GOOD SAMARITAN FDN FOR BETTER HEALTH INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
GOOD SAMARITAN FDN FOR BETTER HEALTH INC (EIN 13-3400353)
Tax period
2009-09-01 to 2010-08-31
Filed
2011-07-15
IRS object ID
201131969349300633
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-07-15T11:23:38-05:00Timestamp
Tax Period End Date2010-08-31TaxPeriodEndDate

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 Date2009-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN133400353EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Good Samaritan Foundation For Better HealthBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGOODNameControl
Phone9143685121Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameStacey KirshenbaumName
TitleExecutive DirectorTitle
Phone8453685303Phone
Date Signed2011-07-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJohn W Sadoff JrName
Phone7032511000Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts1106914GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501cXOrganization501c
Web Sitewww.goodsamhosp.org/html/foundation.htmlWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionFundraising events to support the HospitalActivityOrMissionDescription
Nbr Voting Members Governing Body30NbrVotingMembersGoverningBody
Nbr Independent Voting Members28NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers28TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year158467ContributionsGrantsPriorYear
Contributions Grants Current Year886320ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year333788InvestmentIncomePriorYear
Investment Income Current Year41008InvestmentIncomeCurrentYear
Other Revenue Prior Year465473OtherRevenuePriorYear
Other Revenue Current Year-42900OtherRevenueCurrentYear
Total Revenue Prior Year957728TotalRevenuePriorYear
Total Revenue Current Year884428TotalRevenueCurrentYear
Grants And Similar Amnts CY2305399GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year328837SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year75674TotalFundrsngExpCurrentYear
Other Expense Prior Year304528OtherExpensePriorYear
Other Expenses Current Year175667OtherExpensesCurrentYear
Total Expenses Prior Year304528TotalExpensesPriorYear
Total Expenses Current Year2809903TotalExpensesCurrentYear
Revenues Less Expenses Prior Year653200RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1925475RevenuesLessExpensesCY
Total Assets BOY6362019TotalAssetsBOY
Total Assets EOY4294978TotalAssetsEOY
Total Liabilities BOY125208TotalLiabilitiesBOY
Total Liabilities EOY149060TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6236811NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4145918NetAssetsOrFundBalancesEOY
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
Expense2698914Expense
Grants2305399Grants
Revenue407449Revenue
DescriptionGood Samaritan Foundation for Better Health is the fundraising arm of Good Samaritan Hospital. Funds may be raised via the annual campaign, major gifts, planned giving and special events. Special events for this past year included a Spring Ball and a fall Golf Classic.Description
Total Program Service Expense2698914TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members30NbrVotingGoverningBodyMembers
Number Independent Voting Members28NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
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 Policy0DocumentRetentionPolicy
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)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeFormerFormer
Dr Beatrice Bloom
Board Member4.00X000
Joseph Allen
Board Member4.00X000
Dr Carmine Caponigro
Board Member4.00X000
Dr Richard Clarkin
Board Member4.00X000
John DeCicco
Board Member4.00X000
David Evangelista
Board Member4.00X000
Roberta Goldstein
Board Member4.00X000
Sister Fran Gorsuch CBS
Board Member50.00X000
Gilbert Heim
Board Member4.00X000
Gayle Hirsch
Board Member4.00X000
Andrew Kritzer
Board Member4.00X000
Dr Michael Lippe
Board Member4.00X000
Pierson Mapes
Board Member4.00X000
Jeff Marangi
Board Member4.00X000
Michael Mastrangelo
Board Member4.00X000
Dr Glenn Mendoza
Board Member4.00X000
Harold Peterson
Board Member4.00X000
Janetlee Pillitteri
Board Member4.00X000
Louis Siracusano
Board Member4.00X000
Margaret Telscher
Board Member4.00X000
Dr John Urcioli
Board Member4.00X000
Dr Thomas Snopek
Board Member4.00X000
Terence O'Brien
Board Member (Sept)50.00X075830020135
Philip A Patterson
Board Member (Oct - Aug)50.00X033161126844
Frank Stillo
Chairman (May - Aug)6.00X000X
Mark Rothenberg
Chairman (Sept - May)6.00X000X
Sr Joan Granville SC
President (Sept - Oct)6.00X000X
Sr Mary Louise Moran SC
President (Oct - Aug)50.00X000X
Daniel Rifkin
Treasurer6.00X000X
Patricia Lefkowitz
Secretary6.00X000X
Stacey Kirshenbaum
Executive Director50.00012983617773X
Stephen D Majetich
CFO - Charity50.00035188050300X
John Shea
Former Interim CEO0.000792042131791X
Michael Schneiders
Former Ex-Officio0.00034188722480X
Dominick Stanzione
Former CEO0.00056766427073X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3273220TotalReportableCompFrmRltdOrgs
Total Other Compensation296396TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events666787FundraisingEvents
Related Organizations33500RelatedOrganizations
All Other Contributions186033AllOtherContributions
Total Contributions886320TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column41008TotalRevenueColumn
Exclusion$41,008ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events179586GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events450349CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses222486FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-42900TotalRevenueColumn
Exclusion-$42,900ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column884428TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$1,892ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2305399Total
Program Services2305399ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total305575Total
Program Services238350ProgramServices
Management And General21390ManagementAndGeneral
Fundraising45835Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2402Total
Program Services1874ProgramServices
Management And General168ManagementAndGeneral
Fundraising360Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total20860Total
Program Services16271ProgramServices
Management And General1460ManagementAndGeneral
Fundraising3129Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7500Total
Program Services5850ProgramServices
Management And General525ManagementAndGeneral
Fundraising1125Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total639Total
Program Services498ProgramServices
Management And General45ManagementAndGeneral
Fundraising96Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total31815Total
Program Services24816ProgramServices
Management And General2227ManagementAndGeneral
Fundraising4772Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1106Total
Program Services863ProgramServices
Management And General77ManagementAndGeneral
Fundraising166Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total5447Total
Program Services4249ProgramServices
Management And General381ManagementAndGeneral
Fundraising817Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Purchased Services10390081042727315585
Misc Expenses211451649214813172
Bank Fees38553007270578
Taxes/Business Licenses2602031839

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2809903Total
Program Services2698914ProgramServices
Management And General35315ManagementAndGeneral
Fundraising75674Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2518821BOY
EOY673947EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1170585BOY
EOY558925EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1162BOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2671451BOY
EOY3062106EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6362019BOY
EOY4294978EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY36243BOY
EOY1680EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY88965BOY
EOY147380EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY125208BOY
EOY149060EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2394774BOY
EOY524888EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3842037BOY
EOY3608981EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY12049EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6236811BOY
EOY4145918EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6362019BOY
EOY4294978EOY
FieldValueIRS element (for citing)
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 Years1888299CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1138903CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years374957CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year158467CurrentTaxYearMinus1Year
Current Tax Year886320CurrentTaxYear
Total4446946Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1888299CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1138903CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years374957CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year158467CurrentTaxYearMinus1Year
Current Tax Year886320CurrentTaxYear
Total4446946Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total69846AmountsSubstContributorsTotal
Public Support Total1704377100PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year333788CurrentTaxYearMinus1Year
Current Tax Year41008CurrentTaxYear
Total374796Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years662737CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years641217CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years757737CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year699277CurrentTaxYearMinus1Year
Total2760968Total
FieldValueIRS element (for citing)
Total Support7582710TotalSupport
Public Support Pertcentage1700.57720PublicSupportPertcentage170
Public Support Pertcent Prior Year0.51550PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSchedule A, Part IV, Supplemental Information: Schedule A, Part II, Line 10, Explanation for Other Income: Special Events Other IncomeGeneralExplanation

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

FieldValueIRS element (for citing)
DescriptionDue to AffiliatesDescription
Amount$147,380Amount
FieldValueIRS element (for citing)
Total Of Amounts147380TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48: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. 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

FieldValueIRS element (for citing)
Name Of Event1Spring BallNameOfEvent1
Gross Receipts Event1354461GrossReceiptsEvent1
Charitable Contributions Event1285357CharitableContributionsEvent1
Gross Revenue Event169104GrossRevenueEvent1
Rent Facility Costs Event138000RentFacilityCostsEvent1
Other Direct Expenses Event173604OtherDirectExpensesEvent1
Name Of Event2Golf ClassicNameOfEvent2
Gross Receipts Event2275474GrossReceiptsEvent2
Charitable Contributions Event2164992CharitableContributionsEvent2
Gross Revenue Event2110482GrossRevenueEvent2
Cash Prizes Event210000CashPrizesEvent2
Rent Facility Costs Event276477RentFacilityCostsEvent2
Other Direct Expenses Event224405OtherDirectExpensesEvent2
Gross Receipts Total629935GrossReceiptsTotal
Charitable Contributions Total450349CharitableContributionsTotal
Gross Revenue Total Events179586GrossRevenueTotalEvents
Cash Prizes Total Events10000CashPrizesTotalEvents
Rent Facility Costs Total Events114477RentFacilityCostsTotalEvents
Other Direct Expenses Total Events98009OtherDirectExpensesTotalEvents
Direct Expense Summary Events222486DirectExpenseSummaryEvents
Net Income Summary-42900NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Good Samartian Hospital
255 LafayetteSuffernNY109015620131740104501(c)(3)2234806Purchase of Equipment
Good Samartian Hospital
255 Lafayette AvenueSuffernNY109015620131740104501(c)(3)70593General Support
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: The Good Samaritan Foundation for Better Health 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

