TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) ELIOT CHODOSH MD CHAIRMAN - TRUSTEE	1.0	X	X	0	0
(2) AARON VAN DUYNE III VICE CHAIRMAN - TRUSTEE	1.0	X	X	0	0
(3) JAMES VINCI SECRETARY - TRUSTEE	1.0	X	X	0	0
(4) MICHAEL DEBERNARDI TREASURER - TRUSTEE	1.0	X	X	0	0
(5) MICHAEL DARA MD TRUSTEE	1.0	X		0	0
(6) HENRY DRIESSE TRUSTEE	1.0	X		0	0
(7) LAURA KELLY ESQ TRUSTEE	1.0	X		0	0
(8) JAMES KLEIN TRUSTEE	1.0	X		0	0
(9) MARIO ROSELLINI TRUSTEE	1.0	X		0	0
(10) RUTH E SPELLMAN TRUSTEE	1.0	X		0	0
(11) ROBIN WARE TRUSTEE	1.0	X		0	0
(12) BEVERLY WILEN TRUSTEE	1.0	X		0	0
(13) DEBORAH K ZASTOCKI FACHE TRUSTEE - PRESIDENT/CEO	55.0	X	X	636,278	42,296
(14) JOSEPH SCIAN MD TRUSTEE	1.0	X		40,200	0
(15) MICHAEL A RICHETTI VP / CFO	55.0		X	373,234	24,900
(16) THOMAS SCOTT VP / COO	55.0		X	377,510	27,200
(17) MARK LEDERMAN VP, CIO (EFFECTIVE 6/11)	55.0		X	111,298	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) RICHARD WEINBERG MD VP, MEDICAL AFFAIRS	55.0	X			404,114	0	18,049
(19) JULIA MCGOVERN VP, ADMINISTRATIVE SERVICES	55.0	X			256,884	0	17,927
(20) JOANNE REICH VP, NURSING / CNO	55.0	X			211,787	0	16,452
(21) YOLANDA C GEHRING VP,CLINICAL SVCS & EXT AFFAIRS	55.0	X			193,822	0	30,313
(22) DAWN JONES EVP, FOUNDATION	55.0	X			144,429	0	24,339
(23) DONNA KIRBY ED - ACCESS SVCS & WELLNESS	55.0		X		172,810	0	26,913
(24) KAREN STUTZER ED - CLINICAL SERVICES	55.0		X		150,669	0	29,951
(25) GAIL R ELIOT MD PHYSICIAN	55.0			X	355,755	0	21,773
(26) REENA C WAGNER MD PHYSICIAN	55.0			X	348,456	0	9,507
(27) LAURIE S NAHUM MD PHYSCIAN	55.0			X	283,540	0	33,354
(28) JOSHUA NOCHUMSON MD PHYSICIAN	55.0			X	250,436	0	7,999
(29) EDECK PIERRE MD PHYSICIAN	55.0			X	206,529	0	19,854

(A) Name and business address	(B) Description of services	(C) Compensation
OA PETERSON CONSTRUCTION CO INC PO BOX 106 MONTCLAIR,NJ07042	CONSTRUCTION	3,180,048
HOSPITAL BILLING AND COLLECTION 118 LUKENS DRIVE NEW CASTLE,DE19720	BILLING/COLLECTION	2,021,611
CORNERSTONE ADVISORS GROUP LLC PO BOX 569 GEORGETOWN,CT06829	IT CONSULTING	1,754,619
GE HEALTHCARE PO BOX 640944 PITTSBURGH,PA152640944	EQUIP MAINTENANCE	1,268,130
MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS,MN554809146	LABORATORY	804,718
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 68

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	15,126	15,126
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,331,374	2,998,238	333,136	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	71,948,606	64,753,745	7,194,861
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,373,462	4,836,116	537,346
9	Other employee benefits .......	6,741,333	6,067,200	674,133
10	Payroll taxes ...........	5,362,818	4,826,536	536,282
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	346,427	311,784	34,643
c	Accounting ...........	55,911	50,320	5,591
d	Lobbying ...........	59,859	53,873	5,986
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	45,398	40,858	4,540
g	Other ..........	3,075,529	2,767,976	307,553
12	Advertising and promotion ....	1,223,906	1,101,515	122,391
13	Office expenses .......	5,379,877	4,841,889	537,988
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	139,534	125,581	13,953
17	Travel ............	52,967	47,670	5,297
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	90,289	81,260	9,029
20	Interest ...........	2,138,442	1,924,598	213,844
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	8,638,829	7,774,946	863,883
23	Insurance ..............	1,987,172	1,788,455	198,717
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	MEDICAL SUPPLIES	23,232,106	20,908,895	2,323,211	0
b	CONTRACTED SERVICES	13,996,778	12,597,100	1,399,678	0
c	PROVISION FOR DOUBTFUL COLL.	7,382,912	6,644,621	738,291	0
d	UTILITIES	2,239,764	2,015,788	223,976	0
e
f	All other expenses	6,520,979	5,868,882	652,097
25	Total functional expenses. Add lines 1 through 24f	169,379,398	152,442,972	16,936,426	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	1,848	1	1,653
2	Savings and temporary cash investments .......	10,837,331	2	12,387,480
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	17,294,322	4	19,182,165
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	61,650	7	208,093
8	Inventories for sale or use ..............	3,024,904	8	2,993,999
9	Prepaid expenses and deferred charges ............	1,128,136	9	2,022,406
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	178,390,302
b	Less: accumulated depreciation. .....	10b	112,462,626	62,212,035	10c	65,927,676
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	56,092,205	13	59,677,786
14	Intangible assets .........	0	14	116,000
15	Other assets. See Part IV, line 11 ...........	2,210,353	15	4,272,606
16	Total assets. Add lines 1 through 15 (must equal line 34)...	152,862,784	16	166,789,864
	17	Accounts payable and accrued expenses .	17,676,976	17	21,894,021
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	38,510,136	20	44,390,892
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	32,754,718	25	57,687,365
26	Total liabilities. Add lines 17 through 25.....	88,941,830	26	123,972,278
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	58,710,637	27	35,572,630
28	Temporarily restricted net assets .....	3,089,684	28	5,124,323
29	Permanently restricted net assets .....	2,120,633	29	2,120,633
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	63,920,954	33	42,817,586
34	Total liabilities and net assets/fund balances .....	152,862,784	34	166,789,864

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
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)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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 in 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 IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization FORREST S CHILTON 3RD MEMORIAL HOSP
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization FORREST S CHILTON 3RD MEMORIAL HOSP
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

30,000

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

29,859

Total. Add lines 1c through 1i ...............................

59,859

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITY EXPLANATION	SCHEDULE C, PART II-B; LINES 1G AND 1H	DURING 2011, THE ORGANIZATION PAID AN OUTSIDE LOBBYING FIRM $30,000 TO PERFORM LOBBYING SERVICES ON A FEDERAL AND STATE LEVEL RELATED TO MEDICARE, MEDICAID AND OTHER HEALTHCARE LEGISLATIVE MATTERS. THE ORGANIZATION EMPLOYS A VICE PRESIDENT OF CLINICAL SERVICES & EXTERNAL AFFAIRS OF WHICH APPROXIMATELY 5% OF HER TIME AND GROSS COMPENSATION IS ALLOCATED TO LOBBYING EFFORTS ON BEHALF OF THE ORGANIZATION ON A FEDERAL AND STATE LEVEL ON MATTERS RELATED TO MEDICARE AND MEDICAID LEGISLATION AND OTHER HEALTHCARE LEGISLATIVE MATTERS. THIS ALLOCATION AMOUNTED TO $11,207 IN 2011. IN ADDITION, THE ORGANIZATION IS A MEMBER OF THE NEW JERSEY HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WHICH BOTH ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TOWARDS LOBBYING EFFORTS PERFORMED ON BEHALF OF THIS ORGANIZATION. THIS ALLOCATION AMOUNTED TO $18,652 IN 2011.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	2,123,633	2,123,633	2,123,300	104,300
b	Contributions ........			333	2,016,000
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	2,123,633	2,123,633	2,123,633	2,120,300

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	725,785		725,785
b	Buildings ................	64,457,179	33,005,899	31,451,280
c	Leasehold improvements ............	2,701,591	1,480,671	1,220,920
d	Equipment ................	74,041,547	52,404,590	21,636,957
e	Other .................	36,464,200	25,571,466	10,892,734
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				65,927,676

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) LIMITED USE	8,994,413	F
(2) LIMITED USE	0	F
(3) LIMITED USE	0	F
(4) LIMITED USE	0	F
(5) HEDGE FUNDS; LIMITED USE	1,856,102	F
(6) LIMITED USE	21,411,625	F
(7) MUTUAL FUNDS; LIMITED USE	20,419,704	F
(8) EXEMPT ORGANIZATION	6,995,942	F

Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	59,677,786

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
SETTLEMENTS		4,421,603
ACCRUED PENSION COST		47,222,426
MALPRACTICE LIABILITY		4,487,683
ACCRUED INTEREST PAYABLE		1,069,411
OTHER LIABILITIES		486,242




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		57,687,365
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ENDOWMENT FUNDS	SCHEDULE D, PART V; QUESTION 4	THE HOSPITAL'S ENDOWMENT FUNDS CONSIST OF FUNDS ESTABLISHED TO SUPPORT VARIOUS OPERATIONS OF THE HOSPITAL. THE ENDOWMENTS INCLUDE ONLY DONOR-RESTRICTED ENDOWMENT FUNDS. AS REQUIRED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS ARE CLASSIFIED AND REPORTED BASED UPON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. THE ENDOWMENT FUNDS ARE INVESTED CONSISTENT WITH AN INVESTMENT POLICY STATEMENT THAT IS MONITORED BY THE HOSPITAL'S BOARD OF DIRECTORS. THE INVESTMENT POLICY EMPLOYED IS MEANT TO ACHIEVE LONG-TERM GROWTH WHILE PROVIDING MODEST INVESTMENT INCOME WHICH WOULD BE AVAILABLE FOR CURRENT FUNDING. FUNDS ARE PRIMARILY INVESTED IN CASH AND CASH EQUIVALENTS, FIXED INCOME SECURITIES, MUTUAL FUNDS AND EQUITIES.
TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE	SCHEDULE D, PART X	AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC. AND ITS CONTROLLED AFFILIATE, CHILTON MEMORIAL HOSPITAL FOUNDATION, INC., FOR THE YEARS ENDED DECEMBER 31, 2011 AND DECEMBER 31, 2010; RESPECTIVELY. THE FOLLOWING IS THE TEXT OF THE FOOTNOTE INCLUDED IN THE ORGANIZATION'S YEAR ENDED DECEMBER 31, 2011 AUDITED FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48: THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2011 AND 2010.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	4,965,905	631,991	4,333,914	2.680 %
b Medicaid (from Worksheet 3, column a) .....	11,178,733	7,309,978	3,868,755	2.390 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	16,144,638	7,941,969	8,202,669	5.070 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	1,052,041	244,493	807,548	0.500 %
f Health professions education (from Worksheet 5) ..	57,086		57,086	0.040 %
g Subsidized health services (from Worksheet 6) ..	218,405	87,626	130,779	0.080 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	109,484		109,484	0.070 %
jTotal Other Benefits ...	1,437,016	332,119	1,104,897	0.690 %
kTotal. Add lines 7d and 7j. ..	17,581,654	8,274,088	9,307,566	5.760 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

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Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

7,382,912

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

4,060,051

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

57,036,574

Enter Medicare allowable costs of care relating to payments on line 5.....

63,521,023

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-6,484,449

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	CHILTON HOSPITAL 97 WEST PARKWAY POMPTON PLAINS,NJ07444	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

CHILTON HOSPITAL

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	CHILTON HOSPITAL 1 PIKES DRIVE WAYNE,NJ07470	OUTPATIENT PHYSICAL THERAPY
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
ELIGIBILITY FOR DISCOUNTED CARE	SCHEDULE H, PART I, QUESTION 3C	THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2011 POVERTY GUIDELINES (DEPARTMENT OF HEALTH AND SENIOR SERVICES). FEDERAL POVERTY GUIDELINES ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE.
COMMUNITY BENEFIT REPORT	SCHEDULE H, PART I, QUESTION 6A	NOT APPLICABLE.
SUBSIDIZED HEALTH SERVICES	SCHEDULE H, PART I; QUESTION 7G	NO COSTS RELATING TO SUBSIDIZED HEALTHCARE SERVICES ARE ATTRIBUTABLE TO ANY PHYSICIAN CLINICS.
PERCENT OF TOTAL EXPENSE	SCHEDULE H, PART I, QUESTION 7, COLUMN (F)	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $7,382,912.
CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFIT COST	SCHEDULE H, PART I, QUESTION 7	WORKSHEET 2 WAS USED FOR THE COST TO CHARGE RATIO.
COMMUNITY BUILDING ACTIVITIES	SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY CHILTON IMPROVE THE MEDICAL AND SOCIOECONOMIC WELL-BEING OF THE COMMUNITIES IN OUR CARE. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS, AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. THIS ORGANIZATION PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS AND FOR COMMUNITY PROVIDERS. PRESENTATIONS ARE PROVIDED BY PHYSICIANS, NURSES AND OTHER HEALTH CARE PROFESSIONALS. CHILTON MEMORIAL HOSPITAL OFFERS A WEALTH OF PROGRAMS, LECTURES AND SCREENINGS TO PEOPLE IN THE COMMUNITY AND THE HOSPITAL'S BROADER AREA AND ADDRESS A VARIETY OF HEALTH-RELATED ISSUES. THESE EVENTS ALSO HELP LESS-PRIVILEGED CITIZENS RECEIVE THE HEALTHCARE AND EDUCATION THAT THEY OTHERWISE WOULDN'T RECEIVE. A MAJOR COMPONENT OF COMMUNITY BENEFIT FROM CHILTON IS THE COMMUNITY OUTREACH DEPARTMENT. IT PROVIDED 1,250 PROGRAM SESSIONS FOR THE COMMUNITY IN 2011. COMMUNITY OUTREACH COMPRISES FOUR DIVISIONS: NEW VITALITY, COMMUNITY HEALTH, PARENT EDUCATION AND CORPORATE WELLNESS. THESE DIVISIONS DELIVER SPECIALIZED PROGRAMS AND SERVICES, MANY OF WHICH ARE FREE. CHILTON NEW VITALITY OFFERS MANY CLASSES FOR INDIVIDUALS OVER THE AGE OF 50. MEMBERS BENEFIT FROM NEW VITALITY'S EXTENSIVE ROSTER OF LECTURES, WORKSHOPS, CLASSES, SUPPORT GROUPS, TRIPS, HEALTH SCREENINGS AND SOCIAL EVENTS, EACH FOCUSED ON MEETING THE SOCIAL, PHYSICAL, EMOTIONAL, MENTAL AND/OR EDUCATIONAL NEEDS OF THE OLDER ADULT. MEMBERSHIP IS FREE AND INCLUDES ACCESS TO IN-HOME EMERGENCY-RESPONSE SYSTEMS, SUPPORT GROUPS AND EVEN PRESCRIPTION DRUG DISCOUNTS. CHILTON COMMUNITY HEALTH PARTNERS WITH 5 LOCAL HEALTH DEPARTMENTS TO PROVIDE COMMUNITY SCREENINGS, EXAMS AND EDUCATIONAL PROGRAMS DESIGNED TO ENCOURAGE PREVENTIVE CARE, FOSTER PARTICIPATION IN HEALTHCARE INITIATIVES AND PROMOTE GREATER AWARENESS OF COMMUNITY HEALTHCARE ISSUES. CHILTON MEMORIAL HOSPITAL PARTNERS WITH THE FOLLOWING TOWNS TO DELIVER THESE PROGRAMS: POMPTON LAKES, RINGWOOD, WANAQUE, WAYNE AND WEST MILFORD. CHILTON PARENT EDUCATION SERVES AS A VALUABLE RESOURCE FOR FAMILY HEALTH. SEMINARS AND COURSES ARE OFFERED TO HELP NEW OR SEASONED PARENTS GAIN KNOWLEDGE AND INSIGHT ABOUT ALL ASPECTS OF PARENTING, FROM THE EARLY MONTHS OF PREGNANCY THROUGH THE CHILD'S PRE-SCHOOL YEARS. A VARIETY OF TOPICS SUCH AS DIET, SLEEP DISORDERS, DEALING WITH SIBLINGS, LIVING WITH PETS AND SAFETY LESSONS FOR BABYSITTERS CAN BE FOUND IN PARENT EDUCATION PROGRAMS FROM CHILTON.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A; QUESTION 4	BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM FINANCIAL STATEMENT, NET OF ACCOUNTS WRITTEN OFF TO DETERMINE BAD DEBT EXPENSE AT COST. FORREST S. CHILTON, 3RD MEMORIAL HOSPITAL AND ITS CONTROLLED AFFILIATE PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE ATTACHED TEXT WAS OBTAINED FROM THE FOOTNOTES TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF FORREST S. CHILTON, 3RD MEMORIAL HOSPITAL, INC. AND AFFILIATE. ACCOUNTS RECEIVABLE, PATIENTS ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES. CHARITY CARE THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA DEFINED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES ("DOH") WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THE ESTIMATED COSTS OF PROVIDING CHARITY CARE ARE BASED UPON THE DIRECT AND INDIRECT COSTS IDENTIFIED WITH THE SPECIFIC CHARITY CARE SERVICES PROVIDED. THE LEVEL OF CHARITY CARE PROVIDED BY THE HOSPITAL AMOUNTED TO APPROXIMATELY $4,320,007 IN 2011 AND $5,810,130 IN 2010. THE NEW JERSEY HEALTH CARE SUBSIDY FUND ("HCSF") WAS ESTABLISHED FOR VARIOUS PURPOSES, INCLUDING THE DISTRIBUTION OF CHARITY CARE PAYMENTS TO HOSPITALS STATEWIDE. NET PATIENT SERVICE REVENUES INCLUDE SUBSIDY AMOUNTS OF APPROXIMATELY $633,000 IN 2011 AND $386,000 IN 2010.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B; QUESTION 8	MEDICARE COSTS WERE DERIVED FROM THE 2011 MEDICARE COST REPORT. CMH BELIEVES THAT MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS SHOULD BE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. HOWEVER, CONSISTENT WITH FORM 990, SCHEDULE H RULES AND REGULATIONS, THESE COSTS ARE NOT INCLUDED IN PART I BUT ARE PROPERLY REFLECTED IN PART III. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "[T]HE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE," AND PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY, AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVE[D]" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. CMH BELIEVES THAT MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS SHOULD BE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. HOWEVER, CONSISTENT WITH FORM 990, SCHEDULE H RULES AND REGULATIONS, THESE COSTS ARE NOT INCLUDED IN PART I BUT ARE PROPERLY REFLECTED IN PART III. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED "DUAL ELIGIBLES." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FIND
COLLECTION POLICY	SCHEDULE H, PART III, SECTION B; QUESTION 9B	ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE, BUT RATHER, ACCOUNTED FOR AS AN ALLOWANCE. IT IS THE POLICY OF FORREST S. CHILTON, 3RD MEMORIAL HOSPITAL AND ALL ITS HOSPITAL AFFILIATES TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. FOR ACCOUNTS DETERMINED TO BE 'SELF-PAY" AND/OR ACCOUNTS WITH BALANCE AFTER PRIMARY INSURANCE PAYMENTS, THE COLLECTION POLICY REQUIRES: SENDING THREE STATEMENTS, A MINIMUM OF ONE PRE-COLLECTION LETTER AND TELEPHONE CONTACT. THE FACILITY ALSO HAS A CHARITY CARE ACCESS POLICY TO ASSURE PATIENTS ARE PROVIDED WITH CHARITY CARE ASSISTANCE DETERMINED BY STATE AND FEDERAL REGULATIONS. IT IS THE POLICY TO INFORM ALL PATIENTS DEEMED SELF-PAY OF THE APPROPRIATE ASSISTANCE PROGRAMS AVAILABLE. PATIENTS APPLYING FOR CHARITY CARE ASSISTANCE WILL BE FINANCIALLY SCREENED BY A RESOURCE ADVISOR TO DETERMINE ELIGIBILITY ACCORDING TO STATE AND FEDERAL GUIDELINES AND WILL BE INFORMED OF DOCUMENTATION NEEDED TO COMPLETE A CHARITY CARE APPLICATION. PATIENTS NOT ELIGIBLE FOR CHARITY CARE WILL BE FINANCIALLY COUNSELED FOR ALL OTHER OPTIONS. QUALIFIED PATIENTS WILL BE REFERRED TO ALL APPROPRIATE AGENCIES OR PROGRAMS TO MEET OTHER FINANCIAL NEEDS. AT THE TIME OF THE PATIENT VISIT AND PART OF THE REGISTRATION PROCESS AT THE FACILITY, THE FOLLOWING OPTIONS ARE MADE AVAILABLE TO PATIENTS: - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR MEDICAL ASSISTANCE INCLUDING MEDICAID AND SSI; - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR THE NEW JERSEY HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM; AND, - FINANCIAL ARRANGEMENTS INCLUDING: 1. CASH/CREDIT CARD (AMERICAN EXPRESS, DISCOVER, VISA, MASTERCARD), OR 2. FLEXIBLE PAYMENT PLANS. IN ADDITION TO THE ABOVE OPTIONS, THE FACILITY HAS ESTABLISHED A SELF-PAY ASSISTANCE PROGRAM FOR OUR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR MEDICAID OR THE NEW JERSEY HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM. THE SELF-PAY ASSISTANCE PROGRAM RATES ARE REFLECTIVE OF MEDICARE REIMBURSEMENT, AS REQUIRED BY THE STATE OF NEW JERSEY.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTIONS 1J, 3, 4, 5C, 6I & 7	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B,QUESTIONS 9,10,11H,13G,15E,16E,17E,18D,20&21	NOT APPLICABLE.
FACILITY INFORMATION	SCHEDULE H, PART V, SECTION B, QUESTION 19D	THE FACILITY USES 115% OF THE MEDICARE RATE AS THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.
NEEDS ASSESSMENT	SCHEDULE H, PART VI; QUESTION 2	THIS ORGANIZATION CONDUCTS A REVIEW OF KEY FACTOR INFORMATION ANNUALLY WHICH INCLUDES: A REVIEW OF HEALTHCARE UTILIZATION OF ITS SERVICE AREA POPULATION BY SERVICES (CARDIOLOGY, OBSTETRICS, ONCOLOGY, ETC.) FOR DETERMINING INCREASED OR DECREASED HEALTH NEEDS; HEALTHCARE SERVICE ESTIMATES AND FORECASTS (BOTH INPATIENT AND OUTPATIENT); ASSESSMENTS OF LOCAL DEMOGRAPHIC AND SOCIOECONOMIC INFORMATION; AND, A REVIEW OF HEALTH STATUS/NEEDS ASSESSMENTS AND STUDIES CONDUCTED BY MORRIS REGIONAL PUBLIC HEALTH PARTNERSHIP, THE NEW JERSEY HOSPITAL ASSOCIATION AND THE HEALTH RESEARCH EDUCATIONAL TRUST (HRET). THIS ORGANIZATIONS CONDUCT EXTENSIVE SERVICE AREA POPULATION PHYSICIAN NEED STUDY (BY PRIMARY AND SPECIALTY) EVERY THREE TO FIVE YEARS. SPECIFIC SPECIALTY NEEDS ARE CONDUCTED FOR IDENTIFIED GAPS IN SERVICE. IN ADDITION, THIS ORGANIZATION WORKS WITH LOCAL PROVIDERS TO PLAN AND DISCUSS HEALTH NEEDS OF THE POPULATION. ONE FORUM IS A REGIONAL COMMUNITY ADVISORY BOARD CALLED "CHILTON NEIGHBORS FOR BETTER HEALTH" FOR THE MORRIS AND PASSAIC AREAS HOSTED BY THE HOSPITAL WITH REPRESENTATION FROM LOCAL POLITICIANS, LOCAL COMMUNITY HEALTH CENTERS, FIRST RESPONDERS AND OTHER COMMUNITY HEALTH LEADERS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI; QUESTION 3	CHARITY CARE SIGNS ARE POSTED THROUGHOUT THE FACILITY, MAINLY IN PATIENT REGISTRATION AREAS. SIGNS ARE POSTED IN BOTH ENGLISH AND SPANISH. ALL PATIENTS DEEMED SELF PAY ARE SCREENED FOR FINANCIAL ASSISTANCE BY A RESOURCE ADVISOR ACCORDING TO THE FEDERAL POVERTY GUIDELINES AND REFERRED TO APPROPRIATE AGENCIES OR PROGRAMS.
COMMUNITY INFORMATION	SCHEDULE H, PART VI; QUESTION 4	LOCATED IN POMPTON PLAINS, NEW JERSEY, AT THE CROSSROADS OF MORRIS AND PASSAIC COUNTIES, CHILTON MEMORIAL HOSPITAL IS A 260-BED FULLY ACCREDITED ACUTE CARE HOSPITAL WITH 1,602 EMPLOYEES AND MORE THAN 650 PHYSICIANS REPRESENTING 60 MEDICAL SPECIALTIES. CHILTON'S PRIMARY AND SECONDARY SERVICE AREAS COMPRISE 33 TOWNS IN MORRIS PASSAIC ESSEX BERGEN AND SUSSEX COUNTIES. CHILTON IS A DOMINANT PROVIDER OF HEALTH CARE SERVICES TO RESIDENTS ALONG NJ ROUTE 23, STRETCHING APPROXIMATELY 342 SQUARE MILES FROM MORE AFFLUENT SUBURBAN AREAS SUCH AS SOUTHERN MORRIS COUNTY TO MORE RURAL AREAS SUCH AS NORTHERN PASSAIC COUNTY.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI; QUESTION 5	CHILTON HOSPITAL ("CH") AND ITS AFFILIATES ARE COMMITTED TO ENHANCING THE OVERALL HEALTH STATUS OF THE COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE AND RELATED SERVICES. MOREOVER, CH OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1) CH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2) CH OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3) CH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4) CONTROL OF CH RESTS WITH ITS BOARD OF DIRECTORS; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5) SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES.
AFFILIATED HEALTHCARE SYSTEM	SCHEDULE H, PART VI; QUESTION 6	NOT FOR-PROFIT ENTITIES: CHILTON MEMORIAL CORPORATION CHILTON MEMORIAL CORPORATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS THE CHARITABLE TAX-EXEMPT PURPOSES, PROGRAMS AND SERVICES OF FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. CHILTON MEMORIAL HOSPITAL FOUNDATION CHILTON MEMORIAL HOSPITAL FOUNDATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. CHILTON REALTY HOLDING, INC. CHILTON REALTY HOLDING, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(2). THE ORGANIZATION ACTS AS A REALTY HOLDING COMPANY FOR PROPERTY USED IN THE PROVISION BY FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, OF MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. FOR-PROFIT ENTITIES: CHILTON COMMUNITY CARE, INC. A FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS CMC. THE ORGANIZATION IS LOCATED IN POMPTON PLAINS, MORRIS COUNTY, NEW JERSEY. THE ORGANIZATION'S PRIMARY OPERATIONAL FUNCTION IS TO PROVIDE CHILD CARE SERVICES. CHILTON PROFESIONAL PRACTICE CORPORATION A FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS CMC. THE ORGANIZATION IS LOCATED IN POMPTON PLAINS, MORRIS COUNTY, NEW JERSEY. THE ORGANIZATION PROVIDES HEALTHCARE SERVICES. CHILTON SPORTS MEDICINE & REHABILITATION MANAGEMENT, INC. A FOR-PROFIT ENTITY WHOSE SOLE SHAREHOLDER IS CMC. THE ORGANIZATION IS LOCATED IN POMPTON PLAINS, MORRIS COUNTY, NEW JERSEY. THE ORGANIZATION PROVIDES HEALTHCARE SERVICES.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART VI; QUESTION 7	NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number
22-1559402

