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ObjectId: 201833189349313793 - Submission: 2018-11-14
TIN: 22-1487576
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for the latest information.
OMB No. 1545-0047
20
17
Open to Public Inspection
Name of the organization
HMH HOSPITALS CORPORATION
Employer identification number
22-1487576
Part I
Identification of Disregarded Entities
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
HUMCTOURO LLC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
26-1844522
INACTIVE
NJ
0
0
HMHHC
(2)
HACKENSACK PHYSICIAN ALLIANCE LLC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
45-4966639
INACTIVE
NJ
0
0
HMHHC
(3)
20 PROSPECT AVENUE HOLDINGS LLC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
47-4381262
INACTIVE
NJ
0
108,991,667
HMHHC
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)
12C
NA
No
(2)
SHORE REHABILITATION INSTITUTE INC
425 JACK MARTIN BOULEVARD
BRICK
,
NJ
08724
22-3274755
HEALTH SVCS.
NJ
501(C)(3)
3
MHC
No
(3)
PALISADES MEDICAL ASSOCIATES LLC
7600 RIVER ROAD
NORTH BERGEN
,
NJ
07047
22-3814193
HEALTH SVCS.
NJ
501(C)(3)
10
PMC
No
(4)
MERIDIAN MEDICAL GROUP-RETAIL CLINIC PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755228
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(5)
MERIDIAN MEDICAL GROUP-FACULTY PRACTICE
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755230
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(6)
MERIDIAN MEDICAL ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755233
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(7)
MERIDIAN MEDICAL GROUP-PRIMARY CARE PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981653
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(8)
MERIDIAN MEDICAL GROUP-SPECIALTY CAREPC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981647
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(9)
MERIDIAN TRAUMA ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
14-1981651
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(10)
MERIDIAN OBGYN ASSOCIATES PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
06-1755239
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(11)
MERIDIAN PEDIATRIC SURGICAL ASSOC PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
77-0720131
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(12)
SOMC MEDICAL GROUP PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
27-1412183
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(13)
HACKENSACK SPECIALTY CARE ASSOCIATES PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
20-1017013
HEALTH SVCS.
NJ
501(C)(3)
12A
HMHHC
Yes
(14)
HACKENSACK UNIVERSITY MEDICAL GROUP PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-3376459
HEALTH SVCS.
NJ
501(C)(3)
12A
HMHHC
Yes
(15)
HUMC CARDIOVASCULAR PARTNERS PC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-0614861
HEALTH SVCS.
NJ
501(C)(3)
10
HMHHC
Yes
(16)
HUMC MEDICAL OBSERVATION PA
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
27-2371424
HEALTH SVCS.
NJ
501(C)(3)
12A
HMHHC
Yes
(17)
MERIDIAN OCCUPATIONAL HEALTH PC
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
27-2377326
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
No
(18)
THE AUXILIARY OF HACKENSACKUMC
30 PROSPECT AVENUE
HACKENSACK
,
NJ
07601
22-1537117
SUPPORT HMHHC
NJ
501(C)(3)
12C
HMHHC
Yes
(19)
MERIDIAN MEDICAL GROUP-PEDIATRIC UROLOGY
1350 CAMPUS PARKWAY
NEPTUNE
,
NJ
07753
81-3921186
HEALTH SVCS.
NJ
501(C)(3)
10
HMH
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)
HUMCUSPI SURGERY CENTERS LLC
30 PROSPECT AVE
HACKENSACK
,
NJ
07601
38-3875474
HEALTH SVCS
NJ
HMHHC
RELATED
10,759,147
20,209,604
No
0
No
50.100 %
(2)
OLD BRIDGE MEDICAL ASSOCIATES LLC
1 HOSPITAL PLZ
OLD BRIDGE
,
NJ
08857
22-2894388
HEALTH SVCS
NJ
NA
(3)
RARITAN BAY SURGICAL PARTNERS LLC
530 NEW BRUNSWICK AVE
PERTH AMBOY
,
NJ
08861
46-5153212
HEALTH SVCS
NJ
NA
(4)
COASTAL CO-OP OF NJ
1350 CAMPUS PKWY
NEPTUNE
,
NJ
07753
22-3603146
PURCHASING
NJ
NA
(5)
MERIDIAN HEALTH VILLAGE REALTY ASSOC
1350 CAMPUS PKWY
NEPTUNE
,
NJ
07753
27-4328412
REAL ESTATE
NJ
NA
(6)
MERIDIAN LIVING AT MANALAPAN LLC
1350 CAMPUS PKWY
NEPTUNE
,
NJ
07753
47-3603026
HEALTH SVCS
NJ
NA
(7)
HACKENSACK MERIDIAN LIVING AT HOLMDEL
1350 CAMPUS PKWY
NEPTUNE
,
NJ
07753
81-5095156
HEALTH SVCS
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)
HACKENSACK MERIDIAN HLTH MANAGEMENT INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2608891
SVC MANAGEMENT
NJ
NA
C CORP
No
(4)
PALISADES CHILD CARE CENTER INC
343 THORNALL STREET
EDISON
,
NJ
08837
22-2812623
DAY CARE CENTER
NJ
NA
C CORP
No
(5)
HACKENSACKUMC CASUALTY COMPANY LTD
CHEVRON HOUSE 44 CHURCH STREET
HAMILTON
HM12
BD
22-1487576
FINANCIAL VEHICLE
BD
HMHHC
C CORP
0
26,570,203
100.000 %
Yes
(6)
RARITAN INSURANCE LTD
23 LIME TREE BAY AVE PO BOX 1363
GRAND CAYMAN
CJ
FINANCIAL VEHICLE
CJ
NA
C CORP
No
(7)
COASTAL MEDICAL INSURANCE LTD
CHEVRON HOUSE 44 CHURCH STREET
HAMILTON
HM12
BD
98-0166769
FINANCIAL VEHICLE
BD
NA
C CORP
No
(8)
OAPCA INC
1140 ROUTE 72 WEST
MANAHAWKIN
,
NJ
08050
22-3298974
CONDO ASSOC
NJ
NA
C CORP
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
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
Yes
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
Yes
r
Other transfer of cash or property to related organization(s)
............................
1r
Yes
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
HACKENSACK UNIV MED CTR CASUALTY COMPANY LTD
R
2,000,000
COST
(2)
HACKENSACK UNIVERSITY MEDICAL GROUP PC
R
75,300,668
COST
(3)
HUMC Cardiovascular Partners PC
R
22,288,343
COST
(4)
Hackensack Specialty Care Associates PC
R
325,308
COST
(5)
HUMC Medical Observation PA
R
1,225,073
COST
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, PART II
HMH HOSPITALS CORPORATION IS RELATED TO SEVERAL ADDITIONAL TAX-EXEMPT ORGANIZATIONS NOT SHOWN IN PART II AS THOSE ORGANIZATIONS ARE PART OF THE GROUP EXEMPTION UNDER HACKENSACK MERIDIAN HEALTH, INC.
SCHEDULE R, PART V
HACKENSACK MERIDIAN HEALTH, INC. IS THE SOLE MEMBER OF HMH HOSPITALS CORPORATION AND THE TAX-EXEMPT PARENT ENTITY OF THE TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY NETWORK. HMH HOSPITALS CORPORATION ROUTINELY PAYS EXPENSES FOR VARIOUS AFFILIATES WITHIN THE NETWORK IN THE ORDINARY COURSE OF BUSINESS. THESE RELATED PARTY TRANSACTIONS ARE RECORDED ON THE REVENUE/EXPENSE AND BALANCE SHEET STATEMENTS OF HMH HOSPITALS CORPORATION AND ITS AFFILIATES. THESE ENTITIES WORK TOGETHER TO DELIVER HIGH QUALITY HEALTHCARE AND WELLNESS SERVICES TO THE COMMUNITIES IN WHICH THEY ARE SITUATED.
Schedule R (Form 990) 2017
Additional Data
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