2013-07-12T21:24:40-05:00 2012-08-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2011-09-01 810667395 Bon Secours Community Hospital Foundation BONS 8453685151 255 Lafayette Avenue Suffern NY 109015620 Philip Patterson 8453685303 2013-07-12 1 David A Craig P00542227 7032511000 2011 2016-02-24 21:20:13Z Philip Patterson 255 Lafayette Avenue Suffern NY 109015620 184927 0 0928 X www.bschsf.org/community X 2002 NY Fundraising to support patient related activities at Bon Secours Community Hospital. 30 28 0 28 0 0 155233 133619 0 0 32237 24859 728 -13537 188198 144941 505725 2325 0 0 89300 115522 0 0 123058 44524 60276 639549 178123 -451351 -33182 1262650 1438119 284756 468836 977894 969283 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 37484 2325 Bon Secours Community Hospital Foundation is the fundraising arm of Bon Secours Community Hospital. Funds may be raised via the annual campaign, major gifts / planned giving, and special events. Special events included a Spring golf classic, and other fundraising events. 37484 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 X 30 28 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Dave Larkin 4433672204 8990 Old Annapolis Road Columbia MD 21045 X Steve Albanese 4.00 X 0 0 0 John Bell 4.00 X 0 0 0 James Biondi 4.00 X 0 0 0 Marie Cain 4.00 X 0 0 0 David Claisse 4.00 X 0 0 0 Deanne Connolly 4.00 X 0 0 0 Katrina Foster 4.00 X 0 0 0 Barbara Heckman FNP 4.00 X 0 0 0 Christopher Kane 4.00 X 0 0 0 Howard Kuperman 4.00 X 0 0 0 Thomas McCarron 4.00 X 0 0 0 Darryl R McKeeby 4.00 X 0 0 0 John Meder 4.00 X 0 0 0 William A Onofry Esq 4.00 X 0 0 0 Shaun Parker 4.00 X 0 0 0 Elena Quinn 4.00 X 0 0 0 Jacob Reckess 4.00 X 0 0 0 Roy Shepherd 4.00 X 0 0 0 Joseph Spano DC 4.00 X 0 0 0 Guy Spradling 4.00 X 0 0 0 Lisa Toaldo DMD 4.00 X 0 0 0 Charlene Trotter 4.00 X 0 0 0 Judith Westdyke-Rudy 4.00 X 0 0 0 Julie Witherow 4.00 X 0 0 0 Matthew Witherow Esq 4.00 X 0 0 0 Clare Brady 50.00 X X 0 169557 12540 Paul Brislin 6.00 X X 0 0 0 John Donahue 6.00 X X 0 0 0 Linda Hannigan 6.00 X X 0 0 0 Philip A Patterson 50.00 X X 0 493725 113614 David Capone 50.00 X 0 149888 5397 Stacey Kirschenbaum 50.00 X 0 130626 24450 Melinda Hancock 50.00 X 0 292838 33668 Terence O'Brien 0.00 X 0 568025 8215 0 1804659 197884 0 1 1 0 0 109378 1000 23241 2257 133619 24960 24960 101 -101 -101 -101 26348 109378 39885 -13537 -13537 144941 0 0 11322 2325 2325 107376 21475 10738 75163 8146 1629 815 5702 2547 509 255 1783 Purchased Services 57608 11522 5761 40325 Misc Taxes & Licenses 121 24 12 85 178123 37484 17581 123058 97891 185511 309416 310028 3291 1690 837080 938546 14972 2344 1262650 1438119 668 5718 284088 463118 284756 468836 X 137523 29047 223005 322870 617366 617366 977894 969283 1262650 1438119 X -33182 24571 X 0 1 1 X 1 1 X 131327 155233 133619 420179 131327 155233 133619 420179 420179 24218 26295 32237 24960 107710 271547 104813 16007 19510 26348 438225 966114 0.43490 0.39220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to BSHSI 407877 Due to Affiliates 55241 463118 Description of Uncertain Tax Positions Under FIN 48: Part X: 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 (Formerly FIN 48). ASC 740 (Formerly FIN 48) 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 (Formerly FIN 48) 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 (Formerly FIN 48). 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 $95,733 and $89,500 of net operating loss carryforwards as of August 31, 2012 and 2011, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2012 and 2011. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. Gala 71860 59367 12493 18716 7606 Golf Classic 39858 35943 3915 10693 2870 1 24008 14068 9940 135726 109378 26348 29409 10476 39885 -13537 1 1 0 0 0 0 0 0 0 Clare Brady 0 142485 0 0 0 27072 0 3900 0 8640 0 182097 0 0 Philip A Patterson 0 442839 0 0 0 50886 0 73079 0 40535 0 607339 0 0 David Capone 0 130405 0 0 0 19483 0 0 0 5397 0 155285 0 0 Stacey Kirschenbaum 0 130463 0 0 0 163 0 7577 0 16873 0 155076 0 0 Melinda Hancock 0 254357 0 5017 0 33464 0 4898 0 28770 0 326506 0 0 Terence O'Brien 0 0 0 0 0 568025 0 0 0 8215 0 576240 0 0 Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Community Hospital Foundation, 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 Supplemental Information Part III Part I, Line 4a Severance Policy: 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: Terence O'Brien, $568,025 Part I, Line 4b: The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to 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. 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 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 Bon Secours Community Hospital Foundation provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All officer's and director's hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Voluntary Board Members are not compensated for their time. Philip A. Patterson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the CEO of Bon Secours Charity Health System which includes direct management, monitoring and oversight of Bon Secours Charity Health System and it related organizations. David Capone's compensation is paid by Good Samaritan Hospital of Suffern, NY, a related organization. The compensation he receives is for his role as the CFO of Bon Secours Charity Health System, Inc., which includes direct financial management, monitoring and oversight over the System and its related organizations. Melinda Hancock's compensation is paid by St. Mary's Hospital of Richmond, Inc., a related organization. The compensation she receives is for her role as the CFO of Bon Secours Virginia Health System which includes direct financial management, monitoring and oversight of Bon Secours Richmond Health System, Bon Secours Hampton Roads Health System and their related organization. Stacey Kirschenbaum's compensation is paid by Good Samaritan Hospital, a related organization. The compensation she receives is for her role as the Executive Director of Bon Secours Community Hospital Foundation, Bon Secours Warwick Health Foundation and the Good Samaritan Foundation for Better. Clare Brady's compensation is paid by Bon Secours Community Hospital, a related organization. The compensation she receives is for her role as the VP of Mission of Bon Secours Charity Health System, Inc. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 24,571. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. - Management Services MD 501(c)(3) 11b 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) 11b N/A 0 Good Samaritan Hospital 255 Lafayette Avenue Suffern NY 109015620 131740104 Healthcare NY 501(c)(3) 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) 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) 3 Bon Secours Charity Health System Inc 0 St Anthony Community Hospital 15-19 Maple Avenue Warwick NY 109901028 141340100 Healthcare NY 501(c)(3) 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) 5 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) 5 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) 3 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) 3 Bon Secours Charity Health System Inc 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0