TY 2020 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) Brian Cuddy MD Chair, Neurosurgeon - RSFPP	0.5 ................. 49.5	X	X	0	1,025,169	70,138
(2) Susan Datta MD Vice-Chairperson, Internist - RSFPP	0.5 ................. 49.5	X	X	0	349,309	69,476
(3) Brian White Board Member (End 03/20); Atlantic Group President - BSMH	0.5 ................. 53.5	X		0	1,968,502	37,978
(4) Brian YANofchick Board Member (Beg 01/20); Chief Sponsorship Officer Atlantic Grp. - BSMH	0.5 ................. 53.5	X		0	575,471	22,269
(5) Edward McKelvey Board Member	0.5 ................. 3.5	X		0	0	0
(6) Henry West MD Board Member, Surgeon - RSFPP	0.5 ................. 49.5	X		0	555,493	54,829
(7) JAMES THOMAS Board Member (Beg 01/20 - End 03/20)	0.5 ................. 3.5	X		0	0	0
(8) John B Holloway Jr Board Member, CEO - MSSC	0.5 ................. 53.5	X		0	464,000	31,001
(9) JOSEPH GAGE JR JD Board Member (Beg 03/20); BSMH Chief HR Officer	0.5 ................. 53.5	X		0	1,252,571	266,776
(10) Mary Thornley EDD Board Member	0.5 ................. 3.5	X		0	0	0
(11) Roberta Pinckney Board Member	0.5 ................. 3.5	X		0	0	0
(12) Wael Haidar MD Board Member (Beg 01/20), BSMH Chief Clinical Officer	0.5 ................. 53.5	X		0	1,492,186	521,231
(13) Wills C Geils MD Board Member	0.5 ................. 3.5	X		721	11,844	0
(14) Anthony Jackson VP & CEO Acute Care Services (End 03/20)	10.0 ................. 40.0		X	0	855,077	45,986
(15) Bret D Johnson CFO & SVP / Treasurer (End 05/20)	1.0 ................. 49.0		X	0	710,578	26,784
(16) Christopher Glenn Interim CFO/Treasurer (Beg 06/20)	1.0 ................. 49.0		X	0	252,908	9,801
(17) JAMES BERG Interim CEO (Beg 01/20 - End 12/20)	1.0 ................. 49.0		X	0	576,206	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Jeffrey DiLisi MD CEO (Beg 12/20)	1.0 .......................49.0	X				0	90,385	0
(19) Gretchen Morin Chief Administrative Officer	50.0 .......................0.0		X			216,953	0	41,447
(20) Matthew Desmond VP Ops Acute Care (Beg 08/20)	10.0 .......................40.0		X			0	293,768	47,258
(21) Mitchell Siegan MD VP CMO - Acute Care	10.0 .......................40.0		X			0	575,800	66,324
(22) Pennie Peralta Chief Nursing Officer - BSSF (End 09/20)	25.0 .......................25.0		X			0	414,967	32,614
(23) Tavia Buck Chief Nursing Officer - BSSF (Beg 09/20)	50.0 .......................0.0		X			233,635	0	23,705
(24) Troy Powell VP Ops Continuing Care (Beg 01/20)	10.0 .......................40.0		X			0	338,182	46,378
(25) ELLEN BENKE Pharmacist	50.0 .......................0			X		160,906	0	27,106
(26) James Hovis Pharmacist	50.0 .......................0			X		154,607	0	18,586
(27) John Zimmer Chief Physicist	50.0 .......................0			X		236,194	0	26,750
(28) Scotty WELCH Pharmacist	50.0 .......................0			X		153,448	0	41,499
(29) Thomas Baxley Manager Pharmacy	50.0 .......................0			X		204,114	0	47,394
(30) Francis Wyckoff Jr Former Key, Director of Pharmacy	15.0 .......................35.0				X	0	269,416	37,797
(31) Lorraine Lutton Former CEO	0.0 .......................0.0				X	0	1,401,488	7,065
(32) Stephanie McKoin Former Key, Director of Perioperative Services	15.0 .......................35.0				X	0	227,655	36,034
(33) Vanessa Shamrock Former Key, Director of Lab Services	15.0 .......................35.0				X	0	178,349	18,579

- 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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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2020

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 (explain in Part VI). 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
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
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
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	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
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

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

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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization Bon Secours-St Francis Xavier Hospital Inc

Part I Contributors	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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization Bon Secours-St Francis Xavier Hospital Inc		Employer identification number 57-1067254

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) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization Bon Secours-St Francis Xavier Hospital Inc			Employer identification number 57-1067254
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) (2020)

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2020

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

Term 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 .....	13,580,943		13,580,943
b	Buildings ....	121,394,182	64,055,783	57,338,399
c	Leasehold improvements	1,726,783	1,163,317	563,466
d	Equipment ....	67,902,342	52,052,253	15,850,089
e	Other .....	3,309,790	6,521	3,303,269
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				90,636,166

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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)Investment in RSF Cancer Center	-57,196	F
(2)Intercompany REceivables	233,137,966	F
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	233,080,770

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)Third Party Receivable				1,693,800
(2)Other Assets				608,744
(3)PHYSICIAN RECRUITMENT				84,318
(4)RIGHT OF USE ASSET				21,374,488
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				23,761,350

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
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	85,950,312
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) 2020

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

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. Roper St. Francis Healthcare and its affiliates are members of Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), and all of the other entities that are controlled directly or indirectly by BSMH are described collectively as the Company. Below is the related statement from the Bon Secours Mercy Health, Inc. consolidated audited financial statements: The Company and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. Their related income is exempt from federal income tax under Section 501(A). Some of the subsidiaries are taxable entities, and some of the income of the tax-exempt entities is subject to taxation as unrelated business taxable income. The Company and its subsidiaries file U.S. federal income tax returns, and they also file in various state and foreign jurisdictions. The Company accounts for uncertain tax positions in accordance with ASC Topic 740, Income Taxes. The Company accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The Company has determined that no significant unrecognized tax benefits or liabilities exist as of December 31, 2020 and 2019. Accounting for uncertainty in income taxes, ASC Topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The Company is subject to routine audits by taxing jurisdictions. There are no current audits in progress. As of December 31, 2020 and 2019, the Company has no uncertain tax positions. The Company's taxable subsidiaries had $199,705 and $205,170 net operating loss carryforwards as of December 31, 2020 and 2019, respectively, which expire in varying periods through 2037 and are available to offset future taxable income. The Company accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to be in effect during the year in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. Interest and penalties related to income taxes are accounted for as income tax expense. The Company has placed a full valuation allowance on the deferred tax assets as of December 31, 2020 and 2019 as the Company considers it more likely than not that these amounts will not be utilized in future periods.

Schedule D (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			13,718,428	4,083,321	9,635,107	4.72 %
b	Medicaid (from Worksheet 3, column a) . . . . .			22,950,650	21,170,774	1,779,876	0.87 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	36,669,078	25,254,095	11,414,983	5.59 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			69,178		69,178	0.03 %
f	Health professions education (from Worksheet 5) . . .			129,789	6,950	122,839	0.06 %
g	Subsidized health services (from Worksheet 6) . . . .					0	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			56,241		56,241	0.03 %
j	Total. Other Benefits . .	0	0	255,208	6,950	248,258	0.12 %
k	Total. Add lines 7d and 7j .	0	0	36,924,286	25,261,045	11,663,241	5.72 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing					0
2	Economic development					0
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building					0
7	Community health improvement advocacy					0
8	Workforce development			847		847
9	Other					0
10	Total	0	0	847	0	847

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

24,971,631

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).....

55,008,442

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

53,457,545

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

1,550,897

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 %
1RSFH West Ashley Cancer Center LLC	Cancer Treatment	9.3 %	0 %	90.7 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

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?1Name, 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)
1	Bon Secours St Francis Xavier Hospital 2095 Henry Tecklenburg Blvd Charleston,SC29414 https://www.rsfh.com/st-francis-hospital/ HTL-0750	X	X	X

Schedule H (Form 990) 2020

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)

	Bon Secours St Francis Xavier Hospital
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):

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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

Yes

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): https://www.rsfh.com/mission-department/

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 20

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

Yes

If "Yes" (list url): https://www.rsfh.com/mission-department/

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) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Bon Secours St Francis Xavier Hospital
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 200.0%
and FPG family income limit for eligibility for discounted care of 400.0%

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)

Was widely publicized 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):

https://www.rsfh.com/billing-financial-assistance/

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

https://www.rsfh.com/billing-financial-assistance/

A plain language summary of the FAP was widely available on a website (list url):
https://www.rsfh.com/billing-financial-assistance/

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	Bon Secours St Francis Xavier Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

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

	Bon Secours St Francis Xavier Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2020

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. In an effort to create a greater impact on the community and address the greatest needs, Roper St. Francis Healthcare participated in and produced a joint Community Health Needs Assessment (CHNA) in collaboration with the Medical University of South Carolina and the Trident United Way. Data for the CHNA was collected from January - February 2019. To gather community input the Community Health Needs Assessment team disseminated a community survey with the purpose of identifying a general overview of the most concerning health topics. The surveys had 5,128 responses which greatly surpassed the number of responses from the previous CHNA of 905 survey responses. This level of engagement is an immediate benefit of collaborating with community partners. Furthermore, the team hosted 19 Interviews with community leaders, elected officials and health care professionals, held 12 focus groups with 57 participants from the community at large, and had 100 participants at the team's community input session. During the 2019 CHNA planning process, specific community groups and organizations, including area schools, churches, and clinics, were included to to engage more members from African American, Latino, low socioeconomic and rural communities. Using feedback from the surveys, interviews, focus groups and the community input session a summary of community feedback was created. This summary would be used in the creation of team's priorities and ultimately the implementation strategy.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. Roper Hospital, Inc. Bon Secours St. Francis Xavier Hospital Roper St. Francis Mt. Pleasant Hospital Roper St. Francis Hospital - Berkeley Inc. Medical University of South Carolina
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. Trident United Way
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. The Roper St. Francis Healthcare (RSFH) is comprised of Roper Hospital, Bon Secours St. Francis Xavier Hospital, Roper St Francis Mount Pleasant Hospital, and Roper St. Francis Berkeley Hospital. These hospitals are collectively referred to as "Roper St. Francis Healthcare" or "RSFH." RSFH's Community Needs Assessment Team developed implementation strategies for each health issue identified as a strategic priority. This implementation plan was rolled out over 3 years. Some strategies may be addressed by more than one RSFH hospital or the system as a whole. The team developed a monitoring method at the conclusion of the implementation planning process to provide status updates to community partners, stakeholders, and the community-at-large. The following are the 2020 strategies and outcomes on the 5 issues identified as priorities in the 2020 Community Health Needs Assessment. Access to Care 2020 Strategies and Outcomes: Strategy (System-wide): Navigate high users of emergency departments to primary care medical homes, and to refer underinsured and uninsured patients to AccessHealth and/or the Transitions Clinic. * During 2020, the four local hospital systems actively participated in AccessHealth Tri-County Network in order to collaborate with local healthcare systems to identify Emergency Department (ED) "super utilizers". * RSFH coordinated with AccessHealth and the Transition Clinic to navigate uninsured ED "super utilizers" to these programs. During 2020, AccessHealth had 2,728 patients, including 690 new patients, and Transitions Clinic had 1,313 patients, including 350 new patients, which resulted in a reduction in ED visits for these patients by 83%. * RSFH developed a team-based program to create a comprehensive, patient-centered care plan for ED "super utilizers," engaging both RSFH and community resources. Strategy (System-wide): Coordinate and collaborate with safety-net partners for delivery of services, including area Federally Qualified health Centers (FQHC), free clinics, and homeless shelters. * RSFH provides lab work, free supplies, and ancillaries to partner medical clinics and supportive agencies. During 2020, RSFH updated all in-kind service agreements with partnered clinics and supportive agencies to provide equitable services to all partners. Additionally, RSFH added the Shifa Clinic to the partner clinics that are supported. * RSFH managed care coordination for eligible patients referred from local partners through the shared care navigation hub managed by AccessHealth. Those served are included in the 2,728 patients served by AccessHealth in 2020. Strategy (System-wide): Provide in-home care to patients with limited mobility through Home Health and Hospice Care. * RSFH provided high quality care for patients with transportation or mobility issues or those with end-of-life needs through in-home or inpatient Hospice or Home Health Services. During 2020, 6,027 patients received Home Health Services, while 613 patients received In-home Hospice care and 460 patients received Inpatient Hospice care. Clinical Preventative Services 2020 Strategies and Outcomes: Strategy (System-wide): Provide routine, primary care for low-income, uninsured adults. * RSFH provides lab work, free supplies, and ancillaries to partner medical clinics and supportive agencies. During 2020, RSFH updated all in-kind service agreements with partnered clinics and supportive agencies to provide equitable services to all partners. Additionally, RSFH added the Shifa Clinic to the partner clinics that are supported. * RSFH also provided financial support for clinical staff and infrastructure at Our Lady of Mercy Outreach. Strategy (System-wide): Provide early intervention services for patients diagnosed with HIV/AIDS. * RSFH enrolled HIV positive patients into the federally funded Ryan White program. In 2020, The Ryan White Wellness Center provided comprehensive HIV and primary care for 836 HIV positive patients. * In 2020, RSFH worked with the Ryan White Wellness Center to ensure continued health insurance coverage for 308 HIV positive adult patients using federal and employer insurance programs. * RSFH sought grant funding to expand primary prevention services for high risk HIV negative adults and prevent the rate of transmission for HIV positive patients. As a result, the Ryan White Wellness Center provided HIV prevention to 144 HIV negative patients in 2020. * During 2020, RFSH provided 453 HIV tests in clinic testing locations. Due to COVID-19, the community events RSFH intended to support to address this health need were delayed until 2021. Strategy (System-wide): Provide evidence-based outpatient care for diabetic patients and expand access to free annual breast health screenings for all women, particularly African-American women. * Through its affiliated physician entity, Roper St. Francis Physician Partners (RSFPP), the system tracked the percentage of patients who receive evidence-based outpatient care for diabetes. In 2020, 90.75% of all RSFPP with a diagnosis of diabetes received A1c testing. * The annual "Family Wellness Night" and other screening events held for underserved men and women to get breast and colorectal screenings resulted in 48 clinical breast exams and 42 referrals for additional screening. Due to COVID-19 colorectal screenings were delayed until 2021, but 200 home colon cancer screening tests were distributed through partner clinics to support this strategy. * Due to the impact of COVID-19, several of the programs and strategies that RSFH intended to implement to address this health need were delayed with plans to resume these programs in 2021. Behavioral Health 2020 Strategies and Outcomes: Strategy (System-wide): Coordinate services between Emergency Departments and regional mental health agencies. * During 2020, RSFH continued to participate and collaborate in the Charleston/Dorchester Mental Health Department's community task force. Additionally, RSFH donated billboard space to support the "SC HOPES" mental health hotline. * During 2020, RSFH coordinated care of behavioral health patients, using local agencies and resources for support. * RSFH collaborates with mental health providers to engage community members in highest need areas to direct appropriate services. In 2020, 1,064 bags of fresh produce were distributed to families in need. RSFH also held a voter registration drive and a utility assistance drive in its community. Strategy (System-wide): Provide services and education to combat the opioid epidemic. * RSFH has continued building relationships with local law enforcement to create an alliance for holding Drug Take Back events and to expand their initiative. * RSFH organized Drug Take Back events with local law enforcement throughout the tri-county area. During 2020, RSFH successfully completed two grants to increase the reach of the take back events with education and awareness around the opioid epidemic. 591 pounds of drugs were collected through 10 drug take back events in 2020. Strategy (System-wide): Provide mental health screenings at wellness and postpartum OB/GYN visits. * RSFH incorporates depression screenings at primary care wellness visits and postpartum OB/GYN patient visits. In 2020, 78.4% of all patients received a depression screening during primary care wellness checks and 93.7% of all patients received a depression screening during the follow-up postpartum visit. Continued Below.
Schedule H, Part V, Section B, Line 11 Facility , 2	Facility , 2 - Bon Secours St. Francis Xavier Hospital (Continued). Continued from above. Obesity, Nutrition, and Physical Activity 2020 Strategies and Outcomes: Strategy (System-wide): increase opportunities for comprehensive wellness. * RSFH requires all system employees to have an annual primary care screening. In 2020, 88% of RSFH employees had PCP visits. * RSFH promotes employee participation in disease-specific events to increase health awareness and advocacy. In 2020, RSFH employees recorded 3,033 hours of staff time supporting initiatives while serving 9,753 community residents. * Due to the impact of COVID-19, several of the programs and strategies that RSFH intended to implement to address this health need were delayed with plans to resume these programs in 2021. Strategy (System-wide): Collaborate with local partners to increase healthy food options in underprivileged communities. * RSFH engaged community members in highest need areas to promote wellness and nutrition. In 2020, 1,064 bags of fresh produce were distributed to families in need through the Farmacy Project. * RSFH collaborates with Lowcountry Food Bank and East Cooper Meals on Wheels to provide home-delivered meals in low-income communities. In 2020, 3,684 meals were provided to homebound residents in Charleston County. Strategy (System-wide): Host evidence-based health and wellness community programs for older adults. * RSFH offered physical wellness classes specifically targeting older adults. In 2020, 766 seniors were enrolled as members at Lowcountry Senior Center and 888 seniors enrolled at Waring Senior Center. There were 41,373 visits to fitness centers and exercise activities in 2020. Maternal, Infant, and Child Health 2020 Strategies and Outcomes: Strategy (Bon Secours St. Francis Hospital): Offer specialized services for high risk pregnancies. * Bon Secours St. Francis Xavier Hospital (BSSF) offered specialized care teams for high risk pregnant women to include a board-certified maternal fetal medicine specialist during 2020. * BSSF supported a Maternal Fetal Medicine program that includes medical management, counseling, biophysical profiles, diagnosis and management of birth defects as well as other highly specialized services. During 2020, this program had 5,299 patient visits with 1,402 total patients served. Strategy (Bon Secours St. Francis Hospital): Provide prenatal care for uninsured patients that are not eligible for Medicaid. * BSSF provided prenatal care for eligible uninsured and immigrant patients of Our Lady of Mercy Outreach. During 2020, this support resulted in 46 annual exams, 8 deliveries, and 46 GYN patients. * During 2020, BSSF signed contracts to continue partnerships that provide routine lab work, radiology services, prenatal education classes, and Maternal Fetal Medicine services for Spanish speaking patients. Strategy (Bon Secours St. Francis Hospital, Roper St. Francis Mt. Pleasant Hospital, and Roper St. Francis Berkeley Hospital): Host expectant parent education classes and tours, and Safe Sitter classes. * During 2020, BSSF, MPH and BH facilitated regularly scheduled expectant parent education classes and hospital tours as well as Safe Sitter classes. The classes facilitated during the year total 161, including 35 free classes, and had 1,250 participants. All prioritized needs identified in the hospital's CHNA have been addressed.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. Full charity care will be provided to patients with income 200% or less of FPG. Patients with an FPG of 201% - 400% will receive a discount based upon a sliding scale. Patients who qualify and are receiving benefits from the following programs may be presumed eligible for 100 percent financial assistance - food stamps, county and state relief programs, homelessness, deceased patients, and religious organizations. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the financial assistance application. In order to determine the appropriate level of financial assistance to apply to a patient's account, the facility will utilize a scoring mechanism, with the assistance of a third party vendor that provides a patient profile, or require the patient to complete a financial assistance application. Household income, as defined for federal tax guidelines, will be considered in determining whether a patient is eligible for financial assistance.
Schedule H, Part V, Section B, Line 16 Facility , 1	Facility , 1 - Bon Secours St. Francis Xavier Hospital. The patient handbook provided with registration references the Policy and includes contact information for patients who need assistance. In addition, signs are posted at all Hospital registration sites that reference our financial assistance policies and how they are accessed.

Schedule H (Form 990) 2020

Page 9

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?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2020

Page 10

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
Schedule H, Part I, Line 3c Bon Secours St. Francis Xavier Hospital	In addition to using the FPG to determine eligibility for free or discounted care, the system offers a 35% discount for patients who are uninsured. A 10% prompt payment discount is offered to all self-pay or self-pay-after-insurance patients who pay the balance at one time. Medical indigency adjustments are available to those that meet the established guidelines.
Schedule H, Part V, Section B Line 16g	Roper St. Francis Healthcare (RSFH) hospitals implemented new policies and procedures in January 2016 to meet the notification requirements outlined under the final IRS Section 501(r) regulations. Training materials were revised, new scripting was developed, and training sessions were held for applicable Revenue Cycle employees which required competency sign-off for those who completed the training. Procedures initially implemented included offering a copy of the plain language summary (PLS) to patients as part of the intake process. Individuals were notified about the FAP by receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or other measures reasonably calculated to attract patients' attention. As a result of an annual internal review, it was determined that the PLS of RSFH's Financial Assistance Policy (FAP) was not being offered to all patients at intake during 2020. Immediately upon recognition of the minor oversight, RSFH began taking steps to offer a copy of the PLS to all patients who visit the hospital facilities by adding scripting to notify patients of the availability of financial assistance and offering a copy of the PLS to the patient intake process. In addition, RSFH will add new language to the Consent for Treatment, Payment, and Health Care Operations (Consent) form required to be signed by all patients, including a copy of the PLS attached as an addendum to the Consent to certify that the patient is aware of RSFH's FAP and a copy of the PLS was offered. Additional training has also been provided to all applicable staff. RSFH widely publicized its FAP, the FAP Application, and the PLS on the organization's website, includes a conspicuous written notice about the FAP on patients' billing statements, posts conspicuous public displays in the Emergency Department and Registration areas of the hospitals, and notifies members of the community about availability of the FAP. RSFH will continue to perform an internal audit on a regular and continuous basis at least once per year to ensure compliance. We do not believe the minor oversight to be considered "willful or egregious" and RSFH has performed internal research to identify how the minor oversight occurred and taken additional steps to ensure compliance going forward.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Roper St. Francis Healthcare
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Cost of financial assistance at cost was calculated with a cost to charge ratio using worksheet 2. The cost related to Medicaid patients was determined using Roper St. Francis Healthcare's cost accounting system and included both inpatients and outpatients for traditional Medicaid and Medicaid managed care plans. For subsidized services Roper St. Francis Healthcare's cost accounting system used to determine cost related to the specific service excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ration of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.
Schedule H, Part II Community Building Activities	Roper St. Francis Healthcare addresses various community concerns including health improvement, poverty, workforce development, and access to health care. Roper St. Francis Healthcare hospitals conduct community health education and support groups, health fairs and screenings for the communities served. Roper St. Francis Healthcare hospitals work with state and local leadership to address community needs and provide healthcare services to the poor and underserved. Roper St. Francis Healthcare hospitals provide programs to improve the physical surroundings and housing in the communities served. Inadequate housing has a negative impact on the health of residents in the area by leading to violence in the neighborhoods. A robust economy positively impacts residents covered by health insurance and improves the capacity of the community to support health services.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON ROPER ST. FRANCIS HEALTHCARE'S HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. ROPER ST. FRANCIS HEALTHCARE'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. ROPER ST. FRANCIS HEALTHCARE RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, ROPER ST. FRANCIS HEALTHCARE RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF ROPER ST. FRANCIS HEALTHCARE'S ININSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, ROPER ST. FRANCIS HEALTH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. ANY DISCOUNTS APPLIED TO SELF-PAY PATIENTS WOULD BE DEEMED EITHER CHARITY OR A CONTRACTUAL ADJUSTMENT. BAD DEBT WOULD BE BASED ON THE BALANCE AFTER THE CHARITY OR CONTRACTUAL ADJUSTMENT THAT IS DEEMED UNCOLLECTABLE FOLLOWING A REASONABLE COLLECTION EFFORT.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	For patients who do not turn in a signed charity care application, after 120 days of collection efforts, Roper St. Francis Healthcare uses the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The data received through this software is believed to err on the side of denying charity. The estimate of bad debt that could have been charity is based on the system error rate. Please note that patients who complete a full charity care application and qualify for charity under our policy are granted charity regardless of the score in the self-pay compass system.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	BON SECOURS MERCY HEALTH'S (BSMH) AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE ACTIVITY OF ROPER ST. FRANCIS HEALTHCARE, DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BSMH ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AS AN OPERATING EXPENSE. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, 2. SIGNIFICANT ACCOUNTING POLICIES, (d) NET PATIENT ACCOUNTS AND NET PATIENT SERVICE REVENUE (PAGE 17) STATES Patient receivables are recorded at net realizable value based on certain assumptions determined by payor class. For third party payors including Medicare, Medicaid, and commercial insurance, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay receivables, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	BON SECOURS MERCY HEALTH AND ITS MEMBERS, INCLUDING ROPER ST. FRANCIS HEALTHCARE (RSFH), FOLLOW THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY ("CHA GUIDELINES") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. RSFH'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Roper St. Francis Healthcare (RSFH) uses the same reasonable efforts and follows the same reasonable process for collecting amounts due for services provided to all patients, including insured, underinsured or uninsured patients. Collection activities may occur during the pre-registration process and will continue until account resolution, a determination the account is uncollectible, or determination of eligibility for financial assistance. The collection process may include the use of deposits, the implementation of payment plans or discretionary settlements. The collection process may involve the use of outside collection agencies. The collection process is documented in the patient's account files accessible to the Hospital and its business associates involved in the collection process. Collection will not, however, be pursued against patients who fall within populations exempt from collection action by law.
Schedule H, Part V, Section B, Line 16a FAP website	- Bon Secours St. Francis Xavier Hospital: Line 16a URL: https://www.rsfh.com/billing-financial-assistance/;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Bon Secours St. Francis Xavier Hospital: Line 16b URL: https://www.rsfh.com/billing-financial-assistance/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- Bon Secours St. Francis Xavier Hospital: Line 16c URL: https://www.rsfh.com/billing-financial-assistance/;
Schedule H, Part VI, Line 2 Needs assessment	The CHNA team used surveys sent out to the community at large and asked respondents to rank the top 10 topics areas from Health People 2020 that impact the communities where they live and/or work from 1 (most concerning) to 10 (least concerning). The top five health topic areas prioritized by the community were then used as the focus of health improvement efforts going forward. Additionally, secondary sources of data in the assessment process came from interviews with community leaders, elected officials and health care professionals, health focus groups with the community at large, and feedback from participants at the CHNA team's community input session. Healthy People 2020 is consistently recognized as a national benchmark for healthcare goals and standards.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Statements to patients from the Hospital outline our charity care policy and our charity care policy is posted on our website. If patients indicate they are not able to pay their bill, we will provide the patient with a charity care application. The Hospital shall send anyone who requests information on the Hospital's financial assistance program a letter outlining required information and a financial assistance application form. Requests for financial assistance may be proposed by sources other than the patient, such as the patient's physician, family members, social service organizations, community or religious groups, or Hospital personnel. Patients can also meet with a member or our financial counseling department to learn about their financial assistance options. Brochures are printed in English and Spanish telling patients to contact the financial counseling department. The Hospital wants its patients focus to be on health and recovery and not financial worry. There is absolutely no additional cost for our financial counseling assistance. Additionally, patients can meet with staff of the Medicaid program. The program staff will meet with patients individually to help them apply for publicly supported programs such as Medicaid, Medicare, and disability. Counselors meet with patients in the Hospital as well as making home visits as appropriate. The staff can also help identify resources to help pay for medication. All of this information is posted on our website with the appropriate contact information.
Schedule H, Part VI, Line 4 Community information	The primary service area for Roper St. Francis Healthcare and its four hospitals (collectively referred to as RSFH) consists of Charleston, Berkeley, and Dorchester counties. These counties include the major municipalities of Charleston, North Charleston, Mount Pleasant, and Summerville. The tri-county area that makes up the primary service area has a population of approximately 750,000 residents and is expected to grow based on the results of the most recently completed Community Health Needs Assessment (CHNA). These residents are 47% Male and 53% Female with a majority between the ages of 18 and 64. The average annual household income of the tri-county area is between $50,000 - $75,000 with the average level of education being an Associates degree. The race/ethnicity of these residents is approximately 66% White (non-Hispanic), 27% African American, and 6% Hispanic/Latinx. Based on the respondents from the CHNA the average amount of individuals with no health insurance is between 6.8% in Dorchester County, 7.5% in Berkeley County, and 10.6% in Charleston County. Accordingly to national health rankings, South Carolina struggles with high rates of premature death, obesity, violent crime, poverty, and diabetes. However, County Health Rankings and Roadmaps ranks the Tri-County region high in overall health compared to the other 43 counties in South Carolina. Additional detail regarding the community served by RSFH can be found in the CHNA at the following link: https://www.rsfh.com/mission-department/
Schedule H, Part VI, Line 5 Promotion of community health	In keeping with our mission of healing all people with compassion, faith, and excellence, Roper St. Francis Healthcare strives to enrich the health of our community. We do this by offering charity care to those in need, reaching out to our neighbors with health fairs and educational materials, sponsoring organizations and events that promote wellness and community well-being, and marshaling our resources to advance the health and dignity of each person with whom we come in contact. We are the Low Country's only non-governmental, not for profit healthcare system. With this distinction, we believe it is our responsibility to advocate for and respond to our neighbors needs through community benefit. Surplus funds are returned to our community through the development of new facilities to serve population growth, the expansion of existing facilities, subsidizing care for those who are unable to pay, sponsorship of healthcare related activities including outreach clinics and programs for the uninsured, and investing in technology to improve the quality of patient care. The Organization is committed to the enrichment of healthcare in our community as evidenced by the composition of our Board of Directors and Open Medical Staff. Our governing body is comprised of a 13-member Board of Directors. At least nine directors must have their primary residence in a community served by the System. Five directors must be physicians actively engaged in the full time practice of medicine. The hospital extends medical staff privileges to all qualified physicians in the area for most of our departments.
Schedule H, Part VI, Line 6 Affiliated health care system	Roper St. Francis Healthcare (RSFH) is a charitable health care delivery system based in Charleston, South Carolina. The 657-bed health system provides services at 90 facilities and doctors' offices conveniently located throughout our region. On January 2, 2020, Bon Secours Mercy Health, Inc. (BSMH), through its affiliate HealthSpan Partners, completed an agreement with the Medical Society of South Carolina to restructure the RSFH joint venture. The restructuring increased BSMH's ownership interest in the joint venture from a noncontrolling 27% to a controlling 51%. Following the restructuring, RSFH is a member of Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), and all of the other entities that are controlled directly or indirectly by BSMH are described collectively as the System. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of Ohio, New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSMH 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. BSMH's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2019-2021). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, that the struggle for a more humane world is not an option. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression. - Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSMH and the SQP (Strategic Quality Plan). System-wide community benefit for 2020 per the audit footnote is as follows: Total 2020 Community Benefit: $687.5 Million Benefits to the Broader Community: $117.1 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $447 million Cost of Care for Those Who Could Not Afford to Pay: $123.4 million Community Benefit as Percent of Total Expense: 7.1 percent.
Schedule H, Part VI, Line 7 State filing of community benefit report	SC

