2022-11-10T13:01:03-06:00 2021-12-31 346565596 Ernst & Young US LLP 1 Manhattan West New York NY 10001 990 2021-01-01 223392808 Foundation for Morristown Medical Center FOUN 9735932400 475 South Street Morristown NJ 07960 Kevin Lenahan EVP, Chief Bus & Strategy Officer 9735932400 2022-11-10 1 Kevin Lenahan XXX-XX-XXXX Nicole Sokolowski P01683199 2127733000 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Kevin Lenahan 475 South Street Morristown NJ 07960 35869455 0 X www.f4mmc.org X 501c3 1995 NJ Refer to Schedule OThe Foundation for Morristown Medical Center is a not-for-profit fundraising organization which solicits funds in its general appeal to support both Morristown Medical Center, which is a division of AHS Hospital Corporation, and the community as the Foundation's Board may deem appropriate. 36 29 0 140 6969 0 19322498 24250715 0 0 7348783 7307165 0 -46700 26671281 31511180 7814776 7231000 0 0 3307097 3062011 371572 328861 2906161 763430 1110102 12256875 11731974 14414406 19779206 172014542 194034598 4575705 4356862 167438837 189677736 X To inspire community philanthropy to advance exceptional health care for patients at Morristown Medical Center. The objective is to use philanthropy to preserve and expand the Medical Center's programs and services in patient care, clinical research, medical and public health education, and preventive medicine. 0 0 7231000 7231000 0 The Foundation for Morristown Medical Center (F4MMC) is a standalone foundation, which is a not-for-profit fundraising organization that solicits funds in its general appeal for the benefit and support of Atlantic Health System, Inc. and AHS Hospital Corporation (the Corporation), and all subsidiaries thereof. Morristown Medical Center is the principal recipient of the fundraising carried out by F4MMC. 7231000 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 36 29 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ NY PA FL X X Ken Butkowski 9734512005 475 South Street Morristown NJ 07960 Andrew Rooke Jr Trustee 2.00 X 0 0 0 Anthony A Lombardo Trustee 2.00 X 0 0 0 Anu Gupta Trustee 2.00 X 0 0 0 Brenda Matti-Orozco MD FACP Trustee 2.00 55.00 X 0 381285 25491 Jason Smith MD Trustee 2.00 55.00 X 0 767318 27291 Carol S Jones MSN RN Trustee 2.00 55.00 X 0 479869 49691 Chirag Patel Trustee 2.00 X 0 0 0 Christine Gilfillan Trustee 2.00 X 0 0 0 David Taylor MD Trustee 2.00 X 0 0 0 Eric Whitman MD Trustee 2.00 55.00 X 0 945141 29103 Fran Davino Trustee 2.00 X 0 0 0 Glenn Yarnis Trustee 2.00 X 0 0 0 Harvey Gerhard MD Trustee 2.00 X 0 0 0 James Slater MD Trustee 2.00 X 0 0 0 J Peter Simon Trustee 55.00 X 0 0 0 John Jack Burke III Trustee 2.00 X 0 0 0 Joseph C Graff Trustee-Treasurer 2.00 X 0 0 0 Juliet Patsalos-Fox Trustee 2.00 X 0 0 0 Katie Nolle Trustee 2.00 X 0 0 0 Kelly Sturman Trustee 2.00 X 0 0 0 Keerti Sharma MD Trustee 2.00 55.00 X 0 288511 30841 Keith Richardson Trustee 2.00 X 0 0 0 Linda Gillam MD Trustee 2.00 55.00 X 0 1098844 19216 Lori Ingber PHD Trustee-Secretary 2.00 X X 0 0 0 Marc Adee Trustee-Vice Chairman 2.00 X 0 0 0 Marianne Ehinger Trustee 2.00 X 0 0 0 Mary Anne Wood Trustee 2.00 X 0 0 0 Mary Courtemanche Trustee 2.00 X 0 0 0 Patricia O'Keefe SVP, CNE/Pres. MMC 2.00 55.00 X X 0 1693445 203375 Richard P Goryeb Trustee 2.00 X 0 0 0 Robert Tafaro - Chairman Trustee 2.00 X X 0 0 0 Thomas P Mac Mahon Trustee 2.00 X 0 0 0 W Rodman Ryan Trustee 2.00 X 0 0 0 Walter Lewis MD Trustee 2.00 X 0 0 0 William D Bruen Jr Trustee 2.00 X 0 0 0 William Marino Trustee 2.00 X 0 0 0 Cynthia W O'Donnell Director of Gift Planning 55.00 X 0 201022 37839 Kevin Lenahan EVP-Chief Business and Strategy Officer 2.00 55.00 X 0 2093426 464680 Jennifer Smith Chief Development Offier 55.00 X 0 417981 22912 0 8366842 910439 0 0 1 0 0 220450 480053 23550212 483438 24250715 7059336 6969 7052367 4466404 4218575 247829 247829 247829 93000 220450 139700 -46700 -46700 31511180 0 6969 7253496 7231000 7231000 2469363 1002606 1466757 592648 240626 352022 2250 2250 24000 24000 328861 328861 354255 61315 292940 396599 396599 78269 31779 46490 182592 182592 20408 8286 12122 17458 7088 10370 34271 34271 11731974 7231000 1594813 2906161 13454760 12327151 78110616 93525619 74320504 81752755 3209605 3507708 2919057 2921365 172014542 194034598 2299757 2201934 2275948 2154928 4575705 4356862 X 50612631 59394744 116826206 130282992 167438837 189677736 172014542 194034598 X 19779206 11222858 -8763165 X 0 1 X 1 0 X 16834955 17626509 20125139 19322498 24250715 98159816 16834955 17626509 20125139 19322498 24250715 98159816 5966100 92193716 3741083 4580004 7704855 6456681 7052367 29534990 8148 215 6969 15332 127710138 0.72190 0.72590 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 116826206 22328654 5936231 14808099 130282992 112624515 17076307 4358410 17233023 116826206 108868955 18661526 7177359 22083325 112624515 112948519 16130639 -2259437 17950766 108868955 98294270 23068070 8012241 16426062 112948519 0.00000 0.35000 0.65000 0 0 0 Annuities Payable 2154928 2154928 31650880 11222858 139700 11362558 20288322 11222858 11222858 31511180 11871674 139700 139700 11731974 0 11731974 Part V, Line 4: Specific purposes of the Corporation shall be to provide grants and gifts to other 501(c)(3) organizations to pursue their charitable, scientific and educational purposes, which grants and gifts may be restricted to specific purposes or may be for the general operating funds of the organization in the discretion of the Board of Trustees of the Corporation. In particular, the Corporation shall make grants and gifts for the benefit and support of ATLANTIC HEALTH SYSTEM, INC. and AHS HOSPITAL CORP., all subsidiaries thereof, with the principal beneficiary of the Corporation to be Morristown Medical Center, Morristown, NJ, organizations described in 501(c)(3) of the Code which are exempt from Federal income tax pursuant to 501(a) of the Code, and which qualify pursuant to 170(c) of the Code, and to further the charitable, educational and scientific purposes of ATLANTIC HEALTH SYSTEM, INC. and AHS HOSPITAL CORP. (hereinafter referred to collectively as the "AHS"), including but not limited to the receiving of contributions and the use thereof to or for the benefit of AHS ; carrying on fundraising activities for the benefit of the Supported Organization, and the distribution of net income and any excess contributions to the AHS, and the distribution of net income and any excess contributions to AHS. Part XI, Line 2d - Other Adjustments: Event Expenses - Netted in Statement of Revenue - Part VIII 139,700. Part XI, Line 4b - Other Adjustments: Net unrealized gains on investment 11,222,858. Part XII, Line 2d - Other Adjustments: Event Expenses - Netted in Statement of Revenue - Part VIII 139,700. X X 1 Phonathon 455 NW 35th St Ste 104 Boca Raton FL 33431 Mail/Phone 0 864007 328861 536433 864007 328861 536433 NJ NY PA FL DE F4MMC Golf Classic 313450 220450 93000 128333 11367 313450 220450 93000 128333 11367 139700 -46700 1 Morristown Medical Center-Divison of AHS 100 Madison Avenue Morristown NJ 07960 521958352 501(c)(3) 8979963 0 Program Services. 1 0 Part I, Line 2: The organization conducts due diligence to review and select grant recipients and is comfortable that the grants are used for their intended purposes. The grants issued were made to related organizations to further their tax-exempt purposes. 0 1 0 0 0 0 0 0 0 Kevin Lenahan EVP-Chief Business and Strategy Offi 0 1107938 0 964080 0 21408 0 449632 0 15048 0 2558106 0 0 Patricia O'Keefe SVP, CNE/Pres. MMC 0 836963 0 704084 0 152398 0 190548 0 12827 0 1896820 0 112190 Linda Gillam MD Trustee 0 700120 0 56250 0 342474 0 10150 0 9066 0 1118060 0 0 Eric Whitman MD Trustee 0 748242 0 76250 0 120649 0 26100 0 3003 0 974244 0 0 Jason Smith MD Trustee 0 466903 0 300415 0 0 0 8600 0 18691 0 794609 0 0 Carol S Jones MSN RN Trustee 0 362681 0 110130 0 7058 0 37050 0 12641 0 529560 0 0 Jennifer Smith Chief Development Offier 0 387823 0 30158 0 0 0 1374 0 21538 0 440893 0 0 Brenda Matti-Orozco MD FACP Trustee 0 333002 0 0 0 48283 0 10050 0 15441 0 406776 0 0 Keerti Sharma MD Trustee 0 270572 0 3821 0 14118 0 10150 0 20691 0 319352 0 0 Cynthia W O'Donnell Director of Gift Planning 0 197116 0 3906 0 0 0 22398 0 15441 0 238861 0 0 Part I, Line 4b 2021 Supplemental Executive Retirement Plan (SERP) Earned Credits Atlantic Health implemented a non-qualified Supplemental Executive Retirement Plan (SERP) paid entirely by Atlantic Health System. The SERP is provided to individuals that hold an executive position with Atlantic Health System. The SERP is in addition to benefits provided under the Atlantic Health System 403(b) and the Cash Balance plan if hired prior to December 15, 2013. During 2021, the following Trustee received SERP credits: Patricia O'Keefe 190,548 The above amounts represent earned credits which have not vested and were not included in the respective 2021 W-2 compensation. However, the earned credits were included as Other Compensation in Column (F) of Part VII and in Schedule J, Column (C) of the 2021 IRS 990 tax return per IRS guidance. Once the Trustee meets the applicable vesting criteria of the plan, the SERP credits will be included as taxable compensation in their respective Form W-2 of that year. 2021 Supplemental Executive Retirement Plan (SERP)Taxable Distributions The following Trustee received taxable SERP distributions during 2021 based on the vesting criteria of the plan document. These taxable SERP distributions were included in the Trustee's 2021 W-2 and reported in Other Reportable Compensation in Schedule J (Sch J, (B)(ii))of the this IRS 990: Patricia O'Keefe 112,190 X 2277 Sale of comp property X 11 372675 Sale of comp property X COVID Related 1 91341 Sale of comp propert X Gift Cards 11 13975 Cash value of cards X Toys 8 3170 Sale of comp propert 0 1 0 Part I, Column (b): The amounts in Part I, column (b) represent the number of different contributions for each category. Form 990, Part VI, Section A, line 6 As per the bylaws, each of the entities has one "member", that being Atlantic Health System, Inc. There are no other members or classes of membership whatsoever as indicated in the bylaws. Atlantic Health System, Inc. is the sole member of this organization. Atlantic Health System, Inc. has the right to elect the members of this organization's board of trustees and has certain reserved powers as outlined in the organiztion's bylaws. Form 990, Part VI, Section A, line 7a Atlantic Health System, Inc. is the only "member" that wholly owns the Foundation for Morristown Medical Center. As a result, Atlantic Health System, Inc. may elect the members of the governing bodies for each of the entities. Form 990, Part VI, Section A, line 7b Atlantic Health System, Inc. is the only "member" that wholly owns the Foundation for Morristown Medical Center. As a result, Atlantic Health System, Inc. approves the decisions of the governing bodies. Form 990, Part VI, Section B, line 11b The final draft of the Form 990 was distributed to the "Accounting Sub-Committee" for their review. The "Accounting Sub-Committee" will then present the Form 990 to the Financial Oversight Committee who will then present the Form 990 to the Board of Directors. Form 990, Part VI, Section B, line 12c We require disclosure of potential conflicts. This policy governs all personnel at Atlantic, including Board Members. Additionally, the Board Committee members must fill out annual disclosures with specific questions regarding potential conflicts. For potential conflicts involving employees, conflicts involving business relationships require prior disclosure and approval by the Compliance Officer (General Counsel). Conflicts involving Board members require approval from the Compliance Officer and the head of the Audit Committee, who may refer those conflicts to the Compliance Committee of the Board. Restrictions are fact-dependent, but may include recusal from deliberations regarding subject matter affected by the conflict. Form 990, Part VI, Section B, line 15 A review of officer compensation by an independent 3rd party (Sullivan Cotter)is completed every year. The most recent survey was conducted in 2021. Officers reviewed include: President and Chief Executive Officer; EVP, Integrated Service Delivery & CEO, Hospital Division EVP, Chief Business and Strategy Officer EVP, Chief Physician Executive SVP, Chief Clinical Officer EVP, Chief Administrative Officer SVP, President, OMC SVP, CNE/President, MMC SVP, President, Western Region SVP, President, CMC SVP, Chief Information Officer VP, Clinical Intelligence EVP, General Counsel VP, AHS, President ACO VP, COO Atlantic Medical Group VP, Ambulatory Services VP, Insurance Networks VP, Physician Enterprise Strategy VP, Compliance and Audit VP, Finance VP, Revenue Cycle VP, Facilities VP, Government & Public Affairs VP, Service Lines VP, Integrated Care VP, Marketing & Communications VP, Chief Diversity Officer VP, Chief Strategy Officer VP, Quality & Patient Safety EVP, Chief Health System Officer VP, Human Resources SVP, Chief Financial Officer On behalf of Atlantic Health, Sullivan Cotter conducts an annual total compensation survey based on appropriate comparability data for like positions in like organizations. The results of the survey are presented to the Executive Committee of the board which documents the findings and recommendations in committee minutes. Compensation for key physicians is determined by soliciting salary data from published sources. These salary recommendations are then approved by the Executive Committee of the board. Form 990, Part VI, Section C, line 18 Currently the Foundation for Morristown Medical Center retains copies of the filed Form 990 for the last three years and Form 1023 with the most senior management's assistant. Public disclosure of these Form 990 can be made at any time at each of the organization's sites. In addition, the Form 990 is posted on the website "www.foundationcenter.org and "guidestar.org". Form 990, Part VI, Section C, line 19 The organization does not currently make its financial statements open to public disclosure, but the statement of financial position is available by accessing the Form 990 from the website. The governing documents and conflict of interest polices are not currently made available to the public. Form 990, Part XI, line 9: Distributions to Morristown Division-Capital -8,979,963. Beneficial Interest in Charitable Remainder Unitrust 216,798. AHS Hospital Corp 475 South Street Morristown NJ 07960 521958352 Healthcare NJ 501(c)(3) Line 3 Atlantic Health System Inc 1 Atlantic Ambulance Corporation 475 South Street Morristown NJ 07960 223820288 Healthcare Transportation NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 Atlantic Health System Inc 475 South Street Morristown NJ 07960 223380375 Human Health through AHS Hospital Corp. NJ 501(c)(3) Line 12a, I N/A 0 Newton Medical Center Foundation 175 High Street Newton NJ 07860 222618102 Administers donations, grants and bequests and performs fundraising NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Prime Care Inc 175 High Street Newton NJ 07860 222759566 Provides home health and other healthcare services NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 North Jersey Health Care Properties Inc 175 High Street Newton NJ 07860 223519709 Owns commercial buildings and conducts leasing activities NJ 501(c)(2) Atlantic Health System Inc 1 Practice Associates Medical Group 475 South Street Morristown NJ 07960 202088165 Physician Services NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Chilton Memorial Corporation 97 West Parkway Pompton Plains NJ 07444 222719339 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Chilton Medical Center Auxiliary Inc 97 West Parkway Pompton Plains NJ 07444 222883605 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Chilton Medical Center Foundation Inc 97 West Parkway Pompton Plains NJ 07444 223084817 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Chilton Realty Holding Inc 97 West Parkway Pompton Plains NJ 07444 223067739 Real Estate and Leasing Activities for the Benefit of Exempt Organization NJ 501(c)(2) Atlantic Health System Inc 1 Foundation for Hackettstown Medical Center 651 Willow Grove Street Hackettstown NJ 07840 226106281 Fundraising for Hackettstown Medical Center NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Medical Center Partners Inc 651 Willow Grove Street Hackettstown NJ 07840 454789273 Physician Services NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Hackettstown