TY 2015 Form 990

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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

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)		(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.	0

Section B. Total Support

Calendar year (or fiscal year beginning in)		(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...	0
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)) .........

0 %

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)		(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.)	0

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)) .........

0 %

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)) ......

0 %

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:	15000272
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

6,599

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

6,599

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Pt II-B Line 1	SCHEDULE C, PART II-B, LINE 1ITHE ORGANIZATION IS A MEMBER OF THE AMERICAN MEDICAL REHABILITATION PROVIDERS ASSOCIATION WHICH ENGAGES IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBERS. A PORTION OF THE DUES PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $6,599 IN 2015.

Schedule C (Form 990 or 990EZ) 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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

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 ...
b	Buildings
c	Leasehold improvements	173,668	109,128	64,540
d	Equipment ...	2,412,392	1,631,419	780,973
e	Other ...
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				845,513

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
DUE TO MEMBERS	509,506
ST EST. AMOUNTS DUE TO 3RD PARTIES	455,726
LT EST. AMOUNTS DUE TO 3RD PARTIES	639,457
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,604,689
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	19,593,471
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	107,276
e	Add lines 2a through 2d .....................			2e	107,276
3	Subtract line 2e from line 1..................			3	19,486,195
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	19,486,195

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	16,239,393
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	107,276
e	Add lines 2a through 2d....................			2e	107,276
3	Subtract line 2e from line 1...................			3	16,132,117
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	16,132,117

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
Pt X, Line 2	SCHEDULE D, PART X, QUESTION 2THE INSTITUTE ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OR MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET.
Pt XI, Line 2d	SCHEDULE D, PART IX, LINE 2DAMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 INCLUDES:-PROVISION FOR DOUBTFUL COLLECTIONS: $107,276
Pt XII, Line 2d	SCHEDULE D, PART XII, LINE 2DAMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25 INCLUDES:-PROVISION FOR DOUBTFUL COLLECTIONS: $107,276

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000272
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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

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 30000.000 %

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 50000.000 %

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) . . .				0 %
b	Medicaid (from Worksheet 3, column a) . . . . .	191,038	172,462	18,576	0.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .				0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	191,038	172,462	18,576	0.120 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).				0 %
f	Health professions education (from Worksheet 5) . . .				0 %
g	Subsidized health services (from Worksheet 6) . . . .				0 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .				0 %
j	Total. Other Benefits . .				0 %
k	Total. Add lines 7d and 7j .	191,038	172,462	18,576	0.120 %

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.

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

107,276

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).....

14,918,906

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

12,440,731

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

2,478,175

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 %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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)			Other (Describe)	Facility reporting group
1	SHORE REHABILITATION INSTITUTE INC 425 JACK MARTIN BLVD BRICK,NJ08724 WWW.MERIDIANHEALTH.COM 22219	X	REHAB CENTER	1

Schedule H (Form 990) 2015

Page 4

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)

	SHORE REHABILITATION INSTITUTE INC
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 16

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

Yes

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

Yes

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): www.meridianhealth.com/location/shore-rehabilitation-institute

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): www.meridianhealth.com/community/community-outreach

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

Yes

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

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SHORE REHABILITATION INSTITUTE INC
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 3.00000000% and FPG family income limit for eligibility for discounted care of 5.00000000%

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):

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

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

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

Page 6

Part VFacility Information (continued)

	SHORE REHABILITATION INSTITUTE INC
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?..................

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

Page 7

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
SHORE REHABILITATION INSTITUTE, INC. Other	SCHEDULE H, PART V, SECTION BSHORE REHABILITATION INSTITUTE, INC. ("SRI") IS A NONPROFIT CORPORATION WITH TWO MEMBERS. MERIDIAN HOSPITALS CORPORATION IS A TWO-THIRDS MEMBER OF SRI AND JFK JOHNSON REHABILITATION INSTITUTE ("JRI") IS A ONE-THIRD MEMBER OF SRI. JRI IS CONTROLLED BY THE COMMUNITY HOSPITAL GROUP, INC. D/B/A JFK MEDICAL CENTER ("JFK"), AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT HOSPITAL. JFK OPERATES TWO SEPARATELY LICENSED HEALTHCARE FACILITIES: THE ANTHONY M. YELENCSICS COMMUNITY HOSPITAL AND JRI. SRI IS A 40-BED, ACUTE REHABILITATION FACILITY THAT OFFERS A COMPREHENSIVE RANGE OF INPATIENT AND OUTPATIENT SERVICES AND IS LOCATED ADJACENT TO OCEAN MEDICAL CENTER ("OMC") IN BRICK, NJ. OMC OPERATES AS A TAX-EXEMPT HOSPITAL UNDER MERIDIAN HOSPITALS CORPORATION'S INTERNAL REVENUE CODE 501(C)(3) DETERMINATION.OMC IS PART OF HACKENSACK MERIDIAN HEALTH, INC., FKA MERIDIAN HEALTH SYSTEM, INC., ("HMH"), A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. HMH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") IN 2016 WHICH INCLUDED THE SAME COMMUNITY SERVED BY SRI. SINCE SRI IS PHYSICALLY ATTACHED TO OMC, THE COMMUNITY SERVED BY OMC WAS PART OF HMH'S CHNA. HMH'S CHNA CAN BE FOUND AT WWW.MERIDIANHEALTH.COM/LOCATION/SHORE-REHABILITATION-INSTITUTE/ UNDER COMMUNITY/COMMUNITY OUTREACH.SRI HAS ADOPTED AND ABIDES BY JFK'S FINANCIAL ASSISTANCE POLICY AND BILLING AND COLLECTIONS POLICY.
SHORE REHABILITATION INSTITUTE, INC. Pt V Line 5	SCHEDULE H, PART V, SECTION B, QUESTION 5 ON NOVEMBER 12, 2015, APPROXIMATELY 90 INDIVIDUALS (REPRESENTING HOSPITAL-SPECIFIC COMMUNITY ADVISORY COMMITTEES, COUNTY AND LOCAL PUBLIC HEALTH OFFICERS, COMMUNITY AND BUSINESS LEADERS, SOCIAL SERVICE PROVIDERS, AS WELL AS INTERNAL STAKEHOLDERS OF MERIDIAN HEALTH) GATHERED TO EVALUATE, DISCUSS AND PRIORITIZE HEALTH ISSUES FOR THE HOSPITALS' COMMUNITIES, BASED ON FINDINGS OF THE 2015 PRC COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC) BEGAN THE MEETING WITH A PRESENTATION OF KEY FINDINGS FROM THE CHNA, HIGHLIGHTING THE SIGNIFICANT HEALTH ISSUES IDENTIFIED FROM THE RESEARCH. FOLLOWING THE DATA REVIEW, PRC ANSWERED ANY QUESTIONS AND PARTICIPANTS BROKE INTO GROUPS REPRESENTING EACH OF THE MERIDIAN HEALTH HOSPITALS. FOR EACH HOSPITAL-FOCUSED GROUP, MODERATORS AND RECORDERS FACILITATED A GROUP DIALOGUE. EACH MEMBER THEN COMPLETED A PRIORITIZATION WORKSHEET FOR THE HOSPITAL COMMUNITY OF FOCUS, EVALUATING EACH HEALTH ISSUE. INPUT WAS ALSO GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY POPULATIONS (INCLUDING AFRICAN-AMERICAN, AMERICAN INDIAN, ARABIC, ASIAN, BLIND AND DEAF, BRAZILIAN, CAUCASIAN, DISABLED, EASTERN EUROPEAN, EASTERN INDIAN, ELDERLY, ETHNIC, FILIPINO, GRANDPARENTS RAISING GRANDCHILDREN, HAITIAN, HISPANIC, IMMIGRANTS, LGBT, LOW-INCOME, MEDICARE/MEDICAID, MENTALLY ILL, MIDDLE EASTERN, NON-ENGLISH SPEAKING, ORTHODOX, RUSSIAN, SINGLE MOTHERS, UNDOCUMENTED, UNEMPLOYED, UNINSURED/UNDERINSURED, VETERANS, WOMEN, YOUNG ADULTS, YOUTH), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (INCLUDING AFRICAN-AMERICAN, ALL GROUPS, BLIND AND DEAF, CHILDREN, CHILDREN OF ADDICTS, THOSE WITH CHRONIC DISEASE, DISABLED, THOSE WITH DUAL-DIAGNOSES, ELDERLY, FAMILY CARE RECIPIENTS, FORMERLY IMPRISONED, FOSTER CARE CHILDREN, HAITIAN, HISPANIC, HOMELESS, LGBT, LOW EDUCATION, LOW INCOME, MEDICARE/MEDICAID, MENTALLY ILL, MULTI-RACIAL, PART-TIME WORKERS, PREGNANT TEENS, SUBSTANCE ABUSERS, UNDOCUMENTED, UNEMPLOYED, UNINSURED/UNDERINSURED, VETERANS, YOUNG ADULTS, YOUTH).
SHORE REHABILITATION INSTITUTE, INC. Pt V Line 6a	SCHEDULE H, PART V, SECTION B, QUESTIONS 6A & 6BFINAL PARTICIPATION INCLUDED REPRESENTATIVES OF THE FOLLOWING ORGANIZATIONS:-ADVISORY COMMITTEE AT MERIDIAN -ASBURY PARK PEDIATRICS -ASBURY PARK SCHOOL DISTRICT -BROOKDALE COMMUNITY COLLEGE -CAC -CENTRAL JERSEY CLUB OF THE NATL ASSOC OF NEGRO BUSINESS -CENTRASTATE HEALTHCARE SYSTEM -COASTAL GASTROENTEROLOGY ASSOCIATES -FAMILY HEALTH CENTER -FAMILY SUPPORT CENTER OF NEW JERSEY -FOOD CIRCUS SUPERMARKETS, INC. -FOODBANK OF MONMOUTH AND OCEAN COUNTIES -FORMER SCHOOL HEALTH/SOCIAL SERVICE DIRECTOR -FREEHOLD AREA HEALTH DEPARTMENT -JANE H. BOOKER FAMILY HEALTH CENTER -JERSEY SHORE GERIATRICS -JERSEY SHORE UNIVERSITY MEDICAL CENTER -LAW ENFORCEMENT/PUBLIC SAFETY -LUNCH BREAK -MARLBORO TOWNSHIP PUBLIC SCHOOLS -MARSD -MERIDIAN HEALTH -MERIDIAN PARTNERS IN HEALTH -MONMOUTH COUNTY HEALTH DEPARTMENT -MONMOUTH COUNTY REGIONAL HEALTH COMMISSION #1 -MONMOUTH DAY CARE CENTER INC. -MONMOUTH FAMILY MEDICINE GROUP -MONOC -NEW JERSEY BLIND CITIZENS ASSOCIATION -O.C.E.A.N. INC./HEAD START -OCEAN COUNTY HEALTH DEPARTMENT -OCEAN MONMOUTH HEALTH ALLIANCE -OCEAN PARK OB/GYN -OCEAN PULMONARY -PARKER FAMILY HEALTH CENTER, AMERICAN LEGION -PERINATAL INSTITUTE -POINT PLEASANT PRESBYTERIAN CHURCH -SCHOOL -SEACREST VILLAGE -SOUTHERN OCEAN MEDICAL CENTER -SOUTHERN OCEAN ROTARY CLUB -ST. FRANCIS CENTER, LBICC, INC. -SUNRISE COUNSELING SERVICES, LLC -TOWNSHIP OF NEPTUNE -UNITED WAY OF MONMOUTH COUNTY -WALL COMMUNITY ALLIANCE -YMCA
