2014-11-12T10:05:43-06:00 2013-12-31 346565596 Ernst & Young US LLP 111 Monument Circle Suite 4000 Indianapolis IN 46204 990 2013-01-01 223392808 Foundation for Morristown Medical Center FOUN 9735932400 475 South Street Morristown NJ 07960 Kevin Lenahan VP of Finance-CFO 9735932400 2014-11-12 0 P00032493 3176817000 2013 2015-11-30 17:44:51Z Kevin Lenahan 475 South Street Morristown NJ 07960 31298636 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. 34 24 0 223 20522 19522 20627013 15054855 0 0 2309286 5905125 -185302 -1553 22750997 20958427 7006466 5043030 0 0 1098357 2309469 345860 238765 2274543 121790 290693 8572473 7881957 14178524 13076470 101311235 118850144 3008014 3149375 98303221 115700769 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 5421992 5043030 This return consists of a standalone Foundation which is a not-for-profit fundraising organization which solicits funds in its general appeal to support both Morristown Medical Center and the Community as deemed appropriate. 5421992 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 1 0 1 1 1 0 0 0 0 0 0 1 1 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 34 24 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NJ NY PA FL DE X X Ken Butkowski 9734512005 100 Madison Avenue - Box 920 Morristown NJ 07960 Christopher J Baldwin Trustee 2.00 X 0 0 0 William D Bruen Jr Trustee 2.00 X 0 0 0 William Conger Trustee 2.00 X 0 0 0 Abbie Giordano Trustee 2.00 X 0 0 0 William Ju MD Trustee 2.00 X 0 0 0 Daniel Lehrhoff Trustee 2.00 X 0 0 0 Gaines Mimms MD Trustee 2.00 X 0 0 0 Trish O'Keefe Trustee 2.00 37.50 X 0 391111 65298 Grant Van Siclen Parr MD Trustee 2.00 25.00 X 0 55995 0 Leslie C Quick III Trustee 2.00 X 0 0 0 Marc Robinson trustee 2.00 X 0 0 0 Anne S Rooke Trustee 2.00 X 0 0 0 J Peter Simon Trustee 2.00 X 0 0 0 Mark J Simon Trustee 2.00 X 0 0 0 David Shulkin MD Trustee 2.00 37.50 X 0 993612 33544 Karen Walsh Trustee 2.00 X 0 0 0 Finn Wentworth Trustee 2.00 X 0 0 0 Shari Bunks Geller Trustee 2.00 X 0 0 0 Harvey Gerhard MD Trustee 2.00 X 0 0 0 Richard Goryeb Trustee 2.00 X 0 0 0 William Greenblatt Trustee 2.00 X 0 0 0 Damion A Martins MD Trustee 2.00 37.50 X 0 555054 102575 Daniel Pyo MD Trustee 2.00 X 0 0 0 Gil Santaliz Trustee 2.00 X 0 0 0 Paul Sturman Trustee 2.00 X 0 0 0 Susan Walter Trustee 2.00 X 0 0 0 Edward B Deutsch Trustee 2.00 X 0 0 0 Gregory J Mulford Trustee 2.00 37.50 X 0 317578 3099 Guy Taylor Trustee 2.00 X 0 0 0 Mrk D Widmann Trustee 2.00 X 0 0 0 John A Gerson Trustee 2.00 X 0 0 0 Derek T Malmberg Trustee 2.00 X 0 0 0 George Saunders Trustee 2.00 X 0 0 0 Beth Wipperman Trustee 2.00 X 0 0 0 James F Quinn Chief Development Officer 37.50 X 0 313466 110800 Cynthia W O'Donnell JD Director of Gift Planning 37.50 X 0 153640 11164 Hyona Revere Director of Major Gifts 37.50 X 0 151031 9053 Christine Hajsok Director of Finance 37.50 X 0 149123 11783 Regina Diverio Director-Communications 37.50 X 0 127993 5574 Bonnie Gannon Director-Relations 37.50 X 0 118785 11183 Susan Johns Major Gifts 37.50 X 0 106548 4343 0 3433936 368416 0 0 1 0 0 150220 14904635 64437 15054855 2663112 20522 2642590 13473676 10231663 3242013 3242013 3242013 88789 150220 108298 -19509 -19509 18204 248 17956 17956 20958427 0 20522 5883050 4326330 4326330 716700 716700 1999599 378962 1620637 309870 309870 14382 14382 238765 238765 41781 41781 63490 63490 88766 88766 24730 24730 51824 51824 5720 5720 7881957 5421992 185422 2274543 14329033 12750632 39959754 50971863 45111789 41723462 10700736 1910659 2703451 101311235 118850144 1426337 1577190 1581677 1572185 3008014 3149375 X 24008102 29558786 46835412 53515660 27459707 32626323 98303221 115700769 101311235 118850144 X 13076470 5823936 -1502858 X 0 1 X 1 0 X 9056345 11881492 14766658 20441711 15053302 71199508 9056345 11881492 14766658 20441711 15053302 71199508 4260835 66938673 1198917 2797866 1511954 2140604 2663112 10312453 81511961 0 0.82120 0.81560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 74295119 12998553 5394199 6545888 86141983 60179353 18844913 4371231 9100378 74295119 60633886 12989768 148154 13592455 60179353 57108691 9557598 4280237 10312640 60633886 54655373 7307198 3030613 7884493 57108691 0.38000 0.62000 0 0 0 10700736 C 10700736 Annuities Payable 1572185 1572185 20958427 0 20958427 0 20958427 7881957 0 7881957 0 7881957 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 1 Jay Angeletti Group 17 Village Road New Vernon NJ 07976 Consulting and Fundraising 0 8090811 38000 8052811 Harris Connect 1511 Route 22 Brewster NY 10509 Direct Mail/Internet/Phone 0 322876 200765 122111 8413687 238765 8174922 NJ NY PA FL DE Golf Event 110500 60500 50000 50784 319 Craniofacial Gala 41911 33136 8775 7617 8597 9191 4 86598 56584 30014 437 27638 48 475 3192 239009 150220 88789 8054 78422 8645 475 12702 108298 -19509 18204 40 208 1 1.00000 18204 40 208 248 17956 NJ 1 0 0 0 0.50000 0.50000 Christine Hajsok 475 South Street Morristown NJ 07960 0 Christine Hajsok 149123 The Director of Finance for the Foundation for Morristown Medical Center. She manages and oversees all fundraising activities for this entity. X 1 0 1 Morristown Medical Center 100 Madison Avenue Morristown NJ 07960 521958352 501(c)(3) 4326330 Program Services. 1 0 Project Independence 108 702200 Nursing School Tuition Grants 7 14500 Part I, Line 2: The organization uses due diligence in the process for reviewing and selecting grant recipients and is comfortable that the grants are used for their intended purpose. The grants issued were made to related organizations to further their exempt purpose. Schedule I, Part III, Line 1 Project Independence is a grant funding project to help Morristown Medical Center patients over a temporary financial hardship. 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 would be aware of the financial position of the patient and is working with them 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 $7,000 are made payable directly to the individual. Schedule I, Part III, Line 2 2012-2013 WAMMC Scholarship The Women's Association of Morristown Medical Center (WAMMC) is a dynamic, volunteer-based organization with a legacy of service that encompasses over a century. Its mission is to support Morristown Medical Center in advancing the quality of healthcare it offers, through fundraising. WAMMC established the Scholarship Trust Fund in 1995. Our Scholarship Trust Fund awards financial aid to qualified MMC or ARI employees pursuing studies in the healthcare field. Submitting an application does not obligate WAMMC to award a scholarship. In the 2014 calendar year, WAMMC anticipates awarding a total of $20,000 in scholarships. WAMMC Scholarship Award Criteria Award criteria must include but are not limited to: 1. The applicant being a full time, on-site MMC or ARI employee who is providing direct patient care or involved in other activities that impact patient care. Applicant, whose employment status changes during the award year, will not receive funding. 2. Supervisor (the person responsible for your performance review) and colleague recommendation(s) as this information is critical in our decision making process. 3. Hospital, community and professional activities. 4. Request for aid should be for studies not covered by Atlantic Healths tuition reimbursement plan. 5. Nursing credentials held by applicant. 6. MD and DDS degrees are not supported. WAMMC Scholarship Funds What can they be used for? 1. WAMMC will award scholarship funds for courses that are specific for healthcare, i.e., English, art, history, math, physical education courses are not supported. 2. WAMMC will award scholarship funds for books needed for a specific course, prep or review courses. 3. MD, MBA and DDS degrees are not supported. Applicants Responsibilities: Applications will be available as of October 1 and must be completed and submitted, along with the necessary recommendations, on or before February 1. 1. Applicant must be a current employee of MMC or ARI, and remain a full time employee and work on site at AHSs Morristown Medical Center. 2. The applicant must enroll in a course with a recognized health care program accreditation, review program, or be accepted for a clinical experience at MMC or ARI department to be able to apply for a WAMMC scholarship. 3. It is the responsibility of the applicant to ensure that by February 1 the WAMMC Scholarship Committee has received all information required for their decision. Scholarship Application Process Submitting a completed application does not obligate WAMMC, a volunteer based organization, to award a scholarship. Completed applications are due February 1. No application received after February1 will be considered. A complete application requires the following items: 1. Completed application. Please do not use abbreviated form or acronyms and remember to include a course description. 2. Completed Reference Form(s). This information is critical in our decision making process. The WAMMC Scholarship Committee will notify the applicant of its decision by March 1. The Scholarship Committee may award the total amount of aid requested or a portion of the aid requested. Requirements for Reference Form Ask your supervisor to complete and forward the WAMMC Reference Form. Additional references may be submitted and is recommended. All references are due February 1. Requirements for Scholarship Payments WAMMC scholarship payments will be made only after the semester, course or clinical experience is successfully completed. To receive scholarship award payment for the approved course, you must: 1. Must still be a full time employee and work on site at AHS Morristown Medical Center. 2. Supply a formal school transcript for the approved course(s) with grade(s). A graded course is only reimbursed if the applicant has received a minimum of 2.0 on a 4.0 scale. 3. For education that does not have a grade, supply a certificate or letter from the provider showing satisfactory completion of classes (e.g. pass/fail). 4. If aid was for a clinical experience, provide a letter from your MMC or ARI Department Supervisor, or MMC or ARI Program Coordinator stating that your work met their expectations. 5. An official itemized tuition bill must accompany the formal school transcript. 6. The above information must be received by the WAMMC Scholarship Committee no later than 90 days after course completion. 7. It is the responsibility of the applicant to ensure that the WAMMC Scholarship Committee has received all the required information for the scholarship payment. Requirements for Book Scholarship Payments To receive scholarship award payment for the approved book(s), you must: 1. Supply a formal school transcript or certificate or letter from the provider of the course showing satisfactory completion of classes. 2. Provide a receipt for the book(s). Receipt must show the school bookstore name, the specific title of the book and the course name. If a book is purchased from another source, the receipt must have the name of the vendor, specific title of the book and information from the school, teacher or vendor, stating the book was required. 3. The above information must be received by the WAMMC Scholarship Committee no later than 90 days after course completion. 4. It is the responsibility of the applicant to ensure that the WAMMC Scholarship Com 0 0 0 0 0 0 0 0 0 Trish O'Keefe Trustee 0 327776 0 59200 0 4135 0 63200 0 2098 0 456409 0 59200 David Shulkin MD Trustee 0 666467 0 300700 0 26445 0 29211 0 4333 0 1027156 0 300700 Damion A Martins MD Trustee 0 459434 0 95200 0 420 0 97600 0 4975 0 657629 0 95200 Gregory J Mulford Trustee 0 317095 0 0 0 483 0 0 0 3099 0 320677 0 0 James F Quinn Chief Development Officer 0 263652 0 35700 0 14114 0 106217 0 4583 0 424266 0 35700 Cynthia W O'Donnell JD Director of Gift Planning 0 147818 0 4500 0 1322 0 5900 0 5264 0 164804 0 4500 Hyona Revere Director of Major Gifts 0 147328 0 3400 0 303 0 5500 0 3553 0 160084 0 3400 Christine Hajsok Director of Finance 0 144069 0 4600 0 454 0 5700 0 6083 0 160906 0 4600 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 - Soliciatations 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 These above amounts were paid by a related organization. Hess Corp Refer to below. 6063089 Performance. Christopher J Baldwin (Board Member-Trustee) is an Executive Officer of Hess Corp. AHS Hospital Corp (A related organization) paid Hess Corp. $6,063,089 during 2013 for applicable goods. Transaction is considered to be negotiated at arms-length. 0 Pfizer Refer to below. 422794 Performance. Paul Sturman (Board Member-Trustee) is an employee of Pfizer. AHS Hospital Corp (A related organization) paid Pfizer $422,794 during 2013 for applicable goods. Transaction is considered to be negotiated at arms-length. 0 Robert Rooke Refer to below. 22287 Peformance. Robert Rooke is the son of Ann Rooke(Trustee and Officer-AHS and F4MMC). AHS (A related organization) compensated Robert Rooke $22,287 during 2013. Transaction is considered to be negotiated at arms-length. 0 Deloitte Refer to below. 523868 Performance. Derek Malmberg (Board Member-Trustee) is a Partner at Deloitte. AHS Hospital Corp (A related organization) paid Deloitte $523,868 during 2013 for applicable services. Transaction is considered to be negotiated at arms-length. 0 MidAtlantic Neonatiology Associates Refer to below. 1316596 Performance. Gaines Mimms, MD (Board Member-Trustee) is a Neonatologist at MidAtlantic Neonatiology Assoc, AHS Hospital Corp (A related organization) paid MidAtlantic Neonatiology $1,316,596 during 2013 for applicable services. Transaction is considered to be negotiated at arms-length. 0 X 1035 Sale of comp property X 6450 Sale of comp property X 10 10499 Sale of comp property X Toys 88 26637 Sale of comp propert X Electronics 9 8335 Sale of comp propert X Entertainment 2 7596 Cash value of gift X Gift Cards 3 3885 Cash value of cards 0 1 0 Form 990, Part VI, Section A, line 6 As per the by-laws, 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 by-laws. Form 990, Part VI, Section A, line 7a Atlantic Health System, Inc. is the only "member" which 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" which 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 11 The final draft of the IRS 990 was distributed to the "Accounting Sub-Committee" for their review. The "Accounting Sub-Committee" then presents it to the Financial Oversight Committee who will then present it to the Board of Directors. Form 990, Part VI, Section B, line 12c In conjunction wtih Atlantic Health System (Parent), the Foundation for Morristown Medical Center 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 (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 In conjunction with Atlantic Health System (Parent): Line 15A: - A review of officer compensation by an independent 3rd party (Integrated Healthcare Strategies) is completed every year. The most recent survey was conducted in 2013. Officers include President and CEO AH, VP HR & CAO, VP Finance & CFO, VP Legal Affairs, VP Quality & Chief Medical Officer, AHS; VP Government Affairs; VP, Behavioral & Integrative Medicine & CIO, VP Finance & Treasurer, VP AHS & President OH, VP AH & President MMC, and VP AHS & President NMC; VP, System Development & Chief Strategy Officer. In 12/15/2013, VP AHS & President CCM. - On behalf of Atlantic Health, Integrated Healthcare Strategies 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 Compensation Committee of the board which documents the findings and recommendations in committee minutes. Line 15b: - Compensation for key physicians is determined by soliciting salary data from 3 to 4 published sources. These salary recommendations are then reviewed with the MD Contract Committee and approved by the Physician Compensation Committee of the board. Form 990, Part VI, Section C, line 18 Currently the Foundation for Morristown Medical Center retains copies of the filed IRS 990 for the last three years and IRS Form 1023 with the most senior management's assistant. Public disclosure of these IRS 990's can be made at any time at each of the organization's sites. In addition, the 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 it's 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 -2,798,914. Beneficial Interest in Charitable Remainder Unitrust 1,296,056. 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 9 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 11a, I N/A 0 Newton Medical Center Foundation 175 High Street Newton NJ 07860 222618102 Administers donations, grants and bequets 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 9 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 11a, 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 Colelction 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 Atlantic Health System Inc C 0 Nutley Medical Care PA 100 Madison Avenue Morristown NJ 07960 223645010 Healthcare NJ Atlantic Health System Inc C 0 Non-Invasice Diagnstics PA 100 Madison Avenue Morristown NJ 07960 202027439 Healthcare NJ Atlantic Health System Inc C 0 Speciality Care of Practice Associates PA 100 Madison Avenue Morristown NJ 07960 030376428 Healthcare NJ Atlantic Health System Inc C 0 Maternal Fetal Medicine of PRactice Associates PA 100 Madison Avenue Morritown NJ 07960 030376421 Healthcare NJ Atlantic Health System Inc C 0 Madison Pediatrics PA 100 Madison Avenue Morristown NJ 07960 223645007 Healthcare NJ Atlantic Health System Inc C 0 North Jersey Health Ventures Inc 175 High STreet Newton NJ 07860 222705732 Investments in healthcare related joint ventures NJ AHS Investment Corp C 0 AHS ACO LLC 475 South Street Morristown NJ 07960 273800813 Physician Practice NJ AHS Investment Corp C 0 The Northwest New Jersey MedicalSurgicalAlliance PC 175 High Street Newton NJ 07860 450577942 Healthcare Services NJ AHS Investment Corp C 0 The Northwest New Jersey Urgent Care Alliance PC 175 High Street Newton NJ 07860 830492357 Healthcare Services NJ Atlantic Health System Inc C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 AHS Hospital Corp Q 10301910 Actual amount of transaction. AHS Hospital Corp B 22443905 Actual amount of transaction. AHS Hospital Corp B 2798914 Actual amount of transaction.