GOOD SAMARITAN FDN FOR BETTER HEALTH INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN FDN FOR BETTER HEALTH INC (EIN 13-3400353)
- Tax period
- 2011-09-01 to 2012-08-31
- Filed
- 2013-07-12
- IRS object ID
- 201321959349300602
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-12T21:45:25-05:00 | Timestamp |
| Tax Period End Date | 2012-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1750 TYSONS BLVD | AddressLine1 |
| City | MCLEAN | City |
| State | VA | State |
| ZIP Code | 221024219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 133400353 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Foundation For Better Health | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 8453685151 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Philip Patterson | Name |
| Title | CEO - BSCHS | Title |
| Phone | 8453685303 | Phone |
| Date Signed | 2013-07-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David A Craig | Name |
| PTIN | P00542227 | PTIN |
| Phone | 7032511000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Philip Patterson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1201188 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.goodsamhosp.org/html/foundation.html | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | Fundraising events to support the Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 35 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 33 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 33 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1136944 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 980369 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 25935 | InvestmentIncomePriorYear |
| Investment Income Current Year | 24687 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -72803 | OtherRevenuePriorYear |
| Other Revenue Current Year | -132704 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1090076 | TotalRevenuePriorYear |
| Total Revenue Current Year | 872352 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1699626 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 978334 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 222985 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 362750 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 414376 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 510391 | OtherExpensePriorYear |
| Other Expenses Current Year | 229217 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2433002 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1570301 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1342926 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -697949 | RevenuesLessExpensesCY |
| Total Assets BOY | 3386727 | TotalAssetsBOY |
| Total Assets EOY | 3679888 | TotalAssetsEOY |
| Total Liabilities BOY | 739632 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1694171 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2647095 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1985717 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1096727 | Expense |
| Grants | 978334 | Grants |
| Description | Good Samaritan Foundation for Better Health is the fundraising arm of Good Samaritan Hospital. Funds may be raised via the annual campaign, major gifts, planned giving and special events. Special events for this past year included a Spring Ball and a fall Golf Classic. | Description |
| Total Program Service Expense | 1096727 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 9 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 35 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 33 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Julie Owen | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8458567215 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20 Grand Street | AddressLine1 |
| City | Warwick | City |
| State | NY | State |
| ZIP Code | 10990 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (39 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|
| Mark Acker | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Joseph Allen MD | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Heather Bowie | |||||||
| Board Member (Jan-Aug) | 4.00 | X | 0 | 0 | 0 | ||
| Richard Clarkin MD | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| John DeCicco | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Nicholas DeSantis | |||||||
| Board Member (Jan-Aug) | 4.00 | X | 0 | 0 | 0 | ||
| David Evangelista | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Sister Fran Gorsuch CBS | |||||||
| Board Member | 50.00 | X | 0 | 0 | 0 | ||
| Ronald Haber | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Gilbert Heim | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Gayle Hirsch Esq | |||||||
| Board Member | 50.00 | X | 0 | 264425 | 31628 | ||
| Jack Holt | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Geanette Katz | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Andrew Kritzer | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Joseph Lagana | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Aurelius Licata | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Pierson Mapes | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Jeffrey Marangi | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Michael Mastrangelo | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Kathy Medici | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Glenn Mendoza MD | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Irene Mouzakitis | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Harold Peterson | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Janetlee Pilliterri | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Amra Sabic-El-Rayess PhD | |||||||
| Board Member (Jan-Aug) | 4.00 | X | 0 | 0 | 0 | ||
| Louis Siracusano | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Thomas Snopek MD | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Ann Mrkic Zgonena Esq | |||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | ||
| Patricia Lefkowitz | |||||||
| Board Member | 6.00 | X | 0 | 0 | 0 | X | |
| Sr Mary Louise Moran SC | |||||||
| President | 50.00 | X | 0 | 0 | 0 | X | |
| Philip A Patterson | |||||||
| CEO - BSCHS | 50.00 | X | 0 | 493725 | 113614 | X | |
| Daniel Rifkin | |||||||
| Treasurer (Sept-Dec) | 6.00 | X | 0 | 0 | 0 | X | |
| Frank Stillo | |||||||
