MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL (EIN 02-0222156)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-09
- IRS object ID
- 201421299349300207
- Schema version
- 2012v2.1
- 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 G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-09T07:30:43-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010523282 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1 |
| City | Portland | City |
| State | ME | State |
| ZIP Code | 041041100 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222156 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 6033565461 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 038605001 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Scott McKinnon | Name |
| Title | President & CEO | Title |
| Phone | 6033565461 | Phone |
| Date Signed | 2014-05-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Barbara J McGuan CPA | Name |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | Phone |
| Date Prepared | 2014-05-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Scott McKinnon | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 038605001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 65399558 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.memorialhospitalnh.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 543 | TotalNbrEmployees |
| Total Nbr Volunteers | 73 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 173102 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 555036 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 68927414 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 62396653 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 565551 | InvestmentIncomePriorYear |
| Investment Income Current Year | 233086 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 575987 | OtherRevenuePriorYear |
| Other Revenue Current Year | -27966 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 70242054 | TotalRevenuePriorYear |
| Total Revenue Current Year | 63156809 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27563896 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 35117259 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 819562 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 40504315 | OtherExpensePriorYear |
| Other Expenses Current Year | 26505961 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 68068211 | TotalExpensesPriorYear |
| Total Expenses Current Year | 61623220 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2173843 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1533589 | RevenuesLessExpensesCY |
| Total Assets BOY | 71845152 | TotalAssetsBOY |
| Total Assets EOY | 74062812 | TotalAssetsEOY |
| Total Liabilities BOY | 25192746 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 25061742 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 46652406 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 49001070 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington Valley area of New Hampshire. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 52962851 | Expense |
| Revenue | 62144813 | Revenue |
| Description | Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington area of New Hampshire. Memorial Hospital is a 25 bed Critical Access Hospital and a 45 bed Intermediate Care Facility (Merriman House). The Hospital provides Med/Surg, ICU, ICF, Ovstetrics, Radiology/Imaging, Oncology/Infusion, Cardiac Rehab, Wound Care, Specialty Care, ED and Primary Care. The Hospital had 4,834 Acute Inpatients Days and 12,528 ED Outpatient Visits in Fiscal Year 2013. | Description |
| Total Program Service Expense | 52962851 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 98 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 543 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Scott McKinnon CEO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6033565461 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 038605001 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Gene Bergoffen | ||||||||
| Board Chair | 1.00 | X | X | 0 | 0 | 0 | ||
| Phil Davies | ||||||||
| 1st Vice Chair | 1.00 | X | X | 0 | 0 | 0 | ||
| John Stratton | ||||||||
| 2nd Vice Chair | 1.00 | X | X | 0 | 0 | 0 | ||
| Laura Jawitz | ||||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | ||
| Thaire Bryant | ||||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | ||
| Melissa Myers | ||||||||
| At Large Member | 1.00 | X | 0 | 0 | 0 | |||
| Janice Crawford | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Barbara Hopkins | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Daphne Wall | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Ken Cargill | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Allan Stam | ||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Roger Clapp | ||||||||
| Past Treasurer | 1.00 | X | X | 0 | 0 | 0 | ||
| George Epstein | ||||||||
| Past Board Member | 1.00 | X | 0 | 0 | 0 | |||
| Scott McKinnon | ||||||||
| President/CEO | 40.00 | X | 305967 | 0 | 36343 | |||
| Vera Schumann | ||||||||
| Senior VP/CFO | 40.00 | X | 31724 | 0 | 0 | |||
| John Newton | ||||||||
| Past CFO | 40.00 | X | 352508 | 0 | 17040 | |||
| Steven Wyrsch | ||||||||
| COO | 40.00 | 225490 | 0 | 4988 | X | |||
| Raymond Rabideau | ||||||||
| Chief Medical Officer | 40.00 | 0 | 292200 | 30648 | X | |||
| Marni Madnick | ||||||||
| Medical Staff President | 40.00 | 8083 | 290830 | 34943 | X | |||
| Kimberly Goodwin | ||||||||
| Medical Director | 40.00 | 218697 | 0 | 26891 | X | |||
| Douglas Taylor | ||||||||
| Orthopedic Surgeon | 40.00 | 1000 | 543354 | 34943 | X | |||
