TY 2021 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JOHN T GRIBBIN...................................................................... TRUSTEE - PRESIDENT/CEO	55.0 ................. 0.0	X	X			1,241,943	32,525
(2) THOMAS W SCOTT...................................................................... SVP/COO	55.0 ................. 0.0		X			655,441	89,921
(3) DAVID A DE SIMONE ESQ...................................................................... SVP TRANSFORMATION/CLO	55.0 ................. 0.0			X		552,325	78,756
(4) JOHN A DELLOCONO...................................................................... SVP/CFO	55.0 ................. 0.0		X			574,957	38,673
(5) JAMES J MATERA MD...................................................................... SVP/MEDICAL DIRECTOR	50.0 ................. 0.0			X		512,640	72,315
(6) CATHLEEN G JANZEKOVICH...................................................................... VP, PATIENT SERVICES	50.0 ................. 0.0			X		331,052	53,632
(7) MOUSTAFA SHAFEY MD...................................................................... MEDICAL DIR. - MENTAL HLTH	50.0 ................. 0.0				X	349,220	28,440
(8) DEBORAH ROMMEL-CONNORS MBA...................................................................... VP REVENUE CYCLE	50.0 ................. 0.0			X		311,172	63,223
(9) JAMES RICHVALSKY...................................................................... VP, PHYSICIAN PRACTICE MGMT	50.0 ................. 0.0				X	327,894	36,532
(10) FRANCES KEANE...................................................................... VP HUMAN RESOURCES	50.0 ................. 0.0			X		317,416	37,870
(11) KAREN B FREEMAN MSA...................................................................... VP QUALITY & PATIENT SAFETY	50.0 ................. 0.0			X		327,987	21,834
(12) HOWARD A STEIN MD...................................................................... PHYSICIAN	50.0 ................. 0.0				X	315,205	25,678
(13) NANCY BARONE...................................................................... CSHCF VP OF DEVELOPMENT	50.0 ................. 0.0				X	277,157	33,599
(14) KIM A KELLY RN MS...................................................................... VP CLINICAL SVCS.(TERM 9/2/21)	50.0 ................. 0.0			X		265,693	28,799
(15) VINCENT L D'ELIA...................................................................... VP MRKTING PUBLIC/GOVT REL.	50.0 ................. 0.0			X		263,530	23,015
(16) KIMBERLY H SIMERS...................................................................... AVP INTEGRATIVE HEALTH	50.0 ................. 0.0				X	246,051	29,052
(17) DANIELLE VANWERT...................................................................... VP CLINICAL SVCS.(EFF. 9/2/21)	50.0 ................. 0.0			X		211,317	11,752

(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/1099-NEC)
(18) AMIT S KHAROD MD........................................................................ TRUSTEE	50.0 .......................0.0	X		0	198,612	9,319
(19) JOHN P DETULLIO MD........................................................................ TRUSTEE	10.0 .......................0.0	X		50,071	0	0
(20) KENNETH ENG DO........................................................................ TRUSTEE	10.0 .......................0.0	X		50,000	0	0
(21) ASHISH AWASTHI MD FACC........................................................................ TRUSTEE	5.0 .......................0.0	X		20,000	0	0
(22) JOHN F EGGERT........................................................................ CHAIR - TRUSTEE	1.0 .......................0.0	X	X	0	0	0
(23) JOHN M CANTALUPO ESQ........................................................................ VICE CHAIR - TRUSTEE	1.0 .......................0.0	X	X	0	0	0
(24) KENNETH J REILLY CWS........................................................................ SECRETARY/TREASURER - TRUSTEE	1.0 .......................0.0	X	X	0	0	0
(25) NADIA K BATCHELOR........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(26) ROBERT GORDON DDS........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(27) MAUREEN M LAWRENCE........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(28) PETER G LICATA ESQ........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(29) BARBARA MCMORROW........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(30) GERARD K NORKUS........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(31) WILLIAM A SCHORIES........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(32) BRETT TAFT........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0
(33) MAHER YOUSSEF MD........................................................................ TRUSTEE	1.0 .......................0.0	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
HIGH ENERGY ELECTRIC INC, 5042 INDUSTRIAL ROAD UNIT D FARMINGDALE,NJ07727	CONSTRUCTION	4,746,390
BRIAN TRACY, 120 COTTON STREET PHILADELPHIA,PA19127	ARCHITECT	1,681,548
HOLMDEL PHYSICIAN ASSOCIATES, 66 WEST GILBERT STREET TINTON FALLS,NJ07701	MEDICAL	1,346,514
MAINSAIL HOLDCO LLC, PO BOX 1437 COLUMBUS,GA31902	BILLING	790,448
ERNST YOUNG LLP, PO BOX 640382 PITTSBURGH,PA152640382	CONSULTING/AUDIT	654,766
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 43

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

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) .

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

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 on 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 on 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) 2021

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

11a

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

11b

A 35% controlled entity of a person described on 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 on 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) 2021

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) 2021

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization CENTRASTATE MEDICAL CENTER INC

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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization CENTRASTATE MEDICAL CENTER INC		Employer identification number 22-1750190

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization CENTRASTATE MEDICAL CENTER INC			Employer identification number 22-1750190
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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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)? ........

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

20,434

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

20,434

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 II	DURING 2021, THE ORGANIZATION PAID AN OUTSIDE LOBBYING FIRM WHICH ENGAGED IN LOBBYING EFFORTS ON BEHALF OF THE ORGANIZATION ADRESSING FEDERAL AND STATE HEALTHCARE MATTERS. THIS ALLOCATION AMOUNTED TO $15,600 DURING THE YEAR ENDED DECEMBER 31, 2021. In addition, the organization is a member of the new jersey hospital association which engages in lobbying efforts on behalf of its member hospitals. A portion of the dues paid to this organization has been allocated to lobbying activities performed on behalf of the organization. This allocation amounted to $4,834 during the year ended december 31, 2021.

Return Reference

Explanation

SCHEDULE C, PART II-B; LINE II

DURING 2021, THE ORGANIZATION PAID AN OUTSIDE LOBBYING FIRM WHICH ENGAGED IN LOBBYING EFFORTS ON BEHALF OF THE ORGANIZATION ADRESSING FEDERAL AND STATE HEALTHCARE MATTERS. THIS ALLOCATION AMOUNTED TO $15,600 DURING THE YEAR ENDED DECEMBER 31, 2021. In addition, the organization is a member of the new jersey hospital association which engages in lobbying efforts on behalf of its member hospitals. A portion of the dues paid to this organization has been allocated to lobbying activities performed on behalf of the organization. This allocation amounted to $4,834 during the year ended december 31, 2021.

Schedule C (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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) 2021

Page 2

Part III

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

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

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

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

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	14,120,897		14,120,897
b	Buildings ....	205,909,641	123,947,091	81,962,550
c	Leasehold improvements
d	Equipment ....	127,867,718	89,387,619	38,480,099
e	Other .....	15,963,749	5,970,927	9,992,822
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				144,556,368

Schedule D (Form 990) 2021

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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
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)PROGRAM RELATED INVESTMENTS	149,780,347	F
(2)OTHER INVESTMENTS	472,816	F
(3)ASSETS HELD BY RELATED ORG.	19,809,865	F
(4)INVESTMENT IN CCIC	7,196,824	F
(5)INVESTMENT IN SURGICARE	226,055	F
(6)INVESTMENT IN CS HEALTH PRTNRS	323,035	F
(7)LIFE CARE CONTRACTS APPLEWOOD	4,891,761	F
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	182,700,703

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 - CURRENT				10,208,668
(2)DUE FROM AFFILIATES - NC				7,161,820
(3)OTHER RECEIVABLES				2,204,685
(4)SECURITY DEPOSITS				577,088
(5)RESTRICTED CASH - ASSET				942,544
(6)OPERATING LEASE ASSETS				4,915,223
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				26,010,028

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
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	51,004,153
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) 2021

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 X; LINE 2

THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CENTRASTATE HEALTHCARE SYSTEM, INC AND RELATED ENTITIES FOR THE YEARS ENDED DECEMBER 31, 2021 AND DECEMBER 31, 2020; RESPECTIVELY. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE SYSTEM'S 2021 AUDITED CONSOLIDATED FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): THE SYSTEM ACCOUNTS FOR DEFFERED TAX ASSETS AND LIABILITIES BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL REPORTING AND TAX BASIS OF ASSETS AND LIABILITIES USING ENACTED TAX RATES AND LAWS THAT WILL BE IN EFFECT WHEN DIFFERENCES ARE EXPECTED TO REVERSE. AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, THE SYSTEM HAS MADE REASONABLE ESTIMATES OF THE PROVISION FOR THE INCOME TAXES AND DEFFERED TAX BALANCES BASED ON ACCOUNTING GUIDANCE INCLUDED IN ACCOUNTING STANDARDS CODIFICATION 740, INCOME TAXES. THE SYSTEM WILL CONTINUE TO REFINE ITS CALCULATIONS IN FUTURE PERIODS AS ADDITIONAL REGULATIONS AND GUIDANCE ARE ISSUED BY THE INTERNAL REVENUE SERVICE (IRS).

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	1	1	Program Services	FINANCIAL VEHICLE	1,728,330
	Central America and the Caribbean	0	0	Investments		14,065,016















3a	Sub-total ....	1	1			15,793,346
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	1	1			15,793,346

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2021

Schedule F (Form 990) 2021Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
SCHEDULE F, PART I	DURING 2021, THIS ORGANIZATION REMITTED $1,728,330 TO CENTRASTATE CAPTIVE INSURANCE CO., LTD., A FINANCIAL VEHICLE, ON BEHALF OF AND FOR THE BENEFIT OF THIS ORGANIZATION.

Schedule F (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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? . . . . . .

