2019-11-05T08:41:35-06:00 2018-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2018-01-01 133400353 GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH % MAUREEN BURKE GOOD 8453685151 255 Lafayette Avenue Suffern NY 10901 MARY LEAHY MD CEO - BSCHS 8453685305 2019-11-04 true LAURA KIELCZEWSKI P00740769 2127733000 164.57.159.254 26308520193085000025 2019-11-04 P CE4D3F0B42E73FE2D2DB8750BDCFCB0574B0A649 047C777BBD395ADD529156C75D94AFF56594489C 2018 2020-01-14 16:20:31Z MARY LEAHY MD 255 Lafayette Avenue Suffern NY 10901 923345 false 0928 X www.bschsf.org/goodsam X 1986 NY Fundraising for the benefit of Good Samaritan Hospital of Suffern, NY. 27 25 0 40 0 0 735272 694982 0 0 16656 29847 -142586 -91565 609342 633264 10999 62322 0 0 216099 98244 0 0 378717 328553 455190 555651 615756 53691 17508 3481523 3842118 13270 35925 3468253 3806193 THE MISSION IS TO MAKE VISIBLE GOD'S LOVE AND TO BE GOOD HELP TO THOSE IN NEED, ESPECIALLY THOSE WHO ARE POOR, VULNERABLE 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. false false 181695 62322 0 The Good Samaritan Foundation is the voice of philanthropy for Good Samaritan Regional Medical Center. We increase awareness, create good will and raise funds to further the mission of the Bon Secours Charity Health System - to give Good Help to Those in Need. A few of the many ways that we've helped bring state-of-the-art medical care to our community: Facility and infrastructure improvements: -Patients that require emergency medical care receive expert attention in our newly expanded and renovated Emergency Department. Here, clinicians provide care using "ahead-of-the-art" equipment and technology. -Moms, dads and siblings bond with newborns in our new Family Unit. The unit also includes specially designed pediatric areas for children needing in-patient care. -Patients receive same day diagnostic and surgical procedures in the new Ambulatory Surgery Center. The center features state-of-the-art operating suites and advanced medical equipment. New equipment and state-of-the-art technology: -Upgrades to Electrophysiology Lab prevent patients with cardiac rhythm abnormalities from experiencing cardiac crises by mapping, detecting and treating even the most complicated cases. -Our da Vinci advanced surgical robotic system allows physicians to perform minimally invasive procedures. -The 128-slice CT scan allows clinicians to view high-definition images while patients receive low-dose radiation. -New MRI equipment is wider than the standard providing patients greater comfort and less confinement than standard equipment. Programs: The Bobbi Lewis Cancer Program provides personalized, compassionate, state-of-the-art oncology care. Community-wide support makes expanding and upgrading Good Samaritan's cancer services possible. Fundraising: We raise funds so children and adults in our community can count on state-of-the-art care when they come to Good Samaritan. The Foundation receives support from public and private organizations and individuals including board members, vendors, patients, their families, residents and our employees. Throughout the year, we initiate appeals and apply for grants. We also host a variety of events: The Spring Ball, Golf & Tennis Classic and Corks & Forks. Our signature annual events have raised millions of dollars over the years for patients at Good Samaritan. -The Spring Ball has been Rockland County's most prestigious