| Morice Dennery | ||||||||
| Surgeon | 40.00 | 0 | 526693 | 34943 | X | |||
| Victor Lazaron | ||||||||
| Surgeon | 40.00 | 1000 | 431852 | 34943 | X | |||
| David Riss | ||||||||
| MD | 40.00 | 1000 | 422878 | 27266 | X | |||
| Robert Tilney | ||||||||
| Surgeon | 40.00 | 0 | 361414 | 27266 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1145469 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2869221 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 310214 | TotalOtherCompensation |
| Number Individuals GT100 K | 35 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MWV Healthcare Assoc Inc | |||||
| PO Box 2540 | North Conway | NH | 03860 | Physician Services | 8400637 |
| NORDX | |||||
| 301 US Route 1 Ste A | Scarborough | ME | 04074 | Reference Laboratory | 332387 |
| Diversified Clinical Services | |||||
| 45 Salisbury Rd 300 | Jacksonville | FL | 32216 | Wound Care Services | 318326 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 75397 | Locums Services | 291675 |
| Hinckley Allen & Snyder | |||||
| 11 South Main Street | Concord | NH | 03301 | Legal Services | 252890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Fundraising Events | 34141 | FundraisingEvents |
| All Other Contributions | 520895 | AllOtherContributions |
| Total Contributions | 555036 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Patient Service Revenue | 621110 | 111170303 | 111170303 | |
| Other Patient Service Revenue | 621110 | 427093 | 175253 | $251,840 |
| Provision for Bad Debt | 621110 | -7759210 | -7759210 | |
| Contractual Allowances | 621110 | -41441533 | -41441533 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 62396653 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41330 | TotalRevenueColumn |
| Exclusion | $41,330 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 114357 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 142323 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -27966 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -27966 | TotalRevenueColumn |
| Exclusion | -$27,966 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2090901 | Securities |
| Other | 144482 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1985440 | Securities |
| Other | 58187 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 105461 | Securities |
| Other | 86295 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 191756 | TotalRevenueColumn |
| Exclusion | $191,756 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 56799 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 34141 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 56799 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 63156809 | TotalRevenueColumn |
| Related Or Exempt Function Income | 62144813 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $456,960 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1227731 | Total |
| Program Services | 573379 | ProgramServices |
| Management And General | 654352 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25841642 | Total |
| Program Services | 22525571 | ProgramServices |
| Management And General | 3122969 | ManagementAndGeneral |
| Fundraising | 193102 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 395673 | Total |
| Program Services | 344899 | ProgramServices |
| Management And General | 47817 | ManagementAndGeneral |
| Fundraising | 2957 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6262872 | Total |
| Program Services | 5459203 | ProgramServices |
| Management And General | 756870 | ManagementAndGeneral |
| Fundraising | 46799 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1389341 | Total |
| Program Services | 1211057 | ProgramServices |
| Management And General | 167902 | ManagementAndGeneral |
| Fundraising | 10382 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 317993 | Total |
| Management And General | 317993 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95627 | Total |
| Management And General | 95627 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44762 | Total |
| Management And General | 44762 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8728192 | Total |
| Program Services | 8728192 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8863 | Total |
| Management And General | 8863 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2672481 | Total |
| Management And General | 2107388 | ManagementAndGeneral |
| Fundraising | 565093 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 441507 | Total |
| Management And General | 441507 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1571609 | Total |
| Program Services | 1509957 | ProgramServices |
| Management And General | 61652 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46096 | Total |
| Program Services | 34467 | ProgramServices |
| Management And General | 10400 | ManagementAndGeneral |
| Fundraising | 1229 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 972838 | Total |
| Program Services | 972838 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3669579 | Total |
| Program Services | 3669579 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 4388257 | 4388257 | |
| Medicaid Enhancement Ta | 2696039 | 2696039 | |
| Equipment Lease | 852118 | 849413 | 2705 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61623220 | Total |
| Program Services | 52962851 | ProgramServices |
| Management And General | 7840807 | ManagementAndGeneral |
| Fundraising | 819562 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11668040 | BOY |
| EOY | 6688420 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9569980 | BOY |
| EOY | 15444451 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7338200 | BOY |
| EOY | 8592470 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1906329 | BOY |
| EOY | 2131649 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23319 | BOY |
| EOY | 350006 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 65418212 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 36902390 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28573535 | BOY |
| EOY | 28515822 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8348027 | BOY |
| EOY | 9047979 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 366950 | BOY |
| EOY | 302088 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273695 | BOY |
| EOY | 262308 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3777077 | BOY |
| EOY | 2727619 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71845152 | BOY |
| EOY | 74062812 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4082435 | BOY |
| EOY | 4599974 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19106647 | BOY |
| EOY | 18680037 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 542664 | BOY |
| EOY | 320731 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1461000 | BOY |
| EOY | 1461000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25192746 | BOY |
| EOY | 25061742 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45694398 | BOY |
| EOY | 47917756 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 344645 | BOY |
| EOY | 469951 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 613363 | BOY |
| EOY | 613363 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46652406 | BOY |
| EOY | 49001070 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71845152 | BOY |
| EOY | 74062812 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1533589 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 879936 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -64861 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | 1 | OtherActivities |
| Other Activities | $7,984 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 7984 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | The Hospital pays dues to various associations, a portion of which is attributable to lobbying expenses. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6740032 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1132158 | InvestmentEarningsOrLosses |
| End Of Year Balance | 7872190 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6639144 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 100888 | InvestmentEarningsOrLosses |
| End Of Year Balance | 6740032 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3575593 | BeginningOfYearBalance |
| Contributions | 2400000 | Contributions |
| Investment Earnings Or Losses | 663551 | InvestmentEarningsOrLosses |
| End Of Year Balance | 6639144 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3311669 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 263924 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3575593 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3205137 | BeginningOfYearBalance |
| Contributions | 640000 | Contributions |
| Investment Earnings Or Losses | -533468 | InvestmentEarningsOrLosses |
| End Of Year Balance | 3311669 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.97750 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.01250 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.01000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 598483 | OtherCostOrOtherBasis |
| Book Value | 598483 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41415304 | OtherCostOrOtherBasis |
| Depreciation | 21744588 | Depreciation |
| Book Value | 19670716 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20227937 | OtherCostOrOtherBasis |
| Depreciation | 13710070 | Depreciation |
| Book Value | 6517867 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3176488 | OtherCostOrOtherBasis |
| Depreciation | 1447732 | Depreciation |
| Book Value | 1728756 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28515822 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Contingent Liabilities | Description |
| Amount | $1,461,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1461000 | TotalOfAmounts |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
Name Of Organization NameOfOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Davenport & Barr Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19 Rock Pine Drive | AddressLine1 |
| City | East Thetford | City |
| State | VT | State |
| ZIP Code | 05043 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Managing Philantropy Department | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 90940 | GrossReceipts |
| Amount Retained By Contractor | 56450 | AmountRetainedByContractor |
| Net To Organization | 34490 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 90940 | TotalGrossReceipts |
| Total Retained By Contractors | 56450 | TotalRetainedByContractors |
| Total Net To Organization | 34490 | TotalNetToOrganization |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Annual Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 58210 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 32695 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 25515 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 20639 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 4876 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Gala | NameOfEvent2 |
| Gross Receipts Event2 | 32730 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 1446 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 31284 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 12893 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 7961 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 2450 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 7980 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 90940 | GrossReceiptsTotal |
| Charitable Contributions Total | 34141 | CharitableContributionsTotal |
| Gross Revenue Total Events | 56799 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 33532 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 7961 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 2450 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 12856 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 56799 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 250.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2538672 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1387490 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1151182 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8329332 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9644979 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1315647 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10868004 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11032469 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -164465 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10868004 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11032469 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -164465 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,084,723 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 18531339 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 18531339 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 250.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 7: A cost reporting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. | ||
| Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to provision for bad debts and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each major payor source of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.During 2013, the Hospital increased its estimate from $3,025,000 to $3,783,299 in the allowance for doubtful accounts relating to self-pay patients. During 2013, self-pay write-offs increased from $6,166,466 to $7,001,207. Such increases resulted from trends experienced in the collection of amounts from self-pay patients. | ||
| Part III, Line 8: The Organization used a cost report as the costing methodology to determine the amount of allowable Medicare costs. | ||
| Part III, Line 9b: With the exception of insurance coverage the collection activity shall not be initiated or pursued for any amount approved under the Memorial Hospital Healthcare Assistance Program. | ||
| Part V, Section B, Line 3: A community needs assessment survey was used to elicit community input and information. The needs assessment survey was distributed in June 9, 2010 edition of the Conway Daily Sun and reached over 16,000 people in New Hampshire and Maine. An additional 2,000 copies were made available to and distributed by the members of the MWV Community Collaborative. In addition, the Gibson Center for Senior Services and the Mount Washington Valley Chamber of Commerce circulated the survey to their members. The survey resulted in 592 responses. | Memorial Hospital | |
| Part V, Section B, Line 12h: 1. Documentation in the case of a civil union to determine household size.2. Applicants that have Health Savings Accounts must provide proof that the HSA has been spent down prior to applying for Healthcare Assistance. | Memorial Hospital | |
| Part VI, Line 2: See narrative provided for Schedule H, Part V, Section B, Line 3. | ||
| Part VI, Line 3: The Hospital utilizes several methods for communicating and education patients regarding financial assistance with their hospital bills. At our registration and credit and collection offices it is visible to all with handouts. Our website includes information regarding the Healthcare Assistance Program. Hospital bills with a patient liability include information regarding the availability of financial assistance. Also the State Hospital Association website has links to various programs. | ||
| Part VI, Line 4: The Hospital serves the northern part of Carroll County in New Hampshire and the western portion of Oxford County in Maine. The Mount Washington Valley is a four season destination resort area and serves the tourists that frequent the area. | ||
| NH | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Scott McKinnon | ||||||||||||||
| President/CEO | 242592 | 0 | 63375 | 0 | 0 | 0 | 7325 | 0 | 29018 | 0 | 342310 | 0 | 0 | 0 |
| John Newton | ||||||||||||||
| Past CFO | 233750 | 0 | 25500 | 0 | 93258 | 0 | 0 | 0 | 17040 | 0 | 369548 | 0 | 0 | 0 |
| Steven Wyrsch | ||||||||||||||
| COO | 182215 | 0 | 43275 | 0 | 0 | 0 | 3804 | 0 | 1184 | 0 | 230478 | 0 | 0 | 0 |
| Raymond Rabideau | ||||||||||||||
| Chief Medical Officer | 0 | 292200 | 0 | 0 | 0 | 0 | 0 | 7226 | 0 | 23422 | 0 | 322848 | 0 | 0 |
| Marni Madnick | ||||||||||||||
| Medical Staff President | 8083 | 290830 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 27443 | 8083 | 325773 | 0 | 0 |
| Kimberly Goodwin | ||||||||||||||
| Medical Director | 218697 | 0 | 0 | 0 | 0 | 0 | 6636 | 0 | 20255 | 0 | 245588 | 0 | 0 | 0 |
| Douglas Taylor | ||||||||||||||
| Orthopedic Surgeon | 1000 | 543354 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 27443 | 1000 | 578297 | 0 | 0 |
| Morice Dennery | ||||||||||||||
| Surgeon | 0 | 526693 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 27443 | 0 | 561636 | 0 | 0 |
