Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
HOLY NAME MEDICAL CENTER
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
718 TEANECK ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
TEANECK, NJ07666
D Employer identification number

22-1487322
E Telephone number

G Gross receipts $ 329,673,414
F Name and address of principal officer:
MICHAEL MARON
718 TEANECK ROAD
TEANECK,NJ07666
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HOLYNAME.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1958
M State of legal domicile: NJ
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE QUALITY MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN THE COMMUNITY REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 21
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 19
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 2,362
6 Total number of volunteers (estimate if necessary) ............. 6 720
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  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,138,611 574,625
9 Program service revenue (Part VIII, line 2g) ......... 300,095,758 314,241,680
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 8,591,050 2,144,762
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,313,150 3,486,361
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 313,138,569 320,447,428
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 182,588 101,542
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) 154,034,098 161,039,825
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 130,967,577 137,571,186
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 285,184,263 298,712,553
19 Revenue less expenses. Subtract line 18 from line 12....... 27,954,306 21,734,875
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 324,392,964 333,952,585
21 Total liabilities (Part X, line 26)............. 181,313,932 183,402,268
22 Net assets or fund balances. Subtract line 21 from line 20..... 143,079,032 150,550,317
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: HOLY NAME MEDICAL CENTER IS A COMMUNITY OF CAREGIVERS COMMITTED TO A MINISTRY OF HEALING, EMBRACING THE TRADITION OF CATHOLIC PRINCIPLES, THE PURSUIT OF PROFESSIONAL EXCELLENCE, AND CONSCIENTIOUS STEWARDSHIP. THE MEDICAL CENTER HELPS THE COMMUNITY ACHIEVE THE HIGHEST ATTAINABLE LEVEL OF HEALTH THROUGH EDUCATION, PREVENTION AND TREATMENT.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 137,864,433 including grants of $ 0 ) (Revenue $ 139,669,103 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY INPATIENT 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.
4b (Code:   ) (Expenses $ 117,443,710 including grants of $ 0 ) (Revenue $ 146,514,299 )
EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY OUTPATIENT 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.
4c (Code:   ) (Expenses $ 13,441,766 including grants of $ 0 ) (Revenue $ 22,644,265 )
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 THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
4d Other program services (Describe in Schedule O.)
(Expenses $ 101,542 including grants of $ 101,542 ) (Revenue $ 5,414,013 )
4e Total program service expensesMediumBullet268,851,451
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
Yes
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
145
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,362
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
21
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
19
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletRYAN KENNEDY CPA
718 TEANECK ROAD
TEANECK,NJ07666 (201) 833-7016
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) ROBERT BRITZ........................................................................
CHAIRMAN - TRUSTEE
1.0
.......................0.0
X   X       0 0 0
(2) JOHN GERAGHTY........................................................................
VICE-CHAIRMAN - TRUSTEE
1.0
.......................0.0
X   X       0 0 0
(3) SISTER BARBARA MORAN CJSP........................................................................
SECRETARY - TRUSTEE
1.0
.......................0.0
X   X       0 0 0
(4) EDWIN H RUZINSKY CPA........................................................................
TREASURER - TRUSTEE
1.0
.......................0.0
X   X       0 0 0
(5) ARNOLD BALSAM........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(6) DAVID BUTLER MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(7) FRANK BRUNETTI ESQ........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(8) TED A CARNEVALE CPA........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(9) DALE A CREAMER........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(10) JOSEPH FRASCINO MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(11) SISTER ANNE HAYES CSJP........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(12) DAVID E LANDERS MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(13) SALVATORE LARAIA MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(14) DANIEL LEBER........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(15) MICHAEL MARON........................................................................
TRUSTEE- PRESIDENT/CEO
55.0
.......................0.0
X   X       1,680,872 0 496,915
(16) SISTER ANTOINETTE MOORE CSJP........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(17) JOSEPH PARISI JR........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
Form 990 (2014)
Form 990 (2014)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) SISTER ANN RUTAN CJSP........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(19) SISTER ANN TAYLOR CJSP........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(20) LEON TEMIZ........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(21) RONALD WHITE MD........................................................................
TRUST-PRESIDENT, MEDICAL STAFF
55.0
.......................0.0
X   X       0 0 0
(22) JOSEPH M LEMAIRE TERM 627........................................................................
TRUSTEE - ASST SEC/ASST TREAS
55.0
.......................0.0
X   X       722,025 0 24,927
(23) RYAN KENNEDY CPA........................................................................
VP; CHIEF FINANCIAL OFFICER
55.0
.......................0.0
    X       382,331 0 21,295
(24) ADAM JARRETT MD........................................................................
CHIEF MEDICAL OFFICER
55.0
.......................0.0
      X     700,302 0 142,171
(25) SHERYL SLONIM........................................................................
SENIOR VP; PATIENT CARE SVCS
55.0
.......................0.0
      X     580,539 0 207,325
(26) MICHAEL SKVARENINAEFF 62214........................................................................
CHIEF INFORMATIONAL OFFICER
55.0
.......................0.0
      X     279,803 0 26,213
(27) JOHN GRANGEIA TERM 12714........................................................................
VP; PROFESSIONAL SERVICES
55.0
.......................0.0
      X     272,829 0 11,692
(28) STEVEN MOSSER........................................................................
VP; FACILITIES
55.0
.......................0.0
      X     269,031 0 31,591
(29) CYNTHIA KAUFHOLD........................................................................
VP; REVENUE CYCLE MANAGEMENT
55.0
.......................0.0
      X     235,271 0 36,841
(30) MARYANN KICENUIK EFF 71414........................................................................
VP; LEGAL SERVICES
55.0
.......................0.0
      X     225,237 0 13,787
(31) RICHARD VAN EERDE EFF 62214........................................................................
VP; FINANCE
55.0
.......................0.0
      X     191,013 0 16,166
(32) APRIL RODGERS........................................................................
VP; HUMAN RESOURCES
55.0
.......................0.0
      X     168,220 0 26,003
(33) SHARAD WAGLE MD........................................................................
MEDICAL DIRECTOR
55.0
.......................0.0
        X   357,505 0 24,831
(34) RAVIT BARKAMA........................................................................
EXEC DIR CLINICAL RESEARCH
55.0
.......................0.0
        X   348,217 0 34,691
(35) KYUNG-HEE CHOI........................................................................
VP; KOREAN MEDICAL PROGRAM
55.0
.......................0.0
        X   241,200 0 8,693
(36) ALLAN J CAGGIANO........................................................................
PHYSICIST
55.0
.......................0.0
        X   228,969 0 31,048
(37) DEBORAH ZAYAS........................................................................
VP; NURSING SERVICES
55.0
.......................0.0
        X   225,844 0 15,477
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,109,208 0 1,169,666
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet239
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ALOYSIUS BUTLER CLARK,
PO BOX 672
WILMINGTON,DE198990672
ADVERTISING 2,951,466
CLAUDIO BOZZO SON INC,
503 FARLEY ROAD
WHITEHOUSE STATION,NJ08889
CONSTRUCTION 2,836,791
MAYO COLLABORATIVE SERVICES INC,
PO BOX 9146
MINNEAPOLIS,MN554809146
LABORATORY 1,265,979
GE MEDICAL SYSTEMS INFORMATION TECH,
15724 COLLECTIONS CENTER DRIVE
CHICAGO,IL60693
MAINTENANCE/SERVICE 1,215,864
TRIMEDX INC,
PO BOX 636129
CINCINNATI,OH452636129
MAINTENANCE/SERVICE 917,173
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet96
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 122,978
f All other contributions, gifts, grants, and
similar amounts not included above
1f
451,647
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 574,625
 Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 541900 308,849,124 308,849,124    
b OTHER HEALTHCARE RELATED REVENUE 541900 3,192,446 3,192,446    
c SCHOOL OF NURSING 900099 2,200,110 2,200,110    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 314,241,680
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 574,445     574,445
4 Income from investment of tax-exempt bond proceeds..MediumBullet 828,410     828,410
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,062,878  
b Less: rental expenses 798,688  
c Rental income or (loss) 264,190 0
d Net rental income or (loss).......MediumBullet 264,190     264,190
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 9,158,105 11,100
b Less: cost or other basis and sales expenses 8,423,280 4,018
c Gain or (loss) 734,825 7,082
d Net gain or (loss)..........MediumBullet 741,907     741,907
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..MediumBullet 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...MediumBullet 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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 900099 1,924,742     1,924,742
b DAY CARE 624410 952,894     952,894
c TELEVISION & TELEPHONE 517000 344,535     344,535
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 3,222,171
12 Total revenue. See Instructions......MediumBullet 320,447,428 314,241,680   5,631,123
Form 990 (2014)
Form 990 (2014)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
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 domestic organizations and domestic governments. See Part IV, line 21 .... 31,317 31,317
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 70,225 70,225
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 .... 6,798,399 6,118,559 679,840  
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 .... 127,711,600 114,940,440 12,771,160  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,499,564 2,249,608 249,956  
9 Other employee benefits ....... 9,606,403 8,645,762 960,641  
10 Payroll taxes ........... 14,423,859 12,981,473 1,442,386  
11 Fees for services (non-employees):        
a Management ...... 25,000 22,500 2,500  
b Legal ......... 821,512 739,361 82,151  
c Accounting ........... 239,412 215,471 23,941  
d Lobbying ........... 88,441 79,597 8,844  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 197,623 177,861 19,762  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 3,434,590 3,091,131 343,459  
12 Advertising and promotion .... 5,038,981 4,535,083 503,898  
13 Office expenses ....... 18,640,432 16,776,389 1,864,043  
14 Information technology ...... 33,187 29,868 3,319  
15 Royalties .. 0      
16 Occupancy ........... 4,486,131 4,037,518 448,613  
17 Travel ............ 444,882 400,394 44,488  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 249,646 224,681 24,965  
20 Interest ........... 5,373,579 4,836,221 537,358  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 16,705,973 15,035,376 1,670,597  
23 Insurance .............. 1,911,557 1,720,401 191,156  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 49,657,066 44,691,359 4,965,707 0
b PURCHASED SERVICES 9,639,588 8,675,629 963,959  
c REPAIRS 7,742,366 6,968,129 774,237  
d PHYSICIAN FEES 7,518,434 6,766,591 751,843  
e All other expenses 5,322,786 4,790,507 532,279  
25 Total functional expenses. Add lines 1 through 24e 298,712,553 268,851,451 29,861,102 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 297,269 1 536,118
2 Savings and temporary cash investments ......... 30,365,167 2 26,181,496
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 31,182,657 4 33,942,669
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 4,819,713 8 5,746,602
9 Prepaid expenses and deferred charges .......... 3,850,373 9 3,429,980
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 373,569,247
b Less: accumulated depreciation ..... 10b 236,080,411 136,198,277 10c 137,488,836
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 ..... 87,076,130 13 92,086,480
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 30,603,378 15 34,540,404
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 324,392,964 16 333,952,585
Liabilities 17 Accounts payable and accrued expenses ......... 39,925,933 17 42,745,685
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 311,804 19 252,356
20 Tax-exempt bond liabilities ............. 113,663,777 20 110,626,868
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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 .. 3,173,593 23 6,919,129
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.................... 24,238,825 25 22,858,230
26 Total liabilities. Add lines 17 through 25......... 181,313,932 26 183,402,268
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 132,139,565 27 137,222,578
28 Temporarily restricted net assets ........... 9,929,467 28 13,317,739
29 Permanently restricted net assets ........... 1,010,000 29 10,000
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 143,079,032 33 150,550,317
34 Total liabilities and net assets/fund balances ........ 324,392,964 34 333,952,585
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
320,447,428
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
298,712,553
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
21,734,875
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
143,079,032
5
Net unrealized gains (losses) on investments ...............
5
974,503
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-15,238,093
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
150,550,317
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? .................
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2014
(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2015. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......... 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 its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
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


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2014)

Additional Data


Software ID:  
Software Version:  
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 Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ......................................

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable 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) 2014


Schedule C (Form 990 or 990-EZ) 2014
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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
60,000
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
28,441
j
Total. Add lines 1c through 1i ...............................
88,441
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
SCHEDULE C, PART II-B; LINES 1G AND 1I DURING 2014, HOLY NAME MEDICAL CENTER PAID AN OUTSIDE INDEPENDENT LOBBYING FIRM $60,000 FOR LOBBYING ON A FEDERAL AND STATE LEVEL RELATED TO MEDICARE, MEDICAID AND OTHER HEALTHCARE LEGISLATIVE MATTERS. THE ORGANIZATION HAS ALLOCATED TOWARD LOBBYING ACTIVITY A PERCENTAGE OF TOTAL 2014 COMPENSATION PAID TO THE VICE PRESIDENT OF PLANNING AND GOVERNMENT AFFAIRS TO REPRESENT TIME SPENT ADDRESSING FEDERAL AND STATE HEALTHCARE MATTERS. THIS ALLOCATION AMOUNTED TO $13,110. THE ORGANIZATION IS A MEMBER OF THE NEW JERSEY HOSPITAL ASSOCIATION WHICH ENGAGES IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $15,331.
Schedule C (Form 990 or 990EZ) 2014

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
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 value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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.
1a
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 XIII, the text of the footnote to its financial statements that describes these items.
b
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)
Revenue included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
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:
a
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 10,939,467 9,434,352 7,897,777 8,479,363 12,058,693
b Contributions ........ 4,169,163 2,874,632 3,782,260 442,431 501,730
c Net investment earnings, gains, and losses 89,883 233,966 193,148 -46,614 193,750
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........
1,870,774 1,603,483 2,438,833 977,403 4,274,810
f Administrative expenses ....          
g End of year balance ...... 13,327,739 10,939,467 9,434,352 7,897,777 8,479,363
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet0.075 %
c
Temporarily restricted endowment SchDMd Bullet99.925 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   3,471,294 3,471,294
b Buildings ................   192,027,964 99,043,830 92,984,134
c Leasehold improvements ............        
d Equipment ................   173,545,216 134,792,373 38,752,843
e Other .................   4,524,773 2,244,208 2,280,565
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 137,488,836
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) GOVERNMENT SECURITIES 49,104,627 F
(2) MORGAN STANLEY SWEEP ACCOUNT 6,162,528 F
(3) TD WEALTH MGMT US GOVT 1,093,829 F
(4) NORTH JERSEY COMMUNITY BANK 0 F
(5) DEPOSIT 894,762 F
(6) GEM REALTY SECURITIES, LTD 1,997,845 F
(7) MS CAPITAL PARTNERS V 1,481,451 F
(8) CARLSON CAPITAL DOUBLE BLACK   F
(9) CERBERUS INTERNATIONAL, LTD 417,310 F
(10) YORK CREDIT OPPORTUNITIES FUND   F
(11) BREVAN HOWARD FUND LTD CLASS B   F
(12) INTEREST IN FOUNDATION 3,770,456 F
(13) CASH & CASH EQUIVALENTS 17,157,130 F
(14) QUALCARE ALLIANCE NETWORKS INC 441,806 F
(15) ACCRUED INTEREST 280,370 F
(16) CERTIFICATES OF DEPOSIT 2,117,371 F
(17) EQUITY SECURITIES 7,083,813 F
(18) TACONIC OPPORTUNITIES UNIT TR.   F
(19) MS OPPORTUNISTIC MORTGAGE INC. 83,182 F
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 92,086,480
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 19,373,324
(2) DEFERRED FINANCING COSTS 1,487,961
(3) OTHER RECEIVABLES 8,494,552
(4) OTHER ASSETS 5,184,567





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 34,540,404
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DUE TO THIRD-PARTY PAYORS 392,113
OTHER LIABILITIES 5,175,838
ASSET RETIREMENT OBLIGATION 103,538
DUE TO AFFILLIATES 17,186,741





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 22,858,230
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 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 XIII.) ........... 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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ............ 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 XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE D, PART V; QUESTION 4 ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH INTENT AND IN FURTHERANCE OF THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria
used to award the grants or assistance? ...........................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total expenditures
for and investments
in region
Central America and the Caribbean 1 1 Investments INVESTMENTS 104,908
Central America and the Caribbean 1   Investments INVESTMENTS 116,950
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 2 1 221,858
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 2 1 221,858
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(a)(c) Region (b)(d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; do not file with Form 990)............................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)...............................................
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713; do not file with Form 990).....................................
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
ReturnReference Explanation
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2014
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining eligibility for free or discounted care.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
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? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (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) ..
    5,464,503 1,192,692 4,271,811 1.430 %
b Medicaid (from Worksheet 3,
column a) ....
    33,665,157 23,815,405 9,849,752 3.300 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    39,129,660 25,008,097 14,121,563 4.730 %
Other Benefits
    3,666,076 6,887 3,659,189 1.220 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    576,750 800 575,950 0.190 %
g Subsidized health services
(from Worksheet 6) ..
    26,119,235 17,084,740 9,034,495 3.020 %
h Research (from Worksheet 7)     445,853 0 445,853 0.150 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    186,068 0 186,068 0.060 %
j Total. Other Benefits ..     30,993,982 17,092,427 13,901,555 4.640 %
k Total. Add lines 7d and 7j .     70,123,642 42,100,524 28,023,118 9.370 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
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     1,361 0 1,361 0 %
3 Community support     23,227 0 23,227 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members     26,374 0 26,374 0.010 %
6 Coalition building     2,075 0 2,075 0 %
7 Community health improvement advocacy     16,304 0 16,304 0.010 %
8 Workforce development     10,540 0 10,540 0 %
9 Other            
10 Total     79,881 0 79,881 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
12,405,063
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
4,883,886
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
122,784,554
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
133,358,425
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-10,573,871
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 HOLY NAME MEDICAL CENTER
718 TEANECK ROAD
TEANECK,NJ07666
WWW.HOLYNAME.ORG
10205
X X         X     1
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10 Yes  
a If "Yes" (list url): WWW.HOLYNAME.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule h, part v; section b, question 3j Detailed data tables (vs. Simple descriptions) are included in the chna to enhance understanding.
Schedule h, part v, section b, question 5 Over 80 interviews were conducted including primary care providers; behavioral health providers; elder services provider; social services; hospital clinical providers and administrative staff; public health officials; public housing staff; advocacy organizations; faith-based organizations and public officials.
Schedule h, part v, section b, questions 6a & 6b Hackensack university medical center, englewood hospital and medical center, the valley hospital and christian health care center collaborated on a county-wide chna. Holy name created an accompanying chna addressing its specific service areas. The community health improvement partnership ("chip") of bergen county was also a partnering organization in the creation of the chna.
Schedule h, part v, section b, question 7d The chna was also discussed at the annual open public meeting of the bergen county community health improvement plan, and made available at the medical center's annual open public meeting.
Schedule h, part v, section b, question 11 Both the bergen county chna and the medical center's chna identified five significant areas of need: obesity, chronic disease, elder health, access to care, and mental health and substance abuse. The last area, mental health and substance abuse, is not a specialty of the medical center; although a 23-bed acute care psychiatric unit is available, ambulatory services are not. Consequently, efforts to address excessive drinking, drug use and gambling issues are led by other community organizations and supported by the medical center through education, participation in county task forces, coordination efforts, screening, referral and other support. Obesity, deemed an "umbrella" condition that increases the risk of numerous diseases, is being addressed via community education, lectures, programs, classes and screening. Hnmc also participates with the county "chip" in its behavior change and self-management programs. Chronic disease encompasses a wide range of conditions, e.g., cardiac disease, cancer, chronic respiratory conditions and diabetes. Efforts have focused on prevention, education and chronic disease self-management. Diabetes, which may be categorized under both obesity and chronic disease, was the focus of a coordinated regional shared screening and referral event in conjunction with other county hospitals. Fully redesigned end-of-life offerings address the issues contributing to health quality and longevity that invariably accompany later stage chronic diseases. Various care screenings and referrals, programs, education, support and other types of intervention have been strengthened to address this too-often overlooked, yet crucial aspect. Bergen county is the third oldest county in new jersey and has the greatest absolute number of elderly. Education, screenings, follow-up, coordination with community groups, senior centers, re-education and expansion of home care staff have been employed. This category overlaps with chronic disease initiatives and, again, we note the use of end-of-life offerings to foster wellness and quality of life. Although present in bergen county, access to care is more pronounced in hudson county. Socioeconomic factors such as language barriers and lack of transportation greatly increase the risk of lack of both preventive care and care for existing conditions, resulting in overuse of ERs and less optimal outcomes. An expanded system of free transportation has been implemented for persons unable to obtain transportation; and a network of bilingual physician practices that will accept low-pay, Medicaid and free care has been increased in the target area. A multi-specialty volunteer physician practice in bergen county that provides free care to persons in financial need is also supported by the medical center via free clinical services and financial support. Perhaps the greatest access issue is lack of insurance, which has been addressed via the medical center's large-scale ACA enrollment activities targeting both spanish-speaking and asian language-speaking persons.
Schedule h, part v,section b,qs 13b,13h,15e,16i,18d,19d,20e,21c,21d,23&24 Not applicable.
Schedule h, part v, section b, question 22d The facility uses 33% of gross charges to approximate the average charged managed care rate as the maximum amount that can be charged to fap-eligible individuals for emergency or other medically necessary care.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. 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?4
Name and address Type of Facility (describe)
1 ORADELL REHAB
514 KINDERKAMACK ROAD
ORADELL,NJ07649
OUTPATIENT CENTER
2 VILLA MARIE CLAIRE
12 WEST SADDLE RIVER ROAD
SADDLE RIVER,NJ07458
HOSPICE
3 HNH FITNESS LLC
514 KINDERKAMACK ROAD
ORADELL,NJ07649
MEDICALLY BASED FITNESS CENTER
4 UNION CITY LAB
408 37TH STREET
UNION CITY,NJ07087
OFF-SITE LAB
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
SCHEDULE H, PART I; LINE 3C Income-based criteria used to determine eligibility are in accordance with the nj administrative code 10:52 sub-chapters 11, 12 and 13. Federal poverty guidelines are included in the criteria for determining eligibility for charity and discounted care.
SCHEDULE H, PART I; LINE 6A Not applicable.
SCHEDULE H, PART I, QUESTION 7 The organization's cost accounting system was utilized.
SCHEDULE H, PART II Activities classified as community building include use of hnmc's facility and/or employees to support efforts that: promote the positive growth of the community; assist diverse groups in coming together for the community's short and long term benefit; and seek to protect the community from anything that could significantly affect the health and well-being of the community. Hnmc also assists other non-profits and provides various forms of non-monetary aid. In addition, employees are permitted to assist valid non-profit organizations during paid work time. Among the organizations so aided are nursing homes, boy scouts, houses of worship, community service groups, battered women's shelters, rotary clubs, police groups, environmental groups, schools, and nursing homes. Hnmc also allows the public to use various meeting rooms (in non-clinical areas) and its conference center for events. Career days are held for local high schools, fostering entrance of interested and applicable students into the health professions. Although hnmc's parking fees are minimal, free parking is extended to persons in need. Hnmc was one of nine hospitals in new jersey designated by the new jersey department of health ("njdoh") as a regional medical coordination center ("mcc"). The only facility in bergen county to be so designated, hnmc's on-campus mcc was able to be activated in the event of public health emergencies and/or a terrorist attack causing mass casualty incidents, infectious or communicable disease, or other types of public health disruption. The mcc also monitored, on a daily basis, situational awareness of local activity. In 2014, the njdoh lost much of its federal funding for the statewide program, cutting in half the number of mcc's it could support. Hnmc chose not to apply to renew its designation but has maintained most of its capabilities on its own. Given hnmc's proximity to new york city (i.e., five miles north of the george washington bridge), emergency preparedness is deemed necessary to ensure the health and well-being of the community, regardless of the mcc designation. Central to this commitment is a hnmc-funded vice president whose job function includes substantial involvement in preparedness both on-campus and in the community. Hnmc has long been recognized by state and federal sectors for its expertise in emergency preparedness and response. A frequent participant in local and new york city disaster drills, hnmc has participated in several large scale disaster drills, as well as drills conducted by the centers for disease control involving local, county, state, and federal agencies' emergency response to threats of public health significance. Hnmc maintains its designation by the federal division of global migration and quarantine to deal with possible communicable diseases and acts of bioterrorism occurring on public health conveyances. Hnmc is also active in the northern new jersey urban area security initiative. Members of holy name ems serve on the statewide nj ems task force. The medical center maintains a special operations team comprised of paramedics and emergency medical technicians who are ready to respond 24 hours a day, 7 days a week to assist local communities with emergencies. During 2014, hnmc prepared and taught courses in responding to an active shooter situation. Devised in conjunction with the police department of teaneck, nj, hnmc's video training was used during over 2,000 hours of training.
SCHEDULE H, PART III, SECTION A; LINE 4 Bad debt expense was calculated using the providers' bad debt expense from its financial statements, net of accounts written off at charges. Hnmc and its affiliates prepare and issue audited consolidated financial statements. The attached texts were obtained from the footnotes to the audited financial statements of hnmc and subsidiaries. Patient accounts receivable and net patient service revenue Patient accounts receivable and net patient service revenue from third-party programs for which the company receives payment under various reimbursement formulae or negotiated rates are stated at the estimated net amounts realizable and receivable from such payers, which are generally less than the company's established billing rates. The amount of the allowance for doubtful accounts is based upon management's assessment of historical and expected net collections, business and economic conditions, trends in health care coverage and other collection indicators. Additions to the allowance for doubtful accounts result from the provision for bad debts. Accounts written off as uncollectible are deducted from the allowance for doubtful accounts. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payers, and others for services rendered and includes retroactive revenue adjustments due to ongoing and future audits, reviews, and investigations. Charity care For patients that do not receive free care and who are deemed eligible for charity care, care given but not paid for is classified as charity care. Management believes that, because of the difficulties involved with obtaining patient cooperation, the present charity care guidelines understate the medical center's charity care amounts and overstate the level of bad debts reported. The cost of charity care is estimated by utilizing a cost accounting system, and includes the direct and indirect cost of providing charity care services.
SCHEDULE H, PART III, SECTION B; LINE 8 Medicare costs were derived from the hospital's cost accounting system. Medicare underpayments and bad debt are considered to be community benefit and associated costs are includable on the form 990, schedule h, part i. The organization feels that medicare underpayments (shortfall) and bad debt are community benefit and associated costs are includable on the form 990, schedule h, part i. 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 health care services to all individuals 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 medical center 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 treasury 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. Medicare underpayments and bad debt are community benefit and associated costs are includable on the form 990, schedule h, part i. The american hospital association ("aha") holds the position that medicare underpayments (or, "shortfalls") and bad debt are community benefit and thus includable on the form 990, schedule h, part i. The medical center agrees with the aha's 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 stated that the irs should incorporate the full value of the community benefit provided by hospitals by counting medicare underpayments (shortfall) as quantifiable community benefit for the following reasons: - the provision of care for the elderly and serving medicare patients is an essential part of the community benefit standard. - medicare, like medicaid, does not fund the full cost of care. Medicare's reimbursement to hospitals equates to only 92 cents for every dollar spent by the hospitals on care of medicare patients. The medicare payment advisory commission ("medpac") in its march 2007 report to congress cautioned that underpayment will worsen. - 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, the so called "dual eligibles." There is a very 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 the medical center also regard patient bad debt as a community benefit and thus includable on the form 990, schedule h, part i. Similar to medicare underpayment (shortfalls), there also are compelling reasons that patient bad debt should be counted as quantifiable community benefit as noted below: - 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, non-profit 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 actually 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 departments, regardless of ability to pay. Patients who have outstanding bills are not turned away, in sharp contrast to 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 findings "support the validity of the use of uncompensated care (bad debt and charity care) as a measure of community benefits," assum
SCHEDULE H, PART III, SECTION B; LINE 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 hnmc and subsidiaries' business office 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 the sending of three statements, a minimum of one pre-collection letter, and telephone contact for any account over $5,000, or at the discretion of the account representative and/or supervisor. The medical center also has a charity care access policy to assure patients are provided with charity care assistance as 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 are financially screened by a resource advisor to determine eligibility according to state and federal guidelines and are informed of documentation required to complete a charity care application. Patients not eligible for charity care receive financial counseling for all other options. Qualified patients are referred to all appropriate agencies or programs to meet other financial needs. At the time of the patient visit, and as part of the registration process at the medical center, 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/checks/credit card (american express, discover, visa, mastercard), 2. Flexible payment plans. In addition to the above options, the medical center has established a self-pay assistance program for its uninsured patients that do not qualify for either medicaid or the new jersey hospital care payment assistance program. Patients whose income falls between 300% and 500% of the federal poverty guideline are eligible for rates that are reflective of medicare reimbursement, as referred by the state of new jersey. For patients whose income is above 500% of the federal poverty guidelines, the medical center utilizes a compassionate care fee schedule.
SCHEDULE H, PART VI; QUESTION 2 Hnmc utilizes a variety of means by which it identifies and analyzes patient care needs. Among them are: patient satisfaction data; analysis of demographics; analysis of utilization and market trends; review of externally published data and information; acuity levels (daily planning of staffing); and individual projects/evaluation/reviews. Hnmc also commissions external specialists to conduct surveys and focus groups of individuals, households, physicians, and others. Hnmc also is a member of the bergen county community health improvement program ("chip"), whose mission is to evaluate and address the health needs of the county. The chip produces an extensive, very useful, database demonstrating the needs of the county's residents. Hnmc is a founding member of the northern new jersey maternal-child health consortium (now the partnership for maternal and child health of northern new jersey), whose mission is to educate and promote appropriate healthcare to woman and infants in the area. Again, a complete needs assessment is performed every three years and is provided to members for their use. In addition, us census bureau data is utilized, as is purchased market data, and databases of all acute and same-day care throughout both new jersey and new york, the source of which is billing data provided to the respective state departments of health. Such databases provide perhaps the greatest wealth of clinical, demographic, financial and other information, and are extremely valuable in understanding and addressing the needs of the communities served by hnmc. Data from the county and state health departments, and from the new jersey hospital association, are also used. In accordance with provisions of the affordable care act, enacted march 23, 2010, the medical center began a comprehensive community health needs assessment ("chna") in late 2011 in cooperation with the bergen county "chip" and four other hospitals whose service areas also include municipalities in bergen county. This chna was completed in 2013. The medical center also created a hnmc-specific chna that addresses its service areas in northern hudson county, incorporates the bergen county chna, and provides an implementation plan for all areas. The two documents provide a wealth of information with respect to the needs of the community served and are posted on the medical center's website.
SCHEDULE H, PART VI; QUESTION 3 Prior to or during an admission, all patients without insurance are screened for possible assistance from other sources (e.g., medicaid, veteran administration, s.s.i., or municipal welfare). If the patient is found to be ineligible for any or all of the aforementioned, the patient will be screened for charity care. The education of patients at hnmc is provided in-person by knowledgeable medical center personnel at the time of the initial screening, and accompanied by a packet of information that includes all contact information as well. Arrangements for follow up are typically made immediately. If the patient qualifies for charity care, the patient is not billed for services. The medical center's billing and collection policy includes specific language stating that charity care patients are not billed. Through its compassionate care program, hnmc further assists uninsured patients who do not qualify for charity care and who are ineligible for medicare, medicaid or other federal and state insurance programs. The purpose of the program is to decrease the financial burden of patients in the community served by hnmc. If the patient meets certain eligibility requirements for financial assistance as described below, further discounts will be applied to the patient's bill. - self-pay patients are eligible for the compassionate care fee schedule regardless of income. - patients whose income levels fall within the published hhs poverty guidelines and do not qualify for benefits under the federal undocumented alien program, nj state medicaid program, or charity care program, will be considered for additional discounts. These discounts will be provided to patients who meet the required guidelines. - patients who qualify for the n.j. Medical care assistance program and whose income falls within 200%-300% of the federal poverty limits will be eligible for discounts ranging from 20%-100% off of gross billed charges. Patients who qualify for this program, but who have a balance after the discount, will be responsible for between 20%-80% of the n.j. Medicaid rate. - patients who do not qualify for the n.j. Medical care assistance program and whose income fall within 300%-500% of the federal poverty limits will be eligible for a discount based upon medicare rates. - patients whose income is above 500% of the federal poverty limits will be eligible for hnmc compassionate care fee schedule as stated above.
SCHEDULE H, PART VI; QUESTION 4 Located in teaneck, in the southern portion of bergen county and approximately five miles to the northwest of new york city, hnmc's primary service area ("psa") comprises 15 municipalities in bergen county and 3 municipalities in hudson county, new jersey. Hnmc's secondary service area ("ssa") includes 17 municipalities in bergen county and 2 municipalities in hudson county. Together, the psa and ssa account for approximately 80 percent of the medical center's admission volume. As the sole catholic hospital in an area that is estimated at more than 50% roman catholic, hnmc also draws from towns well beyond both the psa and ssa. The majority of psa towns have an average population of 27,500, and are located in the southern half of bergen county. Overall, the service area is 44% hispanic, although the proportions differ markedly between bergen and hudson: 76% of the residents of bergen psa towns are not hispanic; while the four hudson county towns together count 76% of their residents as hispanic. The racial mix of the psa is approximately 60% white, 22% asian, 10% black, and 8% other, including multi-racial persons. Certain towns in the region are heavily korean; korean/asian presence is much less pronounced in the four hudson county towns. The broad age make-up of the primary service area includes 23% aged up to 19; 50% aged 20-54; and 27% aged 55 and older. The last category is projected to see the most significant growth during the next fifteen years. With the exception of two hudson county towns, all ssa zip codes are located throughout bergen county. The towns in this service area are much smaller than those of the psa, averaging only 14,000 residents each. In stark contrast to the largely hispanic hudson county psa towns, the two hudson ssa towns are only 20% hispanic. The overall racial mix of the service area is 76% white, 13% asian, 4% black, and 7% other, including multi-racial persons. The overall korean presence is significant, but only half that seen in the primary service area. The area's age mix is similar to the psa, with 23% aged up to 19; 51% aged 20-54; and 26% aged 55 and older. The medical center's service area is primarily suburban, with many residents working outside bergen county in places such as new york city. However, there are large employers in the service area, e.g., other hospitals, a large sports chain, a large communications firm, a large pharmaceutical firm, and a large commercial laboratory. Residents of hnmc's service area are also served by another community hospital and a tertiary care facility with trauma services. Hnmc's psa covers a majority of the towns serviced by the other community hospital, whereas the tertiary care facility's primary service area also includes many towns to the west that are not part of hnmc's service area. Given the number of service area residents who work in nearby new york city, it is not surprising that a small portion of these residents also receive their healthcare in manhattan. While the service area is predominantly non-hispanic caucasian, both hispanics (of any race) and asian populations (principally korean) are the fastest growing groups. In response, the medical center has programs addressing these groups' needs, and physicians and nurses fluent in the applicable languages. In 2008, approximately 75 korean physicians joined the medical staff, adding to the need for staff and services to meet this growing segment of the community. In 2014, the medical center expanded its korean medical program to include a focus on chinese and filipino residents as well, renaming the service "asian health services."
SCHEDULE H, PART VI; QUESTION 5 Hnmc promotes the health of its communities in a variety of ways. The majority of the board of trustees live in bergen county, new jersey, where hnmc is located, with most living in the municipalities of the medical center's defined service area. The trustees' understanding of the service area is thus enhanced, as is their understanding of the need to reinvest funds in improvements in patient care, medical education and research. As part of its charitable purpose, hnmc provides a wide array of services to the community, targeted toward improving the health of the community. The majority of such services are free. A small sampling of such activities is provided below. - frequent health fairs throughout the region are given. At these fairs risk assessments, screenings and literature are provided (many in spanish and korean, as well as english). - immunizations are provided. - free and/or very low fee transportation (e.g., for cancer treatment, dialysis) is available. - community health nurses and mobile learning are also provided. - staff from various departments throughout the medical center visit local schools to provide health classes. - screenings, e.g., blood pressure, cancer, stroke, diabetes, prostate cancer, breast cancer, osteoporosis, peripheral artery disease, skin cancer, colon cancer, and other clinical screening and education are provided, often as part of community programs specific to the particular disease group. - senior centers are supported with free exercise classes, lectures and screenings. - support groups are provided, such as cancer, perinatal bereavement, adult bereavement, new mothers, diabetes, smoking, and cardiac disease. - hnmc's als bike team, als and bls vehicles and/or special operations vehicles are present at events occurring in municipalities in hnmc's service area without charge. - courses (provided either free or for a low fee) are provided throughout the year. Examples include: cpr certification, defensive driving, general and specialty (e.g., osteoporosis) exercise, breastfeeding preparation, stress management, diabetes self-management, baby care basics, weight management, and parenting. - classes to promote better health are abundant: yoga, weight reduction, osteoporosis, proper hand-washing, tai chi, cooking for cardiac patients. - lectures, often involving hnmc's medical staff as presenters, are provided, the majority of which are free. Men's health, women's health, a mid-life and menopause lecture series, sleep disorders, allergies, depression, asthma, uterine fibroids, copd, stroke, hypertension, mental wellness, cardiac issues, alzheimer's, joint replacement, sleep apnea, cancers, children's health, disaster preparedness, and general health and well-being are among the topics presented. - hnmc's fully updated and redesigned website (www.holyname.org) provides a wealth of free consumer health information. The site includes an on-line medical library housing information on diseases and conditions, surgeries and procedures, vitamins and supplements, nutrition, wellness, and a drug reference. On-line risk assessments and quizzes are also available, as is the ability to set up a personal health page. Information is also presented in spanish, and a korean language version is also available (www.kholyname.org). A new interactive body guide ("symptom checker") to research health information about the symptoms the user is experiencing. - hnmc's "ask-my-nurse" program, which provides 24/7 phone access to registered nurses, is provided free of charge. - blood drives are hosted regularly at hnmc. Many health services are subsidized by hnmc, such as its clinics, hospice and hemodialysis programs. Each year the medical center contributes to airfare, supplies and other support for hnmc nurses and doctors to travel to third world countries (e.g., haiti) to provide medical care, including surgery, to persons who otherwise would never receive adequate treatment due to poverty and lack of access. Hnmc supports the bergen volunteer medical initiative ("bvmi"), which provides free care to persons in need and other similar programs. Hnmc also participates in the women, infants and children ("wic") and health start programs, providing nutritional and social services, ancillary services and other programs to participants. Inexpensive medically supervised day care for ill children is available on campus to working parents in the community affording them the ability to work even when a child is sick. Senior or disabled persons requiring medical day care are transported free of charge to hnmc's adult day care program, reducing the burden on family caretakers. Hnmc's emergency department ("ed") is open 24 hours a day, every day of the year. Although the ed generally is able to cover its costs, it provides a significant amount of uncompensated care and is a well-used resource for many without insurance who rely on it for care. Other services, such as clinics, do not cover their costs, and hnmc absorbs the additional expense. Language interpretation is available for approximately 220 languages at the medical center through use of a commercial service that provides a live translator 24/7 free of charge to the patient and family. Hnmc has an open medical staff with privileges available to all qualified physicians in the area. Hnmc has intentionally sought out physicians fluent in spanish and who care for hispanic populations, and provides free transportation for such populations (as well as others) unable to access care on their own. Hnmc has also added many korean physicians to its medical staff and provides a korean clinic weekly, with korean speaking physicians and nurses, as the asian community is one of the fastest growing sectors in the county. Recent additions of staff to support the expanded Chinese and Filipino populations address needs specific to these groups. Care is provided in a culturally sensitive manner. The institute for clinical research at hnmc provides exceptional investigators, facilities, and services for sponsoring agencies that seek to advance patient care through superior clinical research. The institute is dedicated to conducting expeditious, high-quality clinical trials to test new medications, devices, diagnostic modalities and treatment protocols. As a dynamic healthcare institution that has received many honors of distinction for its clinical excellence and compassionate patient care, hnmc is well-suited to participate in the quest for scientific breakthroughs. Hnmc's state-of-the-art facilities match the highest standards for carrying out today's most promising clinical research. The institute provides sponsors with research support throughout all the stages of their clinical trials. Since its inception, hnmc has been actively involved in health professions education, training, educating and mentoring healthcare professionals. The holy name school of nursing was founded in 1925, with a dedication to fostering the well-being and dignity of all individuals, sick or well. The registered nurse ("rn") program is a highly competitive registered nurse diploma program, and is accredited with the new jersey board of nursing and the national league for nursing accrediting commission. In 1972 the school expanded to include a practical nurse ("lpn") program as well, which is a 12-month practical nurse diploma program also accredited with the new jersey board of nursing. Both programs continue to supply the region with highly skilled nurses of many ethnicities and age groups. In addition to its own nursing school, hnmc provides, free of charge, both a training ground and mentoring for students from various health academic programs of several colleges and universities. A variety of "externships" are also offered without charge. Career days are also held on campus, and the medical center participates in health career days throughout various schools and communities. Hnmc has a number of academic relationships through which it serves as an educational environment for students. Affiliation agreements are maintained with several colleges and universities for nursing students, and for radiology, nuclear medicine, ultrasound, respiratory, and surgical technicians. Trainees from a university who are predominantly doctor of pharmacy students complete rotations in acute critical care, infectious disease, oncology, nephrology, and administration. Community health students rotate through the medical center as well. Physical and/or occupational therapy students from with ten colleges in new jersey and other states complete clinical rotations at the medical center; hnmc employees serve as supervisors and clinical instructors for these students. Undergraduate, nurse practitioner and nursing doctoral students from yet another university complete rotations with oversight from hnmc's department of nursing education. Each year, hnmc accepts a small number of residents in health policy, health finance, and health mana
SCHEDULE H, PART VI; QUESTION 6 The medical center is the sole member of seven entities: (i) holy name health care foundation, inc., a non-profit corporation which seeks voluntary donations to support the health care services provided by the medical center; (ii) holy name real estate corp., a non-profit corporation which manages, and in some cases possesses title to and engages in leasing arrangements with respect to, real estate holdings of the medical center and its related entities; (iii) health partner services, inc., a for-profit corporation engaged in providing management services for health care providers; (iv) holy name ems, inc., a non-profit corporation which owns and operates the medical center's basic life support ("bls") and advanced life support ("als") vehicles and services; (v) ms comprehensive care center, a non-profit ambulatory care program for ms patients; (vi) hnmc hospital/physician aco, l.l.c., a non-profit limited liability company formed as an accountable care organization; and (vii) hnh fitness, l.l.c., a for-profit limited liability company that operates a medically based fitness and wellness center, located in the borough of oradell, bergen county, new jersey. Included in the facility is a satellite non-profit physical therapy practice that is operated by the medical center. The medical center is also a 40% owner of holy name renal care, l.l.c., a for-profit limited liability company that operates an ambulatory renal dialysis service on the medical center's campus.
SCHEDULE H, PART VI; QUESTION 7 Not applicable. The entity and related provider organizations are located in new jersey. New jersey does not require hospitals to annually submit a community benefit report.
Schedule H (Form 990) 2014
Additional Data


