ACO Name and Location - Holy Name Medical Center

1 ACO name and Location Holy name Medical Center ACO, LLC 718 Teaneck Road Teaneck, New Jersey 07666 ACO Primary Contact Primary Contact name Emma Yamada Primary Contact Phone Number 201-379-5660 Primary Contact Email Address Organizational Information ACO participants: ACO Participants ACO Participant in Joint Venture (Enter Y or N) General Surgery Practice Llc N PHILIP TSAI, MD N Breast Care Partners Pc N Richard Tancer DO N CHUL HYUN MD N Arnold Schoen, MD N Marc Polimeni N RADIATION ONCOLOGY PARTNERS, PC N BIRCH TREE Medical ASSOCIATES, PA N EXCELCARE Medical ASSOCIATES, PA N North Jersey Infectious Disease Group Llc N CLOSTER INTERNAL MEDICINE, PC N CHUL HYUN MD N Holy name Medical Center , Inc. N North Jersey Orthopaedic Specialists N Irving Paltrowitz Md Joel Goldfarb Md M Schmidt Md P Micale Md Pa N NELLIE LEE MD N David F Porter , PA N Cohen Rosen & Kmieczak Dpm Pa N Marc Polimeni N Dr Chung Medical Clinic P C N CLIFFSIDE Medical , LLC N Women's Health Care Group Pc N NORTH JERSEY NEUROLOGY CARE, PA N CHANG W.

2 LEE MD, N Hee Yang N Foot & Ankle Therapy Pc N Peace Health Partners, Pc N House Physician Partners, N Luke Eyerman MD, LLC N NELLIE LEE MD N Hee Yang N KYU S. WANG MD, PC N Gene Medical Group Llc N Center For Dynamic Aging, Llc N Mulkay Cardiology Consultants At Holy name Medical Center , Pc N Pan S. Ko, MD, PC N Holy name Primary Care And Specialty Associates Pc N Primary Care Of Oradell N HOLY name Medical ASSOCIATES PC N Conrado Boja Md Llc N BREAST IMAGING PARTNERS, PC N HOLY name CARDIOLOGY ASSOCIATES, PC N Joo Medical Center N HOLY name PULMONARY ASSOCIATES, PC N ACO governing body: Member Member's Voting Power Membership Type ACO Participant TIN Legal Business name /DBA, if Applicable Last name First name Title/Position Berkowitz Charles Member 1 Medicare Beneficiary Representative N/A Jarrett Adam Chair 1 ACO Participant Representative HOLY name Medical ASSOCIATES PC Coleman Clenton Member 1 ACO Participant Representative EXCELCARE Medical ASSOCIATES, PA Tartacoff Randy Member 1 ACO Participant Representative Holy name Medical Center , Inc.

3 Barkama Ravit Member 1 ACO Participant Representative Holy name Medical Center , Inc. Kennedy Ryan Member 1 ACO Participant Representative Holy name Medical Center , Inc. Katz Terri Member 1 ACO Participant Representative Center For Dynamic Aging, Llc Poole John Member 1 ACO Participant Representative EXCELCARE Medical ASSOCIATES, PA Key ACO clinical and administrative leadership: Randy Tartacoff, MD ACO Executive Adam Jarrett, MD Medical Director Sharon Lawson-Davis, JD, BA, BSN, RN, CPHQ, HACP Compliance Officer Randy Tartacoff, MD Quality Assurance/Improvement Officer Associated committees and committee leadership: Committee name Committee Leader name and Position Finance Committee Ryan Kennedy, CPA, Chair Quality Improvement Committee Randy Tartacoff, MD, Chair Types of ACO participants, or combinations of participants, that formed the ACO: Partnerships or joint venture arrangements between hospitals and ACO professionals Shared Savings and Losses Amount of Shared Savings/Losses N/A Shared Savings Distribution N/A Quality Performance Results Our ACO did not participate in the Shared Savings Program in the previous performance year, therefore this section is not applicable at this time.

4 Payment Rule Waivers No, our ACO does not use the SNF 3-Day Rule Waiver.