2016-11-10T17:26:53-06:00 2015-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2015-01-01 133400353 Good Samaritan Foundation For Better Health % PETER KENNIFF GOOD 8453685151 255 Lafayette Avenue Suffern NY 10901 Christopher Banks VP of Philanthropy 8453685305 2016-11-09 true LAURA KIELCZEWSKI P00740769 2127733000 2015 2017-02-10 21:41:12Z Christopher Banks 255 Lafayette Avenue Suffern NY 10901 1403484 false 0928 X www.bschsf.org/goodsam X 1986 NY Fundraising for the benefit of Good Samaritan Hospital of Suffern, NY 33 31 0 20 0 339632 1204831 0 0 5088 22483 3320911 -83770 3665631 1143544 93780 1144984 0 0 102132 307291 0 0 408955 163689 276939 359601 1729214 3306030 -585670 3169708 2560726 17367 28213 3152341 2532513 X The mission is to bring compassion to health care and to be hood help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. false false 1261837 1144984 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. 1261837 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 8 0 true 0 false false false false false true true false false false false X 33 31 false false false false true true true true true false false true true true true false false false false false NY X PETER KENNIFF 8453685305 255 LAFAYETTE AVENUE Suffern NY 10901 X Angela Clarkin Board Member 0.5 0.0 X 0 0 0 Richard Clarkin MD Board Member 0.5 0.0 X 0 0 0 John DeCicco Secretary 0.5 0.0 X 0 0 0 Nicholas DeSantis Board Member 0.5 0.0 X 0 0 0 Suzanne Donaghy Board Member 0.5 0.0 X 0 0 0 Tessa Garcia Board Member 0.5 0.0 X 0 0 0 Sr Fran Gorsuch CBS Board Member 0.5 0.0 X 0 0 0 Colin Gray Board Member 0.5 0.0 X 0 0 0 Gil Heim Board Member 0.5 0.0 X 0 0 0 Gayle Hirsch Esq Board Member 0.5 0.0 X 0 149495 24900 Jack Holt Chairman 1.0 0.0 X X 0 0 0 Jeffrey Horowitz Board Member 0.5 0.0 X 0 0 0 Geanette Katz Board Member 0.5 0.0 X 0 0 0 Kevin Kern Board Member 0.5 0.0 X 0 0 0 Joseph Lagana Board Member 0.5 0.0 X 0 0 0 Mary Leahy MD CEO - BSCHS 1.0 39.0 X X 0 951438 86622 Patricia Lefkowitz Board Member 0.5 0.0 X 0 0 0 Aurelius Licata Board Member 0.5 0.0 X 0 0 0 Pierson Mapes Board Member (Jan - Oct) 0.5 0.0 X 0 0 0 Jeffrey Marangi Board Member 0.5 0.0 X 0 0 0 Kathy Medici Board Member 0.5 0.0 X 0 0 0 Glenn Mendoza MD Board Member 0.5 0.0 X 0 0 0 Mona Montal Board Member 0.5 0.0 X 0 0 0 Sr Mary-Louise Moran SC President 1.0 0.0 X X 0 0 0 Harold Peterson Board Member 0.5 0.0 X 0 0 0 Amra Sabic-El-Rayess PhD Board Member 0.5 0.0 X 0 0 0 Louis Siracusano Board Member 0.5 0.0 X 0 0 0 Frank Stillo Board Member 0.5 0.0 X 0 0 0 Irene Tsetsekos Board Member 0.5 0.0 X 0 0 0 Eric Wiggins Treasurer 0.5 0.0 X X 0 0 0 Bryan Newman Board Member 0.5 0.0 X 0 0 0 Mark Acker Board Member 0.5 0.0 X 0 0 0 Joseph Allen Board Member 0.5 0.0 X 0 0 0 Heather Bowie Board Member 0.5 0.0 X 0 0 0 Christopher Banks VP of Philanthropy 40.0 10.0 X 0 244242 27492 0 1345175 139014 0 false true false NONE 0 345179 190000 669652 21010 1204831 0 22483 22483 0 0 0 0 0 0 176170 345179 259940 -83770 -83770 0 0 0 1143544 -61287 1144984 1144984 0 0 0 0 0 0 0 0 0 0 0 0 0 0 271074 54215 27107 189752 1884 377 188 1319 20970 4194 2097 14679 13363 2673 1336 9354 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2671 534 267 1870 58510 11702 5851 40957 0 0 0 0 0 0 0 0 9 8 1 0 6829 1366 683 4780 0 0 0 0 1169 234 117 818 0 0 0 0 0 0 0 0 0 0 0 0 16594 3319 1659 11616 Purchased Services 170147 34029 17015 119103 Supplies 21010 4202 2101 14707 1729214 1261837 58422 408955 0 0 0 271664 434833 588959 354640 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1628085 1144391 0 0 0 0 0 0 681000 626862 3169708 2560726 5060 28213 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12307 0 17367 28213 X 905083 533108 2209484 1961631 37774 37774 3152341 2532513 3169708 2560726 X -585670 -7320 55500 0 0 -82338 X false true X true false X 980369 1380886 987190 339632 1204831 4892908 0 0 980369 1380886 987190 339632 1204831 4892908 156362 4736546 24687 8225 15947 5088 22483 76430 0 196132 182105 204485 3344118 176170 4103010 9072348 0.52209 0.52290 X Part II, Line 10 Explanation for Other Income: Special Events Revenue 2011 AMOUNT: $ 167,493 2012 AMOUNT: $ 182,105 2013 AMOUNT: $ 204,485 2014 AMOUNT: $ 33,000 2015 AMOUNT: $ 176,170 Insurance Reimbursement Income 2011 AMOUNT: $ 28,639 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 0 656141 906451 -250310 0.01890 0.98110 true false 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. Fall Classic 152700 127919 24781 2450 46575 44365 Spring Ball 257000 204362 52638 53220 6500 25915 1 111649 12898 98751 68708 1000 11207 521349 345179 176170 2450 168503 7500 81487 259940 -83770 false Good Samaritan Hospital of Suffern 255 Lafayette Avenue Suffern NY 109015620 131740104 501(c)(3) 1140684 General Support 1 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. false true false false false false false false false Gayle Hirsch Esq Board Member 0 145643 0 3060 0 792 0 9945 0 14955 0 174395 0 0 Mary Leahy MD CEO - BSCHS 0 563172 0 336638 0 51628 0 55342 0 31280 0 1038060 0 0 Christopher Banks VP of Philanthropy 0 223512 0 20235 0 495 0 3109 0 24383 0 271734 0 0 Part I, Line 3 Bon Secours Health System, Inc., (BSHSI) a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee Part I, Line 4b: PARTICIPATE IN, OR RECEIVE PAYMENT FROM, A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: The filing organization participates in a BSHSI 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. Form 990, Part VI, line 6 MEMBERS OR STOCKHOLDERS: BON SECOURS CHARITY HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF GOOD SAMARITAN FOUNDATION FOR BETTER HEALTH. 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 by Bon Secours Health System, Inc., one of two corporate members of Bon Secours Charity Health System, Inc. along with the Sisters of Charity of Saint Elizabeth. 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 or is jointly reserved to Bon Secours Health System, Inc., the Sisters of Charity of Saint Elizabeth and WMC - Rockland, 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 process the organization uses to review the Form 990 consists of a review of the return in draft form by the Board of Directors. All comments and changes are reviewed and discussed with management and incorporated into the return as applicable prior to filing. Form 990, Part VI, Line 12c MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1)disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). 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, Bon Secours Charity Health System, Inc. FORM 990, PART VI, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF BON SECOURS HEALTH SYSTEM, INC. (BSHSI) ENGAGES IN A COMPREHENSIVE PROCESS FOR THE OVERSIGHT AND MANAGEMENT OF REMUNERATION FOR EXECUTIVE EMPLOYEES AND DISQUALIFIED PARTIES OF THE BSHSI. 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 BSHSI BOARD OF DIRECTORS AND COMPENSATION COMMITTEE MINUTES. Form 990, Part VI, Line 19 the organization's governing documents, conflict of interest policy, and financial statements are made available for public inspection 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 Fran Gorsuch, CBS does not receive compensation as she has taken a vow of poverty. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: - PV, Writeoffs, Allowances, Pledge Adjustments $ (82,338) WMC Health Network - Rockland Inc 100 Woods Rd Valhalla NY 10595 320467873 Parent Org NY 501(c)(3) 11c, III-FI Na false WESTCHESTER COUNTY HEALTH CARE CORP 100 WOODS ROAD VALHALLA NY 10595 133964321 Parent Org NY 115 NA false Bon Secours Charity Health System Inc 255 Lafayette Ave Suffern NY 10901 912135195 Local System NY 501(c)(3) 11C, III-FI WCHCC false Good Samaritan Hospital of Suffern NY 255 Lafayette Ave Suffern NY 10901 131740104 Healthcare NY 501(c)(3) LINE 3 BSCHSI false Bon Secours Community Hospital 160 E Main St Port Jervis NY 12771 141347717 Healthcare NY 501(c)(3) LINE 3 BSCHSI false St Francis Center at the Knolls dba Mt 20 Grand St Warwick NY 10990 061370576 Longterm Care NY 501(c)(3) LINE 9 BSCHSI false St Anthony's Community Hospital 15-19 Maple Ave Warwick NY 10990 141340100 Healthcare NY 501(c)(3) Line 3 BSCHSI false Bon Secours Community Hospital Foundatio 255 Lafayette Ave Suffern NY 10901 810667395 FOUNDATION NY 501(c)(3) Line 7 BSCHSI false Bon Secours Warwick Health Foundation - 255 Lafayette Ave Suffern NY 10901 141972807 FOUNDATION NY 501(c)(3) Line 7 St Anthony false Villa Francis at the Knolls dba Schervie 20 Grand St Warwick NY 10990 061381994 Nursing svcs NY 501(c)(3) Line 9 BSCHSI false Bon Secours Health System Medical Group 255 Lafayette Ave Suffern NY 10901 223636986 Primary Care NY 501(c)(3) Line 9 BSCHSI false false true true false false false false false false false false true false false false false false false false Good Samaritan Hospital b 2386603 Good Samaritan Hospital c 424926