TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) MICHAEL MARON...................................................................... TRUSTEE - PRESIDENT & CEO	55.0 ................. 0.0	X	X				2,020,093	0	29,679
(2) ADAM JARRETT MD FACHE...................................................................... EVP, CHIEF MEDICAL OFFICER	55.0 ................. 0.0			X			884,466	0	186,582
(3) SHERYL SLONIM DNP RN-BC...................................................................... EVP, PCS & CNO(RETIRED 1/8/20)	55.0 ................. 0.0			X			1,003,822	0	2,026
(4) MARYANN KICENUIK ESQ...................................................................... VP, GENERAL COUNSEL	55.0 ................. 0.0			X			728,977	0	104,679
(5) RYAN KENNEDY CPA...................................................................... EVP/CFO, ASSIST. SEC/TREAS	55.0 ................. 0.0		X				700,494	0	114,346
(6) SAIKRISHNAN KANDAMANGALAM...................................................................... EVP, CHIEF INFORMATION OFFICER	55.0 ................. 0.0			X			511,806	0	40,661
(7) KRISTEN L SILBERSTEIN...................................................................... VP, PAYOR RELATIONS	55.0 ................. 0.0				X		444,393	0	92,661
(8) STEVEN L MOSSER...................................................................... EVP, OPERATIONS	55.0 ................. 0.0			X			426,473	0	43,361
(9) RON WHITE MD...................................................................... DIRECTOR, MEDICAL AFFAIRS	55.0 ................. 0.0				X		431,206	0	28,743
(10) SEAN O'ROURKE...................................................................... VP, HEALTH PARTNERS SERVICES	55.0 ................. 0.0				X		374,257	0	43,261
(11) RAVIT BARKAMA MD...................................................................... AVP, CLINICAL DEVELOPMENT	55.0 ................. 0.0				X		354,368	0	40,501
(12) MICHELE ACITO DNP RN NE-BC...................................................................... EVP, CNO (EFF 06/28/20)	55.0 ................. 0.0			X			363,191	0	29,546
(13) PHYLLIS MARINO MD...................................................................... MEDICAL DIRECTOR	55.0 ................. 0.0				X		349,627	0	24,153
(14) MICHAEL SKVARENINA...................................................................... FORMER KEY EMPLOYEE	55.0 ................. 0.0					X	294,970	0	37,667
(15) DAVID BUTLER MD...................................................................... TRUSTEE	55.0 ................. 0.0	X					0	214,439	23,935
(16) JOHN POOLE MD...................................................................... TRUSTEE - PRESIDENT MED STAFF	25.0 ................. 0.0	X					69,600	0	0
(17) JOSEPH A FRASCINO MD...................................................................... CHAIRPERSON - TRUSTEE	1.0 ................. 0.0	X	X				0	0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) FERNANDO GARIP........................................................................ VICE CHAIRPERSON - TRUSTEE	1.0 .......................0.0	X	X
(19) SISTER BARBARA MORAN CSJP........................................................................ SECRETARY - TRUSTEE	1.0 .......................0.0	X	X
(20) EDWIN H RUZINSKY CPA........................................................................ TREASURER - TRUSTEE	1.0 .......................0.0	X	X
(21) PAUL BAKER........................................................................ TRUSTEE	1.0 .......................0.0	X
(22) TED A CARNEVALE CPA........................................................................ TRUSTEE	1.0 .......................0.0	X
(23) DALE A CREAMER........................................................................ TRUSTEE	1.0 .......................0.0	X
(24) MAUREEN DONOHUE........................................................................ TRUSTEE	1.0 .......................0.0	X
(25) JAMES DOWLING........................................................................ TRUSTEE	1.0 .......................0.0	X
(26) MICHAEL R DRESSLER ESQ........................................................................ TRUSTEE	1.0 .......................0.0	X
(27) JOHN M GERAGHTY........................................................................ TRUSTEE	1.0 .......................0.0	X
(28) SALVATORE LARAIA MD........................................................................ TRUSTEE	1.0 .......................0.0	X
(29) DANIEL LEBER........................................................................ TRUSTEE	1.0 .......................0.0	X
(30) SISTER ANTOINETTE MOORE CSJP........................................................................ TRUSTEE	1.0 .......................0.0	X
(31) JOSEPH PARISI JR........................................................................ TRUSTEE	1.0 .......................0.0	X
(32) LEON TEMIZ........................................................................ TRUSTEE	1.0 .......................0.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
TRIMEDX INC, PO BOX 636129 CINCINNATI,OH452636129	CLINICAL ENGINEERING	4,805,840
SODEXHO INC AFFILIATES, PO BOX 360170 PITTSBURGH,PA152516170	CAFETERIA SVCS.	4,003,798
CLAUDIO BOZZO SON INC, 503 FARLEY ROAD WHITEHOUSE STATION,NJ08889	CONSTRUCTION	3,675,790
PHELPS CONSTRUCTION GROUP LLC, 315 WOTTON STREET UNIT K BOONTON,NJ07005	CONSTRUCTION	1,973,356
RIVERSIDE MEDICAL GROUP, 714 10TH STREET SECAUCUS,NJ07094	MEDICAL	1,800,000
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 121

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2020

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 5 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 2020 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2020. 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—2019. 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—2020. 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—2019. 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) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(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 5 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 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. 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—2019. 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) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) 2020

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 lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2020

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 (explain in Part VI). 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 0.015 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 0.035	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) 2020

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

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) 2020

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization HOLY NAME MEDICAL CENTER

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization HOLY NAME MEDICAL CENTER		Employer identification number 22-1487322

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization HOLY NAME MEDICAL CENTER			Employer identification number 22-1487322
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:
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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

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

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2020

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) 2017	(b) 2018	(c) 2019	(d) 2020	(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) 2020

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|No

(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)? ........

Yes

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

86,102

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

86,102

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
SCHEDULE C, PART II-B; LINE 1I	HOLY NAME MEDICAL CENTER ENGAGES IN LOBBYING EFFORTS ON A FEDERAL AND STATE LEVEL. DURING 2020, THE ORGANIZATION PAID AN INDEPENDENT FIRM FOR LOBBYING AND OTHER CONSULTING SERVICES. A PORTION OF THE AMOUNTS PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. DURING 2020, THIS ALLOCATION AMOUNTED TO $64,500. IN ADDITION, HOLY NAME MEDICAL CENTER IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION ("AHA"), THE NEW JERSEY HOSPITAL ASSOCIATION ("NJHA") AND THE NEW JERSEY BUSINESS & INDUSTRY ASSOCIATION ("NJBIA") WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $21,602 DURING 2020.

Return Reference

Explanation

SCHEDULE C, PART II-B; LINE 1I

HOLY NAME MEDICAL CENTER ENGAGES IN LOBBYING EFFORTS ON A FEDERAL AND STATE LEVEL. DURING 2020, THE ORGANIZATION PAID AN INDEPENDENT FIRM FOR LOBBYING AND OTHER CONSULTING SERVICES. A PORTION OF THE AMOUNTS PAID TO THIS ORGANIZATION HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. DURING 2020, THIS ALLOCATION AMOUNTED TO $64,500. IN ADDITION, HOLY NAME MEDICAL CENTER IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION ("AHA"), THE NEW JERSEY HOSPITAL ASSOCIATION ("NJHA") AND THE NEW JERSEY BUSINESS & INDUSTRY ASSOCIATION ("NJBIA") WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $21,602 DURING 2020.

Schedule C (Form 990 or 990EZ) 2020

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2020

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 ....	17,265,260	17,139,015	17,974,962	13,370,743	17,784,371
b	Contributions ...	1,746,802	2,303,074	3,243,196	7,522,236	2,830,030
c	Net investment earnings, gains, and losses	1,090,762	1,351,808	-367,084	616,667	161,879
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,232,212	3,528,637	3,712,059	3,534,684	7,405,537
f	Administrative expenses ....
g	End of year balance ......	18,870,612	17,265,260	17,139,015	17,974,962	13,370,743

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

Term endowment SchDMd Bullet

100.000 %

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 .....	7,313,472		7,313,472
b	Buildings ....	224,457,753	141,794,378	82,663,375
c	Leasehold improvements	3,244,188	2,970,389	273,799
d	Equipment ....	204,841,489	160,579,620	44,261,869
e	Other .....	16,164,092		16,164,092
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				150,676,607

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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)CASH & CASH EQUIV; LIM USE	3,616,513	F
(2)MUTUAL FUNDS-FIX INC; LIM USE	979,363	F
(3)MUTUAL FUNDS - EQUITY; LIM USE	5,657,053	F
(4)EQUITIES; LIMITED USE	433,837	F
(5)CORPORATE BONDS; LIMITED USE	1,280,726	F
(6)U.S. GOVT OBLIGATIONS; LIM USE	-186,900	F
(7)CERT OF DEPOSIT; LIMITED USE	1,790,932	F
(8)ALT INVESTMENTS; LIMITED USE	9,949	F
(9)ACCRUED INTEREST; LIMITED USE	228	F
(10)CASH & CASH EQUIVALENTS	1,316,458	F
(11)MUTUAL FUNDS - FIXED INCOME	92,699,448	F
(12)MUTUAL FUNDS - EQUITY	36,434,295	F
(13)EQUITIES	2,067,304	F
(14)CORPORATE BONDS	11,217,608	F
(15)U.S. GOVERNMENT OBLIGATIONS	11,062,180	F
(16)CERTIFICATES OF DEPOSIT	289,690	F
(17)ALTERNATIVE INVESTMENTS	695,073	F
(18)ACCRUED INTEREST	117,204	F
(19)ASSETS HELD BY RELATED ORG.	3,705,223	F
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	173,186,184

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)DUE FROM AFFILIATES				38,490,182
(2)OTHER RECEIVABLES				17,864,023
(3)OTHER ASSETS				14,652,565
(4)RIGHT OF USE ASSETS				12,310,836
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				83,317,606

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	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	96,380,804
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) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART V; QUESTION 4	ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH INTENT AND IN FURTHERANCE OF THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES. THE MEDICAL CENTER HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO THE ENDOWMENT FUNDS.

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 500 %

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? . . . . . . . . .

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

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) . . .	3,753,719	375,355	3,378,364	0.760 %
b	Medicaid (from Worksheet 3, column a) . . . . .	59,423,559	37,971,244	21,452,315	4.820 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	63,177,278	38,346,599	24,830,679	5.580 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,872,081		1,872,081	0.420 %
f	Health professions education (from Worksheet 5) . . .	313,981		313,981	0.070 %
g	Subsidized health services (from Worksheet 6) . . . .	50,750,724	20,282,444	30,468,280	6.840 %
h	Research (from Worksheet 7) .	1,114,219		1,114,219	0.250 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	392,397		392,397	0.090 %
j	Total. Other Benefits . .	54,443,402	20,282,444	34,160,958	7.670 %
k	Total. Add lines 7d and 7j .	117,620,680	58,629,043	58,991,637	13.250 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	56,298	56,298	0.010 %
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	56,298	56,298	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

12,503,224

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. ......

3,003,832

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).....

127,323,407

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

170,177,406

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

-42,853,999

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1BERGEN RENAL CARE
2CENTER LLC	HEALTHCARE SERVICES	6 %	35 %
3BERGEN RENAL HOME PD
4CENTER LLC	HEALTHCARE SERVICES	6 %	35 %
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

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?1Name, 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)					Facility reporting group
1	HOLY NAME MEDICAL CENTER 718 TEANECK ROAD TEANECK,NJ07666 WWW.HOLYNAME.ORG 10205	X	X	X	1

Schedule H (Form 990) 2020

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)

	HOLY NAME MEDICAL CENTER
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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.HOLYNAME.ORG

Other website (list url): WWW.HEALTHYBERGEN.ORG

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 19

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

Yes

If "Yes" (list url): WWW.HOLYNAME.ORG

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

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

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

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 500.%

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)

Was widely publicized 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):

WWW.HOLYNAME.ORG

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

WWW.HOLYNAME.ORG

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

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

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

	HOLY NAME MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2020

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
SCHEDULE H, PART V, SECTION B, QUESTION 5	WHILE CONDUCTING ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") HOLY NAME MEDICAL CENTER ("HNMC") TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. THE ORGANIZATION'S CHNA INCORPORATES DATA FROM BOTH QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH (THE COMMUNITY HEALTH SURVEY) AND SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA). THESE QUANTITATIVE COMPONENTS ALLOW FOR COMPARISON TO BENCHMARK DATA AT THE COUNTY, STATE AND NATIONAL LEVELS. QUALITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH GATHERED THROUGH AN ONLINE KEY INFORMANT SURVEY OF VARIOUS COMMUNITY STAKEHOLDERS. KEY INFORMANT SURVEY -------------------- IN AN EFFORT TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, THE ORGANIZATION UTILIZED A KEY INFORMANT SURVEY AS PART OF ITS CHNA PROCESS. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY THE PARTICIPATING HOSPITALS AND THE COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP ("CHIP") OF BERGEN COUNTY. THIS LIST INCLUDED NAMES AND CONTACT INFORMATION FOR PROVIDERS AND REPRESENTATIVES OF BEHAVIORAL HEALTH, CHILDREN AND FAMILIES, COMMUNITY CENTERS AND RECREATION, BERGEN COUNTY, VARIOUS MUNICIPALITIES, CULTURAL ADVOCATES AND ORGANIZATIONS FOOD RESOURCES, CLINICAL AND OTHER HEALTH SPECIALTIES, HOUSING AND HOMELESSNESS, LAW ENFORCEMENT, FIRE, EMS, OLDER ADULTS/HEALTHY AGING, PHILANTHROPY, RELIGIOUS OR FAITH-BASED ORGANIZATIONS, SERVICES FOR LOW-RESOURCE INDIVIDUALS AND FAMILIES AND A VARIETY OF OTHER COMMUNITY LEADERS. ADMINISTRATIVE AND CLINICAL LEADERSHIP FROM THE PARTICIPATING HOSPITALS WERE ALSO INCLUDED. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. KEY INFORMANTS WERE INTERVIEWED BY PHONE USING A STRUCTURED INTERVIEW GUIDE DEVELOPED BY JOHN SNOW, INC. ("JSI") AND THE CHNA STEERING COMMITTEE. IN ALL, APPROXIMATELY 80 COMMUNITY STAKEHOLDERS IN BERGEN COUNTY TOOK PART IN THE KEY INFORMANT SURVEY. IN THE PHONE SURVEY, KEY INFORMANTS WERE ASKED TO RATE THE DEGREE TO WHICH VARIOUS HEALTH ISSUES ARE A PROBLEM IN THEIR OWN COMMUNITY. FOLLOW-UP QUESTIONS ASKED THEM TO DESCRIBE WHY THEY IDENTIFY PROBLEM AREAS AS SUCH, AND HOW THESE MIGHT BE BETTER ADDRESSED. RESULTS OF THIS SURVEY ARE INCLUDED IN THE CHNA. PARTICIPATION INCLUDED REPRESENTATIVES OF THE ORGANIZATIONS LISTED BELOW: - OFFICE OF ALCOHOL AND DRUG DEPENDENCY, BERGEN COUNTY DEPT OF HEALTH SERVICES; - COMPREHENSIVE BEHAVIORAL HEALTH CARE; - DIVISION OF MENTAL HEALTH SERVICES, BERGEN COUNTY DEPT OF HEALTH SERVICES; - PARTNERSHIP FOR MATERNAL AND CHILD HEALTH; - PASCACK VALLEY HIGH SCHOOL; - CHILDREN'S AID AND FAMILY SERVICES; - DWIGHT MORROW ZONE, BERGEN FAMILY CENTER; - HACKENSACK SCHOOL DISTRICT; - COMMUNITY CENTERS AND RECREATION; - WESTWOOD RECREATION DEPARTMENT; - WYCKOFF BOARD OF HEALTH; - BERGEN COUNTY DIVISION OF COMMUNITY DEVELOPMENT; - TOWNSHIP OF TEANECK; - DIVISION OF DISABILITY SERVICES, BERGEN COUNTY DEPT OF HEALTH SERVICES; - PUBLIC HEALTH NURSE, CITY OF GARFIELD; - BERGEN COUNTY DEPARTMENT OF HEALTH SERVICES; - HEALTH AND HUMAN SERVICES COMMITTEE, BERGEN COUNTY LINKS; - HEALTH INSURANCE AGENT/INTERPRETER; - HEALTH AND WELLNESS COORDINATOR, GARDEN STATE EQUALITY; - MEALS ON WHEELS NORTH JERSEY; - REGISTERED DIETICIAN, SHOP RITE OF HILLSDALE; - REGISTERED DIETICIAN, SHOPRITE OF NORTHVALE; - VAN DYK HEALTH CARE; - BERGEN COUNTY CANCER EDUCATION AND EARLY DETECTION, BERGEN CO. DEPT. OF HEALTH SERVICES; - JEWISH HOME FAMILY; - AMERICAN CANCER SOCIETY; - BERGEN VOLUNTEER MEDICAL INITIATIVE; - CANCERCARE; - NORTH HUDSON COMMUNITY ACTION; - LEADERSHIP, BERGEN COUNTY HOSPITALS; - PHYSICIANS, BERGEN COUNTY HOSPITALS; - TRUSTEES, BERGEN COUNTY HOSPITALS; - ASIAN HEALTH SERVICES, HOLY NAME MEDICAL CENTER; - SENIOR HOUSING SERVICES; - BERGEN COUNTY HOUSING AUTHORITY; - RIDGECREST APARTMENTS; - WESTWOOD POLICE DEPARTMENT; - WESTWOOD FOR ALL AGES; - MIDLAND PARK SENIOR CENTER AND AGE-FRIENDLY RIDGEWOOD; - BERGEN COUNTY DIVISION OF SENIOR SERVICES; - AGE FRIENDLY ENGLEWOOD; - BERGEN COUNTY DIVISION OF SENIOR SERVICES; - THE RUSSELL BERRIE FOUNDATION; - RELIGIOUS OR FAITH-BASED INDIVIDUALS/REPRESENTATIVES; - FAMILY PROMISE OF RIDGEWOOD; - NORTH HUDSON COMMUNITY ACTION CORPORATION; AND - SOCIAL SERVICE ASSOCIATION OF RIDGEWOOD AND VICINITY.
SCHEDULE H, PART V, SECTION B, QUESTIONS 7A & 7B	THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: WWW.HOLYNAME.ORG/INCLUDES/FILES/HNMC-CHNA-2019.PDF ADDITIONALLY, THE COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP OF BERGEN COUNTY'S CHNA, WHICH INCLUDES THIS ORGANIZATION, IS MADE WIDELY AVAILABLE AT THE FOLLOWING URL: WWW.HEALTHYBERGEN.ORG
SCHEDULE H, PART V, SECTION B, QUESTION 7D	IN ADDITION TO POSTING THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") ON THE MEDICAL CENTER'S WEBSITE AND MAKING A PAPER COPY AVAILABLE WITHIN THE HOSPITAL FACILITY, THE CHNA WAS DISCUSSED AT THE ANNUAL OPEN PUBLIC MEETING OF THE BERGEN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN AND WAS MADE AVAILABLE AT THE MEDICAL CENTER'S ANNUAL OPEN PUBLIC MEETING.
SCHEDULE H, PART V, SECTION B, QUESTION 10A	THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 10A, IS THE HOME PAGE FOR THE SYSTEM. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: WWW.HOLYNAME.ORG/INCLUDES/FILES/2019-IMPLEMENTATION-STRATEGY.PDF
SCHEDULE H, PART V, SECTION B, QUESTION 11	PRIORITY AREAS -------------- HOLY NAME'S CHNA PROVIDED MANY OPPORTUNITIES TO VET QUANTITATIVE AND QUALITATIVE FINDINGS. BASED ON THESE FINDINGS, HOLY NAME'S SERVICE LINES AND AREAS OF EXPERTISE, LEADERSHIP AND STAFF FROM HOLY NAME MEDICAL CENTER IDENTIFIED THREE COMMUNITY HEALTH PRIORITY AREAS, WHICH TOGETHER EMBODY THE LEADING HEALTH ISSUES AND BARRIERS TO CARE FOR RESIDENTS OF THE HOSPITAL'S SERVICE AREA: (1) CHRONIC/COMPLEX CONDITIONS AND RISK FACTORS; (2) SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE; AND (3) MENTAL HEALTH AND SUBSTANCE USE DISORDERS. PRIORITY POPULATIONS -------------------- BASED ON THE CHNA'S QUANTITATIVE AND QUALITATIVE FINDINGS, THERE WAS AGREEMENT THAT THE IMPLEMENTATION STRATEGY SHOULD PRIORITIZE CERTAIN DEMOGRAPHIC AND SOCIOECONOMIC SEGMENTS OF THE POPULATION THAT HAVE COMPLEX NEEDS OR FACE ESPECIALLY SIGNIFICANT BARRIERS TO CARE. FIVE PRIORITY POPULATIONS WERE IDENTIFIED: - INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS; - OLDER ADULTS; - RACIALLY, ETHNICALLY & CULTURALLY DIVERSE POPULATIONS; - INDIVIDUALS WITH LIMITED RESOURCES; AND - YOUTH AND ADOLESCENTS. PRIORITY AREA #1: CHRONIC / COMPLEX CONDITIONS AND RISK FACTORS --------------------------------------------------------------- GOALS INCLUDE: (1) ENHANCE ACCESS TO HEALTH EDUCATION, SCREENING AND REFERRAL/TREATMENT SERVICES (2) SUPPORT INDIVIDUALS WITH CHRONIC/COMPLEX CONDITIONS AND THEIR CAREGIVERS (3) ENHANCE UNDERSTANDING OF END-OF-LIFE NEEDS AND CARE OBJECTIVES ADDRESSING THESE GOALS INCLUDE: - SCREEN FOR CHRONIC/COMPLEX CONDITIONS AND RISK FACTORS AND REFER TO APPROPRIATE SERVICES; - INCREASE THE NUMBER OF INDIVIDUALS WHO RECEIVE EDUCATION REGARDING CHRONIC/COMPLEX CONDITIONS AND RISK FACTORS; - INCREASE SKILLS, CONFIDENCE, AND ABILITIES OF PARENTS AND CAREGIVERS; - INCREASE THE NUMBER OF INDIVIDUALS FROM PRIORITY POPULATIONS ENGAGED IN CARE; - IMPROVE COORDINATION OF CARE FOR ADULTS WITH CHRONIC/COMPLEX CONDITIONS; - PROMOTE CHRONIC DISEASE MANAGEMENT AND BEHAVIORAL CHANGE; - INCREASE HEALTHY EATING AND PHYSICAL ACTIVITY; - INCREASE ACCESS TO END-OF-LIFE AND PALLIATIVE CARE PROGRAMS; - DECREASE SOCIAL ISOLATION AMONG OLDER ADULTS; - INCREASE THE NUMBER OF ADULTS WITH ADVANCE HEALTHCARE DIRECTIVES; AND - PROVIDE SUPPORT FOR THE HEALTH CARE OF IMPOVERISHED PERSONS IN MILOT, HAITI. PRIORITY AREA #2: SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE ------------------------------------------------------------------ GOALS INCLUDE: (1) ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO CARE ISSUES THAT INHIBIT THE ABILITY OF INDIVIDUALS TO LEAD HAPPY, HEALTHY, AND PRODUCTIVE LIVES (2) REDUCE HEALTH DISPARITIES OBJECTIVES ADDRESSING THESE GOALS INCLUDE: - SUPPORT PROGRAMS AND POLICIES THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH; - ADDRESS COMMON BARRIERS TO ACCESSING HEALTH CARE; - PROMOTE CARE COORDINATION AND ENGAGEMENT IN PRIMARY CARE; - PROMOTE CULTURAL COMPETENCY, HEALTH LITERACY, AND LINGUISTICALLY; APPROPRIATE CARE TO REDUCE HEALTH DISPARITIES AND TO INCREASE ACCESS TO SERVICES; - REDUCE INAPPROPRIATE USE OF THE EMERGENCY ROOM AND HOSPITAL READMISSIONS; AND - REDUCE TRANSPORTATION BARRIERS. PRIORITY AREA #3: MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS ------------------------------------------------------------- GOAL: (1) SUPPORT AND/OR IMPLEMENT STRATEGIES THAT PROMOTE MENTAL, EMOTIONAL, AND SOCIAL WELL-BEING OBJECTIVES ADDRESSING THIS GOAL INCLUDE: - ENHANCE IDENTIFICATION OF INDIVIDUALS WITH UNDIAGNOSED MENTAL AND BEHAVIORAL HEALTH CONDITIONS; - SUPPORT EFFORTS THAT AIM TO REDUCE THE STIGMA ASSOCIATED WITH MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER; - SUPPORT INITIATIVES THAT PROMOTE HEALTHY MENTAL, EMOTIONAL, AND SOCIAL BEHAVIORS; - EXPAND ACCESS TO BEHAVIORAL HEALTH SCREENING, TREATMENT, AND SUPPORTIVE SERVICES; - COLLABORATE WITH CLINICAL AND COMMUNITY-BASED PARTNERS TO ADDRESS MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER; AND - REDUCE USE OF OPIOIDS, ESPECIALLY OPIOID PRESCRIPTIONS ISSUED BY HNMC AND ITS AFFILIATES. NEEDS THAT WILL NOT BE ADDRESSED -------------------------------- THERE ARE ALSO COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED THROUGH HOLY NAME'S CHNA THAT WERE NOT PRIORITIZED FOR INCLUSION IN THE IMPLEMENTATION STRATEGY. REASONS FOR THIS INCLUDE: - FEASIBILITY OF HOLY NAME HAVING AN IMPACT ON THIS ISSUE IN THE SHORT OR LONG-TERM - SPECIFIC CAPABILITY OF THE ORGANIZATION - THE ISSUE IS ALREADY ADDRESSED BY COMMUNITY PARTNERS IN A WAY THAT DOES NOT WARRANT ADDITIONAL SUPPORT POVERTY/EMPLOYMENT, HOUSING STABILITY, AND CERTAIN LEVELS OF BEHAVIORAL AND SUBSTANCE ABUSE NEEDS WERE IDENTIFIED AS COMMUNITY NEEDS, BUT WERE DEEMED TO BE OUTSIDE OF HOLY NAME MEDICAL CENTER'S PRIMARY SPHERE OF INFLUENCE. HOLY NAME REMAINS OPEN AND WILLING TO WORK WITH HOSPITALS AND OTHER PUBLIC AND PRIVATE PARTNERS TO ADDRESS THESE ISSUES SHOULD AN OPPORTUNITY ARISE. HOLY NAME MEDICAL CENTER WILL STRIVE TO PROMOTE ITS MISSION: "WE ARE A COMMUNITY OF CAREGIVERS COMMITTED TO A MINISTRY OF HEALING, EMBRACING THE TRADITION OF CATHOLIC PRINCIPLES, THE PURSUIT OF PROFESSIONAL EXCELLENCE, AND CONSCIENTIOUS STEWARDSHIP. WE HELP OUR COMMUNITY ACHIEVE THE HIGHEST ATTAINABLE LEVEL OF HEALTH THROUGH EDUCATION, PREVENTION AND TREATMENT." IN CONCERT WITH THIS MISSION, THE MEDICAL CENTER IS COMMITTED TO THE STRATEGIES OUTLINED BELOW AND INCLUDED WITHIN THE ORGANIZATION'S IMPLEMENTATION STRATEGY ACTION PLAN.
SCHEDULE H, PART V, SECTION B, QUESTION 16	THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 16, IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. THESE DOCUMENTS CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: WWW.HOLYNAME.ORG/FINANCIAL/FINANCIAL-ASSISTANCE-POLICY.ASPX

Schedule H (Form 990) 2020

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address		Type of Facility (describe)
1	ENGLEWOOD PULMONARY 200 GRAND AVENUE ENGLEWOOD,NJ07631	OUTPATIENT SERVICES - PULMONARY
2	VILLA MARIA CLAIRE 12 WEST SADDLE RIVER ROAD SADDLE RIVER,NJ07458	HOSPICE FACILITY
3	HNMC RADIOLOGY & ADULT CLINIC 222 CEDAR LANE TEANECK,NJ07666	OUTPATIENT SERVICES - RADIOLOGY & CLINIC
4	ORADELL REHAB 514 KINDERKAMACK ROAD ORADELL,NJ07649	OUTPATIENT SERVICES - REHABILITATION
5	HN INSTITUTE FOR WOUND HEALING 699 TEANECK ROAD TEANECK,NJ07666	OUTPATIENT SERVICES - WOUNDCARE
6	HNH FITNESS LLC 514 KINDERKAMACK ROAD ORADELL,NJ07649	MEDICALLY BASED FITNESS CENTER
7	UNION CITY LAB 408 37TH STREET 2ND FLOOR UNION CITY,NJ07087	LABORATORY
8	HACKENSACK CARDIOLOGY 493 ESSEX STREET HACKENSACK,NJ07601	OUTPATIENT SERVICES - CARDIOLOGY
9	UNION CITY CARDIOLOGY 529 39TH STREET UNION CITY,NJ07087	OUTPATIENT SERVICES - CARDIOLOGY
10

Schedule H (Form 990) 2020

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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
SCHEDULE H, PART I; LINE 3C	IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, HOLY NAME MEDICAL CENTER USES OTHER FACTORS IN DETERMINING ELIGIBILITY CRITERIA FOR FREE AND DISCOUNTED CARE. OTHER FACTORS TO DETERMINE ELIGIBILITY INCLUDE: - ASSET LEVEL; - MEDICAL INDIGENCY; - INSURANCE STATUS; - UNDERINSURANCE STATUS; AND - RESIDENCY. ADDITIONAL INFORMATION WITH RESPECT TO HNMC'S ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IS OUTLINED BELOW. NEW JERSEY CHARITY CARE ----------------------- NJ CHARITY CARE IS FREE OR REDUCED CHARGE CARE WHICH IS PROVIDED TO PATIENTS WHO RECEIVE INPATIENT AND OUTPATIENT SERVICES AT ACUTE CARE HOSPITALS THROUGHOUT THE STATE OF NEW JERSEY. CHARITY CARE IS AVAILABLE ONLY FOR EMERGENT OR MEDICALLY NECESSARY HOSPITAL CARE. SOME SERVICES SUCH AS PHYSICIAN FEES, ANESTHESIOLOGY FEES, RADIOLOGY INTERPRETATION, AND OUTPATIENT PRESCRIPTIONS ARE SEPARATE FROM HOSPITAL CHARGES AND MAY NOT BE ELIGIBLE FOR REDUCTION. IN ACCORDANCE WITH CHARITY CARE GUIDELINES, PAYMENT ASSISTANCE IS AVAILABLE TO NEW JERSEY RESIDENT PATIENTS WHOSE HOUSEHOLD GROSS INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINES AND WHO: 1. HAVE NO HEALTH COVERAGE OR HAVE COVERAGE THAT PAYS ONLY PART OF THE BILL; 2. ARE INELIGIBLE FOR ANY PRIVATE OR GOVERNMENTAL SPONSORED COVERAGE (SUCH AS MEDICAID): AND 3. MEET THE INCOME AND ASSETS CRITERIA DESCRIBED BELOW. CHARITY CARE IS AVAILABLE TO THOSE THAT DO NOT QUALIFY FOR STATE OR FEDERAL PROGRAMS. INCOME CRITERIA - PATIENTS WITH FAMILY GROSS INCOME LESS THAN OR EQUAL TO 200% OF THE FEDERAL POVERTY GUIDELINES ("FPG") ARE ELIGIBLE FOR 100% CHARITY CARE COVERAGE. PATIENTS WITH FAMILY GROSS INCOME GREATER THAN 200% BUT LESS THAN OR EQUAL TO 300% OF FPG ARE ELIGIBLE FOR DISCOUNTED CARE UNDER THE CHARITY CARE PROGRAM. FREE OR DISCOUNTED CHARGES ARE DETERMINED BY THE FOLLOWING FEE SCHEDULE: INCOME AS A PERCENTAGE OF HHS POVERTY INCOME GUIDELINES: LESS THAN OR EQUAL TO 200% -- 0% OF MEDICAID RATE GREATER THAN 200% BUT LESS THAN OR EQUAL TO 225% -- 20% OF MEDICAID RATE GREATER THAN 225% BUT LESS THAN OR EQUAL TO 250% -- 40% OF MEDICAID RATE GREATER THAN 250% BUT LESS THAN OR EQUAL TO 275% -- 60% OF MEDICAID RATE GREATER THAN 275% BUT LESS THAN OR EQUAL TO 300% -- 80% OF MEDICAID RATE GREATER THAN 300% -- UNINSURED DISCOUNT RATE AVAILABLE ASSETS CRITERIA - INDIVIDUAL ASSETS CANNOT EXCEED $7,500 AND FAMILY ASSETS CANNOT EXCEED $15,000. SHOULD AN APPLICANT'S ASSETS EXCEED THESE LIMITS, HE/SHE MAY "SPEND DOWN" THE ASSETS TO THE ELIGIBLE LIMITS THROUGH PAYMENT OF THE EXCESS TOWARD THE HOSPITAL BILL AND OTHER APPROVED OUT-OF-POCKET MEDICAL EXPENSES. CHARITY CARE MAY BE AVAILABLE TO NON-NEW JERSEY RESIDENTS, SUBJECT TO SPECIFIC PROVISIONS (SUCH AS EMERGENCY MEDICAL CONDITIONS). NEW JERSEY UNINSURED DISCOUNT CARE RATE --------------------------------------- UNINSURED NEW JERSEY STATE RESIDENT PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE AND WHOSE INCOME FALLS LESS THAN OR EQUAL TO 500% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR A DISCOUNT BASED UPON MEDICARE RATES AS PER THE NJ STATE STATUTE P.L. 2008, CHAPTER 60, APPROVED ON AUGUST 8, 2008, ASSEMBLY, NO. 2609, AS ENACTED BY THE SENATE AND GENERAL ASSEMBLY OF THE STATE OF NEW JERSEY. COMPASSIONATE CARE DISCOUNT POLICY ---------------------------------- PATIENTS WHO DO NOT QUALIFY FOR ANY HEALTHCARE RELATED GOVERNMENTAL SPONSORED COVERAGE OR PROGRAMS UNDER HNMC'S FAP AND DO NOT HAVE PRIMARY INSURANCE COVERAGE WILL BE ELIGIBLE FOR OUR COMPASSIONATE CARE DISCOUNT POLICY. THIS DISCOUNT IS APPLIED AT THE TIME OF BILLING. THE COMPASSIONATE CARE DISCOUNT IS ONLY FOR UNINSURED PATIENTS AND IS NOT DEPENDENT ON INCOME OR ASSET CRITERIA, AND NO APPLICATION IS REQUIRED. IT IS FOR ALL SELF-PAY PATIENTS THAT DO NOT QUALIFY OR DO NOT CHOOSE TO APPLY FOR ANY HOSPITAL PAYMENT ASSISTANCE PROGRAMS. DISCOUNTS APPLIED ARE FOR OUTPATIENT DIAGNOSTIC TESTING SUCH AS RADIOLOGY OR LABORATORY SERVICES, AND A FLAT FEE RATE IS APPLIED TO LEVELS OF CARE SUCH AS AN INPATIENT (I.E. MEDICAL, SURGICAL, OR ICU) OR SAME DAY SURGERY. THE COMPASSIONATE CARE DISCOUNT DOES NOT APPLY TO BALANCES AFTER INSURANCE PAYMENTS, COSMETIC SURGERY, AND OTHER SPECIAL PROGRAMS. THIS DISCOUNT WILL BE APPLIED AT THE TIME OF BILLING. AMOUNT GENERALLY BILLED ("AGB") ------------------------------- PER INTERNAL REVENUE CODE 501(R)(5) CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE FOR FAP-ELIGIBLE INDIVIDUALS UNDER HNMC'S FAP WILL BE LIMITED TO BUT NOT BILLED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.
SCHEDULE H, PART I, QUESTION 6A	NOT APPLICABLE.
SCHEDULE H, PART I, QUESTION 7	THE ORGANIZATION'S COST ACCOUNTING SYSTEM WAS UTILIZED.
SCHEDULE H, PART II	ACTIVITIES CLASSIFIED AS COMMUNITY BUILDING INCLUDE USE OF HOLY NAME MEDICAL CENTER'S FACILITY AND/OR EMPLOYEES TO SUPPORT EFFORTS THAT: - PROMOTE THE POSITIVE GROWTH OF THE COMMUNITY; - ASSIST DIVERSE GROUPS IN COMING TOGETHER FOR THE COMMUNITY'S SHORT AND LONG TERM BENEFIT; AND - SEEK TO PROTECT THE COMMUNITY FROM ANYTHING THAT COULD SIGNIFICANTLY AFFECT THE HEALTH AND WELL-BEING OF THE COMMUNITY. HNMC ALSO ASSISTS OTHER NON-PROFITS AND PROVIDES VARIOUS FORMS OF NON-MONETARY AID. IN ADDITION, EMPLOYEES ARE PERMITTED TO ASSIST VALID NON-PROFIT ORGANIZATIONS DURING PAID WORK TIME. AMONG THE ORGANIZATIONS AIDED ARE: NURSING HOMES, BOY SCOUTS, HOUSES OF WORSHIP, COMMUNITY SERVICE GROUPS, ROTARY CLUBS, POLICE GROUPS, ENVIRONMENTAL GROUPS AND SCHOOLS. HNMC ALSO ALLOWS THE PUBLIC TO USE VARIOUS MEETING ROOMS (IN NON-CLINICAL AREAS) AND ITS CONFERENCE CENTER FOR EVENTS. CAREER DAYS ARE HELD FOR LOCAL HIGH SCHOOLS, FOSTERING ENTRANCE OF INTERESTED AND APPLICABLE STUDENTS INTO THE HEALTH PROFESSIONS. HNMC WAS ONE OF NINE HOSPITALS IN NEW JERSEY DESIGNATED BY THE NEW JERSEY DEPARTMENT OF HEALTH ("NJDOH") AS A REGIONAL MEDICAL COORDINATION CENTER ("MCC"). THE ONLY FACILITY IN BERGEN COUNTY TO BE SO DESIGNATED, HNMC'S ON-CAMPUS MCC WAS ABLE TO BE ACTIVATED IN THE EVENT OF PUBLIC HEALTH EMERGENCIES AND/OR A TERRORIST ATTACK CAUSING MASS CASUALTY INCIDENTS, INFECTIOUS OR COMMUNICABLE DISEASE OR OTHER TYPES OF PUBLIC HEALTH DISRUPTION. THE MCC ALSO MONITORED, ON A DAILY BASIS, SITUATIONAL AWARENESS OF LOCAL ACTIVITY. IN 2014, THE NJDOH LOST MUCH OF ITS FEDERAL FUNDING FOR THE STATEWIDE PROGRAM, CUTTING IN HALF THE NUMBER OF MCC'S IT COULD SUPPORT. HNMC CHOSE NOT TO APPLY TO RENEW ITS DESIGNATION BUT HAS MAINTAINED MOST OF ITS CAPABILITIES ON ITS OWN. GIVEN HNMC'S PROXIMITY TO NEW YORK CITY (I.E., FIVE MILES NORTH OF THE GEORGE WASHINGTON BRIDGE) EMERGENCY PREPAREDNESS IS DEEMED NECESSARY TO ENSURE THE HEALTH AND WELL-BEING OF THE COMMUNITY, REGARDLESS OF THE MCC DESIGNATION.
SCHEDULE H, PART III, SECTION A, QUESTIONS 2, 3 & 4	BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM ITS FINANCIAL STATEMENTS, NET OF ACCOUNTS WRITTEN OFF AT CHARGES. HNMC AND ITS AFFILIATES PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE BELOW WAS OBTAINED FROM THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS OF HNMC AND SUBSIDIARIES. PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ----------------------------------------------------------- NET PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION FOR WHICH THE MEDICAL CENTER EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THE MEDICAL CENTER USES A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR CATEGORIES OF PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN RECOGNIZING REVENUE ON AN INDIVIDUAL CONTRACT BASIS. THE PORTFOLIO CONSISTS OF MAJOR PAYOR CLASSES FOR INPATIENT AND OUTPATIENT REVENUE. BASED ON HISTORICAL COLLECTION TRENDS AND OTHER ANALYSES, THE MEDICAL CENTER BELIEVES THAT REVENUE RECOGNIZED BY UTILIZING THE PORTFOLIO APPROACH APPROXIMATES THE REVENUE THAT WOULD HAVE BEEN RECOGNIZED IF AN INDIVIDUAL CONTRACT APPROACH WERE USED. THE MEDICAL CENTER'S INITIAL ESTIMATE OF THE TRANSACTION PRICE FOR THE SERVICES PROVIDED TO PATIENTS SUBJECT TO REVENUE RECOGNITION IS DETERMINED BY REDUCING THE TOTAL STANDARD CHARGES RELATED TO THE PATIENT SERVICES PROVIDED BY VARIOUS ELEMENTS OF VARIABLE CONSIDERATION, INCLUDING CONTRACTUAL ADJUSTMENTS, DISCOUNTS, IMPLICIT PRICE CONCESSIONS, AND OTHER REDUCTIONS TO THE MEDICAL CENTER'S STANDARD CHARGES. THE MEDICAL CENTER DETERMINES THE TRANSACTION PRICE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL OR FORMULA DRIVEN RATES FOR THE SERVICES RENDERED (SEE DESCRIPTION OF THIRD-PARTY PAYMENT PROGRAMS BELOW). THE ESTIMATES FOR CONTRACTUAL ALLOWANCES AND DISCOUNTS ARE BASED ON CONTRACTUAL AGREEMENTS, THE MEDICAL CENTER'S DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. FOR UNINSURED AND UNDER-INSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE MEDICAL CENTER DETERMINES THE TRANSACTION PRICE ASSOCIATED WITH SERVICES RENDERED ON THE BASIS OF CHARGES REDUCED BY IMPLICIT PRICE CONCESSIONS. IMPLICIT PRICE CONCESSIONS INCLUDED IN THE ESTIMATE OF THE TRANSACTION PRICE ARE BASED ON THE MEDICAL CENTER'S HISTORICAL COLLECTION EXPERIENCE FOR APPLICABLE PATIENT PORTFOLIOS. GENERALLY, THE MEDICAL CENTER BILLS PATIENTS AND THIRD-PARTY PAYORS AFTER THE SERVICES ARE PERFORMED AND THE PATIENT IS DISCHARGED. NET PATIENT SERVICE REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE MEDICAL CENTER. NET PATIENT SERVICE REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL CHARGES. THE MEDICAL CENTER BELIEVES THAT THIS METHOD PROVIDES A REASONABLE DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE SERVICES NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES OR PATIENTS RECEIVING SERVICES IN THE MEDICAL CENTER'S OUTPATIENT SETTINGS. THE MEDICAL CENTER MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE MEDICAL CENTER OR THE COMMENCEMENT OF AN OUTPATIENT SERVICE TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE OR THE COMPLETION OF THE OUTPATIENT VISIT. AS SUBSTANTIALLY ALL OF ITS PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, THE MEDICAL CENTER HAS ELECTED TO NOT DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY UNSATISFIED AT THE END OF THE REPORTING PERIOD. THE UNSATISFIED OR PARTIALLY UNSATISFIED PERFORMANCE OBLIGATIONS REFERRED TO ABOVE ARE PRIMARILY RELATED TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD FOR PATIENTS WHO REMAIN ADMITTED AT THAT TIME (IN-HOUSE PATIENTS). THE PERFORMANCE OBLIGATIONS FOR IN-HOUSE PATIENTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH FOR THE MAJORITY OF THE MEDICAL CENTER'S IN-HOUSE PATIENTS OCCURS WITHIN DAYS OR WEEKS AFTER THE END OF THE REPORTING PERIOD. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FOR THE YEAR ENDED DECEMBER 31, 2020, CHANGES IN THE MEDICAL CENTER'S ESTIMATES OF IMPLICIT PRICE CONCESSIONS, DISCOUNTS, CONTRACTUAL ADJUSTMENTS OR OTHER REDUCTIONS TO EXPECTED PAYMENTS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS WERE NOT SIGNIFICANT. PORTFOLIO COLLECTION ESTIMATES ARE UPDATED BASED ON COLLECTION TRENDS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AS OF AN FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019 WERE NOT SIGNIFICANT. THE MEDICAL CENTER HAS DETERMINED THAT THE NATURE, AMOUNT, TIMING AND UNCERTAINTY OF REVENUE AND CASH FLOWS ARE AFFECTED BY THE FOLLOWING FACTORS: PAYORS, LINES OF BUSINESS AND TIMING OF WHEN REVENUE IS RECOGNIZED.
SCHEDULE H, PART III, SECTION B, QUESTION 8	MEDICARE COSTS WERE DERIVED FROM THE 2020 MEDICARE COST REPORT. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL), BAD DEBT AND ASSOCIATED COSTS ARE COMMUNITY BENEFIT AND ARE 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 WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "THE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL MUST PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS WHO CANNOT PAY FOR SUCH SERVICES. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVED" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY THE DEPARTMENT OF TREASURY REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA'S POSITION. AS OUTLINED IN THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. FROM THE LATEST DATA PROVIDED BY THE AHA, MEDICARE REIMBURSES HOSPITALS ONLY 87 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 42 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLE." THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR THOSE WHO DO NOT PAY ALL, OR A PORTION OF THE ALREADY DISCOUNTED BILLED AMOUNTS UNDER OUR FINANCIAL ASSISTANCE POLICY. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFIT" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS RE
SCHEDULE H, PART III, SECTION B, QUESTION 9B	ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE BUT, RATHER, ACCOUNTED FOR AS AN ALLOWANCE. IT IS THE POLICY OF HOLY NAME MEDICAL CENTER AND ITS SUBSIDIARIES TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. ADDITIONALLY, HNMC IS COMMITTED TO BILL PATIENTS AND INSURANCE CARRIERS IN A MANNER THAT IS UNDERSTANDABLE, PROFESSIONAL, COMPASSIONATE AND IN COMPLIANCE WITH ALL STATE, LOCAL AND FEDERAL RULES INCLUDING INTERNAL REVENUE CODE SECTION 501(R). IT IS THE INTENTION THAT THE BILLING AND COLLECTION POLICY BE CONSISTENT WITH HNMC'S FINANCIAL ASSISTANCE POLICY ("FAP") AND ANY INCONSISTENCIES SHALL BE GUIDED BY THE FAP AND APPLIED IN A MANNER THAT BENEFITS THE PATIENT. HNMC WILL FOLLOW THE FOLLOWING PROCEDURES WHEN PURSUING BILLING AND COLLECTION ACTIONS: (1) PATIENTS SHALL BE REGISTERED IN THE HOSPITAL'S INFORMATION SYSTEM IN A MANNER THAT ENSURES THE CAPTURE OF THE INFORMATION NECESSARY TO EFFECTIVELY PROVIDE MEDICALLY NECESSARY CARE AND TO PROFESSIONALLY BILL FOR SERVICES RENDERED; (2) AFTER SERVICES ARE RENDERED THE PATIENTS OR GUARANTOR'S INSURANCE (IF ANY) SHALL BE BILLED. IF THE PATIENT HAS NO INSURANCE AND WAS REGISTERED SELF-PAY THE BILL FOR SERVICES WILL BE ADJUSTED IN ACCORDANCE WITH THE HOSPITAL'S FAP; (3) THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO COLLECT FROM AN INSURANCE CARRIER PRIOR TO BILLING THE PATIENT FOR SERVICES RENDERED. IF AFTER REASONABLE EFFORTS ARE MADE TO COLLECT FROM THE INSURANCE CARRIER THE HOSPITAL SHALL SEEK ASSISTANCE FROM THE PATIENT TO CONTACT THE INSURANCE CARRIER AND RESOLVE THE OUTSTANDING CLAIM. IF THESE EFFORTS ARE NOT SUCCESSFUL THEN THE ACCOUNT MAY BE CHANGED TO A SELF-PAY ACCOUNT; (4) AFTER THE ACCOUNT, OR ANY PORTION OF SUCH ACCOUNT, IS DEEMED SELF-PAY THE HOSPITAL, OR IT'S DESIGNATED AGENT, WILL BILL THE PATIENT OR GUARANTOR FOR THE REMAINING BALANCE ON THE ACCOUNT; (5) ACCOUNTS THAT ARE DEEMED SELF-PAY WILL RECEIVE UP TO FOUR STATEMENTS AND/OR NOTICES ASKING THAT THE ACCOUNT BALANCE BE PAID; (6) AFTER EXHAUSTING REASONABLE EFFORTS OVER A PERIOD OF UP TO 120 DAYS TO COLLECT A SELF-PAY BALANCE, THE HOSPITAL MAY REFER THE ACCOUNT TO A COLLECTION AGENCY. SUCH REFERRAL SHALL NOT BE DEEMED TO BE AN EXTRAORDINARY COLLECTION ACTION ("ECA"); (7) AN ACCOUNT WITH A COLLECTION AGENCY SHALL GENERALLY BE PURSUED UP TO 180 DAYS UNLESS, AFTER CONSULTING WITH THE HOSPITAL, IT IS DETERMINED TO MAINTAIN AN ACCOUNT BEYOND THAT TIMEFRAME. IF IT IS DETERMINED BY THE HOSPITAL'S PATIENT FINANCIAL SERVICES DEPARTMENT THAT THE ACCOUNT REQUIRES AN ECA, AND SUCH ACCOUNT MEETS THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R), INCLUDING BUT NOT LIMITED TO WAITING A MINIMUM OF 120 DAYS AFTER THE FIRST POST DISCHARGE BILL TO COMMENCE ECA ACTIVITIES, THE AGENCY SHALL NOTIFY THE PATIENT IN WRITING A MINIMUM OF 30 DAYS PRIOR TO COMMENCING ECA. SUCH NOTIFICATION SHALL INCLUDE A COPY OF THE HOSPITALS PLAIN LANGUAGE SUMMARY OF THE FAP ALONG WITH A STATEMENT AS TO WHICH ECA'S THE AGENCY MAY BE TAKING. IF WITHIN THE 30 DAY NOTICE PERIOD THE PATIENT REQUESTS FINANCIAL ASSISTANCE, AND THE ACCOUNT IS NOT OLDER THAN 240 DAYS FROM THE FIRST POST DISCHARGE BILL, THEN THE PATIENT SHALL BE GIVEN TIME TO APPLY FOR FINANCIAL ASSISTANCE BEFORE ANY ECAS MAY BE INITIATED. IN THE EVENT THAT AN ECA HAS BEEN INITIATED AND THE ACCOUNT IS NOT OLDER THAN 240 DAYS FROM THE FIRST POST DISCHARGE BILLING DATE AND THE PATIENT REQUESTS FINANCIAL ASSISTANCE THEN THE ECA WILL BE SUSPENDED TO ALLOW FOR THE PATIENT TO APPLY FOR FINANCIAL ASSISTANCE. THE FIRST POST DISCHARGE BILL SHALL BE THE FIRST BILL A PATIENT RECEIVES FOR SERVICES REGARDLESS IF SERVICES ARE ONGOING. ECA'S THAT THE HOSPITAL OR ITS AGENTS MAY TAKE UPON THE EXPIRATION OF THE NOTIFICATION PERIOD INCLUDE: - REPORTING ADVERSE INFORMATION TO A CREDIT REPORTING AGENCY; - PLACING A LIEN ON PROPERTY; AND - GARNISHING WAGES.
SCHEDULE H, PART VI, QUESTION 2	IN ACCORDANCE WITH PROVISIONS OF THE AFFORDABLE CARE ACT, ENACTED MARCH 23, 2010, HNMC BEGAN A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA"). THE ORGANIZATION'S 1ST CHNA WAS COMPLETED IN 2013, ITS 2ND IN 2016, AND ITS MOST RECENT IN 2019. A COMPLETE NEEDS ASSESSMENT IS PERFORMED EVERY THREE YEARS AND IS MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. IN ADDITION TO THE CHNA PROCESS DESCRIBED ABOVE AND IN SCHEDULE H, SECTION B, QUESTIONS 1-12 AND SECTION C, HNMC UTILIZES A VARIETY OF MEANS BY WHICH IT IDENTIFIES AND ANALYZES PATIENT CARE NEEDS. AMONG THEM ARE: - PATIENT SATISFACTION DATA; - ANALYSIS OF DEMOGRAPHICS; - ANALYSIS OF UTILIZATION AND MARKET TRENDS; - REVIEW OF EXTERNALLY PUBLISHED DATA AND INFORMATION; - ACUITY LEVELS (DAILY PLANNING OF STAFFING); AND - INDIVIDUAL PROJECTS/EVALUATION/REVIEWS. HNMC ALSO COMMISSIONS EXTERNAL SPECIALISTS TO CONDUCT SURVEYS AND FOCUS GROUPS OF INDIVIDUALS, HOUSEHOLDS, PHYSICIANS AND OTHERS. ADDITIONALLY, HNMC IS A MEMBER OF THE BERGEN COUNTY COMMUNITY HEALTH IMPROVEMENT PROGRAM ("CHIP"), WHOSE MISSION IS TO EVALUATE AND ADDRESS THE HEALTH NEEDS OF THE COUNTY. THE CHIP PRODUCES AN EXTENSIVE, VERY USEFUL, DATABASE DEMONSTRATING THE NEEDS OF THE COUNTY'S RESIDENTS. HNMC IS A FOUNDING MEMBER OF THE NORTHERN NEW JERSEY MATERNAL-CHILD HEALTH CONSORTIUM (NOW THE PARTNERSHIP FOR MATERNAL AND CHILD HEALTH OF NORTHERN NEW JERSEY), WHOSE MISSION IS TO EDUCATE AND PROMOTE APPROPRIATE HEALTHCARE TO WOMAN AND INFANTS IN THE AREA. IN ADDITION, US CENSUS BUREAU DATA IS UTILIZED, AS IS PURCHASED MARKET DATA AND DATABASES OF ALL ACUTE AND SAME-DAY CARE THROUGHOUT BOTH NEW JERSEY AND NEW YORK, THE SOURCE OF WHICH IS BILLING DATA PROVIDED TO THE RESPECTIVE STATE DEPARTMENTS OF HEALTH. SUCH DATABASES PROVIDE PERHAPS THE GREATEST WEALTH OF CLINICAL, DEMOGRAPHIC, FINANCIAL AND OTHER INFORMATION, AND ARE EXTREMELY VALUABLE IN UNDERSTANDING AND ADDRESSING THE NEEDS OF THE COMMUNITIES SERVED BY HNMC. DATA FROM THE COUNTY AND STATE HEALTH DEPARTMENTS, AND FROM THE NEW JERSEY HOSPITAL ASSOCIATION, ARE ALSO USED. IN ADDITION, THE MEDICAL CENTER PARTICIPATES IN VARIOUS POPULATION HEALTH MODELS, AND HAS DONE SO SINCE 2013. AMONG THESE ARE THREE BUNDLED PAYMENT PROGRAMS AND A MEDICARE SHARED SAVINGS PROGRAM, AN ACO. IN ADDITION, THE HOSPITAL IS IN FIVE OTHER ACOS. THESE PROGRAMS PROIVDE CLAIMS DATA, WHICH ARE ANALYZED, PROVIDING VALUABLE INSIGHTS INTO CARE NEEDS AND INTO WAYS TO FACILITATE BETTER HEALTH AND HEALTH CARE WHILE REDUCING COSTS.
SCHEDULE H, PART VI, QUESTION 3	IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(4) HOLY NAME MEDICAL CENTER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY WIDELY PUBLICIZING THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS WIDELY PUBLICIZED IN THE FOLLOWING WAYS: 1) TO ENSURE THE COMMUNITY SERVED BY HNMC IS AWARE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, INFORMATIVE SIGNS AND POSTERS ARE POSTED IN ENGLISH, SPANISH AND KOREAN. THESE SIGNS AND POSTERS ADVISE PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO APPLY IN PUBLIC ACCESS AREAS (EMERGENCY ROOM AND PATIENT ACCESS). 2) THE COMPLETE FINANCIAL ASSISTANCE POLICY ("FAP"), PLAIN LANGUAGE SUMMARY ("PLS") AND FINANCIAL ASSISTANCE APPLICATION FORM AS WELL AS THE CHARITY CARE APPLICATION IS AVAILABLE ON HNMC'S WEBSITE AT: WWW.HOLYNAME.ORG/FINANCIAL. 3) THE FAP, APPLICATION AND PLS ARE ALSO AVAILABLE UPON REQUEST A FREE COPY IS AVAILABLE BY MAIL OR IN HARD COPY FORM AT HNMC'S FINANCIAL COUNSELING OFFICE AND PATIENT ACCESS DEPARTMENT ON THE MAIN FLOOR. THE ORGANIZATION'S FINANCIAL COUNSELING OFFICE IS OPEN MONDAY THROUGH FRIDAY BETWEEN 8:30AM TO 2:30PM. AN APPOINTMENT MAY BE SCHEDULED BY CALLING (201) 833-3157. 4) DURING THE INTAKE REGISTRATION PROCESS, THE PLS IS PROVIDED TO ALL PATIENTS. 5) HNMC HAS TRANSLATED ITS FAP, FINANCIAL ASSISTANCE APPLICATION FORM, AND THE PLS IN OTHER LANGUAGES WHERE THE PRIMARY LANGUAGE OF THE RESIDENTS OF THE COMMUNITY SERVED BY HNMC REPRESENTS 5% OR 1,000; WHICHEVER IS LESS; OF THE POPULATION OF INDIVIDUALS LIKELY TO BE AFFECTED OR ENCOUNTERED BY HNMC. TRANSLATED VERSIONS ARE ALSO AVAILABLE UPON REQUEST AND ARE POSTED ON HNMC'S WEBSITE. IN CIRCUMSTANCES WHERE A SIGNIFICANT NUMBER OF PATIENTS ARE NOT PROFICIENT IN READING AND WRITING ENGLISH, OR WHOSE PRIMARY LANGUAGE IS OTHER THAN WHAT HNMC HAS ALREADY TRANSLATED, MAY REQUEST ASSISTANCE IN ORDER TO COMPLETE REQUIRED FORMS.
SCHEDULE H, PART VI, QUESTION 4	LOCATED IN TEANECK, IN THE SOUTHERN PORTION OF BERGEN COUNTY AND APPROXIMATELY FIVE MILES TO THE NORTHWEST OF NEW YORK CITY, HNMC'S PRIMARY SERVICE AREA ("PSA") COMPRISES 15 MUNICIPALITIES IN BERGEN COUNTY AND 3 MUNICIPALITIES IN HUDSON COUNTY, NEW JERSEY. HNMC'S SECONDARY SERVICE AREA ("SSA") INCLUDES 17 MUNICIPALITIES IN BERGEN COUNTY AND 2 MUNICIPALITIES IN HUDSON COUNTY. TOGETHER, THE PSA AND SSA ACCOUNT FOR APPROXIMATELY 80 PERCENT OF THE MEDICAL CENTER'S ADMISSION VOLUME. AS THE SOLE CATHOLIC HOSPITAL IN AN AREA THAT IS ESTIMATED AT MORE THAN 50% ROMAN CATHOLIC, HNMC ALSO DRAWS FROM TOWNS WELL BEYOND BOTH THE PSA AND SSA. THE MAJORITY OF PSA TOWNS HAVE AN AVERAGE POPULATION OF 27,500, AND ARE LOCATED IN THE SOUTHERN HALF OF BERGEN COUNTY. OVERALL, THE SERVICE AREA IS 44% HISPANIC, ALTHOUGH THE PROPORTIONS DIFFER MARKEDLY BETWEEN BERGEN AND HUDSON: 76% OF THE RESIDENTS OF BERGEN PSA TOWNS ARE NOT HISPANIC; WHILE THE FOUR HUDSON COUNTY TOWNS TOGETHER COUNT 76% OF THEIR RESIDENTS AS HISPANIC. THE RACIAL MIX OF THE PSA IS APPROXIMATELY 60% WHITE, 22% ASIAN, 10% BLACK, AND 8% OTHER, INCLUDING MULTI-RACIAL PERSONS. CERTAIN TOWNS IN THE REGION ARE HEAVILY KOREAN; KOREAN/ASIAN PRESENCE IS MUCH LESS PRONOUNCED IN THE FOUR HUDSON COUNTY TOWNS. THE BROAD AGE MAKE-UP OF THE PRIMARY SERVICE AREA INCLUDES 23% AGED UP TO 19; 50% AGED 20-54; AND 27% AGED 55 AND OLDER. THE LAST CATEGORY IS PROJECTED TO SEE THE MOST SIGNIFICANT GROWTH DURING THE NEXT FIFTEEN YEARS. WITH THE EXCEPTION OF TWO HUDSON COUNTY TOWNS, ALL SSA ZIP CODES ARE LOCATED THROUGHOUT BERGEN COUNTY. THE TOWNS IN THIS SERVICE AREA ARE MUCH SMALLER THAN THOSE OF THE PSA, AVERAGING ONLY 14,000 RESIDENTS EACH. IN STARK CONTRAST TO THE LARGELY HISPANIC HUDSON COUNTY PSA TOWNS, THE TWO HUDSON SSA TOWNS ARE ONLY 20% HISPANIC. THE OVERALL RACIAL MIX OF THE SERVICE AREA IS 76% WHITE, 13% ASIAN, 4% BLACK, AND 7% OTHER, INCLUDING MULTI-RACIAL PERSONS. THE OVERALL KOREAN PRESENCE IS SIGNIFICANT, BUT ONLY HALF THAT SEEN IN THE PRIMARY SERVICE AREA. THE AREA'S AGE MIX IS SIMILAR TO THE PSA, WITH 23% AGED UP TO 19; 51% AGED 20-54; AND 26% AGED 55 AND OLDER. THE MEDICAL CENTER'S SERVICE AREA IS PRIMARILY SUBURBAN, WITH MANY RESIDENTS WORKING OUTSIDE BERGEN COUNTY IN PLACES SUCH AS NEW YORK CITY. HOWEVER, THERE ARE LARGE EMPLOYERS IN THE SERVICE AREA, E.G., OTHER HOSPITALS, A LARGE SPORTS CHAIN, A LARGE COMMUNICATIONS FIRM, A LARGE PHARMACEUTICAL FIRM, A UNIVERSITY, AND A LARGE COMMERCIAL LABORATORY. RESIDENTS OF HNMC'S SERVICE AREA ARE ALSO SERVED BY TWO COMMUNITY HOSPITALS AND A TERTIARY CARE FACILITY WITH TRAUMA SERVICES. GIVEN THE NUMBER OF SERVICE AREA RESIDENTS WHO WORK IN NEARBY NEW YORK CITY, IT IS NOT SURPRISING THAT A SMALL PORTION OF THESE RESIDENTS ALSO RECEIVE THEIR HEALTHCARE IN MANHATTAN. HNMC'S PSA AND SSA COVER A MAJORITY OF THE TOWNS SERVICED BY THE OTHER COMMUNITY HOSPITALS, WHEREAS THE TERTIARY CARE FACILITY'S PRIMARY SERVICE AREA ALSO INCLUDES MANY TOWNS TO THE WEST THAT ARE NOT PART OF HNMC'S SERVICE AREA. NEW JERSEY IS EXPERIENCING SIGNIFICANT CONSOLIDATION OF FORMERLY INDEPENDENT HOSPITALS INTO ANY OF THREE LARGE SYSTEMS. TWO OF THE THREE HOSPITALS WITHIN HNMC'S SERVICE AREA ARE PART OF NEW JERSEY'S LARGEST SYSTEM; THE THIRD IS AWAITING APPROVAL TO JOIN THEM. WHILE THE SERVICE AREA IS PREDOMINANTLY NON-HISPANIC CAUCASIAN, BOTH HISPANICS (OF ANY RACE) AND ASIAN POPULATIONS (PRINCIPALLY KOREAN) ARE THE FASTEST GROWING GROUPS. IN RESPONSE, THE MEDICAL CENTER HAS PROGRAMS ADDRESSING THESE GROUPS' NEEDS, AND PHYSICIANS AND NURSES FLUENT IN THE APPLICABLE LANGUAGES. IN 2008, APPROXIMATELY 75 KOREAN PHYSICIANS JOINED THE MEDICAL STAFF, ADDING TO THE NEED FOR STAFF AND SERVICES TO MEET THIS GROWING SEGMENT OF THE COMMUNITY. IN 2014, THE MEDICAL CENTER EXPANDED ITS KOREAN MEDICAL PROGRAM TO INCLUDE A FOCUS ON CHINESE AND FILIPINO RESIDENTS AS WELL, RENAMING THE SERVICE "ASIAN HEALTH SERVICES,THEREAFTER BOTH JAPANESE AND ASIAN INDIAN PROGRAMS WERE INCORPORATED AS WELL.
SCHEDULE H, PART VI, QUESTION 5	HNMC PROMOTES THE HEALTH OF ITS COMMUNITIES IN A VARIETY OF WAYS. PLEASE REFER TO "PROMOTION OF COMMUNITY HEALTH" WITHIN THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O FOR ADDITIONAL INFORMATION.
SCHEDULE H, PART VI; QUESTION 6	OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES. NOT-FOR-PROFIT SYSTEM AFFILIATED ENTITIES ========================================= PEACE MINISTRIES, INC. ---------------------- PEACE MINISTRIES, INC. IS THE TAX-EXEMPT PARENT OF THE SYSTEM. THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER PEACE MINISTRIES, INC. OR HOLY NAME MEDICAL CENTER, INC. THE SYSTEM IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS IN THE STATE OF NEW JERSEY. THE PRIMARY ACTIVITY OF THE ORGANIZATION IS TO GOVERN, SUPPORT AND ADVOCATE FOR THE PUBLIC CHARITABLE MINISTRIES OF THE EASTERN REGION OF THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF PEACE. PEACE MINISTRIES, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). HOLY NAME MEDICAL CENTER ------------------------ HOLY NAME MEDICAL CENTER IS A COMPREHENSIVE, 361-BED ACUTE CARE FACILITY PROVIDING TECHNOLOGICALLY ADVANCED AND LEADING EDGE CARE ACROSS A CONTINUUM THAT ENCOMPASSES EDUCATION, PREVENTION, DIAGNOSIS, TREATMENT, REHABILITATION AND WELLNESS MAINTENANCE. OVER 1,000 PHYSICIANS, REPRESENTING DOZENS OF MEDICAL SPECIALTIES, PROVIDE PERSONAL ATTENTION IN A CULTURALLY SENSITIVE ENVIRONMENT, CREATING AN EXCEPTIONAL HEALTH CARE EXPERIENCE FOR EVERY PATIENT. HNMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, HNMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, HNMC OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. 1. HNMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. HNMC OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. HNMC MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF HNMC RESTS WITH ITS BOARD OF TRUSTEES AND, TO THE EXTENT SET FORTH IN ITS BYLAWS, PEACE MINISTRIES, INC. HNMC'S BOARD IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. HOLY NAME HEALTH CARE FOUNDATION, INC. -------------------------------------- HOLY NAME HEALTH CARE FOUNDATION, INC. IS A NON-PROFIT CORPORATION THAT WAS ESTABLISHED TO RAISE FUNDS FOR THE MEDICAL CENTER AND ITS AFFILIATED ORGANIZATIONS. HOLY NAME HEALTH CARE FOUNDATION, INC. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). HOLY NAME REAL ESTATE CORPORATION --------------------------------- HOLY NAME REAL ESTATE CORPORATION IS A NON-PROFIT CORPORATION WHICH WAS ORGANIZED TO OWN, LEASE AND OPERATE PROPERTY FOR THE BENEFIT OF THE MEDICAL CENTER AND ITS AFFILIATED ORGANIZATIONS. HOLY NAME REAL ESTATE CORPORATION IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). HOLY NAME EMS, INC. ------------------ HOLY NAME EMS, INC. IS A NON-PROFIT CORPORATION WHICH OWNS AND OPERATES THE MEDICAL CENTER'S BASIC LIFE SUPPORT ("BLS") AND ADVANCED LIFE SUPPORT ("ALS") MEDICAL INTENSIVE CARE VEHICLES AND SERVICES; HOLY NAME EMS, INC. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). MS COMPREHENSIVE CARE CENTER ---------------------------- MS COMPREHENSIVE CARE CENTER IS A NON-PROFIT CORPORATION WHICH OFFERS COMPREHENSIVE MEDICAL, NURSING, BILLING, REHABILITATIVE, PSYCHOLOGICAL AND EDUCATIONAL CARE TO PATIENTS WITH MULTIPLE SCLEROSIS. MS COMPREHENSIVE CARE CENTER IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(2). THE CRUDEM FOUNDATION, INC. --------------------------- THE CRUDEM FOUNDATION, INC. IS A NON-PROFIT CORPORATION WHICH WAS ESTABLISHED TO RAISE FUNDS FOR THE HOSPITAL SACRE COEUR IN MILOT HAITI. THE CRUDEM FOUNDATION, INC. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). HOLY NAME HEALTH PHYSICIANS, P.C. --------------------------------- HOLY NAME HEALTH PHYSICIANS, P.C. IS A NON-PROFIT PROFESSIONAL CORPORATION WHICH ENGAGES IN PROFESSIONAL MEDICAL HEALTHCARE SERVICES WHICH ARE HIGH QUALITY AND COST EFFECTIVE FOR THE BENEFIT OF THE COMMUNITY AND IN SUPPORT OF THE CHARITABLE PURPOSES OF HOLY NAME MEDICAL CENTER AND ITS AFFILIATES. HOLY NAME HEALTH PHYSICIANS, P.C. IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). HNH FITNESS, LLC ---------------- HNH FITNESS, LLC IS A SINGLE MEMBER LIMITED LIABILITY COMPANY WHOSE SOLE MEMBER IS HOLY NAME MEDICAL CENTER. THE ORGANIZATION OPERATES A MEDICALLY BASED FITNESS AND WELLNESS CENTER AND PHYSICAL THERAPY PRACTICE. HOLY NAME MEDICAL CENTER ACO, LLC --------------------------------- HOLY NAME MEDICAL CENTER ACO, LLC IS A SINGLE MEMBER LIMITED LIABILITY COMPANY WHOSE SOLE MEMBER IS HOLY NAME MEDICAL CENTER. THE ORGANIZATION OPERATES AS ACCOUNTABLE CARE ORGANIZATION. HARMONY HEALTH ALLIANCE, LLC ---------------------------- HARMONY HEALTH ALLIANCE, LLC IS A SINGLE MEMBER LIMITED LIABILITY COMPANY WHOSE SOLE MEMBER IS HOLY NAME MEDICAL CENTER. THE ORGANIZATION IS A CLINICALLY INTEGRATED NETWORK OF HEALTHCARE PROVIDERS WITH THE GOAL OF PROVIDING IMPROVED PATIENT CARE QUALITY, EXPERIENCE, EFFICIENCY AND ENGAGEMENT. FOR-PROFIT SYSTEM AFFILIATED ENTITIES ===================================== HEALTH PARTNER SERVICES, INC. ----------------------------- HEALTH PARTNER SERVICES, INC. IS A FOR-PROFIT CORPORATION ENGAGED IN PROVIDING MANAGEMENT SERVICES FOR HEALTHCARE PROVIDERS. PAIX TECHNOLOGIES, INC. ----------------------- PAIX TECHNOLOGIES, INC. IS A FOR-PROFIT CORPORATION ENGAGED IN SELLING A SOFTWARE LICENSE FOR DEVELOPED APPLICATIONS. HOLY NAME PHYSICIAN NETWORK --------------------------- THE HOLY NAME PHYSICIAN NETWORK WAS FORMED ACCORDING TO EACH GROUP'S SPECIALIZED PRACTICE. THE FOR-PROFIT ORGANIZATIONS WITHIN THE HOLY NAME PHYSICIAN NETWORK ARE OUTLINED BELOW: - PEACE HEALTH PARTNERS, P.C.; - HOUSE PHYSICIAN PARTNERS, P.C.; - HEMATOLOGY ONCOLOGY PARTNERS, P.C.; - RIVERSIDE FAMILY PRACTICE, P.C.; - RADIATION ONCOLOGY PARTNERS, P.C.; - EXCELCARE MEDICAL ASSOCIATES, P.A.; - BREAST IMAGING PARTNERS, P.C.; - HOLY NAME CARDIOLOGY ASSOCIATES, P.C.; - BREAST CARE PARTNERS, P.C.; - HOLY NAME PULMONARY ASSOCIATES, P.C.; - WOMEN'S CLINIC PARTNERS, P.C.; - MULKAY CARDIOLOGY CONSULTANTS AT HOLY NAME MEDICAL CENTER; - HOLY NAME PRIMARY CARE & SPECIALTY ASSOCIATES, P.C.; - PRIMARY CARE OF ORADELL; - HOLY NAME MEDICAL ASSOCIATES, P.C.; - NORTH JERSEY MEDICAL ASSOCIATES, P.C.; - NORTH JERSEY MEDICAL PARTNERS, P.C.; - HOLY NAME PHYSICIAN PARTNERS, P.C.; AND - HOLY NAME ANESTHESIA PARTNERS, P.C. THESE ORGANIZATIONS ENGAGE IN PROFESSIONAL MEDICAL HEALTHCARE SERVICES WHICH ARE HIGH QUALITY AND COST EFFECTIVE FOR THE BENEFIT OF THE COMMUNITY AND IN SUPPORT OF THE CHARITABLE PURPOSES OF HOLY NAME MEDICAL CENTER AND ITS AFFILIATES.
SCHEDULE H, PART VI; QUESTION 7	NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. NEW JERSEY DOES NOT REQUIRE HOSPITALS TO ANNUALLY SUBMIT A COMMUNITY BENEFIT REPORT.

Schedule H (Form 990) 2020

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
HOLY NAME MEDICAL CENTER

Employer identification number
22-1487322

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) BERGEN CATHOLIC HIGH SCHOOL 1040 ORADELL AVENUE ORADELL,NJ07649	22-1599180	RELIGIOUS ORG	22,207	PROGRAM SUPPORT
(2) CAUCUS EDUCATIONAL CORP 75 MIDLAND AVE MONTCLAIR,NJ07042	22-3240680	501(C)(3)	125,000	PROGRAM SUPPORT
(3) HOLY NAME HEALTH CARE FOUNDATION INC 718 TEANECK ROAD TEANECK,NJ07666	22-2737143	501(C)(3)	15,000	PROGRAM SUPPORT
(4) SAVE LATIN AMERICA 138 39TH STREET UNION CITY,NJ07087	22-2942402	501(C)(3)	26,000	PROGRAM SUPPORT
(5) SINAI SPECIAL NEEDS INSTITUTE 1485 TEANECK RD STE 304 TEANECK,NJ07666	13-4198529	501(C)(3)	125,000	PROGRAM SUPPORT
(6) TEMPLE EMANUEL OF THE PASCACK VALLEY 87 OVERLOOK DRIVE WOODCLIFF LAKE,NJ07677	22-6013926	RELIGIOUS ORG	10,000	PROGRAM SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2020

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant
(1) NURSING SCHOLARSHIPS	106	107,971
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I; QUESTION 2	GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.
SCHEDULE I, PART II	PLEASE NOTE THAT CERTAIN GIFTS, GRANTS AND CONTRIBUTIONS PROVIDED TO OTHER ORGANIZATIONS WERE LESS THAN OR EQUAL TO $5,000 EACH. THEREFORE, IN ACCORDANCE WITH FORM 990 RULES AND REGULATIONS THOSE CONTRIBUTIONS WOULD NOT BE INCLUDED WITHIN IN SCHEDULE I, PART II. THE TOTAL AMOUNTS PAID FOR CONTRIBUTIONS AND EVENT SPONSORSHIPS CAN BE FOUND WITHIN CORE FORM, PART IX, LINE 1.

Schedule I (Form 990) 2020

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
Graphic Arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

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 on 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 on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
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) 2020

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)
1MICHAEL MARON TRUSTEE - PRESIDENT & CEO	(i) (ii)	1,278,714 ------------- 0	700,000 ------------- 0	41,379 ------------- 0	11,400 ------------- 0	18,279 ------------- 0	2,049,772 ------------- 0	0 ------------- 0
2ADAM JARRETT MD FACHE EVP, CHIEF MEDICAL OFFICER	(i) (ii)	543,363 ------------- 0	300,000 ------------- 0	41,103 ------------- 0	154,621 ------------- 0	31,961 ------------- 0	1,071,048 ------------- 0	0 ------------- 0
3SHERYL SLONIM DNP RN-BC EVP, PCS & CNO(RETIRED 1/8/20)	(i) (ii)	18,237 ------------- 0	100,000 ------------- 0	885,585 ------------- 0	672 ------------- 0	1,354 ------------- 0	1,005,848 ------------- 0	660,189 ------------- 0
4MARYANN KICENUIK ESQ VP, GENERAL COUNSEL	(i) (ii)	609,687 ------------- 0	75,000 ------------- 0	44,290 ------------- 0	86,400 ------------- 0	18,279 ------------- 0	833,656 ------------- 0	0 ------------- 0
5RYAN KENNEDY CPA EVP/CFO, ASSIST. SEC/TREAS	(i) (ii)	478,325 ------------- 0	200,000 ------------- 0	22,169 ------------- 0	82,385 ------------- 0	31,961 ------------- 0	814,840 ------------- 0	0 ------------- 0
6SAIKRISHNAN KANDAMANGALAM EVP, CHIEF INFORMATION OFFICER	(i) (ii)	404,382 ------------- 0	100,000 ------------- 0	7,424 ------------- 0	11,400 ------------- 0	29,261 ------------- 0	552,467 ------------- 0	0 ------------- 0
7KRISTEN L SILBERSTEIN VP, PAYOR RELATIONS	(i) (ii)	360,879 ------------- 0	80,000 ------------- 0	3,514 ------------- 0	61,400 ------------- 0	31,261 ------------- 0	537,054 ------------- 0	0 ------------- 0
8STEVEN L MOSSER EVP, OPERATIONS	(i) (ii)	345,629 ------------- 0	75,000 ------------- 0	5,844 ------------- 0	11,400 ------------- 0	31,961 ------------- 0	469,834 ------------- 0	0 ------------- 0
9RON WHITE MD DIRECTOR, MEDICAL AFFAIRS	(i) (ii)	418,280 ------------- 0	10,000 ------------- 0	2,926 ------------- 0	11,400 ------------- 0	17,343 ------------- 0	459,949 ------------- 0	0 ------------- 0
10SEAN O'ROURKE VP, HEALTH PARTNERS SERVICES	(i) (ii)	342,497 ------------- 0	25,000 ------------- 0	6,760 ------------- 0	11,400 ------------- 0	31,861 ------------- 0	417,518 ------------- 0	0 ------------- 0
11RAVIT BARKAMA MD AVP, CLINICAL DEVELOPMENT	(i) (ii)	327,688 ------------- 0	25,000 ------------- 0	1,680 ------------- 0	11,400 ------------- 0	29,101 ------------- 0	394,869 ------------- 0	0 ------------- 0
12MICHELE ACITO DNP RN NE-BC EVP, CNO (EFF 06/28/20)	(i) (ii)	334,439 ------------- 0	25,000 ------------- 0	3,752 ------------- 0	11,400 ------------- 0	18,146 ------------- 0	392,737 ------------- 0	0 ------------- 0
13PHYLLIS MARINO MD MEDICAL DIRECTOR	(i) (ii)	274,925 ------------- 0	0 ------------- 0	74,702 ------------- 0	9,936 ------------- 0	14,217 ------------- 0	373,780 ------------- 0	0 ------------- 0
14MICHAEL SKVARENINA FORMER KEY EMPLOYEE	(i) (ii)	278,682 ------------- 0	0 ------------- 0	16,288 ------------- 0	5,706 ------------- 0	31,961 ------------- 0	332,637 ------------- 0	0 ------------- 0
15DAVID BUTLER MD TRUSTEE	(i) (ii)	0 ------------- 213,048	0 ------------- 0	0 ------------- 1,391	0 ------------- 4,356	0 ------------- 19,579	0 ------------- 238,374	0 ------------- 0

Schedule J (Form 990) 2020

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
SCHEDULE J, PART I; QUESTION 4A	THE FOLLOWING INDIVIDUAL INCLUDED IN SCHEDULE J, PART II RECEIVED A SEVERANCE PAYMENT DURING CALENDAR YEAR 2020 WHICH WAS INCLUDED IN HER 2020 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: PHYLLIS MARINO, M.D., $71,308.
SCHEDULE J, PART I; QUESTION 4B	THE AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES A CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THIS AMOUNT WAS NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN HER 2020 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: SHERYL SLONIM, DNP, RN-BC, $827,313. THE DEFERRED COMPENSATION AMOUNTS REFLECTED IN SCHEDULE J, PART II, COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDE UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION 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 2020 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: ADAM JARRETT, M.D., FACHE, $143,221; MARYANN KICENUIK, ESQ., $75,000; RYAN KENNEDY, CPA, $70,985 AND KRISTEN SILBERSTEIN, $50,000.
SCHEDULE J, PART I; QUESTION 7	CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2020 WHICH WAS INCLUDED IN SCHEDULE J, PART II, COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2020 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
SCHEDULE J, PART II, COLUMN F	THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) INCLUDE VESTED BENEFITS IN A DEFERRED COMPENSATION PLAN AS THESE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR YEARS' FORMS 990 AND ARE NOW BEING REPORTED AGAIN ON THIS YEAR'S FORM 990. THESE HAVE BEEN TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.

Schedule J (Form 990) 2020

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
HOLY NAME MEDICAL CENTER

Employer identification number
22-1487322

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NJ HEALTH CARE FACILITIES FINANCING AUTHORITY	22-1987084		07-12-2016	54,425,000	SEE SUPPLEMENTAL INFO		X		X		X
B	NJ HEALTH CARE FACILITIES FINANCING AUTHORITY	22-1987084		04-02-2020	19,100,000	SEE SUPPLEMENTAL INFO		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	7,250,000		0
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	54,425,000		19,100,000
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	597,834		233,746
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	0		0
11 Other spent proceeds .............	53,827,166		18,866,254
12 Other unspent proceeds .............	0		0
13 Year of substantial completion .............	2016		2020
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2019, a current refunding issue)? ........		X	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2019, an advance refunding issue)? ........		X		X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2020

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.600 %		0.600 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %
6 Total of lines 4 and 5 .............	0.600 %		0.600 %
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X

Schedule K (Form 990) 2020

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........	0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SCHEDULE K

SCHEDULE K, PART I, LINE A, COLUMN F PER THE ORGANIZATION'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, THE PROCEEDS OF THE NEW JERSEY HEALTHCARE FACILITIES AUTHORITY SERIES 2016A & 2016B BOND FINANCING WERE USED TO FUND AND PAY IN FULL THE 2006 DEBT SERVICE RESERVE FUND, 2006 DEBT SERVICE PRINCIPAL FUND AND THE 2006 DEBT SERVICE INTEREST FUND FOR THE SERIES 2006 BONDS. SCHEDULE K, PART I, LINE B, COLUMN F PER THE ORGANIZATION'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, THE PROCEEDS OF THE NEW JERSEY HEALTHCARE FACILITIES AUTHORITY SERIES 2020 BOND FINANCING WERE USED TO REFUND THE SERIES 2010 BONDS.

Schedule K (Form 990) 2020

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No
(1) MICHAEL MARON	TRUSTEE/OFFICER	SuppRetCASD		X	27,080,087	27,080,087		No	Yes		Yes





Total ............... $						27,080,087

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2020

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) PATRICK MARON	FAMILY MEMBER OF OFFICER/TRUSTEE	125,359	EMPLOYEE		No
(2) BARBARA CARNEVALE	FAMILY MEMBER OF TRUSTEE	74,766	EMPLOYEE		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART II, SUPPLEMENTAL RETIREMENT BENEFIT - CASD

MICHAEL A. MARON, THE ORGANIZATION'S CEO, AGREED TO RELINQUISH BENEFITS TO WHICH HE WAS OTHERWISE ENTITLED IN EXCHANGE FOR A SPLIT DOLLAR LIFE INSURANCE RETENTION AND LOAN PLAN (THE PLAN). THIS EXCHANGE WAS DONE AT NO ADDED COST TO THE ORGANIZATION. THE ORGANIZATION WILL BE FULLY REPAID ITS LOANS, PLUS INTEREST, BY THE CEO OR HIS ESTATE. TO ENSURE REPAYMENT, THE LOAN IS SECURED BY COLLATERAL ASSIGNMENTS ON TWO LIFE INSURANCE POLICIES' CASH VALUE AND DEATH PROCEEDS. THE PLAN IS STRUCTURED TO PROVIDE THE ORGANIZATION WITH A SIGNIFICANT RETENTION INCENTIVE. THE ORGANIZATION'S ADVISORS HAVE OPINED THAT THIS NEW PROGRAM SATISFIES ALL APPLICABLE LAWS, COMPENSATION REASONABLESNESS AND BEST PRACTICE STANDARDS.

Schedule L (Form 990 or 990-EZ) 2020

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

HOLY NAME MEDICAL CENTER

Employer identification number

22-1487322

Return Reference	Explanation
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	HOLY NAME MEDICAL CENTER ("HNMC") IS A PRIVATE, 361-BED NEW JERSEY-LICENSED GENERAL ACUTE CARE MEDICAL CENTER. THE MEDICAL CENTER IS A NON-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF NEW JERSEY, AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE BY VIRTUE OF BEING AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. PURSUANT TO ITS CHARITABLE PURPOSES, HNMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, GENDER IDENTITY, NATIONAL ORIGIN, AGE, DISABILITY OR ABILITY TO PAY. MOREOVER, HNMC OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN INTERNAL REVENUE SERVICE ("IRS") REVENUE RULING 69-545: 1. HNMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. HNMC OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS, WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. HNMC MAINTAINS A MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF HNMC RESTS WITH ITS BOARD OF TRUSTEES AND, TO THE EXTENT SET FORTH IN ITS BYLAWS, PEACE MINISTRIES, INC. HNMC'S BOARD IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE, PROGRAMS AND ACTIVITIES. THE OPERATIONS OF HNMC, AS SHOWN THROUGH THE FACTORS OUTLINED ABOVE AND OTHER INFORMATION CONTAINED HEREIN, CLEARLY DEMONSTRATE THAT HNMC PROVIDES SUBSTANTIAL COMMUNITY BENEFIT, THAT THE USE AND CONTROL OF HNMC 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. PEACE MINISTRIES, INC ("PMI") IS A NON-PROFIT CORPORATION UNDER THE LAWS OF THE STATE OF NEW JERSEY AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE BY VIRTUE OF BEING AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE. PMI IS THE SOLE MEMBER OF THE MEDICAL CENTER. THIS TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OF EACH ENTITY IS EITHER PMI OR HNMC. MISSION ======= WE ARE A COMMUNITY OF CAREGIVERS COMMITTED TO A MINISTRY OF HEALING, EMBRACING THE TRADITION OF CATHOLIC PRINCIPLES, THE PURSUIT OF PROFESSIONAL EXCELLENCE, AND CONSCIENTIOUS STEWARDSHIP. WE HELP OUR COMMUNITY ACHIEVE THE HIGHEST ATTAINABLE LEVEL OF HEALTH THROUGH EDUCATION, PREVENTION AND TREATMENT. HISTORY ======= THE MEDICAL CENTER WAS FOUNDED BY THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF PEACE (THE "SISTERS") IN 1925, AND IN 1958 WAS INCORPORATED AS AN INDEPENDENT NEW JERSEY NON-PROFIT CORPORATION, SPONSORED BY THE SISTERS. IT WAS THE DEDICATION OF TWO TEANECK SURGEONS AND THE LEADERSHIP OF A SISTER THAT MADE HNMC A REALITY IN 1925. RECOGNIZING THE NEED TO SERVE THE SICK AND INDIGENT OF THE COMMUNITY, DR. FRANK MCCORMACK AND DR. GEORGE PITKIN APPEALED TO MOTHER GENERAL AGATHA BROWN OF THE SISTERS FOR HELP IN FINDING A SUITABLE MEDICAL CENTER SITE AND PROVIDING ADMINISTRATIVE AND NURSING STAFF. THE SISTERS PURCHASED THE ESTATE OF THE LATE WILLIAM WALTER PHELPS AND ERECTED THE MEDICAL CENTER THERE, STAFFING IT WITH SISTERS. AT ITS OPENING IN 1925, HNMC HAD 115 BEDS. FIVE YEARS LATER, A 90-BED CLINIC BUILDING WAS BUILT TO MEET THE NEEDS OF AREA RESIDENTS WHO HAD BEEN IMPOVERISHED BY THE GREAT DEPRESSION. TEANECK WAS LITTLE MORE THAN A RURAL VILLAGE THEN; IN ALL OF BERGEN COUNTY THERE WERE SOME 250,000 INHABITANTS. WITH THE COMPLETION OF THE GEORGE WASHINGTON BRIDGE IN 1931, A SURGE OF DEVELOPMENT FOLLOWED WORLD WAR II AND THE AREA SOON BECAME A THRIVING RESIDENTIAL AND BUSINESS COMMUNITY. HNMC THRIVED AS WELL. IN 1955 A SECOND ADDITION WAS COMPLETED: THE FOUR-STORY, 110-BED MARIAN BUILDING, WITH TWO MORE STORIES ADDED TO THE FACILITY WITHIN THE NEXT TEN YEARS. DURING THE 1960'S, THE WEST WING OF THE MARIAN BUILDING WAS ENLARGED BY THREE MORE UNITS. FACED AGAIN WITH THE THREAT OF OVERCROWDING IN THE 1980'S, THE MEDICAL CENTER COMPLEX WAS ONCE MORE ENLARGED WITH CONSTRUCTION OF THE BRESLIN/KENNEDY BUILDING. IN 1993 THE "NEW ADDITION" WAS CONSTRUCTED, PRINCIPALLY TO ACCOMMODATE THE INCREASING AMBULATORY AND SAME-DAY-STAY PATIENTS, AND A NEW PHYSICAL MEDICINE BUILDING WAS ADDED. A FOUR-LEVEL REGIONAL CANCER CENTER WAS COMPLETED IN THE LATE 1990'S. MORE RECENT ADDITIONS INCLUDE A NEW 41-BAY EMERGENCY DEPARTMENT, A HEALTH AND FITNESS CENTER, AND A RESIDENTIAL HOSPICE, VILLA MARIE CLAIRE. THE MEDICAL CENTER HAS GROWN IN SIZE, REPUTATION AND CAPABILITY WITH EACH ADDITION. AS HNMC CELEBRATES OVER 95 YEARS, IT CONTINUES TO TAKE STEPS TO BECOME A NATIONAL MODEL BY IMPLEMENTING NEW, ADVANCED TECHNOLOGIES AND MEDICAL/SURGICAL TECHNIQUES, AS WELL AS BEST PRACTICES IN PROCESSES SUCH AS SIMULATION LEARNING, HEALTHCARE INFORMATION SYSTEMS, END-OF-LIFE CARE, DISASTER PREPAREDNESS, AND BUILDING CONSTRUCTION AND DESIGN. IMPROVEMENTS SUCH AS THESE ALLOW HNMC TO PROVIDE EVERY PATIENT WITH A SUPERIOR EXPERIENCE CHARACTERIZED BY SAFE, HIGH QUALITY CARE. LEADING-EDGE CARE ================= HNMC IS A COMPREHENSIVE, 361-BED ACUTE CARE FACILITY PROVIDING LEADING-EDGE MEDICAL PRACTICE AND TECHNOLOGY ADMINISTERED IN AN ENVIRONMENT ROOTED IN A TRADITION OF COMPASSION AND RESPECT FOR EVERY PATIENT. HNMC OFFERS HIGH QUALITY HEALTHCARE ACROSS A CONTINUUM THAT ENCOMPASSES EDUCATION, PREVENTION, EARLY INTERVENTION, COMPREHENSIVE TREATMENT OPTIONS, REHABILITATION, AND WELLNESS MAINTENANCE-FROM PRE-CONCEPTION THROUGH END-OF-LIFE. WITH MORE THAN 900 PHYSICIANS REPRESENTING DOZENS OF MEDICAL AND SURGICAL SPECIALTIES, HNMC PROVIDES AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR ITS PATIENTS. A FEW OF THE "CENTERS OF EXCELLENCE" AT HNMC INCLUDE: - THE PATRICIA LYNCH CANCER CENTER AT HOLY NAME (INCLUDING A NEW INFUSION CENTER AND GYNECOLOGICAL SPECIALTY); - INTERVENTIONAL INSTITUTE (OFFERING INNOVATIVE, NON-SURGICAL TREATMENT OPTIONS); - CARDIOVASCULAR SERVICES; - GEORGE P. PITKIN M.D. EMERGENCY CARE CENTER; - WOMEN'S AND CHILDREN'S HEALTH SERVICES; - HOSPICE AND PALLIATIVE CARE SERVICES, BOTH HOME-BASED AND RESIDENTIAL, INCLUDING VILLA MARIE CLAIRE, HNMC'S COMPREHENSIVE HOSPICE FACILITY IN SADDLE RIVER, NJ; - BREAST CENTER; AND - INSTITUTE FOR SIMULATION LEARNING. OTHER OUTSTANDING SERVICES INCLUDE, BUT ARE NOT LIMITED TO: - SPECIALTY SURGERY SERVICES WITH EXPERTISE IN MINIMALLY INVASIVE TECHNIQUES, INCLUDING ROBOTICS; - ADVANCED RADIOLOGICAL IMAGING; - REHABILITATION MEDICINE, AND SPORTS MEDICINE, ENCOMPASSING HNH FITNESS, HNMC'S MEDICALLY-BASED FITNESS CENTER IN ORADELL, NJ; - BARIATRIC MEDICINE; - CENTER FOR SLEEP MEDICINE; - MATERNAL-FETAL MEDICINE FOR HIGH-RISK AND COMPLICATED PREGNANCIES; - RENAL DIALYSIS; - THE NEW INSTITUTE FOR WOUND HEALING; - CULTURALLY AND LINGUISTICALLY-SENSITIVE HEALTH PROGRAMS, SUCH AS ASIAN HEALTH SERVICES, WHICH ADDRESSES KOREAN, CHINESE, JAPANESE, FILIPINO, AND ASIAN INDIAN NEEDS, AND THE HISPANIC OUTREACH PROGRAM, FAMILIA Y SALUD; - INSTITUTE FOR CLINICAL RESEARCH; - MULTIPLE SCLEROSIS CENTER; AND - THE SISTER CLAIRE TYNAN SCHOOL OF NURSING.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	PROMOTION OF COMMUNITY HEALTH ============================= HNMC PROMOTES THE HEALTH OF ITS COMMUNITIES IN A VARIETY OF WAYS. THE MAJORITY OF THE BOARD OF TRUSTEES LIVE IN BERGEN COUNTY, NEW JERSEY, WHERE HNMC IS LOCATED, WITH MOST LIVING IN THE MUNICIPALITIES OF THE MEDICAL CENTER'S DEFINED SERVICE AREA. THE TRUSTEES' UNDERSTANDING OF THE SERVICE AREA IS THUS ENHANCED, AS IS THEIR UNDERSTANDING OF THE NEED TO REINVEST FUNDS IN IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. AS PART OF ITS CHARITABLE PURPOSE, HNMC PROVIDES A WIDE ARRAY OF SERVICES TO THE COMMUNITY, TARGETED TOWARD IMPROVING THE HEALTH OF THE COMMUNITY. THE MAJORITY OF SUCH SERVICES ARE FREE. A SMALL SAMPLING OF SUCH ACTIVITIES IS PROVIDED BELOW. - FREQUENT HEALTH FAIRS THROUGHOUT THE REGION ARE GIVEN. AT THESE FAIRS RISK ASSESSMENTS, SCREENINGS AND LITERATURE ARE PROVIDED (MANY IN SPANISH AND KOREAN, AS WELL AS ENGLISH); - IMMUNIZATIONS ARE PROVIDED; - ENROLLMENT ASSISTANCE FOR PERSONS WHO WISH TO OBTAIN HEALTH INSURANCE (ANY TYPE) BUT WHO HAVE HAD DIFFICULTY DUE TO LANGUAGE OR OTHER BARRIERS. - NEED-BASED FREE AND/OR VERY LOW FEE TRANSPORTATION (E.G., FOR CANCER TREATMENT, DIALYSIS) IS AVAILABLE; - COMMUNITY HEALTH NURSES AND MOBILE LEARNING ARE ALSO PROVIDED; - STAFF FROM VARIOUS DEPARTMENTS THROUGHOUT THE MEDICAL CENTER VISIT LOCAL SCHOOLS TO PROVIDE HEALTH CLASSES; - SCREENINGS, E.G., BLOOD PRESSURE, CANCER, STROKE, DIABETES, PROSTATE CANCER, BREAST CANCER, OSTEOPOROSIS, PERIPHERAL ARTERY DISEASE, SKIN CANCER, COLON CANCER, AND OTHER CLINICAL SCREENING AND EDUCATION ARE PROVIDED, TYPICALLY AS PART OF COMMUNITY PROGRAMS SPECIFIC TO THE PARTICULAR DISEASE GROUP; - SENIOR CENTERS ARE SUPPORTED WITH FREE EXERCISE CLASSES, LECTURES AND SCREENINGS; - SUPPORT GROUPS ARE PROVIDED, SUCH AS CANCER, PERINATAL BEREAVEMENT, ADULT BEREAVEMENT, NEW MOTHERS, DIABETES, SMOKING, AND CARDIAC DISEASE; - HNMC'S ALS BIKE TEAM, ALS VEHICLES AND/OR SPECIAL OPERATIONS VEHICLES ARE PRESENT AT EVENTS OCCURRING IN MUNICIPALITIES IN HNMC'S SERVICE AREA WITHOUT CHARGE; - COURSES (PROVIDED EITHER FREE OR FOR A LOW FEE) ARE PROVIDED THROUGHOUT THE YEAR. EXAMPLES INCLUDE: CPR CERTIFICATION, DEFENSIVE DRIVING, GENERAL AND SPECIALTY (E.G., OSTEOPOROSIS) EXERCISE, BREASTFEEDING PREPARATION, STRESS MANAGEMENT, DIABETES SELF-MANAGEMENT, BABY CARE BASICS, WEIGHT MANAGEMENT, AND PARENTING; - CLASSES TO PROMOTE BETTER HEALTH ARE ABUNDANT: YOGA, WEIGHT REDUCTION, PILATES, STRENGTH AND BALANCE; OSTEOPOROSIS, PROPER HAND-WASHING, QI GONG AND TAI CHI, COOKING FOR CARDIAC PATIENTS; - LECTURES, OFTEN INVOLVING HNMC'S MEDICAL STAFF AS PRESENTERS, ARE PROVIDED, THE MAJORITY OF WHICH ARE FREE. MEN'S HEALTH, WOMEN'S HEALTH, A MID-LIFE AND MENOPAUSE LECTURE SERIES, SLEEP DISORDERS, ALLERGIES, DEPRESSION, ASTHMA, UTERINE FIBROIDS, COPD, STROKE, HYPERTENSION, MENTAL WELLNESS, CARDIAC ISSUES, ALZHEIMER'S, JOINT REPLACEMENT, SLEEP APNEA, CANCERS, CHILDREN'S HEALTH, DISASTER PREPAREDNESS, AND GENERAL HEALTH AND WELL-BEING ARE AMONG THE TOPICS PRESENTED; - HNMC'S WEBSITE (WWW.HOLYNAME.ORG) PROVIDES A WEALTH OF FREE CONSUMER HEALTH INFORMATION. THE SITE INCLUDES AN ON-LINE MEDICAL LIBRARY HOUSING INFORMATION ON DISEASES AND CONDITIONS, SURGERIES AND PROCEDURES, VITAMINS AND SUPPLEMENTS, NUTRITION, WELLNESS, AND A DRUG REFERENCE. ON-LINE RISK ASSESSMENTS AND QUIZZES ARE ALSO AVAILABLE, AS IS THE ABILITY TO SET UP A PERSONAL HEALTH PAGE. A KOREAN LANGUAGE VERSION IS ALSO AVAILABLE (WWW.KHOLYNAME.ORG). AN INTERACTIVE BODY GUIDE ("SYMPTOM CHECKER") ALLOWS THE USER TO RESEARCH HEALTH INFORMATION ABOUT THE SYMPTOMS THE USER IS EXPERIENCING; - BLOOD DRIVES ARE HOSTED REGULARLY AT HNMC. EACH YEAR THE MEDICAL CENTER CONTRIBUTES TO AIRFARE, SUPPLIES AND OTHER SUPPORT FOR HNMC NURSES AND DOCTORS TO TRAVEL TO THIRD WORLD COUNTRIES (E.G., HAITI) TO PROVIDE MEDICAL CARE, INCLUDING SURGERY, TO PERSONS WHO OTHERWISE WOULD NEVER RECEIVE ADEQUATE TREATMENT DUE TO POVERTY AND LACK OF ACCESS. HNMC SUPPORTS THE BERGEN VOLUNTEER MEDICAL INITIATIVE ("BVMI"), WHICH PROVIDES FREE CARE TO PERSONS IN NEED AND OTHER SIMILAR PROGRAMS. HOLY NAME ALSO PARTICIPATES IN THE WOMEN, INFANTS AND CHILDREN ("WIC") AND HEALTH START PROGRAMS, PROVIDING NUTRITIONAL AND SOCIAL SERVICES, ANCILLARY SERVICES AND OTHER PROGRAMS TO PARTICIPANTS. INEXPENSIVE MEDICALLY SUPERVISED DAY CARE FOR ILL CHILDREN IS AVAILABLE ON CAMPUS TO WORKING PARENTS IN THE COMMUNITY AFFORDING THEM THE ABILITY TO WORK EVEN WHEN A CHILD IS SICK. SENIOR OR DISABLED PERSONS REQUIRING MEDICAL DAY CARE ARE TRANSPORTED FREE OF CHARGE TO HNMC'S ADULT DAY CARE PROGRAM, REDUCING THE BURDEN ON FAMILY CARETAKERS. HNMC'S EMERGENCY DEPARTMENT ("ED") IS OPEN 24 HOURS A DAY, EVERY DAY OF THE YEAR. ALTHOUGH THE ED GENERALLY IS ABLE TO COVER ITS COSTS, IT PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE AND IS A WELL-USED RESOURCE FOR MANY WITHOUT INSURANCE WHO RELY ON IT FOR CARE. OTHER SERVICES, SUCH AS CLINICS, DO NOT COVER THEIR COSTS, AND HNMC ABSORBS THE ADDITIONAL EXPENSE. LANGUAGE INTERPRETATION IS AVAILABLE FOR APPROXIMATELY 220 LANGUAGES AT THE MEDICAL CENTER THROUGH USE OF A COMMERCIAL SERVICE THAT PROVIDES A LIVE TRANSLATOR 24/7, FREE OF CHARGE TO THE PATIENT AND FAMILY. HNMC HOSTS A PROGRAM ("PROJECT SEARCH") IN WHICH PERSONS AGED 18-22 WITH DISABILITIES WHO MIGHT OTHERWISE BE UNABLE TO OBTAIN EMPLOYMENT ARE TAUGHT MARKETABLE SKILLS VIA MENTORED ROTATIONS IN MANY OF THE MEDICAL CENTER'S DEPARTMENTS. A TEACHER IS PROVIDED BY BERGEN COUNTY. OTHERWISE, HNMC PROVIDES A DEDICATED CLASSROOM AND STAFF FROM SEPTEMBER THROUGH JUNE, OFFERING THREE ELEVEN-WEEK SUPERVISED ROTATIONS FOR EACH STUDENT. THIS VERY SUCCESSFUL PROGRAM HAS PROVIDED THESE STUDENTS WITH THE ABILITY TO SEEK JOBS, AND THE MEDICAL CENTER HAS ALSO HIRED SOME OF THE STUDENTS UPON COMPLETION. THE MEDICAL CENTER ABSORBS ALL COSTS WITHOUT REIMBURSEMENT. HNMC HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. HNMC HAS INTENTIONALLY SOUGHT OUT PHYSICIANS FLUENT IN SPANISH AND WHO CARE FOR HISPANIC POPULATIONS, AND PROVIDES FREE TRANSPORTATION FOR SUCH POPULATIONS (AS WELL AS OTHERS) UNABLE TO ACCESS CARE ON THEIR OWN. HNMC HAS ALSO ADDED MANY KOREAN PHYSICIANS TO ITS MEDICAL STAFF AND PROVIDES A KOREAN CLINIC WEEKLY, WITH KOREAN SPEAKING PHYSICIANS (AND NURSES), AS THE ASIAN COMMUNITY IS ONE OF THE FASTEST GROWING SECTORS IN THE COUNTY. RECENT ADDITIONS OF STAFF TO SUPPORT THE EXPANDED CHINESE, JAPANESE, FILIPINO AND ASIAN INDIAN POPULATIONS ADDRESS NEEDS SPECIFIC TO THESE GROUPS. CARE IS PROVIDED IN A CULTURALLY SENSITIVE MANNER. THE INSTITUTE FOR CLINICAL RESEARCH AT HNMC PROVIDES EXCEPTIONAL INVESTIGATORS, FACILITIES, AND SERVICES FOR SPONSORING AGENCIES THAT SEEK TO ADVANCE PATIENT CARE THROUGH SUPERIOR CLINICAL RESEARCH. THE INSTITUTE IS DEDICATED TO CONDUCTING EXPEDITIOUS, HIGH-QUALITY CLINICAL TRIALS TO TEST NEW MEDICATIONS, DEVICES, DIAGNOSTIC MODALITIES AND TREATMENT PROTOCOLS. AS A DYNAMIC HEALTH CARE INSTITUTION THAT HAS RECEIVED MANY HONORS OF DISTINCTION FOR ITS CLINICAL EXCELLENCE AND COMPASSIONATE PATIENT CARE, HNMC IS WELL-SUITED TO PARTICIPATE IN THE QUEST FOR SCIENTIFIC BREAKTHROUGHS. HNMC'S STATE-OF-THE-ART FACILITIES MATCH THE HIGHEST STANDARDS FOR CARRYING OUT TODAY'S MOST PROMISING CLINICAL RESEARCH. THE INSTITUTE PROVIDES SPONSORS WITH RESEARCH SUPPORT THROUGHOUT ALL THE STAGES OF THEIR CLINICAL TRIALS. SINCE ITS INCEPTION, HNMC HAS BEEN ACTIVELY INVOLVED IN HEALTH PROFESSIONS EDUCATION, TRAINING, EDUCATING AND MENTORING HEALTHCARE PROFESSIONALS. THE HOLY NAME SCHOOL OF NURSING WAS FOUNDED IN 1925, WITH A DEDICATION TO FOSTERING THE WELL-BEING AND DIGNITY OF ALL INDIVIDUALS, SICK OR WELL. THE REGISTERED NURSE ("RN") PROGRAM IS A HIGHLY COMPETITIVE REGISTERED NURSE DIPLOMA PROGRAM, AND IS ACCREDITED WITH THE NEW JERSEY BOARD OF NURSING AND THE NATIONAL LEAGUE FOR NURSING ACCREDITING COMMISSION. IN 1972 THE SCHOOL EXPANDED TO INCLUDE A PRACTICAL NURSE ("LPN") PROGRAM AS WELL, WHICH IS A 12-MONTH PRACTICAL NURSE DIPLOMA PROGRAM ALSO ACCREDITED WITH THE NEW JERSEY BOARD OF NURSING. BOTH PROGRAMS CONTINUE TO SUPPLY THE REGION WITH HIGHLY SKILLED NURSES OF MANY ETHNICITIES AND AGE GROUPS. THE REGISTERED NURSE PROGRAM HAS A COLLABORATIVE AGREEMENT WITH SAINT PETER'S UNIVERSITY TO PROVIDE STUDENTS IN THE PROGRAM THE OPTION OF TAKING COLLEGE CREDITS, IN ADDITION TO THE BASIC CURRICULUM, TO EARN AN ASSOCIATE OF APPLIED SCIENCE (AAS) DEGREE IN HEALTH SCIENCES FROM SAINT PETER'S UNIVERSITY. HNMC ALSO SUPPORTS ITS COMMUNITY THROUGH THE USE OF THE MEDICAL CENTER'S FACILITY AND/OR EMPLOYEES TO SUPPORT EFFORTS THAT: PROMOTE THE POSITIVE GROWTH OF THE COMMUNITY; ASSIST DIVERSE GROUPS IN COMING TOGETHER FOR THE COMMUNITY'S SHORT AND LONG TERM BENEFIT; AND SEEK TO PROTECT THE COMMUNITY FROM ANYTHING THAT COULD SIGNIFICANTLY AFFECT THE HEALTH AND WELL-BEING OF THE COMMUNITY.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	HNMC ALSO ASSISTS OTHER NON-PROFITS AND PROVIDES VARIOUS FORMS OF NON-MONETARY AID AS WELL. IN ADDITION, EMPLOYEES ARE PERMITTED TO ASSIST VALID NON-PROFIT ORGANIZATIONS DURING PAID WORK TIME. AMONG THE ORGANIZATIONS SO AIDED ARE NURSING HOMES, BOY SCOUTS, HOUSES OF WORSHIP, COMMUNITY SERVICE GROUPS, BATTERED WOMEN'S SHELTERS, ROTARY CLUBS, POLICE GROUPS, ENVIRONMENTAL GROUPS, SCHOOLS, AND NURSING HOMES. HNMC ALSO ALLOWS THE PUBLIC TO USE VARIOUS MEETING ROOMS (IN NON-CLINICAL AREAS) AND ITS CONFERENCE CENTER FOR EVENTS. CAREER DAYS ARE HELD FOR LOCAL HIGH SCHOOLS, FOSTERING ENTRANCE OF INTERESTED AND APPLICABLE STUDENTS INTO THE HEALTH PROFESSIONS. ALTHOUGH HNMC'S PARKING FEES ARE MINIMAL, FREE PARKING IS EXTENDED TO PERSONS IN NEED. SINCE 2012, THE MEDICAL CENTER HAS PROVIDED ASSISTANCE TO A HOSPITAL IN THE EARTHQUAKE-RAVAGED COUNTRY OF HAITI THROUGH CASH SUPPORT, PROVISION OF EQUIPMENT AND PERSONNEL WORKING TO REBUILD THE HOSPITAL'S OPERATIONS, AND THROUGH TRAINING HEALTH PROVIDERS WORKING AT THE HOSPITAL. AFFILIATIONS AND ACADEMIC RELATIONSHIPS ======================================= THE HNMC COMMUNITY ENJOYS ACADEMIC RELATIONSHIPS THAT PROVIDE AN EDUCATIONAL ENVIRONMENT FOR STUDENTS FROM A VARIETY OF HEALTHCARE PROFESSIONS: - AFFILIATION AGREEMENTS ARE MAINTAINED WITH BERGEN COMMUNITY COLLEGE (PARAMUS, NJ) FOR NURSING STUDENTS, AND FOR RADIOLOGY, ULTRASOUND, RESPIRATORY, AND SURGICAL TECHNICIANS. TRAINEES FROM RUTGERS UNIVERSITY (NEW BRUNSWICK, NJ) ARE PREDOMINANTLY DOCTOR OF PHARMACY STUDENTS WHO ARE COMPLETING ROTATIONS IN ACUTE CRITICAL CARE, INFECTIOUS DISEASE, ONCOLOGY, NEPHROLOGY, AND ADMINISTRATION. THE TRAINEES ARE SUPERVISED BY A CLINICAL CARE COORDINATOR FROM THE UNIVERSITY. STUDENTS FROM OTHER PROGRAMS MAY BE ACCEPTED AS WELL. ONE COMMUNITY HEALTH STUDENT ROTATES THROUGH HNMC AS WELL. - THE MEDICAL CENTER MAINTAINS A COLLABORATIVE AGREEMENT WITH ST. PETER'S UNIVERSITY (JERSEY CITY, NJ) TO PROVIDE THE OPTION FOR HOLY NAME SCHOOL OF NURSING STUDENTS TO TAKE ADDITIONAL COLLEGE CREDITS TO EARN AN ASSOCIATES OF APPLIED SCIENCE ("AAS") DEGREE IN HEALTH SCIENCES. THE AAS COMPLEMENTS THE DIPLOMA AWARDED FROM THE HOLY NAME SCHOOL OF NURSING. EMPLOYEES OF HNMC ARE ALSO ABLE TO CONTINUE THEIR STUDIES BY PURSUING BACHELOR'S (BSN), MASTER'S, AND ADVANCED PRACTICE NURSING DEGREES AT ST. PETER'S UNIVERSITY. IN THIS PROCESS, STUDENT EMPLOYEES WORK WITH VARIOUS ADMINISTRATIVE LEADERS WITHIN HNMC TO COMPLETE CLINICAL ROTATIONS. - UNDERGRADUATE, NURSE PRACTITIONER AND NURSING DOCTORAL STUDENTS FROM FAIRLEIGH DICKINSON UNIVERSITY ("FDU") COMPLETE ROTATIONS WITH OVERSIGHT FROM HNMC'S DEPARTMENT OF NURSING EDUCATION. IN ADDITION, THE MEDICAL CENTER HOSTS, AT NO CHARGE, CLASSES PROVIDED BY FDU FOR BOTH NURSES AND ADULT LEARNERS. - HNMC HAS A NUMBER OF OTHER ACADEMIC RELATIONSHIPS THROUGH WHICH IT SERVES AS AN EDUCATIONAL ENVIRONMENT FOR STUDENTS. AFFILIATION AGREEMENTS ARE MAINTAINED WITH SEVERAL COLLEGES AND UNIVERSITIES FOR NURSING STUDENTS, AND FOR RADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, RESPIRATORY, AND SURGICAL TECHNICIANS. TRAINEES FROM A UNIVERSITY WHO ARE PREDOMINANTLY DOCTOR OF PHARMACY STUDENTS COMPLETE ROTATIONS IN ACUTE CRITICAL CARE, INFECTIOUS DISEASE, ONCOLOGY, NEPHROLOGY, AND ADMINISTRATION. COMMUNITY HEALTH STUDENTS ROTATE THROUGH THE MEDICAL CENTER AS WELL. PHYSICAL AND/OR OCCUPATIONAL THERAPY STUDENTS FROM WITH TEN COLLEGES IN NEW JERSEY AND OTHER STATES COMPLETE CLINICAL ROTATIONS AT THE MEDICAL CENTER; HNMC EMPLOYEES SERVE AS SUPERVISORS AND CLINICAL INSTRUCTORS FOR THESE STUDENTS. UNDERGRADUATE, NURSE PRACTITIONER AND NURSING DOCTORAL STUDENTS FROM YET ANOTHER UNIVERSITY COMPLETE ROTATIONS WITH OVERSIGHT FROM HNMC'S DEPARTMENT OF NURSING EDUCATION. IN ALL CASES, INSTRUCTION AND OVERSITE ARE PROVIDED BY HNMC STAFF. - DURING CERTAIN YEARS STUDENTS FROM A PREPARATORY SCHOOL COMPLETE INTERNSHIPS AT THE MEDICAL CENTER IN VARIOUS DEPARTMENTS. TYPICALLY, SUCH STUDENTS ARE CONSIDERED DISADVANTAGED FROM A SOCIOECONOMIC STANDPOINT AND BENEFIT FROM THE COACHING RECEIVED FROM MEMBERS OF THE SENIOR ADMINISTRATIVE STAFF. THE STUDENTS SPEND ONE FULL DAY EACH WEEK AT HOLY NAME OVER THE COURSE OF A SEMESTER. EMERGENCY PREPAREDNESS ====================== HNMC WAS ONE OF NINE HOSPITALS IN NEW JERSEY DESIGNATED BY THE NEW JERSEY DEPARTMENT OF HEALTH ("NJDOH") AS A REGIONAL MEDICAL COORDINATION CENTER ("MCC"). THE ONLY FACILITY IN BERGEN COUNTY TO BE SO DESIGNATED, HNMC'S ON-CAMPUS MCC'S PURPOSE WAS ABLE TO BE ACTIVATED IN THE EVENT OF PUBLIC HEALTH EMERGENCIES AND/OR A TERRORIST ATTACK CAUSING MASS CASUALTY INCIDENTS, INFECTIOUS OR COMMUNICABLE DISEASE, OR OTHER TYPES OF PUBLIC HEALTH DISRUPTION. THE MCC ALSO MONITORED, ON A DAILY BASIS, SITUATIONAL AWARENESS OF LOCAL ACTIVITY. IN 2014, THE NJDOH LOST MUCH OF ITS FEDERAL FUNDING FOR THE STATEWIDE PROGRAM, CUTTING IN HALF THE NUMBER OF MCC'S IT COULD SUPPORT. HNMC CHOSE NOT TO APPLY TO RENEW ITS DESIGNATION BUT HAS MAINTAINED MOST OF ITS CAPABILITIES ON ITS OWN. GIVEN HNMC'S PROXIMITY TO NEW YORK CITY (I.E., FIVE MILES NORTH OF THE GEORGE WASHINGTON BRIDGE), EMERGENCY PREPAREDNESS IS DEEMED NECESSARY TO ENSURE THE HEALTH AND WELL-BEING OF THE COMMUNITY, REGARDLESS OF THE MCC DESIGNATION. HNMC HAS LONG BEEN RECOGNIZED BY STATE AND FEDERAL SECTORS FOR ITS EXPERTISE IN EMERGENCY PREPAREDNESS AND RESPONSE. HNMC HAS PARTICIPATED IN SEVERAL LARGE SCALE DISASTER DRILLS, AS WELL AS DRILLS CONDUCTED BY THE CENTERS FOR DISEASE CONTROL INVOLVING LOCAL, COUNTY, STATE, AND FEDERAL AGENCIES' EMERGENCY RESPONSE TO THREATS OF PUBLIC HEALTH SIGNIFICANCE. HNMC MAINTAINS ITS DESIGNATION BY THE FEDERAL DIVISION OF GLOBAL MIGRATION AND QUARANTINE TO DEAL WITH POSSIBLE COMMUNICABLE DISEASES AND ACTS OF BIOTERRORISM OCCURRING ON PUBLIC HEALTH CONVEYANCES. HNMC IS ALSO ACTIVE IN THE NORTHERN NEW JERSEY URBAN AREA SECURITY INITIATIVE. MEMBERS OF HOLY NAME EMS SERVE ON THE STATEWIDE NJ EMS TASK FORCE. THE MEDICAL CENTER MAINTAINS A SPECIAL OPERATIONS TEAM COMPRISED OF PARAMEDICS AND EMERGENCY MEDICAL TECHNICIANS WHO ARE READY TO RESPOND 24 HOURS A DAY, 7 DAYS A WEEK TO ASSIST LOCAL COMMUNITIES WITH EMERGENCIES.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	CORONAVIRUS PANDEMIC ==================== Following the admission of our first COVID-19 positive patient on March 4, 2020, Holy Name Medical Center quickly became the epicenter of NJ's outbreak and one of the first and hardest hit hospitals in the country. With the COVID inpatient census doubling every four days to a peak of 251 inpatients, and thousands of virus-positive patients being monitored in their homes with telemedicine, Holy Name was "ground zero" of the pandemic. Holy Name's massive crisis response and management effort to confront unprecedented challenges resulted in a remarkable safety record to treat patients and to protect staff and patients. Less than 10 percent of all employees who were tested for COVID tested positive, and following the building of five new ICUs, not one employee tested positive. We retrofitted the medical center to build new ICUs to handle patient surge and to isolate COVID-positive patients. Over four weeks in March-April, our facilities team, with input from nursing and other clinicians, built five ICUs containing 75 beds. IVs, pumps, ventilators, monitors, and medication computers were placed outside rooms through punch-through ports, which safeguarded precious PPE and reduced the number of times clinical staff had to go inside. Overhead mirrors enabled caregivers outside to see patients' faces, while intercoms facilitated conversations. Additionally, we built 250 unique negative-pressure isopods from off-the-shelf materials readily available at building supply centers to surround COVID-positive patients for treatment and transportation and to protect staff. Also, 276 negative-pressure areas were constructed. As the pandemic continued, we developed new treatment protocols and participated in clinical trials as a result of Holy Name's high profile, which normally would have been reserved for large academic institutions, for remdesivir, blood plasma, Regeneron antibody cocktails, and Pluristem with placental stem cells, which Holy Name was the first in the country to use. In the beginning of June 2020 as we embarked upon a "new normal" on our road to recovery, we conducted a deep, rigorous cleaning of our 450,000 square feet of clinical and non-clinical space using manual disinfection, electrostatic sanitizing mist, and UV-C light. Our routine steps include rigorous cleaning and sterilizing in patient care locations; adopting new screening protocols and protection procedures for patients and staff; and separating non-COVID treatment areas from COVID treatment areas. We have carefully reopened to the public in phases, expanding services as public health guidelines permit. We are now scheduling elective surgeries and procedures; resuming many elective tests, such as mammograms and colonoscopies; and offering select in-person rehabilitation therapy services. To safeguard our patients and staff, we have instituted procedures for pre-registering, pre-admission COVID-19 testing, and entering all our facilities. Our website, www.holyname.org, contains crucial facts and information on COVID-19 to educate and inform the community. Additionally, we have a COVID-19 Toolkit on our website which provides information on COVID-19 vaccinations, testing, and treatments. Patients are able to schedule appointments for testing and vaccinations online as well as perform self-assessments to diagnose their symptoms. RECOGNITION =========== HNMC IS RECOGNIZED FOR ITS CLINICAL SKILL, QUALITY OUTCOMES AND HIGH RATE OF PATIENT SATISFACTION BY MULTIPLE NATIONAL ACCREDITATION AGENCIES AND BENCHMARKING ORGANIZATIONS. HNMC HOLDS MAGNET STATUS FOR OUTSTANDING NURSING CARE FROM THE AMERICAN NURSES CREDENTIALING CENTER ("ANCC"). THE MAGNET RECOGNITION PROGRAM WAS DEVELOPED BY THE ANCC TO RECOGNIZE HEALTHCARE ORGANIZATIONS THAT PROVIDE NURSING EXCELLENCE, AND TO PROVIDE A VEHICLE FOR DISSEMINATING SUCCESSFUL NURSING PRACTICES AND STRATEGIES. ONLY EIGHT PERCENT (8%) OF HOSPITALS NATIONWIDE ARE MAGNET RECOGNIZED HOSPITALS. ACCREDITED BY THE JOINT COMMISSION ("TJC") HNMC HAS ALSO RECEIVED TJC'S GOLD SEAL OF APPROVAL FOR HEALTHCARE QUALITY AND SAFETY FOR EACH OF HIP REPLACEMENT AND KNEE REPLACEMENT. HNMC IS ALSO CERTIFIED BY TJC AS A PRIMARY STROKE CENTER. HOLY NAME IS RECOGNIZED BY THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION AS A GOLD-PLUS, HONOR ROLL ELITE, PRIMARY STROKE CENTER AS PART OF THE "GET WITH THE GUIDELINES" PROGRAM, AND IS A BARIATRIC SURGERY CENTER OF EXCELLENCE, DESIGNATED AND ACCREDITED BY THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY ("MBSQIP"). HNMC IS DESIGNATED AS A CENTER OF EXCELLENCE BY AAGL (AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS) FOR ITS MINIMALLY INVASIVE GYNECOLOGY SERVICE; BY SRC (SURGICAL REVIEW CORPORATION) FOR ITS ROBOTIC SURGERY PROGRAM; AND BY THE AMERICAN COLLEGE OF RADIOLOGY FOR BREAST IMAGING. HNMC HOLDS THE WOMEN'S CHOICE AWARDS FOR EACH OF "AMERICA'S BEST HOSPITALS FOR CANCER CARE,"AMERICAN'S BEST HOSPITALS FOR BARIATRIC SURGERY." HNMC HAS BEEN PRAISED REPEATEDLY AS AN EXEMPLARY WORKPLACE BY NJBIZ (THE LEADING WEEKLY BUSINESS PUBLICATION IN NEW JERSEY), WHICH CITES HNMC AS A TOP BUSINESS (ALL INDUSTRIES) IN ITS 50 BEST PLACES TO WORK IN NEW JERSEY PROGRAM, A DESIGNATION EARNED BY HNMC, AND BY NO OTHER HOSPITAL, FOR 14 YEARS IN A ROW.
CORE FORM, PART III; LINE 4D	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, GENDER IDENTITY, NATIONAL ORIGIN, AGE, DISABILITY OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7	PEACE MINISTRIES, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. PEACE MINISTRIES, INC. HAS THE 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"). 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"). IN ADDITION, THE ORGANIZATION'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 EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER, ASSISTANT VICE PRESIDENT OF FINANCE AND EXECUTIVE DIRECTOR OF FINANCE ("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 THE ORGANIZATION'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"). 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 THE ORGANIZATION'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 THE ORGANIZATION'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"). THE ORGANIZATION'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 OFFICERS AND KEY EMPLOYEES INCLUDED IN CORE FORM, PART VII OF THIS FEDERAL FORM 990. 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 THE ORGANIZATION'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.
CORE FORM, PART VI, SECTION C; QUESTION 19	THE ORGANIZATION HAS ISSUED TAX-EXEMPT BONDS TO FINANCE VARIOUS CAPITAL IMPROVEMENT PROJECTS, RENOVATIONS AND EQUIPMENT. IN CONJUNCTION WITH THE ISSUANCE OF THESE TAX-EXEMPT BONDS, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED WITH THE TAX-EXEMPT BOND PROSPECTUS WHICH WAS MADE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW. 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 REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION OR A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THIS ORGANIZATION OR A RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THE ORGANIZATION'S BOARD OF TRUSTEES.
CORE FORM, PART VII AND SCHEDULE J	MICHAEL SKVARENINA, A FORMER KEY EMPLOYEE OF THE ORGANIZATION, IS STILL EMPLOYED WITHIN THE SYSTEM AS THE VICE PRESIDENT OF INFORMATION TECHNOLOGY.
CORE FORM, PART VII AND SCHEDULE J	MICHAEL MARON IS AN OFFICER OF THIS ORGANIZATION AND INVOLVED IN THE LEADERSHIP AND MANAGEMENT OF THIS ORGANIZATION. MR. MARON IS EMPLOYED BY THIS ORGANIZATION AND RECEIVES A FORM W-2. ACCORDINGLY, HIS COMMON LAW EMPLOYER/EMPLOYEE RELATIONSHIP IS WITH HOLY NAME MEDICAL CENTER (EIN: 22-1487322). HOLY NAME MEDICAL CENTER FILED A 2020 FORM 4720 WHICH INCLUDED A REMITTANCE OF EXCISE TAX RELATED TO MR. MARON'S COMPENSATION IN EXCESS OF $1M.
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"). 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 OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE SYSTEM; NOT SOLELY THIS ORGANIZATION.
CORE FORM, PART XI; QUESTION 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - CHANGE IN NET INTEREST OF HOLY NAME HEALTH CARE FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - ($829,592); AND - CHANGE IN BENEFICIAL INTEREST IN HOLY NAME HEALTH CARE FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $1,403,311.
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"). AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES, FOR THE YEARS ENDED DECEMBER 31, 2020 AND DECEMBER 31, 2019; 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. THE ORGANIZATION'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.
CORE FORM, PART XII; QUESTION 3A	THE ORGANIZATION IS AN AFFILIATE WITHIN HOLY NAME MEDICAL CENTER, INC. AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM ENGAGED AN INDEPENDENT CPA FIRM TO PREPARE AND ISSUE AN AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE MEDICALLY NECESSARY HEALTHCARE SVCS TO INDIVIDUALS IN THE COMMUNITY REGARDLESS OF RACE, COLOR, CREED, SEX, GENDER IDENTITY, NAT'L ORIGIN, AGE, DISABILITY OR ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	3,345
6	Total number of volunteers (estimate if necessary) .............	6	435
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	716,496
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	684,544

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,712,580	87,928,733
9	Program service revenue (Part VIII, line 2g) .........	448,759,353	393,676,205
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,630,263	-709,201
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,809,307	2,300,845
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	462,911,503	483,196,582
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	681,770	442,181
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	198,950,667	198,501,387
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	244,052,173	246,203,463
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	443,684,610	445,147,031
19	Revenue less expenses. Subtract line 18 from line 12.......	19,226,893	38,049,551
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	414,463,274	538,902,803
21	Total liabilities (Part X, line 26).............	182,803,449	264,212,487
22	Net assets or fund balances. Subtract line 21 from line 20.....	231,659,825	274,690,316

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	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 191,793,378 including grants of $ 0 ) (Revenue $ 220,604,149 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY OUTPATIENT SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.

4b	(Code: ) (Expenses $ 174,847,734 including grants of $ 0 ) (Revenue $ 143,735,940 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY INPATIENT SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.

4c	(Code: ) (Expenses $ 15,854,999 including grants of $ 0 ) (Revenue $ 21,005,963 )
	EXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY EMERGENCY DEPARTMENT SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 18,180,435 including grants of $ 442,181 ) (Revenue $ 8,330,153 )
4e	Total program service expenses400,676,546

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,957,743	214,439	841,801

1a	Federated campaigns..		1a
b	Membership dues..		1b	133,950
c	Fundraising events..		1c
d	Related organizations		1d	2,038,041
e	Government grants (contributions)		1e	85,685,652

f	All other contributions, gifts, grants, and similar amounts not included above		1f	71,090

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		87,928,733

		Business Code
2a	NET PATIENT SERVICE REVENUE	622110	385,346,052	385,346,052
b	OTHER HEALTHCARE RELATED REVENUE	622110	6,612,921	5,896,425	716,496
c	SCHOOL OF NURSING	611310	1,717,232	1,717,232
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		393,676,205

3 Investment income (including dividends, interest, and othersimilar amounts) ......			3,314,109			3,314,109
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,082,169	6a
b	Less: rental expenses		507,918	6b
c	Rental income or (loss)	0	574,251	6c
d	Net rental income or (loss).......			574,251			574,251
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		559,995	7a
b	Less: cost or other basis and sales expenses	4,583,305		7b
c	Gain or (loss)	-4,583,305	559,995	7c
d	Net gain or (loss).........			-4,023,310			-4,023,310
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CAFETERIA		900099	1,076,696			1,076,696
b	DAY CARE		624410	649,898			649,898
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,726,594
12	Total revenue. See instructions.....			483,196,582	392,959,709	716,496	1,591,644

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	334,210	334,210
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	107,971	107,971
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	7,259,802	6,533,822	725,980	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	168,276,996	151,449,296	16,827,700
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,711,396	3,340,256	371,140
9	Other employee benefits .......	6,116,245	5,504,621	611,624
10	Payroll taxes ...........	13,136,948	11,823,253	1,313,695
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	264,860	238,374	26,486
c	Accounting ...........	256,192	230,573	25,619
d	Lobbying ...........	86,102	77,492	8,610
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	297,682	267,914	29,768
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	15,170,974	13,653,877	1,517,097	0
12	Advertising and promotion ....	4,218,059	3,796,253	421,806
13	Office expenses .......	12,417,166	11,175,449	1,241,717
14	Information technology ......	7,881,665	7,093,498	788,167
15	Royalties ..	0
16	Occupancy ...........	5,197,518	4,677,766	519,752
17	Travel ............	329,320	296,388	32,932
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	81,646	73,481	8,165
20	Interest ...........	2,758,761	2,482,885	275,876
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	18,080,108	16,272,097	1,808,011
23	Insurance ...	2,584,581	2,326,123	258,458
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	104,112,858	93,701,572	10,411,286	0
b	PHYSICIAN SERVICES	46,670,300	42,003,270	4,667,030	0
c	PURCHASED SERVICES	11,105,845	9,995,260	1,110,585	0
d	REPAIRS & MAINTENANCE	9,719,540	8,747,586	971,954	0
e	All other expenses	4,970,286	4,473,259	497,027
25	Total functional expenses. Add lines 1 through 24e	445,147,031	400,676,546	44,470,485	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 ........			21,486,173	1	16,687,167
2	Savings and temporary cash investments .........			10,464,172	2	22,341,371
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			50,615,573	4	48,443,957
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	27,080,087
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			9,189,241	8	11,116,249
9	Prepaid expenses and deferred charges ......			4,778,360	9	6,053,575
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	456,020,994
b	Less: accumulated depreciation	10b	305,344,387	133,225,035	10c	150,676,607
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			102,752,849	13	173,186,184
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			81,951,871	15	83,317,606
16	Total assets. Add lines 1 through 15 (must equal line 33)...			414,463,274	16	538,902,803

17	Accounts payable and accrued expenses .....	55,482,987	17	77,747,766
18	Grants payable ...	0	18	0
19	Deferred revenue .........	1,523,172	19	554,270
20	Tax-exempt bond liabilities .........	77,044,949	20	65,859,248
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	5,562,003	23	23,670,399
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	43,190,338	25	96,380,804
26	Total liabilities. Add lines 17 through 25..	182,803,449	26	264,212,487

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	212,749,825	27	254,173,316
28	Net assets with donor restrictions ...........	18,910,000	28	20,517,000
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	231,659,825	32	274,690,316
33	Total liabilities and net assets/fund balances ........	414,463,274	33	538,902,803

(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
(1) HNH FITNESS LLC 718 TEANECK ROAD TEANECK,NJ07666 59-3836367	WELLNESS	NJ	590,676	4,492,467	HNMC
(2) HOLY NAME MEDICAL CENTER ACO LLC 718 TEANECK ROAD TEANECK,NJ07666 81-0906043	HEALTHCARE	NJ	456,190	977,364	HNMC
(3) HARMONY HEALTH ALLIANCE LLC 718 TEANECK ROAD TEANECK,NJ07666 82-1374662	HEALTHCARE	NJ	6,290	20,547	HNMC

(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)HOLY NAME HEALTH CARE FOUNDATION 718 TEANECK ROAD TEANECK,NJ07666 22-2737143	FUNDRAISING	NJ	501(C)(3)	509(A)(3)	HNMC	Yes
(2)HOLY NAME REAL ESTATE CORP 718 TEANECK ROAD TEANECK,NJ07666 22-3412504	PROPERTY CO	NJ	501(C)(3)	509(A)(3)	HNMC	Yes
(3)MS COMPREHENSIVE CARE CENTER 718 TEANECK ROAD TEANECK,NJ07666 22-2402959	HEALTHCARE	NJ	501(C)(3)	509(A)(2)	HNMC	Yes
(4)HOLY NAME EMS INC 718 TEANECK ROAD TEANECK,NJ07666 27-0294681	HEALTHCARE	NJ	501(C)(3)	509(A)(3)	HNMC	Yes
(5)THE CRUDEM FOUNDATION INC 718 TEANECK ROAD TEANECK,NJ07666 43-1660199	FUNDRAISING	MO	501(C)(3)	509(A)(1)	HNHC FDN		No
(6)PEACE MINISTRIES INC 399 HUDSON TERRACE ENGLEWOOD CLIFFS,NJ07632 46-5202238	RELIGIOUS ORD	NJ	501(C)(3)	509(A)(1)	NA		No
(7)HOLY NAME HEALTH PHYSICIANS PC 718 TEANECK ROAD TEANECK,NJ07666 85-2279567	HEALTHCARE	NJ	501(C)(3)	509(A)(3)	HNMC	Yes
(8)HOLY NAME HEALTH INC 718 TEANECK ROAD TEANECK,NJ07666 85-3847378	INACTIVE	NJ	501(C)(3)	509(A)(3)	PEACE MIN		No

(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?		(k) Percentage ownership
(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	(k) Percentage ownership

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) HEALTH PARTNER SERVICES INC	R	4,463,000	COST
(2) MS COMPREHENSIVE CARE CENTER	D	1,042,092	COST
(3) HOLY NAME REAL ESTATE CORPORATION	E	4,249,163	COST
(4) HOLY NAME EMS	D	630,587	COST
(5) HOLY NAME HEALTH CARE FOUNDATION INC	E	68,427	COST
(6) HOLY NAME HEALTH CARE FOUNDATION INC	C	1,788,041	COST
(7) HOLY NAME REAL ESTATE CORPORATION	O	152,316	COST

(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?		(k) Percentage ownership
(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	(k) Percentage ownership