Software ID:  
Software Version:  
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.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number
22-1487322
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) SISTERS OF ST JOSEPH OF PEACE
399 HUDSON TERRACE
ENGLEWOOD CLIFFS,NJ07632
22-3412084 501(C)(3) 10,000       PROGRAM SUPPORT






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated 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
(1) EDUCATIONAL SCHOLARSHIPS 54 70,225      












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
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) 2014


Additional Data


Software ID:  
Software Version:  


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, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used 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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 (E) amounts for that individual.
(A) Name and Title (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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1MICHAEL MARONTRUSTEE- PRESIDENT/CEO (i)
(ii)
1,096,750
...............................
0
550,000
...............................
0
34,122
...............................
0
475,124
...............................
0
21,791
...............................
0
2,177,787
...............................
0
0
...............................
0
2JOSEPH M LEMAIRE TERM 627TRUSTEE - ASST SEC/ASST TREAS (i)
(ii)
442,600
...............................
0
250,000
...............................
0
29,425
...............................
0
10,400
...............................
0
14,527
...............................
0
746,952
...............................
0
0
...............................
0
3RYAN KENNEDY CPAVP; CHIEF FINANCIAL OFFICER (i)
(ii)
280,999
...............................
0
100,000
...............................
0
1,332
...............................
0
10,400
...............................
0
10,895
...............................
0
403,626
...............................
0
0
...............................
0
4ADAM JARRETT MDCHIEF MEDICAL OFFICER (i)
(ii)
421,750
...............................
0
250,000
...............................
0
28,552
...............................
0
120,380
...............................
0
21,791
...............................
0
842,473
...............................
0
0
...............................
0
5SHERYL SLONIMSENIOR VP; PATIENT CARE SVCS (i)
(ii)
372,868
...............................
0
175,000
...............................
0
32,671
...............................
0
192,460
...............................
0
14,865
...............................
0
787,864
...............................
0
0
...............................
0
6MICHAEL SKVARENINAEFF 62214CHIEF INFORMATIONAL OFFICER (i)
(ii)
212,017
...............................
0
50,000
...............................
0
17,786
...............................
0
4,422
...............................
0
21,791
...............................
0
306,016
...............................
0
0
...............................
0
7JOHN GRANGEIA TERM 12714VP; PROFESSIONAL SERVICES (i)
(ii)
255,824
...............................
0
10,000
...............................
0
7,005
...............................
0
8,492
...............................
0
3,200
...............................
0
284,521
...............................
0
0
...............................
0
8STEVEN MOSSERVP; FACILITIES (i)
(ii)
241,750
...............................
0
25,000
...............................
0
2,281
...............................
0
9,800
...............................
0
21,791
...............................
0
300,622
...............................
0
0
...............................
0
9CYNTHIA KAUFHOLDVP; REVENUE CYCLE MANAGEMENT (i)
(ii)
223,500
...............................
0
10,000
...............................
0
1,771
...............................
0
9,300
...............................
0
27,541
...............................
0
272,112
...............................
0
0
...............................
0
10MARYANN KICENUIK EFF 71414VP; LEGAL SERVICES (i)
(ii)
218,008
...............................
0
0
...............................
0
7,229
...............................
0
8,758
...............................
0
5,029
...............................
0
239,024
...............................
0
0
...............................
0
11RICHARD VAN EERDE EFF 62214VP; FINANCE (i)
(ii)
190,022
...............................
0
0
...............................
0
991
...............................
0
7,689
...............................
0
8,477
...............................
0
207,179
...............................
0
0
...............................
0
12APRIL RODGERSVP; HUMAN RESOURCES (i)
(ii)
167,109
...............................
0
0
...............................
0
1,111
...............................
0
4,212
...............................
0
21,791
...............................
0
194,223
...............................
0
0
...............................
0
13SHARAD WAGLE MDMEDICAL DIRECTOR (i)
(ii)
353,192
...............................
0
0
...............................
0
4,313
...............................
0
10,400
...............................
0
14,431
...............................
0
382,336
...............................
0
0
...............................
0
14RAVIT BARKAMAEXEC DIR CLINICAL RESEARCH (i)
(ii)
266,516
...............................
0
80,000
...............................
0
1,701
...............................
0
10,400
...............................
0
24,291
...............................
0
382,908
...............................
0
0
...............................
0
15KYUNG-HEE CHOIVP; KOREAN MEDICAL PROGRAM (i)
(ii)
217,316
...............................
0
20,000
...............................
0
3,884
...............................
0
8,693
...............................
0
0
...............................
0
249,893
...............................
0
0
...............................
0
16ALLAN J CAGGIANOPHYSICIST (i)
(ii)
228,167
...............................
0
300
...............................
0
502
...............................
0
9,257
...............................
0
21,791
...............................
0
260,017
...............................
0
0
...............................
0
17DEBORAH ZAYASVP; NURSING SERVICES (i)
(ii)
203,986
...............................
0
20,000
...............................
0
1,858
...............................
0
8,200
...............................
0
7,277
...............................
0
241,321
...............................
0
0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
SCHEDULE J, PART I; QUESTION 4B THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2014 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: MICHAEL MARON, $464,724; ADAM JARRETT, M.D., $109,980 AND SHERYL SLONIM, $182,060.
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 2014 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2014 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) 2014

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet 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.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number
22-1487322
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
Yes No Yes No Yes No
A NJ HEALTH CARE FACILITIES FINANCING AUTHORITY
 
22-1987084 64579FHK2 06-15-2006 60,816,719 CONSTRUCTION/RENOVATION/EQUIP   X   X   X
B NJ HEALTH CARE FACILITIES FINANCING AUTHORITY
 
22-1987084 64579FH89 09-02-2010 55,971,065 BOND REFUNDING/CAPITAL EXPENDITURE   X   X   X
C NJ HEALTH CARE FACILITIES FINANCING AUTHORITY
 
22-1987084 64579FJT1 11-22-2006 7,000,000 HNH FITNESS ACQUISITION   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 10,025,558 47,290,816 0  
2 Amount of bonds legally defeased . . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 64,937,963 55,971,117 7,039,950  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 5,744,107 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 416,077  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . . 1,014,001 1,242,174 103,703  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 0 43,900  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 42,313,332 7,560,834 6,476,266  
11 Other spent proceeds . . . . . . . . . . . . . . 15,831,828 47,290,816 5  
12 Other unspent proceeds . . . . . . . . . . . . . . 32,376 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2009 2010 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X   X     X    
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . .   X X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   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   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X     X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
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   X     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? X   X     X    
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X   X     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? X   X     X    
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 . . SchKMediumBullet 0.600 % 0.600 % 0.600 %  
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 . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0.600 % 0.600 % 0.600 %  
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 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   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X   X   X    
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X X     X    
b Exception to rebate? . . . . . . . .   X   X   X    
c No rebate due? . . . . . . . . X     X X      
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .   X   X X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider . . . . . . . . . 0
 
0
 
0
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . . 0
 
0
 
0
 
 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
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? X   X   X      
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K, PART IV; LINE 2C THE REBATE COMPUTATIONS WERE PERFORMED ON JULY 6, 2011 FOR BOND A AND ON DECEMBER 1, 2011 FOR BOND C.
Schedule K (Form 990) 2014

Additional Data


Software ID:  
Software Version:  

