TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JOSE CORTES...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(2) GLENN K TIPPY CPCU CLU...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(3) CLAY HINRICHS MD...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(4) BOGDEN BIENKO...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(5) ERIC CROSS...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(6) MICHAEL HALPIN...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(7) MICHAEL LAVERY...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(8) BARBARA-JAYNE LEWTHWAITE PHD...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(9) TIMOTHY C MCDONOUGH...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(10) RAY NISIVOCCIA CPA...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(11) JAMES J TRAVIS...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(12) NORMAN WORTH...................................................................... TRUSTEE	2.00 .................	X			0	0	0
(13) JAMES G LEE...................................................................... CHAIRMAN; EVP & CFO, AHC	5.00 ................. 57.00	X	X		0	662,822	135,961
(14) TERRY FORDE...................................................................... PRESIDENT & CEO, AHC	3.00 ................. 59.00	X	X		0	1,225,363	219,138
(15) JASON C COE...................................................................... SECRETARY; PRESIDENT, HRMC	45.00 ................. 15.00	X	X		0	393,566	82,998
(16) ROBERT C PETERSON...................................................................... CHIEF FINANCIAL OFFICER	50.00 ................. 10.00		X		273,061	0	60,899
(17) KENNETH JANOWSKI...................................................................... CHIEF MEDICAL OFFICER	40.00 ................. 10.00			X	297,229	0	66,839

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO INC PO BOX 536922 ATLANTA,GA303536922	FOOD MGMT SERVICES	724,972
DRINKER BIDDLE & REATH LLP ONE LOGAN SQUARE SUITE 2000 PHILADELPHIA,PA191036996	LEGAL SERVICES	692,008
ZENITH PHYSICIANS LLC PO BOX 447 HACKETTSTOWN,NJ07840	HOSPITALIST GROUP	603,538
HACKETTSTOWN PEDIATRIC HOSPITALIST LLC 290 UNION BLVD TOTOWA,NJ07512	PEDIATRIC HOSPITALIST	575,000
MEDASSETS INC PO BOX 405652 ATLANTA,GA303845652	REVENUE CYCLE SERVICE	539,681
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 31

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

2015

Open to Public
Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Part I

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

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

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(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.

Section B. Total Support

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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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)		(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.)

Section B. Total Support

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.)..

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

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
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)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization HACKETTSTOWN COMMUNITY HOSPITAL

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization HACKETTSTOWN COMMUNITY HOSPITAL		Employer identification number 22-6106281

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization HACKETTSTOWN COMMUNITY HOSPITAL			Employer identification number 22-6106281
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

2015

Open to Public Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ....

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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" on Form 990, Part IV, line 8.

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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' on 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 ...	1,145,121		1,145,121
b	Buildings	52,192,078	32,425,780	19,766,298
c	Leasehold improvements	8,541,385	4,899,134	3,642,251
d	Equipment ...	62,536,137	51,112,453	11,423,684
e	Other ...	4,267,882	1,697,706	2,570,176
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				38,547,530

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
CONSTRUCTION PAYABLE	50,410
MOBII OCCUPANCY GUARANTEE LIAB	867,660
OTHER LONG TERM LIABILITY	33,870
DUE TO PARENT ORGANIZATION	32,229,053
THIRD PARTY PAYABLES	741,685
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	33,922,678
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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' on 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

PART X, LINE 2:

FIN 48 NOTES: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 OR 2014. THE CORPORATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2012 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) 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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	990,108	125,254	864,854	0.980 %
b	Medicaid (from Worksheet 3, column a) . . . . .	1,172,076	644,011	528,065	0.600 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	2,162,184	769,265	1,392,919	1.580 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	954,295	69,216	885,079	1.000 %
f	Health professions education (from Worksheet 5) . . .	244,942		244,942	0.280 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	36,979		36,979	0.040 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	37,008		37,008	0.040 %
j	Total. Other Benefits . .	1,273,224	69,216	1,204,008	1.360 %
k	Total. Add lines 7d and 7j .	3,435,408	838,481	2,596,927	2.940 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	3,265	3,265	0 %
3	Community support	27,353	27,353	0.030 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	30,618	30,618	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,622,660

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. ......

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

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

26,496,010

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

43,035,530

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

-16,539,520

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(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 %	(e) Physicians' profit % or stock ownership %
11 HACKETTSTOWN DIAGNOSTIC ASSOCIATES LLC	IMAGING CENTER	50.000 %	50.000 %
22 DYNAMIC IMAGING ASSOCIATES LLC	EQUIPMENT HOLDING COMPANY	50.000 %	50.000 %
33 RADIOLOGY ASSOCIATES OF HACKETTSTOWN LLC	IMAGING CENTER	33.300 %	66.700 %
44 HACKETTSTOWN REGIONAL MRILLC	EQUIPMENT HOLDING COMPANY	33.300 %	66.700 %
55 MRI ASSOCIATES OF HACKETTSTOWN LLC	IMAGING CENTER	50.000 %	50.000 %
66 GCM LLC	EQUIPMENT HOLDING COMPANY	50.000 %	50.000 %
77 TRI MED ASSOCIATES	REAL ESTATE ENTITY	33.300 %	66.700 %
88 GORDON HACKETTSTOWN MAB ASSOCIATES	MEDICAL OFFICE BUILDING VENTURE	20.000 %	22.500 %
9
10
11
12
13

Schedule H (Form 990) 2015

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)
1	HACKETTSTOWN COMMUNITY HOSPITAL 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840 HTTP://WWW.HRMCNJ.ORG/ 12101	X	X	X

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	HACKETTSTOWN COMMUNITY HOPITAL
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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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 .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

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. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.HRMCNJ.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.HRMCNJ.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on 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) 2015

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Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HACKETTSTOWN COMMUNITY HOPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTP://WWW.HRMCNJ.ORG/FINANCIAL-ASSISTANCE.ASP

The FAP application form was widely available on a website (list url):

SAME AS LINE 16A

A plain language summary of the FAP was widely available on a website (list url):
SAME AS LINE 16A

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

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Part VFacility Information (continued)

	HACKETTSTOWN COMMUNITY HOPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

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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
HACKETTSTOWN COMMUNITY HOPITAL	PART V, SECTION B, LINE 5: HACKETTSTOWN COMMUNITY HOSPITAL UNDERTOOK A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT WHICH CONCLUDED IN 2015. THE PURPOSE OF THE STUDY WAS TO GATHER CURRENT STATISTICS AND QUALITATIVE FEEDBACK ON THE KEY HEALTH ISSUES FACING OUR SERVICE MARKET RESIDENTS. SECONDARY DATA WAS RESEARCHED AND UPDATED. FIFTY FIVE COMMUNITY STAKEHOLDERS COMPLETED A "KEY INFORMANT SURVEY TOOL". AFTER COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, APPROXIMATELY 23 LEADERS FROM HACKETTSTOWN COMMUNITY HOSPITAL, COMMUNITY AGENCIES AND AREA HEALTHCARE AND SOCIAL SERVICES ORGANIZATIONS MET TO REVIEW AND PRIORITIZE THE FINDINGS AND TO DEVELOP AN IMPLEMENTATION PLAN. THE FOLLOWING KEY STAKEHOLDERS PARTICIPATED IN THE PROCESS:ADMINISTRATIVE DIRECTOR, HRMC;BACH'S MEDICAL SUPPLIES;BENTLEY COMMONS AT PARAGON VILLAGE;CENTENARY COLLEGE;CHELSEA AT BROOKFIELD;CHIEF NURSING OFFICER, HRMC;CHURCH OF THE ASSUMPTION;COMMUNITY PREVENTION RESOURCES;COORDINATOR, HEALTHLINK, HRMC;EMS, HRMC;EXECUTIVE DIRECTOR, HRMC;FAMILY GUIDANCE OF WARREN COUNTY;HACKETTSTOWN BUSINESS IMPROVEMENT;HACKETTSTOWN POLICE DEPARTMENT;HACKETTSTOWN ROTARY CLUB;HEALTH EDUCATOR, HRMC;HEALTHSTART PRENATAL CLINIC, HRMC;HEALTH VILLAGE;HOME INSTEAD;HOUSE OF THE GOOD SHEPHERD;KAREN ANN QUINLAN HOSPICE;KIWANIS CLUB OF HACKETTSTOWN;LONG VALLEY FIRST AID SQUAD;MANAGER, CENTER FOR HEALTHIER LIVING, HRMC;MANAGER, COUNSELING AND ADDICTION CENTER, HRMC;MANAGER, EDUCATION, HRMC;MANAGER, EMERGENCY DEPARTMENT, HRMC;MANAGER, MARKETING AND PUBLIC RELATIONS, HRMC;MT. OLIVE HEALTH DEPARTMENT;NORTH WARREN REGIONAL SCHOOL DISTRICT;PHYSICIAN, EMERGENCY DEPARTMENT, HRMC;PLANNED PARENTHOOD;PRESIDENT, HACKETTSTOWN REGIONAL MEDICAL CENTER;PROJECT SELF-SUFFICIENCY;UNITED WAY OF NORTHERN NJ;WARREN COUNTY AGENCY ON AGING AND DISABILITY;WARREN COUNTY DEPARTMENT OF HUMAN SERVICES;WARREN COUNTY HEALTH DEPARTMENT;WARREN COUNTY MENTAL HEALTH BOARD;WARREN COUNTY OFFICE OF EMERGENCY MANAGEMENT;WARREN COUNTY SURROGATE;WARREN COUNTY TEMPORARY ASSISTANCE;WARREN COUNTY TRANSPORTATION COORDINATOR;WASHINGTON TOWNSHIP HEALTH DEPARTMENT;ZUFALL, FEDERALLY QUALIFIED HEALTH CENTER.
HACKETTSTOWN COMMUNITY HOPITAL	PART V, SECTION B, LINE 11: THE FOLLOWING WERE IDENTIFIED AS THE KEY COMMUNITY PRIORITIES: ACCESS TO CARE,CHRONIC DISEASE MANAGEMENT, COORDINATION OF CARE, AND MENTAL HEALTH.THE PLAN TO ADDRESS THESE ISSUES ARE AS FOLLOWS. ACCESS TO CARE:GOAL - INCREASE ACCESS TO AFFORDABLE QUALITY HEALTH CARE FOR HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA RESIDENTS. OBJECTIVE - IDENTIFY A COMPREHENSIVE LIST OF AVAILABLE COMMUNITY RESOURCES FOR THE LOW INCOME AND UNINSURED POPULATION IN HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA BY MARCH 2017. ACTIONS - > IDENTIFY COMMUNITY PARTNERS TO OBTAIN AND EVALUATE AVAILABLE RESOURCES AND RESOURCE GUIDES. > WORK WITH COMMUNITY PARTNERS TO CONSOLIDATE RESOURCE INFORMATION ON AREA HEALTH CLINICS AND LOCAL RESOURCES. > POST INFORMATION ON THE HOSPITAL'S WEBSITE AND DISTRIBUTE THROUGH: HACKETTSTOWN MEDICAL CENTER'S FINANCIAL COUNSELORS, EMERGENCY DEPARTMENT, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT AND OTHER IDENTIFIED AGENCIES.PLAN TO EVALUATE - HACKETTSTOWN MEDICAL CENTER WILL EVALUATE THE DISTRIBUTION OF THE RESOURCE GUIDE BY CONTACTING THE LOCAL AGENCIES TO EVALUATE THE NUMBER THAT WERE PROVIDED TO COMMUNITY RESIDENTS. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, ZUFALL HEALTH CENTER, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, WARREN COUNTY DIVISION OF HUMAN SERVICES, UNITED WAY.MENTAL HEALTH/SUBSTANCE ABUSE: GOAL - INCREASE ACCESS TO EXISTING MENTAL HEALTH SERVICES AND INCREASE AWARENESS OF MENTAL HEALTH ISSUES FOR HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA. OBJECTIVE - IDENTIFY A COMPREHENSIVE LIST OF AVAILABLE RESOURCES FOR THOSE IN NEED OF MENTAL HEALTH AND ADDICTION SERVICES IN HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA BY MARCH 2017. ACTIONS - > IDENTIFY AND CONTACT COMMUNITY PARTNERS TO PARTICIPATE IN A MENTAL HEALTH STRATEGY WORKGROUP. > IDENTIFY LOCAL COMMUNITY PARTNERS TO OBTAIN AND EVALUATE AVAILABLE RESOURCES AND RESOURCE GUIDES. > WORK WITH LOCAL COMMUNITY PARTNERS TO CONSOLIDATE RESOURCE INFORMATION. > POST INFORMATION ON THE HOSPITAL'S WEBSITE AND DISTRIBUTE THROUGH: HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, SCHOOLS, CHURCHES, EMERGENCY DEPARTMENT, FIRST AID SQUADS, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, ZUFALL HEALTH CENTER. PLAN TO EVALUATE - HACKETTSTOWN MEDICAL CENTER WILL EVALUATE THE DISTRIBUTION OF THE RESOURCE GUIDE BY CONTACTING LOCAL AGENCIES TO EVALUATE THE NUMBER THAT WERE DISTRIBUTED. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, EMERGENCY DEPARTMENT, FIRST AID SQUADS, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, ZUFALL HEALTH CENTER WARREN COUNTY DIVISION OF HUMAN SERVICES, FAMILY GUIDANCE, LOCAL SCHOOLS AND CHURCHES. OBJECTIVE - DECREASE MENTAL HEALTH STIGMA BY INCREASING AWARENESS AND IDENTIFICATION OF MENTAL HEALTH /SUBSTANCE ABUSE DISORDERS. ACTIONS - > EXPLORE EVIDENCED BASED TRAINING OPPORTUNITIES TO INCREASE AWARENESS OF MENTAL HEALTH ISSUES. > IDENTIFY TARGET GROUPS TO RECEIVE TRAINING SUCH AS STUDENT ASSISTANCE COUNSELORS, CLERGY, AND LOCAL FIRST AID SQUADS. > ENGAGE GROUPS TO BE TRAINED AND COLLECT DATA ON THE NEEDS OF THE GROUP. HOLD TRAINING FOR 25 PARTICIPANTS IN YEAR ONE. PLAN TO EVALUATE - EVALUATE THE SUCCESS OF THE PROGRAM BY FEEDBACK FROM PARTICIPANTS. POTENTIAL PARTNERS - MENTAL HEALTH WORKGROUP, HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, CENTER FOR HEALTHIER LIVING, FAMILY GUIDANCE, NAMI. CHRONIC DISEASE MANAGEMENT/COORDINATION OF CARE: GOAL - REDUCE RISK FACTORS FOR CHRONIC DISEASE AND IMPROVE MANAGEMENT OF DISEASE CONDITIONS THROUGH PROMOTION AND EDUCATION OF HEALTHY LIFESTYLES. OBJECTIVE - INCREASE THE NUMBER OF PARTICIPANTS ATTENDING CHRONIC DISEASE EDUCATION PROGRAMS AND SUPPORT GROUPS. ACTIONS - > PROVIDE AT LEAST 4 EDUCATIONAL OPPORTUNITIES FOR THOSE DIAGNOSED WITH CHRONIC DISEASES SUCH AS DIABETES, CARDIOVASCULAR DISEASE AND PULMONARY DISEASE. > WORK WITH LOCAL COMMUNITY RESOURCES AND PHYSICIANS TO REFER PATIENTS TO SUPPORT GROUPS. > INCREASE ATTENDANCE AT THE HEALTHY HEARTS, BETTER BREATHER'S CLUB AND DIABETES SUPPORT GROUPS. PLAN TO EVALUATE - > DOCUMENT THE NUMBER OF EDUCATIONAL PROGRAMS. > EVALUATE THE NUMBER OF PEOPLE ATTENDING THE PROGRAMS VERSUS ATTENDANCE IN THE PAST. > EVALUATE THE NUMBER OF PEOPLE REFERRED TO SUPPORT GROUPS THROUGH COMMUNITY AGENCIES AND PHYSICIANS BY SURVEY. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, LOCAL HEALTH DEPARTMENTS, ZUFALL HEALTH CLINIC, LOCAL PRIMARY CARE PHYSICIAN'S. OBJECTIVE - PARTNER WITH COMMUNITY AGENCIES TO PROVIDE 3 HEALTH SCREENINGS AND 3 EDUCATION EVENTS TO THE LOW INCOME AND UNINSURED POPULATION.ACTIONS - > IDENTIFY LOCAL AGENCIES TO COORDINATE HEALTH EDUCATION PROGRAMS AND SCREENINGS. > PROVIDE AT LEAST 3 SCREENINGS AND 3 COMMUNITY EDUCATION PROGRAMS TO IDENTIFY THOSE AT RISK FOR CHRONIC DISEASES. > TARGET PROGRAMS AND SCREENINGS TO THE LOW INCOME AND UNINSURED POPULATION. PLAN TO EVALUATE - DOCUMENT THE COMPLETION OF 3 COMMUNITY EDUCATION AND SCREENING PROGRAMS. > EVALUATE THE NUMBER OF PEOPLE WHO ATTENDED THE PROGRAM. > EVALUATE THE NUMBER OF PEOPLE REFERRED FROM THE SCREENING PROGRAM. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, ZUFALL HEALTH CLINIC, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, WARREN COUNTY DIVISION OF HUMAN SERVICES, LOCAL CHURCHES.RATIONALE FOR COMMUNITY HEALTH NEEDS NOT ADDRESSED: HACKETTSTOWN MEDICAL CENTER PLANS TO ADDRESS ALL OF THE HEALTH PRIORITIES AS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND PRIORITIZATION SESSION. COORDINATION OF CARE WILL FOCUS ON CHRONIC DISEASE MANAGEMENT.

Schedule H (Form 990) 2015

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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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

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
PART I, LINE 3C:	HACKETTSTOWN COMMUNITY HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA DEFINED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. PATIENTS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR FREE CARE. PATIENTS BETWEEN 200% AND 300% OF THE FPG ARE ELIGIBLE FOR DISCOUNTED CARE.PART I, LINE 6A:ALTHOUGH NOT REQUIRED BY THE STATE OF NEW JERSEY, HACKETTSTOWN COMMUNITY HOSPITAL PREPARED A 2015 COMMUNITY BENEFIT REPORT AND MADE IT READILY AVAILABLE TO THE COMMUNITY ON OUR WEBSITE.
PART I, LINE 7:	IN ORDER TO DETERMINE THE EXPENSE FOR CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST, HACKETTSTOWN COMMUNITY HOSPITAL UTILIZED COST TO CHARGE RATIOS TO DETERMINE THE COST OF THESE PROGRAMS.
PART I, LN 7 COL(F):	NO BAD DEBT IS INCLUDED IN THE FUNCTIONAL EXPENSES IN PART IX OF THE FORM 990 AND THEREFORE NO ADJUSTMENT WAS NECESSARY TO COMPUTE THE PERCENTAGES IN THE CHART FOR LINE 7.
PART II, COMMUNITY BUILDING ACTIVITIES:	COMMUNITY BUILDING:THE HACKETTSTOWN COMMUNITY HOSPITAL ADMINISTRATIVE TEAM ACTIVELY PARTICIPATES AS MEMBERS OF THE HACKETTSTOWN ROTARY AND IN THEIR EFFORTS TO IMPROVE THE HEALTH AND SAFETY OF THE HACKETTSTOWN COMMUNITY.HACKETTSTOWN COMMUNITY HOSPITAL WORKS JOINTLY WITH STATE AND COUNTY AGENCIES TO COORDINATE DISASTER PREPAREDNESS POLICIES AND PROCEDURES IN THE EVENT OF A LARGE STAGE DISASTER AFFECTING HACKETTSTOWN AND THE SURROUNDING COMMUNITIES.HACKETTSTOWN COMMUNITY HOSPITAL HAS ALSO PARTNERED WITH MANY PROGRAMS TO PROVIDE INTERNSHIPS TO STUDENTS WHO ARE PURSUING CAREERS IN A VARIETY OF HEALTH PROFESSIONS INCLUDING BUT NOT LIMITED TO: NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIAGNOSTIC IMAGING, BEHAVIORAL HEALTH AND ADDICTION COUNSELING AND PHARMACY RESIDENTS.THE CENTER FOR HEALTHIER LIVING PLAYS AN ACTIVE ROLE IN THE WARREN SUSSEX CHRONIC DISEASE COALITION WHICH IS DEDICATED TO THE IMPLEMENTATION OF EVIDENCE/PRACTICE BASED POLICY, AND ENVIRONMENTAL AND SYSTEM CHANGE INTERVENTIONS FOR CHRONIC DISEASE PREVENTION AND CONTROL WITH A FOCUS ON CANCER. THE COALITION IS COMMITTED TO MAINTAINING A DIVERSE PARTNERSHIP OF COMMUNITY MEMBERS AND AGENCIES.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL COLLECTIONS AND PROVISION FOR DOUBTFUL COLLECTIONS. FOR PATIENT ACCOUNTS RECEIVABLE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL COLLECTIONS AND PROVISION FOR DOUBTFUL COLLECTIONS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION RECORDS A PROVISION FOR DOUBTFUL COLLECTIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL COLLECTIONS.
PART III, LINE 8:	MEDICARE IN ORDER TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES, HACKETTSTOWN COMMUNITY HOSPITAL UTILIZED COST TO CHARGE RATIOS AS DETERMINED BY THE HOSPITAL'S MEDICARE COST REPORT. THE TOTAL COST WAS COMPARED TO PAYMENTS RECEIVED FROM THE MEDICARE PROGRAM. THE SHORTFALL CALCULATED REPRESENTS UNREIMBURSED COSTS UNDER THE MEDICARE PROGRAM THAT THE HOSPITAL ABSORBS ON BEHALF OF THE PATIENTS THAT IT SERVES.THE SHORTFALL ON PART III, LINE 7 IS CONSIDERED TO BE A COMMUNITY BENEFIT.
PART III, LINE 9B:	COLLECTION PRACTICESINDIVIDUALS THAT QUALIFY FOR 100% CHARITY CARE UNDER THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES GUIDELINES ARE NOT BILLED FOR ANY AMOUNTS. INDIVIDUALS THAT QUALIFY FOR PARTIAL CHARITY CARE UNDER THESE GUIDELINES ARE BILLED AT A REDUCED RATE. FINANCIAL COUNSELORS ARE AVAILABLE TO ALL PATIENTS TO DETERMINE WHETHER ANY PROGRAMS (E.G. CHARITY CARE, MEDICAID) ARE AVAILABLE TO ASSIST PATIENTS.FINANCIAL ASSISTANCE PROCESS AND COLLECTION PROTOCOL ARE WELL DEFINED WITH MANAGERS AVAILABLE TO GUIDE AND HANDLE EXCEPTION SITUATIONS. OUTSOURCED AGENCIES AND COLLECTIONS FIRMS ARE EXPECTED TO ADHERE TO HACKETTSTOWN COMMUNITY HOSPITAL'S POLICY. BAD DEBT, CHARITY AND ADMINISTRATIVE WRITE OFF ARE CLEARLY DEFINED WITH PRE-DETERMINED AUTHORIZATION LEVELS DEPENDING ON THE MAGNITUDE GRANTED.
PART VI, LINE 2:	NEEDS ASSESSMENT:HACKETTSTOWN COMMUNITY HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015 UTILIZING THE SERVICES OF HOLLERAN CONSULTING. A WIDE VARIETY OF COMMUNITY PARTNERS PARTICIPATED IN THE PROCESS TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY. UPON COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, AND IMPLEMENTATION PLAN WAS DEVELOPED AND APPROVED IN 2016. ALTHOUGH THE STATE OF NEW JERSEY DOES NOT REQUIRE THAT A COMMUNITY BENEFIT REPORT BE FILED, HACKETTSTOWN COMMUNITY HOSPITAL (HCH) PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS POSTED ON ITS WEBSITE AND MAILED TO THE COMMUNITY UPON REQUEST. A MEETING IS HELD EACH YEAR TO INFORM THE COMMUNITY.
PART VI, LINE 3:	PATIENT EDUCATION:ALL PATIENTS OF THE HOSPITAL THAT DO NOT HAVE INSURANCE ARE PROVIDED WITH INFORMATION REGARDING FINANCIAL ASSISTANCE. THE INFORMATION PROVIDES INFORMATION REGARDING THE REQUIREMENTS FOR QUALIFYING FOR CHARITY CARE AND OTHER ASSISTANCE PROGRAMS. IN ADDITION, THE HOSPITAL HAS A FULL TIME FINANCIAL COUNSELING OFFICE WITH DEDICATED FINANCIAL COUNSELORS THAT PROVIDE SCREENINGS AND INFORMATION TO ALL PATIENTS REQUESTING ASSISTANCE.
PART VI, LINE 4:	COMMUNITY INFORMATION:HACKETTSTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS MADE UP OF 12 ZIP CODES THAT STRADDLE THE WESTERN PORTION OF MORRIS COUNTY AND THE CENTRAL AND EASTERN SIDE OF WARREN COUNTY, WITH ONE ADDITIONAL ZIP CODE LOCATED IN NEIGHBORING SUSSEX COUNTY TO THE NORTH. HRMC'S PSA COMPRISES A POPULATION BASE OF APPROXIMATELY 100,000.HACKETTSTOWN COMMUNITY HOSPITAL'S SECONDARY SERVICE AREA IS MADE UP OF SEVEN ZIP CODES THAT INCLUDE THE SOUTHERN TIP OF SUSSEX COUNTY AND PORTIONS OF THE SOUTH CENTRAL AND NORTHERN SECTIONS OF WARREN COUNTY. HRMC'S SSA COMPRISES A POPULATION BASE OF ALMOST 35,000.
PART VI, LINE 5:	COMMUNITY HEALTH PROMOTION:HACKETTSTOWN COMMUNITY HOSPITAL, DBA HACKETTSTOWN REGIONAL MEDICAL CENTER, OPENED IN 1973 AND IS A FULLY LICENSED 111 BED ACUTE CARE HOSPITAL THAT PROVIDES ACUTE CARE, EMERGENCY, DIAGNOSTIC, SURGICAL AND OUTPATIENT SERVICES TO RESIDENTS OF WARREN, MORRIS, SUSSEX AND HUNTERDON COUNTIES. HACKETTSTOWN COMMUNITY HOSPITAL IS A FAITH BASED, NOT FOR PROFIT ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF HACKETTSTOWN COMMUNITY RESIDENTS COMMITTED TO OUR MISSION OF IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES THROUGH A MINISTRY OF PHYSICAL, MENTAL AND SPIRITUAL HEALING. MEMBERS OF THE HACKETTSTOWN COMMUNITY HOSPITAL ADMINISTRATION AND LEADERSHIP TEAM ARE ALSO ACTIVE IN THE COMMUNITY SERVING ON VARIOUS BOARDS, COALITIONS AND COMMITTEES TO HELP ADDRESS HEALTH ISSUES IN THE COMMUNITY.IN KEEPING WITH OUR MISSION, HACKETTSTOWN REGIONAL MEDICAL CENTER CONTINUES TO PROMOTE GOOD HEALTH THROUGH THE PROGRAMS OFFERED BY THE CENTER FOR HEALTHIER LIVING. A TOTAL OF 7891 COMMUNITY RESIDENTS WERE SERVED THROUGH THE VARIOUS PROGRAMS OFFERED BY THE CENTER IN 2015.AT HACKETTSTOWN REGIONAL MEDICAL CENTER WE BELIEVE THAT EDUCATION IS THE FIRST AND OFTEN THE MOST IMPORTANT STEP IN ACHIEVING GOOD HEALTH. HACKETTSTOWN REGIONAL MEDICAL CENTER PROMOTES A LIFESTYLE CHANGE THAT EMPHASIZES REGULAR EXERCISE, GOOD NUTRITION, EARLY DETECTION OF ILLNESS AND THE KNOWLEDGE TO MAKE INFORMED HEALTH RELATED DECISIONS.IN ORDER TO HELP AREA RESIDENTS ACHIEVE OPTIMAL HEATH, HACKETTSTOWN REGIONAL MEDICAL CENTER, THROUGH THE CENTER FOR HEALTHIER LIVING, OFFERED A NUMBER OF HEALTH PROMOTION AND EDUCATION CLASSES AND HEALTH SCREENINGS IN 2015 INCLUDING:> A VARIETY OF HEALTH SCREENINGS INCLUDING CANCER SCREENINGS WERE OFFERED AT THE CENTER FOR HEALTHIER LIVING, COMMUNITY HEALTH FAIRS, AND SCHOOL HEALTH FAIRS AND AREA BUSINESSES.> HEALTH EDUCATION PROGRAMS WERE HELD AT THE CENTER FOR HEALTHIER LIVING, SEVERAL SENIOR GROUP MEETINGS, SENIOR HOUSING AND AREA BUSINESS. SENIOR EXERCISE PROGRAMS LIKE TAI CHI AND ARTHRITIS EXERCISE KEEP SENIORS ACTIVE AND FLEXIBLE. "BACK IN TIME" HISTORY SERIES PROVIDES SENIORS THE OPPORTUNITY TO ENGAGE IN LIFELONG LEARNING, USE CRITICAL THINKING SKILLS AND TO SOCIALIZE.> SUPPORT GROUPS HELPED ADDRESS THE NEEDS OF THOSE WITH CHRONIC ILLNESS INCLUDING PULMONARY DISEASE, CARDIAC ILLNESSES AND DIABETES AND BREAST CANCER.> DIABETES PREVENTION EFFORTS INCLUDED PRE-DIABETES WORKSHOPS. > INFLUENZA VACCINES WERE GIVEN AT NO CHARGE TO THE HOMELESS AND MEDICALLY UNDERSERVED THROUGH A FOOD PANTRY AND PROJECT HOMELESS CONNECT. > PRENATAL EDUCATION CLASSES WERE OFFERED AT NO COST TO UNDERINSURED WOMEN AND FAMILIES INCLUDING CHILDBIRTH EDUCATION, BREAST FEEDING CLASSES, SIBLING CLASSES AND BABY CARE CLASSES> HACKETTSTOWN COMMUNITY HOSPITAL OFFERS A VARIETY OF CPR AND FIRST AID CLASSES TO OUR COMMUNITY. CLASSES ARE OFFERED FREE OR FOR A NOMINAL FEE TO LOCAL POLICE, FIREFIGHTERS AND EMS. A LARGE NUMBER OF COMMUNITY RESIDENTS WERE INSTRUCTED IN "HANDS-ONLY" CPR AT A NUMBER OF HEALTH FAIRS.HACKETTSTOWN REGIONAL MEDICAL CENTER IS COMMITTED TO ENSURING THAT THE COMMUNITIES IT SERVES THRIVE IN A CULTURE OF WELLNESS AND HAVE ACCESS TO AND THE BENEFITS OF HIGH QUALITY, EQUITABLE HEALTHCARE THAT PROMOTES PHYSICAL, MENTAL AND SPIRITUAL WELLBEING.
PART VI, LINE 6:	AFFILIATED HEALTH CARE:HACKETTSTOWN COMMUNITY HOSPITAL IS A MEMBER OF THE ADVENTIST HEALTHCARE SYSTEM BASED IN GAITHERSBURG, MARYLAND. ADVENTIST HEALTHCARE PROVIDES MANAGERIAL AND SHARED SERVICES TO HACKETTSTOWN COMMUNITY HOSPITAL IN SUPPORT OF ITS MISSION TO SERVE HACKETTSTOWN AND THE OTHER COMMUNITIES IN ITS PRIMARY AND SECONDARY SERVICE AREAS.
PART VI, LINE 7, REPORTS FILED WITH STATES	NJ

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

Complete if the organization answered "Yes," on 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

2015

Open to Public
Inspection

Name of the organization
HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number
22-6106281

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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) HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840	22-2333410	501(C)(3)	15,350	GENERAL SUPPORT FROM HOSPITAL AUXILIARY.
(2) HACKETTSTOWN BUSINESS IMPROVEMENT DISTRICT 219 MAIN ST HACKETTSTOWN,NJ07840	20-2535990	501(C)(3)	5,300	EVENT SPONSORSHIPS: SPRING FESTIVAL AND HOMETOWN HOLIDAY
(3) HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840	22-2333410	501(C)(3)	400,000	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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)
(2)
(3)
(4)
(5)
(6)
(7)

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

PART I, LINE 2:

IN SUPPORT OF ITS MISSION AND VISION TO BE A LEADING RESOURCE FOR INNOVATIVE PATIENT -CENTERED HEALTHCARE, THE HOSPITAL AND ITS AUXILIARY WILL PROVIDE GRANTS AND ASSISTANCE TO AFFILIATED ENTITIES SUCH AS ITS FOUNDATION AND OTHER NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. PRIOR TO PROVIDING THIS ASSISTANCE, HOSPITAL ADMINISTRATION REVIEWS AND APPROVES REQUESTS FOR NEEDS THAT FULFILL OUR MISSION AND SUPPORT THE COMMUNITY.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

Any related organization?

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

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

The organization?

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

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

For persons listed on 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 ............

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JAMES G LEECHAIRMAN; EVP & CFO, AHC	(i) (ii)	0 ------------- 498,437	0 ------------- 159,345	0 ------------- 5,040	0 ------------- 110,360	0 ------------- 25,601	0 ------------- 798,783	0 ------------- 0
2TERRY FORDEPRESIDENT & CEO, AHC	(i) (ii)	0 ------------- 864,928	0 ------------- 328,406	0 ------------- 32,029	0 ------------- 191,122	0 ------------- 28,016	0 ------------- 1,444,501	0 ------------- 0
3JASON C COESECRETARY; PRESIDENT, HRMC	(i) (ii)	0 ------------- 290,030	0 ------------- 94,356	0 ------------- 9,180	0 ------------- 51,577	0 ------------- 31,421	0 ------------- 476,564	0 ------------- 0
4ROBERT C PETERSONCHIEF FINANCIAL OFFICER	(i) (ii)	211,924 ------------- 0	55,504 ------------- 0	5,633 ------------- 0	28,584 ------------- 0	32,315 ------------- 0	333,960 ------------- 0	0 ------------- 0
5KENNETH JANOWSKICHIEF MEDICAL OFFICER	(i) (ii)	232,990 ------------- 0	60,994 ------------- 0	3,245 ------------- 0	35,722 ------------- 0	31,117 ------------- 0	364,068 ------------- 0	0 ------------- 0
6STELLA VISAGGIOCHIEF OPERATING OFFICER	(i) (ii)	220,920 ------------- 0	59,079 ------------- 0	3,377 ------------- 0	32,524 ------------- 0	35,664 ------------- 0	351,564 ------------- 0	0 ------------- 0
7MARY ANN ANDERSONCHIEF NURSING OFFICER	(i) (ii)	207,542 ------------- 0	53,445 ------------- 0	28,785 ------------- 0	10,082 ------------- 0	16,565 ------------- 0	316,419 ------------- 0	0 ------------- 0
8JUDITH H WIEGANDEXE DIR, BUS DEVELOPMENT	(i) (ii)	116,226 ------------- 0	49,390 ------------- 0	53,474 ------------- 0	6,053 ------------- 0	19,564 ------------- 0	244,707 ------------- 0	0 ------------- 0
9CHRISTOPHER R MAZZIEDIRECTOR OF BUSINESS OPERATIONS	(i) (ii)	156,867 ------------- 0	0 ------------- 0	101 ------------- 0	4,694 ------------- 0	8,070 ------------- 0	169,732 ------------- 0	0 ------------- 0
10TRACY HEIMBACHADMINISTRATIVE DIRECTOR	(i) (ii)	115,508 ------------- 0	20,593 ------------- 0	119 ------------- 0	2,997 ------------- 0	23,858 ------------- 0	163,075 ------------- 0	0 ------------- 0
11MICHAEL SCHIAVONEOB/GYN PHYSICIAN	(i) (ii)	210,485 ------------- 0	0 ------------- 0	2,534 ------------- 0	569 ------------- 0	8,068 ------------- 0	221,656 ------------- 0	0 ------------- 0
12JEANNE JEPSONDIRECTOR, HUMAN RESOURCES	(i) (ii)	118,851 ------------- 0	21,306 ------------- 0	247 ------------- 0	3,557 ------------- 0	14,631 ------------- 0	158,592 ------------- 0	0 ------------- 0
13ANTONELLA AUCIELLOSTAFF PHYSICIAN	(i) (ii)	156,850 ------------- 0	0 ------------- 0	450 ------------- 0	3,022 ------------- 0	289 ------------- 0	160,611 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

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

PART I, LINE 3

COMPENSATION DEFINED. THE COMPENSATION REPORTED FOR THE EMPLOYEES SET FORTH ON SCHEDULE J IS COMPRISED OF THE FOLLOWING: BASE COMPENSATION INCLUDES NONDISCRETIONARY PAYMENTS, AGREED UPON IN ADVANCE, CONTINGENT ONLY UPON THE PAYEES PERFORMANCE OF AGREED UPON SERVICES (SUCH AS SALARY OR FEES). INCENTIVE COMPENSATION INCLUDES PAYMENTS BASED ON SATISFACTION OF PRE-DETERMINED PERFORMANCE TARGETS SUCH AS QUALITY/PATIENT SAFETY GOALS, EMPLOYEE AND CUSTOMER ENGAGEMENT GOALS, ORGANIZATIONAL GROWTH, AND FINANCIAL PERFORMANCE, AMONG OTHER THINGS. A NEW EXECUTIVE RETENTION 457F PLAN, EFFECTIVE JANUARY 1, 2015, REPLACED THE ADVENTIST HEALTHCARE CAPITAL ACCUMULATION ACCOUNT PLAN. PRE-TAX CONTRIBUTIONS ACCUMULATED ANNUALLY ARE DISTRIBUTED ON JANUARY 1ST OF THE 2ND YEAR, IF STILL EMPLOYED. THERE IS A 2 YEAR DEFERRAL PERIOD BEFORE PAYMENTS ARE RELEASED. THE FIRST PAYMENT FOR THE NEW EXECUTIVE RETENTION PLAN, RELATED TO CONTRIBUTIONS ACCUMULATED IN 2015, WILL BE DISTRIBUTED ON JANUARY 1, 2017 AND CONTRIBUTIONS ACCUMULATED IN 2016 WILL BE DISTRIBUTED ON JANUARY 1, 2018. IN ADDITION, OTHER REPORTABLE COMPENSATION INCLUDES LONG-TERM DISABILITY COVERAGE, CELL PHONE ALLOWANCES, CASH-OUT OF UNUSED PAID TIME OFF (PTO) HOURS (ONLY FOR EMPLOYEES THAT LEAVE OUR ORGANIZATION), IMPUTED VALUE OF LIFE INSURANCE BENEFITS, TAXABLE PAYABLE PAY, AND SEVERANCE, AS APPLICABLE. NON-TAXABLE BENEFITS INCLUDES PRE-TAX PAYROLL DEDUCTIONS (SUCH AS FLEXIBLE MEDICAL SPENDING, DEPENDENT CARE, AND EMPLOYEE HEALTH BENEFIT PREMIUM), AND THE EMPLOYER PORTION OF CERTAIN EMPLOYEE BENEFITS SUCH AS HEALTH INSURANCE, DENTAL INSURANCE, VISION INSURANCE, LIFE INSURANCE, BASE CONTRIBUTIONS TO RETIREMENT PLANS, MATCHING OF EMPLOYEE RETIREMENT CONTRIBUTIONS, ETC. PAY PRACTICE: ADVENTIST HEALTHCARE UTILIZES A SINGLE EMPLOYER ID FOR ALL OF ITS AFFILIATED ENTITIES FOR EMPLOYMENT PURPOSES. AS SUCH, ACTUAL COMPENSATION AND BENEFITS ARE CHARGED TO THE RESPECTIVE ENTITIES AND THE RESULTING COMPENSATION AND BENEFITS ARE REPORTED ON EACH AFFILIATE'S IRS FORM 990 AS IF PAID DIRECTLY BY SUCH AFFILIATE. HACKETTSTOWN FOLLOWS ADVENTIST HEALTHCARE'S PAY PRACTICE. MR. COE'S COMPENSATION AND BENEFITS ARE PAID BY ADVENTIST HEALTHCARE AND NOT CHARGED BACK TO HACKETTSTOWN COMMUNITY HOSPITAL. AS APPLICABLE, THE SAME AND NON-ADDITIVE COMPENSATION AND EMPLOYMENT BENEFIT PLAN CONTRIBUTION AMOUNTS WERE ALSO DISCLOSED IN THE ADVENTIST HEALTHCARE INC.'S RELATED ENTITIES RETURNS. INDEPENDENT GUIDELINES - WHEN SETTING COMPENSATION FOR THE "OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES," ADVENTIST HEALTHCARE FULLY COMPLIES WITH THE PROCEDURAL SAFE GUARDS EMBODIED IN IRS REGULATIONS. COMPENSATION FOR ADVENTIST HEALTHCARE AND HACKETTSTOWN COMMUNITY HOSPITAL "OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES" IS ENTIRELY SET BY A COMMITTEE OF ADVENTIST HEALTHCARE'S BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES A SUMMARY OF HEALTH CARE SALARIES AND BENEFITS FOR COMPARABLE SIZED ORGANIZATIONS BOTH NATIONALLY AND IN THE NEW JERSEY-NEW YORK REGION. TO FURTHER ENSURE REASONABLENESS, BOTH COMPENSATION AND BENEFITS ARE TARGETED AT THE 50TH PERCENTILE (OR MEDIAN) OF THE MARKET. PAY PHILOSOPHY - FOR ALL HACKETTSTOWN COMMUNITY HOSPITAL EMPLOYEES INCLUDING THOSE LISTED ON SCHEDULE J, THE GOAL OF ADVENTIST HEALTHCARE IS TO OFFER COMPETITIVE SALARIES IN ORDER TO ATTRACT, HIRE AND RETAIN QUALIFIED AND TALENTED INDIVIDUALS. MAINTAINING A QUALITY, STABLE WORKFORCE HAS A POSITIVE IMPACT ON THE WORKPLACE AND ON THE CARE PROVIDED TO OUR PATIENTS/RESIDENTS AND THEIR FAMILIES. IN GENERAL, NON-EXECUTIVE EMPLOYEES ARE COMPENSATED UTILIZING THE FULL WAGE SCALE FOR THEIR RESPECTIVE POSITIONS, COMPARED TO THE MARKET. HOWEVER, EXECUTIVES ARE GENERALLY LIMITED TO THE MEDIAN OF THE MARKET FOR THEIR RESPECTIVE POSITIONS.

PART I, LINES 4A-B

A NEW EXECUTIVE RETENTION 457F PLAN, EFFECTIVE JANUARY 1, 2015, REPLACED THE ADVENTIST HEALTHCARE CAPITAL ACCUMULATION ACCOUNT PLAN. PRE-TAX CONTRIBUTIONS ACCUMULATED ANNUALLY ARE DISTRIBUTED ON JANUARY 1ST OF THE 2ND YEAR, IF STILL EMPLOYED. THERE IS A 2 YEAR DEFERRAL PERIOD BEFORE PAYMENTS ARE RELEASED. THE FIRST PAYMENT FOR THE NEW EXECUTIVE RETENTION PLAN, RELATED TO CONTRIBUTIONS ACCUMULATED IN 2015, WILL BE DISTRIBUTED ON JANUARY 1, 2017 AND CONTRIBUTIONS ACCUMULATED IN 2016 WILL BE DISTRIBUTED ON JANUARY 1, 2018. THE FOLLOWING EMPLOYEE LISTED BELOW FELL OUTSIDE THE AGE BRACKET TO BE INCLUDED IN THE 457F PLAN, AND THEY RECEIVED A LUMP-SUM CASH BONUS PAYMENT: MARY ANN ANDERSON: $24,844 ALSO, IN 2015, SEVERANCE PAYMENTS WERE MADE TO: JUDITH H WIEGAND: $50,976

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 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

2015

Open to Public
Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	BY LAWS, ARTICLE II: THERE SHALL BE A SINGLE CLASS OF CONSTITUENT MEMBERS OF THE HOSPITAL CORPORATION (INDIVIDUAL - MEMBER, COLLECTIVELY - MEMBERSHIP), WHICH SHALL CONSIST OF THE DULY ELECTED MEMBERS OF THE BOARD OF DIRECTORS OF ADVENTIST HEALTHCARE, INC., A NONPROFIT CORPORATION EXISTING UNDER AND OPERATING BY VIRTUE OF THE LAWS OF THE STATE OF MARYLAND.
FORM 990, PART VI, SECTION A, LINE 7A	BY LAWS, ARTICLES II AND III (VARIOUS PARTS) TRUSTEES OF THIS ORG ARE ELECTED BY THE MEMBER (I.E. ADVENTIST HEALTHCARE, INC.).
FORM 990, PART VI, SECTION A, LINE 7B	BY LAWS, ARTICLE II- RESERVED AUTHORITY AND RESPONSIBILITY: NOTWITHSTANDING ANY PROVISION OF THE CERTIFICATE OF INCORPORATION OR THESE BYLAWS TO THE CONTRARY, THE FOLLOWING ACTIONS ARE RESERVED TO THE MEMBERSHIP: 1. THE PURCHASE, SALE OR DISPOSITION OF REAL PROPERTY OF THE HOSPITAL CORPORATION; 2. THE ADOPTION, ALTERING, AMENDING OR REPLACING OF THE CERTIFICATE OF INCORPORATION OR THE BYLAWS OF THE HOSPITAL CORPORATION; 3. THE LIQUIDATION, DISSOLUTION, WINDING UP OR ABANDONMENT OF THE HOSPITAL CORPORATION; AND 4. THE RETENTION AND EXERCISE OR DELEGATION OF VOTING RIGHTS ASSOCIATED WITH THE OWNERSHIP OF ANY SHARES OF STOCK OR INTEREST OWNED OR HELD BY THE HOSPITAL CORPORATION OR ANY ENTITY SUBSIDIARY TO OR CONTROLLED BY THE HOSPITAL CORPORATION ("SUBSIDIARY ORGANIZATION") IN CONNECTION WITH THE FOLLOWING ACTIONS: (A) THE AMENDMENT OF THE ORGANIZATIONAL DOCUMENTS OF A SUBSIDIARY ORGANIZATION; (B) THE CONSOLIDATION OF A SUBSIDIARY ORGANIZATION WITH ONE OR MORE ENTITIES TO FORM A NEW CONSOLIDATED CORPORATION; (C) THE MERGER OF A SUBSIDIARY ORGANIZATION INTO ANOTHER ENTITY OR THE MERGER OF ONE OR MORE OTHER ENTITIES INTO A SUBSIDIARY ORGANIZATION; (D) THE SALE, LEASE, EXCHANGE OR OTHER TRANSFER OF ALL, OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF A SUBSIDIARY ORGANIZATION, INCLUDING ITS GOODWILL AND FRANCHISES; (E) THE PARTICIPATION BY A SUBSIDIARY ORGANIZATION IN A SHARE EXCHANGE AS THE ENTITY THE STOCK/INTEREST OF WHICH IS TO BE ACQUIRED; (F) THE VOLUNTARY OR INVOLUNTARY LIQUIDATION, DISSOLUTION OR WINDING-UP OF A SUBSIDIARY ORGANIZATION. 5. APPOINTMENT OF MEMBERS OF THE BOARD OF THE HOSPITAL CORPORATION FROM NOMINEES SUBMITTED BY THE BOARD OF THE HOSPITAL CORPORATION; 6. REMOVAL OF MEMBERS OF THE BOARD OF THE HOSPITAL CORPORATION. 7. AUTHORIZE AND APPROVE THE ISSUANCE OF DEBT AND THE USE OF PROCEEDS OF SUCH DEBT FOR AND ON BEHALF OF THE HOSPITAL CORPORATION; 8. DEVELOP CAPITAL INVESTMENT, CAPITAL ALLOCATION AND BORROWING POLICIES FOR THE HOSPITAL CORPORATION; 9. CEASE PROVIDING HEALTH CARE SERVICES NECESSARY FOR OPERATION AS A LICENSED GENERAL ACUTE CARE FACILITY AT ANY SITE; 10. CHANGE THE STATED PURPOSES, MISSION OR PHILOSOPHY OF THE HOSPITAL CORPORATION, OR ANY CONTROLLED ENTITY AS FOUND IN THE ARTICLES OF INCORPORATION, BYLAWS, OR OTHER GOVERNING DOCUMENTS OF THE HOSPITAL CORPORATION; 11. ADOPTING THE HOSPITAL CORPORATION'S ANNUAL AND LONG-TERM CAPITAL AND OPERATION BUDGETS; 12. MAKING ANY MAJOR CHANGES IN ANY OF THE HOSPITAL CORPORATION'S INSURANCE PROGRAM; AND 13. RECOMMENDING ANY UNBUDGETED CAPITAL EXPENDITURE OF THE HOSPITAL CORPORATION'S CAPITAL BUDGET IN EXCESS OF $500,000.
FORM 990, PART VI, SECTION B, LINE 11	PRIOR TO FILING THE FORM 990, THE FORM WAS PREPARED BY THE INTERNAL FINANCE TEAM OF THE HEALTH SYSTEM WITH INPUT FROM MANY HOSPITAL DEPARTMENTS. IT WAS REVIEWED IN DETAIL BY THE HRMC CONTROLLER AND CFO. THE FORM WAS DISCUSSED AND REVIEWED IN DETAIL WITH THE ORGANIZATION'S OUTSIDE TAX ADVISORS. THE CFO THEN CONDUCTED A HIGHER LEVEL REVIEW OF THE FORM WITH THE HRMC PRESIDENT. THE 990 WAS THEN MADE AVAILABLE TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	PURSUANT TO THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, EACH BOARD MEMBER, OFFICER, DIRECTOR AND ANY EMPLOYEE IN A POSITION THAT REQUIRES COORDINATION AND/OR NEGOTIATION WITH CONTRACTORS OR SUPPLIERS, IS REQUIRED ON AN ANNUAL BASIS TO DISCLOSE ANY BUSINESS OR FINANCIAL RELATIONSHIP OUTSIDE OF THE ORGANIZATION. COMPLIANCE WITH POLICY IS MONITORED AND ENFORCED BY THE HUMAN RESOURCES DEPARTMENT, INTEGRITY DEPARTMENT AND THE LEGAL DEPARTMENT IN THE EVENT THERE IS A CONFLICT OF INTEREST, BOARD MEMBERS WILL RECUSE THEMSELVES FROM VOTING.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION FOLLOWS THE COMPENSATION GUIDELINES OF ITS SOLE MEMBER, ADVENTIST HEALTHCARE, INC. A TAX-EXEMPT AFFILIATE. INDEPENDENT GUIDELINES - WHEN SETTING COMPENSATION FOR THE CEO/PRESIDENT, ADVENTIST HEALTHCARE FULLY COMPLIES WITH THE PROCEDURAL SAFEGUARDS EMBEDDED IN THE IRS REGULATIONS. COMPENSATION FOR ADVENTIST HEALTHCARE'S CEO/PRESIDENT IS ENTIRELY SET BY A COMMITTEE OF ADVENTIST HEALTHCARE INC.'S BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES A SUMMARY OF HEALTHCARE SALARIES AND BENEFITS FOR COMPARABLE SIZED ORGANIZATIONS BOTH NATIONALLY AND THE BALTIMORE-WASHINGTON REGION. TO FURTHER ENSURE REASONABLENESS, BOTH COMPENSATION AND BENEFITS ARE TARGETED AT THE 50TH PERCENTILE OF THE MARKET.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	NET ORGANIZATION TRANSFERS -1,527,200.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

HACKETTSTOWN COMMUNITY HOSPITAL

Employer identification number

22-6106281

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

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ADVENTIST HEALTHCARE INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1532556	HEALTHCARE SERVICES	MD	501(C)(3)	LINE 3	MID-ATLANTIC ADVENTIST HEALTHCARE CORPORATION		No
(2)ADVENTIST HEALTHCARE URGENT CARE CENTERS INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 46-1577511	CLINIC - EMERGENCY CARE	MD	501(C)(3)	LINE 9	ADVENTIST HEALTHCARE INC		No
(3)ADVENTIST HOME HEALTH SERVICES INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-0986808	HOME CARE SERVICES	MD	501(C)(3)	LINE 9	ADVENTIST HEALTHCARE INC		No
(4)ADVENTIST PHYSICIAN SERVICES INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 20-4600646	PHYSICIAN SERVICES	MD	501(C)(3)	LINE 9	ADVENTIST HEALTHCARE INC		No
(5)ADVENTIST REHABILITATION HOSPITAL OF MARYLAND INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 20-1486678	REHABILITATION HOSPITAL	MD	501(C)(3)	LINE 3	ADVENTIST HEALTHCARE INC		No
(6)ADVENTIST REHABILITATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 30-0780513	REHABILITATION SERVICES	MD	501(C)(3)	LINE 9	ADVENTIST REHABILITATION HOSPITAL OF MARYLAND INC		No
(7)HACKETTSTOWN REGIONAL MEDICAL CENTER EMERGENCY SERVICES INC 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840 27-0820164	AMBULANCE SERVICE	NJ	501(C)(3)	LINE 11A, I	HACKETTSTOWN COMMUNITY HOSPITAL INC	Yes
(8)HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION INC 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840 22-2333410	FUNDRAISING	NJ	501(C)(3)	LINE 11A, I	HACKETTSTOWN COMMUNITY HOSPITAL INC	Yes
(9)MEDICAL CENTER PARTNERS INC 651 WILLOW GROVE STREET HACKETTSTOWN,NJ07840 45-4789273	PHYSICIAN SERVICES	NJ	501(C)(3)	LINE 11A, I	HACKETTSTOWN COMMUNITY HOSPITAL INC	Yes
(10)MID-ATLANTIC ADVENTIST HEALTHCARE CORPORATION 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1884153	HOLDING COMPANY	MD	501(C)(3)	LINE 9	N/A		No
(11)ADVENTIST BEHAVIORAL HEALTH FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 20-5479860	FUNDRAISING	MD	501(C)(3)	LINE 11A, I	ADVENTIST HEALTHCARE INC		No
(12)REGINALD S LOURIE CENTER FOR INFANTS AND YOUNG CHILDREN 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1255870	BEHAVIORAL CARE	MD	501(C)(3)	LINE 9	ADVENTIST HEALTHCARE INC		No
(13)SHADY GROVE ADVENTIST HOSPITAL FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1216429	FUNDRAISING	MD	501(C)(3)	LINE 11A, I	N/A		No
(14)WASHINGTON ADVENTIST HOSPITAL FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1692158	FUNDRAISING	MD	501(C)(3)	LINE 11A, I	ADVENTIST HEALTHCARE INC		No
(15)WASHINGTON ADVENTIST FITNESS CENTER 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 27-4758462	WELLNESS	MD	501(C)(3)	LINE 9	ADVENTIST HEALTHCARE INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

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

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) PREMIER MEDICAL NETWORK INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 52-1952469	JOINT PHYSICIAN CONT	MD	ADVENTIST HEALTHCARE INC	C				No
(2) CLARKSBURG COMMUNITY HOSPITAL INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 27-2330124	HOLDS PROPERTY FOR FUTURE NON-PROFIT HOSPITAL	MD	ADVENTIST HEALTHCARE INC	C				No
(3) WASHINGTON ADVENTIST HOSPITAL INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG,MD208781419 27-2330170	HOLDS PROPERTY FOR FUTURE NON-PROFIT HOSPITAL	MD	ADVENTIST HEALTHCARE INC	C				No

Schedule R (Form 990) 2015

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

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 .....................

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

Yes

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

Yes

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

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

f Dividends from related organization(s) ............................

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

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

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

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

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

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION	B	400,000	COST
(2) HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION	B	15,350	COST
(3) HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION	C	259,565	COST
(4) HRMC EMERGENCY MEDICAL SERVICES	L	58,348	COST
(5) MEDICAL CENTER PARTNERS INC	L	35,824	COST
(6) ADVENTIST HEALTHCARE INC	M	2,324,773	COST
(7) ADVENTIST HEALTHCARE INC	P	5,083,842	COST
(8) ADVENTIST HEALTHCARE INC	Q	1,527,200	COST

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: "WE DEMONSTRATE GOD'S CARE BY IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES THROUGH A (SEE SCH O) MINISTRY OF PHYSICAL, MENTAL AND SPIRITUAL HEALING." HRMC'S VISION IS TO BE "A LEADING RESOURCE FOR INNOVATIVE PATIENT-CENTERED HEALTHCARE." HRMC'S VALUES ARE "RESPECT, INTEGRITY, SERVICE, EXCELLENCE AND STEWARDSHIP (RISES)."
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,007
6	Total number of volunteers (estimate if necessary) .............	6	104
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	147,432
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-5,747

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,465,824	389,932
9	Program service revenue (Part VIII, line 2g) .........	83,627,687	86,393,023
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	901,263	170,389
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-77,124	-140,763
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	85,917,650	86,812,581
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	53,535	423,650
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)	43,929,777	45,201,383
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 45,912
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	41,164,273	42,892,947
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	85,147,585	88,517,980
19	Revenue less expenses. Subtract line 18 from line 12.......	770,065	-1,705,399
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	101,209,448	93,379,582
21	Total liabilities (Part X, line 26).............	43,450,774	39,085,532
22	Net assets or fund balances. Subtract line 21 from line 20.....	57,758,674	54,294,050

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 72,453,217 including grants of $ 423,650 ) (Revenue $ 86,895,586 )
	HACKETTSTOWN REGIONAL MEDICAL CENTER, A NOT-FOR-PROFIT INTEGRATED HEALTH SERVICES ACUTE CARE HOSPITAL, SEEKS TO CONTRIBUTE VALUE TO THE COMMUNITY BY PROMOTING HEALTH AND WELLNESS. HRMC OFFERS ACUTE CARE INPATIENT SERVICES, PHYSICIAN-STAFFED 24-HOUR EMERGENCY SERVICES, A DIAGNOSTIC IMAGING CENTER AS WELL AS LABORATORY, PATHOLOGY, SURGICAL AND OUTPATIENT SERVICES AVAILABLE ON-AND-OFF-CAMPUS, THROUGH AFFILIATIONS AND LINKAGE AGREEMENTS. HRMC ALSO OFFERS WELLNESS PROGRAMS, INCLUDING EDUCATIONAL CLASSES AND SCREENINGS DESIGNED TO ENCOURAGE COMMUNITY MEMBERS TO ADOPT A HEALTHIER LIFESTYLE, AVOID ILLNESS AND LIVE LIFE TO ITS FULLEST.2015 YEAR IN REVIEWCHARITY CARE PROVIDED TO THE COMMUNITY $864,854UNREIMBURSED COSTS OF MEDICAID PROGRAM $528,065COMMUNITY HEALTH SERVICES $885,079HEALTH PROFESSIONS EDUCATION $244,942COMMUNITY HEALTH RESEARCH $36,979FINANCIAL AND IN-KIND CONTRIBUTIONS $37,008COMMUNITY BENEFITS OPERATIONS $30,618TOTAL $2,627,5452015 TOTAL SERVICES PROVIDEDCOMMUNITY BENEFIT PROGRAMS INCLUDE: SCREENINGS, CLASSES, PROGRAMS, SUPPORT GROUPS, VACCINATIONS AND HEALTH PROFESSIONS EDUCATION.A TOTAL OF 14,189 PEOPLE WERE SERVED THROUGH COMMUNITY BENEFIT PROGRAMS IN 2015.NOTE: IN 2015, HRMC PROVIDED AN ADDITIONAL $20 MILLION IN UNCOMPENSATED CARE ATTRIBUTABLE TO MEDICARE SHORTFALLS AND BAD DEBT. COMMUNITY BENEFIT ACTIVITIES INCLUDE INDIRECT COSTS FOR 2015.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses72,453,217

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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
(A) Name and Title
(18) STELLA VISAGGIO........................................................................ CHIEF OPERATING OFFICER	40.00 .......................10.00	X		283,376	0	68,188
(19) MARY ANN ANDERSON........................................................................ CHIEF NURSING OFFICER	40.00 .......................10.00	X		289,772	0	26,647
(20) JUDITH H WIEGAND........................................................................ EXE DIR, BUS DEVELOPMENT	40.00 .......................10.00	X		219,090	0	25,617
(21) CHRISTOPHER R MAZZIE........................................................................ DIRECTOR OF BUSINESS OPERATIONS	40.00 .......................10.00		X	156,968	0	12,764
(22) TRACY HEIMBACH........................................................................ ADMINISTRATIVE DIRECTOR	40.00 .......................10.00		X	136,220	0	26,855
(23) MICHAEL SCHIAVONE........................................................................ OB/GYN PHYSICIAN	40.00 .......................10.00		X	213,019	0	8,637
(24) JEANNE JEPSON........................................................................ DIRECTOR, HUMAN RESOURCES	40.00 .......................10.00		X	140,404	0	18,188
(25) ANTONELLA AUCIELLO........................................................................ STAFF PHYSICIAN	40.00 .......................10.00		X	157,300	0	3,311

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,166,439	2,281,751	756,042

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	259,565
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	130,367

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		389,932

			Business Code
2a	PATIENT SERVICE REVENU	900099	83,057,064	83,057,064
b	ANCILLIARY SERVICE REV	900099	3,335,959	3,335,959
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			86,393,023

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			673,967			673,967
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		682,772
b	Less: rental expenses		1,491,450
c	Rental income or (loss)		-808,678
d	Net rental income or (loss)......			-808,678			-808,678
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		44,162,154
b	Less: cost or other basis and sales expenses		44,665,732
c	Gain or (loss)		-503,578
d	Net gain or (loss).....			-503,578			-503,578
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		14,028
b	Less: direct expenses ...b		635
c	Net income or (loss) from fundraising events..			13,393			13,393
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..
10a	Gross sales of inventory, less returns and allowances ..
	a		21,737
b	Less: cost of goods sold ..b		17,209
c	Net income or (loss) from sales of inventory..			4,528			4,528
Business Code			Miscellaneous Revenue
11a	CAFETERIA INCOME		900099	499,620			499,620
b	MAINTENANCE INCOME		900099	147,432		147,432
c	PHARMACY INCOME		900099	2,942			2,942
d	All other revenue ....
e	Total. Add lines 11a–11d ......			649,994
12	Total revenue. See Instructions......			86,812,581	86,393,023	147,432	-117,806

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	420,650	420,650
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	3,000	3,000
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,610,718		1,610,718
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	34,788,114	29,828,319	4,959,795
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	673,107	577,141	95,966
9	Other employee benefits .......	5,307,283	4,550,615	756,668
10	Payroll taxes ...........	2,822,161	2,419,801	402,360
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	124,566		124,566
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	73,243		73,243
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	8,062,120	6,495,528	1,566,430	162
12	Advertising and promotion ....	275,654		275,654
13	Office expenses .......	8,429,445	6,873,516	1,534,429	21,500
14	Information technology ......	5,083,842	3,863,720	1,220,122
15	Royalties ..
16	Occupancy ...........	3,642,712	2,978,590	642,307	21,815
17	Travel ............	20,372	14,551	5,821
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	53,568	41,860	9,273	2,435
20	Interest ...........	1,314,226	1,314,226
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,830,555	4,807,361	23,194
23	Insurance ...	446,293		446,293
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	8,247,126	8,247,126
b	COST ALLOC. FROM PARENT	2,230,604		2,230,604
c	RECRUITMENT	58,621	17,213	41,408
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	88,517,980	72,453,217	16,018,851	45,912
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1,280	1	1,280
2	Savings and temporary cash investments .........			42,026,808	2	32,450,134
3	Pledges and grants receivable, net ......			93,748	3	58,929
4	Accounts receivable, net .............			8,028,398	4	11,034,639
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
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
					6
7	Notes and loans receivable, net ....			686,475	7	614,900
8	Inventories for sale or use ........			1,771,971	8	1,861,623
9	Prepaid expenses and deferred charges ......			740,557	9	852,261
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	128,682,603
b	Less: accumulated depreciation	10b	90,135,073	40,636,324	10c	38,547,530
11	Investments—publicly traded securities .			2,788,505	11	2,777,924
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			1,342,168	13	1,563,794
14	Intangible assets ...............			867,660	14	867,660
15	Other assets. See Part IV, line 11 ...........			2,225,554	15	2,748,908
16	Total assets. Add lines 1 through 15 (must equal line 34)...			101,209,448	16	93,379,582

17	Accounts payable and accrued expenses .....	7,186,977	17	5,162,854
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..	48,196	23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	36,215,601	25	33,922,678
26	Total liabilities. Add lines 17 through 25..	43,450,774	26	39,085,532

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	56,390,933	27	52,843,737
28	Temporarily restricted net assets ...........	1,367,741	28	1,450,313
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	57,758,674	33	54,294,050
34	Total liabilities and net assets/fund balances ........	101,209,448	34	93,379,582