TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Steve Dormer...................................................................... Board Member	1.0 ................. 1.0	X	X	0	0	0
(2) Tamer El-Rayess...................................................................... Treasurer	1.0 ................. 1.0	X	X	0	0	0
(3) Sandra Grannum...................................................................... Board Member	1.0 ................. 1.0	X		0	0	0
(4) Linda Hunter MD...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(5) Steve Kent...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(6) Sylvain Klein...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(7) Mary Leahy MD...................................................................... CEO - BSCHS	36.0 ................. 4.0	X	X	70,705	880,733	86,622
(8) Sr Anne Lutz...................................................................... Board Member (End 05/15)	1.0 ................. 39.0	X		0	0	0
(9) Sr Roseann Mazzeo...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(10) Andrea Mazzoccoli...................................................................... Board Member (End 05/15)	1.0 ................. 39.0	X		0	765,982	60,742
(11) Sr Mary Eileen O'Brien...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(12) Clement Osei MD...................................................................... Board Member (End 05/15)	39.0 ................. 1.0	X		181,757	0	30,216
(13) Robert Porr...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(14) Daniel Rifkin...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(15) Kenneth Steinglass MD...................................................................... Board Member (End 05/15)	1.0 ................. 1.0	X		0	0	0
(16) John Wallenhorst PhD...................................................................... Board Member	1.0 ................. 39.0	X	X	0	471,244	22,057
(17) Mark Tulis...................................................................... Chair	1.0 ................. 2.0	X	X	0	0	0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Mark Nantz........................................................................ 1st Vice Chair	1.0 .......................39.0	X	X			0	1,292,681	127,721
(19) Zubeen Shroff........................................................................ Vice Chair	1.0 .......................2.0	X	X			0	0	0
(20) Michael Israel........................................................................ Vice Chair	0.5 .......................39.5	X	X			0	2,175,973	148,160
(21) John Heimerdinger........................................................................ Secretary	1.0 .......................2.0	X	X			0	0	0
(22) Anthony Mahler........................................................................ Board Member	0.5 .......................39.5	X				0	447,254	97,904
(23) Susan Gervertz........................................................................ Board Member	1.0 .......................2.0	X				0	0	0
(24) Renee Garrick MD........................................................................ Board Member	0.5 .......................39.5	X				0	0	0
(25) Gary Brudnicki........................................................................ Board Member	0.5 .......................39.5	X				0	1,263,967	142,132
(26) Richard Wishnie........................................................................ Board Member	1.0 .......................1.0	X				0	0	0
(27) Julie Switzer........................................................................ Board Member	0.5 .......................39.5	X				0	694,385	122,300
(28) Maureen Creegan........................................................................ Secretary (End 05/15)	1.0 .......................1.0	X	X			0	0	0
(29) Sr Ellen Dauwer........................................................................ Board Member	1.0 .......................1.0	X				0	0	0
(30) Marsha Casey........................................................................ Board Member	1.0 .......................39.0	X				0	833,630	122,753
(31) Martin Evers MD........................................................................ President - MedPC	40.0 .......................0.0		X			295,790	0	42,886
(32) Peter Kenniff........................................................................ CFO	39.0 .......................1.0		X			421,549	0	6,661
(33) Rodney Williams MD........................................................................ CMO	40.0 .......................0.0			X		543,032	0	29,370
(34) Pamela Tarulli........................................................................ SVP HR	40.0 .......................0.0			X		341,622	0	36,377
(35) Jeffrey Reilly........................................................................ COO (END 12/15)	38.0 .......................2.0			X		407,925	0	24,663
(36) Sophie Crawford-Rosso........................................................................ VP PCS	40.0 .......................0.0			X		174,544	0	26,020
(37) Judith Lindberg........................................................................ VP PCS	40.0 .......................0.0			X		191,484	0	20,753
(38) Toni Clark........................................................................ EVP Senior Services	40.0 .......................0.0			X		256,324	0	21,808
(39) Deborah Marshall........................................................................ SVP Marketing/Strategy	40.0 .......................0.0			X		247,114	0	32,448
(40) Maureen Price........................................................................ CIO	40.0 .......................0.0			X		253,079	0	14,322
(41) Phyllis Yezzo........................................................................ SVP PCS	40.0 .......................0.0			X		177,747	0	3,821
(42) Cary Hirsch MD........................................................................ Physician	40.0 .......................0.0				X	1,083,208	0	20,295
(43) Thomas Facelle MD........................................................................ Director of Surgery	40.0 .......................0.0				X	785,932	0	21,820
(44) Seth Hurwitz MD........................................................................ Cardiologist	40.0 .......................0.0				X	727,027	0	44,252
(45) Lee Root MD........................................................................ Physician	40.0 .......................0.0				X	681,052	0	44,446
(46) Leon Harris........................................................................ Physician	40.0 .......................0.0				X	670,521	0	23,963

(A) Name and business address	(B) Description of services	(C) Compensation
Crothall Healthcare Inc, 13028 Collections Center Chicago,IL60693	Engineering	6,990,091
Morrison Management Specialists, PO Box 102289 Atlanta,GA30368	Food Services	4,927,113
Aramark CTS Inc, 12483 Collections Center Dr Chicago,IL60693	Engineering	4,150,178
Access Rehabilitation Services, 16 Maybrook Rd Ste H Campbell Hall,NY10916	Rehab Therapy	3,623,801
Hospital Attending Physicians, 484 Temple Hill Rd Ste 102 New Windsor,NY12553	Physician Services	2,454,821
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 89

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1	0
2	Recoveries of prior-year distributions	2	0
3	Other gross income (see instructions)	3	0
4	Add lines 1 through 3	4	0
5	Depreciation and depletion	5	0
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6	0
7	Other expenses (see instructions)	7	0
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8	0

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a	0
b	Average monthly cash balances	1b	0
c	Fair market value of other non-exempt-use assets	1c	0
d	Total (add lines 1a, 1b, and 1c)	1d	0
e	Discount claimed for blockage or other factors (explain in detail in Part VI): 0
2	Acquisition indebtedness applicable to non-exempt use assets	2	0
3	Subtract line 2 from line 1d	3	0
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4	0
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5	0
6	Multiply line 5 by .035	6	0
7	Recoveries of prior-year distributions	7	0
8	Minimum Asset Amount (add line 7 to line 6)	8	0

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1	0
2	Enter 85% of line 1	2	0
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3	0
4	Enter greater of line 2 or line 3	4	0
5	Income tax imposed in prior year	5	0
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6	0

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes		0
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity		0
3 Administrative expenses paid to accomplish exempt purposes of supported organizations		0
4 Amounts paid to acquire exempt-use assets		0
5 Qualified set-aside amounts (prior IRS approval required)		0
6 Other distributions (describe in Part VI). See instructions		0
7Total annual distributions. Add lines 1 through 6.		0
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions		0
9 Distributable amount for 2015 from Section C, line 6		0
10 Line 8 amount divided by Line 9 amount		0 %

Section E - Distribution Allocations (see instructions)	(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6			0
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)		0
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......0
e From 2014.......0
fTotal of lines 3a through e	0
g Applied to underdistributions of prior years		0
h Applied to 2015 distributable amount			0
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.	0
4Distributions for 2015 from Section D, line 7:
$ 0
a Applied to underdistributions of prior years		0
b Applied to 2015 distributable amount			0
c Remainder. Subtract lines 4a and 4b from 4.	0
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)		0
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)			0
7 Excess distributions carryover to 2016. Add lines 3j and 4c.	0
8 Breakdown of line 7:
a
b
c Excess from 2013.......0
d From 2014.......0
e From 2015.......0

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Bon Secours Charity Health System Affiliated Group

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Bon Secours Charity Health System Affiliated Group		Employer identification number 45-2964467

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Bon Secours Charity Health System Affiliated Group			Employer identification number 45-2964467
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

66,341

Total. Add lines 1c through 1i ....................................................................................................

66,341

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1, Lobbying Activities	The filing organization maintains memberships to various professional healthcare associations. Portions of their membership dues are used for lobbying activities. The lobbying portion of such dues is included on line 1i.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. 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 ...	4,589,780		4,589,780
b	Buildings	141,380,328	74,227,042	67,153,286
c	Leasehold improvements	1,899,308	517,799	1,381,509
d	Equipment ...	169,306,514	109,230,596	60,075,918
e	Other ...	10,653,234	6,365,628	4,287,606
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				137,488,099

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
Medicare Settlements	7,803,182
FIN 47 LT Asbestos Liab	3,176,240
Capital Lease LT Liability	2,087,016
ARCHDIOCESE LT PENSION LIABILITY	9,258,380
Other Misc. Liabilities	531,565
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	22,856,383
2. Liability for uncertain tax positions. 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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference

Explanation

Part IV, Line 2b

Certain facilities hold, safeguard, manage and account for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents and written requests for $50 or more are honored, by check, within a reasonable time frame. Generally, all custodial funds in excess of $50 are held in interest bearing accounts separate from that of the organization.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,354,097	572,395	781,702	0.150 %
b	Medicaid (from Worksheet 3, column a) . . . . .	84,131,786	66,508,165	17,623,621	3.420 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	85,485,883	67,080,560	18,405,323	3.570 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	561,873	18,595	543,278	0.110 %
f	Health professions education (from Worksheet 5) . . .	3,021,239		3,021,239	0.600 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	15,837		15,837
j	Total. Other Benefits . .	3,598,949	18,595	3,580,354	0.710 %
k	Total. Add lines 7d and 7j .	89,084,832	67,099,155	21,985,677	4.280 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	191,019	191,019	0.040 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	366,128	366,128	0.070 %
8	Workforce development
9	Other
10	Total	557,147	557,147	0.110 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

14,025,335

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

141,539,291

Enter Medicare allowable costs of care relating to payments on line 5.....

160,875,572

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-19,336,281

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?3 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Facility reporting group
1	Good Samaritan Hospital of SuffernNY 255 Lafayette Avenue Suffern,NY10901 goodsamhosp.org 4329000H	X	X	X	A
2	St Anthony Community Hospital 15 Maple Avenue Warwick,NY10990 stanthonycommunityhosp.org 3529000H	X	X	X	A
3	Bon Secours Community Hospital 160 East Main Street Port Jervis,NY12771 bonsecourscommunityhosp.org 3535001H	X	X	X	A

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

123

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): http://bschc.org

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 0.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V

The FAP application form was widely available on a website (list url):

