2013-11-15T15:43:56-06:00 2012-12-31 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2012-01-01 221494446 ST MARY'S HOSPITAL STMA 9735947835 350 BOULEVARD PASSAIC NJ 07055 NICHOLAS LANZA 9735947835 2013-11-15 1 JULIUS C GREEN CPA JD P00350393 2159720701 2012 2016-03-07 17:11:31Z NICHOLAS LANZA 350 BOULEVARD PASSAIC NJ 07055 168388389 0 X WWW.SMH-PASSAIC.ORG X 1895 NJ ST. MARY'S IS A NON-PROFIT ACUTE CARE HOSPITAL OFFERING A BROAD RANGE OF HEALTH CARE SERVICES. 19 19 1561 150 0 0 4253847 15193876 148139011 151867020 -11119894 60104 847637 1007597 142120601 168128597 0 0 0 0 92122651 89472595 0 0 0 83028129 80344720 175150780 169817315 -33030179 -1688718 66531092 48308042 144227733 126949886 -77696641 -78641844 X SINCE 1895, WHEN THE SISTERS OF CHARITY OF ST. ELIZABETH FOUNDED THE HOSPITAL, ST. MARY'S HAS BEEN DEDICATED TO SERVING THE HEALTH NEEDS OF THE PEOPLE OF CLIFTON, PASSAIC AND THE SOUTH BERGEN COMMUNITIES. TODAY WE OFFER CONVENIENT ACCESS TO THE LATEST DIAGNOSTIC EQUIPMENT, A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES, AS WELL AS AN ARRAY OF EDUCATION, WELLNESS AND OUTREACH PROGRAMS. 0 0 165322400 151875975 HEALTHCARE SERVCIES RENDERED TO APPROXIMATELY 140,000 PATIENTS FOR APPROXIMATELY 50,000 PATIENT DAYS ON BOTH AN INPATIENT AND OUTPATIENT BASIS REGARDLESS OF AN INDIVIDUALS ABILITY TO PAY. THESE SERVICES INCLUDE ACUTE MEDICAL/SURGICAL, CRITICAL CARE, OBSTETRICS, NURSERY, AS WELL AS BEHAVIORAL HEALTH. 165322400 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 159 0 1 1561 1 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NJ X NICHOLAS LANZA 9733654300 350 BOULEVARD PASSAIC NJ 07055 SR BARBARA CONROY 1.00 X X 0 0 0 CRAIG BROWN 1.00 X 0 0 0 SR ELIZABETH CAHILL 1.00 X 0 0 0 SR MAUREEN DUNNE 1.00 X 0 0 0 SR BARBARA GARLAND 1.00 X 0 0 0 SR THOMAS MARY SALERNO 1.00 1.00 X 0 0 0 VINCENT GIARDINO 1.00 X 0 0 0 DOLORES HEALEY 1.00 X 0 0 0 GEORGE JACOBS 1.00 X 0 0 0 HAROLD JAWETZ MD 1.00 X 0 0 0 JOHN F LAEZZA JR 1.00 X 0 0 0 CHARLES E LAROSA 1.00 X 0 0 0 MARIO MARGHELLA 1.00 1.00 X 0 0 0 AHMED MEKKAWY MD 1.00 1.00 X 0 0 0 RAVINDER NARANG MD 1.00 X 0 0 0 MARILYN POMEROY 1.00 X 0 0 0 WILLIAM A WALSH 1.00 X 0 0 0 GABRIELLA WEISS MD 1.00 X 0 0 0 MICHAEL J SNIFFEN 37.50 1.00 X X 907768 0 0 WILLIAM CUSICK 37.50 1.00 X X 453367 0 0 MOST REV ARTHUR J SERRATELLI 1.00 X 0 0 0 EDWARD J CONDIT 37.50 1.00 X 275588 0 0 NICHOLAS LANZA 37.50 1.00 X 104231 0 0 JOHN D ARCH 37.50 X 120497 0 0 CHRISTINA FISCHER 37.50 1.00 X 201384 0 0 HUZAIFA SHAKIR 37.50 X 212073 0 0 DANIEL CONROY 37.50 X 208069 0 0 MARIE A KASSAI 37.50 X 206391 0 0 KI SOOK YOO 37.50 X 204861 0 0 CATHY LYNCH KILIC 37.50 1.00 X 185654 0 0 3079883 0 0 95 0 1 0 AMERICHOICEBERGEN DRUG CORP PO BOX 642755 PITTSBURGH PA 15264 PHARMACEUTICAL 6336894 OWENS & MINOR PO BOX 8500-55182 PHILADELPHIA PA 19178 MEDICAL SUPPLY SERVICES 3925155 ALLSCRIPTS HEALTHCARE LLC 222 MERCHANDISE MART PLAZA SUITE 2 CHICAGO IL 60654 SOFTWARE PROGRAMING 3381949 MEDTRONIC 4642 COLLECTION CENTER DRIVE CHICAGO IL 60693 CARDIAC SUPPLY SERVICES 2407266 RAMAPO VALLEY ANESTHESIA ASSOC 100 ROUTE 59 SUFFERN NY 10901 ANESTHESIA SERVICES 2270830 25 645282 12916321 1632273 15193876 PATIENT SERVICES 623000 151867020 151867020 151867020 60104 60104 207377 259792 -52415 -52415 -52415 JOINT COMMISSION RESOURCES 900099 889481 889481 CAFETERIA 722210 123874 123874 REBATES 900099 21071 21071 25586 8955 16631 1060012 168128597 151875975 0 1058746 X 72789692 71458688 1331004 2598280 2551511 46769 9366028 9197440 168588 4718595 4633660 84935 1167603 1167603 125770 125770 18470944 18470944 185890 185890 1570246 1570246 642126 642126 3777800 3777800 175303 175303 81212 81212 2144735 2144735 3328779 3328779 1382675 1382675 MEDICAL SUPPLIES 26700070 26700070 BAD DEBT EXPENSE 16134990 16134990 REPAIRS & MAINTENANCE 1386778 1386778 DIETARY 1233872 1233872 1835927 1835927 169817315 165322400 4494915 0 13411 13410 289752 1091722 18332587 18081815 2706945 2724668 1217667 239217 98350179 73859424 24607496 24490755 83898 83898 19279336 1582557 66531092 48308042 29530872 28708985 1290021 5047912 41452547 40208208 5444249 5243861 212950 526671 66297094 47214249 144227733 126949886 X -77813885 -78759088 117244 117244 -77696641 -78641844 66531092 48308042 X -1688718 743515 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2350011 2350011 43948842 31173424 12775418 47222000 42686000 4536000 4829326 4829326 24490755 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 25538828 ACCRUED REORGANIZATION COSTS -88653 ACCRUED PENSION LIABILITY 19553307 OTHER LONG-TERM LIABILITIES 1269329 CREDIT BALANCE PREPAID INVOICES 941438 47214249 X 168388389 0 168388389 -259792 -259792 168128597 170820622 1003307 1003307 169817315 0 169817315 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN THE FINANCIAL STATEMENTS USING A RECOGNITION THRESHOLD OF MORE LIKELY THAN NOT AS TO WHETHER THE UNCERTAINTY WILL BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD. THE HOSPITAL'S FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURNS FOR 2009 THROUGH 2012 REMAIN SUBJECT TO EXAMINATION BY THE IRS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -259,792. PART XII, LINE 2D - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT 743,515. RENTAL EXPENSES 259,792. 1 1 1 X 300.000000000000 0 1 1 1 0 1 1 10285228 8776924 1508304 0.00980 16794938 16565954 228984 0.00150 27080186 25432878 1647308 0.01070 54160352 50775756 3384596 0.02200 54160352 50775756 3384596 0.02200 1 16134990 62692107 64538014 -1845907 X 1 1 1 1 ST MARY'S HOSPITAL

350 BOULEVARD PASSAIC NJ 07055

WWW.SMH-PASSAIC.ORG X X X ST MARY'S HOSPITAL 1 1 1 300.000000000000 0 1 X X X X X 1 1 X X X X X X X 1 0 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 16134990. PART III, LINE 4: ACCOUNTS ARE INDIVIDUALLY ANALYZED FOR COLLECTABILITY; IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS ARE DEEMED UNCOLLECTIBLE AFTER THREE ATTEMPTS ARE MADE TO COLLECT THE DEBT AND THE ACCOUNTS ARE RETURNED TO THE HOSPITAL FROM COLLECTION. BAD DEBT IS ASSUMED TO BE A COMMUNITY BENEFIT BECAUSE THE HOSPITAL HAS ACCEPTED THIS LOSS. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES THE COST-TO-CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS FOR THOSE WHO QUALIFY FOR CHARITY CARE ALL PATIENTS ARE SCREENED FOR FEDERAL AND GOVERNMENTAL PROGRAMS, MEDICARE, MEDICAID, AND NJ FINANCIAL ASSISTANCE. ST. MARY'S HOSPITAL PART V, SECTION B, LINE 14G: THE HOSPITAL WILL PROVIDE THE ACTUAL POLICY AND PROCEDURES MANUAL TO PATIENT UPON REQUEST. INFORMATION REGARDING FINANCIAL ASSISTANCE IS POSTED CLEARLY THROUGHOUT THE HOSPITAL. PART VI, LINE 2: FOR THE PAST 4 YEARS THE COMMUNITY HEALTH DEPARTMENT HAS CONDUCTED A COMMUNITY HEALTH ASSESSMENT AS REQUIRED BY THE AFFORDABLE CARE ACT. THE MOST RECENT ASSESSMENT WAS COMPLETED IN 2012 AND IS BEING IMPLEMENTED.THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH A PAPER SURVEY AND SMALL GROUP QUESTIONS AND DISCUSSIONS AT: SENIOR CENTERS, CHURCH GROUPS, AND IMMIGRANT EDUCATIONAL PROGRAMS. WE DO ONE ON ONE INQUIRIES AS WE GO ALONG. WE ALSO HAVE STRONG CONNECTIONS WITH THE FEDERAL QUALIFIED CLINICS ON 8TH STREET, GARFIELD, AND MAIN STREET - THEY TOO HELP US TO MONITOR COMMUNITY NEEDS. PART VI, LINE 3: OUTREACH WORKERS EDUCATE PEOPLE IN THE COMMUNITIES WHENEVER POSSIBLE EXPLAINING ANY ASSISTANCE PROGRAMS THAT MAY BE AVAILABLE TO THEM. THE COMMUNITY HEALTH DEPARTMENT WILL THEN CONNECT THEM TO THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS ADVISORS WHO PROVIDE THE AVAILABILITY OF FINANCIAL ASSISTANCE ON A CASE BY CASE BASIS. PART VI, LINE 4: THE HOSPITAL SERVES PASSAIC, CLIFTON, WALLINGTON, LYNDHURST, RUTHERFORD, EAST RUTHERFORD, CARLSTADT, AND LODI, NEW JERSEY. THE MAJORITY OF THE POPULATION IS CONSIDERED LOW-INCOME. APPROXIMATELY 13.6% OF FAMILIES IN PASSAIC COUNTY ARE BELOW THE FAMILY POVERTY LEVELS. PART VI, LINE 5: ST MARY'S HOSPITAL HAS CONSISTENTLY WORKED IN PASSAIC AND ITS SURROUNDING TOWNS IN DESCRIBING PROGRAM, EDUCATIONAL NEEDS AND IN OFFERING FREE HEALTH CARE SCREENINGS. IN ADDITION, THE HOSPITAL CONDUCTS FOOD DRIVES AND PROVIDES CLOTHING AND GENERAL CARE FOR MANY LOW INCOME FAMILIES.SMH COMMUNITY HEALTH DEPARTMENT ENGAGES A COMMUNITY ADVISORY BOARD CONSISTING OF REPRESENTATIVES FROM LOCAL AND COUNTY HEALTH SERVICE AGENCIES. THIS GROUP SEEKS FUNDING /GRANT OPPORTUNITIES TO BENEFIT THE COMMUNITY WE SERVE.ANY SURPLUS FUNDS ARE REINVESTED IN THE CAPITAL OF THE HOSPITAL, USED FOR TECHNOLOGY PURCHASES FOR THE LATEST MEDICAL EQUIPMENT, AND HELD FOR FUTURE USES FOR CARE OF THE INDIGENT. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF A HEALTH SYSTEM BUT COLLABORATES WITH OTHER HEALTH AGENCIES WHENEVER POSSIBLE. X X X 1 0 0 0 0 0 0 0 0 MICHAEL J SNIFFEN 329856 0 0 0 577912 0 0 0 0 0 907768 0 0 0 WILLIAM CUSICK 241521 0 0 0 211846 0 0 0 0 0 453367 0 0 0 EDWARD J CONDIT 275588 0 0 0 0 0 0 0 0 0 275588 0 0 0 CHRISTINA FISCHER 201384 0 0 0 0 0 0 0 0 0 201384 0 0 0 HUZAIFA SHAKIR 212073 0 0 0 0 0 0 0 0 0 212073 0 0 0 DANIEL CONROY 208069 0 0 0 0 0 0 0 0 0 208069 0 0 0 MARIE A KASSAI 206391 0 0 0 0 0 0 0 0 0 206391 0 0 0 KI SOOK YOO 204861 0 0 0 0 0 0 0 0 0 204861 0 0 0 CATHY LYNCH KILIC 185654 0 0 0 0 0 0 0 0 0 185654 0 0 0 PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS: MICHAEL SNIFFEN - $577,912 WILLIAM CUSICK - $211,846 A NEW JERSEY HEALTH CARE FACILITIES FINANCING AUTHORITY 221987084 2007-02-28 45150000 PURCHASE CERTAIN ASSETS OF A MEDICAL CENTER; REFINANCE 1999 BONDS 0 0 0 A 4877635 45150000 986851 36739000 7424149 2007 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11 THE HOSPITAL WILL PROVIDE A COPY OF THE FORM 990 TO THE GOVERNING BODY AND PRESENT THE FORM IN DETAIL TO THE BOARD AT A REGULARLY SCHEDULED MEETING AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL HAS A CORPORATE COMPLIANCE POLICY, WHICH ADDRESSES CONFLICTS OF INTEREST, IN PLACE THAT THE BOARD MEMBERS AND OFFICERS READ AND SIGN OFF ON ANNUALLY. THE COMPLIANCE OFFICER REVIEWS AND MONITORS THE POLICY AND IS KEPT INFORMED OF ANY COMPLIANCE ISSUES. VIOLATIONS ARE HANDLED ON A CASE BY CASE BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES IN EXECUTIVE SESSION REVIEWS THE COMPENSATION OF EXECUTIVES. AN ANALYSIS IS PRESENTED AND REVIEWED AS TO ACCOMPLISHMENTS AGAINST ESTABLISHED GOALS. THE FINANCIAL AND CLINICAL PERFORMANCE OF THE HOSPITAL IS REVIEWED AGAINST INDUSTRY BENCHMARKS. FINALLY, MARKET COMPENSATION DATA IS REVIEWED AND COMPARED TO EXECUTIVE COMPENSATION AS TO REASONABLENESS OF COMPENSATION LEVELS TO ENSURE COMPENSATION DOES NOT EXCEED FAIR MARKET VALUE. THE EXECUTIVES' SALARIES ARE APPROVED BY THE BOARD AND DOCUMENTED VIA EXECUTIVE SESSION MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL ALSO MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G NEO NATOLOGY - ON CALL: PROGRAM SERVICE EXPENSES 70,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,000. PODIATRY FEES: PROGRAM SERVICE EXPENSES 70,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,500. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 11,392,643. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,392,643. CONSULTING: PROGRAM SERVICE EXPENSES 1,938,776. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,938,776. TRANSCRIPTION SERVICES: PROGRAM SERVICE EXPENSES 450,518. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 450,518. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 3,350,416. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,350,416. OUTSIDE LAB TESTS: PROGRAM SERVICE EXPENSES 565,468. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 565,468. DIALYSIS SERVICE: PROGRAM SERVICE EXPENSES 6,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,700. CARDIAC SERVICES: PROGRAM SERVICE EXPENSES 89,940. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,940. PATHOLOGY SERVICES: PROGRAM SERVICE EXPENSES 29,506. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,506. OTHER FEES: PROGRAM SERVICE EXPENSES 506,477. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 506,477. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT 743,515. ST MARY'S HEALTH CORPORATION 350 BOULEVARD PASSAIC NJ 07055 ESTABLISH, MAINTAIN, AND PROMOTE EDUCATION AND RESEARCH TO HUMAN HEALTH NJ 501(C)(3) LINE 4 N/A 0 ST MARY'S HOSPITAL FOUNDATION 350 BOULEVARD PASSAIC NJ 07055 542116468 FUNDRAISING ACTIVITIES AND SUPPORT TO HOSPITAL NJ 501(C)(3) LINE 4 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0