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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Return Reference Explanation
CORE FORM, PART III Holy name medical center ("hnmc") is a private, 361-bed new jersey-licensed general acute care medical center. The medical center is a non-profit corporation under the laws of the state of new jersey, and is exempt from federal income taxes under section 501(a) of the internal revenue code by virtue of being an organization described in section 501(c)(3) of the code. Pursuant to its charitable purposes, hnmc 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, hnmc operates consistently with the following criteria outlined in irs revenue ruling 69-545: 1. Hnmc provides medically necessary healthcare services to all individuals regardless of ability to pay, including charity care, self-pay, medicare and medicaid patients; 2. Hnmc operates an active emergency department for all persons, which is open 24 hours a day, 7 days a week, 365 days per year; 3. Hnmc maintains a medical staff, with privileges available to all qualified physicians; 4. Control of hnmc rests with its board of trustees and the sisters of st. Joseph of peace. Both boards are 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. The operations of hnmc, as shown through the factors outlined above and other information contained herein, clearly demonstrate that hnmc provides substantial community benefit and that the use and control of hnmc is for the benefit of the public and that no part of the income or net earnings of the organization inures to the benefit of any private individual, nor is any private interest being served other than incidentally. The sisters of st. Joseph of peace health care system corporation (the "holding company") is a non-profit corporation under the laws of the state of new jersey, and is exempt from federal income taxes under section 501(a) of the internal revenue code by virtue of being an organization described in section 501(c)(3) of the code. The holding company is the sole member of the medical center. This tax-exempt integrated healthcare delivery system consists of a group of affiliated healthcare organizations. The sole member of each entity is either the holding company or hnmc. Mission ======= We are a community of caregivers committed to a ministry of healing, embracing the tradition of catholic principles, the pursuit of professional excellence, and conscientious stewardship. We help our community achieve the highest attainable level of health through education, prevention and treatment. History ======= The medical center was founded by the congregation of the sisters of st. Joseph of peace (the "sisters") in 1925, and in 1958 was incorporated as an independent new jersey non-profit corporation, sponsored by the sisters. It was the dedication of two teaneck surgeons and the leadership of a sister that made hnmc a reality in 1925. Recognizing the need to serve the sick and indigent of the community, drs. Frank mccormack and george pitkin appealed to mother general agatha brown of the sisters for help in finding a suitable medical center site and providing administrative and nursing staff. The sisters purchased the estate of the late william walter phelps and erected the medical center there, staffing it with sisters. At its opening in 1925, hnmc boasted 115 beds. Five years later, a 90-bed clinic building was built to meet the needs of area residents who had been impoverished by the great depression. Teaneck was little more than a rural village then; in all of bergen county there were some 250,000 inhabitants. With the completion of the george washington bridge in 1931, a surge of development followed world war ii, and the area soon became a thriving residential and business community. Hnmc thrived as well. In 1955 a second addition was completed: the four-story, 110-bed marian building, with two more stories added to the facility within the next ten years. During the 1960's, the west wing of the marian building was enlarged by three more units. Faced again with the threat of overcrowding in the 1980's, the medical center complex was once more enlarged with construction of the breslin/kennedy building. In 1993 the "new addition" was constructed, principally to accommodate the increasing ambulatory and same-day-stay patients, and a new physical medicine building was added. A four-level regional cancer center was completed in the late 1990's. More recent additions include a new 41-bay emergency department, a health and fitness center, and a residential hospice, villa marie claire. The medical center has grown in size, reputation and capability with each addition. As hnmc celebrates almost 90 years, it continues to take steps to become a national model by implementing new, advanced technologies and medical/surgical techniques, as well as best practices in processes such as simulation learning, medication administration, healthcare information systems, disaster preparedness, and building construction and design. Improvements such as these allow hnmc to provide every patient with a superior experience characterized by safe, high quality care. Leading-edge care ================= Hnmc is a comprehensive, 361-bed acute care facility providing leading-edge medical practice and technology administered in an environment rooted in a tradition of compassion and respect for every patient. Hnmc offers high quality healthcare across a continuum that encompasses education, prevention, early intervention, comprehensive treatment options, rehabilitation, and wellness maintenance-from pre-conception through end-of-life. With almost 900 physicians representing dozens of medical and surgical specialties, hnmc provides an exceptional healthcare experience for its patients. A few of the "centers of excellence" at hnmc include: - regional cancer center (including a new gynecological specialty) - interventional institute (offering innovative, non-surgical treatment options) - cardiovascular services - george p. Pitkin m.d. emergency care center - women's and children's health services - hospice and palliative care services, both home-based and residential (villa marie claire, hnmc's comprehensive hospice facility in saddle river, nj) - bone and joint center - breast center - institute for simulation learning Other outstanding services include, but are not limited to: - specialty surgery services with expertise in minimally invasive techniques, including robotics - advanced radiological imaging - rehabilitation medicine, and sports medicine, encompassing hnh fitness, hnmc's medically-based fitness center in oradell, nj - bariatric medicine - center for sleep medicine - maternal-fetal medicine for high-risk and complicated pregnancies - renal dialysis - culturally- and linguistically-sensitive health programs, such as the asian health services, addressing korean, chinese and filipino needs, and hispanic outreach program, "familia y salud." - institute for clinical research - multiple sclerosis center - the holy name school of nursing
CORE FORM, PART III Promotion of community health ============================= Hnmc promotes the health of its communities in a variety of ways. The majority of the board of trustees live in bergen county, new jersey, where hnmc is located, with most living in the municipalities of the medical center's defined service area. The trustees' understanding of the service area is thus enhanced, as is their understanding of the need to reinvest funds in improvements in patient care, medical education and research. As part of its charitable purpose, hnmc provides a wide array of services to the community, targeted toward improving the health of the community. The majority of such services are free. A small sampling of such activities is provided below. - frequent health fairs throughout the region are given. At these fairs risk assessments, screenings and literature are provided (many in spanish and korean, as well as english). - immunizations are provided. - free and/or very low fee transportation (e.g., for cancer treatment, dialysis) is available. - community health nurses and mobile learning are also provided. - staff from various departments throughout the medical center visit local schools to provide health classes. - screenings, e.g., blood pressure, cancer, stroke, diabetes, prostate cancer, breast cancer, osteoporosis, peripheral artery disease, skin cancer, colon cancer, and other clinical screening and education are provided, often as part of community programs specific to the particular disease group. - senior centers are supported with free exercise classes, lectures and screenings. - support groups are provided, such as cancer, perinatal bereavement, adult bereavement, new mothers, diabetes, smoking, and cardiac disease. - hnmc's als bike team, als vehicles and/or special operations vehicles are present at events occurring in municipalities in hnmc's service area without charge. - courses (provided either free or for a low fee) are provided throughout the year. Examples include: cpr certification, defensive driving, general and specialty (e.g., osteoporosis) exercise, breastfeeding preparation, stress management, diabetes self-management, baby care basics, weight management, and parenting. - classes to promote better health are abundant: yoga, weight reduction, osteoporosis, proper hand-washing, tai chi, cooking for cardiac patients. - lectures, often involving hnmc's medical staff as presenters, are provided, the majority of which are free. Men's health, women's health, a mid-life and menopause lecture series, sleep disorders, allergies, depression, asthma, uterine fibroids, copd, stroke, hypertension, mental wellness, cardiac issues, alzheimer's, joint replacement, sleep apnea, cancers, children's health, disaster preparedness, and general health and well-being are among the topics presented. - hnmc's fully updated and redesigned website (www.holyname.org) provides a wealth of free consumer health information. The site includes an on-line medical library housing information on diseases and conditions, surgeries and procedures, vitamins and supplements, nutrition, wellness, and a drug reference. On-line risk assessments and quizzes are also available, as is the ability to set up a personal health page. a korean language version is also available (www.kholyname.org). A new interactive body guide ("symptom checker") to research health information about the symptoms the user is experiencing. - hnmc's "ask-my-nurse" program, which provides 24/7 phone access to registered nurses, is provided free of charge. - blood drives are hosted regularly at hnmc. Many health services are subsidized by hnmc, such as its clinics, hospice and hemodialysis programs. Each year the medical center contributes to airfare, supplies and other support for hnmc nurses and doctors to travel to third world countries (e.g., haiti) to provide medical care, including surgery, to persons who otherwise would never receive adequate treatment due to poverty and lack of access. Hnmc supports the bergen volunteer medical initiative ("bvmi"), which provides free care to persons in need and other similar programs. Hnmc also participates in the women, infants and children ("wic") and health start programs, providing nutritional and social services, ancillary services and other programs to participants. Inexpensive medically supervised day care for ill children is available on campus to working parents in the community affording them the ability to work even when a child is sick. Senior or disabled persons requiring medical day care are transported free of charge to hnmc's adult day care program, reducing the burden on family caretakers. Hnmc's emergency department ("ed") is open 24 hours a day, every day of the year. Although the ed generally is able to cover its costs, it provides a significant amount of uncompensated care and is a well-used resource for many without insurance who rely on it for care. Other services, such as clinics, do not cover their costs, and hnmc absorbs the additional expense. Language interpretation is available for approximately 220 languages at the medical center through use of a commercial service that provides a live translator 24/7, free of charge to the patient and family. Hnmc has an open medical staff with privileges available to all qualified physicians in the area. Hnmc has intentionally sought out physicians fluent in spanish and who care for hispanic populations, and provides free transportation for such populations (as well as others) unable to access care on their own. Hnmc has also added many korean physicians to its medical staff and provides a korean clinic weekly, with korean speaking physicians (and nurses), as the asian community is one of the fastest growing sectors in the county. Recent additions of staff to support the expanded Chinese and Filipino populations address needs specific to these groups. Care is provided in a culturally sensitive manner. The institute for clinical research at hnmc provides exceptional investigators, facilities, and services for sponsoring agencies that seek to advance patient care through superior clinical research. The institute is dedicated to conducting expeditious, high-quality clinical trials to test new medications, devices, diagnostic modalities and treatment protocols. As a dynamic health care institution that has received many honors of distinction for its clinical excellence and compassionate patient care, hnmc is well-suited to participate in the quest for scientific breakthroughs. Hnmc's state-of-the-art facilities match the highest standards for carrying out today's most promising clinical research. The institute provides sponsors with research support throughout all the stages of their clinical trials. Since its inception, hnmc has been actively involved in health professions education, training, educating and mentoring healthcare professionals. The holy name school of nursing was founded in 1925, with a dedication to fostering the well-being and dignity of all individuals, sick or well. The registered nurse ("rn") program is a highly competitive registered nurse diploma program, and is accredited with the new jersey board of nursing and the national league for nursing accrediting commission. In 1972 the school expanded to include a practical nurse ("lpn") program as well, which is a 12-month practical nurse diploma program also accredited with the new jersey board of nursing. Both programs continue to supply the region with highly skilled nurses of many ethnicities and age groups. Hnmc also supports its community through the use of the medical center's facility and/or employees to support efforts that: promote the positive growth of the community; assist diverse groups in coming together for the community's short and long term benefit; and seek to protect the community from anything that could significantly affect the health and well-being of the community. Hnmc also assists other non-profits and provides various forms of non-monetary aid as well. In addition, employees are permitted to assist valid non-profit organizations during paid work time. Among the organizations so aided are nursing homes, boy scouts, houses of worship, community service groups, battered women's shelters, rotary clubs, police groups, environmental groups, schools, and nursing homes. Hnmc also allows the public to use various meeting rooms (in non-clinical areas) and its conference center for events. Career days are held for local high schools, fostering entrance of interested and applicable students into the health professions. Although hnmc's parking fees are minimal, free parking is extended to persons in need. Since 2012, the medical center has provided assistance to a hospital in the earthquake-ravaged country of haiti through cash support, provision of equipment and personnel working to rebuild the hospital's operations, and through training health providers working at the hospital.
CORE FORM, PART III Affiliations and academic relationships ======================================= The hnmc community enjoys academic relationships that provide an educational environment for students from a variety of healthcare professions: - in july 2010, hnmc began accepting third and fourth year students from the touro college of osteopathic medicine (new york, ny), to complete clinical rotations in fulfillment of their curriculum. - affiliation agreements are maintained with bergen community college (paramus, nj) for nursing students, and for radiology, ultrasound, respiratory, and surgical technicians. Trainees from rutgers university (new brunswick, nj) are predominantly doctor of pharmacy students who are completing rotations in acute critical care, infectious disease, oncology, nephrology, and administration. The trainees are supervised by a clinical care coordinator from the university. One community health student rotates through hnmc as well. - the medical center maintains a collaborative agreement with st. Peter's college (jersey city, nj) to provide the option for holy name school of nursing students to take additional college credits to earn an associates of applied science ("aas") degree in health sciences. The aas complements the diploma awarded from the holy name school of nursing. Employees of hnmc are also able to continue their studies by pursuing bachelor's (bsn), master's, and advanced practice nursing degrees at st. Peter's college. In this process, student employees work with various administrative leaders within hnmc to complete clinical rotations. - undergraduate, nurse practitioner and nursing doctoral students from farleigh dickinson university ("fdu") complete rotations with oversight from hnmc's department of nursing education. In addition, the medical center hosts, at no charge, classes provided by fdu for adult learners. - Hnmc has a number of other academic relationships through which it serves as an educational environment for students. Affiliation agreements are maintained with several colleges and universities for nursing students, and for radiology, nuclear medicine, ultrasound, respiratory, and surgical technicians. Trainees from a university who are predominantly doctor of pharmacy students complete rotations in acute critical care, infectious disease, oncology, nephrology, and administration. Community health students rotate through the medical center as well. Physical and/or occupational therapy students from with ten colleges in new jersey and other states complete clinical rotations at the medical center; hnmc employees serve as supervisors and clinical instructors for these students. Undergraduate, nurse practitioner and nursing doctoral students from yet another university complete rotations with oversight from hnmc's department of nursing education. In all cases, instruction and oversite are provided by hnmc staff. - each year, hnmc accepts students from the columbia university mailman school of public health program in health policy and management as summer interns. Interns work on specific projects under the direction of members of senior management. - every year students from a preparatory school complete internships at the medical center in various departments. Typically, such students are disadvantaged from a socioeconomic standpoint and benefit from the coaching received from members of the senior administrative staff. The students spend one full day each week at holy name over the course of a semester. Emergency preparedness ====================== Hnmc was one of nine hospitals in new jersey designated by the new jersey department of health ("njdoh") as a regional medical coordination center ("mcc"). The only facility in bergen county to be so designated, hnmc's on-campus mcc's purpose was able to be activated in the event of public health emergencies and/or a terrorist attack causing mass casualty incidents, infectious or communicable disease, or other types of public health disruption. The mcc also monitored, on a daily basis, situational awareness of local activity. In 2014, the njdoh last much of its federal funding for the statewide program, cutting in half the number of mcc's it could support. Hnmc chose not to apply to renew its designation but has maintained most of its capabilities on its own. Given hnmc's proximity to new york city (i.e., five miles north of the george washington bridge), emergency preparedness is deemed necessary to ensure the health and well-being of the community, regardless of the mcc designation. Central to this commitment is a hnmc-funded vice president whose job function includes substantial involvement in preparedness both on-campus and in the community. Hnmc has long been recognized by state and federal sectors for its expertise in emergency preparedness and response. A frequent participant in local and new york city disaster drills, hnmc has participated in several large scale disaster drills, as well as drills conducted by the centers for disease control involving local, county, state, and federal agencies' emergency response to threats of public health significance. Hnmc maintains its designation by the federal division of global migration and quarantine to deal with possible communicable diseases and acts of bioterrorism occurring on public health conveyances. Hnmc is also active in the northern new jersey urban area security initiative. Members of holy name ems serve on the statewide nj ems task force. The medical center maintains a special operations team comprised of paramedics and emergency medical technicians who are ready to respond 24 hours a day, 7 days a week to assist local communities with emergencies. Recognition ============ Hnmc is recognized for its clinical skill, quality outcomes and high rate of patient satisfaction by multiple national accreditation agencies and benchmarking organizations. Hnmc holds magnet status for outstanding nursing care from the american nurses credentialing center ("ancc"). The magnet recognition program was developed by the ancc to recognize healthcare organizations that provide nursing excellence, and to provide a vehicle for disseminating successful nursing practices and strategies. Only six percent (6%) of hospitals nationwide are magnet recognized hospitals. Hnmc also received the beacon award for critical care excellence for its telemetry and intensive care units. This award from the american association of critical-care nurses recognizes nursing excellence in professional practice, patient care and outcomes. Us news & world report cited hnmc as one of the best hospitals in new jersey and the new york metro area, 2013-2014. Holy name received "high-performing" status in nine specialties: diabetes and endocrinology, gastroenterology, geriatrics, gynecology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology. The medical center carries an "a" rating from the leapfrog group for safety, and is also a community 5-star top provider, awarded by cleverly and associates. It was also ranked fourth in the state for safety by consumer reports. holy name is recognized by the american heart association/american stroke association as a gold-plus primary stroke center as part of the "get with the guidelines" program. Hnmc has been praised repeatedly as an exemplary workplace by modern healthcare's 100 best places to work in healthcare program, in which the medical center ranked in the top ten; and by njbiz (the leading weekly business publication in new jersey), which cites hnmc as a top business (all industries) in its 50 best places to work in new jersey program, a designation earned by hnmc for 10 years in a row.
CORE FORM, PART III; LINE 4D EXPENSES INCURRED IN PROVIDING 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.
CORE FORM, PART VI, SECTION B; QUESTION 11B THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING OF THE FEDERAL FORM 990 WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION THE ORGANIZATION'S AUDIT COMMITTEE ASSUMED THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990. 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. 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. A MEETING WAS ALSO HELD TO REVIEW THE FINAL DRAFT OF THE FEDERAL FORM 990 WITH THE ORGANIZATION'S AUDIT COMMITTEE FOR REVIEW AND APPROVAL. FOLLOWING THIS REVIEW THE FINAL FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO THE FILING OF THE TAX RETURN WITH THE IRS.
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 CHIEF COMPLIANCE OFFICER FOR REVIEW. THEREAFTER THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS. THEREAFTER, THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER PRESENTS THIS SUMMARY TO THE ORGANIZATION'S GOVERNANCE COMMITTEE FOR ITS REVIEW AND DISCUSSION.
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, EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER AND VICE PRESIDENT OF PATIENT CARE SERVICES. 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, EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER AND VICE PRESIDENT OF PATIENT CARE SERVICES. 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, EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER AND VICE PRESIDENT OF PATIENT CARE SERVICES. 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.
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. THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY.
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 OF THE ORGANIZATION; NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THE ORGANIZATION'S BOARD OF TRUSTEES.
CORE FORM, PART VII AND SCHEDULE J THIS ORGANIZATION TRANSFERRED THE PAYROLL OF CERTAIN INDIVIDUALS TO HOLY NAME HEALTH CARE FOUNDATION, INC., A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, DURING 2014. CELESTE ORANCHAK, VICE PRESIDENT OF DEVELOPMENT, WAS ONE OF THESE INDIVIDUALS AS HER DUTIES ARE IN SUPPORT OF THE FOUNDATION. THEREFORE, SHE IS NO LONGER REPORTED ON THIS ORGANIZATION'S CORE FORM, PART VII OR SCHEDULE J. HER COMPENSATION AND BENEFITS CAN BE FOUND ON THE FORM 990 OF HOLY NAME HEALTH CARE FOUNDATION, INC. IN ADDITION, THE ORGANIZATION RE-EVALUATED THE LISTING OF KEY EMPLOYEES AND DETERMINED THAT CERTAIN INDIVIDUALS, ALTHOUGH MEETING THE INCOME TEST, DO NOT MEET THE RESPONSIBILITY TEST AND SHOULD, THEREFORE, NOT BE REPORTED AS KEY EMPLOYEES ON PART VII OF THIS FORM 990. THESE EMPLOYEES ARE STILL EMPLOYED BY THE MEDICAL CENTER SO THEY ARE NOT DISCLOSED AS FORMER KEY EMPLOYEES.
CORE FORM, PART VII, SECTION A, COLUMN B 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 RELATED AFFILIATES. 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, 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 ALL RELATED ORGANIZATIONS AND THIS ORGANIZATION, IN TOTAL.
CORE FORM, PART XI; QUESTION 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - CHANGE IN NET INTEREST OF HOLY NAME HEALTH CARE FOUNDATION, INC. - ($2,049,791) - NET ASSETS RELEASED FROM RESTRICTION FOR CAPITAL PURPOSES - $18,889 - TRANSFERS TO AFFILIATES - ($14,926,816) - TRANSFER FROM HOLY NAME HEALTH CARE FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $58,455 - CHANGE IN BENEFICIAL INTEREST IN HOLY NAME HEALTH CARE FOUNDATION, INC. - $2,326,593 - NET CHANGE IN TEMPORARILY RESTRICTED INVESTMENT GAIN - $84,867 - NET ASSETS RELEASED FROM RESTRICTION FOR OPERATIONS; TEMPORARILY RESTRICTED - ($230,481) - NET ASSETS RELEASED FROM RESTRICTION FOR CAPITAL PURPOSES; TEMPORARILY RESTRICTED - ($18,889) - NET ASSETS TRANSFER; TEMPORARILY RESTRICTED - $1,000,000 - NET ASSETS TRANSFER; PERMANENTLY RESTRICTED - ($1,000,000) - ADJUSTMENT TO REFLECT BEGINNING BALANCES WITH RESPECT TO INCLUSION OF HNMC HOSPITAL/PHYSICIAN ACO, L.L.C., A SINGLE MEMBER LIMITED LIABILITY COMPANY WHOLLY OWNED BY THIS ORGANIZATION - ($500,920)
CORE FORM, PART XII; QUESTION 2 AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF HOLY NAME MEDICAL CENTER, INC. AND AFFILIATES, FOR THE YEARS ENDED DECEMBER 31, 2014 AND DECEMBER 31, 2013; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINS CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. HOLY NAME MEDICAL CENTER'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE AUDITED FINANCIAL STATEMENTS 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) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number