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			6,421,046	430,596	5,990,450	1.740 %
b	Medicaid (from Worksheet 3, column a) . . . . .			28,813,724	22,062,982	6,750,742	1.970 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			35,234,770	22,493,578	12,741,192	3.710 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	22	1,243,216	1,217,863	0	1,217,863	0.350 %
f	Health professions education (from Worksheet 5) . . .	5	62	2,615,905	69,250	2,546,655	0.740 %
g	Subsidized health services (from Worksheet 6) . . . .			5,715,905	0	5,715,905	1.660 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	3	469	224,072	110,000	114,072	0.030 %
j	Total. Other Benefits . .	30	1,243,747	9,773,745	179,250	9,594,495	2.780 %
k	Total. Add lines 7d and 7j .	30	1,243,747	45,008,515	22,672,828	22,335,687	6.490 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1	1,800	5,531	0	5,531	0 %
3	Community support	1	2,481	44,137	31,377	12,760	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	1	150	468	0	468	0 %
9	Other
10	Total	3	4,431	50,136	31,377	18,759	0 %

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. ......

3,148,637

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. ......

314,864

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).....

76,534,464

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

103,102,800

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

-26,568,336

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

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)
1	CENTRASTATE MEDICAL CENTER 901 WEST MAIN STREET FREEHOLD,NJ07728 WWW.CENTRASTATE.COM 11302	X	X	X	X	X

Schedule H (Form 990) 2021

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)

	CENTRASTATE 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..................................

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

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

Yes

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

Hospital facility’s website (list url): SEE PART V; SECTION C

Other website (list url):

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

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

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

Yes

If "Yes" (list url): SEE PART V; SECTION C

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CENTRASTATE 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):

SEE PART V; SECTION C

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

SEE PART V; SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V; SECTION C

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	CENTRASTATE 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) 2021

Page 7

Part VFacility Information (continued)

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

	CENTRASTATE 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) 2021

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	IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") THIS ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY ITS HOSPITAL FACILITIES. CENTRASTATE MEDICAL CENTER IS A FOUNDING MEMBER OF THE HEALTH IMPROVEMENT COALITION OF MONMOUTH COUNTY (HICMC) AND HAS A SEAT ON THE ORGANIZATION'S SEVEN-MEMBER STEERING COMMITTEE, ALONG WITH REPRESENTATIVES OF COUNTY AND LOCAL HEALTH DEPARTMENTS AND OTHER MONMOUTH COUNTY HOSPITALS. ORGANIZED IN 2005, HICMC, WITH THE COOPERATION OF THE GOVERNMENTAL PUBLIC HEALTH PARTNERSHIP OF MONMOUTH COUNTY, AREA AGENCIES, ORGANIZATIONS, HEALTHCARE PROVIDERS INCLUDING ALL FIVE HOSPITALS IN MONMOUTH COUNTY, AND INDIVIDUALS, HAS COLLABORATED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) EVERY FIVE YEARS (2007-2011, 2012-2016 AND 2017-2019). THE CURRENT MONMOUTH COUNTY PLAN WAS COMPLETED IN 2018 AND IS FOR THE YEARS 2018-2022 AND INCLUDES THE COMMUNITIES OF WESTERN MONMOUTH COUNTY CENTRASTATE IS ALSO A PARTICIPATING MEMBER OF THE OCEAN MONMOUTH HEALTH ALLIANCE, THE PREVENTION COALITION OF MONMOUTH COUNTY, THE FREEHOLD AREA MUNICIPAL ALLIANCE AND NEIGHBORHOOD CONNECTIONS TO HEALTH. FOR THE PURPOSES OF THIS CHNA, CENTRASTATE MEDICAL CENTER, INC. ALSO REVIEWED THE CHNA'S AND CHIP'S OF ADJACENT COUNTIES, SPECIFICALLY OCEAN, MERCER AND MIDDLESEX, AND CONDUCTED SURVEYS THROUGHOUT THE COMMUNITIES SERVED BY CENTRASTATE MEDICAL CENTER, INC. BOTH ELECTRONICALLY AND VIA HARD-COPY AND DETERMINED THE RESULTS WERE CONSISTENT WITH THE MONMOUTH COUNTY ASSESSMENTS AND PLANS UPON WHICH CENTRASTATE MEDICAL CENTER, INC. BASED ITS CHNA. A BASE "SECONDARY DATA PROFILEAN "URBAN PROFILE" WERE PREPARED FOR MONMOUTH COUNTY BY HOLLERAN CONSULTING OF PHILADELPHIA THAT INCLUDED DEMOGRAPHIC AND HOUSEHOLD INFORMATION, MORTALITY RATES, COMMUNICABLE DISEASE RATES AND CANCER INCIDENCE AND MORTALITY RATES. THE PROFILES WERE UPDATED PERIODICALLY. COPIES OF BOTH STUDIES ARE AVAILABLE IN THE CENTRASTATE MEDICAL CENTER, INC. COMMUNITY RELATIONS OFFICE. THE COALITION EXAMINED SCIENTIFIC SURVEY DATA FROM NEARLY 600 HOUSEHOLDS, AS WELL AS FOCUS GROUP FEEDBACK. CENTRASTATE MEDICAL CENTER, INC. FURTHER REVIEWED THE HEALTHY NEW JERSEY 2020 OBJECTIVES, BASELINES, AND TARGETS. BECAUSE MANY OF THE STATISTICS REFLECT AVAILABLE COUNTY-WIDE OR STATE-WIDE DATA, CENTRASTATE MEDICAL CENTER, INC. CONDUCTED AN ADDITIONAL SURVEY AS WELL AS SEVERAL INTERVIEWS AND MEETINGS DESIGNED TO FURTHER IDENTIFY THE HEALTH NEEDS PARTICULAR TO WESTERN MONMOUTH COUNTY. THE RESULTS WERE RANKED ACCORDING TO SEVERITY AFTER CONSULTATIONS WERE CONDUCTED BETWEEN CENTRASTATE MEDICAL CENTER, INC. CHNA LEADERSHIP AND THE PUBLIC HEALTH OFFICERS SERVING MONMOUTH COUNTY AS WELL AS EACH OF THE COMMUNITIES IN WESTERN MONMOUTH COUNTY TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS OF THE CENTRASTATE MEDICAL CENTER, INC. COMMUNITIES.
SCHEDULE H, PART V, SECTION B, QUESTIONS 6A & 6B	CENTRASTATE MEDICAL CENTER IS A FOUNDING MEMBER OF THE HEALTH IMPROVEMENT COALITION OF MONMOUTH COUNTY (HICMC) AND HAS A SEAT ON THE ORGANIZATION'S SEVEN-MEMBER STEERING COMMITTEE, ALONG WITH REPRESENTATIVES OF COUNTY AND LOCAL HEALTH DEPARTMENTS AND OTHER MONMOUTH COUNTY HOSPITALS. ORGANIZED IN 2005, HICMC, WITH THE COOPERATION OF THE GOVERNMENTAL PUBLIC HEALTH PARTNERSHIP OF MONMOUTH COUNTY, AREA AGENCIES, ORGANIZATIONS, HEALTHCARE PROVIDERS INCLUDING ALL FIVE HOSPITALS IN MONMOUTH COUNTY, AND INDIVIDUALS, HAS COLLABORATED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) EVERY FIVE YEARS (2007-2011, 2012-2016 AND 2017-2019). THE CURRENT MONMOUTH COUNTY PLAN WAS COMPLETED IN 2018 AND IS FOR THE YEARS 2018-2022 AND INCLUDES THE COMMUNITIES OF WESTERN MONMOUTH COUNTY CENTRASTATE IS ALSO A PARTICIPATING MEMBER OF THE OCEAN MONMOUTH HEALTH ALLIANCE, THE PREVENTION COALITION OF MONMOUTH COUNTY, THE FREEHOLD AREA MUNICIPAL ALLIANCE AND NEIGHBORHOOD CONNECTIONS TO HEALTH.
SCHEDULE H, PART V, SECTION B, QUESTIONS 7A & 7D	THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.; 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: https://www.centrastate.com/wp-content/uploads/sites/9/2020/01/CHNA-and-Im plementation-Plan-2020-FINAL-Board-to-approve-December-122019-002.pdf
SCHEDULE H, PART V, SECTION B, QUESTION 10A	THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.; 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 IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: https://www.centrastate.com/wp-content/uploads/sites/9/2020/01/CHNA-and-Im plementation-Plan-2020-FINAL-Board-to-approve-December-122019-002.pdf
SCHEDULE H, PART V, SECTION B, QUESTION 11	THE ORGANIZATION'S IMPLEMENTATION STRATEGY DESCRIBES THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE ORGANIZATION'S CHNA. THROUGH THE ASSESSMENT OF ITS COMMUNITIES THE ORGANIZATION IDENTIFIED THE FOLLOWING KEY PRIORITIES: OBESITY, SUBSTANCE ABUSE, MENTAL HEALTH, ACCESS TO HEALTH CARE, AND TRANSPORTATION. THE ORGANIZATION INTENDS TO TAKE THE FOLLOWING ACTIONS WITH RESPECT TO EACH IDENTIFIED COMMUNITY HEALTH NEED. Significant Health Need #1: Mental Health (Substance Abuse [including vaping] and Suicide) Strategies: ----------- Mental Health ------------- Collaborate with the Monmouth County Mental Health Director on strategies and programs to address mental health issues. Consult with elected and appointed state officials to regulate mental health insurance to increase access to mental health services, including treatment for substance use disorders. Identify strategies on how to publicize the availability of mental health programs. Substance Abuse --------------- Collaborate, share resources and develop programming (particularly vaping) with the local Municipal Alliances for the Prevention of Substance Abuse for programming and education in the community and particularly in the schools. Partner with the local Municipal Alliances in efforts to reduce the availability of electronic nicotine delivery systems (vaping). Increase participation in the Prevention Coalition of Monmouth County to plan comprehensive substance abuse awareness planning and programming; to provide a forum for community members and organizations to work together to improve substance abuse prevention strategies within the service area while increasing public awareness related to substance abuse trends and community resources. Increase and expand substance abuse programming including vaping at the CentraState Student Health Awareness Center. Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care. Utilize certified Recovery Coaches in the Emergency Department to engage with patients who have been administered naloxone (NARCAN). Continue to monitor and track prescribing and dispensing of Schedule II, III, IV and V drugs and other controlled substances. Suicide ------- The CentraState Student Health Awareness Center, in cooperation with school counselors, undertake plans to develop and deliver a curriculum-based program that helps all students learn to recognize warning signs of suicide in themselves and others. Provide low income or at-risk public school students and their families with information about social services and health care supports. Significant Health Need #2: Chronic Disease (Cardiovascular [Heart Disease/Stroke], Cancer, Diabetes) Strategies: ----------- Cardiovascular -------------- Develop and implement programs and services to enhance knowledge of heart disease management and control the risk factors for heart disease. Offer a cardiac support group for the public. Increase community outreach efforts including lectures and screenings (blood pressure and cholesterol) by participating in community events (town days, fairs, senior center events and American Heart Association programs and events. Provide cardiopulmonary resuscitation classes for the community. Offer weight management programs and classes. Promote and expand the Gloria Saker Women's Heart Program at CentraState (for women at risk) including education and awareness, prevention, risk factor assessment and program referral (dietary counseling, smoking cessation, stress management) in collaboration with area physicians. Cancer ------ Continue to partner with the Ocean Monmouth Health Alliance to conduct programs aimed at education, prevention and access to treatment for cancer. Programs include "Choose Your Cover" (free skin cancer education and screenings at the beach); "Cancer You Can Prevent" (Colorectal cancer toolkits for primary care physicians to prevent colorectal cancer); Free Oral Cancer Screenings; promote with local governments Tobacco-Free Living at beaches, parks and recreational areas; preventing cervical cancer by increasing HPV immunizations. Increase number and frequency of cancer screenings offered through the CentraState Statesir Cancer Center and the Health Awareness Center. Increase breast cancer screenings (mammograms) by the CentraState Women's Center. Combine information about human papillomavirus (HPV) and the benefits of vaccination with efforts to support vaccine series completion (e.g., patient and parent education or reminders, physician education, etc.) Diabetes -------- Increase education for diabetes prevention, early identification and disease management to high-risk populations in our service area. Expand pre-diabetes education programming at the hospital and in the community. Provide increased access of Diabetes Center nurses to primary care physicians in Freehold Borough for nutrition counseling (English and Spanish classes) to include glucose testing, education and follow-up evaluations. Include free glucose screening at community events in the service area. Significant Health Need #3: Healthy Lifestyles (Obesity, Nutrition, Physical Activity, Access to Care) Strategies: ----------- Obesity, Nutrition and Physical Activity Participate in the Mobile Food Pantry at the Freehold Family Health Center by Fulfill Food Bank. Provide "Live Life Well" programs including seminars on eating well, relaxing well and moving well. Continue nutrition seminars for senior centers. Expand the "Plant Powered Program" (a 10-week program on plant based eating which has been shown to significantly help with weight loss, improved digestion, lower cholesterol and triglycerides, drop blood pressure and help with blood sugar management.) Provide live cooking demonstrations for the community. Expand participation in the Shaping NJ Grant for schools in Freehold Borough and Freehold Township advising of nutritional content of school food recipes and benefits of exercising. Increase participation in service area school wellness councils and activities. Partner with the CentraState Fitness Center to provide nutrition education for children. Use media-based efforts, in particular social media platforms, to educate residents and change the attitudes and beliefs that contribute to unhealthy behaviors. Access to Care -------------- Partner with community-based organizations to increase outreach and education about enrollment for health insurance coverage through the Health Insurance Marketplaces (Exchanges). Continue to grow the CentraState Community Health Plan. Explore additional CentraState Health Pavilions, which include Family Practice at CentraState offices, rehabilitation and laboratory services and Immediate Care Centers, in service area communities. Recruit graduating residents from the CentraState-based Family Residency Program. Continue to recruit primary care physicians, physician assistants, nurse practitioners and specialty care physicians to the service area. Collaborate with the newly created coalition "Neighborhood Connections to Health" led by the Visiting Nurse Association (VNA) Health Group and the Freehold Health Dept. under grants from the Robert Wood Johnson Foundation and the Nicholson Foundation. The organization goals are to find solutions to health issues within the community through collaboration. Continue to support the new Federally Qualified Health Center (FQHC) "Freehold Family Health Center" in Freehold Borough and continue to commit CentraState resources to the facility and its programs/services. Collaborate with the Mayor's Freehold Boro Wellness Council to conduct a health fair for residents, including follow-up with education and free screenings. Provide culturally sensitive assistance and care coordination, and guide patients through available medical, insurance, and social support (Patient navigators). Tailor health care to patients' norms, beliefs, and values, as well as their language and literacy skills. Develop programs in conjunction with the Freehold Borough schools to address health issues of students and families. Develop programs through the CentraState Health Awareness Center in conjunction with other departments to provide the community with health education, promotion and literacy. Use vouchers, tickets for prize drawings, and other incentives to encourage patients to undergo preventive care such as screenings, vaccinations, etc.
SCHEDULE H, PART V, SECTION B, QUESTION 16	THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.; 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: https://www.centrastate.com/billing/

