TY 2022 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/1099-NEC)
(1) JOHN HEIMERDINGER SECRETARY	1.0 ................. 8.0	X	X	0	0	0
(2) MARY LEAHY MD PRESIDENT & CEO	36.0 ................. 4.0	X	X	0	1,243,364	108,073
(3) MICHAEL ISRAEL VICE CHAIR	1.0 ................. 39.0	X	X	0	3,405,987	57,096
(4) RICHARD WISHNIE CHAIR	1.0 ................. 5.0	X	X	0	0	0
(5) SR ANNE LUTZ BSMH REP	1.0 ................. 39.0	X	X	0	0	0
(6) SR MAUREEN SULLIVAN BSMH REP	1.0 ................. 39.0	X	X	0	0	0
(7) TAMER EL-RAYESS MD 1ST VICE CHAIR & TREASURER	1.0 ................. 2.0	X	X	0	0	0
(8) GARY BRUDNICKI BOARD MEMBER	1.0 ................. 39.0	X		0	2,333,526	70,137
(9) JOSHUA RATNER BOARD MEMBER	1.0 ................. 39.0	X		0	1,068,839	80,357
(10) JULIE SWITZER BOARD MEMBER	1.0 ................. 39.0	X		0	1,062,607	47,287
(11) LAISHY WILLIAMS CARLSON BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(12) MICHAEL ROSENBLUT BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(13) RENEE GARRICK MD BOARD MEMBER	1.0 ................. 39.0	X		0	1,168,872	66,731
(14) SANDRA GRANNUM BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(15) STEVEN KENT BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(16) SUSAN GEVERTZ BOARD MEMBER	1.0 ................. 2.0	X		0	0	0
(17) PETER KENNIFF CFO - thru 10/2022	39.0 ................. 1.0		X	8,274	0	616

(A) Name and business address	(B) Description of services	(C) Compensation
SHIFTWISE INC 2121 N 117 AVENUE STE 200 OMAHA,NE68164	TEMPORARY SUPPORT	9,117,958
CROTHALL HEALTHCARE INC 13028 COLLECTIONS CTR CHICAGO,IL60693	ENGINEERING	7,359,160
MORRISON HEALTHCARE PO BOX 102289 ATLANTA,GA30368	FOOD SERVICES	6,435,050
ACCESS REHABILITATION SERVICES 16 MAYBROOK RD STE H CAMPBELL HALL,NY10916	REHAB SERVICES	5,791,800
E4 SERVICES LLC 1540 INTERNATIONAL PKWY STE 2000 LAKE MARY,FL32746	IT SUPPORT	4,279,996
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 116

- TIN:

SCHEDULE A
(Form 990)

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

2022

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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	1,650,443	1,740,145	1,455,869	1,145,190	1,003,325	6,994,972
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	1,650,443	1,740,145	1,455,869	1,145,190	1,003,325	6,994,972
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons	0	0	0	0	0	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.	0	0	824,516	1,118,307	920,152	2,862,975
c	Add lines 7a and 7b..	0	0	824,516	1,118,307	920,152	2,862,975
8	Public support. (Subtract line 7c from line 6.)						4,131,997

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
9	Amounts from line 6...	1,650,443	1,740,145	1,455,869	1,145,190	1,003,325	6,994,972
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	0	0	0	0	0
11	Net income from unrelated business activities not included on 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.) ..	102,789	111,496	95,589	92,237	109,788	511,899
13	Total support. (Add lines 9, 10c, 11, and 12.)..	1,753,232	1,851,641	1,551,458	1,237,427	1,113,113	7,506,871

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 2022 (line 8, column (f) divided by line 13, column (f)) .........

55.04 %

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

70.46 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

0 %

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

0 %

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

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) .

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

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 on 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 on 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) 2022

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

11a

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

11b

A 35% controlled entity of a person described on 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 on 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) 2022

Page 6

Part V

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

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

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

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

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

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

Schedule A (Form 990) 2022

Page 7

Part V

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

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2022 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

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, Part III, Line 12 Other Income	DESCRIPTION - OTHER INCOME, COLUMN A - 102789.0, COLUMN B - 111496.0, COLUMN C - 95589.0, COLUMN D - 92237.0, COLUMN E - 109788.0, COLUMN F - 511899.0;

Schedule A (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

Schedule B
(Form 990)

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

2022

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) (2022)

Schedule B (Form 990) (2022) 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) (2022)

Schedule B (Form 990) (2022)

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) (2022)

Schedule B (Form 990) (2022)

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) (2022)

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE C
(Form 990)

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

2021

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

138,839

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

138,839

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
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	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) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2021

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) 2021

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 ....	229,000,110	136,972,217	92,027,893
c	Leasehold improvements	1,287,641	1,158,682	128,959
d	Equipment ....	250,562,316	211,429,268	39,133,048
e	Other .....	77,602,908	10,484,903	67,118,005
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				203,439,864

Schedule D (Form 990) 2021

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

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	73,265,748
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) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part IV, Line 2b Explanation of escrow agreement

CERTAIN FACILITIES HOLD, SAFEGUARD, MANAGE AND ACCOUNT FOR THE PERSONAL FUNDS OF RESIDENTS WHO HAVE AUTHORIZIZED 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 TIMEFRAME. GENERALLY, ALL CUSTODIAL FUNDS IN EXCESS OF $50 ARE HELD IN INTEREST BEARING ACCOUNTS SEPARATE FROM THAT OF THE FACILITIES.

Schedule D (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2022

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 25000 %

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 50000 %

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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			1,996,552	41,898	1,954,654	0.30 %
b	Medicaid (from Worksheet 3, column a) . . . . .			117,468,430	69,214,112	48,254,318	7.49 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	119,464,982	69,256,010	50,208,972	7.79 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).		110,652	4,623,734	0	4,623,734	0.72 %
f	Health professions education (from Worksheet 5) . . .		974	1,050,013		1,050,013	0.16 %
g	Subsidized health services (from Worksheet 6) . . . .			6,934,297		6,934,297	1.08 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .		2,300	64,716		64,716	0.01 %
j	Total. Other Benefits . .	0	113,926	12,672,760	0	12,672,760	1.97 %
k	Total. Add lines 7d and 7j .	0	113,926	132,137,742	69,256,010	62,881,732	9.76 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing					0	0 %
2	Economic development					0	0 %
3	Community support		838	238,277	0	238,277	0.04 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy		405	158,130	0	158,130	0.02 %
8	Workforce development		90	754,918	0	754,918	0.12 %
9	Other		270	44,509	0	44,509	0.01 %
10	Total	0	1,603	1,195,834	0	1,195,834	0.19 %

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. ......

34,356,197

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).....

121,196,865

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

180,859,002

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

-59,662,137

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) 2022

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	GOOD SAMARITAN HOSPITAL OF SUFFERNNY 255 LAFAYETTE AVE SUFFERN,NY10901 GOODSAMHOSP.ORG 4329000H/XXX-XX-XXXX	X	X	X	A
2	ST ANTHONY COMMUNITY HOSPITAL 15 MAPLE AVENUE WARWICK,NY10990 STANTHONYCOMMUNITYHOSP.ORG 3529000H/XXX-XX-XXXX	X	X	X	A
3	BON SECOURS COMMUNITY HOSPITAL 160 EAST MAIN STREET PORT JERVIS,NY12771 BONSECOURSCOMMUNITYHOSP.ORG 3535001H/XXX-XX-XXXX	X	X	X	A

Schedule H (Form 990) 2022

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)

	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):

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 22

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): https://www.goodsamhosp.org/community-health-needs-assessment2; https://www.bonsecourscommunityhosp.

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 22

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

Yes

If "Yes" (list url): https://www.goodsamhosp.org/Uploads/Public/Documents/Good%20Samaritan/Healthy%20Communities%20ACO/We

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) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	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 250.0%
and FPG family income limit for eligibility for discounted care of 500.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX

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

http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX

A plain language summary of the FAP was widely available on a website (list url):
http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX

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) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

	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) 2022

Page 7

Part VFacility Information (continued)

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

	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) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. In 2022, the Bon Secours Charity Health System hospitals partnered with the Rockland County (NY) and Orange County (NY) Health Departments, other county hospitals, health and human service agencies, and the community at large from within the greater Rockland and Orange County area to assess the health needs of the communities and to develop a comprehensive Community Health Needs Assessment (CHNA) and Community Health Improvement Plan. The research and analysis that went into choosing the health priorities was extensive and the areas of focus were chosen with the goal of improving the health and wellbeing of all residents within the service area. From March - May 2022, hospitals and the seven Local Health Departments of the Mid-Hudson (NY) Region: Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester, partnered with the Siena College Research Institute (SCRI) to conduct a public opinion survey of 5,699 Hudson Valley NY residents. Residents aged 18 and older were interviewed from within the above mentioned counties to ensure representative county-wide samples. SCRI contacted respondents via landline telephone, cell phone, an online panel, online surveys at various in-person events, and other community partnerships to enhance representation from across the region. To further supplement the data collected, several community focus group sessions were held. In the summer of 2022, county hospitals, along with the Rockland and Orange County Epidemiologists, and health department staffs, discussed areas of identified need, health disparities and areas of community assets and strength. Through community asset surveys, local residents provided their feedback on community strengths, where to focus resources to improve quality of life, and top health issues in their communities. A majority of the community felt that increasing access to basic healthcare was an important goal and the health issues that residents identified as the most concerning were preventable and chronic diseases, drug use (prescription and illegal), mental health (depression, anxiety, stress), and aging problems. Other discussions with community members highlighted a growing concern about access to affordable and nutritious food and housing. This combination of data gathering and prioritization offered valuable insight into the needs of specific communities and populations as well as the barriers they face to achieving optimal health. As guidance for the hospital CHNAs, all data gathered through this collaborative process served as the required research and public input to identify public health needs and develop action plans necessary to address the specific needs of the communities the hospital serves.
Schedule H, Part V, Section B, Line 6a Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. THE FOLLOWING HOSPITALS WITHIN BON SECOURS CHARITY HEALTH SYSTEM CONDUCTED A JOINT COMMMUNITY HEALTH NEEDS ASSESSMENT (CHNA): GOOD SAMARITAN HOSPITAL OF SUFFERN, NY (GSH); ST. ANTHONY COMMUNITY HOSPITAL (SACH); BON SECOURS COMMUNITY HOSPITAL (BSCH).
Schedule H, Part V, Section B, Line 7 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. 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.
Schedule H, Part V, Section B, Line 11 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. The Bon Secours Charity Health System's individual hospital 2022 - 2024 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: * Increase Cancer Screening Rates for breast, cervical, and colorectal cancers * Improve Vaccination Rates In partnership with the Orange County health department, Orange county hospitals, 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: * Increase access to healthy and affordable foods and beverages * Increase food security * Increase Cancer Screening Rates for breast, cervical, and colorectal cancers * Prevent opioid and other substance misuse and deaths All three hospitals within the Bon Secours Charity Health System have chosen to work towards increasing Cancer Screening Rates as one of the community health improvement goals. To achieve this, the following evidence based interventions have been chosen: * Remove structural barriers to cancer screening by increasing primary care provider connections * Remove economic barriers to cancer screening by ensuring access to health insurance Good Samaritan Hospital will also work on Improving Vaccination Rates with the following action: * Implement and promote the use of Standing orders for vaccinations during inpatient hospitalizations. The NYS Prevention Agenda outlines that this strategy is specific for Influenza vaccines for ages 6 months and older and Pneumonia vaccines for ages 65 and older Bon Secours Community Hospital and St. Anthony Community Hospital have jointly chosen to also work towards increasing access to healthy and affordable foods and beverages and increasing food security with the following actions: * Screen for food insecurity, facilitate and actively support referrals Bon Secours Community Hospital and St. Anthony Community Hospital will also jointly implement the following actions to prevent opioid and other substance misuse and deaths: * Increase the availability of Medication Assisted Therapy, including Buprenorphine * Promote and support the expansion of the Peer RX application for peer referrals at the ED * Establish additional permanent safe disposal sites for prescription drugs and distribution of Naloxone boxes
Schedule H, Part V, Section B, Line 13 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. 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.
Schedule H, Part V, Section B, Line 15 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. 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.
Schedule H, Part V, Section B, Line 16 Facility A, 1	Facility A, 1 - FACILITY REPORTING GROUP A. 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) 2022

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?58
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	CENTER FOR PHYSICAL REHABILITATION 70 HATFIELD LANE GOSHEN,NY10924	OUTPATIENT PHYSICAL THERAPY
5	GOOD SAMARITAN HOME CARE 90 CRYSTAL RUN ROAD WALLKILL,NY10941	HOME CARE
6	CARDIOLOGY CONSULTANTS-STONY POINT 12 LIBERTY SQUARE MALL STONY POINT,NY10980	CARDIOLOGY
7	GOOD SAMARITAN HOME CARE 1 CROSFIELD AVENUE SUITE 202 WEST NYACK,NY10994	HOME CARE
8	METROPOLITAN CARDIOLOGY CONSULTANTS SUFFERN 257 LAFAYETTE AVENUE SUFFERN,NY10901	CARDIOLOGY
9	BON SECOURS NEUROLOGY 100 ROUTE 59 SUFFERN,NY10901	NEUROLOGY
10	BON SECOURS UROLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10901	UROLOGY
11	RAMAPO VALLEY SURGICAL ASSOCIATES 257 LAFAYETTE AVENUE SUFFERN,NY10901	OUTPATIENT AMBULATORY SURGERY
12	RAMAPO VALLEY SURGICAL ASSOCIATES 10 LIBERTY SQUARE MALL STONY POINT,NY10980	OUTPATIENT AMBULATORY SURGERY
13	WOMEN'S IMAGING CENTER 55 RONALD REGAN BOULEVARD WARWICK,NY10990	OUTPATIENT WOMEN'S IMAGING
14	CENTER FOR PHYSICAL REHABILITATION 153 SOUTH ROUTE 94 WARWICK,NY10990	OUTPATIENT REHAB
15	HUDSON VALLEY MEDICAL ASSOCIATES 26 FIREMANS MEMORIAL DRIVE PAMONA,NY10924	INTERNAL MEDICINE
16	METROPOLITAN CARDIOLOGY CONSULTANTS GOSHEN 30 HATFIELD LANE GOSHEN,NY10924	CARDIOLOGY
17	ROCKLAND PULMONARY & MEDICAL ASSOCIATES 257 LAFAYETTE AVENUE SUFFERN,NY10901	PULMONOLOGY
18	MONSIGNOR PATRICK J FRAWLEY MENTAL HEALTH 3 CAMPBELL AVENUE SUFFERN,NY10901	MENTAL HEALTH
19	ROCKLAND HEART & VASCULAR ASSOCIATES 972 ROUTE 45 SUITE 103 PAMONA,NY10970	CARDIOLOGY
20	ED PHYSICIANS 257 LAFAYETTE AVENUE SUFFERN,NY10901	EMERGENCY ROOM
21	MOB PORT JERVIS PRIMARY 161 EAST MAIN STREET PORT JERVIS,NY12771	PRIMARY CARE
22	APS RAMAPO OBGYN 974 ROUTE 45 POMONA,NY10970	OB/GYN
23	APS TALLMAN OBGYN 134 ROUTE 59 SUFFERN,NY10901	OB/GYN
24	CARDIOLOGY CONSULTANTS-WEST NYACK 1 CROSFIELD AVENUE STE 407 WEST NYACK,NY10994	CARDIOLOGY
25	NANUET MEDICAL 36 COLLEGE AVE NANUET,NY10954	INTERNAL MEDICINE
26	ST ANTHONY SLEEP DISORDER INSTITUTE 74 NORTH MAIN STREET FLORIDA,NY10921	SLEEP LAB
27	PORT JERVIS GASTROENTEROLOGY 39 EAST MAIN STREET PORT JERVIS,NY12771	GASTROENTEROLOGY
28	BON SECOURS MEDICAL GROUP 15 MAPLE AVENUE WARWICK,NY10990	INTERNAL MEDICINE
29	MONROE INTERNAL MEDICINE 505 ROUTE 208 MONROE,NY10950	INTERNAL MEDICINE
30	GOSHEN PRIMARY CARE PHYSICIANS 1 HATFIELD LANE GOSHEN,NY10924	PRIMARY CARE
31	ROCKLAND HEART & VASCULAR ASSOCIATES 2 EXECUTIVE BOULEVARD SUITE 406 SUFFERN,NY10901	CARDIOLOGY
32	BON SECOURS MEDICAL GROUP 60 DUTCH HILL RD ORANGEBURG,NY10962	INTERNAL MEDICINE/SPECIALTY
33	MEHTA PULMONARY 55 OLD NYACK TURNPIKE NANUET,NY10954	PULMONOLOGY
34	MAHWAH MEDICAL 10 FRANKLIN TURNPIKE MAHWAH,NJ07430	INTERNAL MEDICINE
35	PAIN MANAGEMENT 257 LAFAYETTE AVENUE SUFFEREN,NY10901	PAIN MANAGEMENT
36	FIRST CARE PHYSICIAN ASSOCIATES 505 ROUTE 208 MONROE,NY10950	PRIMARY CARE
37	ROCKLAND PULMONARY & MEDICAL ASSOCIATES 27 LIBERTY SQUARE MALL STONY POINT,NY10980	PULMONOLOGY
38	ORTHOPEDICS 257 LAFAYETTE AVENUE SUFFERN,NY10901	ORTHOPEDICS
39	GOPAL SHAH MD 33 DELAWARE STREET PORT JERVIS,NY12771	PRIMARY CARE
40	ALAM PCP 906 PENNSYLVANIA AVENUE MATAMORAS,PA18336	PRIMARY CARE
41	PRIMARY MEDICAL CARE ROCKLAND 124 EAST RAMAPO ROAD SUITE 4 GARNERVILLE,NY10923	PRIMARY CARE
42	ROCKLAND HEART & VASCULAR ASSOCIATES 79 ROUTE 59 SUITE 5 SUFFERN,NY10901	CARDIOLOGY
43	WARWICK FAMILY PRACTICE 214 WEST STREET WARWICK,NY10990	INTERNAL MEDICINE
44	BON SECOURS MEDICAL GROUP 5 SKINNER STREET PORT JERVIS,NY12771	CARDIOLOGY
45	LAFAYETTE MEDICAL-GASPARE POLIZZI 599 STATE ROUTE 32 HIGHLAND MILLS,NY10930	PRIMARY CARE
46	BON SECOURS MEDICAL GROUP 2 EXECUTIVE BOULEVARD STE 406 SUFFERN,NY10901	PRIMARY CARE
47	GEORGE COX MD 257 LAFAYETTE AVENUE SUFFERN,NY10901	PRIMARY CARE
48	LUTWAK CARDIOLOGY 505 ROUTE 208 MONROE,NY10950	CARDIOLOGY
49	LUTWAK CARDIOLOGY 4 SOUTH AIRMONT ROAD SUFFERN,NY10901	CARDIOLOGY
50	BYADGI PRIMARY CARE 601 BROAD STREET MILFORD,PA18337	PRIMARY CARE
51	BON SECOURS COMMUNITY SLEEP DISORDER INS 30 CANAL ST STE 2 PORT JERVIS,NY12771	SLEEP LAB
52	NEPHROLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10901	NEPHROLOGY
53	YACOV TENDLER MD 257 LAFAYETTE AVENUE PORT JERVIS,NY12771	CARDIOLOGY
54	APS CARDIAC ANESTHESIA 257 LAFAYETTE AVENUE SUFFERN,NY10901	CARDIOLOGY
55	HEART FAILURE 257 LAFAYETTE AVENUE SUFFERN,NY10901	CARDIOLOGY
56	PRIMARY CARE ASSOCIATES OF ROCKLAND 971 ROUTE 45 STE 204 POMONA,NY10970	PRIMARY CARE
57	RAINFORD CARDIOLOGY 257 LAFAYETTE AVENUE SUFFERN,NY10990	CARDIOLOGY
58	CARDIOLOGY CONSULTANTS-RAMSEY 27 SOUTH FRANKLIN TURNPIKE RAMSEY,NJ07446	CARDIOLOGY

Schedule H (Form 990) 2022

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
Schedule H, Part V, Section B FACILITY REPORTING GROUP A CONSISTS OF:	FACILITY 1: GOOD SAMARITAN HOSPITAL OF SUFFERN, NY (GSH) FACILITY 2: ST. ANTHONY COMMUNITY HOSPITAL (SACH) FACILITY 3: BON SECOURS CCOMMUNITY HOSPITAL (BSCH)
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	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 MEDICAID 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 COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS 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, INITIATED THE FOLLOWING PROGRAMS: PHYSICIAN LIAISON SERVICE AS CASES BEGAN IN THE REGION, BSCSH 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 COVID VACCINE PROGRAM AS PART OF THE WMCHEALTH, BON SECOURS CHARITY HEALTH SYSTEM PROVIDED VACCINES IN CONJUNTION WITH THE NEW YORK STATE VACCINE PROGRAM IN 2022. PART I, LINE 7F HEALTH PROFESSIONS EDUCATION 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 7 THE FOLLOWING CHARITY CARE PECENTAGES HAVE BEEN DERIVED BY ONLY INCLUDING HOSPITAL EXPENSES: PERCENT OF TOTAL EXPENSE LINE 7A: .37 LINE 7B: 9.20 LINE 7D: 9.57 LINE 7E: .88 LINE 7F: .20 LINE 7G: 1.32 LINE 7I .01 LINE 7J: 2.42 LINE 7K: 11.99
Schedule H, Part II Community Building Activities	THE BSCHS COMMUNITY ENGAGEMENT TEAM WORKS WITH THE LOCAL HEALTH DEPARTMENTS, SEVERAL AREA EMPLOYERS AND SPECIFIC GEOGRAPHICAL AND RELIGIOUS GROUPS TO IDENTIFY PERSONAL HEALTH RELATED NEEDS. 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. BASED ON THESE NEEDS: IN 2022, BSCHS CLINICAL STAFF AND PHYSICIANS PROVIDED FREE VIRTUAL AND IN PERSON EDUCATION ON HEALTH-RELATED TOPICS TO CLOSE TO 500 EMPLOYEES AT THE FOLLOWING WORKSITES: ORANGE AND ROCKLAND UTILITIES, EAST RAMAPO SCHOOL DISTRICT, SUFFERN CENTRAL SCHOOL DISTRICT, TOWN OF RAMAPO, SOUTH ORANGETOWN SCHOOL DISTRICT, JCC OF ROCKLAND, NORTH ROCKLAND SCHOOL DISTRICT, ROCKLAND BOCES, WARWICK SCHOOL DISTRICT, THE VILLAGE OF SUFFERN. BSCHS MEDICAL AND PROFESSIONAL STAFF ALSO PARTICIPATE IN WEEKLY LOCAL RADIO STATION INTERVIEWS THROUGH WHICH OVER 60,000 LISTENERS WERE ABLE TO LEARN ABOUT A LARGE SPECTRUM OF MEDICAL CONDITIONS. ALL BSCHS FACILITIES, AND MEDICAL AND ANCILLARY STAFF, CONTINUED TO PARTICIPATE WITH THE NYSDOH IN THEIR EFFORTS TO ADMINISTER FREE COVID VACCINES THROUGHOUT 2022. IN ADDITION TO PROVIDING STAFF TO ADMINISTER THE COVID VACCINES, THE COMMUNITY ENGAGEMENT DIRECTOR PROVIDED 320 FREE SEASONAL FLU SHOTS TO THE COMMUNITY GROUPS AND LOCAL EMPLOYERS. ALSO IN 2022, A MAJOR FOCUS WAS ON FOOD INSECURITY AND HOSPITAL ALEADERSHIP AND SFTAFF FACILITATED T AND PARTICIPATED IN SEVERAL FOOD DRIVES AND PRODUCE DISTRIBUTION EVENTS. ADDITIONALLY, THE FOLLOWING ACTIVITIES AND PROGRAMS THAT BENEFIT THE COMMUNITY CONTINUED IN 2022: GSH CONTINUES TO COLLABORATE WITH THE ROCKLAND PRIDE CENTER, A LOCAL PROVIDER OF SERVICES TO THE LGBT 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. ADDITIONALLY, THROUGH A PARTNERSHIP WITH THE ORANGE COUNTY DEPARTMENT OF HEALTH, THE SACH DIETICIAN WAS ABLE TO DISTRIBUTE FOOD ASSISTANCE BAGS AND FARMERS MARKET VOUCHERS TO PATIENTS WHO SELF IDENTIFIED AS FOOD INSECURE PRIOR TO HOSPITAL DISCHARGE.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	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.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	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.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	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.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	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.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	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.
Schedule H, Part V, Section B, Line 16a FAP website	A - ST. ANTHONY COMMUNITY HOSPITAL: Line 16a URL: http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part V, Section B, Line 16b FAP Application website	A - ST. ANTHONY COMMUNITY HOSPITAL: Line 16b URL: http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	A - ST. ANTHONY COMMUNITY HOSPITAL: Line 16c URL: http://bschs.bonsecours.com/BSCH/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part VI, Line 2 Needs assessment	IN 2022, THE BON SECOURS CHARITY HEALTH SYSTEM HOSPITALS PARTNERED WITH THE ROCKLAND COUNTY (NY) AND ORANGE COUNTY (NY) HEALTH DEPARTMENTS, OTHER COUNTY HOSPITALS, HEALTH AND HUMAN SERVICE AGENCIES, AND THE COMMUNITY AT LARGE FROM WITHIN THE GREATER ROCKLAND AND ORANGE COUNTY AREA TO ASSESS THE HEALTH NEEDS OF THE COMMUNITIES AND TO DEVELOP A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY HEALTH IMPROVEMENT PLAN. THE RESEARCH AND ANALYSIS THAT WENT INTO CHOOSING THE HEALTH PRIORITIES WAS EXTENSIVE AND THE AREAS OF FOCUS WERE CHOSEN WITH THE GOAL OF IMPROVING THE HEALTH AND WELLBEING OF ALL RESIDENTS WITHIN THE SERVICE AREA. FROM MARCH - MAY 2022, HOSPITALS AND THE SEVEN LOCAL HEALTH DEPARTMENTS OF THE MID-HUDSON (NY) REGION: DUTCHESS, ORANGE, PUTNAM, ROCKLAND, SULLIVAN, ULSTER, AND WESTCHESTER, PARTNERED WITH THE SIENA COLLEGE RESEARCH INSTITUTE (SCRI) TO CONDUCT A PUBLIC OPINION SURVEY OF 5,699 HUDSON VALLEY NY RESIDENTS. RESIDENTS AGED 18 AND OLDER WERE INTERVIEWED FROM WITHIN THE ABOVE MENTIONED COUNTIES TO ENSURE REPRESENTATIVE COUNTY-WIDE SAMPLES. SCRI CONTACTED RESPONDENTS VIA LANDLINE TELEPHONE, CELL PHONE, AN ONLINE PANEL, ONLINE SURVEYS AT VARIOUS IN-PERSON EVENTS, AND OTHER COMMUNITY PARTNERSHIPS TO ENHANCE REPRESENTATION FROM ACROSS THE REGION. TO FURTHER SUPPLEMENT THE DATA COLLECTED, SEVERAL COMMUNITY FOCUS GROUP SESSIONS WERE HELD. IN THE SUMMER OF 2022, COUNTY HOSPITALS, ALONG WITH THE ROCKLAND AND ORANGE COUNTY EPIDEMIOLOGISTS, AND HEALTH DEPARTMENT STAFFS, DISCUSSED AREAS OF IDENTIFIED NEED, HEALTH DISPARITIES AND AREAS OF COMMUNITY ASSETS AND STRENGTH. THROUGH COMMUNITY ASSET SURVEYS, LOCAL RESIDENTS PROVIDED THEIR FEEDBACK ON COMMUNITY STRENGTHS, WHERE TO FOCUS RESOURCES TO IMPROVE QUALITY OF LIFE, AND TOP HEALTH ISSUES IN THEIR COMMUNITIES. A MAJORITY OF THE COMMUNITY FELT THAT INCREASING ACCESS TO BAASIC HEALTHCARE WAFS AN IMPORTANTTGOAL AND THE HEALTH ISSUES THAT RESIDENTS IDENTIFIED AS THE MOST CONCERNING WERE PREVENTABLE AND CHRONIC DISEASES, DRUG USE (PRESCRIPTION AND ILLEGAL), MENTAL HEALTH (DEPRESSION, ANXIETY, STRESS), AND AGING PROBLEMS. OTHER DISCUSSIONS WITH COMMUNITY MEMBERS HIGHLIGHTED A GROWING CONCERN ABOUT ACCESS TO AFFORDABLE AND NUTRITIOUS FOOD AND HOUSING. THIS COMBINATION OF DATA GATHERING AND PRIORITIZATION OFFERED VALUABLE INSIGHT INTO THE NEEDS OF SPECIFIC COMMUNITIES AND POPULATIONS AS WELL AS THE BARRIERS THEY FACE TO ACHIEVING OPTIMAL HEALTH. AS GUIDANCE FOR THE HOSPITAL CHNAS, ALL DATA GATHERED THROUGH THIS COLLABORATIVE PROCESS SERVED AS THE REQUIRED RESEARCH AND PUBLIC INPUT TO IDENTIFY PUBLIC HEALTH NEEDS AND DEVELOP ACTION PLANS NECESSARY TO ADDRESS THE SPECIFIC NEEDS OF THE COMMUNITIES THE HOSPITAL SERVES.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	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. 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.
Schedule H, Part VI, Line 4 Community information	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%).
Schedule H, Part VI, Line 5 Promotion of community health	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 2022, the following support groups met either virtually or in person: diabetes, wound and ostomy care, traumatic brain injury, amputee, mended hearts (cardiac support group), and perinatal bereavement. In addition, parenting, newborn care and breastfeeding classes met virtually with staff at Good Samaritan hospital leading those classes. In Port Jervis, the physical therapy department's "get fit Port Jervis" walking club continued to host group walks that were led by a physical therapist. Community members were able to walk as a group outdoors during the mild weather . The healthcare speaker's bureau continued to offer virtual health education to the community and continues to educate the community on broad topics such as cancer prevention and the importance of screenings, cardiac health, orthopedics, women's health, obesity, stroke, diabetes, wound care, trauma prevention, men's health, nutrition and fall prevention.
Schedule H, Part VI, Line 6 Affiliated health care system	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.
Schedule H, Part VI, Line 7 State filing of community benefit report	NY

Schedule H (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

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

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2022

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) 2022

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) TRANSPORTATION FOR INDIGENT PATIENTS	167	13,784	Cost
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation
Schedule I, Part III, Column (b) Estimated Number Of Recipients	TRANSPORTATION FOR INDIGENT PATIENTS : AVERAGE NUMBER OF PARTICIPANTS DETERMINED BASED ON TOTAL COST DIVIDED BY AVERAGE COST PER TRIP.

Schedule I (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2022

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) 2022

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1MICHAEL ISRAEL VICE CHAIR	(i) (ii)	0 ------------- 2,013,987	0 ------------- 1,365,000	0 ------------- 27,000	0 ------------- 0	0 ------------- 57,096	0 ------------- 3,463,083	0 ------------- 0
2MARY LEAHY MD PRESIDENT & CEO	(i) (ii)	0 ------------- 937,936	0 ------------- 305,428	0 ------------- 0	0 ------------- 42,700	0 ------------- 65,373	0 ------------- 1,351,436	0 ------------- 0
3GARY BRUDNICKI BOARD MEMBER	(i) (ii)	0 ------------- 1,556,526	0 ------------- 750,000	0 ------------- 27,000	0 ------------- 0	0 ------------- 70,137	0 ------------- 2,403,663	0 ------------- 0
4RENEE GARRICK MD BOARD MEMBER	(i) (ii)	0 ------------- 881,908	0 ------------- 286,964	0 ------------- 0	0 ------------- 38,200	0 ------------- 28,531	0 ------------- 1,235,603	0 ------------- 0
5JOSHUA RATNER BOARD MEMBER	(i) (ii)	0 ------------- 791,139	0 ------------- 264,950	0 ------------- 12,750	0 ------------- 42,700	0 ------------- 37,657	0 ------------- 1,149,196	0 ------------- 0
6JULIE SWITZER BOARD MEMBER	(i) (ii)	0 ------------- 776,327	0 ------------- 259,280	0 ------------- 27,000	0 ------------- 0	0 ------------- 47,287	0 ------------- 1,109,894	0 ------------- 0
7CARY HIRSCH MD PHYSICIAN	(i) (ii)	698,063 ------------- 0	0 ------------- 0	9,434 ------------- 0	0 ------------- 0	9,434 ------------- 0	716,931 ------------- 0	0 ------------- 0
8SETH HURWITZ PHYSICIAN	(i) (ii)	392,901 ------------- 0	0 ------------- 0	327,303 ------------- 0	29,979 ------------- 0	9,429 ------------- 0	759,612 ------------- 0	0 ------------- 0
9SUNANDAN A PANDYA PHYSICIAN	(i) (ii)	685,648 ------------- 0	58,828 ------------- 0	1,693 ------------- 0	19,470 ------------- 0	34,021 ------------- 0	799,660 ------------- 0	0 ------------- 0
10GUNJAN SHUKLA PHYSICIAN	(i) (ii)	678,173 ------------- 0	0 ------------- 0	51,704 ------------- 0	19,470 ------------- 0	34,021 ------------- 0	783,368 ------------- 0	0 ------------- 0
11RAJIV SINGH PHYSICIAN	(i) (ii)	667,005 ------------- 0	52,195 ------------- 0	1,004 ------------- 0	26,944 ------------- 0	103 ------------- 0	747,251 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation

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.

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan

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) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE O
(Form 990)

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

2021

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 PANDEMIC. AS A RESULT OF THE COVID-19 PANDEMIC, BSCHS EXPERIENCED A DECLINE IN PATIENT VISITS, ADMISSIONS, AND MEDICAL PROCEDURES PERFORMED. ELECTIVE MEDICAL PROCEDURES WERE SUSPENDED BY STATE AND LOCAL GOVERNMENTS AT VARYING TIME PERIODS BEGINNING IN MID-MARCH 2020 THROUGH LATE MAY 2020, CONTRIBUTING TO A SIGNIFICANT DECLINE IN NET PATIENT SERVICE REVENUE DUE TO COVID-19 WHEN COMPARED TO HISTORIC AND FORECASTED RESULTS FOR THAT PERIOD. ADDITIONALLY, IN RESPONSE TO THE PANDEMIC, BSCHS INCURRED ADDITIONAL COSTS FOR TESTING, PERSONAL PROTECTIVE EQUIPMENT, THIRD-PARTY CONTRACT SERVICES AND OTHER OPERATING COSTS ASSOCIATED WITH ENSURING EMPLOYEE AND PATIENT SAFETY WHILE OPERATING DURING A PANDEMIC. BSCHS RECEIVED GRANT PAYMENTS, WHICH ARE CONSIDERED NONEXCHANGE TRANSACTIONS, FROM THE FEDERAL GOVERNMENT DISTRIBUTED UNDER THE CARES ACT. FOR THE YEAR ENDED DECEMBER 31, 2021, BSCHS RECEIVED $7.7 MILLION, WHICH IS INCLUDED IN NONOPERATING ACTIVITIES IN THE BON SECOURS CHARITY HEALTH SYSTEM, INC. (A COMPONENT UNIT OF WESTCHESTER COUNTY HEALTH CARE CORPORATION) THE CARES ACT PAYMENTS ARE SUBJECT TO AUDIT AND COMPLIANCE WITH FEDERAL REGULATIONS. BSCHS BELIEVES IT HAS MET THE CONDITIONS TO RETAIN THESE FUNDS. THE CARES ACT ALSO PROVIDED FOR AN EXPANSION OF THE MEDICARE ACCELERATED AND ADVANCE PAYMENT PROGRAM ("MEDICARE ADVANCES") FOR PATIENT SERVICES. UNDER THE PROGRAM, BSCHS RECEIVED APPROXIMATELY $61.9 MILLION AND RECORDED THESE PAYMENTS IN OTHER SHORT-TERM AND LONG-TERM LIABILITIES IN THE STATEMENTS OF NET POSITION AT DECEMBER 31, 2020. PRIOR TO THE BEGINNING OF THE RECOUPMENT PERIOD, BSCHS CONTINUED TO BILL FOR SERVICES PROVIDED TO MEDICARE PATIENTS AND WAS PAID BY MEDICARE, AS USUAL. THE RECOUPMENT PERIOD BEGAN IN APRIL 2021 AS AMOUNTS BILLED TO MEDICARE FOR SERVICES PROVIDED ARE BEING OFFSET AGAINST THE ADVANCE PAYMENTS RECEIVED UNTIL THE ADVANCE IS FULLY RECOUPED BY THE MEDICARE PROGRAM. THE BALANCE WAS PAID IN FULL AS OF DECEMBER 31, 2022. ADDITIONALLY, THE INTERNAL REVENUE SERVICE ("IRS") ALLOWED BSCHS TO DEFER REMITTANCE OF EMPLOYER SOCIAL SECURITY TAX OF $9.8 MILLION THROUGH THE YEAR ENDED DECEMBER 31, 2020, $4.9 MILLION WAS INCLUDED IN ACCRUED SALARIES AND RELATED WITHHOLDINGS IN THE STATEMENTS OF NET POSITION AT DECEMBER 31, 2022 AND 2021, AND $4.9 MILLION WAS INCLUDED IN OTHER LONG TERM LIABILITIES IN THE STATEMENT OF NET POSITION AT DECEMBER 31, 2021. 50% OF THE DEFERRED EMPLOYER SOCIAL SECURITY TAX WAS PAID ON JANUARY 3, 2022, AND THE REMAINING BALANCE WILL BE PAID ON JANUARY 2, 2023. BSCHS ALSO RECEIVED GRANT FUNDS FROM THE FEDERAL EMERGENCY MANAGEMENT AGENCY ("FEMA") RELATED TO ADDITIONAL UNREIMBURSED COVID-19 EXPENSES INCURRED BY BSCHS DURING THE PANDEMIC. FOR THE YEAR ENDED DECEMBER 31, 2022, BSCHS RECEIVED APPROXIMATELY $3.3 MILLION FROM FEMA WHICH IS INCLUDED IN NONOPERATING ACTIVITIES IN THE STATEMENT OF REVENUES, EXPENSES AND CHANGES IN NET POSITION.
Form 990, Part VI, Line 6 Classes of members or stockholders	THE MEMBERS OF BSCHS ARE AS FOLLOWS: WMC - ROCKLAND, INC. - 60% BON SECOURS MERCY HEALTH, INC. TOGETHER WITH SISTERS OF CHARITY (SOC) - 40%. 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 Members or stockholders electing members of governing body	THE GOVERNING BODY OF THE MEMBERS WITHIN THE GROUP, WITH THE EXCEPTION OF MEDPC, ARE APPOINTED BY ITS MEMBERS, WMC-ROCKLAND, BSMH AND SOC AND ARE SUBJECT TO THE APPROVAL OF ITS MEMBERS.
Form 990, Part VI, Line 7b Decisions requiring approval by 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 AND SOC, CERTAIN AUTHORITIES ARE RESERVED TO BSMH AND WMC-ROCKLAND, AND CERTAIN AUTHORITIES ARE RESERVED SOLELY TO BSMH.
Form 990, Part VI, Line 11b Review of form 990 by governing body	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 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 15a Process to establish compensation of top management official	THE ORGANIZATION HAS A COMPREHENSIVE PROCESS FOR THE OVERSIGHT AND MANAGEMENT OF REMUNERATION FOR THE CEO. 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 15b Process to establish compensation of other employees	THE ORGANIZATION HAS A COMPREHENSIVE PROCESS FOR THE OVERSIGHT AND MANAGEMENT OF REMUNERATION FOR 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 Required 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	SISTERS MAUREEN SULLIVAN AND ANNE LUTZ DO NOT RECEIVE COMPENSATION AS THEY HAVE TAKEN A VOW OF POVERTY.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	PERFORMANCE BASED REVENUE - Total Revenue: 2236987, Related or Exempt Function Revenue: 2236987, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; ALL OTHER REVENUE - Total Revenue: 2233158, Related or Exempt Function Revenue: 1787105, Unrelated Business Revenue: 0, Revenue Excluded from Tax Under Sections 512, 513, or 514: 446053;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	TRANSFERS FROM AFFILIATES - 76045038;

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2021

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)	Type I	NA		No
(2)WMC HEALTH NETWORK - ULSTER INC 100 WOODS ROAD VALHALLA,NY10595 32-0477183	SUPPORTING	NY	501(c)(3)	Type I	WCHCC		No
(3)WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA,NY10595 13-3964321	HEALTHCARE	NY			NA		No
(4)WMC NEW YORK INC 100 WOODS ROAD VALHALLA,NY10595 13-4107894	FUNDRAISING	NY	501(c)(3)	Type I	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 ROAD 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)	Type I	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 HOSPITAL 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 42084 STATE ROUTE 28 MARGARETVILLE,NY12455 22-3143565	NURSING HOME	NY	501(c)(3)	10	MMH		No
(13)MARGARETVILLE HEALTH FOUNDATION 42084 STATE HIGHWAY MARGARETVILLE,NY12455 26-1998454	SUPPORT FDN	NY	501(c)(3)	Type I	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)	Type 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) 2021

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

Schedule R (Form 990) 2021

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) 2021

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) 2021

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) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

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	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	3,775
6	Total number of volunteers (estimate if necessary) .............	6	37
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	18,096,792	14,377,832
9	Program service revenue (Part VIII, line 2g) .........	576,141,451	584,661,001
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	473,309	370,073
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	12,018,692	16,483,135
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	606,730,244	615,892,041
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	22,524	13,734
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	342,283,863	336,609,728
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	297,321,495	307,878,461
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	639,627,882	644,501,923
19	Revenue less expenses. Subtract line 18 from line 12.......	-32,897,638	-28,609,882
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	223,032,633	283,126,035
21	Total liabilities (Part X, line 26).............	281,867,915	294,526,161
22	Net assets or fund balances. Subtract line 21 from line 20.....	-58,835,282	-11,400,126

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 555,885,487 including grants of $ 13,734 ) (Revenue $ 600,366,615 )
	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 4 YEARS IN A ROW (2018-2021). 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 expenses555,885,487

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) CARY HIRSCH MD PHYSICIAN	40.0 .......................0.0	X	707,497	0	9,434
(19) GUNJAN SHUKLA PHYSICIAN	40.0 .......................0.0	X	729,877	0	53,491
(20) RAJIV SINGH PHYSICIAN	40.0 .......................0.0	X	720,204	0	27,047
(21) SETH HURWITZ PHYSICIAN	40.0 .......................0.0	X	720,204	0	39,408
(22) SUNANDAN A PANDYA PHYSICIAN	40.0 .......................0.0	X	746,169	0	53,491

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,632,225	10,283,194	613,168

1a	Federated campaigns..		1a	0
b	Membership dues..		1b	0
c	Fundraising events..		1c	0
d	Related organizations		1d	2,058,162
e	Government grants (contributions)		1e	11,378,259

f	All other contributions, gifts, grants, and similar amounts not included above		1f	941,411

g	Noncash contributions included in lines 1a - 1f:$		1g	0

h Total. Add lines 1a-1f.......		14,377,832

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	583,523,996	583,523,996	0	0
b	CAPITATION REVENUE	623000	1,137,005	1,137,005	0	0
c			0	0	0	0
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		584,661,001

3 Investment income (including dividends, interest, and othersimilar amounts) ......			370,073	0	0	370,073
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	0	880,833	6a
b	Less: rental expenses	0	549,365	6b
c	Rental income or (loss)	0	331,468	6c
d	Net rental income or (loss).......			331,468	0	0	331,468
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	0	0	7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	NYS DELIVERY SYSTEM REFORM INCENTIVE PYMNT		900099	5,500,000	5,500,000	0	0
b	SERVICE AGREEMENTS		900099	3,669,829	3,669,829	0	0
c	REBATES & GPO DISCOUNTS		900099	2,511,693	2,511,693	0	0
d	All other revenue ....			4,470,145	4,024,092	0	446,053
e	Total. Add lines 11a–11d ......			16,151,667
12	Total revenue. See instructions.....			615,892,041	600,366,615	0	1,147,594

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	13,734	13,734
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	8,889	889	8,000	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0	0	0	0
7	Other salaries and wages........	251,478,825	232,084,536	19,394,289	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,109,942	7,165,997	1,943,945	0
9	Other employee benefits .......	54,829,223	52,628,737	2,200,486
10	Payroll taxes ...........	21,182,849	19,268,314	1,914,535	0
11	Fees for services (non-employees):
a	Management ......	0	0	0	0
b	Legal .........	850,932	21,644	829,288	0
c	Accounting ...........	506,283	28,194	478,089	0
d	Lobbying ...........	138,839	0	138,839	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	24,123,151	24,022,579	100,572	0
12	Advertising and promotion ....	1,232,674	59,322	1,173,352	0
13	Office expenses .......	12,253,182	7,743,498	4,509,684	0
14	Information technology ......	6,201,499	2,659,052	3,542,447
15	Royalties ..	0	0	0	0
16	Occupancy ...........	18,812,540	13,023,440	5,789,100	0
17	Travel ............	668,244	599,754	68,490	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	237,321	211,489	25,832	0
20	Interest ...........	8,133,456	865,002	7,268,454	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization ..	22,599,487	22,599,487	0	0
23	Insurance ...	14,089,200	13,991,825	97,375	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	87,600,904	87,600,904	0	0
b	PURCHASED SERVICES	64,544,862	45,459,123	19,085,739	0
c	OUTSOURCED SERVICES	35,366,942	19,178,579	16,188,363	0
d	DIETARY SUPPLIES	3,928,253	654,393	3,273,860	0
e	All other expenses	6,590,692	6,004,995	585,697	0
25	Total functional expenses. Add lines 1 through 24e	644,501,923	555,885,487	88,616,436	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 ........			3,375,234	1	730,822
2	Savings and temporary cash investments .........			34,574	2	34,574
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			49,817,228	4	54,946,121
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			14,008,886	8	13,516,938
9	Prepaid expenses and deferred charges ......			3,662,990	9	3,543,323
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	563,484,934
b	Less: accumulated depreciation	10b	360,045,070	145,885,285	10c	203,439,864
11	Investments—publicly traded securities .			30,086	11	30,086
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			6,218,350	15	6,884,307
16	Total assets. Add lines 1 through 15 (must equal line 33)...			223,032,633	16	283,126,035

17	Accounts payable and accrued expenses .....	85,775,651	17	96,288,226
18	Grants payable ...		18
19	Deferred revenue .........	262,875	19	250,567
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D	130,832	21	93,096
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 ..	124,522,240	23	124,628,524
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	71,176,317	25	73,265,748
26	Total liabilities. Add lines 17 through 25..	281,867,915	26	294,526,161

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-59,671,511	27	-12,236,355
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 ...........	-58,835,282	32	-11,400,126
33	Total liabilities and net assets/fund balances ........	223,032,633	33	283,126,035