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.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
Bon Secours - Richmond Health System
Inc
Employer identification number

52-1988421
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes in 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 .........
1b
 
 
2
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 in line 1a? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2017
Page 2

Schedule J (Form 990) 2017
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Toni Ardabell
CEO-BSV 		(i)

(ii)		 0
-------------
677,035 		0
-------------
130,351 		0
-------------
742,660 		0
-------------
105,750 		0
-------------
2,002 		0
-------------
1,657,798 		0
-------------
196,397
2Janice Burnett
Board Member 		(i)

(ii)		 0
-------------
667,595 		0
-------------
240,070 		0
-------------
435,772 		0
-------------
129,000 		0
-------------
14,169 		0
-------------
1,486,606 		0
-------------
92,090
3Stephan Quiriconi
Treasurer 		(i)

(ii)		 0
-------------
349,584 		0
-------------
69,669 		0
-------------
41,366 		0
-------------
5,300 		0
-------------
10,953 		0
-------------
476,872 		0
-------------
0
4Jim Godwin
VP HR 		(i)

(ii)		 0
-------------
199,313 		0
-------------
13,959 		0
-------------
20,578 		0
-------------
18,746 		0
-------------
21,050 		0
-------------
273,646 		0
-------------
0
5Thomas Auer
CEO-BSMG (End 10/17) 		(i)

(ii)		 0
-------------
439,234 		0
-------------
57,599 		0
-------------
411,094 		0
-------------
16,200 		0
-------------
410 		0
-------------
924,537 		0
-------------
0
6Herbert Cummings
COO-BSMG (Beg 11/17) 		(i)

(ii)		 0
-------------
269,439 		0
-------------
42,358 		0
-------------
395 		0
-------------
10,800 		0
-------------
27,267 		0
-------------
350,259 		0
-------------
0
7Kevin Sheppard
VP - Integration 		(i)

(ii)		 0
-------------
249,332 		0
-------------
16,355 		0
-------------
558 		0
-------------
4,621 		0
-------------
27,152 		0
-------------
298,018 		0
-------------
0
8Tushar Shah
Family Physician 		(i)

(ii)		 248,653
-------------
0 		0
-------------
0 		270
-------------
0 		12,028
-------------
0 		28,546
-------------
0 		289,497
-------------
0 		0
-------------
0
9Aparna Ranjan
Family Physician 		(i)

(ii)		 183,862
-------------
0 		26,091
-------------
0 		15,453
-------------
0 		8,998
-------------
0 		0
-------------
0 		234,404
-------------
0 		0
-------------
0
10Nermine Saleh
Medical Director 		(i)

(ii)		 178,177
-------------
0 		1,406
-------------
0 		189
-------------
0 		9,549
-------------
0 		28,878
-------------
0 		218,199
-------------
0 		0
-------------
0
11Kimberly Kothe
Physical Therapist 		(i)

(ii)		 158,481
-------------
0 		150
-------------
0 		97
-------------
0 		1,974
-------------
0 		25,412
-------------
0 		186,114
-------------
0 		0
-------------
0
12Vikki Cullop
RN, Hospice 		(i)

(ii)		 141,047
-------------
0 		150
-------------
0 		40
-------------
0 		0
-------------
0 		18,217
-------------
0 		159,454
-------------
0 		0
-------------
0
Schedule J (Form 990) 2017
Page 3

Schedule J (Form 990) 2017
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 3 Bon Secours Mercy Health, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee
Part I, Line 4b The filing organization participates in a BSMH sponsored executive retirement program that allows for deposits into additional retirement plans and is available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution or participated in the plan include: Toni Ardabell, $381,880; Janice Burnett, $106,552; James Godwin, $0; Stephen Quiriconi, $0.
Part I, Line 7 The organization provides annual incentive compensation for listed individuals. The organization's Board of Trustees establishes objective thresholds which must be achieved for incentives to be awarded. The Board also establishes threshold, target and maximum levels for incentive awards. Within these established parameters, the Board determines the CEO's incentive award and incentive awards for other listed individuals are determined by the listed individual's supervisor and disclosed to the Board. The Board may authorize modified incentive awards when appropriate in its judgment.
Schedule J (Form 990) 2017
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