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C	THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2015 POVERTY GUIDELINES (DEPARTMENT OF HEALTH AND SENIOR SERVICES). FEDERAL POVERTY GUIDELINES ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE. CENTRASTATE MEDICAL CENTER, INC. FOLLOWS THE NJ ADMINISTRATIVE CODE 8:31B AND CONSIDERS INDIVIDUAL ASSETS OVER $7,500 AND FAMILY ASSETS OVER $15,000 IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. IN ADDITION, THERE IS A "SPEND DOWN" PROVISION ALLOWING FINANCIAL ASSISTANCE IF THE AMOUNT DUE FROM THE PATIENT IS GREATER THAN THE ASSETS OVER THE STATED THRESHOLDS.
SCHEDULE H, PART I; QUESTION 6A	NOT APPLICABLE
SCHEDULE H, PART I; QUESTION 7	WORKSHEET 2 WAS USED FOR THE COST TO CHARGE RATIO.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY CENTRASTATE MEDICAL CENTER, INC. IMPROVE THE MEDICAL AND SOCIOECONOMIC WELL-BEING OF OUR COMMUNITIES. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. CENTRASTATE MEDICAL CENTER, INC. PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS, COMMUNITY AND PROVIDERS. PHYSICIANS, NURSES AND OTHER HEALTHCARE PROFESSIONALS DEDICATE THEIR KNOWLEDGE AND TIME TO ENSURE THE COMMUNITY IS WELL EDUCATED ON TOPICS PROMOTING HEALTHY LIVING.
SCHEDULE H, PART III, SECTION A; QUESTION 4	THE FOOTNOTE BELOW EXPLAINS THE ORGANIZATIONS METHODOLOGY WITH RESPECT TO NET PATIENT SERVICE REVENUE. CHANGES IN THE SYSTEM'S ESTIMATES OF IMPLICIT PRICE CONCESSIONS, DISCOUNTS, CONTRACTUAL ADJUSTMENTS OR OTHER CHANGES 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 FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020 WAS NOT SIGNIFICANT.
SCHEDULE H, PART III, SECTION B; QUESTION 8	MEDICARE COSTS WERE DERIVED FROM THE 2021 MEDICARE COST REPORT. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS 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 INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION 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 "[T]HE TERM CHARITABLE IS USED IN 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 HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. 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 "REMOVE[D]" 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 TREAS. 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. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. 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 POSITION. AS OUTLINED IN THE AHA 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. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 92 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION ("MEDPAC") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 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 ELIGIBLES." 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 FINANCIAL ASSISTANCE PROGRAMS. 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 BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPE
SCHEDULE H, PART III, SECTION B; QUESTION 9B	DURING FINANCIAL COUNSELING, THE PATIENT IS SCREENED FOR ELIGIBILITY IN PUBLIC ASSISTANCE PROGRAMS, INCLUDING MEDICARE, MEDICAID, THE CATASTROPHIC ILLNESS FUND FOR CHILDREN, AND THE VIOLENT CRIME COMPENSATION BOARD. THE PATIENT IS ASSISTED WITH THE ENROLLMENT PROCESS FOR ANY PROGRAMS FOR WHICH THE PATIENT HAS PROBABLE ELIGIBILITY. BILLS MAY BE REDUCED FROM 20% TO 100% BASED UPON FINANCIAL ASSISTANCE CRITERIA. THE PATIENT RESPONSIBILITY PORTION OF 20%, 40%, 60% OR 80% IS BASED UPON RATES ESTABLISHED IN P.L. 1971 C. 136. SPEND DOWN ASSETS, THROUGH PARTIAL PAYMENT OF THE HOSPITAL BILL IS ALLOWED TO ENABLE THE PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE. THE AMOUNT FOR WHICH THE PATIENT IS RESPONSIBLE AFTER PARTIAL FINANCIAL ASSISTANCE SHALL BE LIMITED TO 30% OF INCOME, PER NJAC 8:31B. UNINSURED PATIENTS WITH INCOME BETWEEN 301%-500% OF FEDERAL POVERTY LEVELS WILL BE PROVIDED A SIGNIFICANT DISCOUNT, IN ACCORDANCE WITH P.L. 1971 C. 136. PATIENTS ARE BILLED ROUTINELY FOR UNPAID BALANCES AND SHALL BE NOTIFIED OF ANY IMPENDING COLLECTION OR LEGAL ACTION. PATIENTS ARE PROVIDED WITH CONTACT INFORMATION TO DISCUSS ANY QUESTIONS OR PROBLEMS. PATIENT BILLS INDICATE THE AVAILABILITY OF PAYMENT SCHEDULES. UPON PATIENT REQUEST, THE FOLLOWING PAYMENT SCHEDULE FOR BALANCES OF $100 OR MORE MAY BE AGREED UPON: BALANCE OF $100 - $450 - MONTHLY PAYMENT = 1/4 OF THE BALANCE, $451 - $3,000 = 1/12 OF THE BALANCE, OVER $3,000 = MINIMUM OF $250 PER MONTH OR 1% OF GROSS INCOME/MONTH, WHICHEVER IS MORE. IF THE PATIENT AND MEDICAL CENTER REPRESENTATIVE MUTUALLY AGREE TO A PAYMENT SCHEDULE AND PAYMENTS ARE RECEIVED AS AGREED, FURTHER COLLECTION ACTION WILL NOT BE TAKEN. EXCEPTIONS TO THE ABOVE SCHEDULE MAY BE MADE BY PATIENT FINANCIAL SERVICES MANAGEMENT UPON THE REQUEST OF THE PATIENT, AND DOCUMENTATION BY THE PATIENT OF INABILITY TO PAY ACCORDING TO THE ESTABLISHED SCHEDULE. IF, AT THE END OF THE FINANCIAL SCREENING ATTEMPTS AND BILLING CYCLE, THE PATIENT HAS NOT BEEN APPROVED FOR FINANCIAL ASSISTANCE AND/OR IS NOT ON A PAYMENT PLAN, OR AFTER THERE HAS BEEN A DEFAULT IN PAYMENT, THE ACCOUNT WILL BE ASSIGNED TO A COLLECTION AGENCY AND/OR ATTORNEY FOR COLLECTIONS. PAYMENT PLAN, OR AFTER THERE HAS BEEN A DEFAULT IN PAYMENT, THE ACCOUNT WILL BE ASSIGNED TO A COLLECTION AGENCY AND/OR ATTORNEY FOR COLLECTIONS.
SCHEDULE H, PART VI; QUESTION 2	In addition to the community health needs assessment process outlined in schedule h, section b, questions 1-12 and section c, this organization conducts a review of key factor information annually which includes: a review of healthcare utilization of its service area population by services (urology, cardiology, obstetrics, etc.) For determining increased or decreased health needs; healthcare services estimates and forecasts (both inpatient and outpatient); assessments of local demographic and socioeconomic information; and, a review of health status/needs assessments and studies conducted by external parties. The organization conducts an extensive service area physician needs study (by primary and specialty) every three to five years. Specific specialty needs are conducted for identified gaps in service. These reviews inform medical staff development at the medical center to assure responsiveness to identified community needs. The organization collaborates with community partners to plan and conduct health needs assessments to assess and address health needs of the community it serves. The wide-based collaborative partnership retains an outside consulting firm to assess community data and perception. Community data is collected from county health profiles, health statistics, demographics, socioeconomic data, phone surveys, paper surveys and focus groups. From those assessments, community health improvement plans are published identifying the specific health priorities. Through a planned and organized effort, the group works collectively to address the priorities by tapping the resources of the community and collaborating on initiatives. CentraState Healthcare System, Inc. Actively contributes to this process and engages in the identified priorities that match its mission, expertise, resources and capacity. In addition to these organized needs assessment efforts, various CentraState Healthcare System, Inc. Leadership attend community meetings with local providers, local health departments, local politicians, organizations and community leaders to discuss the health needs of the population.
SCHEDULE H, PART VI; QUESTION 3	In accordance with Internal Revenue Code section 501(r)(4) the organization informs and educates patients and persons who may be billed for patient care about their eligibility for financial assistance by widely publicizing various documents. These documents are widely publicized in the following ways: (1) the financial assistance policy ("fap"), financial assistance application ("application") and plain language summary ("pls") are all available on-line at the following website: https://CentraStatecorp.azureedge.net/wp-content/uploads/sites/9/2021/01 /financial-assistance-policy-2021-002.pdf (2) paper copies of the fap, application and the pls are available upon request without charge by mail and are available in at various areas throughout the hospital facility which include the hospital admissions department and the outpatient and emergency room registration areas. (3) the fap, application and pls are available in English and in the primary language of populations with limited proficiency in English ("LEP") that constitute the lesser of 1,000 individuals or 5% of the community served by the organization's primary service area. (4) all patients are offered a copy of the pls as part of the intake process. Additionally, signs or displays are conspicuously posted in public medical center locations including all admissions/registration areas and the emergency department, that notify and inform patients about the availability of financial assistance. All billing statements include conspicuous written notice which informs patients about the availability of financial assistance. CentraState Medical Center, Inc. also informs and notifies members of the community served about the fap.
SCHEDULE H, PART VI; QUESTION 4	The community in which CentraState Medical Center, Inc. Serves is concentrated in Monmouth and ocean counties. The average household income in the service area is $139,993. The median household age is 44. The total population in the service area for 2019 is 357,095 with 124,895 households. The racial mix of the service area population includes 73% white, 10% Asian, 4% black, 11% Hispanic and 2% multi-racial. Gender mix is represented by 51% female and 49% male.
SCHEDULE H, PART VI; QUESTION 5	CentraState contributes to the community through substantial employee involvement with other charitable and public organizations such as girl scouts of the jersey shore, work force investment bureau of Monmouth county, Veterans Community Association, Fingerprint America, Sunrise Optimist Club, Monmouth-Ocean Development Council, Muscular Dystrophy Association, Freehold Township, Monmouth County Child Advocacy Center, The National Organization of Women Business Owners, Rutgers University, Cancer Institute of New Jersey and the College Advisory Boards of Monmouth County Community College and Brookdale Community College. Efforts include increasing services to cancer survivors, coordinating efforts for fund raising and organizing student training programs. CentraState also provides additional community benefit through its 174 volunteers who contributed over 32,752 hours of service to their community through opportunities in every hospital department. Volunteers significantly enhance patient and family support in the following service categories: blood cart, dietary menu, emergency department lounge, flowers, gift shop/cart, hospitality cart, information desks, mail or messenger, prn/floaters, pastoral care, animal assisted therapy, snack bar, surgery waiting area, patient transport, hair care, service learning.
SCHEDULE H, PART VI; QUESTION 6	OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE CENTRASTATE HEALTHCARE SYSTEM, INC.: NOT-FOR-PROFIT CENTRASTATE HEALTHCARE SYSTEM, INC. ENTITIES =========================================================== CENTRASTATE HEALTH SYSTEM, INC. ------------------------------- CENTRASTATE HEALTH SYSTEM, INC. ("CSHS") IS THE TAX-EXEMPT PARENT OF THE CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"). THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS CSHS. THE SYSTEM IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS THROUGHOUT THE STATE OF NEW JERSEY AND IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). CENTRASTATE MEDICAL CENTER, INC. -------------------------------- CENTRASTATE MEDICAL CENTER, INC. ("CSMC") IS LOCATED IN FREEHOLD, MONMOUTH COUNTY, NEW JERSEY, IS A 276-BED ACUTE CARE FACILITY. CSMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CSMC 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, CSMC OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. CENTER FOR AGING, INC. ---------------------- CENTER FOR AGING, INC. ("APPLEWOOD") 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)(2). APPLEWOOD CONSISTS OF 281 INDEPENDENT APARTMENTS, 20 COTTAGES, 40 RESIDENTIAL HEALTH CARE UNITS, AND A 60-BED SKILLED NURSING FACILITY. THE ORGANIZATION PROVIDES FOR THE CARE OF THE ELDERLY. APPLEWOOD ALSO GOES OUT TO THE COMMUNITY THROUGH SENIOR'S FIRST, WHICH IS A COMPLIMENTARY COMMUNITY OUTREACH AND HEALTHCARE EDUCATION PROGRAM FOR THOSE 60 YEARS AND OLDER IN A 25-MILE RADIUS OF FREEHOLD, NJ. THE CENTER'S PROGRAMS INCLUDE HEALTH FAIRS, BLOOD PRESSURE SCREENINGS, AND HEALTH EDUCATION AND PRESENTATIONS ON PREVENTION AND TREATMENT. IN ADDITION, THERE IS ALSO A SUPPORT GROUP FOR PARKINSON'S DISEASE AS WELL AS COMMUNITY SERVICE REFERRALS. CENTRASTATE ASSISTED LIVING, INC. --------------------------------- CENTRASTATE ASSISTED LIVING, INC. ("MONMOUTH CROSSING") 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)(2). MONMOUTH CROSSING OWNS AND OPERATES AN ASSISTED LIVING FACILITY FOR THE ELDERLY CONSISTING OF 76 UNITS WITH 16 UNITS FOR MEMORY CARE. THE FACILITY PROVIDES RESIDENTS WITH SPECIAL NEEDS AND MEMORY-RELATED DISEASES: RECEIVE COMPREHENSIVE, ATTENTIVE SERVICES IN A SAFE ENVIRONMENT WHERE SPECIALIZED ACTIVITIES AND PROGRAMMING ARE PROVIDED. MONMOUTH CROSSING OFFERS SERVICES TO RESIDENTS OF LOW AND MODERATE MEANS AND THOSE ON MEDICAID AS WELL. HEALTHCARE AFFILIATES, INC. --------------------------- HEALTHCARE AFFILIATES, INC. ("THE MANOR") 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)(2). THE MANOR PROVIDES SKILLED NURSING SERVICES FOR 123 ELDERLY RESIDENTIAL UNITS INCLUDING SUBACUTE, REHABILITATION AND I.V. THERAPY. THE FACILITY FOCUS IS ON HELPING RESIDENTS ACHIEVE THEIR MAXIMUM POTENTIAL FOR INDEPENDENCE, PERSONAL COMFORT AND QUALITY OF LIFE. THE MANOR IS MEDICARE/MEDICAID CERTIFIED, LICENSED BY THE STATE OF NEW JERSEY, AND ACCREDITED BY THE JOINT COMMISSION. THE FACILITY PROVIDES CHARITY CARE FOR THE INDIGENT WHERE APPROPRIATE. CENTRASTATE HEALTHCARE FOUNDATION, INC. --------------------------------------- CENTRASTATE HEALTHCARE FOUNDATION, 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). THROUGH FUNDRAISING ACTIVITIES THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF CSMC; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT 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. OTHER CENTRASTATE HEALTHCARE SYSTEM, INC. ENTITIES ================================================== CENTRASTATE CAPTIVE INSURANCE CO., LTD. --------------------------------------- CENTRASTATE CAPTIVE INSURANCE CO., LTD. A CONTROLLED FOREIGN CORPORATION OF CENTRASTATE MEDICAL CENTER. THE ORGANIZATION WAS FORMED AND OPERATES SOLELY IN THE CAYMAN ISLANDS WITH NO U.S. ACTIVITIES OR PRESENCE. CENTRASTATE CARDIOLOGY ASSOCIATES, P.C. ------------------------------------ CENTRASTATE CARDIOLOGY ASSOCIATES, P.C. IS AN ENTITY WHOSE NOMINEE SOLE SHAREHOLDER IS A LICENSED MD HOLDING SHARES FOR THE BENEFIT OF CSMC. THE ORGANIZATION IS LOCATED IN FREEHOLD, MONMOUTH COUNTY, NEW JERSEY. THIS ENTITY PROVIDES MEDICAL SERVICES IN SUPPORT OF AND IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF CSMC. CENTRASTATE HEALTHCARE SERVICES, INC. ------------------------------------- CENTRASTATE HEALTHCARE SERVICES, INC. IS AN ENTITY WHOSE SOLE SHAREHOLDER IS CSHS. THE ORGANIZATION IS LOCATED IN FREEHOLD, MONMOUTH COUNTY, NEW JERSEY AND PROVIDES HEALTHCARE SERVICES. CENTRASTATE MEDICAL ASSOCIATES, P.C. ------------------------------------ CENTRASTATE MEDICAL ASSOCIATES, P.C. IS AN ENTITY WHOSE NOMINEE SOLE SHAREHOLDER IS A LICENSED MD HOLDING SHARES FOR THE BENEFIT OF CSMC. THE ORGANIZATION IS LOCATED IN FREEHOLD, MONMOUTH COUNTY, NEW JERSEY. THIS ENTITY PROVIDES MEDICAL SERVICES IN SUPPORT OF AND IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF CSMC. CENTRASTATE SPECIALISTS, P.C. ----------------------------- CENTRASTATE SPECIALISTS, P.C. IS AN ENTITY WHOSE NOMINEE SOLE SHAREHOLDER IS A LICENSED MD HOLDING SHARES FOR THE BENEFIT OF CSMC. THE ORGANIZATION IS LOCATED IN FREEHOLD, MONMOUTH COUNTY, NEW JERSEY. THIS ENTITY PROVIDES MEDICAL SERVICES IN SUPPORT OF AND IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF CSMC.
SCHEDULE H, PART VI; QUESTION 7	The entity and related provider organizations are located in New Jersey. The state of New Jersey does not require hospitals to annually file a community benefit report with the state of New Jersey.

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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 .....

Yes

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? ....

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any 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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1JOHN T GRIBBIN TRUSTEE - PRESIDENT/CEO	(i) (ii)	787,653 ------------- 0	445,146 ------------- 0	9,144 ------------- 0	26,000 ------------- 0	6,525 ------------- 0	1,274,468 ------------- 0	0 ------------- 0
2THOMAS W SCOTT SVP/COO	(i) (ii)	448,122 ------------- 0	90,071 ------------- 0	117,248 ------------- 0	73,454 ------------- 0	16,467 ------------- 0	745,362 ------------- 0	52,855 ------------- 0
3DAVID A DE SIMONE ESQ SVP TRANSFORMATION/CLO	(i) (ii)	361,147 ------------- 0	75,917 ------------- 0	115,261 ------------- 0	64,976 ------------- 0	13,780 ------------- 0	631,081 ------------- 0	44,549 ------------- 0
4JOHN A DELLOCONO SVP/CFO	(i) (ii)	472,879 ------------- 0	94,554 ------------- 0	7,524 ------------- 0	19,500 ------------- 0	19,173 ------------- 0	613,630 ------------- 0	0 ------------- 0
5JAMES J MATERA MD SVP/MEDICAL DIRECTOR	(i) (ii)	423,519 ------------- 0	81,600 ------------- 0	7,521 ------------- 0	68,930 ------------- 0	3,385 ------------- 0	584,955 ------------- 0	0 ------------- 0
6CATHLEEN G JANZEKOVICH VP, PATIENT SERVICES	(i) (ii)	289,173 ------------- 0	39,556 ------------- 0	2,323 ------------- 0	51,490 ------------- 0	2,142 ------------- 0	384,684 ------------- 0	0 ------------- 0
7MOUSTAFA SHAFEY MD MEDICAL DIR. - MENTAL HLTH	(i) (ii)	316,686 ------------- 0	30,820 ------------- 0	1,714 ------------- 0	26,000 ------------- 0	2,440 ------------- 0	377,660 ------------- 0	0 ------------- 0
8DEBORAH ROMMEL-CONNORS MBA VP REVENUE CYCLE	(i) (ii)	268,210 ------------- 0	39,398 ------------- 0	3,564 ------------- 0	56,166 ------------- 0	7,057 ------------- 0	374,395 ------------- 0	0 ------------- 0
9JAMES RICHVALSKY VP, PHYSICIAN PRACTICE MGMT	(i) (ii)	282,101 ------------- 0	41,922 ------------- 0	3,871 ------------- 0	26,000 ------------- 0	10,532 ------------- 0	364,426 ------------- 0	0 ------------- 0
10FRANCES KEANE VP HUMAN RESOURCES	(i) (ii)	272,684 ------------- 0	40,545 ------------- 0	4,187 ------------- 0	26,000 ------------- 0	11,870 ------------- 0	355,286 ------------- 0	0 ------------- 0
11KAREN B FREEMAN MSA VP QUALITY & PATIENT SAFETY	(i) (ii)	265,424 ------------- 0	59,015 ------------- 0	3,548 ------------- 0	19,500 ------------- 0	2,334 ------------- 0	349,821 ------------- 0	0 ------------- 0
12HOWARD A STEIN MD PHYSICIAN	(i) (ii)	285,465 ------------- 0	28,156 ------------- 0	1,584 ------------- 0	19,500 ------------- 0	6,178 ------------- 0	340,883 ------------- 0	0 ------------- 0
13NANCY BARONE CSHCF VP OF DEVELOPMENT	(i) (ii)	238,103 ------------- 0	35,254 ------------- 0	3,800 ------------- 0	26,000 ------------- 0	7,599 ------------- 0	310,756 ------------- 0	0 ------------- 0
14KIM A KELLY RN MS VP CLINICAL SVCS.(TERM 9/2/21)	(i) (ii)	187,788 ------------- 0	39,398 ------------- 0	38,507 ------------- 0	24,192 ------------- 0	4,607 ------------- 0	294,492 ------------- 0	0 ------------- 0
15VINCENT L D'ELIA VP MRKTING PUBLIC/GOVT REL.	(i) (ii)	227,026 ------------- 0	33,882 ------------- 0	2,622 ------------- 0	19,500 ------------- 0	3,515 ------------- 0	286,545 ------------- 0	0 ------------- 0
16KIMBERLY H SIMERS AVP INTEGRATIVE HEALTH	(i) (ii)	223,171 ------------- 0	22,025 ------------- 0	855 ------------- 0	26,000 ------------- 0	3,052 ------------- 0	275,103 ------------- 0	0 ------------- 0
17DANIELLE VANWERT VP CLINICAL SVCS.(EFF. 9/2/21)	(i) (ii)	175,942 ------------- 0	35,300 ------------- 0	75 ------------- 0	7,382 ------------- 0	4,370 ------------- 0	223,069 ------------- 0	0 ------------- 0
18AMIT S KHAROD MD TRUSTEE	(i) (ii)	0 ------------- 198,612	0 ------------- 0	0 ------------- 0	0 ------------- 4,000	0 ------------- 5,319	0 ------------- 207,931	0 ------------- 0

Schedule J (Form 990) 2021

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; QUESTIONS 1A AND 1B	The organization provided travel for companions of officers and trustees for the annual board retreat and certain educational seminars. The organization paid social club dues for John T. Gribbin, President/CEO of the organization, which are part of his employment agreement contract. Utilization of this membership was primarily for the benefit of CentraState Medical Center, Inc.
SCHEDULE J, PART I; QUESTION 4B	THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2021 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: THOMAS W. SCOTT, $114,626 AND DAVID A. DE SIMONE, ESQ., $97,497. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") 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 2021 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: THOMAS W. SCOTT, $53,954; DAVID A. DE SIMONE, ESQ., $45,476; JAMES J. MATERA, M.D., $49,430; CATHLEEN G. JANZEKOVICH, $31,990 AND DEBORAH ROMMEL-CONNORS, MBA, $30,166.
SCHEDULE J, PART I; QUESTION 7	CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2021 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2021 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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

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

2021

Open to Public Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

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






Total ............... $						0

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) 2021

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) FORMER TRUSTEE	50% OWNER IN JV WITH CSHS, INC.	408,904	SEE PART V		No

Part V

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

Return Reference

Explanation

SCHEDULE L, PART V

1. FRED MORELLI, FORMER TRUSTEE, IS A 100% OWNER OF CORPORATE STAR. CORPORATE STAR IS A 50% OWNER OF PIER PRACTICE SOLUTIONS, THE OTHER 50% IS OWNED BY CENTRASTATE HEALTHCARE SERVICES, INC., A RELATED ORGANIZATION. PIER PRACTICE SOLUTIONS RECEIVES MANAGEMENT, PRODUCTION INCOME FROM PLACEMENT OF MEDICAL MALPRACTICE INSURANCE AND SERVICES FOR CENTRASTATE CAPTIVE INSURANCE COMPANY, LTD., SPC; WHICH IS WHOLLY OWNED BY CENTRASTATE MEDICAL CENTER, INC. ALL TRANSACTIONS ARE DONE WITHIN AN ARM'S LENGTH BASIS.

