INSPIRA HOMECARE & HOSPICECARE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
INSPIRA HOMECARE & HOSPICECARE INC (EIN 22-6067549)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-11
IRS object ID
201123159349302837
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-11T14:31:09-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WithumSmithBrown PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1465 South St Ste 200AddressLine1
CityMorristownCity
StateNJState
ZIP Code079606497ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN226067549EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOMECARE & HOSPICECARE OF SOUTH JERSEY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOMENameControl
Phone8566418610Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1333 IRVING AVENUEAddressLine1
CityBRIDGETONCity
StateNJState
ZIP Code08302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTHOMAS P BALDOSAROName
TitleVICE PRESIDENT FINANCETitle
Date Signed2011-11-10DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameScott MarianiName
Phone9738989494Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHESTER B KALETKOWSKINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1333 IRVING AVENUEAddressLine1
CityBRIDGETONCity
StateNJState
ZIP Code08302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13650884GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SJHS.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1965YearFormation
State Legal DomicileNJStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION'S MISSION IS TO PROVIDE MEDICALLY NECESSARY HOSPICE SERVICES, HOME HEALTHCARE AND ADULT MEDICAL CARE SERVICES TO ELDERLY AND HANDICAPPED RESIDENTS OF SOUTHERN NEW JERSEY.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees184TotalNbrEmployees
Total Nbr Volunteers99TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year610960ContributionsGrantsPriorYear
Contributions Grants Current Year669141ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11615859ProgramServiceRevenuePriorYear
Program Service Revenue CY12892383ProgramServiceRevenueCY
Investment Income Prior Year67924InvestmentIncomePriorYear
Investment Income Current Year72282InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year12294743TotalRevenuePriorYear
Total Revenue Current Year13633806TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7502921SalariesEtcPriorYear
Salaries Etc Current Year7392416SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4880121OtherExpensePriorYear
Other Expenses Current Year5209269OtherExpensesCurrentYear
Total Expenses Prior Year12383042TotalExpensesPriorYear
Total Expenses Current Year12601685TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-88299RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1032121RevenuesLessExpensesCY
Total Assets BOY6612636TotalAssetsBOY
Total Assets EOY7887540TotalAssetsEOY
Total Liabilities BOY3913108TotalLiabilitiesBOY
Total Liabilities EOY3988891TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2699528NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3898649NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE ORGANIZATION'S PRIMARY EXEMPT PURPOSE IS TO PROVIDE MEDICALLY NECESSARY HOSPICE SERVICES, HOME HEALTHCARE SERVICES AND ADULT MEDICAL DAY CARE SERVICES TO ELDERLY AND HANDICAPPED RESIDENTS OF SOUTHERN NEW JERSEY WHO ARE ALONE OR HOMEBOUND IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense5662464Expense
Grants0Grants
Revenue7087828Revenue
DescriptionEXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY HOSPICE CARE TO THE RESIDENTS OF SOUTHERN NEW JERSEY IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 38,209 HOSPICE CARE PATIENTS IN 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2543531Expense
Grants0Grants
Revenue3702054Revenue
DescriptionEXPENSES INCURRED IN FUNCTIONING AS A CERTIFIED HOME HEALTH AGENCY AS A DIRECT PROVIDER OF SKILLED NURSING, THERAPY SERVICES AND HOME HEALTH AIDES FOR RESIDENTS OF SALEM AND CUMBERLAND COUNTIES IN NEW JERSEY (EXCLUDING THE CITY OF VINELAND, NJ) IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 20,534 HOME HEALTH PATIENTS IN 2010.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1611396Expense
Grants0Grants
Revenue2102501Revenue
DescriptionEXPENSES INCURRED IN PROVIDING MEDICALLY NECESSARY ADULT MEDICAL DAY CARE SERVICES TO ELDERLY OR HANDICAPPED ADULTS WHO ARE ALONE OR HOMEBOUND IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 25,599 ELDERLY AND HANDICAPPED PATIENTS DURING 2010.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1524120TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense11341511TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees184NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledNJStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHN A DIANGELONamePerson
Telephone Number8566418610TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1333 IRVING AVENUEAddressLine1
CityBRIDGETONCity
StateNJState
ZIP Code08302ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MICHAEL M ROSSI III
CHAIRMAN - TRUSTEE3.0XX000
ANN M BUDDE
VICE CHAIR - TRUSTEE3.0XX000
RICHARD HARZ
SECRETARY - TRUSTEE3.0XX000
DAVID ROBBINS JR
TREASURER - TRUSTEE3.0XX000
BRUNO A BASILE
TRUSTEE3.0X000
ALFRED F CAGGIANO
TRUSTEE3.0X000
JOHN B CATALANO MD
TRUSTEE3.0X07000
BEVERLY L DAIRSOW
TRUSTEE3.0X000
FRANK DEMAIO MD
TRUSTEE3.0X000
ALBERT A FRALINGER JR
TRUSTEE3.0X000
EILEEN A HALLISSEY
TRUSTEE3.0X000
NAUVEED IQBAL MD
TRUSTEE3.0X083330
CHESTER B KALETKOWSKI
TRUSTEE;EX-OFFICIO - PRES./CEO3.0XX01448069442249
HUGH MCCAFFREY
TRUSTEE3.0X000
MAURICE SHEETZ MD
TRUSTEE;EX-OFFICIO3.0X0272670
JACK M SHIELDS MD
TRUSTEE3.0X093120
TACIE TRULL
TRUSTEE3.0X000
JOHN A DIANGELO
ASSISTANT TREASURER3.0X041710698959
ROBERT M DANGEL ESQ
ASSISTANT TREASURER3.0X031026987671
WAYNE PENDLETON
EXECUTIVE DIRECTOR30.0X023941431512
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2460470TotalReportableCompFrmRltdOrgs
Total Other Compensation660391TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonFRANK GIANNANTONIO ASSOCIATES INCNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line144 STELTON ROAD SUITE 315AddressLine1
CityPISCATAWAYCity
StateNJState
ZIP Code08854ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesBILLINGDescriptionOfServices
Compensation223301Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events47140FundraisingEvents
Government Grants622001GovernmentGrants
Total Contributions669141TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE5419001258301212583012
OTHER HEALTHCARE RELATED REVENUE541900309371309371
FieldValueIRS element (for citing)
Total Program Service Revenue12892383TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column77665TotalRevenueColumn
Exclusion$77,665ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5383Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-5383Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-5383TotalRevenueColumn
Exclusion-$5,383ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events11695GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events47140CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses11695FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13633806TotalRevenueColumn
Related Or Exempt Function Income12892383RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$72,282ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5805763Total
Program Services5225187ProgramServices
Management And General580576ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total318144Total
Program Services286330ProgramServices
Management And General31814ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total716309Total
Program Services644678ProgramServices
Management And General71631ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total552200Total
Program Services496980ProgramServices
Management And General55220ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total4060Total
Program Services3654ProgramServices
Management And General406ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total118090Total
Program Services106281ProgramServices
Management And General11809ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1476Total
Program Services1328ProgramServices
Management And General148ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total834083Total
Program Services750675ProgramServices
Management And General83408ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total78718Total
Program Services70844ProgramServices
Management And General7874ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1722260Total
Program Services1550034ProgramServices
Management And General172226ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total231948Total
Program Services208753ProgramServices
Management And General23195ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11706Total
Program Services10535ProgramServices
Management And General1171ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total101661Total
Program Services91495ProgramServices
Management And General10166ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total366802Total
Program Services330122ProgramServices
Management And General36680ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total37790Total
Program Services34011ProgramServices
Management And General3779ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
AGENCY PERSONNEL463761417385463760
EQUIPMENT REPAIRS & MAINT.309687278718309690
OUTSIDE SERVICES280963252867280960
UTILITIES205694185125205690
PROFESSIONAL DUES232112088923220

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total417359Total
Program Services375620ProgramServices
Management And General41739ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12601685Total
Program Services11341511ProgramServices
Management And General1260174ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY837BOY
EOY837EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY437775BOY
EOY2279510EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1348403BOY
EOY1567939EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2900502BOY
EOY2502819EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY18780BOY
EOY24919EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis783280LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec345600LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY534746BOY
EOY437680EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1259700BOY
EOY1007760EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY111893BOY
EOY66076EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6612636BOY
EOY7887540EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1779605BOY
EOY2080637EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY199604BOY
EOY130013EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1933899BOY
EOY1778241EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3913108BOY
EOY3988891EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2699528BOY
EOY3898649EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2699528BOY
EOY3898649EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6612636BOY
EOY7887540EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1032121ReconcilationRevenueExpenses
Reconcilation Other Changes167000ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years743040CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years705580CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years767707CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year610960CurrentTaxYearMinus1Year
Current Tax Year669141CurrentTaxYear
Total3496428Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years743040CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years705580CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years767707CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year610960CurrentTaxYearMinus1Year
Current Tax Year669141CurrentTaxYear
Total3496428Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total1703496428PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years474256CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years476640CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years79203CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67924CurrentTaxYearMinus1Year
Current Tax Year77665CurrentTaxYear
Total1175688Total
FieldValueIRS element (for citing)
Total Support4672116TotalSupport
Gross Receipts From Admissions Etc53468922GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.74836PublicSupportPertcentage170
Public Support Pertcent Prior Year0.75867PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis37750OtherCostOrOtherBasis
Book Value37750BookValue
FieldValueIRS element (for citing)
BuildingsBuildings

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis366501OtherCostOrOtherBasis
Depreciation108009Depreciation
Book Value258492BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis379029OtherCostOrOtherBasis
Depreciation237591Depreciation
Book Value141438BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings437680TotalOfBookValueLandBuildings

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Lobster BakeNameOfEvent1
Gross Receipts Event137080GrossReceiptsEvent1
Charitable Contributions Event127549CharitableContributionsEvent1
Gross Revenue Event19531GrossRevenueEvent1
Other Direct Expenses Event19531OtherDirectExpensesEvent1
Name Of Event2Tree of LightNameOfEvent2
Gross Receipts Event28635GrossReceiptsEvent2
Charitable Contributions Event28263CharitableContributionsEvent2
Gross Revenue Event2372GrossRevenueEvent2
Other Direct Expenses Event2372OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events13120GrossReceiptsOtherEvents
Charitable Contrib Other Events11328CharitableContribOtherEvents
Gross Revenue Other Events1792GrossRevenueOtherEvents
Other Direct Expenses Other Events1792OtherDirectExpensesOtherEvents
Gross Receipts Total58835GrossReceiptsTotal
Charitable Contributions Total47140CharitableContributionsTotal
Gross Revenue Total Events11695GrossRevenueTotalEvents
Other Direct Expenses Total Events11695OtherDirectExpensesTotalEvents
Direct Expense Summary Events11695DirectExpenseSummaryEvents

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CHESTER B KALETKOWSKI
0478039011500008550300411927030322018903180830148
JOHN A DIANGELO
0320442058787037877078465020494051606500
ROBERT M DANGEL ESQ
0248873033962027434064934022737039794000
WAYNE PENDLETON
0204359017308017747018909012603027092600

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COMPENSATION INFORMATIONSCHEDULE J, PART I; QUESTION 4BTHE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNT WAS NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THIS AMOUNT WAS REPORTED AS EMPLOYEE BENEFIT PLAN CONTRIBUTIONS ON PRIOR YEARS FORMS 990. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN THE INDIVIDUAL'S 2010 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: CHESTER B. KALETKOWSKI, $830,148. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2010 FORM W-2, AS TAXABLE WAGES: CHESTER B. KALETKOWSKI, $381,796; JOHN A. DIANGELO, $57,673 AND ROBERT M. D'ANGEL, ESQ., $33,188.
COMPENSATION INFORMATIONSCHEDULE J, PART I; QUESTION 7THE FOLLOWING INDIVIDUALS RECEIVED A BONUS DURING CALENDAR YEAR 2010 WHICH BONUS AMOUNTS WERE INCLUDED IN COLUMN B (II) HEREIN AND IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: CHESTER B. KALETKOWSKI, $115,000; JOHN A. DIANGELO, $58,787; ROBERT M. D'ANGEL, ESQ., $33,962 AND WAYNE PENDLETON, $17,308.
COMPENSATION INFORMATIONSCHEDULE J, PART II; COLUMN B(III)CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J OF THIS FEDERAL FORM 990 RECEIVED COMPENSATION WITH RESPECT TO PAID TIME OFF, WHICH WAS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III) HEREIN AND IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.
COMPENSATION INFORMATIONSCHEDULE J, PART II, COLUMN FTHE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN F FOR THE FOLLOWING INDIVIDUAL INCLUDES VESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") BECAUSE THE AMOUNT WAS NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THIS AMOUNT WAS REPORTED AS DEFERRED COMPENSATION ON PRIOR FORMS 990 AND IS CURRENTLY TREATED AS TAXABLE AND REPORTED ON THE INDIVIDUAL'S 2010 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: CHESTER B. KALETKOWSKI, $830,148.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (30 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSCORE FORM, PART III; LINE 4DEXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY HOSPICE SERVICES, HOME HEALTHCARE AND ADULT MEDICAL CARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION A; QUESTION 1 AND SCHEDULE L; PART IVTHE ORGANIZATION IS A TAX-EXEMPT AFFILIATE IN SOUTH JERSEY HEALTH SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. FOR THE PERIOD JANUARY 1, 2010 THROUGH DECEMBER 31, 2010 AND DURING THE ORDINARY COURSE OF BUSINESS, THE ORGANIZATION MAY ENGAGE IN ONE OR MORE TRANSACTIONS WITH COMPANIES THAT (1) ARE OWNED BY AN INDIVIDUAL WHO IS A MEMBER OF THE BOARD OF TRUSTEES OF THIS ORGANIZATION OR A RELATED NOT-FOR-PROFIT ORGANIZATION, (2) ARE OWNED BY A FAMILY MEMBER OF AN INDIVIDUAL WHO IS A MEMBER OF THE BOARD OF TRUSTEES OF THIS ORGANIZATION OR A RELATED NOT-FOR-PROFIT ORGANIZATION, OR (3) WHEREIN A BOARD MEMBER OF THIS ORGANIZATION OR A FAMILY MEMBER OF A BOARD MEMBER OF THIS ORGANIZATION IS EITHER AN OFFICER, DIRECTOR, TRUSTEE OR KEY EMPLOYEE OF THE COMPANY WITH WHICH THIS ORGANIZATION OR A RELATED NOT-FOR-PROFIT ORGANIZATION TRANSACTS BUSINESS. IN THESE SITUATIONS, ANY GOODS PURCHASED OR SERVICES PERFORMED ARE DONE AT FAIR MARKET VALUE RATES PURSUANT TO ARMS LENGTH NEGOTIATIONS. ANY SUCH TRANSACTIONS ARE DISCLOSED TO, REVIEWED AND APPROVED BY THE FULL BOARD OF TRUSTEES. THE ORGANIZATION MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE AND USES REASONABLE EFFORTS TO OBTAIN THIS INFORMATION FROM THE MEMBERS OF ITS BOARD OF TRUSTEES. THE ORGANIZATION FOLLOWS A FORMALIZED BID PROCESS WHEREIN ALL TRANSACTIONS OF THIS NATURE ARE SENT OUT TO BID. IF IT IS DETERMINED THAT THE ORGANIZATION WILL ENTER INTO A TRANSACTION IDENTIFIED ABOVE, IT IS SENT TO THE FULL BOARD OF TRUSTEES FOR REVIEW AND APPROVAL. THE INTERESTED PERSON IN THESE CASES RECUSES THEMSELVES FROM THE VOTING PROCESS. THIS RECUSAL PROCESS IS OUTLINED IN THE ORGANIZATION'S WRITTEN CONFLICT OF INTEREST POLICY WHICH ALL BOARD MEMBERS AND SENIOR MANAGEMENT REVIEW ANNUALLY. DURING 2010 THE ORGANIZATION OR A RELATED NOT-FOR-PROFIT ORGANIZATION ENGAGED IN THE FOLLOWING: PAYMENT BY SOUTH JERSEY HOSPITAL, INC. IN THE AMOUNT OF $3,051 TO FRALINGER ENGINEERING FOR ENGINEERING SERVICES. MR. FRALINGER IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PAYMENT BY SOUTH JERSEY HOSPITAL, INC. IN THE AMOUNT OF $9,296 TO IQBAL & KAHN SURGICAL ASSOCIATES, INC. FOR MEDICAL SERVICES. DR. IQBAL IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. LENDING OF MONEY IN PREVIOUS YEARS BY SOUTH JERSEY HOSPITAL, INC. TO IQBAL & KAHN SURGICAL ASSOCIATES, INC. IN THE TOTAL AMOUNT OF $166,667 FOR START-UP CAPITAL REQUIREMENTS FOR THE MEDICAL PRACTICE IN RESPONSE TO AN IDENTIFIED HEALTHCARE COMMUNITY NEED AND MEDICAL SERVICES SHORTAGE. DR. IQBAL IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PLEASE NOTE THAT THIS TRANSACTION IS ALSO DISCLOSED ON SCHEDULE L OF THE SOUTH JERSEY HOSPITAL, INC. FORM 990. BRUNO A. BASILE HAS A DAUGHTER THAT IS EMPLOYED BY SOUTH JERSEY HOSPITAL, INC. AS A PHARMACIST FOR WHICH SHE RECEIVED FORM W-2, BOX 5 WAGES IN THE AMOUNT OF $52,503 DURING 2010. MR. BASILE IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PLEASE NOTE THAT THIS TRANSACTION IS ALSO DISCLOSED ON SCHEDULE L OF THE SOUTH JERSEY HOSPITAL, INC. FORM 990. RICHARD HARZ' SPOUSE IS EMPLOYED BY SOUTH JERSEY HOSPITAL, INC. AS A REGISTERED NURSE FOR WHICH SHE RECEIVED FORM W-2, BOX 5 WAGES IN THE AMOUNT OF $72,649 DURING 2010. MR. HARZ IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PLEASE NOTE THAT THIS TRANSACTION IS ALSO DISCLOSED ON SCHEDULE L OF THE SOUTH JERSEY HOSPITAL, INC. FORM 990. PAYMENT BY SOUTH JERSEY HOSPITAL, INC. IN THE AMOUNT OF $31,522 TO PERFORMANCE MARKETING FOR MARKETING SERVICES DURING 2010. MICHAEL M. ROSSI, III'S SPOUSE IS AN EMPLOYEE OF PERFORMANCE MARKETING. MR. ROSSI IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PAYMENT BY SOUTH JERSEY HEALTH SYSTEM FOUNDATION, INC. IN THE AMOUNT OF $91,836 TO PERFORMANCE MARKETING FOR MARKETING SERVICES DURING 2010. MICHAEL M. ROSSI, III'S SPOUSE IS AN EMPLOYEE OF PERFORMANCE MARKETING. MR. ROSSI IS A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PAYMENT BY SOUTH JERSEY HOSPITAL IN THE AMOUNT OF $72,089 TO DAVID SHIELDS, M.D. FOR PHYSICIAN SERVICES. JACK M. SHIELDS, M.D. IS THE BROTHER OF DAVID SHIELDS, M.D. AND A BOARD MEMBER OF HOMECARE AND HOSPICECARE OF SOUTH JERSEY, INC. PLEASE NOTE THAT THIS TRANSACTION IS ALSO DISCLOSED ON SCHEDULE L OF THE SOUTH JERSEY HOSPITAL, INC. FORM 990.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7SOUTH JERSEY HEALTH SYSTEM, INC. ("SYSTEM") IS THE SOLE MEMBER OF THIS ORGANIZATION. SYSTEM HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION B; QUESTION 11ATHE ORGANIZATION IS AN AFFILIATE IN SOUTH JERSEY HEALTH SYSTEM, INC. AND AFFILIATES ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. SOUTH JERSEY HEALTH SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THIS ORGANIZATION'S FEDERAL FORM 990 WAS MADE AVAILABLE TO EACH VOTING MEMBER OF ITS GOVERNING BODY, ITS BOARD OF TRUSTEES, PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). IN ADDITION, EACH MEMBER OF THE SOUTH JERSEY HEALTH SYSTEM, INC. COMPENSATION COMMITTEE REVIEWED THIS ORGANIZATION'S FORM 990 PRIOR TO FILING WITH THE IRS. THE SOUTH JERSEY HEALTH SYSTEM INC. COMPENSATION COMMITTEE HAS ASSUMED THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION AND FILING PROCESS FOR ALL TAX-EXEMPT AFFILIATES OF THE SYSTEM. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND SYSTEM INDIVIDUALS INCLUDING IN HOUSE COUNSEL, VICE-PRESIDENT OF FINANCE, DIRECTOR OF INTERNAL AUDIT AND VARIOUS OTHER INDIVIDUALS TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S FINANCE PERSONNEL AND VARIOUS OTHER INDIVIDUALS FOR FINAL REVIEW AND APPROVAL PRIOR TO PRESENTATION OF THE FEDERAL FORM 990 TO THE MEMBERS OF THE SOUTH JERSEY HEALTH SYSTEM, INC. COMPENSATION COMMITTEE AND THEREAFTER TO EACH MEMBER OF THIS ORGANIZATION'S BOARD OF TRUSTEES.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION B; QUESTION 12THE ORGANIZATION IS AN AFFILIATE IN THE SOUTH JERSEY HEALTH SYSTEM ("SYSTEM"). THE ORGANIZATION AND THE SYSTEM REGULARLY MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO THE ORGANIZATION AND THE GENERAL COUNSEL FOR LEGAL AFFAIRS FOR REVIEW. THEREAFTER THE GENERAL COUNSEL PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS. THEREAFTER, THE GENERAL COUNSEL OF THE ORGANIZATION PRESENTS THIS SUMMARY TO THE ORGANIZATION'S GOVERNANCE COMMITTEE FOR ITS REVIEW AND DISCUSSION.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION B; QUESTION 15THE ORGANIZATION IS AN AFFILIATE IN A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THIS FILING ORGANIZATION ITSELF HAS NO PAID SENIOR MANAGEMENT PERSONNEL RECEIVING COMPENSATION DIRECTLY FROM THIS ORGANIZATION. RATHER, KEY SENIOR MANAGEMENT PERSONNEL, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE SYSTEM AND THE CHIEF EXECUTIVE OFFICER OF THIS ORGANIZATION ARE EMPLOYED BY THE TAX-EXEMPT HOSPITAL WITHIN THE HEALTH CARE SYSTEM. HOWEVER, THE COMPENSATION AND BENEFITS OF THESE INDIVIDUALS ARE SHOWN ON THIS TAX RETURN BECAUSE THEY ARE ALSO EITHER OFFICERS OR BOARD MEMBERS OF THIS ORGANIZATION. ACCORDINGLY, THE HOSPITAL'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF THE HOSPITAL'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE HOSPITAL TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING BUT NOT LIMITED TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMPENSATION AND BENEFITS OF THE OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 IS REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER AND THE HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS.
DISCLOSURE INFORMATIONCORE FORM, PART VI, SECTION C; QUESTION 19THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY SECRETARY OF THE TREASURY.
COMPENSATION INFORMATION DISCLOSURECORE FORM, PART VII AND SCHEDULE JPART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THE RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THIS ORGANIZATION'S BOARD OF TRUSTEES.
OTHER CHANGES IN NET ASSETSCORE FORM, PART XI; QUESTION 5OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDE: - CHANGE IN NET UNREALIZED GAINS AND LOSSES ON INVESTMENTS - $167,000
AUDITED FINANCIAL STATEMENTSCORE FORM, PART XII; QUESTION 2THE ORGANIZATION IS AN AFFILIATE WITHIN THE SOUTH JERSEY HEALTH SYSTEM ("SYSTEM"), A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM'S PARENT ENTITY IS SOUTH JERSEY HEALTH SYSTEM, INC. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF SOUTH JERSEY HEALTH SYSTEM, INC. AND ALL ENTITIES WITHIN THE SYSTEM FOR THE YEARS ENDED DECEMBER 31, 2010 AND DECEMBER 31, 2009; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINED CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE SOUTH JERSEY HEALTH SYSTEM, INC. AUDIT COMMITTEE HAS ASSUMED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS, WHICH INCLUDES THIS ORGANIZATION, AND THE SELECTION OF AN INDEPENDENT AUDITOR.
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MICHAEL M ROSSI III TITLE:CHAIRMAN - TRUSTEE HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ANN M BUDDE TITLE:VICE CHAIR - TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:RICHARD HARZ TITLE:SECRETARY - TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DAVID ROBBINS JR TITLE:TREASURER - TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:BRUNO A BASILE TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ALFRED F CAGGIANO TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOHN B CATALANO MD TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:BEVERLY L DAIRSOW TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:FRANK DEMAIO MD TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ALBERT A FRALINGER JR TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:EILEEN A HALLISSEY TITLE:TRUSTEE HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:NAUVEED IQBAL MD TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:CHESTER B KALETKOWSKI TITLE:TRUSTEE;EX-OFFICIO - PRES./CEO HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:HUGH MCCAFFREY TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MAURICE SHEETZ MD TITLE:TRUSTEE;EX-OFFICIO HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JACK M SHIELDS MD TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:TACIE TRULL TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOHN A DIANGELO TITLE:ASSISTANT TREASURER HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT M DANGEL ESQ TITLE:ASSISTANT TREASURER HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:WAYNE PENDLETON TITLE:EXECUTIVE DIRECTOR HOURS:25

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
SOUTH JERSEY HEALTH SYSTEM INC
333 IRVING AVENUEBRIDGETONNJ08302222508425HEALTH SVCS.NJ501(C)(3)509(a)(3)N/A
SOUTH JERSEY HEALTH SYSTEM FDN INC
333 IRVING AVENUEBRIDGETONNJ08302223746758SUPPORT SJHS.NJ501(C)(3)509(a)(3)SJH
SOUTH JERSEY HOSPITAL INC
333 IRVING AVENUEBRIDGETONNJ08302210634484HEALTH SVCS.NJ501(C)(3)HOSPITALSJHS
SOUTH JERSEY HEALTHCARE LIFE INC
2950 COLLEGE DRIVE SUITE 1EVINELANDNJ08360264827936HEALTH SVCS.NJ501(C)(3)509(A)(2)SJHS

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1BPOC LPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1333 IRVING AVENUEAddressLine1
CityBRIDGETONCity
StateNJState
ZIP Code08302ZIPCode
FieldValueIRS element (for citing)
EIN222956029EIN
Primary ActivityREAL ESTATEPrimaryActivity
Legal Domicile StateNJLegalDomicileState
Disproportionate AllocationsfalseDisproportionateAllocations
Code V$0CodeVAmount
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.00000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipDirect Controlling Entity NADirectControllingEntityNAAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
HELP SERVICES OF SOUTH JERSEY INC
PO BOX 126SALEMNJ08079222823028HEALTHCARE SVCS.NJH&H CARE SVCSC CORP.5458651044571.00000
JERSEY HEALTH MANAGEMENT INC
333 IRVING AVENUEBRIDGETONNJ08302222502241HEALTH SERVICESNJC CORP.N/A
PHYSICIANS OF SOUTHERN NEW JERSEY PC
2950 COLLEGE DRIVE SUITE 1EVINELANDNJ08360205745047MEDICAL SVCS.NJC CORP.N/A
JUNO ASSURANCE LTD
FINANCIAL VEHICLEFOREIGN CORP.N/AAON HOUSE 4TH FLOORPEMBROKEBDHM 08BD
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
HELP SERVICES OF SOUTH JERSEY INC
D1054134
HELP SERVICES OF SOUTH JERSEY INC
E836210

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