BON SECOURS COMMUNITY HOSPITAL FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BON SECOURS COMMUNITY HOSPITAL FOUNDATION (EIN 81-0667395)
Tax period
2010-09-01 to 2011-08-31
Filed
2012-07-16
IRS object ID
201201989349300720
Schema version
2010v3.4
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)
Timestamp2012-07-16T11:02:35-05:00Timestamp
Tax Period End Date2011-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810667395EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Bon Secours Community Hospital 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
TitleCFO-BSCHSTitle
Phone8453685305Phone
Date Signed2012-07-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaura L CatlettName
Phone7032511000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonStacey KirschenbaumNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1255 Lafayette AvenueAddressLine1
CitySuffernCity
StateNYState
ZIP Code109015620ZIPCode
FieldValueIRS element (for citing)
Gross Receipts206980GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.bschsf.org/communityWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionFundraising to support patient related activities at Bon Secours Community Hospital.ActivityOrMissionDescription
Nbr Voting Members Governing Body25NbrVotingMembersGoverningBody
Nbr Independent Voting Members23NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers23TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year131237ContributionsGrantsPriorYear
Contributions Grants Current Year155233ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year26295InvestmentIncomePriorYear
Investment Income Current Year32237InvestmentIncomeCurrentYear
Other Revenue Prior Year-12503OtherRevenuePriorYear
Other Revenue Current Year728OtherRevenueCurrentYear
Total Revenue Prior Year145029TotalRevenuePriorYear
Total Revenue Current Year188198TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year96420GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY505725GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year82204SalariesEtcPriorYear
Salaries Etc Current Year89300SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year20074TotalFundrsngExpCurrentYear
Other Expense Prior Year16975OtherExpensePriorYear
Other Expenses Current Year44524OtherExpensesCurrentYear
Total Expenses Prior Year195599TotalExpensesPriorYear
Total Expenses Current Year639549TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-50570RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-451351RevenuesLessExpensesCY
Total Assets BOY1593989TotalAssetsBOY
Total Assets EOY1262650TotalAssetsEOY
Total Liabilities BOY145066TotalLiabilitiesBOY
Total Liabilities EOY284756TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1448923NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY977894NetAssetsOrFundBalancesEOY
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
Expense610107Expense
Grants505725Grants
DescriptionBon Secours Community Hospital Foundation is the fundraising arm of Bon Secours Community Hospital. Funds may be raised via the annual campaign, major gifts / planned giving, and special events. Special events included a Spring golf classic, and other fundraising events.Description
Total Program Service Expense610107TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
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
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members25NbrVotingGoverningBodyMembers
Number Independent Voting Members23NumberIndependentVotingMembers
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Kathleen Hylas
Board Member (Sept-Nov)4.00X000
James Biondi
Board Member4.00X000
John Bell
Board Member4.00X000
Howard Kuperman
Board Member4.00X000
Thomas McCarron
Board Member4.00X000
Darryl R McKeeby
Board Member4.00X000
John Meder
Board Member4.00X000
Shaun Parker
Board Member4.00X000
Steve Albanese
Board Member4.00X000
Lisa Toaldo DMD
Board Member4.00X000
Marie Cain
Board Member4.00X000
Barbara Heckman FNP
Board Member4.00X000
William A Onofry Esq
Board Member4.00X000
Jacob Reckess
Board Member4.00X000
Roy Shepherd
Board Member4.00X000
Joseph Spano DC
Board Member4.00X000
Guy Spradling
Board Member4.00X000
Charlene Trotter
Board Member4.00X000
Julie Witherow
Board Member4.00X000
Matthew Witherow Esq
Board Member4.00X000
Philip A Patterson
CEO - BSCHS50.00X082263845504X
Paul Brislin
Secretary6.00X000X
Clare Brady
President50.00X014909310420X
John Donahue
Chairman6.00X000X
Linda Hannigan
Treasurer6.00X000X
Stacey Kirschenbaum
Executive Director50.00013483719902X
David Capone
CFO - BSCHS (Aug)50.00000X
Melinda Hancock
Int CFO-BSCHS (Apr-Aug)50.00027200524032X
Terence O'Brien
Former CEO - BSCHS0.0006214649664X
Stephen D Majetich
Former CFO - BSCHS0.00034508627031X
John Shea
Former Int CEO- BSCHS0.00050105710196X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2846180TotalReportableCompFrmRltdOrgs
Total Other Compensation146749TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events83923FundraisingEvents
All Other Contributions71310AllOtherContributions
Total Contributions155233TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column32237TotalRevenueColumn
Exclusion$32,237ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events16955GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events83923CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses18782FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-1827TotalRevenueColumn
Exclusion-$1,827ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming2555GrossIncomeGaming

