efile Public Visual Render
ObjectId: 201803189349302970 - Submission: 2018-11-14
TIN: 22-1802017
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.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
HARTWYCK WEST NURSING HOME INC
Employer identification number
22-1802017
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
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)
JFK HEALTH SYSTEM INC
98 JAMES STREET
EDISON
,
NJ
08820
22-2421432
HEALTHCARE
NJ
501(C)(3)
509(A)(3)
NA
No
(2)
THE COMMUNITY HOSPITAL GROUP INC
98 JAMES STREET
EDISON
,
NJ
08820
22-6019101
HEALTHCARE
NJ
501(C)(3)
HOSPITAL
JFKHS
No
(3)
MUHLENBERG REGIONAL MEDICAL CENTER INC
98 JAMES STREET
EDISON
,
NJ
08820
22-1487258
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
JFKHS
No
(4)
MUHLENBERG FOUNDATION INC
98 JAMES STREET
EDISON
,
NJ
08820
51-0212678
FUNDRAISING
NJ
501(C)(3)
509(A)(1)
MRMC
No
(5)
JFK MEDICAL CENTER FOUNDATION INC
98 JAMES STREET
EDISON
,
NJ
08820
22-2315044
FUNDRAISING
NJ
501(C)(3)
509(A)(1)
JFKHS
No
(6)
JFK HEALTH SYSTEMS REALTY CORPORATION
98 JAMES STREET
EDISON
,
NJ
08820
52-1703518
INACTIVE
NJ
501(C)(2)
JFKHS
No
(7)
ROBERT WOOD JOHNSON JR LIFESTYLE INSTITUTE INC
98 JAMES STREET
EDISON
,
NJ
08820
22-2421433
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
JFKHS
No
(8)
JFK ASSISTED LIVING INC
98 JAMES STREET
EDISON
,
NJ
08820
22-3715324
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
HWNH
Yes
(9)
HARTWYCK AT OAK TREE INC
98 JAMES STREET
EDISON
,
NJ
08820
22-2666023
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
JFKHS
No
(10)
HARTWYCK AT JFK INC
98 JAMES STREET
EDISON
,
NJ
08820
20-4144804
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
JFKHS
No
(11)
JFK MEDICAL ASSOCIATES PA
98 JAMES STREET
EDISON
,
NJ
08820
46-2219798
HEALTHCARE
NJ
501(C)(3)
509(A)(2)
JFKHS
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2017
Page 2
Schedule R (Form 990) 2017
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)
MEDIPLEX SURGICAL CENTER ASSOCIATION LP
98 JAMES STRET
EDISON
,
NJ
08820
22-2846980
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)
ATLANTIC INSURANCE EXCHANGE LTD
CLARENDON HOUSE 2 CHURCH STREET
HAMILTON
BD
98-1330735
FINANCIAL VEHICLE
BD
NA
C
No
(2)
CENTRAL JERSEY MEDICAL GROUP PA
98 JAMES STREET
EDISON
,
NJ
08820
22-3477610
INACTIVE
NJ
NA
C
No
(3)
JFK MEDICAL GROUP PC
98 JAMES STREET
EDISON
,
NJ
08820
22-3482637
HEALTHCARE
NJ
NA
C
No
(4)
JFK HARTWYCK MANAGEMENT & CONSULTING INC
98 JAMES STREET
EDISON
,
NJ
08820
22-3812130
INACTIVE
NJ
HWNH
C
100.000 %
Yes
(5)
JFK HEALTHSHARE INC
98 JAMES STREET
EDISON
,
NJ
08820
22-2528967
MANAGEMENT
NJ
NA
C
No
(6)
MIDTOWN SHOPS INC
98 JAMES STREET
EDISON
,
NJ
08820
22-1536954
INACTIVE
NJ
NA
C
No
(7)
THE PRIMARY CARE NETWORK INC
98 JAMES STREET
EDISON
,
NJ
08820
52-2069919
INACTIVE
NJ
NA
C
No
(8)
JFK AMBULATORY CARE PA
98 JAMES STREET
EDISON
,
NJ
08820
47-3018240
HEALTHCARE
NJ
NA
C
No
Schedule R (Form 990) 2017
Page 3
Schedule R (Form 990) 2017
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
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
Yes
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
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2017
Page 4
Schedule R (Form 990) 2017
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) 2017
Page 5
Schedule R (Form 990) 2017
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2017
Additional Data
Software ID:
17005306
Software Version: