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) MICHAEL ISRAEL...................................................................... VICE CHAIR	1.0 ................. 39.0	X	X		0	2,830,472	126,770
(2) GARY BRUDNICKI...................................................................... BOARD MEMBER	1.0 ................. 39.0	X			0	1,944,738	115,276
(3) MARK FERSKO...................................................................... BOARD MEMBER (thru 11/20)	1.0 ................. 1.0	X			0	1,108,610	77,188
(4) MARY LEAHY MD...................................................................... PRESIDENT & CEO	36.0 ................. 4.0	X	X		0	1,054,505	84,948
(5) CARY HIRSCH MD...................................................................... PHYSICIAN	40.0 ................. 0.0			X	1,074,370	0	25,453
(6) JULIE SWITZER...................................................................... BOARD MEMBER	1.0 ................. 39.0	X			0	960,705	92,165
(7) RENEE GARRICK MD...................................................................... BOARD MEMBER	1.0 ................. 39.0	X			0	973,426	66,389
(8) ARVIND AGARWAL...................................................................... PHYSICIAN	40.0 ................. 0.0			X	799,785	0	39,943
(9) PERMINDER S GREWAL...................................................................... PHYSICIAN	40.0 ................. 0.0			X	755,367	0	48,386
(10) SUNANDAN PANDYA...................................................................... PHYSICIAN	40.0 ................. 0.0			X	700,771	0	58,092
(11) BANGALORE SRIDHARA...................................................................... PHYSICIAN	40.0 ................. 0.0			X	712,446	0	23,653
(12) JOSHUA RATNER...................................................................... BOARD MEMBER (EFFECT. 11/20)	1.0 ................. 39.0	X			0	659,785	73,735
(13) PETER KENNIFF...................................................................... CFO	39.0 ................. 1.0		X		462,455	0	52,660
(14) JOHN HEIMERDINGER...................................................................... SECRETARY	1.0 ................. 7.0	X	X		0	0	0
(15) SUSAN GEVERTZ...................................................................... BOARD MEMBER	1.0 ................. 2.0	X			0	0	0
(16) RICHARD WISHNIE...................................................................... CHAIR	1.0 ................. 5.0	X	X		0	0	0
(17) TAMER EL-RAYESS...................................................................... 1st Vice Chair & TREASURER	1.0 ................. 2.0	X	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
CROTHALL HEALTHCARE INC, 13028 COLLECTIONS CTR CHICAGO,IL60693	ENGINEERING	8,066,475
MORRISON HEALTHCARE, PO BOX 102289 ATLANTA,GA30368	FOOD SERVICE	6,349,382
ACCESS REHABILITATION SERVICES, 16 MAYBROOK RD STE H CAMPBELL HALL,NY10916	REHAB THERAPY	4,635,638
SKANSKA USA BUILDING INC, 14776 COLLECTIONS CENTER DR CHICAGO,IL60693	CONSTRUCTION	9,930,451
AVAAP USA LLC, 510 THORNALL ST STE 250 EDISON,NJ08837	IT SERVICES	3,773,896
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 95

- 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.
right arrow

Attach to Form 990 or Form 990-EZ.
right 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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 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.") .	0	0	0	0	0	0
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	1,923,266	1,781,088	1,650,443	1,740,145	1,455,869	8,550,811
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....						0
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge						0
6	Total. Add lines 1 through 5	1,923,266	1,781,088	1,650,443	1,740,145	1,455,869	8,550,811
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons						0
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.					840,031	840,031
c	Add lines 7a and 7b..					840,031	840,031
8	Public support. (Subtract line 7c from line 6.)						7,710,780

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...	1,923,266	1,781,088	1,650,443	1,740,145	1,455,869	8,550,811
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..						0
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.						0
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.						0
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..	122,030	99,086	102,789	111,496	95,589	530,990
13	Total support. (Add lines 9, 10c, 11, and 12.)..	2,045,296	1,880,174	1,753,232	1,851,641	1,551,458	9,081,801

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)) .........

84.904 %

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

93.523 %

Section D. Computation of Investment Income Percentage

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

0 %

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

0 %

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

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a	0
b	Average monthly cash balances	1b	0
c	Fair market value of other non-exempt-use assets	1c	0
d	Total (add lines 1a, 1b, and 1c)	1d	0
e	Discount claimed for blockage or other factors (explain in detail in Part VI): 0
2	Acquisition indebtedness applicable to non-exempt use assets	2	0
3	Subtract line 2 from line 1d	3	0
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4	0
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5	0
6	Multiply line 5 by 0.035	6	0
7	Recoveries of prior-year distributions	7	0
8	Minimum Asset Amount (add line 7 to line 6)	8	0

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

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

Schedule A (Form 990 or 990-EZ) 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	0
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2	0
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3	0
4 Amounts paid to acquire exempt-use assets	4	0
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5	0
6 Other distributions (describe in Part VI). See instructions	6	0
7Total annual distributions. Add lines 1 through 6.	7	0
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8	0
9 Distributable amount for 2020 from Section C, line 6	9	0
10 Line 8 amount divided by Line 9 amount	10	0 %

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			0
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.		0
3 Excess distributions carryover, if any, to 2020:
a From 2015.......0
b From 2016.......0
c From 2017.......0
d From 2018.......0
e From 2019.......0
fTotal of lines 3a through e	0
g Applied to underdistributions of prior years		0
h Applied to 2020 distributable amount			0
i Carryover from 2015 not applied (see instructions)	0
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.	0
4Distributions for 2020 from Section D, line 7:
$ 0
a Applied to underdistributions of prior years		0
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.	0
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.		0
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.			0
7 Excess distributions carryover to 2021. Add lines 3j and 4c.	0
8 Breakdown of line 7:
a Excess from 2016.....0
b Excess from 2017.....0
c Excess from 2018.....0
d Excess from 2019.....0
e Excess from 2020.....0

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, Part I	One subordinate (ST. FRANCIS CENTER AT THE KNOLLS D/B/A MOUNT ALVERNO ASSISTED LIVING CENTER) included in this return has public charity status as an organization described in section 509(a)(2). Schedule A, Part III is completed to report this entity's activities.

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2020

Name of the organization

BON SECOURS CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. 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 CHARITY HEALTH SYSTEM AFFILIATED GROUP

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 CHARITY HEALTH SYSTEM AFFILIATED GROUP		Employer identification number 45-2964467

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

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

Page 4


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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2020

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

BON SECOURS CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

56,949

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

56,949

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
Part II-B, Line 1, Lobbying Activities	The filing organization maintains memberships IN various HEALTHCARE professional associations. Portions of the membership dues are used for lobbying activities. The lobbying portion of such dues, AS PROVIDED BY THE MEMBERSHIP ORGANIZATION, is included on PART IX, line 11D.

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 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 .....	5,031,959		5,031,959
b	Buildings ....	176,969,381	109,567,082	67,402,299
c	Leasehold improvements	2,287,641	2,039,509	248,132
d	Equipment ....	233,283,090	192,228,787	41,054,303
e	Other .....	27,091,010	8,594,174	18,496,836
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				132,233,529

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	98,490,972
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

Part IV, Line 2B

CERTAIN FACILITIES HOLD, SAFEGUARD, MANAGE AND ACCOUNT FOR THE PERSONAL FUNDS OF RESIDENTS WHO HAVE AUTHORIZED THE FACILITIES IN WRITING TO MANAGE PERSONAL FUNDS. FUND REQUESTS LESS THAN $50 ARE AVAILABLE FOR IMMEDIATE DISTRIBUTION TO RESIDENTS AND WRITTEN REQUESTS FOR $50 OR MORE ARE HONORED, BY CHECK, WITHIN A REASONABLE TIME FRAME. GENERALLY, ALL CUSTODIAL FUNDS IN EXCESS OF $50 ARE HELD IN INTEREST BEARING ACCOUNTS SEPARATE FROM THAT OF THE FACILITIES.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 250 %

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 500 %

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? . . . . . .

Yes

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		(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) . . .		3,237,607	53,286	3,184,321	0.530 %
b	Medicaid (from Worksheet 3, column a) . . . . .		112,566,314	62,312,710	50,253,604	8.310 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		115,803,921	62,365,996	53,437,925	8.840 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	89,309	4,860,177		4,860,177	0.800 %
f	Health professions education (from Worksheet 5) . . .	595	877,588		877,588	0.150 %
g	Subsidized health services (from Worksheet 6) . . . .		6,231,032		6,231,032	1.030 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	89,904	11,968,797		11,968,797	1.980 %
k	Total. Add lines 7d and 7j .	89,904	127,772,718	62,365,996	65,406,722	10.820 %

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.

		(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	1,654	34,052	34,052	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	225	130,231	130,231	0.020 %
8	Workforce development	27	131,186	131,186	0.020 %
9	Other	70	197,798	197,798	0.030 %
10	Total	1,976	493,267	493,267	0.080 %

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

Yes

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

34,561,679

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).....

119,407,244

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

166,885,201

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

-47,477,957

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 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?3Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Facility reporting group
1	ST ANTHONY COMMUNITY HOSPITAL 15 MAPLE AVENUE WARWICK,NY10990 STANTHONYCOMMUNITYHOSP.ORG 3529000H/XXX-XX-XXXX	X	X	X	A
2	BON SECOURS COMMUNITY HOSPITAL 160 EAST MAIN STREET PORT JERVIS,NY12771 BONSECOURSCOMMUNITYHOSP.ORG 3535001H/XXX-XX-XXXX	X	X	X	A
3	GOOD SAMARITAN HOSPITAL OF SUFFERNNY 255 LAFAYETTE AVE SUFFERN,NY10901 GOODSAMHOSP.ORG 4329000H/XXX-XX-XXXX	X	X	X	A

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)

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

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

123

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

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

Yes

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

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

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

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

Yes

If "Yes" (list url): See Part V

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)

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

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.%
and FPG family income limit for eligibility for discounted care of 500.%

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):

See Part V

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

See Part V

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

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

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

Yes

Did the hospital facility have in place during the tax year a 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)

	Facility Reporting Group - A
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
Part V, section B	FACILITY REPORTING GROUP A CONSISTS OF: FACILITY 1: ST. ANTHONY COMMUNITY HOSPITAL (SACH) FACILITY 2: BON SECOURS COMMUNITY HOSPITAL (BSCH) FACILITY 3: GOOD SAMARITAN HOSPITAL OF SUFFERN, NY (GSH)
Part V, Line 5	Bon Secours Charity Health System (BSCHS) was part of a large collaborative comprised of 17 hospitals and 7 local health departments from the lower Hudson Valley area in New York that directed a comprehensive 7-County Community Health Assessment. The BSCHS Community Engagement Director participated in this collaborative. BSCHS paid $25,000 for its share of the cost of the assessment. The 7-County collaborative hired the research team at Siena College who began the assessment process in November 2017 which continued through 2019. They conducted a random sample community health survey which resulted in the Mid-Hudson Region Community Health Assessment 2019-2021 (CHNA). The survey was designed to collect information around several priorities identified by the New York State Department of Health's Prevention Agenda 2019-2024 and to inform future health improvement efforts within the 7-County area. Survey data collection, analysis, and charting were provided by the team from Siena College Research Institute (SCRI). SCRI administered a random digit dial survey by phone which took place between April and September of 2018, utilizing both landline and mobile phone numbers to reach respondents. Results were then weighted by gender, age, race, and region according to the U.S. Census 2010. THE REGIONAL COMMUNITY HEALTH ASSESSMENT SURVEY COLLECTED RESPONSES FROM 5,372 RESIDENTS OF THE MID-HUDSON REGION. THIS SURVEY WAS CONDUCTED BY RANDOM DIGIT DIAL IN ORDER TO GAUGE THE PERCEPTION OF RESIDENTS SURROUNDING HEALTH AND RESOURCES IN THEIR COMMUNITIES. TO FURTHER SUPPLEMENT THE DATA COLLECTED, MEMBERS OF THE REGIONAL COMMUNITY HEALTH ASSESSMENT STEERING COMMITTEE HELD 12 FOCUS GROUPS WITH SERVICE PROVIDERS TO UNDERSTAND THE NEEDS OF SPECIFIC COMMUNITIES AND UNDERREPRESENTED POPULATIONS, AND THE BARRIERS THEY FACE TO ACHIEVING OPTIMAL HEALTH. Prior to holding the focus groups, a Stakeholder Interview Form was sent to providers to supply additional insight on local factors influencing community health. This survey covered several topics, including the populations served; issues affecting health in the communities; health barriers; and interventions used to address social determinants of health. Throughout the seven counties, 285 surveys were completed by service providers. The responses varied throughout each county, and the differences were addressed in the focus groups. The data from the CHNA, Stakeholder Interview forms, and focus groups, along with Behavioral Risk Factor Surveillance System (BRFSS) data, was presented to audiences in both Rockland and Orange counties. The Rockland County Community Health Forum was held in June of 2019 and 60 local health/human services providers and Community Based Organizations (CBOs) assisted in the selection of Rockland County's community health focus areas. The Orange County Community Health Priority Selection Summit was also held in June of 2019 where more than 100 participants assisted with the selection of Orange County's community health focus areas. IN 2020, THE WORK OUTLINED IN THE IMPLEMENTATION PLANS FOR THE 2019 - 2021 CHNAS FOR GOOD SAMARITAN HOSPITAL, ST. ANTHONY COMMUNITY HOSPITAL, AND BON SECOURS COMMUNITY HOSPITAL CONTINUED TO MOVE FORWARD. STAFF AT ALL 3 HOSPITALS CONTINUED THE CANCER SCREENING PROGRAMS, FOOD INSECURITY SCREENING AND REFERRALS, TOBACCO CESSATION EDUCATION, AND SEXUALLY TRANSMITTED INFECTION EDUCATION AND SCREENINGS. THE COVID-RELATED SHUT DOWN IMPACTED ONE OF OUR COMMUNITY PARTNERS FOR THE SUBSTANCE ABUSE REFERRAL PROGRAM BUT PROGRESS IS BEING MADE WITH A NEW COMMUNITY AGENCY PARTNER.
Part V, Line 6a	The following hospitals within Bon Secours Charity Health System conducted a joint Community Health Needs Assessment (CHNA): Good Samaritan Hospital of Suffern, NY (GSH); St. Anthony Community Hospital (SACH); Bon Secours Community Hospital (BSCH).
Part V, Line 7	THE CHNA'S ARE WIDELY AVAILABLE TO THE PUBLIC. THE CHNA'S ARE EASILY ACCESSIBLE ON THE BSCHS WEBSITE: https://www.bschs.org/community-health-needs-assessment1 PART V, LINE 7D THE CHNA FOR EACH HOSPITAL WAS DISTRIBUTED AT VARIOUS COMMUNITY EVENTS. COPIES WERE PROVIDED TO VARIOUS COMMUNITY MEMBERS AND GROUPS. ADDITIONALLY, THE CHNA'S AND THE NEW YORK STATE COMMUNITY SERVICE PLANS ARE POSTED ON THE BSCHS WEBSITE. PART V, LINE 10 THE BSCHS IMPLEMENTATION STRATEGY PLAN WAS ADOPTED IN 2019 AND IS POSTED ON THE WEBSITE: https://www.bschs.org/community-health-needs-assessment1
Part V, Line 11	THE BON SECOURS CHARITY HEALTH SYSTEM'S INDIVIDUAL HOSPITAL 2019 - 2021 CHNA IMPLEMENTATION PLANS WERE DEVELOPED BY USING EVIDENCE BASED INTERVENTIONS, AS RECOMMENDED BY THE NYS PREVENTION AGENDA 2019 - 2024. THE OVERARCHING STRATEGY OF THE NYS PREVENTION AGENDA IS TO IMPLEMENT PUBLIC HEALTH APPROACHES THAT IMPROVE THE HEALTH AND WELL-BEING OF ENTIRE POPULATIONS AND ACHIEVE HEALTH EQUITY. THIS STRATEGY INCLUDES AN EMPHASIS ON SOCIAL DETERMINANTS OF HEALTH, DEFINED BY HEALTHY PEOPLE 2020, AS THE CONDITIONS IN THE ENVIRONMENT IN WHICH PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS. THE PREVENTION AGENDA ALSO FORMS THE IMPORTANT FRAMEWORK THROUGH WHICH COMMUNITY HEALTH NEEDS ARE PRIORITIZED. THE PREVENTION AGENDA'S FIVE PRIORITY AREAS SERVE AS THE BLUEPRINT FOR STATE AND LOCAL ACTION TO IMPROVE THE HEALTH OF NEW YORKERS. AS PER THE NYSDOH REQUIREMENTS, EACH HOSPITAL MUST CHOOSE A MINIMUM OF TWO HEALTH GOALS TO ADDRESS FROM AMONG THE FOLLOWING FIVE PRIORITY AREAS: . PREVENT CHRONIC DISEASES . PROMOTE A HEALTHY AND SAFE ENVIRONMENT . PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN . PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS . PREVENT COMMUNICABLE DISEASES IN PARTNERSHIP WITH THE ROCKLAND COUNTY HEALTH DEPARTMENT, ROCKLAND COUNTY HOSPITALS, HEALTH AND HUMAN SERVICE AGENCIES, GOOD SAMARITAN HOSPITAL HAS CHOSEN THE FOLLOWING PREVENTION AGENDA GOALS TO WORK TOWARDS OVER THE NEXT THREE YEARS: 1. INCREASE CANCER SCREENING RATES FOR BREAST, CERVICAL, AND COLORECTAL CANCERS 2. PREVENT OPIOID AND OTHER SUBSTANCE MISUSE AND DEATHS IN PARTNERSHIP WITH THE ORANGE COUNTY HEALTH DEPARTMENT, ORANGE COUNTY HOSPITALS, AND HEALTH AND HUMAN SERVICE AGENCIES, BON SECOURS COMMUNITY HOSPITAL AND ST. ANTHONY COMMUNITY HOSPITAL HAVE CHOSEN THE FOLLOWING PREVENTION AGENDA GOALS TO WORK TOWARDS OVER THE NEXT THREE YEARS: 1. PREVENT INITIATION OF TOBACCO USE, INCLUDING COMBUSTIBLE TOBACCO AND ELECTRONIC VAPING PRODUCTS BY YOUTH AND YOUNG ADULTS 2. PROMOTE TOBACCO USE CESSATION 3. INCREASE CANCER SCREENING RATES FOR BREAST, CERVICAL, AND COLORECTAL CANCERS 4. REDUCE THE ANNUAL RATE OF GROWTH FOR SEXUALLY TRANSMITTED INFECTIONS 5. INCREASE FOOD SECURITY ALL THREE HOSPITALS WITHIN THE BON SECOURS CHARITY HEALTH SYSTEM HAVE CHOSEN TO INCREASE CANCER SCREENING RATES AS ONE OF OUR COMMUNITY HEALTH GOALS. TO ACHIEVE THIS, EMPLOYEE TEAMS HAVE CHOSEN THE FOLLOWING EVIDENCE-BASED INTERVENTIONS: 1. CONDUCT COMMUNITY EDUCATION SESSIONS ON THE NEED FOR CANCER SCREENINGS AT LOCAL LIBRARIES, SENIOR CENTERS, AND COMMUNITY EVENTS 2. DEVELOP A CONSISTENT MESSAGE ACROSS ALL ENTITIES TO INCREASE CANCER SCREENINGS, ESPECIALLY DURING AWARENESS MONTHS FOR BREAST, CERVICAL AND COLORECTAL CANCERS 3. EVALUATE HOW PATIENTS HAVE FOUND CANCER SCREENINGS THROUGH SURVEYS (I.E. NEWSPAPER, MAILINGS, FLYERS, WORD OF MOUTH, SOCIAL MEDIA OR OTHER) TO PREVENT OPIOID AND OTHER SUBSTANCE MISUSE AND DEATHS, GOOD SAMARITAN HOSPITAL HAS CHOSEN THE FOLLOWING EVIDENCE-BASED INTERVENTIONS: 1. DEVELOP INTERNAL POLICIES/PROCEDURES FOR INITIATION OF BUPRENORPHINE ADMINISTRATION IN EMERGENCY DEPARTMENT (ED) 2. DEVELOP CONTRACTS WITH PEER SERVICES FOR WARM HAND OFF FOR CONTINUED CARE 3. DEVELOP INTERNAL POLICIES/PROCEDURES FOR DISTRIBUTION OF NALOXONE KITS IN ED BON SECOURS COMMUNITY HOSPITAL AND ST. ANTHONY COMMUNITY HOSPITAL HAVE BOTH CHOSEN TO REDUCE THE ANNUAL RATE OF GROWTH FOR SEXUALLY TRANSMITTED INFECTIONS (STI) AS ONE OF OUR COMMUNITY HEALTH GOALS. TO ACHIEVE THIS, BOTH HOSPITALS WILL IMPLEMENT THE FOLLOWING EVIDENCE-BASED INTERVENTIONS: 1. PARTNER WITH LOCAL HEALTH DEPARTMENT TO EDUCATE EMERGENCY DEPARTMENT PHYSICIANS AND OTHER CLINICAL STAFF ON THE IMPORTANCE OF SCREENING AND TESTING FOR STI 2. INCREASE CLINICALLY APPROPRIATE STI SCREENING, TESTING, AND TREATMENT FOR PATIENTS IN EMERGENCY DEPARTMENT TO PREVENT INITIATION OF TOBACCO USE, INCLUDING COMBUSTIBLE TOBACCO AND ELECTRONIC VAPING PRODUCTS BY YOUTH AND YOUNG ADULTS, AND TO PROMOTE TOBACCO USE CESSATION, BON SECOURS COMMUNITY HOSPITAL HAS CHOSEN THE FOLLOWING EVIDENCE-BASED INTERVENTIONS: 1. CREATE A MEDIA CAMPAIGN INCLUDING POSTERS AND ADVERTISEMENTS ABOUT THE DANGERS OF TOBACCO USE AND VAPING 2. PROVIDE COMMUNITY PRESENTATIONS ON THE EFFECTS OF SMOKING AND VAPING TO HIGH SCHOOL AGE STUDENTS 3. EDUCATE THE COMMUNITY ABOUT MEDICAID BENEFITS TO ASSIST WITH SMOKING CESSATION 4. HOST FREEDOM FROM SMOKING CLASSES ST. ANTHONY COMMUNITY HOSPITAL WILL WORK TOWARDS INCREASING FOOD SECURITY BY IMPLEMENTING THESE EVIDENCE-BASED INTERVENTIONS: 1. DEVELOP STANDARDIZED DEFINITION AND SCREENING QUESTIONS TO IDENTIFY FOOD INSECURITY FOR ALL INPATIENTS 2. CREATE INTERNAL PROCESS FOR ACTIVE CONNECTION OF FOOD TO INSECURE PATIENTS TO GOVERNMENT-ASSISTED FOOD SOURCES, I.E. WIC AND SNAP GOOD SAMARITAN HOSPITAL, BON SECOURS COMMUNITY HOSPITAL, AND ST. ANTHONY COMMUNITY HOSPITAL HAVE CHOSEN SPECIFIC PREVENTION AGENDA GOALS BASED ON OUR INTERNAL RESOURCES, EXPERTISE, AND THE COMMITMENT TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY MEMBERS. WITH RESPECT TO THE PREVENTION AGENDA GOALS THAT OUR HOSPITALS HAVE NOT SPECIFICALLY CHOSEN TO ADDRESS, WE WILL SUPPORT THE EFFORTS OF COMMUNITY ORGANIZATIONS THAT ARE UNIQUELY QUALIFIED TO MEET VARIOUS AND SPECIFIC HEALTH GOALS. GOOD SAMARITAN HOSPITAL IS LOCATED IN ROCKLAND COUNTY, NY AND BOTH BON SECOURS COMMUNITY HOSPITAL AND ST. ANTHONY COMMUNITY HOSPITAL ARE LOCATED IN ORANGE COUNTY, NY. BOTH COUNTIES HAVE EXTENSIVE NETWORKS OF HEALTH AND HUMAN SERVICE AGENCIES AND COMMUNITY BASED ORGANIZATIONS. WITHIN ROCKLAND AND ORANGE COUNTIES, THERE ARE EIGHT HOSPITALS, HUNDREDS OF MEDICAL PROVIDERS, SEVERAL TWO-YEAR AND FOUR-YEAR COLLEGES, A MEDICAL SCHOOL, AND SEVERAL LARGE FEDERALLY QUALIFIED HEALTH CENTERS. THE FOLLOWING AGENCIES AND COALITIONS ARE UNIQUELY POSITIONED TO SERVE AS COMMUNITY RESOURCES TO MEET BOTH SPECIFIC AND DIVERSE COMMUNITY NEEDS: ACCESS SUPPORTS FOR LIVING, ACTION TOWARD INDEPENDENCE, ALCOHOLISM & DRUG ABUSE COUNCIL, THE ARC OF ORANGE COUNTY AND ROCKLAND COUNTY, BIKUR CHOLIM, CATHOLIC CHARITIES, CENTER FOR SAFETY AND CHANGE, COMMUNITY COLLABORATIVES IN WESTERN RAMAPO, SPRING VALLEY, HAVERSTRAW AND NYACK, CORNERSTONE FAMILY HEALTHCARE, DISPUTE RESOLUTION CENTER, EPILEPSY SOCIETY OF SOUTHERN NEW YORK, EZRAS CHOILIM HEALTH CENTER, FARMWORKERS COMMUNITY CORP., HACSO COMMUNITY CENTER, HIGHLAND REHABILITATION AND NURSING CENTER, HUDSON RIVER HEALTHCARE, HUDSON VALLEY PERINATAL NETWORK, IMMIGRATION COALITION OF ROCKLAND, INDEPENDENT LIVING, INC., INSPIRE, JAWONIO, JEWISH FAMILY SERVICES, KONBIT NEG LAKAY, LEGAL SERVICES OF THE HUDSON VALLEY, MATERNAL-INFANT SERVICES NETWORK, MENTAL HEALTH ASSOCIATION OF ORANGE AND ROCKLAND, NAMI ORANGE AND ROCKLAND, ORANGE COUNTY AND ROCKLAND COUNTY DEPARTMENTS OF HEALTH AND MENTAL HEALTH, PEOPLE TO PEOPLE, POW'R AGAINST TOBACCO, RECAP, INC., REFUAH HEALTH CENTER, REHABILITATION SUPPORT SERVICES, INC., RESTORATIVE MANAGEMENT CORP., ROCKLAND PRIDE CENTER, SAFE HARBORS OF THE HUDSON, INC., SAFE HOMES OF ORANGE COUNTY, UNITED WAY OF ROCKLAND, UNITED WAY OF THE DUTCHESS-ORANGE REGION, AND VCS, INC.
Part V, Line 13h	Patients above the 500% Federal Poverty Guidelines are eligible for the lower of the 60% discount on total charges or the Medicare FFS rate, after they have paid the required out of pocket expense of 20% of family income. Part V, Line 15e BSCHS provides financial assistance outreach services to all patients who do not have insurance. The service provider explains the options for federal and state financial assistance and provides assistance in filling out all required applications, including an application for Charity Care. The service provider reaches out to all patients who do not have insurance, either by meeting with patients who are still at the Hospital OR reaching out to those discharged. contact information is also provided on the FINANCIAL ASSISTANCE POLICY summary and on our Charity Care application for patient convenience.
Part V, Lines 16a, 16b AND 16C	The financial assistance policy (FAP), FAP application and plain language summary can be found at the following websites: http://bschs.bonsecours.com/bsch/billing-insurance-and-financial-assistanc e.aspx http://bschs.bonsecours.com/gsh/billing-insurance-and-financial-assistance .aspx http://bschs.bonsecours.com/sach/billing-insurance-and-financial-assistanc e.aspx
Part V, Line 16J	In addition to the methods reported on lines 16a through 16i, brochures are available at the time of registration, and onsite counselors and hospital paid eligibility vendor staff are available to assist patients. All billing statements also include information regarding the FAP and the eligibility vendor contacts all uninsured patients to determine the patient's eligibility for all Federal and State financial assistance programs including Charity Care.

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?57
Name and address		Type of Facility (describe)
1	THE AMBULATORY SURGERY CENTER 257 LAFAYETTE AVENUE SUFFERN,NY10901	AMBULATORY SURGERY CENTER
2	GOSHEN MEDICAL ASSOCIATES 70 HATFIELD LANE SUITE 101 GOSHEN,NY10924	INTERNAL MEDICINE
3	ROCKLAND PULMONARY & MEDICAL ASSOCIATES 2 CROSFIELD AVENUE WEST NYACK,NY10994	PULMONOLOGY
4	GOOD SAMARITAN HOME CARE 90 CRYSTAL RUN ROAD WALLKILL,NY10941	HOME CARE
5	GOOD SAMARITAN HOME CARE 1 CROSFIELD AVENUE SUITE 202 WEST NYACK,NY10994	HOME CARE
6	CENTER FOR PHYSICAL REHABILITATION 70 HATFIELD LANE GOSHEN,NY10924	OUTPATIENT PHYSICAL THERAPY
7	CARDIOLOGY CONSULTANTS-STONY POINT 12 LIBERTY SQUARE MALL STONY POINT,NY10980	CARDIOLOGY
8	METROPOLITAN CARDIOLOGY CONSULTANTS SUFF 257 LAFAYETTE AVENUE SUFFERN,NY10901	CARDIOLOGY
9	BON SECOURS NEUROLOGY 100 ROUTE 59 SUFFERN,NY10901	NEUROLOGY
10	RAMAPO VALLEY SURGICAL ASSOCIATES 257 LAFAYETTE AVENUE SUFFERN,NY10901	OUTPATIENT AMBULATORY SURGERY
11	RAMAPO VALLEY SURGICAL ASSOCIATES 10 LIBERTY SQUARE MALL STONY POINT,NY10980	OUTPATIENT AMBULATORY SURGERY
12	WOMEN'S IMAGING CENTER 26 FIREMANS MEMORIAL DRIVE PAMONA,NY10970	INTERNAL MEDICINE
13	HUDSON VALLEY MEDICAL ASSOCIATES 26 FIREMANS MEMORIAL DRIVE PAMONA,NY10924	INTERNAL MEDICINE IMAGING CENTER
14	CENTER FOR PHYSICAL REHABILITATION 153 SOUTH ROUTE 94 WARWICK,NY10990	OUTPATIENT REHAB
15	BON SECOURS UROLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10901	UROLOGY
16	METROPOLITAN CARDIOLOGY CONSULTANTS GOSH 30 HATFIELD LANE GOSHEN,NY10924	CARDIOLOGY
17	ROCKLAND PULMONARY & MEDICAL ASSOCIATES 257 LAFAYETTE AVENUE SUFFERN,NY10901	PULMONOLOGY
18	Nanuet Medical 36 College Ave Nanuet,NY10954	INTERNAL MEDICINE
19	MONSIGNOR PATRICK J FRAWLEY MENTAL HEALT 3 CAMPBELL AVENUE SUFFERN,NY10901	MENTAL HEALTH
20	MOB PORT JERVIS PRIMARY 161 EAST MAIN STREET PORT JERVIS,NY12771	PRIMARY CARE
21	ROCKLAND HEART & VASCULAR ASSOCIATES 972 ROUTE 45 SUITE 103 PAMONA,NY10970	CARDIOLOGY
22	CARDIOLOGY CONSULTANTS-WEST NYACK 505 ROUTE 208 MONROE,NY10950	INTERNAL MEDICINE
23	PORT JERVIS GASTROENTEROLOGY 39 EAST MAIN STREET PORT JERVIS,NY12771	GASTROENTEROLOGY
24	BON SECOURS MEDICAL GROUP 15 MAPLE AVENUE WARWICK,NM10990	INTERNAL MEDICINE
25	MONROE INTERNAL MEDICINE 505 ROUTE 208 MONROE,NY10950	INTERNAL MEDICINE
26	ST ANTHONY SLEEP DISORDER INSTITUTE 74 NORTH MAIN STREET FLORIDA,NY10921	SLEEP LAB
27	Bon Secours Medical Group 60 Dutch Hill Rd Orangeburg,NY10962	INTERNAL MEDICINE/SPECIALTY
28	MAHWAH MEDICAL 10 FRANKLIN TURNPIKE MAHWAH,NJ07430	INTERNAL MEDICINE
29	ROCKLAND HEART & VASCULAR ASSOCIATES 2 EXECUTIVE BOULEVARD SUITE 406 SUFFERN,NY10901	CARDIOLOGY
30	GOSHEN PRIMARY CARE PHYSICIANS 1 HATFIELD LANE GOSHEN,NY10924	PRIMARY CARE
31	MEHTA PULMONARY 55 OLD NYACK TURNPIKE NANUET,NY10954	PULMONOLOGY
32	FIRST CARE PHYSICIAN ASSOCIATES 505 ROUTE 208 MONROE,NY10950	PRIMARY CARE
33	GOPAL SHAH MD 33 DELAWARE STREET PORT JERVIS,NY12771	PRIMARY CARE
34	ALAM PCP 906 PENNSYLVANIA AVENUE MATAMORAS,PA18336	PRIMARY CARE
35	BON SECOURS MEDICAL GROUP 2 EXECUTIVE BOULEVARD SUITE 406 SUFFERN,NY10901	PRIMARY CARE
36	ROCKLAND PULMONARY & MEDICAL ASSOCIATES 27 LIBERTY SQUARE MALL STONY POINT,NY10980	PULMONOLOGY
37	PRIMARY MEDICAL CARE ROCKLAND 124 EAST RAMAPO ROAD SUITE 4 GARNERVILLE,NY10923	PRIMARY CARE
38	Warwick Family Practice 214 West Street Warwick,NY10990	INTERNAL MEDICINE
39	LAFAYETTE MEDICAL-GASPARE POLIZZI 599 STATE ROUTE 32 HIGHLAND MILLS,NY10930	PRIMARY CARE
40	LUTWAK CARDIOLOGY 505 ROUTE 208 MONROE,NY10950	CARDIOLOGY
41	LUTWAK CARDIOLOGY 4 SOUTH AIRMONT ROAD SUFFERN,NY10901	CARDIOLOGY
42	ROCKLAND HEART & VASCULAR ASSOCIATES 79 ROUTE 59 SUITE 5 SUFFERN,NY10901	CARDIOLOGY
43	PORT JERVIS INTERNAL 32 CANAL ST PORT JERVIS,NY12771	INTERNAL MEDICINE
44	GEORGE COX MD 257 LAFAYETTE AVENUE SUFFERN,NY10901	PRIMARY CARE
45	BYADGI PRIMARY CARE 601 BROAD STREET MILFORD,PW18337	PRIMARY CARE
46	YACOV TENDLER MD 257 LAFAYETTE AVENUE PORT JERVIS,NY12771	CARDIOLOGY
47	BON SECOURS MEDICAL GROUP 5 SKINNER STREET PORT JERVIS,NY12771	CARDIOLOGY
48	BON SECOURS MEDICAL GROUP 500 NEW HEMPSTEAD ROAD NEW CITY,NY10956	INTERNAL MEDICINE
49	NEPHROLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10901	NEPHROLOGY
50	BON SECOURS COMMUNITY SLEEP DISORDER INS 30 CANAL ST STE 2 PORT JERVIS,NY12771	SLEEP LAB
51	CARDIOLOGY CONSULTANTS-RAMSEY 27 SOUTH FRANKLIN TURNPIKE RAMSEY,NJ07446	CARDIOLOGY
52	RAINFORD CARDIOLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10990	CARDIOLOGY
53	NEPHROLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10990	NEPHROLOGY
54	NORTH ROCKLAND MEDICAL ASSOCIATES 71 SOUTH ROUTE 9W WEST HAVERSTRAW,NY10993	PRIMARY CARE
55	MONROE PRIMARY CARE 745 ROUTE 17M MONROE,NY10950	PRIMARY CARE
56	BON SECOURS MEDICAL GROUP 104 BENNETT AVENUE MILFORD,PA18337	INTERNAL MEDICINE
57	GOOD SAMARITAN HOME CARE 120 WHITE PLAINS ROAD 4TH FL TARRYTOWN,NY10591	HOME CARE

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
PART I, LINE 7A	CHARITY CARE AT COST IS COMPUTED BY APPLYING THE COST-TO-CHARGE RATIO TO THE AGGREGATE CHARITY ADJUSTMENTS. PART I, LINE 7B UNREIMBURSED MEDICAID IS COMPUTED BY DETERMINING THE COST OF MEDICAID SERVICES LESS PAYMENTS RECEIVED FOR THESE SERVICES. TO DETERMINE THE COST OF MEDICAID SERVICES PROVIDED, A COST-TO-CHARGE RATIO IS APPLIED TO TRADITIONAL AND MANAGED MEDICAID GROSS CHARGES. PAYMENTS INCLUDE PAYMENTS FOR INDIVIDUAL CLAIMS, PAYMENTS FROM THE MEDICAID PROGRAM PAID OUTSIDE THE CLAIM PROCESS (SUCH AS MEDICAL EDUCATION PAYMENTS) AND EXPECTED OR ACTUAL COST REPORT SETTLEMENTS. PART I, LINE 7C UNREIMBURSED COSTS FROM OTHER MEANS-TESTED GOVERNMENT PROGRAMS ARE COMPUTED BY APPLYING A COST-TO-CHARGE RATIO TO THE TOTAL CHARGES TO PATIENTS COVERED UNDER THESE PROGRAMS. THE CHARGES ARE IDENTIFIED BY THE FINANCIAL CLASS ASSIGNED TO THE PATIENT. PART I, LINE 7 A-C COMPUTATIONS THE COST-TO-CHARGE RATIO IS DERIVED USING THE SUGGESTED COMPUTATION IN WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. OPERATING EXPENSES AND GROSS PATIENT CHARGES ARE TAKEN FROM THE GENERAL LEDGER, EXPENSES FOR NONPATIENT CARE ACTIVITIES RECORDED IN OPERATING EXPENSES ARE APPROXIMATED AS DIRECTLY EQUALING OTHER OPERATING REVENUE. PART I, LINE 7E COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS ARE ACCUMULATED THROUGHOUT THE YEAR AND REPORTED AT ACTUAL COST IN A SOFTWARE PROGRAM THAT SPECIFICALLY ADDRESSES THIS PURPOSE. AS A RESULT OF THE COVID-19 PANDEMIC, BSCHS INITIATED THE FOLLOWING PROGRAMS: PHYSICIAN LIAISON SERVICE AS CASES BEGAN IN THE REGION, BSCHS MADE GRADUAL CHANGES TO VISITATION POLICIES, ULTIMATELY RESULTING IN NO VISITORS ON SITE, EXCEPT PEDIATRICS AND END-OF-LIFE CIRCUMSTANCES. BSCHS LAUNCHED A PHYSICIAN LIAISON SERVICE WHERE COMMUNICATION WITH FAMILY MEMBERS WAS ACCOMPLISHED THROUGH THE FAMILY FIRST CELL PHONE APPLICATION. THIS APPLICATION ALLOWED FOR ONE WAY TEXTING OF PATIENT STATUS UPDATES TO SELECTED FAMILY MEMBERS. THIS PROVIDED GREAT COMFORT TO OUR PATIENT'S FAMILIES AND DECREASED CALLS TO OUR NURSES AND DOCTORS, THUS ALLOWING THEM TO CONTINUE TO PROVIDE CARE TO OUR PATIENTS IN NEED. COVID TESTING SITES SHORTLY AFTER THE PANDEMIC BEGAN, BSCHS SET UP COVID TESTING SITES AT EACH OF THE HOSPITAL LOCATIONS AS WELL AS VARIOUS LOCATIONS THROUGHOUT ROCKLAND AND ORANGE COUNTIES. THESE DRIVE THRU AND WALK UP TESTING SITES WERE PROVIDED TO THE COMMUNITIES AT NO COST TO THE PATIENT. MEAL TRAIN PROGRAM TO PREPARE FOR COVID-19 SURGES REGIONALLY, NYS ISSUED NY PAUSE, WHICH MANDATED RESTAURANTS TO OPERATE FOR DELIVERY AND TAKEOUT ONLY. WITH ON-SITE DINING UNAVAILABLE AND LOCAL BUSINESSES CLOSED WITH WORK-FROM-HOME OPERATIONS, THE RESTAURANT INDUSTRY WAS FACING SIGNIFICANT ECONOMIC CHALLENGES. TO SUPPORT OUR LOCAL COMMUNITY BUSINESSES, BSCSH PARTICIPATED IN THE MEAL TRAIN PROGRAM. ENGAGEMENT IN THIS PROGRAM PROVIDED THE COMMUNITY AN OPPORTUNITY TO SUPPORT FRONT LINE STAFF AS WELL AS LOCAL RESTAURANTS. THE PROGRAM PROVIDED APPROXIMATELY 23,000 MEALS AND GENERATED AN ESTIMATED $320,000 INTO THE LOCAL ECONOMY. PART I, LINE 7F HEALTH PROFESSIONS EDUCATION COST IS DETERMINED AS THE DIRECT AND INDIRECT COST OF QUALIFYING EDUCATION ACTIVITIES AS TRADITIONALLY REPORTED IN COLUMNS 21-24 ON WORKSHEET B OF THE MEDICARE COST REPORT AS A MEDICAL EDUCATION PROGRAM OR OTHER ALLIED HEALTH PROGRAM. PART I, LINE 7G SUBSIDIZED HEALTH SERVICES DURING 2020, BSCHS RECEIVED FUNDING OF APPROXIMATELY $90.5 MILLION THROUGH THE PROVIDER RELIEF FUND ESTABLISHED BY THE CARES ACT AND ADMINISTERED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE AMOUNTS RECEIVED WERE INCLUDED IN NONOPERATING ACTIVITIES IN THE STATEMENTS OF REVENUES, EXPENSES AND CHANGES IN NET POSITION. PART I, LINE 7 THE FOLLOWING CHARITY CARE PERCENTAGES HAVE BEEN DERIVED BY ONLY INCLUDING HOSPITAL EXPENSES: Percent of total expense Line 7a: 0.66 Line 7b: 10.36 Line 7d: 11.02 Line 7e: 1.00 Line 7f: 0.18 LINE 7G: 1.28 Line 7j: 2.47 Line 7k: 13.49 Part II, Community Building Activities BSCHS WAS ACTIVELY ENGAGED IN COMMUNITY BUILDING ACTIVITIES WHICH PROMOTED THE HEALTH OF THE COMMUNITIES THROUGHOUT ITS SERVICE AREA. BSCHS HAS A DEDICATED COMMUNITY ENGAGEMENT DEPARTMENT WHICH EVALUATES, PLANS, AND IMPLEMENTS COMMUNITY HEALTH AND EDUCATION PROGRAMS, BASED ON COMMUNITY NEED AS WELL AS REQUESTS FOR PROGRAMS ON SPECIFIC TOPICS. IN EARLY 2020, SEVERAL SUPPORT GROUPS MET MONTHLY IN THE BSCHS FACILITIES AND AN ADDITIONAL GROUP, SPONSORED BY BSCHS, MET AT AN OFF-SITE LOCATION. HOWEVER, AS THE PANDEMIC CAUSED US TO SHUT DOWN IN PERSON MEETINGS, SEVERAL OF OUR SUPPORT GROUPS TRANSITIONED TO MEETING VIRTUALLY THROUGH THE USE OF ZOOM OR WEBEX. AS THE ABILITY TO SEND SPEAKERS INTO THE COMMUNITY CAME TO A HALT, THE BSCHS HEALTHCARE SPEAKERS' BUREAU WAS ABLE TO OFFER VIRTUAL HEALTH EDUCATION TO THE COMMUNITY. SINCE THEN, VIRTUAL HEALTH PROGRAMS HAVE BECOME VERY POPULAR AND HAVE ALLOWED OUR HEALTH EXPERTS TO REACH LARGER AUDIENCES. WE CONTINUE TO EDUCATE THE COMMUNITY ON BROAD TOPICS SUCH AS CARDIAC HEALTH, ORTHOPEDICS, WOMEN'S HEALTH, OBESITY, STROKE, DIABETES, WOUND CARE, TRAUMA PREVENTION, ASTHMA, SENIOR SERVICES, MEN'S HEALTH, NUTRITION, MEDICATION MANAGEMENT, ETC. IN PORT JERVIS, LOCATED IN ORANGE COUNTY, NY, BSCH IS CONTINUING TO TRANSFORM THE DELIVERY OF HEALTHCARE THROUGH ITS BUILDING HEALTHY COMMUNITIES INITIATIVES AND ITS TRANSFORMATIVE MEDICAL VILLAGE PROJECT. THROUGHOUT 2020, BSCH HAS WORKED TO ADVANCE THIS PHYSICAL PLANT MODERNIZATION AND RENOVATION PROJECT BY BEGINNING CONSTRUCTION OF A NEW LABORATORY, BARIATRIC UNIT, AND PHASE 1 OF A 10,000 SQUARE FOOT EMERGENCY DEPARTMENT. THIS INITIATIVE WILL PROVIDE SIGNIFICANT AND MUCH NEEDED IMPROVEMENTS NECESSARY TO IMPLEMENT BSCH'S INNOVATIVE DSRIP-RELATED EFFORTS TO INCREASE THE BREADTH OF THE OUTPATIENT DELIVERY SYSTEM IN WESTERN ORANGE COUNTY THROUGH THE CREATION OF A MEDICAL VILLAGE. BUILDING UPON BSCH'S IN-PATIENT REDUCTION AND RECONFIGURATION EXPERIENCE THROUGH THE HEAL-NY PROGRAM AND LEVERAGING VALUE-BASED PURCHASING EFFORTS, THE MEDICAL VILLAGE WILL IMPROVE THE QUALITY, SAFETY, EFFECTIVENESS AND EFFICIENCY OF CARE DELIVERY TO THE MORE THAN 80,000 MEDICAID BENEFICIARIES IN ORANGE COUNTY AND ENSURE THAT BSCH IS ON A SUSTAINABLE PATH. BSCH WAS AWARDED $24.5 MILLION IN CAPITAL RESTRUCTURING FINANCING PROGRAM ("CRFP") GRANT FUNDS TO UNDERTAKE THIS MAJOR PROJECT, WHICH INCLUDED SEVERAL OF THE DSRIP PROJECT AREAS SUCH AS CARE TRANSITIONS INTERVENTION TO REDUCE 30 DAY READMISSIONS FOR CHRONIC HEALTH CONDITIONS, INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH, COMMUNITY CRISIS STABILIZATION SERVICES, IMPLEMENTATION OF EVIDENCE-BASED STRATEGIES IN THE COMMUNITY TO ADDRESS CHRONIC DISEASE, SUCH AS DIABETES AND ASTHMA. IMPLEMENTATION OF THESE PROJECTS IS ACHIEVED THROUGH INCREASED ACCESS TO PRIMARY CARE, OUTPATIENT SERVICES, AND AN EXPANSION OF COMMUNITY SERVICES. THE TOTAL ANTICIPATED PROJECT COST FOR THIS PROJECT IS $41.5 MILLION WHICH WILL BE FUNDED IN PART BY CAPITAL RESTRUCTURING FINANCE PROGRAM (CRFP) GRANT FUNDS ($24.5 MILLION). PLANNING AND COLLABORATION FOR BSCH'S MEDICAL VILLAGE HAS BEEN ONGOING WITH STAKEHOLDERS AND COMMUNITY ORGANIZATIONS. THE PARTICIPATORY DEVELOPMENT PROCESS RESULTED IN A PLAN THAT INCLUDED A STRATEGY TO REDUCE 25 STAFFED BEDS AND DECERTIFY 36 LICENSED BEDS THAT PRESERVES CRITICAL SAFETY-NET CAPACITY AND CREATES NEW SPACE FOR A RANGE OF AMBULATORY CARE AND SOCIAL SERVICES. KEY PARTNERS INCLUDE: WESTCHESTER MEDICAL CENTER, BON SECOURS MEDICAL GROUP, CATHOLIC CHARITIES, EASTER SEALS, THE MATERNAL-INFANT SERVICES NETWORK, SHOPRITE SUPER MARKET, NEW YORK STATE OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES, ORANGE COUNTY DEPARTMENT OF HEALTH, ORANGE COUNTY DEPARTMENT OF MENTAL HEALTH, PORT JERVIS COMMUNITY GARDEN, EMPOWERING PORT JERVIS, PORT JERVIS LIBRARY, THE SALVATION ARMY, SUNY COMMUNITY COLLEGES, AND 1199SEIU WORKFORCE. WHEN COMPLETE, THE BON SECOURS COMMUNITY HOSPITAL MEDICAL VILLAGE PROJECT WILL ADD EXPANDED ACCESS TO PRIMARY CARE, A NEW OBSERVATION UNIT AND EMERGENCY ROOM DIVERSION PROGRAM, RADIOLOGY DEPARTMENT, WELLNESS AREA WITH HEALTH AND NUTRITIONAL PROGRAMMING, ENHANCED CARE COORDINATION BY SUPPORTING PRACTICES THAT MEET THE NCQA PCMH LEVEL 3 ACCREDITATION, CO-LOCATED BEHAVIORAL HEALTH PROVIDERS AND COMMUNITY BASED ORGANIZATIONS TO DELIVER VITAL DISEASE MANAGEMENT AND PREVENTION. IN ADDITION, CONNECTING BSCH TO HEALTHLINKNY, WHICH OFFERS ELECTRONIC ACCESS TO PATIENTS' COMMUNITY-WIDE HEALTH RECORDS, WILL SERVE AS THE REGION'S ACCESS POINT TO THE STATEWIDE HEALTH INFORMATION NETWORK OF NEW YORK (SHIN-NY), SUPPORTING COLLABORATION BETWEEN HEALTHCARE PROVIDERS ACROSS THE STATE. AS OF DECEMBER 31, 2020, CONSTRUCTION WAS COMPLETED FOR THREE NEW CLINICAL AREAS: A NEW MEDICAL/SURGICAL UNIT WITH ALL PRIVATE ROOMS; A NEW LABORATORY AND PHASE 1 OF THE NEW EMERGENCY DEPARTMENT. CONSTRUCTIONS IS EXPECTED TO BE COMPLETED FOR PHASE II LABORATORY; EMERGENCY DEPARTMENT/FAST TRACK; IMAGING; EMERGENCY DEPARTMENT ENTRANCE AND MAIN L
PART III, LINE 2	BAD DEBT EXPENSE INCLUDES: 1) ACTUAL WRITE OFFS OF DISCOUNTED GROSS CHARGES WHERE IT IS DETERMINED THAT AN UNINSURED PATIENT CAN PAY AND DOES NOT PAY; AND 2) THE ESTIMATED WRITE OFFS FOR UNINSURED PATIENT ACCOUNTS WITH OUTSTANDING BALANCES AFTER DISCOUNT. ESTIMATES ARE BASED ON HISTORICAL COLLECTION RATES. PART III, LINE 3 THE ORGANIZATION DOES NOT REPORT AN ESTIMATE FOR THE PORTION OF BAD DEBT EXPENSE THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. THE ORGANIZATION TAKES THE POSITION THAT AMPLE OPPORTUNITY AND ASSISTANCE IS PROVIDED TO THE PATIENT TO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. IF SUFFICIENT INFORMATION IS NOT PROVIDED, THE ORGANIZATION MUST ASSUME THE PATIENT DOES NOT QUALIFY. PART III, LINE 4 PLEASE SEE FOOTNOTE 2 "PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE" ON PAGE 19 IN THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ("AFS"), ALLOWANCE FOR DOUBTFUL ACCOUNTS IS DISCUSSED IN THE SECOND PARAGRAPH OF THE FOOTNOTE.
Part III, Line 8	THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT. THE ORGANIZATION IS ASSUMING A GOVERNMENT BURDEN BY PROVIDING CARE in excess of the revenue. the MEDICARE ALLOWABLE COSTS REFLECTED IN PART III ARE REFLECTED IN the FACILITY'S MEDICARE COST REPORT. THE COST REPORT SEGREGATES THE TOTAL FACILITY ACTUAL EXPENSES INTO COSTS FOR SUPPORT DEPARTMENTS, CLINICAL DEPARTMENTS (ROUTINE AND ANCILLARY) AND NONREIMBURSEABLE DEPARTMENTS. THE COST REPORT USES APPROPRIATE STATISTICAL BASES TO "STEP DOWN" SUPPORT COSTS TO ALLOWABLE CLINICAL AND NONREIMBURSEABLE DEPARTMENTS. THE CHARGES FOR CLINICAL DEPARTMENTS ARE MATCHED TO THE TOTAL COST FOR THESE DEPARTMENTS FOR A COST-TO-CHARGE RATIO.
Part III, Line 9B	THE ORGANIZATION HAS A WRITTEN POLICY THAT DESCRIBES COLLECTION PRACTICES APPLYING TO PATIENTS THAT QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR FULL ASSISTANCE, NO COLLECTION EFFORTS ARE PURSUED ON THAT PATIENT'S ACCOUNT(S). IF PARTIAL ASSISTANCE IS PROVIDED, THE PATIENT IS RESPONSIBLE FOR THE ADJUSTED ACCOUNT BALANCE AND COLLECTION EFFORTS WILL FOLLOW THE ESTABLISHED PRACTICES FOR ALL PATIENTS WHERE A SELF-PAY BALANCE EXISTS. COLLECTION EFFORTS ARE NOT PURSUED ON ANY PENDING FINANCIAL ASSISTANCE PROGRAM ACCOUNT. SPECIFIC CRITERIA EXISTS FOR HOW MUCH FINANCIAL ASSISTANCE, PARTIAL OR TOTAL, WILL BE PROVIDED TO THE PATIENT BASED ON THE ASSESSED NEED. CRITERIA IS BASED ON FEDERAL POVERTY GUIDELINES AND IS REVIEWED AND UPDATED ANNUALLY. ONCE A PATIENT HAS BEEN DEEMED ELIGIBLE FOR THE PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP), THE PATIENT IS NOTIFIED BY LETTER WITHIN 60 DAYS AFTER RECEIPT OF THE APPLICATION AND SUPPORTING DOCUMENTATION. THE PATIENT RETAINS ELIGIBILITY FOR A PERIOD OF TWELVE MONTHS FROM THE DATE OF THE APPLICATION. NOTICE OF THIS ELIGIBILITY IS PROVIDED TO HOSPITAL ADMISSIONS, BILLING AND COLLECTION STAFF BY THE ASSIGNMENT OF A SPECIFIC FINANCIAL CLASS WITH ACCOMPANYING ELIGIBILITY DATES. AT THE END OF THE TWELVE MONTH PERIOD, THE PATIENT IS RESPONSIBLE FOR REAPPLYING FOR FAP ELIGIBILITY. BSCHS's collection policy contains provisions on collection practices which all facilities follow for patients known to qualify for financial assistance. The Charity Care Policy specifically provides the following collection practices: a. Any firm contracted with the hospital for collection purposes shall also provide information to BSCHS patients on how to apply for financial assistance, in accordance with all provisions of this policy. b. Accounts will not be sent to an external collection agency without the patient or his/her designee having an opportunity and adequate time to develop an alternative payment arrangement. Accounts will not be referred for collection while an application for financial assistance is pending. c. All patients will receive a minimum of thirty (30) days written notice on data mailers/billing statements that their account is subject to referral to a collection agency. d. BSCHS will not commence collection activity on any account for which financial assistance has been approved. The application for charity care will include a statement that the patient will not be responsible for any bills until such time that a decision on the application has been made. e. All legal firms and collection agencies with whom BSCHS may contract for collection services conductS all collection activities in accordance with THE ORGANIZATION'S policies and procedures. Further, such firms shall not commence any legal proceedings on an account without the prior written consent of BSCHS. f. BSCHS makeS THE best effort to work with the patient to determine an equitable payment schedule/installment plan for any out-of-pocket expenses, considering the patient's financial and medical circumstances. The monthly payments on any installment plan will not exceed 10% of the patient's gross monthly income and there will be no interest charges on an approved PAYMENT plan. g. BSCHS, including any law firm or collection agency with which it contracts, will not force the sale or foreclose of a patient's primary residence to collect an outstanding bill. h. BSCHS will not pursue collections against any patient who was eligible for Medicaid at the time services were rendered.
Part VI, Line 2	IN ADDITION TO THE CHNA, BSCHS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGHOUT THE YEAR BY SPEAKING WITH COMMUNITY AGENCY REPRESENTATIVES AND COMMUNITY SERVICE PROVIDERS. THE BSCHS COMMUNITY ENGAGEMENT STAFF WORK DIRECTLY WITH LOCAL UNITED WAYS TO LEARN ABOUT, AND MEET, COMMUNITY NEEDS. IN 2020, A MAJOR FOCUS WAS ON FOOD INSECURITY AND HOSPITAL LEADERSHIP AND STAFF FACILITATED AND PARTICIPATED IN SEVERAL FOOD DRIVES AND PRODUCE DISTRIBUTION EVENTS. ADDITIONALLY, THE FOLLOWING ACTIVITIES AND PROGRAMS THAT BENEFIT THE COMMUNITY CONTINUED IN 2020: GSH CONTINUES TO COLLABORATE WITH THE ROCKLAND PRIDE CENTER, A LOCAL PROVIDER OF SERVICES TO THE LGBTQ COMMUNITY TO IDENTIFY BARRIERS IN ACCESSING HEALTHCARE AND TO UNDERSTAND SPECIFIC HEALTH NEEDS; BSCH STAFF PROVIDED EDUCATION TO THE CENTER FOR DEVELOPMENTAL DISABILITIES STAFF ON INFECTION CONTROL AND PARTICIPATED, EVERY MONTH, IN THE PROJECT DISCOVERY COMMUNITY OUTREACH PROGRAM TO PROVIDE HOUSEHOLD NECESSITIES, FOOD AND CLOTHING TO THOSE IN NEED IN THE COMMUNITY. SACH STAFF BEGAN TO SCREEN INPATIENTS FOR FOOD INSECURITY AND MADE "WARM HAND-OFF" REFERRALS TO LOCAL FOOD SOURCES AND DSS AGENCIES. GSH AND BSCH EACH PROVIDED A DONATION OF 2,000 PAIRS OF SOCKS TO THE ROCKLAND COUNTY WARMING STATION AND THE ORANGE COUNTY VETERANS ASSOCIATION. THE COMMUNITY ENGAGEMENT DIRECTOR PROVIDED OVER 350 FREE SEASONAL FLU SHOTS TO COMMUNITY GROUPS AND EMPLOYERS. BY ACTIVELY PARTICIPATING AND COLLABORATING WITH THESE AGENCIES, ORGANIZATIONS, AND THE COMMUNITY, BSCHS IS ABLE TO OBTAIN INPUT AND INSIGHT ON THE HEALTH NEEDS AND CONCERNS OF THE COMMUNITIES SERVED. ADDITIONALLY, THE BSCHS COMMUNITY ENGAGEMENT TEAM WORKS WITH SEVERAL AREA EMPLOYERS AND SPECIFIC GEOGRAPHICAL AND RELIGIOUS GROUPS TO IDENTIFY PERSONAL HEALTH RELATED NEEDS. BASED ON THESE NEEDS, IN 2020, BSCHS CLINICAL STAFF AND PHYSICIANS PROVIDED CLOSE TO 100 HOURS OF VIRTUAL EDUCATION ON PREVENTIVE HEALTH INTERVENTIONS TO A TOTAL OF OVER 8O0 EMPLOYEES AT THE FOLLOWING WORKSITES: AVON, CLARKSTOWN CENTRAL SCHOOL DISTRICT, DOMINICAN COLLEGE, EAST RAMAPO SCHOOL DISTRICT, EASTWICK COLLEGE, JCC OF ROCKLAND, NORTH ROCKLAND SCHOOL DISTRICT, ORANGE-ULSTER BOCES, PFIZER, INC., PEARL RIVER SCHOOL DISTRICT, RAMAPO COLLEGE, ROCKLAND BOCES, ROCKLAND COMMUNITY COLLEGE, SALVATION ARMY, ST. DOMINIC HOME, ST. THOMAS AQUINAS COLLEGE, SOUTH ORANGETOWN SCHOOL DISTRICT, TD BANK, TOWN OF HAVERSTRAW, TOWN OF ORANGETOWN, TOWN OF RAMAPO, UNEEDA ENTERPRIZES, INC., FARLEY ELEMENTARY SCHOOL, M & T BANK, AND THE VILLAGE OF SUFFERN. AT LEAST ONE OR TWO OF THE FOLLOWING PREVENTIVE HEALTH TOPICS WAS PRESENTED AT EACH WORK SITE: BACK HEALTH AND ERGONOMICS, BENEFITS OF WALKING, BETTER HEARING, BREAST HEALTH, CARDIAC HEALTH & STROKE AWARENESS, CONCUSSION MANAGEMENT, EMERGENCY CARE, FALL PREVENTION, MANAGING STRESS, MANAGING MEDICATIONS, NUTRITION (FOOD LABELING, HEALTHY DINING OUT), SLEEPING HEALTHY, VITAMINS/SUPPLEMENTS, AND WOMEN'S HEART HEALTH. Part VI, Line 3 Patient financial assistance policy is communicated to patients upon scheduling, registration, THROUGH visible postings of the policy in common areas throughout the hospital, brochures at registration and on the Bon Secours website. In addition, patient statements request that patients apply for financial assistance if needed, once any patient financial obligation is determined. BSCHS is committed to ensuring access to health care services for all. As a health care provider, BSCHS treats all patients, whether insured, underinsured or uninsured, with dignity, respect and compassion throughout admission, delivery of services, discharge and billing and collection processes. BSCHS addresses the needs of the uninsured by providing free or reduced fees FOR hospital services and Is ACTIVELY ENGAGED IN community outreach efforts to assist with enrollment in Medicaid and other medical coverage programs, including free community-based preventive and primary care services. BSCHS proactively screens to identify individuals and their families who may qualify for federal, state or local health insurance programs or the BSCHS Patient Financial Assistance Program ("FAP") and assists potential eligible patients through the qualification process. Potentially eligible patients that do not qualify for a federal or state health insurance program are referred to the Financial Assistance Coordinator located in Patient Financial Services for assistance in completing the documentation required to establish FAP eligibility. Patients are responsible for providing the information necessary to complete the documentation. The FAP aids uninsured and underinsured patients who do not qualify for government-sponsored health insurance and who communicate their inability to pay for their medical care. The FAP provides 100% financial assistance to uninsured patients with annual family incomes at or below 250% of the Federal Poverty Guidelines ("FPG"). INCOMES UP TO 500% ARE ALSO DISCOUNTED AT THE LOWER PERCENTAGES as indicated in the chart included in the FAP or the AMOUNTS GENERALLY BILLED ("AGB"). BSCHS offers 100% charity care to its patients with income up to 250% of the FPG. Patients with income between 251% - 350% of the FPG are offered the lower of a 50% reduction of total charges or the APG (the Medicare FFS rate). Patients with income between 351% - 500% of the FPG are offered the lower of a 30% reduction of total charges or the APG (the Medicare FFS rate). BSCHS IS DEDICATED TO MEETING THE NEEDS OF NON-ENGLISH SPEAKING PATIENTS BY HAVING ON-SITE SPANISH TRANSLATORS, AND OTHER LANGUAGE TRANSLATION SERVICES. IN ADDITION, BSCHS EMPLOYS A TELEPHONE LANGUAGE SERVICE WHICH ASSISTS IN MEETING ANY LANGUAGE NEEDS THAT ARISE. THE TRANSLATION SERVICES ARE OFFERED TO NON-ENGLISH SPEAKING PATIENTS FROM ADMISSION TO DISCHARGE, INCLUDING THROUGH THE FINANCIAL ASSISTANCE PROCESS. FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON SCHEDULING, REGISTRATION, THROUGH VISIBLE POSTINGS OF THE POLICY IN COMMON AREAS THROUGHOUT THE HOSPITAL, BROCHURES AT REGISTRATION AND ON BON SECOURS WEBSITE. IN ADDITION, PATIENT STATEMENTS REQUEST THAT PATIENTS APPLY FOR FINANCIAL ASSISTANCE IF NEEDED, ONCE ANY PATIENT'S FINANCIAL OBLIGATION IS DETERMINED.
Part VI, Line 4	BSCHS FACILITIES OPERATE AND SERVE POPULATIONS OF LOWER NEW YORK, PRINCIPALLY ROCKLAND AND ORANGE COUNTIES. ROCKLAND COUNTY IS LOCATED APPROXIMATELY 30 MILES NORTH OF MANHATTAN ON THE WEST SIDE OF THE HUDSON RIVER. HOME TO EIGHT PUBLIC SCHOOL DISTRICTS AND EIGHT COLLEGES AND UNIVERSITIES, THE 199-SQUARE MILE AREA INCLUDES FIVE TOWNS AND NINETEEN VILLAGES. THIS COUNTY OF 120,000 ACRES IS DESIGNATED A PRESERVE AMERICA COMMUNITY, CONTAINING MORE THAN 35,000 ACRES OF PRESERVED OPEN SPACE AND PARKLAND. ACCORDING TO DATAUSA, IN 2019, ROCKLAND COUNTY, NY HAD A POPULATION OF 325,789 PEOPLE WITH A MEDIAN AGE OF 35.9 AND A MEDIAN HOUSEHOLD INCOME OF $100,916. THE 5 LARGEST ETHNIC GROUPS IN ROCKLAND COUNTY, NY ARE WHITE (NON-HISPANIC) (62.5%), BLACK OR AFRICAN AMERICAN (NON-HISPANIC) (11.3%), OTHER (HISPANIC) (9.54%), WHITE (HISPANIC) (6.82%), AND ASIAN (NON-HISPANIC) (5.91%). ORANGE COUNTY IS LOCATED IN THE SOUTHEASTERN AREA OF NEW YORK, APPROXIMATELY 40 MILES NORTH OF NEW YORK CITY, AND IS BOARDERED ON THE EAST BY THE HUDSON RIVER AND ON THE WEST BY THE DELAWARE RIVER. ORANGE COUNTY IS 839 SQUARE MILES AND IS A MIX OF URBAN, SUBURBAN, FARMLAND AND RURAL AREAS. ORANGE COUNTY HAS THREE CITIES, TWENTY TOWNS, AND NINETEEN VILLAGES. THE COUNTY HAS NINETEEN PUBLIC SCHOOL DISTRICTS AND THREE COLLEGES AND UNIVERSITIES. ACCORDING TO DATAUSA, IN 2019, ORANGE COUNTY, NY HAD A POPULATION OF 384,940 PEOPLE WITH A MEDIAN AGE OF 36.9 AND A MEDIAN HOUSEHOLD INCOME OF $84,458. THE 5 LARGEST ETHNIC GROUPS IN ORANGE COUNTY, NY ARE WHITE (NON-HISPANIC) (62.6%), WHITE (HISPANIC) (12.5%), BLACK OR AFRICAN AMERICAN (NON-HISPANIC) (10.9%), OTHER (HISPANIC) (6.05%), AND ASIAN (NON-HISPANIC) (2.95%).
Part VI, Line 5	BSCHS FACILITIES PROMOTED THE HEALTH OF THE COMMUNITY TO FURTHER ITS EXEMPT PURPOSE THROUGH VARIOUS PROGRAMS AND INITIATIVES THROUGHOUT THE YEAR. BSCHS' COMMUNITY ENGAGEMENT DEPARTMENT PROVIDED EDUCATIONAL PRESENTATIONS AT VARIOUS COMMUNITY LOCATIONS ON BROAD TOPICS SUCH AS CARDIAC HEALTH, ORTHOPEDICS, WOMEN'S HEALTH, OBESITY, STROKE, DIABETES, WOUND CARE, SAFETY, ASTHMA, SENIOR SERVICES, ETC. THE COMMUNITY ENGAGEMENT DEPARTMENT ALSO HELD SERVICE LINE SPECIFIC PROGRAMS SUCH AS BREAST AND CERVICAL CANCER SCREENINGS, PROSTATE CANCER AND COLORECTAL CANCER SCREENINGS, HEARING TESTING, SLEEP DISTURBANCE SEMINARS, AS WELL AS OTHER PROGRAMS BENEFITING THE COMMUNITY. BSCHS EXPECTS TO CONTINUE PROVIDING THESE PROGRAMS AND SERVICES THROUGH 2021. BSCHS CONTINUED ITS COMMITMENT TO BEING ACCESSIBLE AND PROVIDING FOR THE HEALTH CARE NEEDS OF THE COMMUNITIES IN ITS SERVICE AREA. AS EVIDENCED BY BSCHS' ACTIVE PARTICIPATION IN THE VARIOUS DSRIP PROJECTS, BSCHS PROVIDED IMPROVED ACCESS TO HEALTH CARE SERVICES, ESPECIALLY TO THE UNDERSERVED POPULATION, AS WELL AS PROVIDED VARIOUS OPPORTUNITIES TO ENROLL IN GOVERNMENTAL AND/OR COMMUNITY HEALTH PLANS. IN PORT JERVIS, THROUGH A MISSION GRANT, BSCHS PROVIDED TRANSPORTATION SERVICES TO UNINSURED AND MEDICAID PATIENTS TO COORDINATE CARE. ALL THREE BSCHS HOSPITALS PARTNERED WITH LOCAL FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) TO INCREASE PUBLIC AWARENESS OF THE AVAILABLE SERVICES THAT WERE EITHER FREE OF CHARGE OR BASED ON A SLIDING SCALE PAYMENT. IN FURTHERANCE OF THIS COMMITMENT, ALL BSCHS FACILITIES PROVIDED SPACE EACH MONTH, FREE OF CHARGE, TO INSURANCE SPECIALISTS TO MEET WITH PATIENTS TO REGISTER FOR HEALTH INSURANCE BENEFITS. IN RESPONSE TO THE GROWING COMMUNITY NEEDS OF ITS SERVICE AREA, BSCHS CONTINUED TO RECRUIT AND HIRE MORE EMPLOYED PHYSICIANS, WHO ACCEPT MEDICAID AND PARTICIPATE IN PROGRAMS TO PROVIDE CHARITY CARE, IN ALIGNMENT WITH THE BSCHS MISSION. BSCHS ALSO CONTINUED TO ADDRESS THE COMMUNITY NEED FOR CHRONIC DISEASE PREVENTION AT ALL OF ITS FACILITIES. THE FOLLOWING PROGRAMS AND INITIATIVES WERE PROVIDED, WHICH ARE EXPECTED TO CONTINUE: IN ADDITION TO THE CHNA, BSCHS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGHOUT THE YEAR BY SPEAKING WITH COMMUNITY AGENCY REPRESENTATIVES AND COMMUNITY SERVICE PROVIDERS. THE BSCHS COMMUNITY ENGAGEMENT STAFF WORK DIRECTLY WITH LOCAL UNITED WAYS TO LEARN ABOUT, AND MEET, COMMUNITY NEEDS. IN 2020, A MAJOR FOCUS WAS ON FOOD INSECURITY AND HOSPITAL LEADERSHIP AND STAFF FACILITATED AND PARTICIPATED IN SEVERAL FOOD DRIVES AND PRODUCE DISTRIBUTION EVENTS. ADDITIONALLY, THE FOLLOWING ACTIVITIES AND PROGRAMS THAT BENEFIT THE COMMUNITY CONTINUED IN 2020: GSH CONTINUES TO COLLABORATE WITH THE ROCKLAND PRIDE CENTER, A LOCAL PROVIDER OF SERVICES TO THE LGBTQ COMMUNITY TO IDENTIFY BARRIERS IN ACCESSING HEALTHCARE AND TO UNDERSTAND SPECIFIC HEALTH NEEDS; BSCH STAFF PROVIDED EDUCATION TO THE CENTER FOR DEVELOPMENTAL DISABILITIES STAFF ON INFECTION CONTROL AND PARTICIPATED, EVERY MONTH, IN THE PROJECT DISCOVERY COMMUNITY OUTREACH PROGRAM TO PROVIDE HOUSEHOLD NECESSITIES, FOOD AND CLOTHING TO THOSE IN NEED IN THE COMMUNITY. SACH STAFF BEGAN TO SCREEN INPATIENTS FOR FOOD INSECURITY AND MADE "WARM HAND-OFF" REFERRALS TO LOCAL FOOD SOURCES AND DSS AGENCIES. GSH AND BSCH EACH PROVIDED A DONATION OF 2,000 PAIRS OF SOCKS TO THE ROCKLAND COUNTY WARMING STATION AND THE ORANGE COUNTY VETERANS ASSOCIATION. THE COMMUNITY ENGAGEMENT DIRECTOR PROVIDED OVER 350 FREE SEASONAL FLU SHOTS TO COMMUNITY GROUPS AND EMPLOYERS. BY ACTIVELY PARTICIPATING AND COLLABORATING WITH THESE AGENCIES, ORGANIZATIONS, AND THE COMMUNITY, BSCHS IS ABLE TO OBTAIN INPUT AND INSIGHT ON THE HEALTH NEEDS AND CONCERNS OF THE COMMUNITIES SERVED. ADDITIONALLY, THE BSCHS COMMUNITY ENGAGEMENT TEAM WORKS WITH SEVERAL AREA EMPLOYERS AND SPECIFIC GEOGRAPHICAL AND RELIGIOUS GROUPS TO IDENTIFY PERSONAL HEALTH RELATED NEEDS. BASED ON THESE NEEDS, IN 2020, BSCHS CLINICAL STAFF AND PHYSICIANS PROVIDED CLOSE TO 100 HOURS OF VIRTUAL EDUCATION ON PREVENTIVE HEALTH INTERVENTIONS TO A TOTAL OF OVER 8O0 EMPLOYEES AT THE FOLLOWING WORKSITES: AVON, CLARKSTOWN CENTRAL SCHOOL DISTRICT, DOMINICAN COLLEGE, EAST RAMAPO SCHOOL DISTRICT, EASTWICK COLLEGE, JCC OF ROCKLAND, NORTH ROCKLAND SCHOOL DISTRICT, ORANGE-ULSTER BOCES, PFIZER, INC., PEARL RIVER SCHOOL DISTRICT, RAMAPO COLLEGE, ROCKLAND BOCES, ROCKLAND COMMUNITY COLLEGE, SALVATION ARMY, ST. DOMINIC HOME, ST. THOMAS AQUINAS COLLEGE, SOUTH ORANGETOWN SCHOOL DISTRICT, TD BANK, TOWN OF HAVERSTRAW, TOWN OF ORANGETOWN, TOWN OF RAMAPO, UNEEDA ENTERPRIZES, INC., FARLEY ELEMENTARY SCHOOL, M & T BANK, AND THE VILLAGE OF SUFFERN. AT LEAST ONE OR TWO OF THE FOLLOWING PREVENTIVE HEALTH TOPICS WAS PRESENTED AT EACH WORK SITE: BACK HEALTH AND ERGONOMICS, BENEFITS OF WALKING, BETTER HEARING, BREAST HEALTH, CARDIAC HEALTH & STROKE AWARENESS, CONCUSSION MANAGEMENT, EMERGENCY CARE, FALL PREVENTION, MANAGING STRESS, MANAGING MEDICATIONS, NUTRITION (FOOD LABELING, HEALTHY DINING OUT), SLEEPY HEALTHY, VITAMINS/SUPPLEMENTS, AND WOMEN'S HEART HEALTH. BSCHS'S POPULATION HEALTH DEPARTMENT STAFF FURTHERED THE ORGANIZATION'S EXEMPT PURPOSES BY PROMOTING THE HEALTH OF THE COMMUNITY IN BOTH ROCKLAND AND ORANGE COUNTY. STAFF HAVE BEEN INVOLVED IN MANAGING PREVENTIVE AND CHRONIC DISEASES USING THE PRINCIPLES OF THE PATIENT CENTERED MEDICAL HOME, SUCH AS PREVENTIVE OUTREACH FOR PATIENTS WITH DIABETES, OUTREACH TO MANAGE MEDICATION ADHERENCE FOR BEHAVIORAL HEALTH PATIENTS, AND PATIENT EDUCATION. POPULATION HEALTH CARE MANAGERS CONDUCTED OUTREACH TO DIABETES PATIENTS TO ENROLL THEM IN A MENTOR/MENTEE PROGRAM, ASSISTED DIABETIC PATIENTS TO TRACK THEIR HEALTH BY PROVIDING GLUCOMETERS AND SCALES TO PATIENTS IN NEED, CONDUCTED A COLORECTAL AWARENESS CAMPAIGN, PROVIDED A FREE INITIAL CONSULT TO PATIENTS WHO SCREENED POSITIVE FOR BEHAVIORAL HEALTH SCREENING, PROVIDED FLU SHOTS IN THE COMMUNITY IN ROCKLAND COUNTY, AND HELD PATIENT ADVISORY COMMITTEE MEETINGS IN ROCKLAND AND ORANGE COUNTY TO EDUCATE PATIENTS ON SERVICES AND PREVENTION. BSCHS EXPECTS TO CONTINUE THESE SERVICES AND PROGRAMS DESCRIBED ABOVE THROUGH 2021.
Part VI, Line 6	BSCHS IS A NOT-FOR-PROFIT, NON-STOCK MEMBERSHIP CORPORATION THAT IS THE SOLE MEMBER OF LEGAL ENTITIES THAT OPERATE HOSPITALS, NURSING HOMES, AND OTHER HEALTHCARE-RELATED FACILITIES IN THE STATE OF NEW YORK. BON SECOURS MERCY, INC., FORMERLY BON SECOURS HEALTH SYSTEM, INC. ("BSMI", FORMERLY "BSHSI") A NOT-FOR-PROFIT, NON-STOCK MEMBERSHIP CORPORATION, IS A MEMBER OF BSCHS WITH A FORTY PERCENT (40%) ECONOMIC INTEREST IN BSCHS. SISTERS OF CHARITY OF SAINT ELIZABETH ("SOCSE"), A NEW JERSEY NOT-FOR-PROFIT CORPORATION, IS A MEMBER OF BSCHS WITHOUT ANY ECONOMIC INTEREST. BSCHS, A CATHOLIC HEALTH SYSTEM, IS CANONICALLY CO-SPONSORED BY BON SECOURS MINISTRIES ("BSM"), AN AFFILIATE OF BSHSI AND SOCSE. BSMI IS A NOT-FOR-PROFIT, NON-STOCK MEMBERSHIP CORPORATION, AND THE SOLE MEMBER OF WHICH IS BON SECOURS, INC. ("BSI"). BSMI IS A CORPORATION FORMED TO PARTICIPATE IN THE CHARITABLE HEALTHCARE SYSTEM NOW SPONSORED BY BSM THROUGHOUT THE UNITED STATES OF AMERICA THROUGH WHICH THE HEALTHCARE MISSION OF THE SISTERS OF BON SECOURS, USA, THE FOUNDING PARTICIPATING ENTITY OF BSM, IS FURTHERED. THE MINISTRY OF BSHSI AIDS THOSE IN NEED, PARTICULARLY THOSE WHO ARE SICK AND DYING, BY OFFERING SERVICES THAT INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: 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. AS A MEMBER OF THE CATHOLIC HEALTH MINISTRY AND A MEMBER OF BON SECOURS MERCY, INC. (BSMI), THIS ORGANIZATION AND ITS RELATED ENTITIES ARE CALLED TO CONTINUE THE HEALING MINISTRY OF JESUS. THEY EXIST TO BENEFIT THE PEOPLE LIVING IN THE COMMUNITIES WE SERVE. THROUGH ALL OF THE SERVICES OFFERED TO THE COMMUNITY, THE MISSION IS "TO BRING COMPASSION TO HEALTH CARE AND TO BE GOOD HELP TO THOSE IN NEED, ESPECIALLY THOSE WHO ARE POOR AND DYING. AS A SYSTEM OF CAREGIVERS, WE COMMIT OURSELVES TO HELP BRING PEOPLE AND COMMUNITIES TO HEALTH AND WHOLENESS AS PART OF THE HEALING MINISTRY OF JESUS CHRIST AND THE CATHOLIC CHURCH." THIS ORGANIZATION AND RELATED ORGANIZATIONS SHARE THE BSHSI VISION. "INSPIRED BY THE HEALING MINISTRY OF JESUS CHRIST AND THE CHARISM OF BON SECOURS, BON SECOURS HEALTH SYSTEM WILL BE RECOGNIZED FOR ITS LEADERSHIP IN JUSTICE, TRANSFORMING THE COMMUNITIES IN WHICH WE SERVE AND WORK INTO PLACES OF HEALTH AND HOPE, AND BEING A PROPHETIC VOICE FOR SYSTEMIC US HEALTH REFORM AND A MORE HUMANE WORLD." WESTCHESTER COUNTY HEALTHCARE CORPORATION WAS CREATED IN 1997 AS A NEW YORK PUBLIC BENEFIT CORPORATION AND OWNS AND OPERATES A NUMBER OF HEALTHCARE FACILITIES INCLUDING WESTCHESTER MEDICAL CENTER LOCATED IN VALHALLA, NEW YORK. IN DECEMBER, 2014, WMC AND BSHSI ENTERED INTO A TRANSACTION (THE "AFFILIATION") UNDER WHICH: WMC, OR ITS SUBSIDIARY, BECAME A MAJORITY CO-MEMBER IN BSCHS AND MANAGES THE DAY TO DAY OPERATIONS OF BSCHS AND ITS SUBSIDIARIES AND FACILITIES PURSUANT TO A MANAGEMENT AGREEMENT APPROVED BY THE NEW YORK STATE DEPARTMENT OF HEALTH; BSCHS AND ITS SUBSIDIARIES REMAIN A CATHOLIC HEALTHCARE MINISTRY SUBJECT TO THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTHCARE SERVICES. WMC APPOINTS AT LEAST SIXTY PERCENT (60%) OF THE MEMBERS OF THE BSCHS BOARD OF DIRECTORS, WHILE BSHSI AND SOCSE JOINTLY APPOINT APPROXIMATELY 40% OF THE BSCHS BOARD, AND EACH MEMBER OF BSCHS HOLDS CERTAIN RESERVE POWERS. PLEASE SEE SCHEDULE R FOR LISTINGS OF THE RELATED ORGANIZATIONS AND SCHEDULE H FOR THE HOSPITALS INCLUDED IN THIS RETURN.
Part VI, Line 7	List of States Receiving Community Benefit Report: NY

Schedule H (Form 990) 2020

Additional Data

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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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number
45-2964467

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of 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) TRANSPORTATION FOR INDIGENT PATIENTS	171	13,732
(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 (Form 990) 2020

Additional Data

Software ID:
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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes 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? .............

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

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)
1MARY LEAHY MD PRESIDENT & CEO	(i) (ii)	0 ------------- 802,085	0 ------------- 252,420	0 ------------- 0	0 ------------- 39,900	0 ------------- 45,048	0 ------------- 1,139,453	0 ------------- 0
2MICHAEL ISRAEL VICE CHAIR	(i) (ii)	0 ------------- 1,849,662	0 ------------- 954,810	0 ------------- 26,000	0 ------------- 44,745	0 ------------- 82,025	0 ------------- 2,957,242	0 ------------- 0
3RENEE GARRICK MD BOARD MEMBER	(i) (ii)	0 ------------- 736,266	0 ------------- 237,160	0 ------------- 0	0 ------------- 37,200	0 ------------- 29,189	0 ------------- 1,039,815	0 ------------- 0
4GARY BRUDNICKI BOARD MEMBER	(i) (ii)	0 ------------- 1,390,660	0 ------------- 528,078	0 ------------- 26,000	0 ------------- 44,745	0 ------------- 70,531	0 ------------- 2,060,014	0 ------------- 0
5JULIE SWITZER BOARD MEMBER	(i) (ii)	0 ------------- 699,530	0 ------------- 235,175	0 ------------- 26,000	0 ------------- 44,745	0 ------------- 47,420	0 ------------- 1,052,870	0 ------------- 0
6PETER KENNIFF CFO	(i) (ii)	385,782 ------------- 0	73,964 ------------- 0	2,709 ------------- 0	21,519 ------------- 0	31,141 ------------- 0	515,115 ------------- 0	0 ------------- 0
7CARY HIRSCH MD PHYSICIAN	(i) (ii)	998,828 ------------- 0	50,000 ------------- 0	25,542 ------------- 0	21,519 ------------- 0	3,934 ------------- 0	1,099,823 ------------- 0	0 ------------- 0
8MARK FERSKO BOARD MEMBER (thru 11/20)	(i) (ii)	0 ------------- 813,479	0 ------------- 269,131	0 ------------- 26,000	0 ------------- 44,745	0 ------------- 32,443	0 ------------- 1,185,798	0 ------------- 0
9PERMINDER S GREWAL PHYSICIAN	(i) (ii)	642,365 ------------- 0	38,750 ------------- 0	74,252 ------------- 0	21,519 ------------- 0	26,867 ------------- 0	803,753 ------------- 0	0 ------------- 0
10BANGALORE SRIDHARA PHYSICIAN	(i) (ii)	548,361 ------------- 0	65,625 ------------- 0	98,460 ------------- 0	21,246 ------------- 0	2,407 ------------- 0	736,099 ------------- 0	0 ------------- 0
11ARVIND AGARWAL PHYSICIAN	(i) (ii)	770,208 ------------- 0	0 ------------- 0	29,577 ------------- 0	21,519 ------------- 0	18,424 ------------- 0	839,728 ------------- 0	0 ------------- 0
12SUNANDAN PANDYA PHYSICIAN	(i) (ii)	539,746 ------------- 0	65,625 ------------- 0	95,400 ------------- 0	21,246 ------------- 0	36,846 ------------- 0	758,863 ------------- 0	0 ------------- 0
13JOSHUA RATNER BOARD MEMBER (EFFECT. 11/20)	(i) (ii)	0 ------------- 527,620	0 ------------- 132,165	0 ------------- 0	0 ------------- 39,900	0 ------------- 33,835	0 ------------- 733,520	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

PART I, LINE 3

THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J PART I LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION AS DESCRIBED BELOW: THE BOARD OF DIRECTORS, PERSONNEL AND COMPENSATION COMMITTEE SETS THE LEVEL OF TOTAL COMPENSATION (BASE SALARY AND INCENTIVE COMPENSATION) AND THE BENEFITS PROVIDED TO THE ORGANIZATION'S SENIOR EXECUTIVES. IN ORDER TO SET BASE SALARY AND INCENTIVE COMPENSATION LEVELS, THE COMMITTEE WORKS WITH A NATIONAL INDEPENDENT COMPENSATION CONSULTING FIRM. THE CONSULTING FIRM ASSISTS THE COMMITTEE WITH ITS DECISION-MAKING PROCESSES TO ENSURE THAT (I) EXECUTIVE COMPENSATION LEVELS ARE REASONABLE AND APPROPRIATE RELATIVE TO THOSE OF OTHER SIMILAR ORGANIZATIONS, AS WELL AS (II) SUCH LEVELS MEET THE "REBUTTABLE PRESUMPTION OF REASONABLENESS." STANDARD COMPENSATION LEVELS ARE DETERMINED BASED ON COMPETITIVE MARKET DATA FOR COMPARABLE POSITIONS IN SIMILAR SIZE AND TYPE OF ORGANIZATIONS AND EACH EXECUTIVE'S SCOPE OF RESPONSIBILITIES. IN ADDITION, INCENTIVE COMPENSATION ARRANGEMENTS ARE BASED ON EACH EXECUTIVE'S ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS SET FORTH AT THE BEGINNING OF EACH CALENDAR YEAR, THE ACHIEVEMENT OF WHICH IS MEASURED AT THE END OF EACH CALENDAR YEAR BY THE CEO OR THE BOARD OF DIRECTORS DEPENDING ON THE EXECUTIVE.

PART I, LINE 4B

THE FILING ORGANIZATION PARTICIPATES IN A BON SECOURS CHARITY HEALTH SYSTEM, INC. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THAT ALLOWS FOR DEPOSITS INTO ADDITIONAL RETIREMENT PLANS AND IS AVAILABLE ONLY TO OFFICERS AND CERTAIN OTHER EMPLOYEES. THE 457(F) PLAN IS A NON-QUALIFIED PLAN AND IS SUBJECT TO A MINIMUM THREE-YEAR SERVICE REQUIREMENT BEFORE VESTING ON DEPOSITS MADE INTO THIS PLAN.

Schedule J (Form 990) 2020

Additional Data

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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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Return Reference	Explanation
Form 990, Part III, Line 2	SIGNIFICANT PROGRAM SERVICE CHANGES: IN MARCH 2020, THE WORLD HEALTH ORGANIZATION DECLARED COVID-19, THE DISEASE CAUSED BY THE NOVEL CORONAVIRUS, A GLOBAL PANDEMIC. BSCHS EXPERIENCED A DECLINE IN INPATIENT AND OUTPATIENT ACTIVITIES AND AN INCREASE IN COST AND UTILIZATION OF MEDICAL SUPPLIES AND PERSONAL PROTECTIVE EQUIPMENT NECESSARY TO ENSURE EMPLOYEE AND PATIENT SAFETY. THE COVID-19 PANDEMIC REQUIRED AN UNPRECEDENTED MOBILIZATION EFFORT ON THE PART OF BSCHS IN ORDER TO APPROPRIATELY CARE FOR COVID-19 PATIENTS WHILE SIMULTANEOUS AND ACROSS VIRTUALLY ALL DEPARTMENTS AND DISCIPLINES WITHIN EACH CAMPUS. THIS ENABLED A SIGNIFICANTLY HIGH LEVEL OF OPERATIONAL AND CLINICAL COORDINATION THAT ALLOWED BSCHS TO ACHIEVE MEANINGFUL ACCESS AND HIGH QUALITY CLINICAL OUTCOMES FOR ITS PATIENTS. BSCHS INITIATIVES INCLUDE: CLINICAL TEAM DEPLOYMENT AT THE ONSET OF THE PANDEMIC, THE MULTIDISCIPLINARY CLINICAL LEADERSHIP TEAM IMPLEMENTED A TEAM-BASED CARE MODEL TO ENSURE THE APPROPRIATE CLINICAL CARE TEAMS WERE DEPLOYED TO COVID AND NON-COVID UNITS, AND THAT TEAM MEMBERS WERE CROSS TRAINED TO PROVIDE OPTIMAL PATIENT CARE. THE IMPLEMENTATION OF THIS MODEL ENSURED THAT PROVIDER STAFFING WAS MAXIMIZED THROUGH STAFF REASSIGNMENT AND NURSE CROSS TRAINING FOR ICU COVERAGE AND OTHER UNITS THROUGHOUT THE HOSPITALS, DEPLOYMENT OF ADDITIONAL PHYSICIAN RESIDENTS, AND RE-ACTIVATING FORMER BEDSIDE CLINICAL STAFF FROM OTHER AREAS OF THE ORGANIZATION. SUCH STEPS HAVE ALLOWED THE HOSPITALS TO SUFFICIENTLY STAFF UP TO ACCOMMODATE THE INFLUX OF COVID-19 PATIENTS WHILE AVOIDING THE NEED TO FURLOUGH ANY STAFF. THE PROVIDER TEAM-BASED MODEL INCLUDED THE REDEPLOYED OF PHYSICIANS AND ADVANCED PROVIDERS INTO INPATIENT CARE AREAS TO COVER CLINICAL SERVICES INCLUDING INPATIENT UNITS, ICUS AND ED (EX. ADULT CARDIOLOGISTS COVERED GENERAL MEDICINE UNIT, ANESTHESIOLOGISTS COVERED GENERAL MEDICINE, CARDIAC SURGEONS COVERED COVID UNIT). IN ADDITION, PROVIDERS WERE SUPPORTED BY A SCRIBING PROCESS TO IMPROVE EFFICIENCY. EACH DAY THERE WAS "COVID CONSULT TEAM" WHICH PROVIDED A DAILY POINT OF CONTACT FROM CLINICAL TEAMS FOR COVID DISCUSSIONS AND PATIENT MANAGEMENT ISSUES. FINALLY, THE CLINICAL TEAMS IDENTIFIED AND DEVELOPED PRONING TEAMS TO POSITION PATIENTS IN SEVERE ACUTE RESPIRATORY DISTRESS SYNDROME AND IMPROVE CLINICAL OUTCOMES. NURSING DEVELOPED SIMILAR TEAM-BASED CARE MODEL THROUGH AN INITIAL ASSESSMENT OF STAFF NEEDS AND CURRENT COMPETENCY FOR CRITICAL CARE SERVICES. NURSING LEADERSHIP, EDUCATION AND QUALITY THEN CROSS TRAINED APPROPRIATE STAFF TO COVER REQUIRED AREAS SUCH AS ICU AND MEDICAL UNITS. CLINICAL STAFF WAS TRAINED AND DEPLOYED FROM AREAS SUCH AS PERIOPERATIVE SERVICES, PEDIATRICS, NURSING LEADERSHIP, EDUCATION AND OUTPATIENT CLINICAL PROGRAM MANAGERS. AS A RESULT OF THE SUCCESS OF THIS MODEL, PLANS ARE CURRENTLY UNDERWAY TO EXPAND THE TEAM-BASED MODEL TO INCLUDE ANCILLARY SERVICES AS TEAMS REDEPLOY FULL TIME BACK TO ALL CARE UNITS. TELEHEALTH BSCHS LEVERAGED ITS HIGHLY TOUTED TELE-HEALTH NETWORK AND INFRASTRUCTURE TO EXPAND AND ENHANCE CARE BETWEEN HOSPITALS WHILE HELPING TO PROTECT STAFF BY LIMITING STAFF EXPOSURE TO PATIENTS. INITIATIVES DEPLOYED THROUGH THE EHEALTH CENTER INCLUDED: - INCREASED DEPLOYMENT OF TELE-HEALTH CART TECHNOLOGY WITHIN HOSPITAL EMERGENCY DEPARTMENTS WITH TRAINING TO ALL STAFF, FOR EXPANDED CARE. - DEVELOPMENT OF AN ESCALATION PROCESS TO MANAGE LIMITED VISITATION. THIS INVOLVED THE USE OF IPAD COMMUNICATION DEVICES MANAGED THROUGH THE EHEALTH CENTER. - EXPANSION OF CERTAIN TELE-HEALTH SERVICES IN HIGHEST DEMAND, INCLUDING ICU, PSYCHIATRICS, EMERGENCY MEDICINE, NEUROSCIENCES, AND E-SITTER PATIENT MONITORING TO PROVIDE CONSULTS THROUGHOUT THE NETWORK SITES. - FACILITATED REGULAR COMMUNICATION WITH FAMILY MEMBERS OF PATIENTS TO REVIEW UPDATES IN CARE. RECONFIGURATION OF EICU WORKFLOWS: - CRITICAL CARE PROVIDERS SET PATIENT TARGETS, EICU TEAM PROVIDED CONSTANT MONITORING OF VENTILATOR METRICS AND ESCALATED FEEDBACK TO PROVIDERS IN UNIT, - 24/7 VENT MANAGEMENT RESULTING IN INCREASED RATE OF VENTILATOR EXTUBATION, - EXPANDED EICU CONSULTS, - INTEGRATION OF THE EICU PROVIDERS WITH CLINICAL TEAM MANAGEMENT, - IMPROVED PATIENT SAFETY, ABILITY TO COHORT PATIENTS, AND TRANSITIONS OF CARE. VALUE CREATED BY THIS SERVICE INCLUDE: - FIRST, THE SERVICE ADDED TO PATIENT SAFETY AND CARE STANDARDIZATION IN TIMES OF HIGH PROVIDER STRAIN (CLINICAL BEST PRACTICES, CORRECT ISOLATION AND COHORTING PRACTICES), - SECOND, THE SERVICE PERFORMED CLINICAL WORKLOAD BALANCING FUNCTIONS FOR THE BEDSIDE TEAMS REDUCING PROVIDER EXPOSURE(S), - THIRD, THE SETUP OF THE SERVICE WITH FREQUENT IMPROVEMENT INTERVALS ALLOWED FOR RAPID ADAPTATION TO CHANGING CONDITIONS, - LASTLY, THE SERVICE ALLOWED FOR EFFECTIVE AND STANDARDIZED COMMUNICATION PATTERNS BETWEEN A NUMBER OF DIFFERENT TEAMS. THROUGHOUT THE PANDEMIC SURGE, BSCHS FLEXED ORGANIZATION OPERATIONS AND STAFFING TO MEET THE DEMAND AND NEEDS OF ITS COMMUNITY AND PATIENTS. THESE SUCCESSFUL OPERATIONAL ADJUSTMENTS ALLOWED BSCHS TO EXPAND CAPACITY, MAINTAIN INTERNAL AND EXTERNAL COMMUNICATION AND QUICKLY DEVELOP PROCESSES TO TEST AND TREAT PATIENTS. INCREASING BSCHSI BED CAPACITY AS CASES BEGAN IN THE REGION, BSCHS MADE GRADUAL CHANGES TO VISITATION POLICIES, ULTIMATELY RESULTING IN NO VISITORS ON SITE, EXCEPT PEDIATRICS AND END-OF-LIFE CIRCUMSTANCES. FOLLOWING THAT, BSCHS BEGAN TO RESCHEDULE ELECTIVE SURGICAL PROCEDURE AND PROVIDED PATIENTS OF THE OUTPATIENT MEDICAL OFFICES THE ABILITY TO SHIFT TO VIRTUAL VISITS. WHILE DOING THIS, BSCHS INCREASED BED CAPACITY. IN ADDITION TO THE INCREASE IN BED CAPACITY, STAFF ADJUSTMENTS INCLUDED THE DEPLOYMENT OF WORK FROM HOME PROCESSES FOR APPROPRIATE NON-CLINICAL, NON-ESSENTIAL STAFF. NON-CLINICAL, NON-ESSENTIAL STAFF WHO COULD NOT WORK FROM HOME WAS REDEPLOYED INTO NEWLY DEFINED ROLES TO SUPPORT COVID-19 OPERATIONS. THESE ROLES INCLUDED ED GREETERS, ENTRYWAY TEMPERATURE SCREENING, AND THE CALL CENTER. TO SUPPORT THE ORGANIZATION'S NEEDS TO MONITOR AND TRACK COVID-19 ACTIVITIES, A NETWORK-WIDE COVID-19 DASHBOARD WAS DEVELOPED AS A CENTRAL REPOSITORY OF ANALYTICAL INFORMATION. THIS DASHBOARD INCLUDED INFORMATION RELATED TO: PATIENT CENSUS AND UTILIZATION, BED AND BED UNIT USAGE, AVAILABLE SURGE CAPACITY, PPE AND MEDICAL EQUIPMENT SUPPLY LEVELS, DIAGNOSTIC AND ANTIBODY TESTING VOLUME. FUNDING FOR COVID-19 ACTIVITIES: BSCHS HAS WORKED WITH LOCAL AND REGIONAL RESOURCES TO COMPLY WITH APPROPRIATE GUIDELINES FOR COVID-19 RELATED RELIEF FUNDS. THIS FUNDING INCLUDED: . CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT, GRANTS AND ADVANCES - BSCHS RECEIVED OVER $92.4 MILLION OF FUNDING THROUGH DECEMBER 2020 . FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) FUNDING - BSCHS HAS PREPARED ALL APPROPRIATE SUBMISSIONS TO REQUEST FEMA FUNDING FOR COVID-19 RELATED DISASTER RELIEF FORM 990, PART VI, LINE 6 Members or stockholders: THE MEMBERS OF BSCHS ARE AS FOLLOWS: WMC - ROCKLAND, INC. - 60% BON SECOURS MERCY HEALTH, INC. (FORMERLY BON SECOURS HEALTH SYSTEM, INC) TOGETHER WITH SISTERS OF CHARITY (SOC) - 40%. ON SEPTEMBER 1, 2018, BON SECOURS HEALTH SYSTEM, INC (BSHSI) AND MERCY HEALTH COMBINED TO BECOME BON SECOURS MERCY HEALTH, INC (BSMH). Pursuant to New York State Law, as an organization engaged in the profession of medicine, Bon Secours Charity Health System Medical Group, P.C. (MedPC) was the sole shareholder of the organization who is engaged in the practice of medicine and licensed to practice in the State of New York AND THE STATE OF NEW JERSEY.
Form 990, Part VI, Line 7a	Power to elect or appoint members: The governing bodY of the members within the Group, with the exception of MedPC, are appointed by its members, WMC-Rockland, BSMH (FORMERLY BSHSI) and SOC and are subject to the approval of its members.
Form 990, Part VI, Line 7b	Decisions reserved to members or stockholders: Certain authorities of the members of the Group, with the exception of Bon Secours Charity Health System Medical Group, PC, are jointly reserved to WMC-Rockland, BSMH (FORMERLY BSHSI) and SOC, certain authorities are reserved to BSMH (FORMERLY BSHSI) and WMC-Rockland, and certain authorities are reserved solely to BSMH (FORMERLY BSHSI).
Form 990, Part VI, Line 11b	Process used to review the Form 990: THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT WITH ASSISTANCE FROM VARIOUS DEPARTMENTS THROUGHOUT THE ORGANIZATION. THE FORM 990 WAS REVIEWED BY INTERNAL LEADERSHIP AND OUR EXTERNAL TAX ADVISORS. UPON COMPLETION OF THE VARIOUS REVIEWS, THE FORM 990 WAS PROVIDED TO THE BOARD OF THE ORGANIZATION FOR APPROVAL PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Line 12c	MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: The organization monitors and enforces compliance with the Conflict of Interest policy by means of a survey developed and approved by the Chief Compliance Officer. The survey is sent to all trustees, officers, and key executives for completion. All survey responses are reviewed by the Chief Compliance Officer. Any potential conflicts identified in the responses are discussed with senior management and/or referred to the WMC Health Conflicts of Interest Committee for discussion. Potential actions to be taken in response to a conflict can be one or more of the following: 1) disclosure of the conflict, 2) individual recusal from decisions for transactions where that individual may have a conflict, 3) request in writing THAT the individual alleviates the conflict, or 4) removal of the individual from employment.
FORM 990, PART VI, LINE 15	process for determining compensation: The organization has a comprehensive process for the oversight and management of remuneration for the CEO and other senior executives. Compensation for such key employees is set by reviewing and relying on objective market data to ensure they receive compensation that is in full compliance with the IRS' rebuttable presumption of reasonableness. The organization maintains a compensation philosophy, reviews pay practices against LOCAL, REGIONAL AND NATIONAL healthcare organizations and approves all remunerative decisions for this group of individuals. Further, the organization ensures that all levels of pay within the organization are reasonable based on performance and validates that incentives payments, if any, are adequately supported. Such decisions are documented in Board and other relevant Committee minutes.
Form 990, Part VI, Line 19	PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A: SISTER MAUREEN SULLIVAN DOES NOT RECEIVE COMPENSATION AS SHE HAS TAKEN A VOW OF POVERTY. FORM 990, PART VII, SECTION B: A PORTION OF THE AMOUNT PAID TO HOLT CONSTRUCTION CORP AND SKANSKA USA BUILDING INC MAY INCLUDE EXPENSE REIMBURSEMENTS. THIS AMOUNT IS NOT EASILY DISTINGUISHABLE.
Form 990, Part XI, Line 9	Other changes in net assets: Transfers to Affiliates $88,422,463

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:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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 CHARITY HEALTH SYSTEM AFFILIATED
GROUP

Employer identification number

45-2964467

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)WMC HEALTH NETWORK - ROCKLAND INC 100 WOODS ROAD VALHALLA,NY10595 32-0467873	SUPPORTING	NY	501(C)(3)	12A	NA		No
(2)WMC HEALTH NETWORK - ULSTER INC 100 WOODS ROAD VALHALLA,NY10595 32-0477183	SUPPORTING	NY	501(C)(3)	12A	WCHCC		No
(3)WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA,NY10595 13-3964321	HEALTHCARE	NY	115	N/A	NA		No
(4)WMC NEW YORK INC 100 WOODS ROAD VALHALLA,NY10595 13-4107894	FUNDRAISING	NY	501(C)(3)	12A	WCHCC		No
(5)NORTH ROAD LHCSA INC 241 NORTH ROAD POUGHKEEPSIE,NY12601 46-5293268	HOMECARE SVCS	NY	501(C)(3)	10	WCHCC		No
(6)MID-HUDSON VALLEY EARLY EDUCATION CENTER 100 WOODS RD TAYLOR PAVILION VALHALLA,NY10595 46-5534882	PRESCHOOL	NY	501(C)(3)	7	WCHCC		No
(7)WESTCHESTER MEDICAL CENTER FOUNDATION 100 WOODS ROAD VALHALLA,NY10595 13-4095845	FUNDRAISING	NY	501(C)(3)	7	WCHCC		No
(8)HEALTHALLIANCE INC 741 GRANT AVENUE LAKE KATRINE,NY12449 26-1850453	SUPPORTING	NY	501(C)(3)	12A	WCHCC		No
(9)HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS 396 BROADWAY KINGSTON,NY12401 14-1349558	EXEMPT HOSP	NY	501(C)(3)	3	HA INC		No
(10)HEALTHALLIANCE HOSP MARY'S AVE CAMPUS 105 MARYS AVENUE KINGSTON,NY12401 14-1338470	EXEMPT HOSP	NY	501(C)(3)	3	HA INC		No
(11)MARGARETVILLE MEMORIAL HOSPITAL 42084 STATE ROUTE 28 MARGARETVILLE,NY12455 15-0552726	EXEMPT HOSP	NY	501(C)(3)	3	HA INC		No
(12)MARGARETVILLE NURSING HOME INC 42158 STATE HIGHWAY 28 MARGARETVILLE,NY12455 22-3143565	NURSING HOME	NY	501(C)(3)	10	MMH		No
(13)MARGARETVILLE HEALTH FOUNDATION 42084 STATE HIGHWAY 28 MARGARETVILLE,NY12455 26-1998454	SUPPORT FDN	NY	501(C)(3)	12A	MMH		No
(14)GOOD SAMARITAN FDN FOR BETTER HEALTH 255 LAFAYETTE AVE SUFFERN,NY10901 13-3400353	SUPPORT FDN	NY	501(C)(3)	7	BSCHS		No
(15)BON SECOURS COMMUNITY HOSPITAL FDN 255 LAFAYETTE AVE SUFFERN,NY10901 81-0667395	SUPPORT FDN	NY	501(C)(3)	7	BSCHS		No
(16)BON SECOURS WARWICK HEALTH FOUNDATION 255 LAFAYETTE AVE SUFFERN,NY10901 14-1972807	SUPPORT FDN	NY	501(C)(3)	7	BSCHS		No
(17)BON SECOURS CHARITY HEALTH SYSTEM INC 255 LAFAYETTE AVE SUFFERN,NY10901 91-2135195	SUPPORTING	NY	501(C)(3)	12C, III-FI	WCHCC		No
(18)HealthAlliance Foundation Inc 741 GRANT AVENUE LAKE KATRINE,NY12449 22-2511450	FUNDRAISING	NY	501(C)(3)	7	HA INC		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	(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

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) HUDSON RIVER WEST INSURANCE LIMITED 23 LIME TREE BAY AVE PO BOX 1051 GRAND CAYMANKY1-1102 CJ	CAP INSURANCE	CJ	BSCHS	C CORP					No
(2) HUDSON RIVER NORTH INSURANCE LIMITED 23 LIME TREE BAY AVE PO BOX 1051 GRAND CAYMANKY1-1102 CJ	CAP INSURANCE	CJ	HEALTHALLIANCE	C CORP					No
(3) NORTHEAST PROVIDER SOLUTIONS INC 100 WOODS ROAD VALHALLA,NY10595 13-3991673	MSO & HEARING AID	NY	NA	C CORP					No
(4) WMC ADVANCED PHYSICIAN SERVICES PC 19 BRADHURST AVENUE HAWTHORNE,NY10595 26-4709927	PHYSICIAN OFFICES	NY	NA	C CORP					No
(5) WESTCHESTER MEDICAL REGIONAL PHYS SVCS 241 NORTH ROAD POUGHKEEPSIE,NY10532 46-5522536	PHYSICIAN OFFICES	NY	NA	C CORP					No
(6) WCHCC (BERMUDA) LIMITED VICTORIA HALL 11 VICTORIA STREET HAMILTON BD	CAP INSURANCE	BD	NA	C CORP					No
(7) KINGSTON REGIONAL HEALTH CARE ENTERPRISE 396 BROADWAY KINGSTON,NY12401 16-1514994	INVESTMENT	NY	HAH BWAY	C CORP					No
(8) MID HUDSON PHYSICIANS PC 396 BROADWAY KINGSTON,NY12401 20-3564769	MEDICAL SVCS	NY	NA	C CORP					No
(9) BSCHS MEDICAL GROUP PC 10 FRANKLIN TURNPIKE MAHWAH,NJ07430 82-1632215	PHYSICIAN OFFICES	NJ	BSCHS	C CORP					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) ............................

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

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

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

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

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

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

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

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

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

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

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

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:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO OPERATE SEVERAL ACUTE CARE HOSPITALS, LONG-TERM CARE FACILITIES AND OTHER HEALTHCARE SERVICES FOR THE RESIDENTS OF THE COMMUNITIES SERVED.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	4,153
6	Total number of volunteers (estimate if necessary) .............	6	172
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,537,904	100,568,312
9	Program service revenue (Part VIII, line 2g) .........	563,879,753	485,723,128
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,074,227	465,126
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	10,731,180	10,979,832
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	580,223,064	597,736,398
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	52,613	13,732
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	325,744,446	331,990,244
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	272,459,902	272,705,823
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	598,256,961	604,709,799
19	Revenue less expenses. Subtract line 18 from line 12.......	-18,033,897	-6,973,401
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	214,623,748	200,653,211
21	Total liabilities (Part X, line 26).............	224,750,489	306,175,816
22	Net assets or fund balances. Subtract line 21 from line 20.....	-10,126,741	-105,522,605

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 522,611,097 including grants of $ 13,732 ) (Revenue $ 496,458,927 )
	BON SECOURS CHARITY HEALTH SYSTEM AFFILIATED GROUP IS COMPOSED OF THREE ACUTE CARE HOSPITALS, A PRIMARY AND SPECIALTY MEDICAL CARE PRACTICE AND TWO LONG-TERM CARE AND RESIDENTIAL FACILITIES: GOOD SAMARITAN HOSPITAL OF SUFFERN, NY; BON SECOURS COMMUNITY HOSPITAL; ST. ANTHONY COMMUNITY HOSPITAL; BON SECOURS CHARITY HEALTH SYSTEM MEDICAL GROUP, PC; ST. FRANCIS CENTER AT THE KNOLLS (DBA MOUNT ALVERNO CENTER); AND VILLAS FRANCIS AT THE KNOLLS (DBA SCHERVIER PAVILION). GOOD SAMARITAN HOSPITAL (GSH) OPERATES A 286-BED HOSPITAL LOCATED IN SUFFERN, NEW YORK THAT PROVIDES EMERGENCY, MEDICAL, SURGICAL, OBSTETRICAL/GYNECOLOGICAL AND ACUTE CARE SERVICES TO ROCKLAND AND ORANGE COUNTIES, NEW YORK AND NORTHERN BERGEN COUNTY, NEW JERSEY. GSH HAS A DESIGNATED STROKE CENTER AND ACUTE MYOCARDIAL INFARCTION (AMI) PROGRAM, AND A REGIONAL CARDIOVASCULAR PROGRAM, PROVIDING OPEN HEART SURGERY, A CARDIAC CATHETERIZATION LABORATORY, EMERGENCY ANGIOPLASTY, ELECTROPHYSIOLOGY STUDIES AND A PACEMAKER CLINIC. GSH IS THE ONLY FACILITY IN THE REGION WITH AN ANGIOGRAPHY SUITE TO TREAT VASCULAR DISEASE WITH NEW 3D DIAGNOSTIC EQUIPMENT WHICH PROVIDES IMAGE GUIDED THERAPY TO EVALUTE ARTERIES AND VEINS TO IDENTIFY BLOCKAGES MORE PRECISELY. GSH HAS BEEN NAMED ONE OF HEALTH GRADES AMERICA'S 100 BEST HOSPITAL'S FOR CORONARY INTERVENTION FOR 3 YEARS IN A ROW (2018-2020). ALONG WITH THE CORONARY INTERVENTION EXCELLENCE AWARD FROM HEALTHGRADES, GSH HAS RECEIVED MANY AWARDS AND IN 2014 WAS NAMED ONE OF THE NATION'S 50 TOP CARDIOVASCULAR HOSPITALS BY TRUVEN HEALTH ANALYTICS. GSH OFFERS A COMPREHENSIVE WOMEN'S BREAST CENTER, WOUND AND HYPERBARIC CENTER, SLEEP STUDY CENTER AND MATERNAL/CHILD SERVICES, INCLUDING A LEVEL II NEONATAL INTENSIVE CARE UNIT SUPPORTED BY PEDIATRIC SUBSPECIALISTS FROM WESTCHESTER MEDICAL CENTER (WMC). THE WOMEN'S BREAST CENTER AT GSH IS THE ONLY FACILITY IN THE AREA THAT OFFERS A HIGH RISK SCREENING PROGRAM TO IDENTIFY WOMEN WHO MEET CRITERIA FOR HIGH RISK, DURING THEIR ROUTINE SCREENINGS. GSH'S SURGICAL WEIGHT LOSS INSTITUTE PROVIDES PRE-OPERATIVE, SURGICAL CARE AND OUTPATIENT POST-OPERATIVE BARIATRIC SUPPORT. GSH ALSO PROVIDES KIDNEY DIALYSIS, PSYCHIATRIC AND SUBSTANCE ABUSE SERVICES AND A RANGE OF SOCIAL SUPPORT SERVICES, EDUCATION AND POPULATION HEALTH SERVICES. THE OB EMERGENCY DEPARTMENT IN COLLABORATION WITH THE OB HOSPITALIST PROGRAM PROVIDES EMERGENCY OBSTETRICAL SERVICES IN THE OB EMERGENCY DEPARTMENT. THE OB-GYN DEPARTMENT RECEIVED THE HEALTHGRADES FIVE STAR AWARD FOR VAGINAL DELIVERY FOR THE 6 CONSECUTIVE YEARS (2015-2020) BY HEALTHGRADES, AS WELL AS THE OBSTETRICS AND GYNECOLOGY EXCELLENCE AWARD FOR 2 CONSECUTIVE YEARS (2019-2020). THE CAMPUS ALSO INCLUDES A MEDICAL OFFICE BUILDING HOUSING A STATE-OF-THE-ART AMBULATORY SURGERY CENTER, WHICH INCLUDES PRIMARY CARE AND SPECIALTY PHYSICIANS. GSH'S CERTIFIED HOME CARE AGENCY PROVIDES HOME HEALTH SERVICES TO THE RESIDENTS OF ROCKLAND AND ORANGE COUNTIES, NEW YORK. THIS PROGRAM IS FOR PATIENTS WHO HAVE ACUTE NEEDS AND REQUIRE HOME CARE FOR A RELATIVELY SHORT PERIOD OF TIME AND WILL BE DISCHARGED WHEN THEY ARE STABILIZED OR RETURNED TO A PRE-ILLNESS LEVEL OF FUNCTIONING. ADDITIONAL SERVICES INCLUDE WOUND AND OSTOMY ASSESSMENTS, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, MEDICAL SOCIAL WORK, NUTRITION AND HOME HEALTH AIDES. THE HOME HEALTH AGENCY IS CERTIFIED FOR EXPANSION INTO MANHATTAN AND WESTCHESTER COUNTY, NEW YORK. BON SECOURS COMMUNITY HOSPITAL (BSCH) OPERATES A 122-BED ACUTE CARE HOSPITAL LOCATED IN PORT JERVIS, NEW YORK THAT PROVIDES COMMUNITY-BASED CARE TO RESIDENTS IN THE PORT JERVIS, NEW YORK AND SURROUNDING AREAS (ORANGE AND SULLIVAN COUNTIES IN NEW YORK, SUSSEX COUNTY IN NEW JERSEY AND PIKE COUNTY IN PENNSYLVANIA). BSCH PROVIDES EMERGENCY CARE, LABORATORY AND IMAGING SERVICES, MEDICAL AND SURGICAL SERVICES, INTENSIVE CARE UNIT, INPATIENT DIALYSIS, CARDIOPULMONARY CARE, INFUSION THERAPY OUTPATIENT WOUND CARE, AND A DIABETES PROGRAMS. BSCH ALSO OFFERS INPATIENT PSYCHIATRIC SERVICES AND A CHEMICAL DEPENDENCY PROGRAM. A MEDICAL OFFICE BUILDING WITH PRIMARY CARE AND DIAGNOSTIC SERVICES IS LOCATED ACROSS THE STREET FROM BSCH. BSCH ALSO OFFERS A WIDE RANGE OF HEALTH EDUCATION AND POPULATION HEALTH SUPPORT SERVICES FOR THE COMMUNITY. ST. JOSEPH'S PLACE IS A 46-BED NURSING CARE CENTER LOCATED ON THE FIRST FLOOR OF BSCH THAT PROVIDES 24-HOUR NURSING CARE, LONG- AND SHORT-TERM REHABILITATION, TRACHEOTOMY CARE, HEAD TRAUMA CARE, RESPIRATORY CARE AND PSYCHOLOGICAL SERVICES. ST. ANTHONY COMMUNITY HOSPITAL (SACH) OPERATES A 60-BED HOSPITAL THAT IS LOCATED IN WARWICK, NEW YORK SERVING THE RESIDENTS OF ORANGE COUNTY, NEW YORK, AND SUSSEX AND PASSAIC COUNTIES, NEW JERSEY. SACH PROVIDES EMERGENCY CARE, MEDICAL AND SURGICAL SERVICES, LABORATORY AND IMAGING SERVICES, OBSTETRICAL, GYNECOLOGICAL AND ORTHOPEDICS. THE SACH AMBULATORY SERVICES CENTER PROVIDES VARIOUS CONVENIENT SERVICES, INCLUDING ADMITTING, PRE-ADMISSION SCREENING, ENDOSCOPY, MINOR SURGERY AND SAME-DAY SURGERY. AN INFUSION CENTER PROVIDES LONG-TERM INTRAVENOUS ANTIBIOTICS, BLOOD TRANSFUSIONS, IRON THERAPY, CHEMOTHERAPY AND LONG-TERM CATHETER INSERTION AND MAINTENANCE. SACH EDUCATION AND OUTREACH SERVICES INCLUDE A DIABETES EDUCATION PROGRAM AND POPULATION HEALTH IMPROVEMENT PROGRAMS. BON SECOURS CHARITY HEALTH SYSTEM MEDICAL GROUP, PC (MEDPC) PROVIDES MEDICAL SERVICES TO SUFFERN, NEW YORK AND SURROUNDING COMMUNITIES. THEIR SERVICES INCLUDE PRIMARY CARE AND VARIOUS SPECIALTY PROFESSIONAL SERVICES. THE ORGANIZATION SEEKS TO LOCATE ITS PHYSICIAN PRACTICE SITES IN AREAS THAT MOST EFFECTIVELY MEET THE NEEDS OF THE COMMUNITY. VILLA FRANCIS AT THE KNOLLS, INC. D/B/A SCHERVIER PAVILION (SCHERVIER) IS A 122-BED, SKILLED NURSING FACILITY LOCATED IN WARWICK, NEW YORK. SCHERVIER PROVIDES THERAPEUTIC AND SOCIAL ACTIVITIES DESIGNED TO ENHANCE THE PHYSICAL AND MENTAL CAPABILITIES TO HELP RESIDENTS MAINTAIN AND OPTIMIZE THEIR LEVEL OF DAILY INDEPENDENCE. SCHERVIER IS PART OF THE 27-ACRE WARWICK CAMPUS THAT INCLUDES MOUNT ALVERNO CENTER AND SACH. LOCATED IN SCHERVIER IS A FULL-SERVICE ADULT DAY CARE PROGRAM KNOWN AS DAY-AT-A-TIME. IT PROVIDES HEALTH CARE, RECREATIONAL AND THERAPEUTIC ACTIVITIES FROM TWO TO FIVE DAYS PER WEEK FOR THE COGNITIVELY IMPAIRED AND PHYSICALLY FRAIL. THE PROGRAM PROVIDES AN ALTERNATIVE TO NURSING HOME PLACEMENT AND HOME HEALTH CARE. ST. FRANCIS CENTER AT THE KNOLLS, INC. D/B/A MOUNT AVERNO CENTER (MOUNT ALVERNO) IS AN ADULT HOME LOCATED ON THE SACH CAMPUS WITH AN ASSISTED LIVING PROGRAM SERVING 85 RESIDENTS BY PROVIDING INDIVIDUALIZED CARE PLANS DESIGNED TO HELP RESIDENTS REACH AND MAINTAIN A MAXIMUM LEVEL OF INDEPENDENCE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses522,611,097

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) SANDRA GRANNUM........................................................................ BOARD MEMBER	1.0 .......................1.0	X	0	0	0
(19) STEVEN KENT........................................................................ BOARD MEMBER	1.0 .......................1.0	X	0	0	0
(20) LAISHY WILLIAMS CARLSON........................................................................ BOARD MEMBER	1.0 .......................1.0	X	0	0	0
(21) SR ANNE MARIE MACK........................................................................ BOARD MEMBER (EFFECT. 3/20)	1.0 .......................1.0	X	0	0	0
(22) SR MAUREEN SULLIVAN........................................................................ BOARD MEMBER (EFFECT. 9/20)	1.0 .......................39.0	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,505,194	9,532,241	884,658

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,478,544
e	Government grants (contributions)		1e	98,377,407

f	All other contributions, gifts, grants, and similar amounts not included above		1f	712,361

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

h Total. Add lines 1a-1f.......		100,568,312

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	484,798,282	484,798,282
b	CAPITATION REVENUE	623000	924,846	924,846
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		485,723,128

3 Investment income (including dividends, interest, and othersimilar amounts) ......			452,698			452,698
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		811,193	6a
b	Less: rental expenses		567,160	6b
c	Rental income or (loss)	0	244,033	6c
d	Net rental income or (loss).......			244,033			244,033
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	12,428		7a
b	Less: cost or other basis and sales expenses	0		7b
c	Gain or (loss)	12,428		7c
d	Net gain or (loss).........			12,428			12,428
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	REBATES & GPO DISCOUNTS		900099	4,130,109	4,130,109
b	NYS DELIVERY SYSTEM REFORM INCENTIVE PYMTS		900099	3,370,027	3,370,027
c	SERVICE AGREEMENTS		900099	1,877,450	1,877,450
d	All other revenue ....			1,358,213	1,358,213
e	Total. Add lines 11a–11d ......			10,735,799
12	Total revenue. See instructions.....			597,736,398	496,458,927		709,159

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	13,732	13,732
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	515,116	51,512	463,604
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	248,407,949	228,757,961	19,649,988
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,741,076	6,861,729	1,879,347
9	Other employee benefits .......	54,826,554	52,276,178	2,550,376
10	Payroll taxes ...........	19,499,549	17,776,688	1,722,861
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	520,969	20,316	500,653
c	Accounting ...........	491,351		491,351
d	Lobbying ...........	56,949		56,949
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	28,064,799	28,031,653	33,146
12	Advertising and promotion ....	582,090	42,504	539,586
13	Office expenses .......	9,099,499	6,907,074	2,192,425
14	Information technology ......	3,437,694	1,593,396	1,844,298
15	Royalties ..	0
16	Occupancy ...........	16,014,795	10,593,268	5,421,527
17	Travel ............	652,599	572,302	80,297
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	161,502	46,169	115,333
20	Interest ...........	7,966,109	7,966,109
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	25,017,476	24,824,909	192,567
23	Insurance ...	12,105,376	10,974,018	1,131,358
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	70,885,973	70,885,973
b	PURCHASED SERVICES	42,776,523	26,389,607	16,386,916
c	OUTSOURCED SERVICES	45,142,336	19,320,045	25,822,291
d	OTHER EXPENSES	9,729,783	8,705,954	1,023,829
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	604,709,799	522,611,097	82,098,702	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 ........			676,493	1	601,596
2	Savings and temporary cash investments .........			281,238	2	34,574
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			70,795,298	4	48,940,419
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 ...........			0	7	0
8	Inventories for sale or use ............			10,678,849	8	12,011,929
9	Prepaid expenses and deferred charges ......			3,395,968	9	2,792,994
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	444,663,081
b	Less: accumulated depreciation	10b	312,429,552	122,644,677	10c	132,233,529
11	Investments—publicly traded securities .			30,086	11	30,086
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			6,121,139	15	4,008,084
16	Total assets. Add lines 1 through 15 (must equal line 33)...			214,623,748	16	200,653,211

17	Accounts payable and accrued expenses .....	71,274,579	17	81,556,807
18	Grants payable ...	0	18	0
19	Deferred revenue .........	907,222	19	610,001
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	171,808	21	156,443
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 ..	124,869,876	23	125,361,593
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	27,527,004	25	98,490,972
26	Total liabilities. Add lines 17 through 25..	224,750,489	26	306,175,816

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-10,962,970	27	-106,358,834
28	Net assets with donor restrictions ...........	836,229	28	836,229
	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 ...........	-10,126,741	32	-105,522,605
33	Total liabilities and net assets/fund balances ........	214,623,748	33	200,653,211