Schedule H (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
Bon Secours-St Francis Xavier Hospital Inc

Employer identification number
57-1067254

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 noncash 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) 2020

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
(1) Oncology services	115	58,555
(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

Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.

The sponsorship committee for Roper St. Francis Healthcare meets monthly to discuss charitable giving in the community and the Organization's plans to sponsor worthy community activities that promote healthcare. The Committee is comprised of the CEO of the System, the Hospital and Physicians Network CEOs, the VP of Mission, and the Director of the Foundation. The Committee's goals are as follows: To support the community through charitable givings and sponsorships that are consistent with our Organization's mission and values, to enhance the health of those whom we serve, to meet community needs and exercise care of the resources entrusted to Roper St. Francis Healthcare, and to focus charitable giving and sponsorships on the major public health needs of the community. Roper St. Francis Healthcare provides funding to dozens of non-profit community partners to meet the health needs of our community. Organizations must apply annually for funding by describing which priority health need they are impacting and by providing program details outlining the strategies used to impact the community health need. The Committee, which is comprised of leaders throughout the system who have a stake in community engagement, meets annually to review applications from community partners and awardees are provided a restricted-use letter to specify the intent of funding. Awardees are required to report back on how the funds were used in their subsequent application for funding.

Schedule I (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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 on 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 on 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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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) 2020

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)
1Brian Cuddy MD Chair, Neurosurgeon - RSFPP	(i) (ii)	0 ------------- 958,594	0 ------------- 42,701	0 ------------- 23,874	0 ------------- 28,050	0 ------------- 42,088	0 ------------- 1,095,307	0 ------------- 0
2Susan Datta MD Vice-Chairperson, Internist - RSFPP	(i) (ii)	0 ------------- 286,750	0 ------------- 52,860	0 ------------- 9,699	0 ------------- 26,443	0 ------------- 43,033	0 ------------- 418,785	0 ------------- 0
3JOSEPH GAGE JR JD Board Member (Beg 03/20); BSMH Chief HR Officer	(i) (ii)	0 ------------- 510,193	0 ------------- 307,164	0 ------------- 435,214	0 ------------- 237,573	0 ------------- 29,203	0 ------------- 1,519,347	0 ------------- 188,061
4Wael Haidar MD Board Member (Beg 01/20), BSMH Chief Clinical Officer	(i) (ii)	0 ------------- 753,924	0 ------------- 441,459	0 ------------- 296,803	0 ------------- 499,315	0 ------------- 21,916	0 ------------- 2,013,417	0 ------------- 50,000
5Brian White Board Member (End 03/20); Atlantic Group President - BSMH	(i) (ii)	0 ------------- 412,506	0 ------------- 375,003	0 ------------- 1,180,993	0 ------------- 5,700	0 ------------- 32,278	0 ------------- 2,006,480	0 ------------- 303,270
6Brian YANofchick Board Member (Beg 01/20); Chief Sponsorship Officer Atlantic Grp. - BSMH	(i) (ii)	0 ------------- 289,533	0 ------------- 137,869	0 ------------- 148,069	0 ------------- 7,200	0 ------------- 15,069	0 ------------- 597,740	0 ------------- 0
7John B Holloway Jr Board Member, CEO - MSSC	(i) (ii)	0 ------------- 339,000	0 ------------- 125,000	0 ------------- 0	0 ------------- 8,550	0 ------------- 22,451	0 ------------- 495,001	0 ------------- 0
8Henry West MD Board Member, Surgeon - RSFPP	(i) (ii)	0 ------------- 517,281	0 ------------- 37,618	0 ------------- 594	0 ------------- 28,050	0 ------------- 26,779	0 ------------- 610,322	0 ------------- 0
9Lorraine Lutton Former CEO	(i) (ii)	0 ------------- 22,079	0 ------------- 411,252	0 ------------- 968,157	0 ------------- 7,065	0 ------------- 0	0 ------------- 1,408,553	0 ------------- 170,203
10Bret D Johnson CFO & SVP / Treasurer (End 05/20)	(i) (ii)	0 ------------- 188,281	0 ------------- 275,288	0 ------------- 247,009	0 ------------- 8,550	0 ------------- 18,234	0 ------------- 737,362	0 ------------- 92,667
11Anthony Jackson VP & CEO Acute Care Services (End 03/20)	(i) (ii)	0 ------------- 521,515	0 ------------- 167,266	0 ------------- 166,296	0 ------------- 8,550	0 ------------- 37,436	0 ------------- 901,063	0 ------------- 56,502
12Christopher Glenn Interim CFO/Treasurer (Beg 06/20)	(i) (ii)	0 ------------- 204,117	0 ------------- 34,330	0 ------------- 14,461	0 ------------- 4,490	0 ------------- 5,311	0 ------------- 262,709	0 ------------- 0
13JAMES BERG Interim CEO (Beg 01/20 - End 12/20)	(i) (ii)	0 ------------- 576,206	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 576,206	0 ------------- 0
14Stephanie McKoin Former Key, Director of Perioperative Services	(i) (ii)	0 ------------- 193,166	0 ------------- 25,419	0 ------------- 9,070	0 ------------- 6,941	0 ------------- 29,093	0 ------------- 263,689	0 ------------- 0
15Vanessa Shamrock Former Key, Director of Lab Services	(i) (ii)	0 ------------- 150,595	0 ------------- 22,160	0 ------------- 5,594	0 ------------- 5,419	0 ------------- 13,160	0 ------------- 196,928	0 ------------- 0
16Francis Wyckoff Jr Former Key, Director of Pharmacy	(i) (ii)	0 ------------- 222,996	0 ------------- 40,014	0 ------------- 6,406	0 ------------- 22,274	0 ------------- 15,523	0 ------------- 307,213	0 ------------- 0
17Pennie Peralta Chief Nursing Officer - BSSF (End 09/20)	(i) (ii)	0 ------------- 281,473	0 ------------- 99,387	0 ------------- 34,107	0 ------------- 8,550	0 ------------- 24,064	0 ------------- 447,581	0 ------------- 29,944
18Matthew Desmond VP Ops Acute Care (Beg 08/20)	(i) (ii)	0 ------------- 246,560	0 ------------- 30,455	0 ------------- 16,753	0 ------------- 8,348	0 ------------- 38,910	0 ------------- 341,026	0 ------------- 0
19Troy Powell VP Ops Continuing Care (Beg 01/20)	(i) (ii)	0 ------------- 250,310	0 ------------- 86,736	0 ------------- 1,136	0 ------------- 7,443	0 ------------- 38,935	0 ------------- 384,560	0 ------------- 0
20Gretchen Morin Chief Administrative Officer	(i) (ii)	189,297 ------------- 0	21,939 ------------- 0	5,717 ------------- 0	4,482 ------------- 0	36,965 ------------- 0	258,400 ------------- 0	0 ------------- 0
21Tavia Buck Chief Nursing Officer - BSSF (Beg 09/20)	(i) (ii)	188,353 ------------- 0	25,299 ------------- 0	19,983 ------------- 0	21,119 ------------- 0	2,586 ------------- 0	257,340 ------------- 0	14,848 ------------- 0
22Mitchell Siegan MD VP CMO - Acute Care	(i) (ii)	0 ------------- 473,193	0 ------------- 61,290	0 ------------- 41,317	0 ------------- 28,050	0 ------------- 38,274	0 ------------- 642,124	0 ------------- 0
23John Zimmer Chief Physicist	(i) (ii)	234,350 ------------- 0	0 ------------- 0	1,844 ------------- 0	14,185 ------------- 0	12,565 ------------- 0	262,944 ------------- 0	0 ------------- 0
24Thomas Baxley Manager Pharmacy	(i) (ii)	183,445 ------------- 0	18,886 ------------- 0	1,783 ------------- 0	6,432 ------------- 0	40,962 ------------- 0	251,508 ------------- 0	0 ------------- 0
25ELLEN BENKE Pharmacist	(i) (ii)	158,869 ------------- 0	0 ------------- 0	2,037 ------------- 0	4,595 ------------- 0	22,511 ------------- 0	188,012 ------------- 0	0 ------------- 0
26James Hovis Pharmacist	(i) (ii)	153,613 ------------- 0	0 ------------- 0	994 ------------- 0	4,774 ------------- 0	13,812 ------------- 0	173,193 ------------- 0	0 ------------- 0
27Scotty WELCH Pharmacist	(i) (ii)	152,331 ------------- 0	0 ------------- 0	1,117 ------------- 0	3,205 ------------- 0	38,294 ------------- 0	194,947 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2020

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
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours Mercy Health System SERP	The Bon Secours Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Brian White, $367,344; Brian Yanofchick, $33,400; Joseph Gage, Jr., JD, $168,235; and Wael Haidar, MD, $55,099.
Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health SERP	The Mercy Health SERP plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 50%, 75%, and 100% in their accounts after 5, 6, and 7 years of service, respectively. Vesting occurs earlier for death or total disability or reaching age 60 while employed, or involuntary termination of employment within 24 months after a change in control of the organization or due to position elimination. Payments during employment are made for required tax withholding. Payment of the vested account balance in a lump sum occurs after termination of employment. Amounts includable as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Joseph Gage, Jr., JD, $0.
Schedule J, Part I, Line 4b Terms and conditions of the Bon Secours SERP	The filing organization participates in a Bon Secours sponsored executive retirement program that allows for deposits into additional retirement plans available to officers and certain key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits is made into this plan. Individuals that participated or received a distribution include: Wael Haidar, MD, $86,425.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	A related organization of Bon Secours St. Francis Xavier Hospital, Inc. determined the compensation of the Organization's CEO using the following methods: Compensation Committee Independent Compensation Consultant Compensation Survey or Study Approval by the Board or Compensation Committee
Schedule J, Part I, Line 4a Severance or change-of-control payment	Severance Benefits consisting of continuation of base salary and insurance benefits were provided to listed individuals for specified periods. The listed individuals executed releases and waivers of claims in exchange for the severance benefits. Salary continuation amounts provided during the reporting year to listed individuals were as follows: Lorraine Lutton, $797,954; Bret D. Johnson, $153,129; and Brian White, $423,080.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	The Roper St. Francis Healthcare 457(f) Plan's purpose is to offer eligible employees of the employer deferred compensation benefits to supplement Eligible Employees' retirement income. The Plan is intended to be a top-hat plan (i.e. an unfunded deferred compensation plan maintained for certain members of a select group of management or highly compensated employees). INDIVIDUALS THAT PARTICIPATED OR RECEIVED A DISTRIBUTION INCLUDE: Bret D. Johnson, $59,534; Pennie Peralta, $20,531; Anthony Jackson, $36,502; Lorraine Lutton, $115,203; Tavia Buck, $14,849; Troy Powell, $0.
Schedule J, Part I, Line 7 Non-fixed payments	Goals are developed each year to support the Organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports it to the full Board of Directors. Progress on each metric is reported to the Board each month on the corporate scorecard. At year-end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full Board. Annual incentives for the executives are based 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard.

Schedule J (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

Return Reference	Explanation
Form 990, Part VI, Line 6 Classes of members or stockholders	The sole member of the Corporation is Roper St. Francis Healthcare, a South Carolina nonprofit, nonstock corporation. Roper St. Francis Healthcare is in turn governed by a Board of Directors appointed by its members. The members of Roper St. Francis Healthcare (RSFH) are The Medical Society of South Carolina (49%), a South Carolina nonprofit corporation, and HealthSpan Partners (51%), a Ohio nonprofit corporation. HealthSpan Partners (HSP) is a supporting organization of Bon Secours Mercy Health, Inc. (BSMH).
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	RSFH is governed by a 12-member board of directors (the Board of Directors). Subject to certain Nominating Committee approvals, six directors are appointed by each of MSSC and HSP. In the event of a dispute it is the Members intent that the members of RSFH's Board of Directors are appointed to such positions because they have a willingness to serve the needs of Roper as a whole and not the needs of any individual Member. In the event of a stalemate, the Members management teams are to attempt in good faith to resolve the matter within fifteen days. If the management teams are unable to resolve the stalemate, the matter shall be submitted to the President/CEO of BSMH for review and resolution
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	The following actions shall require the unanimous affirmative approval of all of the founding members: (a) to amend the Articles of Incorporation or By-laws, including without limitation, any change in the Corporation's purposes; provided, however, that, subject to the procedures and voting requirements with respect to the admission of non-founding members, Schedule 3.1 may be amended with the approval of two (2) of the founding members to reflect the admission of a non-founding member; (b) to dissolve or liquidate the Corporation and to determine the distribution of assets upon dissolution; (c) to merge or consolidate the Corporation or to sell, convey, transfer, lease, or otherwise dispose of all or substantially all of its assets; (d) to appoint the President and Chief Executive Officer of the Corporation in a manner other than that established within the By-laws; (e) to alter or amend the Corporation's ethical performance standards (defined below); or (f) to enter into any material agreement whereby a third party will: (i) become an equity owner in any joint venture with the Corporation or any System participant and will not be legally obligated to support the Corporation's ethical performance standards; or (ii) manage a substantial part of the facilities, assets, or operations of the system and will not be legally obligated to comply with and support the Corporation's ethical performance standards.
Form 990, Part VI, Line 11b Review of form 990 by governing body	The Form 990 was prepared by the BSMH Tax Department with assistance and oversight by management and was reviewed by an independent accounting firm. Reviews were then conducted by senior management. Upon review, the Form 990 along with a summary memo is forwarded to the governing body for approval. After approval by the governing body the final version is filed with the Internal Revenue Service.
Form 990, Part VI, Line 12c Conflict of interest policy	The HR policy requires COI disclosures from "every RSFH senior leader, employed physicians and non-physician practitioners, all directors and all Value Analysis Team members". The governing board policies define covered persons as "directors and to all officers (as defined by the President/CEO) and all persons who serve in a position functionally equivalent to that of a corporate officer". All covered persons shall complete and return to the Secretary an annual statement that each of them: (a) has received a copy of the Conflict of Interest Policy; (b) has read and understands the Policy; (c) agrees to comply with this Policy; (d) understands that the Policy applies to all committees; and (e) understands that the Organization is a charitable organization and must continuously engage primarily in activities which accomplish one or more of its tax-exempt purposes.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	An independent company, Gallagher, provides research, advice and guidance to the HR Committee and senior leadership to ensure the Organization's compensation programs for executives covered by the "Intermediate Sanctions Legislation" (IRC Section 4958) are aligned with its stated philosophy: Base salaries are targeted at the 50th percentile of the established comparator market; Total cash compensation (base salary plus annual incentive payments) are targeted at the 75th percentile of the established comparator market; Total direct compensation (total cash compensation plus long term incentive payments) will not exceed the 90th percentile of the established comparator market; Benefits are targeted at market median; and In aggregate, base salary, total cash compensation, total direct compensation and benefits comprise total remuneration for executives. The HR Committee ensures that executive total compensation is reflective of the Organization's stated compensation philosophy. The committee, in this process, authorizes and supports an annual three step process utilizing Gallagher's resources: 1) Salary levels, annual bonus targets/payments and long term incentive grants are compared rigorously each year with market data based on comparable positions and organizations. A. Comparable organizations are typically not-for-profit healthcare systems with similar operating revenues. B. Historically, performance incentive payouts generally track with a normal bonus payout distribution. Incentive goals are primarily based on formally defined quantitative goals approved by the HR Committee of the RSFH Board of Directors. 2) All recommended pay decisions are tested against these data and the organization's stated compensation philosophy. 3) A formal opinion letter is prepared by Gallagher, representing that senior executives are compensated within the reasonableness standards mandated by the IRS. This letter provides a "safe harbor" for the organization's senior leadership relative to the reasonableness of total executive compensation consistent with IRC Section 4958.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	See explanation for 15A.
Form 990, Part VI, Line 19 Required documents available to the public	The organization's governing documents, conflict of interest policy and financial statements are available to the public upon request.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Other income - Total Revenue: 50636, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 50636;
Form 990, Part IX, Line 11g Other Fees	Purchased Services - Total Expense: 10495106, Program Service Expense: 8396085, Management and General Expenses: 2099021, Fundraising Expenses: ; Professional Fees - Total Expense: 19586632, Program Service Expense: 19586632, Management and General Expenses: , Fundraising Expenses: ; Corp Admin Fees - Total Expense: 31929219, Program Service Expense: 25543375, Management and General Expenses: 6385844, Fundraising Expenses: ; Other Fees - Total Expense: 4577985, Program Service Expense: 3662388, Management and General Expenses: 915597, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Other Changes in Fund Balance - -1620; Equity Transfers - 25414834; Net Pension and Benefit Allocation - -784526; Capital Contribution - 21800; Allocate Physician Partners Dues to Balance - -3209164;
Form 990, Part XII, Line 3b Reason organization did not undergo required audit	During the year ended December 31, 2020, the organization received Provider Relief Funds (PRF) and state grants through the CARES Act in response to the COVID-19 pandemic. PRF and state grant payments are accounted for as government grants. Bon Secours Mercy Health, Inc. and its subsidiaries, including Roper St. Francis Healthcare, will undergo an audit as set forth in the Single Audit Act and OMB Circular A-133. Due to the unusual circumstances associated with the COVID-19 pandemic and the PRF and other state grants, the OMB extended the filing deadline for the audit. The audit is in process and will be completed by the extended filing deadline.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

Bon Secours-St Francis Xavier Hospital Inc

Employer identification number

57-1067254

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)Bon Secours Mercy Health Inc 1701 Mercy Health Place CINCINNATI,OH45237 52-1301088	HEALTHCARE SYSTEM PARENT	MD	501(c)(3)	3	NA		No
(2)Bon Secours Baltimore Community Works Inc 26 North Fulton Avenue Baltimore,MD21223 52-1732800	Grant Making Foundation	MD	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(3)Bon Secours Ireland DAC	Local System Parent Org.	EI	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(4)BON SECOURS MERCY HEALTH FOUNDATION 1701 Mercy Health Place CINCINNATI,OH45237 20-1072726	FUNDRAISING	OH	501(c)(3)	7	Bon Secours Mercy Health Inc		No
(5)Bon Secours New Jersey Health System Inc 1505 Marriottsville Road Marriottsville,MD27104 22-2754781	Local System Parent Org.	NJ	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(6)Bon Secours New York Health System Inc 2975 Independence Avenue Bronx,NY10463 91-2135196	Local System Parent Org.	NY	501(c)(3)	Type I	Bon Secours Mercy Health Inc		No
(7)Bon Secours Richmond Health System 8580 Magellan Parkway Richmond,VA23227 52-1988421	Local System Parent Org.	VA	501(c)(3)	3	Bon Secours Mercy Health Inc		No
(8)Bon Secours St Francis Health System Inc 1 St Francis Drive Greenville,SC29601 58-2504528	Local System Parent Org.	SC	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(9)COMMUNITY MERCY HEALTH SYSTEM 100 Medical Center Drive SPRINGFIELD,OH45504 30-0272454	MARKET PARENT	OH	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(10)HEALTHSPAN PARTNERS 1701 Mercy Health Place CINCINNATI,OH45237 46-3055925	MARKET PARENT	OH	501(c)(3)	Type II	Bon Secours Mercy Health Inc		No
(11)MERCY HEALTH RETIREMENT TRUST 1701 Mercy Health Place CINCINNATI,OH45237 31-6046304	RETIREMENT TRUST	OH	501(c)(3)	7	Bon Secours Mercy Health Inc		No
(12)Mercy Health Services 1505 Marriottsville Road Marriottsville,MD27104 25-1585441	Local System Parent Org.	PA	501(c)(3)	Type III-FI	Bon Secours Mercy Health Inc		No
(13)St Francis Physician Services Inc One St Francis Drive Greenville,SC29601 13-4290167	Physician Services	SC	501(c)(3)	10	Bon Secours Mercy Health Medical Group LLC		No
(14)MERCY FRANCISCAN SENIOR HEALTH AND HOUSING SERVICES INC 7010 ROWAN HILLS DR CINCINNATI,OH45227 31-1308729	RETIREMENT HOME	OH	501(c)(3)	10	MERCY HEALTH CINCINNATI LLC		No
(15)MERCY FRANCISCAN SOCIAL MINISTRIES INC 1800 LOGAN STREET CINCINNATI,OH45210 31-1222942	LOW INCOME HOUSING	OH	501(c)(3)	7	MERCY HEALTH CINCINNATI LLC		No
(16)Bon Secours - Stuart Circle Hospital Inc 8580 Magellan Parkway Richmond,VA23227 54-1740128	Health Care	VA	501(c)(3)	3	Bon Secours Richmond Health System		No
(17)Laburnum Properties 8580 Magellan Parkway Richmond,VA23227 52-1260700	Title Holding Company	VA	501(c)(2)		Bon Secours Richmond Health System		No
(18)Rappahannock General Hospital Foundation 101 Harris Road Kilmarnock,VA22482 54-1210450	Supporting Organization	VA	501(c)(3)	7	Bon Secours Richmond Health System		No
(19)IVNA Health Services 5008 Monument Avenue Richmond,VA23230 54-1479847	Home Care Services	VA	501(c)(3)	10	Bon Secours Home Care LLC		No
(20)Bayley Properties 7007 Harbour View Blvd Suffolk,VA23435 54-1424748	Title Holding Company	VA	501(c)(2)		Bon Secours - DePaul Medical Center LLC		No
(21)LOURDES HOSPITAL AUXILIARY GIFT SHOP 1530 LONE OAK ROAD PADUCAH,KY42003 61-0927805	FUNDRAISING	KY	501(c)(3)	10	MERCY HEALTH FOUNDATION		No
(22)C H HEALTH SERVICES COMPANY 100 Medical Center Drive SPRINGFIELD,OH45504 31-1181984	HOSPITAL	OH	501(c)(3)	3	COMMUNITY MERCY HEALTH SYSTEM		No
(23)COMMUNITY MERCY HEALTH PARTNERS 100 Medical Center Drive SPRINGFIELD,OH45504 31-0785684	HOSPITAL	OH	501(c)(3)	3	COMMUNITY MERCY HEALTH SYSTEM		No
(24)THE WALLACE S MURRAY AND FRANCES RABBITTS MURRAY MEMORIAL TRUST 100 Medical Center Drive SPRINGFIELD,OH45504 34-6827136	INDIGENT MEDICAL CARE	OH	501(c)(3)	Type I	NA		No
(25)SIMON OUTREACH SERVICES 2600 NAVARRE AVENUE OREGON,OH43616 34-1383325	MEDICAL OFFICE RENTAL	OH	501(c)(3)	10	MERCY HEALTH NORTH LLC		No
(26)MERCY PROPERTY HOLDINGS 2200 JEFFERSON AVENUE TOLEDO,OH43604 30-0699825	TITLE HOLDING COMPANY	OH	501(c)(2)		MERCY HEALTH NORTH LLC		No
(27)MERCY COLLEGE OF OHIO 2221 MADISON AVENUE TOLEDO,OH43604 34-1726619	MEDICAL COLLEGE	OH	501(c)(3)	2	MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC		No
(28)HOSPICE OF THE VALLEY 5190 MARKET STREET YOUNGSTOWN,OH44512 34-1288745	HOSPICE SERVICES	OH	501(c)(3)	10	MERCY HEALTH YOUNGSTOWN LLC		No
(29)HUMILITY HOUSE 755 OHLTOWN ROAD AUSTINTOWN,OH44515 34-1894783	NURSING HOME	OH	501(c)(3)	10	MERCY HEALTH YOUNGSTOWN LLC		No
(30)ST JOSEPH HEALTH CENTER AUXILIARY 677 EASTLAND SE WARREN,OH44484 34-6556121	FUNDRAISING	OH	501(c)(3)	10	MERCY HEALTH YOUNGSTOWN LLC		No
(31)THE ASSUMPTION VILLAGE 9800 N MARKET STREET NORTH LIMA,OH44452 34-1013695	NURSING HOME	OH	501(c)(3)	10	MERCY HEALTH YOUNGSTOWN LLC		No
(32)NEW VISION MEDICAL LABORATORIES INC 750 W HIGH ST STE 400 LIMA,OH45801 34-1937267	MEDICAL LAB SERVICES	OH	501(c)(3)	3	ST RITA'S MEDICAL CENTER LLC		No
(33)ALLEN MEDICAL CENTER MEDICAL OFFICE BUILDING 200 WEST LORAIN ST OBERLIN,OH44074 36-4504991	MEDICAL OFFICE RENTAL	OH	501(c)(3)	10	MERCY HEALTH - ALLEN HOSPITAL LLC		No
(34)COMMUNITY HEALTH PARTNERS PHYSICIANS OFFICE BUILDINGS 3700 KOLBE ROAD LORAIN,OH44053 34-1268828	MEDICAL OFFICE RENTAL	OH	501(c)(3)	10	MERCY HEALTH - REGIONAL MEDICAL CENTER LLC		No
(35)St Francis Hospital Inc One St Francis Drive Greenville,SC29601 58-2504530	Hospital	SC	501(c)(3)	3	Bon Secours St Francis Health System Inc		No
(36)Bon Secours Housing II Inc 26 North Fulton Avenue Baltimore,MD21223 52-1543174	Low Income Housing	MD	501(c)(3)	10	Bon Secours Baltimore Community Works Inc		No
(37)Bon Secours Housing Inc 26 North Fulton Avenue Baltimore,MD21223 52-1442707	Low Income Housing	MD	501(c)(3)	10	Bon Secours Baltimore Community Works Inc		No
(38)Liberty Medical Center 1505 Marriottsville Road Marriottsville,MD27104 52-1466304	Health Care	MD	501(c)(3)	3	Bon Secours Baltimore Community Works Inc		No
(39)Our Money Place Inc 26 North Fulton Avenue Baltimore,MD21223 56-2306119	Financial services education	MD	501(c)(3)	10	Bon Secours Baltimore Community Works Inc		No
(40)Unity Properties Inc 26 North Fulton Avenue Baltimore,MD21223 52-1857768	Low Income Housing	MD	501(c)(3)	7	Bon Secours Baltimore Community Works Inc		No
(41)Bon Secours Baltimore Development Inc 26 North Fulton Avenue Baltimore,MD21223 76-0785344	Community Housing	MD	501(c)(3)	7	Unity Properties Inc		No
(42)HEALTHSPAN INTEGRATED CARE 1701 Mercy Health Place CIncinnati,OH45237 34-0922268	HMO	OH	501(c)(3)	10	HEALTHSPAN PARTNERS		No
(43)Roper St Francis Healthcare 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 57-0831165	Local System Parent Org.	SC	501(c)(3)	3	HEALTHSPAN PARTNERS		No
(44)Bon Secours - St Francis Xavier Hospital Inc 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 57-1067254	Hospital	SC	501(c)(3)	3	Roper St Francis Healthcare		No
(45)Clinical Biotechnology Research Institute at RSFH 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 47-5407453	Healthcare	SC	501(c)(3)	4	Roper St Francis Healthcare		No
(46)Roper Hospital Inc 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 57-0828733	Hospital	SC	501(c)(3)	3	Roper St Francis Healthcare		No
(47)Roper St Francis Foundation 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 57-1068509	Fundraising	SC	501(c)(3)	Type I	Roper St Francis Healthcare		No
(48)Roper St Francis Hospital - Berkeley Inc 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 26-3710229	Hospital	SC	501(c)(3)	3	Roper St Francis Healthcare		No
(49)Roper St Francis Mount Pleasant Hospital 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 57-0360499	Hospital	SC	501(c)(3)	3	Roper St Francis Healthcare		No
(50)Roper St Francis Physicians Network 8536 Palmetto Commerce Pkwy Suite 201 Ladson,SC29456 26-2946628	Physician Services	SC	501(c)(3)	10	Roper St Francis Healthcare		No
(51)BSHS Member 2 Limited	Holding Company	EI	501(c)(3)		Bon Secours Ireland DAC		No
(52)BSHS Member 3 Limited	Holding Company	EI	501(c)(3)		Bon Secours Ireland DAC		No
(53)Bon Secours Health System CLG	Hospital	EI	501(c)(3)	3	Bon Secours Ireland DAC		No
(54)Frances Schervier Home and Hospital 2975 Independence Avenue Bronx,NY10463 13-1740397	Long term nursing care	NY	501(c)(3)	10	Bon Secours NY Health System		No
(55)Schervier Apartments LLC 2975 Independence Avenue Bronx,NY10463 47-1364217	Long term nursing care	NY	501(c)(3)	10	Bon Secours NY Health System		No
(56)St Mary Hospital Inc 308 Willow Hoboken,NJ07030 22-1487324	Hospital	NJ	501(c)(3)	3	Bon Secours New Jersey Health System Inc		No
(57)Pennsylvania Health Choice Plan 1505 Marriottsville Road Marriottsville,MD27104	Health Care	PA	501(c)(3)	10	Mercy Health Services		No
(58)The Medical Society of South Carolina 69-B Barre St Charleston,SC29401 57-0288358	Supporting Org/Founding Member	SC	501(c)(3)	Type III-FI	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) MERCY FRANCISCAN AT WINTON WOODS I LP 10290 Mill Road Cincinnati,OH45231 31-1624311	Rental Real Estate	OH	NA	N/A
(2) Broad64 Imaging LLC 8580 Magellan Parkway Richmond,VA23227 20-5886018	Imaging Services	VA	NA	N/A
(3) Memorial Ambulatory Surgery Center LLC 8580 Magellan Parkway Richmond,VA23227 59-3813233	Ambulatory Surgery Center	VA	NA	N/A
(4) Richmond Radiation Oncology Center I LLC 8580 Magellan Parkway Richmond,VA23227 20-8444551	Radiation Oncology Services	VA	NA	N/A
(5) RI LP 8580 Magellan Parkway Richmond,VA23227 54-1708835	Imaging Services	VA	NA	N/A
(6) Harbour View MOB 2 LLC 5818 Harbour View Blvd Suite A1 Suffolk,VA23435 82-2484997	Real Estate	VA	NA	N/A
(7) Lourdes Ambulatory Surgery Center 225 Medical Center Drive Paducah,KY42003 20-5588350	Surgery Center	KY	NA	N/A
(8) Marshall County MRI LLC 615 Old Symsonia Road Benton,KY42025 61-0601267	MRI facility	KY	NA	N/A
(9) Community Mercy Home Care Services of Springfield LLC 1700 Edison Drive Milford,OH45150 31-1746556	Home Care	OH	NA	N/A
(10) NWO Integrated Laboratories Mercy LLC 2200 Jefferson Avenue Toledo,OH43624 34-1898285	Laboratory services	OH	NA	N/A
(11) Tiffin Ambulatory Surgical Associates 45 St Lawrence Drive Tiffin,OH44833 37-1567866	Ambulatory Surgery Center	OH	NA	N/A
(12) Urologic Oncology of Mahoning Valley LLC 1044 Belmont Ave Youngstown,OH44501 26-2989686	Radiation Therapy	OH	NA	N/A
(13) New Vision Medical Lab LLC 750 W High Street Lima,OH45801 34-1913433	Lab Services	OH	NA	N/A
(14) West Central Ohio Group Ltd 801 Medical Drive Lima,OH45804 34-1848147	Orthopedic Hospital	OH	NA	N/A
(15) PREMIUM SURGERY CENTER LLC 5217 Maryland Way SUITE 200 Brentwood,TN37027 20-0400753	Surgery Center	TN	NA	N/A
(16) Upstate Surgery Center LLC One St Francis Drive Greenville,SC29601 56-2186977	Ambulatory Surgery Center	SC	NA	N/A
(17) Bon Secours Diagnostic Imaging LLC 10 S Academy Street Suite 300 Greenville,SC29601	Outpatient Imaging Centers	SC	NA	N/A
(18) Bon Secours Place at St Petersburg LLP 10300 Fourth Street North St Petersburg,FL33716 59-3589729	Assisted Living/Senior Care	FL	NA	N/A
(19) Bon Secours Apartments Consolidated GP LLC 1800 West Baltimore St Baltimore,MD21223 85-0795104	Low Income Housing	MD	NA	N/A
(20) Bon Secours Apartments Consolidated LP 1800 West Baltimore St Baltimore,MD21223 85-0766183	Low Income Housing	MD	NA	N/A
(21) Bon Secours Apartments II LP 1800 West Baltimore St Baltimore,MD21223 52-2063512	Low Income Housing	MD	NA	N/A
(22) Bon Secours Apartments III LP 1800 West Baltimore St Baltimore,MD21223 52-2134444	Low Income Housing	MD	NA	N/A
(23) Bon Secours Apartments LP 1800 West Baltimore St Baltimore,MD21223 52-1952505	Low Income Housing	MD	NA	N/A
(24) Bon Secours Benet House LLC 26 North Fulton Ave Baltimore,MD21223 46-3055312	Low Income Housing	MD	NA	N/A
(25) Bon Secours Benet House LP 26 North Fulton Ave Baltimore,MD21223 36-4765400	Low Income Housing	MD	NA	N/A
(26) Bon Secours Chesapeake Apartments LP 26 North Fulton Ave Baltimore,MD21223 20-0107034	Low Income Housing	MD	NA	N/A
(27) Bon Secours Gibbons Apartments LP 26 North Fulton Ave Baltimore,MD21223 47-2322323	Low Income Housing	MD	NA	N/A
(28) Bon Secours New Shiloh II Limited Partnership 26 North Fulton Ave Baltimore,MD21223 82-0655142	Low Income Housing	MD	NA	N/A
(29) Bon Secours Shiloh LP 26 North Fulton Ave Baltimore,MD21223 20-3965243	Low Income Housing	MD	NA	N/A
(30) Bon Secours Smallwood Summit LP 26 North Fulton Ave Baltimore,MD21223 52-2280175	Low Income Housing	MD	NA	N/A
(31) Bon Secours Wayland LP 26 North Fulton Ave Baltimore,MD21223 27-0468688	Low Income Housing	MD	NA	N/A
(32) Liberty Senior Housing LP 1800 West Baltimore St Baltimore,MD21223 52-2134447	Low Income Housing	MD	NA	N/A
(33) Lowcountry Surgery Center LLC dba Roper St Francis Eye Center 8536 Palmetto Commerce Parkway Ladson,SC29456 58-1693021	Ambulatory Surgery Center	SC	NA	N/A
(34) RSFH - ATI Physician Therapy 125 Doughty St Ste 760 Charleston,SC29403 47-4797980	Physical Therapy	SC	NA	N/A
(35) BON SECOURS MERCY HEALTH INNOVATIONS LLC 1701 MERCY HEALTH PLACE CINCINNATI,OH45237 82-0639499	BUSINESS DEVELOPMENT	OH	NA	N/A

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) MERCY HEALTH INSURANCE COMPANY (SPC) LTD 98-0621978	SELF-INSURANCE	CJ	NA	C Corporation					No
(2) MERCY FRANCISCAN AT WINTON WOODS I INC 10290 MILL ROAD CINCINNATI,OH45231 31-1658668	LOW-INCOME HOUSING	OH	NA	C Corporation					No
(3) MERCY HEALTH VENTURES INC 1701 Mercy Health Place CINCINNATI,OH45237 31-1185477	DIVERSIFIED ACTIVITIES	OH	NA	C Corporation					No
(4) Bon Secours-Virginia Healthsource Inc 8580 Magellan Parkway Richmond,VA23227 54-1417686	Ambulatory Healthcare Services	VA	NA	C Corporation					No
(5) Richmond Radiation Oncology Center Inc 8580 Magellan Parkway Richmond,VA23227 54-1570244	Ambulatory Healthcare Services	VA	NA	C Corporation					No
(6) Ironbridge Assisted Living Retirement Community LC 5801 Bremo Road Richmond,VA23226 54-1807857	Ambulatory Healthcare Services	VA	NA	C Corporation					No
(7) Richmond MRI Inc 8580 Magellan Parkway Richmond,VA23227 54-1568452	Medical Services	VA	NA	C Corporation					No
(8) Chesterfield Community Healthcare Center Inc 8580 Magellan Parkway Richmond,VA23227 54-1812738	Ambulatory Healthcare Services	VA	NA	C Corporation					No
(9) RHS Management Corp 8580 Magellan Parkway Richmond,VA23227 54-1313425	Independent Living Facility	VA	NA	C Corporation					No
(10) Professional Health Care Management Services Inc 150 Kingsley Lane Norfolk,VA23505 54-1241031	Administrative	VA	NA	C Corporation					No
(11) Maryview Building Corporation 3636 High Street Portsmouth,VA23707 54-1306612	Administrative	VA	NA	C Corporation					No
(12) Bon Secours - Tidewater Diversified Inc 160 Kingsley Lane Norfolk,VA23505 54-1431826	Pharmacy	VA	NA	C Corporation					No
(13) OSF Inc 2 Bernadine Drive Newport News,VA23602 54-1369919	Rental	VA	NA	C Corporation					No
(14) NORTHPARKE MEDICAL COMMONS CONDO ASSN 333 N LIMESTONE ST SPRINGFIELD,OH45503 31-1391230	REAL PROPERTY MGMNT	OH	NA	C Corporation					No
(15) NORTHSIDE CORPORATION 2200 JEFFERSON AVENUE TOLEDO,OH43604 34-1318438	RESIDENT RENTALS	OH	NA	C Corporation					No
(16) RALPH EWE TRUST 270 PARK AVENUE NEW YORK,NY10017 34-6866422	BENEFICIAL TRUST	NY	NA	Trust					No
(17) ELIZABETH HINES CATES TRUST PNC 1900 E 9TH ST CLEVELAND,OH44114 34-6515678	BENEFICIAL TRUST	OH	NA	Trust					No
(18) WILLIS PARK TRUST PNC 1900 E 9TH ST CLEVELAND,OH44114 34-6519904	BENEFICIAL TRUST	OH	NA	Trust					No
(19) ERMA GIBSON BALDWIN TRUST PNC 1900 E 9TH ST CLEVELAND,OH44114 34-6515566	BENEFICIAL TRUST	OH	NA	Trust					No
(20) MCAULEY MANAGEMENT SERVICES INC 730 W MARKET STREET LIMA,OH45801 34-1379037	PROPERTY RENTAL	OH	NA	C Corporation					No
(21) LIMA MEDICAL SUPPLIES INC 730 W MARKET STREET LIMA,OH45801 34-0944477	MEDICAL EQUIPMENT	OH	NA	C Corporation					No
(22) Cornerstone Alliance Inc 2615 Fort Amanda Road Suite B LIMA,OH45804 34-1834730	Medical Management	OH	NA	C Corporation					No
(23) COMMUNITY HEALTH PARTNERS ENTERPRISES INC 3700 KOLBE ROAD LORAIN,OH44053 34-1455525	HOLDING COMPANY	OH	NA	C Corporation					No
(24) Optimum Health Network Inc One St Francis Drive Greenville,SC29601 57-0973524	Healthcare Services	SC	NA	C Corporation					No
(25) Post Office Plaza Owners Association Inc 1807 N Boulevard Anderson,SC29621	REAL PROPERTY MGMNT	SC	NA	C Corporation					No
(26) Bon Secours-Florida Integrated Services Inc 10300 Fourth Street North St Petersburg,FL33716 65-0779777	Holding Company/Assisted Living	FL	NA	C Corporation					No
(27) Unity Housing Inc 26 North Fulton Avenue Baltimore,MD21223 52-1952507	Low Income Housing	MD	NA	C Corporation					No
(28) Bon Secours Wayland LLC 26 North Fulton Avenue Baltimore,MD21223 27-0468561	Low Income Housing	MD	NA	C Corporation					No
(29) Bon Secours New Shiloh II LLC 26 North Fulton Avenue Baltimore,MD21223 82-0631206	Low Income Housing	MD	NA	C Corporation					No
(30) HEALTHSPAN INC 225 PICTORIA DR CINCINNATI,OH45246 31-1431434	INSURANCE	OH	NA	C Corporation					No
(31) HEALTHSPAN SOLUTIONS INC 1701 Mercy Health Place CINCINNATI,OH45237 30-0810766	CONSULTING	OH	NA	C Corporation					No
(32) HEALTHCARE SERVICES AND SUPPORT 1701 Mercy Health Place CINCINNATI,OH45237 81-2388652	HEALTHCARE SERVICES	OH	NA	C Corporation					No
(33) Barringtons Hospital Limited	Hospital	EI	NA	C Corporation					No
(34) BMC Properties Limited	REAL PROPERTY MGMNT	EI	NA	C Corporation					No
(35) Bon Secours New York Housing Development Fund Corporation 2975 Independence Avenue Bronx,NY10463 47-2224316	Low Income Housing	NY	NA	C Corporation					No
(36) CareAlliance Medical Services Corporation 8536 Palmetto Commerce Pkwy STE 201 Ladson,SC29456 57-1012837	Inactive	SC	NA	C Corporation					No

