2016-11-15T08:24:48-06:00 2015-12-31 366055558 GRANT THORNTON LLP 201 S COLLEGE STREET CHARLOTTE NC 28244 990 2015-01-01 226106281 HACKETTSTOWN COMMUNITY HOSPITAL HACK 9088525100 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 JAMES G LEE EXE. VICE PRESIDENT AND CFO 3013153025 2016-11-15 1 MICHELE MELCHIOR P00488037 7046323500 2015 2017-02-10 21:41:12Z HACKETTSTOWN REGIONAL MEDICAL CENTER JAMES G LEE 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 132987607 0 1071 X WWW.HRMCNJ.ORG X 1955 NJ "WE DEMONSTRATE GOD'S CARE BY IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES THROUGH A (SEE SCH O) MINISTRY OF PHYSICAL, MENTAL AND SPIRITUAL HEALING." HRMC'S VISION IS TO BE "A LEADING RESOURCE FOR INNOVATIVE PATIENT-CENTERED HEALTHCARE." HRMC'S VALUES ARE "RESPECT, INTEGRITY, SERVICE, EXCELLENCE AND STEWARDSHIP (RISES)." 15 12 1007 104 147432 -5747 1465824 389932 83627687 86393023 901263 170389 -77124 -140763 85917650 86812581 53535 423650 0 0 43929777 45201383 0 0 45912 41164273 42892947 85147585 88517980 770065 -1705399 101209448 93379582 43450774 39085532 57758674 54294050 X "WE DEMONSTRATE GOD'S CARE BY IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES THROUGH A MINISTRY OF PHYSICAL, MENTAL AND SPIRITUAL HEALING." HRMC'S VISION IS TO BE "A LEADING RESOURCE FOR INNOVATIVE PATIENT-CENTERED HEALTHCARE." HRMC'S VALUES ARE "RESPECT, INTEGRITY, SERVICE, EXCELLENCE AND STEWARDSHIP (RISES)." 0 0 72453217 423650 86895586 HACKETTSTOWN REGIONAL MEDICAL CENTER, A NOT-FOR-PROFIT INTEGRATED HEALTH SERVICES ACUTE CARE HOSPITAL, SEEKS TO CONTRIBUTE VALUE TO THE COMMUNITY BY PROMOTING HEALTH AND WELLNESS. HRMC OFFERS ACUTE CARE INPATIENT SERVICES, PHYSICIAN-STAFFED 24-HOUR EMERGENCY SERVICES, A DIAGNOSTIC IMAGING CENTER AS WELL AS LABORATORY, PATHOLOGY, SURGICAL AND OUTPATIENT SERVICES AVAILABLE ON-AND-OFF-CAMPUS, THROUGH AFFILIATIONS AND LINKAGE AGREEMENTS. HRMC ALSO OFFERS WELLNESS PROGRAMS, INCLUDING EDUCATIONAL CLASSES AND SCREENINGS DESIGNED TO ENCOURAGE COMMUNITY MEMBERS TO ADOPT A HEALTHIER LIFESTYLE, AVOID ILLNESS AND LIVE LIFE TO ITS FULLEST.2015 YEAR IN REVIEWCHARITY CARE PROVIDED TO THE COMMUNITY $864,854UNREIMBURSED COSTS OF MEDICAID PROGRAM $528,065COMMUNITY HEALTH SERVICES $885,079HEALTH PROFESSIONS EDUCATION $244,942COMMUNITY HEALTH RESEARCH $36,979FINANCIAL AND IN-KIND CONTRIBUTIONS $37,008COMMUNITY BENEFITS OPERATIONS $30,618TOTAL $2,627,545*2015 TOTAL SERVICES PROVIDEDCOMMUNITY BENEFIT PROGRAMS INCLUDE: SCREENINGS, CLASSES, PROGRAMS, SUPPORT GROUPS, VACCINATIONS AND HEALTH PROFESSIONS EDUCATION.A TOTAL OF 14,189 PEOPLE WERE SERVED THROUGH COMMUNITY BENEFIT PROGRAMS IN 2015.*NOTE: IN 2015, HRMC PROVIDED AN ADDITIONAL $20 MILLION IN UNCOMPENSATED CARE ATTRIBUTABLE TO MEDICARE SHORTFALLS AND BAD DEBT. COMMUNITY BENEFIT ACTIVITIES INCLUDE INDIRECT COSTS FOR 2015. 72453217 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 139 0 1 1007 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NJ X ROBERT PETERSON 9088506931 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 JOSE CORTES TRUSTEE 2.00 X 0 0 0 GLENN K TIPPY CPCU CLU TRUSTEE 2.00 X 0 0 0 CLAY HINRICHS MD TRUSTEE 2.00 X 0 0 0 BOGDEN BIENKO TRUSTEE 2.00 X 0 0 0 ERIC CROSS TRUSTEE 2.00 X 0 0 0 MICHAEL HALPIN TRUSTEE 2.00 X 0 0 0 MICHAEL LAVERY TRUSTEE 2.00 X 0 0 0 BARBARA-JAYNE LEWTHWAITE PHD TRUSTEE 2.00 X 0 0 0 TIMOTHY C MCDONOUGH TRUSTEE 2.00 X 0 0 0 RAY NISIVOCCIA CPA TRUSTEE 2.00 X 0 0 0 JAMES J TRAVIS TRUSTEE 2.00 X 0 0 0 NORMAN WORTH TRUSTEE 2.00 X 0 0 0 JAMES G LEE CHAIRMAN; EVP & CFO, AHC 5.00 57.00 X X 0 662822 135961 TERRY FORDE PRESIDENT & CEO, AHC 3.00 59.00 X X 0 1225363 219138 JASON C COE SECRETARY; PRESIDENT, HRMC 45.00 15.00 X X 0 393566 82998 ROBERT C PETERSON CHIEF FINANCIAL OFFICER 50.00 10.00 X 273061 0 60899 KENNETH JANOWSKI CHIEF MEDICAL OFFICER 40.00 10.00 X 297229 0 66839 STELLA VISAGGIO CHIEF OPERATING OFFICER 40.00 10.00 X 283376 0 68188 MARY ANN ANDERSON CHIEF NURSING OFFICER 40.00 10.00 X 289772 0 26647 JUDITH H WIEGAND EXE DIR, BUS DEVELOPMENT 40.00 10.00 X 219090 0 25617 CHRISTOPHER R MAZZIE DIRECTOR OF BUSINESS OPERATIONS 40.00 10.00 X 156968 0 12764 TRACY HEIMBACH ADMINISTRATIVE DIRECTOR 40.00 10.00 X 136220 0 26855 MICHAEL SCHIAVONE OB/GYN PHYSICIAN 40.00 10.00 X 213019 0 8637 JEANNE JEPSON DIRECTOR, HUMAN RESOURCES 40.00 10.00 X 140404 0 18188 ANTONELLA AUCIELLO STAFF PHYSICIAN 40.00 10.00 X 157300 0 3311 2166439 2281751 756042 35 0 1 0 SODEXO INC PO BOX 536922 ATLANTA GA 303536922 FOOD MGMT SERVICES 724972 DRINKER BIDDLE & REATH LLP ONE LOGAN SQUARE SUITE 2000 PHILADELPHIA PA 191036996 LEGAL SERVICES 692008 ZENITH PHYSICIANS LLC PO BOX 447 HACKETTSTOWN NJ 07840 HOSPITALIST GROUP 603538 HACKETTSTOWN PEDIATRIC HOSPITALIST LLC 290 UNION BLVD TOTOWA NJ 07512 PEDIATRIC HOSPITALIST 575000 MEDASSETS INC PO BOX 405652 ATLANTA GA 303845652 REVENUE CYCLE SERVICE 539681 31 259565 130367 389932 PATIENT SERVICE REVENU 900099 83057064 83057064 ANCILLIARY SERVICE REV 900099 3335959 3335959 86393023 673967 673967 682772 1491450 -808678 -808678 -808678 44162154 44665732 -503578 -503578 -503578 14028 635 13393 13393 21737 17209 4528 4528 CAFETERIA INCOME 900099 499620 499620 MAINTENANCE INCOME 900099 147432 147432 PHARMACY INCOME 900099 2942 2942 649994 86812581 86393023 147432 -117806 420650 420650 3000 3000 1610718 1610718 34788114 29828319 4959795 673107 577141 95966 5307283 4550615 756668 2822161 2419801 402360 124566 124566 73243 73243 8062120 6495528 1566430 162 275654 275654 8429445 6873516 1534429 21500 5083842 3863720 1220122 3642712 2978590 642307 21815 20372 14551 5821 53568 41860 9273 2435 1314226 1314226 4830555 4807361 23194 446293 446293 MEDICAL SUPPLIES 8247126 8247126 COST ALLOC. FROM PARENT 2230604 2230604 RECRUITMENT 58621 17213 41408 88517980 72453217 16018851 45912 1280 1280 42026808 32450134 93748 58929 8028398 11034639 686475 614900 1771971 1861623 740557 852261 128682603 90135073 40636324 38547530 2788505 2777924 1342168 1563794 867660 867660 2225554 2748908 101209448 93379582 7186977 5162854 48196 36215601 33922678 43450774 39085532 X 56390933 52843737 1367741 1450313 57758674 54294050 101209448 93379582 X -1705399 -232025 -1527200 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1145121 1145121 52192078 32425780 19766298 8541385 4899134 3642251 62536137 51112453 11423684 4267882 1697706 2570176 38547530 CONSTRUCTION PAYABLE 50410 MOBII OCCUPANCY GUARANTEE LIAB 867660 OTHER LONG TERM LIABILITY 33870 DUE TO PARENT ORGANIZATION 32229053 THIRD PARTY PAYABLES 741685 33922678 X PART X, LINE 2: FIN 48 NOTES: THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2015 OR 2014. THE CORPORATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THE CORPORATION'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2012 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 0 1 1 990108 125254 864854 0.00980 1172076 644011 528065 0.00600 2162184 769265 1392919 0.01580 954295 69216 885079 0.01000 244942 244942 0.00280 36979 36979 0.00040 37008 37008 0.00040 1273224 69216 1204008 0.01360 3435408 838481 2596927 0.02940 3265 3265 0.00000 27353 27353 0.00030 30618 30618 0.00030 1 3622660 26496010 43035530 -16539520 X 1 1 1 HACKETTSTOWN DIAGNOSTIC ASSOCIATES LLC IMAGING CENTER 0.50000 0.50000 2 DYNAMIC IMAGING ASSOCIATES LLC EQUIPMENT HOLDING COMPANY 0.50000 0.50000 3 RADIOLOGY ASSOCIATES OF HACKETTSTOWN LLC IMAGING CENTER 0.33300 0.66700 4 HACKETTSTOWN REGIONAL MRILLC EQUIPMENT HOLDING COMPANY 0.33300 0.66700 5 MRI ASSOCIATES OF HACKETTSTOWN LLC IMAGING CENTER 0.50000 0.50000 6 GCM LLC EQUIPMENT HOLDING COMPANY 0.50000 0.50000 7 TRI MED ASSOCIATES REAL ESTATE ENTITY 0.33300 0.66700 8 GORDON HACKETTSTOWN MAB ASSOCIATES MEDICAL OFFICE BUILDING VENTURE 0.20000 0.22500 1 1 HACKETTSTOWN COMMUNITY HOSPITAL 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 HTTP://WWW.HRMCNJ.ORG/ 12101 X X X HACKETTSTOWN COMMUNITY HOPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X HTTP://WWW.HRMCNJ.ORG X 1 16 1 HTTP://WWW.HRMCNJ.ORG 0 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.HRMCNJ.ORG/FINANCIAL-ASSISTANCE.ASP X SAME AS LINE 16A X SAME AS LINE 16A X X X X X 1 X 0 X X X 1 X 0 0 HACKETTSTOWN COMMUNITY HOPITAL PART V, SECTION B, LINE 5: HACKETTSTOWN COMMUNITY HOSPITAL UNDERTOOK A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT WHICH CONCLUDED IN 2015. THE PURPOSE OF THE STUDY WAS TO GATHER CURRENT STATISTICS AND QUALITATIVE FEEDBACK ON THE KEY HEALTH ISSUES FACING OUR SERVICE MARKET RESIDENTS. SECONDARY DATA WAS RESEARCHED AND UPDATED. FIFTY FIVE COMMUNITY STAKEHOLDERS COMPLETED A "KEY INFORMANT SURVEY TOOL". AFTER COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, APPROXIMATELY 23 LEADERS FROM HACKETTSTOWN COMMUNITY HOSPITAL, COMMUNITY AGENCIES AND AREA HEALTHCARE AND SOCIAL SERVICES ORGANIZATIONS MET TO REVIEW AND PRIORITIZE THE FINDINGS AND TO DEVELOP AN IMPLEMENTATION PLAN. THE FOLLOWING KEY STAKEHOLDERS PARTICIPATED IN THE PROCESS:ADMINISTRATIVE DIRECTOR, HRMC;BACH'S MEDICAL SUPPLIES;BENTLEY COMMONS AT PARAGON VILLAGE;CENTENARY COLLEGE;CHELSEA AT BROOKFIELD;CHIEF NURSING OFFICER, HRMC;CHURCH OF THE ASSUMPTION;COMMUNITY PREVENTION RESOURCES;COORDINATOR, HEALTHLINK, HRMC;EMS, HRMC;EXECUTIVE DIRECTOR, HRMC;FAMILY GUIDANCE OF WARREN COUNTY;HACKETTSTOWN BUSINESS IMPROVEMENT;HACKETTSTOWN POLICE DEPARTMENT;HACKETTSTOWN ROTARY CLUB;HEALTH EDUCATOR, HRMC;HEALTHSTART PRENATAL CLINIC, HRMC;HEALTH VILLAGE;HOME INSTEAD;HOUSE OF THE GOOD SHEPHERD;KAREN ANN QUINLAN HOSPICE;KIWANIS CLUB OF HACKETTSTOWN;LONG VALLEY FIRST AID SQUAD;MANAGER, CENTER FOR HEALTHIER LIVING, HRMC;MANAGER, COUNSELING AND ADDICTION CENTER, HRMC;MANAGER, EDUCATION, HRMC;MANAGER, EMERGENCY DEPARTMENT, HRMC;MANAGER, MARKETING AND PUBLIC RELATIONS, HRMC;MT. OLIVE HEALTH DEPARTMENT;NORTH WARREN REGIONAL SCHOOL DISTRICT;PHYSICIAN, EMERGENCY DEPARTMENT, HRMC;PLANNED PARENTHOOD;PRESIDENT, HACKETTSTOWN REGIONAL MEDICAL CENTER;PROJECT SELF-SUFFICIENCY;UNITED WAY OF NORTHERN NJ;WARREN COUNTY AGENCY ON AGING AND DISABILITY;WARREN COUNTY DEPARTMENT OF HUMAN SERVICES;WARREN COUNTY HEALTH DEPARTMENT;WARREN COUNTY MENTAL HEALTH BOARD;WARREN COUNTY OFFICE OF EMERGENCY MANAGEMENT;WARREN COUNTY SURROGATE;WARREN COUNTY TEMPORARY ASSISTANCE;WARREN COUNTY TRANSPORTATION COORDINATOR;WASHINGTON TOWNSHIP HEALTH DEPARTMENT;ZUFALL, FEDERALLY QUALIFIED HEALTH CENTER. HACKETTSTOWN COMMUNITY HOPITAL PART V, SECTION B, LINE 11: THE FOLLOWING WERE IDENTIFIED AS THE KEY COMMUNITY PRIORITIES: ACCESS TO CARE,CHRONIC DISEASE MANAGEMENT, COORDINATION OF CARE, AND MENTAL HEALTH.THE PLAN TO ADDRESS THESE ISSUES ARE AS FOLLOWS. ACCESS TO CARE:GOAL - INCREASE ACCESS TO AFFORDABLE QUALITY HEALTH CARE FOR HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA RESIDENTS. OBJECTIVE - IDENTIFY A COMPREHENSIVE LIST OF AVAILABLE COMMUNITY RESOURCES FOR THE LOW INCOME AND UNINSURED POPULATION IN HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA BY MARCH 2017. ACTIONS - > IDENTIFY COMMUNITY PARTNERS TO OBTAIN AND EVALUATE AVAILABLE RESOURCES AND RESOURCE GUIDES. > WORK WITH COMMUNITY PARTNERS TO CONSOLIDATE RESOURCE INFORMATION ON AREA HEALTH CLINICS AND LOCAL RESOURCES. > POST INFORMATION ON THE HOSPITAL'S WEBSITE AND DISTRIBUTE THROUGH: HACKETTSTOWN MEDICAL CENTER'S FINANCIAL COUNSELORS, EMERGENCY DEPARTMENT, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT AND OTHER IDENTIFIED AGENCIES.PLAN TO EVALUATE - HACKETTSTOWN MEDICAL CENTER WILL EVALUATE THE DISTRIBUTION OF THE RESOURCE GUIDE BY CONTACTING THE LOCAL AGENCIES TO EVALUATE THE NUMBER THAT WERE PROVIDED TO COMMUNITY RESIDENTS. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, ZUFALL HEALTH CENTER, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, WARREN COUNTY DIVISION OF HUMAN SERVICES, UNITED WAY.MENTAL HEALTH/SUBSTANCE ABUSE: GOAL - INCREASE ACCESS TO EXISTING MENTAL HEALTH SERVICES AND INCREASE AWARENESS OF MENTAL HEALTH ISSUES FOR HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA. OBJECTIVE - IDENTIFY A COMPREHENSIVE LIST OF AVAILABLE RESOURCES FOR THOSE IN NEED OF MENTAL HEALTH AND ADDICTION SERVICES IN HACKETTSTOWN MEDICAL CENTER'S SERVICE AREA BY MARCH 2017. ACTIONS - > IDENTIFY AND CONTACT COMMUNITY PARTNERS TO PARTICIPATE IN A MENTAL HEALTH STRATEGY WORKGROUP. > IDENTIFY LOCAL COMMUNITY PARTNERS TO OBTAIN AND EVALUATE AVAILABLE RESOURCES AND RESOURCE GUIDES. > WORK WITH LOCAL COMMUNITY PARTNERS TO CONSOLIDATE RESOURCE INFORMATION. > POST INFORMATION ON THE HOSPITAL'S WEBSITE AND DISTRIBUTE THROUGH: HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, SCHOOLS, CHURCHES, EMERGENCY DEPARTMENT, FIRST AID SQUADS, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, ZUFALL HEALTH CENTER. PLAN TO EVALUATE - HACKETTSTOWN MEDICAL CENTER WILL EVALUATE THE DISTRIBUTION OF THE RESOURCE GUIDE BY CONTACTING LOCAL AGENCIES TO EVALUATE THE NUMBER THAT WERE DISTRIBUTED. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, EMERGENCY DEPARTMENT, FIRST AID SQUADS, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, ZUFALL HEALTH CENTER WARREN COUNTY DIVISION OF HUMAN SERVICES, FAMILY GUIDANCE, LOCAL SCHOOLS AND CHURCHES. OBJECTIVE - DECREASE MENTAL HEALTH STIGMA BY INCREASING AWARENESS AND IDENTIFICATION OF MENTAL HEALTH /SUBSTANCE ABUSE DISORDERS. ACTIONS - > EXPLORE EVIDENCED BASED TRAINING OPPORTUNITIES TO INCREASE AWARENESS OF MENTAL HEALTH ISSUES. > IDENTIFY TARGET GROUPS TO RECEIVE TRAINING SUCH AS STUDENT ASSISTANCE COUNSELORS, CLERGY, AND LOCAL FIRST AID SQUADS. > ENGAGE GROUPS TO BE TRAINED AND COLLECT DATA ON THE NEEDS OF THE GROUP. HOLD TRAINING FOR 25 PARTICIPANTS IN YEAR ONE. PLAN TO EVALUATE - EVALUATE THE SUCCESS OF THE PROGRAM BY FEEDBACK FROM PARTICIPANTS. POTENTIAL PARTNERS - MENTAL HEALTH WORKGROUP, HACKETTSTOWN MEDICAL CENTER'S COUNSELING AND ADDICTION CENTER, CENTER FOR HEALTHIER LIVING, FAMILY GUIDANCE, NAMI. CHRONIC DISEASE MANAGEMENT/COORDINATION OF CARE: GOAL - REDUCE RISK FACTORS FOR CHRONIC DISEASE AND IMPROVE MANAGEMENT OF DISEASE CONDITIONS THROUGH PROMOTION AND EDUCATION OF HEALTHY LIFESTYLES. OBJECTIVE - INCREASE THE NUMBER OF PARTICIPANTS ATTENDING CHRONIC DISEASE EDUCATION PROGRAMS AND SUPPORT GROUPS. ACTIONS - > PROVIDE AT LEAST 4 EDUCATIONAL OPPORTUNITIES FOR THOSE DIAGNOSED WITH CHRONIC DISEASES SUCH AS DIABETES, CARDIOVASCULAR DISEASE AND PULMONARY DISEASE. > WORK WITH LOCAL COMMUNITY RESOURCES AND PHYSICIANS TO REFER PATIENTS TO SUPPORT GROUPS. > INCREASE ATTENDANCE AT THE HEALTHY HEARTS, BETTER BREATHER'S CLUB AND DIABETES SUPPORT GROUPS. PLAN TO EVALUATE - > DOCUMENT THE NUMBER OF EDUCATIONAL PROGRAMS. > EVALUATE THE NUMBER OF PEOPLE ATTENDING THE PROGRAMS VERSUS ATTENDANCE IN THE PAST. > EVALUATE THE NUMBER OF PEOPLE REFERRED TO SUPPORT GROUPS THROUGH COMMUNITY AGENCIES AND PHYSICIANS BY SURVEY. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, LOCAL HEALTH DEPARTMENTS, ZUFALL HEALTH CLINIC, LOCAL PRIMARY CARE PHYSICIAN'S. OBJECTIVE - PARTNER WITH COMMUNITY AGENCIES TO PROVIDE 3 HEALTH SCREENINGS AND 3 EDUCATION EVENTS TO THE LOW INCOME AND UNINSURED POPULATION.ACTIONS - > IDENTIFY LOCAL AGENCIES TO COORDINATE HEALTH EDUCATION PROGRAMS AND SCREENINGS. > PROVIDE AT LEAST 3 SCREENINGS AND 3 COMMUNITY EDUCATION PROGRAMS TO IDENTIFY THOSE AT RISK FOR CHRONIC DISEASES. > TARGET PROGRAMS AND SCREENINGS TO THE LOW INCOME AND UNINSURED POPULATION. PLAN TO EVALUATE - DOCUMENT THE COMPLETION OF 3 COMMUNITY EDUCATION AND SCREENING PROGRAMS. > EVALUATE THE NUMBER OF PEOPLE WHO ATTENDED THE PROGRAM. > EVALUATE THE NUMBER OF PEOPLE REFERRED FROM THE SCREENING PROGRAM. POTENTIAL PARTNERS - HACKETTSTOWN MEDICAL CENTER, ZUFALL HEALTH CLINIC, WARREN COUNTY HEALTH DEPARTMENT, MT. OLIVE HEALTH DEPARTMENT, WARREN COUNTY DIVISION OF HUMAN SERVICES, LOCAL CHURCHES.RATIONALE FOR COMMUNITY HEALTH NEEDS NOT ADDRESSED: HACKETTSTOWN MEDICAL CENTER PLANS TO ADDRESS ALL OF THE HEALTH PRIORITIES AS IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND PRIORITIZATION SESSION. COORDINATION OF CARE WILL FOCUS ON CHRONIC DISEASE MANAGEMENT. PART I, LINE 3C: HACKETTSTOWN COMMUNITY HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA DEFINED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. PATIENTS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR FREE CARE. PATIENTS BETWEEN 200% AND 300% OF THE FPG ARE ELIGIBLE FOR DISCOUNTED CARE.PART I, LINE 6A:ALTHOUGH NOT REQUIRED BY THE STATE OF NEW JERSEY, HACKETTSTOWN COMMUNITY HOSPITAL PREPARED A 2015 COMMUNITY BENEFIT REPORT AND MADE IT READILY AVAILABLE TO THE COMMUNITY ON OUR WEBSITE. PART I, LINE 7: IN ORDER TO DETERMINE THE EXPENSE FOR CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST, HACKETTSTOWN COMMUNITY HOSPITAL UTILIZED COST TO CHARGE RATIOS TO DETERMINE THE COST OF THESE PROGRAMS. PART I, LN 7 COL(F): NO BAD DEBT IS INCLUDED IN THE FUNCTIONAL EXPENSES IN PART IX OF THE FORM 990 AND THEREFORE NO ADJUSTMENT WAS NECESSARY TO COMPUTE THE PERCENTAGES IN THE CHART FOR LINE 7. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING:THE HACKETTSTOWN COMMUNITY HOSPITAL ADMINISTRATIVE TEAM ACTIVELY PARTICIPATES AS MEMBERS OF THE HACKETTSTOWN ROTARY AND IN THEIR EFFORTS TO IMPROVE THE HEALTH AND SAFETY OF THE HACKETTSTOWN COMMUNITY.HACKETTSTOWN COMMUNITY HOSPITAL WORKS JOINTLY WITH STATE AND COUNTY AGENCIES TO COORDINATE DISASTER PREPAREDNESS POLICIES AND PROCEDURES IN THE EVENT OF A LARGE STAGE DISASTER AFFECTING HACKETTSTOWN AND THE SURROUNDING COMMUNITIES.HACKETTSTOWN COMMUNITY HOSPITAL HAS ALSO PARTNERED WITH MANY PROGRAMS TO PROVIDE INTERNSHIPS TO STUDENTS WHO ARE PURSUING CAREERS IN A VARIETY OF HEALTH PROFESSIONS INCLUDING BUT NOT LIMITED TO: NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIAGNOSTIC IMAGING, BEHAVIORAL HEALTH AND ADDICTION COUNSELING AND PHARMACY RESIDENTS.THE CENTER FOR HEALTHIER LIVING PLAYS AN ACTIVE ROLE IN THE WARREN SUSSEX CHRONIC DISEASE COALITION WHICH IS DEDICATED TO THE IMPLEMENTATION OF EVIDENCE/PRACTICE BASED POLICY, AND ENVIRONMENTAL AND SYSTEM CHANGE INTERVENTIONS FOR CHRONIC DISEASE PREVENTION AND CONTROL WITH A FOCUS ON CANCER. THE COALITION IS COMMITTED TO MAINTAINING A DIVERSE PARTNERSHIP OF COMMUNITY MEMBERS AND AGENCIES. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL COLLECTIONS AND PROVISION FOR DOUBTFUL COLLECTIONS. FOR PATIENT ACCOUNTS RECEIVABLE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL COLLECTIONS AND PROVISION FOR DOUBTFUL COLLECTIONS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CORPORATION RECORDS A PROVISION FOR DOUBTFUL COLLECTIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL COLLECTIONS. PART III, LINE 8: MEDICARE IN ORDER TO DETERMINE THE COST OF PROVIDING MEDICARE SERVICES, HACKETTSTOWN COMMUNITY HOSPITAL UTILIZED COST TO CHARGE RATIOS AS DETERMINED BY THE HOSPITAL'S MEDICARE COST REPORT. THE TOTAL COST WAS COMPARED TO PAYMENTS RECEIVED FROM THE MEDICARE PROGRAM. THE SHORTFALL CALCULATED REPRESENTS UNREIMBURSED COSTS UNDER THE MEDICARE PROGRAM THAT THE HOSPITAL ABSORBS ON BEHALF OF THE PATIENTS THAT IT SERVES.THE SHORTFALL ON PART III, LINE 7 IS CONSIDERED TO BE A COMMUNITY BENEFIT. PART III, LINE 9B: COLLECTION PRACTICESINDIVIDUALS THAT QUALIFY FOR 100% CHARITY CARE UNDER THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES GUIDELINES ARE NOT BILLED FOR ANY AMOUNTS. INDIVIDUALS THAT QUALIFY FOR PARTIAL CHARITY CARE UNDER THESE GUIDELINES ARE BILLED AT A REDUCED RATE. FINANCIAL COUNSELORS ARE AVAILABLE TO ALL PATIENTS TO DETERMINE WHETHER ANY PROGRAMS (E.G. CHARITY CARE, MEDICAID) ARE AVAILABLE TO ASSIST PATIENTS.FINANCIAL ASSISTANCE PROCESS AND COLLECTION PROTOCOL ARE WELL DEFINED WITH MANAGERS AVAILABLE TO GUIDE AND HANDLE EXCEPTION SITUATIONS. OUTSOURCED AGENCIES AND COLLECTIONS FIRMS ARE EXPECTED TO ADHERE TO HACKETTSTOWN COMMUNITY HOSPITAL'S POLICY. BAD DEBT, CHARITY AND ADMINISTRATIVE WRITE OFF ARE CLEARLY DEFINED WITH PRE-DETERMINED AUTHORIZATION LEVELS DEPENDING ON THE MAGNITUDE GRANTED. PART VI, LINE 2: NEEDS ASSESSMENT:HACKETTSTOWN COMMUNITY HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015 UTILIZING THE SERVICES OF HOLLERAN CONSULTING. A WIDE VARIETY OF COMMUNITY PARTNERS PARTICIPATED IN THE PROCESS TO IDENTIFY AND PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY. UPON COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, AND IMPLEMENTATION PLAN WAS DEVELOPED AND APPROVED IN 2016. ALTHOUGH THE STATE OF NEW JERSEY DOES NOT REQUIRE THAT A COMMUNITY BENEFIT REPORT BE FILED, HACKETTSTOWN COMMUNITY HOSPITAL (HCH) PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS POSTED ON ITS WEBSITE AND MAILED TO THE COMMUNITY UPON REQUEST. A MEETING IS HELD EACH YEAR TO INFORM THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION:ALL PATIENTS OF THE HOSPITAL THAT DO NOT HAVE INSURANCE ARE PROVIDED WITH INFORMATION REGARDING FINANCIAL ASSISTANCE. THE INFORMATION PROVIDES INFORMATION REGARDING THE REQUIREMENTS FOR QUALIFYING FOR CHARITY CARE AND OTHER ASSISTANCE PROGRAMS. IN ADDITION, THE HOSPITAL HAS A FULL TIME FINANCIAL COUNSELING OFFICE WITH DEDICATED FINANCIAL COUNSELORS THAT PROVIDE SCREENINGS AND INFORMATION TO ALL PATIENTS REQUESTING ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION:HACKETTSTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS MADE UP OF 12 ZIP CODES THAT STRADDLE THE WESTERN PORTION OF MORRIS COUNTY AND THE CENTRAL AND EASTERN SIDE OF WARREN COUNTY, WITH ONE ADDITIONAL ZIP CODE LOCATED IN NEIGHBORING SUSSEX COUNTY TO THE NORTH. HRMC'S PSA COMPRISES A POPULATION BASE OF APPROXIMATELY 100,000.HACKETTSTOWN COMMUNITY HOSPITAL'S SECONDARY SERVICE AREA IS MADE UP OF SEVEN ZIP CODES THAT INCLUDE THE SOUTHERN TIP OF SUSSEX COUNTY AND PORTIONS OF THE SOUTH CENTRAL AND NORTHERN SECTIONS OF WARREN COUNTY. HRMC'S SSA COMPRISES A POPULATION BASE OF ALMOST 35,000. PART VI, LINE 5: COMMUNITY HEALTH PROMOTION:HACKETTSTOWN COMMUNITY HOSPITAL, DBA HACKETTSTOWN REGIONAL MEDICAL CENTER, OPENED IN 1973 AND IS A FULLY LICENSED 111 BED ACUTE CARE HOSPITAL THAT PROVIDES ACUTE CARE, EMERGENCY, DIAGNOSTIC, SURGICAL AND OUTPATIENT SERVICES TO RESIDENTS OF WARREN, MORRIS, SUSSEX AND HUNTERDON COUNTIES. HACKETTSTOWN COMMUNITY HOSPITAL IS A FAITH BASED, NOT FOR PROFIT ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF HACKETTSTOWN COMMUNITY RESIDENTS COMMITTED TO OUR MISSION OF IMPROVING THE HEALTH OF PEOPLE AND COMMUNITIES THROUGH A MINISTRY OF PHYSICAL, MENTAL AND SPIRITUAL HEALING. MEMBERS OF THE HACKETTSTOWN COMMUNITY HOSPITAL ADMINISTRATION AND LEADERSHIP TEAM ARE ALSO ACTIVE IN THE COMMUNITY SERVING ON VARIOUS BOARDS, COALITIONS AND COMMITTEES TO HELP ADDRESS HEALTH ISSUES IN THE COMMUNITY.IN KEEPING WITH OUR MISSION, HACKETTSTOWN REGIONAL MEDICAL CENTER CONTINUES TO PROMOTE GOOD HEALTH THROUGH THE PROGRAMS OFFERED BY THE CENTER FOR HEALTHIER LIVING. A TOTAL OF 7891 COMMUNITY RESIDENTS WERE SERVED THROUGH THE VARIOUS PROGRAMS OFFERED BY THE CENTER IN 2015.AT HACKETTSTOWN REGIONAL MEDICAL CENTER WE BELIEVE THAT EDUCATION IS THE FIRST AND OFTEN THE MOST IMPORTANT STEP IN ACHIEVING GOOD HEALTH. HACKETTSTOWN REGIONAL MEDICAL CENTER PROMOTES A LIFESTYLE CHANGE THAT EMPHASIZES REGULAR EXERCISE, GOOD NUTRITION, EARLY DETECTION OF ILLNESS AND THE KNOWLEDGE TO MAKE INFORMED HEALTH RELATED DECISIONS.IN ORDER TO HELP AREA RESIDENTS ACHIEVE OPTIMAL HEATH, HACKETTSTOWN REGIONAL MEDICAL CENTER, THROUGH THE CENTER FOR HEALTHIER LIVING, OFFERED A NUMBER OF HEALTH PROMOTION AND EDUCATION CLASSES AND HEALTH SCREENINGS IN 2015 INCLUDING:> A VARIETY OF HEALTH SCREENINGS INCLUDING CANCER SCREENINGS WERE OFFERED AT THE CENTER FOR HEALTHIER LIVING, COMMUNITY HEALTH FAIRS, AND SCHOOL HEALTH FAIRS AND AREA BUSINESSES.> HEALTH EDUCATION PROGRAMS WERE HELD AT THE CENTER FOR HEALTHIER LIVING, SEVERAL SENIOR GROUP MEETINGS, SENIOR HOUSING AND AREA BUSINESS. SENIOR EXERCISE PROGRAMS LIKE TAI CHI AND ARTHRITIS EXERCISE KEEP SENIORS ACTIVE AND FLEXIBLE. "BACK IN TIME" HISTORY SERIES PROVIDES SENIORS THE OPPORTUNITY TO ENGAGE IN LIFELONG LEARNING, USE CRITICAL THINKING SKILLS AND TO SOCIALIZE.> SUPPORT GROUPS HELPED ADDRESS THE NEEDS OF THOSE WITH CHRONIC ILLNESS INCLUDING PULMONARY DISEASE, CARDIAC ILLNESSES AND DIABETES AND BREAST CANCER.> DIABETES PREVENTION EFFORTS INCLUDED PRE-DIABETES WORKSHOPS. > INFLUENZA VACCINES WERE GIVEN AT NO CHARGE TO THE HOMELESS AND MEDICALLY UNDERSERVED THROUGH A FOOD PANTRY AND PROJECT HOMELESS CONNECT. > PRENATAL EDUCATION CLASSES WERE OFFERED AT NO COST TO UNDERINSURED WOMEN AND FAMILIES INCLUDING CHILDBIRTH EDUCATION, BREAST FEEDING CLASSES, SIBLING CLASSES AND BABY CARE CLASSES> HACKETTSTOWN COMMUNITY HOSPITAL OFFERS A VARIETY OF CPR AND FIRST AID CLASSES TO OUR COMMUNITY. CLASSES ARE OFFERED FREE OR FOR A NOMINAL FEE TO LOCAL POLICE, FIREFIGHTERS AND EMS. A LARGE NUMBER OF COMMUNITY RESIDENTS WERE INSTRUCTED IN "HANDS-ONLY" CPR AT A NUMBER OF HEALTH FAIRS.HACKETTSTOWN REGIONAL MEDICAL CENTER IS COMMITTED TO ENSURING THAT THE COMMUNITIES IT SERVES THRIVE IN A CULTURE OF WELLNESS AND HAVE ACCESS TO AND THE BENEFITS OF HIGH QUALITY, EQUITABLE HEALTHCARE THAT PROMOTES PHYSICAL, MENTAL AND SPIRITUAL WELLBEING. PART VI, LINE 6: AFFILIATED HEALTH CARE:HACKETTSTOWN COMMUNITY HOSPITAL IS A MEMBER OF THE ADVENTIST HEALTHCARE SYSTEM BASED IN GAITHERSBURG, MARYLAND. ADVENTIST HEALTHCARE PROVIDES MANAGERIAL AND SHARED SERVICES TO HACKETTSTOWN COMMUNITY HOSPITAL IN SUPPORT OF ITS MISSION TO SERVE HACKETTSTOWN AND THE OTHER COMMUNITIES IN ITS PRIMARY AND SECONDARY SERVICE AREAS. PART VI, LINE 7, REPORTS FILED WITH STATES NJ 1 HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 222333410 501(C)(3) 15350 GENERAL SUPPORT FROM HOSPITAL AUXILIARY. HACKETTSTOWN BUSINESS IMPROVEMENT DISTRICT 219 MAIN ST HACKETTSTOWN NJ 07840 202535990 501(C)(3) 5300 EVENT SPONSORSHIPS: SPRING FESTIVAL AND HOMETOWN HOLIDAY HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 222333410 501(C)(3) 400000 GENERAL SUPPORT 2 PART I, LINE 2: IN SUPPORT OF ITS MISSION AND VISION TO BE A LEADING RESOURCE FOR INNOVATIVE PATIENT -CENTERED HEALTHCARE, THE HOSPITAL AND ITS AUXILIARY WILL PROVIDE GRANTS AND ASSISTANCE TO AFFILIATED ENTITIES SUCH AS ITS FOUNDATION AND OTHER NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. PRIOR TO PROVIDING THIS ASSISTANCE, HOSPITAL ADMINISTRATION REVIEWS AND APPROVES REQUESTS FOR NEEDS THAT FULFILL OUR MISSION AND SUPPORT THE COMMUNITY. X X X X 1 1 0 0 0 0 0 0 0 JAMES G LEE CHAIRMAN; EVP & CFO, AHC 0 498437 0 159345 0 5040 0 110360 0 25601 0 798783 0 0 TERRY FORDE PRESIDENT & CEO, AHC 0 864928 0 328406 0 32029 0 191122 0 28016 0 1444501 0 0 JASON C COE SECRETARY; PRESIDENT, HRMC 0 290030 0 94356 0 9180 0 51577 0 31421 0 476564 0 0 ROBERT C PETERSON CHIEF FINANCIAL OFFICER 211924 0 55504 0 5633 0 28584 0 32315 0 333960 0 0 0 KENNETH JANOWSKI CHIEF MEDICAL OFFICER 232990 0 60994 0 3245 0 35722 0 31117 0 364068 0 0 0 STELLA VISAGGIO CHIEF OPERATING OFFICER 220920 0 59079 0 3377 0 32524 0 35664 0 351564 0 0 0 MARY ANN ANDERSON CHIEF NURSING OFFICER 207542 0 53445 0 28785 0 10082 0 16565 0 316419 0 0 0 JUDITH H WIEGAND EXE DIR, BUS DEVELOPMENT 116226 0 49390 0 53474 0 6053 0 19564 0 244707 0 0 0 CHRISTOPHER R MAZZIE DIRECTOR OF BUSINESS OPERATIONS 156867 0 0 0 101 0 4694 0 8070 0 169732 0 0 0 TRACY HEIMBACH ADMINISTRATIVE DIRECTOR 115508 0 20593 0 119 0 2997 0 23858 0 163075 0 0 0 MICHAEL SCHIAVONE OB/GYN PHYSICIAN 210485 0 0 0 2534 0 569 0 8068 0 221656 0 0 0 JEANNE JEPSON DIRECTOR, HUMAN RESOURCES 118851 0 21306 0 247 0 3557 0 14631 0 158592 0 0 0 ANTONELLA AUCIELLO STAFF PHYSICIAN 156850 0 0 0 450 0 3022 0 289 0 160611 0 0 0 PART I, LINE 3 COMPENSATION DEFINED. THE COMPENSATION REPORTED FOR THE EMPLOYEES SET FORTH ON SCHEDULE J IS COMPRISED OF THE FOLLOWING: BASE COMPENSATION INCLUDES NONDISCRETIONARY PAYMENTS, AGREED UPON IN ADVANCE, CONTINGENT ONLY UPON THE PAYEES PERFORMANCE OF AGREED UPON SERVICES (SUCH AS SALARY OR FEES). INCENTIVE COMPENSATION INCLUDES PAYMENTS BASED ON SATISFACTION OF PRE-DETERMINED PERFORMANCE TARGETS SUCH AS QUALITY/PATIENT SAFETY GOALS, EMPLOYEE AND CUSTOMER ENGAGEMENT GOALS, ORGANIZATIONAL GROWTH, AND FINANCIAL PERFORMANCE, AMONG OTHER THINGS. A NEW EXECUTIVE RETENTION 457F PLAN, EFFECTIVE JANUARY 1, 2015, REPLACED THE ADVENTIST HEALTHCARE CAPITAL ACCUMULATION ACCOUNT PLAN. PRE-TAX CONTRIBUTIONS ACCUMULATED ANNUALLY ARE DISTRIBUTED ON JANUARY 1ST OF THE 2ND YEAR, IF STILL EMPLOYED. THERE IS A 2 YEAR DEFERRAL PERIOD BEFORE PAYMENTS ARE RELEASED. THE FIRST PAYMENT FOR THE NEW EXECUTIVE RETENTION PLAN, RELATED TO CONTRIBUTIONS ACCUMULATED IN 2015, WILL BE DISTRIBUTED ON JANUARY 1, 2017 AND CONTRIBUTIONS ACCUMULATED IN 2016 WILL BE DISTRIBUTED ON JANUARY 1, 2018. IN ADDITION, OTHER REPORTABLE COMPENSATION INCLUDES LONG-TERM DISABILITY COVERAGE, CELL PHONE ALLOWANCES, CASH-OUT OF UNUSED PAID TIME OFF (PTO) HOURS (ONLY FOR EMPLOYEES THAT LEAVE OUR ORGANIZATION), IMPUTED VALUE OF LIFE INSURANCE BENEFITS, TAXABLE PAYABLE PAY, AND SEVERANCE, AS APPLICABLE. NON-TAXABLE BENEFITS INCLUDES PRE-TAX PAYROLL DEDUCTIONS (SUCH AS FLEXIBLE MEDICAL SPENDING, DEPENDENT CARE, AND EMPLOYEE HEALTH BENEFIT PREMIUM), AND THE EMPLOYER PORTION OF CERTAIN EMPLOYEE BENEFITS SUCH AS HEALTH INSURANCE, DENTAL INSURANCE, VISION INSURANCE, LIFE INSURANCE, BASE CONTRIBUTIONS TO RETIREMENT PLANS, MATCHING OF EMPLOYEE RETIREMENT CONTRIBUTIONS, ETC. PAY PRACTICE: ADVENTIST HEALTHCARE UTILIZES A SINGLE EMPLOYER ID FOR ALL OF ITS AFFILIATED ENTITIES FOR EMPLOYMENT PURPOSES. AS SUCH, ACTUAL COMPENSATION AND BENEFITS ARE CHARGED TO THE RESPECTIVE ENTITIES AND THE RESULTING COMPENSATION AND BENEFITS ARE REPORTED ON EACH AFFILIATE'S IRS FORM 990 AS IF PAID DIRECTLY BY SUCH AFFILIATE. HACKETTSTOWN FOLLOWS ADVENTIST HEALTHCARE'S PAY PRACTICE. MR. COE'S COMPENSATION AND BENEFITS ARE PAID BY ADVENTIST HEALTHCARE AND NOT CHARGED BACK TO HACKETTSTOWN COMMUNITY HOSPITAL. AS APPLICABLE, THE SAME AND NON-ADDITIVE COMPENSATION AND EMPLOYMENT BENEFIT PLAN CONTRIBUTION AMOUNTS WERE ALSO DISCLOSED IN THE ADVENTIST HEALTHCARE INC.'S RELATED ENTITIES RETURNS. INDEPENDENT GUIDELINES - WHEN SETTING COMPENSATION FOR THE "OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES," ADVENTIST HEALTHCARE FULLY COMPLIES WITH THE PROCEDURAL SAFE GUARDS EMBODIED IN IRS REGULATIONS. COMPENSATION FOR ADVENTIST HEALTHCARE AND HACKETTSTOWN COMMUNITY HOSPITAL "OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND THE HIGHEST COMPENSATED EMPLOYEES" IS ENTIRELY SET BY A COMMITTEE OF ADVENTIST HEALTHCARE'S BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES A SUMMARY OF HEALTH CARE SALARIES AND BENEFITS FOR COMPARABLE SIZED ORGANIZATIONS BOTH NATIONALLY AND IN THE NEW JERSEY-NEW YORK REGION. TO FURTHER ENSURE REASONABLENESS, BOTH COMPENSATION AND BENEFITS ARE TARGETED AT THE 50TH PERCENTILE (OR MEDIAN) OF THE MARKET. PAY PHILOSOPHY - FOR ALL HACKETTSTOWN COMMUNITY HOSPITAL EMPLOYEES INCLUDING THOSE LISTED ON SCHEDULE J, THE GOAL OF ADVENTIST HEALTHCARE IS TO OFFER COMPETITIVE SALARIES IN ORDER TO ATTRACT, HIRE AND RETAIN QUALIFIED AND TALENTED INDIVIDUALS. MAINTAINING A QUALITY, STABLE WORKFORCE HAS A POSITIVE IMPACT ON THE WORKPLACE AND ON THE CARE PROVIDED TO OUR PATIENTS/RESIDENTS AND THEIR FAMILIES. IN GENERAL, NON-EXECUTIVE EMPLOYEES ARE COMPENSATED UTILIZING THE FULL WAGE SCALE FOR THEIR RESPECTIVE POSITIONS, COMPARED TO THE MARKET. HOWEVER, EXECUTIVES ARE GENERALLY LIMITED TO THE MEDIAN OF THE MARKET FOR THEIR RESPECTIVE POSITIONS. PART I, LINES 4A-B A NEW EXECUTIVE RETENTION 457F PLAN, EFFECTIVE JANUARY 1, 2015, REPLACED THE ADVENTIST HEALTHCARE CAPITAL ACCUMULATION ACCOUNT PLAN. PRE-TAX CONTRIBUTIONS ACCUMULATED ANNUALLY ARE DISTRIBUTED ON JANUARY 1ST OF THE 2ND YEAR, IF STILL EMPLOYED. THERE IS A 2 YEAR DEFERRAL PERIOD BEFORE PAYMENTS ARE RELEASED. THE FIRST PAYMENT FOR THE NEW EXECUTIVE RETENTION PLAN, RELATED TO CONTRIBUTIONS ACCUMULATED IN 2015, WILL BE DISTRIBUTED ON JANUARY 1, 2017 AND CONTRIBUTIONS ACCUMULATED IN 2016 WILL BE DISTRIBUTED ON JANUARY 1, 2018. THE FOLLOWING EMPLOYEE LISTED BELOW FELL OUTSIDE THE AGE BRACKET TO BE INCLUDED IN THE 457F PLAN, AND THEY RECEIVED A LUMP-SUM CASH BONUS PAYMENT: MARY ANN ANDERSON: $24,844 ALSO, IN 2015, SEVERANCE PAYMENTS WERE MADE TO: JUDITH H WIEGAND: $50,976 FORM 990, PART VI, SECTION A, LINE 6 BY LAWS, ARTICLE II: THERE SHALL BE A SINGLE CLASS OF CONSTITUENT MEMBERS OF THE HOSPITAL CORPORATION (INDIVIDUAL - MEMBER, COLLECTIVELY - MEMBERSHIP), WHICH SHALL CONSIST OF THE DULY ELECTED MEMBERS OF THE BOARD OF DIRECTORS OF ADVENTIST HEALTHCARE, INC., A NONPROFIT CORPORATION EXISTING UNDER AND OPERATING BY VIRTUE OF THE LAWS OF THE STATE OF MARYLAND. FORM 990, PART VI, SECTION A, LINE 7A BY LAWS, ARTICLES II AND III (VARIOUS PARTS) TRUSTEES OF THIS ORG ARE ELECTED BY THE MEMBER (I.E. ADVENTIST HEALTHCARE, INC.). FORM 990, PART VI, SECTION A, LINE 7B BY LAWS, ARTICLE II- RESERVED AUTHORITY AND RESPONSIBILITY: NOTWITHSTANDING ANY PROVISION OF THE CERTIFICATE OF INCORPORATION OR THESE BYLAWS TO THE CONTRARY, THE FOLLOWING ACTIONS ARE RESERVED TO THE MEMBERSHIP: 1. THE PURCHASE, SALE OR DISPOSITION OF REAL PROPERTY OF THE HOSPITAL CORPORATION; 2. THE ADOPTION, ALTERING, AMENDING OR REPLACING OF THE CERTIFICATE OF INCORPORATION OR THE BYLAWS OF THE HOSPITAL CORPORATION; 3. THE LIQUIDATION, DISSOLUTION, WINDING UP OR ABANDONMENT OF THE HOSPITAL CORPORATION; AND 4. THE RETENTION AND EXERCISE OR DELEGATION OF VOTING RIGHTS ASSOCIATED WITH THE OWNERSHIP OF ANY SHARES OF STOCK OR INTEREST OWNED OR HELD BY THE HOSPITAL CORPORATION OR ANY ENTITY SUBSIDIARY TO OR CONTROLLED BY THE HOSPITAL CORPORATION ("SUBSIDIARY ORGANIZATION") IN CONNECTION WITH THE FOLLOWING ACTIONS: (A) THE AMENDMENT OF THE ORGANIZATIONAL DOCUMENTS OF A SUBSIDIARY ORGANIZATION; (B) THE CONSOLIDATION OF A SUBSIDIARY ORGANIZATION WITH ONE OR MORE ENTITIES TO FORM A NEW CONSOLIDATED CORPORATION; (C) THE MERGER OF A SUBSIDIARY ORGANIZATION INTO ANOTHER ENTITY OR THE MERGER OF ONE OR MORE OTHER ENTITIES INTO A SUBSIDIARY ORGANIZATION; (D) THE SALE, LEASE, EXCHANGE OR OTHER TRANSFER OF ALL, OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF A SUBSIDIARY ORGANIZATION, INCLUDING ITS GOODWILL AND FRANCHISES; (E) THE PARTICIPATION BY A SUBSIDIARY ORGANIZATION IN A SHARE EXCHANGE AS THE ENTITY THE STOCK/INTEREST OF WHICH IS TO BE ACQUIRED; (F) THE VOLUNTARY OR INVOLUNTARY LIQUIDATION, DISSOLUTION OR WINDING-UP OF A SUBSIDIARY ORGANIZATION. 5. APPOINTMENT OF MEMBERS OF THE BOARD OF THE HOSPITAL CORPORATION FROM NOMINEES SUBMITTED BY THE BOARD OF THE HOSPITAL CORPORATION; 6. REMOVAL OF MEMBERS OF THE BOARD OF THE HOSPITAL CORPORATION. 7. AUTHORIZE AND APPROVE THE ISSUANCE OF DEBT AND THE USE OF PROCEEDS OF SUCH DEBT FOR AND ON BEHALF OF THE HOSPITAL CORPORATION; 8. DEVELOP CAPITAL INVESTMENT, CAPITAL ALLOCATION AND BORROWING POLICIES FOR THE HOSPITAL CORPORATION; 9. CEASE PROVIDING HEALTH CARE SERVICES NECESSARY FOR OPERATION AS A LICENSED GENERAL ACUTE CARE FACILITY AT ANY SITE; 10. CHANGE THE STATED PURPOSES, MISSION OR PHILOSOPHY OF THE HOSPITAL CORPORATION, OR ANY CONTROLLED ENTITY AS FOUND IN THE ARTICLES OF INCORPORATION, BYLAWS, OR OTHER GOVERNING DOCUMENTS OF THE HOSPITAL CORPORATION; 11. ADOPTING THE HOSPITAL CORPORATION'S ANNUAL AND LONG-TERM CAPITAL AND OPERATION BUDGETS; 12. MAKING ANY MAJOR CHANGES IN ANY OF THE HOSPITAL CORPORATION'S INSURANCE PROGRAM; AND 13. RECOMMENDING ANY UNBUDGETED CAPITAL EXPENDITURE OF THE HOSPITAL CORPORATION'S CAPITAL BUDGET IN EXCESS OF $500,000. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING THE FORM 990, THE FORM WAS PREPARED BY THE INTERNAL FINANCE TEAM OF THE HEALTH SYSTEM WITH INPUT FROM MANY HOSPITAL DEPARTMENTS. IT WAS REVIEWED IN DETAIL BY THE HRMC CONTROLLER AND CFO. THE FORM WAS DISCUSSED AND REVIEWED IN DETAIL WITH THE ORGANIZATION'S OUTSIDE TAX ADVISORS. THE CFO THEN CONDUCTED A HIGHER LEVEL REVIEW OF THE FORM WITH THE HRMC PRESIDENT. THE 990 WAS THEN MADE AVAILABLE TO THE ORGANIZATION'S BOARD OF DIRECTORS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PURSUANT TO THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, EACH BOARD MEMBER, OFFICER, DIRECTOR AND ANY EMPLOYEE IN A POSITION THAT REQUIRES COORDINATION AND/OR NEGOTIATION WITH CONTRACTORS OR SUPPLIERS, IS REQUIRED ON AN ANNUAL BASIS TO DISCLOSE ANY BUSINESS OR FINANCIAL RELATIONSHIP OUTSIDE OF THE ORGANIZATION. COMPLIANCE WITH POLICY IS MONITORED AND ENFORCED BY THE HUMAN RESOURCES DEPARTMENT, INTEGRITY DEPARTMENT AND THE LEGAL DEPARTMENT IN THE EVENT THERE IS A CONFLICT OF INTEREST, BOARD MEMBERS WILL RECUSE THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION FOLLOWS THE COMPENSATION GUIDELINES OF ITS SOLE MEMBER, ADVENTIST HEALTHCARE, INC. A TAX-EXEMPT AFFILIATE. INDEPENDENT GUIDELINES - WHEN SETTING COMPENSATION FOR THE CEO/PRESIDENT, ADVENTIST HEALTHCARE FULLY COMPLIES WITH THE PROCEDURAL SAFEGUARDS EMBEDDED IN THE IRS REGULATIONS. COMPENSATION FOR ADVENTIST HEALTHCARE'S CEO/PRESIDENT IS ENTIRELY SET BY A COMMITTEE OF ADVENTIST HEALTHCARE INC.'S BOARD OF TRUSTEES. IN SETTING COMPENSATION, THE GOVERNING BOARD COMMITTEE RELIES UPON MARKET COMPARABILITY DATA PROVIDED BY AN INDEPENDENT OUTSIDE COMPENSATION CONSULTANT WHO PROVIDES A SUMMARY OF HEALTHCARE SALARIES AND BENEFITS FOR COMPARABLE SIZED ORGANIZATIONS BOTH NATIONALLY AND THE BALTIMORE-WASHINGTON REGION. TO FURTHER ENSURE REASONABLENESS, BOTH COMPENSATION AND BENEFITS ARE TARGETED AT THE 50TH PERCENTILE OF THE MARKET. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET ORGANIZATION TRANSFERS -1,527,200. ADVENTIST HEALTHCARE INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521532556 HEALTHCARE SERVICES MD 501(C)(3) LINE 3 MID-ATLANTIC ADVENTIST HEALTHCARE CORPORATION 0 ADVENTIST HEALTHCARE URGENT CARE CENTERS INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 461577511 CLINIC - EMERGENCY CARE MD 501(C)(3) LINE 9 ADVENTIST HEALTHCARE INC 0 ADVENTIST HOME HEALTH SERVICES INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 520986808 HOME CARE SERVICES MD 501(C)(3) LINE 9 ADVENTIST HEALTHCARE INC 0 ADVENTIST PHYSICIAN SERVICES INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 204600646 PHYSICIAN SERVICES MD 501(C)(3) LINE 9 ADVENTIST HEALTHCARE INC 0 ADVENTIST REHABILITATION HOSPITAL OF MARYLAND INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 201486678 REHABILITATION HOSPITAL MD 501(C)(3) LINE 3 ADVENTIST HEALTHCARE INC 0 ADVENTIST REHABILITATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 300780513 REHABILITATION SERVICES MD 501(C)(3) LINE 9 ADVENTIST REHABILITATION HOSPITAL OF MARYLAND INC 0 HACKETTSTOWN REGIONAL MEDICAL CENTER EMERGENCY SERVICES INC 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 270820164 AMBULANCE SERVICE NJ 501(C)(3) LINE 11A, I HACKETTSTOWN COMMUNITY HOSPITAL INC 1 HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION INC 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 222333410 FUNDRAISING NJ 501(C)(3) LINE 11A, I HACKETTSTOWN COMMUNITY HOSPITAL INC 1 MEDICAL CENTER PARTNERS INC 651 WILLOW GROVE STREET HACKETTSTOWN NJ 07840 454789273 PHYSICIAN SERVICES NJ 501(C)(3) LINE 11A, I HACKETTSTOWN COMMUNITY HOSPITAL INC 1 MID-ATLANTIC ADVENTIST HEALTHCARE CORPORATION 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521884153 HOLDING COMPANY MD 501(C)(3) LINE 9 N/A 0 ADVENTIST BEHAVIORAL HEALTH FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 205479860 FUNDRAISING MD 501(C)(3) LINE 11A, I ADVENTIST HEALTHCARE INC 0 REGINALD S LOURIE CENTER FOR INFANTS AND YOUNG CHILDREN 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521255870 BEHAVIORAL CARE MD 501(C)(3) LINE 9 ADVENTIST HEALTHCARE INC 0 SHADY GROVE ADVENTIST HOSPITAL FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521216429 FUNDRAISING MD 501(C)(3) LINE 11A, I N/A 0 WASHINGTON ADVENTIST HOSPITAL FOUNDATION INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521692158 FUNDRAISING MD 501(C)(3) LINE 11A, I ADVENTIST HEALTHCARE INC 0 WASHINGTON ADVENTIST FITNESS CENTER 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 274758462 WELLNESS MD 501(C)(3) LINE 9 ADVENTIST HEALTHCARE INC 0 PREMIER MEDICAL NETWORK INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 521952469 JOINT PHYSICIAN CONT MD ADVENTIST HEALTHCARE INC C 0 CLARKSBURG COMMUNITY HOSPITAL INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 272330124 HOLDS PROPERTY FOR FUTURE NON-PROFIT HOSPITAL MD ADVENTIST HEALTHCARE INC C 0 WASHINGTON ADVENTIST HOSPITAL INC 820 W DIAMOND AVE SUITE 600 GAITHERSBURG MD 208781419 272330170 HOLDS PROPERTY FOR FUTURE NON-PROFIT HOSPITAL MD ADVENTIST HEALTHCARE INC C 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION B 400000 COST HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION B 15350 COST HACKETTSTOWN COMMUNITY HOSPITAL FOUNDATION C 259565 COST HRMC EMERGENCY MEDICAL SERVICES L 58348 COST MEDICAL CENTER PARTNERS INC L 35824 COST ADVENTIST HEALTHCARE INC M 2324773 COST ADVENTIST HEALTHCARE INC P 5083842 COST ADVENTIST HEALTHCARE INC Q 1527200 COST