2017-10-30T10:17:08-05:00 2016-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2016-01-01 133400353 GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH % MAUREEN BURKE GOOD 8453685151 255 Lafayette Avenue Suffern NY 10901 Mary Leahy CEO 8453685305 2017-10-25 true LAURA KIELCZEWSKI P00740769 2127733000 164.57.159.254 26308520173035000006 2017-10-30 P 050F75853A9F423F493495C03CDD05FDA32C01D0 050F75853A9F423F493495C03CDD05FDA32C01D0 2016 2021-01-29 14:40:06Z Mary Leahy 255 Lafayette Avenue Suffern NY 10901 654421 false 0928 X www.bschsf.org/goodsam X 1986 NY Fundraising for the benefit of Good Samaritan Hospital of Suffern, NY 34 31 0 30 0 1204831 547127 0 0 22483 8194 -83770 -73765 1143544 481556 1144984 603 0 0 307291 316533 0 0 430427 276939 553678 1729214 870814 -585670 -389258 2560726 2940805 28213 40822 2532513 2899983 X 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 378868 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 comfortable (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. 378868 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 false false true false false false false false false false false false false false false false true false false false true 10 0 true 0 false false false false false true true false false false false X 34 31 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 Suzanne Donaghy Board Member 1.0 0.0 X 0 0 0 Tessa Garcia Board Member 1.0 0.0 X 0 0 0 Sr Fran Gorsuch CBS Board Member 1.0 39.0 X 0 6943 6322 Colin Gray 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 147131 25291 Jack Holt Board Member 1.0 0.0 X 0 0 0 Jeffrey Horowitz 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 777821 51211 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 Mona Montal 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 (AS OF 1/1/16) 1.0 0.0 X 0 0 0 Lawrence Garvey Board Member (AS OF 1/1/16) 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 Christopher Banks VP of Philanthropy 15.0 25.0 X 0 229170 41548 0 1161065 124372 0 false true false NONE 0 326350 220777 0 547127 0 8194 8194 0 0 0 0 0 0 99100 326350 172865 -73765 -73765 0 0 0 0 0 0 0 481556 -65571 0 0 603 603 0 0 0 0 0 0 277899 55580 27789 194530 6651 1331 665 4655 16758 3352 1675 11731 15225 3044 1523 10658 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7133 1427 713 4993 47658 9532 4765 33361 0 0 0 0 0 0 0 0 316 284 32 0 12422 2484 1242 8696 0 0 0 0 1899 380 190 1329 0 0 0 0 0 0 0 0 0 0 0 0 60141 12028 6014 42099 Purchased Services 424109 288823 16911 118375 870814 378868 61519 430427 0 0 0 434833 235776 354640 257921 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1144391 1820246 0 0 0 0 0 0 626862 626862 2560726 2940805 28213 40822 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28213 40822 X 533108 410676 1961631 2406360 37774 82947 2532513 2899983 2560726 2940805 X -389258 26139 0 0 0 730589 X false true X true false X 1380886 987190 339632 1204831 547127 4459666 0 0 1380886 987190 339632 1204831 547127 4459666 90392 4369274 8225 15947 5088 22483 8194 59937 0 182105 204485 3344118 176170 99100 4005978 8525581 0.51249 0.52209 X Part II, Line 10 Explanation for Other Income: Special Events Revenue 2012 AMOUNT: $ 182,105 2013 AMOUNT: $ 204,485 2014 AMOUNT: $ 33,000 2015 AMOUNT: $ 176,170 2016 AMOUNT: $ 99,100 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1999405 615372 125470 2489307 2249715 656141 906451 1999405 0.03300 0.96700 true false SUPPLEMENTAL SURVIVOR 0 INSURANCE-CASH SURRENDER VALUE 230489 SURVIVING SPOUSE INSURANCE- 0 CASH SURRENDER VALUE 396373 626862 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 221900 162100 59800 52500 11000 860 Fall Classic 108750 99750 9000 51095 4610 2 94800 64500 30300 51800 1000 425450 326350 99100 155395 12000 5470 172865 -73765 false true false false false false false false false Gayle Hirsch Esq Board Member 0 146333 0 0 0 798 0 10039 0 15252 0 172422 0 0 Mary Leahy MD CEO - BSCHS 0 627821 0 150000 0 0 0 15900 0 35311 0 829032 0 0 Christopher Banks VP of Philanthropy 0 228657 0 0 0 513 0 17706 0 23842 0 270718 0 0 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 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 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 ARE MARRIED. 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 GSFBH is appointed by its member, BSHSI and subject to approval of WMC Health Network-Rockland, Inc. (WMC-ROCKLAND), one of the three corporate members of Bon Secours Charity Health System (BSHS) along with BSHSI, and The Sisters of Charity of Saint Elizabeth (SCSE). FORM 990, PART VI, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS: Certain authorities of GSFBH are reserved to its member or is jointly reserved to BSHSI, the SCSE and WMC-Rockland, the three corporate members of BSCHSI. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990: The Form 990 was prepared by our tax advisors together with our finance department with the assistance from various departments throughout the organization. The Form 990 was reviewed by internal leadership. Upon completion of the various reviews, the Form 990 was presented 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 WMCHealth 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 the individual alleviate the conflict, or 4) removal of the individual from employment. Form 990, Part VI lines 13 and 14 Written whistleblower and document retention and destruction policies: The Foundation does not have its own written whistblower and document retention and destruction policies; however, the Foundation does follow the policies approved by the Board of its related organization, BSCHSI. FORM 990, PART VI, LINE 15 THE COMPENSATION COMMITTEE OF WMC HEALTH NETWORK-ROCKLAND, INC. (WMC-ROCKLAND) ENGAGES IN A COMPREHENSIVE PROCESS FOR THE OVERSIGHT AND MANAGEMENT OF REMUNERATION FOR EXECUTIVE EMPLOYEES AND DISQUALIFIED PARTIES OF BSCHS. 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 STATEMENT 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. SISTER FRAN GORSUCH, CBS HAS TAKEN A VOW OF POVERTY AND ONLY RECEIVES IMPUTED INCOME for HOUSING AND GROUP TERM LIFE INSURANCE. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: - Prior Year Pledge Adjustments $ 2,020 - TRANSFERS FROM AFFILIATES $ 728,569 --------- TOTAL $ 730,589 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 241 NORTH ROAD POUGHKEEPSIE NY 12601 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 HEALTHALLIANCE SENIOR LIVING CORP 396 BROADWAY KINGSTON NY 12401 300164277 RTMNT COMM NY 501(C)(3) 10 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 BSCHSI false BON SECOURS WARWICK HEALTH FOUNDATION 255 LAFAYETTE AVE SUFFERN NY 10901 141972807 SUPPORT FDN NY 501(C)(3) 7 BSCHSI false BON SECOURS CHARITY HEALTH SYSTEM INC 255 LAFAYETTE AVE SUFFERN NY 10901 912135195 SUPPORTING NY 501(C)(3) 12C, III-FI WCHCC false HUDSON RIVER WEST INSURANCE (BARBADOS) 38 PINE ROAD BELLEVILLE ST MICHAEL BB CAP INSURANCE BB BSCHSI C CORP 474216 10940250 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 HAH BWAY C CORP true false false false false false false false false false false false false false false false false true true false Bon Secours Charity Health System Inc q 394415 Cost Bon Secours Charity Health System Inc r 79647 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.