ST JAMES FOUNDATION INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
ST JAMES FOUNDATION INC (EIN 16-1486437)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-09
IRS object ID
201743139349300524
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-11-09T10:41:25-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN160765486PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1LUMSDEN & MCCORMICK LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1369 FRANKLIN STREETAddressLine1Txt
CityBUFFALOCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN161486437EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST JAMES MERCY FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTJABusinessNameControlTxt
Phone6073248000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1411 CANISTEO STREETAddressLine1Txt
CityHORNELLCityNm
State AbbreviationNYStateAbbreviationCd
ZIP148432104ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTANLEY D KONOPKOPersonNm
Person TitleCFOPersonTitleTxt
Phone6073248000PhoneNum
Signature2017-11-06SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J GRIMALDIPreparerPersonNm
PTINP01295846PTIN
Phone7168563300PhoneNum
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJENNIFER L SULLIVANPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1411 CANISTEO STREETAddressLine1Txt
CityHORNELLCityNm
State AbbreviationNYStateAbbreviationCd
ZIP148432104ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$145,933GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTP://WWW.STJAMESMERCY.ORG/FOUNDATION-OVERVIEW.SWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionSEE SCHEDULE O ST. JAMES MERCY FOUNDATION, INC. STRIVES TO PROVIDE RESOURCES TO BENEFIT ST. JAMES MERCY HOSPITAL, ESTABLISHING PROGRAMS THAT ENCOURAGE A STRONG TRADITION OF CHARITABLE GIVING IN ORDER TO SUSTAIN AND INCREASE HEALTH CARE SERVICES IN THE REGION WE SERVE, NOW AND INTO THE FUTURE.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee2TotalEmployeeCnt
Total Volunteers20TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$49,869PYContributionsGrantsAmt
CY Contributions Grants$73,179CYContributionsGrantsAmt
PY Program Service Revenue$47,110PYProgramServiceRevenueAmt
CY Program Service Revenue$56,521CYProgramServiceRevenueAmt
PY Investment Income$4,250PYInvestmentIncomeAmt
CY Investment Income$9,443CYInvestmentIncomeAmt
PY Other Revenue-$4,955PYOtherRevenueAmt
CY Other Revenue-$1,126CYOtherRevenueAmt
PY Total Revenue$96,274PYTotalRevenueAmt
CY Total Revenue$138,017CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$25,751CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$141,174PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$58,415CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$23,516CYTotalFundraisingExpenseAmt
PY Other Expenses$47,912PYOtherExpensesAmt
CY Other Expenses$37,823CYOtherExpensesAmt
PY Total Expenses$189,086PYTotalExpensesAmt
CY Total Expenses$121,989CYTotalExpensesAmt
PY Revenues Less Expenses-$92,812PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$16,028CYRevenuesLessExpensesAmt
Total Assets BOY$577,306TotalAssetsBOYAmt
Total Assets EOY$623,338TotalAssetsEOYAmt
Total Liabilities BOY$35,465TotalLiabilitiesBOYAmt
Total Liabilities EOY$67,386TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$541,841NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$555,952NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionST. JAMES MERCY FOUNDATION, INC. STRIVES TO PROVIDE RESOURCES TO BENEFIT ST. JAMES MERCY HOSPITAL, ESTABLISHING PROGRAMS THAT ENCOURAGE A STRONG TRADITION OF CHARITABLE GIVING IN ORDER TO SUSTAIN AND INCREASE HEALTH CARE SERVICES IN THE REGION WE SERVE, NOW AND INTO THE FUTURE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$49,320ExpenseAmt
Grant$25,751GrantAmt
DescST. JAMES MERCY FOUNDATION, INC. PROVIDES PHILANTHROPIC SUPPORT SOLELY TO ST. JAMES MERCY HOSPITAL THROUGH GIFTS FROM INDIVIDUALS, CORPORATIONS AND PUBLIC ENTITIES. THE FOUNDATION HELPS TO ACCOMPLISH THE PRIORITIES OF ST. JAMES MERCY HOSPITAL THROUGH FUNDRAISING, VOLUNTEERISM AND STEWARDSHIP.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$29,437ExpenseAmt
Revenue$56,521RevenueAmt
DescTHE AQUINAS GIFT SHOP IS A PROGRAM SERVICE FOR ST. JAMES MERCY FOUNDATION, INC. THE AQUINAS GIFT SHOP IS STAFFED BY VOLUNTEERS FROM THE ST. JAMES AUXILIARY.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$78,757TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee2EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STANLEY D KONOPKOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6073248110PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1411 CANISTEO STREETAddressLine1Txt
CityHORNELLCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14843ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
STEVE PECK
CHAIRPERSON0.30Yes (X)Yes (X)$0$0$0
PETER WALL
VICE CHAIRPERSON0.30Yes (X)Yes (X)$0$0$0
LISA SCHWARTZ
SECRETARY/TREASURER0.30Yes (X)Yes (X)$0$0$0
NANCY BARTELL
MEMBER0.30Yes (X)$0$0$0
KATHY DESSENA
MEMBER0.30Yes (X)$0$0$0
ELLIE MOREY
MEMBER0.30Yes (X)$0$0$0
TERRY PULLMAN
MEMBER0.30Yes (X)$0$0$0
JENNIFER L SULLIVAN
PRESIDENT/CEO1.00Yes (X)$0$243,319$13,07939.00
STANLEY D KONOPKO
CFO0.30Yes (X)$0$0$039.70
DUSTIN HEWITT
EXECUTIVE DIRECTOR40.00Yes (X)$48,333$0$5,840
FieldValueIRS element (for citing)
Total Reportable Comp From Org$48,333TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$243,319TotReportableCompRltdOrgAmt
Total Other Compensation$18,919TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$30,559FundraisingAmt
All Other Contributions$42,620AllOtherContributionsAmt
Total Contributions$73,179TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescAQUINAS GIFT SHOPDesc
Business453220BusinessCd
Total Revenue Column$56,521TotalRevenueColumnAmt
Related Or Exempt Func Income$56,521RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$56,521TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,550TotalRevenueColumnAmt
Exclusion$3,550ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$5,893SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$5,893SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,893TotalRevenueColumnAmt
Exclusion$5,893ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$6,790FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$30,559ContriRptFundraisingEventAmt
Fundraising Direct Expenses$7,916FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$1,126TotalRevenueColumnAmt
Exclusion-$1,126ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$138,017TotalRevenueColumnAmt
Related Or Exempt Func Income$56,521RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$8,317ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$25,751TotalAmt
Program Services$25,751ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$26,538TotalAmt
Program Services$13,269ProgramServicesAmt
Management And General$13,269ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$17,889TotalAmt
Program Services$17,889ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$13,988TotalAmt
Program Services$9,810ProgramServicesAmt
Management And General$4,178ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,000TotalAmt
Management And General$2,000ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$509TotalAmt
Program Services$255ProgramServicesAmt
Management And General$254ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,118TotalAmt
Program Services$1,118ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,767TotalAmt
Program Services$3,767ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$30TotalAmt
Program Services$15ProgramServicesAmt
Management And General$15ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmtProgram ServicesProgramServicesAmt
FUNDRAISING EXPENSE$23,516$23,516
MISCELLANEOUS EXPENSE$6,883$6,883

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$121,989TotalAmt
Program Services$78,757ProgramServicesAmt
Management And General$19,716ManagementAndGeneralAmt
Fundraising$23,516FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$46,235BOYAmt
EOY$49,987EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$20,514EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$19,909LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$19,865LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$74BOYAmt
EOY$44EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$530,997BOYAmt
EOY$552,793EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$577,306BOYAmt
EOY$623,338EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$35,465BOYAmt
EOY$67,386EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$35,465BOYAmt
EOY$67,386EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,981BOYAmt
EOY$222EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$257,586BOYAmt
EOY$285,456EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$270,274BOYAmt
EOY$270,274EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$541,841BOYAmt
EOY$555,952EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$577,306BOYAmt
EOY$623,338EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$16,028ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,917NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$747,551CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$93,165CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$46,674CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$49,869CurrentTaxYearMinus1YearAmt
Current Tax Year$73,179CurrentTaxYearAmt
Total$1,010,438TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$747,551CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$93,165CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$46,674CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$49,869CurrentTaxYearMinus1YearAmt
Current Tax Year$73,179CurrentTaxYearAmt
Total$1,010,438TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$1,010,438PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$23,606CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$24,176CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,641CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,250CurrentTaxYearMinus1YearAmt
Current Tax Year$9,443CurrentTaxYearAmt
Total$69,116TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year-$4,955CurrentTaxYearMinus1YearAmt
Current Tax Year-$1,126CurrentTaxYearAmt
Total-$6,081TotalAmt
FieldValueIRS element (for citing)
Total Support$1,073,473TotalSupportAmt
Public Support CY1700.94130PublicSupportCY170Pct
Public Support PY1700.92620PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$270,274BeginningYearBalanceAmt
End Year Balance$270,274EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$271,674BeginningYearBalanceAmt
Grants Or Scholarships$1,400GrantsOrScholarshipsAmt
End Year Balance$270,274EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$271,674BeginningYearBalanceAmt
End Year Balance$271,674EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$269,621BeginningYearBalanceAmt
Contributions$2,053ContributionsAmt
End Year Balance$271,674EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$269,621BeginningYearBalanceAmt
End Year Balance$269,621EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,909OtherCostOrOtherBasisAmt
Depreciation$19,865DepreciationAmt
Book Value$44BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$44TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescASSETS WHOSE USE IS LIMITEDDesc
Book Value$552,793BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$552,793TotalBookValueOtherAssetsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART V, LINE 4:FormAndLineReferenceDesc
ExplanationWITH THE HELP OF NEARLY 350 COMMUNITY MEMBERS, BUSINESS PARTNERS, EMPLOYEES, PROVIDERS, AND FRIENDS AND DONORS LIKE YOU, SJM FOUNDATION RAISES CHARITABLE GIFTS TO MAKE POSSIBLE A RANGE OF FACILITIES IMPROVEMENTS, CAPITAL EQUIPMENT, AND PROGRAM INITIATIVES, INCLUDING: - MANAGEMENT LEADERSHIP TRAINING - MERCY SUITE REFURBISHMENTS - PHYSICAL THERAPY (BARIATRIC HI-LO PLINTH) - PHYSICAL THERAPY (BIODEX BALANCE ASSESSMENT AND TREATMENT SYSTEM) - CARDIAC REHABILITATION PROGRAM SOFTWARE - EMT COMMUNITY-BASED TRAINING (WITH SUPPORT FROM BETHESDA FOUNDATION) - RENOVATION OF SJMH LOBBYExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF OUTINGEvent1Nm
Gross Receipts Event1$37,349GrossReceiptsEvent1Amt
Charitable Contri Event1$30,559CharitableContriEvent1Amt
Gross Revenue Event1$6,790GrossRevenueEvent1Amt
Cash Prizes Event1$749CashPrizesEvent1Amt
Non Cash Prizes Event1$590NonCashPrizesEvent1Amt
Rent Facility Costs Event1$4,006RentFacilityCostsEvent1Amt
Food And Beverage Event1$2,329FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$242OtherDirectExpensesEvent1Amt
Gross Receipts Total$37,349GrossReceiptsTotalAmt
Charitable Contributions Tot$30,559CharitableContributionsTotAmt
Gross Revenue Total Events$6,790GrossRevenueTotalEventsAmt
Cash Prizes Total Events$749CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$590NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$4,006RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$2,329FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$242OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$7,916DirectExpenseSummaryEventsAmt
Net Income Summary-$1,126NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1ST JAMES MERCY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1411 CANISTEO STREETAddressLine1Txt
CityHORNELLCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14843ZIPCd
FieldValueIRS element (for citing)
Recipient EIN160743310RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$25,751CashGrantAmt
Purpose Of GrantSPECIFIC SUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FOUNDATION'S BOARD APPROVES ALL TRANSFERS TO ST. JAMES MERCY HOSPITAL.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonJENNIFER L SULLIVANPersonNm
TitlePRESIDENT/CEOTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$243,319CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$2,596DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$10,483NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$256,398TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3STANLEY D. KONOPKO HAS SERVED AS THE ORGANIZATION'S CFO SINCE AUGUST 2013. MR. KONOPKO IS A PARTNER OF BONADIO & CO., LLP, AN ACCOUNTING FIRM, WHICH WAS PAID $334,894 FOR MR. KONOPKO'S SERVICES TO BOTH THE FOUNDATION AND ST. JAMES MERCY HOSPITAL, A RELATED ORGANIZATION, IN 2016. THE FEES WERE PAID BY ST. JAMES MERCY HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 6ST. JAMES MERCY HOSPITAL IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE MEMBERS OF THE GOVERNING BODY ARE ELECTED BY ST. JAMES MERCY HOSPITAL, THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7BTHE GOVERNING BODY OF ST. JAMES MERCY FOUNDATION, INC. CAN MAKE RECOMMENDATIONS FOR CERTAIN TYPES OF ACTIONS THAT REQUIRE APPROVAL BY THE SOLE CORPORATE MEMBER. SOME EXAMPLES INCLUDE APPOINTING OR REMOVING MEMBERS OF THE GOVERNING BODY, AMENDING ARTICLES OF INCORPORATION AND AMENDING BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES MERCY FOUNDATION, INC. HAS DESIGNATED THE AUDIT AND COMPLIANCE COMMITTEE OF ST. JAMES MERCY HOSPITAL AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12CA CALL FOR CONFLICTS IS PART OF EVERY BOARD MEETING. THE ANNUAL BOARD OF DIRECTORS EDUCATION SESSION WAS COMPLETED ON DECEMBER 6, 2016.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES.
FORM 990, PART VI, SECTION C, LINE 19ORGANIZATIONAL DOCUMENTS, SUCH AS THE ARTICLES OF INCORPORATION, CORPORATE BYLAWS, GOVERNANCE POLICIES BELIEVED TO BE OF INTEREST TO THE PUBLIC, CONFLICT OF INTEREST POLICIES AND THE IRS FORM 990, ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C:THE AUDIT AND COMPLIANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSIGHT OF THE AUDIT. THERE HAS NOT BEEN A CHANGE FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1ST JAMES MERCY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1411 CANISTEO STREETAddressLine1Txt
CityHORNELLCityNm
State AbbreviationNYStateAbbreviationCd
ZIP14843ZIPCd
FieldValueIRS element (for citing)
EIN160743310EIN
Primary ActivitiesHEALTHCARE AND HOSPITAL SERVICESPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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