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) AMERICAN HEART ASSOCIATION1 UNION STREET SUITE 301 ROBBINSVILLE,NJ08691	13-5613797	501(C)(3)	7,500	AFFIL. SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
GRANT FUND MONITORING	SCHEDULE I, PART I; QUESTION 2	GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) DEBORAH K ZASTOCKI FACHE	(i) (ii)	487,548 0	142,259 0	6,471 0	25,800 0	16,496 0	678,574 0	0 0
(2) MICHAEL A RICHETTI	(i) (ii)	311,887 0	59,792 0	1,555 0	4,800 0	20,100 0	398,134 0	0 0
(3) THOMAS SCOTT	(i) (ii)	287,119 0	54,941 0	35,450 0	4,500 0	22,700 0	404,710 0	0 0
(4) RICHARD WEINBERG MD	(i) (ii)	325,554 0	74,653 0	3,907 0	11,500 0	6,549 0	422,163 0	0 0
(5) JULIA MCGOVERN	(i) (ii)	212,658 0	42,083 0	2,143 0	17,700 0	227 0	274,811 0	0 0
(6) JOANNE REICH	(i) (ii)	176,421 0	33,709 0	1,657 0	15,100 0	1,352 0	228,239 0	0 0
(7) YOLANDA C GEHRING	(i) (ii)	165,327 0	26,045 0	2,450 0	29,300 0	1,013 0	224,135 0	0 0
(8) DAWN JONES	(i) (ii)	121,537 0	21,714 0	1,178 0	9,600 0	14,739 0	168,768 0	0 0
(9) DONNA KIRBY	(i) (ii)	151,283 0	19,673 0	1,854 0	25,900 0	1,013 0	199,723 0	0 0
(10) KAREN STUTZER	(i) (ii)	135,661 0	13,343 0	1,665 0	24,400 0	5,551 0	180,620 0	0 0
(11) GAIL R ELIOT MD	(i) (ii)	210,293 0	0 0	145,462 0	21,300 0	473 0	377,528 0	0 0
(12) REENA C WAGNER MD	(i) (ii)	347,216 0	0 0	1,240 0	8,500 0	1,007 0	357,963 0	0 0
(13) LAURIE S NAHUM MD	(i) (ii)	262,309 0	20,000 0	1,231 0	13,500 0	19,854 0	316,894 0	0 0
(14) JOSHUA NOCHUMSON MD	(i) (ii)	249,196 0	0 0	1,240 0	2,200 0	5,799 0	258,435 0	0 0
(15) EDECK PIERRE MD	(i) (ii)	201,529 0	5,000 0	0 0	0 0	19,854 0	226,383 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
COMPENSATION INFORMATION	SCHEDULE J, PART I; QUESTION 1	THE ORGANIZATION'S VICE PRESIDENT/CHIEF OPERATING OFFICER, THOMAS SCOTT, RELOCATED TO THE STATE OF NEW JERSEY FROM THE STATE OF CONNECTICUT. IN ORDER TO FACILITATE THE RELOCATION OF HIS PRIMARY RESIDENCE, THE ORGANIZATION PROVIDED A HOUSING ALLOWANCE TO HIM. THE HOUSING ALLOWANCE FOR MR. SCOTT TOTALED $34,000. THIS AMOUNT WAS INCLUDED IN HIS 2011 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES AND IN SCHEDULE J, PART II, COLUMN B(III) HEREIN.
COMPENSATION INFORMATION	SCHEDULE J, PART I; QUESTION 4A	GAIL R. ELIOT, M.D., A PHYSICIAN OF THE ORGANIZATION RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $145,462. THIS AMOUNT WAS INCLUDED IN HER 2011 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.
COMPENSATION INFORMATION	SCHEDULE J, PART I; QUESTION 7 AND CORE FORM, PART VII	CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2011 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2011 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number
22-1559402

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	NJ HEALTH CARE FACILITIES FINANCING AUTHORITY	22-1987084	64579FZE6	11-01-2009	38,486,520	REFUND '93/REFINANCE LOC/CAP PROJ		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	0
2 Amount of bonds legally defeased . . . . . . . . . .	0
3 Total proceeds of issue . . . . . . . . . . . . .	43,247,683
4 Gross proceeds in reserve funds . . . . . . . .	27,965,340
5 Capitalized interest from proceeds . . . . . . . . . .	0
6 Proceeds in refunding escrows . . . . . . . . . . .	5,163,148
7 Issuance costs from proceeds . . . . . . . . . . .	928,625
8 Credit enhancement from proceeds . . . . . . . . . .	0
9 Working capital expenditures from proceeds . . . . . . .	0
10 Capital expenditures from proceeds . . . . . . . . . .	7,299,531
11 Other spent proceeds . . . . . . . . . . .	0
12 Other unspent proceeds . . . . . . . . . . .	1,891,039
13 Year of substantial completion . . . . . . . . . . .	2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .		X
15 Were the bonds issued as part of an advance refunding issue? . . . .	X
16 Has the final allocation of proceeds been made? . . . . . .		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0.00000%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0.00000%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	0.00000%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?		X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . .	0
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X
b Name of provider . . . . . .	0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X
6 Did the bond issue qualify for an exception to rebate? .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SHARON VAN DUYNE	FAMILY MEMBER - TRUSTEE	77,140	EMPLOYEE		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Identifier	Return Reference	Explanation
COMMUNITY BENEFIT STATEMENT	CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	BACKGROUND ========== CHILTON HOSPITAL ("CH") IS A GENERAL MEDICAL AND SURGICAL HOSPITAL. CH IS RECOGNIZED BY THE IRS AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CH OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1) CH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2) CH OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3) CH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4) CONTROL OF CH RESTS WITH ITS BOARD OF DIRECTORS; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5) SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. HISTORY ======= THE FIRST CHAPTER OF CH'S HISTORY WAS WRITTEN IN 1947. FORREST S. CHILTON III, M.D., AND HIS WIFE, ELIZABETH, DONATED A TRACT OF LAND ON NEWARK-POMPTON TURNPIKE TO BUILD A HOSPITAL IN MEMORY OF THEIR SON WHOSE LIFE WAS LOST IN WORLD WAR II. THEIR ACTION SPARKED A SUCCESSFUL DRIVE TO BUILD A FACILITY THAT WOULD SERVE THE HEALTH NEEDS OF THE COMMUNITY AND BECAME A REALITY WITH A 50-BED FACILITY IN 1954, AND EXPANDED TO 119 BEDS IN 1961. IN AUGUST 1968, A 40-ACRE TRACT WAS PURCHASED ONE MILE WEST OF THE NEWARK-POMPTON TURNPIKE SITE AND ANOTHER BUILDING, THE WEST PARKWAY FACILITY, WAS DEDICATED NOVEMBER 20, 1971. THE NEXT GOAL WAS TO COMBINE THE TWO BUILDINGS ON WEST PARKWAY AND CONSTRUCTION OF AN EXPANDED HOSPITAL BEGAN IN 1981. THIS INCLUDED A NEW PATIENT WING, NEW GROUND FLOOR FACILITY, AND A COMPLETE REMODELING OF THE ORIGINAL BUILDING. THE "NEW" CH WAS DEDICATED IN JUNE 1984. TODAY, CH IS A 260-BED, ACUTE-CARE, NON-PROFIT COMMUNITY HOSPITAL WITH APPROXIMATELY 1,450 EMPLOYEES. IT FEATURES SOME OF THE MOST SOPHISTICATED DIAGNOSTIC AND THERAPEUTIC EQUIPMENT AVAILABLE. CH'S COMPASSIONATE HEALTH-CARE PROFESSIONALS PROVIDE ADVANCED, COST-EFFECTIVE CARE, AND ALL OF ITS RESOURCES, INCLUDING THE STAFF PATIENTS WILL MEET, AS WELL AS THOSE THEY MAY NOT, ARE DEDICATED TO ONE PURPOSE - RETURNING YOU TO THE BEST POSSIBLE HEALTH. MORE THAN 650 PHYSICIANS REPRESENTING MORE THAN 60 DIFFERENT SPECIALTIES HOLD STAFF PRIVILEGES AT CH. THEY ARE SUPPORTED BY ALLIED HEALTH PROFESSIONALS WHO UTILIZE THE MOST CURRENT TECHNOLOGIES AND ON-GOING EDUCATION IN TREATMENT, WHILE NEVER LOSING SIGHT OF THE IMPORTANCE AND DIGNITY OF EACH INDIVIDUAL PATIENT. CH IS LICENSED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND IS A MEMBER OF THE VOLUNTARY HOSPITAL ASSOCIATION OF AMERICA, AMERICAN HOSPITAL ASSOCIATION, AND NEW JERSEY HOSPITAL ASSOCIATION. MISSION STATEMENT ================= THE MISSION OF CH IS TO PROMOTE WELLNESS AND PROVIDE COMPASSIONATE CARE AND HEALING. VISION STATEMENT ================ CH WILL BECOME THE LOCAL PREFERRED PROVIDER OF HIGH QUALITY PERSONALIZED HEALTHCARE. AWARDS AND COMMENDATIONS ======================== CH RECEIVED THREE-YEAR APPROVAL WITH COMMENDATION FROM THE COMMISSION ON CANCER. CH'S SLEEP HEALTH INSTITUTE RECEIVED ACCREDITATION FROM THE AMERICAN ACADEMY OF SLEEP MEDICINE. HEALTHGRADES STUDY FINDS PATIENT OUTCOMES AT CH AMONG NATION'S BEST FOR STROKE CARE. ACCORDING TO HEALTHGRADES HOSPITAL QUALITY IN AMERICA STUDY, CH WAS RANKED AMONG THE TOP TEN PERCENT NATIONALLY FOR STROKE CARE AND FIVE STAR RATED FOR STROKE CARE, THE HIGHEST POSSIBLE. THE STUDY, THE LARGEST OF ITS KIND, ANALYZED PATIENT OUTCOMES AT VIRTUALLY ALL OF THE NATION'S 5,000 HOSPITALS OVER THE YEARS 2006, 2007 AND 2008. THE 2010 STUDY ALSO FOUND THAT CH IS THE HIGHEST RANKED HOSPITAL IN THE NORTH WESTERN AREA FOR STROKE CARE. CH RECEIVED PRIMARY STROKE CENTER DESIGNATION FROM THE STATE OF NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES. CH RECEIVED CERTIFICATION AS A PRIMARY STROKE CENTER FROM THE JOINT COMMISSION FOR MEETING STRICT GUIDELINES FOR THE RAPID DIAGNOSIS AND TREATMENT OF STROKE, FROM THE EMERGENCY ROOM THROUGH REHABILITATION. PRIMARY STROKE CENTERS ADHERE TO NATIONAL STANDARDS FOR STROKE CARE THAT IMPROVE OUTCOMES FOR PATIENTS, AND HAVE ACUTE STROKE TEAMS AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK, READY TO RAPIDLY ASSESS AND TREAT PATIENTS. THE PRIMARY STROKE CENTER CERTIFICATION PROGRAM WAS DEVELOPED IN COLLABORATION WITH THE AMERICAN STROKE ASSOCIATION. IN MARCH 2012, CH'S TOTAL JOINT CENTER RECEIVED JOINT COMMISSION CERTIFICATION FOR TOTAL KNEE AND TOTAL HIP REPLACEMENT SERVICES. THE TOTAL JOINT CENTER, LOCATED ON THE THIRD FLOOR, RENOVATED IN 2011, HAS 24 PRIVATE ROOMS AND A REHABILITATION GYM LOCATED WITHIN THE CENTER OF THE UNIT. THE CENTER PROVIDES A FULL SPECTRUM OF CARE BEGINNING WITH PRE-HOSPITALIZATION EDUCATION, ACUTE CARE DURING THE HOSPITALIZATION, AND POST-DISCHARGE EDUCATION AND SUPPORT. 2011 STATISTICS =============== DURING 2011 CH HAD 10,265 INPATIENT ADMISSIONS, 122,241 OUTPATIENT ADMISSIONS AND 48,182 EMERGENCY ROOM ADMISSIONS. CENTERS OF EXCELLENCE ===================== 1. CHILTON CANCER CENTER THE CANCER CENTER AT CH, AN AMERICAN COLLEGE OF SURGEONS APPROVED COMMUNITY HOSPITAL COMPREHENSIVE CANCER PROGRAM, IS LOCATED ADJACENT TO THE HOSPITAL AT COLLINS PAVILION AND USES THE LATEST TECHNOLOGY TO DIAGNOSE, TREAT, AND PROVIDE SUPPORT TO CANCER PATIENTS. EVERY PHASE OF CANCER CARE - FROM REGISTRATION TO LAB WORK TO TREATMENT TO SUPPORT SERVICES - IS LOCATED UNDER ONE ROOF, ELIMINATING THE NEED FOR TRAVEL TO A LARGER CANCER FACILITY. THE CANCER CENTER FEATURES A CARING STAFF OF PROFESSIONALS WHO STRIVE TO PROVIDE THE HIGHEST LEVEL OF CARE AVAILABLE AND TREAT EACH PERSON AS AN INDIVIDUAL. RADIATION ONCOLOGY ------------------ RADIATION THERAPY IS ONE OF THE MOST COMMON TREATMENTS FOR CANCER AND IS USED IN MORE THAN HALF OF ALL CANCER CASES. RADIATION THERAPY USES A STREAM OF HIGH-ENERGY PARTICLES OR WAVES, SUCH AS X-RAYS, GAMMA RAYS, ELECTRONS, OR PROTONS TO DESTROY OR DAMAGE CANCER CELLS. THE CANCER CENTER AT CH FEATURES STATE-OF-THE-ART INTENSITY-MODULATED RADIATION THERAPY (IMRT), WHICH AIMS DIRECTLY AT THE TUMOR AND DELIVERS PRECISE RADIATION DOSES, SPARING ADJACENT NORMAL TISSUES. AT CH, IMRT IS USED TO TREAT PROSTATE AND HEAD AND NECK CANCER. ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, EACH RADIATION TREATMENT TAKES APPROXIMATELY 10 MINUTES AND THE CANCER CENTER'S LOCATION ALSO AFFORDS PATIENTS THE OPPORTUNITY TO HAVE THEIR LAB WORK AND TREATMENT PLANNING ALL DONE IN THE SAME BUILDING. CHEMOTHERAPY/INFUSION THERAPY ----------------------------- THE CANCER CENTER AT CH FEATURES AN INFUSION THERAPY AREA. IN THIS AREA, CHEMOTHERAPY, BLOOD TRANSFUSIONS, ANTIBIOTICS, STEROIDS, REMICADE AND OTHER MEDICATIONS ARE ADMINISTERED TO AMBULATORY OUTPATIENTS. THIS IS AN OPEN ROOM AREA WHERE PATIENTS CAN RELAX IN RECLINERS OR IN A PRIVATE ROOM WHILE RECEIVING THEIR TREATMENT. EXPERIENCED REGISTERED NURSES WHO ARE ALSO CERTIFIED IN ONCOLOGY STAFF THE DEPARTMENT. REFRESHMENTS ARE AVAILABLE TO OUR PATIENTS, AND OUR LIBRARY HAS PATIENT EDUCATION MATERIALS AVAILABLE FOR THEIR USE. EVERY EFFORT IS MADE TO ENSURE THE EXPERIENCE AT CH'S CANCER CENTER IS A COMFORTABLE ONE. SUPPORT SERVICES ---------------- CH'S CANCER CENTER HAS AN ONCOLOGY SOCIAL WORKER ON-SITE TO PROVIDE EMOTIONAL SUPPORT, FINANCIAL ASSISTANCE AND TO ARRANGE TRANSPORTATION FOR PATIENTS. IN ADDITION, THE ONCOLOGY SOCIAL WORKER RUNS A WOMAN TO WOMAN SUPPORT GROUP DEDICATED TO THE PARTICULAR NEEDS OF WOMEN WHO ARE EXPERIENCING THE EMOTIONAL AND PHYSICAL EFFECTS OF CANCER SURGERY AND TREATMENT. THIS GROUP MEETS THE FIRST, THIRD AND FIFTH TUESDAY OF EVERY MONTH AND HELPS WOMEN TO ACQUIRE STRESS MANAGEMENT, COMMUNICATION AND COPING SKILLS, AND ACHIEVE A SENSE OF EMPOWERMENT. THIS SUPPORT GROUP PROVIDES WOMEN WITH A FORUM TO SHARE THEIR CONCERNS, STORIES, EXPERIENCES, FEELINGS AND PROBLEMS. NUTRITION --------- CH'S CANCER CENTER PROVIDES ACCESS TO A DIETITIAN WHO CONDUCTS IN-HOUSE OR PHONE SESSIONS TO PROVIDE EDUCATION ON HOW TO INCREASE CALORIC INTAKE TO PREVENT WEIGHT LOSS DURING TREATMENTS. THE DIETITIAN ALSO EDUCATES PATIENTS ON HOW TO PREVENT THE NAUSEA, VOMITING AND DIARRHEA THAT CAN SOMETIMES ACCOMPANY CHEMOTHERAPY TREATMENTS. THE DIETICIAN'S GOAL IS TO INCREASE EACH PATIENT'S OVERALL NUTRITIONAL STATUS AND HELP THE PATIENT MAINTAIN THAT STATUS DURING TREATMENTS. PARKING AND TRANSPORTATION -------------------------- CH'S CANCER CENTER OFFERS CONVENIENT, FREE PARKING AND A FREE OUTPATIENT TRANSPORTATION PROGRAM FOR THOSE WHO HAVE NO OTHER WAY TO GET TO THE CANCER CENTER.
COMMUNITY BENEFIT STATEMENT CONT'D	CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	ADDITIONAL SERVICES ------------------- THE CANCER CENTER FEATURES PRIVATE CHANGING AREAS WITH LOCKERS TO STORE YOUR BELONGINGS. ACCESS TO A RESOURCE LIBRARY FEATURING BOOKS, A TOUCH SCREEN COMPUTER, AND A TELEVISION WITH VHS AND DVD PLAYER IS ALSO AVAILABLE. 2. EMERGENCY DEPARTMENT EXPECT THE BEST CARE FROM THE EMERGENCY DEPARTMENT AT CH. THE STATE-OF-THE-ART EMERGENCY DEPARTMENT OFFERS UNPRECEDENTED PRIVACY AND IS STAFFED 24- HOURS A DAY BY PHYSICIANS BOARD-CERTIFIED IN EMERGENCY MEDICINE. OUR CARING STAFF IS THERE TO HELP INDIVIDUALS AND THEIR FAMILIES IN THE TIME OF AN EMERGENCY. AN INDIVIDUAL'S VISIT TO THE EMERGENCY DEPARTMENT AREA MAY REQUIRE ADDITIONAL TESTING TO EVALUATE YOUR SITUATION. DEPENDING ON YOUR SITUATION, YOU MAY REQUIRE BLOOD TESTS, X-RAYS, CT SCANS OR VARIOUS OTHER TESTS TO DIAGNOSE YOUR CONDITION. AT CH, THESE ADDITIONAL SERVICES ARE LOCATED AT THE HOSPITAL SO THAT YOUR CONDITION WILL BE DIAGNOSED AS QUICKLY AS POSSIBLE AND THAT YOUR TREATMENT CAN BEGIN. FAST TRACK ---------- THE FAST TRACK OFFERS THE COMFORT OF THE HOSPITAL'S EMERGENCY DEPARTMENT WHILE TREATING PATIENTS IN A FAST AND EFFICIENT MANNER. PATIENTS WITH MINOR AILMENTS AND INJURIES ARE TREATED IN APPROXIMATELY ONE HOUR OR LESS BY EMERGENCY HEALTH-CARE PROFESSIONALS AND EMERGENCY MEDICINE BOARD CERTIFIED PHYSICIANS. FAST TRACK PATIENTS INCLUDE THOSE SUFFERING FROM INSECT BITES, SPRAINS, STRAINS, EAR ACHES, SORE THROATS, AND OTHER NON-LIFE THREATENING ILLNESSES. PEDIATRIC EMERGENCY DEPARTMENT ------------------------------ CH PEDIATRIC EMERGENCY PHYSICIANS STAFF THE EMERGENCY DEPARTMENT 24/7. CHILDREN UNDER 17 YEARS OF AGE WILL BE SEEN BY A PEDIATRIC EMERGENCY DOCTOR IN ABOUT 20 MINUTES FROM THE TIME OF REGISTRATION - SO PATIENTS DON'T HAVE TO WORRY ABOUT WAITING. BETWEEN THE HOURS OF 7:00 AM AND 11:30 PM, CHILDREN ARE SEEN IN THE PEDIATRIC EMERGENCY DEPARTMENT. AT ALL OTHER TIMES, THE CHILDREN ARE SEEN IN THE MAIN EMERGENCY DEPARTMENT. THE PEDIATRIC EMERGENCY DEPARTMENT IS EQUIPPED KID FRIENDLY TREATMENT AREAS WITH WALLS COVERED WITH CARTOON CANINES AND UNDER-THE-SEA MOTIFS, AS WELL AS A SEPARATE WAITING AREA WITH A CHILD-FRIENDLY ENVIRONMENT MAKE WHAT OTHERWISE BE A STRESSFUL VISIT TO AN EMERGENCY ROOM LESS INTIMIDATING. THE UNIT ALSO OFFERS SPECIAL EQUIPMENT THAT COMES IN ALL SIZES TO FIT THE NEEDS OF CHILDREN OF ALL SIZES. 