2020-09-15T09:25:59-05:00 2019-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-10-01 020222131 Frisbie Memorial Hospital FRIS 6033325211 11 Whitehall Road Rochester NH 03867 Brian Hughes Board of Trustees Chairman 6033325211 2020-09-09 1 Nicholas E Porto P01310283 2078792100 2020-09-09 208.105.168.164 2020-09-09 14:23:24 ED P BC8AE4E166BFDF24A7972DDCC457CE4FCF4C8ABA DA1D1F22D002DE74304CAE64996AD19EA354FE22 2018 2021-01-29 14:40:06Z Brian Hughes 11 Whitehall Road Rochester NH 03867 147915939 0 X www.fmhwdc.org X 1941 NH To excel at caring for the community. 12 10 1232 125 376306 17332 478413 454013 152557888 142635430 2470869 563388 1287648 516769 156794818 144169600 198967 255181 0 0 87276240 81546497 0 0 154405 85378683 79878318 172853890 161679996 -16059072 -17510396 114107159 99285851 67651648 71122865 46455511 28162986 X To excel at caring for the community by providing safe, effective, equitable, timely healthcare services. We will ally ourselves with other community healthcare providers to enhance our mutual ability to improve the health of our community, and the quality of life for the people we serve. 0 0 126906993 255181 142268375 Frisbie Memorial Hospital is a nonprofit community hospital that continuously evaluates and addresses the comprehensive healthcare needs of Rochester, NH and the surrounding communities. In response to these healthcare needs, the hospital coordinates, develops, and provides high-quality, affordable, preventative, educational, acute, and chronic care services. In fiscal year ending September 30, 2019, 25,530 patients were treated in our emergency department, 4,723 ambulance calls were made, 2,952 inpatients were cared for, and surgeries on 7,368 patients were performed. Additionally, 229 newborns were welcomed into the world, 25,371 radiology procedures/tests provided, 79,950 rehabilitative treatments were provided, 371,462 laboratory tests were performed, and 4,012 oncology patients were treated. 6322750 0 0 Frisbie Memorial Hospital provided uncompensated care for those in need. Frisbie ranks among the top in New Hampshire for the money value of charity care provided to patients. 513790 0 0 Frisbie Memorial Hospital presented or sponsored numerous community programs which assisted with the special needs of our most vulnerable at risk population groups. These programs improved education and health awareness in the community, and provided greater access to health services. 133743533 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 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 1 0 0 0 0 1 1 1 1 0 0 1 63 0 1 1232 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NH X Douglas M Johnson 4044965291 600 Galleria Parkway SE Suite 1400 Atlanta GA 30339 John Britton MD Trustee 2.00 2.00 X 0 0 0 Mark Farrell Trustee 2.00 2.00 X 0 0 0 John Hall Trustee 2.00 2.00 X 0 0 0 Frank Jones Trustee 2.00 2.00 X 0 0 0 Ron Poulin Trustee 3.00 2.00 X 0 0 0 Julie Reynolds Trustee 2.00 2.00 X 0 0 0 Lisa Stanley Trustee (end 9/19) 2.00 2.00 X 0 0 0 Brian Szymanski MD Trustee 2.00 2.00 X 0 0 0 Brian Hughes Chairman, Trustee 3.00 3.00 X X 0 0 0 James Jalbert Vice Chairman, Trustee 3.00 3.00 X X 0 0 0 TJ Jean VC; TTEE; VP Phys. Services 40.00 2.00 X X 90686 0 425 William Cormier Secretary, Trustee 3.00 3.00 X X 0 0 0 Jeanette Poulin Treasurer, Trustee 3.00 3.00 X X 0 0 0 Jocelyn Caple MD President & CEO 40.00 5.00 X 319642 0 29134 Robert Cochrane VP Finance, CFO (end 2/19) 40.00 5.00 X 298358 0 26717 James Hutchinson Interim CFO 40.00 5.00 X 0 0 0 Christi Green VP Human Resources 40.00 0.00 X 154050 0 10353 Trevor Eide MD Physician 40.00 0.00 X 527922 0 21561 John Freese MD Physician 40.00 0.00 X 531076 0 19302 Kathleen O'Malley Maxfield MD Physician 40.00 0.00 X 426621 0 11026 Michael Southworth MD Physician 40.00 0.00 X 423801 0 19301 Robert A Brown Jr MD Physician 40.00 0.00 X 411877 0 19269 John Marzinsik Former President & CEO (end 2/18) 0.00 0.00 X 539525 0 66708 Paula Mahoney Former VP Phys. Practices (end 7/18) 0.00 0.00 X 430027 0 0 Joseph Shields Former Senior VP (end 7/18) 0.00 0.00 X 277943 0 40434 4431528 0 264230 97 1 1 1 Crothall Healthcare 13028 Collections Center Drive Chicago IL 60693 Facilities management 3888474 Unidine Corporation PO Box 360639 Pittsburgh PA 152516639 Dietary services 2252219 Prism Healthcare Partners LTD 190 South LA Salle St STE 2900 Chicago IL 60603 Management consulting 2205284 FocusOne Solutions Inc PO Box 3037 Omaha NE 681030037 Staffing solutions 1788903 Surgical Associates of Rochester 21 Whitehall Rd STE 3 Rochester NH 03867 Physician practices 1625000 13 454013 454013 Net patient service revenue 621110 132325218 132325218 Disproportionate share funding 621110 5391386 5391386 Management/health care support 621110 4355171 3988116 367055 Cafeteria and catering 561000 563655 563655 142635430 292556 9251 283305 4017171 3746339 270832 270832 270832 Equity Earnings in Affiliates 523000 328971 328971 Equity Earnings in Benevera, LLC 523000 187798 187798 516769 144169600 142268375 376306 1070906 252181 252181 3000 3000 929365 731270 196701 1394 65306537 52548838 12659739 97960 393987 317021 76375 591 10597674 8543951 2037826 15897 4318934 3475226 837230 6478 1126371 1126371 343517 343517 41149 41149 17904033 15119520 2757687 26826 283330 222071 61259 3503228 2242222 1255747 5259 1661072 1661072 8458840 6344130 2114710 213605 160204 53401 264583 198437 66146 1392099 1044074 348025 11617135 8712851 2904284 Drugs/medical supplies 20969134 20123137 845997 NH MET 6641722 6641722 0 Provision for bad debts 5209669 5209669 0 UBIT Expense 25254 25254 0 223577 167683 55894 161679996 133743533 27782058 154405 732064 863357 1813338 7821173 16624306 12710927 3449405 3109701 797321 828039 161522738 106368753 61263019 55153985 8584835 1270417 13122247 9647690 7720624 7880562 114107159 99285851 21131279 24538515 21616486 21630503 9859128 7267724 3915000 2475000 11129755 15211123 67651648 71122865 X 43498277 24627095 1040542 1619199 1916692 1916692 46455511 28162986 114107159 99285851 -17510396 -782129 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 19291 0 0 0 19291 0 Part II-B, Line 1: The Hospital pays dues to various professional and healthcare associations, a portion of which is made available for lobbying expenditures to further the associations' member-organizations' exempt missions. The below detail provides additional disclosures and information regarding the Hospital's dues and associated lobbying costs. Organization: American Hospital Association Total Dues Paid: $26,296 Estimated Portion Expended for Lobbying Purposes: $6,132 Organization: New Hampshire Hospital Association Total Dues Paid: $69,078 Estimated Portion Expended for Lobbying Purposes: $13,159 14647540 21325 33680 5009104 79016 9614425 17792984 206456 1327943 4600638 79205 14647540 31526165 100889 2877676 16587188 124558 17792984 29464678 2195487 134000 31526165 34288142 -4823464 29464678 0.63220 0.19940 0.16840 1 0 181776 181776 88654791 52186432 36468359 1498988 1177076 321912 69278638 51528786 17749852 1908545 1476459 432086 55153985 Corporate bonds 955233 F Assets held in employee benefit plans 8692457 F 9647690 DSH Revenue Receivable 1358370 Malpractice claims receivable 1758165 Other assets 299420 Investment in Yankee Alliance, LLC 5000 Investment in Benevera Health, LLC 455531 Cash surrender value of life insurance policies 449730 Investment in Strafford Health Alliance 2941522 Due from Benevera 612824 7880562 Estimated third party payor settlements 396813 Due to affiliates 1442100 Malpractice liability claims payable 4468165 Accrued Pension 8904045 15211123 X 143321068 -782129 -782129 144103197 41149 25254 66403 144169600 161613593 0 161613593 41149 25254 66403 161679996 Part V, Line 4: The Hospital's endowment funds are to be used in furtherance of the Hospital's charitable mission. Part X, Line 2: The Hospital and the Foundation are not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Hospital and Foundation's tax positions and concluded the Hospital and Foundation have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to the consolidated financial statements. Part XI, Line 4b - Other Adjustments: Unrelated Business Income Tax 25,254. Part XII, Line 4b - Other Adjustments: Unrelated Business Income Tax 25,254. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 2884466 2884466 0.01840 38327652 27847096 10480556 0.06700 41212118 27847096 13365022 0.08540 1998316 32599 1965717 0.01260 54319061 20724149 33594912 0.21470 56317377 20756748 35560629 0.22730 97529495 48603844 48925651 0.31270 116474 116474 0.00070 116474 116474 0.00070 1 1959098 0 21150612 33486025 -12335413 X 1 1 1 1 Frisbie Memorial Hospital 11 Whitehall Road Rochester NH 03867 www.frisbiehospital.com 00028 X X X Geropsychiatric Unit Frisbie Memorial Hospital 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X Please see Part V, Section C X 1 16 0 1 0 1 X 250.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X Please see Part V, Section C X Please see Part V, Section C X Please see Part V, Section C X X X X X X 1 X 0 X X X X X 1 X 0 0 Frisbie Memorial Hospital Part V, Section B, Line 5: Members of the committee were chosen based on their knowledge of local healthcare. Crescendo Consulting Group, LLC was also brought in to assist in the completion of the CHNA. Please see page 5 of the Hospital's 2018 CHNA for a detailed list of community members. Frisbie Memorial Hospital Part V, Section B, Line 11: Please see the attached Community Health Needs Assessment and Action Plan for how Frisbie Memorial Hospital is addressing the significant needs identified in its most recently conducted CHNA.Over the past several years, FMH has been exceedingly resource strapped from both a financial and a personnel standpoint and has, therefore, not been able to respond to the community needs assessment in the manner to which it has strived in the past.1. In the realm of mental illness prevention and treatment, FMH continues to maintain the 20 bed inpatient geropsychiatry unit as well as an outpatient service for geropsychiatry. FMH also provides social workers in its ambulatory practices, and provides behavioral health services in the emergency department. FMH has historically provided these programs, and FMHhas been committed to maintaining them, but FMH has not been able to increase services in this area in response to the 2019 needs assessment.2. With regard to substance misuse prevention and treatment, for several years, FMH has offered a medication assisted treatment program (MAT - Saboxone) which was championed by several FMH providers. Unfortunately, these providers chose to leave the organization over the past year. Since that time, FMH's MAT program has struggled with lack of provider leadership. Meanwhile, the ROAD to a Better Life MAT program has grown in capacity and offers a much more robust program than FMH ever had in the past. Recognizing the greater capacity and enhanced programming at ROAD to a Better Life MAT (they offer peer counseling groups and other wrap-around services), FMH will be referring new, acute patients to this program. https://roadtoabetterlifenh.com/locations/3. Although FMH prides itself on being an affordable health care option for its community and provides financial assistance to many members of the community, FMH has not been able to address directly the burden of the high cost of prescription medication for members of its community. Frisbie Memorial Hospital Part V, Section B, Line 20e: Frisbie Memorial Hospital notified individuals of the financial assistance policy during the admissions process, prior to and during the patient discharge process, and in communications with the individuals when discussing the individuals' medical bills. Frisbie Memorial Hospital also documented its determination of whether individuals were eligible for financial assistance under the hospital's financial assistance policy. Schedule H, Part V, Section B, Line 7a & 10a: The Hospital's latest CHNA and Implementation Strategy, released in January of 2019 for the 2018 tax year, is available on the Hospital's website at:https://www.fmhwdc.org/ Schedule H, Part V, Section B, Line 16a-c: The Hospital's Financial Assistance Policy, Application, and Plain Language Summary can be found online at:https://www.fmhwdc.org/ 20 1 - Rochester Obstetrics & Gynecology 21 Whitehall Road Rochester NH 03867 Outpatient obstetrical and gynecological services 2 - Rochester Hill Family Practice 245 Rochester Hill Road Rochester NH 03867 Preventative Health Services 3 - Skyhaven Internal Medicine 6 Healthcare Drive Rochester NH 03867 Outpatient Primary Healthcare Services 4 - White Mountain Med Ctr Primary Care 2531 White MTN Highway Sanbornville NH 03872 Outpatient primary care services 5 - Rochester Pediatric Associates 245 Rochester Hill Road Rochester NH 03867 Outpatient and Inpatient pediatric medical care 6 - Family Care of Farmington 316 NH Route 11 Farmington NH 03835 Preventative Healthcare Services 7 - Strafford Cardiology 21 Whitehall Road Rochester NH 03867 Outpatient and Inpattient Cardiology services 8 - Barrington Family Practice 426 Calef Highway Barrington NH 03825 Physician Family Practice 9 - Rochester Vascular Surgery 6 Healthcare Drive Rochester NH 03867 Outpatient vascular disease services 10 - Family Care of Somersworth 245 Rochester Hill Road Rochester NH 03867 Preventative Health Services 11 - Rochester Pulmonary Medicine 21 Whitehall Road Rochester NH 03867 Outpatient and inpatient respiratory illness care 12 - Diabetes and Endocrine Center 245 Rochester Hill Road Rochester NH 03867 Outpatient Diabetes Treatment Center 13 - Sanford Medical Associates 272 Cottage Street Sanford ME 04073 Outpatient and inpatient general surgery 14 - Barrington Walk-In-Care 426 Calef Highway Barrington NH 03825 Walk-In Clinic 15 - Rochester Rheumatology 21 Whitehall Road Rochester NH 03867 Outpatient treatment of rhematic and autoimmune diseases 16 - Rochester Infectious Disease 21 Whitehall Road Rochester NH 03867 Outpatient care for patients with infectious disease 17 - Seacoast Business & Health Clinic 11 Whitehall Road Rochester NH 03867 Occupational Health 18 - Skyhaven Surgery Center LLC 11 Whitehall Road Rochester NH 03867 Ambulatory Surgery 19 - Granite State Lab LLC 11 Whitehall Road Rochester NH 03867 Laboratory Services 20 - Granite State Express LLC 11 Whitehall Road Rochester NH 03867 Express Care Part I, Line 7: The Instructions for Form 990, Schedule H, Part I, contain a template, titled "Worksheet 2", that may be used to determine the overall cost to charge ratio. This ratio may be applied to the charges listed throughout the Schedule H in order to calculate their associated costs. Where applicable, the Hospital has utilized Worksheet 2 for various calculations; the Hospital utilized Worksheet 2 for all calculations on Part I, Line 7, except for the following specific instance:Schedule H, Worksheet 6 - Subsidized Health Services (the supporting worksheet for Part I, Line 7g). The Hospital did not utilize Worksheet 2 to determine the profit or loss for each of the hospital clinical services or hospital-owned physician practices. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in Part II, Community Building Activities, Line 1(c), total community building expense, the Hospital utilized the actual estimated costs on the modified Medicare cost report. Part I, Line 7g: Frisbie Hospital has several hospital clinical services and hospital-owned physician practices. Per the instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may classify any applicable physician practices that the Hospital subsidizes or that operate at a loss, including service areas such as the Hospital's inpatient psychiatric unit, when completing Schedule H as "subsidized health services". Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that are either subsidized by the Hospital or that operate at a loss, and the associated costs of these practices, in its calculation of subsidized health services as presented on the 2018 Schedule H, Part I, Line 1g:a. Inpatient Psychiatric Unitb. Outpatient Psychiatric Servicesc. Oncologyd. Family Care of Somersworthe. Barrington Family Practicef. Rochester Pulmonary Medicineg. Internal Medicineh. Rheumatologyi. Rochester Infectous Diseasej. Rochester Vascular Surgeryk. Diabetes Servicesl. Strafford Cardiologym. Rochester Pediatricsn. Barrington Walk-In Clinico. OB/GYN Servicesp. White Mountain Medical q. Wound Care Clinicr. Emergency Room Servicess. Sanford Medical Servicest. Ambulance Servicesu. Family Care of FarmingtonThe above listed hospital clinical services and hospital-owned physician practices have an aggregate community benefit, otherwise categorized as an aggregate loss or subsidy from the Hospital, of approximately $33.59 million. In accordance with IRS Instructions for Schedule H, this community benefit figure does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $33.59 million is a conservative figure that reconciles to the community benefit reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e. Part I, Ln 7 Col(f): The Hospital's total bad debt expense for the fiscal year is reported on the Hospital's Form 990, Part IX, Line 24(c), as $5,209,669. The Hospital's total bad debt expense as reported on Form 990, Part IX, is also subtracted for purposes of calculating the percentage in this column (please see the attached financial statements, page 30). Part II, Community Building Activities: Please see narrative for Part VI, Line 5. Part III, Line 2: The Hospital utilized Worksheet 2 from the IRS Instructions for Schedule H to determine the ratio of patient-care to cost-to-charge (approximately 37.61% for fiscal year 2019). This ratio is then multiplied by the Hospital's total bad debt expense of $5,209,669 to determine the Schedule H, Part III, Line 2, bad debt expense of $1,959,098. Part III, Line 3: Frisbie Memorial Hospital estimates this percentage based upon historical data. This amount is reported at cost, and is not reported as a community benefit within Schedule H, Part I, Line 7. Part III, Line 4: Please see Footnote 2, "Accounts Receivable and the Allowance for Doubtful Accounts" on page 11 of the attached audited financial statements. Part III, Line 8: Form 990, Schedule H instructions and guidance contain a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost, including costs related to Medicare charges. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 7 was Schedule H, Section B, Line 5 and and Line 6, total revenue received from Medicare and Medicare allowable costs, respectively. The Hospital utilized its Medicare cost reports to derive the estimated costs and payments for these services.As previously described in the the Hospital's supplemental disclosure for Schedule H, Part I, Line 7g, the Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and inpatient psychiatric units should all be considered community benefits; these services, facilities, and programs provide a benefit to community members and are both offered and subsidized by the Hospital.Medicare shortfall is reported to the State of New Hampshire in the Community Benefits Report, under Section 4, Unreimbursed Costs, Government-Sponsored Health Care.In prior years, the State of New Hampshire used MET dollars to service the general fund of the State. However, recently the State has used these dollars to directly fund medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact is considered a healthcare-related expenditure by the Hospital. Part III, Line 9b: The Hospital's collection policy allows accounts which are known to qualify for free care to be removed from internal records of outstanding debts, and for such accounts to be transferred to an outside agency for further collection activity and procedures. Part VI, Line 2: Frisbie Memorial Hospital (FMH) conducts a Community Needs Assessment every three years, the most recent completed in January of 2019. FMH worked with Health Strategies Plus to bring together health care and public services stakeholders.The Frisbie Memorial Hospital CHNA methodology includes a combination of quantitative and qualitative research methods designed to evaluate perspectives and opinions of area stakeholders and healthcare consumers - including those from underserved populations. The methodology used helps prioritize the needs and establish a basis for continued community engagement.The major sections of the methodology include the following: - Strategic secondary research - Qualitative discussion groups with Leadership Team members - Community surveys - Needs prioritization using a modified Delphi process Part VI, Line 3: Frisbie Memorial Hospital is committed to providing quality health care that is affordable and accessible to all, regardless of the care-recipient's ability to pay. The Hospital offers financial assistance to eligible patients and help patients apply for other programs that they may be eligible. Patients can learn more about these programs by visiting the Hospital's website or contacting the Hospital's Patient Accounts department. Beginning with patient registration and through the billing process, patients can obtain an application for financial assistance or speak with a financial counselor. Part VI, Line 4: Frisbie Memorial Hospital's patient service area is urban, consisting of Northern Strafford, NH and Western York, ME counties. Population served for our Strafford County (upon which Frisbie is located in) is over 128,000 with a median income of $50,759 and 11.7% of community residents living below the federal poverty guidelines. Part VI, Line 5: Frisbie's Community Education & Conference Center is utilized by a multitude of community-based social and civic organizations as a convenient location for holding professional trainings and seminars, conferences, meetings, maternal classes, caregiver trainings and wellness events. The Conference Center is available at no charge to community nonprofit organizations for health promotion, disease prevention, and educational purposes. In light of the facts and circumstances surrounding the Community Center's varied purposes, the Hospital has claimed 50% of the expenses for this area as a benefit to the community. Part VI, Line 6: Through its affiliations, Frisbie Memorial Hospital and its partners work together to improve access to preventative health care services as well as those services put in place to address the following prioritized needs identified in 2015 Community Health Needs Assessment: Affordable medical care; mental health services; Substance abuse treatment services.- Granite State Lab: offers lower cost laboratory services- Seacoast RediCare: provides convenient access to health care services, which help to fill the gap between family physician and emergency room visits.- Women's Life Imaging: provides convenient access to preventative mammography services.- Rochester Community Counseling: a joint effort between Community Partners and Frisbie Memorial Hospital to improve access to much behavioral health services in Rochester. Part VI, Line 7, Reports Filed With States NH,ME 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 236822 Financial support for the recipient organization's mission. 1 Part I, Line 2: All donations are tracked internally and follow up calls are placed to ensure funds have been used for the purposes of which they were intended. X X X 1 1 0 0 0 0 0 1 0 Jocelyn Caple MD President & CEO 312742 0 6900 0 0 0 0 0 29134 0 348776 0 0 0 Robert Cochrane VP Finance, CFO (end 2/19) 283358 0 15000 0 0 0 0 0 26717 0 325075 0 0 0 Christi Green VP Human Resources 135050 0 19000 0 0 0 0 0 10353 0 164403 0 0 0 Trevor Eide MD Physician 392116 0 135806 0 0 0 0 0 21561 0 549483 0 0 0 John Freese MD Physician 263513 0 267563 0 0 0 0 0 19302 0 550378 0 0 0 Kathleen O'Malley Maxfield MD Physician 426621 0 0 0 0 0 0 0 11026 0 437647 0 0 0 Michael Southworth MD Physician 423801 0 0 0 0 0 0 0 19301 0 443102 0 0 0 Robert A Brown Jr MD Physician 190196 0 221681 0 0 0 0 0 19269 0 431146 0 0 0 John Marzinsik Former President & CEO (end 2/18) 165950 0 0 0 373575 0 64049 0 2659 0 606233 0 0 0 Paula Mahoney Former VP Phys. Practices (end 7/18) 256132 0 17000 0 156895 0 0 0 0 0 430027 0 0 0 Joseph Shields Former Senior VP (end 7/18) 156347 0 0 0 121596 0 18500 0 21934 0 318377 0 35684 0 Part I, Lines 4a-b Line 4a: The following individuals listed in Form 990, Part VII received a severance payment from the Hospital during the 2018 calendar year. - John Marzinisik received $259,878 - Joseph Shields received $257,360 - Paula Mahoney received $141,953 The severance payments were paid to the above individuals during the fiscal year covered by the previous year's tax return but after December 31, 2017. In accordance with IRS instructions, these amounts have been reflected on the Organization's 2018 Form 990 filing in Schedule J, Part II, Column B(iii) as part of the recipients' Box 5 2018 Form W-2 taxable wages. In addition, Robert Cochrane, the Organization's former VP of Finance and CFO, resigned from the Organization's Board of Directors and received a severance payment in the amount of $143,750 during the filing period covered by this Form 990 but after December 31, 2018. In accordance with IRS instructions, this amount will be reflected on the Organization's 2019 Form 990 filing in Schedule J, Part II, Column B(iii) as part of the recipients' Box 5 2019 Form W-2 taxable wages. Line 4b: The Hospital has a 457(f) deferred compensation plan which covers highly compensated employees. The Organization incurred liabilities related to salary continuation agreements with highly compensated employees. Under the terms of the agreements, the covered plan participants are entitled to receive a lump sum of their account balance, including earnings, within 30 days after the date elected by the employee. There were no employees who received new or additional payments under the 457(f) plan into their plan-funds for the 2018 calendar year. Joseph Shields received a distribution from his 457(f) plan of $35,684. This amount has been reported as part of his W-2 taxable wages and disclosed in Schedule J, Part II, Columns B(iii) and F. Part I, Line 7 A portion of compensation is at-risk and variable, and payment depends on the quality of job performance. Unrelated Organization Compensation During the fiscal year, Frisbie Memorial Hospital and Frisbie Foundation, of which the Hospital is the sole member, had an interim CFO, James Hutchinson. Mr. Hutchinson was compensated through a consulting firm, Warbird Consulting Partners. However, this arrangement did not begin until March of 2019. Therefore, Mr. Hutchinson did not receive any compensation from the Hospital during the 2018 calendar year. The amount paid to Warbird Consulting Partners for Mr. Hutchinson's services for the period covering March, 2019, through September, 2019 (the end of each Organizations' tax year) was $274,064. Warbird was paid an additional $47,598 by Frisbie Memorial Hospital during this period to cover travel expenses and other discretionary fees incurred by Mr. Hutchinson while providing his services. In accordance with IRS instructions, as Mr. Hutchinson did not receive any compensation during the 2018 calendar year, the compensation he received for providing his services to Frisbie Memorial Hospital and the Foundation during the fiscal year filing period has been omitted from both Part VII and Schedule J of each Organizations' 2018 Form 990. The entirety of the compensation that Mr. Hutchinson received for his services, for the period covering March, 2019, through December, 2019, will be disclosed on each Organizations' 2019 Form 990, Part VII and Schedule J, for the Organizations' tax years ending September 30, 2020. A NHHEFA 020279866 644614QD4 2014-08-01 22475000 Refunding Series 2006 Bonds 0 0 0 A 22475000 22475000 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 John Britton MD Board Member 1625000 Dr. Britton is a 33.33% owner of Surgical Associates of Rochester. The general surgeons at Surgical Associates of Rochester provide a wide range of services to patients of the Hospital, from minor office procedures to major surgery, done with both laparoscopic and open techniques, for adult and pediatric patients. During 2018, Frisbie Memorial Hospital paid $1,625,000 to Surgical Associates of Rochester for services rendered to the Hospital. All transactions were at arm's length. 0 Form 990, Part VI, Section A, line 2 Trustees Ronald Poulin and Jeanette Poulin have a family relationship. Form 990, Part VI, Section A, line 3 During the fiscal year, Frisbie Memorial Hospital and Frisbie Foundation, of which the Hospital is the sole member, had an interim CFO, James Hutchinson. Mr. Hutchinson was compensated through a consulting firm, Warbird Consulting Partners. However, this arrangement did not begin until March of 2019. Therefore, Mr. Hutchinson did not receive any compensation from the Hospital during the 2018 calendar year. The amount paid to Warbird Consulting Partners for Mr. Hutchinson's services for the period covering March, 2019, through September, 2019 (the end of each Organizations' tax year) was $274,064. Warbird was paid an additional $47,598 by Frisbie Memorial Hospital during this period to cover travel expenses and other discretionary fees incurred by Mr. Hutchinson while providing his services. In accordance with IRS instructions, as Mr. Hutchinson did not receive any compensation during the 2018 calendar year, the compensation he received for providing his services to Frisbie Memorial Hospital and the Foundation during the fiscal year filing period has been omitted from both Part VII and Schedule J of each Organizations' 2018 Form 990. The entirety of the compensation that Mr. Hutchinson received for his services, for the period covering March, 2019, through December, 2019, will be disclosed on each Organizations' 2019 Form 990, Part VII and Schedule J, for the Organizations' tax years ending September 30, 2020. Form 990, Part VI, Section B, line 11b The Form 990 is prepared with the assistance of the Hospital's independent public accounting firm and is thoroughly reviewed by key financial staff. The 990 will be reviewed by the governing body after it has been filed with the IRS. Form 990, Part VI, Section B, line 12c In accordance with the written conflict of interest policy, the office of the President annually secures a signed copy of the Trustee/Officer Conflict of Interest Statement and maintains them on file. Form 990, Part VI, Section B, line 15 Each year, the executive compensation committee comprised of four members of the FMH Board reviews the Hospital CEO performance and compensation. The VP of Human Resources presents the compensation committee with comparative salary and benefit data. Senior management compensation is also reviewed by the committee, but their compensation is determined by the CEO. Form 990, Part VI, Section C, line 19 The Hospital will provide its governing documents, financial statements, and conflict of interest policy upon request. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990: In January 2019, the Organization and HCA Healthcare, Inc. signed a non-binding letter of intent (LOI) to affiliate the organizations. This non-binding LOI was the first step in a lengthy process that included due diligence, negotiation of a definitive agreement, review and approval of each member's Board of Directors, and federal and state regulatory approval processes. Expected benefits of the affiliation include expanding the Organization's primary and specialty services in New Hampshire, expanding access to health care in rural communities, and increasing competition by delivering higher-quality, lower cost care. In March of 2020, the purchase of Frisbie Memorial Hospital was completed. At the time of this return's filing, the Hospital is in the process of winding down and completing the financial aspects of the sale in terms of transfer to HCA. It expects that this process will be complete prior to the end of its next fiscal year ending September 30, 2020. The Hospital's tax return for the fiscal year ending September 30, 2020 will likely be a final return. Form 990, Part VI, Line 16b: The Hospital does not have a formal joint venture policy in written format. However, any joint venture agreement the Hospital may consider is thoroughly vetted by the board or subcommittee to ensure that the joint venture significantly improves and furthers the Hospital's exempt charitable mission. On-going monitoring is also conducted to safeguard the Hospital's invested assets from private benefit or other misappropriation. Granite State Lab LLC 11 Whitehall Road Manchester NH 03867 464121424 Laboratory Services NH -228120 181091 Frisbie Memorial Hospital Granite State Express LLC 11 Whitehall Road Manchester NH 03867 464115911 Express Care NH 0 0 Frisbie Memorial Hospital Frisbie Foundation 11 Whitehall Road Rochester NH 03867 020465942 Coordinate Funds Raised for Hospital NH 501(c)(3) Line 12b, II Frisbie Memorial Hospital 1 Skyhaven Surgery Center LLC 11 Whitehall Road Rochester NH 03867 463885261 Ambulatory Surgery NH Frisbie Memorial Hospital Related -1235896 -792954 0 1 0.98000 Seacoast Business & Health Clinic Seacoast Redicare 396 High Street Somersworth NH 03878 020375898 Occupational Health NH Frisbie Memorial Hospital C -76713 1248996 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 Skyhaven Surgery Center LLC B 1055000 Actual per Books Granite State Lab LLC L 90464 Actual per Books Form 990, Schedule R, Part III Skyhaven Surgery Center, LLC is a multi-member limiited liability company formed in August 2013 to own and operate an ambulatory surgery center in the city of Rochester. The Frisbie Foundation is the majority owner of the Surgery Center and its operating agreement provides that individual physician members or entitites will own no greater than 10% individually or 30% in aggregate of the membership rights in the Surgery Center. On December 7, 2017, the Board of Trustees voted to discontinue the operations of the Surgery Center. The operating results and activity of the Surgery Center for 2018 and 2017 are reported as discontinued operations in the Hospital's audited consolidated statements of operations.