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column2555TotalRevenueColumn
Exclusion$2,555ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column188198TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$32,965ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total505725Total
Program Services505725ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total83378Total
Program Services65035ProgramServices
Management And General5836ManagementAndGeneral
Fundraising12507Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5922Total
Program Services4619ProgramServices
Management And General415ManagementAndGeneral
Fundraising888Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1741Total
Program Services1358ProgramServices
Management And General122ManagementAndGeneral
Fundraising261Fundraising

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Purchased Services418793266529326282
Dietary6445024597
Misc Taxes & Licenses2602031839

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total639549Total
Program Services610107ProgramServices
Management And General9368ManagementAndGeneral
Fundraising20074Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY380376BOY
EOY97891EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY457900BOY
EOY309416EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY11311BOY
EOY3291EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY725234BOY
EOY837080EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY19168BOY
EOY14972EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1593989BOY
EOY1262650EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY0BOY
EOY668EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY145066BOY
EOY284088EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY145066BOY
EOY284756EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY712378BOY
EOY137523EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY119179BOY
EOY223005EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY617366BOY
EOY617366EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1448923BOY
EOY977894EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1593989BOY
EOY1262650EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-451351ReconcilationRevenueExpenses
Reconcilation Other Changes-19678ReconcilationOtherChanges
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 Years139686CurrentTaxYearMinus4Years
Current Tax Year Minus1 Year131327CurrentTaxYearMinus1Year
Current Tax Year155233CurrentTaxYear
Total426246Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years139686CurrentTaxYearMinus4Years
Current Tax Year Minus1 Year131327CurrentTaxYearMinus1Year
Current Tax Year155233CurrentTaxYear
Total426246Total
FieldValueIRS element (for citing)
Public Support Total170426246PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years24218CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year26295CurrentTaxYearMinus1Year
Current Tax Year32237CurrentTaxYear
Total82750Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years165934CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years271547CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years104813CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16007CurrentTaxYearMinus1Year
Current Tax Year19510CurrentTaxYear
Total577811Total
FieldValueIRS element (for citing)
Total Support1086807TotalSupport
Public Support Pertcentage1700.39220PublicSupportPertcentage170
Public Support Pertcent Prior Year0.21070PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

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$265,315
Due to Affiliates$18,773
FieldValueIRS element (for citing)
Total Of Amounts284088TotalOfAmounts

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 FIN 48. 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 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. 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 $89,500 and $98,300 of net operating loss carryforwards as of August 31, 2011 and 2010, respectively, which expire in varying periods through 2031 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2011 and 2010. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change.2Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Golf Classic Orange CountyNameOfEvent1
Gross Receipts Event154295GrossReceiptsEvent1
Charitable Contributions Event142115CharitableContributionsEvent1
Gross Revenue Event112180GrossRevenueEvent1
Rent Facility Costs Event11000RentFacilityCostsEvent1
Other Direct Expenses Event12511OtherDirectExpensesEvent1
Name Of Event2GalaNameOfEvent2
Gross Receipts Event246583GrossReceiptsEvent2
Charitable Contributions Event241808CharitableContributionsEvent2
Gross Revenue Event24775GrossRevenueEvent2
Rent Facility Costs Event26521RentFacilityCostsEvent2
Food And Beverage Event28250FoodAndBeverageEvent2
Entertainment Event2500EntertainmentEvent2
Gross Receipts Total100878GrossReceiptsTotal
Charitable Contributions Total83923CharitableContributionsTotal
Gross Revenue Total Events16955GrossRevenueTotalEvents
Rent Facility Costs Total Events7521RentFacilityCostsTotalEvents
Food And Beverage Total Events8250FoodAndBeverageTotalEvents
Entertainment Total Events500EntertainmentTotalEvents
Other Direct Expenses Total Events2511OtherDirectExpensesTotalEvents
Direct Expense Summary Events18782DirectExpenseSummaryEvents
Net Income Summary-1827NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Bon Secours Community HospitalBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1160 E Main StreetAddressLine1
CityPort JervisCity
StateNYState
ZIP Code127712253ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient141347717EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant505725AmountOfCashGrant
Purpose Of GrantGeneral Support and CapitalPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
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 (7 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
Philip A Patterson
04345850516430336410017150028354086814200
Clare Brady
01197460125200168270342606994015951300
Stacey Kirschenbaum
012517709507015303740016162015473900
Melinda Hancock
022248804933501820376023656029603700
Terence O'Brien
0-35360006250000009664063112800
Stephen D Majetich
016080000018428605148021883037211700
John Shea
06783600043322104848053480511253089556

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Lines 4a-bPart 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: John Shea, $228,582; Terence O'Brien, $625,000; Stephen D. Majetich, $131,560 Part I, Line 4b: The organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirements plans and available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vestings on deposits are made into this plan. The following individual received a distribution payment in 2010: John Shea, $105,932.
Part IIIPart I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Community Hospital Foundation, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation committee Independent Compensation consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation CommitteeSupplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 Bon Secours Community Hospital, which in turn is the sole member of Bon Secours Community Hospital Foundation.
Form 990, Part VI, Section A, line 7aThe governing body of Bon Secours Community Hospital Foundation is appointed by its Member, Bon Secours Community Hospital and subject to approval by Bon Secours Health System, Inc., one of two corporate members of Bon Secours Charity Health System along with the Sisters of Charity of Saint Elizabeth of Convent Station.
Form 990, Part VI, Section A, line 7bCertain authorities of Bon Secours Community Hospital Foundation are reserved to its member or are jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station, the two corporate members of Bon Secours Charity Health System, Inc.
Form 990, Part VI, Section B, line 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 of July 16, 2012. 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 July 16, 2012.
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 12c
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 B, line 15
Bon Secours Community Hospital Foundation provides any documents open to public inspection upon request.Form 990, Part VI, Section C, line 19
Hours worked are not tracked on an entity by entity basis. All officers' and directors' 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. Melinda Hancock's compensation was paid by St. Mary's Hospital, a related organization of Bon Secours Health System Inc and Good Samaritan Hospital, a related organization. The compensation she received was for her role as the VP of Strategic Finance at Bon Secours Richmond Health System, Inc and also for her role as the interim CFO of Bon Secours Charity Health System, which began in June of 2010. 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. Gayle Hirsch is a board member of the filing organization and is not compensated for this position. The compensation disclosed on Form 990, Part VII relates to services provided to a related organization as an independent contractor.Form 990, Part VII:
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 43,440. Prior period adjustments: -38,820. PV adjustment for pledges receivable -6,269. Expenses already reported in functional expenses -18,029. Total to Form 990, Part XI, Line 5: -19,678.Form 990, Part XI, line 5:

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 System Inc0
Bon Secours Community Hospital
160 E Main StreetPort JervisNY127712253141347717HealthcareNY501(c)(3)3Bon Secours Charity Health System Inc0
St Francis Center at the Knolls (dba Mount Alverno Center)
20 Grand StreetWarwickNY109901028061370576Long-term CareNY501(c)(3)3Bon Secours Charity Health System Inc0
St Anthony Community Hospital
15-19 Maple AvenueWarwickNY109901028141340100HealthcareNY501(c)(3)3Bon Secours Charity Health System Inc0
Good Samaritan Foundation for Better Health
255 Lafayette AvenueSuffernNY109015620133400353Grant Making FoundationNY501(c)(3)5Bon Secours Charity Health System Inc0
Bon Secours Warwick Health Foundation
20 Grand StreetWarwickNY109901028141972807Grant Making FoundationNY501(c)(3)5Bon Secours Charity Health System Inc0
Villa Francis at the Knolls (dba Schervier Pavilion)
20 Grand StreetWarwickNY109901028061381994Skilled Nursing FacilityNY501(c)(3)3Bon Secours Charity Health System Inc0
Bon Secours Charity Health System Medical Group PC
255 Lafayette AvenueSuffernNY109015620223636986Primary CareNY501(c)(3)3Bon Secours Charity Health System Inc0
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 Org1LoansOrGuaranteesFromOtherOrg
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 Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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