3. MOTHER BABY CENTER THE MOTHER BABY CENTER IS OFTEN THE FIRST EXPERIENCE A FAMILY HAS WITH CH. AT THE MOTHER BABY CENTER, OVER 1,000 NEW BABIES ARE WELCOMED INTO THE WORLD EACH YEAR. THE CENTER, WHICH WAS COMPLETELY RENOVATED IN 2009, FEATURES PRIVATE LABOR/DELIVERY/RECOVERY ROOMS WITH STATE-OF-THE-ART EQUIPMENT, ANESTHESIOLOGISTS WHO ARE AVAILABLE 24 HOURS A DAY, AND TWO FULLY EQUIPPED OPERATING SUITES. ALONG WITH THE NEWBORN NURSERY, A FOUR-BED SPECIAL CARE NURSERY IS AVAILABLE. CH HAS THE STATE-OF-THE-ARE TECHNOLOGY IN ORDER TO KEEP FAMILIES TOGETHER, ALLOWING THAT IMPORTANT BOND TO FORM BETWEEN MOTHER AND BABY. THE CENTER OFFERS NUMEROUS OTHER SERVICES INCLUDING PRE-CONCEPTION COUNSELING, GENETIC COUNSELING AND PERINATOLOGY SERVICES, CHILDBIRTH EDUCATION, NEWBORN CARE, POSTPARTUM CARE, LACTATION SERVICES, AND PEDIATRICS AND AMENITIES SUCH AS MASSAGES AND FAMILY CELEBRATION MEAL. 4. HEART AND VASCULAR CARE CARDIOVASCULAR DISEASE IS THE LEADING CAUSE OF DEATH IN THE UNITED STATES OF AMERICA. ACCORDINGLY, CH IS DEDICATED TO THE DIAGNOSIS AND TREATMENT OF ALL CARDIOVASCULAR DISORDERS. FROM CH'S EMERGENCY ROOM CARE, THROUGH ITS INPATIENT UNITS, AND IN ITS MULTITUDE OF OUTPATIENT SERVICES, CH'S TEAM OF SKILLED PROFESSIONALS DELIVERS SUPERIOR CARE AND TREATS EACH PATIENT AS AN INDIVIDUAL. CARDIOVASCULAR INTERVENTIONAL LAB --------------------------------- CARDIAC CATHETERIZATION SERVICES WERE INITIATED AT CH IN 1997. A DIAGNOSTIC CATHETERIZATION, ALSO KNOWN AS CORONARY ANGIOGRAPHY OR HEART CATHETERIZATION PROVIDES DETAILED INFORMATION ABOUT THE FUNCTION OF THE HEART AND ITS ARTERIES. CH HAS A STAFF OF PHYSICIANS WHO PERFORM THIS PROCEDURE. THE MAJORITY OF CH'S OUTPATIENTS RECEIVE CLOSURE DEVICES, WHICH ALLOW FOR AMBULATION IN 45 MINUTES AND DISCHARGE WITHIN ONE HOUR RATHER THAN THE TRADITIONAL SIX HOURS OF BED REST. PRIMARY ANGIOPLASTY ------------------- IN JUNE 2005, THE CATHETERIZATION LABORATORY AT CH WAS LICENSED TO PERFORM PRIMARY ANGIOPLASTY FOR PATIENTS SUFFERING FROM A HEART ATTACK. THIS MINIMALLY INVASIVE PROCEDURE HAS BEEN SHOWN TO BE APPROXIMATELY 25% MORE EFFECTIVE THAN TRADITIONAL MEDICATIONS AT PREVENTING DEATH FROM HEART ATTACK. CH HAS A STAFF OF INTERVENTIONAL CARDIOLOGISTS PERFORMING PRIMARY ANGIOPLASTY. THESE PHYSICIANS ALONG WITH A TEAM OF HIGHLY SKILLED NURSES AND TECHNOLOGISTS ARE AVAILABLE 24/7 TO PROVIDE LOCAL RESIDENTS WITH THE BEST AND MOST IMMEDIATE CARDIAC CARE, ELIMINATING THE NEED TO TRANSFER TO ANOTHER FACILITY. 5. OUTPATIENT SERVICES COMPREHENSIVE BREAST CENTER --------------------------- THE COMPREHENSIVE BREAST CENTER AT CH, ALSO LOCATED IN COLLINS PAVILION, IS A SPECIAL PLACE DEDICATED TO PARTNERING WITH PATIENTS FOR THEIR BREAST-CARE NEEDS. SINCE EVERY WOMAN'S NEEDS ARE DIFFERENT, THE COMPREHENSIVE BREAST CENTER CARES FOR EACH WOMAN IN A COMPLETELY PERSONAL WAY. CH'S BREAST CENTER SPECIALISTS PROVIDE VALUABLE SERVICES TO WOMEN WITH BREAST CANCER AND OFFER PREVENTATIVE SERVICES, INCLUDING DIGITAL SCREENING AND DIAGNOSTIC MAMMOGRAPHY, ULTRASOUNDS, STEREO TACTIC CORE BIOPSY AND ULTRASOUND-GUIDED CORE BIOPSY. THE BREAST CENTER ALSO OFFERS EDUCATION AND COUNSELING, INCLUDING BREAST SELF-EXAMINATION (BSE) INSTRUCTIONS, CARING, EMOTIONAL SUPPORT, AND PROMPT FOLLOW-UP WITH TEST RESULTS. IN ADDITION, THEY OFFER A FULL LINE OF BREAST PROSTHESES (SILICONE BREAST FORMS) AND BRAS FOR WOMEN WHO HAVE HAD A PARTIAL OR FULL MASTECTOMY. DIABETES EDUCATION PROGRAM -------------------------- THE DIABETES EDUCATION PROGRAM AT CH HELPS ADULTS WITH DIABETES TAKE STEPS THAT WILL MAKE THEM FEEL BETTER AND STAY HEALTHIER. THIS PROGRAM IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION FOR MEETING HIGH NATIONAL STANDARDS. THIS PROGRAM SERVES DIABETIC ADULTS AND THEIR SUPPORT GIVERS. OTHERS WHO WILL BENEFIT FROM THIS PROGRAM INCLUDE: - PEOPLE WHO WANT INFORMATION ON RECENT ADVANCES IN DIABETES MANAGEMENT, SUCH AS CARBOHYDRATE COUNTING - PEOPLE WHOSE MEDICAL THERAPY HAS CHANGED - FAMILY/SIGNIFICANT OTHERS WHO PROVIDE SUPPORT TO PEOPLE WITH DIABETES THE PROGRAM INCLUDES: - INDIVIDUAL ASSESSMENT BY CERTIFIED DIABETES EDUCATORS (A REGISTERED DIETICIAN AND REGISTERED NURSE) - HANDS-ON GROUP CLASSES WHERE INDIVIDUALS LEARN ABOUT: - DIET AND MEAL PLANNING - MEDICATIONS - IMPORTANCE OF PHYSICAL ACTIVITY - BLOOD GLUCOSE MONITORING - FOOT AND EYE CARE - DENTAL HYGIENE - HOW TO AVOID COMPLICATIONS PAIN MANAGEMENT --------------- THE PAIN MANAGEMENT CENTER AT CH IS A MULTIDISCIPLINARY PAIN CENTER DEDICATED TO TREATING INDIVIDUALS SUFFERING FROM PAIN. DESIGNED TO RESTORE PATIENTS TO A STRONGER PHYSICAL AND MENTAL STATE, CH'S PROGRAM UTILIZES DIAGNOSTIC, CURATIVE AND THERAPEUTIC STATE-OF-THE-ART PROCEDURES THAT SIGNIFICANTLY REDUCE AND ELIMINATE PAIN. WITH PHYSICIANS CREDENTIALED IN PAIN MANAGEMENT, CH'S CENTER IS HERE TO HELP INDIVIDUALS GET BACK TO A LIFE WITHOUT PAIN. SPECIALIZING IN BACK AND NECK PAIN, CH'S PHYSICIANS OFFER NUMEROUS PAIN MANAGEMENT OPTIONS: - NERVE BLOCKS - CRYO ANALGESIA - RADIO FREQUENCY RHIZOTOMY - SUBCUTANEOUS INFUSION PUMPS AND CATHETERS - TRIGGER POINT INJECTIONS - PATIENT-CONTROLLED ANALGESIA - CONTINUOUS EPIDURAL ANALGESIA TYPES OF PAIN TREATED INCLUDE: - CERVICAL, THORACIC, AND LOW BACK PAIN FROM DISK DISEASE, WHIPLASH, SCIATICA, FACET JOINT DISEASE, SPINAL CORD INJURY - NECK, SHOULDER, ARM AND HAND PAIN - MYOFASCIAL PAIN (MUSCLE, TENDON, LIGAMENT) - NEURALGIAS, POST-HERPETIC NEURALGIA (SHINGLES), DIABETIC NEUROPATHY, PAIN FOLLOWING NERVE INJURY, TRIGEMINAL NEURALGIA, - POST-SURGICAL PAIN (INCISIONAL, PHANTOM LIMB) - SYMPATHETICALLY MAINTAINED PAIN (REFLEX SYMPATHETIC DYSTROPHY, CAUSALGIA, CRPS 1 AND CRPS II) - FACIAL PAIN - PERIPHERAL VASCULAR ISCHEMIC PAIN - JOINT AND BONE PAIN - CANCER PAIN RADIOLOGY --------- THE RADIOLOGY DEPARTMENT AT CH PROVIDES A COMPREHENSIVE ARRAY OF ADVANCED STATE-OF-THE-ART IMAGING FOR INPATIENTS, OUTPATIENTS, AND EMERGENCY PATIENTS. THE IMAGING SERVICES AVAILABLE INCLUDE COMPUTED TOMOGRAPHY SCAN (CT SCAN), MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE, POSITRON-EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT), ULTRASOUND AND X-RAY. DIAGNOSTIC IMAGING CT SCANNER: CH HAS A SIXTY-FOUR (64) SLICE LIGHTSPEED CT SCANNER. A CT SCANNER IS A NON-INVASIVE TEST THAT CAPTURES ANATOMICAL IMAGES OF THE BODY. THIS EQUIPMENT CAN SCAN SPECIFIC SECTIONS OF THE BODY IN SECONDS AND THE ENTIRE BODY IN JUST MINUTES. IT IS USED FOR NUMEROUS PURPOSES, INCLUDING TRAUMA, CHEST/ABDOMEN/PELVIS EXAMS, ANGIOGRAPHY, CARDIAC, VASCULAR AND STROKE ASSESSMENT, AND MORE.
COMMUNITY BENEFIT STATEMENT CONT'D	CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	MAGNETIC RESONANCE IMAGING: THE MAGNETIC RESONANCE IMAGING (MRI) SCANNER, WHICH SERVES BOTH INPATIENTS AND OUTPATIENTS, USES A MAGNETIC FIELD, RADIO WAVES, AND COMPUTERS TO PRODUCE DETAILED IMAGES OF THE BODY. WITH MRI, MANY DISEASES CAN NOW BE IDENTIFIED AT THEIR EARLIEST, MOST TREATABLE STAGES, RESULTING IN QUICKER TREATMENT, FASTER RECOVERY, AND, IN SOME CASES, LONGER LIFE. CH'S MAGNETOM AVANTO'S INVITING DESIGN MAKES IT ACCESSIBLE FOR MOST PATIENTS. THE SYSTEM'S FASTER SCANNING TIMES AND FEET-FIRST ENTRIES ALSO DECREASE THE ANXIETY OF PATIENTS WHO ARE UNCOMFORTABLE IN SMALL SPACES. ADDITIONALLY, THE SYSTEM FEATURES AUDIOCOMFORT, REDUCING ACOUSTICAL NOISE BY UP TO 97 PERCENT. WITH THE NEW STEREO CONNECTION, PATIENTS CAN ENJOY THE MUSIC OF THEIR CHOICE BY SUPPLYING THE TECHNICIAN WITH A CD UPON ARRIVAL. NUCLEAR MEDICINE NUCLEAR MEDICINE TESTING IS A SAFE AND PAINLESS WAY TO CAPTURE VALUABLE DIAGNOSTIC INFORMATION. THROUGH THE USE OF SMALL AMOUNTS OF RADIOACTIVE MATERIAL, CH'S DUAL HEAD NUCLEAR MEDICINE SCANNER PROVIDES IMPORTANT IMAGES OF BODY STRUCTURE AND FUNCTION. BECAUSE THE RADIOACTIVE MATERIAL IS ATTRACTED TO SPECIFIC ORGANS, BONES OR TISSUES, THE EMISSIONS THEY PRODUCE CAN PROVIDE CRUCIAL INFORMATION ABOUT A PARTICULAR TYPE OF CANCER OR DISEASE. INFORMATION GATHERED DURING A NUCLEAR MEDICINE EXAM IS MORE COMPREHENSIVE THAN OTHER IMAGING PROCEDURES BECAUSE IT DESCRIBES ORGAN FUNCTION, NOT JUST STRUCTURE. POSITRON-EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) SCANNER PET/CT OFFERS THE COMBINATION OF ANATOMICAL IMAGES SUPPLIED BY CT AND FUNCTIONAL INFORMATION SUPPLIED BY PET ALL IN A SINGLE NON-INVASIVE DIAGNOSTIC PROCEDURE. ACCLAIMED AS ONE OF THE MOST IMPORTANT HEALTHCARE INNOVATIONS, A PET/CT IS A NON-SURGICAL MEANS TO DETERMINE WHETHER A TUMOR IS MALIGNANT OR BENIGN. IT CAN ALSO PINPOINT THE LOCATION OF CANCER AND DETERMINE IF IT HAS RETURNED TO PREVIOUSLY AFFECTED ORGANS OR ELSEWHERE IN THE BODY. A PET/CT SCAN IS ESPECIALLY BENEFICIAL IN THE DIAGNOSIS, STAGING, AND RE-STAGING OF CANCER, AS WELL AS IN THE DIAGNOSIS OF HEART DISEASE. ULTRASOUND ULTRASOUND USES ULTRA HIGH FREQUENCY SOUND WAVES TO PRODUCE IMAGES FOR DIAGNOSTIC REPORTING. IT IS MAINLY USED FOR PREGNANCY, ABDOMINAL ORGANS, BLOOD FLOW TO THE EXTREMITIES AND NEEDLE PLACEMENT DURING BIOPSIES. X-RAY X-RAYS ARE USEFUL TOOLS FOR EXAMINING THE SKELETAL SYSTEM AND CERTAIN SOFT TISSUE DISEASES. CH OFFERS BOTH DIGITAL AND NON-DIGITAL EQUIPMENT. THE EMERGENCY DEPARTMENT IS EQUIPPED WITH DIGITAL X-RAY EQUIPMENT TO REDUCE THE TURNAROUND TIME FOR PATIENT NEEDING ROUTINE EXAMS. REHABILITATION SERVICES ----------------------- CH COMBINES TRAINED, EXPERIENCED THERAPISTS WITH THE MOST ADVANCED EQUIPMENT AVAILABLE TODAY. CH'S MULTI-DISCIPLINARY TEAM PROVIDES TREATMENT FOR WORK, HOME OR SPORTS-RELATED INJURIES AS WELL AS CONDITIONS STEMMING FROM ILLNESS OR ACCIDENTS. FROM INITIAL ASSESSMENT TO RECOVERY, CH'S STAFF CONSISTENTLY SCORES WELL ABOVE NATIONAL STANDARDS FOR CARE IN A VARIETY OF AREAS. PHYSICAL THERAPY - CH'S THERAPISTS APPLY PROVEN TECHNIQUES TO ENSURE THAT INJURED WORKERS RETURN TO THE JOB QUICKLY, AND ARE TRAINED TO AVOID INJURING THEMSELVES AGAIN. FOR SPORTS INJURIES, CH CONCENTRATES ITS EFFORTS ON HELPING ATHLETES GET BACK TO COMPETITION AS SOON AS POSSIBLE. IN CASES WHERE PROBLEMS HAVE RESULTED FROM ARTHRITIS, STROKE AND HEART DISEASE, CH'S TEAM'S MAIN GOAL IS TO RESTORE FUNCTION TO EACH PATIENT. OCCUPATIONAL THERAPY - OCCUPATIONAL THERAPISTS EVALUATE AND TREAT PATIENTS TO IMPROVE THEIR PHYSICAL, DEVELOPMENTAL OR COGNITIVE ABILITIES TO PERFORM DAILY ACTIVITIES. THE FOCUS IS TO PROMOTE INDEPENDENCE IN "LIFE SKILLS". CH OCCUPATIONAL THERAPISTS HAVE ALSO COMPLETED ADDITIONAL TRAINING AS CERTIFIED HAND THERAPISTS. THEY WORK CLOSELY WITH THE REFERRING PHYSICIANS TO HELP PATIENTS RECOVER FROM COMPLEX HAND INJURIES OR SURGERY. SPEECH-LANGUAGE PATHOLOGY - CH'S SPECIALLY TRAINED TEAM USES THE MOST ADVANCED DIAGNOSTIC AND TREATMENT RESOURCES AVAILABLE TO HELP PEOPLE WHO HAVE LOST THE ABILITY TO SPEAK OR SWALLOW, AND THOSE WITH DIMINISHED CAPABILITIES. 