FMH Wind-Down Company: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FMH Wind-Down Company (EIN 02-0222131)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-13
- IRS object ID
- 201802259349301325
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-13T13:44:49-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 507 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222131 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FRIS | BusinessNameControlTxt |
| Phone | 6033325211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jocelyn Caple MD | PersonNm |
| Person Title | Interim President/CEO | PersonTitleTxt |
| Phone | 6033325211 | PhoneNum |
| Signature | 2018-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Preparation | 2018-08-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jocelyn Caple MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $163,061,010 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.frisbiehospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1941 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To excel at caring for the community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1174 | TotalEmployeeCnt |
| Total Volunteers | 132 | TotalVolunteersCnt |
| Total Gross UBI | $438,881 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $23,925 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $240,621 | PYContributionsGrantsAmt |
| CY Contributions Grants | $187,397 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $146,141,383 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $147,306,971 | CYProgramServiceRevenueAmt |
| PY Investment Income | $963,134 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,167,515 | CYInvestmentIncomeAmt |
| PY Other Revenue | $533,527 | PYOtherRevenueAmt |
| CY Other Revenue | -$666,763 | CYOtherRevenueAmt |
| PY Total Revenue | $147,878,665 | PYTotalRevenueAmt |
| CY Total Revenue | $148,995,120 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $109,542 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $219,240 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $79,081,033 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $87,123,256 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $160,968 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $65,332,413 | PYOtherExpensesAmt |
| CY Other Expenses | $82,870,094 | CYOtherExpensesAmt |
| PY Total Expenses | $144,522,988 | PYTotalExpensesAmt |
| CY Total Expenses | $170,212,590 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,355,677 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$21,217,470 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $136,936,545 | TotalAssetsBOYAmt |
| Total Assets EOY | $131,957,524 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $49,123,520 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $68,412,836 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $87,813,025 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $63,544,688 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $134,472,619 | ExpenseAmt |
| Grant | $219,240 | GrantAmt |
| Revenue | $146,873,540 | RevenueAmt |
| Desc | 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, 2017, 28,913 patients were treated in our emergency department, 15,319 ambulance calls were made, 3,374 inpatients were cared for, and surgeries on 8,027 patients were performed. Additionally, 307 newborns were welcomed into the world, 22,838 radiology procedures/tests provided, 57,742 rehabilitative treatments were provided, 373,741 laboratory tests were performed, and 4,487 oncology patients were treated. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,699,685 | ExpenseAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $544,420 | ExpenseAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $141,716,724 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 59 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1174 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Robert Cochrane | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033325211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| John Britton MD | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Mark Farrell | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| John Hall | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| James Jalbert | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Frank Jones | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Julie Reynolds | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Lisa Stanley | ||||||||||
| Trustee | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Brian Szymanski MD | ||||||||||
| Trustee | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Greg Smith | ||||||||||
| Trustee (part year) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Leslie Simpson | ||||||||||
| Trustee (part year) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Brian Hughes | ||||||||||
| Chairman, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| TJ Jean | ||||||||||
| Vice Chairman, Trustee | 3.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| William Cormier | ||||||||||
| Secretary, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Jeanette Poulin | ||||||||||
| Treasurer, Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Ron Poulin | ||||||||||
| Former Chariman, Trustee | 3.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| John Marzinsik | ||||||||||
| CEO | 40.00 | 5.00 | $752,721 | $0 | $33,454 | Yes (X) | ||||
| Steve Guimond | ||||||||||
| CFO (end 3/17) | 40.00 | 5.00 | $295,032 | $0 | $0 | Yes (X) | ||||
| Robert Cochrane | ||||||||||
| VP Finance, CFO | 40.00 | 5.00 | $0 | $0 | $0 | Yes (X) | ||||
| Amy Dumont | ||||||||||
| VP Operations | 40.00 | 0.00 | $235,785 | $0 | $26,701 | Yes (X) | ||||
| Carol Themelis | ||||||||||
| VP Human Resources (end 3/17) | 40.00 | 0.00 | $185,709 | $0 | $2,646 | Yes (X) | ||||
| Paula Mahoney | ||||||||||
| VP Physician Practices | 40.00 | 0.00 | $213,404 | $0 | $84,478 | Yes (X) | ||||
| Joseph Shields | ||||||||||
| Senior VP | 40.00 | 0.00 | $411,678 | $0 | $75,903 | Yes (X) | ||||
| Trevor Eide MD | ||||||||||
| Physician | 40.00 | 0.00 | $488,233 | $0 | $22,465 | Yes (X) | ||||
| John Freese MD | ||||||||||
| Physician | 40.00 | 0.00 | $456,229 | $0 | $17,749 | Yes (X) | ||||
| Mathurin Malby MD | ||||||||||
| Physician | 40.00 | 0.00 | $468,889 | $0 | $37,202 | Yes (X) | ||||
| Michael Metzger MD | ||||||||||
| Physician | 40.00 | 0.00 | $392,151 | $0 | $26,951 | Yes (X) | ||||
| Michael Southworth MD | ||||||||||
| Physician | 40.00 | 0.00 | $489,207 | $0 | $27,944 | Yes (X) | ||||
| Nick Samilo | ||||||||||
| Former CFO | 0.00 | 0.00 | $264,209 | $0 | $17,880 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,653,247 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $373,373 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 94 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HealthNET Systems Consulting | |||||
| 20 Burlington Mall Road | Burlington | MA | 01803 | IT Consulting | $3,134,027 |
| Crothall Healthcare | |||||
| 13028 Collections Center Drive | Chicago | IL | 60693 | Facilities Management | $2,852,616 |
| Surgical Associates of Rochester | |||||
| 21 Whitehall Road Suite 3 | Rochester | NH | 03867 | Physician Practice | $1,683,465 |
| Unidine Corporation | |||||
| PO Box 360639 | Pittsburgh | PA | 152516639 | Dietary Services | $1,559,358 |
| Navine Haffty & Associates LLC | |||||
| 1900 West Park Drive Suite 180 | Westborough | MA | 01581 | IT Consulting | $838,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $187,397 | AllOtherContributionsAmt |
| Total Contributions | $187,397 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net Patient Service Revenue | 621110 | $135,118,860 | $135,118,860 | |
| Disproportionate Share Funding | 621110 | $6,392,433 | $6,392,433 | |
| Miscellaneous Revenue | 621110 | $4,780,863 | $4,347,432 | $433,431 |
| Cafeteria | 561000 | $591,578 | $591,578 | |
| Meaningful Use | 621110 | $423,237 | $423,237 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $147,306,971 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $513,394 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $5,450 | UnrelatedBusinessRevenueAmt |
| Exclusion | $507,944 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,720,011 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $14,065,890 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,654,121 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,654,121 | TotalRevenueColumnAmt |
| Exclusion | $1,654,121 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| Equity Earnings in Affiliates | 523000 | $147,966 | $147,966 |
| Equity Earnings in Benevera, LLC | 523000 | -$814,729 | -$814,729 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$666,763 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $148,995,120 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $146,873,540 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $438,881 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,495,302 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $219,240 | TotalAmt |
| Program Services | $219,240 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,646,108 | TotalAmt |
| Program Services | $205,716 | ProgramServicesAmt |
| Management And General | $1,440,392 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,722,989 | TotalAmt |
| Program Services | $53,179,083 | ProgramServicesAmt |
| Management And General | $12,442,852 | ManagementAndGeneralAmt |
| Fundraising | $101,054 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,549,575 | TotalAmt |
| Program Services | $2,020,341 | ProgramServicesAmt |
| Management And General | $525,410 | ManagementAndGeneralAmt |
| Fundraising | $3,824 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,935,807 | TotalAmt |
| Program Services | $10,250,626 | ProgramServicesAmt |
| Management And General | $2,665,777 | ManagementAndGeneralAmt |
| Fundraising | $19,404 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,268,777 | TotalAmt |
| Program Services | $3,382,676 | ProgramServicesAmt |
| Management And General | $879,698 | ManagementAndGeneralAmt |
| Fundraising | $6,403 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,032 | TotalAmt |
| Management And General | $295,032 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,230 | TotalAmt |
| Management And General | $177,230 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,363 | TotalAmt |
| Management And General | $123,363 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,810 | TotalAmt |
| Management And General | $14,810 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,558 | TotalAmt |
| Management And General | $124,558 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,480,467 | TotalAmt |
| Program Services | $12,302,196 | ProgramServicesAmt |
| Management And General | $5,151,586 | ManagementAndGeneralAmt |
| Fundraising | $26,685 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765,784 | TotalAmt |
| Program Services | $7,078 | ProgramServicesAmt |
| Management And General | $758,706 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,045,272 | TotalAmt |
| Program Services | $943,600 | ProgramServicesAmt |
| Management And General | $1,098,275 | ManagementAndGeneralAmt |
| Fundraising | $3,397 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,281,162 | TotalAmt |
| Program Services | $6,772,071 | ProgramServicesAmt |
| Management And General | $1,509,091 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,317 | TotalAmt |
| Program Services | $101,554 | ProgramServicesAmt |
| Management And General | $32,562 | ManagementAndGeneralAmt |
| Fundraising | $201 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,214,803 | TotalAmt |
| Program Services | $1,214,803 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,930,901 | TotalAmt |
| Program Services | $6,930,901 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,166,403 | TotalAmt |
| Program Services | $1,371,903 | ProgramServicesAmt |
| Management And General | $794,500 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Supplies | $23,370,474 | $23,186,280 | $184,194 |
| Bad Debt Expense | $12,962,566 | $12,962,566 | |
| NH Medicaid Enhancement | $5,350,579 | $5,350,579 | |
| Equipment Maintenance | $1,395,660 | $1,278,798 | $116,862 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,713 | TotalAmt |
| Program Services | $36,713 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,212,590 | TotalAmt |
| Program Services | $141,716,724 | ProgramServicesAmt |
| Management And General | $28,334,898 | ManagementAndGeneralAmt |
| Fundraising | $160,968 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,901,772 | BOYAmt |
| EOY | $1,209,842 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,401,023 | BOYAmt |
| EOY | $1,991,593 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,417,311 | BOYAmt |
| EOY | $24,784,938 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,577,375 | BOYAmt |
| EOY | $4,040,135 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,842,887 | BOYAmt |
| EOY | $1,326,575 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $158,886,603 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $91,269,204 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,354,579 | BOYAmt |
| EOY | $67,617,399 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,486,025 | BOYAmt |
| EOY | $11,243,311 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $12,843,120 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,955,573 | BOYAmt |
| EOY | $6,900,611 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,936,545 | BOYAmt |
| EOY | $131,957,524 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,142,261 | BOYAmt |
| EOY | $19,385,785 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,670,934 | BOYAmt |
| EOY | $21,587,470 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,313,657 | BOYAmt |
| EOY | $12,048,933 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000,000 | BOYAmt |
| EOY | $4,995,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,003,332 | BOYAmt |
| EOY | $10,395,648 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,123,520 | BOYAmt |
| EOY | $68,412,836 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,292,631 | BOYAmt |
| EOY | $61,024,294 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $603,702 | BOYAmt |
| EOY | $603,702 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,916,692 | BOYAmt |
| EOY | $1,916,692 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,813,025 | BOYAmt |
| EOY | $63,544,688 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,936,545 | BOYAmt |
| EOY | $131,957,524 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$21,217,470 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $568,180 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,619,047 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $14,810 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $14,810 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital pays dues to various associations, a portion of which is attributable to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,526,165 | BeginningYearBalanceAmt |
| Contributions | $100,889 | ContributionsAmt |
| Investment Earnings Or Losses | $2,877,676 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $16,587,188 | OtherExpendituresAmt |
| Administrative Expenses | $124,558 | AdministrativeExpensesAmt |
| End Year Balance | $17,792,984 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,464,678 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,195,487 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $134,000 | OtherExpendituresAmt |
| End Year Balance | $31,526,165 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $34,288,142 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$4,823,464 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,464,678 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,227,443 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,323,272 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $262,573 | OtherExpendituresAmt |
| End Year Balance | $34,288,142 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $28,491,800 | BeginningYearBalanceAmt |
| Contributions | $78,472 | ContributionsAmt |
| Investment Earnings Or Losses | $2,898,384 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $241,213 | OtherExpendituresAmt |
| End Year Balance | $31,227,443 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.86210 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.13790 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $181,776 | OtherCostOrOtherBasisAmt |
| Book Value | $181,776 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $88,602,496 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,474,251 | DepreciationAmt |
| Book Value | $41,128,245 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,510,699 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,059,298 | DepreciationAmt |
| Book Value | $451,401 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,653,564 | OtherCostOrOtherBasisAmt |
| Depreciation | $41,398,668 | DepreciationAmt |
| Book Value | $25,254,896 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,938,068 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,336,987 | DepreciationAmt |
| Book Value | $601,081 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $67,617,399 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Corporate Bonds | $6,132,595 | F |
| Assets Held in Employee Benefit Plans | $6,710,525 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $12,843,120 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DSH Revenue Receivable | $1,337,645 |
| Malpractice Claims Receivable | $1,271,986 |
| Other Assets | $506,759 |
| Investment in Yankee Alliance, LLC | $5,000 |
| Investment in Benevera Health, LLC | $201,835 |
| Cash Surrender Value, Life Insurance | $653,948 |
| Investment in Strafford Health Alliance | $2,923,438 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,900,611 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Third Party Payor Settlements | $1,216,784 |
| Due to Affiliates | $652,048 |
| Malpractice Liability Claims Payable | $1,621,986 |
| Accrued Pension | $6,904,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,395,648 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $149,402,029 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $568,180 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $568,180 | RevenueNotReportedAmt |
| Revenue Subtotal | $148,833,849 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $124,558 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $36,713 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $161,271 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $148,995,120 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $170,051,319 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $170,051,319 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $124,558 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $36,713 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $161,271 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $170,212,590 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 36,713. |
| Part XII, Line 4b - Other Adjustments: | Unrelated Business Income Tax 36,713. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,510,346 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,510,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,236,996 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,334,854 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,902,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04390 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,747,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,334,854 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,412,488 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $470,329 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $470,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $69,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $69,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,837,058 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,396,156 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $440,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $226,275 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $226,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,602,662 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,396,156 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,206,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,350,004 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,731,010 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,618,994 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08650 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,718,574 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $471,857 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,128,825 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $52,033,264 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$21,904,439 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.frisbiehospital.com | WebsiteAddressTxt |
| State License | 00028 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Geropsychiatric Unit | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | Please see Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.frisbiehospital.com | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Please see Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Please see Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Please see Part V, Section C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| Frisbie Memorial Hospital | Part V, Section B, Line 11: Frisbie Memorial Hospital is empowering individuals to make healthy lifestyle choices and providing access to preventative care services. For more information, please see attached Community Health Needs Assessment. |
| 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. |
| Part V, Section B, Line 7a, CHNA website: | https://www.frisbiehospital.com/wp-content/uploads/2016/03/Frisbie_CommunityHealthNeedsAssessment.pdf |
| Part V, Section B, Line 16a, FAP website: | https://www.frisbiehospital.com/wp-content/uploads/2018/04/Frisbie-Memorial-Hospital-Financial-Assistance-Policy.pdf |
| Part V, Section B, Line 16b, FAP Application website: | https://www.frisbiehospital.com/wp-content/uploads/2018/04/Financial-Assistance-Application.pdf |
| Part V, Section B, Line 16c, plain language summary website: | http://www.frisbiehospital.com/patients-and-visitors/billing-insurance/financial-assistance/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Skyhaven Surgery Center LLC | ||||
| 11 Whitehall Road | Rochester | NH | 03867 | Ambulatory Surgery |
| 2 - Seacoast Business & Health Clinic | ||||
| 11 Whitehall Road | Rochester | NH | 03867 | Occupational Health |
| 3 - Granite State Lab LLC | ||||
| 11 Whitehall Road | Rochester | NH | 03867 | Laboratory Services |
| 4 - Granite State Express LLC | ||||
| 11 Whitehall Road | Rochester | NH | 03867 | Express Care |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 12,962,566. |
| Part II, Community Building Activities: | Please see narrative for Part VI, Line 5. |
| Part III, Line 2: | The Medicare cost report ratio of cost to charge is used to determine cost of bad debt expense. |
| 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 Part 1, Line 7. |
| Part III, Line 4: | Please see Footnote 2, "Accounts Receivable and the Allowance for Doubtful Accounts" on page 12 of the attached audited financial statements. |
| Part III, Line 8: | Medicare shortfall is reported on the annual Community Benefit Report to the State of New Hampshire under "unreimbursed costs" government sponsored healthcare.In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for 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: | Collection policy provides for accounts known to qualify for free care be removed from transfer to an outside agency for further collection activity. |
| Part VI, Line 2: | Frisbie Memorial Hospital (FMH) conducts a Community Needs Assessment every three years, the most recent completed in 2015. FMH worked with Health Strategies Plus to bring together health care and public services stakeholders. |
| Part VI, Line 3: | Frisbie Memorial Hospital is committed to providing quality health care that is affordable and accessible to all, regardless of ability to pay. We offer 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 our website or contacting our Patient Accounts department. Beginning with the registration process and through the billing, patients can obtain an application for financial assistance or speak with a financial counselor. |
| Part VI, Line 4: | FMH's patient service area is urban, consisting of Northern Strafford, NH and Western York, ME counties. Population served is over 125,000 with a median income of $59,519 and 13.2% 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. |
| 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Great Bay Community College | |||||||
| 320 Corporate Drive | Portsmouth | NH | 03801 | 900531902 | 501(c)(3) | $10,000 | Financial support for the recipient organization's mission. |
| Foundation for Healthy Communities | |||||||
| 125 Airport Road | Concord | NH | 03301 | 020275078 | 501(c)(3) | $156,845 | Financial support for the recipient organization's mission. |
| Leadership Greater Rochester | |||||||
| 18 South Main Street | Rochester | NH | 03867 | 020185370 | 501(c)(3) | $5,000 | Financial support for the recipient organization's mission. |
| Rochester Child Care Center | |||||||
| 95 Charles Street | Rochester | NH | 03867 | 020327002 | 501(c)(3) | $5,000 | Financial support for the recipient organization's mission. |
| James W Foley Legacy Foundation Inc | |||||||
| 4 Conifer Circle | Rochester | NH | 03867 | 471759388 | 501(c)(3) | $10,000 | Financial support for the recipient organization's mission. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John Marzinsik | ||||||||||||||
| CEO | $412,534 | $0 | $279,481 | $0 | $60,706 | $0 | $11,231 | $0 | $22,223 | $0 | $786,175 | $0 | $0 | $0 |
| Steve Guimond | ||||||||||||||
| CFO (end 3/17) | $295,032 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $295,032 | $0 | $0 | $0 |
| Amy Dumont | ||||||||||||||
| VP Operations | $235,785 | $0 | $0 | $0 | $0 | $0 | $7,500 | $0 | $19,201 | $0 | $262,486 | $0 | $0 | $0 |
| Carol Themelis | ||||||||||||||
| VP Human Resources (end 3/17) | $133,334 | $0 | $15,100 | $0 | $37,275 | $0 | $1,174 | $0 | $1,472 | $0 | $188,355 | $0 | $0 | $0 |
| Paula Mahoney | ||||||||||||||
| VP Physician Practices | $181,904 | $0 | $15,000 | $0 | $16,500 | $0 | $62,229 | $0 | $22,249 | $0 | $297,882 | $0 | $0 | $0 |
| Joseph Shields | ||||||||||||||
| Senior VP | $366,068 | $0 | $33,000 | $0 | $12,610 | $0 | $53,654 | $0 | $22,249 | $0 | $487,581 | $0 | $0 | $0 |
| Trevor Eide MD | ||||||||||||||
| Physician | $256,541 | $0 | $231,692 | $0 | $0 | $0 | $8,889 | $0 | $13,576 | $0 | $510,698 | $0 | $0 | $0 |
| John Freese MD | ||||||||||||||
| Physician | $242,855 | $0 | $213,374 | $0 | $0 | $0 | $3,301 | $0 | $14,448 | $0 | $473,978 | $0 | $0 | $0 |
| Mathurin Malby MD | ||||||||||||||
| Physician | $281,930 | $0 | $186,959 | $0 | $0 | $0 | $9,481 | $0 | $27,721 | $0 | $506,091 | $0 | $0 | $0 |
| Michael Metzger MD | ||||||||||||||
| Physician | $391,351 | $0 | $800 | $0 | $0 | $0 | $10,600 | $0 | $16,351 | $0 | $419,102 | $0 | $0 | $0 |
| Michael Southworth MD | ||||||||||||||
| Physician | $488,407 | $0 | $800 | $0 | $0 | $0 | $0 | $0 | $27,944 | $0 | $517,151 | $0 | $0 | $0 |
| Nick Samilo | ||||||||||||||
| Former CFO | $177,209 | $0 | $5,000 | $0 | $82,000 | $0 | $0 | $0 | $17,880 | $0 | $282,089 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Lines 4a-b | Nick Samilo, was the organization's CFO through August 24, 2016. He received the following severance payments: $41,000 in October of 2016, and $20,500 in November and December of 2016. He also received severance payments of $20,500 in January and February of 2017. 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 they are entitled to receive a lump sum of their account balance, including earnings, within 30 days after the date elected by the employee. Payments received by employees under the 457(f) plan for the calendar year ending 12/31/16 and were included in Schedule J, Part II, Column C were as follows: Paula Mahoney - $38,484 Joseph Shields - $26,643 There were no distributions from anyone's plan during 2016. |
| Part I, Line 7 | The bonus compensation listed for the Organization's physicians is based on a Relative Value Unit-Based compensation system. |
| Form 990, Part VII, Line 6: | Steve Guimond served as interim CFO of the Hospital from August 2016 to March 2017 when a permanent CFO was hired. Mr. Guimond was a contracted professional who was leased through a managmenet company, Leaders for Today, an unrelated organization. The Hospital paid $295,032 to Leaders for Today for Mr. Guimond's services to the organization. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NHHEFA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 644614QD4 | CUSIPNum |
| Bond Issued | 2014-08-01 | BondIssuedDt |
| Issue Price | $22,475,000 | IssuePriceAmt |
| Purpose | Refunding Series 2006 Bonds | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $575,000 | RetiredAmt |
| Total Proceeds | $22,475,000 | TotalProceedsAmt |
| Refunding Escrow | $22,475,000 | RefundingEscrowAmt |
| Substantial Completion | 2014 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | John Britton MD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Board Member | RelationshipDescriptionTxt |
| Transaction | $1,683,465 | TransactionAmt |
| Transaction | 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 2016, Frisbie Memorial Hospital paid $1,683,465 to Surgical Associates of Rochester for services rendered to the Hospital. All transactions were at arm's length. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | Steve Guimond served as interim CFO of the Hospital from August 2016 to March 2017 when a permanent CFO was hired. Mr. Guimond was a contracted professional who was leased through a managmenet company, Leaders for Today, an unrelated organization. The Hospital paid $295,032 to Leaders for Today for Mr. Guimond's services to the organization. |
| 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 CFO then reviews the 990 and brings it to the board for discussion and comment. After any questions are answered, the return is filed with the Internal Revenue Service. |
| 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. |
| Form 990, Part VII: | Nick Samilo, was the organization's CFO through August 24, 2016. At the conclusion of his tenure, Steve Guimond served as interim-CFO on a subcontract basis until March of 2017 when Robert Cochrane was hired as Vice President of Finance & CFO. IRS instructions indicate that Part VII of Form 990 and Part II of Schedule J should report compensation information based on the calendar year falling within the reportable fiscal year. Accordingly, these sections have been prepared utilizing 2016 compensation information. As Mr. Samilo received compensation and benefits from the Hospital during 2016 as an officer, he is required to have his 2016 compensation disclosed. As his tenure with the organization terminated before the fiscal year covered by this return, he is being listed as a former officer of the organization. Similarly, as Mr. Cochrane did not begin his tenure with the organization until 2017, no compensation is being reported for him in Form 990, Part VII, or Schedule J, Part II. The Hospital's 2017 Form 990 will be the first year to report any compensation for Mr. Cochrane. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 12,302,196. Management and general expenses 5,151,586. Fundraising expenses 26,685. Total expenses 17,480,467. |
| Form 990, Part XI, line 9: | Equity Transfer to Affiliate -3,619,047. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the prior year. |
| 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. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| Granite State Lab LLC | |||||||||
| 11 Whitehall Road | Manchester | NH | 03867 | 464121424 | Laboratory Services | NH | -$210,913 | $237,758 | Frisbie Memorial Hospital |
| Granite State Express LLC | |||||||||
| 11 Whitehall Road | Manchester | NH | 03867 | 464115911 | Express Care | NH | $0 | $0 | Frisbie Memorial Hospital |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020465942 | EIN |
| Primary Activities | Coordinate Funds Raised for Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12b, II | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Skyhaven Surgery Center LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463885261 | EIN |
| Primary Activities | Ambulatory Surgery | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Share Of Total Income | -$1,558,788 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $2,062,557 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.90000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Seacoast Business & Health Clinic Seacoast Redicare | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 396 High Street | AddressLine1Txt |
| City | Somersworth | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03878 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020375898 | EIN |
| Primary Activities | Occupational Health | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$49,410 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,131,623 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Skyhaven Surgery Center LLC | ||
| B | $3,778,167 | Actual per Books |
| Granite State Lab LLC | ||
| L | $201,953 | Actual per Books |
| Skyhaven Surgery Center LLC | ||
| L | $1,114,392 | Actual per Books |