gala for nearly 30 years. It is the one time each year when the entire Good Samaritan community comes together to reaffirm its commitment to advance healthcare in our region. -The Golf & Tennis Classic has been a legacy event for 25 years. Golf enthusiasts play on an elite 18-Hole course while those who prefer tennis volley in a tournament of their own. -Corks & Forks, A Celebration of Food and Wine, is our newest event. Culinary enthusiasts can enjoy five-course signature dishes and wine pairings courtesy of Hudson Valley's award-winning chefs and our wine partner. 181695 true true false false false false false false false true false false false true false false false true false false false false false false true false false true true true false false false false false false false false false false false false false true false false false true 8 0 true 0 false false false false false true true false false false false false false X 27 25 true false false false true true true true true false false true true true true false false false false false NY X MAUREEN BURKE 8453685448 255 LAFAYETTE AVENUE Suffern NY 10901 X Nicholas DeSantis Board Member 1.0 0.0 X 0 0 0 Gil Heim Board Member 1.0 0.0 X 0 0 0 Gayle Hirsch Esq Board Member 1.0 39.0 X 0 155653 29535 Jack Holt Board Member (term 4/18) 1.0 0.0 X 0 0 0 Geanette Katz Secretary 1.0 0.0 X X 0 0 0 Kevin Kern Treasurer 1.0 0.0 X X 0 0 0 Joseph Lagana Board Member 1.0 0.0 X 0 0 0 Mary Leahy MD CEO - BSCHS 1.0 39.0 X X 0 916194 91847 Patricia Lefkowitz Board Member 1.0 0.0 X 0 0 0 Aurelius Licata Board Member 0.0 0.0 X 0 0 0 Kathy Medici Board Member 1.0 0.0 X 0 0 0 Glenn Mendoza MD Board Member 1.0 0.0 X 0 0 0 Harold Peterson Chair 1.0 0.0 X X 0 0 0 Amra Sabic-El-Rayess PhD Board Member 1.0 0.0 X 0 0 0 Louis Siracusano Board Member 1.0 0.0 X 0 0 0 Frank Stillo Board Member 1.0 0.0 X 0 0 0 Mark Acker Board Member 1.0 0.0 X 0 0 0 Joseph Allen Board Member 1.0 0.0 X 0 0 0 Heather Bowie Board Member 1.0 0.0 X 0 0 0 Gene Cortes Board Member 1.0 0.0 X 0 0 0 Lawrence Garvey Board Member 1.0 0.0 X 0 0 0 Angela Clarkin Board Member 1.0 0.0 X 0 0 0 Richard Clarkin MD Board Member 1.0 0.0 X 0 0 0 John DeCicco Board Member 1.0 0.0 X 0 0 0 JAIN JACOB BOARD MEMBER 1.0 0.0 X 0 0 0 JOYCE WALGROVE BOARD MEMBER 1.0 0.0 X 0 0 0 JOSEPH CASERES BOARD MEMBER (EFFECT. 1/1/18) 1.0 0.0 X 0 0 0 SR SUSAN EVELYN RSM BOARD MEMBER (EFFECT. 1/1/18) 1.0 39.0 X 0 0 0 0 1071847 121382 0 false true false NONE 0 293326 401656 694982 0 31763 31763 0 0 0 0 0 26140 28056 -1916 -1916 -1916 170460 293326 262025 -91565 -91565 0 0 0 0 0 0 0 633264 -61718 56175 56175 6147 6147 0 0 0 0 90651 18130 9065 63456 4040 808 404 2828 -2823 -565 -282 -1976 6376 1275 638 4463 0 0 0 0 0 7803 7023 780 0 107433 21487 10743 75203 83887 16777 8389 58721 4607 4146 461 0 0 4893 979 489 3425 0 3426 685 343 2398 0 0 0 52354 10471 5235 36648 PURCHASED SERVICES 190787 38157 19079 133551 615756 181695 55344 378717 0 0 478667 207180 158824 117380 0 3250 0 0 0 0 0 0 0 0 0 0 0 0 2224578 2894854 0 0 0 0 0 0 619454 619454 3481523 3842118 13270 35925 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13270 35925 X 688477 394336 2742002 3331010 37774 80847 3468253 3806193 3481523 3842118 X 17508 -21738 342170 X false true X true false X 339632 1204731 547127 735272 694982 3521744 0 0 339632 1204731 547127 735272 694982 3521744 353759 3167985 5088 22483 8194 16649 31763 84177 0 3344118 176170 99100 155129 