efile Public Visual Render
ObjectId: 201503209349311620 - Submission: 2015-11-16
TIN: 22-1487576
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
HACKENSACK UNIVERSITY MEDICAL CENTER
Employer identification number
22-1487576
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)
HUMCTOURO LLC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
26-1844522
INACTIVE
NJ
0
0
HUMC
(2)
HACKENSACK PHYSICIAN ALLIANCE LLC
30 prospect avenue
hackensack
,
NJ
07601
45-4966639
inactive
NJ
0
0
humc
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)
BERGEN HEALTH MANAGEMENT SYSTEM INC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-2989731
DAY CARE
NJ
501(C)(3)
509(A)(2)
HUHN
No
(2)
BERGEN HOME HEALTH SERVICES INC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-3091474
HLTHCARE SVCS
NJ
501(C)(3)
509(A)(2)
HUHN
No
(3)
HACKENSACK UNIV MED CTR FDN INC
360 ESSEX STREET 301
HACKENSACK
,
NJ
07601
22-2339534
SUPPORT HUMC
NJ
501(C)(3)
509(A)(3)
HUHN
No
(4)
HACKENSACK SPECIALTY CARE ASSOC PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
20-1017013
PHYS. SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
(5)
HACKENSACK UNIVERSITY HEALTH NETWORK
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-2595857
SUPPORT
NJ
501(C)(3)
509(A)(3)
NA
No
(6)
NJ TRAUMA AND CRITICAL CARE ASSOCIATES
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
20-1123530
PHYS. SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
(7)
HACKENSACK UNIVERSITY MEDICAL GROUP PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-3376459
PHYS. SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
(8)
HUMC CARDIOVASCULAR PARTNERS PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-0614861
PHYS. SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
(9)
HUMC MEDICAL OBSERVATION PA
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-2371424
PHYS. SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
(10)
THE AUXILIARY OF HACKENSACKUMC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-1537117
SUPPORT HUMCF
NJ
501(C)(3)
509(A)(3)
HUMC
Yes
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
(1)
HUMCUSP SURGERY CENTERS LLC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
38-3875474
HEALTHCARE SVCS.
NJ
HUMC
RELATED
2,105,594
11,754,477
No
0
No
50.100 %
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)
PEDIATRIC SPECIALTIES OF OAKLAND PA
5 SUMMIT AVENUE
HACKENSACK
,
NJ
07601
22-3537262
HEALTHCARE SVCS.
NJ
NA
S CORP.
No
(2)
HACKENSACKUMC CASUALTY COMPANY LTD
22-1487576
FINANCIAL VEHICLE
BD
HUMC
FOREIGN CORP.
2,755,571
36,036,692
100.000 %
Yes
(3)
BERGEN HEALTH SERVICES INC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-2849212
INACTIVE
NJ
NA
C CORP.
No
(4)
NORTH JERSEY OCCUPATIONAL MEDICINE ASSOC
20 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-3508404
INACTIVE
NJ
HUMC
C CORP.
0
0
100.000 %
Yes
(5)
NEW AMSTERDAM MEDICAL ASSOCIATES PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-0849894
PHYSICIAN SVCS.
NY
HUMC
C CORP.
5,850,713
11,428,939
100.000 %
Yes
(6)
HACKENSACK OCCUPATIONAL MEDICINE PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
86-1153504
INACTIVE
NJ
HUMC
C CORP.
1,109,719
3,360,363
100.000 %
Yes
(7)
HUMC PRIMARY CARE ASSOCIATES PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
45-3744725
PHYSICIAN SVCS.
NJ
HUMC
C CORP.
18,623,880
33,765,956
100.000 %
Yes
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
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
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
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
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
Yes
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)
HACKENSACK UNIV MED CTR CASUALTY COMPANY LTD
R
4,161,769
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
HACKENSACK UNIVERSITY HEALTH NETWORK IS THE SOLE MEMBER OF HACKENSACKUMC AND THE TAX-EXEMPT PARENT ENTITY OF HACKENSACK UNIVERSITY HEALTH NETWORK AND SUBSIDIARIES AND CONTROLLED ENTITIES; ALL OF WHICH CONSTITUTE A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("NETWORK"). HACKENSACKUMC ROUTINELY PAYS EXPENSES FOR VARIOUS AFFILIATES WITHIN THE NETWORK IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF HACKENSACKUMC 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
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