BON SECOURS COMMUNITY HOSPITAL FOUNDATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- BON SECOURS COMMUNITY HOSPITAL FOUNDATION (EIN 81-0667395)
- Tax period
- 2009-09-01 to 2010-08-31
- Filed
- 2011-07-11
- IRS object ID
- 201101929349300005
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-07-11T07:47:35-05:00 | Timestamp |
| Tax Period End Date | 2010-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1750 TYSONS BLVD | AddressLine1 |
| City | MCLEAN | City |
| State | VA | State |
| ZIP Code | 221024219 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810667395 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bon Secours Community Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BONS | NameControl |
| Phone | 9143685121 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Stacey Kirschenbaum | Name |
| Title | Chief Executive Officer | Title |
| Phone | 8453685303 | Phone |
| Date Signed | 2011-07-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John W Sadoff Jr | Name |
| Phone | 7032511000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Philip A Patterson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 173539 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c | X | Organization501c |
| Web Site | www.bonsecourscommunityhosp.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | Fundraising to support patient related activities at Bon Secours Community Hospital. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 24 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 19 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 131237 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -33344 | InvestmentIncomePriorYear |
| Investment Income Current Year | 26295 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 80420 | OtherRevenuePriorYear |
| Other Revenue Current Year | -12503 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 47076 | TotalRevenuePriorYear |
| Total Revenue Current Year | 145029 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 96420 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 82204 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 14877 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 36272 | OtherExpensePriorYear |
| Other Expenses Current Year | 16975 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 36272 | TotalExpensesPriorYear |
| Total Expenses Current Year | 195599 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 10804 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -50570 | RevenuesLessExpensesCY |
| Total Assets BOY | 1485489 | TotalAssetsBOY |
| Total Assets EOY | 1448923 | TotalAssetsEOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1485489 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1448923 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 173780 | Expense |
| Grants | 96420 | Grants |
| Description | Bon Secours Communitry 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 Ball, a fall golf classic, and other fundraising events. | Description |
| Total Program Service Expense | 173780 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 0 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 24 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Julie Owen | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8458567215 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20 Grand Street | AddressLine1 |
| City | Warwick | City |
| State | NY | State |
| ZIP Code | 10990 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|---|
| Philip A Patterson | ||||||||
| Board Member (Oct-Aug) | 50.00 | X | 0 | 331611 | 26844 | |||
| Kathleen Hylas | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Sally Beecher | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| James Biondi | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| John Bell | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Barbara Buchanan | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Ronald Demczak | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Howard Kuperman | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Thomas McCarron | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Darryl R McKeeby | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| John Meder | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Shaun Parker | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Steve Albanese | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Barry Short | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Lisa Toaldo DMD | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| R Michael Worden | ||||||||
| Board Member | 4.00 | X | 0 | 0 | 0 | |||
| Gerald Hansen | ||||||||
| Board Member (Sept-May) | 4.00 | X | 0 | 0 | 0 | |||
| Terence O'Brien | ||||||||
| Board Member (Sept) | 50.00 | X | 0 | 758300 | 20135 | |||
| Leah Cerkvenik | ||||||||
| Board Member (Sept-Apr) | 50.00 | X | 0 | 386135 | 79838 | |||
| Jeffrey Reilly | ||||||||
