2012-07-16T11:02:35-05:00 2011-08-31 DELOITTE TAX LLP 1750 TYSONS BLVD MCLEAN VA 221024219 990 2010-09-01 810667395 Bon Secours Community Hospital Foundation BONS 8453685151 255 Lafayette Avenue Suffern NY 109015620 Stacey Kirschenbaum 8453685305 2012-07-16 1 Laura L Catlett 7032511000 2010 2016-02-24 21:20:13Z Stacey Kirschenbaum 255 Lafayette Avenue Suffern NY 109015620 206980 0 0928 X www.bschsf.org/community X 2002 NY Fundraising to support patient related activities at Bon Secours Community Hospital. 25 23 0 23 0 0 131237 155233 0 0 26295 32237 -12503 728 145029 188198 96420 505725 0 0 82204 89300 0 0 20074 16975 44524 195599 639549 -50570 -451351 1593989 1262650 145066 284756 1448923 977894 The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. 0 0 610107 505725 Bon Secours Community Hospital Foundation is the fundraising arm of Bon Secours Community Hospital. Funds may be raised via the annual campaign, major gifts / planned giving, and special events. Special events included a Spring golf classic, and other fundraising events. 610107 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 25 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Julie Owen 8458567215 20 Grand Street Warwick NY 10990 X Kathleen Hylas 4.00 X 0 0 0 James Biondi 4.00 X 0 0 0 John Bell 4.00 X 0 0 0 Howard Kuperman 4.00 X 0 0 0 Thomas McCarron 4.00 X 0 0 0 Darryl R McKeeby 4.00 X 0 0 0 John Meder 4.00 X 0 0 0 Shaun Parker 4.00 X 0 0 0 Steve Albanese 4.00 X 0 0 0 Lisa Toaldo DMD 4.00 X 0 0 0 Marie Cain 4.00 X 0 0 0 Barbara Heckman FNP 4.00 X 0 0 0 William A Onofry Esq 4.00 X 0 0 0 Jacob Reckess 4.00 X 0 0 0 Roy Shepherd 4.00 X 0 0 0 Joseph Spano DC 4.00 X 0 0 0 Guy Spradling 4.00 X 0 0 0 Charlene Trotter 4.00 X 0 0 0 Julie Witherow 4.00 X 0 0 0 Matthew Witherow Esq 4.00 X 0 0 0 Philip A Patterson 50.00 X X 0 822638 45504 Paul Brislin 6.00 X X 0 0 0 Clare Brady 50.00 X X 0 149093 10420 John Donahue 6.00 X X 0 0 0 Linda Hannigan 6.00 X X 0 0 0 Stacey Kirschenbaum 50.00 X 0 134837 19902 David Capone 50.00 X 0 0 0 Melinda Hancock 50.00 X 0 272005 24032 Terence O'Brien 0.00 X 0 621464 9664 Stephen D Majetich 0.00 X 0 345086 27031 John Shea 0.00 X 0 501057 10196 0 2846180 146749 0 1 1 0 0 83923 71310 155233 32237 32237 16955 83923 18782 -1827 -1827 2555 2555 2555 188198 0 0 32965 505725 505725 83378 65035 5836 12507 5922 4619 415 888 1741 1358 122 261 Purchased Services 41879 32665 2932 6282 Dietary 644 502 45 97 Misc Taxes & Licenses 260 203 18 39 639549 610107 9368 20074 380376 97891 457900 309416 11311 3291 725234 837080 19168 14972 1593989 1262650 0 668 145066 284088 145066 284756 X 712378 137523 119179 223005 617366 617366 1448923 977894 1593989 1262650 X -451351 -19678 X 0 1 1 X 1 1 X 139686 131327 155233 426246 139686 131327 155233 426246 426246 24218 26295 32237 82750 165934 271547 104813 16007 19510 577811 1086807 0.39220 0.21070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to BSHSI 265315 Due to Affiliates 18773 284088 Description of Uncertain Tax Positions Under FIN 48: Part X: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under 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.2 Golf Classic Orange County 54295 42115 12180 1000 2511 Gala 46583 41808 4775 6521 8250 500 100878 83923 16955 7521 8250 500 2511 18782 -1827 1 Bon Secours Community Hospital 160 E Main Street Port Jervis NY 127712253 141347717 501(c)(3) 505725 General Support and Capital 1 0 X X X X X 1 1 0 0 0 0 0 0 0 Philip A Patterson 0 434585 0 51643 0 336410 0 17150 0 28354 0 868142 0 0 Clare Brady 0 119746 0 12520 0 16827 0 3426 0 6994 0 159513 0 0 Stacey Kirschenbaum 0 125177 0 9507 0 153 0 3740 0 16162 0 154739 0 0 Melinda Hancock 0 222488 0 49335 0 182 0 376 0 23656 0 296037 0 0 Terence O'Brien 0 -3536 0 0 0 625000 0 0 0 9664 0 631128 0 0 Stephen D Majetich 0 160800 0 0 0 184286 0 5148 0 21883 0 372117 0 0 John Shea 0 67836 0 0 0 433221 0 4848 0 5348 0 511253 0 89556 Part I, Lines 4a-b 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: 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. Supplemental Information Part III Part I, Line 3: Bon Secours Health System, Inc., a related organization of Bon Secours Community Hospital Foundation, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation committee Independent Compensation consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is one of two corporate members of Bon Secours Charity Health System along with the Sisters of Charity of Saint Elizabeth of Convent Station. Bon Secours Charity Health System, Inc. is the sole member of Bon Secours Community Hospital, which in turn is the sole member of Bon Secours Community Hospital Foundation. Form 990, Part VI, Section A, line 7a The governing body of Bon Secours Community Hospital Foundation is appointed by its Member, Bon Secours Community Hospital and subject to approval by Bon Secours Health System, Inc., one of two corporate members of Bon Secours Charity Health System along with the Sisters of Charity of Saint Elizabeth of Convent Station. Form 990, Part VI, Section A, line 7b Certain authorities of Bon Secours Community Hospital Foundation are reserved to its member or are jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station, the two corporate members of Bon Secours Charity Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date 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. 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 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 Bon Secours Community Hospital Foundation provides any documents open to public inspection upon request. Form 990, Part VII: Hours worked are not tracked on an entity by entity basis. All 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: 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. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. - Management Services MD 501(c)(3) 11b Bon Secours Inc 0 Bon Secours Charity Health System Inc 255 Lafayette Avenue Suffern NY 109015620 912135195 Local System Parent Org. NY 501(c)(3) 11b N/A 0 Good Samaritan Hospital 255 Lafayette Avenue Suffern NY 109015620 131740104 Healthcare NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 Bon Secours Community Hospital 160 E Main Street Port Jervis NY 127712253 141347717 Healthcare NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 St Francis Center at the Knolls (dba Mount Alverno Center) 20 Grand Street Warwick NY 109901028 061370576 Long-term Care NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 St Anthony Community Hospital 15-19 Maple Avenue Warwick NY 109901028 141340100 Healthcare NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 Good Samaritan Foundation for Better Health 255 Lafayette Avenue Suffern NY 109015620 133400353 Grant Making Foundation NY 501(c)(3) 5 Bon Secours Charity Health System Inc 0 Bon Secours Warwick Health Foundation 20 Grand Street Warwick NY 109901028 141972807 Grant Making Foundation NY 501(c)(3) 5 Bon Secours Charity Health System Inc 0 Villa Francis at the Knolls (dba Schervier Pavilion) 20 Grand Street Warwick NY 109901028 061381994 Skilled Nursing Facility NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 Bon Secours Charity Health System Medical Group PC 255 Lafayette Avenue Suffern NY 109015620 223636986 Primary Care NY 501(c)(3) 3 Bon Secours Charity Health System Inc 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0