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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART I, LINE 1 PROVIDE COMPREHENSIVE, STATE-OF-THE-ART PATIENT SERVICES; EMPHASIZE CARING AND OTHER HUMAN VALUES IN THE TREATMENT OF PATIENTS AND IN RELATIONS AMONG EMPLOYEES, MEDICAL STAFF AND THE COMMUNITY; BE A CENTER OF EDUCATION AND RESEARCH; PROVIDE EMPLOYEES AND MEDICAL STAFF WITH MAXIMUM OPPORTUNITIES TO ACHIEVE THEIR PERSONAL AND PROFESSIONAL GOALS. 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. |
| 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)VOTE IN THE ELECTION OF TRUSTEES AND TO CAST ONE VOTE FOR EACH TRUSTEE ELECTED; B)ONE VOTE ON ALL OTHER MATTERS TO BE VOTED ON. |
| 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)AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS, B)SALE, LEASE OR EXCHANGE OF SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS, C)MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION, D)DISSOLUTION, E)APPROVAL OF THE ANNUAL BUDGET, F)ANY SUBSTANTIAL TRANSFER OF FUNDS BY GRANT, GIFT OR LOAN, G)ANY OTHER MATTER THAT BY LAW REQUIRES THE APPROVAL OF THE MEMBER. |
| 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 PARENT COMPANY OF ENGLEWOOD HOSPITAL AND MEDICAL CENTER, FORM 990 WAS REVIEWED WITH ALL MEMBERS; PRESENTATION WAS MADE BY SENIOR MANAGEMENT AS WELL AS BY THE ORGANIZATION'S EXTERNAL 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 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. |
| OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | Form 990, Part VI, Lines 15A AND 15B ENGLEWOOD HOSPITAL AND MEDICAL CENTER HAS A STANDING EXECUTIVE COMPENSATION COMMITTEE THAT MEETS THREE TO FIVE TIMES PER YEAR TO REVIEW MANAGEMENT'S PERFORMANCE AND APPROVE THEIR COMPENSATION LEVELS. REVIEW CRITERIA INCLUDES, BUT IS NOT LIMITED TO, OPERATING RESULTS, PERSONAL AND INSTITUTIONAL OBJECTIVES, ETC. THE COMMITTEE ALSO ENGAGES AN INDEPENDENT FIRM TO ASSESS COMPETITIVE COMPENSATION WITHIN THE LOCAL AREA COMMENSURATE WITH EXPERIENCE AND RESPONSIBILITY. FINALLY, DATA IS GATHERED FROM SEVERAL SOURCES REFLECTING LOCAL MARKET RATES AND COMPENSATION LEVELS FOR SIMILAR POSITIONS. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | Form 990, Part VI, Line 19 ENGLEWOOD HOSPITAL AND MEDICAL CENTER 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. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 CHANGE IN MINIMUM PENSION FUNDING $(2,143,893) CHANGE IN NET ASSETS OF FOUNDATION $ 6,704,202 -------------- TOTAL $(8,848,085) REQUIRED AUDIT FORM 990, PART XII, LINE 3B ENGLEWOOD HOSPITAL AND MEDICAL CENTER UNDERWENT THE REQUIRED AUDIT IN FULL COMPLIANCE WITH THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES - COMMUNITY TOTAL FEES:71783347 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES - HOSPITAL TOTAL FEES:22489527 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES - ADMIN TOTAL FEES:2366171 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:NURSE PRACTITIONER FEES TOTAL FEES:3247576 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:STATE OF NJ ADUSTED ADM FEE TOTAL FEES:2148504 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING FEES TOTAL FEES:2362379 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:TRANSCRIPTION FEES TOTAL FEES:486968 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ALL OTHER FEES TOTAL FEES:2384585 |
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