| Victor Lazaron | ||||||||||||||
| Surgeon | 1000 | 431852 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 27443 | 1000 | 466795 | 0 | 0 |
| David Riss | ||||||||||||||
| MD | 1000 | 422878 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 19766 | 1000 | 450144 | 0 | 0 |
| Robert Tilney | ||||||||||||||
| Surgeon | 0 | 361414 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 19766 | 0 | 388680 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 5 | A portion of the CEO and CMO Compensation was based on achieving certain organization goals including financial goals related to meeting target operational margin. |
| Part I, Line 6 | A portion of the CEO and CMO Compensation was based on achieving certain organization goals including financial goals related to meeting target operational margin. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | New Hampshire Health and Education Facilities Authority | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 020279866 | IssuerEIN |
| CUSIP Number | 644614QC6 | CUSIPNumber |
| Date Issued | 2006-06-14 | DateIssued |
| Issue Price | 20955000 | IssuePrice |
| Description Of Purpose | To construct & renovate Hospital facility and payoff existing debt | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 2274963 | AmountRetired |
| Total Proceeds | 20955000 | TotalProceeds |
| Amount In Reserve Fund | 1725373 | AmountInReserveFund |
| Issuance Costs From Proceeds | 324775 | IssuanceCostsFromProceeds |
| Capital Expenditures | 20630225 | CapitalExpenditures |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 1 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| New Program Services | Form 990, Part III, line 2 | The Hospital opened a sleep lab during FY 2013 offering a new services to North Conway and surrounding area residents. |
| Form 990, Part VI, Section A, line 6 | The sole member of Memorial Hospital is the Memorial Development Foundation. | |
| Form 990, Part VI, Section A, line 7b | The sole member of the Memorial Development Foundation ratifies the appointments to the Board of Trustees of Memorial Hospital | |
| Form 990, Part VI, Section B, line 11 | Form 990 is provided to the Finance Committee and the full Board of Trustees. It is sent to the entire Finance Committee via electronic means and then forwarded to the full Board of Trustees for approval. | |
| Form 990, Part VI, Section B, line 12c | Conflict of interest declaration forms are submitted annually in January by members of the Board of Trustees and are shared with the full board for information purposes and reviewd in depth by the Governance Committee. It is the members responsibility to notify the board should any conflicts arise in between signing and of all members of the board to immediately raise any conflicts that they become aware of and the board member with a conflict will recuse themselves from discussions and votes on the issue. | |
| Form 990, Part VI, Section B, line 15 | The Compensation Committee of the Board conducts the CEO evaluation and compensation process. The CEO's performance is reviewed against targets set for the year and his semi-annual bonus determination. The CEO compensation is compared to the Sullivan Cotter and Associates information and periodically reviewed by our compensation consultant. No one with a conflict of interest relative to the Hospital is involved in these discussions and minutes are recorded by the Secretary of the Board. Determining compensation for other officers and key employees included reference to professional association compensation data for comparable organizations and position scope. Compensation was reviewed and approved by the CEO and/or the Executive Committee of the Board of Trustees acting as the Compensation Committee. | |
| Form 990, Part VI, Section C, line 19 | Memorial Hospital will make copies of such documents available to the general public upon request. | |
| Other Fees | Form 990, Part IX, line 11g | Contract Services: Program service expenses 8,728,192. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,728,192. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 9: | Equity Loss in Subsidiary -64,861. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Memorial Development Foundation | ||||||||||
| PO Box 5001 | North Conway | NH | 03860 | 223160795 | Coordinate healthcare | NH | 501(c)(3) | Line 11a, I | N/A | 0 |
| VN & HCS of Northern Carroll Cty | ||||||||||
| PO Box 432 | North Conway | NH | 03860 | 020311473 | Visiting nurse & hospice services | NH | 501(c)(3) | Line 9 | N/A | 0 |
| White Mountain Community Health | ||||||||||
| PO Box 2800 | Conway | NH | 03818 | 020358715 | Community health center | NH | 501(c)(3) | Line 9 | N/A | 0 |
| Carroll County Health & Home Care Services Inc | ||||||||||
| PO Box 420 | Chocorua | NH | 03817 | 237337000 | Home Care Services | NH | 501(c)(3) | Line 7 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MWV Healthcare Assoc Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2540 | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020477066 | EIN |
| Primary Activity | Contract with healthcare professionals and retail | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 8381165 | ShareOfTotalIncome |
| Share Of EOY Assets | 1419838 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| MWV Healthcare Assoc Inc | ||
| P | 8549748 | Amounts Paid |
| White Mountain Community Health | ||
| J | 59004 | Amounts Paid |
| White Mountain Community Health | ||
| Q | 62272 | Amounts Paid |
| White Mountain Community Health | ||
| P | 60800 | Amounts Paid |