BON SECOURS WARWICK HEALTH FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
BON SECOURS WARWICK HEALTH FOUNDATION (EIN 14-1972807)
Tax period
2011-09-01 to 2012-08-31
Filed
2013-07-12
IRS object ID
201321959349300702
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-07-12T22:04:30-05:00Timestamp
Tax Period End Date2012-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11750 TYSONS BLVDAddressLine1
CityMCLEANCity
StateVAState
ZIP Code221024219ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN141972807EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Bon Secours Warwick Health FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBONSNameControl
Phone8453685151Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1255 Lafayette AvenueAddressLine1
CitySuffernCity
StateNYState
ZIP Code109015620ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameStacey KirschenbaumName
TitleCEO - BSCHSTitle
Phone8453685303Phone
Date Signed2013-07-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDavid A CraigName
PTINP00542227PTIN
Phone7032511000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPhilip PattersonNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1255 Lafayette AvenueAddressLine1
CitySuffernCity
StateNYState
ZIP Code109015620ZIPCode
FieldValueIRS element (for citing)
Gross Receipts198944GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.stanthonycommunityhosp.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionFundraising events to support the HospitalActivityOrMissionDescription
Nbr Voting Members Governing Body27NbrVotingMembersGoverningBody
Nbr Independent Voting Members25NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year54078ContributionsGrantsPriorYear
Contributions Grants Current Year102491ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year124617InvestmentIncomePriorYear
Investment Income Current Year70568InvestmentIncomeCurrentYear
Other Revenue Prior Year25470OtherRevenuePriorYear
Other Revenue Current Year10268OtherRevenueCurrentYear
Total Revenue Prior Year204165TotalRevenuePriorYear
Total Revenue Current Year183327TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1023441GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY629785GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year114376SalariesEtcPriorYear
Salaries Etc Current Year116679SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year122517TotalFundrsngExpCurrentYear
Other Expense Prior Year14257OtherExpensePriorYear
Other Expenses Current Year58345OtherExpensesCurrentYear
Total Expenses Prior Year1152074TotalExpensesPriorYear
Total Expenses Current Year804809TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-947909RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-621482RevenuesLessExpensesCY
Total Assets BOY2117705TotalAssetsBOY
Total Assets EOY1536866TotalAssetsEOY
Total Liabilities BOY40699TotalLiabilitiesBOY
Total Liabilities EOY146661TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2077006NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1390205NetAssetsOrFundBalancesEOY
Mission DescriptionThe 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense664790Expense
Grants629785Grants
DescriptionBon Secours Warwick Health Foundation is the fundraising arm of St. Anthony's Community Hospital, Mount Alverno Center and Schervier Pavilion. Funds may be raised annually via the annual campaign, major gifts/planned giving and special events. Special events general include a Spring Ball, a fall golf classic and other fundraising activities.Description
Total Program Service Expense664790TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members27NbrVotingGoverningBodyMembers
Number Independent Voting Members25NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Julie OwenBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8458567215TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line120 Grand StreetAddressLine1
CityWarwickCity
StateNYState
ZIP Code10990ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Donna Applegate
Board Member4.00X000
Julie Cauda
Board Member (Jan-Aug)4.00X000
Sister Madeline Cipriano RSM
Board Member (Jan-Aug)4.00X000
Stratos Colman
Board Member4.00X000
Sue Devincenzo
Board Member4.00X000
Tom Fitzgerald
Board Member4.00X000
Inez Freud
Board Member4.00X000
Caroline Hamling
Board Member (Jan-Aug)4.00X000
Deirdre Hamling
Board Member (Sept-Apr)4.00X000
Harold Hansen DC
Board Member (Jan-Aug)4.00X000
Mary Juliano
Board Member (Jan-Aug)4.00X000
Leo R Kaytes
Board Member4.00X000
Kevin Kern
Board Member (Jan-Aug)4.00X000
Souzie Miller
Board Member (Jan-Aug)4.00X000
Eileen Patterson
Board Member (Sept-Mar)4.00X000
Frank Petrucci
Board Member4.00X000
Tomi Prvulovic MD
Board Member4.00X000
Douglas Stage Esq
Board Member (Jan-Aug)4.00X000
Barbara Sullivan
Board Member (Jan-Aug)4.00X000
Cindy Vander Plaat
Board Member (Jan-Aug)4.00X000
Bruce Zaretsky
Board Member (Jan-Aug)4.00X000
Clare Brady
President50.00X016955712540X
Steve Kent
Chairman6.00X000X
Helen Laskow
Secretary (Sept-Dec)6.00X000X
Bonni Masi Oswald
Secretary (Jan-Aug)6.00X000X
Philip A Patterson
CEO - BSCHS50.00X0493725113614X
Terry Quint
Treasurer6.00X000X
David Capone
CFO - BSCHS50.0001498885397X
Stacey Kirschenbaum
Executive Director50.00013062624450X
Terence O'Brien
Former CEO - BSCHS0.0005680258215X
Melinda Hancock
Former CFO-BSCHS50.00029283833668X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1804659TotalReportableCompFrmRltdOrgs
Total Other Compensation197884TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events56338FundraisingEvents
Related Organizations5000RelatedOrganizations
All Other Contributions41153AllOtherContributions
Noncash Contributions475NoncashContributions
Total Contributions102491TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7995TotalRevenueColumn
Exclusion$7,995ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities62573Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities62573Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column62573TotalRevenueColumn
Exclusion$62,573ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events25885GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events56338CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses15617FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column10268TotalRevenueColumn
Exclusion$10,268ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column183327TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$80,836ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total629785Total
Program Services629785ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total106037Total
Program Services21207ProgramServices
Management And General10604ManagementAndGeneral
Fundraising74226Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3159Total
Program Services632ProgramServices
Management And General316ManagementAndGeneral
Fundraising2211Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7483Total
Program Services1497ProgramServices
Management And General748ManagementAndGeneral
Fundraising5238Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total772Total
Program Services154ProgramServices
Management And General77ManagementAndGeneral
Fundraising541Fundraising

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Purchased Services5720311441572040042
Tax and License3707437259

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total804809Total
Program Services664790ProgramServices
Management And General17502ManagementAndGeneral
Fundraising122517Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2091158BOY
EOY1504468EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY6298BOY
EOY3595EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY20249BOY
EOY28803EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2117705BOY
EOY1536866EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY499BOY
EOY6122EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY40200BOY
EOY140539EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY40699BOY
EOY146661EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1378171BOY
EOY782010EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY698835BOY
EOY608195EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2077006BOY
EOY1390205EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2117705BOY
EOY1536866EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-621482ReconcilationRevenueExpenses
Reconcilation Other Changes-65319ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years207510CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years2812CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year54078CurrentTaxYearMinus1Year
Current Tax Year102491CurrentTaxYear
Total366891Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years207510CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years2812CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year54078CurrentTaxYearMinus1Year
Current Tax Year102491CurrentTaxYear
Total366891Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total70660AmountsSubstContributorsTotal
Public Support Total170296231PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years-36472CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years34163CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year29673CurrentTaxYearMinus1Year
Current Tax Year7995CurrentTaxYear
Total35359Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years160469CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years138510CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year62616CurrentTaxYearMinus1Year
Current Tax Year25885CurrentTaxYear
Total387480Total
FieldValueIRS element (for citing)
Total Support789730TotalSupport
Public Support Pertcentage1700.37510PublicSupportPertcentage170
Public Support Pertcent Prior Year0.37860PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSchedule A, Part IV, Supplemental Information: Schedule A, Part II, Line 10, Explanation for Other Income: Special Events Revenue: $25,885GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Due to BSHSI$88,668
Due to Affiliates$51,871
FieldValueIRS element (for citing)
Total Of Amounts140539TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDescription of Uncertain Tax Positions Under FIN 48:Identifier
Return ReferencePart X:ReturnReference
ExplanationSchedule 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.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Tent PartyNameOfEvent1
Gross Receipts Event147149GrossReceiptsEvent1
Charitable Contributions Event126539CharitableContributionsEvent1
Gross Revenue Event120610GrossRevenueEvent1
Non Cash Prizes Event11600NonCashPrizesEvent1
Other Direct Expenses Event110390OtherDirectExpensesEvent1
Name Of Event2GolfNameOfEvent2
Gross Receipts Event235074GrossReceiptsEvent2
Charitable Contributions Event229799CharitableContributionsEvent2
Gross Revenue Event25275GrossRevenueEvent2
Non Cash Prizes Event21255NonCashPrizesEvent2
Other Direct Expenses Event22372OtherDirectExpensesEvent2
Gross Receipts Total82223GrossReceiptsTotal
Charitable Contributions Total56338CharitableContributionsTotal
Gross Revenue Total Events25885GrossRevenueTotalEvents
Non Cash Prizes Total Events2855NonCashPrizesTotalEvents
Other Direct Expenses Total Events12762OtherDirectExpensesTotalEvents
Direct Expense Summary Events15617DirectExpenseSummaryEvents
Net Income Summary10268NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistancePurpose Of GrantPurposeOfGrant
St Anthony Community Hospital
15-19 Maple AvenueWarwickNY109901028141340100501(c)(3)4846090General Support
Villa Francis at the Knolls (dba Schervier Pavilion)
20 Grand StreetWarwickNY109901028061381994501(c)(3)1444520General support
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Clare Brady
0142485000270720390008640018209700
Philip A Patterson
044283900050886073079040535060733900
David Capone
0130405000194830005397015528500
Stacey Kirschenbaum
013046300016307577016873015507600
Terence O'Brien
000005680250008215057624000
Melinda Hancock
02543570501703346404898028770032650600

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Supplemental InformationPart IIIPart I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Warwick Health Foundation, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Committee Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee
Supplemental InformationPart IIIPart I, Line 4a: 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 O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6Bon 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 St. Anthony Community Hospital, which in turn is the sole member of Bon Secours Warwick Health Foundation.
Form 990, Part VI, Section A, line 7aThe governing body of Bon Secours Warwick Health Foundation is appointed by its Member, St. Anthony 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 7bCertain authorities of Bon Secours Warwick Health Foundation 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 11The 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 12cThe 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 15The 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 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 19Bon Secours Warwick Health Foundation provides any documents open to public inspection upon request.
Form 990, Part XI, line 5:Net unrealized losses on investments: -63,334. Transfer from Affiliate: Amounts reported on affiliated Form 990: Refund of Grant Money: NPV Adj for Pledges Receivable: -1,985. Total to Form 990, Part XI, Line 5: -65,319.Changes in Net Assets or Fund Balances:
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. 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. 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. Inez Freund's compensation was paid by St. Anthony's Hospital, a related organization. The compensation was for work as an independent contractor. 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Bon Secours Health System Inc
1505 Marriottsville RoadMarriottsvilleMD21104521301088Parent Org. - Management ServicesMD501(c)(3)11bBon Secours Inc0
Bon Secours Charity Health System Inc
255 Lafayette AvenueSuffernNY109015620912135195Local System Parent Org.NY501(c)(3)11b0N/A
Good Samaritan Hospital
255 Lafayette AvenueSuffernNY109015620131740104HealthcareNY501(c)(3)3Bon Secours Charity Health System0
Bon Secours Community Hospital
160 E Main StreetPort JervisNY127712253141347717HealthcareNY501(c)(3)3Bon Secours Charity Health System0
St Francis Center at the Knolls (dba Mount Alverno Center)
20 Grand StreetWarwickNY109901028061370576Long-term CareNY501(c)(3)3Bon Secours Charity Health System0
St Anthony Community Hospital
15-19 Maple AvenueWarwickNY109901028141340100HealthcareNY501(c)(3)3Bon Secours Charity Health System0
Bon Secours Community Hospital Foundation
255 Lafayette AvenueSuffernNY109015620810667395Grant Making FoundationNY501(c)(3)7Bon Secours Charity Health System0
Good Samaritan Foundation For Better Health
255 Lafayette AvenueSuffernNY109015620141972807Grant Making FoundationNY501(c)(3)7Bon Secours Charity Health System0
Villa Francis at the Knolls (dba Schervier Pavilion)
20 Grand StreetWarwickNY109901028061381994Skilled Nursing FacilityNY501(c)(3)3Bon Secours Charity Health System0
Bon Secours Charity Health System Medical Group PC
255 Lafayette AvenueSuffernNY109015620223636986Primary CareNY501(c)(3)3Bon Secours Charity Health System0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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