2023-11-13T10:55:33-06:00 2022-12-31 346565596 Ernst & Young US LLP 1 MANHATTAN WEST NEW YORK NY 10001 990 2022-01-01 832620066 Chambers Center For Well-Being LLC CHAM 9734512005 475 South Street Morristown NJ 07960 Michael Walter SVP, CFO 9734512005 2023-11-13 1 Michael Walter XXX-XX-XXXX 0 Nicole Sokolowski P01683199 2127733000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Michael Walter 475 South Street Morristown NJ 07960 902752 0 X N/A X 2018 NJ To promote health and wellbeing for the benefit of the surrounding community. 4 0 0 0 0 0 0 0 713235 902752 0 0 0 0 713235 902752 0 0 0 0 1148195 1408643 0 0 2665 918406 812409 2066601 2221052 -1353366 -1318300 0 0 2863471 4181771 -2863471 -4181771 The purpose of the Chambers Center for Well-Being LLC is to operate as an integrative medicine facility including physician consultations, nutrition, fitness, stress management, complementary treatment services and other charitable or educational services. 0 0 1842362 0 902752 Operates the Chambers Center for Well-Being, an integrative medicine facility including physician consultation, nutrition, fitness, stress management and complementary treatment services. 1842362 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X KEN BUTKOWSKI 9734512005 475 SOUTH STREET MORRISTOWN NJ 07960 Brian Gragnolati President & CEO 2.00 55.00 X X 0 5942931 1085393 Nichell Sumpter EVP-Chief Administrative O 2.00 55.00 X X 0 1650538 210951 Cristin Cooney Director-Workforce Wellbei 2.00 55.00 X X 0 113426 0 Christopher Zipp DO Trustee 2.00 55.00 X X 0 573458 41605 Michael Walter SVP-Chief Financial Officer 2.00 55.00 X 0 255292 37236 Kevin Lenahan EVP-Chief Business & Strategy Officer 2.00 55.00 X 0 917182 1431850 0 9452827 2807035 0 0 1 0 0 Healthcare Related Ser 621300 902752 902752 902752 902752 902752 0 0 1379031 1143906 233470 1655 29612 24563 5013 36 39612 32858 6706 48 226211 187642 38298 271 11878 9853 2011 14 Supplies 467317 387639 79117 561 Other Expenses 45420 37676 7690 54 Sales Tax 21971 18225 3720 26 2221052 1842362 376025 2665 0 0 113611 78050 2749860 4103721 2863471 4181771 X 0 0 0 0 -2863471 -4181771 -2863471 -4181771 0 0 -1318300 0 X 0 0 0 X 40781 40781 300815 713235 902752 1916802 40781 300815 713235 902752 1957583 0 0 0 1957583 40781 300815 713235 902752 1957583 1.00000 0.00000 X 0 Due to AHS Hospital Corp 4103721 4103721 0 1 0 0 0 0 0 0 0 Brian Gragnolati President & CEO 0 2744023 0 2437600 0 761308 0 1068675 0 16718 0 7028324 0 690901 Kevin Lenahan EVP-Chief Business & Strategy Office 0 266037 0 52083 0 599062 0 1415320 0 16530 0 2349032 0 2578814 Nichell Sumpter EVP-Chief Administrative O 0 768201 0 757596 0 124741 0 194240 0 16711 0 1861489 0 110079 Christopher Zipp DO Trustee 0 480052 0 92440 0 966 0 21350 0 20255 0 615063 0 0 Michael Walter SVP-Chief Financial Officer 0 205292 0 50000 0 0 0 33750 0 3486 0 292528 0 0 Part I, Line 4b 2022 Supplemental Executive Retirement Plan (SERP) Earned Credits During 2022, Atlantic Health System implemented a non-qualified SERP paid entirely by Atlantic Health System. The SERP is provided to individuals that hold an executive position with Atlantic Health System. The SERP is in addition to benefits provided under the Atlantic Health System 403(b) and the Cash Balance plan if hired prior to December 15, 2013. During 2022, the following Trustees received SERP credits: Brian Gragnolati $1,051,602 Nichell Sumpter 185,390 Michael Walter 33,750 The above amounts represent earned credits which have not vested and were not included in their respective 2022 Form W-2's compensation. However, the earned credits were included as Other Compensation in Column (F) of Part VII and as Deferred Compensation in Column (C) of Part II, Schedule J of the 2022 Form 990 per Internal Revenue Service guidance. Once the Trustees meet the applicable vesting criteria of the plan, the SERP credits will be included as taxable compensation in their respective Forms W-2's of that year. 2022 Supplemental Executive Retirement Plan (SERP)Taxable Distributions The following Trustees received taxable SERP distributions during 2022 based on their vesting criteria of the plan document. These taxable SERP distributions were included in the respective 2022 W-2's and is reported in Other Reportable Compensation in Schedule J (Sch J, (B)(ii)) of this IRS 990: Brian Gragnolati $690,901 Nichell Sumpter 110,079 Part I, Line 4b: 2022 Mid Career Hire Plan Earned Credits The following