22-1487322
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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

(1) HNH FITNESS LLC
718 TEANECK ROAD
TEANECK,NJ07666
59-3836367
WELLNESS NJ 1,330,388 6,149,758 HNMC
 
(2) HNLS LLC
718 TEANECK ROAD
TEANECK,NJ07666
45-3636025
INACTIVE NJ 0 0 HNMC
 
(3) HNMC HOSPITALPHYSICIAN ACO LLC
718 TEANECK ROAD
TEANECK,NJ07666
45-5412543
HEALTHCARE NJ 148,209 263,495 HNMC
 






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 entity?
Yes No
(1) HOLY NAME HEALTH CARE FOUNDATION
718 TEANECK ROAD

TEANECK,NJ07666
22-2737143
FUNDRAISING NJ 501(C)(3) 509(A)(3) HNMC
 
Yes
 
(2) HOLY NAME REAL ESTATE CORP
718 TEANECK ROAD

TEANECK,NJ07666
22-3412504
PROPERTY CO NJ 501(C)(3) 509(A)(3) HNMC
 
Yes
 
(3) SISTERS OF ST JOSEPH OF PEACE
718 TEANECK ROAD

TEANECK,NJ07666
22-3412084
RELIGIOUS ORD NJ 501(C)(3) 170B1AI NA
 
 
No
(4) MS COMPREHENSIVE CARE CENTER
718 TEANECK ROAD

TEANECK,NJ07666
22-2402959
HEALTHCARE NJ 501(C)(3) 509(A)(2) HNMC
 
Yes
 
(5) HOLY NAME EMS INC
718 TEANECK ROAD

TEANECK,NJ07666
27-0294681
HEALTHCARE NJ 501(C)(3) 509(A)(3) HNMC
 
Yes
 
(6) THE CRUDEM FOUNDATION INC
718 TEANECK ROAD

TEANECK,NJ07666
43-1660199
HEALTHCARE MO 501(C)(3) 509(A)(1) HNMC FDN
 
 
No


For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No 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)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTH PARTNER SERVICES INC

718 TEANECK ROAD
TEANECK,NJ07666
22-3618636
MGMT SERVICES NJ HNMC
 
C CORP. 0 3,571,594 100.000 % Yes  
(2) PEACE HEALTH PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
22-3618634
HLTHCARE SVCS NJ NA
 
C CORP.         No
(3) HOUSE PHYSICIANS PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
22-3808427
HLTHCARE SVCS NJ NA
 
C CORP.         No
(4) HEMATOLOGYONCOLOGY PHYSICIANS

718 TEANECK ROAD
TEANECK,NJ07666
22-3808421
HLTHCARE SVCS NJ NA
 
C CORP.         No
(5) RIVERSIDE FAMILY CARE

718 TEANECK ROAD
TEANECK,NJ07666
20-0446233
HLTHCARE SVCS NJ NA
 
C CORP.         No
(6) RADIATION ONCOLOGY PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
20-1104758
HLTHCARE SVCS NJ NA
 
C CORP.         No
(7) EXCELCARE MEDICAL ASSOCIATES

718 TEANECK ROAD
TEANECK,NJ07666
20-3130405
HLTHCARE SVCS NJ NA
 
C CORP.         No
(8) BREAST IMAGING PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
75-3226059
HLTHCARE SVCS NJ NA
 
C CORP.         No
(9) HOLY NAME CARDIOLOGY ASSOCIATES PC

718 TEANECK ROAD
TEANECK,NJ07666
75-3226063
HLTHCARE SVCS NJ NA
 
C CORP.         No
(10) BREAST CARE PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
11-3787403
HLTHCARE SVCS NJ NA
 
C CORP.         No
(11) HOLY NAME PULMONARY ASSOCIATES PC

718 TEANECK ROAD
TEANECK,NJ07666
83-0511119
HLTHCARE SVCS NJ NA
 
C CORP.         No
(12) WOMEN'S CLINIC PARTNERS

718 TEANECK ROAD
TEANECK,NJ07666
36-4635222
HLTHCARE SVCS NJ NA
 
C CORP.         No
(13) MULKAY CARDIOLOGY CONSULTANTS AT HNMC

718 TEANECK ROAD
TEANECK,NJ07666
46-3392343
HLTHCARE SVCS NJ N/A
C CORP.         No
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
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, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) HEALTH PARTNER SERVICES INC

R 13,460,000 COST
(2) HEALTH PARTNER SERVICES INC

D 339,763 COST
(3) MS COMPREHENSIVE CARE CENTER

D 687,483 COST
(4) HOLY NAME REAL ESTATE CORPORATION

D 1,309,432 COST
(5) HOLY NAME EMS INC

E 50,065 COST
(6) HOLY NAME HEALTH CARE FOUNDATION

D 2,125,295 COST
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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 V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
SCHEDULE R, PART V HOLY NAME MEDICAL CENTER ROUTINELY PAYS EXPENSES FOR VARIOUS RELATED AFFILIATES IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.
Schedule R (Form 990) 2014
Additional Data


Software ID:  
Software Version: