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CENTRASTATE HEALTHCARE FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CENTRASTATE HEALTHCARE FOUNDATION (EIN 22-2383065)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-05
IRS object ID
201333099349301468
Schema version
2012v2.0
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)
Timestamp2013-11-05T10:50:32-08:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 Monument Circle Suite 2600AddressLine1
CityIndianapolisCity
StateINState
ZIP Code46204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN222383065EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CentraState Healthcare FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCENTNameControl
Phone7322947022Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameJohn A DelloconoName
TitleSVP/CFOTitle
Date Signed2013-11-05DateSigned
Authorize Third PartyfalseAuthorizeThirdParty
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJohn T Gribbin Pres CEONameOfPrincipalOfficerPerson
Gross Receipts3271601GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileNJStateLegalDomicile
Activity Or Mission DescriptionTo inspire broad based community philanthropic support for advancing exceptional healthcare at the CentraState Healthcare System.ActivityOrMissionDescription
Nbr Voting Members Governing Body22NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers1TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year2137584ContributionsGrantsPriorYear
Contributions Grants Current Year2719686ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year225115InvestmentIncomePriorYear
Investment Income Current Year215884InvestmentIncomeCurrentYear
Other Revenue Prior Year140444OtherRevenuePriorYear
Other Revenue Current Year120953OtherRevenueCurrentYear
Total Revenue Prior Year2503143TotalRevenuePriorYear
Total Revenue Current Year3056523TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2188492GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1435370GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year626735SalariesEtcPriorYear
Salaries Etc Current Year695020SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year822579TotalFundrsngExpCurrentYear
Other Expense Prior Year566914OtherExpensePriorYear
Other Expenses Current Year600284OtherExpensesCurrentYear
Total Expenses Prior Year3382141TotalExpensesPriorYear
Total Expenses Current Year2730674TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-878998RevenuesLessExpensesPriorYear
Revenues Less Expenses CY325849RevenuesLessExpensesCY
Total Assets BOY8869165TotalAssetsBOY
Total Assets EOY10342183TotalAssetsEOY
Total Liabilities BOY713395TotalLiabilitiesBOY
Total Liabilities EOY1592230TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8155770NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8749953NetAssetsOrFundBalancesEOY
Mission DescriptionTo inspire broad based community philanthropic support for advancing exceptional healthcare at the CentraState Healthcare System.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1435370Expense
Grants1435370Grants
DescriptionGrant of Equipment, Supplies, and Funds to CentraState Medical Center and related organizations.Description
Total Program Service Expense1435370TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109614NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees7NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members22NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledNJStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDominick SalernoNamePerson
Telephone Number7322947022TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Kenneth Tomkovich MD
Trustee3.000.00X000
Edward M Soffen MD
Trustee3.000.00X000
Gerard K Norkus
Trustee3.000.00X000
John T Gribbin
President & CEO1.0049.00X0980881227199X
Larry Metz
Trustee3.000.00X000
Vincent Maltese Esquire
Trustee3.000.00X000
Valerie Mac Phee
Trustee3.000.00X000
Robert Kash
Trustee3.000.00X000
Clara Glory
Trustee3.000.00X000
Kenneth W Faistl MD
Trustee3.000.00X000
Peter Licata
Trustee3.000.00X000
John F Eggert
Trustee3.000.00X000
Brian Koslow
Trustee3.000.00X000
Orly Tabak Vallario
Trustee3.000.00X000
June B Duck MD
Trustee3.000.00X000
Joseph Cipriano MD
Trustee3.000.00X000
John A Brandeisky DPM
Trustee3.000.00X0151510
Robert A Bennett
Trustee3.000.00X000
Wlliam J Setaro Ed D
Trustee3.000.00X000
Jack Aaronson
Trustee3.000.00X000
M Michael Jones MD
Trustee3.000.00X000
Robert McGirr
Trustee3.000.00X000
John Dellocono
SR VP-CFO1.0049.00044381887414X
Daniel Messina
SR VP-COO1.0049.000597441112864X
Roman Lucky
VP Development38.000.00206709036063X
FieldValueIRS element (for citing)
Total Reportable Comp From Org206709TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2037291TotalReportableCompFrmRltdOrgs
Total Other Compensation463540TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events59780FundraisingEvents
Government Grants71971GovernmentGrants
All Other Contributions2587935AllOtherContributions
Total Contributions2719686TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column201412TotalRevenueColumn
Exclusion$201,412ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities64262Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities49790Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities14472Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column14472TotalRevenueColumn
Exclusion$14,472ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events286241GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events59780CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses165288FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column120953TotalRevenueColumn
Exclusion$120,953ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3056523TotalRevenueColumn
Exclusion$336,837ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1435370Total
Program Services1435370ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total242772Total
Management And General242772ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total352483Total
Management And General52872ManagementAndGeneral
Fundraising299611Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total99765Total
Management And General8979ManagementAndGeneral
Fundraising90786Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total12142Total
Management And General12142ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7211Total
Management And General1803ManagementAndGeneral
Fundraising5408Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total35851Total
Management And General8963ManagementAndGeneral
Fundraising26888Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total19813Total
Management And General4953ManagementAndGeneral
Fundraising14860Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total29013Total
Management And General7253ManagementAndGeneral
Fundraising21760Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total6963Total
Management And General1741ManagementAndGeneral
Fundraising5222Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalFundraisingFundraisingManagement And GeneralManagementAndGeneral
Bad Debt7725477254
Program Expense124921124921
Other Expenses131247131247
Campaign Development Expense137622137622

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total18247Total
Fundraising18247Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2730674Total
Program Services1435370ProgramServices
Management And General472725ManagementAndGeneral
Fundraising822579Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY185932BOY
EOY446314EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1780669BOY
EOY2203331EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1331236BOY
EOY1832007EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY77177BOY
EOY14008EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1254548BOY
EOY1090040EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY218892BOY
EOY348918EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis921873LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec205582LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY740064BOY
EOY716291EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3280647BOY
EOY3691274EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8869165BOY
EOY10342183EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY84950BOY
EOY240402EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY628445BOY
EOY1351828EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY713395BOY
EOY1592230EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY602911BOY
EOY-182734EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6938946BOY
EOY8318774EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY613913BOY
EOY613913EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8155770BOY
EOY8749953EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8869165BOY
EOY10342183EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses325849ReconcilationRevenueExpenses
Reconciliation Unrealized Invest268334ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1477017CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1291609CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1145126CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2137584CurrentTaxYearMinus1Year
Current Tax Year2719686CurrentTaxYear
Total8771022Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1477017CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1291609CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1145126CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2137584CurrentTaxYearMinus1Year
Current Tax Year2719686CurrentTaxYear
Total8771022Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total1736469AmountsSubstContributorsTotal
Public Support Total1707034553PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years315622CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years260968CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years217358CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year217478CurrentTaxYearMinus1Year
Current Tax Year201412CurrentTaxYear
Total1212838Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support9983860TotalSupport
Gross Receipts From Admissions Etc2831110GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.70460PublicSupportPertcentage170
Public Support Pertcent Prior Year0.71370PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis598320OtherCostOrOtherBasis
Book Value598320BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis31197OtherCostOrOtherBasis
Depreciation29803Depreciation
Book Value1394BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis292356OtherCostOrOtherBasis
Depreciation175779Depreciation
Book Value116577BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings716291TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Liability-Split Interest Agreement$126,276
Due to CentraState MC - Intercompany$1,225,552
FieldValueIRS element (for citing)
Total Of Amounts1351828TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt3056523TotRevenueEtcAuditedFinclStmt
Revenue Subtotal3056523RevenueSubtotal
Total Revenue Per Form9903056523TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2730674TotExpensesEtcAuditedFinclStmt
Expenses Subtotal2730674ExpensesSubtotal
Total Expenses Per Form9902730674TotalExpensesPerForm990

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agreement Ref FundraisingfalseAgreementRefFundraising

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1MS EventsNameOfEvent1
Gross Receipts Event1193304GrossReceiptsEvent1
Charitable Contributions Event156300CharitableContributionsEvent1
Gross Revenue Event1137004GrossRevenueEvent1
Other Direct Expenses Event171887OtherDirectExpensesEvent1
Name Of Event2Band Aid OpenNameOfEvent2
Gross Receipts Event2152717GrossReceiptsEvent2
Charitable Contributions Event23480CharitableContributionsEvent2
Gross Revenue Event2149237GrossRevenueEvent2
Other Direct Expenses Event293401OtherDirectExpensesEvent2
Gross Receipts Total346021GrossReceiptsTotal
Charitable Contributions Total59780CharitableContributionsTotal
Gross Revenue Total Events286241GrossRevenueTotalEvents
Other Direct Expenses Total Events165288OtherDirectExpensesTotalEvents
Direct Expense Summary Events165288DirectExpenseSummaryEvents
Net Income Summary120953NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistancePurpose Of GrantPurposeOfGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
VNA Health Group
176 Riverside AvenueRed BankNJ07701210639369501 (c) 395000Comm Organization Donation
National MS Society
1 Kalisa WayParamusNJ07652135661935501 (c) 3142000Comm Organization Donation
March Of Dimes
2400 Main Street Extension 1SayrevilleNJ08872131846366501 (c) 3108000Comm Organization Donation
CentraState Medical Center
901 West Main StreetFreeholdNJ07728221750190501 (c) 31157178167684Ambulatory Campus additionCostEquipment
CentraState Assoc Auxiliary
901 West Main StreetFreeholdNJ07728221750190501 (c) 386450Comm Organization Donation
Applewood Estates
1 Applewood DriveFreeholdNJ07728222575377501 (c) 31293612767Resident NeedsCostEquipment
American Heart Association
1 Union Street Suite 301RobbinsvilleNJ08691135613797501 (c) 3100000Comm Organization Donation
American Cancer Society
2310 Route 34 Suite 1DManasquanNJ08736131788491501 (c) 3158000Comm Organization Donation
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants8TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGrantmaker's Description of How Grants are UsedIdentifier
ExplanationThe Foundation solicits and raises funds for operating and capital needs , 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgs
Roman Lucky
VP Development1762092441860822055215511242772
John T Gribbin
President & CEO532598230545217738214688125111208080
John Dellocono
SR VP-CFO31070070459626597194715467531232
Daniel Messina
SR VP-COO404670920831006889889713967710305

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Sch J, Part I, Line 7Part 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.
Sch J, Part I, Line 1aPart 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".

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 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.
Form 990, Part VI, Line 15bForm 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 12cForm 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 11bForm 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 7bForm 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 7aForm 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 6Form 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
CentraState Assisted Living Inc
560 Iron Bridge RoadFreeholdNJ07728223520730Assisted LivingNJ501 (c) 39CentraState Healthcare System Inctrue
CentraState Healthcare Affiliates Inc
689 West Main StreetFreeholdNJ07728521594300Nursing HomeNJ501 (c) 39CentraState Healthcare System Inctrue
Center for Aging Inc
1 Applewood DriveFreeholdNJ07728222575377CCRCNJ501 (c) 39CentraState Healthcare System Inctrue
CentraState Healthcare Systems Inc
901 West Main StreetFreeholdNJ07728222482803ManagementNJ501 (c) 311afalseN/A
CentraState Medical Center
901 West Main StreetFreeholdNJ07728221750190Medical CenterNJ501 (c) 33CentraState Healthcare System Inctrue

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrg
CentraState Medical Associates PC
901 West Main StreetFreeholdNJ07728223402359Med/HlthNJN/AC corptrue
CentraState Healthcare Services Inc
901 West Main StreetFreeholdNJ07728222512830Med/HlthNJN/AC corptrue
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CentraState Healthcare Services Inc
a103326Cost
CentraState Medical Center
q818785Cost
CentraState Medical Center
p91242Cost
CentraState Medical Center
b1324862Cost