Schedule R (Form 990) 2020

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) ............................

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

Yes

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

Yes

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

Yes

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) ............................

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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	(d) Method of determining amount involved

Schedule R (Form 990) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2020

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) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0

1	Briefly describe the organization’s mission or most significant activities: Operation of nonprofit hospital facility in Charleston, SC.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	959
6	Total number of volunteers (estimate if necessary) .............	6	82
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	179,030
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	48,433

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	521,208	7,675,059
9	Program service revenue (Part VIII, line 2g) .........	252,389,798	242,556,006
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-11,446	9,337
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,677,165	1,146,952
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	254,576,725	251,387,354
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	325	58,555
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	70,877,597	68,375,000
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	129,517,981	135,623,492
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	200,395,903	204,057,047
19	Revenue less expenses. Subtract line 18 from line 12.......	54,180,822	47,330,307
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	284,113,937	383,224,246
21	Total liabilities (Part X, line 26).............	51,363,980	86,899,725
22	Net assets or fund balances. Subtract line 21 from line 20.....	232,749,957	296,324,521

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 182,742,540 including grants of $ 58,555 ) (Revenue $ 242,556,006 )
	Bon Secours St. Francis Xavier Hospital traces its origins back to 1882 when five Sisters of Charity of Our Lady of Mercy opened St. Francis Infirmary in downtown Charleston as the first Catholic hospital in the state. In 2020, Bon Secours St. Francis Xavier HOspital contributed $11.6 million in community benefit. Please visit our website for a detailed community benefit report at: http://www.rsfh.com/mission-department/.

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 expenses182,742,540

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,360,578	13,879,324	1,674,805

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,455,967
e	Government grants (contributions)		1e	6,208,288

f	All other contributions, gifts, grants, and similar amounts not included above		1f	10,804

g	Noncash contributions included in lines 1a - 1f:$		1g	586

h Total. Add lines 1a-1f.......		7,675,059

		Business Code
2a	Net Patient Service	621400	242,482,419	242,482,419
b	Joint Venture Income	900003	73,587	73,587
c
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		242,556,006

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4,432			4,432
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		153,282	6a
b	Less: rental expenses		128,670	6b
c	Rental income or (loss)	0	24,612	6c
d	Net rental income or (loss).......			24,612			24,612
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	4,905		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	4,905	0	7c
d	Net gain or (loss).........			4,905			4,905
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	49,235
b	Less: cost of goods sold ..		10b	16,408
c	Net income or (loss) from sales of inventory..			32,828			32,828
Business Code			Miscellaneous Revenue
11a	Cafeteria Revenue		722210	859,846			859,846
b	Third-party lab services		621500	178,598		178,598
c	Professional services		900099	432		432
d	All other revenue ....			50,636	0	0	50,636
e	Total. Add lines 11a–11d ......			1,089,512
12	Total revenue. See instructions.....			251,387,354	242,556,006	179,030	977,259

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	58,555	58,555
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	516,461	445,136	71,325
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	55,114,954	47,503,432	7,611,522
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,260,821	1,008,657	252,164
9	Other employee benefits .......	7,469,217	5,975,374	1,493,843
10	Payroll taxes ...........	4,013,547	3,210,838	802,709
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	66,588,942	57,188,480	9,400,462	0
12	Advertising and promotion ....	5,676	4,541	1,135
13	Office expenses .......	6,481,209	5,184,967	1,296,242
14	Information technology ......	22,128	17,702	4,426
15	Royalties ..
16	Occupancy ...........	1,801,568	1,441,254	360,314
17	Travel ............	6,104	4,883	1,221
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	9,008	7,206	1,802
20	Interest ...........	1,615,843	1,615,843
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	10,343,318	10,343,318
23	Insurance ...	22,669	18,135	4,534
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	44,361,298	44,361,298
b	Medicaid DSH tax	4,210,769	4,210,769
c	Physician Recruitment	46,211	46,211
d	Federal and State Income Tax	44,711	44,711
e	All other expenses	64,038	51,230	12,808	0
25	Total functional expenses. Add lines 1 through 24e	204,057,047	182,742,540	21,314,507	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 ........			21,500	1	21,500
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			34,858,225	4	28,972,176
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			3,933,297	8	5,301,114
9	Prepaid expenses and deferred charges ......			1,089,849	9	1,451,170
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	207,914,040
b	Less: accumulated depreciation	10b	117,277,874	105,723,218	10c	90,636,166
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			134,396,790	13	233,080,770
14	Intangible assets ...............			379,130	14	0
15	Other assets. See Part IV, line 11 ...........			3,711,928	15	23,761,350
16	Total assets. Add lines 1 through 15 (must equal line 33)...			284,113,937	16	383,224,246

17	Accounts payable and accrued expenses .....	541,519	17	949,413
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	19,691	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	50,802,770	25	85,950,312
26	Total liabilities. Add lines 17 through 25..	51,363,980	26	86,899,725

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	232,749,957	27	296,324,521
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	232,749,957	32	296,324,521
33	Total liabilities and net assets/fund balances ........	284,113,937	33	383,224,246