Regional Medical Center Emergency Services Inc 651 Willow Grove Street Hackettstown NJ 07840 270820164 Ambulance Services NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Adult Day Center of the Visiting Nurse Association of Somerset County 200 Mount Airy Rd Basking Ridge NJ 07920 222865641 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visting Nurse Association of Somerset Hills Community Health Services Inc 200 Mount Airy Rd Basking Ridge NJ 07920 223413041 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visiting Nurse Assoc of Somerset Hills Home Health and Hospice ServicesInc 200 Mount Airy Rd Basking Ridge NJ 07920 221487373 Home health and hospice services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visting Nurse Association of Somerset Hills Inc 200 Mount Airy Rd Basking Ridge NJ 07920 222888648 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Morris Photopheresis 100 Madison Avenue Morristown NJ 07960 223314012 Healthcare Research NJ 0 0 Affiliated Collection Services LLC 17 Prospect Street Morristown NJ 07960 270555659 Collection Services NJ 0 0 Morristown Medical Investors 200 American Road Morris Plains NJ 07950 650840535 Real Estate NJ 0 0 Primary Care Partners LLC 475 South Street Morristown NJ 07960 274980253 Physician Services NJ 0 0 Atlantic Rehabilitation Institute LLC 680 South Fourth Street Louisville KY 40202 814711074 Rehabilitation Facility KY 0 0 Atlantic Health Partners LLC 475 SOUTH STREET Morristown NJ 07960 824198770 Physician Services NJ 0 0 Healthcare Transformation Consortium LLC 475 SOUTH STREET Morristown NJ 07960 832553269 Physician Services NJ 0 0 HTC Telemedicine Physician Group LLC 475 SOUTH STREET Morristown NJ 07960 842191233 Physician Services NJ 0 0 Atlantic Health Management Corp and Subsidiaries 200 American Road Morris Plains NJ 07950 223538027 Health NJ N/A C 0 AHS Insurance Company LTD 200 American Road Morris Plains NJ 07950 223380375 Insurance NJ N/A C 0 Nutley Medical Care PA 100 Madison Avenue Morristown NJ 07960 223645010 Healthcare NJ N/A C 0 Non-Invasive Diagnostics PA 100 Madison Avenue Morristown NJ 07960 202027439 Healthcare NJ N/A C 0 Specialty Care of Practice Associates PA 100 Madison Avenue Morristown NJ 07960 030376428 Healthcare NJ N/A C 0 Maternal Fetal Medicine of Practice Associates PA 100 Madison Avenue Morristown NJ 07960 030376421 Healthcare NJ N/A C 0 Madison Pediatrics PA 100 Madison Avenue Morristown NJ 07960 223645007 Healthcare NJ N/A C 0 AHS ACO LLC 475 South Street Morristown NJ 07960 273800813 Physician Practice NJ N/A C 0 The Northwest New Jersey MedicalSurgical Alliance PC 175 High Street Newton NJ 07860 450577942 Healthcare Services NJ N/A C 0 The Northwest New Jersey Urgent Care Alliance PC 175 High Street Newton NJ 07860 830492357 Healthcare Services NJ N/A C 0 Chilton Community Care Inc and Subs 97 West Parkway Pompton Plains NJ 07444 222869148 Healthcare NJ N/A C 0 Chilton Medical Group PC 97 West Parkway Pompton Plains NJ 07444 383769436 Healthcare NJ N/A C 0 Robert & Susan Sameth 2011 CHA PO Box 218 Far Hills NJ 07931 900842326 Charitable Remainder Uni-Trust (2) NJ N/A T 0 Atlantic Advanced Urgent Care LLC 475 South Street Morristown NJ 07960 831558799 Healthcare NJ C 0 Care Better ACO LLC 475 South Street Morristown NJ 07960 831224464 Physician Practice NJ C 0 Atlantic Executive Health PA 475 South Street Morristown NJ 07960 471944011 Physician Practice NJ C 0 AHS Health Network LLC 475 South Street Morristown NJ 07960 474079001 Physician Practice NJ C 0 Atlantic Health ACO LLC 475 South Street Morristown NJ 07960 474126650 Physician Practice NJ C 0 Tertiary Care Specialists of Practice Associates PA 475 South Street Morristown NJ 07960 830713277 Physician Practice NJ C 0 Visiting Nurse Association of Somerset Hills Office Park Condominium 200 Mount Airy Rd Basking Ridge NJ 07920 261183397 Home health services NJ C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 AHS Hospital Corp B 8979963 Actual amount of transaction. AHS Hospital Corp B 35596690 Actual amount of transaction. AHS Hospital Corp P 20448770 Actual amount of transaction.