Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 675,950 | 557,656 | 1,344,812 | 2,970,177 | 2,674,131 | 8,222,726 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 675,950 | 557,656 | 1,344,812 | 2,970,177 | 2,674,131 | 8,222,726 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | 4,821,937 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 3,400,789 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 675,950 | 557,656 | 1,344,812 | 2,970,177 | 2,674,131 | 8,222,726 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 545 | 369 | 83 | 72 | 11,912 | 12,981 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Total support. Add lines 7 through 10 | 8,235,707 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part V, Line 1a | ALL VENDORS AND EMPLOYEES OF THE FOUNDATION ARE PAID BY ST. LUKE'S CORNWALL HOSPITAL, EIN 14-1340054, THE COMMON PAYMASTER. ST. LUKE'S CORNWALL HOSPITAL ISSUES ALL FORMS 990S AND W-2S AND FILES ALL FEDERAL EMPLOYMENT TAX RETURNS RELATING TO THESE INDIVIDUALS. SALARIES ARE ALLOCATED TO THE FOUNDATION BASED ON THE INDIVIDUALS EMPLOYED AT THIS ORGANIZATION. |
| Form 990, Part VI, Line 15 | THE ORGANIZATION IS AN AFFILIATE WITHIN MONTEFIORE HEALTH SYSTEM, INC., A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"), WHICH INCLUDES ST. LUKE'S CORNWALL HOSPITAL ("HOSPITAL"). THE CEO AND TREASURER OF THE FOUNDATION ARE EMPLOYED AND COMPENSATED BY THE HOSPITAL. AS IT RELATES TO COMPENSATION FROM THE HOSPITAL: THE ST. LUKE'S CORNWALL HOSPITAL BOARD OF TRUSTEES HAS CHARGED THE COMPENSATION COMMITTEE OF THE BOARD (WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS WITH NO CONFLICTS OF INTEREST IN REGARDS TO EXECUTIVE COMPENSATION) WITH MAKING ALL DECISIONS RELATED TO COMPENSATION FOR THE PRESIDENT/CEO AND CFO OF THE HOSPITAL THAT ARE BOTH BOARD MEMBERS AND OFFICERS OF THE FOUNDATION. ALL DECISIONS MADE BY THE COMPENSATION COMMITTEE ARE APPROPRIATELY AND TIMELY DOCUMENTED IN MEETING MINUTES. THE COMPENSATION COMMITTEE'S REVIEW PROCESS FOLLOWS THE INTERMEDIATE SANCTIONS GUIDELINES FOR QUALIFYING FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THE COMMITTEE RETAINS AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IT WITH THIS PROCESS. COMPENSATION LEVELS ARE ESTABLISHED CONSIDERING DATA FOR COMPARABLE ORGANIZATIONS, AN ASSESSMENT OF MANAGEMENT PERFORMANCE (INCLUDING THE SERVICES PROVIDED TO THE COMMUNITY), AND OTHER BUSINESS JUDGMENT FACTORS, CONSISTENT WITH ST. LUKE'S EXECUTIVE COMPENSATION PHILOSOPHY. THE COMMITTEE'S DECISIONS ARE MADE IN THE BEST INTEREST OF ST LUKE'S, AND ARE INTENDED TO ENSURE THE RECRUITMENT AND RETENTION OF KEY EXECUTIVE TALENT, CONSISTENT WITH THE MARKET PRACTICES OF OTHER NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS OF COMPARABLE SCOPE, MISSION AND COMPLEXITY. ON AN ANNUAL BASIS, THE COMMITTEE PROVIDES THE FULL BOARD OF TRUSTEES WITH A DESCRIPTION OF THE COMMITTEE'S REVIEW AND APPROVAL PROCESS AND ITS DECISIONS. ALL DECISIONS MADE BY THE COMPENSATION COMMITTEE ARE APPROPRIATELY AND TIMELY DOCUMENTED IN MEETING MINUTES. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | THE ORGANIZATION SOLE MEMBER WAS CHANGED FROM ST. LUKE'S CORNWALL HEALTH SYSTEM, INC. TO ST. LUKE'S CORNWALL HOSPITAL EFFECTIVE 1/1/2022. ORGANIZATION ADOPTED NEW BYLAWS EFFECTIVE 1/1/2023. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | ST. LUKE'S CORNWALL HOSPITAL IS THE SOLE MEMBER OF THE ORGANIZATION. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | ST. LUKE'S CORNWALL HOSPITAL, THE SOLE MEMBER OF THE ORGANIZATION, HAS THE AUTHORITY TO APPOINT AND REMOVE THE GOVERNING BOARD OF THE FOUNDATION. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | ST. LUKE'S CORNWALL HOSPITAL, THE SOLE MEMBER OF THE ORGANIZATION, HAS THE POWERS GRANTED BY LAW TO THE MEMBER IN THEIR CAPACITY AS THE CORPORATE MEMBER INCLUDING THE POWER TO APPOINT AND REMOVE THE GOVERNING BOARD OF THE FOUNDATION, AUTHORIZE AND APPROVE AMENDMENTS TO THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE FOUNDATION, AUTHORIZE AND APPROVE ANY SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL THE ASSETS OF THE FOUNDATION AND AUTHORIZE AND APPROVE ANY MERGER, CONSOLIDATION OR NON-JUDICIAL DISSOLUTION OF THE FOUNDATION. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FORM 990 WAS PREPARED BY THE MONTEFIORE'S TAX DEPARTMENT WORKING CLOSELY WITH ST. LUKE'S FINANCE TEAM AND ASSISTED BY VARIOUS DEPARTMENTS THROUGHOUT THE HEALTH SYSTEM. THE FORM 990 WAS REVIEWED AND APPROVED BY THE VICE-PRESIDENT-FINANCE AND THE ST. LUKE'S SENIOR LEADERSHIP INCLUDING THE CHIEF FINANCIAL OFFICER. IN ADDITION, AN INDEPENDENT ACCOUNTING FIRM WAS ENGAGED TO REVIEW THE FORM 990. UPON COMPLETION OF THE VARIOUS REVIEWS, THE FORM 990 WAS PRESENTED TO THE FOUNDATION'S BOARD OF TRUSTEES FOR REVIEW AND APPROVAL PRIOR TO FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE ORGANIZATION AND THE SYSTEM REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF DIRECTORS IS REQUIRED TO BE DISCLOSED TO THE OTHER MEMBER OF THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD, EITHER THROUGH THE ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY MEMBER OF THE BOARD OF DIRECTORS HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER IS PROHIBITED FROM VOTING OR PERSONALLY INFLUENCES THE BOARD ON THE MATTER. THE FOUNDATION HAS ADOPTED THE CONFLICT OF INTEREST POLICY OF ST. LUKE'S CORNWALL HOSPITAL. ALL OFFICERS AND BOARD MEMBERS OF THE ORGANIZATION ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, IN THEIR CAPACITY AS AN OFFICER OF THE FOUNDATION OR AS A BOARD MEMBER OF THE FOUNDATION. COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE SECRETARY OF THE BOARD OF TRUSTEES AND CONCERNS PRESENTED BY THE RESPONSES ARE DISCLOSED TO THE HOSPITAL'S COMPLIANCE OFFICER. ANY POTENTIAL CONFLICTS ARE DISCLOSED AND REPORTED TO THE SYSTEM'S PRESIDENT/CEO AND THE HOSPITAL'S FINANCE COMMITTEE FOR DISCUSSION AND ALLEVIATION OF THE CONFLICT. DOCUMENTATION OF THE EXISTENCE AND RESOLUTION OF THE CONFLICT, INCLUDING ANY MEETING MINUTES, IS MAINTAINED BY THE SECRETARY OF THE BOARD. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| Form 990, Part XI, Line 9 | CONCERNING EMPLOYEE BENEFITS ALLOCATION: ST. LUKE'S CORNWALL HOSPITAL IS THE COMMON PAYMASTER FOR THE FOUNDATION. ALL PAYROLL TAXES AND EMPLOYEE BENEFITS ARE PAID BY ST. LUKE'S CORNWALL HOSPITAL AND ALLOCATED BACK TO THE ORGANIZATION BASED ON A COMPOSITE RATE OF SALARIES FOR ALL BENEFIT COSTS. THE ORGANIZATION'S ASSESSMENT FOR EMPLOYEE BENEFITS IS REFLECTED ON LINE 9, OTHER EMPLOYEES BENEFITS, OF PART IX THAT INCLUDES COST FOR BOTH PENSION AND PAYROLL TAXES. |
| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |