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ObjectId: 201631959349301458 - Submission: 2016-07-13
TIN: 52-1988421
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.
Attach to Form 990.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
Bon Secours - Richmond Health System
Employer identification number
52-1988421
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
(1)
Bon Secours Ambulatory Services LLC
8580 Magellan Parkway
Richmond
,
VA
23227
27-1672951
All Other Outpatient Care Centers
VA
2,209,830
1,839,539
Bon Secours Richmond Health System Inc
(2)
Bon Secours Home Care LLC
8580 Magellan Parkway
Richmond
,
VA
23227
27-1672759
Home Health Care Services
VA
20,634,627
13,383,647
Bon Secours Richmond Health System Inc
(3)
Bon Secours VA Medical Group I LLC
8580 Magellan Parkway
Richmond
,
VA
23227
27-1908136
Offices of Physicians
VA
0
0
Bon Secours Ambulatory Services LLC
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?
Yes
No
(1)
Bon Secours Health System Inc
1505 Marriotsville Road
Marriottsville
,
MD
21104
52-1301088
Parent Org. Management Services
MD
501(c)(3)
Line 11c, III-FI
Bon Secours Inc
No
(2)
Bon Secours Richmond Healthcare Foundation
8580 Magellan Parkway
Richmond
,
VA
23227
54-1201346
Grant Making Foundation
VA
501(c)(3)
Line 7
Bon Secours Richmond LLC
No
(3)
Bon Secours St Mary's Hospital Richmond Inc
8580 Magellan Parkway
Richmond
,
VA
23227
54-0793767
Health Care
VA
501(c)(3)
Line 3
Bon Secours Richmond Health System
Yes
(4)
Bon Secours Memorial Regional Medical Center
8580 Magellan Parkway
Richmond
,
VA
23227
54-1744931
Health Care
VA
501(c)(3)
Line 3
Bon Secours Richmond Health System
Yes
(5)
Bon Secours Richmond Community Hospital
8580 Magellan Parkway
Richmond
,
VA
23227
54-0647482
Health Care
VA
501(c)(3)
Line 3
Bon Secours Richmond Health System
Yes
(6)
Bon Secours St Francis Medical Center
8580 Magellan Parkway
Richmond
,
VA
23227
31-1716973
Health Care
VA
501(c)(3)
Line 3
Bon Secours Richmond Health System
Yes
(7)
Laburnum Properties
8580 Magellan Parkway
Richmond
,
VA
23227
52-1260700
Title Holding Company
VA
501(c)(2)
Bon Secours Richmond Health System
Yes
(8)
Rappahanock General Hospital Foundation
101 Harris Road
Kilmarnock
,
VA
22482
54-1210450
Supporting Organization
VA
501(c)(3)
Line 7
Bon Secours Richmond Health System
Yes
(9)
Chesapeake Medical Group
101 Harris Road
Kilmarnock
,
VA
22482
54-1857174
Healthcare Services
VA
501(c)(3)
Line 9
Bon Secours Richmond Health System
Yes
(10)
Chesapeake Hospital Corporation
PO Box 1449
Kilmarnock
,
VA
22482
23-7424835
Health Care
VA
501(c)(3)
Line 3
Bon Secours Richmond Health System
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Page 2
Schedule R (Form 990) 2014
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
St Mary's MRI Center LP
8580 Magellan Parkway
Richmond
,
VA
23227
54-1568022
Imaging Services
VA
N/A
(2)
RI LP
8580 Magellan Parkway
Richmond
,
VA
23227
54-1708835
Imaging Services
VA
N/A
(3)
Broad64 Imaging LLC
8580 Magellan Parkway
Richmond
,
VA
23227
20-5886018
Imaging Services
VA
N/A
(4)
Richmond Radiation Oncology Center I LLC
8580 Magellan Parkway
Richmond
,
VA
23227
20-8444551
Radiation Oncology Services
VA
N/A
(5)
Chesterfield Community Healthcare Center MOB I LLC
435 Southlake Blvd
Richmond
,
VA
23236
54-1745670
Rental- Medical Office Building
VA
N/A
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
CCHC Inc
8580 Magellan Parkway
Richmond
,
VA
23227
54-1812738
Ambulatory Healthcare Services
VA
Bon Secours Richmond Health System Inc
C
5,127
308,435
100.000 %
Yes
(2)
RHS Management Corporation
8580 Magellan Parkway
Richmond
,
VA
23227
54-1313425
Independent Living Facility
VA
Bon Secours Richmond Health System Inc
C
646,246
71,482
100.000 %
Yes
(3)
Bon Secours - Virginia HealthSource Inc
8580 Magellan Parkway
Richmond
,
VA
23227
54-1417686
Ambulatory Healthcare Services
VA
Bon Secours Richmond Health System Inc
C
35,392,844
37,781,815
100.000 %
Yes
(4)
Richmond MRI Inc
8580 Magellan Parkway
Richmond
,
VA
23227
54-1568452
Imaging Services
VA
Bon Secours - Virginia HealthSource Inc
C
1,210,104
322,503
100.000 %
Yes
Schedule R (Form 990) 2014
Page 3
Schedule R (Form 990) 2014
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
No
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
.....................
1a
Yes
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
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
(1)
St Mary's Hospital - Short Pump Land
C
6,700,091
FMV
(2)
St Mary's Hospital - CMG EPIC Maintenance Fees
C
137,810
FMV
(3)
St Mary's Hospital - RGH Debt Payoff at Acquisition
C
10,008,451
FMV
(4)
St Mary's Hospital - Loan to Rappahannock General Hospital Pre-Acquisition
D
1,000,000
FMV
(5)
Rappahannock General Hospital - Transfer Investment in RGH
R
5,061,621
FMV
(6)
St Mary's Hospital - Shared Services dues
P
364,411
FMV
(7)
St Mary's Hospital - Intercompany Rent
P
41,762
FMV
(8)
Rappahannock General Hospital Foundation - Intercompany Interest Income
A
66,667
FMV
Schedule R (Form 990) 2014
Page 4
Schedule R (Form 990) 2014
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(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
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2014
Page 5
Schedule R (Form 990) 2014
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) 2014
Additional Data
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