2012-03-15T08:45:48-05:00 2011-04-01 PARENTEBEARD LLC 1650 MARKET STREET STE 4500 PHILADELPHIA PA 19103 990 2011-01-01 221500572 NEWTON MEMORIAL HOSPITAL NEWT 9735798301 175 HIGH STREET NEWTON NJ 07860 THOMAS J SENKER 9735798301 2012-03-07 1 JULIUS GREEN CPA 2159720701 2010 2016-02-24 21:20:13Z X THOMAS J SENKER 175 HIGH STREET NEWTON NJ 07860 35564987 0 X WWW.NMHNJ.ORG X 1932 NJ THE HOSPITAL'S VISION - BE RECOGNIZED AS A PREMIER PROVIDER OF HEALTHCARE SERVICES BY 2012 X 18 13 1233 200 0 0 3809482 799188 125488572 34442477 1553878 197862 -88180 -124589 130763752 35314938 6003930 0 0 0 70477406 20165162 0 0 0 55424270 14003155 131905606 34168317 -1141854 1146621 130302920 0 48519935 0 81782985 0 X TO PROVIDE EXCEPTIONAL CARE AND SERVICE AS WELL AS DEMONSTRATING THE FOLLOWING VALUES: PASSION - FOR EVERYTHING WE DO, COMPASSION - FOR YOU AND YOUR FAMILY, RESPECT - FOR EACH OTHER, INTEGRITY - ALWAYS, AND QUALITY - WITHOUT COMPROMISE. 0 1 25910699 34442477 TO PROVIDE HEALTHCARE SERVICES TO NEWTON AND THE SURROUNDING AREA. THE THREE LARGEST PROGRAM SERVICES ARE NET PATIENT SERVICE REVENUE OF $34,169,717; OTHER PROGRAM REVENUE OF $174,351 AND PSYCH REVENUE OF $68,464. THE COMMUNITY BENEFIT CONTRIBUTION OF NEWTON MEMORIAL HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO, AND PROVISION OF, HEALTH CARE SERVICES AND PROGRAMS AND TO IMPROVE HEALTH IN OUR COMMUNITIES.SEE SCHEDULE H FOR ADDITIONAL INFORMATION REGARDING THE HOSPITAL'S COMMUNITY BENEFIT CONTRIBUTIONS. 25910699 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 1 82 0 1 1233 1 0 0 0 0 0 0 0 0 0 0 X 18 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X DAVID S RIKKOLA CFO 9735798301 175 HIGH STREET NEWTON NJ 07860 X MARK AVONDOGLIO 4.20 X 0 0 0 GLENN A CLARK 4.20 X 0 0 0 RICHARD I CLARK 4.20 X 0 0 0 CRAIG U DANA 4.20 X 0 0 0 PHILLIP D DEACON 4.20 X 0 0 0 DR NICK P DIBITETTO 4.20 X 0 0 0 BRIAN FITZPATRICK 4.20 X 0 0 0 WILLIAM I HOUGHTON III 4.20 X 0 0 0 CONSTANCE C MIERENDORF PHD 4.20 X 0 0 0 GEORGE W MORVILLE JR 4.20 X 0 0 0 PAUL J OWENS MD 4.20 X 0 0 0 JEFFREY J QUINN 4.20 X 0 0 0 ROBERT E MCCRACKEN 4.20 X X 0 0 0 TAMMIE HORSFIELD 4.20 X X 0 0 0 JAMES S HUBLEY 4.20 X X 0 0 0 CHRISTOPHER LYNCH 4.20 X X 0 0 0 E JANE BROWN 4.20 X X 0 0 0 CLAUDETTE DELONG 4.20 X X 0 0 0 THOMAS J SENKER 37.50 X X 202712 0 9347 SEAN O'ROURKE 37.50 X 103239 0 9596 DAVID RIKKOLA 37.50 X 101722 0 9821 SHASHIDHAR REDDY MD 37.50 X 131003 0 6067 JOHN O'BRIEN MD 37.50 X 107134 0 8239 DONALD RUBINO MD 37.50 X 106314 0 9657 DAVID LAZARUS 37.50 X 106296 0 9658 858420 0 62385 7 0 1 0 MEDICAL SEARCH LLC PO BOX 535213 ATLANTA GA 303535213 PHYSICIAN STAFFING SERVICES 392126 CERNER CORPORATION 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 SOFTWARE SUPPORT & CONSULTING 305979 METZ & ASSOC TWO WOODLAND DRIVE DALLAS PA 18612 FOOD SERVICES 226180 REED SMITH LLP 136 MAIN STREET PRINCETON NJ 08543 LEGAL SERVICES 213232 AMERICAN RED CROSS PO BOX 33093 NEWARK NJ 07188 LAB SERVICES 212552 21 7500 754781 36907 799188 NET PATIENT SVC REV 621990 34169717 34169717 OTHER PATIENT SERVICES 621990 174351 174351 PSYCHIATRIC REV 621300 68464 68464 EDUCATION PROGRAMS 611600 26500 26500 LAB SERVICES 621500 3445 3445 34442477 187754 187754 30 30 73528 218668 -145140 -145140 -145140 10078 10078 10078 10078 29337 31381 -2044 -2044 PURCHASE REBATES/DISC 900099 17326 17326 CAFETERIA & VENDING 722210 2702 2702 PHARMACY-EMPLOYEES 446110 1319 1319 1248 1248 22595 35314938 34442477 0 73273 436438 218219 218219 36125 36125 13811171 11596733 2214438 337201 279877 57324 3897485 3233713 663772 1646742 1366796 279946 46072 46072 185406 185406 1516205 872126 644079 144711 144711 5250174 4451658 798516 1475020 1475020 634999 504679 130320 34844 15163 19681 281761 219774 61987 1787597 1384930 402667 391942 305715 86227 BAD DEBT EXPENSE 1751492 1366164 385328 HCCR FUND 200496 200496 BILLING/COLLECTION EXPE 195197 195197 CLEANING/GROUNDS MAINTE 75676 59027 16649 MISCELLANEOUS FEES 19023 19023 12540 12540 34168317 25910699 8257618 0 82202 0 15396108 0 0 12714916 0 0 0 0 1506008 0 1747714 0 49621808 0 35945591 0 5593814 0 0 0 7694759 0 130302920 0 17650885 22452235 336669 8080146 0 48519935 0 X 71603247 0 6475186 0 3704552 0 81782985 0 130302920 0 X 1146621 -82929606 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 35314938 34168317 1146621 491989 -83421595 -82929606 -81782985 33001927 491989 -3055049 -2563060 35564987 -250049 -250049 35314938 34418366 250049 250049 34168317 0 34168317 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE AND LOCAL TAXES. WHEN APPLICABLE, A PROVISION FOR FEDERAL INCOME TAXES IS REFLECTED IN THE FINANCIAL STATEMENTS AND IS INCLUDED IN SUPPLIES AND OTHER EXPENSES ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. A PROVISION FOR FEDERAL INCOME TAXES WAS NOT APPLICABLE FOR THE THREE MONTH PERIOD ENDED MARCH 31, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: WRITE OFF OF OTHER RECEIVABLE -3,163,008. CHANGE IN VALUE OF PERPETUAL TRUSTS 107,959. NET ASSETS TRANSFERRED TO AHS HOSPITAL CORP. ON 4/1/11 -80,366,546. PART XII, LINE 2D - OTHER ADJUSTMENTS: WRITE OFF OF OTHER RECEIVABLE -3,163,008. CHANGE IN VALUE OF PERPETUAL TRUSTS 107,959. PART XII, LINE 4B - OTHER ADJUSTMENTS: GIFT SHOP EXPENSES -31,381. RENTAL EXPENSES -218,668. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP EXPENSES 31,381. RENTAL EXPENSES 218,668. SCHEDULE D, PART XI: THE AUDITED FINANCIAL STATEMENTS WERE FOR THE THREE MONTH PERIOD ENDED MARCH 31, 2011. THIS RECONCILIATION SECTION ON SCHEDULE D WAS PREPARED BASED ON THIS PERIOD, BUT ALSO INCLUDES THE TRANSFER OF NEWTON MEMORIAL HOSPITAL'S ASSETS AND LIABILITIES TO AHS HOSPITAL CORP. ON APRIL 1, 2011. 1 1 1 X 1 X 1 1 1 0 1 1 1788998 1788998 0.05520 112093 112093 0.00350 1901091 1901091 0.05870 31751 2835 28916 0.00090 428065 137480 290585 0.00900 459816 140315 319501 0.00990 2360907 140315 2220592 0.06860 1 270313 103090 10197641 12148105 -1950464 X 1 1 1 1 NEWTON MEMORIAL HOSPITAL

175 HIGH STREET NEWTON NJ 07860

X X X NA 1 PART I, LINE 7: THE COSTING METHODOLOGY USED WAS BASED ON THE 2011 MEDICARE COST REPORT SCHEDULE S-10. PART I, LINE 7G: THE ORGANIZATION INCLUDED $254,487 OF COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1751492. PART I, LINE 6B AN ANNUAL REPORT IS PUBLISHED AND A PUBLIC MEETING WITH THE COMMUNITY IS HELD AND WHAT WE PROVIDE FOR THE COMMUNITY IS DISCUSSED OPENLY AT THIS MEETING. IN ADDITION TO THE VOLUNTEER BOARD OF DIRECTORS THERE IS A COMMUNITY ADVISORY COMMITTEE WITH REPRESENTATIVES OF VARIOUS COMMUNITY MEMBERS WHO MEET TWICE A YEAR, RECEIVE UPDATES ON THE HOSPITAL, AND GIVE THE HOSPITAL FEEDBACK. PART I, LINE 7 QUANTIFIABLE COMMUNITY BENEFIT:THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATION'S (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES. THESE GUIDELINES RECOMMEND THE FOLLOWING:1) REPORT CHARITY CARE AT COST, NOT CHARGES.2) DO NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND QUICK PAY DISCOUNTS AS PART OF CHARITY CARE EXPENSE.3) DO NOT COUNT MEDICARE SHORTFALL AS A COMMUNITY BENEFIT.4) REPORT THE NET EXPENSE FOR COMMUNITY BENEFIT SERVICES, I.E., THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYERS, AND OTHER EXTERNAL SOURCES.THE GOAL OF THE REPORTING GUIDELINES IS TO PRODUCE COMMUNITY BENEFIT FINANCIAL REPORTS THAT REFLECT TRUE COSTS AND THAT DESCRIBE COMMUNITY BENEFIT ACTIVITIES THAT INCREASE ACCESS TO HEALTH CARE AND IMPROVE COMMUNITY HEALTH. PART II: HOSPITAL STAFF PARTICIPATE IN THE UNITED WAY DAY OF CARING AND IN COLLECTING AND DONATING BACKPACKS TO UNITED WAY. THIS IS CONSIDERED A WORKING DAY FOR THOSE WHO PARTICIPATE. THE STAFF ALSO ARE ACTIVE ON THE BOARD OF UNITED WAY AND ON COMMITTEES FOR UNITED WAY.THE HOSPITAL'S PRESIDENT & CEO PARTICIPATES IN THE SUSSEX COUNTY ECONOMIC DEVELOPMENT PARTNERSHIP OF SUSSEX COUNTY CHAMBER OF COMMERCE TO IMPROVE ECONOMIC QUALITY OF LIFE FOR SUSSEX COUNTY. THE PRESIDENT & CEO IS ALSO A MEMBER OF THE YMCA PIONEERING HEALTHY COMMUNITIES INITIATIVE AND SPENT TIME IN WASHINGTON, DC FOR TRAINING IN DECEMBER 2008. MEMBERS OF THE EDUCATION, OUTREACH, COMMUNITY BENEFITS DEPARTMENTS, AND BEHAVIORAL HEALTH AREAS PARTICIPATE ACTIVELY IN COALITION BUILDING WITH THE SUSSEX COUNTY COMMUNITY HEALTH PARTNERSHIP, COALITION FOR HEALTHY & SAFE FAMILIES, SUSSEX COUNTY HUMAN SERVICES ADVISORY COUNCIL, SUSSEX COUNTY CHAMBER OF COMMERCE WELLNESS COMMITTEE, SUSSEX COUNTY KEEP KIDS SAFE COUNCIL, SUSSEX COUNTY PROVIDER AND SENIOR PROVIDER GROUPS, SUSSEX COUNTY CHAMBER OF COMMERCE (SCCC), SCCC ECONOMIC DEVELOPMENT PARTNERSHIP, SCCC WELLNESS COMMITTEE; GINNIE'S HOUSE BOARD OF DIRECTORS, GINNIE'S HOUSE CHILD ADVOCACY CENTER, GINNIE'S HOUSE PROGRAM COMMITTEE, SUSSEX COUNTY MULTIDISCIPLINARY TREATMENT TEAM (MDT); CHAIR OF SUSSEX COUNTY SEXUAL ASSAULT RESOURCE TEAM; CO-CHAIR SUSSEX COUNTY DOMESTIC PREPAREDNESS TASK FORCE; NORTHWEST REGIONAL PARTNERSHIP & FIRST RECEIVER EDUCATION TEAM FOR AWARENESS & OPERATIONS; PIONEERING HEALTHIER COMMUNITIES, ACTIVATE AMERICA PROGRAM COMMITTEE, SUSSEX COUNTY SCHOOLS TASK FORCE FOR PIONEERING HEALTHIER COMMUNITIES; AMERICAN HEART ASSOCIATION REGIONAL FACULTY (BLS, ACLS, PALS); NEWTON ROTARY CLUB, BOARD OF DIRECTORS SUSSEX COUNTY COMMUNITY COLLEGE; GARDEN STATE ASSOCIATION OF DIABETES EDUCATORS; SUSSEX COUNTY CANCER COALITION; PIKE COUNTY CHILD DEATH REVIEW TEAM; & PIKE COUNTY INTERAGENCY COUNCIL.ONE FULL TIME HOSPITAL EMPLOYEE WHO HAS PARTICIPATED IN A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT WITHIN THE COUNTY AND STATE IN ADDITION TO CO-CHAIRING THE SUSSEX COUNTY DOMESTIC PREPAREDNESS TASK FORCE MANAGES THE COMMUNITY BENEFITS COORDINATION AND OPERATION. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS:PATIENT ACCOUNTS RECEIVABLE RESULTING FROM THE HEALTH CARE SERVICES PROVIDED BY THE HOSPITAL ARE STATED AT THE ESTIMATED NET AMOUNTS RECEIVABLE FROM PAYORS. ADDITIONS TO ALLOWANCE FOR DOUBTFUL ACCOUNTS RESULT FROM THE PROVISION FOR BAD DEBTS. ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNTS OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH COVERAGE AND OTHER COLLECTION INDICATORS.THE COSTING METHODOLOGY USED IN DETERMINING BAD DEBT EXPENSE AT COST AND THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS BAD DEBT EXPENSES TIMES COST TO CHARGE RATIO.IN DETERMINING BAD DEBT EXPENSE, PATIENT LIABILITIES ARE NET OF THIRD PARTY PAYMENTS AND PATIENT DISCOUNTS.THE METHOD THE ORGANIZATION USES TO DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY IS THAT UNINSURED DISCOUNTED SELF PAY PATIENTS THAT ARE CLASSIFIED AS BAD DEBT TIMES COST TO CHARGE RATIO.NEW JERSEY HOSPITALS PROVIDE CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THAT IS PART OF THE HOSPITAL'S CARING MISSION, AND IT IS ALSO A MANDATE WRITTEN IN STATE LAW. NEW JERSEY DOES NOT HAVE A PUBLIC HOSPITAL SYSTEM. PART III, LINE 8: THE COSTING METHODOLOGY/SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS THE COST TO CHARGE RATIO PER THE 2011 MEDICARE COST REPORT SCHEDULE S-10.NEW JERSEY HOSPITALS PROVIDE CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THAT IS PART OF THE HOSPITAL'S CARING MISSION, AND IT IS ALSO A MANDATE WRITTEN IN STATE LAW. NEW JERSEY DOES NOT HAVE A PUBLIC HOSPITAL SYSTEM. PART III, LINE 9B: ALL PATIENTS ARE PROVIDED WITH FREE AND BELOW COST CARE GUIDELINES VIA NOTICES AND SIGNS AT TIME OF SERVICE. UNINSURED INPATIENTS ARE QUALIFIED FOR CHARITY OR MEDICAID. OUTPATIENTS ARE SCREENED FOR ELECTIVE SERVICES. HOSPITAL PRE-COLLECTION AND COLLECTION AGENCIES ALSO PROVIDE INFORMATION TO PATIENTS ABOUT QUALIFICATION FOR UNCOMPENSATED CARE. PART VI, LINE 2: THE LAST COMMUNITY ASSESSMENT WAS COMPLETED THROUGH THE SUSSEX COUNTY HUMAN SERVICES ADVISORY COUNCIL IN 2008. THIS WAS AN UPDATE OF THE 2003 ASSESSMENT WHICH THE HOSPITAL PARTNERED WITH AND CHAMPIONED FOR THE SUSSEX COUNTY DIVISION OF HEALTH & HUMAN SERVICES. THE DATA WAS BASED ON HOUSEHOLD SURVEYS AND UTILIZED VALIDATED QUESTIONS AS WELL AS TARGETED FOCUS GROUPS.NEWTON MEMORIAL HOSPITAL IS ALSO A PART OF THE COMMUNITY HEALTH PARTNERSHIP THAT RELEASED THE SUSSEX COUNTY HEALTH IMPROVEMENT PLAN IN JULY OF 2008. THE DATA WAS BASED ON SURVEYS COMPLETED IN 2005 AND UTILIZED VALIDATED QUESTIONS AS WELL AS TARGETED FOCUS GROUPS.NEWTON MEMORIAL HOSPITAL HAS BEEN VERY ACTIVE IN COMMUNITY ASSESSMENTS AND PARTICIPATES ACTIVELY IN THE SUSSEX COUNTY PIONEERING HEALTHIER COMMUNITIES WHICH IS A COALITION OF LEADERS TO ASSIST IN MAKING NECESSARY POLICY CHANGES TO PROMOTE HEALTHIER LIVING AND A HEALTHIER COMMUNITY WITHIN THE COUNTY. THE PRESIDENT & CEO AS WELL AS THE DIRECTOR OF EDUCATION, OUTREACH & COMMUNITY BENEFITS OF THE HOSPITAL PARTICIPATE ACTIVELY ON THE OVERSIGHT COMMITTEE AS WELL AS SUBCOMMITTEES OF THIS COALITION.NEWTON MEMORIAL HOSPITAL PROVIDES PROGRAMMING AND SERVICES BASED ON THESE ACTIVE/CURRENT COMMUNITY ASSESSMENTS TO RESIDENTS. NEWTON MEMORIAL HOSPITAL WORKS WITHIN COALITIONS AS WELL AS WITH PARTNERS TO MEET ASSESSED COMMUNITY NEEDS. THIS IS A MAJOR STRATEGIC INITIATIVE ADDRESSING IDENTIFIED NEEDS AND PROBLEMS. PART VI, LINE 3: NEWTON MEMORIAL HOSPITAL PROVIDES FINANCIAL COUNSELING INFORMATION IN ENGLISH AND SPANISH TO THOSE IN NEED.NEWTON MEMORIAL HOSPITAL'S POLICY FOR THE PURPOSE OF PROVIDING INPATIENT AND/OR OUTPATIENT SERVICES TO THE MEDICALLY INDIGENT RESIDENTS OF NEW JERSEY STATES: "THE HOSPITAL'S FINANCIAL COUNSELOR WILL INTERVIEW ALL APPLICANTS TO DETERMINE ELIGIBILITY. INITIAL APPROVAL FOR REDUCED RATES WILL BE MADE BY THE DIRECTOR OF PATIENT ACCOUNTS. AN ELIGIBILITY DETERMINATION ON ANY APPLICATION WILL BE MADE WITHIN TEN (10) WORKING DAYS FOLLOWING THE APPLICANT'S COMPLETION AND SUBMISSIONS OF ALL REQUIRED INFORMATION." ELIGIBILITY REQUIREMENT: ALL APPLICANTS WILL BE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ASSURE ELIGIBILITY IN THE FOLLOWING CATEGORIES PRIOR TO FORWARDING THE APPLICATION TO THE DIRECTOR OF PATIENT ACCOUNTS FOR INITIAL APPROVAL. 1. RESIDENCY: BELOW COST OR FREE CARE WILL BE AVAILABLE TO ALL ELIGIBLE NEW JERSEY RESIDENTS. 2. AGE: THE APPLICANT MUST HAVE REACHED THE AGE OF MAJORITY OR BE EMANCIPATED. UNDERAGE APPLICANTS REQUIRING SERVICES UNDER THIS POLICY MUST HAVE THEIR PARENT, GUARDIAN, OR RESPONSIBLE PARTY COMPLETE ALL APPLICATION FORMS. 3. THIRD PARTY ASSISTANCE: AN ELIGIBILITY ASSESSMENT WILL BE CONDUCTED BY THE FINANCIAL COUNSELOR UTILIZING CURRENT PUBLIC ASSISTANCE STANDARDS AS PUBLISHED BY THE NEW JERSEY DEPARTMENT OF INSTITUTIONS AND AGENCIES, DIVISION OF PUBLIC WELFARE. THE HOSPITAL'S FINANCIAL COUNSELOR WILL REFER APPLICANTS DEEMED ELIGIBLE FOR THIRD PARTY ASSISTANCE TO ONE OR MORE OF THE FOLLOWING APPROPRIATE PROGRAMS: A. PUBLIC ASSISTANCE MEDICAID B. SSI MEDICAID C. MEDICARE D. SOCIAL SECURITY DISABILITY E. NEW JERSEY STATE DISABILITY UNEMPLOYMENT F. DIRECT ENROLLMENT IN BLUE CROSS AND BLUE SHIELD G. OTHER MEDICAL INSURANCE (SCHOOL PROGRAMS, ETC.) FAILURE OF THE PATIENT TO APPLY FOR ELIGIBLE PUBLIC ASSISTANCE PROGRAMS WILL TERMINATE HIS/HER ELIGIBILITY FROM THE HOSPITAL'S INDIGENCE PROGRAM.ALL OBSTETRICAL APPLICANTS ELIGIBLE FOR MEDICAID ASSISTANCE WILL BE REFERRED TO THE FINANCIAL COUNSELOR. 4. INCOME TEST: THE PERSON'S INCOME FOR ELIGIBILITY DETERMINATIONS WILL BE THE LESSER OF THE ACTUAL GROSS INCOME OF THE APPLICANT OR FAMILY FOR THE TWELVE (12) MONTHS PRECEDING THE SERVICES OR FOUR TIMES THE ACTUAL GROSS INCOME OF THE APPLICANT OR FAMILY OF THE THREE (3) MONTHS PRECEDING THE SERVICES. APPLICANTS ARE REQUIRED TO PRODUCE VERIFICATION OF INCOME AS A CONDITION OF ELIGIBILITY, E.G., TAX RETURNS, PAY STUBS, BANK STATEMENTS, ETC. 5. ASSET TEST: THE APPLICANT CAN BE DEEMED INELIGIBLE IF HE/SHE POSSESSES EITHER REAL OR PERSONAL PROPERTY WHICH WOULD ENABLE HIM/HER TO MEET HIS/HER MEDICAL FINANCIAL REQUIREMENTS. ASSETS WILL BE CONSIDERED IN THE ELIGIBILITY REQUIREMENTS FOR ALL CASES. ASSETS ARE DEFINED AS CASH, SAVINGS AND CHECKING ACCOUNTS, CERTIFICATES OF DEPOSIT, TREASURY NOTES, STOCKS AND BONDS, OTHER NEGOTIABLE PAPER, AND REAL ESTATE OTHER THAN THE APPLICANT'S PRIMARY RESIDENCE. INDIVIDUAL ASSETS MAY NOT EXCEED $7,500.00; FAMILY ASSETS MAY NOT EXCEED $15,000.00. HOSPITAL FEE SCHEDULE: FREE CARE OR BELOW COST CARE WILL BE DETERMINED BY USE OF THE NEW JERSEY STATE DEPARTMENT OF HEALTH FEE SCHEDULE.PERIODIC REVIEW: APPROVED APPLICANTS ARE ELIGIBLE FOR BELOW COST OR FREE CARE FOR A MAXIMUM PERIOD OF ONE (1) YEAR FROM THE APPLICATION DATE AFTER WHICH DATE THEIR ELIGIBILITY WILL AGAIN BE VERIFIED. PART VI, LINE 4: NEWTON MEMORIAL HOSPITAL IS LOCATED IN SUSSEX COUNTY IN THE SKYLANDS REGION OF THE STATE AND APPROXIMATELY 60 MILES FROM MANHATTAN. NEWTON IS THE COUNTY SEAT AND PARTICIPATES IN THE NORTHWEST REGIONAL PARTNERSHIP FOR EMERGENCY PREPAREDNESS. IN ADDITION, NEWTON MEMORIAL HOSPITAL PROVIDES SERVICES TO RESIDENTS IN SUSSEX COUNTY, PART OF WARREN COUNTY, AND PIKE COUNTY, PENNSYLVANIA.FROM THE 2008 COMMUNITY ASSESSMENT, THERE ARE APPROXIMATELY 151,442 RESIDENTS. THE MINORITY POPULATION IS 9% AND THERE HAS BEEN APPROXIMATELY A 6% INCREASE IN POPULATION IN THE LAST 6 YEARS. THERE HAS BEEN AN INCREASE IN THE NUMBER OF HISPANIC POPULATION SEEN WITHIN THE HOSPITAL. PATIENTS IN THE WOMEN'S HEALTH CENTER AND ADULT MEDICAL CLINIC COME FROM TWO SOURCES OF THIS HISPANIC COMMUNITY--EL REFUGIO BASED IN NEWTON AND BLESSED KATERI MINISTRY BASED IN SPARTA.THE MEDIAN AGE FOR THE COUNTY IS 39 AND 60% OF RESIDENTS ATTENDED COLLEGE. THE MEDIAN INCOME IN 2008 IS $74,420. THE UNEMPLOYMENT RATE IS 3.9%, HIGHEST AMONG 16-19 YEAR OLDS AND THERE ARE 6,628 RESIDENTS LIVING IN POVERTY.THERE ARE 14,245 HOUSEHOLDS WITH AN INDIVIDUAL 65 AND OVER IN RESIDENCE. AT THE SAME TIME THE NUMBER OF BIRTHS DECREASED BY 10% FROM 1,778 TO 1,601.SUSSEX COUNTY RANKS FIRST IN THE PERCENTAGE OF WOMEN RECEIVING PRENATAL CARE DURING THE FIRST TRIMESTER (90%). IN FACT NEWTON MEMORIAL HOSPITAL PROVIDED PRENATAL CARE TO 99% OF THE PATIENTS IN THE WOMEN'S HEALTH CENTER.THE LEADING CAUSES OF DEATH ARE HEART DISEASE AND CANCER; THERE ARE 134 CASES OF HIV. THERE WAS A 33% INCREASE IN EMERGENCY SCREENING SERVICES AND A 7% DECREASE IN OUTPATIENT MENTAL HEALTH SERVICES.FOR THE SAME PERIOD, THERE WAS A 183% INCREASE IN INJECTION DRUG USERS, 14.6% OF THE ADULT POPULATION REQUIRED ALCOHOL/DRUG TREATMENT AND 37% HAD NO INSURANCE.THERE ARE 2,410 STUDENTS WHO RECEIVE FREE OR REDUCED COST LUNCHES. SCHOOL BASED INCIDENCES OF VIOLENCE/VANDALISM INCREASED 5%. INCIDENTS OF SUBSTANCE ABUSE INCREASED 23%. OVERALL ADMISSIONS TO THE JUVENILE DETENTION CENTER ARE DOWN 15%. HOWEVER, FEMALE ADMISSIONS ARE UP 116%.REPORTS OF CHILD ABUSE AND NEGLECT HAVE INCREASED 30%. SUSSEX COUNTY IS ONE OF 5 COUNTIES STATEWIDE THAT HAS INCREASED EVERY YEAR. OUT OF HOME PLACEMENTS ARE DOWN FOR THE SAME PERIOD OF TIME. THE NUMBER OF FAMILY CRISIS INTERVENTION UNIT CASES IS DOWN 35% EXCEPT FOR CASES INVOLVING A "SERIOUS THREAT TO THE SAFETY OF THE JUVENILE" WHICH ARE UP BY 12%.THE NUMBER OF DOMESTIC VIOLENCE OFFENSES IS DOWN 24%. THE OVERALL CRIME RATE IN SUSSEX COUNTY INCREASED BY 27% - LARGELY NON-VIOLENT CRIMES INCLUDING LARCENY, THEFT AND BURGLARY.NEWTON MEMORIAL IS THE LARGEST HOSPITAL IN SUSSEX COUNTY AND SAINT CLARE'S, SUSSEX IS A SMALLER HOSPITAL WITHIN THE COUNTY WHICH SEES PATIENTS. PART VI, LINE 6: NEWTON MEMORIAL HOSPITAL:1. OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; 2. HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA; 3. HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY;4. WORKS WITH OTHER AFFILIATED OR CLINICALLY AFFILIATED STAFF AND THEIR FACILITIES TO PROVIDE MEDICAL OR SCIENTIFIC RESEARCH PROGRAMS;5. ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS FROM PASSAIC COMMUNITY COLLEGE IN NURSING, SUSSEX COUNTY COMMUNITY COLLEGE FOR ALLIED HEALTH FIELDS MEDICAL ASSISTANT STUDENTS, SURGICAL TECHNICIAN STUDENTS, RESPIRATORY THERAPY STUDENTS AS WELL AS WILLIAM PATERSON UNIVERSITY NURSING STUDENTS, DOVER BUSINESS COLLEGE FOR PRACTICAL NURSE STUDENTS, CENTRAL STERILE PROCESSING STUDENTS. IN ADDITION, INTERNS IN SOCIAL WORK, HEALTH EDUCATION, PHARMACY, EXERCISE PHYSIOLOGY, BEHAVIORAL HEALTH, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, HOSPITAL ADMINISTRATION, EMERGENCY MEDICAL TECHNICIAN CLINICAL TIME IN THE EMERGENCY DEPARTMENT AND OTHER PROGRAMS HAVE BEEN PROVIDED AT NEWTON MEMORIAL HOSPITAL; 6. PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS;7. THE BOARD OF DIRECTORS IS MADE UP OF PEOPLE WHO RESIDE WITHIN THE COMMUNITY WE SERVE AND VOLUNTEER THEIR TIME BECAUSE OF THEIR CONCERN FOR THE HOSPITAL AND THE COMMUNITY IT SERVES. PART VI, LINE 7: NORTH JERSEY HEALTH CARE CORPORATION ("NJHCC") AND SUBSIDIARIES (COLLECTIVELY THE "CORPORATION") WERE INCORPORATED IN THE STATE OF NEW JERSEY AND, AS APPLICABLE, WERE ORGANIZED TO PROVIDE HOSPITAL, HOME HEALTH CARE AND OTHER COMMUNITY HEALTH CARE SERVICES TO PATIENTS FROM THE SUSSEX COUNTY, NEW JERSEY AND SURROUNDING COMMUNITIES OR TO PROVIDE FINANCIAL SUPPORT TO THE CORPORATION THROUGH LEASING ACTIVITIES RELATED TO INVESTMENT AND OWNERSHIP OF OFFICE BUILDINGS OR FUND-RAISING ACTIVITIES.NJHCC HAS THE FOLLOWING WHOLLY OWNED OR CONTROLLED SUBSIDIARIES:NEWTON MEMORIAL HOSPITAL ("HOSPITAL")PRIME CARE, INC. ("PRIME CARE")NORTH JERSEY HEALTH VENTURES, INC. ("VENTURES")NORTH JERSEY HEALTH CARE PROPERTIES, INC. ("PROPERTIES")NEWTON MEMORIAL HOSPITAL FOUNDATION, INC. ("FOUNDATION")NJHCC IS A NOT-FOR-PROFIT ORGANIZATION AND WAS ESTABLISHED TO OVERSEE THE POLICIES AND ACTIVITIES OF ITS SUBSIDIARIES. ITS SUBSIDIARIES PROVIDE A FULL RANGE OF HEALTH CARE AND OTHER SERVICES AS BRIEFLY DESCRIBED BELOW.THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION. THE HOSPITAL IS LOCATED IN NEWTON, NEW JERSEY AND PROVIDES REGIONAL HEALTH CARE SERVICES INCLUDING A BROAD RANGE OF ADULT, PEDIATRIC, REHABILITATION, PSYCHIATRIC, OBSTETRICAL/GYNECOLOGICAL, ONCOLOGY AND INTENSIVE CARE SERVICES TO PATIENTS FROM AND SURROUNDING THE SUSSEX COUNTY COMMUNITY. THE HOSPITAL ALSO PROVIDES NUMEROUS OUTPATIENT AMBULATORY SERVICES AND EMERGENCY CARE. IN ADDITION, THE HOSPITAL PROVIDES FAMILY COUNSELING, PERSONAL CARE, HOMELESS AND RESIDENTIAL PROGRAMS.PRIME CARE IS A NOT-FOR-PROFIT ORGANIZATION WHICH OPERATES A MEDICARE CERTIFIED HOME HEALTH AGENCY AND PROVIDES VARIOUS WELLNESS, HEALTH EDUCATION AND OTHER HEALTH PROMOTION SERVICES.VENTURES WAS INCORPORATED ON JANUARY 30, 1986 AND CARRIES ON FOR-PROFIT ACTIVITIES. CURRENTLY, VENTURES HOLDS INVESTMENTS IN CERTAIN HEALTH CARE RELATED JOINT VENTURES.PROPERTIES IS A NOT-FOR-PROFIT ORGANIZATION WHICH WAS FORMED TO OWN COMMERCIAL BUILDINGS AND CONDUCT LEASING ACTIVITIES. THE ORGANIZATION OWNS AND CONDUCTS LEASING OPERATIONS OF COMMERCIAL BUILDINGS IN SPARTA AND NEWTON, NEW JERSEY AND IN MILFORD, PENNSYLVANIA AND A CONDOMINIUM IN NEWTON, NEW JERSEY.FOUNDATION IS A NOT-FOR-PROFIT FUND-RAISING ORGANIZATION THAT SOLICITS FUNDS IN ITS GENERAL APPEAL TO SUPPORT THE HOSPITAL AND AFFILIATED ORGANIZATIONS AND THE HEALTH CARE NEEDS OF THE COMMUNITY, AS THE FOUNDATION'S BOARD MAY DEEM APPROPRIATE. REPORTS FILED WITH STATES PART VI, LINE 7 NJ ADDITIONAL COMMUNITY BENEFIT INFORMATION DUE TO THE MERGER OF NEWTON MEMORIAL HOSPITAL INTO AHS HOSPITAL CORP. EFFECTIVE APRIL 1, 2011, FULL STATISTICAL COMMUNITY BENEFIT INFORMATION FOR THE 2011 YEAR COULD NOT BE PROVIDED ON THIS FINAL RETURN. COMMUNITY BENEFIT INFORMATION FOR NEWTON MEMORIAL HOSPITAL WILL BE INCLUDED ON THE 2011 FORM SCHEDULE H OF AHS HOSPITAL CORP. X 0 0 X X X X X 0 1 0 1 0 0 0 0 0 THOMAS J SENKER 93178 0 86789 0 22745 0 6136 0 3211 0 212059 0 0 0 PART I, LINE 1A CONTRACTUALLY OBLIGATED COMPENSATION RELATED TO RETIREMENT WAS GROSSED UP TO MINIMIZE TAXABLE IMPACT TO PRESIDENT & CEO THOMAS SENKER. PART I, LINE 4B PRESIDENT & CEO THOMAS SENKER PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SPONSORED BY NEWTON MEMORIAL HOSPITAL. NO AMOUNT WAS PAID FROM THIS PLAN DURING THE SHORT PERIOD ENDED APRIL 1, 2011. PART I, LINE 5 NEWTON MEMORIAL HOSPITAL ACCRUED POTENTIAL BONUS PAYMENTS BASED ON NET REVENUE AND PERFORMANCE TARGETS AS DESCRIBED IN A FORMAL WRITTEN BONUS PROGRAM APPROVED BY THE BOARD. BRIAN FITZPATRICK WIFE (KATHLEEN FITZPATRICK) IS AN EMPLOYEE OF NEWTON MEMORIAL HOSPITAL 23546 COMPENSATION 0 GEORGE MORVILLE JR SON-IN-LAW (JOHN BRAND) IS AN EMPLOYEE OF NEWTON MEMORIAL HOSPITAL 12579 COMPENSATION 0 CASH & CASH EQUIVALENTS 2011-04-01 15276629 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) INVESTMENTS-MUTUAL FUNDS 2011-04-01 36631090 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) PATIENT ACCOUNTS RECEIVABLE 2011-04-01 13586331 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) OTHER RECEIVABLES 2011-04-01 2335216 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) INVENTORIES 2011-04-01 1492664 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) DUE FROM AFFILIATES 2011-04-01 607808 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) PREPAID EXPENSES 2011-04-01 1357786 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) DEPOSITS 2011-04-01 15024 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) IBNR-INSURANCE RECOVERABLES 2011-04-01 1822203 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) PROPERTY, PLANT AND EQUIPMENT, NET 2011-04-01 48719348 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) BENEFICIAL INTEREST IN NET ASSETS OF NEWTON MEMORIAL HOSPITAL FOUNDATION 2011-04-01 1889262 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) BENEFICIAL INTEREST IN PERPETUAL TRUSTS 2011-04-01 3812511 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) DEFERRED FINANCING COSTS, NET 2011-04-01 595585 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) ACCOUNTS PAYABLE AND ACCRUED EXPENSES 2011-04-01 -15286492 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) DUE TO AFFILIATES 2011-04-01 -9416 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) AMOUNTS DUE TO THIRD-PARTY PAYERS 2011-04-01 -7905902 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) OBLIGATIONS UNDER CAPITAL LEASE 2011-04-01 -198739 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) TAX-EXEMPT BOND LIABILITIES 2011-04-01 -22456284 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) ACCRUED MALPRACTICE LIABILITY 2011-04-01 -1918078 BOOK VALUE 521958352 AHS HOSPITAL CORP 475 SOUTH STREET MORRISTOWN NJ 07960 501(C)(3) TRANSACTION EXPENSE - LEGAL FEES 2011-04-01 118210 COST 250749630 REED SMITH 136 MAIN STREET PRINCETON NJ 08540 LLP 1 1 0 0 1 1 1 1 1 1 PART I, LINE 2E: THE FOLLOWING BOARD MEMBERS OF NEWTON MEMORIAL HOSPITAL BECAME BOARD MEMBERS OF AHS HOSPITAL CORP. AFTER THE MERGER:GLENN CLARKROBERT MCCRACKENPAUL OWENS, MDTHE FOLLOWING OFFICERS OF NEWTON MEMORIAL HOSPITAL BECAME EMPLOYEES OF AHS HOSPITAL CORP. AFTER THE MERGER:THOMAS SENKER REMAINED PRESIDENT OF NEWTON MEMORIAL HOSPITAL, WHICH BECAME A DIVISION OF AHS HOSPITAL CORP. AFTER THE MERGER.SEAN O'ROURKE BECAME THE DIRECTOR OF OPERATIONS AT NEWTON MEMORIAL HOSPITAL, WHICH BECAME A DIVISION OF AHS HOSPITAL CORP. AFTER THE MERGER.DAVID RIKKOLA BECAME THE DIRECTOR OF AHS INVESTMENT CORP. AFTER THE MERGER. PART I, LINE 7C: UPON CONSUMMATION OF THE MERGER ON APRIL 1, 2011, THE NEWTON MEMORIAL HOSPITAL MASTER INDENDTURE WAS DISCHARGED AND TWO SEPARATE NOTES WERE ISSUED FOR THE NEWTON MEMORIAL HOSPITAL 1997 AND 2001 REVENUE BONDS UNDER THE AHS HOSPITAL CORP. MASTER INDENTURE. ON MAY 1, 2011, AHS EXECUTED A LOAN WITH NEW JERSEY HEALTH CARE FACILITIES FINANCING AUTHORITY WITH A PORTION OF THE PROCEEDS USED TO REFUND THE OUTSTANDING NEWTON MEMORIAL HOSPITAL 1997 REVENUE BONDS. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 EFFECTIVE APRIL 1, 2011, NEWTON MEMORIAL HOSPITAL ("NEWTON") MERGED INTO AHS HOSPITAL CORP. ("AHS"). AHS WAS THE SURVIVING CORPORATION. ALL PROPERTY OF NEWTON WAS TRANSFERRED TO AHS, AND AHS ASSUMED ALL LIABILITIES OF NEWTON. AHS IS AN ORGANIZATION EXEMPT FROM TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FILING WAS PREPARED BY THE FINANCE DEPARTMENT WITH THE ASSISTANCE OF TAX ADVISORS. THE COMPLETED FILING WAS REVIEWED BY THE CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER. UPON FINALIZATION OF THE FORM 990, COPIES WERE MADE AVAILABLE TO BOARD MEMBERS. FORM 990 IS FILED WITH THE IRS AFTER THIS REVIEW PROCESS. FORM 990, PART VI, SECTION B, LINE 12C EACH "INTERESTED PERSON" OF THE HOSPITAL SHALL ANNUALLY SIGN THE NEW JERSEY HEALTH CARE CORPORATION ("NJHCC") CONFLICT OF INTEREST DISCLOSURE STATEMENT (FORM #1885C) WHICH AFFIRMS THAT SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY OR THE NJHCC BY-LAWS, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS THAT NJHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES UNDER IRC SECTION 501(C)(3) OR 501(C)(4) OF THE INTERNAL REVENUE CODE. ON THE CONFLICT OF INTEREST DISCLOSURE STATEMENT, ALL "INTERESTED PERSONS" MUST DETAIL ALL EXISTING OR POTENTIAL CONFLICTS OF INTEREST AND FILE THE FORM WITH THE CHIEF COMPLIANCE OFFICER ANNUALLY. INTERIM DISCLOSURES SHALL ALSO BE REQUIRED AS CONFLICTS DEVELOP SUBSEQUENT TO THE ANNUAL DISCLOSURES. TO ENSURE THAT NJHCC OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEW SHALL BE CONDUCTED BY THE CHIEF COMPLIANCE OFFICER. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULTS OF APPROPRIATE NEGOTIATIONS. B. WHETHER PHYSICIAN RECRUITMENT PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. C. WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER NJHCC'S CHARITABLE PURPOSES, AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. D. WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES AND THIRD PARTY PAYORS FURTHER NJHCC'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION REVIEWED AND DETERMINED THE TOTAL CASH COMPENSATION (CONSISTS OF BASE SALARY AND INCENTIVE AWARDS) OF THE PRESIDENT & CEO AND ALL EXECUTIVES (NAMELY, THE SVP-OPERATIONS/COO, VP-MEDICAL AFFAIRS/CMO, VP-FINANCE/CFO, VP-HR/CHIEF HR OFFICER AND CHIEF LEGAL OFFICER, VP-PATIENT CARE SERVICES/CNO, VP-FOUNDATION/CHIEF DEVELOPMENT OFFICER AND VP-MARKETING/BUSINESS DEVELOPMENT). THE ORGANIZATION ENGAGED INDEPENDENT CONSULTING FIRM, SULLIVAN COTTER AND ASSOCIATES, INC. TO PROVIDE GUIDANCE, ANALYSIS, RECOMMENDATIONS AND A REASONABLENESS OPINION. THIS PROCESS WAS LAST UNDERTAKEN IN 2008 FOR ALL OF THE AFOREMENTIONED EMPLOYEES. THE PROCESS INCLUDED SULLIVAN COTTER'S EVALUATION OF TOTAL CASH COMPENSATION FOR THESE EMPLOYEES BY USING COMPREHENSIVE COMPETITIVE MARKET DATA TO BENCHMARK SUCH COMPENSATION AGAINST OTHER HOSPITALS WITH SIMILAR NET REVENUE, COMPLEXITY, SCOPE, NON-PROFIT STATUS AND SIMILAR POSITIONS. MARKET DATA USED INCLUDES BOTH REGIONAL AND NATIONAL DATA. SULLIVAN COTTER DOCUMENTS ITS FINDINGS AND DELIVERS A WRITTEN REPORT AND OPINION TO THE ORGANIZATION. SULLIVAN COTTER'S FINDINGS AND RECOMMENDATIONS ARE REVIEWED BY THE EXECUTIVE COMPENSATION SUBCOMMITTEE OF THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS OF THE ORGANIZATION WHOSE REVIEW VIA ANALYSIS AND DELIBERATION IS DOCUMENTED IN THE MINUTE(S) OF ITS MEETINGS REGARDING SAME. UPON RECOMMENDATION OF THE EXECUTIVE COMPENSATION SUBCOMMITTEE OF THE GOVERNANCE COMMITTEE, THE FINDINGS AND RECOMMENDATIONS ARE ULTIMATELY REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS OF THE ORGANIZATION. THE BOARD'S FINDINGS AND DETERMINATIONS ARE DOCUMENTED IN THE MINUTES OF ITS MEETING(S) REGARDING SAME. 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. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN (B) AVERAGE HOURS PER WEEK LISTED IN PART VII ARE FOR THIS LEGAL ENTITY ONLY. BOARD MEMBERS AND OFFICERS ALSO DEVOTE TIME TO THE RELATED ORGANIZATIONS LISTED ON SCHEDULE R. TOTAL AVERAGE HOURS PER WEEK FOR ALL RELATED ORGANIZATIONS ARE AS FOLLOWS: BOARD MEMBERS - 5.8 HOURS PER WEEK PRESIDENT & CEO THOMAS J. SENKER - 42.5 HOURS PER WEEK COO SEAN O'ROURKE - 42.5 HOURS PER WEEK CFO DAVID RIKKOLA - 42.5 HOURS PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 491,989. WRITE OFF OF OTHER RECEIVABLE -3,163,008. CHANGE IN VALUE OF PERPETUAL TRUSTS 107,959. NET ASSETS TRANSFERRED TO AHS HOSPITAL CORP. ON 4/1/11 -80,366,546. TOTAL TO FORM 990, PART XI, LINE 5: -82,929,606. NEWTON MEMORIAL HOSPITAL FOUNDATION INC 175 HIGH STREET NEWTON NJ 07860 222618102 ADMINISTERS DONATIONS, GRANTS & BEQUESTS AND PERFORMS FUNDRAISING NJ 501(C)(3) LINE 7 NORTH JERSEY HEALTH CARE CORPORATION 0 NORTH JERSEY HEALTH CARE CORPORATION 175 HIGH STREET NEWTON NJ 07860 222618100 OVERSEES POLICIES AND ACTIVITIES OF SUBSIDIARIES NJ 501(C)(3) LINE 11A, I N/A 0 NORTH JERSEY HEALTH CARE PROPERTIES INC 175 HIGH STREET NEWTON NJ 07860 223519709 OWNS COMMERCIAL BUILDINGS AND CONDUCTS LEASING ACTIVITIES NJ 501(C)(2) NORTH JERSEY HEALTH CARE CORPORATION 0 PRIME CARE INC 175 HIGH STREET NEWTON NJ 07860 222759566 PROVIDES HOME AND HEALTH CARE SERVICES NJ 501(C)(3) LINE 9 NORTH JERSEY HEALTH CARE CORPORATION 0 NORTH JERSEY HEALTH VENTURES INC 175 HIGH STREET NEWTON NJ 07860 222705732 INVESTMENTS IN HEALTH CARE RELATED JOINT VENTURES NJ N/A C 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 NORTH JERSEY HEALTH CARE PROPERTIES INC J 218668 COST