2015-06-09T08:07:11-05:00 2014-08-31 990 2013-09-01 810667395 Bon Secours Community Hospital Foundation BONS 8453685151 255 Lafayette Avenue Suffern NY 109015620 Christopher Banks VP of Philantrophy 8453685058 2015-06-09 0 2013 2016-03-07 17:11:31Z Christopher Banks 255 Lafayette Avenue Suffern NY 109015620 225785 0 X www.bschsf.org/community X 2002 NY Fundraising for the benefit of Bon Secours Community Hospital 22 19 0 5 0 0 44356 172074 0 0 17679 44506 -2192 -293 59843 216287 65600 78612 0 0 78753 9711 0 0 21524 36345 21771 180698 110094 -120855 106193 1511612 1672051 576262 609140 935350 1062911 X The mission is to bring compassion to health care and to be good 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. 0 0 85495 78612 Bon Secours Community Hospital Foundation is the fundraising arm of Bon Secours Community Hospital. Touching numerous residents in the New York, New Jersey and Pennsylvania tri-state region, the work of the Bon Secours Community Hospital Foundation helps to fulfill the mission of Bon Secours to give compassion and healing to those in need. Just a few of the many ways the Foundation supports Bon Secours Community Hospital include raising funding for: State-of-the-art technology and medical equipment Hospital infrastructure improvements St. Josephs Place Roberta Glinton Memorial Fund Emergency Department 85495 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 22 19 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Laura Ellison 4433673835 8990 Old Annapolis Road Columbia MD 21045 X Clare Brady President 1.00 49.00 X X 0 235458 11595 Paul Brislin Sec (Sep-Dec)/BM (Jan-Aug) 0.50 0.00 X X 0 0 0 Marie Cain Board Member 0.50 0.00 X 0 0 0 David Claisse Board Member 0.50 0.00 X 0 0 0 Deanne Connolly Board Member 0.50 0.00 X 0 0 0 John Donahue Board Member 0.50 0.00 X 0 0 0 Linda Hannigan Treasurer 0.50 0.00 X X 0 0 0 Chris Kane Board Member 0.50 0.00 X 0 0 0 Patricia Korth Board Member 0.50 0.00 X 0 0 0 Howard Kuperman Board Member 0.50 0.00 X 0 0 0 Mary Leahy MD CEO - BSCHS (Oct-Aug) 0.50 49.50 X X 0 506375 43233 Catherine Mascolo Board Member (Sep-Dec) 0.50 0.00 X 0 0 0 Darryl McKeeby Board Member 0.50 0.00 X 0 0 0 Laurie Miller Board Member 0.50 0.00 X 0 0 0 William Onofry Esq Board Member 0.50 0.00 X 0 0 0 Shaun Parker Board Member 0.50 0.00 X 0 0 0 Elena Quinn Board Member 0.50 0.00 X 0 0 0 Jeffrey Reilly Board Member 0.50 49.50 X 0 322317 7573 Bernadette Schilling Board Member 0.50 0.00 X 0 0 0 Roy Shepherd Board Member 0.50 0.00 X 0 0 0 Joseph Spano DC Board Member (Sep-Dec) 0.50 0.00 X 0 0 0 Lisa Toaldo DMD Chair 1.00 0.00 X X 0 0 0 Charlene Trotter Board Member 0.50 0.00 X 0 0 0 Julie Witherow Board Member (Sep-Dec) 0.50 0.00 X 0 0 0 Matthew Witherow Esq Board Member 0.50 0.00 X 0 0 0 Philip Patterson CEO - BSCHS (Sep) 0.50 49.50 X X 0 604909 72532 Stacey Kirschenbaum Executive Director 5.00 20.00 X 0 141445 19208 Melinda Hancock Former CFO 0.00 50.00 X 0 365950 30891 David Capone Former CFO 0.00 0.00 X 0 261699 9284 0 2438153 194316 0 1 1 0 0 53028 119046 172074 44506 44506 9205 53028 9498 -293 -293 216287 0 0 44213 78612 78612 6279 1256 628 4395 3112 622 311 2179 320 64 32 224 8751 1750 875 6126 2016 403 202 1411 734 734 Purchased Services 10270 2054 1027 7189 110094 85495 3075 21524 611346 824196 889180 828272 11086 19583 1511612 1672051 576262 609140 576262 609140 X 46220 234639 271764 250999 617366 577273 935350 1062911 1511612 1672051 106193 18098 3270 0 X 0 1 X 1 1 1 X 131327 155233 133619 44356 172074 636609 131327 155233 133619 44356 172074 636609 88350 548259 26295 32237 24960 17679 44506 145677 16007 19510 26348 380 9205 71450 853736 0.64220 0.61370 X Schedule A, Part II, Line 10, Explanation of Other Income: Special Event Income - 2009 Amount: $ 16,007. 2010 Amount: $ 16,955. 2011 Amount: $ 26,348. 2012 Amount: $ 380. 2013 Amount: $ 9,205. Raffle - 2010 Amount: $ 2,555. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to BSHSI 538257 Due to Affiliates 70883 609140 X Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740. ASC 740 addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and derecognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System' Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The system accounts for uncertain tax positions in accordance with ASC Topic 740. Income taxes of the System's for-profit subsidiaries are not material to the accompanying consolidated financial statements. The System's taxable subsidiaries have approximately $61,513 and $66,681 of net operating loss carryforwards as of August 31, 2014 and 2013, respectively, which expire in varying periods through 2034 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2014 and 2013. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Golf 60663 52208 8455 7842 1656 Vegas Night 1570 820 750 62233 53028 9205 7842 1656 9498 -293 1 Bon Secours Community Hospital 255 Lafayette Avenue Suffern NY 109015620 810667395 501(c)(3) 78612 General Support 1 0 Part I, Line 2 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. 1 1 0 0 0 0 0 0 0 Clare Brady President 0 144258 0 60378 0 30822 0 3900 0 7695 0 247053 0 0 Mary Leahy MD CEO - BSCHS (Oct-Aug) 0 300114 0 115252 0 91009 0 21289 0 21944 0 549608 0 0 Jeffrey Reilly Board Member 0 196461 0 85647 0 40209 0 6602 0 971 0 329890 0 0 Philip Patterson CEO - BSCHS (Sep) 0 336904 0 205912 0 62093 0 45612 0 26920 0 677441 0 3750 Stacey Kirschenbaum Executive Director 0 119712 0 21481 0 252 0 9291 0 9917 0 160653 0 0 Melinda Hancock Former CFO 0 270243 0 56597 0 39110 0 5235 0 25656 0 396841 0 0 David Capone Former CFO 0 0 0 0 0 261699 0 0 0 9284 0 270983 0 0 Part I, Line 3 Bon Secours Health System, Inc., 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 Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Lines 4a-b Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individual(s) received severance payments during the applicable calendar year: David Capone, $256,154. 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 this plan. Individuals that received a distribution include: Philip Patterson, $4,902. Form 990, Part VI, Section A, line 2 Board Members Julie Witherow and Matthew Witherow, Esq. have a family relationship. Form 990, Part VI, Section A, line 4 On September 1, 2014, the bylaws of the filing organization were amended to change the year end from August 31st to December 31st. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is one of two corporate members of Bon Secours Charity Health System along with the Sisters of Charity of Saint Elizabeth of Convent Station. Bon Secours Charity Health System, Inc. is the sole member of Bon Secours Community Hospital, which in turn is the sole member of Bon Secours Community Hospital Foundation. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Community Hospital Foundation is appointed by its Member, Bon Secours Community Hospital and subject to approval by Bon Secours Health System, Inc., one of two corporate members of Bon Secours Charity Health System along with the Sisters of Charity of Saint Elizabeth of Convent Station. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Community Hospital Foundation are reserved to its member or are jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station, the two corporate members of Bon Secours Charity Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c 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, Section B, 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 independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS's 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, Section b, Line 15b: Compensation Process Other Officers/Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization provides any documents open to 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. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. - Management Services MD 501(c)(3) Line 11c, III-FI Bon Secours Inc 0 Bon Secours Charity Health System Inc 255 Lafayette Avenue Suffern NY 109015620 912135195 Local System Parent Org. NY 501(c)(3) Line 11a, I Bon Secours Health System Inc 0 Good Samaritan Hospital of Suffern NY 255 Lafayette Avenue Suffern NY 109015620 131740104 Healthcare NY 501(c)(3) Line 3 Bon Secours Charity Health System Inc 0 Bon Secours Community Hospital 160 E Main Street Port Jervis NY 127712253 141347717 Healthcare NY 501(c)(3) Line 3 Bon Secours Charity Health System Inc 0 St Francis Center at the Knolls (dba Mount Alverno Center) 20 Grand Street Warwick NY 109901028 061370576 Long-term Care NY 501(c)(3) Line 9 Bon Secours Charity Health System Inc 0 St Anthony Community Hospital 15-19 Maple Avenue Warwick NY 109901028 141340100 Healthcare NY 501(c)(3) Line 3 Bon Secours Charity Health System Inc 0 Good Samaritan Foundation for Better Health 255 Lafayette Avenue Suffern NY 109015620 133400353 Grant Making Foundation NY 501(c)(3) Line 7 Bon Secours Charity Health System Inc 0 Bon Secours Warwick Health Foundation 20 Grand Street Warwick NY 109901028 141972807 Grant Making Foundation NY 501(c)(3) Line 7 Bon Secours Charity Health System Inc 0 Villa Francis at the Knolls (dba Schervier Pavilion) 20 Grand Street Warwick NY 109901028 061381994 Skilled Nursing Facility NY 501(c)(3) Line 9 Bon Secours Charity Health System Inc 0 Bon Secours Charity Health System Medical Group PC 255 Lafayette Avenue Suffern NY 109015620 223636986 Primary Care NY 501(c)(3) Line 9 Bon Secours Charity Health System Inc 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0