See Part V

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Facility Reporting Group - A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, section B	Facility Reporting Group A consists of: - Facility 1: Good Samaritan Community Hospital of Suffern, NY - Facility 2: St. Anthony Community Hospital - Facility 3: Bon Secours Community Hospital
Part V, Line 5	Staff from BSCHS represents the health system on numerous community boards and agencies, year round. Collaboration with these agencies is one of the key means of acquiring input from the community with regards to health concerns and needs. Additionally, BSCHS employees work closely with several community liaisons who work closely with area employers and specific geographical and religious groups with the specific focus of gathering community input on their own, personally identified health-related needs. The CHNA for each hospital was printed for distribution at community events; over 2000 copies were given to various community members and groups. Additionally, the CHNAs and the NYS CSP are posted on the BSCHS websites.
Part V, Line 6a	The following hospitals within Bon Secours Charity Health System conducted a joint CHNA: Good Samaritan Hospital of Suffern, NY; St. Anthony Community Hospital; Bon Secours Community Hospital.
Part V, Line 7	CHNA Website http://bschs.org/about-us-community-health-needs-assessment.html Part V, Line 7d The CHNA for each hospital was printed for distribution at community events; over 2,000 copies were given to various community members and groups. Additionally, the CHNAs and the NYS CSP are posted on the BSCHS websites.
Part V, Line 11	Based on data from the community assessment and the NYS Prevention Agenda priorities, the most significant health needs of the service area are as follows: - Chronic Disease prevention - Healthy and Safe environments - Healthy Women, Infants and Children - Mental Health and Substance Abuse - Communicable Diseases BS Charity chose to address the Chronic Disease prevention needs with a focus on Obesity and Diabetes as previously described above. BSCHS supports the following participant organizations, community resources, and programs to address the remaining identified health needs as follows: Healthy and Safe Environments encompasses air and water quality issues, access to healthy foods, assault-related hospitalizations, and hospitalizations/ED visits related to falls. BSCHS is partnered with the Rockland and Orange County Departments of Health and supports their efforts to address these concerns. In addition to BSCHS Maternal and Infant hospital-based services, the Lower Hudson Valley Perinatal Network (LHVPN) has expertise and resources available to address these concerns. BSCHS supports LHVPN's mission to enhance maternal, child and family health services in Dutchess, Putnam, Orange, Rockland & Westchester counties. The outpatient program at The Monsignor Patrick J. Frawley Psychiatric Unit at Good Samaritan Hospital is designed to treat emotional and psychiatric disorders in adolescents, adults and geriatric patients. In addition, our patients have access to a number of comprehensive services in the Alcohol Outpatient Clinic and our Chemical Dependency Program. In addition to direct care for individuals, the Mental Health Outpatient Clinic offers mental health consultation and outreach services to community organizations. The Rockland County Department of Mental Health oversees delivery of high quality, comprehensive, person-centered and recovery oriented mental health services, developmental disability services and chemical dependency services. Bon Secours Community Hospital provides psychiatric, psychological, medical and neurological care in a supportive environment. The New Directions Program utilizes a multidisciplinary treatment team consisting of psychiatrists, nurses, case managers, social workers, and CASAC counselors. The Adult Inpatient Program at Bon Secours Community Hospital is designed to provide a patient-centered and comprehensive treatment program for adults ages 18 and older who are struggling with an acute phase of mental illness. The Orange County Department of Mental Health exists to ensure that quality Mental Health, Developmental Disabilities and Chemical Dependency services are accessible to all the people of Orange County, that such services are delivered in a cost effective, timely and culturally sensitive manner under the jurisdiction of the Mental Hygiene Law of New York State and provided within the rules, regulations, policies and procedures of the licensing authority of appropriate State Offices. Additional mental health and substance abuse resources are available at Orange Regional Medical Center. In addition to the communicable diseases that BSCHS addresses through immunization clinics and in-patient vaccination, BSCHS also supports Refuah Health Center, Hudson River Healthcare, Middletown Community Health Center, the Rockland and Orange county health departments and the NYS Dept. of Health in their efforts to combat communicable diseases.
Part V, Line 13b	For patients above 200% of the Federal Poverty Guidelines, BSCHS utilizes a sliding scale with no limit for eligibility of discounted care.
Part V, Line 16a and 16b	FAP Website http://bschs.org/patients-and visitors-financial-assistance.html
Part V, Line 16i	The Financial Assistance Policy refers to the Financial Assistance Procedures that describe the measures to publicize the policy within the community served by the hospital facility. In addition to the methods reported on lines 16a-h, brochures are available at the time of registration, and onsite counselors and eligibility vendors are available to assist patients. All billings statements also include information regarding the FAP.
Part V, Line 22d	The following applies for 01/01/2015 - 08/31/2015: For uninsured and underinsured patients with annual family incomes greater than 200% of the FPG, as adjusted by the Medicare geographic wage index for each community served to reflect that communitys relative cost of living (Adjusted FPG) the program offers a reduction to the amount of the full charges for medically necessary services either as charity care or through the Bon Secours CSA. The CSA is market-adjusted and based on the payment discount received by other health care payers doing business in the community and is currently set at 80% discount of total charges. For these patients, the Financial Assistance program sets a maximum annual family payment liability based on a sliding scale determined by family income and size. A standard Bon Secours sliding scale is also adjusted by the Medicare geographic wage index of each community served to reflect that communitys relative cost of living. THE FOLLOWING APPLIES FOR 09/01/2015 - 12/31/2015: FOR UNINSURED AND UNDERINSURED PATIENTS WITH ANNUAL FAMILY INCOMES GREATER THAN 200% OF THE FPG, AS ADJUSTED BY THE MEDICARE GEOGRAPHIC WAGE INDEX FOR EACH COMMUNITY SERVED TO REFLECT THAT COMMUNITY'S RELATIVE COST OF LIVING ("ADJUSTED FPG") THE PROGRAM MAY OFFER A REDUCTION TO THE AMOUNT OF THE FULL CHARGES FOR MEDICALLY NECESSARY SERVICES AS CHARITY CARE. FOR THESE PATIENTS, THE FINANCIAL ASSISTANCE PROGRAM SETS A MAXIMUM ANNUAL FAMILY PAYMENT LIABILITY BASED ON A SLIDING SCALE DETERMINED BY FAMILY INCOME AND SIZE. A STANDARD BON SECOURS SLIDING SCALE IS ADJUSTED BY THE MEDICARE GEOGRAPHIC WAGE INDEX OF EACH COMMUNITY SERVED TO REFLECT THAT COMMUNITY'S RELATIVE COST OF LIVING.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?41
Name and address		Type of Facility (describe)
1	Regional Kidney Center 33-1 Route 17M Harriman,NY10926	Outpatient Dialysis Center
2	Women's Imaging Center 55 Ronald Reagan Boulevard Warwick,NY10990	Outpatient Women's Imaging Center
3	The Ambulatory Surgery Center 257 Lafayette Avenue Suffern,NY10901	Ambulatory Surgery Center
4	Monsignor Patrick J Frawley Mental Healt 3 Campbell Avenue Suffern,NY10901	Mental Health
5	Center for Physical Rehabilitation 153 South Route 94 Warwick,NY10990	Outpatient Rehab
6	Good Samaritan Home Care 1 Crossfield Avenue Suite 202 West Nyack,NY10994	Home Care
7	Good Samaritan Home Care 15 Matthew Street Suite 302 Goshen,NY10924	Home Care
8	St Anthony Sleep Disorder Institute 74 North Main Street Florida,NY10921	Sleep Lab
9	Center for Physical Rehabilitation 70 Hatfield Lane Goshen,NY10924	Outpatient Physical Therapy
10	Good Samaritan Home Care 2975 Independence Avenue Bronx,NY10463	Home Care
11	Bon Secours Medical Group 601 Broad Street Milford,PA18337	Internal Medicine
12	Bon Secours Medical Group 104 Bennett Avenue Milford,PA18337	Internal Medicine
13	Goshen Medical Associates 70 Hatfield Lane Suite 101 Goshen,NY10924	Internal Medicine
14	Goshen Primary Care Physicians 1 Hatfield Lane Goshen,NY10924	Primary Care
15	Hudson Valley Medical Associates 26 Firemans Memorial Drive Pomona,NY10970	Internal Medicine
16	Bon Secours Medical Group 5 Skinner Street Port Jervis,NY12771	Cardiology
17	Bon Secours Medical Group GE 15 Maple Avenue Warwick,NY10990	Gastroenterology
18	Rockland Heart & Vascular Associates 79 Route 59 Suite 5 Suffern,NY10901	Pulmonology
19	Mahwah Medical 10 Franklin Turnpike Mahwah,NJ07430	Internal Medicine
20	Rockland Heart & VascHudson Valley Medi 2 Executive Boulevard Suite 406 Suffern,NY10901	Cardiology
21	Rockland Heart & Vascular Associates 972 Route 45 Suite 103 Pomona,NY10970	Cardiology
22	Rockland Pulmonary & Medical Assoc 2 Crossfield Avenue West Nyack,NY10994	Pulmonology
23	Warwick Palliative Care 22 Van Duzer Place Warwick,NY10990	Palliative Care
24	Bon Secours Medical Group 500 New Hempstead Road New City,NY10956	Internal Medicine
25	Bon Secours Medical Group 2 Executive Boulevard Suffern,NY10901	Primary Care
26	Mehta Pulmonary 55 Old Nyack Turnpike Nanuet,NY10954	Pulmonology
27	North Rockland Medical Associates 71 South Route 9W West Haverstraw,NY10993	Primary Care
28	Gopal Shah MD 33 Delaware Street Port Jervis,NY12771	Primary Care
29	Ralph Bowman MD 170 East Main Street Port Jervis,NY12771	Primary Care
30	Lutwak Cardiology 505 Route 208 Monroe,NY10950	Cardiology
31	MOB Port Jervis Primary 161 East Main Street Port Jervis,NY12771	Primary Care
32	George Cox MD 257 Lafayette Avenue Suffern,NY10901	Primary Care
33	Metropolitan Cardiology Consultants Suff 257 Lafayette Avenue Suffern,NY10901	Cardiology
34	Bon Secours Neurology 100 Route 59 Suffern,NY10901	Neurology
35	Rockland Pulmonary Medical Associates Su 257 Lafayette Avenue Suffern,NY10901	Pulmonary
36	Ramapo Valley Surgical Associates 257 Lafayette Avenue Suffern,NY10901	Outpatient Ambulatory Surgery
37	Rockland Heart Vascular Associates Inner 257 Lafayette Avenue Suffern,NY10901	Pulmonology
38	Yacov Tendler IM 257 Lafayette Avenue Suffern,NY10901	Primary Care
39	Alam PCP 906 Pennsylvania Avenue Matamoras,NY18336	Primary Care
40	Metropolitan Cardiology Consultants-Gosh 30 Hatfield Lane Goshen,NY10924	Cardiology
41	PORT JERVIS GASTROENTEROLOGY 39 EAST MAIN STREET PORT JERVIS,NY12771	GASTROENTEROLOGY

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 7a	Charity Care at cost is computed by applying a cost-to-charge ratio to the aggregate charity adjustments recorded in the general ledger.
Part I, Line 7b	Unreimbursed Medicaid is computed by determining the cost of Medicaid services supplied less payments received for these services. To determine the cost of Medicaid services provided, a cost-to-charge ratio is applied to traditional and managed Medicaid gross charges captured in the patient accounting system and general ledger. Payments include payments for individual claims, payments from the Medicaid program paid outside the claim process (such as medical education payments) and expected or actual cost report settlements.
Part I, Line 7c	Unreimbursed costs from other means-tested government programs are computed by applying a cost-to-charge ratio to the total charges to patients covered under these programs. The charges are identified by the financial class assigned to the patient.
Part I, Line 7 a-c computations	The cost-to-charge ratio is derived using the suggested computation in Worksheet 2, Ratio of Patient Care Cost-to-Charges. Operating expenses and Gross patient charges are taken from the general ledger, Expenses for nonpatient care activities recorded in operating expenses are approximated as directly equaling other operating revenue, assuming these activities do not provide profit.
Part I, Line 7e	Community health improvement services and community benefit operations are accumulated throughout the year and reported at actual cost in a software program that specifically addresses this purpose.
Part I, Line 7f	Health professions education cost is determined as the direct and indirect cost of qualifying education activities as traditionally reported in columns 21-24 on Worksheet B of the Medicare cost report as a Medical Education program, nursing school or other allied health program.
Part II, Community Building Activities	Bon Secours Charity Health System is actively engaged in improving community health in the Port Jervis area through its Building Healthy Communities initiative. The BSCHS Director of Building Healthy Communities, through the Bon Secours Community Hospital Medical Village project, is focused on improving community health in the Port Jervis area. The Medical Village Project is a collaborative effort to transform healthcare delivery in the Port Jervis market. Working with community members, organizations, and other key stakeholders, we have identified gaps in our current delivery system and created new partnerships to offer our patients a much greater level of care coordination and access to additional ambulatory and social services. We are partnering with Cornerstone FQHC to co-locate dental and expanded primary care services, creating a retail pharmacy, co-locating expanded behavioral health services in our ED, adding crisis stabilization services, and designating space within the hospital for wellness programs and consultation through our agency and community partners. In addition, we are creating a Transition of Care mechanism to provide a warm handoff from our ED and primary care settings to these on-site services; giving our patients the resources they need to achieve health equity in the communities we serve.
Part III, Line 2	Bad debt expense on the general ledger includes: 1) actual write offs of discounted gross charges where it is determined an uninsured patient can pay and does not pay; and 2) the estimated write offs for uninsured patient accounts with outstanding balances after discount. Estimates are based on historical collection rates. When an uninsured patient is billed for patient care services, the charges are automatically discounted and the patient is requested to only pay the amount after discount. The discount is recorded as an adjustment to gross revenue and is not recorded in bad debt expense. If the balance after discount is not paid or not paid in full, the unpaid amount will be written off to bad debt expense. When a patient remits a payment on an account that has already been written off to bad debt expense, the payment is recorded as a recovery of bad debt which reduces bad debt expense.
Part III, Line 3	The organization does not report an estimate for the portion of bad debt expense that may have been likely to qualify for financial assistance under the hospital's charity care policy. The organization takes the position that ample opportunity and assistance is provided to the patient to qualify under the financial assistance policy. If sufficient information is not provided, the organization must assume the patient does not qualify.
Part III, Line 4	Please see Footnote "(2d) Accounts Receivable, net" discussing "accounts receivable" on pages 9-10 in the attached BSCHS consolidated audited financial statements ("AFS"), "Allowance for doubtful accounts" is discussed in the second paragraph in Footnote "(8) Net Patient Service Revenue" on pages 24-25 of the attached AFS, There is not a separate "bad debt expense" footnote in the AFS.
Part III, Line 8	Medicare allowable costs reflected in Part III come directly from the facility's Medicare cost report. The cost report segregates the total facility actual expenses into costs for support departments, clinical departments (routine and ancillary) and nonreimburseable departments. The cost report uses appropriate statistical bases to "step down" support costs to allowable clinical and nonreimburseable departments. The charges for clinical departments are matched to the total cost for these departments for a cost-to-charge ratio. Medicare-specific allowable costs for in- and outpatient ancillary departments are computed by applying the department-specific cost-to-charge ratio to the Medicare program charges by department. For routine departments, a per diem total cost is computed and applied to Medicare program days for the Medicare routine program cost.
Part III, Line 9b	The hospital has a written policy that describes collection practices applying to patients that qualify for charity care or financial assistance. If full assistance is approved, no collection efforts are pursued on that patient's account(s). If partial assistance is provided, the patient is responsible for the adjusted account balance and collection efforts will follow the established practices for all patients where a self-pay balance exists. Collection efforts are not pursued on any pending FAP account. Specific criteria exist for how much financial assistance, partial or total, will be provided to the patient based on the assessed need. Criteria is based on Federal Poverty Guidelines and is reviewed and updated annually. Once a patient has been deemed eligible for the Patient Financial Assistance Program (FAP), the patient is notified by letter within 60 days after receipt of the application and supporting documentation. The patient retains eligibility for a period of twelve months from the date of the application. This eligibility is signaled to hospital admissions, billing and collection staff by the assignment of a specific financial class with accompanying eligibility dates. At the end of those twelve months, the patient is responsible for reapplying for FAP eligibility.
Part VI, Line 2	In 2015, the Bon Secours Charity Health System Community Outreach department and the Healthy Communities department worked collaboratively with the Rockland County and Orange County Departments of Health and Mental Health to assess current community needs, as well as the progress made towards achieving the goals of the current CHNA implementation plans. In addition, the BSCHS Outreach and Healthy Communities departments participate in several community coalitions and organizations through which community input is gathered.
Part VI, Line 3	Patient financial assistance policy is communicated to patients verbally upon scheduling, registration, visible postings of the policy in common areas throughout the hospital, brochures and on Bon Secours website. In addition, patient statements request that patients apply for financial assistance if needed, once any patient financial obligation is determined. Bon Secours is committed to ensuring access to health care services for all. As a health care provider, Bon Secours treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. Bon Secours addresses the needs of the uninsured by providing free or reduced fees on hospital services and community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. Bon Secours proactively screens to identify individuals and their families who may qualify for federal, state or local health insurance programs or the Bon Secours Patient Financial Assistance Program ("FAP") and assists the potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 200% of the Federal Poverty Guidelines ("FPG"). A sliding scale assistance policy is offered to patients who exceed the income guidelines for 100% assistance. Sliding scale assistance is provided to patients and progressively declines in proportion to the patient's higher income level. Additionally, all uninsured (i.e. self pay) patients are given a reduction to the amount of the full charges for medically necessary services through a community service adjustment ("CSA"). The CSA is market adjusted and based on the payment discount received by other health care payers doing business in the community. For these patients, the FAP also sets a maximum annual family payment liability to ensure that no family faces a catastrophic financial burden in receiving necessary health care services. Based on research conducted by the Tax Foundation, a non partisan tax research group based in Washington DC, the maximum annual family liability is based on a sliding scale determined by the family income and size. In addition, a variety of other potential payment options are available. Bon Secours is dedicated to meeting the needs of non-English speaking patients by having on-site Spanish translators, and other language translation services. In addition, Bon Secours employs a telephone language service which assists in meeting any language needs that arise. The translation services are offered to non-English speaking patients from admission to discharge, including through the financial process.