| Chairman (Sept-Dec) | 6.00 | X | 0 | 0 | 0 | X | |
| Margaret Telscher Esq | |||||||
| Sec (Sept-Dec); Chair | 6.00 | X | 0 | 0 | 0 | X | |
| Eric Wiggins | |||||||
| Treasurer (Jan-Aug) | 6.00 | X | 0 | 0 | 0 | X | |
| David Capone | |||||||
| CFO - BSCHS | 50.00 | 0 | 149888 | 5397 | X | ||
| Stacey Kirschenbaum | |||||||
| Executive Director | 50.00 | 0 | 130626 | 24450 | X | ||
| Melinda Hancock | |||||||
| Former Int. CFO - BSCHS | 50.00 | 0 | 292838 | 33668 | X | ||
| Terence O'Brien | |||||||
| Former CEO - BSCHS | 0.00 | 0 | 568025 | 8215 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1899527 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 216972 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 405267 | FundraisingEvents |
| Related Organizations | 91000 | RelatedOrganizations |
| All Other Contributions | 484102 | AllOtherContributions |
| Noncash Contributions | 42435 | NoncashContributions |
| Total Contributions | 980369 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24687 | TotalRevenueColumn |
| Exclusion | $24,687 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 167493 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 405267 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 328836 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -161343 | TotalRevenueColumn |
| Exclusion | -$161,343 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Reimbursement of Insur | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 28639 | TotalRevenueColumn |
| Exclusion | $28,639 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 28639 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 872352 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$108,017 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 978334 | Total |
| Program Services | 978334 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 331129 | Total |
| Program Services | 66226 | ProgramServices |
| Management And General | 33113 | ManagementAndGeneral |
| Fundraising | 231790 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6151 | Total |
| Program Services | 1230 | ProgramServices |
| Management And General | 615 | ManagementAndGeneral |
| Fundraising | 4306 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25470 | Total |
| Program Services | 5094 | ProgramServices |
| Management And General | 2547 | ManagementAndGeneral |
| Fundraising | 17829 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22639 | Total |
| Program Services | 4528 | ProgramServices |
| Management And General | 2264 | ManagementAndGeneral |
| Fundraising | 15847 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10226 | Total |
| Program Services | 2045 | ProgramServices |
| Management And General | 1023 | ManagementAndGeneral |
| Fundraising | 7158 | Fundraising |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Purchased Services | 195876 | 39175 | 19588 | 137113 |
| Tax /Business Licenses | 276 | 55 | 28 | 193 |
| Membership Dues | 200 | 40 | 20 | 140 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1570301 | Total |
| Program Services | 1096727 | ProgramServices |
| Management And General | 59198 | ManagementAndGeneral |
| Fundraising | 414376 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167267 | BOY |
| EOY | 451775 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 547710 | BOY |
| EOY | 686044 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2619303 | BOY |
| EOY | 2453145 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52447 | BOY |
| EOY | 88924 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3386727 | BOY |
| EOY | 3679888 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17759 | BOY |
| EOY | 30097 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 721873 | BOY |
| EOY | 1664074 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 739632 | BOY |
| EOY | 1694171 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -519919 | BOY |
| EOY | -1153472 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3154965 | BOY |
| EOY | 3101415 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12049 | BOY |
| EOY | 37774 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2647095 | BOY |
| EOY | 1985717 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3386727 | BOY |
| EOY | 3679888 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -697949 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 36571 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 374957 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 158467 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 886320 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1136944 | CurrentTaxYearMinus1Year |
| Current Tax Year | 980369 | CurrentTaxYear |
| Total | 3537057 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 374957 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 158467 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 886320 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1136944 | CurrentTaxYearMinus1Year |
| Current Tax Year | 980369 | CurrentTaxYear |
| Total | 3537057 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 3537057 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 333788 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 41008 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 25935 | CurrentTaxYearMinus1Year |
| Current Tax Year | 24687 | CurrentTaxYear |
| Total | 425418 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 757737 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 699277 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 179586 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 259603 | CurrentTaxYearMinus1Year |
| Current Tax Year | 196132 | CurrentTaxYear |
| Total | 2092335 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 6054810 | TotalSupport |
| Public Support Pertcentage170 | 0.58420 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.55710 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| General Explanation | Schedule A, Part IV, Supplemental Information: Schedule A, Part II, Line 10, Explanation for Other Income: Special Events Revenue: $167,493 Insurance Reimbursement Income: $ 28,639 | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Good Samaritan Hospital | Description |
| Amount | $1,664,074 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1664074 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X: | ReturnReference |
