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  5. BON SECOURS CHARITY HEALTH SYSTEM, INC.

BON SECOURS CHARITY HEALTH SYSTEM, INC.

Company Details

Name: BON SECOURS CHARITY HEALTH SYSTEM, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 05 Apr 1989 (36 years ago)
Entity Number: 1341439
ZIP code: 10901
County: Rockland
Place of Formation: New York
Address: CHIEF EXECUTIVE OFFICER, 255 LAFAYETTE AVE, SUFFERN, NY, United States, 10901

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHARITY HEALTH & WELFARE BENEFIT PLAN 2023 912135195 2024-07-26 BON SECOURS CHARITY HEALTH SYSTEM, INC. 1173
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-09-01
Business code 622000
Sponsor’s telephone number 8453685305
Plan sponsor’s mailing address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812
Plan sponsor’s address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812

Number of participants as of the end of the plan year
Active participants 1149
Retired or separated participants receiving benefits 27

Signature of
Role Plan administrator
Date 2024-07-26
Name of individual signing JENNIFER SLADE
Valid signature Filed with authorized/valid electronic signature
CHARITY HEALTH & WELFARE BENEFIT PLAN 2022 912135195 2023-07-26 BON SECOURS CHARITY HEALTH SYSTEM, INC. 1449
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-09-01
Business code 622000
Sponsor’s telephone number 8453685305
Plan sponsor’s mailing address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812
Plan sponsor’s address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812

Number of participants as of the end of the plan year
Active participants 1146
Retired or separated participants receiving benefits 27

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing JENNIFER SLADE
Valid signature Filed with authorized/valid electronic signature
CHARITY HEALTH & WELFARE BENEFIT PLAN 2021 912135195 2022-07-28 BON SECOURS CHARITY HEALTH SYSTEM, INC. 1095
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-09-01
Business code 622000
Sponsor’s telephone number 8453685305
Plan sponsor’s mailing address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812
Plan sponsor’s address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812

Number of participants as of the end of the plan year
Active participants 871
Retired or separated participants receiving benefits 27

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing TRACY TILLERY
Valid signature Filed with authorized/valid electronic signature
CHARITY HEALTH & WELFARE BENEFIT PLAN 2020 912135195 2022-07-29 BON SECOURS CHARITY HEALTH SYSTEM, INC. 1109
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-09-01
Business code 622000
Sponsor’s telephone number 8453685305
Plan sponsor’s mailing address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812
Plan sponsor’s address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812

Number of participants as of the end of the plan year
Active participants 1068
Retired or separated participants receiving benefits 27

Signature of
Role Plan administrator
Date 2022-07-29
Name of individual signing TRACY TILLERY
Valid signature Filed with authorized/valid electronic signature
CHARITY HEALTH & WELFARE BENEFIT PLAN 2019 912135195 2021-03-30 BON SECOURS CHARITY HEALTH SYSTEM, INC. 1139
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-09-01
Business code 622000
Sponsor’s telephone number 8453685305
Plan sponsor’s mailing address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812
Plan sponsor’s address 255 LAFAYETTE AVE, SUFFERN, NY, 109014812

Number of participants as of the end of the plan year
Active participants 1077
Retired or separated participants receiving benefits 32
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2021-03-30
Name of individual signing TRACY TILLERY
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent CHIEF EXECUTIVE OFFICER, 255 LAFAYETTE AVE, SUFFERN, NY, United States, 10901

History

Start date End date Type Value
2007-08-21 2015-05-19 Address ATTN: PRESIDENT, 255 LAFAYETTE AVENUE, SUFFERN, NY, 10901, USA (Type of address: Service of Process)
1999-12-31 2007-08-21 Address ATTN: PRESIDENT, 255 LAFAYETTE AVENUE, SUFFERN, NY, 10901, USA (Type of address: Service of Process)
1996-11-27 1999-12-31 Name TRI-STATE HEALTH SYSTEM, INC.
1996-11-27 1999-12-31 Address ATTN: SECRETARY, 708 THIRD AVENUE, SUITE 200, NEW YORK, NY, 10017, 4130, USA (Type of address: Service of Process)
1995-05-11 1996-11-27 Name FRANCISCAN HEALTH SYSTEM TRI-STATE REGION, INC.
1989-04-05 1996-11-27 Address POOR HEALTH SYSTEM, INC., 186 JORALEMON STREET, BROOKLYN, NY, 11201, USA (Type of address: Service of Process)
1989-04-05 1995-05-11 Name FRANCISCAN SYSTEM OF WARWICK, INC.

Filings

Filing Number Date Filed Type Effective Date
151026000474 2015-10-26 CERTIFICATE OF AMENDMENT 2015-10-26
150519000396 2015-05-19 CERTIFICATE OF AMENDMENT 2015-05-19
070821000220 2007-08-21 CERTIFICATE OF AMENDMENT 2007-08-21
991231000037 1999-12-31 CERTIFICATE OF AMENDMENT 1999-12-31
961127000200 1996-11-27 CERTIFICATE OF AMENDMENT 1996-11-27
950511000644 1995-05-11 CERTIFICATE OF AMENDMENT 1995-05-11
B762541-11 1989-04-05 CERTIFICATE OF INCORPORATION 1989-04-05

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
91-2135195 Association Unconditional Exemption 255 LAFAYETTE AVE, SUFFERN, NY, 10901-4812 2011-04
In Care of Name % MAUREEN BURKE
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Central - This code is used if the organization is a parent (group ruling) and is not a church or 501(c)(1) organization.
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period 2023-12
Asset 50,000,000 to greater
Income 25,000 to 99,999
Filing Requirement 990 - Required to file Form 990-N - Income less than $50,000 per year
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 94158586
Income Amount 45877
Form 990 Revenue Amount 45877
National Taxonomy of Exempt Entities Health Care: Community Health Systems
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: Generally, a central organization holding a group exemption letter, whose subordinate units covered by the group exemption are also eligible to receive tax-deductible contributions, even though they are not separately listed. Deductibility Limitation: Depends on various factors

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202212
Filing Type E
Return Type 990T
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202112
Filing Type E
Return Type 990T
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202012
Filing Type E
Return Type 990T
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name BON SECOURS CHARITY HEALTH SYSTEM INC
EIN 91-2135195
Tax Period 201512
Filing Type E
Return Type 990
File View File
06-1370576 Association Unconditional Exemption 20 GRAND ST, WARWICK, NY, 10990-1035 2013-11
In Care of Name % FINANCE DEPT
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Subordinate - This code is used if the organization is a subordinate in a group ruling.
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period 1998-12
Asset 5,000,000 to 9,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 21915375
Income Amount 9542748
Form 990 Revenue Amount 0
National Taxonomy of Exempt Entities Health Care: Nursing, Convalescent Facilities
Sort Name ST FRANCIS CENTER AT THE KNOLLS INC
22-3636986 Association Unconditional Exemption 20 GRAND ST, WARWICK, NY, 10990-1035 2011-04
In Care of Name % FINANCE DEPT
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Subordinate - This code is used if the organization is a subordinate in a group ruling.
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are not deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period -
Asset 1,000,000 to 4,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
National Taxonomy of Exempt Entities Health Care: Health Treatment Facilities, Primarily Outpatient
Sort Name MEDICAL GROUP P C

Determination Letter
Final Letter(s) FinalLetter_22-3636986_BONSECOURSCHARITYHEALTHSYSTEMMEDICALGROUPPC_06252010_01.tif
FinalLetter_22-3636986_BONSECOURSCHARITYHEALTHSYSTEMMEDICALGROUPPC_06252010_02.tif
14-1347717 Association Unconditional Exemption 160 E MAIN ST, PORT JERVIS, NY, 12771-2114 2013-11
In Care of Name % FINANCE DEPT
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Subordinate - This code is used if the organization is a subordinate in a group ruling.
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period 2014-12
Asset 10,000,000 to 49,999,999
Income 50,000,000 to greater
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
National Taxonomy of Exempt Entities Health Care: Hospital, General
Sort Name BON SECOURS COMMUNITY HOSPITAL
13-1740104 Association Unconditional Exemption 255 LAFAYETTE AVE, SUFFERN, NY, 10901-4812 2013-11
In Care of Name % FINANCE DEPT
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Subordinate - This code is used if the organization is a subordinate in a group ruling.
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period 2014-12
Asset 50,000,000 to greater
Income 50,000,000 to greater
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
National Taxonomy of Exempt Entities Health Care: Community Health Systems
Sort Name GOOD SAMARITAN HOSPITAL OF SUFFERN
14-1340100 Association Unconditional Exemption 15 MAPLE AVE, WARWICK, NY, 10990-1028 2011-04
In Care of Name % FINANCE DEPT
Group Exemption Number 5747
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Subordinate - This code is used if the organization is a subordinate in a group ruling.
Classification Educational Organization, Local Association of Employees, Horticultural Organization, Business League, Voluntary Employees' Beneficiary Association (Govt. Emps.), Mutual Ditch or Irrigation Co., Cemetery Company, Other Mutual Corp. or Assoc.
Deductibility Contributions are deductible.
Foundation Church 170(b)(1)(A)(i)
Tax Period -
Asset 10,000,000 to 49,999,999
Income 50,000,000 to greater
Filing Requirement 990 - Not required to file (church)
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
National Taxonomy of Exempt Entities Health Care: Community Health Systems
Sort Name ST ANTHONY COMMUNITY HOSPITAL

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Date of last update: 16 Mar 2025

Sources: New York Secretary of State

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