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

CENTRASTATE MEDICAL CENTER INC

Employer identification number

22-1750190

Return Reference	Explanation
CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	CentraState Medical Center ("CSMC") is a 284-bed general acute care hospital located in Freehold, Monmouth County, New Jersey. CSMC is recognized by the Internal Revenue Service ("IRS") as an Internal Revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, CSMC 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, CSMC operates consistently with the following criteria outlined in IRS revenue ruling 69-545: 1. CSMC provides medically necessary healthcare services to all individuals regardless of ability to pay, including charity care, self-pay, Medicare and Medicaid patients; 2. CSMC operates an active emergency room for all persons; which is open 24 hours a day, 7 days a week, 365 days per year; 3. CSMC maintains a closed medical staff, with privileges available based on community need; 4. Control of CSMC rests with its board of trustees and the board of trustees of CentraState Healthcare System, Inc. Both boards are 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 advanced medical care, programs and activities. The operations of CSMC, as shown through the factors outlined above and other information contained herein, clearly demonstrate the hospital provides substantial community benefit and that the use and control of CSMC 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. CSMC's sole corporate member is CentraState Healthcare System, Inc. ("CSHS"). CSHS is also the tax-exempt New Jersey non-profit parent corporation of CentraState healthcare system; an integrated healthcare delivery system ("system"). The sole member of each entity is either CSHS or another CentraState Healthcare System affiliate controlled or owned by CSHS. CentraState Healthcare System is a tax-exempt integrated healthcare delivery system consisting of a group of affiliate healthcare organizations. CentraState Healthcare System is a world-class patient-focused organization comprised of a renowned team of healthcare professionals working together to transform the lives of those in the community. In 2021 CentraState Healthcare system employs over 600 physicians, had approximately 38,000 ER visits, 146,718 outpatient visits and 10,516 admissions. Mission ======= To enhance the health and well-being of the communities through the compassionate delivery of quality healthcare. Vision ====== An organization of caring professionals trusted as the community's health care system of choice for clinical excellence. Recognition/Quality Awards ========================== - Magnet designation for nursing - CSMC is one of only 2 percent of hospitals nationwide to achieve Magnet designation for nursing excellence four times as part of the American Nurses Credentialing Center's Magnet recognition program. Only 8 percent of the approximate 5,800 hospitals in the U.S. hold Magnet designation. CSMC has been a four-time recipient of this designation. - Great Place to Work 2021 certification. - Cancer Care - the Commission on Cancer, a program of the American College of Surgeons, recognizes cancer care programs for their commitment to providing comprehensive, high-quality, and multidisciplinary patient-centered care. The Statesir Cancer Center at CSMC was awarded three-year reaccreditation with commendation, a distinction given only to facilities that exceed standard requirements. The Star and Barry Tobias Women's Health Center was also granted three-year full accreditation by the national accreditation program for breast centers, exemplifying a firm commitment to offering patients every significant advantage in the battle against breast cancer. Both accreditations were awarded after a voluntary, rigorous evaluation process. - National Cancer Institute: National Community Oncology Research Program site of the Atlantic Health Cancer Consortium designation. - CEO Roundtable on Cancer: CEO Cancer Gold Standard T. - Well Workplace - the Wellness Council of America (WELCOA) awarded CentraState Healthcare System the platinum Well Workplace Award for its innovative employee wellness program. CSMC is one of only a few hospitals in the country to achieve platinum-level status. - Stroke top honor - the American Heart Association/American Stroke Association's Get with the Guidelines Stroke Gold Plus achievement award recognizes excellent evidence-based care for stroke patients. CSMC has earned this designation for the past five years and is also among an elite group of hospitals earning the association's target: strokes honor roll for improving stroke care. - College of Healthcare Information Management Executives: Most Wired healthcare organization for the tenth time American Heart Association: Get With The Guidelines Heart Failure and Stroke Gold Quality Achievement Awards. - The American College of Cardiology: recognition for developing and sharing quality practices in treating acute coronary syndrome. - The Joint Commission: Gold Seal of Approval in Heart Failure, a two-year recertification. - American College of Radiology: Diagnostic Imaging Center of Excellence and Low-Dose Rate CT Lung Screening Center of Excellence. - American Heart Association: Workplace Health Achievement Index Gold Level Recognition for the Diabetes Prevention Program. - American College of Surgeons Commission on Cancer: Outstanding Achievement Award. - Surgical Review Corporation: Bariatric Center of Excellence. - Centers for Disease Control and Prevention: first organization to earn full recognition for the Diabetes Prevention Program. - New Jersey Business and Industry Association: Good Neighbor Award for solar program. - Monmouth County Planning Board: 2019 Merit Award for solar program. - Monmouth Ocean Development Council: Silver Gull Community Service Award to the Freehold Family Health Center, a partnership among CentraState, the Rutgers Robert Wood Johnson Medical School Family Medicine Residency Program at CentraState, The Visiting Nurse Association and VNACJ Community Health Center. The Manor Health and Rehabilitation Center ========================================== - U.S. News & World Report: Best Nursing Home for short-term rehabilitation. - Centers for Medicare & Medicaid Services: Five-star rating. - Immunization Action Coalition Immunization Action Coalition: Influenza Vaccination Honor Roll. Monmouth Crossing ================= - New Jersey Department of Health and Senior Services and the Health Care Association of New Jersey: Advanced Standing distinction. - New Jersey Department of Health and Senior Services: Assisted Living Best Practice Award three times. - Holleran: Ranked consistently in the top 5 percent nationally for satisfaction scores. Applewood ========= - Centers for Medicare & Medicaid Services: Five-star rating. Accreditations and Affiliations =============================== Accreditations -------------- - American Academy of Sleep Medicine. - American Association for Cardiovascular and Pulmonary Rehabilitation. - American College of Cardiology chest pain accreditation. - American College of Radiology: mammography, CT, nuclear medicine, radiation oncology, stereotactic breast biopsy, ultrasound) diagnostic imaging center of excellence (DICOE), low-dose rate CT Screening Center of Excellence, Lung Cancer Screening Center Designation. - American College of Surgeons' Commission on Cancer: accredited for the Statesir Cancer Center at CentraState. - American College of Surgeons' National Accreditation program for Breast Centers-The Star and Barry Tobias Women's Health Center. - American Diabetes Association Certification for Diabetes Self-Management Training. - American Nurses Credentialing Center. - American Heart Association. - College of American Pathologists. - Continuing Care Accreditation Commission. - Intersocietal Commission for the Accreditation of Vascular Laboratories (ultrasound). - The Joint Commission (Medical Center, The Manor, Central Jersey Wound Treatment Center, Total Joint Center of New Jersey, Primary Stroke). - New Jersey Department of Health for blood banks. - American College of Cardiology chest pain accreditation.
CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	Affiliations ------------ - American Physical Therapy Association Clinical Education Center - Brookdale Community College: Schools of Nursing and Allied Health, Medical Technology and Respiratory Therapy - Capella University - Chamberlain University - The College of New Jersey - Drexel University - Indiana State University - Jersey Shore Medical Center for Outreach Renal Dialysis Service - Kean University - Mercer County Community College - Middlesex County College - Monmouth County Vocational School - Monmouth-Ocean hospital shared service association - Monmouth University - National Network of Libraries of Medicine - Neumann College - New Jersey City University - Rowan College at Burlington County - Rutgers University - Saint Elizabeth College School of Nutrition and Home Economics - Saint Francis Medical Center School of Nursing - Pennsylvania State University - Stockton University - Thomas Edison State College: School of Nursing - University of Medicine and Dentistry of New Jersey - Newark - University of Medicine and Dentistry of New Jersey - School of Health-Related Professionals in Camden and Lean - Southern New Hampshire University - Union County College - University of Delaware - University of Scranton - Wagner University Member of --------- - American Association of Homes and Services for the Aging - American Hospital Association - American Society of Clinical Pathology - Consortium of Multiple Sclerosis Centers - National Disaster Medical System - National Lymphedema Network - National Multiple Sclerosis Society - New Jersey Association of Mental Health Agencies - New Jersey Association of Nonprofit Homes for the Aging - New Jersey Hospital Association - New Jersey Society of Health System Pharmacists - Schizophrenia Foundation of New Jersey Laboratory Certified By ----------------------- - American College of Clinical Pathologists Nursing ------- - Credentialing Center (ANCC) of the American Nurses Association. - CSMC is an approved provider of continuing education by the New Jersey State Nurses Association, provider number: p102-9/2001-2003. NJNSA is accredited by the ANCC Commission on Accreditation of the American Nurses' Association. Licensed By ----------- - New Jersey Department of Health Approved By ----------- - American Dental Association for Continuing Medical Education - American Medical Association for continuing Medical Education Specialized Services ==================== CSMC offers a full range of clinical and diagnostic services to meet the diverse healthcare needs of the growing communities we serve. Cardiac Services ---------------- Services and programs include: the Thomas J. Blanchet Cardiac diagnostic Center, cardiac catheterization lab, cardiac rehabilitation center and the Gloria Saker Women's Heart Program. Statesir Cancer Center ---------------------- CSMC's multidisciplinary, integrated approach to cancer treatment ensures that our patients receive compassionate care and support-medical, educational, emotional and spiritual. CSMC is accredited by the American College of Surgeons Commission on cancer (COC) as well as the national accreditation program for breast centers (NAPBC), the American College of Radiology (ACR) for radiation oncology, diagnostic Radiology and mammography. CentraState has been designated as a Breast Imaging Center of Excellence (BICOE) and a Diagnostic Imaging Center of Excellence (DICOE). Services include: - cancer navigator program - cancer rehabilitation - clinical trials - colorectal cancer program (robotic surgery) - comprehensive breast care program - comprehensive lung program - infusion therapy services - lymphedema center - medical oncology - chemotherapy and immunotherapy services - palliative/hospice services - prostate cancer program (robotic surgery) - radiation oncology (including IMRT, IGRT, radiosurgery, HDR, cone beam therapy) - genetic testing and counseling - surgical oncology program Critical Care Unit ------------------ Our unit offers enhanced infection control features such as electronic privacy panels and a dedicated air filtration system that helps to contain infectious conditions. Emergency Services Department ----------------------------- Our goal is for you to see a nurse within 15 minutes and a clinician within 30 minutes. The ED also offers 24/7 pediatric emergency coverage and is designated as an advanced primary stroke center by the Joint Commission and the New Jersey Department of Health. Statesir Family Acute Care for Elders Unit ------------------------------------------ This unit helps senior patients recover from illness or injury by providing quality, safe, and seamless care. The ace unit is comprised of dedicated and trained health care professionals who provide support and information to patients and family to return home, avoid complications, and possibly prevent future hospitalizations. Our goal is to help patients stay strong, mobile, and independent while providing the best possible care. Laboratory ---------- The laboratory is accredited by the American College of Clinical Pathologists and the American Association of Blood Banks. It is conveniently located near outpatient registry and offers state-of-the-art technology. Maternity --------- CSMC's maternity unit allows mothers to experience labor, delivery, and recovery in a warm, private, home-like room equipped for normal and complicated deliveries. After delivery, when mothers and their newborns are ready, they are moved to a private suite in the First Impressions Maternity Pavilion, dedicated to postpartum care. CSMC also has a special care nursery which provides premature babies with treatment and care by a team of trained professionals. All special needs are met 24 hours a day under the supervision of a neonatologist. The facility is designated by the state as a community perinatal center intermediate and has received the IBCLC care award from the international board of lactation consultant examiners (IBLCE) and the international lactation consultant association (ILCA) for hiring international board-certified lactation consultants (IBCLCS). Pediatrics ---------- CSMC's pediatric department emphasizes family-centered care, with 24-hour visitation for parents. The patient rooms include beds for parents or guardians who wish to stay overnight and play areas for children. Psychiatric Services -------------------- Offers an inpatient unit that provides care for those needing acute psychiatric/mental healthcare, 24-hour psychiatric emergency assessments through the emergency room, and a 24-hour crisis hotline. Electroconvulsive therapy (ECT services are also available on an outpatient or inpatient basis.
CORE FORM, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	Orthopedics ----------- Programs and services include: the Total Joint Center of New Jersey for knee/hip repair and replacement; shoulder repair and replacement; hand and foot surgery; the Spine Institute of Central Jersey and non-surgical therapies for other orthopedic problems. The Total Joint Center of New Jersey is accredited by the Joint Commission. Outpatient Nutrition Center --------------------------- Offers individual nutrition counseling with a registered dietitian for children and adults. Includes counseling sessions for weight management, cardiac, renal, hepatic, gastrointestinal problems, and others. Radiology --------- Capabilities include x-ray, ultrasound, computed tomography (CT) scan and nuclear medicine. Princeton radiology associates also houses a positron emission tomography (pet)/CT scanner for diagnosing cancer and other diseases or conditions, and an open bore MRI. OceanFirst Rehabilitation Center -------------------------------- Our fully equipped center offers physical, occupational and speech therapy. Inpatient and outpatient services are offered daily. Specialized services include: Linda E. Cardinale MS Center, Central Jersey Wound Treatment Center with lymphedema program, continence program, swallowing disorder therapy, sports medicine and aquatic therapy, including a hydroworx pool. Progressive Care Unit --------------------- This unit treats heart failure patients, as well as transitions patients from the critical care unit. Following a hospital discharge, a registered nurse health coach is available to work with patients to help them become more knowledgeable and independent in managing diet, medications and lifestyle changes. Patients also learn how to most effectively work with their primary care provider for continued support. Additional support includes a free nurse advice. Patients can call the nurse advice line and speak to our cardiac coordinator for answers and help with any needs the heart failure patient may have. Core Form, Part III, Statement of Program Service Accomplishments Short stay unit --------------- A short stay unit is available for patients who do not require an overnight stay. Our same day surgery center performs a variety of surgical and endoscopy procedures on a medical outpatient basis. Surgical Services ----------------- CSMC's surgical services are delivered in state-of-the-art facilities by highly trained physicians and nurses. Patients receive comprehensive surgical support for diagnostic, therapeutic and palliative intervention in the following areas: general surgery, bariatric surgery, breast, colorectal, endovascular surgery, gastrointestinal surgery, neurosurgery, obstetrics/gynecology, ophthalmology, ear, nose and throat, orthopedics (including knee and hip replacements at the Total Joint Center of New Jersey at CSMC), plastic, podiatric, and thoracic surgery. The Star and Barry Tobias Women's Health Center ----------------------------------------------- Offers screenings, digital mammograms, computer-aided detection (cad), ultrasound mammotone biopsy, stereotactic needle biopsy, health education, bone densitometry, and individualized health counseling on a number of topics for women. The center is certified by the American college of radiology; has been named a breast imaging center of excellence for providing high-quality mammograms and other services; and has been named a pink ribbon facility by Hologic for providing excellence in breast health. Specialized Centers and Other Services -------------------------------------- CSMC offers specialized diagnostic and treatment services at its center for sleep disorders and comprehensive lung program. Other specialty services include respiratory therapy for pulmonary diagnostic procedures and rehabilitation, and oncology services, including chemotherapy, support groups and hemodialysis, podiatric services, pain management, and palliative care. Freehold Family Health Center ----------------------------- The Freehold Family Health Center is a unique collaborative initiative with the Visiting Nurse Association (VNA) Health Group, VNACJ Community Health Center, inc. (CHS and Rutgers Robert Wood Johnson Medical School through the Family Medicine Residency Program at CSMC. The facility is accessible to all members of the community, including underserved populations. Bilingual staff are available to assist with all services. Services include: - comprehensive primary and specialty care, including geriatrics, prenatal and behavioral health services; - community health programs such as WIC; - programming by the county councils for young children; and - cancer education and early detection programs. Community-based Programs ======================== Good Stewardship Through Solar ------------------------------ CSMC recently celebrated the completion of a solar carport installation in parking areas around the medical center and ambulatory campus, this installment, in combination with the solar farm at the back of the property, will allow CSC to generate approximately 61 percent of its electric consumption and achieve savings of approximately a half million dollars in energy costs each year, reducing its carbon footprint and the impact on Freehold Township's electrical grid. The carports and solar farm were installed by KDC Solar, a Bedminster-based developer, owner, and operator of solar power facilities. CSMC is the only hospital in the state with a solar installation of this size. It now produces the largest percentage of solar power of any hospital in New Jersey. The combined projects will offset greenhouse gases equivalent to: - 1,026,153 gallons of gas used. - 22,296,869 miles of vehicle traffic. - 1.162 billion smartphones charged. - 9,969,586 pounds of coal burned. - 1,590 homes supplied with electricity for one year. Community Health Outreach ========================= - People throughout the community used CentraState's Live Life Well services more than 55,000 times to enhance their health and manage or prevent chronic conditions through a variety of wellness offerings. - A total of 11,000 people attended health and wellness fairs, sessions, and screenings throughout the year. -Approximately 80,964 people received COVID vaccines. - More than 440 people attended cancer health lectures and screenings, including those for prostate, colorectal, oral, skin, breast, and thyroid cancers. - CSMC provided nearly 2,164 diabetes education encounters to help people manage or reduce their risk of diabetes. - More than 400 people benefited from the peer support of several CSMC support groups. - New and future parents attended more than 330 maternity and well-baby sessions to ensure healthy beginnings for the newest members of our community. - CSMC educated more than 1,350 students about health issues and health careers as a profession. This included summer camps as well as student health awareness center programs that help young people lead healthier lives and prepare to be healthier adults. - More than 2,000 people received life-saving CPR training, including basic life support, advanced life support, and pediatric advanced life support. - The Family Medicine Residency Program, which trains physicians of the future and provides medical care to those unable to pay for their care or who pay a rate that is below market value, served nearly 12,000 patients visits.
CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7	CENTRASTATE HEALTHCARE SYSTEM, INC. ("CSHS") IS THE SOLE MEMBER OF THIS ORGANIZATION. CSHS 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 CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CENTRASTATE HEALTHCARE SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING OF THE FEDERAL FORM 990 WITH THE INTERNAL REVENUE SERVICE ("IRS") AND AFTER PRESENTATION AND REVIEW BY CENTRASTATE HEALTHCARE SYSTEM, INC.'S AUDIT COMMITTEE. AS PART OF THE TAX RETURN PREPARATION PROCESS THE ORGANIZATION 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 ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP OF THE ORGANIZATION 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 ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL AND 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 ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. FOLLOWING THIS REVIEW, THE FINAL FORM 990 WAS PRESENTED TO THE MEMBERS OF CENTRASTATE HEALTHCARE SYSTEM'S AUDIT COMMITTEE FOR REVIEW AND THEREAFTER PROVIDED TO EACH VOTING MEMBER OF THIS ORGANIZATION'S GOVERNING BODY PRIOR TO FILING WITH THE IRS.
CORE FORM, PART VI, SECTION B; QUESTION 12	ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED ANNUALLY, TO REVIEW THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH IS SUBMITTED TO CORPORATE COUNSEL. CORPORATE COUNSEL REVIEWS EACH COMPLETED QUESTIONNAIRE AND PREPARES A REPORT, WHICH IS SHARED WITH THE BOARD OF TRUSTEES GOVERNANCE COMMITTEE AND, ULTIMATELY, THE BOARD OF TRUSTEES. THE POLICY IS ENFORCED, AS NEEDED, DEPENDING ON THE CIRCUMSTANCES - FOR EXAMPLE, THROUGH RECUSAL FROM VOTING, DIVESTITURE OF CONFLICTING PROPERTY INTERESTS OR, IN CERTAIN PAST CASES, RESIGNATION FROM THE BOARD OF TRUSTEES.
CORE FORM, PART VI, SECTION B; QUESTION 15	THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION SUB-COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE 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. IN 2021, THE EXECUTIVE COMPENSATION SUB-COMMITTEE REPORTED TO THE FULL BOARD FOR RATIFICATION. 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, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. 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 SIMILARLY SIZED HEALTHCARE SYSTEMS AND HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. IN ADDITION, THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION ADJUSTMENTS BASED ON MARKET SURVEYS DEVELOPED BY INDEPENDENT CONSULTANTS, INDUSTRY AVERAGE COMPARISON, YEARS OF SERVICE AND OTHER EXEMPT ORGANIZATIONS IN THE GEOGRAPHIC AREA. AFTER A REVIEW OF THE INDIVIDUAL'S PERFORMANCE FOR THE YEAR AND RELYING ON COMPARABLE INFORMATION AND OTHER OBJECTIVE DATA, THE EXECUTIVE COMMITTEE WILL RECOMMEND AN ADJUSTMENT TO THE INDIVIDUAL'S COMPENSATION. ANY DETERMINATIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE EXECUTIVE COMMITTEE MINUTES. 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 APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING, BUT NOT LIMITED TO, THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE CENTRASTATE HEALTHCARE SYSTEM, INC.'S 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 18	Pursuant to state of New Jersey P.L. 2019, chapter 513, (which was effective on July 21, 2020), and amended P.L. 2008, chapter 58 (C.26: 2H-5.1b), this organization has posted on its internet website a copy of this Internal Revenue Service (IRS) Form 990 and all schedules and supporting documentation required to be submitted to the IRS in conjunction with the Form 990 with the exception of those schedules not open for public inspection. Said Form 990 was posted by the organization after filing its Form 990 with the IRS.
CORE FORM, PART VI, SECTION C; QUESTION 19	THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY.
CORE FORM, PART VII AND SCHEDULE J	CORE FORM, PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THIS ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES. John T. Gribbin is an officer and member of this organization's board of trustees; an uncompensated position. Mr. Gribbin is employed and receives a federal form w-2 from this organization. Accordingly, his common law employer/employee relationship is with CentraState Medical Center, Inc. (ein: 22-1750190). This organization filed a 2021 federal form 4720 which included a remittance of excise tax related to his compensation in excess of $1m.
CORE FORM, PART VII, SECTION A, COLUMN B	THIS ORGANIZATION IS AN AFFILIATE WITHIN THE CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM INCLUDES BOTH FOR-PROFIT AND NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF TRUSTEE MEMBERS, OFFICERS AND/OR DIRECTORS LISTED 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, REPRESENT 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 IN CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON 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 CENTRASTATE HEALTHCARE SYSTEM, INC.; NOT SOLELY THIS ORGANIZATION.
CORE FORM, PART XI; LINE 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDES: - CHANGE IN BENEFICIAL INTEREST IN CENTRASTATE HEALTHCARE FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $665,627.
CORE FORM, PART XII; QUESTION 2	THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CENTRASTATE HEALTHCARE SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CENTRASTATE HEALTHCARE SYSTEM, INC. AND ALL ENTITIES WITHIN THE SYSTEM FOR THE YEARS ENDED DECEMBER 31, 2021 AND DECEMBER 31, 2020; 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.
CORE FORM, PART XII; QUESTION 3	THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND ISSUE A SYSTEM WIDE CONSOLIDATED AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AUDIT. THIS ORGANIZATION WAS INCLUDED IN THE SYSTEM WIDE A-133 AUDIT.
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:25956478
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:16023136
FORM 990 PART IX LINE 11G	DESCRIPTION:BILLING & COLLECTION FEES TOTAL FEES:2755983
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING FEES TOTAL FEES:2750500
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:193529
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES TOTAL FEES:1583939

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CENTRASTATE MEDICAL CENTER'S MISSION IS TO ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES THROUGH THE COMPASSIONATE DELIVERY OF QUALITY HEALTHCARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,407
6	Total number of volunteers (estimate if necessary) .............	6	174
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	304,179
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	37,176,954	21,028,284
9	Program service revenue (Part VIII, line 2g) .........	258,223,880	314,406,553
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,911,808	10,412,685
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,291,505	2,949,598
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	305,604,147	348,797,120
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,515	2,693
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)	147,390,489	155,882,906
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)....	152,170,836	187,618,871
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	299,562,840	343,504,470
19	Revenue less expenses. Subtract line 18 from line 12.......	6,041,307	5,292,650
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	428,867,890	417,960,014
21	Total liabilities (Part X, line 26).............	198,755,982	182,297,901
22	Net assets or fund balances. Subtract line 21 from line 20.....	230,111,908	235,662,113

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 309,154,291 including grants of $ 2,693 ) (Revenue $ 315,140,594 )
	EXPENSES INCURRED IN PROVIDING INPATIENT, OUTPATIENT, EMERGENCY AND VARIOUS OTHER MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND IN FURTHERANCE OF CHARITABLE TAX-EXEMPT PURPOSES. PLEASE REFER TO THE COMMUNITY BENEFIT STATEMENT IN SCHEDULE O.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses309,154,291

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,201,071	198,612	714,935

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,192,435
e	Government grants (contributions)		1e	19,835,849

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

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

h Total. Add lines 1a-1f.......		21,028,284

		Business Code
2a	NET PATIENT SERVICE REVENUE	621990	305,870,121	305,870,121
b	OTHER HEALTHCARE RELATED REVENUE	621990	8,536,432	8,536,432
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		314,406,553

3 Investment income (including dividends, interest, and othersimilar amounts) ......			6,414,153		0	6,414,153
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		2,519,736	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	2,519,736	6c
d	Net rental income or (loss).......			2,519,736		304,179	2,215,557
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		78,510,630	7a
b	Less: cost or other basis and sales expenses		74,512,098	7b
c	Gain or (loss)		3,998,532	7c
d	Net gain or (loss).........			3,998,532			3,998,532
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 INCOME		621990	429,862	429,862
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			429,862
12	Total revenue. See instructions.....			348,797,120	314,836,415	304,179	12,628,242

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,693	2,693
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
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 ...........	6,237,859	5,614,074	623,785
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........	119,031,893	107,128,703	11,903,190
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,734,276	5,160,848	573,428
9	Other employee benefits .......	16,020,507	14,418,456	1,602,051
10	Payroll taxes ...........	8,858,371	7,972,534	885,837
11	Fees for services (non-employees):
a	Management ......	249,586	224,627	24,959
b	Legal .........	415,967	374,371	41,596
c	Accounting ...........	654,766	589,289	65,477
d	Lobbying ...........	20,434	18,391	2,043
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	370,132	333,119	37,013
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	49,263,565	44,337,208	4,926,357	0
12	Advertising and promotion ....	2,391,399	2,152,259	239,140
13	Office expenses .......	12,202,395	10,982,155	1,220,240
14	Information technology ......	4,114,211	3,702,790	411,421
15	Royalties ..	0
16	Occupancy ...........	7,747,238	6,972,514	774,724
17	Travel ............	44,194	39,775	4,419
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	2,196,997	1,977,297	219,700
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	13,081,953	11,773,758	1,308,195
23	Insurance ...	2,206,511	1,985,860	220,651
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	75,554,176	67,998,758	7,555,418
b	REPAIRS & MAINTENANCE	4,699,606	4,229,645	469,961
c	PURCHASED SERVICES	4,041,843	3,637,659	404,184
d	FOOD COSTS	1,983,249	1,784,924	198,325
e	All other expenses	6,380,649	5,742,584	638,065
25	Total functional expenses. Add lines 1 through 24e	343,504,470	309,154,291	34,350,179	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 ........			19,024,572	1	13,768,100
2	Savings and temporary cash investments .........			15,235,005	2	14,772,162
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			25,372,209	4	29,761,749
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	0
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 ............			3,722,276	8	3,020,658
9	Prepaid expenses and deferred charges ......			3,947,205	9	3,370,246
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	363,862,005
b	Less: accumulated depreciation	10b	219,305,637	130,218,634	10c	144,556,368
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 ..			206,838,274	13	182,700,703
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			24,509,715	15	26,010,028
16	Total assets. Add lines 1 through 15 (must equal line 33)...			428,867,890	16	417,960,014

17	Accounts payable and accrued expenses .....	47,888,802	17	48,093,151
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	58,033,026	20	53,972,420
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 ..	30,660,960	23	29,228,177
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	62,173,194	25	51,004,153
26	Total liabilities. Add lines 17 through 25..	198,755,982	26	182,297,901

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	212,098,020	27	215,857,150
28	Net assets with donor restrictions ...........	18,013,888	28	19,804,963
	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 ...........	230,111,908	32	235,662,113
33	Total liabilities and net assets/fund balances ........	428,867,890	33	417,960,014

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No

(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)CENTER FOR AGING INC 901 WEST MAIN STREET FREEHOLD,NJ07728 22-2575377	HEALTH SVCS.	NJ	501(C)(3)	509(A)(2)	CSHS		No
(2)CENTRASTATE ASSISTED LIVING INC 901 WEST MAIN STREET FREEHOLD,NJ07728 22-3520730	HEALTH SVCS.	NJ	501(C)(3)	509(A)(2)	CSHS		No
(3)HEALTHCARE AFFILIATES INC 901 WEST MAIN STREET FREEHOLD,NJ07728 52-1594300	HEALTH SVCS.	NJ	501(C)(3)	509(A)(2)	CSHS		No
(4)CENTRASTATE HEALTHCARE SYSTEM INC 901 WEST MAIN STREET FREEHOLD,NJ07728 22-2482803	MANAGEMENT	NJ	501(C)(3)	509(A)(3)	NA		No
(5)CENTRASTATE HEALTHCARE FOUNDATION INC 901 WEST MAIN STREET FREEHOLD,NJ07728 27-2383065	FUNDRAISING	NJ	501(C)(3)	509(A)(1)	CSHS		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, 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