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CENTRASTATE HEALTHCARE FOUNDATION: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
CENTRASTATE HEALTHCARE FOUNDATION (EIN 22-2383065)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-11-07
IRS object ID
201433119349300043
Schema version
2013v3.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2014-11-07T08:12:25-08:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Ernst & Young LLP USBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1111 Monument Circle Suite 4000AddressLine1
CityIndianapolisCity
StateINState
ZIP Code46204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN222383065EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CentraState Healthcare FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCENTBusinessNameControlTxt
Phone7322947022PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1916 Highway 33 - Suite 3AddressLine1
CityFreeholdCity
StateNJState
ZIP Code07728ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJohn A DelloconoPersonNm
Person TitleSVP/CFOPersonTitleTxt
Signature2014-11-07SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonErnst Young LLP USPreparerPersonNm
PTINP00032493PTIN
Phone3176817000PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJohn T Gribbin Pres CEOPrincipalOfficerNm
Gross Receipts$2,547,839GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
All Affiliates IncludedfalseAllAffiliatesIncludedInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1981FormationYr
Legal Domicile StateNJLegalDomicileStateCd
Activity Or MissionTo inspire broad based community philanthropic support for advancing exceptional healthcare at the CentraState Healthcare System.ActivityOrMissionDesc
Voting Members Governing Body21VotingMembersGoverningBodyCnt
Voting Members Independent20VotingMembersIndependentCnt
Total Employee8TotalEmployeeCnt
Total Volunteers1TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$2,719,686PYContributionsGrantsAmt
CY Contributions Grants$1,351,939CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$215,884PYInvestmentIncomeAmt
CY Investment Income$179,543CYInvestmentIncomeAmt
PY Other Revenue$120,953PYOtherRevenueAmt
CY Other Revenue$226,250CYOtherRevenueAmt
PY Total Revenue$3,056,523PYTotalRevenueAmt
CY Total Revenue$1,757,732CYTotalRevenueAmt
PY Grants And Similar Paid$1,435,370PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,022,135CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$695,020PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$703,902CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$838,705CYTotalFundraisingExpenseAmt
PY Other Expenses$600,284PYOtherExpensesAmt
CY Other Expenses$606,919CYOtherExpensesAmt
PY Total Expenses$2,730,674PYTotalExpensesAmt
CY Total Expenses$2,332,956CYTotalExpensesAmt
PY Revenues Less Expenses$325,849PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$575,224CYRevenuesLessExpensesAmt
Total Assets BOY$10,342,183TotalAssetsBOYAmt
Total Assets EOY$10,816,450TotalAssetsEOYAmt
Total Liabilities BOY$1,592,230TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,182,318TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,749,953NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,634,132NetAssetsOrFundBalancesEOYAmt
MissionTo inspire broad based community philanthropic support for advancing exceptional healthcare at the CentraState Healthcare System.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,022,135ExpenseAmt
Grant$1,022,135GrantAmt
DescGrant of Equipment, Supplies, and Funds to CentraState Medical Center and related organizations.Desc
Total Program Service Expenses$1,022,135TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee8EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Form990 T FiledfalseForm990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Form8282 Filed0Form8282FiledCnt
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Excess Business HoldingsfalseExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Org Filed In Lieu Of Form1041falseOrgFiledInLieuOfForm1041Ind
Licensed More Than One StatefalseLicensedMoreThanOneStateInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members21GoverningBodyVotingMembersCnt
Independent Voting Member20IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDominick SalernoPersonNm
Phone7322947022PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1901 West Main StreetAddressLine1
CityFreeholdCity
StateNJState
ZIP Code07728ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Robert McGirr
Trustee3.000.00Yes (X)$0$0$0
M Michael Jones MD
Trustee3.000.00Yes (X)$0$0$0
Jack Aaronson
Trustee3.000.00Yes (X)$0$0$0
Joseph Iantosca
Trustee3.000.00Yes (X)$0$0$0
Robert A Bennett
Trustee3.000.00Yes (X)$0$0$0
Joseph Cipriano MD
Trustee3.000.00Yes (X)$0$0$0
June B Duck MD
Trustee3.000.00Yes (X)$0$0$0
Orly Tabak Vallario
Trustee3.000.00Yes (X)$0$0$0
Brian Koslow
Trustee3.000.00Yes (X)$0$0$0
John F Eggert
Trustee3.000.00Yes (X)$0$0$0
Peter Licata
Trustee3.000.00Yes (X)$0$0$0
Kenneth W Faistl MD
Trustee3.000.00Yes (X)$0$0$0
Clara Glory
Trustee3.000.00Yes (X)$0$0$0
Robert Kash
Trustee3.000.00Yes (X)$0$0$0
Valerie Mac Phee
Trustee3.000.00Yes (X)$0$0$0
Vincent Maltese Esquire
Trustee3.000.00Yes (X)$0$0$0
Larry Metz
Trustee3.000.00Yes (X)$0$0$0
John T Gribbin
President & CEO1.0049.00Yes (X)$0$1,031,552$40,638Yes (X)
Gerard K Norkus
Trustee3.000.00Yes (X)$0$0$0
Edward M Soffen MD
Trustee3.000.00Yes (X)$0$0$0
Kenneth Tomkovich MD
Trustee3.000.00Yes (X)$0$0$0
Roman Lucky
Vice President38.000.00$206,538$0$35,720Yes (X)
Daniel Messina
SR VP-COO1.0049.00$0$612,905$42,034Yes (X)
John Dellocono
SR VP-CFO1.0049.00$0$453,991$44,854Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$206,538TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,098,448TotReportableCompRltdOrgAmt
Total Other Compensation$163,246TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$70,720FundraisingAmt
Government Grants$1,352GovernmentGrantsAmt
All Other Contributions$1,279,867AllOtherContributionsAmt
Total Contributions$1,351,939TotalContributionsAmt
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$167,623TotalRevenueColumnAmt
Exclusion$167,623ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$391,973SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$380,053SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$11,920SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,920TotalRevenueColumnAmt
Exclusion$11,920ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$636,304FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$70,720ContriRptFundraisingEventAmt
Fundraising Direct Expenses$410,054FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$226,250TotalRevenueColumnAmt
Exclusion$226,250ExclusionAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,757,732TotalRevenueColumnAmt
Exclusion$405,793ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,022,135TotalAmt
Program Services$1,022,135ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$242,258TotalAmt
Management And General$242,258ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$358,212TotalAmt
Management And General$53,732ManagementAndGeneralAmt
Fundraising$304,480FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$103,432TotalAmt
Management And General$9,309ManagementAndGeneralAmt
Fundraising$94,123FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$14,310TotalAmt
Management And General$14,310ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,425TotalAmt
Management And General$1,106ManagementAndGeneralAmt
Fundraising$3,319FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$26,659TotalAmt
Management And General$6,665ManagementAndGeneralAmt
Fundraising$19,994FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$24,760TotalAmt
Management And General$6,190ManagementAndGeneralAmt
Fundraising$18,570FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$29,587TotalAmt
Management And General$7,397ManagementAndGeneralAmt
Fundraising$22,190FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$8,183TotalAmt
Management And General$2,046ManagementAndGeneralAmt
Fundraising$6,137FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
Bad Debt$238,686$238,686
Other Expenses$129,103$129,103
Campaign Development Expense$83,430$83,430
Program Expense$30,771$30,771

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$17,005TotalAmt
Fundraising$17,005FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,332,956TotalAmt
Program Services$1,022,135ProgramServicesAmt
Management And General$472,116ManagementAndGeneralAmt
Fundraising$838,705FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$446,314BOYAmt
EOY$541,740EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,203,331BOYAmt
EOY$2,665,941EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,832,007BOYAmt
EOY$1,386,775EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$14,008BOYAmt
EOY$0EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,090,040BOYAmt
EOY$910,991EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$348,918BOYAmt
EOY$249,632EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$958,491LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$235,169LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$716,291BOYAmt
EOY$723,322EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,691,274BOYAmt
EOY$4,338,049EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$10,342,183BOYAmt
EOY$10,816,450EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$240,402BOYAmt
EOY$165,455EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,351,828BOYAmt
EOY$2,016,863EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,592,230BOYAmt
EOY$2,182,318EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$182,734BOYAmt
EOY-$829,327EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,318,774BOYAmt
EOY$8,849,546EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$613,913BOYAmt
EOY$613,913EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,749,953BOYAmt
EOY$8,634,132EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,342,183BOYAmt
EOY$10,816,450EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$575,224ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$459,403NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,291,609CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,145,126CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,137,584CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,719,686CurrentTaxYearMinus1YearAmt
Current Tax Year$1,351,939CurrentTaxYearAmt
Total$8,645,944TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,291,609CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,145,126CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,137,584CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,719,686CurrentTaxYearMinus1YearAmt
Current Tax Year$1,351,939CurrentTaxYearAmt
Total$8,645,944TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$1,998,514SubstantialContributorsTotAmt
Public Support Total170$6,647,430PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$260,968CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$217,358CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$217,478CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$201,412CurrentTaxYearMinus1YearAmt
Current Tax Year$167,623CurrentTaxYearAmt
Total$1,064,839TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$9,710,783TotalSupportAmt
Gross Receipts Rltd Activities$2,651,406GrossReceiptsRltdActivitiesAmt
Public Support CY1700.68450PublicSupportCY170Pct
Public Support PY1700.70460PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$598,320OtherCostOrOtherBasisAmt
Book Value$598,320BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$31,197OtherCostOrOtherBasisAmt
Depreciation$30,201DepreciationAmt
Book Value$996BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$328,974OtherCostOrOtherBasisAmt
Depreciation$204,968DepreciationAmt
Book Value$124,006BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$723,322TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Due to CentraState MC - Intercompany$1,901,357
Liability-Split Interest Agreement$115,506
FieldValueIRS element (for citing)
Total Liability$2,016,863TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$1,757,732TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$1,757,732RevenueSubtotalAmt
Total Revenue Per Form990$1,757,732TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$2,332,956TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$2,332,956ExpensesSubtotalAmt
Total Expenses Per Form990$2,332,956TotalExpensesPerForm990Amt

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agrmt Prof Fundraising ActyfalseAgrmtProfFundraisingActyInd

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Name Of Event1Annual BallNameOfEvent1Amt
Gross Receipts Event1$250,624GrossReceiptsEvent1Amt
Charitable Contri Event1$11,040CharitableContriEvent1Amt
Gross Revenue Event1$239,584GrossRevenueEvent1Amt
Other Direct Expenses Event1$218,309OtherDirectExpensesEvent1Amt
Name Of Event2MS EventsNameOfEvent2Amt
Gross Receipts Event2$203,669GrossReceiptsEvent2Amt
Charitable Contri Event2$53,700CharitableContriEvent2Amt
Gross Revenue Event2$149,969GrossRevenueEvent2Amt
Other Direct Expenses Event2$74,617OtherDirectExpensesEvent2Amt
Other Events Total3OtherEventsTotalCnt
Gross Receipts Other Events$252,731GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$5,980CharitableContriOtherEventsAmt
Gross Revenue Other Events$246,751GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$117,128OthDirectExpnssOtherEventsAmt
Gross Receipts Total$707,024GrossReceiptsTotalAmt
Charitable Contributions Tot$70,720CharitableContributionsTotAmt
Gross Revenue Total Events$636,304GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$410,054OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$410,054DirectExpenseSummaryEventsAmt
Net Income Summary$226,250NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (7 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtPurpose Of GrantPurposeOfGrantTxtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
American Cancer Society
2310 Route 34 Suite 1DManasquanNJ08736131788491501 (c) 3$15,750$0Comm Organization Donation
American Heart Association
1 Union Street Suite 301RobbinsvilleNJ08691135613797501 (c) 3$20,150$0Comm Organization Donation
Applewood Estates
1 Applewood DriveFreeholdNJ07728222575377501 (c) 3$242,770$16,558Resident NeedsCostEquipment
CentraState Medical Center
901 West Main StreetFreeholdNJ07728221750190501 (c) 3$659,004$47,922Ambulatory Campus additionCostEquipment
March Of Dimes
2400 Main Street Extension 1SayrevilleNJ08872131846366501 (c) 3$6,300$0Comm Organization Donation
National MS Society
1 Kalisa WayParamusNJ07652135661935503 (c) 3$6,500$0Comm Organization Donation
VNA Health Group
176 Riverside AvenueRed BankNJ07701210639369501 (c) 3$5,250$0Comm Organization Donation
FieldValueIRS element (for citing)
Total501c3 Org7Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceGrantmaker's Description of How Grants are UsedFormAndLineReferenceDesc
ExplanationThe Foundation solicits and raises funds for operating and capital needs which are recorded and accounted for in accordance with Statement Of Financial Accounting Standards:(SFAS) No 136,transfer of assets to a not-for-profit organization. The Foundation, The Medical Center, Applewood, and The Manor are financially interrelated organizations. Monitoring the use of the funds is accomplished by guidelines established by the granting agency and approved budgets for capital and operations of each agency.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd
Rebuttable Presumption ProcfalseRebuttablePresumptionProcInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
Daniel Messina
SR VP-COO$417,312$91,525$104,068$28,050$13,984$654,939
John Dellocono
SR VP-CFO$320,332$69,016$64,643$28,050$16,804$498,845
John T Gribbin
President & CEO$548,512$191,611$291,429$28,050$12,588$1,072,190
Roman Lucky
Vice President$182,208$15,641$8,689$20,996$14,724$242,258

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1a: Relevant information in regards to selections on 1a.This description is also applicable to Part I - Line 4b.Gross up payments were used for the Supplemental Executive Retirement Plan.The CentraState Healthcare System Supplemental Executive Retirement Plan (the "Plan") is designed to provide competitive retirement income for a select group of management or highly compensated employees.The plan is a defined contribution plan, and is intended to be governed under Section 457(f)of the Code as a plan for an "eligible employer" providing for deferral of compensation that is not an "eligible deferred compensation plan".
Part I, Line 7: Non-Fixed payments not listed aboveIncentive payments are discretionary as certain quality, financial, and statistical indicators must be met. All payments are subject to discretion of the Board.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderCentraState Healthcare Systems (CSHS) a 501 (C) (3) organization is the sole member of its wholly owned subsidiary corporations and not-for-profit entities.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyAs the sole member, the parent corporation has the authority to appoint board members for each of the subsidiary entities of which it is the sole member. This is done by the Chair of the Parent Board, with the advice and consent of the Governance Committee.The Board of Trustees meets monthly and is responsible for the control and management of the property, affairs and funds of the CentraState Healthcare Foundation and for filling vacancies among its members.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersAll of the corporate powers and authority of CentraState Healthcare Foundation, Inc.("Corporation") in the certificate of incorporation and in the laws of the State of New Jersey shall be vested in and exercised by a Board of Trustees. The trustees,of the corporation, shall be drawn solely from the corporation's Board of Trustees. The corporation shall have no fewer than fifteen nor greater than nineteen Trustee positions made up of Chairman, Vice Chairman, Secretary/Treasurer and members.Governance decisions are presented to the parent board with the advice and consent of the Governance Committee.
Form 990, Part VI, Line 11b: Form 990 Review ProcessForm 990 was reviewed by CentraState's Audit Committee and Board Of Trustees, prior to being filed.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsAll officers, trustees and key employees are required, annually, to review the Corporation's Conflicts of Interest Policy and complete a Conflicts of Interest Questionnaire, which is submitted to Corporate Counsel. Counsel reviews each completed questionnaire and prepares a report, which is shared with the Board's Governance Committee and, ultimately, the Board. 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.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThis description is also applicable to Part VI - Line 15a.Annually, the Foundation establishes and maintains reasonable executive compensation and benefits programs that allow the healthcare system to effectively attract, retain, and motivate key executives while maintaining compliance with all legal requirements.CentraState Healthcare System's Board of Trustees has the primary responsibility to provide executive pay and benefit strategies that are competitive and compliant with all legal requirements.Responsibility for providing direct oversight of the executive compensation and benefit programs are vested with the Executive Compensation Sub-Committee(ECSC).The ECSC will engage an independent compensation consultant that reports directly to the committee and provides them with objective compensation data and advice. Decisions regarding executive pay shall be based on objective compensation data from comparable institutions and shall ensure that executive pay is commensurate with individual and organizational performance.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe organization makes its governing documents, conflict of interest policy, and financial statements available upon written request from the public.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
CentraState Medical Center
901 West Main StreetFreeholdNJ07728221750190Medical CenterNJ501 (c) 33CentraState Healthcare System IncYes (true)
CentraState Healthcare Systems Inc
901 West Main StreetFreeholdNJ07728222482803ManagementNJ501 (c) 311afalseN/A
Center for Aging Inc
1 Applewood DriveFreeholdNJ07728222575377CCRCNJ501 (c) 39CentraState Healthcare System IncYes (true)
CentraState Healthcare Affiliates Inc
689 West Main StreetFreeholdNJ07728521594300Nursing HomeNJ501 (c) 39CentraState Healthcare System IncYes (true)
CentraState Assisted Living Inc
560 Iron Bridge RoadFreeholdNJ07728223520730Assisted LivingNJ501 (c) 39CentraState Healthcare System IncYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
CentraState Healthcare Services Inc
901 West Main StreetFreeholdNJ07728222512830Med/HlthNJN/AC corpYes (true)
CentraState Medical Associates PC
901 West Main StreetFreeholdNJ07728223402359Med/HlthNJN/AC corpYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
CentraState Medical Center
b$706,926Cost
CentraState Medical Center
p$124,291Cost
CentraState Medical Center
q$798,878Cost
Center for Aging Inc
b$259,328Cost
CentraState Healthcare Services Inc
a$85,785Cost