| Explanation | 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 FIN48). ASC 740 (formerly FIN48) 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 FIN48) 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 FIN48). 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. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Spring Ball | NameOfEvent1 |
| Gross Receipts Event1 | 277614 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 233517 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 44097 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 3500 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 65984 | RentFacilityCostsEvent1 |
| Entertainment Event1 | 9436 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 64144 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Fall Classic | NameOfEvent2 |
| Gross Receipts Event2 | 223430 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 125850 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 97580 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 23952 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 63328 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 27540 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 6880 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 10859 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 71716 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 45900 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 25816 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 19495 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 16873 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 16845 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 572760 | GrossReceiptsTotal |
| Charitable Contributions Total | 405267 | CharitableContributionsTotal |
| Gross Revenue Total Events | 167493 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 27452 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 148807 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 44413 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 16316 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 91848 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 328836 | DirectExpenseSummaryEvents |
| Net Income Summary | -161343 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 131740104 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 978334 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Purpose Of Grant | General Support | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gayle Hirsch Esq | |||||||||||||
| 0 | 263652 | 0 | 0 | 0 | 773 | 0 | 6962 | 0 | 24666 | 0 | 296053 | 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 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Supplemental Information | Part III | 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 |
| 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. |
Schedule M IRS990ScheduleM
Other Non Cash Contributions Table OtherNonCashContributionsTable (3 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | Food & Wine | 11 | 19435 | Cost/Selling Price |
| X | Slot Machine | 1 | 3000 | Cost/Selling Price |
| X | Golf Bags | 1 | 20000 | Cost/Selling Price |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Method for Determining Number of Contributors: | Identifier |
| Return Reference | Part I, Column (b): | ReturnReference |
| Explanation | refers to the number of contributions. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Board Members Margaret Telscher, Esq and Thomas Snopek, MD have a family relationship. Board Members Margaret Telscher, Esq, Thomas Snopek, MD and Stacey Kirschenbaum have a business 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 Good Samaritan Foundation for Better Health. | |
| Form 990, Part VI, Section A, line 7a | 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 of Convent Station. | |
| Form 990, Part VI, Section A, line 7b | Certain authorities of Good Samaritan Foundation for Better Health are reserved to its member or is 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 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, 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 positions of other officers or key employees of the organization were compared to similar position market data in comparably situated organizations taking into consideration geographic location and organization size where appropriate. 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 Good Samaritan Foundation for Better Health 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 Health. Gayle Hirsch's compensation is paid by Bon Secours Charity Health System Medical Group PC, a related organization. The compensation she receives is for her role as a practice administrator. She also received compensation for independent contract work at Good Samaritan Hospital, a related organization. Sr. Fran Gorsuch and Sr. Mary Louise Moran do not receive payroll distributions as they have taken vows of poverty. | |
| Form 990, Part XI, line 5: | Net unrealized gains on investments: 8,744. PV Adjustments to Pledges Receivable: 27,827. Total to Form 990, Part XI, Line 5: 36,571. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| Good Samaritan Hospital | |||||||||||
| 255 Lafayette Avenue | Suffern | NY | 109015620 | 131740104 | Healthcare | NY | 501(c)(3) | 3 | Bon Secours Charity Health System | 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 | 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 | 0 | |
| St Anthony Community Hospital | |||||||||||
| 15-19 Maple Avenue | Warwick | NY | 109901028 | 141340100 | Healthcare | NY | 501(c)(3) | 3 | Bon Secours Charity Health System | 0 | |
| Bon Secours Community Hospital Foundation | |||||||||||
| 255 Lafayette Avenue | Suffern | NY | 109015620 | 810667395 | Grant Making Foundation | NY | 501(c)(3) | 7 | Bon Secours Charity Health System | 0 | |
| Bon Secours Warwick Health Foundation | |||||||||||
| 20 Grand Street | Warwick | NY | 109901028 | 141972807 | Grant Making Foundation | NY | 501(c)(3) | 7 | Bon Secours Charity Health System | 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 | 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 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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