170460 3944977 7550898 0.41955 0.46493 X Part II, Line 10 Explanation for Other Income: Special Events Revenue 2014 AMOUNT: $ 33,000 2015 AMOUNT: $ 176,170 2016 AMOUNT: $ 99,100 2017 AMOUNT: $ 155,129 2018 AMOUNT: $ 170,460 Forgiveness of Debt 2014 AMOUNT: $ 3,311,118 SHORT PERIOD RETURN GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH FILED A 2014 FORM 990 SHORT PERIOD RETURN. THE ACTIVITY REPORTED REFLECTED THE ACTIVITY OF THE FILING ORGANIZATION FROM SEPTEMBER 1, 2014 THROUGH DECEMBER 31, 2014. THIS SHORT PERIOD WAS A RESULT OF A CHANGE IN THE ACCOUNTING PERIOD OF THE ORGANIZATION FROM A FISCAL YEAR ENDING AUGUST 31 TO A CALENDAR YEAR ENDING DECEMBER 31. THE CHANGE IN ACCOUNTING PERIOD WAS REPORTED ON THE 2014 FORM 990. 2770776 831849 197666 3404959 2489307 774238 483769 2779776 1999405 615372 125470 2489307 2249715 656141 906451 1999405 0.02370 0.97630 false false INSURANCE-CASH SURRENDER VALUE 223080 CASH SURRENDER VALUE 396374 619454 PART V, LINE 4 Intended use of endowment funds: To support the mission of Good Samaritan Hospital of Suffern through program funding and capital acquisitions. SPRING BALL 193379 107379 86000 87523 10500 80343 FALL CLASSIC 149874 109074 40800 10000 8494 2 120533 76873 43660 52961 2000 10204 463786 293326 170460 150484 12500 99041 262025 -91565 true CENTER FOR SAFETY AND CHANGE NINE JOHNSONS LANE NEW CITY NY 10956 132989233 501(C)(3) 17800 GOOD SAMARITAN HOSPITAL 255 LAFAYETTE AVE SUFFERN NY 10901 131740104 501(C)(3) 37917 2 EMPLOYEE ASSISTANCE 11 6147 Part I Description of Procedure for Monitoring Use of Funds The organization complies with Bon Secours Charity 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. false true false false false false false false false Gayle Hirsch Esq Board Member 0 154775 0 0 0 878 0 10570 0 18965 0 185188 0 0 Mary Leahy MD CEO - BSCHS 0 693405 0 222789 0 0 0 38500 0 53347 0 1008041 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J PART I LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION AS DESCRIBED BELOW: THE BOARD OF DIRECTORS PERSONNEL AND COMPENSATION COMMITTEE SETS THE LEVEL OF TOTAL COMPENSATION (BASE SALARY AND INCENTIVE COMPENSATION) AND THE BENEFITS PROVIDED TO THE ORGANIZATION'S SENIOR EXECUTIVES. IN ORDER TO SET BASE SALARY AND INCENTIVE COMPENSATION LEVELS, THE COMMITTEE WORKS WITH A NATIONAL INDEPENDENT COMPENSATION CONSULTING FIRM. THE CONSULTING FIRM ASSISTS THE COMMITTEE WITH ITS DECISION-MAKING PROCESSES TO ENSURE THAT (I) EXECUTIVE COMPENSATION LEVELS ARE REASONABLE AND APPROPRIATE RELATIVE TO THOSE OF OTHER SIMILAR ORGANIZATIONS, AS WELL AS (II) SUCH LEVELS MEET THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" STANDARD COMPENSATION LEVELS ARE DETERMINED BASED ON COMPETITIVE MARKET DATA FOR COMPARABLE POSITIONS IN SIMILAR SIZED AND TYPE OF ORGANIZATIONS AND EACH EXECUTIVE'S SCOPE OF RESPONSIBILITIES. IN ADDITION, INCENTIVE COMPENSATION ARRANGEMENTS ARE BASED ON EACH EXECUTIVE'S ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS SET FORTH AT THE BEGINNING OF EACH CALENDAR YEAR, THE ACHIEVEMENT OF WHICH IS MEASURED AT THE END OF EACH CALENDAR YEAR BY THE CEO OR THE BOARD OF DIRECTORS DEPENDING ON THE EXECUTIVE. PART I, LINE 4B THE FILING ORGANIZATION PARTICIPATES IN A BON SECOURS CHARITY HEALTH SYSTEM, INC. (BSCHS) 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 THE PLAN. NO PAYOUTS HAVE BEEN MADE DURING THE YEAR. FORM 990, PART VI, LINE 2 business or family