2016-11-11T10:04:02-06:00 2015-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2015-01-01 161486437 ST JAMES MERCY FOUNDATION INC STJA 6073248000 411 CANISTEO STREET HORNELL NY 148432104 JENNIFER L SULLIVAN PRESIDENT/CEO 6073248000 2016-11-10 1 MICHAEL J GRIMALDI P01295846 7168563300 2015 2017-02-10 21:41:12Z JENNIFER L SULLIVAN 411 CANISTEO STREET HORNELL NY 148432104 105950 0 X HTTP://WWW.STJAMESMERCY.ORG/FOUNDATION-OVERVIEW.S X 1994 NY SEE SCHEDULE O ST. JAMES MERCY FOUNDATION 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. 12 11 3 125 0 0 46674 49869 48450 47110 135082 4250 -4348 -4955 225858 96274 0 0 0 0 101870 141174 0 0 28088 91137 47912 193007 189086 32851 -92812 593656 577306 88388 35465 505268 541841 ST. JAMES MERCY FOUNDATION 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. 0 0 67462 ST. 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. 31020 47110 THE 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. 98482 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 3 1 0 0 0 0 0 1 1 0 0 0 0 X 12 11 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X STANLEY D KONOPKO 6073248110 411 CANISTEO STREET HORNELL NY 14843 STEVE PECK CHAIRPERSON 0.30 X X 0 0 0 PETER WALL VICE CHAIRPERSON 0.30 X X 0 0 0 LISA SCHWARTZ SECRETARY/TREASURER 0.30 X X 0 0 0 NANCY BARTELL MEMBER 0.30 X 0 0 0 KATHY DESSENA MEMBER 0.30 X 0 0 0 LYNNE FREELAND MEMBER 0.30 X 0 0 0 BEVERLY GILBERT MEMBER 0.30 X 0 0 0 TIM INGALLS MEMBER 0.30 X 0 0 0 UZMA MEHR MD MEMBER 0.30 X 0 163577 24997 ELLIE MOREY MEMBER 0.30 X 0 0 0 JIM NICOLOFF MEMBER 0.30 X 0 0 0 TERRY PULLMAN MEMBER 0.30 X 0 0 0 JENNIFER L SULLIVAN PRESIDENT/CEO 1.00 39.00 X 0 691400 16810 STANLEY D KONOPKO CFO 0.30 39.70 X 0 0 0 SYLVIA BRYANT VP OF MISSION/DIRECTOR OF FOUNDATION 22.00 18.00 X 71892 61403 6100 71892 916380 47907 0 0 1 0 0 27599 22270 49869 AQUINAS GIFT SHOP 453220 47110 47110 47110 5921 5921 1671 -1671 -1671 -1671 3050 27599 8005 -4955 -4955 96274 47110 0 -705 75182 37591 37591 40841 30026 10815 25151 14658 10493 2651 2651 1916 965 951 699 699 7563 7563 30 15 15 FUNDRAISING EXPENSE 28088 28088 MISCELLANEOUS EXPENSE 6965 6965 189086 98482 62516 28088 49348 46235 19909 19835 104 74 544204 0 530997 593656 577306 88388 35465 88388 35465 X -37040 13981 270634 257586 271674 270274 505268 541841 593656 577306 X -92812 -7285 136670 X X 0 1 X 1 0 X 115523 747551 93165 46674 49869 1052782 115523 747551 93165 46674 49869 1052782 1052782 29174 23606 24176 7641 4250 88847 -4955 -4955 1136674 0.92620 0.90820 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 271674 1400 270274 271674 271674 269621 2053 271674 269621 269621 269621 269621 1.00000 0 0 19909 19835 74 74 ASSETS WHOSE USE IS LIMITED 530997 530997 GOLF OUTING 30649 27599 3050 275 201 2928 1694 2907 30649 27599 3050 275 201 2928 1694 2907 8005 -4955 1 0 0 0 0 0 0 0 0 UZMA MEHR MD MEMBER 0 146564 0 16968 0 45 0 2008 0 22989 0 188574 0 0 JENNIFER L SULLIVAN PRESIDENT/CEO 0 288156 0 65623 0 337621 0 2852 0 13958 0 708210 0 0 SCHEDULE J, PART I, LINE 4A PRIOR TO APRIL 30, 2015, ST. JAMES MERCY HOSPITAL, A RELATED ORGANIZATION, WAS A MEMBER OF TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION OPERATES ON A FISCAL YEAR BASIS WHICH BEGAN ON JULY 1, 2014 AND ENDED ON JUNE 30, 2015. PRIOR TO TRINITY HEALTH CORPORATION'S YEAR END, ST. JAMES MERCY HOSPITAL WAS DIVESTED FROM TRINITY HEALTH CORPORATION AND BECAME AN INDEPENDENT COMMUNITY ORGANIZATION GOVERNED BY A SELF-PERPETUATING COMMUNITY BOARD. AS PART OF THAT DIVESTITURE, CERTAIN INDIVIDUALS RECEIVED INCENTIVE COMPENSATION BASED UPON CONTRACTUAL ARRANGEMENTS WITH TRINITY HEALTH CORPORATION WHEREBY A PORTION OF THEIR TOTAL COMPENSATION WAS CONSIDERED "AT RISK AND ONLY PAID IN THE EVENT THAT CERTAIN PERFORMANCE MEASURES WERE ACHIEVED RELATED TO QUALITY, FINANCE, GROWTH AND PEOPLE. THE FINANCE PERFORMANCE MEASURE WAS TIED TO REDUCING THE OVERALL NET LOSS OF THE ORGANIZATION. ALL INCENTIVE COMPENSATION AND SEVERANCE WAS PAID BY TRINITY HEALTH CORPORATION. THE FOLLOWING INDIVIDUALS RECEIVED INCENTIVE COMPENSATION (INCLUDED IN COLUMN B(II) OF SCHEDULE J AND SEVERANCE PAYMENTS (INCLUDED IN COLUMN B(III) OF SCHEDULE J): JENNIFER L. SULLIVAN, HOSPITAL PRESIDENT AND CEO, RECEIVED $65,623 IN INCENTIVE COMPENSATION AND $337,500 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. FORM 990, PART VI, SECTION A, LINE 3 STANLEY 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 $308,864 FOR MR. KONOPKO'S SERVICES TO BOTH THE FOUNDATION AND ST. JAMES MERCY HOSPITAL, A RELATED ORGANIZATION, IN 2015. THE FEES WERE PAID BY ST. JAMES MERCY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED AND RESTATED EFFECTIVE MAY 1, 2015 TO NAME ST. JAMES MERCY HOSPITAL THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 6 BEGINNING MAY 1, 2015, ST. JAMES MERCY HOSPITAL IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. PRIOR TO THIS DATE, ST. JAMES MERCY HEALTH SYSTEM, INC. WAS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE GOVERNING BODY ARE ELECTED BY ST. JAMES MERCY HOSPITAL, THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY OF ST. JAMES MERCY FOUNDATION 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 11 A 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 12C A CALL FOR CONFLICTS IS PART OF EVERY BOARD MEETING. THE ANNUAL BOARD OF DIRECTORS EDUCATION SESSION WAS COMPLETED IN AUGUST 2015. FORM 990, PART VI, SECTION B, LINE 15 THROUGH APRIL 30, 2015, THE ORGANIZATION HAD ADOPTED TRINITY HEALTH CORPORATION'S PROCESS FOR DETERMINING COMPENSATION WHICH INCLUDED THE FOLLOWING: THE 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 ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA AND GUIDANCE COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED HEALTH SYSTEMS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. EFFECTIVE MAY 1, 2015, THE TRINITY HEALTH CORPORATION DIVESTED ITSELF OF ITS INTEREST IN THE ORGANIZATION AND THE ORGANIZATION BECAME AN INDEPENDENT HOSPITAL GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD. THE ORGANIZATION CONTINUED TO FOLLOW THE PROCESS FOR DETERMINING COMPENSATION EXCEPT FOR THE ENGAGEMENT OF EXTERNAL CONSULTANTS. THE BOARD/COMMITTEE UTILIZED OTHER SOURCES OF MARKET DATA AND FOLLOWED THE SAME PROCEDURES AS OUTLINED ABOVE TO DETERMINE COMPENSATION. THERE WERE NO INCENTIVE COMPENSATION PLANS IN EFFECT FROM MAY 1, 2015 THROUGH DECEMBER 31, 2015. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATIONAL 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 XI, LINE 9: TRANSFERS FROM AFFILIATES 130,841. OTHER CHANGES IN NET ASSETS 5,829. 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. ST JAMES MERCY HEALTH SYSTEM INC 411 CANISTEO STREET HORNELL NY 14843 223127184 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT NY 501(C)(3) LINE 11B, II TRINITY HEALTH CORPORATION 0 ST JAMES MERCY HOSPITAL 411 CANISTEO STREET HORNELL NY 14843 160743310 HEALTHCARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST JAMES MERCY HEALTH SYSTEM INC (THROUGH 4302015) 0 SJM PROPERTIES 411 CANISTEO STREET HORNELL NY 14843 161294991 PROPERTY HOLDINGS NY N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0