Part VI, Line 4	BSCHS facilities operate and serve populations of lower New York State, principally Rockland and Orange counties. Rockland County is located approximately 30 miles north of Manhattan on the West side of the Hudson River. The County is a popular residence for people who commute to work in nearby Westchester and Bergen Counties, as well as Manhattan. The County comprises approximately 115,000 acres and contains more than 35,000 acres of preserved open space and park land. Rockland continues to experience steady population growth in its five towns and 19 villages. The most recent Census Department estimates indicate that Rockland County grew 8.7% from 2000 to 2010, and now includes 311,687 residents. Orange County is located in the Hudson River Valley, bordering New Jersey. The County comprises approximately 816 square miles. Orange County continues to experience steady population growth, with the 2010 Census indicating that Orange County grew 9.2% from 2000 to 2010, and now includes 372,813 residents. In Rockland County, there was substantial growth in all age cohorts 65 and older, a consistent trend nationally. Gender among the age groups is roughly equal from the early age cohorts through the 40s, but after age 65, women continue to outnumber men. Population projections - Preliminary population projections through 2035 show that Rockland Countys older population may double in size in the next three decades, while those ages 30 to 44 may shrink in size. While projections are based on historical data and do not always predict accurate trends, the dramatic possible increase in the elderly population is a trend that should be of importance to County service providers and planners. Based on 2010 U.S. Census population estimates, the median age in Orange County has increased by more than 2 years since 2007, to 36.6 years; the largest cohort of residents is age 45-49. The number of residents ages 65-69 is forecasted to more than double from 2000-2020 primarily due to the entry of 'baby boomers' into these age ranges. Twenty-one percent of Rockland Countys population was estimated to be foreign-born in 2010. Among the 63,058 Rockland county residents estimated to be foreign born in 2007, the largest group was born in the Latin America and the Caribbean (48%). One quarter of foreign-born residents (25%) originated from Asia. Approximately another quarter (23%) came from Europe and 3% from Africa. Countywide, 32.9% of persons over age 5 speak a language other than English at home. According to the U.S. Census, 11.1% of residents in Orange County were foreign born, with 22.3% of persons over the age of five speaking a language other than English at home. Rockland Countys rate of poverty for children under 18 increased to 16.9% in 2009 when compared to (15%) in 2000. Poverty rates in Orange County vary greatly based on municipality. Poverty rates exceeding 25% for families with related children under 18 are found in Orange Countys three cities (Middletown, Newburgh, and Port Jervis), as well as in the town of Monroe, largely due to the impact of the village of Kiryas Joel, where the poverty rate is more than 4 times the county average.
Part VI, Line 5	All BSCHS facilities have an open medical staff with privileges available to all qualified physicians in the area and are governed by a System board of directors whose composition is representative of the community, with a majority being independent members of the community. BSCHS has a dedicated Community Outreach department responsible for planning, implementing and evaluating all community health and education programs. In 2015, over 20 support groups and community programs met monthly in our facilities. The Community Outreach department managed the BSCHS Speakers Bureau which connected our medical professionals directly with the community on topics such as Cardiac, Orthopedics, Womens health, Obesity, Stroke, Diabetes, Wound Care, Safety, Asthma, Senior Services, etc. In addition to this, the Outreach department also managed service line specific programs such as Breast and Cervical Cancer screenings, Hearing testing, Sleep Disturbances seminars and others. Access to Care: Bon Secours Charity Health System is committed to responding to and participating in addressing the health care needs of the communities in its service area. This is accomplished through improving access to health care services, especially for the underserved population, and offering various opportunities for community members to enroll in governmental and/or community health plans. All three BSCHS hospitals have partnered with local Federally Qualified Health Centers (FQHC) to increase public awareness of the available services that are either free of charge or based on a sliding scale payment. BSCHS also continues to increase the size of its employed Medical Group and, in accordance with our mission, these practitioners are required to accept Medicaid and to participate in programs to provide charity care. In 2015, all BSCHS facilities donated space each month for the community to meet with insurance specialists in order to register for health insurance benefits. Chronic Disease: The goal of our Heart Disease strategies is to increase the publics awareness of the risk factors for heart disease and to give them information on how to diminish their risk. In 2015, BSCHS hosted or participated in free cardiac awareness and prevention programs that were attended by over 5,000 people. Specific programs focused on prevention, signs and symptoms, blood pressure screenings, obesity and women and heart disease. In addition, BSCHS also participated in the American Heart Walk which was attended by over 800 people. The Lower Hudson Valley Mended Hearts Chapter #368 meets six times a year at a local community center. The cost of the community center, and other group meetings supplies, is paid for through the Community Outreach department budget. The Mended Hearts volunteers are trained to visit cardiac patients and their family members in the hospital to offer hope and support. Through this trained volunteer visitor program, both pre and post cardiac surgery patients are visited by a former heart surgery patient. The BSCHS cancer services provide the community with excellent cancer treatment and support opportunities as well as increase the publics awareness of risk factors and cancer prevention. In 2015, BSCHS had an American College of Surgeon accredited cancer program at Good Samaritan Hospital and Good Samaritan Hospitals Radiation Oncology Services are accredited by the American College of Radiology. BSCHS leadership and cancer program staff work diligently to maintain these accreditations to ensure that the community is receiving the best care available. Additionally, partnerships with the American Cancer Society have helped to develop new community screening programs and to improve patient support offerings. Also in 2015, the Center for Breast Health at Good Samaritan Hospital received NAPbc certification and was recognized for providing excellent breast cancer treatment. BSCHS hosted numerous cancer awareness, early detection, prevention and support programs that reached over 9,000 people. These programs focused on a wide variety of cancer related illnesses and many of them offered the community the opportunity to meet oncology specialists on a one-to-one basis. In addition, BSCHS participated in the American Cancer Societys Making Strides Against Breast Cancer walk which was attended by 2,000 people. A partnership with the Cancer Services Program of Rockland County helped BSCHS to develop ongoing breast and cervical cancer screenings for uninsured and underinsured community members. Through this partnership, 9 free screenings were held in 2015 and 142 people received early detection services. Important to note is that, if a person has a positive finding from any of these free screenings, BSCHS works with the Cancer Services Program to provide all necessary follow up treatment including surgery, chemotherapy and radiation. BSCHS employs a board certified breast surgeon and a board certified colorectal surgeon. Additionally, BSCHS employs two patient navigators to assist breast cancer patients to coordinate their care and access available services. BSCHS continues to financially support the American Cancer Societys Making Strides Against Breast Cancer annual fundraising walk. Our restricted donation helps to produce prevention and early detection educational materials for the communities we serve.
Part VI, Line 6	Bon Secours Charity Health System, Inc. is a not-for-profit, non-stock membership corporation that is the sole member of five healthcare providers that operate hospitals, nursing homes, and other healthcare-related facilities in the State of New York. Bon Secours Health System, Inc. ("BSHSI"), a Maryland not-for-profit, non-stock membership corporation, is a member of Charity with a forty percent (40%) economic interest in Charity. Sisters of Charity of Saint Elizabeth ("SOCSE"), a New Jersey not-for-profit corporation, are a member of Charity without any economic interest. Charity, a Catholic health system, is canonically co-sponsored by Bon Secours Ministries ("BSM"), an affiliate of BSHSI and SOCSE. BSHSI is a not-for-profit, non-stock membership corporation, and the sole member of which is Bon Secours, Inc. ("BSI"). BSHSI is a corporation formed to participate in the charitable healthcare system now sponsored by BSM throughout the United States of America through which the healthcare mission of the Sisters of Bon Secours, USA, the founding participating entity of BSM, is furthered. The Ministry of BSHSI aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSHSI's vision to bring about the holistic health of the communities it serves is implemented through its Strategic Quality Plan which provides focus in five goal areas for the current three year period (2013-2015). One of those goals was to bring our communities to wholeness. To accomplish this, two key strategies are to: - Improve Health Locally and Globally - Build Partnerships for Population Health As a member of the Catholic health ministry and a member of Bon Secours Health System, Inc. (BSHSI), this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is "to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church." This organization and related organizations share the BSHSI Vision. "Inspired by the healing ministry of Jesus Christ and the charism of Bon Secours, Bon Secours Health System will be recognized for its leadership in justice, transforming the communities in which we serve and work into places of health and hope, and being a prophetic voice for systemic US health reform and a more humane world." Westchester County Healthcare Corporation was created in 1997 as a New York public benefit corporation and owns and operates a number of healthcare facilities including Westchester Medical Center located in Valhalla, New York. In December, 2014, WMC and BSHSI agreed to pursue a transaction (the "Affiliation") under which: WMC, or its subsidiary, became a majority co-member in Charity and manage the day to day operations of Charity and its subsidiaries and facilities pursuant to a management agreement approved by the New York State Department of Health; Charity and its subsidiaries remain a Catholic healthcare ministry subject to the Ethical and Religious Directives for Catholic Healthcare Services. WMC appoints at least sixty percent (60%) of the members of the Charity Board of Directors, BSHSI and SOCSE jointly appoint approximately 40% of the Charity Board, and each member of Charity holds certain reserved powers. Please see Schedule R for listings of the related organizations and Schedule H for the hospitals included in this return.
Part VI, Line 7	List of States Receiving Community Benefit Report: NY

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Bon Secours Charity Health System Affiliated
Group

Employer identification number
45-2964467

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1) INDIGENT CAB FARE	188	10,244
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Part III, Line 1	Based on prior year analysis of cab fares the average amount per rider was $54.54. This amount was used to estimate the number of cab fares provided in 2015.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Were any amounts reported on 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 .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Mary Leahy MDCEO - BSCHS	(i) (ii)	33,860 ------------- 529,312	22,837 ------------- 313,801	14,008 ------------- 37,620	2,470 ------------- 52,872	1,900 ------------- 29,380	75,075 ------------- 962,985	0 ------------- 0
2Andrea MazzoccoliBoard Member (End 05/15)	(i) (ii)	0 ------------- 394,357	0 ------------- 297,139	0 ------------- 74,486	0 ------------- 38,978	0 ------------- 21,764	0 ------------- 826,724	0 ------------- 30,752
3Clement Osei MDBoard Member (End 05/15)	(i) (ii)	178,821 ------------- 0	0 ------------- 0	2,936 ------------- 0	11,645 ------------- 0	18,571 ------------- 0	211,973 ------------- 0	0 ------------- 0
4John Wallenhorst PhDBoard Member	(i) (ii)	0 ------------- 259,303	0 ------------- 169,381	0 ------------- 42,560	0 ------------- 11,068	0 ------------- 10,989	0 ------------- 493,301	0 ------------- 0
5Martin Evers MDPresident - MedPC	(i) (ii)	129,567 ------------- 0	165,777 ------------- 0	446 ------------- 0	20,295 ------------- 0	22,591 ------------- 0	338,676 ------------- 0	0 ------------- 0
6Rodney Williams MDCMO	(i) (ii)	371,125 ------------- 0	114,221 ------------- 0	57,686 ------------- 0	20,295 ------------- 0	9,075 ------------- 0	572,402 ------------- 0	0 ------------- 0
7Pamela TarulliSVP HR	(i) (ii)	224,908 ------------- 0	76,504 ------------- 0	40,210 ------------- 0	20,295 ------------- 0	16,082 ------------- 0	377,999 ------------- 0	0 ------------- 0
8Jeffrey ReillyCOO (END 12/15)	(i) (ii)	209,546 ------------- 0	103,856 ------------- 0	94,523 ------------- 0	8,568 ------------- 0	16,095 ------------- 0	432,588 ------------- 0	0 ------------- 0
9Sophie Crawford-RossoVP PCS	(i) (ii)	137,383 ------------- 0	36,677 ------------- 0	484 ------------- 0	3,963 ------------- 0	22,057 ------------- 0	200,564 ------------- 0	0 ------------- 0
10Judith LindbergVP PCS	(i) (ii)	146,867 ------------- 0	43,812 ------------- 0	805 ------------- 0	5,182 ------------- 0	15,571 ------------- 0	212,237 ------------- 0	0 ------------- 0
11Toni ClarkEVP Senior Services	(i) (ii)	163,109 ------------- 0	53,333 ------------- 0	39,882 ------------- 0	14,291 ------------- 0	7,517 ------------- 0	278,132 ------------- 0	0 ------------- 0
12Cary Hirsch MDPhysician	(i) (ii)	1,000,004 ------------- 0	50,000 ------------- 0	33,204 ------------- 0	20,295 ------------- 0	0 ------------- 0	1,103,503 ------------- 0	0 ------------- 0
13Thomas Facelle MDDirector of Surgery	(i) (ii)	600,942 ------------- 0	182,020 ------------- 0	2,970 ------------- 0	20,295 ------------- 0	1,525 ------------- 0	807,752 ------------- 0	0 ------------- 0
14Seth Hurwitz MDCardiologist	(i) (ii)	342,391 ------------- 0	384,312 ------------- 0	324 ------------- 0	20,295 ------------- 0	23,957 ------------- 0	771,279 ------------- 0	0 ------------- 0
15Lee Root MDPhysician	(i) (ii)	492,197 ------------- 0	187,610 ------------- 0	1,245 ------------- 0	20,295 ------------- 0	24,151 ------------- 0	725,498 ------------- 0	0 ------------- 0
16Mark Nantz1st Vice Chair	(i) (ii)	0 ------------- 675,419	0 ------------- 523,457	0 ------------- 93,805	0 ------------- 97,873	0 ------------- 29,848	0 ------------- 1,420,402	0 ------------- 46,960
17Michael IsraelVice Chair	(i) (ii)	0 ------------- 1,257,829	0 ------------- 918,144	0 ------------- 0	0 ------------- 74,814	0 ------------- 73,346	0 ------------- 2,324,133	0 ------------- 0
18Anthony MahlerBoard Member	(i) (ii)	0 ------------- 447,254	0 ------------- 0	0 ------------- 0	0 ------------- 74,814	0 ------------- 23,090	0 ------------- 545,158	0 ------------- 0
19Gary BrudnickiBoard Member	(i) (ii)	0 ------------- 827,076	0 ------------- 436,891	0 ------------- 0	0 ------------- 74,814	0 ------------- 67,318	0 ------------- 1,406,099	0 ------------- 0
20Julie SwitzerBoard Member	(i) (ii)	0 ------------- 583,779	0 ------------- 110,606	0 ------------- 0	0 ------------- 68,814	0 ------------- 53,486	0 ------------- 816,685	0 ------------- 0
21Peter KenniffCFO	(i) (ii)	420,943 ------------- 0	0 ------------- 0	606 ------------- 0	0 ------------- 0	6,661 ------------- 0	428,210 ------------- 0	0 ------------- 0
22Deborah MarshallSVP Marketing/Strategy	(i) (ii)	188,667 ------------- 0	57,088 ------------- 0	1,359 ------------- 0	9,793 ------------- 0	22,655 ------------- 0	279,562 ------------- 0	0 ------------- 0
23Leon HarrisPhysician	(i) (ii)	296,897 ------------- 0	371,644 ------------- 0	1,980 ------------- 0	20,295 ------------- 0	3,668 ------------- 0	694,484 ------------- 0	0 ------------- 0
24Maureen PriceCIO	(i) (ii)	199,740 ------------- 0	51,054 ------------- 0	2,285 ------------- 0	14,098 ------------- 0	224 ------------- 0	267,401 ------------- 0	0 ------------- 0
25Phyllis YezzoSVP PCS	(i) (ii)	165,770 ------------- 0	10,730 ------------- 0	1,247 ------------- 0	0 ------------- 0	3,821 ------------- 0	181,568 ------------- 0	0 ------------- 0
26Marsha CaseyBoard Member	(i) (ii)	0 ------------- 706,524	0 ------------- 127,106	0 ------------- 0	0 ------------- 73,304	0 ------------- 49,449	0 ------------- 956,383	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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.

