SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
HACKENSACK UNIVERSITY MEDICAL CENTER
 
Employer identification number

22-1487576
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    47,952,210 9,808,105 38,144,105 3.170 %
b Medicaid (from Worksheet 3, column a) . . . . .     48,810,812 5,317,057 43,493,755 3.620 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     96,763,022 15,125,162 81,637,860 6.790 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     15,037,577 4,921,674 10,115,904 0.840 %
f Health professions education (from Worksheet 5) . . .     14,518,900 10,720,564 3,798,336 0.320 %
g Subsidized health services (from Worksheet 6) . . . .     9,028,000 4,991,314 4,036,686 0.340 %
h Research (from Worksheet 7) .     3,842,908   3,842,908 0.320 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     338,370   338,370 0.030 %
j Total. Other Benefits . .     42,765,755 20,633,552 22,132,204 1.850 %
k Total. Add lines 7d and 7j .     139,528,777 35,758,714 103,770,064 8.640 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     41,425   41,425  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other     2,259,173 373,734 1,885,439 0.160 %
10 Total     2,300,598 373,734 1,926,864 0.160 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
81,626,225
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
6,825,285
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
310,059,529
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
336,129,970
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-26,070,441
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1COTA
  		CANCER TRACKING AND ANALYSIS 2.229 % 4.337 % 8.167 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?3
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 HACKENSACK UNIVERSITY MEDICAL CENTER
30 PROSPECT AVENUE
HACKENSACK,NJ07601
WWW.HACKENSACKUMC.ORG
10204 		X X X X   X X     1
2 HACKENSACKUMC AT PASCACK VALLEY
250 OLD HOOK ROAD
WESTWOOD,NJ07675
WWW.HACKENSACKUMCPV.ORG
24745 		X X         X   JOINT VENTURE 2
3 HACKENSACKUMC MOUNTAINSIDE
ONE BAY AVENUE
MONTCLAIR,NJ07042
WWW.MOUNTAINSIDEHOSP.COM
10708 		X X         X   JOINT VENTURE 3
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		2
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5    
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a    
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a    
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17   No
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		3
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3   No
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20  
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5    
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a    
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b    
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7    
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8    
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a    
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, QUESTIONS 3J AND 5 The organization conducted a community health needs assessment ("CHNA") through the Community Health Improvement Partnership of Bergen County ("CHIP"). A steering committee made up of senior representatives from each hospital that participated in the CHNA and the BERGEN County Department of Health Services ("BCDHS") guided this project. An advisory committee, which included additional staff from the participating hospitals and BCDHS, as well as representatives from local health departments and a number of Bergen County's leading health and social service organizations, provided additional input. The combined expertise, knowledge, and commitment of the members of these committees were vital to this project. Marla Klein, Partnership Coordinator at BCDHS and Coordinator of the CHIP, managed the project and was the main liaison between the steering committee and John Snow, Inc. ("JSI"), the consulting company that was hired to assist with the assessment. Ms. Klein deserves special recognition for her tireless oversight and support of the CHNA process. During this project, dozens of individuals were interviewed by JSI including administrative and clinical staff from the hospitals, representatives from health and social service agencies, public health officers, other public and elected officials, representatives from advocacy organizations and foundations, and community residents. JSI also conducted a random household mail survey with more than 1,700 residents from Bergen County. A pool of research assistants augmented these findings by collecting nearly 400 additional surveys from low-income, racial/ethnic minority residents of the County at community-based health and social service organizations, open-air markets, faith-based organizations, and other community venues. Finally, information was gathered by the JSI project team from community residents, service providers, and other community health stakeholders through a series of focus groups and listening sessions. These information gathering efforts allowed the steering and advisory committees to gain a better understanding of the health status, healthcare needs, service gaps, and barriers to care of those living in Bergen County. The assessment and planning process was conducted in three phases, which allowed the collaborating organizations to: 1. identify and clarify the healthcare needs and priorities of the residents of Bergen County; 2. engage stakeholders, including key service providers and residents throughout the County; and 3. develop a detailed Bergen County Community Health Improvement Plan. Each of the five partnering hospitals, in turn, developed individual implementation plans that drew from the countywide plan. These individual plans leverage the hospital's strengths and resources and allow them to meet the needs of those who live and work in the communities they serve. The CHNA process compiled and analyzed an array of quantitative and qualitative health related data through community interviews, household and community surveys, and focus groups. For the purpose of this assessment, the steering committee defined health broadly to include not just health status and the existence of disease but also social factors, access to care issues, and overall determinants of health. Data was collected at County-level and whenever possible at the city, town, and borough level. State and national data was also compiled to facilitate comparison and benchmarking of County and local data. Key findings from these data are summarized and the bulk of the data is provided in the appendices to this report. Once all of the assessment's health-related data was compiled, the steering committee implemented a comprehensive strategic planning process involving the hospitals, public health agencies, the County's leading health and social service providers, and the community at-large. The first task in this process was a strategic planning retreat involving the members of the CHNA's steering and advisory committees. Individual strategic planning meetings were then convened with each of the participating hospitals, the Bergen County Health Department, and CHIP. The project's findings were also presented to a number of community groups, including local health department officials, discharge planners and case managers from the participating hospitals, and the Bergen County Mental Health Task Force. Finally, preliminary findings and results were presented to the public at CHIP's annual meeting, which nearly 100 community residents and other community health stakeholders attended. The ultimate purpose of this assessment was to provide actionable data and information along with a detailed strategic plan that would engage the community, promote collaboration, and guide the County's community health improvement efforts. With this in mind, the steering committee was charged with identifying a series of goals and objectives along with a set of evidenced-based strategies that would guide the implementation process and become the core of the County's and CHIP's community health improvement plan. The steering committee agreed that whatever goals were identified needed to be attainable using existing resources. The strategies identified also needed to be shown in the existing peer-reviewed literature to be effective and cost-efficient. Finally, the associated community health improvement plan needed to be aligned with existing national, state, and county strategies being promoted by other private and public agencies, such as the New Jersey Department of Health's Shaping NJ initiative, related to obesity, fitness, and nutrition. With these commitments and public mandates in mind, the hospitals, BCDHS, and the CHIP came together to conduct a three-phased CHNA and planning project, and to update the CHIP's existing community health improvement plan. The Mobilizing for Action through Planning and Partnerships ("MAPP") process helped inform the planning processes. MAPP is a community-driven strategic planning process for improving community health. The MAPP process utilizes four types of community health needs assessments: 1. a community themes and strengths assessment; 2. a local public health system assessment; 3. a community health status report; and 4. a forces of change assessment. While this present effort did not utilize the MAPP process specifically, all four of the MAPP assessments were addressed in the various components of the approach that was applied for this assessment and planning project.
SCHEDULE H, PART V, SECTION B, QUESTION 6a Several hospital facilities collaborated to conduct this CHNA. These facilities included: - HackensackUMC; - Christian Health Care Center; - Englewood Hospital and Medical Center; - Holy Name Medical Center; and - The Valley Hospital.
SCHEDULE H, PART V, SECTION B, QUESTION 6b Several organizations other than hospital facilities collaborated to conduct this CHNA. These facilities included: - BERGEN COUNTY DEPARTMENT OF HEALTH SERVICES; AND - COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP OF BERGEN COUNTY.
SCHEDULE H, PART V, SEC B, Q'S 7D,13H,15E,16I,18E,19D,20E,21D,22D,23&24 NOT APPLICABLE.
SCHEDULE H, PART V, SECTION B, QUESTION 13a THE FACILITY USES A SLIDING SCALE METHOD TO DETERMINE THE ELIGIBILITY FOR DISCOUNTED CARE.
SCHEDULE H, PART V, SECTION B PLEASE NOTE THAT HACKENSACKUMC AT PASCACK VALLEY OFFICIALLY OPENED AND BEGAN PROVIDING MEDICAL SERVICES ON JUNE 1, 2013. THIS HOSPITAL FACILITY, IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(3) RULES AND REGULATIONS, IS REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT WITHIN ITS FIRST THREE YEARS OF OPERATIONS. AS A RESULT, HACKENSACKUMC AT PASCACK VALLEY WILL CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT ON OR BEFORE DECEMBER 31, 2015. SCHEDULE H, PART V, SECTION B, QUESTIONS 1-12 FOR HACKENSACKUMC AT PASCACK VALLEY ARE NOT REQUIRED TO BE ANSWERED WITH THIS 2014 FORM 990 FILING. PLEASE NOTE THAT HACKENSACKUMC MOUNTAINSIDE OFFICIALLY OPENED AND BEGAN PROVIDING MEDICAL SERVICES ON JULY 1, 2012. THIS HOSPITAL FACILITY, IN ACCORDANCE WITH INTERNAL REVENUE CODE 501(R)(3) RULES AND REGULATIONS, IS REQUIRED TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT WITHIN ITS FIRST THREE YEARS OF OPERATIONS. HACKENSACKUMC MOUNTAINSIDE IS A JOINT VENTURE LIMITED LIABILITY COMPANY IN WHICH HACKENSACKUMC IS A MINORITY OWNER WITH THE MAJORITY MEMBER BEING A FOR-PROFIT ENTITY. AS A FOR-PROFIT ENTITY, THE MAJORITY MEMBER WAS UNDER THE IMPRESSION THAT THE INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS NOT REQUIRED TO BE CONDUCTED UNTIL THE RELEASE OF THE FINAL REGULATIONS FOR INTERNAL REVENUE CODE 501(R). UPON BEING NOTIFIED BY HACKENSACKUMC THAT A COMMUNITY HEALTH NEEDS ASSESSMENT WAS REQUIRED TO BE CONDUCTED, THE MAJORITY MEMBER IMMEDIATELY EXERCISED DUE DILIGENCE AND BEGAN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. AS A RESULT, THE INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT FOR HACKENSACKUMC MOUNTAINSIDE WAS COMPLETED AND CONSIDERED "CONDUCTED" FOR PURPOSES OF INTERNAL REVENUE CODE 501(R) ON NOVEMBER 1, 2015.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address Type of Facility (describe)
1 HUMC AT FRANKLIN LAKES
795 FRANKLIN AVENUE
FRANKLIN LAKES,NJ07417 		PRIMARY CARE SERVICES OUTPATIENT ONCOLOGY
2 HUMC MEDICAL ARTS PLAZA
20 PROSPECT AVENUE
HACKENSACK,NJ07601 		VARIOUS OUTPATIENT HEALTHCARE SERVICES
3 THE ALFRED M SANZARI MEDICAL ARTS BLDG
360 ESSEX STREET
HACKENSACK,NJ07601 		VARIOUS OUTPATIENT HEALTHCARE SERVICES
4 HUMC AIR EXPRESS
30 PROSPECT AVENUE
HACKENSACK,NJ07601 		PRIMARY CARE SERVICES, MOBILE ASTHMA SCREENING SERVICES
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
SCHEDULE H, PART I, LINE 3C THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2013 FEDERAL POVERTY GUIDELINES (DEPARTMENT OF HEALTH AND SENIOR SERVICES). FEDERAL POVERTY GUIDELINES ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE. THE FACILITY USES A SLIDING SCALE METHOD TO DETERMINE THE ELIGIBILITY FOR DISCOUNTED CARE.
SCHEDULE H, PART I, LINE 6A ANNUALLY THE ORGANIZATION PREPARES A COMMUNITY BENEFIT REPORT WHICH IS POSTED ON THE ORGANIZATION'S WEBSITE, WWW.HACKENSACKUMC.ORG.
SCHEDULE H, PART II HACKENSACK UNIVERSITY MEDICAL CENTER ("HACKENSACKUMC") ACTIVELY ENGAGES IN COMMUNITY BUILDING ACTIVITIES THAT CONTRIBUTE TO THE OVERALL HEALTH OF THE COMMUNITIES IT SERVES. IN ADDITION, HACKENSACKUMC PROVIDES AND SUBSIDIZES DAY CARE SERVICES FOR THE BENEFIT OF THE COMMUNITY. THIS COMMUNITY BUILDING OPERATION RESULTED IN A LOSS OF $299,000 IN 2014.
SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS, NET OF ACCOUNTS WRITTEN OFF AT CHARGES. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS WERE PREPARED AND ISSUED FOR HACKENSACK UNIVERSITY HEALTH NETWORK AND ITS SUBSIDIARIES AND CONTROLLED ENTITIES, WHICH INCLUDES HACKENSACK UNIVERSITY MEDICAL CENTER ("HACKENSACKUMC"). HACKENSACK UNIVERSITY HEALTH NETWORK AND ITS SUBSIDIARIES AND CONTROLLED ENTITIES CONSTITUTE A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("NETWORK"). PLEASE REFER TO THE NET PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE SECTION OF FOOTNOTE 1 ON PAGE 12 AND THE CHARITY AND UNCOMPENSATED CARE FOOTNOTE 2 ON PAGE 14 OF THE AUDITED FINANCIAL STATEMENTS OF THE NETWORK ATTACHED TO THIS FORM 990.
SCHEDULE H, PART III, LINE 8 THE COSTING METHODOLOGY UTILIZED TO DETERMINE THE MEDICARE ALLOWABLE COSTS WAS THE COST TO CHARGE RATIO AS DERIVED FROM THE 2014 MEDICARE COST REPORT. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT EXPENSE ARE COMMUNITY BENEFIT EXPENSE AND ASSOCIATED COSTS SHOULD BE INCLUDED WITHIN FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH HACKENSACKUMC'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE INTERNAL REVENUE SERVICE ("IRS"). THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE IRC FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "THE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE," AND PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE INDIGENT OR UNDERPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185 WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THIS STANDARD, A HOSPITAL HAS TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY, AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545 WHICH "REMOVED" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THIS STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREASURY REGULATION 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT A HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: - ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; - IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND - HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. ADDITIONALLY, THE AMERICAN HOSPITAL ASSOCIATION ("AHA") OUTLINED IN A LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE CURRENT FORM 990 AND SCHEDULE H, THAT AHA BELIEVES THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT ("TOTAL BENEFITS TO THE COMMUNITY") THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD, - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE INDIGENT AND ARE ALSO ELIGIBLE FOR MEDICAID - ALSO KNOWN AS "DUAL ELIGIBLES." DUAL ELIGIBLES ARE AMONG THE SICKEST AND POOREST INDIVIDUALS COVERED BY EITHER MEDICARE OR MEDICAID. MOST DUAL ELIGIBLES ARE VERY LOW-INCOME INDIVIDUALS. IN 2008, 86% OF DUAL ELIGIBLES HAD ANNUAL INCOMES BELOW 150% OF THE FEDERAL POVERTY LEVEL, COMPARED TO 22% OF NON-DUAL MEDICARE BENEFICIARES. ONLY 7% HAD ANNUAL INCOMES GREATER THAN 200% OF THE FEDERAL POVERTY LEVEL. THERE IS A VERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. THE ANNUAL OVERALL MEDICARE UNDERPAYMENTS MUST BE ASSUMED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND INDIGENT. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH AHA AND HACKENSACKUMC BELIEVE THAT PATIENT BAD DEBT EXPENSE IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT ACCOUNTS DETERMINED TO BE BAD DEBT EXPENSE SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, "NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS", CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOME BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING APPLICATION FOR AND ULTIMATE APPROVAL FOR CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE ACCOUNTING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF THE ORGANIZATION'S BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY AHA, DESPITE THE HOSPITALS' BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS R
SCHEDULE H, PART III, LINE 9B ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE PROVISION FOR BAD DEBT, BUT RATHER, ACCOUNTED FOR AS A REDUCTION TO NET PATIENT SERVICE REVENUE.
SCHEDULE H, PART VI; QUESTION 2 PLEASE REFER TO OUR RESPONSES INCLUDED IN SCHEDULE H, PART V, SECTION B.
SCHEDULE H, PART VI; QUESTION 3 UNDER ITS CHARITY CARE POLICY, HACKENSACKUMC INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS BY MEETING WITH A HOSPITAL FINANCIAL AID SPECIALIST. THE HOSPITAL FINANCIAL AID SPECIALIST ALSO ANSWERS ALL INCOMING CALLS AND MAILS OUT THE NEW JERSEY HOSPITAL CARE BROCHURES UPON REQUEST. THE HOSPITAL FINANCIAL AID RECEPTIONIST WILL PROCESS ALL REQUESTS FOR CHARITY CARE FROM PROSPECTIVE APPLICANTS AND SECURE THE PROPER DOCUMENTATION THAT FOLLOWS THE STATE DEPARTMENT OF HEALTH GUIDELINES FOR FINANCIAL ASSISTANCE. ONCE APPROVED BASED ON INCOME/ASSET GUIDELINES, THEY WILL PREPARE A DETERMINATION OF CHARITY CARE NOTICE BASED ON THE RESULTS OF THE CALCULATIONS AND SEND IT TO THE PATIENT.
SCHEDULE H, PART VI; QUESTION 4 SERVICE AREA ------------ HACKENSACKUMC DEFINES ITS PRIMARY SERVICE AREA FOR INPATIENTS ("PSA") AS BERGEN COUNTY, ITS SECONDARY SERVICE AREA ("SSA") AS PASSAIC AND HUDSON COUNTIES, AND ITS TERTIARY SERVICE AREA ("TSA") AS OTHER COUNTIES IN NEW JERSEY AND CERTAIN COUNTIES IN NEW YORK AND PENNSYLVANIA. THE 2010 POPULATION OF THE PSA AND SSA WERE 905,116 AND 1,135,492, RESPECTIVELY, ACCORDING TO THE U.S. CENSUS BUREAU. IN 2010, APPROXIMATELY 22.6% OF THE PSA POPULATION AND 22.5% OF THE SSA POPULATION WERE UNDER 18 YEARS OF AGE AND 15.1% OF THE PSA POPULATION AND 11.1% OF THE SSA POPULATION WERE 65 YEARS OF AGE AND OLDER, ACCORDING TO THE U.S. CENSUS BUREAU. IN 2014, APPROXIMATELY 58% OF HACKENSACKUMC'S 45,537 DISCHARGES CAME FROM BERGEN COUNTY, 13.4% FROM HUDSON COUNTY AND 12.4% FROM PASSAIC COUNTY. HACKENSACKUMC REFERS TO BERGEN, HUDSON AND PASSAIC COUNTIES AS THE "TRI-COUNTY PSA/SSA". HACKENSACKUMC ALSO ATTRACTS A SIGNIFICANT NUMBER OF PATIENTS WHO RESIDE BEYOND THE TRI-COUNTY PSA/SSA, AND FREQUENTLY THESE PATIENTS ARE SEEKERS OF SUB-SPECIALTY CARE. IN 2014, APPROXIMATELY 16.2% OF HACKENSACKUMC'S DISCHARGES CAME FROM OUTSIDE OF THE TRI-COUNTY PSA/SSA. A CONSISTENT GOAL OF HACKENSACKUMC OVER THE PAST TWO DECADES HAS BEEN TO REDUCE OUTMIGRATION OF PSA AND SSA PATIENTS TO HOSPITALS IN NEW YORK CITY. ALTHOUGH HACKENSACKUMC HAS EXPERIENCED A REDUCTION IN OUTMIGRATION AND INCREASED PSA AND SSA ADMISSIONS, THE CONTINUING REDUCTION OF OUTMIGRATION REMAINS A LONG-TERM OBJECTIVE.
SCHEDULE H, PART VI; QUESTION 5 THIS ORGANIZATION OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. THE ORGANIZATION PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. THE ORGANIZATION OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. THE ORGANIZATION MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF THE ORGANIZATION RESTS WITH ITS BOARD OF GOVERNORS; WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. PLEASE REFER TO SCHEDULE O FOR THE NETWORK'S CHARITY CARE COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW HACKENSACKUMC AND THE NETWORK PROMOTE COMMUNITY HEALTH.
SCHEDULE H, PART VI; QUESTION 6 NOT FOR-PROFIT ENTITIES: HACKENSACK UNIVERSITY HEALTH NETWORK, INC. HACKENSACK UNIVERSITY HEALTH NETWORK, INC. IS AN ORGANIZATION RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION IS THE PARENT ENTITY OF HACKENSACKUMC AND OTHER SUBSIDIARIES AND CONTROLLED ENTITIES INCLUDED IN THE NETWORK. HACKENSACK UNIVERSITY MEDICAL CENTER FOUNDATION, INC. HACKENSACK UNIVERSITY MEDICAL CENTER FOUNDATION, INC. IS AN ORGANIZATION RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF HACKENSACKUMC. BERGEN HEALTH MANAGEMENT SYSTEM, INC. BERGEN HEALTH MANAGEMENT SYSTEM, INC. IS AN ORGANIZATION RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(2). THE ORGANIZATION PROMOTES, SUPPORTS AND FURTHERS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF HACKENSACKUMC. HACKENSACK SPECIALTY CARE ASSOCIATES, P.C. HACKENSACK SPECIALTY CARE ASSOCIATES, P.C. IS A SHAREHOLDER NOMINEE OWNED CORPORATION ORGANIZED UNDER THE NEW JERSEY PROFESSIONAL SERVICE CORPORATION ACT AND IS RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION SERVES AS A PHYSICIAN SERVICES COMPONENT OF HACKENSACKUMC HACKENSACK UNIVERSITY MEDICAL GROUP, P.C. HACKENSACK UNIVERSITY MEDICAL GROUP, P.C. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION SUPPORTS HACKENSACKUMC, A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ACUTE CARE HOSPITAL WHICH PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. IN ADDITION, BY PRACTICING MEDICINE, ENGAGING IN MEDICAL EDUCATION AND WORKING TO IMPROVE THE WELFARE OF INDIVIDUALS IN NEW JERSEY, THE ORGANIZATION COMPRISES A COMPONENT OF THE CLINICAL SERVICE PHYSICIAN PRACTICE PLANS OF HACKENSACKUMC; A TEACHING HOSPITAL, AND IS AN INTEGRAL PART OF THIS INSTITUTION. HUMC CARDIOVASCULAR PARTNERS, P.C. HUMC CARDIOVASCULAR PARTNERS, P.C. IS A SHAREHOLDER NOMINEE OWNED CORPORATION ORGANIZED UNDER THE NEW JERSEY PROFESSIONAL SERVICE CORPORATION ACT AND IS RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION SERVES AS A PHYSICIAN SERVICES COMPONENT OF HACKENSACKUMC. HUMC MEDICAL OBSERVATION, P.A. HUMC MEDICAL OBSERVATION, P.A. IS A SHAREHOLDER NOMINEE OWNED CORPORATION ORGANIZED UNDER THE NEW JERSEY PROFESSIONAL SERVICE CORPORATION ACT AND IS RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION SERVES AS A PHYSICIAN SERVICES COMPONENT OF HACKENSACKUMC. THE AUXILIARY OF HACKENSACK UNIVERSITY MEDICAL CENTER THE AUXILIARY OF HACKENSACK UNIVERSITY MEDICAL CENTER IS AN ORGANIZATION RECOGNIZED BY THE IRS AS TAX-EXEMPT PURSUANT TO IRC 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO IRC 509(A)(3). THE ORGANIZATION SERVES AS THE EXECUTIVE SERVICES COMPONENT OF HACKENSACKUMC. FOR-PROFIT ENTITIES: HACKENSACK UNIVERSITY MEDICAL CENTER CASUALTY COMPANY, LTD. HACKENSACK UNIVERSITY MEDICAL CENTER CASUALTY COMPANY, LTD. IS A CONTROLLED FOREIGN CORPORATION OF HACKENSACKUMC. THE ORGANIZATION WAS FORMED AND OPERATES SOLELY IN BERMUDA. HACKENSACK OCCUPATIONAL MEDICINE ASSOCIATES, P.C. HACKENSACK OCCUPATIONAL MEDICINE ASSOCIATES IS A FOR-PROFIT ENTITY WHOSE NOMINEE OWNER IS HACKENSACKUMC. THE ORGANIZATION IS LOCATED IN HACKENSACK, BERGEN COUNTY, NEW JERSEY. NEW AMSTERDAM MEDICAL ASSOCIATES, P.C. NEW AMSTERDAM MEDICAL ASSOCIATES, P.C. IS A FOR-PROFIT ENTITY WHOSE NOMINEE OWNER IS HACKENSACKUMC. THE ORGANIZATION IS LOCATED IN HACKENSACK, BERGEN COUNTY, NEW JERSEY. HUMC PRIMARY CARE ASSOCIATES, P.C. HUMC PRIMARY CARE ASSOCIATES, P.C. IS A FOR-PROFIT ENTITY WHOSE NOMINEE OWNER IS HACKENSACKUMC. THE ORGANIZATION IS LOCATED IN HACKENSACK, BERGEN COUNTY, NEW JERSEY. HACKENSACK PHYSICIAN ALLIANCE, L.L.C. HACKENSACK PHYSICIAN ALLIANCE, L.L.C. IS AN INACTIVE SINGLE MEMBER LIMITED LIABILITY COMPANY FORMED IN THE STATE OF NEW JERSEY WHOSE SOLE MEMBER IS HACKENSACKUMC. HACKENSACK PHYSICIAN-HOSPITAL ALLIANCE ACO, L.L.C. HACKENSACK PHYSICIAN-HOSPITAL ALLIANCE ACO, L.L.C. IS A SINGLE MEMBER LIMITED LIABILITY COMPANY FORMED IN THE STATE OF NEW JERSEY AND SERVES AS AN ACCOUNTABLE CARE ORGANIZATION WHICH INCLUDES PARTICIPATION OF OVER 400 PHYSICIANS. THE SOLE MEMBER OF HACKENSACK PHYSICIAN-HOSPITAL ALLIANCE ACO, L.L.C. IS HACKENSACK UNIVERSITY HEALTH NETWORK.
SCHEDULE H, PART VI; QUESTION 7 NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. NO COMMUNITY BENEFIT REPORT IS FILED WITH THE STATE OF NEW JERSEY.
Schedule H (Form 990) 2014
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