Forrest S Chilton 3Rd Memorial Hospital

“Deborah k. Zastocki, fache, michael a. Richetti and aaron van duyne, iii - business relationship”

“During 2013, the organization adhered to its own organizational documents including its bylaws. The organization was statutorily merged into ahs hospital corp., a new jersey nonprofit corporation ("ahs") on december 30, 2013. As a result of the statutory merger, the organization, as of the date of the merger, follows the organizational documents of ahs.”

“The organization was statutorily merged into ahs hospital corp., a new jersey nonprofit corporation ("ahs") on december 30, 2013. Accordingly, the governing body of ahs, its board of trustees, became the governing body of this organization effective december 30, 2013. This federal form 990 was provided to each voting member of ahs' governing body prior to the filing with the internal revenue service ("irs"). The governing body of ahs has assumed the responsibility to oversee and coordinate the federal form 990 including the preparation, review and filing process. As part of the organization's federal form 990 tax return preparation process the organization hired a professional cpa firm with experience and expertise in both healthcare and not-for-profit tax return preparation to prepare the federal form 990. The cpa firm's tax professionals worked closely with ahs and this organization's finance personnel including the chief financial officer, director of accounting and various other individuals to obtain the information needed in order to prepare a complete and accurate tax return. The cpa firm prepared a draft federal form 990 and furnished it to the organization's internal working group, including those individuals outlined above for their review. The organization's internal working group reviewed the draft federal form 990 and discussed questions and comments with the cpa firm. Revisions were made to the draft federal form 990 where necessary and a final draft was furnished by the cpa firm to the organization's internal working group for final review and approval. Thereafter, a copy of this form 990 was provided to each voting memeber of ahs' governing body prior to filing with the irs.”

“The organization regularly monitors and enforces compliance with its conflict of interest policy. Annually all members of the board of trustees, officers and senior management personnel are required to review the existing conflict of interest policy and complete a questionnaire. The completed questionnaires are returned to the organization and the organization's president/chief executive officer ("ceo") for review. Thereafter the organization's president/ceo prepares a summary of the completed questionnaires which contains information disclosed on an individual by individual basis and presents this summary to the organization's governance committee for its review and discussion.”

“The organization's board of trustees has an executive compensation committee ("committee"). The committee has adopted a written executive compensation philosophy which it follows when it reviews and approves of the compensation and benefits of the organization's senior management, including the president/chief executive officer, chief operating officer and chief financial officer. The committee reviews the "total compensation" of the individuals which is intended to include both current and deferred compensation and all employee benefits, both qualified and non-qualified. The committee's review is done on at least an annual basis and ensures that the "total compensation" of senior management of the organization is reasonable. The actions taken by the committee enable the organization to receive the rebuttable presumption of reasonableness for purposes of internal revenue code section 4958 with respect to the total compensation of certain members of the senior management team, including the president/chief executive officer, chief operating officer and chief financial officer. The three factors which must be satisfied in order to receive the rebuttable presumption of reasonableness are the following: 1. The compensation arrangement is approved in advance by an "authorized body" of the applicable tax-exempt organization which is composed entirely of individuals who do not have a "conflict of interest" with respect to the compensation arrangement; 2. The authorized body obtained and relied upon "appropriate data as to comparability" prior to making its determination; and 3. The authorized body "adequately documented the basis for its determination" concurrently with making that determination. The committee is comprised of members of the board of trustees each of who are independent and are free from any conflicts of interest. The committee relied upon appropriate comparable data; specifically the committee obtained a written compensation study from an independent firm which specializes in the reviewing of hospital and healthcare system executive compensation and benefits throughout the united states. This study used comparable geographic and demographic market data including but not limited to similar sized hospitals, # of licensed beds and net patient service revenue. The committee adequately documented its basis for its determination through the timely preparation of written minutes of the compensation committee meetings during which the executive compensation and benefits was reviewed and subsequently approved. The actions outlined above with respect to the committee and the establishment of the rebuttable presumption of reasonableness only applies to certain senior management personnel, including but not limited to the president/chief executive officer, chief operating officer and chief financial officer. The compensation and benefits of certain other individuals contained in this form 990 are reviewed annually by the president/chief executive officer with assistance from organization's human resources department in conjunction with the individual's job performance during the year and is based upon other objective factors designed to ensure that reasonable and fair market value compensation is paid by the organization. Other objective factors include market survey data for comparable positions, individual goals and objectives, personnel reviews, evaluations, self-evaluations and performance feedback meetings.”

“The organization has issued tax-exempt bonds to finance various capital improvement projects, renovations and equipment. In conjunction with the issuance of these tax-exempt bonds, the organization's financial statements were included with the tax-exempt bond prospectus which was made available to the general public for review. In addition, the organization's financial statements are made available to the public on a quarterly basis, in compliance with the disclosure requirements of the tax-exempt bonds. The organization's filed certificate of incorporation and any amendments can be obtained and reviewed through the state of new jersey department of the treasury.”

“Part vii and schedule j reflect certain board members and officers receiving compensation and benefits from the organization. Please note this remuneration was for services rendered as full-time employees or independent contractors of the organization; not for services rendered as a voting member or officer of the organization's board of trustees.”

“For the year 2013, this organization was an affiliate within chilton health network; a tax-exempt integrated healthcare delivery system ("system"). The system includes both for-profit and not for-profit organizations. Certain board of trustee members, officers and/or directors listed on core form, part vii and schedule j of this form 990 may hold similar positions with both this organization and other affiliates within the system. The hours shown on this form 990 for board members who receive no compensation for services rendered in a non-board capacity, represent the estimated hours devoted per week for this organization. To the extent these individuals serve as a member of the board of trustees of other related organizations in the system, their respective hours per week per organization are approximately one hour. The hours reflected on part vii of this form 990, for board members who receive compensation for services rendered in a non-board capacity, paid officers and key employees, reflect total hours worked per week on behalf of the system; not solely this organization.”

“Background ========== chilton hospital ("ch") is a general medical and surgical hospital. Ch is recognized by the irs as an internal revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, ch provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. Moreover, ch operates consistently with the following criteria outlined in irs revenue ruling 69-545: 1) ch provides medically necessary healthcare services to all individual's regardless of ability to pay, including charity care, self-pay, medicare and medicaid patients; 2) ch operates an active emergency department for all persons; which is open 24 hours a day, 7 days a week, 365 days per year; 3) ch maintains an open medical staff, with privileges available to all qualified physicians; 4) control of ch rests with its board of directors; which is comprised of independent civic leaders and other prominent members of the community; and 5) surplus funds are used to improve the quality of patient care, expand and renovate facilities and advance medical care; programs and activities. History ======= the first chapter of ch's history was written in 1947. Forrest s. Chilton iii, m.d., and his wife, elizabeth, donated a tract of land on newark-pompton turnpike to build a hospital in memory of their son whose life was lost in world war ii. Their action sparked a successful drive to build a facility that would serve the health needs of the community and became a reality with a 50-bed facility in 1954, and expanded to 119 beds in 1961. In august 1968, a 40-acre tract was purchased one mile west of the newark-pompton turnpike site and another building, the west parkway facility, was dedicated november 20, 1971. The next goal was to combine the two buildings on west parkway and construction of an expanded hospital began in 1981. This included a new patient wing, new ground floor facility, and a complete remodeling of the original building. The "new" ch was dedicated in june 1984. Today, ch is a 260-bed, acute-care, non-profit community hospital with approximately 1,450 employees. It features some of the most sophisticated diagnostic and therapeutic equipment available. Ch's compassionate health-care professionals provide advanced, cost-effective care, and all of its resources, including the staff patients will meet, as well as those they may not, are dedicated to one purpose - returning you to the best possible health. More than 650 physicians representing more than 60 different specialties hold staff privileges at ch. They are supported by allied health professionals who utilize the most current technologies and on-going education in treatment, while never losing sight of the importance and dignity of each individual patient. Ch is licensed by the new jersey department of health and is a member of the voluntary hospital association of america, american hospital association, and new jersey hospital association. Mission statement ================= the mission of ch is to promote wellness and provide compassionate care and healing. Vision statement ================ ch will become the local preferred provider of high quality personalized healthcare. Awards and commendations ======================== ch received three-year approval with commendation from the commission on cancer. Ch's sleep health institute received accreditation from the american academy of sleep medicine. Healthgrades study finds patient outcomes at ch among nation's best for stroke care. According to healthgrades hospital quality in america study, ch was ranked among the top ten percent nationally for stroke care and five star rated for stroke care, the highest possible. The study, the largest of its kind, analyzed patient outcomes at virtually all of the nation's 5,000 hospitals over the years 2006, 2007 and 2008. The 2010 study also found that ch is the highest ranked hospital”

“Additional services ------------------- the cancer center features private changing areas with lockers to store your belongings. Access to a resource library featuring books, a touch screen computer, and a television with vhs and dvd player is also available. 2. Emergency department expect the best care from the emergency department at ch. The state-of-the-art emergency department offers unprecedented privacy and is staffed 24- hours a day by physicians board-certified in emergency medicine. Our caring staff is there to help individuals and their families in the time of an emergency. An individual's visit to the emergency department area may require additional testing to evaluate your situation. Depending on your situation, you may require blood tests, x-rays, ct scans or various other tests to diagnose your condition. At ch, these additional services are located at the hospital so that your condition will be diagnosed as quickly as possible and that your treatment can begin. Fast track ---------- the fast track offers the comfort of the hospital's emergency department while treating patients in a fast and efficient manner. Patients with minor ailments and injuries are treated in approximately one hour or less by emergency health-care professionals and emergency medicine board certified physicians. Fast track patients include those suffering from insect bites, sprains, strains, ear aches, sore throats, and other non-life threatening illnesses. Pediatric emergency department ------------------------------ ch pediatric emergency physicians staff the emergency department 24/7. Children under 17 years of age will be seen by a pediatric emergency doctor in about 20 minutes from the time of registration - so patients don't have to worry about waiting. Between the hours of 7:00 am and 11:30 pm, children are seen in the pediatric emergency department. At all other times, the children are seen in the main emergency department. The pediatric emergency department is equipped kid friendly treatment areas with walls covered with cartoon canines and under-the-sea motifs, as well as a separate waiting area with a child-friendly environment make what otherwise be a stressful visit to an emergency room less intimidating. The unit also offers special equipment that comes in all sizes to fit the needs of children of all sizes. 3. Mother baby center the mother baby center is often the first experience a family has with ch. At the mother baby center, over 1,000 new babies are welcomed into the world each year. The center, which was completely renovated in 2009, features private labor/delivery/recovery rooms with state-of-the-art equipment, anesthesiologists who are available 24 hours a day, and two fully equipped operating suites. Along with the newborn nursery, a four-bed special care nursery is available. Ch has the state-of-the-are technology in order to keep families together, allowing that important bond to form between mother and baby. The center offers numerous other services including pre-conception counseling, genetic counseling and perinatology services, childbirth education, newborn care, postpartum care, lactation services, and pediatrics and amenities such as massages and family celebration meal. 4. Heart and vascular care cardiovascular disease is the leading cause of death in the united states of america. Accordingly, ch is dedicated to the diagnosis and treatment of all cardiovascular disorders. From ch's emergency room care, through its inpatient units, and in its multitude of outpatient services, ch's team of skilled professionals delivers superior care and treats each patient as an individual. Cardiovascular interventional lab --------------------------------- cardiac catheterization services were initiated at ch in 1997. A diagnostic catheterization, also known as coronary angiography or heart catheterization provides detailed information about the function of the heart and its arteries. Ch has a staff of physicians who perform”

“Magnetic resonance imaging: the magnetic resonance imaging (mri) scanner, which serves both inpatients and outpatients, uses a magnetic field, radio waves, and computers to produce detailed images of the body. With mri, many diseases can now be identified at their earliest, most treatable stages, resulting in quicker treatment, faster recovery, and, in some cases, longer life. Ch's magnetom avanto's inviting design makes it accessible for most patients. The system's faster scanning times and feet-first entries also decrease the anxiety of patients who are uncomfortable in small spaces. Additionally, the system features audiocomfort, reducing acoustical noise by up to 97 percent. With the new stereo connection, patients can enjoy the music of their choice by supplying the technician with a cd upon arrival. Nuclear medicine nuclear medicine testing is a safe and painless way to capture valuable diagnostic information. Through the use of small amounts of radioactive material, ch's dual head nuclear medicine scanner provides important images of body structure and function. Because the radioactive material is attracted to specific organs, bones or tissues, the emissions they produce can provide crucial information about a particular type of cancer or disease. Information gathered during a nuclear medicine exam is more comprehensive than other imaging procedures because it describes organ function, not just structure. Positron-emission tomography/computed tomography (pet/ct) scanner pet/ct offers the combination of anatomical images supplied by ct and functional information supplied by pet all in a single non-invasive diagnostic procedure. Acclaimed as one of the most important healthcare innovations, a pet/ct is a non-surgical means to determine whether a tumor is malignant or benign. It can also pinpoint the location of cancer and determine if it has returned to previously affected organs or elsewhere in the body. A pet/ct scan is especially beneficial in the diagnosis, staging, and re-staging of cancer, as well as in the diagnosis of heart disease. Ultrasound ultrasound uses ultra high frequency sound waves to produce images for diagnostic reporting. It is mainly used for pregnancy, abdominal organs, blood flow to the extremities and needle placement during biopsies. X-ray x-rays are useful tools for examining the skeletal system and certain soft tissue diseases. Ch offers both digital and non-digital equipment. The emergency department is equipped with digital x-ray equipment to reduce the turnaround time for patient needing routine exams. Rehabilitation services ----------------------- ch combines trained, experienced therapists with the most advanced equipment available today. Ch's multi-disciplinary team provides treatment for work, home or sports-related injuries as well as conditions stemming from illness or accidents. From initial assessment to recovery, ch's staff consistently scores well above national standards for care in a variety of areas. Physical therapy - ch's therapists apply proven techniques to ensure that injured workers return to the job quickly, and are trained to avoid injuring themselves again. For sports injuries, ch concentrates its efforts on helping athletes get back to competition as soon as possible. In cases where problems have resulted from arthritis, stroke and heart disease, ch's team's main goal is to restore function to each patient. Occupational therapy - occupational therapists evaluate and treat patients to improve their physical, developmental or cognitive abilities to perform daily activities. The focus is to promote independence in "life skills". Ch occupational therapists have also completed additional training as certified hand therapists. They work closely with the referring physicians to help patients recover from complex hand injuries or surgery. Speech-language pathology - ch's specially trained team uses the most advanced diagnostic and treatment resources available to help people”

“7. Weight-loss surgery ch has been named an american society for metabolic and bariatric surgery ("asmbs") bariatric surgery center of excellence. The asmbs center of excellence designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric (weight loss) surgery. To earn a center of excellence designation, the ch bariatric surgery program underwent a rigorous site inspection during which all aspects of ch's surgical processes were closely examined and data on health outcomes was collected. Surgical review corporation ("src"), a subsidiary of asbms, is an organization dedicated to pursuing surgical excellence in the field of bariatric surgery. Src formulates and establishes the rigorous standards with which ch must comply. The organization thoroughly inspects and evaluates each candidate for designation, and upon review, recommends approval of designation for those physicians and facilities whose practices and outcomes meet the stringent demands set forth by src for asmbs. As a service to the community, ch sponsors one free monthly weight-loss surgery seminar. Understanding the issues associated with weight-loss surgery begins with fully educating yourself about severe obesity, including its causes and potential effects on your health, your lifestyle and the people around you. For ch, it's important to make sure that a patient know as much as they can about weight-loss surgery, so that they can make an informed decision about whether it's right for them. 8. Senior health ch offers an array of services, from diagnosis, treatment, inpatient and outpatient rehabilitation. Ch will partner with individuals to educate and help them practice a healthy lifestyle as they age, such as regular physical activity and healthy nutrition, screening for breast, cervical, and colorectal cancers, early detection of diabetes, its complications, and depression. Ch responds to your needs if you or your loved one has an age-related chronic disease or condition, such as alzheimer's disease, arthritis, depression, osteoporosis, urinary incontinence, diabetes, and its complications. The john a. Hartford foundation institute for geriatric nursing designated ch as a nurses improving care for health system elders site. This national designation means that ch is committed to putting into action a systematic change in nursing practice, which would result in sensitive and exemplary care that will benefit all hospitalized older patients. Ch has embarked on a process to ensure all of its nurses have specialized knowledge in geriatric nursing, including specific syndromes and geriatric care. Close to 50% of the population served by ch is over 65 years of age. Ch expects to continue to grow. Ch recognizes the growing and complex needs of its seniors and are committed to creating an optimal, environment for its patients, while continuing to be instrumental in helping them age successfully. Community services ------------------ the department of new vitality services provides education, support, information and referrals for older adults and their families, the clergy, health care professionals, long-term care facilities, assisted living facilities, and other senior residences. In addition, information is provided to corporations, schools, municipalities, and other community agencies. Gerontology services also sponsors a free health and wellness program for adults 66 and older called new vitality. New vitality acts as a resource and referral network for seniors and their caregivers include: - adult day care - adult education programs - adult foster care - adult retirement communities - alzheimer's - assisted living-group homes - boarding homes - case management - congregate apartments - continuing care retirement - communities - counselors - elder abuse - geriatric assessment programs - geriatricians - group homes - home emergency response systems - homecare - hospices - income resources - legal services - long term car”

“Community outreach ================== ch is committed to community outreach and education, offering numerous heath care related programs and activities, including community health fairs, health screenings, health education and medical lectures and seminars annually. Ch neighbors for better health ------------------------------- since 1954, ch has been truly devoted to the community, continuously seeking new methods of improving health needs. A highly effective process was established with the onset of the ch neighbors for better health, an advisory board comprised of: health officers, business leaders, medical professionals, community agency representatives, educators, clergy, attorneys and residents. Building on the personal and professional experience of the advisory board members, innovative methods for improving community health have resulted from this collaborative. "neighbors for health/ch community coalition" was the project's original name. In the beginning, the coalition distributed 5,000 surveys to area residents in order to evaluate the health status and needs of the community. The results led to the creation of programs not only to address those needs, but also to teach and support preventative measures. Based on the results of the top 10 priorities, three subcommittees were formed: psychological health, respiratory health and adolescent health. These subcommittees were responsible for developing at least one preventive health program per year. Each subcommittee's goal was to find the best resource to reach the most people with a positive, effective message. In each area, gatekeepers - people in the community who can help others - were identified. The three subcommittees evolved over the years to become the single task force that ch has today. It meets on a regular basis to design and implement programs to address various health issues. The current task force looks at current health priorities facing the communities. The task force sets priorities facing the communities and it was decided that the following issues get addressed: caregivers series, teenage depression, underage drinking, internet safety, cyber bullying and safe driving. Additionally, the taskforce developed a series of educational webinars that can be accessed through the hospital website and can be viewed in the comfort of your own home or office. Ch realizes that prevention is vital for maintaining a healthy community and a healthy future. Each year, the members spend countless hours planning, promoting and presenting various events around the area. Education and communication are the common tools that the task forces employ to strengthen the community's health awareness. Community health ---------------- in partnership with ch, several local health departments in northern new jersey offers screenings, exams, and educational programs designed to encourage preventive care, foster participation in health care initiatives, and promote greater awareness of community health care issues. New vitality ------------ new vitality is an award-winning health and wellness program tailored to meet the needs of today's mature adults. Members benefit socially, physically, emotionally, mentally and educationally from new vitality's extensive roster of lectures, workshops, classes, support groups, trips and social events. Membership is free. New vitality offers: - health screenings - exercise programs including t'ai chi chih, yoga, better bones, aquacise, dancing and mall walking - information and referral service - access to support groups - educational classes and courses about health, personal finances, insurance, art, music, nutrition and history new vitality offerings are held at ch in pompton plains and various locations throughout the community. Ongoing new vitality programs at ch include, but are not limited to, the following: - alzheimer's disease caregivers support group - bereavement support group - mall walker's club parent education ---------------- ch'”

“Expenses incurred in providing various other medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Please refer to the organization's community benefit statement included in schedule o.”

“OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - NET ASSETS RELEASED FROM RESTRICTION USED FOR PROPERTY AND EQUIPMENT - $1,087,100; - PENSION LIABILITY ADJUSTMENT - $19,496,531; - NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - ($475,557); - CONTRIBUTION FROM CHILTON MEMORIAL HOSPITAL FOUNDATION, INC. REFLECTED IN SCHEDULE B - ($1,971,999); and - TRANSFER OF NET ASSETS AS A RESULT OF STATUATORY MERGER ON 12/30/2013 - ($76,387,107).”

“An independent cpa firm audited the consolidated financial statements of forrest s. Chilton 3rd memorial hospital, inc. And its controlled affiliate; chilton memorial hospital foundation, for the years ended december 31, 2013 and december 31, 2012; respectively. The audited consolidated financial statements contained consolidating schedules on an entity by entity basis. The independent cpa firm issued an unqualified opinion with respect to the consolidated audited financial statements. The forrest s. Chilton 3rd memorial hospital, inc. Audit committee has assumed responsibility for the oversight of the audit of the consolidated financial statements, which includes this organization, and the selection of an independent auditor.”

“Description:contracted services total fees:17707222”

“Description:professional fees total fees:3087077”