2018-11-02T09:37:04-05:00 2017-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2017-01-01 133400353 GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH % MAUREEN BURKE GOOD 8453685151 255 Lafayette Avenue Suffern NY 10901 MARY LEAHY MD CEO - BSCHS 8453685305 2018-10-03 true LAURA KIELCZEWSKI P00740769 2127733000 100.2.84.112 26308520183065000021 2018-11-02 P 89F31758C10140A6CE2E9E470E23FD94F177A9B4 D7645E384763AEB8339B885771554B833BC3ADBE 2017 2018-06-14 16:35:46Z MARY LEAHY MD 255 Lafayette Avenue Suffern NY 10901 917067 false 0928 X www.bschsf.org/goodsam X 1986 NY Fundraising for the benefit of Good Samaritan Hospital of Suffern, NY. 30 28 0 61 0 0 547127 735272 0 0 8194 16656 -73765 -142586 481556 609342 603 10999 0 0 316533 216099 0 0 370987 553678 328553 870814 555651 -389258 53691 2940805 3481523 40822 13270 2899983 3468253 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 130200 0 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 scans 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 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. 130200 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 false true false false false false false false false false false false false false false true false false false true 15 0 true 0 false false false false false true true false false false false X 30 28 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 Nicholas DeSantis Board Member 1.0 0.0 X 0 0 0 Tessa Garcia Board Member (Thru June 2017) 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 150956 27273 Jack Holt Board Member 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 863550 79513 Patricia Lefkowitz Board Member 1.0 0.0 X 0 0 0 Aurelius Licata Board Member 1.0 0.0 X 0 0 0 Jeffrey Marangi Board Member 1.0 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 Sr Mary-Louise Moran SC President 1.0 0.0 X 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 Irene Tsetsekos Board Member 1.0 0.0 X 0 0 0 Bryan Newman 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 CHRISTOPHER BANKS VP OF PHILANTHROPY-TERM 10/17 30.0 10.0 X 0 307303 44344 0 1321809 151130 0 false true false NONE 0 386343 348929 735272 0 16649 16649 0 0 0 0 0 10017 10010 7 7 7 155129 386343 297715 -142586 -142586 0 0 0 0 0 0 0 609342 -125930 10249 10249 750 750 0 0 0 0 165297 33059 16530 115708 3603 721 360 2522 36499 7300 3650 25549 10700 2140 1070 7490 0 0 0 0 0 7206 6485 721 43091 8618 4309 30164 70016 14003 7002 49011 51792 10358 5179 36255 7467 6720 747 0 0 5214 1043 521 3650 0 1453 291 145 1017 0 0 0 50664 10133 5066 35465 PURCHASED SERVICES 81750 16350 8175 57225 OTHER 9900 1980 989 6931 555651 130200 54464 370987 0 0 235776 478667 257921 158824 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1820246 2224578 0 0 0 0 0 0 626862 619454 2940805 3481523 40822 13270 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40822 13270 X 410676 688477 2406360 2742002 82947 37774 2899983 3468253 2940805 3481523 X 53691 52259 462320 X false true X true false X 983140 339632 1204731 547127 735272 3809902 0 0 983140 339632 1204731 547127 735272 3809902 156855 3653047 15947 5088 22483 8194 16649 68361 0 204485 3344118 176170 99100 155129 3979002 7857265 0.46493 0.51249 X Part II, Line 10 Explanation for Other Income: Special Events Revenue 2013 AMOUNT: $ 204,485 2014 AMOUNT: $ 33,000 2015 AMOUNT: $ 176,170 2016 AMOUNT: $ 99,100 2017 AMOUNT: $ 155,129 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 END ON AUGUST 31 TO A CALENDAR YEAR ENDING DECEMBER 31. THE 2015 FORM 990 COVERS THE ENTIRE CALENDAR YEAR. THE CHANGE IN ACCOUNTING PERIOD WAS REPORTED ON THE 2014 FORM 990. 2489307 774238 483769 2779776 1999405 615372 125470 2489307 2249715 656141 906451 1999405 0.02980 0.97020 false false SUPPLEMENTAL SURVIVOR 0 INSURANCE-CASH SURRENDER VALUE 223080 SURVIVING SPOUSE INSURANCE- 0 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 251900 183900 68000 78140 11000 76782 FALL CLASSIC 160700 130700 30000 1625 47651 8238 2 128872 71743 57129 52783 2000 19496 541472 386343 155129 1625 178574 13000 104516 297715 -142586 true Part I Description of Procedure for Monitoring Use of Funds The organization complies with 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. true true false false false false false false false Gayle Hirsch Esq Board Member 0 150119 0 0 0 837 0 10185 0 17088 0 178229 0 0 Mary Leahy MD CEO - BSCHS 0 648050 0 215500 0 0 0 37800 0 41713 0 943063 0 0 CHRISTOPHER BANKS VP OF PHILANTHROPY-TERM 10/17 0 186110 0 45631 0 75562 0 18835 0 25509 0 351647 0 0 PART I, LINE 4A CHRISTOPHER BANKS, VP OF PHILANTHROPY, RECEIVED SEVERANCE PAYMENTS TOTALING $48,822 IN 2017. UPON MR. BANK'S SEPARATION OF EMPLOYMENT WITH BON SECOURS CHARITY HEALTH SYSTEMS, INC. ("BSCHS") (EFFECTIVE 10/12/17), HE WAS PROVIDED SEVERANCE IN RECOGNITION OF HIS SERVICE TO THE ORGANIZATION. PART I, LINE 4B THE FILING ORGANIZATION PARTICIPATES IN A BSCHS SPONSORED EXECUTIVE RETIREMENT PROGRAM 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 RELATED PARTIES: 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 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 15 THE COMPENSATION COMMITTEE ENGAGES IN A COMPREHENSIVE PROCESS FOR THE OVERSIGHT AND MANAGEMENT OF REMUNERATION FOR EXECUTIVE EMPLOYEES. THE COMPENSATION COMMITTEE CONSISTS OF A GROUP OF INDEPENDENT BOARD MEMBERS AND ENGAGES AN INDEPENDENT EXTERNAL COMPENSATION CONSULTANT TO ENSURE THEY RECEIVE APPROPRIATE ANALYSIS OF MARKET AND FOLLOW THE PRACTICES NECESSARY TO OBTAIN FULL COMPLIANCE WITH THE IRS REBUTTABLE PRESUMPTION OF REASONABLENESS. THE COMMITTEE ESTABLISHES AND MAINTAINS A COMPENSATION PHILOSOPHY, REVIEWS PAY PRACTICES AGAINST LOCAL, REGIONAL AND NATIONAL HEALTHCARE ORGANIZATIONS AND APPROVES ALL REMUNERATIVE DECISIONS FOR THIS GROUP OF INDIVIDUALS. THE COMMITTEE REVIEWS AND RECEIVES ASSURANCES THAT ALL LEVELS OF PAY WITHIN THE ORGANIZATION ARE REASONABLE BASED ON PERFORMANCE AND VALIDATES INCENTIVES ARE MET. THESE DECISIONS ARE DOCUMENTED IN THE WMC-ROCKLAND BOARD OF DIRECTORS AND COMPENSATION COMMITTEE MINUTES. 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 MARY-LOUISE MORAN DOES NOT RECEIVE COMPENSATION AS SHE HAS TAKEN A VOW OF POVERTY. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: - PRIOR YEAR PLEDGE ADJUSTMENTS $ (222,510) - TRANSFERS FROM AFFILIATES $ 684,830 ----------- TOTAL $ 462,320 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) 10 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 NY NA C CORP true WMC ADVANCED PHYSICIAN SERVICES PC 19 BRADHURST AVENUE HAWTHORNE NY 10595 264709927 PHYSICIAN OFF NY NA C CORP true WESTCHESTER MEDICAL REGIONAL PHYS SVCS 241 NORTH ROAD POUGHKEEPSIE NY 10532 465522536 PHYSICIAN OFF 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 false false false false false false false false false false false false false false true true false true Bon Secours Charity Health System Inc P 567303 Cost GOOD SAMARITAN HOSPITAL FOR BETTER HEALTH B 107907 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.