2011-05-13T10:49:47-05:00 2010-06-30 EisnerAmper LLP 2015 LINCOLN HIGHWAY POBOX 988 EDISON NJ 088180988 990 2009-07-01 010553478 EAST MOUNTAIN HOSPITAL INC EAST 9082811439 PO BOX 1029 BELLE MEAD NJ 085021029 RANDOLPH JACOBSON 9082811439 2011-05-10 1 RICHARD A SACKIN 7322871000 2009 2016-02-24 21:20:13Z MICHAEL VOORHEES PO BOX 1029 BELLE MEAD NJ 085021029 4137776 0 X eastmountainhospital.com X 2003 NJ EAST MOUNTAIN HOSPITAL IS AN INPATIENT PSYCHIATRIC HOSPITAL. 7 5 57 0 0 0 220 3000 4093662 4132748 2650 130 3815 1898 4100347 4137776 0 0 2225660 2259311 0 0 1881151 1818950 4106811 4078261 -6464 59515 1617949 2007340 2409851 2739727 -791902 -732387 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. 0 0 3508841 4132748 Psychiatric hospital which cared for 405 INPATIENTS AND HAD A TOTAL OF 5,415 PATIENT DAYS. 3508841 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 57 1 0 0 0 0 0 0 0 0 0 0 0 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NJ X X MICHAEL VOORHEES 9082811439 EAST MOUNTAIN ROAD BELLE MEAD NJ 085021029 MARY PAWLIKOWSKI 0.00 X 0 0 0 BOHDAN CEHELYK MD 40.00 X X 229217 0 38275 MICHAEL VOORHEES 40.00 X X 111260 0 26830 DAVID CENTAFONT 0.00 X 0 0 0 ENRICO DEGIRONIMO 0.00 X 0 0 0 RANDOLPH JACOBSON 0.00 X X 0 0 0 PATRICIA TOOLE 0.00 X X 0 0 0 KAREN BRELOWSKI 40.00 X 89191 0 10366 429668 0 75471 2 0 1 0 CARRIER CLINIC PO BOX 147 BELLE MEAD NJ 08502 ADMINISTRATIVE & CLINICAL SUPPORT 753557 sodexo inc po box 905374 CHARLOTTE NC 28290 DIETARY/HOUSEKEEPING SERVICES 135140 2 3000 3000 NET PATIENT REVENUE 624100 4132748 4132748 4132748 130 130 150 150 150 LABOR SUPPORT 900099 1662 1662 ADMINISTRATIVE FEE 900099 52 52 MISCELLANEOUS 900099 34 34 1748 4137776 4132748 0 2028 429657 317250 112407 1451270 1410425 40845 72428 66527 5901 146955 125614 21341 159001 147678 11323 72564 65286 7278 1244 1244 32312 32312 770730 463255 307475 873 873 30236 15372 14864 220538 217033 3505 2591 2591 5096 4555 541 4481 4481 112470 112470 PATIENT - RELATED 377697 377697 DIET/ENVIRONMENTAL SVS 157554 157554 MISCELLANEOUS 17969 12939 5030 BAD DEBT EXPENSE 12595 12595 4078261 3508841 569420 0 795284 1344749 687206 541463 96090 86240 81811 46923 39369 34888 1617949 2007340 405637 275289 2004214 2464438 2409851 2739727 X -791902 -732387 -791902 -732387 1617949 2007340 X 0 1 1 X 0 X 64021 29481 34540 17790 17442 348 34888 DUE TO CARRIER CLINIC 112991 ACCRUED PENSION EXPENSE 39910 DUE TO THIRD PARTIES 2311537 2464438 4137776 4078261 59515 0 59515 4137776 0 4137776 0 4137776 4078261 0 4078261 0 4078261 PART X, QUESTION 2: EFFECTIVE JULY 1, 2009, THE HOSPITAL ADOPTED THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODE (ASC) SUBTOPIC 740-10, INCOME TAXES (ASC 740-10) AND FASB ACCOUNTING STANDARDS UPDATE (ASU) 2009-06, INCOME TAXES (TOPIC 740): IMPLEMENTATION GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AND DISCLOSURE AMENDMENTS FOR NONPUBLIC ENTITIES (ASU 2009-06). UNCERTAINTY IN INCOME TAXES AS USED IN THE CONTEXT OF ASC 740-10 AND ASU 2009-06 REFERS TO THE ACCOUNTING AND DISCLOSURE FOR UNCERTAINTIES IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS AND PRESCRIBES A THRESHOLD OF MORE-LIKELY-THAN-NOT FOR RECOGNITION AND DERECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT REVIEWS TRANSACTIONS TO ESTIMATE POTENTIAL TAX LIABILITIES. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. THE EFFECT OF THE ADOPTION OF ASC 740-10 AND ASU 2009-06 DID NOT HAVE ANY IMPACT ON THE FINANCIAL STATEMENTS OF THE HOSPITAL. 1 1 X 1 X 1 X 100.000000000000 1 1 1 0 0 9412 9412 0.00230 2229340 2129957 99383 0.02440 2238752 2129957 108795 0.02670 338 338 0.00010 338 338 0.00010 2239090 2129957 109133 0.02680 2325 2325 0.00060 2325 2325 0.00060 1 5991 0 1406814 1256417 150397 X 1 1 EAST MOUNTAIN HOSPITAL INC

PO BOX 1029 BELLE MEAD NJ 085021029

X Part I, Line 7, column f - Percent of total expenseBad debt expense for 2009/2010 is $12,595 and is excluded from total expenses for calculating the percentage of total expense.Part I, Line 7 - Costing methodologyThe 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 - Footnote from auditPatient accounts receivable are recorded at the reimbursable 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, Line 2: EAST MOUNTAIN HOSPITAL (EMH) INCORPORATES NATIONAL, STATE, AND CLINICAL INDUSTRY DATA IN THE DEVELOPMENT OF CLINICAL SERVICES. EMH IS A MEMBER OF THE NEW JERSEY ASSOCIATION OF MENTAL HEALTH AND ADDICTION AGENCIES WHICH 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, Line 3: Under a service agreement with Carrier Clinic, a financial counselor 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 financial counselor provides charity care applications to the patient accordingly. Part VI, Line 4: EMH serves the entire state of New Jersey; however the main patient population is from suburban areas. The main source of admissions in 2009/2010 was from Middlesex, Somerset, Ocean, Mercer and Monmouth Counties, all located in New Jersey. Of these five counties, an average of 6.84% of the population falls below poverty level. Part VI, Line 5: 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 spends approximately three hours each month of the year collecting trash. X X X 0 0 0 0 0 0 0 0 0 BOHDAN CEHELYK MD 225717 0 0 0 3500 0 14900 0 23375 0 267492 0 0 0 Form 990, Part VI, Section B, line 11 THE BOARD OF TRUSTEES REVIEWS THE FORM 990 IN ADVANCE OF THE FILING WITH THE IRS. THE 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 AND COTTER, NJMHA, MODERN HEALTHCARE PUBLICATIONS AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISIONS. 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 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, 2010, the total cost of these services amounted to $753,557 - $456,766 for clinical services and $296,791 for various business support functions such as financial reporting, billing, information technology, human resources, and other business functions.