efile Public Visual Render
ObjectId: 201743199349310339 - Submission: 2017-11-15
TIN: 01-0649794
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
16
Open to Public Inspection
Name of the organization
HACKENSACK MERIDIAN HEALTH INC-SUBORDINATES
Employer identification number
01-0649794
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)
RBMC CELL CAPTIVE LLC
530 NEW BRUNSWICK AVENUE
PERTH AMBOY
,
NJ
08861
46-2612616
HEALTH SVCS
NJ
1,042
412,453
RBMC
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)
HACKENSACK MERIDIAN HEALTH INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-3474145
HEALTH SVCS.
NJ
501(C)(3)
509(A)(3)
NA
No
(2)
HACKENSACK UNIVERSITY MEDICAL CENTER
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-1487576
HEALTH SVCS.
NJ
501(C)(3)
HOSPITAL
HMH
No
(3)
SHORE REHABILITATION INSTITUTE INC
425 JACK MARTIN BOULEVARD
BRICK
,
NJ
08724
22-3274755
HEALTH SVCS.
NJ
501(C)(3)
HOSPITAL
MHC
Yes
(4)
PALISADES MEDICAL ASSOCIATES LLC
7600 RIVER ROAD
NORTH BERGEN
,
NJ
07047
22-3814193
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
PMC
Yes
(5)
MERIDIAN MEDICAL GROUP-RETAIL CLINIC PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755228
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(6)
MERIDIAN MEDICAL GROUP-FACULTY PRACTICE
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755230
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(7)
MERIDIAN MEDICAL ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755233
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(8)
MERIDIAN MEDICAL GROUP-PRIMARY CARE PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981653
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(9)
MERIDIAN MEDICAL GROUP-SPECIALTY CAREPC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981647
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(10)
MERIDIAN TRAUMA ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981651
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(11)
MERIDIAN OBGYN ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755239
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(12)
MERIDIAN PEDIATRIC SURGICAL ASSOC PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
77-0720131
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(13)
SOMC MEDICAL GROUP PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
27-1412183
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(14)
HACKENSACK SPECIALTY CARE ASSOCIATES PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
20-1017013
HEALTH SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
No
(15)
HACKENSACK UNIVERSITY MEDICAL GROUP PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-3376459
HEALTH SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
No
(16)
HUMC CARDIOVASCULAR PARTNERS PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-0614861
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HUMC
No
(17)
HUMC MEDICAL OBSERVATION PA
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-2371424
HEALTH SVCS.
NJ
501(C)(3)
509(A)(3)
HUMC
No
(18)
MERIDIAN OCCUPATIONAL HEALTH PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
27-2377326
HEALTH SVCS.
NJ
501(C)(3)
509(A)(2)
HMH
No
(19)
THE AUXILIARY OF HACKENSACKUMC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-1537117
SUPPORT HUMC
NJ
501(C)(3)
509(A)(3)
HUMC
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2016
Page 2
Schedule R (Form 990) 2016
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
HEALTH SVCS
NJ
NA
(2)
OLD BRIDGE MEDICAL ASSOCIATES LLC
1 HOSPITAL PLAZA
OLD BRIDGE
,
NJ
08857
22-2894388
HEALTH SVCS
NJ
RBMC
RELATED
1,398,561
4,168,974
No
No
79.862 %
(3)
RARITAN BAY SURGICAL PARTNERS LLC
530 NEW BRUNSWICK AVENUE
PERTH AMBOY
,
NJ
08861
46-5153212
HEALTH SVCS
NJ
RBMC
RELATED
1,482,034
3,072,036
No
No
73.500 %
(4)
COASTAL CO-OP OF NJ
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
22-3603146
PURCHASING
NJ
MHC
RELATED
3,184,903
1,570,629
No
No
90.000 %
(5)
MERIDIAN HEALTH VILLAGE REALTY ASSOC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
27-4328412
REAL ESTATE
NJ
HMHRC
RELATED
2,879,348
29,880,202
No
No
90.000 %
(6)
JACKSON VILLAGE IMAGING LLC
840 CRESCENT CENTER DRIVE
FRANKLIN
,
TN
37067
32-0443283
HEALTH SVCS
NJ
NA
(7)
MERIDIAN AT STAFFORD LLC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
47-2675296
REAL ESTATE
NJ
NA
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)
RARITAN MANAGEMENT CORPORATION
530 NEW BRUNSWICK AVENUE
PERTH AMBOY
,
NJ
08861
22-2209778
AMBULANCE SVCS
NJ
NA
C CORP
No
(2)
HACKENSACK MERIDIAN HEALTH VENTURES INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2550716
HEALTH SVCS
NJ
NA
C CORP
No
(3)
MERIDIAN HEALTH MANAGEMENT INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2620595
HEALTH SVCS
NJ
NA
C CORP
No
(4)
HACKENSACK MERIDIAN HLTH MANAGEMENT INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2608891
SVC MANAGEMENT
NJ
NA
C CORP
No
(5)
PALISADES CHILD CARE CENTER INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2812623
DAY CARE CENTER
NJ
NA
C CORP
No
(6)
HACKENSACKUMC CASUALTY COMPANY LTD
CHEVRON HOUSE 44 CHURCH STREET
HAMILTON
HM12
BD
22-1487576
FINANCIAL VEHICLE
BD
NA
C CORP
No
(7)
RARITAN INSURANCE LTD
23 LIME TREE BAY AVE PO BOX 1363
GRAND CAYMAN
CJ
FINANCIAL VEHICLE
CJ
RBMC
C CORP
830,792
6,870,573
100.000 %
Yes
(8)
COASTAL MEDICAL INSURANCE LTD
CHEVRON HOUSE 44 CHURCH STREET
HAMILTON
HM12
BD
98-0166769
FINANCIAL VEHICLE
BD
NA
C CORP
No
(9)
SOUTHERN OCEAN HEALTH ALLIANCE INC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
22-3266544
HEALTH SVCS
NJ
MHC
C CORP
0
0
100.000 %
Yes
Schedule R (Form 990) 2016
Page 3
Schedule R (Form 990) 2016
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
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
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
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)
RARITAN INSURANCE LTD
R
830,792
COST
Schedule R (Form 990) 2016
Page 4
Schedule R (Form 990) 2016
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) 2016
Page 5
Schedule R (Form 990) 2016
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
SCHEDULE R
OUTLINED BELOW IS A LIST OF SUBORDINATE ORGANIZATIONS INCLUDED AS SUBORDINATES IN THE HACKENSACK MERIDIAN HEALTH, INC. GROUP EXEMPTION RULING AND IN THIS CONSOLIDATED GROUP FORM 990. - MERIDIAN HOSPITALS CORPORATION (FEID: 22-3471515) - RARITAN BAY MEDICAL CENTER (FEID: 22-1494442) - PALISADES MEDICAL CENTER, INC. (FEID: 22-1487278) - MERIDIAN PRACTICE INSTITUTE, INC. (FEID: 06-1755235) - HACKENSACK MERIDIAN NURSING AND REHABILITATION, INC. (FEID: 52-1772578) - PALISADES GENERAL CARE, INC. (FEID: 22-2587492) - HACKENSACK MERIDIAN HOME CARE SERVICES, INC. (FEID: 22-2731440) - HEALTH INNOVATIONS UNLIMITED, INC. (FEID: 22-2581430) - MERIDIAN HEALTH FOUNDATION, INC. (FEID: 30-0107825) - HACKENSACK UNIVERSITY MEDICAL CENTER FOUNDATION, INC. (FEID: 22-2339534) - JERSEY SHORE UNIVERSITY MEDICAL CENTER FOUNDATION, INC. (FEID: 22-2342452) - RIVERVIEW MEDICAL CENTER FOUNDATION, INC. (FEID: 22-2333524) - OCEAN MEDICAL CENTER FOUNDATION, INC. (FEID: 22-2361311) - SOUTHERN OCEAN MEDICAL CENTER FOUNDATION, INC. (FEID: 22-2666099) - BAYSHORE COMMUNITY HOSPITAL FOUNDATION, INC. (FEID: 22-2367109) - RARITAN BAY HEALTHCARE FOUNDATION, INC. (FEID: 22-2656665) - PALISADES MEDICAL CENTER FOUNDATION, INC. (FEID: 22-3693169) - HACKENSACK MERIDIAN HEALTH REALTY CORPORATION (FEID: 22-3200147) - BERGEN HEALTH MANAGEMENT SYSTEM, INC. (FEID: 22-2989731) - HACKENSACK MERIDIAN AMBULATORY VENTURES, INC. (FEID: 45-1227706)
SCHEDULE R, PART V
MERIDIAN HOSPITALS CORPORATION AND CERTAIN OF ITS AFFILIATES ROUTINELY PAY EXPENSES FOR VARIOUS AFFILIATES WITHIN HACKENSACK MERIDIAN HEALTH IN THE ORDINARY COURSE OF BUSINESS, INCLUDING THE SUBORDINATE ORGANIZATIONS INCLUDED IN THE HACKENSACK MERIDIAN HEALTH, INC. GROUP EXEMPTION RULING AND THIS CONSOLIDATED GROUP FORM 990. IN ADDITION, HACKENSACK UNIVERSITY MEDICAL CENTER, A RELATED TAX-EXEMPT HOSPITAL NOT INCLUDED IN THE GROUP EXEMPTION RULING, ROUTINELY PAYS EXPENSES FOR VARIOUS AFFILIATES WITHIN HACKENSACK MERIDIAN HEALTH IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF HACKENSACK MERIDIAN HEALTH, INC.; THE TAX-EXEMPT PARENT OF HACKENSACK MERIDIAN HEALTH, AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED. EXPENSES FOR VARIOUS AFFILIATES WITHING HACKENSACK MERIDIAN HEALTH IN THE ORDINARY COURSE OF BUSINESS.
Schedule R (Form 990) 2016
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