SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on 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
2016
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
 
No
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
 
 
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) . . . 		    28,770,642 2,945,875 25,824,767 1.940 %
b Medicaid (from Worksheet 3, column a) . . . . .     199,420,309 149,983,604 49,436,705 3.720 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     228,190,951 152,929,479 75,261,472 5.660 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     2,295,317 306,469 1,988,848 0.150 %
f Health professions education (from Worksheet 5) . . .     42,027,524 12,826,641 29,200,883 2.200 %
g Subsidized health services (from Worksheet 6) . . . .     9,159,313 5,736,622 3,422,691 0.260 %
h Research (from Worksheet 7) .     4,868,004 1,352,049 3,515,955 0.260 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     737,601   737,601 0.060 %
j Total. Other Benefits . .     59,087,759 20,221,781 38,865,978 2.930 %
k Total. Add lines 7d and 7j .     287,278,710 173,151,260 114,127,450 8.590 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2016
Schedule H (Form 990) 2016
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            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
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
51,135,571
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
7,675,998
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
295,409,090
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
345,778,515
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-50,369,425
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

 

No
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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2016
Schedule H (Form 990) 2016
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?3Name, 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.COM
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) 2016
Page 4
Schedule H (Form 990) 2016
Page 4
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 16
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  
6 a 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 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE SECTION C
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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2016
Page 5
Schedule H (Form 990) 2016
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
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 Was widely publicized 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
SEE SECTION C
b
SEE SECTION C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2016
Page 6
Schedule H (Form 990) 2016
Page 6
Part VFacility Information (continued)

Billing and Collections
HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2016
Page 7
Schedule H (Form 990) 2016
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
HACKENSACK UNIVERSITY MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2016
Page 4
Schedule H (Form 990) 2016
Page 4
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 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 16
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  
6 a 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   No
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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2016
Page 5
Schedule H (Form 990) 2016
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
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   No
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   No
15 Explained the method for applying for financial assistance?................... 15   No
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 Was widely publicized within the community served by the hospital facility?........ 16   No
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2016
Page 6
Schedule H (Form 990) 2016
Page 6
Part VFacility Information (continued)

Billing and Collections
HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2016
Page 7
Schedule H (Form 990) 2016
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
HACKENSACKUMC AT PASCACK VALLEY
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2016
Page 4
Schedule H (Form 990) 2016
Page 4
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 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 15
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  
6 a 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   No
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   No
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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2016
Page 5
Schedule H (Form 990) 2016
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
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   No
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   No
15 Explained the method for applying for financial assistance?................... 15   No
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 Was widely publicized within the community served by the hospital facility?........ 16   No
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
 
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2016
Page 6
Schedule H (Form 990) 2016
Page 6
Part VFacility Information (continued)

Billing and Collections
HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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
Schedule H (Form 990) 2016
Page 7
Schedule H (Form 990) 2016
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
HACKENSACKUMC MOUNTAINSIDE
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2016
Page 8
Schedule H (Form 990) 2016
Page 8
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, 16j, 18e, 19e, 20e, 21c, 21d, 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, QUESTION 5 HACKENSACKUMC AND HACKENSACKUMC AT PASCACK VALLEY (FACILITY REPORTING GROUPS #1 & #2) -------------------------------------------------------------------- The organizations 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. To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was implemented as part of this process. A list of recommended participants was provided by the CHIP; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 75 community stakeholders in Bergen County took part in the Online Key Informant Survey, as outlined below: - Bergen County Cancer Education and Early Detection - Bergen County Department of Health Services - Bergen County Department of Human Services - Bergen County School Nurses Association - Bergen County Special Services - Bergen County United Way - Bergen County Youth Services Commission - Bergen Regional Medical Center - Bergen Volunteer Center - Bergenfield/Hackensack Health Departments - Brightview Senior Living - CancerCare - Care Plus Medical Services - Center for Dentistry at HUMC - Children's Aid and Family Services - Christian Health Care Center - Edgewater Office of Public Health/Health Department - Englewood Health Department - Fair Lawn Senior Center - Friends to Friends Community Church - Geriatric Services, Inc. - Gold's Gym - Hackensack University Medical Center - HARP of Hackensack University Medical Center - Healthy Families North Jersey - High Focus Centers - Holy Name Medical Center - Jewish Family Service of Bergen and North Hudson - Metropolitan AME Zion Church - Narcotics Anonymous - North Hudson Community Action Corp Health Center - Northern Valley ADC - Paramus Board of Health and Human Services - Partnership for Maternal and Child Health of North NJ - Pascack Valley Meals on Wheels - Senior Source - Teaneck Health Department/Social Services - Teaneck Police Department - Community Health Improvement Partnership (CHIP) of Bergen County - Valley Health System - Valley Home Care - West Bergen Mental Healthcare Through this process, input was gathered from several individuals whose organizations work with low-income, minority populations or other medically underserved populations. Minority/medically underserved populations represented: African-Americans, Asians, children, day laborers, the disabled, elderly population, foster children, those with high deductibles, Hispanics, the homeless, immigrants, Koreans, residents with low education level, low income residents, Medicare/Medicaid recipients, the mentally ill, MICA clients, Native Americans, non-English speaking persons, obese individuals, students attending schools in low income areas, teenage mothers, undocumented individuals, unemployed residents, the uninsured/underinsured and veterans. In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed. HACKENSACKUMC MOUNTAINSIDE (FACILITY REPORTING GROUP #3) -------------------------------------------------------- Beginning in August 2015, HackensackUMC Mountainside undertook a comprehensive community health needs assessment ("CHNA") to evaluate the health needs of individuals living in the hospital service area within Essex County in New Jersey. The purpose of the assessment was to gather current statistics and qualitative feedback on the key health issues facing county residents. HackensackUMC Mountainside contracted with Holleran, a research firm based in Lancaster, Pennsylvania, to execute this project. The completion of the CHNA enabled HackensackUMC Mountainside to take an in-depth look at its community. The findings from the assessment were utilized by HackensackUMC Mountainside to prioritize public health issues and develop a community health implementation plan focused on meeting community needs. HackensackUMC Mountainside is committed to the people it serves and the communities where they reside. Healthy communities lead to lower health care costs, robust community partnerships, and an overall enhanced quality of life. This CHNA Final Summary Report serves as a compilation of the overall findings of each research component. Community engagement and feedback were an integral part of the CHNA process. HackensackUMC Mountainside sought community input through key informant interviews with community leaders and partners, an online community member survey available to all residents, and inclusion of community leaders in the prioritization and implementation planning process. Public health and health care professionals shared knowledge and expertise about health issues, and leaders and representatives of non-profit and community-based organizations provided insight on the community, including the medically underserved, low income, and minority populations. Key informant participants represented the following: - Alaris Health Center - ARC of Essex County - Bloomfield Health Officer - Bloomfield Volunteer Emergency Squad - Brookdale Shop Rite Mayor of Montclair - COPE Center, Inc. - Councilmen of Glen Ridge - Doctors of Family Medicine - Doctor of Internal Medicine - Gates Manor Nursing Home - HOMEcorp - Homesharing - Human Needs Food Pantry - Job Haines Home - Keils Pharmacy - Lifelong Montclair - Mayor of Glen Ridge - Mayor of Montclair - Montclair Emergency Services for the Homeless - Montclair Health Department - Montclair Neighborhood Development Corporation - Montclair YMCA - Nursing Supervisor of Bloomfield Township - Partners for Health - Public Health Coordinator - Public Health Nurse of Nutley Township - Salvation Army - Township Clerk of Montclair Through this process, input was gathered from several individuals whose organizations work with low-income, minority populations or other medically underserved populations. Minority/medically underserved populations represented: African-Americans, Asians, children, day laborers, the disabled, elderly population, foster children, those with high deductibles, Hispanics, the homeless, immigrants, Koreans, residents with low education level, low income residents, Medicare/Medicaid recipients, the mentally ill, MICA clients, Native Americans, non-English speaking persons, obese individuals, students attending schools in low income areas, teenage mothers, undocumented individuals, unemployed residents, the uninsured/underinsured and veterans. In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might be better addressed.
SCHEDULE H, PART V, SECTION B, QUESTION 6a HACKENSACKUMC AND HACKENSACKUMC AT PASCACK VALLEY (FACILITY REPORTING GROUPS #1 & #2) --------------------------------------------------------------------- The 2016 CHNA for Hackensack University Medical Center and HackensackUMC at Pascack Valley is part of a broader regional assessment made possible through the generous support of Christian Health Care Center (Ramapo Ridge Psychiatric Hospital), Englewood Hospital and Medical Center, Hackensack University Medical Center, HackensackUMC at Pascack Valley, Holy Name Medical Center, and The Valley Hospital. Representatives from each of these hospitals, along with representatives of the Bergen County Department of Health Services ("BCDHS") and the Community Health Improvement Partnership ("CHIP") of Bergen County, worked collaboratively to guide assessments of health needs for Bergen County and for the specific communities served by each hospital.
SCHEDULE H, PART V, SECTION B, QUESTION 6b HACKENSACKUMC AND HACKENSACKUMC AT PASCACK VALLEY (FACILITY REPORTING GROUPS #1 & #2) -------------------------------------------------------------------- Key informants, which were representatives of non-hospital faciliites, participated in the CHNA of HackensackUMC and HackensackUMC at Pascack Valley as fully outlined above in the response to Question 5. HACKENSACKUMC MOUNTAINSIDE (FACILITY REPORTING GROUP #3) -------------------------------------------------------- Key informants, which were representatives of non-hospital faciliites, participated in the CHNA of HackensackUMC Mountainside as fully outlined above in the response to Question 5.
SCHEDULE H, PART V, SECTION B, QUESTION 7 HACKENSACKUMC (FACILITY REPORTING GROUP #1) ------------------------------------------- http://www.hackensackumc.org/wp-content/uploads/2017/04/2016_PRC_CHNA_Exec utive_Summary_-_HUMC.pdf HACKENSACKUMC AT PASCACK VALLEY (FACILITY REPORTING GROUP #2) ------------------------------------------------------------- http://www.hackensackumcpv.com/assets/24/7/2016_PRC_CHNA_Report_-_Hackensa ckUMC_at_Pascack_Valley.pdf HACKENSACKUMC MOUNTAINSIDE (FACILITY REPORTING GROUP #3) -------------------------------------------------------- http://www.mountainsidehosp.com/assets/39/7/CHNA_2015_Mountainside_Hospita l.pdf
SCHEDULE H, PART V, SECTION B, QUESTION 10 HACKENSACKUMC (FACILITY REPORTING GROUP #1) ------------------------------------------- http://www.hackensackumc.org/wp-content/uploads/2017/07/ImplementationStra tegyExecutiveSummary.pdf
SCHEDULE H, PART V, SECTION B, QUESTION 11 HACKENSACKUMC (FACILITY REPORTING GROUP #1) ------------------------------------------- Eleven significant health needs were identified in the 2016 CHNA. These needs will be addressed as follows: 1. Access to Healthcare Services: Continue support of the Bergen Volunteer Medical Initiative, Inc.; Continue to subsidize access to quality healthcare for the underserved and economically challenged; Provide culturally appropriate care (ie. Korean Medical Initiative); Continue to partner with local physicians and dentists to offer a dental clinic program; Continue to offer compassionate care program for those without insurance. 2. Diabetes: Continue outreach to the community with a focus on prevention and early diagnosis; Certify two nurses to become certified Diabetes Nurse Educators; Continue to educate the community on diabetes management through the Hackensack Diabetes Management Center; Implement the Stanford Chronic Disease Self-Management program into the community; Continue to participate in outreach programs through health fairs and speaking engagements. 3. Nutrition, Physical Activity & Weight: Continue to offer employee wellness program; Continue to offer corporate wellness programs to the community; Continue to incorporate Matter of Balance Program into offerings at Hackensacks Wellness Center (HARP); Increase nutritional education and programs across the continuum, including kitchen demos at HARP; Increase physical activity education and programs across the continuum; Continue to participate in outreach programs through health fairs and speaking engagements; Continue to participate and sponsor community physical activity offerings. 4. Substance Abuse: Collaborate with other Bergen County providers in cross continuum initiatives; Continue to offer behavioral health education to the community in support of the Stigma Free Initiative; Create protocols in the ER for mental health and substance abuse screenings; Continue to offer Hackensacks Inpatient Unit to those patients who require some medical management in a behavioral health setting; Continue to offer the behavioral health program to promote mental health through diet and exercise with less focus on medication. 5. Mental Health: Collaborate with other Bergen County providers in cross continuum initiatives; Continue to offer behavioral health education to the community in support of the Stigma Free Initiative; Work with Healthy Futures Weight Management Program to administer mental health screenings to participants; Create protocols in the ER for mental health and substance abuse screenings; Provide outreach and screening activities that identify those with depression; Continue to offer Hackensacks Inpatient Unit to those patients who require some medical management in a behavioral health setting; Continue to offer the behavioral health program to promote mental health through diet and exercise with less focus on medication. 6. Cancer Prevention: Provide preventive health screenings and education. 7. Respiratory Diseases: Provide education including stop smoking programs. 8. Dementia including Alzheimers: Provide education. 9. Heart Disease & Stroke: Provide preventive health screenings and education. 10. Immunizations and Infectious Diseases: Continue to provide public health services, including immunizations, through the HARP program. 11. Potentially Disabling Conditions: Provide community education. HACKENSACKUMC AT PASCACK VALLEY (FACILITY REPORTING GROUP #2) ------------------------------------------------------------- Eleven significant health needs were identified in the 2016 CHNA. These needs will be addressed as follows: 1. Access to Healthcare Services: Ensure local access to primary and specialty care. 2. Diabetes: Continue outreach to the community with a focus on prevention and early diagnosis; Continue to educate the community on diabetes management through Be Well lecture series; Implement the Stanford Chronic Disease Self-Management program into the community; Continue to participate in outreach programs through health fairs and speaking engagements. 3. Nutrition, Physical Activity & Weight: Increase nutritional education and programs through Be Well lecture series, Increase physical activity education and programs; Continue to participate in outreach programs through health fairs and speaking engagements; Continue to participate and sponsor community physical activity offerings. 4. Substance Abuse: Collaborate with other Bergen County providers in cross continuum initiatives. 5. Mental Health: Collaborate with other Bergen County providers in cross continuum initiatives. 6. Cancer prevention: Provide preventive health screenings and education through Be Well lecture series. 7. Respiratory Diseases: Pascack Valley believes this community health issue is more fully addressed within the purview of the county and local health departments as well as other community organizations. Pascack Valley has limited resources, services and expertise available to address this issue. 8. Dementia including Alzheimers: Provide education through Be Well lecture series. 9. Heart Disease & Stroke: Provide preventive health screenings and education through Be Well lecture series. 10. Immunizations and Infectious Diseases: Provide education through Be Well lecture series. 11. Potentially Disabling Conditions: Pascack Valley believes this community health issue is more fully addressed within the purview of the county and local health departments as well as other community organizations. Pascack Valley has limited resources, services and expertise available to address this issue. HACKENSACKUMC MOUNTAINSIDE (FACILITY REPORTING GROUP #3) -------------------------------------------------------- Based on feedback from community partners, including health care providers, public health experts, health and human service agencies, and other community representatives, HackensackUMC Mountainside plans to focus community health improvement efforts on the following health priorities over the next three-year cycle: 1. Chronic Disease Management: Goal: Promote health and reduce chronic disease through improved education, awareness and disease prevention Suggested Objectives: - Increase the proportion of adults who receive chronic disease screenings to maximize treatment options - Increase the proportion of adults who participate in behaviors/programs that reduce risk factors for chronic disease Suggested Key Indicators: - Number of health promotion activities targeting high-risk populations - Number of screenings and referrals to address early detection - Number of individuals participating in health education programs - Number/Percentage of patients who report incorporating healthy lifestyle behaviors and techniques and/or increased knowledge of the components of healthy living/lifestyles - Emergency Department/hospital admissions/readmissions for chronic conditions Intended Outcomes: - Increased utilization of generic screening tools that results in positive improvement on health indicators - Adults making more decisions based on health education - Lower rates of obesity, diabetes, and related chronic conditions and decreased health complications - Increased rates of healthy weight in adults through regular exercise and increase fruits, vegetables, and water consumption - Decreased number of ER visits for chronic conditions Existing Community Resources: - Diabetes Clinical Improvement Program - Brookdale SR - Nutley SR - YMCA 2. Mental Health Goal: Improve mental health through education, review of program expansion potentials and collaboration Suggested Objectives: - Increase mental health collaborations throughout Essex County - Create a resource that can be used easily for mental health information, resources, and referrals - Develop campaign messages to promote peer advocates. (Messages may include identifying the indicators of mental illness and local resources available) - Increase the proportion of adults and children with mental health disorders who receive treatment - Increase mental health screenings by primary care providers Suggested Key Indicators: - Community meetings and educational sessions held on the mental health topic - Number of community members and community health volunteers who serve as informal referral agents and mental health champions for increasing awareness - Number/Percentage of Emergency Department patients presenting with mental health - Issues who are transferred to inpatient or outpatient facilities - Number/Percentage of patients successfully referred for mental health services - Number/Percentage of primary care providers screening for and providing mental health treatment or referrals - Number of mental health and/or substance/alcohol abuse community outreach programs conducted and number of participants Intended Outcomes - Increased number of people using a mental health hotline and attending mental health education sessions - Increased number of at-ris
SCHEDULE H, PART V, SECTION B, QUESTION 13A HACKENSACKUMC (FACILITY REPORTING GROUP #1) ------------------------------------------- THE FACILITY USES A SLIDING SCALE METHOD TO DETERMINE THE ELIGIBILITY FOR DISCOUNTED CARE.
SCHEDULE H, PART V, SECTION B, QUESTION 16 HACKENSACKUMC (FACILITY REPORTING GROUP #1) ------------------------------------------- http://www.hackensackumc.org/patients-visitors/billing-and-insurance/finan ce/
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2016
Page 9
Schedule H (Form 990) 2016
Page 9
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?8
Name and address Type of Facility (describe)
1 HUMC AMBULATORY CARE CENTER-NORTHERN DIV
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 & PHARMACY
3 THE ALFRED M SANZARI MEDICAL ARTS BLDG
360 ESSEX STREET
HACKENSACK,NJ07601 		VARIOUS OUTPATIENT HEALTHCARE SERVICES
4 JOHN THEURER CANCER CENTER AT HUMC
92 SECOND STREET
HACKENSACK,NJ07601 		GAMMA KNIFE SERVICES, FIXED CT, LINEAR ACCELERATOR & PHARMACY
5 HACKENSACKUMC FITNESS & WELLNESS CENTER
87 ROUTE 17 NORTH
MAYWOOD,NJ07607 		PRIMARY CARE
6 HUMC AIR EXPRESS
30 PROSPECT AVENUE
HACKENSACK,NJ07601 		PRIMARY CARE SERVICES, MOBILE ASTHMA SCREENING SERVICES
7 METROPOLITAN SURGERY CENTER
433 HACKENSACK AVENUE
HACKENSACK,NJ07601 		VARIOUS OUTPATIENT HEALTHCARE SERVICES
8 HUMCUSP SURGERY CENTERS LLC
30 PROSPECT AVENUE
HACKENSACK,NJ07601 		VARIOUS OUTPATIENT HEALTHCARE SERVICES
9
10
Schedule H (Form 990) 2016
Page 10
Schedule H (Form 990) 2016
Page 10
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 2016 FEDERAL POVERTY GUIDELINES ("FPG") (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 HACKENSACKUMC IS AN AFFILIATE WITHIN HACKENSACK MERIDIAN HEALTH; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. HACKENSACK MERIDIAN HEALTH, INC. ("HMH") IS THE TAX-EXEMPT PARENT OF THE NETWORK. HACKENSACK MERIDIAN HEALTH PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS MADE AVAILABLE TO THE PUBLIC ON ITS WEBSITE: WWW.HACKENSACKMERIDIANHEALTH.ORG. AT HACKENSACK MERIDIAN, WE RECOGNIZE THAT THE CARE WE PROVIDE THROUGH OUR HOSPITALS AND PARTNER COMPANIES REACHES FAR BEYOND THE BOUNDARIES OF OUR FACILITIES. OUR MISSION TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES WE SERVE IS AT THE HEART OF OUR CHARITABLE ROOTS. COMMUNITY-BASED PREVENTION AND WELLNESS ACTIVITIES WILL PLAY A CRITICAL ROLE IN KEEPING OUR LOCAL COMMUNITIES HEALTHY AND KEEPING HEALTH CARE COSTS DOWN. HACKENSACK MERIDIAN REMAINS COMMITTED TO STRENGTHENING ITS MISSION. HACKENSACK MERIDIAN'S 2016 COMMUNITY BENEFIT REPORT CAN BE FOUND ONLINE AT WWW.HACKENSACKMERIDIANHEALTH.ORG OR BY REQUEST THROUGH ANY ONE OF OUR FACILITIES.
SCHEDULE H, PART I, LINE 7 HACKENSACK UNIVERSITY MEDICAL CENTER USES WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, IN THE IRS FORM 990 SCHEDULE H INSTRUCTIONS TO CALCULATE THE COST TO CHARGE RATIO.
SCHEDULE H, PART III, LINE 3 THE METHODOLOGY USED BY THE ORGANIZATION TO ESTIMATE THE AMOUNT OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS TO APPLY ITS COST TO CHARGE RATIO TO TOTAL SELF-PAY GROSS CHARGES.
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 ORGANIZATION RECEIVED A SIX-MONTH PERIOD AUDITED CONSOLIDATED FINANCIAL STATEMENT. THE ATTACHED TEXT WAS OBTAINED FROM THE FOOTNOTES TO THESE AUDITED FINANCIAL STATEMENTS OF HACKENSACK MERDIAN HEALTH, INC. Patient Accounts Receivable The process for estimating the ultimate collection of receivables involves significant assumptions and judgments. Account balances are written off against the allowance when management feels it is probable the receivable will not be recovered. The use of historical collection and payor reimbursement experience is an integral part of the estimation process related to reserves for doubtful accounts. Revisions in reserve for doubtful accounts estimates are recorded as an adjustment to bad debt expense. Charity and Uncompensated Care The Network provides care to patients who meet certain criteria defined by the New Jersey Department of Health and Senior Services without charge or at amounts less than its established rates. The Network maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished. The Network receives partial reimbursement for the uncompensated care provided. Of the Networks total consolidated operating expenses reported, estimated costs of $49,554,000 for the six month period ended December 31, 2016 are attributable to providing services to charity patients. The estimated costs of providing charity services are based on a calculation which applies a ratio of cost to charges to the gross uncompensated charges associated with providing care to charity patients. The ratio of cost to charges is calculated based on the Networks total operating expenses, excluding bad debt expense, divided by gross patient service revenue.
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 2016 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 INDIVIDUALS 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,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 ELIGIBLES.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 RE
SCHEDULE H, PART VI; QUESTION 2 IN ADDITION TO THE INFORMATION REPORTED IN SCHEDULE H, PART V, SECTION B, QUESTIONS 1 THROUGH 12, THE ORGANIZATIONS ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE AS FOLLOWS: 1. ACCESS TO CARE/SERVICES IS ASSESSED REGULARLY TO IDENTIFY OPPORTUNITIES TO IMPROVE NETWORK ADEQUACY RELATIVE TO THE AVAILABILITY OF MEDICAL MANPOWER AND SITES OF SERVICE; 2. UTILIZATION IS TRACKED BY HACKENSACK MERIDIAN HEALTH ("HMH") OPERATIONAL LEADERS RELATIVE TO CAPACITY AND ABILITY TO ACCOMMODATE DEMAND. WHERE POTENTIAL CAPACITY AND THROUGHPUT CONCERNS ARE IDENTIFIED, FURTHER ASSESSMENTS ARE PERFORMED AND POTENTIAL SOLUTIONS ARE IDENTIFIED; AND 3. FOR KEY SERVICES, HMH HAS DEVELOPED CARE TRANSFORMATION SERVICE TEAMS TO ACCESS SERVICE-SPECIFIC NEEDS AND DEVELOP PLANS TO ADDRESS.
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 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. BERGEN COUNTY ------------- POPULATION, 2016: 939,151 UNDER 5 YEARS OF AGE, 2016: 5.3% UNDER 18 YEARS OF AGE, 2016: 21.4% 65 YEARS OLD AND OVER, 2016: 16.5% PERSONS BELOW POVERTY LEVEL, 2011-2015: 7.1% MEDIAN HOUSEHOLD INCOME, 2011-2015: $85,806 RACIAL COMPOSITION, 2016: WHITE: 57.1% AFRICAN AMERICAN: 7.1% ASIAN: 16.7% HISPANIC OR LATINO ORIGIN: 18.6% OTHER: 0.5% PASSAIC COUNTY -------------- POPULATION, 2016: 507,945 UNDER 5 YEARS OF AGE, 2016: 6.8% UNDER 18 YEARS OF AGE, 2016: 24.1% 65 YEARS OLD AND OVER, 2016: 13.7% PERSONS BELOW POVERTY LEVEL, 2011-2015: 17.3% MEDIAN HOUSEHOLD INCOME, 2011-2015: $59,739 RACIAL COMPOSITION, 2016: WHITE: 41.7% AFRICAN AMERICAN: 15.2% ASIAN: 5.8% HISPANIC OR LATINO ORIGIN: 35.6% OTHER: 1.7% HUDSON COUNTY ------------- POPULATION, 2016: 677,983 UNDER 5 YEARS OF AGE, 2016: 6.9% UNDER 18 YEARS OF AGE, 2016: 20.5% 65 YEARS OLD AND OVER, 2016: 11.0% PERSONS BELOW POVERTY LEVEL, 2011-2015: 17.7% MEDIAN HOUSEHOLD INCOME, 2011-2015: $59,741 RACIAL COMPOSITION, 2016: WHITE: 28.9% AFRICAN AMERICAN: 15.0% ASIAN: 15.9% HISPANIC OR LATINO ORIGIN: 38.8% OTHER: 1.4% 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 HACKENSACK MERIDIAN HEALTH, INC. ("HMH") IS THE TAX-EXEMPT PARENT OF HACKENSACK MERIDIAN HEALTH ("NETWORK"). THIS INTEGRATED HEALTHCARE DELIVERY NETWORK CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER HMH OR ANOTHER NETWORK AFFILIATE CONTROLLED BY HMH. THE NETWORK IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS THROUGHOUT NEW JERSEY. HMH IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). AS THE PARENT ORGANIZATION OF A LARGE TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK IN NEW JERSEY, HMH STRIVES TO CONTINUALLY DEVELOP AND OPERATE A MULTI-HOSPITAL HEALTHCARE NETWORK WHICH PROVIDES SUBSTANTIAL COMMUNITY BENEFIT THROUGH THE PROVISION OF A COMPREHENSIVE SPECTRUM OF HEALTHCARE SERVICES TO THE RESIDENTS OF NEW JERSEY. HMH ENSURES THAT ITS NETWORK PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. NO INDIVIDUALS ARE DENIED NECESSARY MEDICAL CARE, TREATMENT OR SERVICES. THE NETWORK'S ACTIVE HOSPITALS INCLUDE: - HACKENSACK UNIVERSITY MEDICAL CENTER, - JERSEY SHORE UNIVERSITY MEDICAL CENTER, - RIVERVIEW MEDICAL CENTER, - OCEAN MEDICAL CENTER, - SOUTHERN OCEAN MEDICAL CENTER, - BAYSHORE COMMUNITY HOSPITAL, - K. HOVNANIAN CHILDREN'S HOSPITAL, - RARITAN BAY MEDICAL CENTER, AND - PALISADES MEDICAL CENTER, INC. EACH OF THESE HOSPITALS OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. PLEASE REFER TO SCHEDULE R FOR A LISTING OF ALL AFFILIATED ORGANIZATIONS.
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. HACKENSACK MERIDIAN HEALTH PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IT MAKES AVAILABLE TO THE PUBLIC ON ITS WEBSITE: WWW.HACKENSACKMERIDIANHEALTH.ORG.
SCHEDULE H, PART VI PLEASE NOTE THAT MOUNTAINSIDE HOSPITAL ("MH") AND PASCACK VALLEY HOSPITAL ("PVH") ARE BOTH HOSPITAL FACILITIES LISTED IN SCHEDULE H, PART V, SECTION A AND ARE SUBSTANTIALLY RELATED ENTITIES OF HACKENSACK UNIVERSITY MEDICAL CENTER ("HACKENSACKUMC"). HACKENSACKUMC HOLDS A 20% MEMBERSHIP INTEREST IN MH AND A 35% MEMBERSHIP INTEREST IN PVH. THE REMAINING MEMBERSHIP INTERESTS ARE HELD BY AN UNRELATED FOR-PROFIT CORPORATION. THE ORGANIZATIONS EACH ADOPTED ITS CHNA, HOWEVER, IT WAS DISCOVERED DURING THE PREPARATION OF THIS TAX RETURN THAT THEIR IMPLEMENTATION PLANS WERE NOT APPROVED BY THEIR BOARDS OF TRUSTEES. THIS WAS AN OVERSIGHT AND WILL BE CORRECTED AT EACH OF THEIR NEXT BOARD MEETINGS BEFORE THE END OF 2017. PLEASE ALSO NOTE THAT IN PREPARATION OF THIS FORM 990, SCHEDULE H IT WAS DISCOVERED THAT MH AND PVH HAVE NOT ADOPTED AND POSTED A FINANCIAL ASSISTANCE POLICY ("FAP") AND FAP PLAIN LANGUAGE SUMMARY ON THEIR RESPECTIVE WEBSITES. HACKENSACKUMC HAS BEEN WORKING IN CONJUNCTION WITH THE GOVERNING BODIES OF MH AND PVH TO FINALIZE AND ADOPT A FAP, PLAIN LANGUAGE SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE THAT MEET THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4), (5) AND (6). THESE DOCUMENTS WILL BE ADOPTED BY AUTHORIZED BODIES OF MH AND PVH, RESPECTIVELY, AND POSTED IN 2017.
Schedule H (Form 990) 2016
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