A
                  
(11) Province Place of DePaul LLC

6403 Granby Street
Norfolk,VA23505
54-1950880 		Assisted Living Facilities VA N/A
                  
(12) Province Place of Maryview LLC

One Bon Secours Way
Portsmouth,VA23703
54-1842697 		Assisted Living VA N/A
                  
(13) Broad64 Imaging LLC

8580 Magellan Parkway
Richmond,VA23227
20-5886018 		Imaging Services VA N/A
                  
(14) Richmond Radiation Oncology Center I LLC

8580 Magellan Parkway
Richmond,VA23227
20-8444551 		Radiation Oncology Services VA N/A
                  
(15) RI LP

8580 Magellan Parkway
Richmond,VA23227
54-1708835 		Imaging Services VA N/A
                  
(16) Shannon HealthMOB Limited Partnership No1

3 Richland Medical Park Suite 120
Columbia,SC29203
57-1127282 		Rental Real Estate Lessor SC N/A
                  
(17) Bon Secours Benet House LP

26 North Fulton Ave
Baltimore,MD21223
36-4765400 		Low Income Housing MD N/A
                  
(18) Bon Secours Benet House LLC

26 North Fulton Ave
Baltimore,MD21223
46-3055312 		Low Income Housing MD N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Bon Secours Assurance Company Ltd

PO Box 69
    KY1-1102
CJ
98-0152147 		Offshore Captive Management CJ Bon Secours Health System Inc
  		C 29,115,690 119,419,843 100.000 % Yes  
(2) Bon Secours-Florida Integrated Health Services Inc

10300 Fourth Street North
St Petersburg,FL33716
65-0779777 		Holding Company/Assisted Living FL Bon Secours Maria Manor Nursing Care
  		C   1,873,600 100.000 % Yes  
(3) Unity Housing Inc

26 North Fulton Avenue
Baltimore,MD21223
52-1952507 		Low Income Housing MD Unity Properties Inc
  		C -106 350,100 100.000 % Yes  
(4) Bon Secours Wayland LLC

26 North Fulton Avenue
Baltimore,MD21223
27-0468561 		Low Income Housing MD Unity Properties Inc
  		C     100.000 % Yes  
(5) HealthCare Enterprises Inc & Subs

One St Francis Drive
Greenville,SC29601
57-1012852 		Holding Company SC St Francis Health System Inc
  		C     100.000 % Yes  
(6) Professional Health Care Management Inc & Subs

150 Kingsley Lane
Norfolk,VA23505
54-1241031 		Administrative VA Bon Secours Hampton Roads Health System Inc
  		C 548,061 9,540,592 100.000 % Yes  
(7) OSF Inc

2 Bernadine Drive
Newport News,VA23602
54-1369919 		Rental VA Mary Immaculate Hospital Inc
  		C 11,088 1,257,217 100.000 % Yes  
(8) Bon Secours Tidewater Diversified Inc

160 Kingsley Lane
Norfolk,VA23505
54-1431826 		Pharmacy VA Bon Secours DePaul Medical Center Inc
  		C 911,312 2,443,493 100.000 % Yes  
(9) Chesterfield Community Healthcare Center Inc

8580 Magellan Parkway
Richmond,VA23227
54-1812738 		Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc
  		C 5,094 266,814 83.000 % Yes  
(10) Bon Secours-Virginia Healthsource Inc & Subs

8580 Magellan Parkway
Richmond,VA23227
54-1417686 		Ambulatory Healthcare Services VA Bon Secours Richmond Health System Inc
  		C 26,552,492 29,285,141 83.000 % Yes  
(11) RHS Management Corp

8580 Magellan Parkway
Richmond,VA23227
54-1313425 		Independent Living Facility VA Bon Secours Richmond Health System Inc
  		C 520,858 71,681 83.000 % Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Bon Secours Richmond Healthcare Foundation

 B 105,000 Cost
(2) Bon Secours Maria Manor Nursing Care Center

 B 95,000 Cost
(3) Good Samaritan Foundation for Better Health

 B 67,500 Cost
(4) Bon Secours Community Works

 B 85,000 Cost
(5) Bon Secours Kentucky Health System Foundation

 B 85,000 Cost
(6) Frances Schervier Home and Hospital

 B 85,000 Cost
(7) Bon Secours St Francis Health System Foundation

 B 95,350 Cost
(8) Bellefonte Physician Services

 D 13,083,665 Fair Market Value
(9) Bon Secours Baltimore Hospital

 D 11,065,191 Fair Market Value
(10) Baltimore HS Foundation

 D 830,371 Fair Market Value
(11) St Francis Physician Services

 D 39,822,899 Fair Market Value
(12) St Francis Millennium

 D 1,593,705 Fair Market Value
(13) Maryview Medical Center

 D 7,570,738 Fair Market Value
(14) BS Depaul Medical Center

 D 19,507,976 Fair Market Value
(15) BS Richmond Healthcare Foundation

 D 1,477,098 Fair Market Value
(16) Laburnum Properties Inc

 D 311,953 Fair Market Value
(17) BS Home Health Services

 D 735,319 Fair Market Value
(18) St Anthony Community Foundation

 D 520,046 Fair Market Value
(19) Bon Secours Community Hospital

 D 187,999 Fair Market Value
(20) BS Community Hospital Foundation

 D 95,221 Fair Market Value
(21) PP Maryview

 D 266,600 Fair Market Value
(22) PP DePaul

 D 376,801 Fair Market Value
(23) BS Place at SP

 D 326,488 Fair Market Value
(24) Good Samaritan Hospital

 L 8,452,118 Cost
(25) St Anthony's Hospital

 L 1,639,964 Cost
(26) BS Community Hospital

 L 2,523,020 Cost
(27) Frances Schervier Home and Hospital

 L 551,998 Cost
(28) Frances Schervier Home and Hospital - LT Care

 L 91,334 Cost
(29) Maryview Medical Center

 L 4,645,748 Cost
(30) Maryview Medical Center - Shared Services

 L 14,860,138 Cost
(31) Mary Immaculate Hospital

 L 2,574,349 Cost
(32) DePaul Medical Center

 L 2,134,375 Cost
(33) St Francis Hospital

 L 14,846,605 Cost
(34) SF Physician Services

 L 283,200 Cost
(35) Our Lady of Bellefonte Hospital

 L 6,798,043 Cost
(36) Bellefonte Physician Services

 L 495,231 Cost
(37) Baltimore Hospital

 L 3,299,328 Cost
(38) Maria Manor Nursing Care Center

 L 297,469 Cost
(39) Memorial Regional Medical Center

 L 428,429 Cost
(40) St Mary's Hospital

 L 666,908 Cost
(41) St Mary's Hospital - Shared Services

 L 36,814,036 Cost
(42) St Francis Medical Center

 L 309,599 Cost
(43) BS Virginia Healthsource

 L 226,466 Cost
(44) Good Samaritan Hospital

 Q 26,824,271 Fair Market Value
(45) St Anthony's Hospital

 Q 4,003,946 Fair Market Value
(46) BS Community Hospital

 Q 5,450,954 Fair Market Value
(47) Schervier Pavilian

 Q 2,180,977 Fair Market Value
(48) Mt Alverno Center

 Q 449,483 Fair Market Value
(49) Bon Secours Charity Health System Medical Group PC

 Q 3,161,034 Fair Market Value
(50) Frances Schervier Homes & Hospital

 Q 1,657,082 Fair Market Value
(51) Bon Secours New York Health System

 Q 1,104,567 Fair Market Value
(52) Frances Schervier Home & Hospital LT Care

 Q 185,971 Fair Market Value
(53) Maryview Hospital

 Q 22,997,235 Fair Market Value
(54) Maryview Nursing Care Center

 Q 1,000,496 Fair Market Value
(55) PP Maryview

 Q 290,447 Fair Market Value
(56) PP DePaul

 Q 344,028 Fair Market Value
(57) Granby MOB

 Q 95,698 Fair Market Value
(58) Maryview Hospital - Shared Services

 Q 2,663,514 Fair Market Value
(59) 1500 Mary Immac Hosp

 Q 10,889,240 Fair Market Value
(60) 1501 St Francis Nursing

 Q 808,737 Fair Market Value
(61) 1600 DePaul Med Center

 Q 13,328,404 Fair Market Value
(62) St Francis Hospital - Downtown

 Q 31,713,751 Fair Market Value
(63) St Francis Hospital -Eastside

 Q 16,629,821 Fair Market Value
(64) Upstate Surgery Center

 Q 159,692 Fair Market Value
(65) SF Physician Services

 Q 9,160,034 Fair Market Value
(66) St Francis Hospital -Millenium

 Q 480,111 Fair Market Value
(67) Our Lady of Bellefonte Hospital

 Q 18,947,234 Fair Market Value
(68) Our Lady of Bellefonte Hospital

 Q 280,986 Fair Market Value
(69) Baltimore Hospital

 Q 10,961,991 Fair Market Value
(70) BS of Maryland Foudnation

 Q 123,870 Fair Market Value
(71) Maria Manor Nursing Care Center

 Q 3,118,220 Fair Market Value
(72) St Pete Home Care

 Q 60,240 Fair Market Value
(73) Memorial Regional Medical Center

 Q 31,485,597 Fair Market Value
(74) St Mary's Hospital

 Q 41,266,718 Fair Market Value
(75) St Mary's Hospital - Shared Services

 Q 8,690,637 Fair Market Value
(76) Richmond Community Hospital

 Q 3,617,482 Fair Market Value
(77) St Francis Medical Center

 Q 23,600,769 Fair Market Value
(78) RHS Enterprises

 Q 78,795 Fair Market Value
(79) BS Virginia Healthsource

 Q 5,289,464 Fair Market Value
(80) St Mary's MRI

 Q 153,588 Fair Market Value
(81) RI LP

 Q 205,963 Fair Market Value
(82) Broad 64

 Q 150,282 Fair Market Value
(83) Richmond Radiology and Oncology

 Q 196,255 Fair Market Value
(84) Bon Secours Richmond Health System - Home Care

 Q 1,230,498 Fair Market Value
(85) BS Place at SP

 Q 359,211 Fair Market Value
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: