Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
 
 
Employer identification number
52-1301088
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1)  
88 Hamilton Ave
Stamford,CT06902
06-1008595 501(C)(3) 10,000       Employee Hardship Assistance
(2)  
88 Hamilton Ave
Stamford,CT06902
06-1008595 501(C)(3) 62,334       Philippines Relief
(3)  
450 St Bernardine St
Reading,PA196071737
23-1691743 501(C)(3) 20,000       Hurricane Relief in Haiti
(4)  
2000 West Baltimore Street
Baltimore,MD21223
52-1909599 501(C)(3) 53,000       DinnerTime Express - Healthy Eating
(5)  
26 North Fulton Avenue
Baltimore,MD21223
52-1732800 501(C)(3) 100,000       Working Families Initiative
(6)  
7007 Harbour View Blvd
Suffolk,VA23435
54-0548200 501(C)(3) 22,925       Health Education and Literacy
(7)  
150 Kingsley Lane
Norfolk,VA23505
52-1694731 501(C)(3) 100,000       Nurse Navigator and After-Care RN
(8)  
8580 Magellan Pkwy
Richmond,VA23227
54-1201346 501(C)(3) 39,500       Armstrong Prioroties Freshmen Academy
(9)  
8580 Magellan Pkwy
Richmond,VA23227
54-1201346 501(C)(3) 100,000       Congregational Wellness and Navigation Network
(10)  
10300 Fourth Street North
St Petersburg,FL33716
65-0061820 501(C)(3) 56,075       Community Wealth Building and Growing Healthy Food
(11)  
10300 Fourth Street North
St Petersburg,FL33716
65-0061820 501(C)(3) 100,000       HCI Collaboration Grants
(12)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 5,000       Elmer Farnsworth Fund
(13)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 10,000       LCWR National Conference
(14)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 102,336       Peru Relief
(15)  
1505 Marriottsville Road
Marriottsville,MD21104
52-1301091 501(C)(3) 150,000       General Support
(16)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 1,580,317       Peru Construction
(17)  
425 3rd Street SW
Washington,DC20024
51-0175510 501(C)(3) 5,000       Support US Food and Farm Policy
(18)  
255 Lafayette Avenue
Suffern,NY10901
13-3400353 501(C)(3) 94,000       Garden Ministry at 4 Sites
(19)  
15-19 Maple Ave
Warwick,NY10990
14-1340100 501(C)(3) 34,000       Population Health at St. Anthony's
(20)  
2975 Independence Ave
Bronx,NY10463
13-1740397 501(C)(3) 100,000       Healthy Communities - Active Design
(21)  
1000 Ashland Drive
Ashland,KY41101
61-1381952 501(C)(3) 20,000       Benevolent Fund Employee Hardship Assistance
(22)  
1000 Ashland Drive
Ashland,KY41101
61-1381952 501(C)(3) 34,500       Chronic Disease Prevention
(23)  
1000 Ashland Drive
Ashland,KY41101
61-1381952 501(C)(3) 50,000       Employee Wellness Trail
(24)  
1000 Ashland Drive
Ashland,KY41101
61-1381952 501(C)(3) 50,000       Ironton Community Project
(25)  
1000 Ashland Drive
Ashland,KY41101
61-1381952 501(C)(3) 68,000       Oral Health
(26)  
One St Francis Drive
Greenville,SC29601
58-2504530 501(C)(3) 48,000       Access to Care and Parish Wellness Programs
(27)  
One St Francis Drive
Greenville,SC29601
26-0012031 501(C)(3) 25,000       Access to Urgent Care for Unisured Children
(28)  
One St Francis Drive
Greenville,SC29302
26-0012031 501(C)(3) 75,000       Nurse Practitioner for Free Clinic
(29)  
1129 20th Street NW
Washington,DC20036
13-5602319 501(C)(3) 63,193       Bon Secours Bridge Funding
(30)  
1129 20th Street NW
Washington,DC20036
13-5602319 501(C)(3) 18,000       Community Action Stops Abuse
(31)  
1129 20th Street NW
Washington,DC20036
13-5602319 501(C)(3) 162,500       Maternal & Child health community program in Peru
(32)  
1129 20th Street NW
Washington,DC20036
13-5602319 501(C)(3) 60,000       Philippines Relief
(33)  
228 W Lexington Street
Baltimore,MD21201
13-5563422 501(C)(3) 167,000       Haiti Project;Rebuilding of St.Francis de Sales Hospital&Hospital Network Strengthening
(34)  
228 W Lexington Street
Baltimore,MD21201
13-5563422 501(C)(3) 50,000       Philippines Relief
(35)  
122 East 42nd St
New York,NY10168
13-5660870 501(C)(3) 20,000       Philippines Relief
(36)  
1999 Broadway
Denver,CO80202
47-0646706 501(C)(3) 80,000       Strategic Healthcare Partnership Pledge
(37)  
7130 Glen Forest Drive
Richmond,VA23226
27-2368581 501(C)(3) 70,000       Midwives for Haiti Pledge
(38)  
1000 St Christopher Dr
Ashland,KY41101
61-1356023 501(C)(3) 5,000       Golf Tournament Sponsorship
(39)  
315 Calhoun St
Charleston,SC29401
57-1068509 501(C)(3) 5,000       Golf Tournament Sponsorship
(40)  
1000 St Christopher Dr
Ashland,KY41101
61-1356023 501(C)(3) 25,000       Class Sponorship; annual pledge
(41)  
139 First Avenue
Baltimore,MD21227
34-1975939 501(C)(3) 5,000       Sister's Academy General Support
(42)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 59,663       Ministry Program for FY14
(43)  
1505 Marriottsville Road
Marriottsville,MD21104
52-0715237 501(C)(3) 25,000       Compassionate Care Fund
(44)  
2715 Brainbridge Ave
Bronx,NY104584075
86-1164387 501(C)(3) 9,000       All Africa Conference- Sister to Sister
(45)  
119 Number Ten Street
Clinchco,VA24226
04-3739083 501(C)(3) 25,000       Annual Pledge for Lung Clinic
(46)  
6008 College Avenue
Oakland,CA94618
94-3179772 501(C)(3) 5,000       Environmental Health Network
(47)  
PO Box 79727
Baltimore,MD21279
20-5913680 501(C)(3) 5,000       Alliance Donation
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
30
3
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) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Part I, Line 2: Per Bon Secours Health System, Inc.'s system-wide financial and accounting policies, contributions are generally made as reimbursements for funds spent. In such cases, the donee/grantee organization must provide documentation to the filing organization before funds are approved for disbursement. In other cases, grantees submit progress reports on the anniversary date on which the grant was received. The evaluation report includes: 1) progress toward the deployment of the stated goals and objectives, 2) progress towards the achievement of desired outcome as demonstrated by Project Work Plan, 3) an accurate accounting of the revenue and expenses and the amount of the mission fund award expensed, and 4) a summary past, current and future funding sources and efforts to secure sustaining sources of funding. Description of the Bon Secours Health System Mission Fund: Bon Secours Health System, Inc. performs its philanthropic work through its mission department. This initiative, called the Bon Secours Health System Mission Fund ("Mission Fund"), was developed to promote the Catholic Health Ministry and the BSHSI Mission. This purpose is realized through the funding of initiatives that improve the health and well being of communities, particularly for disenfranchised and marginalized people, served by BSHSI Local Systems ("Local Systems"), Cosponsors and the Congregation of the Sisters of Bon Secours. The scope of its purpose and use of funds would be to: -promote healthy community coalition initiatives in conjunction with local system efforts, -develop local system and community excellence for a specific health condition and preventive need, and -improve access for uninsured populations and reduce health disparities among populations in the community. The Strategic Quality Plan of the health system calls for focused efforts to Build Healthier Communities. The health system understands "health" to include social and communal dimensions and has adopted the following articulation of a healthy community. The conditions of communities and individuals served by BSHSI reflect the interaction of significant factors and complex behaviors at the individual, communal, and societal level. It is not likely that interventions by any one organization will result in substantial improvement or benefit to the community. Rather, increased participation by stakeholders and greater cooperation among entities with appropriate skills and resources is necessary for systemic change and improved outcomes. Mission Fund grants place emphasis on increased collaboration among community based members (Healthy Community Initiative), public health officials and other providers of services. The Mission Fund anticipates that most endeavors that seek to bring meaningful improvement require time and commitment. Consequently, local system grant recipients may expect continuity of support (several years) to establish and track outcomes. At the same time, grant applicants need to cultivate and achieve a wide array of financial resources necessary to sustain promising projects and service programs.
Schedule I (Form 990) 2014



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