2017-11-14T09:58:33-06:00 2016-12-31 346565596 Ernst & Young US LLP 100 North Tryon Street - Suite 3800 Charlotte NC 28202 990 2016-01-01 223392808 Foundation for Morristown Medical Center FOUN 9735932400 475 South Street Morristown NJ 07960 Kevin Lenahan SVP-CFO & Admin Officer 9735932400 2017-11-13 0 P00032493 7043726300 198.140.183.1 2017-11-14 09:58:18 ES P 7EEB67306374497AF500F3A4989810E880B4B2A8 114E1D1F23E324535830D0D5509A4A64958E9F65 2016 2021-01-29 14:40:06Z Kevin Lenahan 475 South Street Morristown NJ 07960 36472431 0 X www.f4mmc.org X 501c3 1995 NJ The 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. 37 28 0 230 4366 1007 16601986 13857625 0 0 4335317 3947989 -25743 -7107 20911560 17798507 7400140 7387105 0 0 2132721 3190422 204493 296338 3582687 294718 354378 10032072 11228243 10879488 6570264 128114195 133425507 3980082 4483900 124134113 128941607 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 7387105 7387105 This return consists of a standalone foundation which is a not-for-profit fundraising organization which solicits funds in its general appeal for the benefit and support of Atlantic Health System, Inc. and AHS Hospital Corporation (the Corporation), all subsidiaries thereof, with the principal beneficiary of the Corporation to be Morristown Medical Center. 7387105 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 1 1 0 0 1 1 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 X 37 28 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 100 Madison Avenue - Box 920 Morristown NJ 07960 Mark D Widmann MD Trustee 2.00 55.00 X 0 876760 0 Eric L Lazar MD Trustee 2.00 55.00 X 0 563457 34917 Damion A Martins MD Trustee 2.00 55.00 X 0 710321 29617 Trish O'Keefe Trustee 2.00 55.00 X 0 699860 131107 M Veronica Daly MD Trustee 2.00 55.00 X 0 401796 16051 Daniel Pyo MD FACS FCCWS Trustee 2.00 X 0 0 0 Carol S Jones MSN RN Trustee 2.00 55.00 X 0 327150 39309 Ernist Larini Trustee-Term 6/27/16 2.00 X 0 0 0 Elizabeth Clemente DDS Trustee 2.00 55.00 X 0 331120 28578 Anthony A Lombardo Trustee 2.00 X 0 0 0 Blake Silverman Trustee 2.00 X 0 0 0 Carl J Goldberg Trustee 2.00 X 0 0 0 Cathy Herbst Trustee 2.00 X 0 0 0 Finn Wentworth Trustee, Vice Chairman 2.00 X 0 0 0 Gil Santaliz Trustee 2.00 X 0 0 0 Guy Taylor MD Trustee 2.00 X 0 0 0 James Slater MD Trustee 2.00 X 0 0 0 Joseph C Graff Trustee, Treasurer 2.00 X 0 0 0 Karen R Walsh Trustee, Secretary 2.00 X 0 0 0 Leslie C Quick III Trustee 2.00 X 0 0 0 Marc E Robinson Trustee 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 VI Courtemanche Trustee 2.00 X 0 0 0 Paul L Sturman Trustee 2.00 X 0 0 0 Peter J Cocoziello Trustee 2.00 X 0 0 0 Richard P Diegnan Trustee 2.00 X 0 0 0 Richard P Goryeb Trustee 2.00 X 0 0 0 Robert Tafaro Trustee 2.00 X 0 0 0 Shari Bunks Geller Trustee 2.00 X 0 0 0 Veronica M Goldberg Trustee 2.00 X 0 0 0 William Conger Trustee 2.00 X 0 0 0 William D Ju MD Trustee 2.00 X 0 0 0 William D Bruen Jr Trustee 2.00 X 0 0 0 Christopher J Baldwin Trustee - Term 6/2016 2.00 X 0 0 0 Derek T Malmberg - Term 92016 Trustee 2.00 X 0 0 0 Kevin Lenahan SVP-CFO and Admin Officer 2.00 55.00 X 0 1120735 195052 James F Quinn Chief Development Officer 55.00 X 0 449177 45517 Cynthia W O'Donnell Director of Gift Planning 55.00 X 0 173813 28009 Hyona Revere Dir. of Major Gifts -Term 12/31/16 55.00 X 0 173144 0 Christine Hajsok Director of Finance 55.00 X 0 168303 32059 Regina Diverio Director - Communications 55.00 X 0 144560 17466 Bonnie Gannon Director - Relations 55.00 X 0 144967 22490 Susan Johns Major Gifts 55.00 X 0 129252 19590 0 6414415 639762 0 0 1 0 0 81698 13775927 112830 13857625 3238025 4366 3233659 19341156 18631192 709964 709964 709964 14225 81698 41052 -26827 -26827 21400 1680 19720 19720 17798507 0 4366 3936516 6933217 6933217 453888 453888 2669344 2669344 521078 521078 19998 19998 296338 296338 56389 56389 39538 39538 134412 134412 55476 55476 26057 26057 22508 22508 11228243 7387105 258451 3582687 10507348 7821356 60502122 64571200 43055961 48025569 11279888 9809630 2768876 3197752 128114195 133425507 1994824 1959452 1985258 2524448 3980082 4483900 X 27980620 30647337 60902073 61978213 35251420 36316057 124134113 128941607 128114195 133425507 X 6570264 4866468 -6629238 X 0 1 X 1 0 X 20441711 15053302 23933319 16576243 13850518 89855093 20441711 15053302 23933319 16576243 13850518 89855093 6412500 83442593 2140604 2663112 2541677 3917716 3238025 14501134 104356227 0.79960 0.82080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 96153493 12371179 4163138 14393540 98294270 96541283 15868737 -907015 15349512 96153493 86141983 22846715 2130928 14578343 96541283 74295119 12998553 6690255 7841944 86141983 60179353 18844913 4371231 9100378 74295119 0.37000 0.63000 0 0 0 9809630 C 9809630 Annuities Payable 2524448 2524448 17798507 0 17798507 0 17798507 11228243 0 11228243 0 11228243 Part V, Line 4: The Foundation for Morristown Medical Center (the Foundation) is a not-for-profit fundraising organization which solicits funds in its general appeal to support both Morristown Medical Center, which is a divison of AHS Hospital Corporation, and the community as the Foundation's Board may deem appropriate. The by-laws of the Foundation were amended on September 27, 2007, to provide that funds received by the Foundation after the date of the amendment may be used for the benefit of the Overlook Division of AHS Hospital Corporation upon approval of the Executive Committee of the Board of the Foundation. X X X X X X 1 Telecomp Refer to Part IV of Sched G for ful Rochester NJ 14623 Mail/Phone 0 524754 291118 233636 Ace Twill 22 Russo Place Berkeley Heights NJ 07922 Mail 0 13752 5220 8532 538506 296338 242168 NJ NY PA FL DE Caniofacial Gala 37021 29161 7860 5935 12532 2830 Kids 4 Kids Race 32015 32015 2490 1295 222 4343 2 26887 20522 6365 735 487 6306 1413 2464 95923 81698 14225 9160 14314 6306 1635 9637 41052 -26827 21400 1303 377 1 1.00000 21400 1303 377 1680 19720 NJ 1 0 0 0 0.50000 0.50000 Christine Hajsok 475 South Street Morristown NJ 07960 0 Christine Hajsok The Director of Finance manages & oversees all fundraising activities for this entity. X 1 Schedule G, Part I, Line 2(i) Fundraiser: Telecomp Description of Activity: Mail/Phone Street Address: 3375 Brighton Henrietta Townline Rd City:Rochester State: NJ Zip Code: 14623 1 Morristown Medical Center 100 Madison Avenue Morristown NJ 07960 521958352 501(c)(3) 6933217 Program Services. 1 Project Independence 87 424000 0 Women's Association Scholarship Fund 14 29888 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. Part III, Line 1 Project Independence is a grant funding project to help Morristown Medical Center patients with temporary financial hardships. It is overseen by a volunteer committee made up of care providers from different areas of the Medical Center. They meet every two months to review detailed applications. An application can only be submitted by a case worker who is aware of the financial position of the patients and is working with the patients to secure other types of help including prescription assistance, food stamps, Social Security disability, etc. Most of the recommenders are social workers or patient liaisons. Grants up to $5,500 are made payable directly to the individual. Part III, Line 2 Women's Association Morristown Medical Center (WAMMC) has a long history of supporting quality nursing at Morristown Medical Center. Early on, the WAMMC helped staff the hospital with nurses, and assisted with their housing and uniforms. In 1957, this interest evolved into a formal Scholarship Program, funded entirely by private donations. At that time, one scholarship of $500 would pay tuition costs for the entire three-year program. As tuition costs rose and recipient financial needs increased, generous donations made annually by WAMMC members, continued to underwrite the program. However, the early 1990s brought an economic downturn, which slowed the brisk pace of donations to the Scholarship Program, and necessitated a new approach to ensure the program's future. Since its inception, the Scholarship Program has supported the professional staff at Morristown Medical Center by granting scholarships to high school graduates, and qualified hospital employees pursuing careers in the health care field. A Scholarship Trust Fund was established in 1995, with all scholarship contributions directly benefiting the fund. Presently, the Scholarship Committee spends only the interest generated annually by the fund. In this way, the invested principal remains intact, securing both the fund's future and the Scholarship Program's mission. WAMMC largely attributes the steady growth of this program to the hard work of successful fundraising and the generous donations of WAMMC members. In 2016, approximately $30,000 was awarded to 14 scholars, varying in amounts. Scholarship candidates typically possess high-ranking employee evaluations and are often described as, "Among the best in the department." The candidates are often leaders in their field as members of honorary societies, as hospital committee chairs, or as participants in department studies. It is not unusual for our scholars to be as actively engaged in their local community, as they are in the workplace. 0 0 0 0 0 0 0 0 0 Mark D Widmann MD Trustee 0 874598 0 0 0 2162 0 0 0 0 0 876760 0 0 Eric L Lazar MD Trustee 0 521258 0 0 0 42199 0 18550 0 16367 0 598374 0 0 Damion A Martins MD Trustee 0 594154 0 114100 0 2067 0 13250 0 16367 0 739938 0 114100 Trish O'Keefe Trustee 0 477490 0 158200 0 64170 0 119019 0 12088 0 830967 0 158200 M Veronica Daly MD Trustee 0 343659 0 57500 0 637 0 7950 0 8101 0 417847 0 57500 Carol S Jones MSN RN Trustee 0 250813 0 24212 0 52125 0 29150 0 10159 0 366459 0 0 Elizabeth Clemente DDS Trustee 0 276007 0 48200 0 6913 0 18550 0 10028 0 359698 0 0 Kevin Lenahan SVP-CFO and Admin Officer 0 793695 0 299300 0 27740 0 178685 0 16367 0 1315787 0 299300 James F Quinn Chief Development Officer 0 245309 0 56300 0 147568 0 29150 0 16367 0 494694 0 56300 Cynthia W O'Donnell Director of Gift Planning 0 161892 0 6700 0 5221 0 15921 0 12088 0 201822 0 6700 Hyona Revere Dir. of Major Gifts -Term 12/31/16 0 166044 0 6600 0 500 0 0 0 0 0 173144 0 6600 Christine Hajsok Director of Finance 0 161071 0 6600 0 632 0 15692 0 16367 0 200362 0 6600 Regina Diverio Director - Communications 0 137348 0 5500 0 1712 0 9830 0 7636 0 162026 0 5500 Bonnie Gannon Director - Relations 0 134025 0 4900 0 6042 0 10402 0 12088 0 167457 0 4900 Part I, Line 6 An annual incentive plan exists for the Foundation's Director. The incentive plan distributes bonuses to the Director based on performance results on various performance measurements. The performance measurements include: - Total Philanthropy - Cost per dollar raised - Budget - Solicitations of $100K or more - General Gifts - Renewal - Mail & Phone - Special Gifts - Acquisition and Renewal - Major Gifts - Donor Renewal - Cost - Operating Gain/(Loss) - Cost - Expense per Adjusted Admission/CMIA System - Service - Patient Satisfaction Overall - Growth - IP Admissisions - Growth - OP Visits - People - Employee Engagement Index - Quality & Safety - Nosocomial Infection Maker - Quality & Safety - Mortality - Individual Goals The above performance measures have the following three specific performance goals in order to determine any incentive award: Threshold Target Maximum X 5842 Sale of comp property X 19407 Sale of comp property X 7 945 Sale of comp property X Toys 211 44327 Sale of comp propert X Gift Cards 18 24719 Cash value of cards X Entertainment 6 10590 Cash value of gift X Electronics 2 7000 Sale of comp propert 0 1 0 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. Form 990, Part VI, Section A, line 6 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 In conjunction with Atlantic Health System Inc., the Foundation for Morristown Medical Center (Foundation) requires disclosure of potential conflicts. This policy governs all personnel at the Foundation, 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. 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.ion Form 990, Part VI, Section B, line 15 In conjunction with Atlantic Health System: Line 15A: A review of officer compensation by an independent 3rd party (Mercer) is completed every year. The most recent survey was conducted in 2016. Officers reviewed include President and CEO AHS; SVP Chief Financial & Administrative Officer; SVP, Care Innovation & Technology; SVP, Chief Nursing & Patient Experience Officer; SVP, Chief Human Resource Officer; SVP, Integrated Care Delivery & CEO Hospital Division; SVP, System & Network Planning & Business Development; SVP, Physician Enterprise & President, AMG; SVP Quality & Chief Medical & Academic Officer, AHS; VP Government & Public Affairs; VP AHS & President OMC; VP AHS & President MMC; VP AHS & President CMC; VP AHS & President NMC; VP, President ACO; VP, Clinical Intelligence; VP Legal Affairs & General Counsel; VP, Marketing & Communications; VP, Compliance & Audit; VP Ambulatory Services; VP, Finance; VP, Revenue Cycle; VP, Strategic Development & Network Affairs; VP, Chief Information Officer; VP, Insurance Networks. On behalf of Atlantic Health System, Inc., Mercer conducts an annual total compensation survey based on appropriate comparability data for like positions in like organizations. Line 15B: 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 -6,883,416. Beneficial Interest in Charitable Remainder Unitrust 254,178. 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 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 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 AHS Hospital Corp B 21308502 Actual amount of transaction. AHS Hospital Corp Q 18234678 Actual amount of transaction. AHS Hospital Corp B 6883416 Actual amount of transaction. AHS Hospital Corp P 441276 Actual amount of transaction. AHS Hospital Corp Q 447999 Actual amount of transaction.