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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

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THE CORPORATION

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Related by address

No related companies by address

Date of last update: 14 Nov 2024

Sources: New York Secretary of State

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