Officer/trustee/key employee earned credits in the non-qualified retirement plan-457(f) plan known as the Mid-Career Hire Plan (MCHP): Kevin Lenahan $1,387,870 The above amount represents earned credits which have not vested and were not included in the respective 2022 W-2 compensation. However, the earned credits were included as Other Compensation in Column (F) of Part VII and as Deferred Compensation in Column (C) of Part II, Schedule J of the 2022 IRS 990 tax return per IRS guidance. Once the officer meets the applicable vesting criteria of the plan, the MCHP credits will be included as taxable compensation in their respective W-2's of that year. 2022 Mid Career Hire Plan The organization provides a supplemental non-qualified retirement plan (457f plan) known as the Mid-Career Hire Plan (MCHP) for certain officers and key employees. During 2022, the following officer/key employee received vested distributions in this non-qualified retirement plan. Such distributions were included in Box 1, Box 5 and Box 16 of their respective Form W-2: Kevin Lenahan $2,578,814 The Mid Career Hire Plan was terminated effective January 1, 2023. Any existing participants were transferred at that time into the Supplmental Exectiuve Retirement Plan (SERP) as outlined above. Form 990, Part VI, Section B, line 11b The 2021 Form 990 filings for Chambers Center For Well-Being LLC were prepared by the Finance Department and reviewed and signed by Ernst & Young LLP. The completed filings were reviewed by Chambers Center For Well-Being LLC's Chief Executive Officer and Chief Financial Officer. Subsequently, they were presented the audit committee for review. All board members were invited to the audit committee to take part in the detailed review. Upon finalization of the Form 990, all board members were provided a copy for their files. Form 990 is filed with the Internal Revenue Service after this review process is complete. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. AHS Hospital Corp 475 South Street Morristown NJ 07960 521958352 Healthcare NJ 501(c)(3) Line 3 Atlantic Health System Inc 1 Atlantic Ambulance Corporation 475 South Street Morristown NJ 07960 223820288 Healthcare Transportation NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 Atlantic Health System Inc 475 South Street Morristown NJ 07960 223380375 Human Health Through AHS Hospital Corp NJ 501(c)(3) Line 12a, I N/A 0 Newton Medical Center Foundation 175 High Street Newton NJ 07860 222618102 Administers donations, grants and bequests and performs fundraising. NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Prime Care Inc 175 High Street Newton NJ 07860 222759566 Provides home health and other healthcare services NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 North Jersey Health Care Properties Inc 175 High Street Newton NJ 07860 223519709 Owns commercial buildings and conducts leasing activities NJ 501(c)(2) Atlantic Health System Inc 1 Practice Associates Medical Group 475 South Street Morristown NJ 07960 202088165 Physician Services NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Chilton Medical Center Auxiliary Inc 97 West Parkway Pompton Plains NJ 07444 222883605 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Foundation for Morristown Medical Center 475 South Street Morristown NJ 07960 223392808 Fundraising for exempt organization NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Chilton Realty Holding Inc 97 West Parkway Pompton Plains NJ 07444 223067739 Real Estate and Leasing Activities for the Benefit of Exempt Organization NJ 501(c)(2) Atlantic Health System Inc 1 Foundation for Hackettstown Medical Center 651 Willow Grove Street Hackettstown NJ 07840 222333410 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Medical Center Partners Inc 651 Willow Grove Street Hackettstown NJ 07840 454789273 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Hackettstown Reg Medical Ctr Emergency Medical Services Inc 651 Willow Grove Street Hackettstown NJ 07840 270820164 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 Adult Day Center of the Visiting Nurse Assoc of Somerset County 200 Mount Airy Rd Basking Ridge NJ 07920 222865641 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visting Nurse Assoc of Somerset Hills Comm Health Serv Inc 200 Mount Airy Rd Basking Ridge NJ 07920 223413041 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visiting Nurse Assoc of Somerset Hills Home Hlth &Hosp Serv Inc 200 Mount Airy Rd Basking Ridge NJ 07920 221487373 Home health and hospice services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Visting Nurse Assoc of Somerset Hills Inc 200 Mount Airy Rd Basking Ridge NJ 07920 222888648 Home health services NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 Center for Aging Inc 901 West Main Street Freehold NJ 07728 222575377 Health Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 CentraState Assisted Living Inc 901 West Main Street Freehold NJ 07728 223520730 Health Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 Healthcare Affiliates Inc 901 West Main Street Freehold NJ 07728 521594300 Health Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 1 CentraState Healthcare System Inc 901 West Main Street Freehold NJ 07728 222482803 Management NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 1 CentraState Healthcare Foundation Inc 901 West Main Street Freehold NJ 07728 270383065 Fundrasing NJ 501(c)(3) Line 7 Atlantic Health System Inc 1 CentraState Medical Center 901 West Main Street Freehold NJ 07728 221750190 Healthcare Services NJ 501(c)(3) Line 3 Atlantic Health System Inc 1 Morristown Medical Investors 200 American Road Morris Plains NJ 07950 650840535 Real Estate NJ 0 0 Primary Care Partners LLC 475 South Street Morristown NJ 07960 274980253 Physician Services NJ 0 0 Atlantic Rehabilittation Institute LLC 680 South Fourth Street Louisville KY 40202 814711074 Rehabilitation Facility NJ 0 0 Atlantic Health Partners LLC 475 South Street Morristown NJ 07960 824198770 Physician Services NJ 0 0 Atlantic Health Management Corp and Subsidiaries 200 American Road Morris Plains NJ 07950 223538027 Healthcare NJ N/A C 0 AHS Insurance Company LTD 200 American Road Morris Plains NJ 07950 223380375 Insurance NJ N/A C 0 Nutley Medical Care PA 100 Madison Avenue Morristown NJ 07960 223645010 Healthcare NJ N/A C 0 Non-Invasive Diagnostics PA 100 Madison Avenue Morristown NJ 07960 202027439 Healthcare NJ N/A C 0 Specialty Care of Practice Associates PA 100 Madison Avenue Morristown NJ 07960 030376428 Healthcare NJ N/A C 0 Maternal Fetal Medicine of Practice Associates PA 100 Madison Avenue Morristown NJ 07960 030376421 Healthcare NJ N/A C 0 Madison Pediatrics PA 100 Madison Avenue Morristown NJ 07960 223645007 Healthcare NJ N/A C 0 AHS ACO LLC 475 South Street Morristown NJ 07960 273800813 Physician Practice NJ N/A C 0 The Northwest New Jersey MedicalAlliance PC 175 High Street Newton NJ 07860 450577942 Healthcare Services NJ N/A C 0 The Northwest New Jersey Urgent Care Alliance PC 175 High Street Newton NJ 07860 830492357 Healthcare Services NJ N/A C 0 Chilton Community Care Inc and Subs 97 West Parkway Pompton Plains NJ 07444 222869148 Healthcare NJ N/A C 0 Atlantic Advanced Urgent Care LLC 475 South Street Morristown NJ 07960 831558799 Healthcare NJ N/A C 0 Care Better ACO LLC 475 South Street Morristown NJ 07960 831224464 Physician Practice NJ N/A C 0 Atlantic Executive Health PA 475 South Street Morristown NJ 07960 471944011 Physician Practice NJ N/A C 0 AHS Health Network LLC 475 South Street Morristown NJ 07960 474079001 Physician Practice NJ N/A C 0 Atlantic Health ACO LLC 475 South Street Morristown NJ 07960 474126650 Physician Practice NJ N/A C 0 Tertiary Care Specialists of Practice Associates PA 475 South Street Morristown NJ 07960 830713277 Physician Practice NJ N/A C 0 Visiting Nurse Assoc of Somerset Hills Office Park Condominium 200 Mount Airy Rd Basking Ridge NJ 07920 261183397 Home health services NJ N/A C 0 Ancillary Specialists of Practice Assoc PA 475 South Street Morristown NJ 07960 844693833 Physician Practice NJ C 0 Functional Medicine of Practice Associates 475 South Street Morristown NJ 07960 845006796 Physician Practice NJ C 0 Atlantic Urgent Care LLC 181 High Street Newton NJ 07860 491693160 Healthcare Services NJ C 0 CentraState Healthcare Services Inc 901 West Main Street Freehold NJ 07728 222512830 Health Services NJ Atlantic Healthcare System Inc C 0 CentraState Medical Associates PC 901 West Main Street Freehold NJ 07728 223402359 Health Services NJ Atlantic Healthcare System Inc C 0 CentraState Specialists PC 901 West Main Street Freehold NJ 07728 823704077 Health Services NJ C 0 CentraState Captive Insurance Co LTD 901 West Main Street Freehold NJ 07728 981205985 Health Services CJ Atlantic Healthcare System Inc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0