| Board Member (May-Aug) | 50.00 | X | 0 | 161452 | 12681 | |||
| Paul Brislin | ||||||||
| Secretary | 6.00 | X | 0 | 0 | 0 | X | ||
| Clare Brady | ||||||||
| President | 50.00 | X | 0 | 100531 | 9823 | X | ||
| John Donahue | ||||||||
| Chairman | 6.00 | X | 0 | 0 | 0 | X | ||
| Linda Hannigan | ||||||||
| Treasurer | 6.00 | X | 0 | 0 | 0 | X | ||
| Stacey Kirschenbaum | ||||||||
| Executive Director | 50.00 | 0 | 129836 | 17773 | X | |||
| Lisa Randazzo | ||||||||
| Former EVP | 0.00 | 0 | 71302 | 14180 | X | |||
| Stephen D Majetich | ||||||||
| CFO - Charity | 50.00 | 0 | 351880 | 50300 | X | |||
| John Shea | ||||||||
| Former Interim CEO | 0.00 | 0 | 792042 | 131791 | X | |||
| Thomas Brunelle | ||||||||
| Former EVP | 0.00 | 0 | 0 | 0 | X | |||
| Dominick Stanzione | ||||||||
| Former CEO | 0.00 | 0 | 567664 | 27073 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3579451 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 376258 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 86653 | FundraisingEvents |
| Related Organizations | 10000 | RelatedOrganizations |
| All Other Contributions | 34584 | AllOtherContributions |
| Total Contributions | 131237 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26295 | TotalRevenueColumn |
| Exclusion | $26,295 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 16007 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 86653 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 28510 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -12503 | TotalRevenueColumn |
| Exclusion | -$12,503 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 145029 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $13,792 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96420 | Total |
| Program Services | 96420 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76391 | Total |
| Program Services | 59585 | ProgramServices |
| Management And General | 5347 | ManagementAndGeneral |
| Fundraising | 11459 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 601 | Total |
| Program Services | 469 | ProgramServices |
| Management And General | 42 | ManagementAndGeneral |
| Fundraising | 90 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5212 | Total |
| Program Services | 4065 | ProgramServices |
| Management And General | 365 | ManagementAndGeneral |
| Fundraising | 782 | Fundraising |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Purchased Services | 16203 | 12639 | 1134 | 2430 |
| Bank Fees | 512 | 399 | 36 | 77 |
| Taxes - Business Licens | 260 | 203 | 18 | 39 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195599 | Total |
| Program Services | 173780 | ProgramServices |
| Management And General | 6942 | ManagementAndGeneral |
| Fundraising | 14877 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1035012 | BOY |
| EOY | 693210 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 258051 | BOY |
| EOY | 11311 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 190708 | BOY |
| EOY | 725234 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1718 | BOY |
| EOY | 19168 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1485489 | BOY |
| EOY | 1448923 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1036730 | BOY |
| EOY | 712378 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -163639 | BOY |
| EOY | 119179 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 612398 | BOY |
| EOY | 617366 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1485489 | BOY |
| EOY | 1448923 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1485489 | BOY |
| EOY | 1448923 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1087704 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 139686 | CurrentTaxYearMinus3Years |
| Current Tax Year | 131237 | CurrentTaxYear |
| Total | 1358627 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1087704 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 139686 | CurrentTaxYearMinus3Years |
| Current Tax Year | 131237 | CurrentTaxYear |
| Total | 1358627 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 908546 | AmountsSubstContributorsTotal |
| Public Support Total170 | 450081 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 24218 | CurrentTaxYearMinus1Year |
| Current Tax Year | 26295 | CurrentTaxYear |
| Total | 50513 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 168333 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 165934 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 271547 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 104813 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16007 | CurrentTaxYear |
| Total | 726634 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2135774 | TotalSupport |