SHORE REHABILITATION INSTITUTE, INC. Pt V Line 11	PART V, SECTION B, LINE 11SRI AND HACKENSACK MERIDIAN HEALTH, INC. RECOGNIZE THAT THE CARE IT PROVIDES REACHES FAR BEYOND THE BOUNDARIES OF ITS FACILITIES. OUR MISSION AND HACKENSACK MERIDIAN HEALTH INC.'S MISSION TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY WE SERVE IS AT THE HEART OF OUR CHARITABLE ROOTS. IN THIS NEW ERA OF HEALTHCARE REFORM, COMMUNITY-BASED PREVENTION AND WELLNESS ACTIVITIES PLAY A CRITICAL ROLE IN KEEPING OUR LOCAL COMMUNITIES HEALTHY AND KEEPING HEALTHCARE COSTS DOWN.HACKENSACK MERIDIAN HEALTH, INC. AND ITS AFFILIATE SHORE REHABILITATION INSTITUTE, INC. SUPPORT THIS MISSION THROUGH EXTENSIVE OFFERING OF WELL-ORGANIZED AND DIVERSIFIED HEALTH PROGRAMS AIMED AT PROMOTING COMMUNITY WELLNESS AND DISEASE PREVENTION. ALL PROGRAMS CAN BE CUSTOMIZED TO SUIT AN INDIVIDUAL COMMUNITY OR ORGANIZATION'S NEEDS AND ARE DELIVERED IN A CULTURALLY COMPETENT MANNER. MANY OF OUR PROGRAMS, SCREENINGS AND EDUCATIONAL MATERIALS ARE AVAILABLE IN ENGLISH AS WELL AS SPANISH AND CERTIFIED HEALTH INTERPRETERS ARE AVAILABLE TO ASSIST IN COMMUNICATING TO THESE AUDIENCES.THE SUCCESS AND EFFECTIVENESS OF HACKENSACK MERIDIAN HEALTH INC.'S COMMUNITY BENEFIT PROGRAM IS DERIVED FROM A COMMITTED STAFF OF PHYSICIANS, NURSES, HEALTHCARE SPECIALISTS AND COMMUNITY EDUCATORS ALONG WITH DEDICATED COMMUNITY MEMBERS WHO HELP MERIDIAN IDENTIFY, STRATEGIZE AND IMPLEMENT INITIATIVES THAT POSITIVELY IMPACT THE HEALTH OF THE COMMUNITY.THE GOAL IS TO MAKE A POSITIVE AND SUSTAINABLE IMPACT ON THE HEALTH STATUS OF THE COMMUNITIES WE SERVE, SPECIFICALLY TO:- MONITOR COMMUNITY HEALTH STATUS THROUGH ONGOING COMMUNITY HEALTH NEEDS ASSESSMENT;- PROVIDE COMMUNITIES A VOICE IN IDENTIFYING AND ADDRESSING UNMET HEALTH NEEDS;- DEVELOP AND IMPLEMENT COMMUNITY HEALTH IMPROVEMENT PLANS FOR IDENTIFIED COMMUNITY HEALTH NEEDS THAT; IMPROVE RESIDENTS HEALTH STATUS AND OVERALL QUALITY OF LIFE, REDUCE HEALTH DISPARITIES AND INCREASE ACCESSIBILITY TO PREVENTIVE SERVICES; AND- EMPOWER COMMUNITIES WITH INFORMATION AND RESOURCES TO TAKE CHARGE OF THEIR OWN HEALTH.THE PRIMARY STRATEGIES USED TO ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS ARE:- HEALTH PROMOTION TO CREATE AWARENESS OF IDENTIFIED HEALTH NEEDS AND ENCOURAGE ACTIVE PARTICIPATION IN PREVENTION ACTIVITIES;- HEALTH EDUCATION TO PROVIDE KNOWLEDGE, UNDERSTANDING AND SELF-MANAGEMENT TOOLS FOR HEALTH ISSUES AND DISEASES;-FREE OR LOW COST NON-DIAGNOSTIC, PREVENTIVE HEALTH SCREENINGS FOR EARLY DETECTION OF DISEASE; AND-LEAD AND PARTICIPATE IN COLLABORATION INITIATIVES WITH HEALTH DEPARTMENTS, SOCIAL SERVICE PROVIDERS AND OTHER COMMUNITY GROUPS.SRI TOOK ACTION TO ADDRESS ALL OF THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THAT A REHABILITATIVE FACILITY HAS THE EXPERTISE IN TO EFFECTIVELY ADDRESS (SEE THE ATTACHED IMPLEMENTATION PLAN). SRI DOES NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO HEALTHCARE SERVICES, CANCER, INJURY AND VIOLENCE, MENTAL HEALTH, AND SUBSTANCE ABUSE AND BELIEVES THOSE PRIORITY AREAS ARE MORE FULLY ADDRESSED WITHIN THE PURVIEW OF OCEAN MEDICAL CENTER, THE COUNTY, LOCAL HEALTH DEPARTMENTS AND OTHER COMMUNITY ORGANIZATIONS.SRI PROVIDES INDIVIDUALIZED REHABILITATION SERVICES TO ADULT AND GERIATRIC INDIVIDUALS WITH DISABILITY. OUR SERVICES INCLUDE BUT ARE NOT LIMITED TO, PHYSIATRY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, REHABILITATION NURSING,THERAPEUTIC RECREATION, SOCIAL WORK/CASE MANAGEMENT, PSYCHOLOGY, DIETARY, VOCATIONAL SERVICES, AND DRIVER TRAINING AND ASSESMENTS IN AN OUTPATIENT SETTING. WE PROVIDE A VARIETY OF OTHER PHYSICIAN SPECIALTIES DEPENDING ON THE NEEDS OF OUR PATIENTS.SRI PROVIDES PATIENT CARE WITH AN INTERDISCIPLINARY APPROACH AND EACH MEMBER OF THE TEAM PLAYS AN INTEGRAL ROLE IN THE PLANNING AND IMPLEMENTATION OF THE PATIENT'S PLAN OF CARE. THE PLAN IS DEVELOPED WITH INPUT FROM FAMILY AND CARE GIVERS.BECAUSE OF OUR PHYSICAL LOCATION (ADJOINING OCEAN MEDICAL CENTER) A NUMBER OF SUPPORT AND MEDICAL SERVICES SUCH AS ENVIRONMENTAL AND MAINTENANCE, LABORATORY, PHARMACY, RADIOLOGY AND MANY OTHER EMERGENCY SERVICES ARE PROVIDED BY OCEAN MEDICAL CENTER. THESE CONTRACTED SERVICES ALLOW OUR PATIENTS TO BE IN A FREE STANDING REHABILITATION FACILITY BUT HAVE ACCESS TO MEDICAL SERVICES THAT ARE OF A LEVEL PROVIDED IN AN ACUTE CARE HOSPITAL.
SHORE REHABILITATION INSTITUTE, INC. Pt V Line 21d	PART V, SECTION B, LINE 21DEMERGENCY CARE IS PROVIDED BY THE HACKENSACK MERIDIAN HEALTH FACILITIES UNDER HACKENSACK MERIDIAN HEALTH, INC.'S POLICIES. PATIENTS WITH EMERGENCY NEEDS ARE TRANSFERED UNDER THIS POLICY.