Return Reference

Explanation

Part 1, Line 3

Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee

Part I, Line 4a

Jeffrey Reilly, Chief Operations Officer, Received severance payments totaling $16,442 in 2015. Upon Mr. Reilly's separation of employment with BSCHSI (effective 12/4/15), he was provided a 2-year severance agreement in recognition of his over 20 years of service to the organization. Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: Andrea Mazzoccoli, $30,744 and Mark Nantz, $49,665.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Return Reference	Explanation
Form 990, Part VI, Line 4	Significant changes to governing documents: The governing documents were updated to reflect the following changes: Effective May 19, 2015, Bon Secours Charity Health System, Inc. (BSCHS), Bon Secours Health System, Inc. (BSHSI) and the Sisters of Charity of Saint Elizabeth (SOC) entered into an affiliation agreement with Westchester County Health Care Corporation (WCHCC) and WMC Heath Network - Rockland, Inc. (WMC - Rockland), a subsidiary of WCHCC, in which WMC - Rockland would be the majority member of BSCHS, holding 60% of the economic interest in BSCHS and appointing 60% of the BSCHS Board of Directors. BSHSI holds a 40% economic interest in BSCHS and, together with SOC, appoints 40% of the BSCHS Board of Directors. Further, WCHCC provides management services to BSCHS pursuant to a Department of Health approved management agreement between WCHCC and BSCHS. Prior to the transaction, BSCHS was a subsidiary of BSHSI and SOC.
Form 990, Part VI, Line 6	Members or stockholders: Effective May 19, 2015, the members of BSCHS are as follows: WMC Rockland, Inc. - 60% BSHSI, together with SOC - 40% Prior to May 19, 2015, BSCHS was a subsidiary of BSHSI and SOC. Pursuant to New York State Law, as an organization engaged in the profession of medicine, Bon Secours Charity Health System Medical Group, P.C. (MedPC) has a sole shareholder of the organization who is engaged in the practice of medicine and licensed to practice in the State of New York.
Form 990, Part VI, Line 7a	Power to elect or appoint members: The governing bodies of the members within the Group, with the exception of MedPC, are appointed by its members, WMC-Rockland, BSHSI and SOC and are subject to the approval of its members.
Form 990, Part VI, Line 7b	Decisions reserved to members or stockholders: Certain authorities of the members of the Group, with the exception of Bon Secours Charity Health System Medical Group, PC, are jointly reserved to WMC-Rockland, BSHSI and SOC, certain authorities are reserved to BSHSI and WMC-Rockland, and certain authorities are reserved solely to BSHSI.
Form 990, Part VI, Line 11b	Process used to review the Form 990: Prior to filing, this Form 990 was reviewed by the Finance Committee of the Board as well as the Board of Directors. Members were encouraged to provide comments and feedback. Based on this feedback, applicable changes were made to the return prior to filing.
Form 990, Part VI, Line 12c	Monitoring and enforcement of compliance with conflicts of interest policy: The organization regularly and consistently monitors compliance with its conflicts 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 Chief Compliance Officer (CCO) and General Counsel (GC); (2) an executive conflicts committee, comprised of ,the CEO, CCO, and GC, conducts 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 the Boards audit and compliance committee.
FORM 990, PART VI, LINE 15	The organization has a comprehensive process for the oversight and management of remuneration for the CEO and other senior executives and disqualified parties. Compensation for such key employees is set by reviewing and relying on objective market data to ensure they receive compensation that is in full compliance with the IRS' rebuttable presumption of reasonableness. The organization maintains a compensation philosophy, reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. Further, the organization ensures that all levels of pay within the organization are reasonable based on performance and validates that incentives payments, if any, are adequately supported. Such decisions are documented in Board and other relevant Committee minutes.
Form 990, Part VI, Line 19	Process for making documents available to the public: Any documents open to public inspection are made available upon request.
Form 990, Part XI, Line 9	Other changes in net assets - Archdiocese Pension Plan withdrawal ($13,672,736) - Change in Minimum Pension Liability ($464,435) - Transfers to Affiliates ($13,583,457) - Forgiveness of amounts due to Bon Secours Health System, Inc. $125,106,051 ------------- Total $97,385,423

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Bon Secours Charity Health System Affiliated
Group

Employer identification number

45-2964467

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on 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?
(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	Yes	No
(1)WMC Health Network - Rockland Inc 100 Woods Rd Valhalla,NY10595 32-0467873	Parent Org	NY	501(c)(3)	11c, III-FI	WCHCC		No
(2)Bon Secours Charity Health System AG 1505 Marriottsville Road Marriottsville,MD21104 52-1301088	Parent Org	MD	501(c)(3)	11c, III-FI	Bon Secour		No
(3)Good Samaritan Foundation for Better Hea 255 Lafayette Ave Suffern,NY10901 13-3400353	Foundation	NY	501(c)(3)	LINE 7	BSCHSI		No
(4)Bon Secours Community Hospital Foundatio 255 Lafayette Ave Suffern,NY10901 81-0667395	Foundation	NY	501(c)(3)	Line 7	BSCHSI	Yes
(5)Bon Secours Warwick Health Foundation 255 Lafayette Ave Suffern,NY10901 14-1972807	Foundation	NY	501(c)(3)	Line 7	BSCHSI	Yes
(6)WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA,NY10595 13-3964321	HEALTHCARE	NY	115		NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved
(1) WMC-Rockland	r	2,496,409
(2) BSHSI	r	1,854,146
(3) Good Samaritan Foundation	b	424,926
(4) Good Samaritan Foundation	c	2,386,603
(5) Bon Secours Community Foundation	c	507,565
(6) BON SECOURS CHARITY HEALTH SYSTEM INC	r	18,555,351
(7) Good Samaritan Hospital	r	45,985,309
(8) Good Samaritan Hospital	q	34,587,037
(9) Good Samaritan Foundation for Better Health	q	251,995
(10) St Anthony's Community Hospital	r	47,382,927
(11) St Anthony's Community Hospital	q	22,008,354
(12) St Anthony's Community Hospital	o	11,635,857
(13) Bon Secours Warwick Foundation	q	58,251
(14) Bon Secours Community Hospital	r	42,727,935
(15) Bon Secours Community Hospital	q	21,847,968
(16) Bon Secours Community Hospital	o	18,187,869
(17) Bon Secours Community Foundation	q	28,669
(18) Villa Frances at the Knolls Inc	r	8,256,224
(19) Villa Frances at the Knolls Inc	q	5,113,548
(20) Villa Frances at the Knolls Inc	o	4,254,757
(21) St Francis Center at the Knolls Inc	q	1,642,396
(22) St Francis Center at the Knolls Inc	r	1,271,795
(23) St Francis Center at the Knolls Inc	o	156,946
(24) Bon Secours Medical PC	r	24,865,902
(25) Bon Secours Medical PC	q	8,004,706
(26) Bon Secours Medical PC	o	22,401,960

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Acute care hospitals, physician services and long-term care facilities
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	3,728
6	Total number of volunteers (estimate if necessary) .............	6	328
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	9,653,393	1,497,461
9	Program service revenue (Part VIII, line 2g) .........	487,062,500	482,355,796
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	415,336	204,603
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,461,773	13,066,458
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	502,593,002	497,124,318
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	17,400	10,244
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)	263,235,756	275,917,838
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	254,460,787	229,858,410
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	517,713,943	505,786,492
19	Revenue less expenses. Subtract line 18 from line 12.......	-15,120,941	-8,662,174
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	297,500,374	226,182,504
21	Total liabilities (Part X, line 26).............	365,553,525	205,507,276
22	Net assets or fund balances. Subtract line 21 from line 20.....	-68,053,151	20,675,228

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 451,763,461 including grants of $ 10,244 ) (Revenue $ 490,434,051 )
	Bon Secours Charity Health System Affiliated Group is composed of three acute care hospitals, primary and specialty medical care practices and two long-term care and residential facilities: Good Samaritan Hospital of Suffern, NY; Bon Secours Community Hospital; St. Anthony Community Hospital; Bon Secours Charity Health System Medical Group, PC; St. Francis Center at the Knolls (dba Mount Alverno Center); and Villas Francis at the Knolls (dba Schervier Pavilion). Good Samaritan Hospital (GSH) operates a 286-bed hospital located in Suffern, New York that provides emergency, medical, surgical, obstetrical/gynecological and acute care services to Rockland and Orange Counties, New York and northern Bergen County, New Jersey. GSH has a Level II Trauma Center, a designated stroke center and acute myocardial infarction (AMI) program, and a regional cardiovascular program, providing open hear surgery, a cardiac catheterization laboratory, emergency angioplasty, electrophysiology studies and a pacemaker clinic. GSH has received many awards and in 2014 was named one of the nation's 50 Top Cardiovascular Hospitals by Truven Health Analytics. GSH offers a comprehensive women's breast center, wound and hyperbaric center, sleep study center and maternal/child services, including a Level II neonatal intensive care unit supported by pediatric subspecialists from Westchester Medical Center (WMC). GSH's surgical weight loss institute provides pre-operative, surgical care and outpatient post-operative bariatric support. GSH provides kidney dialysis, psychiatric and substance abuse services and a range of social support services, education and population health services. The campus also includes a medical office building housing a state-of-the-art ambulatory surgery center, and primary care and specialty physicians. GSH's Certified Home Care Agency provides home health services to the residents of Rockland and Orange Counties, New York. This program is for patients who have acute needs and require home care for a relatively short period of time and will be discharged when they are stabilized or returned to a pre-illness level of functioning. Additional services include wound and ostomy assessments, physical therapy, occupational therapy, speech pathology, medical social work, nutrition and home health aides. The home health agency is certified for expansion into Manhattan and Westchester County, New York. Bon Secours Community Hospital (BSCH) operates a 122-bed acute care hospital located in Port Jervis, New York that provides community-based care to residents in the Port Jervis, New York and surrounding areas (Orange and Sullivan Counties in New York, Sussex County in New Jersey and Pike County in Pennsylvania). BSCH provides emergency care, laboratory and imaging services, medical and surgical services, and intensive care unit, inpatient dialysis, cardiopulmonary care, infusion therapy and outpatient wound care and diabetes programs. BSCH also offers inpatient psychiatric services and a chemical dependency program. A medical office building with primary care and diagnostic services is located across the street from BSCH. BSCH also offers a wide range of health education and population health support services for the community. St. Joseph's Place is a 46-bed nursing care center located on the first floor of BSCH that provides 24-hour nursing care, long- and short-term rehabilitation, tracheotomy care, head trauma care, respiratory care and psychological services. St. Anthony's Community Hospital (SACH) operates a 60-bed hospital that is located in Warwick, New York serving the residents of Orange County, New York, and Sussex and Passaic Counties, New Jersey. SACH provides emergency care, medical and surgical services, laboratory and imaging services, obstetrical, and gynecological and orthopedics. The SACH ambulatory services center provides various convenient services, including admitting, pre-admission screening, endoscopy, minor surgery and same-day surgery. An infusion center provides long-term intravenous antibiotics, blood transfusions, iron therapy, chemotherapy and long-term catheter insertion and maintenance. SACH education and outreach services include a diabetes education program and population health improvement programs. Bon Secours Charity Health System Medical Group, PC (MedPC) provides medical services to Suffern, New York and surrounding communities. Their services include primary care and various specialty professional services. The organization seeks to locate its physician practice sites in areas that most effectively meet the needs of the community. Villa Francis at the Knolls, Inc. d/b/a Schervier Pavilion (Schervier) is a 122-bed, skilled nursing facility located in Warwick, New York. Schervier provides therapeutic and social activities designed to enhance the physical and mental capabilities to help residents maintain and optimize their level of daily independence. Schervier is part of the 27-acre Warwick campus that includes Mount Alverno Center and SACH. Located in Schervier is a full-service adult day care program known as Day-At-A-Time. It provides health care, recreational and therapeutic activities from two to five days per week for the cognitively impaired and physically frail. The program provides an alternative to nursing home placement and home health care. St. Francis Center at the Knolls, Inc. d/b/a Mount Averno Center (Mount Alverno) is an adult home located on the SACH campus with an assisted living program serving 85 residents by providing individualized care plans designed to help residents reach and maintain a maximum level of independence.

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 expenses451,763,461

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,510,412	8,825,849	1,374,512

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	0
d	Related organizations		1d	1,141,253
e	Government grants (contributions)		1e	355,746

f	All other contributions, gifts, grants, and similar amounts not included above		1f	462

g	Noncash contributions included in lines 1a-1f:$ 0
h Total.Add lines 1a-1f.......		1,497,461

			Business Code
2a	NET PATIENT SERVICE REVENUE	623000	481,497,255	481,497,255	0	0
b	Capitation Revenue	623000	858,541	858,541	0	0
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			482,355,796

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			204,603			204,603
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		802,976
b	Less: rental expenses		0
c	Rental income or (loss)	0	802,976
d	Net rental income or (loss)......			802,976			802,976
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....			0
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..			0
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..			0
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..			0
Business Code			Miscellaneous Revenue
11a	IAAF/VAPAP		900099	6,869,955	6,869,955	0	0
b	MEANINGFUL USE		900099	2,379,998	0	0	2,379,998
c	INCENTIVES, REBATES & REFUNDS		900099	961,053	961,053	0	0
d	All other revenue ....			2,052,476	247,247	0	1,805,229
e	Total. Add lines 11a–11d ......			12,263,482
12	Total revenue. See Instructions......			497,124,318	490,434,051	0	5,192,806

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	0	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	10,244	10,244
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,856,389	385,639	3,470,750	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	201,576,669	193,708,277	7,868,392	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	7,755,952	6,814,199	941,753	0
9	Other employee benefits .......	40,006,222	39,255,112	751,110	0
10	Payroll taxes ...........	22,722,606	21,890,537	832,069	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	1,215,481	157,174	1,058,307	0
c	Accounting ...........	265,126	0	265,126	0
d	Lobbying ...........	66,341	0	66,341	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	24,718,311	23,514,605	1,203,706
12	Advertising and promotion ....	508,353	28,381	479,972	0
13	Office expenses .......	7,237,644	4,577,226	2,660,418	0
14	Information technology ......	1,725,706	950,283	775,423	0
15	Royalties ..	0	0	0	0
16	Occupancy ...........	14,052,324	11,783,438	2,268,886	0
17	Travel ............	1,006,735	905,378	101,357	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	58,272	32,974	25,298	0
20	Interest ...........	9,294,536	9,294,536	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	24,275,408	24,094,491	180,917	0
23	Insurance ...	8,346,937	6,366,293	1,980,644	0
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	Medical Supplies	64,580,250	64,580,250	0	0
b	Purchased Services	60,788,190	38,422,469	22,365,721	0
c	BSHSI/WMC Mgmt Dues	4,350,555	0	4,350,555	0
d	OTHER EXPENSES	7,368,241	4,991,955	2,376,286	0
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	505,786,492	451,763,461	54,023,031	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			112,880	1	700,275
2	Savings and temporary cash investments .........			308,212	2	350,643
3	Pledges and grants receivable, net ......			29,500	3	2,380,498
4	Accounts receivable, net .............			66,459,131	4	63,808,052
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
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
				0	6	0
7	Notes and loans receivable, net ....			999,959	7	0
8	Inventories for sale or use ........			7,315,491	8	8,277,412
9	Prepaid expenses and deferred charges ......			5,337,116	9	4,048,514
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	327,829,164
b	Less: accumulated depreciation	10b	190,341,065	159,423,502	10c	137,488,099
11	Investments—publicly traded securities .			5,521,772	11	281,227
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			729,184	14	445,658
15	Other assets. See Part IV, line 11 ...........			51,263,627	15	8,402,126
16	Total assets. Add lines 1 through 15 (must equal line 34)...			297,500,374	16	226,182,504

17	Accounts payable and accrued expenses .....	50,793,427	17	53,294,781
18	Grants payable ...	0	18	0
19	Deferred revenue .........	2,387,879	19	2,331,046
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	80,087	21	108,960
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	157,257	23	126,916,106
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	312,134,875	25	22,856,383
26	Total liabilities. Add lines 17 through 25..	365,553,525	26	205,507,276

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	-68,861,112	27	19,867,357
28	Temporarily restricted net assets ...........	807,961	28	807,871
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	-68,053,151	33	20,675,228
34	Total liabilities and net assets/fund balances ........	297,500,374	34	226,182,504