| Gross Receipts From Admissions Etc | 1358627 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.21070 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.64440 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests PY170 | X | ThirtyThreePercntTestsPY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48. As the organization does not conduct a separate audit of its financial statement, 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 $98,300 and $117,200 of net operating loss carryforwards as of August 31, 2010 and 2009, respectively, which expire in varying periods through 2030 and are available to offset future taxable income. The System's deferred tax assets are fully reserved at August 31, 2010 and 2009. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Classic | NameOfEvent1 |
| Gross Receipts Event1 | 107660 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 5000 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 102660 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 8229 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 20281 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 107660 | GrossReceiptsTotal |
| Charitable Contributions Total | 5000 | CharitableContributionsTotal |
| Gross Revenue Total Events | 102660 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 8229 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 20281 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 28510 | DirectExpenseSummaryEvents |
| Net Income Summary | 74150 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| Bon Secours Community Hospital | |||||||
| 160 East Main Street | Port Jervis | NY | 127712245 | 141347717 | 501(C)(3) | 40600 | Replacement of Zeiss Microscope for ENT surgery. |
| Bon Secours Community Hospital | |||||||
| 160 East Main Street | Port Jervis | NY | 127712245 | 141347717 | 501(C)(3) | 9125 | Video Laryngoscope for Emergency Incubations |
| Bon Secours Community Hospital | |||||||
| 160 East Main Street | Port Jervis | NY | 127712245 | 141347717 | 501(C)(3) | 19941 | Replacement of Vascular testing system |
| Bon Secours Community Hospital | |||||||
| 160 East Main Street | Port Jervis | NY | 127712245 | 141347717 | 501(C)(3) | 26754 | Construction and face lift of Sun porch at St. Josephs Place at BSCH. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 4 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: The Bon Secours Community Hospital Foundation asks for grant requests at the beginning of each fiscal year. The organizations and individuals requesting grants are required to fill out an application. The grant committee reviews each grant application and may request additional information, interviews, etc. The grants committee approves applications based on merit and need. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Philip A Patterson | |||||||||||||
| 0 | 236729 | 0 | 0 | 0 | 94882 | 0 | 13896 | 0 | 12948 | 0 | 358455 | 0 | 0 |
| Terence O'Brien | |||||||||||||
| 0 | 505610 | 0 | 135745 | 0 | 116945 | 0 | 6716 | 0 | 13419 | 0 | 778435 | 0 | 0 |
| Leah Cerkvenik | |||||||||||||
| 0 | 256646 | 0 | 112277 | 0 | 17212 | 0 | 59241 | 0 | 20597 | 0 | 465973 | 0 | 0 |
| Jeffrey Reilly | |||||||||||||
| 0 | 145526 | 0 | 14771 | 0 | 1155 | 0 | 4849 | 0 | 7832 | 0 | 174133 | 0 | 0 |
| Stephen D Majetich | |||||||||||||
| 0 | 291497 | 0 | 41127 | 0 | 19256 | 0 | 35041 | 0 | 15259 | 0 | 402180 | 0 | 0 |
| John Shea | |||||||||||||
| 0 | 446997 | 0 | 341161 | 0 | 3884 | 0 | 116092 | 0 | 15699 | 0 | 923833 | 0 | 0 |
| Dominick Stanzione | |||||||||||||
| 0 | 60543 | 0 | 0 | 0 | 507121 | 0 | 0 | 0 | 27073 | 0 | 594737 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Lines 4a-b: | Dominick Stanzione and Terence O'Brien received a severance payment of $503,654 and $60,096, respectively. Part I, Line 4b: The Charity Health System 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 vesting on deposits are made into this plan. | |
| 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 | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 4 | Effective April 26, 2010, the orgnization amended its governing documents to remove term limitations for members of the Foundation's board of directors. |
| Form 990, Part VI, Section A, line 6 | Bon Secours Health System, Inc. is the sole member of Bon Secours Charity Health System, Inc., 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 Charity Health System, Inc. and subject to approval by Bon secours Health system, Inc. |
| Form 990, Part VI, Section A, line 7b | Certain authorities of Bon Secours Community Hospital Foundation are reserved to its member or to Bon Secours 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 Bon Secours Charity Health System, Inc.'s audit and compliance board committee and providing the form to the Bon Secours Community Hospital Foundation's board of directors to allow for a thorough review by both before the filing date of July 15, 2011. Bon Secours Charity Health System, Inc.'s audit and compliance board committee and Bon Secours Community Hospital Foundation's board of directors will review the Form 990 and ask any additional questions regarding the Form 990 before the return is filed July 15, 2011. |
| Form 990, Part VI, Section B, line 12c | Bon Secours Community Hospital Foundation 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 Bon Secours Community Hospital Foundation. 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 participates 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). Part VI, Section B, Line 14: Document Retention and Destruction Policy While Bon Secours Health System, Inc. does not have a written organization-wide document retention and destruction policy, individual department policies and practices are in place to ensure that each department of the organization maintains their documentation in compliance with state and federal requirements. In addition, any areas responsible for medical records have department policies in compliance with Medicare and HIPAA requirements. An organization-wide policy is currently in place for fiscal year ending August 31, 2011. |
| Form 990, Part VI, Section B, line 15 | The compensation committee of the board of Bon Secours Health System, Inc. engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of Bon Secours Community Hospital Foundation as well as other officers, key employees and highest paid employees. The compensation committee consists of a group of independent board members and engages an independent external compensation consultant to ensure the reasonableness of compensation paid to executives and disqualified parties. The committee maintains a Board-approved 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 reported to the BSHSI Board of Directors and documented in the BSHSI 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 Bon Secours Community Hospital Foundation 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 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 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. Terence O'Brien's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as CEO of Bon Secours Charity Health System, Inc. Philip Patterson's compensation is paid by Bon Secours Health System, Inc., a related organization. The compensation he receives is for his role as CEO of Bon Secours Charity Health System, Inc. Jeffrey Reilly's compensation is paid by St. Anthony Community Hospital, a related organization. The compensation he receives is for his role as the VP of Operations of Bon Secours Charity Health System, Inc. Leah Cerkvenik's compensation is paid by St. Anthony Community Hospital, a related organization. The compensation she receives is for her role as the VP of Operations of Bon Secours Charity Health System, Inc. 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. Stephen Majetich's compensation is paid by Good Samaritan Hospital, a related organization. The compensation he receives is for his role as CFO of Bon Secours Charity Health System, Inc. 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| Bon Secours Health System Inc | |||||||||
| 1505 Marriottville Road | Marriottsville | MD | 21104 | 521301088 | Management | MD | 501(c)(3) | Line 11, Type II: 50 | N/A |
| Bon Secours Charity Health System Inc | |||||||||
| 255 Lafayette Avenue | Suffern | NY | 10901 | 912135195 | Management | NY | 501(c)(3) | Line 11, Type II: 50 | N/A |
| Good Samaritan Hospital | |||||||||
| 255 Lafayette Avenue | Suffern | NY | 10901 | 131740104 | Hospital | NY | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A |
| Bon Secours Community Hospital | |||||||||
| 160 E Main Street | Port Jervis | NY | 127712245 | 141347717 | Hospital | NY | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A |
| St Francis Center at the Knolls (dba Mount Alverno Center) | |||||||||
| 20 Grand Street | Warwick | NY | 109901020 | 061370576 | Long-term Care | NY | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A |
| St Anthony Community Hospital | |||||||||
| 15-19 Maple Avenue | Warwick | NY | 109901028 | 141340100 | Hospital | NY | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A |
| Good Samaritan Foundation for Better Health | |||||||||
| 255 Lafayette Avenue | Suffern | NY | 10901 | 133400353 | Foundation | NY | 501(c)(3) | Line 7: 170(b)(1)(a) | N/A |
| Bon Secours Warwick Health Foundation | |||||||||
| 20 Grand Street | Warwick | NY | 109901020 | 141972807 | Foundation | NY | 501(c)(3) | Line 7: 170(b)(1)(a) | N/A |
| Villa Francis at the Knolls (dba Schervier Pavilion) | |||||||||
| 22 Van Duzer Place | Warwick | NY | 109901020 | 061381994 | Skilled Nursing Facility | NY | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GSH Medical Care OC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Lafayette Avenue | AddressLine1 |
| City | Suffern | City |
| State | NY | State |
| ZIP Code | 109015620 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223636986 | EIN |
| Primary Activity | Primary Care | PrimaryActivity |
| Legal Domicile State | NY | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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