Schedule H (Form 990) 2015

Page 8

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?0
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
Pt I Line 3c	SCHEDULE H, PART I, QUESTION 3CJFK MEDICAL CENTER USES THE INCOME/ASSET CRITERIA AND SLIDING SCALE PROVIDED BY THE STATE OF NEW JERSEY WHEN SCREENING PATIENTS FOR FINANCIAL ASSISTANCE. ADDITIONALLY, JFK MEDICAL CENTER HAS A COMPASSIONATE CARE POLICY TO APPLY DISCOUNTS (WHEN APPLICABLE) IF A PATIENT DOES NOT QUALIFY OR ONLY QUALIFIES FOR PARTIAL CHARITY CARE.
Pt I Line 6a	SCHEDULE H, PART I, QUESTION 6AHACKENSACK MERIDIAN HEALTH, INC. PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH INCLUDES SRI AND IS MADE AVAILABLE TO THE PUBLIC ON ITS WEBSITE: HTTPS://WWW.MERIDIANHEALTH.COM/ABOUT-MERIDIAN/ANNUAL-REPORT.ASPX
Pt I Line 7	SCHEDULE H, PART I, QUESTION 7 WORKSHEET 2 OF THE INTERNAL REVENUE SERVICE FORM 990, SCHEDULE H INSTRUCTIONS WAS USED FOR THE COST OF MEDICAID SHORTFALL.
Pt II	SCHEDULE H, PART IIN/A
Pt III Line 2	SCHEDULE H, PART III, QUESTION 2 BAD DEBT PROVISION IS AN ESTIMATE WHICH DETERMINED BY ASSESSING THE COLLECTABILITY OF THE ACCOUNTS RECEIVABLE. IT IS BASED ON A COMBINATION OF THE AGE OF THE ACCOUNTS AND ESTIMATES OF THE NET REALIZABLE VALUE OF THE ACCOUNT AFTER TAKING INTO ACCOUNT ANTICIPATED THIRD PARTY PAYMENTS.
Pt III Line 3	SCHEDULE H, PART III, QUESTION 3 N/A
Pt III Line 4	SCHEDULE H, PART III, QUESTION 4 THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYER CLASSIFICATIONS AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.
Pt III Line 8	SCHEDULE H, PART III, QUESTION 8MEDICARE COSTS WERE DERIVED FROM THE 2015 MEDICARE COST REPORT. TO THE EXTENT THERE WOULD HAVE BEEN A MEDICARE UNDERPAYMENT (SHORTFALL), THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS AND/OR BAD DEBT WOULD BE CONSIDERED A COMMUNITY BENEFIT AND THE ASSOCIATED COSTS SHOULD BE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOL
Pt III Line 9b	SCHEDULE H, PART III, QUESTION 9BAS AN AFFILIATE OF JFK MEDICAL CENTER ("HOSPITAL"), SHORE REHABILITATION INSTITUTE, INC. FOLLOWS THE HOSPITAL'S DEBT COLLECTION POLICY. SHORE REHABILITATION INSTITUTE, INC. AND THE HOSPITAL RECOGNIZE THE FINANCIAL DIFFICULTY IMPOSED ON THE SELF-PAY PATIENT WHO IS LEAST ABLE TO PAY FOR HEALTHCARE SERVICES WHEN BILLED AT THE HOSPITAL'S STANDARD CHARGES. CREDIT ADJUSTMENTS TO THE SELF-PAY BALANCE WILL BE PERMITTED FOR THE PURPOSE OF BILLING AND COLLECTING FROM THE S
Pt VI Line 2	SCHEDULE H, PART VI, QUESTION 2 - NEED ASSESSMENTHACKENSACK MERIDIAN HEALTH, INC., INCLUDING SRI, PLAYS A LEAD ROLE IN WORKING WITH MANY DIFFERENT ORGANIZATIONS THROUGHOUT MONMOUTH AND OCEAN COUNTIES TO IDENTIFY AND ADDRESS THE HEALTH ISSUES THAT IMPACT OUR COMMUNITY THE MOST. THIS COLLABORATIVE EFFORT IS REFERRED TO AS A COMMUNITY HEALTH NEEDS ASSESSMENT AND ITS FINDINGS CAN BE FOUND ON HACKENSACK MERIDIAN HEALTH'S WEBSITE. PLEASE NOTE THAT AT THE TIME THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS
Pt VI Line 3	SCHEDULE H, PART VI, QUESTION 3 - PATIENT EDUCATION OF ELIGIBILITYSRI IS INCLUDED ON HACKENSACK MERIDIAN HEALTH, INC.'S WEBSITE. HACKENSACK MERIDIAN HEALTH, INC. POSTS NOTICES, IN ENGLISH AND SPANISH (THE LANGUAGES MET WITH THE LIMITED ENGLISH PROFICIENCY TEST UNDER INTERNAL REVENUE CODE 501(R) OF THE LESSER OF 5% OR 1,000 INDIVIDUALS), AT EVERY ACCESS POINT OF ITS FACILITIES, VERBALLY INFORMS UNINSURED PATIENTS AT REGISTRATION, FEATURES INFORMATION IN ITS FINANCIAL CONSENT FORM, INCLUDES A SENT
Pt VI Line 4	SCHEDULE H, PART VI, QUESTION 4 - COMMUNITY INFOMATIONTHE FOLLOWING INFORMATION IS BASED ON RECENT CENSUS ESTIMATES: OCEAN COUNTY POPULATION, 2015 588,721 UNDER 5 YEARS OF AGE, 2015 6.8% UNDER 18 YEARS OF AGE, 2015 23.5%65 YEARS OLD AND OVER, 2015 22.1% PERSONS BELOW POVERTY LEVEL, 2009-2013 11.9% MEDIAN HOUSEHOLD INCOME, 2010-2014 $61,839 RACIAL COMPOSITION, 2015: WHITE 84.7% AFRICAN AMERICAN 3.5% ASIAN 2.0% HISPANIC OR LATINO ORIGIN 9.1% OTHER 0.7%
Pt VI Line 5	SCHEDULE H, PART VI, QUESTION 5 - PROMOTION OF COMMUNITY HEALTHSRI OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545:1. THE ORGANIZATION PROVIDES COMPREHENSIVE REHABILITATIVE AND RELATED SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. THE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 3. CONTROL OF THE ORGANIZATION RESTS WITH I
Pt VI Line 6	SCHEDULE H, PART VI, QUESTION 6 - AFFILIATED HEALTH CARE SYSTEMHACKENSACK MERIDIAN HEALTH, INC. -------------------------------- HACKENSACK MERIDIAN HEALTH, INC., FKA MERIDIAN HEALTH SYSTEM, INC. ("HMH") IS THE TAX-EXEMPT PARENT OF HACKENSACK MERIDIAN HEALTH NETWORK ("NETWORK"). THIS INTEGRATED HEALTHCARE DELIVERY NETWORK CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER HMH OR ANOTHER NETWORK AFFILIATE CONTROLLED BY HMH. THE NETW
Pt VI Line 7	SCHEDULE H, PART VI, QUESTION 7NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. NO COMMUNITY BENEFIT REPORT IS FILED WITH THE STATE OF NEW JERSEY. SHORE REHABILITATION INSTITUTE PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IT MAKES AVAILABLE TO THE PUBLIC ON ITS WEBSITE: WWW.MERIDIANHEALTH.COM.
Other	SCHEDULE H, PART VIIN 2016, THE INTERNAL REVENUE SERVICE ("IRS") CONDUCTED AN AUDIT OF SHORE REHABILITATION INSTITUTE, INC.'S ("SRI") COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(3). AS A RESULT OF THE AUDIT, THE IRS IMPOSED AN EXCISE TAX UNDER SECTION 4959 FOR FAILURE TO CONDUCT A CHNA. THE ORGANIZATION FILED FORM 14017, APPLICATION FOR FAST TRACK SETTLEMENT, IN JANUARY 2017 APPEALING THE DECISION.THE FAILURE OCCURRED BECAUSE THE ORGANIZATION BELIEVED IT WAS LICENSED AS AN INPATIENT REH

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000272
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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

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

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

Yes

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)
1SALVATORE INCIARDI	(i) (ii)	------------- 356,817	------------- 180,000	------------- 156,377	------------- 108,951	------------- 23,358	------------- 825,503	------------- 146,625
2JAMES A CLARKE MD	(i) (ii)	------------- 386,666	------------- 77,000	------------- 12,657	------------- 9,125	------------- 31,568	------------- 517,016	-------------
3RICHARD HAND	(i) (ii)	------------- 259,523	------------- 55,000	------------- 41,434	------------- 38,259	------------- 18,538	------------- 412,754	------------- 13,925
4JOSEPH M LEMAIRE	(i) (ii)	------------- 787,587	------------- 200,000	------------- 209,440	------------- 386,113	------------- 34,751	------------- 1,617,891	-------------

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
Pt I Line 4b	SCHEDULE J, PART I; QUESTION 4BTHE AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, BOX 1, AS TAXABLE WAGES AND WERE REPORTED AS RETIREMENT AND OTHER DEFERRED COMPENSATION ON PRIOR FORMS 990 OF THE ORGANIZATION: SALVATORE INCIARDI, $146,625 AND RICHARD HAND, $13,925.THE AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES AN AMOUNT OF COMPENSATION THAT WAS PROVIDED TO THE INDIVIDUAL IN ACCORDANCE WITH HIS EMPLOYMENT CONTRACT AND TERMS OF EMPLOYMENT AT MERIDIAN HEALTH AND IN ACCORDANCE WITH MERIDIAN HEALTH'S COMPENSATION REVIEW AND APPROVAL PROCESS DESCRIBED IN OUR RESPONSE TO CORE FORM, PART VI, QUESTION 15 TO ENSURE COMPENSATION IS REASONABLE AND AT FAIR MARKET VALUE RATES. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN THE INDIVIDUAL'S 2015 FORM W-2, BOXES 1 AND 5, AS TAXABLE WAGES: JOSEPH M. LEMAIRE, $170,000.THE DEFERRED COMPENSATION AMOUNTS REFLECTED IN SCHEDULE J, PART II, COLUMN (C) FOR THE FOLLOWING INDIVIDUALS INCLUDE UNVESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, AS TAXABLE WAGES: RICHARD HAND, $13,600 AND JOSEPH M. LEMAIRE, $348,103. THE DEFERRED COMPENSATION AMOUNTS REFLECTED IN SCHEDULE J, PART II, COLUMN (C) FOR THE FOLLOWING INDIVIDUALS INCLUDE INTEREST CREDITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2015 FORM W-2, AS TAXABLE WAGES: SALVATORE INCIARDI, $65,149 AND JOSEPH M. LEMAIRE, $30,210.
Pt I Line 7	SCHEDULE J, PART I; QUESTION 7CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2015 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2015 FORM W-2, BOXES 1 AND 5 AS TAXABLE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
Other	SCHEDULE J, PART II, COLUMN FTHE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) FOR THE FOLLOWING INDIVIDUALS REPRESENT UNVESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THAT BECAME TAXABLE IN 2015 BECAUSE THEY WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE, AND WERE REPORTED AS RETIREMENT AND OTHER DEFERRED COMPENSATION ON PRIOR FORMS 990 OF THE ORGANIZATION. THESE AMOUNTS WERE TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S 2015 FORM W-2, BOX 1, AS TAXABLE WAGES: SALVATORE INCIARDI, $146,625 AND RICHARD HAND, $13,925.

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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

Return Reference	Explanation
Other	CORE FORM, PART III; STMT OF PROGRAM SERVICE ACCOMPLISHMENTSA JOINT PARTNERSHIP BETWEEN MERIDIAN HOSPITALS CORPORATION AND JFK JOHNSON REHABILITATION INSTITUTE, SHORE REHABILITATION INSTITUTE ("SRI") IS A NOT-FOR-PROFIT 40-BED, ACUTE REHABILITATION FACILITY THAT OFFERS A COMPREHENSIVE RANGE OF INPATIENT AND OUTPATIENT SERVICES. LOCATED ADJACENT TO OCEAN MEDICAL CENTER IN BRICK, NJ, SRI IS FULLY ACCREDITED BY THE JOINT COMMISSION, PROVIDING A BROAD SPECTRUM OF REHABILITATION SERVICES.SRI IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE ("IRS") AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, SRI IS DEVOTED TO THE PROMOTION OF HEALTH THROUGH THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF COMPREHENSIVE REHABILITATION SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. MOREOVER, SRI OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545:1.SRI PROVIDES COMPREHENSIVE REHABILITATIVE AND RELATED SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS,2.SRI MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS,3.CONTROL OF SRI RESTS WITH ITS BOARD OF TRUSTEES, AND4.SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE REHABILITATIVE SERVICES, PROGRAMS AND ACTIVITIES.THE OPERATIONS OF SRI, AS SHOWN THROUGH THE FACTORS OUTLINED ABOVE AND OTHER INFORMATION CONTAINED HEREIN, CLEARLY DEMONSTRATE THAT THE USE AND CONTROL OF THE REHABILITATION FACILITY IS FOR THE BENEFIT OF THE PUBLIC AND THAT NO PART OF THE INCOME OR NET EARNINGS OF THE ORGANIZATION INURES TO THE BENEFIT OF ANY PRIVATE INDIVIDUAL NOR IS ANY PRIVATE INTEREST BEING SERVED OTHER THAN INCIDENTALLY. SRI CONTINUES TO DEMONSTRATE ITS ONGOING AND GROWING COMMITMENT TO THE COMMUNITY BY PROVIDING REHABILITATION SERVICES REGARDLESS OF THE ABILITY TO PAY FOR THE PARTIAL OR FULL COST OF THE CARE DELIVERED. SRI OFFERS AN EXPERIENCED, ENERGETIC TEAM OF PROFESSIONALS DETERMINED TO HELP PATIENTS ACHIEVE THEIR HIGHEST LEVEL OF FUNCTION. THIS MULTI-DISCIPLINARY TEAM PROVIDES A FULL CONTINUUM OF REHABILITATIVE CARE WHILE INDIVIDUALIZING TREATMENT PLANS BASED ON EACH PATIENT'S UNIQUE NEEDS. BRINGING TOGETHER THE LATEST IN REHABILITATION TECHNOLOGY, WITH THE EXPERTISE & CARE OF OUR TEAM, SRI IS COMMITTED TO RESTORING YOUR LIFE BACK TO YOU.OUR MISSION-----------TO DELIVER SAFE CARE AND THE BEST PATIENT EXPERIENCE IN A HEALING ENVIRONMENT TO HELP INDIVIDUALS WITH DISABILITY ATTAIN OPTIMAL FUNCTION AND ADVOCATE FOR THEM IN THE COMMUNITIES WE SERVE.OUR VISION----------WE ASPIRE TO BECOME THE BENCHMARK FOR PATIENT EXPERIENCE, SAFETY, QUALITY AND EFFICIENCY BY ADOPTING AND REFINING BEST PRACTICES AND IMPROVE ACCESS TO REHABILITATION IN THE COMMUNITIES WE SERVE.OUR VALUES----------OUR VALUES ENABLE US TO PROVIDE THE VERY BEST EXPERIENCE TO OUR PATIENTS, GUESTS AND EACH OTHER "THE SRI WAY" AND TO FULFILL OUR MISSION AND ADVANCE TOWARDS OUR VISION.WE PROVIDE INDIVIDUALIZED REHABILITATION SERVICES TO ADULT AND GERIATRIC INDIVIDUALS WITH DISABILITY. OUR SERVICES INCLUDE BUT ARE NOT LIMITED TO, PHYSIATRY, PT, OT, SPEECH PATHOLOGY, REHABILITATION NURSING, THERAPEUTIC RECREATION, SOCIAL WORK/CASE MANAGEMENT, PSYCHOLOGY, DIETARY AND VOCATIONAL SERVICES IN AN INPATIENT OR AN OUTPATIENT SETTING. WE PROVIDE A VARIETY OF OTHER PHYSICIAN SPECIALTIES DEPENDING ON THE NEEDS OF OUR PATIENTS.SHORE REHABILITATION INSTITUTE PROVIDES PATIENT CARE WITH AN INTERDISCIPLINARY APPROACH AND EACH MEMBER OF THE TEAM PLAYS AN INTEGRAL ROLE IN THE PLANNING AND IMPLEMENTATION OF THE PATIENT'S PLAN OF CARE. THE PLAN IS DEVELOPED WITH INPUT FROM FAMILY AND CARE GIVERS.SHORE REHABILITATION IS LOCATED IN BRICK, AN URBAN/SURBURBAN AREA OF OCEAN COUNTY. THIS IS ONE OF THE FASTEST GROWING COUNTIES IN THE STATE WITH MORE THAN 588,000 RESIDENTS.BECAUSE OF OUR PHYSICAL LOCATION (ADJOINING OCEAN MEDICAL CENTER) A NUMBER OF SUPPORT AND MEDICAL SERVICES SUCH AS ENVIRONMENTAL AND MAINTENANCE, LABORATORY, PHARMACY, RADIOLOGY AND MANY OTHER EMERGENCY SERVICES ARE PROVIDED BY OCEAN MEDICAL CENTER. THESE CONTRACTED SERVICES ALLOW OUR PATIENTS TO BE IN A FREE STANDING REHABILITATION FACILITY BUT HAVE ACCESS TO MEDICAL SERVICES THAT ARE OF A LEVEL PROVIDED IN AN ACUTE CARE HOSPITAL.
Pt VI, Line 6	FORM 990, PART VI, SECTION A; QUESTION 6THE ORGANIZATION HAS JFK JOHNSON REHABILITATION INSTITUTE (JRI), A MAJOR COMPONENT OF JFK HEALTH SYSTEM, AS A 1/3 MEMBER AND MERIDIAN HOSPITALS CORPORATION AS A 2/3 MEMBER.
Pt VI, Line 7a	FORM 990, PART VI, SECTION A; QUESTION 7ATHE DIRECTORS ARE ELECTED BY A VOTE OF THE BOARD AT THE ANNUAL MEETING OF THE CORPORATION. THE DIRECTOR MEMBERSHIP COMMITTEE SHALL NOMINATE A SLATE OF DIRECTORS TO SERVE AS OFFICERS TO REPLACE OR RE-ELECT THOSE OFFICERS WHOSE TERMS ARE ENDING. ALL BOARD APPOINTMENTS ARE SUBJECT TO APPROVAL BY THE MEMBERS.
Pt VI, Line 7b	FORM 990, PART VI, SECTION A; QUESTION 7BCERTAIN DECISIONS OF THE GOVERNING BODY OF THE ORGANIZATION ARE SUBJECT TO APPROVAL BY THE MEMBERS.
Pt VI, Line 11b	FORM 990, PART VI, SECTION B; QUESTION 11BTHE FORM 990 IS PREPARED BY MANAGEMENT IN CONJUNCTION WITH THE HACKENSACK MERIDIAN HEALTH, INC. TAX DEPARTMENT AND REVIEWED BY THE MEMBERS OF JFK HEALTH AND THE VP OF FINANCE OF HACKENSACK MERIDIAN HEALTH, INC. FOR THE JOINT VENTURE. ONCE THE FORM 990 TAX RETURN IS APPROVED BY THESE INDIVIDUALS, ALL BOARD MEMBERS ARE SENT AN E-MAIL WITH INSTRUCTIONS ON HOW TO ACCESS THE FORM 990 TAX RETURN FOR THEIR REVIEW AND COMMENTS ON A SECURE WEBSITE PROVIDED BY JFK HEALTH. AT THE END OF THE REVIEW PERIOD, AND AFTER ANY COMMENTS HAVE BEEN ADDRESSED, THE FORM 990 TAX RETURN IS FINALIZED AND FILED.
Pt VI, Line 12c	FORM 990, PART VI, SECTION B; QUESTION 12CSHORE REHABILITATION INSTITUTE, INC. IS 2/3 OWNED BY MERIDIAN HOSPITALS CORPORATION AND HAS ADOPTED A CONFLICT OF INTEREST POLICY SIMILAR TO HACKENSACK MERIDIAN HEALTH, INC.'S POLICY. THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, MANAGERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE WITH RESPECT TO ANY APPLICABLE TRANSACTIONS AND RELATIONSHIPS. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO SHORE REHABILITATION INSTITUTE INC.'S EXECUTIVE DIRECTOR OFFICE FOR REVIEW AND MAINTAINED THERE.
Pt VI, Line 15a	FORM 990, PART VI, SECTION B; QUESTION 15ATHE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF JFK HEALTH SYSTEM AND SALARY AND FRINGE BENEFITS ARE REIMBURSED FROM SHORE REHABILITATION INSTITUTE, INC. TO JFK HEALTH SYSTEM. SALARY IS APPROVED BY JFK HEALTH SYSTEM RULES AS SHOWN BELOW. THE JFK HEALTH SYSTEM BOARD OF DIRECTORS HAS DULY APPOINTED AN EXECUTIVE COMPENSATION COMMITTEE (THE "COMMITTEE") THAT IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF ALL COMPENSATION AND BENEFITS PROVIDED TO EXECUTIVE MANAGEMENT OF THE ORGANIZATION. THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND AN EXECUTIVE COMPENSATION COMMITTEE CHARTER. THE COMMITTEE FOLLOWS THE PROCEDURES DESCRIBED IN THE PHILOSOPHY STATEMENT AND THE CHARTER WHEN IT REVIEWS AND APPROVES THE COMPENSATION AND EMPLOYEE BENEFITS PROVIDED TO THE ORGANIZATION'S SENIOR MANAGEMENT.THE COMMITTEE'S REVIEW ANALYZES EVERY ELEMENT OF COMPENSATION, INCLUDING CURRENT AND DEFERRED COMPENSATION, AND BENEFITS, INCLUDING QUALIFIED AND NON-QUALIFIED BENEFITS. THE COMMITTEE CONDUCTS ITS REVIEW AND APPROVAL PROCESS AT LEAST ANNUALLY, AND APPROVES COMPENSATION AND BENEFITS ONLY TO THE EXTENT THAT THE COMMITTEE HAS CONCLUDED THAT THE TOTAL COMPENSATION AND BENEFITS CONSTITUTES NO MORE THAN REASONABLE COMPENSATION. THE COMMITTEE CONSISTS ENTIRELY OF INDEPENDENT MEMBERS OF THE JFK HEALTH SYSTEM BOARD, THE COMMITTEE REVIEWS IN ADVANCE INDEPENDENT DATA SHOWING THE COMPENSATION PROVIDED BY NON-PROFIT ORGANIZATIONS FOR FUNCTIONALLY SIMILAR POSITIONS, AND THE COMMITTEE PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS. ASSISTING THE COMMITTEE IS AN OUTSIDE COMPENSATION CONSULTANT ALONG WITH OUTSIDE LEGAL COUNSEL. AS A RESULT, THE COMMITTEE'S REVIEW PROCESS IS DESIGNED TO SATISFY THE PROCEDURAL CRITERIA NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES.CERTAIN BOARD MEMBERS LISTED ON CORE FORM, PART VII RECEIVE COMPENSATION FROM MERIDIAN HOSPITALS CORPORATION. THE EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE") OF HACKENSACK MERIDIAN HEALTH, INC., A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK, IS RESPONSIBLE FOR REVIEWING THE EXECUTIVE COMPENSATION OF THE SENIOR MANAGEMENT AND KEY EMPLOYEES OF THE NETWORK. THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY, APPROVED BY THE EXECUTIVE COMMITTEE AND GOVERNING BODY, WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES COMPENSATION AND BENEFITS.THE EXECUTIVE COMPENSATION PHILOSOPHY RECOGNIZES THE SIZE AND COMPLEXITY OF THE HEALTHCARE NETWORK AND THE CRITICAL NEED TO HAVE AND RETAIN EXECUTIVES THAT CONSISTENTLY DEMONSTRATE SUPERIOR LEVELS OF PERFORMANCE SO THAT THE HEALTH NETWORK CAN FULFILL ITS CHARITABLE MISSION.THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS, INCLUDING BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED ON AT LEAST AN ANNUAL BASIS TO ENSURE THAT THE "TOTAL COMPENSATION" OF EACH SENIOR MANAGEMENT AND KEY EMPLOYEE IS REASONABLE.TO ASSIST WITH THE REVIEW, THE COMMITTEE ENGAGES THE SERVICES OF A NATIONALLY RECOGNIZED INDEPENDENT CONSULTING FIRM SPECIALIZING IN EXECUTIVE COMPENSATION FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS, AND RECEIVES REGIONAL MARKET DATA FOR COMPARABLE ORGANIZATIONS, A REPORT SUMMARIZING SUCH DATA, AND AN OPINION LETTER RELATING TO THE REASONABLENESS OF EACH EXECUTIVE'S TOTAL COMPENSATION AND BENEFITS. ADDITIONALLY, A SENIOR MEMBER OF THE CONSULTING FIRM ATTENDS THE COMMITTEE'S MEETINGS TO PROVIDE INFORMATION AND TO RESPOND TO QUESTIONS BY THE MEMBERS OF THE COMMITTEE.THE INDEPENDENT COMMITTEE UTILIZES THE OUTSIDE MARKET DATA COMPARABILITY AND BASED UPON THE ORGANIZATION'S PERFORMANCE, BUSINESS JUDGMENT CONSIDERATIONS, AND THE INDIVIDUAL'S PERFORMANCE ESTABLISHES COMPENSATION FOR EACH INDIVIDUAL. THE COMPREHENSIVE REVIEW PROCESS UTILIZED BY THE COMMITTEE QUALIFIES FOR THE REBUTTABLE PRESUMPTION UNDER SECTION 4958 OF THE INTERNAL REVENUE CODE OF 1986:1.THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX EXEMPT ORGANIZATION, WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A CONFLICT OF INTEREST WITHIN THE MEANING OF THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 4958;2.THE AUTHORIZED BODY OBTAINS AND RELIES UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION, WHICH COMPARABILITY DATA IS PROVIDED AND ANALYZED BY SULLIVAN COTTER AND ASSOCIATES, INC., A WELL-REGARDED EXPERT IN THE AREA OF NOT-FOR-PROFIT HEALTHCARE COMPENSATION; AND3.THE AUTHORIZED BODY ADEQUATELY DOCUMENTS THE BASIS FOR ITS DETERMINATION CONCURRENTLY WITH MAKING THAT DETERMINATION, AGAIN AS REQUIRED IN THE REGULATIONS.AS APPROPRIATE, THE AUTHORIZED BODY SUPPLEMENTS THE COMPARABILITY DATA WITH OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THE REASONABLENESS OF THE COMPENSATION PAID, INCLUDING AN ANALYSIS OF INDIVIDUAL GOALS AND OBJECTIVES, ORGANIZATIONAL PERFORMANCE, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS, AND WRITTEN OFFERS FROM COMPETING ORGANIZATIONS. THE APPROVED COMPENSATION ARRANGEMENTS BY THE EXECUTIVE COMMITTEE ARE REPORTED IN EXECUTIVE SESSION TO THE GOVERNING BOARD BY THE SENIOR MEMBER OF THE CONSULTING FIRM.
Pt VI, Line 15b	FORM 990, PART VI, SECTION B; QUESTION 15BPLEASE REFER TO RESPONSE FOR FORM 990, PART VI, SECTION B; QUESTION 15A ABOVE.
Pt VI, Line 19	FORM 990, PART VI, SECTION C; QUESTION 19SHORE REHABILITATION INSTITUTE, INC.'S FINANCIAL STATEMENTS AND OTHER PUBLIC INFORMATION ARE AVAILABLE UPON REQUEST AT THE SHORE REHABILITATION INSTITUTE, INC. ADMINISTRATIVE OFFICE.
Pt VII, Col (E)	PART VII AND SCHEDULE JTHE EXECUTIVE DIRECTOR AND CERTAIN BOARD MEMBERS ARE COMPENSATED BY JFK MEDICAL CENTER, A ONE-THIRD MEMBER OF SHORE REHABILITATION INSTITUTE, INC. ("SRI") PLEASE NOTE THAT SINCE SRI IS NOT CONTROLLED BY JFK MEDICAL CENTER THEIR COMPENSATION IS NOT REPORTED ON CORE FORM, PART VII OR SCHEDULE J. PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS RECEIVING COMPENSATION AND BENEFITS FROM A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THE RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OF THIS ORGANIZATION'S BOARD.THE METHOD USED IN ESTIMATING THE HOURS PER WEEK REPORTED ON CORE FORM, PART VII FOR THE BOARD MEMBERS COMPENSATED BY JFK MEDICAL CENTER WAS DETERMINED DURING THE ANNUAL BUDGET PROCESS. THE FINANCE DEPARTMENT PERFORMS AN ANALYSIS OF THE EXECUTIVE LEVEL EMPLOYEES' TIME ALLOCATION FROM THE TIMEKEEPING RECORDS.THE HOURS PER WEEK REPORTED ON CORE FORM, PART VII FOR THE BOARD MEMBERS COMPENSATED BY MERIDIAN HOSPITALS CORPORATION ARE ALLOCATED AMONG MANY OF THE RELATED ENTITIES.
Pt XI	FORM 990 , PART XI, LINE 9, CHANGES IN NET ASSETSOTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE:-DISTRIBUTION TO MEMBERS ($1,950,000).
Pt XII, Line 2c	FORM 990, PART XII, QUESTION 2CTHE PROCESS HAS NOT CHANGED SINCE LAST YEAR. SHORE REHABILITATION INSTITUTE, INC. HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.

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:	15000272
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

SHORE REHABILITATION INSTITUTE INC

Employer identification number

22-3274755

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)HACKENSACK MERIDIAN HEALTH INC 343 THORNALL STREET EDISON,NJ08837 22-3474145	HEALTH SERVICES	NJ	501(C)(3)	509(A)(3)	NA		No
(2)MERIDIAN HOSPITALS CORPORATION 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-3471515	HEALTH SERVICES	NJ	501(C)(3)	509(A)(1)	HMH		No
(3)HACKENSACK MERIDIAN HOME CARE SERVICES INC 343 THORNALL STREET EDISON,NJ08837 22-2731440	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(4)JERSEY SHORE UNIVERSITY MEDICAL CENTER FOUNDATION 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-2342452	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(5)RIVERVIEW MEDICAL CENTER FOUNDATION INC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-2333524	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(6)OCEAN MEDICAL CENTER FOUNDATION INC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-2361311	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(7)HACKENSACK MERIDIAN NURSING & REHABILITATION INC 343 THORNALL STREET EDISON,NJ08837 52-1772578	NURSING LTC	NJ	501(C)(3)	509(A)(2)	HMH		No
(8)MERIDIAN HEALTH FOUNDATION INC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 30-0107825	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(9)MERIDIAN PRACTICE INSTITUTE INC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 06-1755235	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(10)HACKENSACK MERIDIAN HEALTH REALTY CORPORATION 343 THORNALL STREET EDISON,NJ08837 22-3200147	TITLE HOLDING	NJ	501(C)(3)	509(A)(3)	HMH		No
(11)HEALTH INNOVATIONS UNLIMITED INC 343 THORNALL STREET EDISON,NJ08837 22-2581430	MED EQUIP.	NJ	501(C)(3)	509(A)(2)	HOME CARE		No
(12)MERIDIAN MEDICAL GROUP-RETAIL CLINIC PC 1350 CAMPUS PARKWAY Neptune,NJ07753 06-1755228	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(13)MERIDIAN MEDICAL GROUP-FACULTY PRACTICE PC 1350 CAMPUS PARKWAY Neptune,NJ07753 06-1755230	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(14)MERIDIAN MEDICAL ASSOCIATES PC 1350 CAMPUS PARKWAY Neptune,NJ07753 06-1755233	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(15)MERIDIAN MEDICAL GROUP-PRIMARY CARE PC 1350 CAMPUS PARKWAY Neptune,NJ07753 14-1981653	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(16)MERIDIAN MEDICAL GROUP-SPECIALTY CARE PC 1350 CAMPUS PARKWAY Neptune,NJ07753 14-1981647	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(17)MERIDIAN TRAUMA ASSOCIATES PC 1350 CAMPUS PARKWAY Neptune,NJ07753 14-1981651	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(18)MERIDIAN OBST & GYN ASSOCIATES PC 1350 CAMPUS PARKWAY Neptune,NJ07753 06-1755239	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(19)MERIDIAN PEDIATRIC SURGICAL ASSOCIATES PC 1350 CAMPUS PARKWAY Neptune,NJ07753 77-0720131	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(20)SOUTHERN OCEAN MEDICAL CENTER FOUNDATION 1350 CAMPUS PARKWAY Neptune,NJ07753 22-2666099	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(21)BAYSHORE COMMUNITY HOSPITAL FOUNDATION 1350 CAMPUS PARKWAY Neptune,NJ07753 22-2367109	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		No
(22)SOMC MEDICAL GROUP PC 1350 CAMPUS PARKWAY Neptune,NJ07753 27-1412183	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(23)MERIDIAN OCCUPATIONAL HEALTH PC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 27-2377326	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(24)HACKENSACK MERIDIAN AMBULATORY VENTURES INC 343 THORNALL STREET EDISON,NJ08837 45-1227706	HEALTH SERVICES	NJ	501(C)(3)	509(A)(2)	HMH		No
(25)RARITAN BAY MEDICAL CENTER 530 NEW BRUNSWICK AVENUE PERTH AMBOY,NJ08861 22-1494442	HEALTH SERVICES	NJ	501(C)(3)	509(A)(1)	HMH		No
(26)RARITAN BAY HEALTHCARE FOUNDATION INC 530 NEW BRUNSWICK AVENUE PERTH AMBOY,NJ08861 22-2656665	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	HMH		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
(1) COASTAL CO-OP OF NJ 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-3603146	PURCHASING	NJ	NA

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) COASTAL MEDICAL INSURANCE LTD 44 CHURCH STREET 3RD FLOOR HAMILTON BD 98-0166769	FINANCIAL VEHICLE	BD	NA	C				No
(2) HACKENSACK MERIDIAN HEALTH VENTURES INC 343 THORNALL STREET EDISON,NJ08837 22-2550716	HEALTHCARE SERVICES	NJ	NA	C				No
(3) MERIDIAN HEALTH MANAGEMENT INC 1350 CAMPUS PARKWAY NEPTUNE,NJ07753 22-2620595	HEALTHCARE SERVICES	NJ	NA	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) ............................

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) .......................

Yes

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

Yes

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

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

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

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

Yes

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

Yes

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

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

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:	15000272
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO DELIVER SAFE CARE AND THE BEST PATIENT EXPERIENCE IN A HEALING ENVIRONMENT TO HELP INDIVIDUALS WITH DISABILITY ATTAIN OPTIMAL FUNCTION AND ADVOCATE FOR THEM IN THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	1
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	186
6	Total number of volunteers (estimate if necessary) .............	6	18
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........	17,393,928	19,479,795
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-42,463	6,327
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	42,778	73
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	17,394,243	19,486,195
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		1,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	9,981,036	10,155,192
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	5,780,932	5,975,925
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	15,761,968	16,132,117
19	Revenue less expenses. Subtract line 18 from line 12.......	1,632,275	3,354,078
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	7,423,464	8,767,875
21	Total liabilities (Part X, line 26).............	2,980,246	2,920,579
22	Net assets or fund balances. Subtract line 21 from line 20.....	4,443,218	5,847,296

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 14,054,816 including grants of $ 1,000 ) (Revenue $ 19,479,795 )
	EXPENSES INCURRED IN DELIVERING SAFE CARE AND THE BEST PATIENT EXPERIENCE IN A HEALING ENVIRONMENT TO HELP INDIVIDUALS WITH DISABILITY ATTAIN OPTIMAL FUNCTION AND ADVOCATE FOR THEM IN THE COMMUNITIES WE SERVE.

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 expenses14,054,816

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) SALVATORE INCIARDI...................................................................... BOARD MEMBER - CHAIRMAN	1.00 .................	X	X			0	693,194	132,309
(2) SCOTT GEBHARD...................................................................... BOARD MEMBER - SECRETARY/TREASURER	1.00 .................	X	X			0	0	0
(3) JAMES A CLARKE MD...................................................................... BOARD MEMBER	1.00 .................	X				0	476,323	40,693
(4) ANTHONY CUZZOLA...................................................................... BOARD MEMBER	1.00 .................	X				0	0	0
(5) KENNETH FITZSIMMONS ESQ...................................................................... BOARD MEMBER	1.00 .................	X				0	0	0
(6) RICHARD HAND...................................................................... BOARD MEMBER	1.00 .................	X				0	355,957	56,797
(7) JOSEPH M LEMAIRE...................................................................... BOARD MEMBER	1.00 .................	X				0	1,197,027	420,864
(8) RICHARD C SMITH...................................................................... BOARD MEMBER	1.00 .................	X				0	0	0
(9) AMIT MOHAN...................................................................... EXECUTIVE DIRECTOR (TERM 11/1/15)	40.00 .................			X		0	0	0
(10) ELIZABETH CLEARY...................................................................... CASE MANAGEMENT COORDINATOR	40.00 .................				X	127,959	0	21,012
(11) REBECCA J MUROSKI...................................................................... OCCUPATIONAL THERAPY COORDINATOR	40.00 .................				X	121,363	0	16,349
(12) JOHN NUZZO RN...................................................................... REGISTERED NURSE	40.00 .................				X	120,496	0	18,229
(13) DEBORAH ANN MURAT...................................................................... PT COORDINATOR	40.00 .................				X	119,168	0	23,025
(14) LISA A GLICKSTEIN...................................................................... NURSE EDUCATOR	40.00 .................				X	117,773	0	7,746

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	606,759	2,722,501	737,024

(A) Name and business address	(B) Description of services	(C) Compensation
JFK MEDICAL CENTER 98 JAMES STREET EDISON,NJ08820	MANAGEMENT SERVICES	503,730




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 1

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

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

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

			Business Code
2a	REHABILITATION REVENUE	623000	19,479,795
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			19,479,795

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			6,327			6,327
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
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
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MISCELLANEOUS REVENUE		900099	73			73
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			73
12	Total revenue. See Instructions......			19,486,195	19,479,795		6,400

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	1,000	1,000
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	0	0
5	Compensation of current officers, directors, trustees, and key employees ....
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	8,262,523	7,436,271	826,252	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	228,444	205,600	22,844	0
9	Other employee benefits .......	1,160,449	1,044,404	116,045	0
10	Payroll taxes ...........	503,776	453,398	50,378	0
11	Fees for services (non-employees):
a	Management ......	286,698	0	286,698	0
b	Legal .........	5,890	0	5,890	0
c	Accounting ...........	60,460	0	60,460	0
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	157,739	0	157,739	0
12	Advertising and promotion ....	47,627	0	47,627	0
13	Office expenses .......	296,765	252,250	44,515	0
14	Information technology ......	48,000	48,000	0	0
15	Royalties ..
16	Occupancy ...........	2,765,426	2,350,612	414,814	0
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	4,880	244	4,636	0
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	173,622	173,622	0	0
23	Insurance ...	243,327	243,327	0	0
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	1,491,459	1,491,459	0	0
b	ALLOCATION OF PERSONNEL COST	394,032	354,629	39,403	0
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	16,132,117	14,054,816	2,077,301	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,561,216	1	5,199,133
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			2,070,694	4	2,672,064
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 ....				7
8	Inventories for sale or use ........				8
9	Prepaid expenses and deferred charges ......			35,489	9	51,165
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,586,060
b	Less: accumulated depreciation	10b	1,740,547	756,065	10c	845,513
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 34)...			7,423,464	16	8,767,875

17	Accounts payable and accrued expenses .....	1,228,292	17	1,315,890
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 ..		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	1,751,954	25	1,604,689
26	Total liabilities. Add lines 17 through 25..	2,980,246	26	2,920,579

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	4,443,218	27	5,847,296
28	Temporarily restricted net assets ...........		28
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 ...........	4,443,218	33	5,847,296
34	Total liabilities and net assets/fund balances ........	7,423,464	34	8,767,875