KINGSBROOK HEALTHCARE FOUNDATION INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- KINGSBROOK HEALTHCARE FOUNDATION INC (EIN 11-2845058)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201323189349302117
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T09:50:15-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1185 AVENUE OF THE AMERICAS | AddressLine1 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 100362602 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 112845058 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGSBROOK HEALTHCARE FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KING | NameControl |
| Phone | 7186045532 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 585 SCHENECTADY AVENUE | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11203 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN SCHMITT | Name |
| Title | CFO | Title |
| Phone | 7186045532 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEVEN LAPSKER | Name |
| PTIN | P00850484 | PTIN |
| Phone | 2123721000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LINDA BRADY MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 585 SCHENECTADY AVENUE | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16949 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 3 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 2 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 16271 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 6397 | InvestmentIncomePriorYear |
| Investment Income Current Year | 678 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6397 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16949 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 0 | OtherExpensePriorYear |
| Other Expenses Current Year | 0 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 0 | TotalExpensesPriorYear |
| Total Expenses Current Year | 0 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6397 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 16949 | RevenuesLessExpensesCY |
| Total Assets BOY | 1336117 | TotalAssetsBOY |
| Total Assets EOY | 1508368 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1336117 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1508368 | NetAssetsOrFundBalancesEOY |
| Mission Description | KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | KINGSBROOK HEALTHCARE FOUNDATION, INC. FUNCTIONS AS THE CHARITABLE AND EDUCATIONAL ARM OF THE KINGSBROOK JEWISH MEDICAL CENTER. | Description |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 3 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | 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 | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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 | JOHN SCHMITT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7186045532 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 585 SCHENECTADY AVENUE | AddressLine1 |
| City | BROOKLYN | City |
| State | NY | State |
| ZIP Code | 11203 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (5 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| HENNA WHITE | |||||||
| CHAIRMAN | 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 | 1264636 | 60530 |
| JOHN SCHMITT | |||||||
| ASSISTANT SECRETARY | 0.50 | 46.50 | X | 0 | 636105 | 145505 | |
| MICHAEL MCDERMOTT | |||||||
| GENERAL COUNSEL | 0.50 | 48.00 | X | 0 | 239487 | 60179 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2140228 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 266214 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 16271 | AllOtherContributions |
| Total Contributions | 16271 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 678 | TotalRevenueColumn |
| Exclusion | $678 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16949 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $678 | ExclusionAmount |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 748697 | BOY |
| EOY | 778771 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 587420 | BOY |
| EOY | 729597 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1336117 | BOY |
| EOY | 1508368 | 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 | 1336117 | BOY |
| EOY | 1508368 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1336117 | BOY |
| EOY | 1508368 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1336117 | BOY |
| EOY | 1508368 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 16949 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 155302 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGSBROOK JEWISH MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 111631759 | EIN |
| Type Of Organization | 501(C)(3) | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 0 | SupportedOrganizationNotified |
| Organized In US | 0 | OrganizedInUS |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 (3 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LINDA BRADY MD | ||||||||||||||
| PRESIDENT & BOARD DIRECTOR | 0 | 767675 | 0 | 404151 | 0 | 92810 | 0 | 23750 | 0 | 36780 | 0 | 1325166 | 0 | 0 |
| JOHN SCHMITT | ||||||||||||||
| ASSISTANT SECRETARY | 0 | 318119 | 0 | 294943 | 0 | 23043 | 0 | 108725 | 0 | 36780 | 0 | 781610 | 0 | 0 |
| MICHAEL MCDERMOTT | ||||||||||||||
| GENERAL COUNSEL | 0 | 237800 | 0 | 0 | 0 | 1687 | 0 | 23659 | 0 | 36520 | 0 | 299666 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART II, COLUMN (C) RETIREMENT AND OTHER DEFERRED COMPENSATION: THE DEFERRED COMPENSATION REPORTED FOR KINGSBROOK JEWISH MEDICAL CENTER EMPLOYEE JOHN SCHMITT INCLUDES ACCRUALS FOR THE TRANSITION STABILIZATION PLAN WHICH WAS IMPLEMENTED IN 2012. THE VALUE OF THE PLAN IS SUBJECT TO RISK OF FORFEITURE (PURSUANT TO IRS REGULATIONS) UNTIL THE EMPLOYEE MEETS SPECIFIC AND DOCUMENTED FUTURE SERVICE REQUIREMENTS. THE PLAN WAS REVIEWED DISCUSSED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE JOINT BOARD OF TRUSTEES/DIRECTORS TO ENHANCE THE RETENTION OF KEY EXECUTIVES AND TO MAINTAIN LEADERSHIP STABILITY AS KINGSBROOK JEWISH MEDICAL CENTER PURSUES OPPORTUNITIES FOR SUSTAINED VIABILITY. THE PLAN IS CONSISTENT WITH TYPICAL MARKET PRACTICES AND REASONABLE IN THE CONTEXT OF THE EMPLOYEE'S TOTAL REMUNERATION, BASED ON ADVICE PROVIDED BY INDEPENDENT EXECUTIVE COMPENSATION CONSULTANTS. THE AGREEMENT EXPIRES 12/31/2014 AND WILL PAID OUT IN JANUARY 2015. THE PAYMENT WILL BE REPORTED AS COMPENSATION IN 2015 AND WILL BE SUBJECT TO ALL APPLICABLE WITHHOLDING AND EMPLOYMENT TAXES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. | |
| 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 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 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 UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS. | |
| FORM 990, PART VI, LINE 13 | KINGSBROOK JEWISH MEDICAL CENTER HAS A WRITTEN WHISTLEBLOWER POLICY WHICH APPLIES TO THE ACTIVITIES OF KINGSBROOK HEALTHCARE FOUNDATION, INC. | WHISTLEBLOWER POLICY |
| FORM 990, PART VI, LINE 14 | KINGSBROOK JEWISH MEDICAL CENTER'S DOCUMENT RETENTION AND DESTRUCTION POLICY APPLIES TO ALL BOOKS AND RECORDS HELD BY KINGSBROOK HEALTHCARE FOUNDATION, INC. | DOCUMENT RETENTION POLICY |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| KINGSBROOK JEWISH MEDICAL CENTER (KJMC) | |||||||||||
| 585 SCHENECTADY AVENUE | BROOKLYN | NY | 11203 | 111631759 | HOSPITAL | NY | 501(C)(3) | LINE 3 | KHCF INC | 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 (KHCF) | |||||||||||
| 585 SCHENECTADY AVENUE | BROOKLYN | NY | 11203 | 030464734 | SUPPORT ORG | NY | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| RUTLAND NURSING HOME INC | |||||||||||
| 585 SCHENECTADY AVENUE | BROOKLYN | NY | 11203 | 112164674 | NURSING HOME | NY | 501(C)(3) | LINE 9 | KHCF INC | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | C | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |