2012-05-11T13:42:56-05:00 2011-06-30 EISNERAMPER LLP 2015 LINCOLN HIGHWAY POBOX 988 EDISON NJ 088180988 990 2010-07-01 010553478 EAST MOUNTAIN HOSPITAL INC EAST 9082811439 PO BOX 1029 BELLE MEAD NJ 085021029 MICHAEL VOORHEES 9082811439 2012-05-10 1 RICHARD A SACKIN 7322871000 2010 2016-02-24 21:20:13Z MICHAEL VOORHEES PO BOX 1029 BELLE MEAD NJ 085021029 5973214 0 X EASTMOUNTAINHOSPITAL.COM X 2003 NJ EAST MOUNTAIN HOSPITAL IS AN INPATIENT PSYCHIATRIC HOSPITAL. 7 5 62 0 0 0 3000 200 4132748 5965089 130 745 1898 6473 4137776 5972507 0 0 0 0 2259311 2329729 0 0 0 1818950 1973070 4078261 4302799 59515 1669708 2007340 2485440 2739727 1548119 -732387 937321 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. 0 0 3716934 5965089 PSYCHIATRIC HOSPITAL WHICH CARED FOR 406 INPATIENTS AND HAD A TOTAL OF 5,299 PATIENT DAYS. 3716934 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 62 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X X MICHAEL VOORHEES 9082811439 40 EAST MOUNTAIN ROAD BELLE MEAD NJ 085021029 MARY PAWLIKOWSKI 0.00 X 0 0 0 BOHDAN CEHELYK MD 40.00 X X 240326 0 41473 MICHAEL VOORHEES 40.00 X X 112251 0 27930 DAVID CENTAFONT 0.00 X 0 0 0 ENRICO DEGIRONIMO 0.00 X 0 0 0 RANDOLPH JACOBSON 0.00 X X 0 0 0 PATRICIA TOOLE 0.00 X X 0 0 0 KAREN BRELOWSKI 40.00 X 91299 0 11189 443876 0 80592 2 0 1 0 CARRIER CLINIC PO BOX 147 BELLE MEAD NJ 08502 ADMINISTRATIVE & CLINICAL SUPPORT 825783 SODEXO INC PO BOX 905374 CHARLOTTE NC 28290 DIETARY & HOUSEKEEPING SERVICES 133959 2 200 200 NET PATIENT REVENUE 624100 5965089 5965089 5965089 745 745 2530 707 1823 1823 PURCHASING DISCOUNT 900099 3831 3831 LABOR SUPPORT 900099 588 588 ADMINISTRATIVE FEE 900099 216 216 15 15 4650 5972507 5965089 0 7218 439563 328239 111324 1476475 1428589 47886 85173 78096 7077 153958 128646 25312 174560 162032 12528 73602 66210 7392 7428 7428 36101 36101 823027 539555 283472 1046 1046 35165 19776 15389 226489 222889 3600 1358 1358 2174 1000 1174 5028 5028 113762 103975 9787 PATIENT - RELATED 453261 453261 DIET/ENVIRONMENTAL SVS 161908 161908 MISCELLANEOUS 24896 13575 11321 BAD DEBT EXPENSE 7825 7825 4302799 3716934 585865 0 1344749 1815766 541463 542062 86240 81332 98231 51951 34888 46280 2007340 2485440 275289 308795 2464438 1239324 2739727 1548119 X -732387 937321 -732387 937321 2007340 2485440 1669708 0 X 0 1 1 X 0 X 80441 34383 46058 17790 17568 222 46280 DUE TO CARRIER CLINIC 118276 ACCRUED PENSION 66183 DUE TO THIRD PARTIES- SEE PART XIV 1054865 1239324 5972507 4302799 1669708 0 1669708 5973214 707 707 5972507 0 5972507 4303506 707 707 4302799 0 4302799 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 XII, LINE 2D: FUNDRAISING EXPENSE $707 PART XIII, LINE 2D: FUNDRAISING EXPENSE $707 FORM 990, PART VIII, LINE 2A & SCHEDULE D, PART X, LINE 4: DUE TO THE FINALIZATION OF SEVERAL PRIOR YEAR NJ STATE MEDICAID AUDITS, AND UPON COMPLETION OF THE YEAR END INDEPENDENT AUDIT, THIRD PARTY LIABILITY RESERVES WERE REDUCED $1,739,813 AND THE SAME AMOUNT WAS RECOGNIZED AND INCLUDED IN THE REPORTED NET PATIENT REVENUE OF $5,965,089. 1 1 X 1 X 1 X 100.000000000000 1 1 1 0 0 28658 28658 0.00670 28658 28658 0.00670 300 300 0.00010 300 300 0.00010 28958 28958 0.00680 271 271 0.00010 271 271 0.00010 1 3860 0 1416138 1404915 11223 X 1 0 1 1 EAST MOUNTAIN HOSPITAL INC

PO BOX 1029 BELLE MEAD NJ 085021029

X EAST MOUNTAIN HOSPITAL INC 1 1 1 100.000000000000 1 100.000000000000 1 X X X X 1 1 X X 1 0 X X X X 1 X 0 0 EAST MOUNTAIN HOSPITAL, INC. PART V, SECTION B, LINE 13G: THE EMH PATIENT HANDBOOK INFORMS PATIENTS THAT THEY HAVE THE RIGHT TO TREATMENT WITHOUT DISCRIMINATION BASED ON THEIR ABILITY TO PAY OR SOURCE OF PAYMENT. PART I, LINE 7, COLUMN F - PERCENT OF TOTAL EXPENSEBAD DEBT EXPENSE FOR FISCAL YEAR ENDED JUNE 30, 2011 IS $7,825 AND IS EXCLUDED FROM TOTAL EXPENSES FOR CALCULATING THE PERCENTAGE OF TOTAL EXPENSE.PART I, LINE 7 - COSTING METHODOLOGYTHE COST-TO-CHARGE RATIO USED FOR PART I, LINE 7 IS BASED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.PART II: 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 FOUR HOURS DURING THE YEAR COLLECTING TRASH.PART III, LINE 4 - FOOTNOTE FROM AUDITPATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE REIMBURSED OR CONTRACTED AMOUNT AND DO NOT BEAR INTEREST. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE HOSPITAL'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN THE HOSPITAL'S EXISTING PATIENT ACCOUNTS RECEIVABLE. THE HOSPITAL DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. THE HOSPITAL REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS PERIODICALLY. PAST DUE BALANCES ARE REVIEWED INDIVIDUALLY FOR COLLECTIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. PART VI, LINE 2: AS PART OF EAST MOUNTAIN HOSPITAL'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, LINE 3: 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, LINE 4: EMH SERVES THE ENTIRE STATE OF NEW JERSEY; HOWEVER, THE MAIN PATIENT POPULATION IS FROM SUBURBAN AREAS. THE MAIN SOURCE OF ADMISSIONS IN FISCAL YEAR ENDED JUNE 30, 2011 WAS FROM SOMERSET, MIDDLESEX, OCEAN, CAPE MAY AND CAMDEN COUNTIES, ALL LOCATED IN NEW JERSEY. OF THESE FIVE COUNTIES, AN AVERAGE OF 8.08% 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. X X X 0 0 0 0 0 0 0 0 0 BOHDAN CEHELYK MD 240326 0 0 0 0 0 17000 0 24473 0 281799 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES REVIEWS THE FORM 990 IN ADVANCE OF THE FILING WITH THE IRS. THE 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 AND COTTER, NJMHA, MODERN HEALTHCARE PUBLICATIONS AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISIONS. 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 EAST MOUNTAIN HOSPITAL PURCHASED ADMINISTRATIVE AND CLINICAL SUPPORT SERVICES IN AN ARM'S-LENGTH TRANSACTION FROM CARRIER CLINIC AS PER THE DULY EXECUTED SERVICE AGREEMENT BETWEEN THE TWO ENTITIES. FOR THE FISCAL YEAR ENDED JUNE 30, 2011, THE TOTAL COST OF THESE SERVICES AMOUNTED TO $825,783 - $557,144 FOR CLINICAL SERVICES AND $268,639 FOR VARIOUS BUSINESS SUPPORT FUNCTIONS SUCH AS FINANCIAL REPORTING, BILLING, INFORMATION TECHNOLOGY, HUMAN RESOURCES, AND OTHER BUSINESS FUNCTIONS.