2021-05-07T12:56:26-05:00 2020-06-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041011100 990 2019-07-01 020226774 Speare Memorial Hospital SPEA 6035361120 16 Hospital Road Plymouth NH 03264 Travis Boucher CFO 6035361120 2021-05-07 1 Joseph R Byrne P01289281 2077752387 2021-05-07 2019 2022-09-23 18:48:47Z Michelle McEwen 16 Hospital Road Plymouth NH 03264 69354127 0 X www.spearehospital.com X 1899 NH To work together to serve the needs of our patients and community, and a vision of a community where all can achieve optimal health. 17 14 503 42 0 0 615662 5628304 63939904 59796402 1390916 1660741 88721 51512 66035203 67136959 290076 255644 0 0 36467865 36712203 0 0 96078 27655826 28970376 64413767 65938223 1621436 1198736 78874073 83889184 31933131 36373458 46940942 47515726 X To maintain a hospital and other such institutions within the state of New Hampshire, with facilities that include medical services to provide for the diagnosis and treatment of patients that may require inpatient, outpatient, emergency care and other pursuits designed to promote the general health of the community. SMH does not discriminate relative to race, religion or national origin, ability to pay and will assure that all patients receive the same level of care through quality assessment monitoring and improvement activities. Speare's formal mission statement is to work together to serve the needs of our patients and community, and a vision of a community where all can achieve optimal health. 0 0 60508668 255644 59796402 SMH is a 25 bed acute-care hospital that provides inpatient and outpatient services to the surrounding community. 60508668 1 1 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 95 0 1 503 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 0 NH X Travis Boucher 6035361120 16 Hospital Road Plymouth NH 03264 Patrick Miller Chair 1.00 0.00 X X 0 0 0 Kevin Young MD Vice Chair 40.00 0.00 X X 144459 0 13150 Robert Maloney Treasurer 1.00 1.00 X X 0 0 0 Quentin Blaine Secretary 1.00 0.00 X X 0 0 0 Lisa Baker Director 40.00 0.00 X 113281 0 9400 Julie Bernier Director 1.00 0.00 X 0 0 0 Jeanie Forrester Director 1.00 0.00 X 0 0 0 Walter Johnson Director 1.00 1.00 X 0 0 0 Sandra Jones Director 1.00 0.00 X 0 0 0 Elizabeth Kleiner Director 1.00 0.00 X 0 0 0 Tom Myrick Director 1.00 1.00 X 0 0 0 Nancy Puglisi Director 1.00 0.00 X 0 0 0 Margaret Turner Director 1.00 0.00 X 0 0 0 Bruce Wiggett Director 1.00 1.00 X 0 0 0 Ronda Kilanowki Director 1.00 0.00 X 0 0 0 Steven Camerino Director 1.00 0.00 X 0 0 0 Michelle McEwen CEO 40.00 1.00 X X 331394 0 52378 Travis Boucher CFO 40.00 1.00 X 168570 0 20956 Joseph Ebner MD CMO 40.00 0.00 X 296607 0 53804 Kristine Hering CNO 40.00 0.00 X 168447 0 15708 Victor Gennaro MD Orthopedic Surgeon 40.00 0.00 X 485225 0 70243 Steven Danosi MD Director of Emergency Medicine 40.00 0.00 X 478570 0 69015 Paul Musco DO Chief of Surgery 40.00 0.00 X 452596 0 60552 Andrew Seefeld MD Dir. of Urgent Care & EMS Dir. 40.00 0.00 X 444018 0 50388 Douglass Weiss MD Orthopedic Physician 40.00 0.00 X 409850 0 42963 3493017 0 458557 51 0 1 0 Asquam Community Health Collaborative 80 Highland Street Laconia NH 03246 IT Services 3202486 Plymouth Regional Rehab Services 790 Lake St Bristol NH 03222 Rehab Management 915105 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Contracted Providers 671171 Alliance Heathcare Services Inc PO Box 735714 Dallas TX 75373 Contracted MRI-Nuclear Medicine 614068 American Healthcare Staffing Association PO Box 1928 Edmond OK 73083 Contracted Clinical Staff 588872 11 4418416 1209888 5628304 Patient Service Revenue 624100 140302091 140302091 Other Operating Revenue 621400 2409162 2269852 139310 Provision for Bad Debts 621410 -7114979 -7114979 Contractual/Char. Adj. 624100 -75799872 -75799872 59796402 741761 741761 51512 0 51512 51512 51512 3134040 2108 2215427 1741 918613 367 918980 918980 67136959 59657092 0 1851563 X 255644 255644 1388154 280290 1107864 28282993 27848693 350880 83420 1474893 1327310 147583 3865999 3405311 460688 1700164 1468243 231921 5419 4680 739 28626 24721 3905 87921 75928 11993 99439 99439 10617097 9397784 1210999 8314 71450 61703 9747 2847231 2458838 386440 1953 1496348 1292230 204118 974622 841673 132949 51711 44657 5873 1181 89127 76969 12158 331979 330837 1142 2823761 2823761 765058 660696 104362 Medical Supplies 5063706 4372961 690745 Medicaid Enhancement Ta 2551975 2551975 Common Area Fees 313282 270547 42735 Dues & Subscriptions 245271 211813 32828 630 506353 421404 84369 580 65938223 60508668 5333477 96078 X 5715408 14879933 9209596 10417373 10100719 6651617 351058 358000 1093913 1201726 692722 745826 56388181 39065478 18543395 17322703 26316727 26292105 5000 5000 935187 839208 5910348 5175693 78874073 83889184 9195861 9882376 15097536 14041530 29081 0 7610653 12449552 31933131 36373458 X 46317894 46886685 623048 629041 46940942 47515726 78874073 83889184 X 1198736 -612088 -11864 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11302 11302 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which is attributable to lobbying activities. X 0 271915 669 272584 270791 1124 271915 270277 514 270791 270206 71 270277 270206 270206 0.00000 1.00000 0.00000 1 0 855030 855030 31878630 20023263 11855367 21869077 18191208 3677869 1785444 851007 934437 17322703 Due from Related Party 1963513 Beneficial Interest in Perpetual Trusts 318380 Investment in Subsidiaries -34853 Deferred System Development Costs 2394791 Deferred Compensation 471507 Executive Life Insurance 62355 5175693 Estimated Third-Party Payor Settlements 8652928 Investment in Subsidiary - Boulder Point -2185356 Deferred Compensation 471507 CARES Act Funding 5510473 12449552 Part III, Line 4: The Hospital's artwork is intended to provide artistic pleasure and a calming appearance for patients of the Hospital to enjoy during their stay. Part V, Line 4: The intended use of the endowment fund is to provide long term operational support for the mission of the Organization. 1 1 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 628623 628623 0.00950 9837267 5218455 4618812 0.07000 10465890 5218455 5247435 0.07950 579526 579526 0.00880 79898 79898 0.00120 659424 659424 0.01000 11125314 5218455 5906859 0.08950 1 3055923 17692535 20035026 -2342491 X 1 1 1 1 Speare Memorial Hospital 16 Hospital Road Plymouth NH 03264 www.spearehospital.com 01300 X X X X Speare Memorial Hospital 0 0 1 X X X X X X X 17 1 0 1 1 X www.spearehospital.com X www.pemibakercommunityhealth.org & www.midstatehealth.org X 1 17 1 http://spearehospital.com/about-speare/community-benefits/ 0 1 X 125.000000000000 225.000000000000 X X X X X 1 1 X X X 1 X https://spearehospital.com/patients-visitors/financial-assistance/ X https://spearehospital.com/patients-visitors/financial-assistance/ X https://spearehospital.com/patients-visitors/financial-assistance/ X X X X 1 X 0 X X X X 1 X 0 0 Speare Memorial Hospital Part V, Section B, Line 5: Speare took into account input from persons who represent the community served by the hospital facility when conducting the 2017-2020 Community Health Needs Assessment (CHNA) of the Central New Hampshire region. For the purpose of the assessment, the geographic area of interest was 18 municipalities comprising the Central New Hampshire Public Health Region with a total resident population of 30,039, and served by the member agencies of the Central New Hampshire Health Partnership.Persons consulted who represent the community include individual community members and stakeholders. The Community Health Needs Assessment Survey yielded 409 individual responses of which 88% were residents of towns within the primary service area. Survey respondents were 74.8% female and 29.5% age 65 years or more. Key stakeholder respondents yielded:- Community member / Volunteer (13 respondents)- Business (10)- Primary Health Care (9)- Education / Youth Services (8)- Municipal / County Government (7)- Public Health (6)- Faith organization (6) - Fire / Emergency Medical Service (5)- Public Safety / Law / Justice (5)- Human Service / Social Service (5)- Mental Health / Behavioral Health (3)- Home Health Care (2)- Civic / Cultural Organization (2)- Medical Sub-Specialty (1) Speare Memorial Hospital Part V, Section B, Line 6b: Speare's CHNA was conducted in partnership with the Central New Hampshire Health Partnership. Community Health Needs Assessment Partners:- Community Action Program Belknap-Merrimack Counties - Communities for Alcohol- and Drug-free Youth (CADY) - Lakes Region Mental Health Services - Mid-State Health Center - Newfound Area Nursing Association - Pemi-Baker Community Health - Additional assistance of the Whole Village Family Resource Center and Plymouth Regional Senior Center Speare Memorial Hospital Part V, Section B, Line 11: Speare is addressing the significant needs identified in the CHNA as follows:- Access to affordable health care services and insurance - Speare provides:o Subsidized Health Services o Primary Care Clinico Primary Care Grantso Prescription Assistance Programo Breast Cancer Screeningo Financial Counseling o Government-Sponsored Health Care o Medicare Costs exceeding reimbursement o Charity Care o Free & Discounted Health Care Services o School Dental Program- Working in partnership with SAU 48, Lin-Wood Public Schools, Warren Village School, Ashland Elementary School, Plymouth Pediatrics, Plymouth OB/GYN, Lincoln Woodstock community child care, and Plymouth and Bristol Women, Infant and Children (WIC) programs, Speare provides: free dental screenings, silver diamine fluoride, temporary fillings and fluoride varnish applications; dental cleanings and sealants to school-aged children on a sliding fee scale; and, case management and financial assistance to those in need.- Access to mental health services - Speare provides:o A psychiatrist to meet with patients of Speare Primary Care as prescribed by their providers.- Access to healthy foods and opportunities for active living - Speare provides:o Community Health Education- Diabetes education and support- Nutrition education at women's health evento 5-2-1-0 Healthy NH Initiativeo Shamrock Shuffle 5k fun run/walk/strollAdditionally Speare is an active partner in the Central New Hampshire Public Health Advisory Council, Central New Hampshire Health Partnerships, Integrated Delivery Network 5, Central New Hampshire Chamber of Commerce, and the Central New Hampshire MACE/CERT. Most of these organizations work towards meeting the needs identified in the CHNA.Speare's financial contributions to several social service agencies supports initiatives aimed at addressing those community needs that do not fall directly within the scope of Speare's mission. These needs include: alcohol and drug use prevention, treatment and recovery, domestic violence and childhood trauma, senior services including assisted living or long term care services, and access to transportation. Speare Memorial Hospital Part V, Section B, Line 16j: The application process is outlined in patient admission packets as well as monthly statements. Part I, Line 7: An accounting system was used to calculate the amounts reported in this table. The accounting system addresses all patient segments. A cost-to-charge ratio was used. Community Relations programs and charity care given to uninsured patients were also considered in calculating amounts disclosed. Part II, Community Building Activities: Speare further promotes community health with its Community Education and Outreach programs, as well as through digital and traditional media. Additionally, Speare conducts a needs assessment to identify priority areas that are in need within the community.The backbone of Speare's Community Outreach and Education program consists of our major events: Diabetes Day, Senior Resource Fair, It's a Guy Thing men's health event, Shamrock Shuffle 5K Health Walk/Run, and Wine, Women & Wisdom women's health event. Each of these focuses on particular health issues identified by the CHNA. Programs identified by the community through ongoing engagement outside the formal assessment process include diabetes education and support, childbirth classes, car seat program, and oncology outreach and education.Additionally, Speare donates medication to community non-profit agencies.Speare uses its online and social media channels and print newsletter to connect our community with information about various health and wellness topics, specific to Speare initiatives and in general, to create discussion and information sharing. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable. Credit is extended without collateral.In evaluating the collectability of accounts receivable, the Organization analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Organization analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Organization records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or on the basis of discounted rates, by State law, or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts. Part III, Line 9b: Speare Memorial Hospital has both a collections policy, and a charity care policy that describes charity eligibility and the steps to complete before a patient's account is written off to bad debt. Part VI, Line 2: In addition to the research described in Part V - Section C, Speare has ongoing discussions with key community leaders about the identified needs, how they are being addressed and other opportunities for action. These include our legislators, municipal leaders, police and fire, local health departments, Plymouth State University, community centers and area clergy. Part VI, Line 3: Patients are educated at time of registration or through educational materials that are distributed through the hospital's website or by community outreach. Speare Memorial Hospital is a member of a state-wide community health network that provides assistance, support, and education relating to eligibility assistance. Part VI, Line 4: Speare Memorial Hospital best defines its community as those towns comprising South Eastern Grafton County based on our patient origin information and, when available, market share data published by the New Hampshire Hospital Association.Speare Memorial Hospital is located in the mountain and lakes region of New Hampshire and primarily serves constituents in Grafton County. Grafton County population size is approximately 86,000 within its 40 distinct municipalities. Its service area includes 17 towns with an approximate total population of 30,000. Part VI, Line 5: Speare further promotes community health with its Community Education and Outreach program, as well as through online and social media.The backbone of Speare's Community Outreach and Education program consisted of four major events: Senior Resource Fair, It's a Guy Thing men's health event, Shamrock Shuffle 5K Health Walk/Run, and Wine, Women & Wisdom women's health event. Each of these focused on/drilled down into specifics on particular health issues identified by the community through ongoing engagement outside the formal assessment process.Additionally, Speare used its online and social media channels to connect our community with information about various health and wellness topics, specific to Speare initiatives and in general, to create discussion and information sharing. Part VI, Line 7, Reports Filed With States NH 1 Communities for Drug and Alcohol Free Youth (CADY) 94 Highland Street Plymouth NH 03264 571212859 501(c)(3) 19750 Educate, engage and empower our schools and communities to prevent and reduce youth alcohol, tobacco, and other drug use and to promote healthy environments and promising futures. Grafton County Senior Citizens Council PO Box 433 Lebanon NH 03766 237248316 501(c)(3) 10000 To develop, strengthen, and provide programs and services that support the health, dignity and independence of older adults and adults with disabilities living in our communities. Transport Central 258 Highland Avenue Plymouth NH 03264 208463821 501(c)(3) 11875 To initiate and provide dispatched and coordinated volunteer driver services to our residents who need transportation. Foundation for Healthy Communities 125 Airport Road Concord NH 03301 200275078 501(c)(3) 172844 Support Medicaid Expansion and the Bureau on Alcohol & Drug Abuse Prevention Lakes Region Mental Health Center 40 Beacon Street East Laconia NH 03246 020272138 501(c)(3) 7721 Lakes Region Mental Health Center is the community leader providing quality, accessible and integrated mental and physical health services, delivered with dedication and compassion. 5 0 Part I, Line 2: The Organization only pays grants to other Section 501(c)(3) organizations. Therefore, no additional monitoring is deemed necessary. Other assistance payments are reviewed on a periodic basis. X X X X X 0 0 0 0 0 0 0 1 0 Kevin Young MD Vice Chair 142959 0 1500 0 0 0 12198 0 952 0 157609 0 0 0 Michelle McEwen CEO 298005 0 29925 0 3464 0 24577 0 27801 0 383772 0 0 0 Travis Boucher CFO 168505 0 0 0 65 0 5240 0 15716 0 189526 0 0 0 Joseph Ebner MD CMO 255357 0 40890 0 360 0 21344 0 32460 0 350411 0 0 0 Kristine Hering CNO 168136 0 0 0 311 0 14299 0 1409 0 184155 0 0 0 Victor Gennaro MD Orthopedic Surgeon 480745 0 2500 0 1980 0 40375 0 29868 0 555468 0 0 0 Steven Danosi MD Director of Emergency Medicine 474175 0 1500 0 2895 0 39462 0 29553 0 547585 0 0 0 Paul Musco DO Chief of Surgery 399251 0 51365 0 1980 0 31272 0 29280 0 513148 0 0 0 Andrew Seefeld MD Dir. of Urgent Care & EMS Dir. 443718 0 0 0 300 0 35965 0 14423 0 494406 0 0 0 Douglass Weiss MD Orthopedic Physician 409213 0 0 0 637 0 33061 0 9902 0 452813 0 0 0 Part I, Line 7 Bonuses were approved at the discretion of the Board and Management for meeting certain criteria. Compensation for the CEO is determined via a compensation committee, compensation survey or study, comparison of other organizations, Form 990 information, board approval and written employment contract. Physician contracts include a provision that they may earn a bonus based on meeting certain productivity, quality and patient experience criteria. A New Hampshire Health And Education Facilities Authority 020279866 2012-12-07 21100000 To pay off and provide advanced refunding for 2010 and 2004 Bonds 0 0 0 A 6935318 21100000 209815 4566977 16323208 2015 1 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: New Hampshire Health And Education Facilities Authority Date the Rebate Computation was Performed: 12/01/2017 Form 990, Part VI, Section A, line 6 The Association consists of all persons who are members at the time of the adoption of the bylaws and other persons who may be elected. Form 990, Part VI, Section A, line 7a A candidate for membership may be elected by a majority vote of members present at any annual or special meeting of the Association provided that a quorum is present. Alternately, a candidate for membership may be elected by a two-thirds vote of the Board of Directors present at any regular or special meeting of the Board provided that a quorum is present. The Association members vote on new board members. Form 990, Part VI, Section A, line 7b The Association members reserve the right to approve changes to the Organization's By-Laws. Form 990, Part VI, Section B, line 11b The Form 990 is presented to the Organization's management and board for review and acceptance prior to filing. Form 990, Part VI, Section B, line 12c Speare Memorial Hospital has a set of procedures to follow to avoid the possibility that those in positions of authority over the Organization may receive an inappropriate benefit. Any possible conflict of interest on the part of any member of the Board, Officer or Employee of the Organization, shall be disclosed in writing to the Board and made a matter of record through an annual procedure and also when the interest involves a specific issue before the Board. Form 990, Part VI, Section B, line 15a Compensation for the CEO is determined via a compensation committee, compensation survey or study, comparison of other organizations 990 information, board approval and written employment contract. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 7,437,825. Management and general expenses 1,166,550. Fundraising expenses 8,314. Total expenses 8,612,689. Contract Nursing & Technicians: Program service expenses 1,959,959. Management and general expenses 44,449. Fundraising expenses 0. Total expenses 2,004,408. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Speare Memorial Hospital 16 Hospital Road Plymouth, NH 03264 EIN 02-0226774 Speare Memorial Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Beneficial Interest in Perpetual Trusts -11,864. Speare Memorial At Boulder Point Boulder Point Drive Plymouth NH 03264 263888977 Real Estate NH 501(c)(3) Line 12a, I Speare Memorial Hospital 1 Speare Health Network LLC 16 Hospital Road Plymouth NH 03264 043372339 Physician/Hospital Organization NH Speare Memorial Hospital C 20728 0.50000 0 Speare Health Ventures Inc 16 Hospital Road Plymouth NH 03264 020366565 Healthcare Services NH Speare Memorial Hospital C 1149867 1724421 1.00000 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Speare Health Venture Inc D 314075 FMV Speare Memorial At Boulder Point K 856109 FMV