2014-04-09T13:52:36-05:00 2013-06-30 EISNERAMPER LLP 111 WOOD AVE SO STE 600 ISELIN NJ 088302700 990 2012-07-01 010553478 EAST MOUNTAIN HOSPITAL INC % MICHAEL VOORHEES EAST 9082811439 PO BOX 1029 Suite BELLE MEAD NJ 085021029 MICHAEL VOORHEES 1111111111 2014-04-15 true RICHARD A SACKIN 7322437000 2012 2015-11-30 17:44:51Z MICHAEL VOORHEES PO BOX 1029 BELLE MEAD NJ 085021029 4620471 false X eastmountainhospital.com X 2003 NJ EAST MOUNTAIN HOSPITAL IS AN INPATIENT PSYCHIATRIC HOSPITAL. 7 5 71 0 0 0 4390394 4619605 1003 675 4318 191 4395715 4620471 250 0 0 0 2294354 2359366 0 0 0 2054185 2096174 4348789 4455540 46926 164931 2745485 2669552 1761238 1520374 984247 1149178 TOGETHER WE WILL PROVIDE A SAFE, STRUCTURED, THERAPEUTIC COMMUNITY TO TREAT ADULTS WHO HAVE BEHAVIORAL AND SUBSTANCE ABUSE PROBLEMS AND RETURN THEM TO THEIR FAMILIES OR THE NEXT LEVEL OF CARE AS SOON AS POSSIBLE. false false 3872402 4619605 PSYCHIATRIC HOSPITAL WHICH CARED FOR 390 INPATIENTS AND HAD A TOTAL OF 5,261 PATIENT DAYS. 3872402 true false false false false false false false false false true false false false true true true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 3 0 true 71 true false false false false false false false false false false X 7 5 false false false false false false false true true false false true true true true true true true true false NJ X X MICHAEL VOORHEES 9082811439 40 EAST MOUNTAIN ROAD BELLE MEAD NJ 085021029 X BOHDAN CEHELYK MD 40.0 X X 246266 0 33053 MICHAEL VOORHEES 40.0 X X 119035 0 27216 DAVID CENTAFONT 0.0 X 0 0 0 ENRICO DEGIRONIMO 0.0 X 0 0 0 RANDOLPH JACOBSON 0.0 X X 0 0 0 PATRICIA TOOLE 0.0 X X 0 0 0 SUSAN BONFIELD 0.0 X 0 0 0 MARY PAWLIKOWSKI 0.0 X 0 0 0 HEIDI HERGERT 40.0 X 101240 0 5136 466541 0 65405 3 false true false CARRIER CLINIC PO BOX 147 BELLE MEAD NJ 08502 ADMIN/CLINICAL 873768 SODEXO INC PO BOX 905374 CHARLOTTE NC 28290 DIETARY/HOUSEKEEPING 145193 2 X 0 NET PATIENT REVENUE 624100 4619605 4619605 4619605 675 675 0 0 0 0 0 0 0 0 0 ALL OTHER REVENUE 900099 191 191 191 4620471 4619605 866 X 0 0 0 0 352412 232230 120182 0 1636479 1622615 13864 51156 47708 3448 150279 125034 25245 169040 158366 10674 87558 76180 11378 13238 13238 34187 34187 0 0 0 897349 619836 277513 1270 1270 37884 21651 16233 6370 6370 0 236708 232946 3762 5116 5116 0 2902 2902 0 0 5725 5725 105679 91351 14328 PATIENT RELATED 415436 415436 DIETARY/ENVIRONMENTAL SVS 170780 170780 BAD DEBTS 33246 33246 MISCELLANEOUS 42726 17005 25721 4455540 3872402 583138 0 2027980 1686552 0 0 0 0 582452 861290 0 0 0 0 0 0 0 0 94349 80507 104455 63252 40704 41203 0 0 0 0 0 0 0 0 0 0 2745485 2669552 345716 326133 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1415522 1194241 1761238 1520374 X 984247 1149178 0 0 0 0 984247 1149178 2745485 2669552 164931 X false true X true false X 86665 45462 41203 17790 17790 41203 0 DUE TO CARRIER CLINIC 56316 ACCRUED PENSION 44400 DUE TO THIRD PARTIES 1093525 1194241 X 4587225 4587225 33246 33246 4620471 4422294 4422294 33246 33246 4455540 PART X, QUESTION #2 THE HOSPITAL IS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS USING A THRESHOLD OF MORE LIKELY THAN NOT TO ESTIMATE POTENTIAL TAX LIABILITIES. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XI, LINE 4B PATIENT BAD DEBTS 33,246 REPORTED AS REVENUE REDUCTION ON AUDITED FINANCIAL STATEMENTS. PART XII, LINE 4B PATIENT BAD DEBTS 33,246 REPORTED AS REVENUE REDUCTION ON AUDITED FINANCIAL STATEMENTS. true true X true X true X 100 true true true false true true 9032 9032 0.00200 9032 9032 0.00200 1125 1125 0.00030 1125 1125 0.00030 10157 10157 0.00230 2468 2468 0.00060 2468 2468 0.00060 true 17352 1361801 1389714 -27913 X true false 1 1 EAST MOUNTAIN HOSPITAL INC

PO BOX 1029 BELLE MEAD NJ 085021029

X EAST MOUNTAIN HOSPITAL INC 1 true X X X X X X X X X 13 true true true X X X X X X false false true true 100 true 100 true X X X X true true X X true false true X X false false PART V, SECTION B, LINE 13G THE EMH PATIENT HANDBOOK INFORMS PATIENTS THAT THEY HAVE THE RIGHT TO TREATMENT WITHOUT DISCRIMINATION BASED ON THEIR ABILITY TO PAY OR SOURCE OF PAYMENT. IN ADDITION TO BEING INCLUDED IN THE PATIENT'S HANDBOOK THAT IS DISTRIBUTED TO EVERY PATIENT, A FINANCIAL COUNSELOR MEETS WITH THE PATIENT ON BEHALF OF EMH DURING THEIR STAY, WHEREBY SOME INFORMATION IS VERIFIED AND IF UPON INITIAL ASSESSEMNT OF THE FINANCIAL COUNSELOR OR UPON THE PATIENT'S REQUEST, THE COUNSELOR DISCUSSES THE FINANCIAL ASSISTANCE (FA) POLICY WITH THE PATIENT AND ASSISTS THE PATIENT IN COMPLETING THE APPLICATION FORM FOR THE FA. THE PATIENT IS THEN ADVISED TO SUBMIT THE NECESSARY FINANCIAL INFORMATION TO COMPLETE THE REVIEW OF THE APPLICATION. PART V, SECTION B, LINE 19D PATIENTS WHO ARE RESIDENTS OF NEW JERSEY AND DO NOT HAVE INSURANCE ARE BILLED PURSUANT TO NEW JERSEY STATE BILLING REGULATIONS. ALL PATIENTS REGARDLESS OF RESIDENCY ARE ABLE TO APPLY FOR FINANCIAL ASSISTANCE. PART I, LINE 7, COLUMN F BAD DEBT EXPENSE FOR THE YEAR ENDED JUNE 30, 2013 IS $33,246 AND IS EXCLUDED FROM TOTAL EXPENSES FOR CALCULATING THE PERCENTAGE OF TOTAL EXPENSE. PART I, LINE 7 THE COST-TO-CHARGE RATIO USED FOR PART I, LINE 7 IS BASED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 4 PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE REIMBURSED OR CONTRACTED AMOUNT AND DO NOT BEAR INTEREST. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE HOSPITAL'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN THE HOSPITAL'S EXISTING PATIENT ACCOUNTS RECEIVABLE. THE HOSPITAL DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. THE HOSPITAL REVIEWS ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS PERIODICALLY. PAST DUE BALANCES ARE REVIEWED INDIVIDUALLY FOR COLLECTIBILITY. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR RECOVERY IS CONSIDERED REMOTE. PART VI, SUPPLEMENTAL INFORMATION 1 NEEDS ASSESSMENT AS PART OF EAST MOUNTAIN HOSPITALS'S (EMH) STRATEGIC PLANNING PROCESS, THE HOSPITAL GATHERS AND INCORPORATES NATIONAL, STATE, AND CLINICAL INDUSTRY DATA IN THE DEVELOPMENT OF CLINICAL SERVICES AND EDUCATIONAL FORUMS. EMH IS A PARTICIPATORY MEMBER OF THE NEW JERSEY ASSOCIATION OF MENTAL HEALTH. THIS ORGANIZATION ALSO PROVIDES BEHAVIORAL HEALTH AND ADDICTION INFORMATION RELEVANT TO THE COMMUNITY'S NEEDS. EMH RECEIVES MANY TELEPHONE CALLS FROM THE GENERAL PUBLIC ON A REGULAR BASIS, REQUIRING REFERRALS TO AND INFORMATION REGARDING COMMUNITY RESOURCES, OTHER TREATMENT CENTERS OUTSIDE THE AREA, SUPPORT GROUPS, SELF-HELP GROUPS, ETC. INFORMATION IS PROVIDED WITHOUT CHARGE. IT IS THROUGH THIS CONTACT WITH THE COMMUNITY THAT ENABLES EMH TO UNDERSTAND WHAT SERVICES ARE NEEDED THROUGHOUT THE GEOGRAPHIC AREA. PART VI, SUPPLEMENTAL INFORMATION 2 PATIENT EDUCATION UNDER A SERVICE AGREEMENT WITH CARRIER CLINIC, A PATIENT SERVICE REPRESENTATIVE MEETS WITH EACH EMH PATIENT, IF THEY ARE MENTALLY CAPABLE, AND/OR A DESIGNATED FAMILY MEMBER OR GUARDIAN INDIVIDUALLY AND ADVISES THEM THAT THEY CAN APPLY FOR CHARITY CARE FOR THEIR SELF PAY BALANCES IF THEY HAVE LIMITED INCOME. THE PATIENT SERVICE REPRESENTATIVE PROVIDES CHARITY CARE APPLICATIONS TO THE PATIENT ACCORDINGLY. PART VI, SUPPLEMENTAL INFORMATION 3 COMMUNITY INFORMATION EMH SERVES THE ENTIRE STATE OF NEW JERSEY; HOWEVER, THE MAIN PATIENT POPULATION IS FROM SUBURBAN AREAS. THE MAIN SOURCE OF ADMISSIONS IN 2012/2013 WAS FROM SOMERSET, MIDDLESEX, MERCER, CAPE MAY AND CAMDEN COUNTIES, ALL LOCATED IN NEW JERSEY. OF THESE FIVE COUNTIES, AN AVERAGE OF 8.74% OF THE POPULATION FALLS BELOW POVERTY LEVEL. PART VI, SUPPLEMENTAL INFORMATION 4 COMMUNITY BUILDING ACTIVITIES EMH IS A MEMBER OF SOMERSET COUNTY'S "ADOPT-A-ROAD" PROGRAM WHICH SUPPORTS THE COMMUNITY'S ONGOING EFFORT TO KEEP ITS ROADS MORE ATTRACTIVE AND SAFE. EMH STAFF IS RESPONSIBLE FOR A TWO MILE STRETCH OF ROAD AND SPENT APPROXIMATELY THIRTY-SIX HOURS DURING THE YEAR COLLECTING TRASH. PART V, LINE 3 WHILE CONDUCTING EMH'S CHNA, A REPRESENTATIVE OF EMH INTERVIWED MENTAL HEALTH ADMINISTRATORS FROM MIDDLESEX, SOMERSET, CAPE MAY, CAMDEN AND MERCER COUNTIES TO DISCUSS SERVICE GAPS IN THE COMMUNITY. THESE COUNTIES REPRESENT APPROXIMATELY 75% OF EMH ADMISSIONS. PART V, SECTION B, LINE 4 IN AN EFFORT TO BE COST-EFFECTIVE, EMH CONDUCTED ITS CHNA IN CONJUNCTION WITH CARRIER CLINIC. EMH IS A HOSPITAL-WITHIN-A-HOSPIAL ON THE CARRIER CLINIC CAMPUS AND THEIR COMMUNITIES ARE SIMILAR. PART V, SECTION B, LINE 7 THE IMPLEMENTATION STRATEGY DEFINES THE NEEDS TO BE ADDRESSED BY JUNE 30, 2014. EMH IS WORKING TOWARDS THE TIMELY IMPLEMENTATION OF THE PLAN. X X X false false false false false false false false false BOHDAN CEHELYK MD 241966 0 4300 9100 23953 279319 0 0 SCHEDULE J, PART II DR. BOHDAN CEHELYK'S OTHER REPORTABLE COMPENSATION OF $4,300 REPRESENTS A PENSION CONTRIBUTION THAT FAILED DISCRIMINATION TESTING, RETIREMENT AND OTHER DEFERRED COMPENSATON OF $9,100 REPRESENTS EAST MOUNTAIN HOSPITAL'S CONTRIBUTION INTO THE TARGET BENEFIT PLAN, AN ERISA PLAN. NONTAXABLE BENEFITS OF $23,953 REPRESENTS HOSPITALIZATION, MEDICAL, DENTAL AND PRESCRIPTION PLAN COVERAGE AS WELL AS LIFE INSURANCE AND LONG-TERM DISABILITY INSURANCE PAID BY EAST MOUNTAIN HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY INTERNAL FINANCIAL STAFF, IS REVIEWED BY AN OUTSIDE CPA CONSULTING FIRM AND IS THEN REVIEWED BY THE BOARD OF TRUSTEES IN ADVANCE OF THE FILING WITH THE IRS. THIS REVIEW IS DOCUMENTED IN THE BOARD OF TRUSTEE MINUTES. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE AND OFFICER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS EAST MOUNTAIN HOSPITAL IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 EAST MOUNTAIN HOSPITAL UTILIZES THE NEW JERSEY HOSPITAL ASSOCIATION, SULLIVAN COTTER, HOSPITAL AND HEALTHCARE COMPENSATION SERVICE AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISONS. THE INFORMATION IS THEN PROVIDED TO THE BOARD OF TRUSTEES TO ENSURE THE SALARIES ARE WITHIN APPROPRIATE MARKET AND NONPROFIT EXECUTIVE COMPENSATION BASES. THE BOARD REVIEWS THE REASONABLENESS OF THE SALARY STRUCTURE FOR OFFICERS WITHIN THE ORGANIZATION AND ALSO REVIEWS AND ESTABLISHES THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR THESE SALARIES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 EAST MOUNTAIN HOSPITAL PROVIDES DOCUMENTS TO THE PUBLIC UPON REQUEST. THE IRS FORM 990 IS ALSO ACCESSIBLE FROM GUIDESTAR ON THE INTERNET. FORM 990, PART VII, SECTION B, INDEPENDENT CONTRACTORS EAST MOUNTAIN HOSPITAL PURCHASED ADMINISTRATIVE AND CLINICAL SUPPORT SERVICES IN AN ARM'S-LENGTH TRANSACTION FROM CARRIER CLINIC AS PER THE DULY EXECUTED SERVICE AGREEMENT BETWEEN THE TWO ENTITIES. FOR THE FISCAL YEAR ENDED JUNE 30, 2013, THE TOTAL COST OF THESE SERVICES AMOUNTED TO $873,768 - $596,255 FOR CLINICAL SERVICES AND $277,513 FOR VARIOUS BUSINESS SUPPORT FUNCTIONS SUCH AS FINANCIAL REPORTING, BILLING, INFORMATION TECHNOLOGY, HUMAN RESOURCES, AND OTHER BUSINESS FUNCTIONS. FORM 990, PART VII, SECTION A MARY PAWLIKOWSKI RESIGNED AS CHAIRPERSON ON JUNE 19, 2013. MICHAEL VOORHEES, EXECUTIVE DIRECTOR, BECAME ACTING CHAIRPERSON UNTIL THE BOARD ELECTED PATRICIA TOOLE AS THE NEW CHAIRPERSON IN SEPTEMBER 2013. FORM 990, PART IX, LINE 11g OTHER FEES FOR SERVICE OTHER FEES FOR SERVICE INCLUDE $873,768 FOR ADMINISTRATIVE AND CLINICAL SUPPORT SERVICES PURCHASED IN AN ARM'S-LENGTH TRANSACTION FROM CARRIER CLINIC AND $23,580 FOR TEMPORARY PSYCHIATRIST FEES. FORM 990, PART IV, LINE 20b THE (FINAL) DRAFT OF THE AUDITED EMH FINANCIAL STATEMENTS FOR FISCAL YEAR ENDED 6/30/13 IS ATTACHED TO THE FORM 990 PENDING COMPLETION OF FINAL AUDIT PROCEDURES BY EMH'S INDEPENDENT AUDITORS. ONCE THE SIGNED COPY OF THE AUDIT REPORT IS ISSUED, EMH WILL FILE AN AMENDED FORM 990 AND WILL ATTACH THE FINAL/SIGNED AUDIT REPORT.