2016-11-14T13:51:27-06:00 2015-12-31 420714325 RSM US LLP 1185 AVENUE OF THE AMERICAS NEW YORK NY 100362602 990 2015-01-01 112845058 KINGSBROOK HEALTHCARE FOUNDATION INC KING 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 JOHN SCHMITT CFO 7186045532 2016-11-14 1 LYNNE JOHNSON P00757336 2123721000 2015 2017-02-10 21:41:12Z LINDA BRADY MD 585 SCHENECTADY AVENUE BROOKLYN NY 11203 384246 0 X N/A X 1987 NY KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER AND RUTLAND NURSING HOME. 3 2 0 2 0 0 170235 270100 0 0 10128 9983 -1008 -113590 179355 166493 150000 364450 0 0 0 0 0 0 0 3112 3244 153112 367694 26243 -201201 1952667 1642593 0 0 1952667 1642593 KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER AND RUTLAND NURSING HOME. 0 0 364450 364450 KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER AND RUTLAND NURSING HOME. 364450 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 NY X JOHN SCHMITT 7186045532 585 SCHENECTADY AVENUE BROOKLYN NY 11203 HENNA WHITE BOARD CHAIR 0.50 8.00 X X 0 0 0 ROBERT REISS BOARD DIRECTOR 0.50 3.00 X 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 0.50 48.00 X X 0 910280 70756 JOHN SCHMITT ASSISTANT TREASURER & CFO 0.50 48.00 X 0 641576 70756 0 1551856 141512 0 0 1 0 0 219850 50250 270100 9983 9983 104163 219850 217753 -113590 -113590 166493 0 0 -103607 364450 364450 BANK FEES AND CHARGES 3244 3244 367694 364450 3244 0 1021914 580314 930753 915582 0 146697 1952667 1642593 0 0 X 1952667 1642593 1952667 1642593 1952667 1642593 -201201 -108873 0 X 0 1 X 1 0 X X 2 KINGSBROOK JEWISH MEDICAL CENTER 111631759 3 1 364450 0 RUTLAND NURSING HOME INC 112164674 9 1 0 0 2 364450 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE FROM KJMC 146697 146697 X PART X, LINE 2: THE COMPANY IS EXEMPT FROM INCOME TAXES UNDER SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ADDITIONALLY, THE COMPANY, AS A NONPROFIT ENTITY, IS SUBJECT TO UNRELATED BUSINESS INCOME TAX ("UBIT"), IF APPLICABLE. FOR THE TAX YEARS ENDED DECEMBER 31, 2015 AND 2014, THE COMPANY DID NOT OWE ANY UBIT. MANAGEMENT EVALUATED THE COMPANY'S TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT THE COMPANY HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ACCOUNTING STANDARDS CODIFICATION ("ASC") 740, ACCOUNTING FOR INCOME TAXES. GENERALLY, THE COMPANY IS SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS ENDED DECEMBER 31, 2012 AND THEREAFTER. PER THE REQUIREMENT TO ASSESS FOR TAX UNCERTAINTY, MANAGEMENT HAS DETERMINED THAT IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS REQUIRED TO BE REPORTED. DINNER 236218 158150 78068 68797 19425 8400 55772 GOLF EVENT 87795 61700 26095 6000 50042 2500 6817 324013 219850 104163 6000 118839 21925 8400 62589 217753 -113590 0 KINGSBROOK JEWISH MEDICAL CENTER 585 SCHENECTADY AVENUE BROOKLYN NY 11203 111631759 501(C)(3) 364450 TO SUPPORT CAPITAL PROJECTS 1 0 0 0 0 0 0 0 0 0 LINDA BRADY MD PRESIDENT & BOARD DIRECTOR 0 821648 0 0 0 88632 0 24700 0 46056 0 981036 0 0 JOHN SCHMITT ASSISTANT TREASURER & CFO 0 357790 0 260023 0 23763 0 24700 0 46056 0 712332 0 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE ORGANIZATION: KINGSBROOK HEALTHCARE SYSTEM, INC. ("KHS") IS THE SOLE MEMBER OF KINGSBROOK HEALTHCARE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF THE GOVERNING BODY: MEMBERS MAY ELECT AND APPOINT MEMBERS OF THE GOVERNING BODY AND BOARD OFFICERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY: KHS IS THE SOLE MEMBER OF KINGSBROOK HEALTHCARE FOUNDATION, INC. AND IT HAS RESERVED POWERS THAT ARE DELINEATED IN THE BYLAWS OF KINGSBROOK HEALTHCARE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 8B KINGSBROOK HEALTHCARE FOUNDATION, INC. HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 REVIEW PROCESS: THE CFO HAS CONDUCTED A DETAILED REVIEW OF THE 990 WITH THE HOSPITAL'S TAX ACCOUNTANT AND ALL APPROPRIATE CHANGES HAVE BEEN MADE. THE 990 WAS THEN REVIEWED WITH THE CEO FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS. THE 990 WAS THEN REVIEWED WITH THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE AND THEN PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW FOR ANY ADDITIONAL COMMENTARY, OBSERVATIONS, OR RECOMMENDATIONS ONCE COMPLETED AND FILED, FORM 990 IS MADE AVAILABLE TO THE FULL BOARD BY THE CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12 CONFLICT OF INTEREST POLICY: KINGSBROOK HEALTHCARE FOUNDATION, INC. FOLLOWS KINGSBROOK JEWISH MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. AT KINGSBROOK JEWISH MEDICAL CENTER, ALL CONFLICTS OF INTEREST ARE REVIEWED BY THE COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS INVOLVING BOARD MEMBERS ARE REFERRED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND/OR ACTION, AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW AND APPROVAL PROCESS: KINGSBROOK HEALTHCARE FOUNDATION, INC. DID NOT PAY COMPENSATION DIRECTLY FOR ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE PAID THROUGH KINGSBROOK JEWISH MEDICAL CENTER'S PAYROLL SYSTEM AND ARE RECORDED ON THE FORM 941 FILED BY KINGSBROOK JEWISH MEDICAL CENTER UNDER THE EMPLOYER INDETIFICATION NUMBER 11-1631759. THE COMPENSATION OF THE EXECUTIVE OFFICERS IS REVIEWED ANNUALLY BY KINGSBROOK JEWISH MEDICAL CENTER (KJMC). FOLLOWING BELOW PROCESS: CONSISTENT WITH BEST PRACTICES IN GOVERNANCE AND FIDUCIARY OVERSIGHT OF TAX-EXEMPT FUNDS, KINGSBROOK JEWISH MEDICAL CENTER (KJMC) HAS INSTITUTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. THE COMPENSATION COMMITTEE IS AUTHORIZED BY THE BOARD TO DEVELOP AND RECOMMEND FOR BOARD APPROVAL THE COMPENSATION OF THE PRESIDENT AND CEO AND MEMBERS OF SENIOR MANAGEMENT (SENIOR VICE PRESIDENTS, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS). ONLY INDEPENDENT MEMBERS OF THE BOARD SHALL PARTICIPATE IN COMPENSATION DELIBERATIONS AND DECISIONS (I.E., EMPLOYEES, MEMBERS OF THE MEDICAL STAFF AND CONSULTANTS ARE NOT DEEMED INDEPENDENT FOR THESE PURPOSES). ALL EXECUTIVE COMPENSATION DECISIONS ARE BASED ON COMPETITIVE MARKET DATA, ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE RESULTS, AND ALIGNMENT WITH KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY. THE BOARD'S COMPENSATION COMMITTEE REVIEWS AND APPROVES ALL EXECUTIVE COMPENSATION TO ENDURE LEGAL AND REGULATORY COMPLIANCE AND ADHERENCE TO GOVERNANCE BEST PRACTICES AND PROPER FIDUCIARY OVERSIGHT AS STEWARDS OF TAX EXEMPT ASSETS. THE EXECUTIVE COMPENSATION PHILOSOPHY STATES ITS INTENT IS TO MAINTAIN A COMPETITIVE EXECUTIVE COMPENSATION PROGRAM IN ORDER TO ATTRACT, RETAIN AND MOTIVATE QUALIFIED EMPLOYEES TO SUPPORT THE MISSION AND BUSINESS GOALS OF KJMC. THE COMPENSATION COMMITTEE RETAINS OUTSIDE LEGAL COUNSEL WHO REVIEWS COMPLIANCE WITH TAX AND REGULATORY REQUIREMENTS AS WELL AS THE SERVICES OF AN INDEPENDENT QUALIFIED COMPENSATION CONSULTANT WHO COMPILES AND ANALYZES PUBLISHED SURVEY-DATA FOR BASE SALARIES AND TOTAL COMPENSATION PROVIDED BY TAX EXEMPT HOSPITALS AND MEDICAL CENTERS SIMILAR TO KJMC IN SIZE, OPERATIONS AND LOCATION. THE COMMITTEE'S REVIEW OF COMPENSATION OCCURS ANNUALLY SUCH THAT EXECUTIVE COMPENSATION AND BENEFITS CONTINUE TO BE COMPETITIVE AND REASONABLE BY FOLLOWING THE PRECEDING GOVERNANCE AND FIDUCIARY PRACTICES, THE COMMITTEE QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS REGULATIONS OF THE INTERNAL REVENUE CODE SUCH THAT THE TOTAL COMPENSATION PROVIDED TO THE EXECUTIVES IS COMPARED TO WHAT IS ORDINARILY PAID FOR LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES," AS DEFINED IN THE INTERMEDIATE SANCTIONS REGULATIONS. BASE PAY FOR EACH EXECUTIVE IS BASED ON FACTORS INCLUDING MARKET DATA, TENURE, EXPERIENCE, AND INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. EXECUTIVE BASE PAY IS REVIEWED AND SET ANNUALLY BY THE INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE OF THE INDEPENDENT DIRECTORS OF KINGSBROOK JEWISH MEDICAL CENTER (KJMC), BASED ON THE EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER. AS DESCRIBED IN KJMC'S EXECUTIVE COMPENSATION PHILOSOPHY AND COMPENSATION COMMITTEE CHARTER, KJMC SUPPORTS PERFORMANCE BASED COMPENSATION AND THEREFORE HAS IMPLEMENTED AN ANNUAL INCENTIVE PAY PROGRAM (EXECUTIVE MANAGEMENT ANNUAL INCENTIVE PLAN) FOR THE EXECUTIVES, WHICH IS CURRENTLY SUSPENDED, AND A LONG-TERM INCENTIVE PAY PROGRAM (ANNUALIZED STRATEGIC PERFORMANCE INCENTIVE) FOR THE PRESIDENT AND CEO. THE ANNUAL AND LONG-TERM INCENTIVE PAY PROGRAMS ARE DESIGNED TO SUPPORT THE ATTAINMENT OF ANNUAL AND STRATEGIC PERFORMANCE OBJECTIVES AND REFLECT A COMBINATION OF FORMULAIC WEIGHTINGS PROVIDING FOR THRESHOLD, TARGET AND MAXIMUM BONUS LEVELS AND DISCRETIONARY JUDGMENT AS DETERMINED BY THE COMPENSATION COMMITTEE. THE PERFORMANCE MEASURES ARE SET PRIOR TO THE BEGINNING OF EACH PLAN YEAR AND PLAN PAYMENTS ARE DETERMINED BASED ON AUDITED FINANCIAL RESULTS AND OTHER MEASURES. THE PROCESS USED FOR DETERMINING THE COMPENSATION OF THE CEO ALSO APPLIES TO MEMBERS OF THE EXECUTIVE STAFF, DEPARTMENT CHAIRS AND OTHER HIGHLY COMPENSATED STAFF EXCEPT THAT THE PRESIDENT AND CEO MAKES COMPENSATION RECOMMENDATIONS TO THE COMPENSATION SUBCOMMITTEE FOR THOSE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE FOR PUBLIC INSPECTION: THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART VI, LINE 13 WHISTLEBLOWER POLICY: KINGSBROOK JEWISH MEDICAL CENTER HAS A WRITTEN WHISTLEBLOWER POLICY WHICH APPLIES TO THE ACTIVITIES OF KINGSBROOK HEALTHCARE FOUNDATION, INC. FORM 990, PART VI, LINE 14 DOCUMENT RETENTION POLICY: KINGSBROOK JEWISH MEDICAL CENTER'S DOCUMENT RETENTION AND DESTRUCTION POLICY APPLIES TO ALL BOOKS AND RECORDS HELD BY KINGSBROOK HEALTHCARE FOUNDATION, INC. KINGSBROOK JEWISH MEDICAL CENTER (KJMC) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 111631759 HOSPITAL NY 501(C)(3) LINE 3 KHS 0 KINGSBROOK JEWISH MEDICAL CENTER AUXILIARIES 585 SCHENECTADY AVENUE BROOKLYN NY 11203 113016121 SUPPORT ORG NY 501(C)(3) LINE 11A, I KJMC 0 KINGSBROOK HEALTHCARE SYSTEM INC (KHS) 585 SCHENECTADY AVENUE BROOKLYN NY 11203 030464734 SUPPORT ORG NY 501(C)(3) LINE 11A, I N/A 0 RUTLAND NURSING HOME INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 112164674 NURSING HOME NY 501(C)(3) LINE 9 KHS 0 KSI INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327654 INACTIVE NY KHCF INC C 0 SINGULAB INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327669 INACTIVE DE KSI INC C 0 ATM NURSE REGISTRY 585 SCHENECTADY AVENUE BROOKLYN NY 11203 562327649 INACTIVE NY KSI INC 0 KINGSBROOK LTACH INC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 800712226 INACTIVE NY KHCF INC C 0 KINGSBROOK MEDICAL ASSOCIATES PC 585 SCHENECTADY AVENUE BROOKLYN NY 11203 452351859 BILLING & COLLECTION NY N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0