2016-05-15T20:28:21-05:00 2015-06-30 EISNERAMPER LLP 111 WOOD AVE SO STE 600 ISELIN NJ 088302700 990 2014-07-01 010553478 EAST MOUNTAIN HOSPITAL INC % MICHAEL VOORHEES EAST PO BOX 1029 BELLE MEAD NJ 085021029 MICHAEL VOORHEES EXECUTIVE DIRECTOR 9082811439 2016-05-16 true RICHARD A SACKIN P00184276 7322437000 2014 2016-08-17 19:52:53Z MICHAEL VOORHEES PO BOX 1029 BELLE MEAD NJ 085021029 4578318 false X eastmountainhospital.com X 2003 NJ EAST MOUNTAIN HOSPITAL IS AN INPATIENT PSYCHIATRIC HOSPITAL 8 6 66 0 0 400 4881118 4550736 30586 26844 277 338 4911981 4578318 0 500 0 0 2622480 2382509 0 0 0 2258687 2139228 4881167 4522237 30814 56081 2018080 2157398 812999 913778 1205081 1243620 TOGETHER WE WILL PROVIDE A SAFE, STRUCTURED, THERAPEUTIC COMMUNITY TO TREAT ADULTS WHO HAVE BEHAVIORAL AND SUBSTANCE ABUSE PROBLEMS AND RETURN THEM TO THEIR FAMILIES OR THE NEXT LEVEL OF CARE AS SOON AS POSSIBLE. false false 3891943 500 4550736 PSYCHIATRIC HOSPITAL WHICH CARED FOR 539 INPATIENTS AND HAD A TOTAL OF 5,549 PATIENT DAYS. 3891943 true false false false false false false false false false true false false true true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 4 0 true 66 true false false false false false false false false false false X 8 6 false false false false false false false true true false false true true true true true true true true false X X MICHAEL VOORHEES 9082811439 PO BOX 1029 BELLE MEAD NJ 085021029 X MICHAEL VOORHEES EXECUTIVE DIRECTOR & TRUSTEE 40.0 0.0 X X 130163 0 21223 DAVID CENTAFONT TRUSTEE 0.0 0.0 X 0 0 0 ENRICO DEGIRONIMO TRUSTEE 0.0 0.0 X 0 0 0 RANDOLPH JACOBSON TREASURER & TRUSTEE 0.0 0.0 X X 0 0 0 PATRICIA TOOLE CHAIRPERSON 0.0 0.0 X 0 0 0 SUSAN BONFIELD TRUSTEE 0.0 0.0 X 0 0 0 CAROL KOSZTYO SECRETARY & TRUSTEE 0.0 0.0 X X 0 0 0 TARA MCKINNEY MD MEDICAL DIRECTOR & TRUSTEE 40.0 0.0 X X 110022 0 1611 BOHDAN CEHELYK MD FORMER MEDICAL DIRECTOR 0.0 0.0 X 253959 0 0 494144 0 22834 3 true true false CARRIER CLINIC PO BOX 147 BELLE MEAD NJ 08502 ADMIN/CLINICAL 870110 SODEXO INC PO BOX 905374 CHARLOTTE NC 28290 DIETARY/HOUSEKEEPING 152144 2 400 400 NET PATIENT REVENUE 624100 4550736 4550736 4550736 26844 26844 0 0 0 0 0 0 0 0 0 ALL OTHER REVENUE 900099 338 338 338 4578318 4550736 0 27182 X 0 500 500 0 0 347586 220043 127543 0 1647179 1629795 17384 39320 36449 2871 177773 161557 16216 170651 159197 11454 86724 77890 8834 28370 28370 36386 36386 0 0 0 870110 582064 288046 757 757 52016 25283 26733 0 0 240926 237097 3829 4496 4496 0 1352 1185 167 0 0 7037 7037 135661 115879 19782 PATIENT RELATED 410316 410316 DIETARY/ENVIRONMENTAL SVS 188434 188434 CONSULTING 16645 16645 BAD DEBTS 2116 2116 57882 39642 18240 4522237 3891943 630294 0 0 0 681759 651757 0 0 622032 636865 0 0 0 0 0 0 0 0 105493 57300 122841 76710 53168 46131 555628 564793 0 0 0 0 0 0 0 200552 2018080 2157398 403919 469773 0 0 0 0 0 0 0 0 0 0 0 0 0 0 409080 444005 812999 913778 X 1205081 1243620 0 0 0 0 1205081 1243620 2018080 2157398 56081 -17542 X false true X true false X 105051 58920 46131 17790 17790 46131 3RD PARTY PAYOR SETTLEMENTS 200552 200552 0 DUE TO CARRIER CLINIC 113346 ACCRUED PENSION 32240 DUE TO THIRD PARTIES 269763 ACCRUED TAIL INSURANCE 28656 444005 X 4558660 -17542 -17542 4576202 2116 2116 4578318 4520121 4520121 2116 2116 4522237 PART X, QUESTION #2 THE HOSPITAL IS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS USING A THRESHOLD OF MORE LIKELY THAN NOT TO ESTIMATE POTENTIAL TAX LIABILITIES. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XI, LINE 4B PATIENT BAD DEBTS 2,116 REPORTED AS REVENUE REDUCTION ON AUDITED FINANCIAL STATEMENTS. PART XII, LINE 4B PATIENT BAD DEBTS 2,116 REPORTED AS REVENUE REDUCTION ON AUDITED FINANCIAL STATEMENTS. true true X true X true X 100 true true true false true true 7859 7859 0.00170 7859 7859 0.00170 7859 7859 0.00170 2587 2587 0.00060 2587 2587 0.00060 true 1077 441122 410056 31066 X true false 1 1 EAST MOUNTAIN HOSPITAL INC PO BOX 1029 BELLE MEAD NJ 085021029 X EAST MOUNTAIN HOSPITAL INC 1 false false true X X X X X X X X X 13 true true false true X WWW.EASTMOUNTAINHOSPITAL.COM X true 13 true WWW.EASTMOUNTAINHOSPITAL.COM false false true X 100 100 X true true X true X X true false true X X false false PART V, SECTION B, LINE 5 WHILE CONDUCTING EMH'S CHNA, A REPRESENTATIVE OF EMH INTERVIEWED MENTAL HEALTH ADMINISTRATORS FROM MIDDLESEX, SOMERSET, CAPE MAY, CAMDEN AND MERCER COUNTIES TO DISCUSS SERVICE GAPS IN THE COMMUNITY. THESE COUNTIES REPRESENT APPROXIMATELY 75% OF EMH ADMISSIONS. PART V, SECTION B, LINE 6A IN AN EFFORT TO BE COST-EFFECTIVE, EMH CONDUCTED ITS CHNA IN CONJUNCTION WITH CARRIER CLINIC. EMH IS A HOSPITAL-WITHIN-A-HOSPITAL ON THE CARRIER CLINIC CAMPUS AND THEIR COMMUNITIES ARE SIMILAR. PART V, SECTION B, LINE 11 IN EMH'S IMPLEMENTATION STRATEGY OF THE CHNA THAT WAS CONDUCTED, APPROVED BY ITS BOARD AND PUBLISHED IN 2013, EMH IDENTIFIED CERTAIN COMMUNITY NEEDS INCLUDING PUBLIC EDUCATION AND ACCESS TO MENTAL HEALTH CARE. EMH ADOPTED A TIMELINE AND STRATEGIES TO ADDRESS THESE NEEDS OVER A THREE-YEAR PERIOD. THE GOALS AND OBJECTIVES SET TO BE COMPLETED BY JUNE 30, 2015 HAVE BEEN MET. THE CHNA PROCESS IDENTIFIED OTHER COMMUNITY NEEDS THAT WERE NOT INCLUDED IN THE IMPLENTATION STRATEGY DUE TO LIMITATIONS IN EXPERTISE AND RESOURCES. PART V, SECTION B, LINE 22D PATIENTS WHO ARE RESIDENTS OF NEW JERSEY AND DO NOT HAVE INSURANCE ARE BILLED PURSUANT TO NEW JERESY STATE BILLING REGULATIONS. ALL PATIENTS REGARDLESS OF RESIDENCY ARE ABLE TO APPLY FOR FINANCIAL ASSISTANCE. PART I, LINE 7, COLUMN F BAD DEBT EXPENSE FOR THE YEAR ENDED JUNE 30, 2015 IS $2,166 AND IS EXCLUDED FROM TOTAL EXPENSES FOR CALCULATING THE PERCENTAGE OF TOTAL EXPENSE. PART I, LINE 7 THE COST-TO-CHARGE RATIO USED FOR PART I, LINE 7 IS BASED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 4 REFER TO AUDITED FINANCIAL STATEMENTS, PAGE 7 FOR FOOTNOTE REGARDING BAD DEBT EXPENSE. PART VI, SUPPLEMENTAL INFORMATION NEEDS ASSESSMENT: AS PART OF EAST MOUNTAIN HOSPITALS'S (EMH) STRATEGIC PLANNING PROCESS, THE HOSPITAL GATHERS AND INCORPORATES NATIONAL, STATE, AND CLINICAL INDUSTRY DATA IN THE DEVELOPMENT OF CLINICAL SERVICES AND EDUCATIONAL FORUMS. EMH IS A PARTICIPATORY MEMBER OF THE NEW JERSEY ASSOCIATION OF MENTAL HEALTH. THIS ORGANIZATION ALSO PROVIDES BEHAVIORAL HEALTH AND ADDICTION INFORMATION RELEVANT TO THE COMMUNITY'S NEEDS. EMH RECEIVES MANY TELEPHONE CALLS FROM THE GENERAL PUBLIC ON A REGULAR BASIS, REQUIRING REFERRALS TO AND INFORMATION REGARDING COMMUNITY RESOURCES, OTHER TREATMENT CENTERS OUTSIDE THE AREA, SUPPORT GROUPS, SELF-HELP GROUPS, ETC. INFORMATION IS PROVIDED WITHOUT CHARGE. IT IS THROUGH THIS CONTACT WITH THE COMMUNITY THAT ENABLES EMH TO UNDERSTAND WHAT SERVICES ARE NEEDED THROUGHOUT THE GEOGRAPHIC AREA. PART VI, SUPPLEMENTAL INFORMATION PATIENT EDUCATION: UNDER A SERVICE AGREEMENT WITH CARRIER CLINIC, A PATIENT SERVICE REPRESENTATIVE MEETS WITH EACH EMH PATIENT, IF THEY ARE MENTALLY CAPABLE, AND/OR A DESIGNATED FAMILY MEMBER OR GUARDIAN INDIVIDUALLY AND ADVISES THEM THAT THEY CAN APPLY FOR CHARITY CARE FOR THEIR SELF PAY BALANCES IF THEY HAVE LIMITED INCOME. THE PATIENT SERVICE REPRESENTATIVE PROVIDES CHARITY CARE APPLICATIONS TO THE PATIENT ACCORDINGLY. PART VI, SUPPLEMENTAL INFORMATION COMMUNITY INFORMATION: EMH SERVES THE ENTIRE STATE OF NEW JERSEY; HOWEVER, THE MAIN PATIENT POPULATION IS FROM SUBURBAN AREAS. THE MAIN SOURCE OF ADMISSIONS IN 2014/2015 WAS FROM MIDDLESEX, SOMERSET, CAPE MAY, OCEAN, MERCER, BURLINGTON AND CAMDEN COUNTIES, ALL LOCATED IN NEW JERSEY. OF THESE COUNTIES, AN AVERAGE OF 10.03% OF THE POPULATION FALLS BELOW POVERTY LEVEL. MANY PATIENTS WHO ARE DISCHARGED FROM EMH DO NOT HAVE THE MEANS TO TRAVEL HOME AND AN EMH EMPLOYEE WILL DRIVE THEM TO THEIR HOME WITHOUT CHARGE. PART VI, SUPPLEMENTAL INFORMATION COMMUNITY BUILDING ACTIVITIES: EMH IS A MEMBER OF SOMERSET COUNTY'S "ADOPT-A-ROAD" PROGRAM WHICH SUPPORTS THE COMMUNITY'S ONGOING EFFORT TO KEEP ITS ROADS MORE ATTRACTIVE AND SAFE. EMH STAFF IS RESPONSIBLE FOR A TWO MILE STRETCH OF ROAD AND SPENT APPROXIMATELY THIRTY-SIX HOURS DURING THE YEAR COLLECTING TRASH. PART III, LINE 6 THE COST-TO-CHARGE RATIO METHOD IS USED FOR PART III, LINE 6. THIS IS THE RATIO OF PATIENT CARE COSTS APPLIED TO CHARGES. PART III, LINE 2 BAD DEBT EXPENSE FOR THE YEAR ENDED JUNE 30, 2015 IS $2,166, WHICH IS BASED ON CHARGES. THE RATIO OF PATIENT CARE COSTS TO CHARGES IS 50.9% WHICH IS APPLIED TO THE BAD DEBT AMOUNT FOR AN ESTIMATED COST OF $1,077. THIS EXPENSE IS REPORTED ON PART III, LINE 2. X X X true false false false false false false false false BOHDAN CEHELYK MD FORMER MEDICAL DIRECTOR 80305 0 0 0 173654 0 0 0 0 0 253959 0 0 0 MICHAEL VOORHEES EXECUTIVE DIRECTOR & TRUSTEE 125763 0 0 0 4400 0 4500 0 16723 0 151386 0 0 0 SCHEDULE J, PART I, LINE 4a & PART II DR. BOHDAN CEHELYK'S OTHER REPORTABLE COMPENSATION (iii) OF $173,654 REPRESENTS SEVERANCE. MICHAEL VOORHEES' OTHER REPORTABLE COMPENSATION (iii) OF $4,400 REPRESENTS PENSION CONTRIBUTION THAT FAILED DISCRIMINATION TESTING, RETIREMENT (c) $4,500 REPRESENTS EAST MOUNTAIN HOSPITAL'S CONTRIBUTION INTO THE TARGET BENEFIT PLAN, AN ERISA PLAN, AND NONTAXABLE BENEFITS (d) $16,723 REPRESENTS HOSPITALIZATION, MEDICAL, DENTAL AND PRESCRIPTION PLAN COVERAGE AS WELL AS LIFE INSURANCE AND LONG-TERM DISABILITY INSURANCE PAID BY EAST MOUNTAIN HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY INTERNAL FINANCIAL STAFF, IS REVIEWED BY AN OUTSIDE CPA CONSULTING FIRM AND IS THEN REVIEWED BY THE BOARD OF TRUSTEES IN ADVANCE OF THE FILING WITH THE IRS. THIS REVIEW IS DOCUMENTED IN THE BOARD OF TRUSTEE MINUTES. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE AND OFFICER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS EAST MOUNTAIN HOSPITAL IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 EAST MOUNTAIN HOSPITAL UTILIZES THE NEW JERSEY HOSPITAL ASSOCIATION, SULLIVAN COTTER, HOSPITAL AND HEALTHCARE COMPENSATION SERVICE AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISONS. THE INFORMATION IS THEN PROVIDED TO THE BOARD OF TRUSTEES TO ENSURE THE SALARIES ARE WITHIN APPROPRIATE MARKET AND NONPROFIT EXECUTIVE COMPENSATION BASES. THE BOARD REVIEWS THE REASONABLENESS OF THE SALARY STRUCTURE FOR OFFICERS WITHIN THE ORGANIZATION AND ALSO REVIEWS AND ESTABLISHES THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR THESE SALARIES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 EAST MOUNTAIN HOSPITAL PROVIDES DOCUMENTS TO THE PUBLIC UPON REQUEST. THE IRS FORM 990 IS ALSO ACCESSIBLE FROM GUIDESTAR ON THE INTERNET. FORM 990, PART VII, SECTION B, INDEPENDENT CONTRACTORS EAST MOUNTAIN HOSPITAL PURCHASED ADMINISTRATIVE AND CLINICAL SUPPORT SERVICES AT COST FROM CARRIER CLINIC AS PER THE DULY EXECUTED SERVICE AGREEMENT BETWEEN THE TWO ENTITIES. FOR THE FISCAL YEAR ENDED JUNE 30, 2015, THE TOTAL COST OF THESE SERVICES AMOUNTED TO $870,110 ($582,064 FOR CLINICAL SERVICES AND $288,046 FOR VARIOUS BUSINESS SUPPORT FUNCTIONS SUCH AS FINANCIAL REPORTING, BILLING, INFORMATION TECHNOLOGY, HUMAN RESOURCES, AND OTHER BUSINESS FUNCTIONS). FORM 990, PART VII, SECTION A, OFFICERS DR. CEHELYK IS NO LONGER EMPLOYED AS A MEDICAL DIRECTOR AS OF MAY 30, 2014. HIS SEVERANCE IS INCLUDED IN HIS 2014 W-2 AND ACCORDINGLY IS REPORTED IN THE 2014/2015 990 ON PART VII & SCHEDULE J. DR. MCKINNEY IS THE NEW MEDICAL DIRECTOR EFFECTIVE JUNE 22, 2014 AND IS ALSO A TRUSTEE AS OF JUNE 30, 2014. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE OTHER FEES FOR SERVICE INCLUDE $870,110 FOR ADMINISTRATION AND CLINICAL SUPPORT SERVICES PURCHASED AT COST FROM CARRIER CLINIC. FORM 990 PART IX LINE 11G DESCRIPTION:OTHER TOTAL FEES:870110