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 (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Terence O'Brien
05056100135745011694506716013419077843500
Philip A Patterson
023672900094882013896012948035845500
Stephen D Majetich
0291497041127019256035041015259040218000
John Shea
04469970341161038840116092015699092383300
Michael Schneiders
0106633000235254010446012034036436700
Dominick Stanzione
06054300050712100027073059473700

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Lines 4a-b:Dominick Stanzione, Terence O'Brien, and Michael Schneiders received severence payments of $503,654, $60,096, and $228,274, 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 IIIPart I, Line 3: Bon Secours Health System, Inc., a related organization of Good Samaritan Foundation for Better Health, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent compensation consultant Written employment contracts Compensation survey or study Approval by the board/compensation committee.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 2Margaret Telscher and Dr. Thomas Snopek have a family relationship.
Form 990, Part VI, Section A, line 4Effective April 26, 2010, the orgnization amended its governing documents to remove term limitations for members of the Foundations board of directors.
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 Good Samaritan Foundation for Better Health.
Form 990, Part VI, Section A, line 7aThe governing body of Good Samaritan Foundation for Better Health is appointed by its Member, Bon Secours Charity Health System, Inc. and subject to approval by Bon Secours Health System, Inc., one of two corporate members of Bon Secours Charity Health System, Inc. along with the Sisters of Charity of Saint Elizabeth of Convent Station.
Form 990, Part VI, Section A, line 7bCertain authorities of Good Samaritan Foundation for Better Health are reserved to its member, Bon Secours Charity Health System, Inc. or is jointly reserved to Bon Secours Health System, Inc. and the Sisters of Charity of Saint Elizabeth of Convent Station, the two corporate members of Bon Secours Charity Health System, Inc.
Form 990, Part VI, Section B, line 11The process the organization uses to review the Form 990 consists of a review by the Bon Secours Charity Health System's audit and compliance board committee and providing the form to the Good Samaritan Foundation for Better Health'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's audit and compliance board committee and the Good Samaritan Foundation for Better Health'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 12cThe Good Samaritan Foundation for Better Health 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 Good Samaritan Foundation for Better Health. 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 15The 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 the Good Samaritan Foundation for Better Health 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 the Good Samaritan Foundation for Better Health 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 19The Good Samaritan Foundation for Better Health 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. 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. Sr. Mary Louise Moran and Sr. Fran Gorsuch did not receive payroll distributions as they have taken vows of poverty.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
Bon Secours Health System Inc
1505 Marriottsville RoadMarriottsvilleMD21104521301088Parent Org - Management ServicesMD501(c)(3)Line 11b, Type 2: 50N/A
Bon Secours Charity Health System Inc
255 Lafayette AvenueSuffernNY109015620912135195Local System Parent Org.NY501(c)(3)Line 11b, Type 2: 50N/A
Good Samaritan Hospital
255 Lafayette AvenueSuffernNY109015620131740104HealthcareNY501(c)(3)Line 3: 170(b)(1)(a)N/A
Bon Secours Community Hospital
160 E Main StreetPort JervisNY127712253141347717HealthcareNY501(c)(3)Line 3: 170(b)(1)(a)N/A
St Francis Center at the Knolls(dba Mount Alverno Center)
20 Grand StreetWarwickNY109901028061370576Long-term CareNY501(c)(3)Line 3: 170(b)(1)(a)N/A
St Anthony Community Hospital
15-19 Maple AvenueWarwickNY109901028141340100HealthcareNY501(c)(3)Line 3: 170(b)(1)(a)N/A
Bon Secours Warwick Health Foundation
20 Grand StreetWarwickNY109901028141972807Grant Making FoundationNY501(c)(3)Line 7:170(b)(1)(a)(N/A
Bon Secours Community Hospital Foundation
255 Lafayette AvenueSuffernNY109015620810667395Grant Making FoundationNY501(c)(3)Line 7:170(b)(1)(a)(N/A
Villa Francis at the Knolls (dba Schervier Pavilion)
20 Grand StreetWarwickNY109901028061381994Skilled Nursing FacilityNY501(c)(3)Line 3: 170(b)(1)(a)N/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1GSH Medical Care PCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1255 Lafayette AvenueAddressLine1
CitySuffernCity
StateNYState
ZIP Code109015620ZIPCode
FieldValueIRS element (for citing)
EIN223636986EIN
Primary ActivityPrimary CarePrimaryActivity
Legal Domicile StateNYLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.