Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(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.") .... | 5,726,982 | 7,700,336 | 5,854,389 | 9,926,143 | 14,439,783 | 43,647,633 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 5,726,982 | 7,700,336 | 5,854,389 | 9,926,143 | 14,439,783 | 43,647,633 |
| 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).. | 1,191,508 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 42,456,125 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 5,726,982 | 7,700,336 | 5,854,389 | 9,926,143 | 14,439,783 | 43,647,633 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 184,132 | 338,891 | 282,171 | 252,176 | 390,502 | 1,447,872 |
| 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.).. | 197,775 | 276,605 | 206,120 | 285,875 | 216,860 | 1,183,235 |
| 11 | Total support Add lines 7 through 10. | 46,278,740 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(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.).. | ||||||
| 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) | |||||
| 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 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 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) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| DESCRIPTION OF RELATIONSHIPS | FORM 990, PART V, LINE 2A ENGLEWOOD HOSPITAL AND MEDICAL CENTER FOUNDATION DOES NOT DIRECTLY PAY ITS EMPLOYEES. THE COMPENSATION AND BENEFITS ARE ALLOCATED FROM ENGLEWOOD HOSPITAL AND MEDICAL CENTER. THE COMPENSATION AND BENEFITS ARE RECORDED ON THE FORM 941 FILED BY ENGLEWOOD HOSPITAL AND MEDICAL CENTER UNDER EMPLOYER IDENTIFICATION NUMBER 22-1487173. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, LINE 2 BOARD MEMBERS, MR. JAY NADEL AND MR. RICHARD KURTZ HAVE A BUSINESS RELATIONSHIP. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | Form 990, Part VI, Line 6 ENGLEWOOD HEALTHCARE SYSTEM IS THE SOLE MEMBER OF ENGLEWOOD HOSPITAL AND MEDICAL CENTER FOUNDATION, INC. |
| DESCRIPTION OF MEMBERS, STOCKHOLDERS, OR OTHER PERSONS WHO HAD THE POWER | TO ELECT OR APPROVE ONE OR MORE MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, LINE 7A ENGLEWOOD HEALTHCARE SYSTEM, SOLE MEMBER, HAS THE RIGHTS AND POWERS TO: A)DETERMINE THE NUMBER OF TRUSTEES THAT WILL COMPRISE THE BOARD OF TRUSTEES OF THE CORPORATION; B)ELECT TRUSTEES OF THE CORPORATION; C)REMOVE ANY TRUSTEE FROM THE CORPORATION'S BOARD OF TRUSTEES, WITH OR WITHOUT CAUSE, AND TO REPLACE ANY SUCH REMOVED TRUSTEE FOR THE UNEXPIRED PORTION OF HIS/HER TERM. D)APPROVE THE ELECTION, REELECTION, APPOINTMENT, REAPPOINTMENT, AND REMOVAL OF ALL OFFICERS OF THE CORPORATION. |
| DESCRIPTION OF GOVERNANCE DECISIONS OF THE ORGANIZATION RESERVED TO | MEMBERS, STOCKHOLDERS, OR PERSONS OTHER THAN THE GOVERNING BODY FORM 990, PART VI, LINE 7B ENGLEWOOD HEALTHCARE SYSTEM, SOLE MEMBER, HAS THE RIGHTS AND POWERS TO APPROVE: A)AMENDMENT, REVISION OR RESTATEMENT OF THE CORPORATION'S CERTIFICATE OF INCORPORATION AND BYLAWS, AND ALL AMENDMENTS OR REVISIONS TO THE CORPORATION'S CERTIFICATE OF INCORPORATION AND BYLAWS THAT MAY BE PROPOSED BY THE BOARD OF TRUSTEES OF THE CORPORATION BEFORE THEY BECOME EFFECTIVE; B)DISSOLUTION, DIVISION, CONVERSION OR LIQUIDATION OF THE CORPORATION, TO CONSOLIDATE OR MERGE THE CORPORATION WITH ANOTHER CORPORATION OR ENTITY, OR TO ACQUIRE SUBSTANTIALLY ALL OF THE ASSETS OF ANOTHER CORPORATION OR ENTITY; C)ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION, INCLUDING THE DISPOSITION OF ANY CONTRIBUTIONS OR OTHER NET FUNDS; D)INCURRENCE OF DEBT BY THE CORPORATION IN EXCESS OF $50,000, UNLESS SPECIFICALLY AUTHORIZED IN THE CORPORATION'S APPROVED BUDGETS; E)EXPENDITURES NOT PROVIDED FOR IN THE APPROVED BUDGETS IN EXCESS OF $50,000; F)CONTRACTUAL COMMITMENTS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS; G)SALE, LEASE OR EXCHANGE OF ANY ASSET OF THE CORPORATION THAT IS VALUED IN EXCESS OF $50,000; H)TRANSFER, GRANT, GIFT, LOAN OR HYPOTHECATION OF ASSETS OF THE CORPORATION NOT PROVIDED FOR IN THE APPROVED BUDGETS, EXCEPT FOR TRANSFERS OF RESTRICTED FUNDS IN ACCORDANCE WITH THE DONOR'S WISHES. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | Form 990, Part VI, Line 11b AT THE OCTOBER MEETING OF ENGLEWOOD HEALTHCARE SYSTEM, THE ULTIMATE PARENT COMPANY OF ENGLEWOOD HOSPITAL AND MEDICAL CENTER FOUNDATION, FORM 990 WAS REVIEWED WITH ALL MEMBERS; PRESENTATION WAS MADE BY SENIOR MANAGEMENT AS WELL AS BY THE ORGANIZATION'S EXTERNAL PROFESSIONAL PREPARER OF FORM 990. QUESTIONS AND ANSWERS ENSUED. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | Form 990, Part VI, Line 12c ENGLEWOOD HOSPITAL AND MEDICAL CENTER, AN AFFILIATE OF ENGLEWOOD HOSPITAL AND MEDICAL CENTER FOUNDATION, HAS CONFLICT OF INTEREST POLICIES THAT APPLY TO OFFICERS, DIRECTORS AND TRUSTEES. ENGLEWOOD HOSPITAL AND MEDICAL CENTER'S NOMINATING AND GOVERNANCE COMMITTEE OF ITS BOARD OF TRUSTEES REVIEWS CONFLICT OF INTEREST STATEMENTS. IF ANY MATTER IS BROUGHT TO THE BOARD IN SUCH A WAY AS TO GIVE RISE TO A CONFLICT OF INTEREST, THE AFFECTED TRUSTEE SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY THE TRUSTEE'S WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS THAT MIGHT BE ASKED, SHALL WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION, AND SHALL BE ALLOWED NO VOTE ON THE MATTER. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | Form 990, Part VI, Line 19 ENGLEWOOD HOSPITAL AND MEDICAL CENTER FOUNDATION COMPLIES WITH ALL GOVERNMENT REQUIREMENTS RELATING TO THE DISCLOSURE OF THESE ITEMS. FINANCIAL INFORMATION IS AVAILABLE PUBLICLY VIA THE REQUIRED SUBMISSION OF DATA TO THE INTERNAL REVENUE SERVICE AND THE NEW JERSEY STATE ATTORNEY GENERAL'S OFFICE. REQUESTS FROM THE PUBLIC FOR ADDITIONAL INFORMATION ARE HANDLED ON A CASE-BY-CASE BASIS. |
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