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ObjectId: 201503209349304230 - Submission: 2015-11-16
TIN: 22-1487322
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
Employer identification number
22-1487322
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
HNH FITNESS LLC
718 TEANECK ROAD
TEANECK
,
NJ
07666
59-3836367
WELLNESS
NJ
1,330,388
6,149,758
HNMC
(2)
HNLS LLC
718 TEANECK ROAD
TEANECK
,
NJ
07666
45-3636025
INACTIVE
NJ
0
0
HNMC
(3)
HNMC HOSPITALPHYSICIAN ACO LLC
718 TEANECK ROAD
TEANECK
,
NJ
07666
45-5412543
HEALTHCARE
NJ
148,209
263,495
HNMC
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
HOLY NAME HEALTH CARE FOUNDATION
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-2737143
FUNDRAISING
NJ
501(C)(3)
509(A)(3)
HNMC
Yes
(2)
HOLY NAME REAL ESTATE CORP
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3412504
PROPERTY CO
NJ
501(C)(3)
509(A)(3)
HNMC
Yes
(3)
SISTERS OF ST JOSEPH OF PEACE
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3412084
RELIGIOUS ORD
NJ
501(C)(3)
170B1AI
NA
No
(4)
MS COMPREHENSIVE CARE CENTER
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-2402959
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
HNMC
Yes
(5)
HOLY NAME EMS INC
718 TEANECK ROAD
TEANECK
,
NJ
07666
27-0294681
HEALTHCARE
NJ
501(C)(3)
509(A)(3)
HNMC
Yes
(6)
THE CRUDEM FOUNDATION INC
718 TEANECK ROAD
TEANECK
,
NJ
07666
43-1660199
HEALTHCARE
MO
501(C)(3)
509(A)(1)
HNMC FDN
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Page 2
Schedule R (Form 990) 2014
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
HEALTH PARTNER SERVICES INC
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3618636
MGMT SERVICES
NJ
HNMC
C CORP.
0
3,571,594
100.000 %
Yes
(2)
PEACE HEALTH PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3618634
HLTHCARE SVCS
NJ
NA
C CORP.
No
(3)
HOUSE PHYSICIANS PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3808427
HLTHCARE SVCS
NJ
NA
C CORP.
No
(4)
HEMATOLOGYONCOLOGY PHYSICIANS
718 TEANECK ROAD
TEANECK
,
NJ
07666
22-3808421
HLTHCARE SVCS
NJ
NA
C CORP.
No
(5)
RIVERSIDE FAMILY CARE
718 TEANECK ROAD
TEANECK
,
NJ
07666
20-0446233
HLTHCARE SVCS
NJ
NA
C CORP.
No
(6)
RADIATION ONCOLOGY PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
20-1104758
HLTHCARE SVCS
NJ
NA
C CORP.
No
(7)
EXCELCARE MEDICAL ASSOCIATES
718 TEANECK ROAD
TEANECK
,
NJ
07666
20-3130405
HLTHCARE SVCS
NJ
NA
C CORP.
No
(8)
BREAST IMAGING PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
75-3226059
HLTHCARE SVCS
NJ
NA
C CORP.
No
(9)
HOLY NAME CARDIOLOGY ASSOCIATES PC
718 TEANECK ROAD
TEANECK
,
NJ
07666
75-3226063
HLTHCARE SVCS
NJ
NA
C CORP.
No
(10)
BREAST CARE PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
11-3787403
HLTHCARE SVCS
NJ
NA
C CORP.
No
(11)
HOLY NAME PULMONARY ASSOCIATES PC
718 TEANECK ROAD
TEANECK
,
NJ
07666
83-0511119
HLTHCARE SVCS
NJ
NA
C CORP.
No
(12)
WOMEN'S CLINIC PARTNERS
718 TEANECK ROAD
TEANECK
,
NJ
07666
36-4635222
HLTHCARE SVCS
NJ
NA
C CORP.
No
(13)
MULKAY CARDIOLOGY CONSULTANTS AT HNMC
718 TEANECK ROAD
TEANECK
,
NJ
07666
46-3392343
HLTHCARE SVCS
NJ
N/A
C CORP.
No
Schedule R (Form 990) 2014
Page 3
Schedule R (Form 990) 2014
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
Yes
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
HEALTH PARTNER SERVICES INC
R
13,460,000
COST
(2)
HEALTH PARTNER SERVICES INC
D
339,763
COST
(3)
MS COMPREHENSIVE CARE CENTER
D
687,483
COST
(4)
HOLY NAME REAL ESTATE CORPORATION
D
1,309,432
COST
(5)
HOLY NAME EMS INC
E
50,065
COST
(6)
HOLY NAME HEALTH CARE FOUNDATION
D
2,125,295
COST
Schedule R (Form 990) 2014
Page 4
Schedule R (Form 990) 2014
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2014
Page 5
Schedule R (Form 990) 2014
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
SCHEDULE R, PART V
HOLY NAME MEDICAL CENTER ROUTINELY PAYS EXPENSES FOR VARIOUS RELATED AFFILIATES IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF THIS ORGANIZATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.
Schedule R (Form 990) 2014
Additional Data
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