2013-11-15T10:16:25-06:00 2012-12-31 861065772 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2012-01-01 452964584 Bon Secours New York Health System Affiliated Group BONS 7185481700 2975 Independence Ave Bronx NY 10463 Kity Khundkar 7185481700 2013-11-15 1 David A Craig P00542227 7032511000 2012 2016-03-07 17:11:31Z Kity Khundkar 2975 Independence Ave Bronx NY 10463 54338966 1 1 5816 X www.scherviercares.org X Nursing care and multi-family housing project for the elderly and handicapped. 15 13 578 96 0 0 298111 377798 54855699 53554775 -9533 8942 484851 395883 55629128 54337398 0 3768 0 0 31273439 31066861 26400 0 0 28121897 26935788 59421736 58006417 -3792608 -3669019 46886477 47397882 54405440 58428921 -7518963 -11031039 X The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help people and communities to health and wholeness. 0 0 52507899 3768 53554775 Frances Schervier Home and Hospital has been providing care to the elderly and persons with disabilities since 1938. Located in the Riverdale section of the northwest Bronx, the 366-bed Schervier Nursing Care Center offers skilled nursing care, short term rehabilitation, respite care, palliative care and hospice services. The Schervier Long Term Home Health Care Program provides in-home nursing care to residents of the Bronx and Westchester County. Certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the home care program provides a comprehensive, coordinated and medically case managed package of services to meet the individual's needs. The Schervier Center for Research in Geriatric Care was established in January 2006. The mission of the Center is to improve the quality of life for elders by obtaining grants for new and innovative programs, conducting research that contributes to the field of aging, hosting professional conferences to promote education and collaboration among those serving the elderly and providing consultation and technical assistance to others in the field.Frances Schervier Housing Development Fund Corporation (the Corporation) is a not for profit corporation, which operates a 155 independent living unit, Department of Housing and Urban Development (HUD) financial multifamily project in the Bronx, New York, under Section 202, Direct Loan Program for Housing the Elderly or Handicapped, FHA Project No. 012 EH225 WAH L8 (the Project). Such projects are regulated by HUD as to rent charges and operating methods. 52507899 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 578 1 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X William Tao 7185481700 2975 Independence Ave Bronx NY 10463 X John L Corcoran 1.00 X 0 0 0 Ralph Dimpel 1.00 X 0 0 0 Catherine A Gasteyer 1.00 X 0 0 0 Monica Higgins 1.00 X 0 0 0 Maria Khury 1.00 X 0 0 0 Howard Malatzky 1.00 X 0 0 0 Sister Patricia Mennor 1.00 X 0 0 0 Dr Frank Maselli 1.00 X 0 0 0 Sister Fran Gorsuch 1.00 49.00 X 0 0 0 Dr Marlon Priest 1.00 49.00 X 0 1039465 158468 Betsey Torres 1.00 X 0 0 0 Sister Pauline Sweeney 1.00 X X 0 0 0 Brother Art Caliman 1.00 49.00 X X 0 0 0 Julia L Rodriguez 1.00 X X 0 0 0 Eileen Malo 50.00 X X 0 283824 32502 Kity Khundkar 50.00 X 301582 0 18883 Greg Poole-Dayan 50.00 X 201610 0 21834 Donald Mallo 50.00 X 165637 0 9139 Olivia Babol-Ibe 50.00 X 201610 0 21834 Angela Macchio 50.00 X 154591 0 19860 Joseph Scarpa 50.00 X 317549 0 30640 Dominic D'Ambrosio 50.00 X 180961 0 20558 Maryann Sero 50.00 X 115387 0 22924 Stephen Kazanjian 50.00 X 127474 0 20022 Theresa Geenty-D'arcy 50.00 X 109497 0 19006 James T Higgins 0.00 X 0 332567 8021 Frances Sequeira 0.00 X 144753 0 4629 2020651 1655856 408320 14 1 1 0 Morrison Mgt Specialists PO Box 102289 Atlanta GA 303682289 Food Services 2358080 Rehabcare Group Inc PO BOX 502096 St Louis MO 631502096 Rehab Services 1972529 Allen Health Care Services 70-00 Austin St Forest Hills NY 11375 Home Care Services 1019729 Accentcare of New York Inc PO Box 416181 Boston MA 022416181 Home Care Services 631121 Neighbors Home Care 2532 Boston Road Bronx NY 104679004 Home Care Services 480124 21 151352 176579 49867 377798 Patient Service Rev. 623000 51738981 51738981 Residential Services 900099 1815794 1815794 53554775 10510 10510 145115 0 145115 145115 145115 1568 -1568 -1568 -1568 Cafeteria/Vending/Gift 722212 175107 175107 Purchase Discounts 900099 25166 25166 Reimbursements/Rebates 900099 25030 25030 25465 25465 250768 54337398 53554775 0 404825 3768 3768 1116581 1004923 111658 21435278 19291750 2143528 5520512 4968461 552051 1463968 1317571 146397 1530522 1377470 153052 436013 392412 43601 474670 427203 47467 15854 14269 1585 4990539 4491485 499054 46417 41775 4642 837132 753419 83713 751066 675959 75107 2237026 2013323 223703 104809 94328 10481 20311 18280 2031 2504418 2504418 2018349 1816514 201835 904432 813989 90443 Purchased Services 4943287 4448958 494329 Medical Supplies 2363717 2127345 236372 NY State Medicare Asses 2238350 2014515 223835 BSHSI Corp. Allocation 1119684 1007716 111968 929714 888048 41666 58006417 52507899 5498518 0 4872073 3445 1516823 2789315 8078296 9306339 136147 118178 154242 138549 44162266 21905776 23277365 22256490 8523008 7826915 50000 328523 4908651 46886477 47397882 6200968 5550500 110321 45993 33291000 31735000 222718 228817 6488236 6436433 8092197 14432178 54405440 58428921 X -9237660 -12263593 1718697 1232554 -7518963 -11031039 46886477 47397882 X -3669019 3385 153558 X 0 1 X 1 1 1 X 337654 172413 352597 298111 377798 1538573 60275719 58560465 54463708 54855699 53554775 281710366 235894 226075 203892 209262 175107 1050230 60849267 58958953 55020197 55363072 54107680 284299169 0 0 0 284299169 790759 491922 326015 189769 155625 1954090 790759 491922 326015 189769 155625 1954090 403123 523563 174295 158713 75661 1335355 62043149 59974438 55520507 55711554 54338966 287588614 0.98860 0.98250 0.00680 0.00770 X Schedule A, Part IV, Supplemental Information: Schedule A, Part III, Line 12, Explanation for Other Income: Cafeteria/Gift Shop Rebates/Discounts All other revenue RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15854 15854 0 Explanation of Lobbying Activities: Part II-B, Line 1: The filing organization paid dues to the Continuing Care Leadership Coalition (CCLC), the Home Care Association of NY State (HCA), the Catholic Hospital Association (CHA) and Leading Age (LA), a portion of which is used for lobbying activities. The portion of dues allocated to lobbying activities for each of these organizations is as follows: Lobbying activity for CCLC ($13,220 or 51.29%), HCA ($2,013 or 14.38%), CHA ($274 or 3%) and LA ($347 or 4.4% avg. between national and state) for a total of $15,854. 0 1 X 2895442 2895442 29252997 16516039 12736958 897508 251503 646005 9707623 4863228 4844395 1408696 275006 1133690 22256490 LT HPL/GL 4294059 Assets Held in Trust 231284 Patient Deposits 117993 Other Misc A/R 265315 4908651 Accrued interest payable 872712 FIN 47 Asbestos Liab 1135151 Deposits and other misc 101347 Other LT Pension/Retirement Liab 4378946 LT HPL/GL 4294059 Medicare Liab 1455330 Due to BSHSI 2194633 14432178 Part IV, Line 2b: Frances Schervier Home and Hospital (dba Schervier Nursing Care Center) holds, safeguards, manages and accounts for the personal funds of residents who have authorized the facility in writing to manage any personal funds. Fund requests less than $50 are available for immediate distribution to residents. Written requests for $50 or more are honored within 3 business days. All excess custodial funds are held in interest bearing accounts separate from that of the organization. 1 1 0 0 0 0 0 0 0 Dr Marlon Priest 0 570835 0 397444 0 71186 0 130955 0 27513 0 1197933 0 43737 Eileen Malo 0 215272 0 49286 0 19266 0 14286 0 18216 0 316326 0 0 Kity Khundkar 233664 0 21838 0 46080 0 2717 0 16166 0 320465 0 5063 0 Greg Poole-Dayan 182700 0 16387 0 2523 0 0 0 21834 0 223444 0 0 0 Donald Mallo 151928 0 12450 0 1259 0 0 0 9139 0 174776 0 0 0 Olivia Babol-Ibe 182700 0 16387 0 2523 0 0 0 21834 0 223444 0 0 0 Angela Macchio 141209 0 12506 0 876 0 0 0 19860 0 174451 0 0 0 Joseph Scarpa 264525 0 25789 0 27235 0 2700 0 27940 0 348189 0 0 0 Dominic D'Ambrosio 159925 0 14663 0 6373 0 0 0 20558 0 201519 0 0 0 James T Higgins 0 -3154 0 0 0 335721 0 0 0 8021 0 340588 0 0 Frances Sequeira -1896 0 0 0 146649 0 0 0 4629 0 149382 0 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of Frances Schervier Home & Hospital, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee _ Part I, Lines 4a-b Bon Secours Health System, Inc. has system wide severance policies for various levels of executive management. Executive positions throughout the system may include, but are not limited to, CEO/President, CFO, COO, EVP, SVP, VP and Directors. Severance periods vary based on length of service, subsequent employment and violations of the severance policy. Generally, severance periods can be up to 24 months. Benefits may include, but are not limited to, base salary, certain health benefits and payment of unused vacation. The following individuals received severance payments in 2012: James T. Higgins, $331,139; Frances Sequeira, $134,848 Supplemental Information Part III The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to certain employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits are made into this plan. Individuals that received a distribution include: Marlon Priest, MD, $43,581; Kity Khundkar, $8,196; Theresa Geenty-D'arcy, $3,368. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours New York Health System, Inc. (BSNYHS). BSNYHS is the sole corporate member and parent of Frances Schervier Home & Hospital (FSHH) and Frances Schervier Housing Development Fund Corporation (FSHDFC). Form 990, Part VI, Section A, line 7a As the sole corporate member, BSNYHS has the power to appoint the President and Executive Vice President of FSHH and FSHDFC. BSNYHS has the power to approve or withhold approval of amendments to their bylaws, approve strategic plans, approve capital budgets, approve operating budgets as well as change the philosophy objectives or purposes of both organizations. In addition, BSNYHS has the power to remove or replace any member of their boards of directors. Form 990, Part VI, Section A, line 7b Certain authorities of FSHH and FSHDFC are reserved to their members or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organizations use to review the Form 990 consist 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 and questions by both before the extended filing date. The local system's audit and compliance committee members review the Form 990, schedules time on their meeting agenda, and provide comments 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' 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 organizations provide 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. Volunteer Board Members are not compensated for their time. Eileen Malo's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation she receives is for her role as the Interim CEO of Bon Secours New York Health System, Inc. which includes direct management, monitoring and oversight of the System and its related organizations. Dr. Marlon Priest's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as the Chief Medical Officer of Bon Secours Health System, Inc. Sr. Fran Gorsuch and Brother Art Caliman do not receive payroll distributions as they have taken vows of poverty. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Additional minimum pension liability 142,873. Other miscellaneous changes in net assets 10,685. Bon Secours Health System Inc (BSHSI) 1505 Marriottville Road Marriottsville MD 21104 521301088 Parent Org - Management Services MD 501(c)(3) Line 11 Bon Secours Inc 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0