CENTRASTATE HEALTHCARE FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CENTRASTATE HEALTHCARE FOUNDATION (EIN 22-2383065)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-09
- IRS object ID
- 202223139349305137
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-09T16:44:04-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WithumSmithBrown PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Jefferson Park Suite 400 | AddressLine1Txt |
| City | Whippany | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 079811070 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222383065 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRASTATE HEALTHCARE FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % LAURA SCHILARE MBA CPA | InCareOfNm |
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 7322947050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST MAIN STREET | AddressLine1Txt |
| City | FREEHOLD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 07728 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA SCHILARE | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 7322947022 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LAURA | PersonFirstNm |
| Person Last | SCHILARE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 000000000 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SCOTT J MARIANI | PreparerPersonNm |
| PTIN | P00642486 | PTIN |
| Phone | 9738989494 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | NANCY BARONE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST MAIN STREET | AddressLine1Txt |
| City | FREEHOLD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 07728 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,049,505 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CENTRASTATEFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1981 | FormationYr |
| Legal Domicile State | NJ | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT THE CHARITABLE TAX-EXEMPT PURPOSES, PROGRAMS AND SERVICES OF CENTRASTATE MEDICAL CENTER; A RELATED IRC SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION AND AFFILIATES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 23 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 21 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,077,933 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,001,155 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $492,675 | PYInvestmentIncomeAmt |
| CY Investment Income | $974,876 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $3,082 | CYOtherRevenueAmt |
| PY Total Revenue | $2,570,608 | PYTotalRevenueAmt |
| CY Total Revenue | $2,979,113 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,410,459 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,827,899 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $706,070 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,121,247 | PYOtherExpensesAmt |
| CY Other Expenses | $1,039,106 | CYOtherExpensesAmt |
| PY Total Expenses | $3,531,706 | PYTotalExpensesAmt |
| CY Total Expenses | $2,867,005 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$961,098 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $112,108 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,299,944 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,825,049 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $245,069 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $571,000 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,054,875 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,254,049 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO SUPPORT THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF CENTRASTATE MEDICAL CENTER, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, AND OTHER CENTRASTATE HEALTHCARE SYSTEM, INC. AFFILIATES, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,827,899 | ExpenseAmt |
| Grant | $1,827,899 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | EXPENSES INCURRED IN SUPPORT OF THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF CENTRASTATE MEDICAL CENTER, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, AND OTHER CENTRASTATE HEALTHCARE SYSTEM, INC. AFFILIATES, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $1,827,899 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 23 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 21 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NJ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA SCHILARE MBA CPA | PersonNm |
| Phone | 7322947050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST MAIN STREET | AddressLine1Txt |
| City | FREEHOLD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 07728 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| JOHN T GRIBBIN | |||||||
| TRUSTEE - CSMC PRESIDENT/CEO | 55.0 | 0.0 | Yes (X) | Yes (X) | $0 | $1,241,943 | $32,525 |
| THOMAS W SCOTT | |||||||
| CSMC SVP/COO | 55.0 | 0.0 | Yes (X) | $0 | $655,441 | $89,921 | |
| JOHN A DELLOCONO | |||||||
| CSMC SVP/CFO | 55.0 | 0.0 | Yes (X) | $0 | $574,957 | $38,673 | |
| NANCY BARONE | |||||||
| VICE PRESIDENT DEVELOPMENT | 50.0 | 0.0 | Yes (X) | $0 | $277,157 | $33,599 | |
| ANTHONY J MARINO MD | |||||||
| TRUSTEE | 50.0 | 0.0 | Yes (X) | $0 | $163,922 | $4,394 | |
| EDWARD M SOFFEN MD | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $1,200 | $0 | |
| JOSEPH IANTOSCA | |||||||
| CHAIR - TRUSTEE | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BRETT TAFT | |||||||
| VICE CHAIR - TRUSTEE | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| VINCENT LABBATE | |||||||
| SECRETARY/TRESURER - TRUSTEE | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ERIX BUXBAUM DO | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JOHN M CANTALUPO ESQ | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JUNE B DUCK MD | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| ROBERT GORDON DDS | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| THOMAS M HOGAN | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DANIEL JACKSON | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| ROBERT KASH | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| BLAKE LAURENCE | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JULIAN LEONE | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| PETER G LICATA | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| ROBERT MCGIRR | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| SANJAY MEHTA DO FAAP | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| LARRY METZ | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| KENNETH J REILLY CWS | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| ANDREW J SANTORO JR | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| WILLIAM J SETARO | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| KENNETH R TOMKOVICH MD | |||||||
| TRUSTEE | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,914,620 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $199,112 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $278,012 | FundraisingAmt |
| Related Organizations | $123,803 | RelatedOrganizationsAmt |
| Government Grants | $799,611 | GovernmentGrantsAmt |
| All Other Contributions | $799,729 | AllOtherContributionsAmt |
| Noncash Contributions | $40,255 | NoncashContributionsAmt |
| Total Contributions | $2,001,155 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $306,217 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $306,217 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $668,659 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $668,659 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $668,659 | TotalRevenueColumnAmt |
| Exclusion | $668,659 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $68,229 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $278,012 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $68,229 | FundraisingDirectExpensesAmt |
| Gaming Gross Income | $5,245 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $2,163 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,082 | TotalRevenueColumnAmt |
| Exclusion | $3,082 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,979,113 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $977,958 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,827,899 | TotalAmt |
| Program Services | $1,827,899 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,508 | TotalAmt |
| Management And General | $23,508 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,171 | TotalAmt |
| Management And General | $74,171 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,871 | TotalAmt |
| Management And General | $10,468 | ManagementAndGeneralAmt |
| Fundraising | $31,403 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,279 | TotalAmt |
| Management And General | $4,320 | ManagementAndGeneralAmt |
| Fundraising | $12,959 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,408 | TotalAmt |
| Management And General | $352 | ManagementAndGeneralAmt |
| Fundraising | $1,056 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,983 | TotalAmt |
| Management And General | $3,496 | ManagementAndGeneralAmt |
| Fundraising | $10,487 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| ALLOC. OF PERSONNEL COSTS | $705,708 | $176,427 | $529,281 |
| DIRECT CORPORATE EXPENSE | $73,080 | $18,270 | $54,810 |
| OTHER EXPENSES | $88,098 | $22,024 | $66,074 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,867,005 | TotalAmt |
| Program Services | $1,827,899 | ProgramServicesAmt |
| Management And General | $333,036 | ManagementAndGeneralAmt |
| Fundraising | $706,070 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,482 | BOYAmt |
| EOY | $19,058 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $768,707 | BOYAmt |
| EOY | $775,084 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,082,676 | BOYAmt |
| EOY | $872,249 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,501 | BOYAmt |
| EOY | $114,743 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,106,413 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $450,497 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $664,385 | BOYAmt |
| EOY | $655,916 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,183,325 | BOYAmt |
| EOY | $18,284,420 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,868 | BOYAmt |
| EOY | $103,579 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,299,944 | BOYAmt |
| EOY | $20,825,049 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,193 | BOYAmt |
| EOY | $113,864 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,876 | BOYAmt |
| EOY | $457,136 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $245,069 | BOYAmt |
| EOY | $571,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,263,220 | BOYAmt |
| EOY | -$2,478,320 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,318,095 | BOYAmt |
| EOY | $22,732,369 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,054,875 | BOYAmt |
| EOY | $20,254,049 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,299,944 | BOYAmt |
| EOY | $20,825,049 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $112,108 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,087,066 | NetUnrlzdGainsLossesInvstAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,585,662 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,807,125 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,503,036 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,077,933 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,001,155 | CurrentTaxYearAmt |
| Total | $10,974,911 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,585,662 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,807,125 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,503,036 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,077,933 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,001,155 | CurrentTaxYearAmt |
| Total | $10,974,911 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,180,747 | SubstantialContributorsTotAmt |
| Public Support Total170 | $9,794,164 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $211,881 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $301,256 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $319,089 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $281,896 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $306,217 | CurrentTaxYearAmt |
| Total | $1,420,339 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $12,395,250 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $1,126,296 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.79016 | PublicSupportCY170Pct |
| Public Support PY170 | 0.63093 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $598,320 | OtherCostOrOtherBasisAmt |
| Book Value | $598,320 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $491,016 | OtherCostOrOtherBasisAmt |
| Depreciation | $443,961 | DepreciationAmt |
| Book Value | $47,055 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,077 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,536 | DepreciationAmt |
| Book Value | $10,541 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $655,916 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENTS | $17,568,436 | F |
| GIFT ANNUITY FUND | $715,984 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $18,284,420 | TotalBookValueProgramRltdAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $401,791 |
| OTHER LIABILITIES | $55,345 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $457,136 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X; LINE 2 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CENTRASTATE HEALTHCARE SYSTEM, INC AND RELATED ENTITIES FOR THE YEARS ENDED DECEMBER 31, 2021 AND DECEMBER 31, 2020; RESPECTIVELY. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE SYSTEM'S 2021 AUDITED CONSOLIDATED FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): THE SYSTEM ACCOUNTS FOR DEFFERED TAX ASSETS AND LIABILITIES BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL REPORTING AND TAX BASIS OF ASSETS AND LIABILITIES USING ENACTED TAX RATES AND LAWS THAT WILL BE IN EFFECT WHEN DIFFERENCES ARE EXPECTED TO REVERSE. AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, THE SYSTEM HAS MADE REASONABLE ESTIMATES OF THE PROVISION FOR THE INCOME TAXES AND DEFFERED TAX BALANCES BASED ON ACCOUNTING GUIDANCE INCLUDED IN ACCOUNTING STANDARDS CODIFICATION 740, INCOME TAXES. THE SYSTEM WILL CONTINUE TO REFINE ITS CALCULATIONS IN FUTURE PERIODS AS ADDITIONAL REGULATIONS AND GUIDANCE ARE ISSUED BY THE INTERNAL REVENUE SERVICE (IRS). | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | BAND AID OPEN | Event1Nm |
| Gross Receipts Event1 | $211,802 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $147,286 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $64,516 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,943 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $48,435 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $280 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $13,858 | OtherDirectExpensesEvent1Amt |
| Event2 | WINE TASTING | Event2Nm |
| Gross Receipts Event2 | $83,155 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $81,270 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $1,885 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $1,885 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $51,284 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $49,456 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $1,828 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $1,828 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $346,241 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $278,012 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $68,229 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,943 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $48,435 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $280 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $17,571 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $68,229 | DirectExpenseSummaryEventsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | NJ | StatesWhereGamingConductedCd |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 WILLOW BROOK ROAD SUITE 5 | AddressLine1Txt |
| City | FREEHOLD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 07728 | ZIPCd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| CENTRASTATE MEDICAL CENTER INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 221750190 | 501(C)(3) | $1,143,683 | $48,752 | FMV | SUPPLIES | GENERAL SUPPORT |
| CENTER FOR AGING INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 222575377 | 501(C)(3) | $430,756 | $6,124 | FMV | SUPPLIES | GENERAL SUPPORT |
| AMERICAN CANCER SOCIETY | ||||||||||
| 1540 ROUTE 138 SUITE 303 | WALL | NJ | 07719 | 131788491 | 501(C)(3) | $6,000 | GENERAL SUPPORT | |||
| VNA OF CENTRAL JERSEY | ||||||||||
| 23 MAIN STREET SUITE D1 | HOLMDEL | NJ | 07733 | 222500031 | 501(C)(3) | $20,000 | GENERAL SUPPORT | |||
| SPECIAL STRIDES | ||||||||||
| 118 FEDERAL ROAD | MONROE TOWNSHIP | NJ | 08831 | 223667820 | 501(C)(3) | $10,000 | GENERAL SUPPORT | |||
| FREEHOLD REGIONAL HIGH SCHOOL | ||||||||||
| 281 ELTON ADELPHIA ROAD | FREEHOLD | NJ | 07728 | 216004798 | 501(C)(3) | $10,000 | GENERAL SUPPORT | |||
| JERSEY SHORE MEDICAL CENTER | ||||||||||
| 1340 CAMPUS PARKWAY BUILD C UNIT | NEPTUNE | NJ | 07753 | 222342452 | 501(C)(3) | $6,780 | GENERAL SUPPORT | |||
| GIRL SCOUTS OF THE JERSEY SHORE | ||||||||||
| 1405 OLD FREEHOLD ROAD | TOMS RIVER | NJ | 08753 | 210731966 | 501(C)(3) | $8,600 | GENERAL SUPPORT | |||
| LAURA DONOVAN ELEMENTARY SCHOOL & FREEHOLD PBA | ||||||||||
| 237 STONEHURST BLVD | FREEHOLD | NJ | 07728 | 222861442 | 501(C)(3) | $5,105 | FMV | SUPPLIES | GENERAL SUPPORT | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 9 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I; QUESTION 2 | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL AND HUMAN RESOURCES DEPARTMENT PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN T GRIBBIN | ||||||||||||||
| TRUSTEE - CSMC PRESIDENT/CEO | $0 | $787,653 | $0 | $445,146 | $0 | $9,144 | $0 | $26,000 | $0 | $6,525 | $0 | $1,274,468 | $0 | $0 |
| THOMAS W SCOTT | ||||||||||||||
| CSMC SVP/COO | $0 | $448,122 | $0 | $90,071 | $0 | $117,248 | $0 | $73,454 | $0 | $16,467 | $0 | $745,362 | $0 | $52,855 |
| JOHN A DELLOCONO | ||||||||||||||
| CSMC SVP/CFO | $0 | $472,879 | $0 | $94,554 | $0 | $7,524 | $0 | $19,500 | $0 | $19,173 | $0 | $613,630 | $0 | $0 |
| NANCY BARONE | ||||||||||||||
| VICE PRESIDENT DEVELOPMENT | $0 | $238,103 | $0 | $35,254 | $0 | $3,800 | $0 | $26,000 | $0 | $7,599 | $0 | $310,756 | $0 | $0 |
| ANTHONY J MARINO MD | ||||||||||||||
| TRUSTEE | $0 | $163,922 | $0 | $0 | $0 | $0 | $0 | $1,479 | $0 | $2,915 | $0 | $168,316 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I; QUESTION 4B | THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") AS THE AMOUNT WAS NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN HIS 2021 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: THOMAS W. SCOTT, $114,626. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUAL INCLUDES UNVESTED BENEFITS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") WHICH IS SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUAL MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNT OUTLINED HEREIN WAS NOT INCLUDED IN HIS 2021 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: THOMAS W. SCOTT, $53,954. |
| SCHEDULE J, PART I; QUESTION 7 | CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2021 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2021 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT. |
| SCHEDULE J, PART II; COLUMN F | THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) INCLUDE VESTED BENEFITS IN A DEFERRED COMPENSATION PLAN AS THESE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR YEARS' FORMS 990 AND ARE NOW BEING REPORTED AGAIN ON THIS YEAR'S FORM 990. THESE HAVE BEEN TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp | |
| Securities Publicly Traded | SecuritiesPubliclyTradedGrp | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp | |
| Real Estate Residential | RealEstateResidentialGrp | |
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp | |
| Food Inventory | FoodInventoryGrp | |
| Drugs And Medical Supplies | DrugsAndMedicalSuppliesGrp | |
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp |
Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | MEDICAL EQUIP. | 3 | $8,650 | FMV |
| Yes (X) | TOYS | 1021 | $5,105 | FMV |
| Yes (X) | IPAD CHARGERS | 400 | $10,000 | FMV |
| Yes (X) | MISC. IN-KIND | 2336 | $16,500 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (true) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE M, PART I; QUESTION 32A | THE ORGANIZATION HIRES INDEPENDENT THIRD-PARTIES TO SELL NON-CASH CONTRIBUTIONS IT RECEIVES; IF THE ORGANIZATION DECIDES NOT TO RETAIN THE ITEM(S). THE ORGANIZATION PAYS FAIR MARKET VALUE RATES AND COMMISSIONS IN THESE INSTANCES. FOR ANY GIFTS OF STOCK THE ORGANIZATION'S POLICY IS TO SELL IT IMMEDIATELY FOLLOWING RECEIPT. |
| SCHEDULE M, PART I; COLUMN B | THE AMOUNTS SHOWN ON PART I, COLUMN B ARE THE NUMBER OF CONTRIBUTIONS RECEIVED. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 | CENTRASTATE HEALTHCARE SYSTEM, INC. ("CSHS") IS THE SOLE MEMBER OF THIS ORGANIZATION. CSHS HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS. |
| CORE FORM, PART VI, SECTION B; QUESTION 11B | THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CENTRASTATE HEALTHCARE SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO THE FILING OF THE FEDERAL FORM 990 WITH THE INTERNAL REVENUE SERVICE ("IRS") AND AFTER PRESENTATION AND REVIEW BY CENTRASTATE HEALTHCARE SYSTEM, INC.'S AUDIT COMMITTEE. AS PART OF THE TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CERTIFIED PUBLIC ACCOUNTING ("CPA") FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP OF THE ORGANIZATION TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S FINANCE PERSONNEL AND INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. FOLLOWING THIS REVIEW, THE FINAL FORM 990 WAS PRESENTED TO THE MEMBERS OF CENTRASTATE HEALTHCARE SYSTEM'S AUDIT COMMITTEE FOR REVIEW AND THEREAFTER PROVIDED TO EACH VOTING MEMBER OF THIS ORGANIZATION'S GOVERNING BODY PRIOR TO FILING WITH THE IRS. |
| CORE FORM, PART VI, SECTION B; QUESTION 12 | ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED ANNUALLY, TO REVIEW THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH IS SUBMITTED TO CORPORATE COUNSEL. CORPORATE COUNSEL REVIEWS EACH COMPLETED QUESTIONNAIRE AND PREPARES A REPORT, WHICH IS SHARED WITH THE BOARD OF TRUSTEES GOVERNANCE COMMITTEE AND, ULTIMATELY, THE BOARD OF TRUSTEES. THE POLICY IS ENFORCED, AS NEEDED, DEPENDING ON THE CIRCUMSTANCES - FOR EXAMPLE, THROUGH RECUSAL FROM VOTING, DIVESTITURE OF CONFLICTING PROPERTY INTERESTS OR, IN CERTAIN PAST CASES, RESIGNATION FROM THE BOARD OF TRUSTEES. |
| CORE FORM, PART VI, SECTION B; QUESTION 15 | THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION SUB-COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. IN 2021, THE EXECUTIVE COMPENSATION SUB-COMMITTEE REPORTED TO THE FULL BOARD FOR RATIFICATION. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY, THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILARLY SIZED HEALTHCARE SYSTEMS AND HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. IN ADDITION, THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION ADJUSTMENTS BASED ON MARKET SURVEYS DEVELOPED BY INDEPENDENT CONSULTANTS, INDUSTRY AVERAGE COMPARISON, YEARS OF SERVICE AND OTHER EXEMPT ORGANIZATIONS IN THE GEOGRAPHIC AREA. AFTER A REVIEW OF THE INDIVIDUAL'S PERFORMANCE FOR THE YEAR AND RELYING ON COMPARABLE INFORMATION AND OTHER OBJECTIVE DATA, THE EXECUTIVE COMMITTEE WILL RECOMMEND AN ADJUSTMENT TO THE INDIVIDUAL'S COMPENSATION. ANY DETERMINATIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE EXECUTIVE COMMITTEE MINUTES. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING, BUT NOT LIMITED TO, THE PRESIDENT/CHIEF EXECUTIVE OFFICER. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE CENTRASTATE HEALTHCARE SYSTEM, INC.'S PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS. |
| CORE FORM, PART VI, SECTION C; QUESTION 19 | THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY. |
| CORE FORM, PART VII AND SCHEDULE J | CORE FORM, PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF A RELATED ORGANIZATION AND NOT FOR SERVICES RENDERED AS A VOTING MEMBER OF THIS ORGANIZATION'S BOARD OF TRUSTEES. JOHN T. GRIBBIN IS LISTED AS AN OFFICER AND A TRUSTEE ON THIS FORM 990. THIS IS HIS SOLE ROLE WITH THE ORGANIZATION. HE PROVIDES NO SERVICES TO OR FOR THE ORGANIZATION AND IS NOT INVOLVED IN THE MANAGEMENT OR DAY TO DAY ACTIVITIES OF THIS ORGANIZATION. MR. GRIBBIN IS EMPLOYED BY A RELATED ORGANIZATION AND WORKS FULL TIME IN THIS CAPACITY FOR CENTRASTATE MEDICAL CENTER, INC. ACCORDINGLY HIS COMMON LAW EMPLOYER/EMPLOYEE RELATIONSHIP IS WITH CENTRASTATE MEDICAL CENTER, INC. (EIN: 22-1750190). CENTRASTATE MEDICAL CENTER, INC. FILED A 2021 FORM 4720 WHICH INCLUDED A REMITTANCE OF EXCISE TAX RELATED TO MR. GRIBBIN'S COMPENSATION IN EXCESS OF $1M. |
| CORE FORM, PART VII, SECTION A, COLUMN B | THIS ORGANIZATION IS AN AFFILIATE WITHIN THE CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM INCLUDES BOTH FOR-PROFIT AND NOT FOR-PROFIT ORGANIZATIONS. CERTAIN BOARD OF TRUSTEE MEMBERS, OFFICERS AND/OR DIRECTORS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENT THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF TRUSTEES OF OTHER RELATED ORGANIZATIONS IN THE SYSTEM, THEIR RESPECTIVE HOURS PER WEEK PER ORGANIZATION ARE APPROXIMATELY THE SAME AS REFLECTED IN CORE FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS AND KEY EMPLOYEES, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF CENTRASTATE HEALTHCARE SYSTEM, INC.; NOT SOLELY THIS ORGANIZATION. |
| CORE FORM, PART XII; QUESTION 2 | THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC. ("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. CENTRASTATE HEALTHCARE SYSTEM, INC. IS THE TAX-EXEMPT PARENT ENTITY OF THE SYSTEM. AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CENTRASTATE HEALTHCARE SYSTEM, INC. AND ALL ENTITIES WITHIN THE SYSTEM FOR THE YEARS ENDED DECEMBER 31, 2021 AND DECEMBER 31, 2020; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNMODIFIED OPINION WITH RESPECT TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. |
| CORE FORM, PART XII; QUESTION 3 | THE ORGANIZATION IS AN AFFILIATE WITHIN CENTRASTATE HEALTHCARE SYSTEM, INC.("SYSTEM"); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE SYSTEM ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND ISSUE A SYSTEM WIDE CONSOLIDATED AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AUDIT. THIS ORGANIZATION WAS INCLUDED IN THE SYSTEM WIDE A-133 AUDIT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CENTER FOR AGING INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 222575377 | HEALTH SVCS. | NJ | 501(C)(3) | 509(A)(2) | CSHS | false |
| CENTRASTATE ASSISTED LIVING INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 223520730 | HEALTH SVCS. | NJ | 501(C)(3) | 509(A)(2) | CSHS | false |
| HEALTHCARE AFFILIATES INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 521594300 | HEALTH SVCS. | NJ | 501(C)(3) | 509(A)(2) | CSHS | false |
| CENTRASTATE HEALTHCARE SYSTEM INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 222482803 | MANAGEMENT | NJ | 501(C)(3) | 509(A)(3) | NA | false |
| CENTRASTATE MEDICAL CENTER INC | ||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 221750190 | HEALTH SVCS. | NJ | 501(C)(3) | HOSPITAL | CSHS | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CENTRASTATE HEALTHCARE SERVICES INC | ||||||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 222512830 | HEALTH SVCS. | NJ | NA | C CORP. | false | |||||
| CENTRASTATE MEDICAL ASSOCIATES PC | ||||||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 223402359 | HEALTH SVCS. | NJ | NA | C CORP. | false | |||||
| CENTRASTATE SPECIALISTS PC | ||||||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 823704077 | HEALTH SVCS. | NJ | NA | C CORP. | false | |||||
| CENTRASTATE CAPTIVE INSURANCE CO LTD | ||||||||||||||
| 981205985 | FINANCIAL VEHICLE | NA | FOREIGN CORP. | false | 23 LIME TREE BAY AVE | GRAND CAYMAN | CJ | KY1-1108 | CJ | |||||
| CENTRASTATE CARDIOLOGY PC | ||||||||||||||
| 901 WEST MAIN STREET | FREEHOLD | NJ | 07728 | 872845417 | HEALTH SVCS. | NJ | NA | C CORP. | false | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART V | FormAndLineReferenceDesc |
| Explanation | This organization is a member of centrastate healthcare system, inc.; a tax-exempt integrated healthcare delivery system. Funds are routinely transferred between affiliates and business activities are common on behalf of the System's affiliates, including this organization. These transactions may be recorded on the revenue/expense and balance sheet statements of this organization and other affiliates. THESE entities work together to deliver high quality cost effective healthcare and wellness services to their communities regardless of ability to pay and in furtherance of charitable tax-exempt purposes. | ExplanationTxt |