Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 220,362 | 236,770 | 308,206 | 266,753 | 332,136 | 1,364,227 |
| 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 | 540,872 | 704,482 | 797,086 | 843,556 | 881,250 | 3,767,246 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 761,234 | 941,252 | 1,105,292 | 1,110,309 | 1,213,386 | 5,131,473 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 5,131,473 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 761,234 | 941,252 | 1,105,292 | 1,110,309 | 1,213,386 | 5,131,473 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | |||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 761,234 | 941,252 | 1,105,292 | 1,110,309 | 1,213,386 | 5,131,473 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS | THE MS COMPREHENSIVE CARE CENTER AT HOLY NAME MEDICAL CENTER IS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. THE ORGANIZATION PROVIDES MULTIPLE SCLEROSIS SERVICES, RESEARCH AND EDUCATION. THE ORGANIZATION IS a SUBSIDIARY OF HOLY NAME MEDICAL CENTER, AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. THE ORGANIZATION'S MISSION, SINCE INCEPTION, IS TO PROVIDE COMPREHENSIVE AND HUMANE CARE TO PATIENTS WITH MULTIPLE SCLEROSIS AND THEIR FAMILIES. THE OVERALL GOAL OF CARE IS MAINTENANCE OF THE PATIENT'S HIGHEST LEVEL OF INDEPENDENCE IN THEIR HOME AND WORK ENVIRONMENT WHILE MAINTAINING SAFETY AND COMFORT. THE BERNARD GIMBEL MS CENTER OPENED IN 1985 AT HOLY NAME HOSPITAL AS AN INDEPENDENT ENTITY. THE CENTER WAS OPEN TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. AT THAT TIME THE STAFF CONSISTED OF A NEUROLOGIST, A NURSE AND A VOLUNTEER. MEDICAL CARE CENTERED ON DIAGNOSIS AND SYMPTOMATIC MANAGEMENT ON AN OUTPATIENT BASIS. THE COMPREHENSIVE INTERDISCIPLINARY CARE MODEL INVOLVED MEDICAL, NURSING, REHAB, PSYCH-SOCIAL SUPPORT AND COORDINATED SERVICES FROM THE MS SOCIETY. THE OVERALL GOAL OF CARE WAS MAINTENANCE OF THE PATIENT'S HIGHEST LEVEL OF INDEPENDENCE IN THEIR HOME AND WORK ENVIRONMENT WHILE MAINTAINING SAFETY AND COMFORT. A VOLUNTEER RUN LENDING LIBRARY OF MS BOOKS AND VIDEOS WAS ORGANIZED AND READILY AVAILABLE TO ALL PATIENTS. DURING THE 1990'S THE CENTER BECAME A RESEARCH SITE FOR MS DRUGS IN DEVELOPMENT. WITH THE ADVENT OF FDA APPROVED SELF-INJECTABLE IMMUNOMODULATING THERAPIES, MANAGEMENT OF MS PATIENTS BECAME MORE COMPLEX. THE NEED FOR ANCILLARY SUPPORT SYSTEMS WAS RECOGNIZED BY THE PHARMACEUTICAL INDUSTRY WHICH CREATED FINANCIAL AND NURSING SUPPORT TEAMS TO HELP PATIENTS BY PHONE OR IN THE HOME. PATIENTS RECEIVED EVER BROADENING EDUCATION FROM BOTH THE CENTER STAFF AND MS SOCIETY OUTREACH AND PUBLICATIONS ADDRESSING THE WIDE RANGING NEEDS OF MS PATIENTS. SELF-INJECTION TECHNIQUE AND ADHERENCE TO THERAPY QUICKLY BECAME AN EDUCATION PRIORITY FOR THE NURSING STAFF. TEACHING WAS DONE BOTH INDIVIDUALLY AND IN GROUPS. THE CENTER CLINICAL STAFF GREW TO FOUR NEUROLOGISTS (PART-TIME), TWO NURSE PRACTITIONERS AND FOUR PART-TIME NURSES. IN 1997, THE IOMS (INTERNATIONAL ORGANIZATION OF MS NURSES) WAS FORMED, IN WHICH ALL CENTER NURSES WERE MEMBERS. AN ENHANCEMENT INITIATED DURING THIS ERA WAS THE MONTHLY TEAM MEETING WHICH ENCOMPASSED MEDICAL, NURSING, SOCIAL WORK, HOME CARE AND REHAB STAFF WHO DISCUSSED ALL ASPECTS OF SELECT PATIENT CASES. ANOTHER COMPLEX MODALITY THAT EMERGED AT THIS TIME WAS THE INTRATHECAL BACLOFEN PUMP. THIS SURGICALLY IMPLANTED PUMP DELIVERS MEDICATION TO RELIEVE SPASTICITY WHICH CAN BE DISABLING. WE TEAMED UP WITH A SPECIALIZED HOME INFUSION AGENCY WHICH CONTINUES TO PROVIDE EXPERTISE AND INDIVIDUALIZED HOME CARE TO THESE PATIENTS. MEDICAL AND NURSING MANAGEMENT OF THESE PATIENTS TAKES A HIGH LEVEL OF SPECIALIZED KNOWLEDGE AND COMMUNICATION SKILL. STARTING IN 2000 MORE COMPLEX MEDICATIONS WERE PROVEN TO DELAY DISABILITY AND SLOW PROGRESSION OF MS. THESE INCLUDED CHEMOTHERAPY AND, EVENTUALLY, MONOCLONAL THERAPIES. WITH THE INCREASE IN EFFICACY CAME INCREASED SIDE EFFECTS AND RISKS WHICH NECESSITATED INCREASED VIGILANCE AND MONITORING BY THE MEDICAL AND NURSING STAFF. AS A RESULT, WE EXPANDED OUR TEAM TO INCLUDE ONCOLOGY DOCTORS AND NURSES TO HELP MANAGE OUR INFUSION PATIENTS. THE CENTER STAFF QUICKLY ATTAINED THE KNOWLEDGE REQUIRED TO TEACH AND SUPPORT THE PATIENTS WHO GRAVITATED TO THIS CENTER IN ORDER TO GET STATE OF THE ART TREATMENT FOR THEIR DISEASE. PHARMACEUTICAL INDUSTRY REPRESENTATIVES VISITED FREQUENTLY TO OFFER SUPPORT TO STAFF WITH MEDICAL UPDATES AND PATIENT SUPPORT SYSTEMS. IN 2006, THE MS COMPREHENSIVE CARE CENTER (FORMERLY KNOWN AS THE BERNARD GIMBEL MS CENTER) BECAME A PART OF HOLY NAME MEDICAL CENTER ("HNMC"). BY THE END OF 2010, THE FIRST ORAL THERAPY FOR MS WAS APPROVED AND MADE COMMERCIALLY AVAILABLE. THIS DRUG IS PROVEN SAFE AND EFFECTIVE BUT CARRIES RISKS THAT REQUIRE PATIENT INVOLVEMENT IN ONGOING TESTING AND MONITORING. THE FDA HAS MANDATED THAT THE FIRST DOSE OF THIS MEDICATION MUST BE ADMINISTERED IN A MEDICAL SETTING WITH SIX HOURS OF VITAL SIGN MONITORING, WHICH IS PROVIDED ON SITE. PATIENT SCREENING FOR THIS MEDICATION AND ONGOING TESTING REQUIRES NURSING CASE MANAGEMENT. A SECOND ORAL MEDICATION WAS APPROVED AT THE END OF 2012, WITH A THIRD EMERGING IN EARLY 2013. EMPHASIS ON DILIGENT PATIENT CARE MANAGEMENT IS THE PRIMARY FOCUS, AS ALL OF THE APPROVED THERAPIES ARE USED IN THE CENTERS PRACTICE. A WHEELCHAIR CLINIC CONTINUES ON A MONTHLY BASIS, AS WELL AS WEEKLY MS EXERCISE CLASSES, MS PATIENT SUPPORT GROUPS, NEWLY DIAGNOSED PATIENT GROUPS (LED BY A PHYSICIAN) AND INTERMITTENT EDUCATIONAL SEMINARS. MS PATIENTS ARE FREQUENT USERS OF PHYSICAL REHABILITATION, INFUSION THERAPY, THE LABORATORY, MRI AND INPATIENT SERVICES. BY JUNE OF 2012, THE CENTER'S CLINICAL STAFF CONSISTED OF ONE NEUROLOGIST, TWO STAFF NURSES, ONE RESEARCH NURSE AND ONE PART-TIME NEUROPSYCHOLOGIST. THE NURSES CONTINUE TO BE MS CERTIFIED BY IOMS. BY OCTOBER OF 2013, THE CENTER'S CLINICAL STAFF INCREASED TO TWO FULL-TIME NEUROLOGISTS, TWO PART-TIME NEUROLOGISTS, TWO STAFF NURSES, ONE RESEARCH NURSE AND A PART-TIME NEUROPSYCHOLOGIST. A THIRD NURSE WAS ADDED THE FOLLOWING YEAR. THE CENTERS HIGHLY EXPERIENCED, MULTIDISCIPLINARY TEAM OF NEUROLOGISTS AND EXPERTS PROVIDE A FULL SPECTRUM OF SERVICES TAILORED TO THE UNIQUE MEDICAL AND EMOTIONAL NEEDS OF MS PATIENTS. THESE SERVICES INCLUDE ADVANCED DIAGNOSTICS, NOVEL TREATMENT STRATEGIES, AND PSYCHOSOCIAL, REHABILITATIVE AND SUPPORTIVE CARE. IN LATE 2014, A DEDICATED MS INFUSION CENTER WAS OPENED, ADMINISTERING IN EXCESS OF 125 INFUSIONS EACH MONTH, AND SUPPORTED BY TWO RNS. 2015 BROUGHT ADDITIONAL SOCIAL WORK SERVICES AND ENHANCED PATIENT EDUCATION, AS WELL AS A BOARD-CERTIFIED NEURO-REHABILITATION SPECIALIST PHYSICIAN WHO IS ALSO A LICENSED PHYSICAL THERAPIST. WITH THE INTRODUCTION OF ADVANCED INFUSION THERAPIES OFFERING MARKED BENEFIT, THE INFUSION CENTER RAPIDLY OUTGREW ITS SQUARE FOOTAGE AND WAS RELOCATED IN 2017 TO A SPACE ABLE TO ACCOMMODATE A VOLUME OF ALMOST 2,000 ANNUAL INFUSIONS. THE PATIENT EXPERIENCE WAS ALSO SIGNIFICANTLY AUGMENTED IN THE NEW CENTER. THE ORIGINAL MISSION OF COMPREHENSIVE AND HUMANE CARE TO PATIENTS WITH MULTIPLE SCLEROSIS AND THEIR FAMILIES CONTINUES TO BE PURSUED. THIS CENTER CONTINUES TO BE A MODEL OF COMPREHENSIVE TERTIARY CARE FOR MS PATIENTS AND HAS BEEN RECOGNIZED WORLD-WIDE. FUNDRAISING ----------- A VARIETY OF FUNDRAISING EVENTS CONTINUE TO OCCUR, INCLUDING AN ANNUAL FASHION SHOW, WALK-A-THONS, AND AN AWARDS DINNER. SUPPORT IS ALSO SOUGHT THROUGH GRANTS, CORPORATE MATCHING GIFTS AND CORPORATE SOLICITATION TO HELP SUPPORT THE MISSION. FOR THE PAST FIVE YEARS, THE MS CENTER HAS HONORED INSPIRATIONAL PATIENTS, VOLUNTEER LEADERS AND ADVOCATES WHO ARE THE "FACE" OF THE MS CENTER AND EXHIBIT COURAGE AND DETERMINATION IN THEIR FIGHT AGAINST MS. RESEARCH IN CONJUNCTION WITH MEDICAL CARE TO MS PATIENTS -------------------------------------------------------- RESEARCH ACTIVITIES BEGAN AT THE CENTER IN THE 1980'S, WITH THE USE OF ANTIDEPRESSANT AND BLADDER MANAGEMENT MEDICATIONS FOR THE MS PATIENT. EFFORTS AT THAT TIME WERE SYMPTOM MANAGEMENT BASED, UNTIL THE DEVELOPMENT OF DISEASE MODIFYING THERAPIES (DMTS) EMERGED. THE FIRST GENERATION OF INJECTABLE DMTS BECAME AVAILABLE IN THE 1990'S, WITH THE APPROVAL OF BETASERON, AVONEX AND COPAXONE. THE PRIMARY FOCUS WAS ON THE RELAPSING REMITTING POPULATION. THE CENTER BEGAN ITS INVOLVEMENT WITH THE USE OF BETASERON IN THE SECONDARY PROGRESSIVE POPULATION IN THE LATE 90'S. COMPARATIVE STUDIES WITH APPROVED THERAPIES, AND EMERGING INTRAVENOUS THERAPIES SUCH AS NATALIZUMAB (TYSABRI) BEGAN IN THE EARLY 2000'S. CURRENTLY, THE CENTER'S PROVISION OF CARE TO MS PATIENTS INVOLVES BOTH THE INFLAMMATORY AND NEURO-DEGENERATIVE PROCESS OF THE DISEASE. EFFORTS CONTINUE TO EXAMINE A NEW DISEASE MODIFYING THERAPY WHICH CHALLENGES THE COST OF HEALTHCARE. IN ADDITION, PRODUCTS WITH POTENTIAL REMYELINATING PROPERTIES ARE UNDER STUDY IN PROGRESSIVE MS PHENOTYPES AS WELL AS RELAPSING REMITTING. PLANS TO EMBARK ON WEARABLE TECHNOLOGY TO ASSIST IN TRACKING PROGRESS OF PATIENTS AS WELL AS USE OF SELF REPORTED PERFORMANCE TOOL TO ASSIST IN CLINICAL PRACTICE WILL BEGIN SHORTLY. CURRENT RESEARCH EFFORTS HAVE BEEN FOCUSED ON PROVIDING THE OPPORTUNITY FOR THE MS PATIENTS TO PARTICIPATE AND CONTRIBUTE TO THE ADVANCEMENT OF MS CARE. THE CENTER CONTINUES TO BE A MODEL OF COMPREHENSIVE TERTIARY CARE FOR MS PATIENTS. THE ORGANIZATION SERVES OVER 2,000 PATIENTS FROM THE GREATER NEW YORK METROPOLITAN REGION WITH MS ON AN ANNUAL BASIS AND HAS A CLINICAL AFFILIATION WITH THE NATIONAL MS SOCIETY. |
| CORE FORM, PART V; QUESTION 1B | HOLY NAME HEALTH CARE FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION ISSUES ALL FEDERAL FORMS W-2G ON BEHALF OF THIS ORGANIZATION. |
| CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 | HOLY NAME MEDICAL CENTER ("HNMC") IS THE SOLE MEMBER OF THIS ORGANIZATION. PEACE MINISTRIES, INC. IS THE SOLE MEMBER OF HNMC. PEACE MINISTRIES, INC. HAS THE ULTIMATE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS. |
| CORE FORM, PART VI, SECTION B; QUESTION 11B | THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM, WHICH INCLUDES HOLY NAME MEDICAL CENTER, INC. ("HNMC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. THIS ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY, ITS BOARD OF TRUSTEES, PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). HNMC'S AUDIT COMMITTEE HAS ASSUMED THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION, REVIEW AND FILING PROCESS FOR ALL TAX-EXEMPT AFFILIATES WITHIN THE SYSTEM. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE SYSTEM HIRED A PROFESSIONAL CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE SYSTEM'S FINANCE PERSONNEL AND VARIOUS OTHER INDIVIDUALS INCLUDING, BUT NOT LIMITED TO, THE CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT OF FINANCE AND CONTROLLER ("INTERNAL WORKING GROUP") TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE INTERNAL WORKING GROUP, INCLUDING THOSE INDIVIDUALS OUTLINED ABOVE FOR THEIR REVIEW. THE INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. FOLLOWING THIS REVIEW, THE FORM 990 WAS THEN PROVIDED TO HNMC'S AUDIT COMMITTEE AND SUBSEQUENTLY TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING WITH THE IRS. |
| CORE FORM, PART VI, SECTION B; QUESTION 12 | THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM, WHICH INCLUDES HOLY NAME MEDICAL CENTER, INC. ("HNMC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. THE ORGANIZATION AND SYSTEM REGULARLY MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO HNMC'S CHIEF COMPLIANCE OFFICER FOR REVIEW. THEREAFTER, THE CHIEF COMPLIANCE OFFICER PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS WHICH IS THEN PRESENTED TO HNMC'S GOVERNANCE COMMITTEE FOR ITS REVIEW AND DISCUSSION. |
| CORE FORM, PART VI, SECTION B; QUESTION 15 | THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM, WHICH INCLUDES HOLY NAME MEDICAL CENTER, INC. ("HNMC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. HNMC'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES THE COMPENSATION AND BENEFITS OF ALL HOLY NAME MEDICAL CENTER VICE PRESIDENTS AND ABOVE ("SENIOR MANAGEMENT PERSONNEL"). THIS INCLUDES BUT IS NOT LIMITED TO, THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND VICE PRESIDENT/CHIEF FINANCIAL OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THESE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO SENIOR MANAGEMENT PERSONNEL. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS WITHIN THE ORGANIZATION ARE REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM HNMC'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS. MEETINGS. |
| CORE FORM, PART VI, SECTION C; QUESTION 19 | THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY. |
| CORE FORM, PART VII AND SCHEDULE J | CORE FORM, PART VII AND SCHEDULE J REFLECTS CERTAIN TRUSTEES AND OFFICERS 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 OR OFFICER OF THE ORGANIZATION'S BOARD OF TRUSTEES. |
| CORE FORM, PART VII, SECTION A, COLUMN B | THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM, WHICH INCLUDES HOLY NAME MEDICAL CENTER, INC. ("HNMC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. CERTAIN BOARD OF TRUSTEE MEMBERS AND OFFICERS INCLUDED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990 FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENTS THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF TRUSTEES OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY THE SAME AS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID KEY EMPLOYEES OR OFFICERS, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE SYSTEM; NOT SOLELY THIS ORGANIZATION. |
| CORE FORM, PART XII; QUESTION 2 | THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM, WHICH INCLUDES HOLY NAME MEDICAL CENTER, INC. ("HNMC"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES, FOR THE YEARS ENDED DECEMBER 31, 2018 AND DECEMBER 31, 2017; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNMODIFIED OPINION WITH RESPECT TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS EACH YEAR. HNMC'S AUDIT COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION AND THE SELECTION OF AN INDEPENDENT AUDITOR. |
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