2025-11-13T14:23:20-06:00 2024-12-31 346565596 Ernst & Young US LLP 1 Manhattan West New York NY 10001 990 2024-01-01 222333410 Foundation for Hackettstown Medical Center FOUN 9734512005 651 Willow Grove Street Hackettstown NJ 07840 Michael Walter SVP, CFO 9734512005 2025-11-13 1 0 Nicole Sokolowski P01683199 2127733000 2024 2025-03-06 01:10:19Z MICHAEL WALTER 651 Willow Grove Street Hackettstown NJ 07840 623682 0 X www.hrmcnjfoundation.org X 501(c)(3) 1980 NJ To serve the philanthropic needs for the Hackettstown Medical Center. 15 13 0 11 0 0 375927 395448 0 0 99204 208613 -38920 -36823 436211 567238 78348 73500 0 0 297020 311676 0 0 197267 28939 56855 404307 442031 31904 125207 3847403 4082641 130434 51253 3716969 4031388 Refer to Schedule O 0 0 2167 2167 Foundation for Hackettstown Medical Center transfers funds to Hackettstown Medical Center (the "Hospital") to support the Hospital and the community it serves. Transfers include payments on various capital campaigns supporting capital projects of the Hospital as well as donations made for a specific purpose benefiting various areas of the Hospital. 54662 54662 Board approved funding that the Foundation awarded to Hackettstown Medical Center fo an Oncology Nurse Navigator to help assist the patient, their family, and/or carefivers across the continuum, to overcome any health barriers, providing a comprehensive assessment and facilitate timely referrals for appointments to the multidisciplinary oncology team. 16671 16671 Board approved funding to Hacketstown Medical Center for a Mobility Aid. This is an early mobilization project that addresses patients needs to be mobile during their hospital stay, contribution to a positive impact on morbidity, mortality, an unnecessary legal lengths of stay. 73500 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NJ X Ken Butkowski 9734512005 475 South Street Morristown NJ 07960 Robert Adams Jr President, Western Region 27.50 27.50 X X 0 1266625 185492 Megan Sandow Chief Development Officer 27.50 27.50 X X 0 337441 32230 Eric Cross Trustee 2.00 X 0 0 0 Janen Ardia Trustee- Chair 2.00 X X 0 0 0 John Johnson Trustee 2.00 X X 0 0 0 Maria DiGiovanni Trustee 2.00 X X 0 0 0 Gregory W Stewart Trustee 2.00 X 0 0 0 Mattar Mattar Trustee 2.00 X 0 0 0 Michael S Selvaggi Esq Trustee 2.00 X 0 0 0 Norman Worth Trustee 2.00 X 0 0 0 Peter Olivieri Trustee 2.00 X 0 0 0 Tom R Dartnell Trustee 2.00 X 0 0 0 Virginia Mahoney Trustee 2.00 X 0 0 0 Mary Maier Trustee 2.00 X 0 0 0 Marvin S Fish Esq Trustee 2.00 X 0 0 0 Michael Walter SVP-Chief Financial Office 2.00 55.00 X 0 1615288 257152 Kevin Lenahan EVP-Chief Business & Strat 2.00 55.00 X 0 2924716 461142 0 6144070 936016 0 0 1 0 0 161006 234442 395448 104458 104458 104155 0 104155 104155 104155 12321 161006 52794 -40473 -40473 7300 3650 3650 3650 567238 0 0 171790 73500 73500 311676 158955 152721 4918 4918 2539 2539 1350 1350 1872 1527 345 42851 42851 Auxiliary Expenses 3325 3325 442031 73500 171264 197267 459287 303334 260720 139882 7907 4697 3119489 3634728 3847403 4082641 116 1435 1500 0 128818 49818 130434 51253 X 800891 995637 2916078 3035751 3716969 4031388 3847403 4082641 125207 189212 0 X 0 1 X 1 0 X 193795 293831 337253 375927 395448 1596254 193795 293831 337253 375927 395448 1596254 162257 1433997 111041 112898 77832 92493 104458 498722 2094976 0.68450 0.71880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2916078 195624 75951 3035751 2946021 41021 70964 2916078 2810912 147105 11996 2946021 2562490 248422 2810912 2311467 256984 5961 2562490 0.23300 0.76700 0 0 0 Due to Affiliates 49818 49818 812894 189212 56444 245656 567238 0 567238 498474 56444 56444 442030 0 442030 Part V, Line 4: The endowment fund will be invested to provide a permanent source of income to be used by the Foundation for Hackettstown Medical Center for its tax-exempt purpose of providing support to the Hackettstown Medical Center. Part XI, Line 2d - Other Adjustments: Fundraising Direct Costs - Netted against Revenue on Form 990 (Part VIII) 56,444. Part XII, Line 2d - Other Adjustments: Fundraising Direct Costs - Netted against Revenue on Form 990 (Part VIII) 56,444. STL 68910 68910 14050 5164 GOLF OUTING 104417 92096 12321 23101 4703 1 5776 173327 161006 12321 37151 15643 52794 -40473 7300 2664 986 0 7300 2664 986 3650 3650 NJ 1 0 0 0 1.00000 Dawn Sullivan 175 High Street Newton NJ 07860 0 Megan Sandow 625 Manages & oversees all special events including obtaining licenses. X 0 1 AHS Hospital Corp (HMC Division) 651 Willow Grove Street Hackettstown NJ 07840 521958352 501(c)(3) 73500 0 Program Services 1 Schedule I, Part I, Line 2: The Finance and Investment Committee of Foundation for Hackettstown Medical Center will recommend to the board of trustees at the annual board meeting the level of funds available for the calendar year. The committee also reviews and monitors the funds distributed and makes recommendations and suggests guidelines for grant levels distributed. 0 1 0 0 0 0 0 0 0 Kevin Lenahan EVP-Chief Business & Strat 0 1415590 0 1094600 0 414526 0 423493 0 37649 0 3385858 0 0 Michael Walter SVP-Chief Financial Office 0 982449 0 592546 0 40293 0 211325 0 45827 0 1872440 0 0 Robert Adams Jr President, Western Region 0 596552 0 510632 0 159441 0 152992 0 32500 0 1452117 0 140479 Megan Sandow Chief Development Officer 0 288158 0 47477 0 1806 0 13443 0 18787 0 369671 0 0 Part I, Line 4b 2024 Supplemental Executive Retirement Plan (SERP) Earned Credits Atlantic Health implemented a non-qualified Supplemental Executive Retirement Plan (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. Robert Adams, Jr. $134,892 Michael Walter 193,222 Kevin Lenahan 385,483 The above amounts represent earned credits which have not vested and were not included in theor respective 2024 W-2's compensation. However, the earned credit was included as Other Compensation in Column (F) of Part VII and in Schedule J, Column (C) of the 2024 IRS 990 tax return per IRS guidance. Once the Trustees meet the applicable vesting criteria of the plan, the SERP credits will be included as taxable compensation in their respective Form W-2 of that year. 2024 Supplemental Executive Retirement Plan (SERP)Taxable Distributions The following Trustee received taxable SERP distributions during 2023 based on the vesting criteria of the plan document. These taxable SERP distributions were included in the Trustee's 2024 W-2 and reported in Other Reportable Compensation in Schedule J (Sch J, (B)(ii))of the this IRS 990: Robert Adams $ 140,479 Kevin Lenahan 357,274 Form 990, Part VI, Section B, line 11b The final draft of the Form 990 was distributed to the Board of Directors for their review. Form 990, Part VI, Section B, line 12c The Foundation for Hackettstown Medical Center (the Foundation) requires disclosure of potential conflicts. This policy governs all personnel at the Foundation, including Board Members. Additionally, the Board Committee members must fill out annual disclosures with specific questions regarding potential conflicts. For potential conflicts involving employees, conflicts involving business relationships require prior disclosure and approval by the Compliance Officer (General Counsel). Conflicts involving Board members require approval from the Compliance Officer and the head of the Audit Committee, who may refer those conflicts to the Compliance Committee of the Board. Restrictions are fact-dependent, but may include recusal from deliberations regarding subject matter affected by the conflict. Form 990, Part VI, Section B, line 15 A review of officer compensation by an independent 3rd party (Sullivan Cotter) is completed every year by AHS Hospital Corp, a related organization. The most recent survey was conducted in 2024. Form 990, Part VI, Section C, line 18 Currently the Foundation for Hackettstown Medical Center retains copies of the filed Form 990 for the last three years and Form 1023 with the most senior management's assistant. Public disclosure of these Forms 990 can be made at any time at each of the organization's sites. In addition, the Form 990 is posted on the website "www.hrmcnjfoundation.org and "guidestar.org". Form 990, Part VI, Section C, line 19 The organization does not currently make its financial statements open to public disclosure, but the statement of financial position is available by accessing the Form 990 from the website. The governing documents and conflict of interest polices are not currently made available to the public. Part III, Line 1 The mission of the Foundation for Hackettstown Medical Center is to conduct philanthropic programs in support of Hackettstown Medical Center and the communities it serves, to preserve and enhance the delivery of quality health, and wellness services, resulting in a healthier community. 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 Chilton Medical Center Foundation Inc 97 West Parkway Pompton Plains NJ 07444 223084817 Support Charitable Exempt Programs and Services of Medical Center 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 Morristown Medical Center 475 South Street Morristown NJ 07960 223392808 Support Charitable Exempt Programs and Services of Medical Center NJ 501(c)(3) Line 7 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 Association 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 Association of Somerset Hills Community Health Services 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 Health and Hospice ServicesInc 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 Association 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 Heatlh Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 0 CentraState Assisted Living Inc 901 West Main Street Freehold NJ 07728 223520730 Health Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 0 Healthcare Affiliates Inc 901 West Main Street Freehold NJ 07728 521594300 Heatlh Services NJ 501(c)(3) Line 10 Atlantic Health System Inc 0 CentraState Healthcare System Inc 901 West Main Street Freehold NJ 07728 222482803 Management NJ 501(c)(3) Line 12a, I Atlantic Health System Inc 0 CentraState Healthcare Foundation Inc 901 West Main Street Freehold NJ 07728 272383065 Fundraising NJ Line 7 Atlantic Health System Inc 0 CentraSate Medical Center 901 West Main Street Freehold NJ 07728 221750190 Healthcare Services NJ 501(c)(3) Line 3 Atlantic Health System Inc 0 Chambers Center for Well-Being LLC 475 South Street Morristown NJ 07960 832620066 Health Services NJ Line 10 Atlantic Health System Inc 0 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 Rehabilitation Institute LLC 680 South Fourth Street Louisville KY 40202 814711074 Rehabilitation Facility NJ 0 0 Atlantic Health Partners LLC 475 South Street Morris Plains NJ 07960 824198770 Physician Services NJ 0 0 Atlantic Brain and Spine LLC 465 South Street Morristown NJ 07960 931467537 Physician Services NJ 0 0 Premier Health Associates LLC 532 Lafayette Road Suite 300 Sparta NJ 07871 222705732 NJ 0 0 Atlantic Health Management Corp and Subsidiaries 200 American Road Morris Plains NJ 07950 223538027 Health 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 MedicalSurgical Alliance 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 Heatlh 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 Association 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 475 South Street Morristown NJ 07960 844693833 Physician Practice NJ C 0 Functional Medicine of Practice Assoc 475 South Street Morristown NJ 07960 845006796 Physician Practice NJ C 0 Altantic Urgent Care LLC 475 South Street Morristown NJ 07960 461693160 Physician Practice NJ C 0 CentraState Healthcare Services Inc 901 West Main Street Freehold NJ 07960 222512830 Heatlh Services NJ Atlantic Health System Inc C 0 CentraState Medical Associates PC 901 West Main Street Freehold NJ 07728 223402359 Health Services NJ Atlantic Health System Inc C 0 CentraState Speciailists PC 901 West Main Street Freehold NJ 07728 823704077 Health Services NJ Atlantic Health System Inc C 0 CentraState Captive Insurance Co LTD 901 West Main Street Freehold NJ 07728 981205985 Health Services CJ Atlantic Health System Inc 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 AHS Hospital Corp B 73500 Cash Value