6. SLEEP HEALTH INSTITUTE THE SLEEP HEALTH INSTITUTE AT CH IS A COMPREHENSIVE DIAGNOSTIC AND TREATMENT CENTER SPECIALIZING IN THE CARE OF ADULTS AND CHILDREN WITH SLEEP PROBLEMS. THE STAFF AT THE SLEEP HEALTH INSTITUTE AT CH KNOWS THE IMPORTANCE OF A RESTFUL SLEEP. SLEEP IS A BASIC NECESSITY OF LIFE, AS IMPORTANT TO HEALTH AND WELL BEING AS AIR, FOOD AND WATER. A GOOD NIGHT'S SLEEP RESULTS IN HIGH LEVELS OF ENERGY AND ALERTNESS DURING THE WAKING HOURS. UNFORTUNATELY, HALF OF ALL AMERICANS WILL LACK THE BENEFITS OF SUFFICIENT SLEEP AT SOME POINT DURING THEIR LIVES. THERE ARE 84 DOCUMENTED SLEEP DISORDERS, WHICH MAY IMPACT AN INDIVIDUAL'S ABILITY TO SLEEP. THE SLEEP HEALTH INSTITUTE AT CH IS DEVOTED TO DIAGNOSING AND TREATING A FULL RANGE OF SLEEP DISTURBANCES IN ADULTS AND CHILDREN. THE SLEEP STUDY --------------- A COMPREHENSIVE SLEEP STUDY, WHICH IS PAINLESS, INVOLVES AN OVERNIGHT STAY IN CH'S COMFORTABLE, HOME LIKE SLEEP CENTER. EACH PATIENT IS PROVIDED WITH HIS/HER OWN PRIVATE BEDROOM WHERE THEIR SLEEP EVALUATION IS CARRIED OUT IN TOTAL PRIVACY. STATE-OF-THE-ART EQUIPMENT MONITORS BRAIN WAVES, EYE MOVEMENTS, BREATHING, BLOOD-OXYGEN LEVELS, HEART RATE AND MUSCLE ACTIVITY DURING SLEEP TO DETERMINE IF A SLEEP DISORDER IS PRESENT. A BOARD CERTIFIED SLEEP PHYSICIAN WILL REVIEW THE FINDINGS AND PROVIDE A COMPLETE REPORT INCLUDING CONCLUSIONS AND THERAPEUTIC RECOMMENDATIONS. IF REQUESTED, A REPORT WILL BE SENT TO A PATIENT'S PRIVATE PHYSICIAN. SNORING AND SLEEP APNEA ----------------------- SNORING MAY BE A SYMPTOM OF A SERIOUS SLEEP DISORDER CALLED SLEEP APNEA. PEOPLE WITH SLEEP APNEA HAVE PAUSES IN BREATHING FOR 10 TO 100 SECONDS DURING SLEEP. MOST EXPERIENCE LOUD SNORING, CHOKING, AND GASPING SOUNDS WHILE STRUGGLING TO BREATHE. THE PATIENT MAY NOT HAVE ANY SYMPTOMS AND BE UNAWARE OF HIS/HER PROBLEM AND IT MAY BE ONLY BROUGHT TO THEIR ATTENTION BY THEIR SPOUSE OR BED PARTNER. UN-REFRESHING SLEEP AND, SOMETIMES DAYTIME SLEEPINESS IS A SYMPTOM. NUMEROUS THERAPIES ARE AVAILABLE TO TREAT THIS DISORDER. IF LEFT UNTREATED, THE SNORING AND SLEEP APNEA FREQUENTLY HAS SERIOUS HEALTH CONSEQUENCES. THERE IS AN INCREASE INCIDENCE OF HEART ATTACK, STROKE, AND OTHER MEDICAL DISORDERS THAT MAY BE LIFE THREATENING. SLEEP DISORDERS IN CHILDREN --------------------------- THE SLEEP HEALTH INSTITUTE AT CH PROVIDES DIAGNOSTICS AND THERAPY FOR CHILDREN OF ALL AGES. THIS INCLUDES TODDLERS, PRE-TEENS AND TEENAGERS. PEOPLE OFTEN THINK OF SNORING AS LIMITED TO ADULTS ONLY; BUT SNORING IN CHILDREN AND ADOLESCENTS IS A SERIOUS PROBLEM THAT NEEDS MEDICAL ATTENTION. EVEN A FEW EPISODES OF SLEEP APNEA IN THIS AGE GROUP COULD HAVE A PROFOUND IMPACT ON THE DAILY LIFE AND SCHOOL PERFORMANCE. UNRECOGNIZED SLEEP APNEA MAY CONTRIBUTE TO SYMPTOMS OF HYPERACTIVITY, SCHOOL PROBLEMS, AND SOMETIMES THE YOUNG CHILD HAS BEEN LABELED WITH A DIAGNOSIS OF "ATTENTION DEFICIT DISORDER." THERE ARE NUMEROUS OTHER SLEEP DISORDERS WHICH ARE MORE PROMINENT IN CHILDREN AND ADOLESCENTS. THIS INCLUDES NIGHT TERRORS, NARCOLEPSY, NIGHTMARES, SLEEPWALKING, AND DELAYED SLEEP CYCLE SYNDROME. NARCOLEPSY ---------- NARCOLEPSY IS A DISORDER THAT OCCURS IN ALL AGE GROUPS BUT MORE PROMINENTLY IN THE TEENAGE AND EARLY TWENTIES. PATIENTS FREQUENTLY ARE EXCEPTIONALLY SLEEPY DURING THE DAY AND MAY HAVE DIFFICULTY WITH STAYING AWAKE DURING THE DAY. OTHER SYMPTOMS INCLUDE SLEEP PARALYSIS AND "DREAMING DURING THE DAY". NARCOLEPSY IS A NEUROLOGIC DISORDER THAT RESPONDS WELL TO TREATMENT ONCE DIAGNOSED. INSOMNIA -------- INSOMNIA CAN OCCUR FOR A VARIETY OF REASONS, WHICH RESULTS IN AN INDIVIDUAL NOT GETTING A FULL NIGHTS REST. THOSE WITH INSOMNIA MAY HAVE MULTIPLE SYMPTOMS INCLUDING TROUBLE FALLING ASLEEP OR STAYING ASLEEP, OR MAY AWAKEN TOO EARLY.
COMMUNITY BENEFIT STATEMENT CONT'D	CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	7. WEIGHT-LOSS SURGERY CH HAS BEEN NAMED AN AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY ("ASMBS") BARIATRIC SURGERY CENTER OF EXCELLENCE. THE ASMBS CENTER OF EXCELLENCE DESIGNATION RECOGNIZES SURGICAL PROGRAMS WITH A DEMONSTRATED TRACK RECORD OF FAVORABLE OUTCOMES IN BARIATRIC (WEIGHT LOSS) SURGERY. TO EARN A CENTER OF EXCELLENCE DESIGNATION, THE CH BARIATRIC SURGERY PROGRAM UNDERWENT A RIGOROUS SITE INSPECTION DURING WHICH ALL ASPECTS OF CH'S SURGICAL PROCESSES WERE CLOSELY EXAMINED AND DATA ON HEALTH OUTCOMES WAS COLLECTED. SURGICAL REVIEW CORPORATION ("SRC"), A SUBSIDIARY OF ASBMS, IS AN ORGANIZATION DEDICATED TO PURSUING SURGICAL EXCELLENCE IN THE FIELD OF BARIATRIC SURGERY. SRC FORMULATES AND ESTABLISHES THE RIGOROUS STANDARDS WITH WHICH CH MUST COMPLY. THE ORGANIZATION THOROUGHLY INSPECTS AND EVALUATES EACH CANDIDATE FOR DESIGNATION, AND UPON REVIEW, RECOMMENDS APPROVAL OF DESIGNATION FOR THOSE PHYSICIANS AND FACILITIES WHOSE PRACTICES AND OUTCOMES MEET THE STRINGENT DEMANDS SET FORTH BY SRC FOR ASMBS. AS A SERVICE TO THE COMMUNITY, CH SPONSORS ONE FREE MONTHLY WEIGHT-LOSS SURGERY SEMINAR. UNDERSTANDING THE ISSUES ASSOCIATED WITH WEIGHT-LOSS SURGERY BEGINS WITH FULLY EDUCATING YOURSELF ABOUT SEVERE OBESITY, INCLUDING ITS CAUSES AND POTENTIAL EFFECTS ON YOUR HEALTH, YOUR LIFESTYLE AND THE PEOPLE AROUND YOU. FOR CH, IT'S IMPORTANT TO MAKE SURE THAT A PATIENT KNOW AS MUCH AS THEY CAN ABOUT WEIGHT-LOSS SURGERY, SO THAT THEY CAN MAKE AN INFORMED DECISION ABOUT WHETHER IT'S RIGHT FOR THEM. 8. SENIOR HEALTH CH OFFERS AN ARRAY OF SERVICES, FROM DIAGNOSIS, TREATMENT, INPATIENT AND OUTPATIENT REHABILITATION. CH WILL PARTNER WITH INDIVIDUALS TO EDUCATE AND HELP THEM PRACTICE A HEALTHY LIFESTYLE AS THEY AGE, SUCH AS REGULAR PHYSICAL ACTIVITY AND HEALTHY NUTRITION, SCREENING FOR BREAST, CERVICAL, AND COLORECTAL CANCERS, EARLY DETECTION OF DIABETES, ITS COMPLICATIONS, AND DEPRESSION. CH RESPONDS TO YOUR NEEDS IF YOU OR YOUR LOVED ONE HAS AN AGE-RELATED CHRONIC DISEASE OR CONDITION, SUCH AS ALZHEIMER'S DISEASE, ARTHRITIS, DEPRESSION, OSTEOPOROSIS, URINARY INCONTINENCE, DIABETES, AND ITS COMPLICATIONS. THE JOHN A. HARTFORD FOUNDATION INSTITUTE FOR GERIATRIC NURSING DESIGNATED CH AS A NURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERS SITE. THIS NATIONAL DESIGNATION MEANS THAT CH IS COMMITTED TO PUTTING INTO ACTION A SYSTEMATIC CHANGE IN NURSING PRACTICE, WHICH WOULD RESULT IN SENSITIVE AND EXEMPLARY CARE THAT WILL BENEFIT ALL HOSPITALIZED OLDER PATIENTS. CH HAS EMBARKED ON A PROCESS TO ENSURE ALL OF ITS NURSES HAVE SPECIALIZED KNOWLEDGE IN GERIATRIC NURSING, INCLUDING SPECIFIC SYNDROMES AND GERIATRIC CARE. CLOSE TO 50% OF THE POPULATION SERVED BY CH IS OVER 65 YEARS OF AGE. CH EXPECTS TO CONTINUE TO GROW. CH RECOGNIZES THE GROWING AND COMPLEX NEEDS OF ITS SENIORS AND ARE COMMITTED TO CREATING AN OPTIMAL, ENVIRONMENT FOR ITS PATIENTS, WHILE CONTINUING TO BE INSTRUMENTAL IN HELPING THEM AGE SUCCESSFULLY. COMMUNITY SERVICES ------------------ THE DEPARTMENT OF NEW VITALITY SERVICES PROVIDES EDUCATION, SUPPORT, INFORMATION AND REFERRALS FOR OLDER ADULTS AND THEIR FAMILIES, THE CLERGY, HEALTH CARE PROFESSIONALS, LONG-TERM CARE FACILITIES, ASSISTED LIVING FACILITIES, AND OTHER SENIOR RESIDENCES. IN ADDITION, INFORMATION IS PROVIDED TO CORPORATIONS, SCHOOLS, MUNICIPALITIES, AND OTHER COMMUNITY AGENCIES. GERONTOLOGY SERVICES ALSO SPONSORS A FREE HEALTH AND WELLNESS PROGRAM FOR ADULTS 50 AND OLDER CALLED NEW VITALITY. NEW VITALITY ACTS AS A RESOURCE AND REFERRAL NETWORK FOR SENIORS AND THEIR CAREGIVERS INCLUDE: - ADULT DAY CARE - ADULT EDUCATION PROGRAMS - ADULT FOSTER CARE - ADULT RETIREMENT COMMUNITIES - ALZHEIMER'S - ASSISTED LIVING-GROUP HOMES - BOARDING HOMES - CASE MANAGEMENT - CONGREGATE APARTMENTS - CONTINUING CARE RETIREMENT - COMMUNITIES - COUNSELORS - ELDER ABUSE - GERIATRIC ASSESSMENT PROGRAMS - GERIATRICIANS - GROUP HOMES - HOME EMERGENCY RESPONSE SYSTEMS - HOMECARE - HOSPICES - INCOME RESOURCES - LEGAL SERVICES - LONG TERM CARE - MULTI-LEVEL FACILITIES - NUTRITION SITES - RESIDENTIAL CARE FACILITIES - SELF HELP GROUPS - SENIOR CENTERS - SENIOR TOWN HOUSING - SERVICES FOR THE BLIND AND VISUALLY HANDICAPPED - SHARED LIVING - TOWN WELFARE DIRECTORS CH'S NEW VITALITY STAFF IS AVAILABLE FOR PUBLIC SPEAKING ENGAGEMENTS. A SAMPLE OF THE TOPICS ADDRESSED IS: "AGING SENSITIVITY" "SLEEP WELL, FEEL BETTER" "MYTHS AND FACTS ABOUT AGING" "ENCOUNTERING THE STEREOTYPE" "MEDICATION MANAGEMENT" "NUTRITION AND AGING" "MEMORY AND AGING" 9. BREAST IMAGING CENTER OF EXCELLENCE THE CHILTON BREAST CENTER HAS BEEN DESIGNATED A BREAST IMAGING CENTER OF EXCELLENCE (BICOE) BY THE AMERICAN COLLEGE OF RADIOLOGY. IT IS AWARDED TO BREAST IMAGING CENTERS THAT ACHIEVE EXCELLENCE BY SEEKING AND EARNING ACCREDITATION IN ALL OF THE ACR'S VOLUNTARY BREAST-IMAGING ACCREDITATION PROGRAMS AND MODULES, IN ADDITION TO THE MANDATORY MAMMOGRAPHY ACCREDITATION PROGRAM. 10. AMERICAN COLLEGE OF RADIOLOGY THE IMAGING DEPARTMENT AT CHILTON HOSPITAL HAS EARNED CERTIFICATION FROM THE AMERICAN COLLEGE OF RADIOLOGY (ACR) IN THE AREAS OF COMPUTER TOMOGRAPHY (CT), MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE, RADIATION ONCOLOGY, ULTRASOUND AND BREAST IMAGING. 11. TOTAL JOINT CENTER THE TOTAL JOINT CENTER PROVIDES ACUTE CARE TO MEET THE NEEDS OF ORTHOPEDIC AND SURGICAL ADULT AND GERIATRIC PATIENTS FROM THE ONSET OF ILLNESS THROUGH ACUTE RECOVERY AND /OR RESTORATIVE PHASES PROGRESSING TO DISCHARGE OR TO TRANSFER TO SKILLED NURSING OR REHABILITATIVE FACILITIES FOR CONTINUATION OF CARE. THE CENTER CONSISTS OF 24 SINGLE ROOMS AND A REHAB GYM. TWO ROOMS HAVE NEGATIVE PRESSURE CAPABILITY AND ONE ROOM IS A BARIATRIC ROOM. PRE-OPERATIVE JOINT REPLACEMENT PATIENT EDUCATION CLASSES ARE PROVIDED BY THE CLINICAL STAFF AND EDUCATION/SUPPORT CONTINUES THROUGH THE HOSPITALIZATION AND POST-DISCHARGE PHASES OF CARE. 12. WOUND CENTER CHILTON'S WOUND CENTER OFFERS A FULL SPECTRUM OF SERVICES AIMED AT RAPIDLY TREATING THE WOUND, REDUCING COMPLICATIONS AND PROMOTING RECOVERY. OUR UNIQUE PROGRAM HIGHLIGHTS A MULTI-DISCIPLINARY TEAM OF EXPERTS, INCLUDING DOCTORS AND NURSES WHO ARE CERTIFIED IN HYPERBARIC THERAPY, ALONG WITH THE NEWEST, MOST INNOVATIVE TECHNIQUES IN WOUND CARE. SINCE 2007, THE CENTER HAS GROWN TO ACCOMMODATE ABOUT 450 VISITS EACH MONTH. FURTHERMORE, WE BOAST AN OUTSTANDING TRACK RECORD OF SUCCESS. CHILTON'S WOUND CENTER HAS CONSISTENTLY ACHIEVED NATIONAL RECOGNITION FOR OUTSTANDING OUTCOMES AND PATIENT SATISFACTION. IN FACT, WE'VE BEATEN THE NATIONAL HEALING RATE AVERAGE SINCE 1999. OVERVIEW OF SERVICES -------------------- YOUR EXPERIENCE AT THE WOUNDCENTER BEGINS WITH A THOROUGH EVALUATION BY OUR CLINICAL SPECIALISTS, FOLLOWED BY AN INDIVIDUALIZED PLAN OF CARE DESIGNED TO RELIEVE PRESSURE, CONTROL PAIN AND ODOR, ENHANCE TISSUE GROWTH, PRESERVE FUNCTION AND ULTIMATELY HEAL THE WOUND. AT THE SAME TIME, WE ADDRESS THE UNDERLYING CAUSE OF THE WOUND TO MINIMIZE THE CHANCE OF RECURRENCE. RECENTLY, WE PURCHASED STATE-OF-THE-ART EQUIPMENT TO HELP US TEST DIABETIC PATIENTS, WHO REPRESENT NEARLY HALF OF THOSE WE SERVE. THIS MACHINE, CALLED A TRANSCUTANEOUS MONITORING SYSTEM (TCOM), PROVIDES VALUABLE INFORMATION ABOUT OXYGEN FLOW TO THE LEGS AND FEET, REPLACING MORE INVASIVE DIAGNOSTIC PROCEDURES AND DIRECTING THE BEST POSSIBLE COURSE OF TREATMENT. YOUR PROGRESS IS CLOSELY MONITORED DURING EACH VISIT TO ASSESS HEALING AND THE RESULTS OF YOUR THERAPY. HYPERBARIC OXYGEN THERAPY ------------------------- AS A CENTRAL COMPONENT OF OUR PROGRAM, THE WOUND CENTER OFFERS HYPERBARIC OXYGEN (HBO) THERAPY - AN ADVANCED, NON-INVASIVE METHOD OF ACCELERATING THE HEALING PROCESS. OFTEN USED IN CONJUNCTION WITH OTHER WOUND-HEALING STRATEGIES, IT WORKS BY ENCLOSING PATIENTS IN A TRANSPARENT CHAMBER THAT ALLOWS THEM TO BREATHE 100 PERCENT OXYGEN AT INCREASED ATMOSPHERIC PRESSURE. THIS RAISES THE CONCENTRATION OF OXYGEN IN THE BLOOD, WHICH SPEEDS CELL REPAIR AND ULTIMATELY HEALS THE WOUND. HBO THERAPY IS CURRENTLY USED TO TREAT MORE THAN 35 DIFFERENT KINDS OF WOUNDS AND MEDICAL CONDITIONS, SUCH AS CARBON MONOXIDE AND CYANIDE POISONING, DECOMPRESSION SICKNESS, CIRCULATORY PROBLEMS, THERMAL BURNS AND OTHER AILMENTS. AT CHILTON HOSPITAL, WE USE THE SEACHRIST 3600E MODEL, WHICH IS CAPABLE OF SUPPORTING UP TO 700 LBS. THIS ENABLES US TO TREAT LARGER PATIENTS AS WELL AS THOSE WHO SUFFER FROM CLAUSTROPHOBIA. FURTHERMORE, ALL SESSIONS ARE CLOSELY MONITORED BY HYPERBARIC-TRAINED PHYSICIANS AND REGISTERED NURSES.
COMMUNITY BENEFIT STATEMENT CONT'D	CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	COMMUNITY OUTREACH ================== CH IS COMMITTED TO COMMUNITY OUTREACH AND EDUCATION, OFFERING NUMEROUS HEATH CARE RELATED PROGRAMS AND ACTIVITIES, INCLUDING COMMUNITY HEALTH FAIRS, HEALTH SCREENINGS, HEALTH EDUCATION AND MEDICAL LECTURES AND SEMINARS ANNUALLY. CH NEIGHBORS FOR BETTER HEALTH ------------------------------- SINCE 1954, CH HAS BEEN TRULY DEVOTED TO THE COMMUNITY, CONTINUOUSLY SEEKING NEW METHODS OF IMPROVING HEALTH NEEDS. A HIGHLY EFFECTIVE PROCESS WAS ESTABLISHED WITH THE ONSET OF THE CH NEIGHBORS FOR BETTER HEALTH, AN ADVISORY BOARD COMPRISED OF: HEALTH OFFICERS, BUSINESS LEADERS, MEDICAL PROFESSIONALS, COMMUNITY AGENCY REPRESENTATIVES, EDUCATORS, CLERGY, ATTORNEYS AND RESIDENTS. BUILDING ON THE PERSONAL AND PROFESSIONAL EXPERIENCE OF THE ADVISORY BOARD MEMBERS, INNOVATIVE METHODS FOR IMPROVING COMMUNITY HEALTH HAVE RESULTED FROM THIS COLLABORATIVE. "NEIGHBORS FOR HEALTH/CH COMMUNITY COALITION" WAS THE PROJECT'S ORIGINAL NAME. IN THE BEGINNING, THE COALITION DISTRIBUTED 5,000 SURVEYS TO AREA RESIDENTS IN ORDER TO EVALUATE THE HEALTH STATUS AND NEEDS OF THE COMMUNITY. THE RESULTS LED TO THE CREATION OF PROGRAMS NOT ONLY TO ADDRESS THOSE NEEDS, BUT ALSO TO TEACH AND SUPPORT PREVENTATIVE MEASURES. BASED ON THE RESULTS OF THE TOP 10 PRIORITIES, THREE SUBCOMMITTEES WERE FORMED: PSYCHOLOGICAL HEALTH, RESPIRATORY HEALTH AND ADOLESCENT HEALTH. THESE SUBCOMMITTEES WERE RESPONSIBLE FOR DEVELOPING AT LEAST ONE PREVENTIVE HEALTH PROGRAM PER YEAR. EACH SUBCOMMITTEE'S GOAL WAS TO FIND THE BEST RESOURCE TO REACH THE MOST PEOPLE WITH A POSITIVE, EFFECTIVE MESSAGE. IN EACH AREA, GATEKEEPERS - PEOPLE IN THE COMMUNITY WHO CAN HELP OTHERS - WERE IDENTIFIED. THE THREE SUBCOMMITTEES EVOLVED OVER THE YEARS TO BECOME THE SINGLE TASK FORCE THAT CH HAS TODAY. IT MEETS ON A REGULAR BASIS TO DESIGN AND IMPLEMENT PROGRAMS TO ADDRESS VARIOUS HEALTH ISSUES. THE CURRENT TASK FORCE LOOKS AT CURRENT HEALTH PRIORITIES FACING THE COMMUNITIES. THE TASK FORCE SETS PRIORITIES FACING THE COMMUNITIES AND IT WAS DECIDED THAT THE FOLLOWING ISSUES GET ADDRESSED: CAREGIVERS SERIES, TEENAGE DEPRESSION, UNDERAGE DRINKING, INTERNET SAFETY, CYBER BULLYING AND SAFE DRIVING. ADDITIONALLY, THE TASKFORCE DEVELOPED A SERIES OF EDUCATIONAL WEBINARS THAT CAN BE ACCESSED THROUGH THE HOSPITAL WEBSITE AND CAN BE VIEWED IN THE COMFORT OF YOUR OWN HOME OR OFFICE. CH REALIZES THAT PREVENTION IS VITAL FOR MAINTAINING A HEALTHY COMMUNITY AND A HEALTHY FUTURE. EACH YEAR, THE MEMBERS SPEND COUNTLESS HOURS PLANNING, PROMOTING AND PRESENTING VARIOUS EVENTS AROUND THE AREA. EDUCATION AND COMMUNICATION ARE THE COMMON TOOLS THAT THE TASK FORCES EMPLOY TO STRENGTHEN THE COMMUNITY'S HEALTH AWARENESS. COMMUNITY HEALTH ---------------- IN PARTNERSHIP WITH CH, SEVERAL LOCAL HEALTH DEPARTMENTS IN NORTHERN NEW JERSEY OFFERS SCREENINGS, EXAMS, AND EDUCATIONAL PROGRAMS DESIGNED TO ENCOURAGE PREVENTIVE CARE, FOSTER PARTICIPATION IN HEALTH CARE INITIATIVES, AND PROMOTE GREATER AWARENESS OF COMMUNITY HEALTH CARE ISSUES. NEW VITALITY ------------ NEW VITALITY IS AN AWARD-WINNING HEALTH AND WELLNESS PROGRAM TAILORED TO MEET THE NEEDS OF TODAY'S MATURE ADULTS. MEMBERS BENEFIT SOCIALLY, PHYSICALLY, EMOTIONALLY, MENTALLY AND EDUCATIONALLY FROM NEW VITALITY'S EXTENSIVE ROSTER OF LECTURES, WORKSHOPS, CLASSES, SUPPORT GROUPS, TRIPS AND SOCIAL EVENTS. MEMBERSHIP IS FREE. NEW VITALITY OFFERS: - HEALTH SCREENINGS - EXERCISE PROGRAMS INCLUDING T'AI CHI CHIH, YOGA, BETTER BONES, AQUACISE, DANCING AND MALL WALKING - INFORMATION AND REFERRAL SERVICE - FREE, CONFIDENTIAL ASSISTANCE WITH QUESTIONS ABOUT MEDICARE AND SECONDARY INSURANCES - ACCESS TO IN-HOME EMERGENCY-RESPONSE SYSTEMS - ACCESS TO SUPPORT GROUPS - EDUCATIONAL CLASSES AND COURSES ABOUT HEALTH, PERSONAL FINANCES, INSURANCE, ART, MUSIC, NUTRITION, WRITING AND HISTORY - HOLIDAY PARTIES NEW VITALITY OFFERINGS ARE HELD AT CH IN POMPTON PLAINS AND VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. ONGOING NEW VITALITY PROGRAMS AT CH INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: - ALZHEIMER'S DISEASE CAREGIVERS SUPPORT GROUP - BEREAVEMENT SUPPORT GROUP - DIABETES EDUCATION & SUPPORT GROUP - MALL WALKER'S CLUB PARENT EDUCATION ---------------- CH'S PARENT EDUCATION DEPARTMENT OFFERS MANY SEMINARS AND COURSES WHERE PARENTS HAVE THE OPPORTUNITY TO GAIN KNOWLEDGE AND INSIGHT ABOUT ALL ASPECTS OF PARENTING, FROM THE EARLY MONTHS OF PREGNANCY THROUGH THE CHILD'S PRE-SCHOOL YEARS. THE SEMINARS AND COURSES OFFERED INCLUDE: - LAMAZE CHILDBIRTH PREPARATION - BREAST-FEEDING - INFANT CARE - PRENATAL YOGA - MOMMY AND ME YOGA - JUST FOR DADS - SIBLING PREPARATION: NEW ADDITIONS - BABY'S SIBLINGS AT BIRTH - GRANDPARENTS CLASS - NEW MOMS GROUP - BABIES AND PETS - SAFE SITTER - BABY'S FIRST 6 MONTHS - BABY BASICS TRAVEL VACCINATION PROGRAM -------------------------- CH'S TRAVEL VACCINATION PROGRAM OFFERS A COMPREHENSIVE AND AFFORDABLE MEANS FOR SAFE AND CONVENIENT TRAVEL AROUND THE WORLD. AVAILABLE VACCINES INCLUDE VARICELLA (CHICKENPOX), HEPATITIS A OR HEPATITIS B IMMUNE GLOBULIN, HEPATITIS B, JAPANESE ENCEPHALITIS, MEASLES-MUMPS-RUBELLA, MENINGOCOCCAL MENINGITIS, PNEUMOVAX, POLIO, RABIES, TETANUS AND DIPHTHERIA TOXOIDS, PERTUSSIS, TYPHOID FEVER AND YELLOW FEVER. IN ADDITION, PRESCRIPTIONS FOR ANTIBIOTIC PROPHYLAXIS, WHEN INDICATED, WILL BE PROVIDED TO THOSE TRAVELING TO ENDEMIC AREAS FOR MALARIA AND TRAVELER'S DIARRHEA. CPR --- CH PROVIDES CPR TRAINING TO INDIVIDUALS IN THE COMMUNITY. THROUGHOUT THE YEARS CH'S AWARD WINNING CPR TRAINING CENTER HAS TRAINED THOUSANDS OF PEOPLE IN CPR, AED, ACLS AND PALS. CH IS A DESIGNATED COMMUNITY TRAINING CENTER THROUGH THE AMERICAN HEART ASSOCIATION. THE TRAINING OFFERED HELPS TO STRENGTHEN THE CHAIN OF SURVIVAL, ESTABLISHED BY THE AHA, IN EVERY COMMUNITY. THE CHAIN OF SURVIVAL IS INTERLOCKING LINKS OF INTERVENTIONS THAT WILL IMPROVE THE OUTCOMES FOR VICTIMS OF CARDIAC AND RESPIRATORY EMERGENCIES AND STROKE. CH'S CPR TRAINING CENTER NOT ONLY OFFERS ON-SITE CLASSES TO ITS OWN EMPLOYEES BUT ALSO TO THE GENERAL PUBLIC. CH ALSO OFFERS PRIVATE CLASSES FOR THOSE INTERESTED IN TRAINING A GROUP OF INDIVIDUALS. SINCE PUBLIC ACCESS DEFIBRILLATION (PAD) IS A NATIONAL STANDARD, CH'S CPR TRAINING CENTER OFFERS AED CLASSES AS PART OF THE CURRICULUM. CALL CENTER & WEBSITE --------------------- IMMEDIATE ACCESS TO CH IS PROVIDED THROUGH A FREE CALL CENTER, WHICH OFFERS THE PUBLIC CONTACT INFORMATION FOR OVER 600 PHYSICIANS IN MORE THAN 60 SPECIALTIES, REGISTRATION FOR COMMUNITY HEALTH PROGRAMS, DIRECTIONS, AND INFORMATION ABOUT CH PROGRAMS AND SERVICES. CH'S WEBSITE (WWW.CHILTONHEALTH.ORG) BRINGS A WEALTH OF HEALTHCARE INFORMATION TO INDIVIDUALS WITH JUST THE CLICK OF A MOUSE. THE HOMEPAGE IS DESIGNED FOR EASY NAVIGATION, AND CH OFFERS EASY ACCESS HEALTH RESOURCES, INTERACTIVE FEATURES SUCH AS QUIZZES, POLLS, AND SURVEYS, ONLINE PHYSICIAN DIRECTORY WITH PHYSICIAN PHOTOS AND BIOS, AND LINKS TO NUMEROUS PATIENT RESOURCES. OTHER COMMUNITY BENEFIT PROGRAMS, CLASSES AND SUPPORT GROUPS ============================================================ OTHER PROGRAMS, LECTURES AND COURSES OFFERED TO THE COMMUNITY BY CH INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: - SMOKING CESSATION PROGRAMS - ALZHEIMER'S DISEASE CAREGIVERS SUPPORT GROUP - ARTHRITIS SUPPORT GROUP - BEREAVEMENT SUPPORT GROUP - CHOLESTEROL EDUCATION CLASS - COPD SUPPORT GROUP - CPR/EMT TRAINING CENTER - DIABETES EDUCATION & SUPPORT GROUP - DIABETES MANAGEMENT OUTPATIENT EDUCATION AND TEACHING PROGRAM - LIVING WILLS - MALL WALKERS CLUB - NEW VITALITY - NUTRITION COUNSELING - PARENT AND CHILDBIRTH EDUCATION - UNITED OSTOMATES OF NORTH JERSEY - WAYNE READS - WEIGHT LOSS SURGERY SEMINARS - WEIGHT LOSS SURGERY SUPPORT GROUP - WOMAN TO WOMAN - YOUR AGING PARENT AND YOU IN 2011, CH OFFERED 1,250 PROGRAMS, HEALTH SCREENINGS AND EDUCATIONAL CLASSES TO ALL MEMBERS OF THE COMMUNITY.
OTHER PROGRAM SERVICES	CORE FORM, PART III; LINE 4D	EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
GOVERNANCE, MANAGEMENT, AND DISCLOSURE	CORE FORM, PART VI, SECTION A; QUESTION 2	DEBORAH K. ZASTOCKI, FACHE AND JOSEPH SCIAN, M.D. - BUSINESS RELATIONSHIP
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION B; QUESTION 11B	THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S INTERNAL WORKING GROUP, INCLUDING THOSE INDIVIDUALS OUTLINED ABOVE FOR THEIR REVIEW. THE ORGANIZATION'S INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. THE ORGANIZATION'S AUDIT COMMITTEE ALSO HELD A MEETING WITH THE FORM 990 PREPARER IN ORDER TO REVIEW AND APPROVE THE TAX RETURN PRIOR TO PROVIDING A COPY TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF ITS GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION THE ORGANIZATION'S AUDIT COMMITTEE ASSUMED THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 INCLUDING THE PREPARATION, REVIEW AND FILING PROCESS. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL INCLUDING THE CHIEF FINANCIAL OFFICER, DIRECTOR OF ACCOUNTING AND VARIOUS OTHER INDIVIDUALS TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION B; QUESTION 12	THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO THE ORGANIZATION AND THE ORGANIZATION'S PRESIDENT/CHIEF EXECUTIVE OFFICER ("CEO") FOR REVIEW. THEREAFTER THE ORGANIZATION'S PRESIDENT/CEO PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS AND PRESENTS THIS SUMMARY TO THE ORGANIZATION'S GOVERNANCE COMMITTEE FOR ITS REVIEW AND DISCUSSION.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION B; QUESTION 15	THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING BUT NOT LIMITED TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS.
DISCLOSURE INFORMATION	CORE FORM, PART VI, SECTION C; QUESTION 19	THE ORGANIZATION HAS ISSUED TAX-EXEMPT BONDS TO FINANCE VARIOUS CAPITAL IMPROVEMENT PROJECTS, RENOVATIONS AND EQUIPMENT. IN CONJUNCTION WITH THE ISSUANCE OF THESE TAX-EXEMPT BONDS, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED WITH THE TAX-EXEMPT BOND PROSPECTUS WHICH WAS MADE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW. IN ADDITION, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC ON A QUARTERLY BASIS, IN COMPLIANCE WITH THE DISCLOSURE REQUIREMENTS OF THE TAX-EXEMPT BONDS. THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY SECRETARY OF STATE.
COMPENSATION INFORMATION DISCLOSURE	CORE FORM, PART VII AND SCHEDULE J	PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THE ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION; NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THE ORGANIZATION'S BOARD OF TRUSTEES.
RELATED HOURS DISCLOSURE	CORE FORM, PART VII, SECTION A, COLUMN B	THIS ORGANIZATION IS AN AFFILIATE WITHIN CHILTON HEALTH NETWORK; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM INCLUDES BOTH FOR-PROFIT AND NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF TRUSTEE MEMBERS, OFFICERS AND/OR DIRECTORS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM, 990 FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENTS THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF TRUSTEES OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY ONE HOUR. THE HOURS REFLECTED ON PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE SYSTEM; NOT SOLELY THIS ORGANIZATION.
BALANCE SHEET RESTATEMENT	CORE FORM, PART X	THE 2010 CONSOLIDATED FINANCIAL STATEMENTS HAVE BEEN RESTATED TO CORRECT THE REPORTING OF OPERATING ROOM INVENTORY. THE HOSPITAL HAD NOT PREVIOUSLY RECORDED AN ASSET FOR OPERATING ROOM INVENTORY HELD FOR USE, AS REQUIRED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. ACCORDINGLY, PREVIOUSLY ISSUED CONSOLIDATED FINANCIAL STATEMENTS WERE RESTATED TO RECOGNIZE THE IMPACT OF THIS REPORTING. THE EFFECT OF THE RESTATEMENT WAS TO INCREASE UNRESTRICTED NET ASSETS BY $2,018,133 AS OF JANUARY 1, 2010. THE BEGINNING BALANCES ON CORE FORM, PART X HAVE BEEN ADJUSTED ACCORDINGLY. ACCORDINGLY.
OTHER CHANGES IN NET ASSETS	CORE FORM, PART XI; QUESTION 5	OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - CHANGE IN UNREALIZED GAINS AND LOSSES ON INVESTMENTS - ($669,221) - NET ASSETS RELEASED FROM RESTRICTION USED FOR PROPERTY AND EQUIPMENT - $1,041,176 - PENSION LIABILITY ADJUSTMENT - ($22,746,815) - NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - $2,034,639 - CONTRIBUTION FROM CHILTON MEMORIAL HOSPITAL FOUNDATION, INC. REFLECTED IN SCHEDULE B - ($1,826,323)
AUDITED FINANCIAL STATEMENTS	CORE FORM, PART XII; QUESTION 2	AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC. AND ITS CONTROLLED AFFILIATE; CHILTON MEMORIAL HOSPITAL FOUNDATION, FOR THE YEARS ENDED DECEMBER 31, 2011 AND DECEMBER 31, 2010; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINED CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE FORREST S. CHILTON 3RD MEMORIAL HOSPITAL, INC. AUDIT COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION, AND THE SELECTION OF AN INDEPENDENT AUDITOR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

FORREST S CHILTON 3RD MEMORIAL HOSP

Employer identification number

22-1559402

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHILTON MEMORIAL CORPORATION 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-2719339	SUPPORT CMH	NJ	501(C)(3)	509(A)(1)	NA		No
(2) CHILTON MEMORIAL HOSPITAL FDN INC 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-3084817	SUPPORT CMH	NJ	501(C)(3)	509(A)(3)	CMH	Yes
(3) CHILTON REALTY HOLDING INC 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-3067739	REAL ESTATE	NJ	501(C)(2)	N/A	CMC		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) CHILTON COMMUNITY CARE INC 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-2869148	CHILD CARE SVCS.	NJ	NA	C CORP.
(2) CHILTON PROFESSIONAL PRACTICE CORP 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-3244165	HEALTH SVCS.	NJ	NA	C CORP.
(3) CHILTON SPORTS MED& REHAB MGMT INC 97 WEST PARKWAY POMPTON PLAINS,NJ07444 22-3119481	HEALTH SVCS.	NJ	NA	C CORP.

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) CHILTON MEMORIAL HOSPITAL FOUNDATION	C	1,826,323	COST
(2) CHILTON MEMORIAL HOSPITAL FOUNDATION	L	506,000	COST
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROMOTE WELLNESS AND PROVIDE COMPASSIONATE CARE AND HEALING.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	1,739
6	Total number of volunteers (estimate if necessary) ....	6	300
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,647,532	2,118,230
9	Program service revenue (Part VIII, line 2g) .........	160,810,190	166,021,406
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,980,181	1,433,566
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	841,437	869,372
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	165,279,340	170,442,574
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	6,000	15,126
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	90,318,608	92,757,593
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	70,072,285	76,606,679
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	160,396,893	169,379,398
19	Revenue less expenses. Subtract line 18 from line 12.......	4,882,447	1,063,176
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	152,862,784	166,789,864
21	Total liabilities (Part X, line 26).............	88,941,830	123,972,278
22	Net assets or fund balances. Subtract line 21 from line 20.....	63,920,954	42,817,586

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 8,882,992 including grants of $ 0 ) (Revenue $ 6,431,028 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY INPATIENT AND OUTPATIENT PHARMACEUTICAL SUPPLIES AND SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4b	(Code: ) (Expenses $ 6,408,039 including grants of $ 0 ) (Revenue $ 9,788,982 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY INPATIENT AND OUTPATIENT LABORATORY SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4c	(Code: ) (Expenses $ 4,615,648 including grants of $ 0 ) (Revenue $ 16,828,035 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 132,536,293 including grants of $ 15,126 ) (Revenue $ 132,973,361 )
4e	Total program service expenses$ 152,442,972

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,517,751	0	350,827

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,051,323
e	Government grants (contributions)1e		66,907

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			2,118,230
			Business Code
2a	NET PATIENT SERVICE REVENUE		541,900	160,821,312	160,821,312
b	OTHER HEALTHCARE RELATED REVENUE		541,900	5,200,094	5,200,094
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			166,021,406
3	Investment income (including dividends, interest
	and other similar amounts).....			1,292,601			1,292,601
4	Income from investment of tax-exempt bond proceeds..			19,138			19,138
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	574,929
b	Less: rental expenses
c	Rental income or (loss)	574,929
d	Net rental income or (loss).......			574,929			574,929
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	324,435	795
b	Less: cost or other basis and sales expenses	143,172	60,231
c	Gain or (loss)	181,263	-59,436
d	Net gain or (loss)..........			121,827			121,827
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	EMPLOYEE MEALS		722,210	283,772			283,772
b	VENDING MACHINES		900,099	10,671			10,671
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			294,443
12	Total revenue. See Instructions....			170,442,574	166,021,406		2,302,938


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			1,848	1	1,653
2	Savings and temporary cash investments .......			10,837,331	2	12,387,480
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			17,294,322	4	19,182,165
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			61,650	7	208,093
8	Inventories for sale or use ..............			3,024,904	8	2,993,999
9	Prepaid expenses and deferred charges ............			1,128,136	9	2,022,406
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	178,390,302
b	Less: accumulated depreciation. .....	10b	112,462,626	62,212,035	10c	65,927,676
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			56,092,205	13	59,677,786
14	Intangible assets .........			0	14	116,000
15	Other assets. See Part IV, line 11 ...........			2,210,353	15	4,272,606
16	Total assets. Add lines 1 through 15 (must equal line 34)...			152,862,784	16	166,789,864
17	Accounts payable and accrued expenses .			17,676,976	17	21,894,021
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			38,510,136	20	44,390,892
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			32,754,718	25	57,687,365
26	Total liabilities. Add lines 17 through 25.....			88,941,830	26	123,972,278
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			58,710,637	27	35,572,630
28	Temporarily restricted net assets .....			3,089,684	28	5,124,323
29	Permanently restricted net assets .....			2,120,633	29	2,120,633
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			63,920,954	33	42,817,586
34	Total liabilities and net assets/fund balances .....			152,862,784	34	166,789,864