relationships: BOARD MEMBERS ANGELA CLARKIN AND RICHARD CLARKIN HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, LINE 6 MEMBERS OR STOCKHOLDERS: BON SECOURS CHARITY HEALTH SYSTEM, INC. (BSCHS) IS THE SOLE MEMBER OF GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH (GSFBH). FORM 990, PART VI, LINE 7A POWER TO ELECT OR APPOINT MEMBERS: The governing body of GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH is appointed by its member, BON SECOURS CHARITY HEALTH SYSTEM, INC. and subject to approval of WMC Health Network-Rockland, Inc. (WMC-ROCKLAND) AND BON SECOURS HEALTH SYSTEM, INC. (BSHSI), TWO of the three corporate members of Bon Secours Charity Health System (BSCHS) The Sisters of Charity of Saint Elizabeth (SCSE). FORM 990, PART VI, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS: Certain authorities of GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH are reserved to its member, BON SECOURS CHARITY HEALTH SYSTEM, INLC or is jointly reserved to WMC HEALTH NETWORK, ROCKLAND, INC., BON SECOURS HEALTH SYSTEM, INC., the SISTERS OF CHARITY, THE THREE CORPORATE MEMBERS OF BON SECOURS CHARITY HEALTH SYSTEM, INC. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990: The Form 990 was prepared by the BON SECOURS CHARITY HEALTH SYSTEM, INC.'S finance department with the assistance from various departments throughout the organization. The Form 990 was reviewed by internal leadership AND OUR EXTERNAL TAX ADVISORS. Upon completion of the various reviews, the Form 990 was PROVIDED to the board of the organization for approval prior to filing with the IRS. FORM 990, PART VI, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: The organization monitors and enforces compliance with the Conflict of Interest policy by means of a survey developed and approved by the Chief Compliance Officer. The survey is sent to all trustees, officers, and key executives for completion. All survey responses are reviewed by the Chief Compliance Officer. Any potential conflicts identified in the responses are discussed with senior management and/or referred to the WMCHealth 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 13 AND 14 Written whistleblower and document retention and destruction policies: The Foundation does not have its own written whistleblower and document retention and destruction policies. However, the Foundation does follow the policies approved by the Board of its related organization, BSCHS. FORM 990, PART VI, LINE 19 PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII BOARD MEMBER POSITIONS ARE GENERALLY VOLUNTARY IN NATURE. COMPENSATED EMPLOYEES OF THE FILING ORGANIZATION AND OTHER RELATED ORGANIZATIONS WHO ALSO HOLD BOARD POSITIONS ARE COMPENSATED ONLY IN RELATION TO THEIR EMPLOYMENT AND DO NOT RECEIVE ADDITIONAL COMPENSATION FOR THEIR BOARD RESPONSIBILITIES. SISTER SUSAN EVELYN DOES NOT RECEIVE COMPENSATION AS SHE HAS TAKEN A VOW OF POVERTY. Form 990, Part IX, Line 9 Other Employee Benefits Amounts for employee benefits are negative this year due to a credit from an allocation of prior year expenses to related organizations. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: - PRIOR YEAR PLEDGE ADJUSTMENTS $ (35,693) - TRANSFERS FROM AFFILIATES $ 377,863 ----------- TOTAL $ 342,170 WMC HEALTH NETWORK - ROCKLAND INC 100 WOODS ROAD VALHALLA NY 10595 320467873 SUPPORTING NY 501(C)(3) 12A NA false WMC HEALTH NETWORK - ULSTER INC 100 WOODS ROAD VALHALLA NY 10595 320477183 SUPPORTING NY 501(C)(3) 12A WCHCC false WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA NY 10595 133964321 HEALTHCARE NY 115 N/A NA false WMC NEW YORK INC 100 WOODS ROAD VALHALLA NY 10595 134107894 FUNDRAISING NY 501(C)(3) 12A WCHCC false NORTH ROAD LHCSA INC 241 NORTH ROAD POUGHKEEPSIE NY 12601 465293268 HOMECARE SVCS NY 501(C)(3) 10 WCHCC false MID-HUDSON VALLEY EARLY EDUCATION CENTER 100 WOODS RD TAYLOR PAVILION VALHALLA NY 10595 465534882 PRESCHOOL NY 501(C)(3) 7 WCHCC false WESTCHESTER MEDICAL CENTER FOUNDATION I 100 WOODS ROAD VALHALLA NY 10595 134095845 FUNDRAISING NY 501(C)(3) 7 WCHCC false HEALTHALLIANCE INC 741 GRANT AVENUE LAKE KATRINE NY 12449 261850453 SUPPORTING NY 501(C)(3) 12A WCHCC false HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS 396 BROADWAY KINGSTON NY 12401 141349558 EXEMPT HOSP NY 501(C)(3) 3 HA INC false HEALTHALLIANCE HOSPITAL MARY'S AVE CAMPU 105 MARYS AVENUE KINGSTON NY 12401 141338470 EXEMPT HOSP NY 501(C)(3) 3 HA INC false MARGARETVILLE MEMORIAL HOSPITAL 42084 STATE ROUTE 28 MARGARETVILLE NY 12455 150552726 EXEMPT HOSP NY 501(C)(3) 3 HA INC false MARGARETVILLE NURSING HOME INC 42158 STATE HIGHWAY 28 MARGARETVILLE NY 12455 223143565 NURSING HOME NY 501(C)(3) 10 MMH false MARGARETVILLE HEALTH FOUNDATION 42084 STATE HIGHWAY 28 MARGARETVILLE NY 12455 261998454 SUPPORT FDN NY 501(C)(3) 12A MMH false FASC FOUNDATION 741 GRANT AVENUE LAKE KATRINE NY 12449 264201295 SUPPORT FDN NY 501(C)(3) 7 HAH BWAY false BON SECOURS COMMUNITY HOSPITAL FDN 255 LAFAYETTE AVE SUFFERN NY 10901 810667395 SUPPORT FDN NY 501(C)(3) 7 BSCHS false BON SECOURS WARWICK HEALTH FOUNDATION 255 LAFAYETTE AVE SUFFERN NY 10901 141972807 SUPPORT FDN NY 501(C)(3) 7 BSCHS false BON SECOURS CHARITY HEALTH SYSTEM INC 255 LAFAYETTE AVE SUFFERN NY 10901 912135195 SUPPORTING NY 501(C)(3) 12C, III-FI WCHCC false HealthAlliance Foundation Inc 741 GRANT AVENUE LAKE KATRINE NY 12449 222511450 FUNDRAISING NY 501(C)(3) 7 HA INC false HUDSON RIVER WEST INSURANCE (BARBADOS) 38 PINE ROAD BELLEVILLE ST MICHAEL BB CAP INSURANCE BB BSCHS C CORP true KINGSTON INSURANCE (BARBADOS) LIMITED 38 PINE ROAD BELLEVILLE ST MICHAEL BB CAP INSURANCE BB HEALTHALLIANCE C CORP true NORTHEAST PROVIDER SOLUTIONS INC 100 WOODS ROAD VALHALLA NY 10595 133991673 MSO & HEARING AID NY NA C CORP true WMC ADVANCED PHYSICIAN SERVICES PC 19 BRADHURST AVENUE HAWTHORNE NY 10595 264709927 PHYSICIAN OFFICES NY NA C CORP true WESTCHESTER MEDICAL REGIONAL PHYS SVCS 241 NORTH ROAD POUGHKEEPSIE NY 10532 465522536 PHYSICIAN OFFICES NY NA C CORP true WCHCC (BERMUDA) LIMITED VICTORIA HALL 11 VICTORIA STREET HAMILTON BD CAP INSURANCE BD NA C CORP true KINGSTON REGIONAL HEALTH CARE ENTERPRISE 396 BROADWAY KINGSTON NY 12401 161514994 INVESTMENT NY HAH BWAY C CORP true MID HUDSON PHYSICIANS PC 396 BROADWAY KINGSTON NY 12401 203564769 MEDICAL SVCS NY NA C CORP true BSCHS MEDICAL GROUP PC 10 FRANKLIN TURNPIKE MAHWAH NJ 07430 821632215 PHYSICIAN OFFICES NJ BSCHS C CORP true false true false false false false false false false false false false false false false true true false false Bon Secours Charity Health System Inc Q 425362 Cost GOOD SAMARITAN HOSPITAL FOR BETTER HEALTH B 50538 Cost SCHEDULE R, PART II, BON SECOURS CHARITY HEALTH SYSTEM, INC. (BSCHS) GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH has a brother-sister relationship with BSCHSS six subordinates in a group exemption within BSCHS.