2013-08-22T05:42:16-07:00 2012-09-30 990 2011-10-01 020222131 FRISBIE MEMORIAL HOSPITAL FRIS 6033325211 11 WHITEHALL RD ROCHESTER NH 03867 JOHN A MARZINZIK 6033325211 2013-08-07 2011 2016-02-24 21:20:13Z JOHN A MARZINZIK 11 WHITEHALL RD ROCHESTER NH 03867 142900390 false X www.frisbiehosiptal.com X 1941 NH To excel at caring for the community by providing safe, effective, equitable, timely healthcare services. We will ally ourselves with other community healcare providers to enhance our mutual ability to improve the health of our community and the quality of life for the people we serve. 14 13 1104 226 8400 65459 186422 127453832 119509000 1442537 1093576 1208760 1744208 130170588 122533206 0 0 66298522 67689648 0 93861 57278033 58076799 123576555 125766447 6594033 -3233241 129542135 126806905 47465525 45436535 82076610 81370370 To excel at caring for the community by providing safe, false false 109721816 116021 122522206 FRISBIE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL THAT CONTINUOSLY 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, AFFORADABLE, PREVENTATIVE, EDUACTIONAL, ACUTE AND CHRONIC CARE SERVICES. IN FY2012 28,981 PATIENTS WERE TREATED IN OUR EMERGENCY DEPARTMENT, 5,629 AMBULANCE CALLS WERE MADE, 3,807 INPATIENTS WERE CARED FOR, AND SURGERY PERFORMED ON 9,345 PATIENTS. 385 NEWBORNS WERE WELCOMED INTO THE WORLD, 52,675 RADIOLOGY PROCEDURES/TESTS PROVIDED, GAVE 77,525 REHABILITATIVE TREATMENTS, PERFORMED 329,211 LABORATORY TESTS AND TREATED 5,550 ONCOLOGY PATIENTS. 6146551 FRISBIE MEMORIAL HOSPITAL PROVIDED UNCOMPENSATED CARE FOR THOSE IN NEED. FRISBIE RANKS AMOUNG THE TOP IN NEW HAMPSHIRE FOR THE MONEY VALUE OF CHARITY CARE PROVIDED TO PATIENTS. 224372 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. 116092739 true false false true false false false false false true true false false true true false false true false false false false false false false false true true false false true true false false false false false false false false false true false false false false false true false false false true 49 0 true 1104 true true true false false false false false false false false false false false false X 14 13 false false false false false false false true true false false false true true true true true true true false NH X JOHN A MARZINZIK 6033325211 11 WHITEHALL RD ROCHESTER NH 03867 STEVE POGGI 3.00 X X 0 0 0 GREG SMITH 3.00 X X 0 0 0 PETER GOWELL 3.00 X X 0 0 0 GARY USHER MD 3.00 X X 0 0 0 ALVIN FELGAR 40.00 X 1222334 0 108895 JOHN MARZINZIK 40.00 X 249842 0 49623 JOSEPH BERE 2.00 X 0 0 0 JOHN BRITTON MD 2.00 X 0 0 0 ROBERT HARRIGAN MD 2.00 X 0 0 0 MARK HOURIHANE 2.00 X 0 0 0 BRIAN HUGHES 2.00 X 0 0 0 DAVID KEEFE 2.00 X 0 0 0 JOSEPH MORONE 2.00 X 0 0 0 JEANETTE POULIN 2.00 X 0 0 0 RONALD POULIN 2 X ROBERT STEELE 2 X KAREN DUTCHER 40 X 684152 50324 DEBORAH SHIPMAN 40 X 175244 20538 CAROL THEMELIS 40 X 179108 52874 PAULA MAHONEY 40 X 167826 41795 MICHAEL METZGER 40 X 418116 16342 JAY BURNS 40 X 415205 22044 SACHIN SAKSENA 40 X 405357 8873 RALPH BROADWATER 40 X 374566 25202 MATHURIN MALBY 40 X 360959 24768 4652709 421278 87 false true false CROTHALL FACILITIES MGMT 13028 COLLECTIONS CTR CHICAGO IL 60693 Facilities Management 3097346 SURGICAL ASSOCIATES 21 WHITEHALL RD ROCHESTER NH 03867 Physician Practice 1510791 UNIDINE CORP 1000 WASHINGTON ST BOSTON MA 03867 Dietary Services 1441805 LABCORP OF AMERICA PO BOX 470 PORTSMOUTH NH 03802 LAboratory Services 660630 DARTMOUTH HITCHCOCK ONE MEDICAL CENTER DR LEBANON NH 06756 Oncology Services 749030 29 70401 116021 186422 Net Patient Service Revenue 622110 89165088 Net Medicare 622110 25241544 Net Medicaid 622110 5102368 119509000 581824 581824 20878936 20367184 511752 511752 511752 70401 Misc Revenue 900099 747183 747183 Cafeteria Income 722210 469219 469219 Gift Shop Income 453220 143691 143691 384115 8400 375715 1744208 122533206 119509000 8400 2829384 0 0 0 0 0 0 1535604 0 1535604 0 51989191 50638938 1284397 65856 1340128 1299620 38532 1976 9302966 9086925 205504 10537 3521759 3418564 98256 4939 207225 0 207225 0 63851 0 63851 0 18165 0 18165 0 15038245 13211489 1824423 2333 540456 114441 426015 0 1146635 427076 718117 1442 4852170 4470235 381935 0 14342 7287 6409 646 200253 175916 23159 1178 1600614 1600614 0 0 5969915 5969915 0 0 1755228 0 1755228 0 Repair & Maintenance 2265129 1451046 814083 0 Supplies 18130651 18049413 76609 4629 Equip Maint/Dues&Subs 1375064 1272404 102335 325 Medicaid Enhancement Tax 4898856 4898856 0 0 125766447 116092739 9579847 93861 7646966 7756793 15939071 13907619 2712956 2805317 2556817 1273010 132124398 67369432 67089374 64754966 26451281 28561169 1511966 1131612 5633704 6616419 129542135 126806905 13885028 13466897 26668639 24995192 6911858 6974446 47465525 45436535 X 80288239 79573728 65679 73950 1722692 1722692 82076610 81370370 129542135 126806905 -3233241 2527001 X false true true X false X 0 0 0 0 0 0 false false false false false false false false true 18165 18165 Pt II-B Line 1i Lobbying portion of hospital association dues 24732265 3759535 28491800 25552520 59916 -816743 63428 24732265 23618029 13042 2021449 100000 25552520 0.94000 0.06000 true false false 181776 181776 72888666 23631380 49257286 3179044 1644975 1534069 40712200 29393969 11318231 15162712 12699108 2463604 64754966 Other Assets 2097306 Deferred Finance Costs 342674 Investment in Affiliates 2233143 Collateralization of Interest Rate Swap 1943296 6616419 Interest Rate Swap 6974446 6974446 Pt V Line 4 To further the hospital's charitable mission true true true X false false true false true true 6146551 6146551 0.04890 17064307 5102368 11961939 0.09510 23210858 5102368 18108490 0.14400 224372 224372 0.00180 200000 200000 0.00160 1408424 873222 535202 0.00430 41952 41952 0.00030 1874748 873222 1001526 0.00800 25085606 5975590 19110016 0.15200 true 6111965 611197 25241544 36802873 -11561329 X true true 1 1 FRISBIE MEMORIAL HOSPITAL

11 WHITEHALL RD ROCHESTER NH 03867

X X X Geropsychiatric Unit FRISBIE MEMORIAL HOSPITAL 1 true true 200 false true X X X true true X X true X X true X X X X X X true X false false Pt I Line 3c Organization uses 200% FPG to determine eligibility Pt I Line 6a A community benefit report is prepared yearly and is available on the organization public website Pt III Line 9b Collection policy provides for accounts known to qualify for free care Pt III Line 9b be removed from transfer to an outside agency for further collection activity Pt III Line 4 Financial Statement footnote: Patient Accounts Receivable are stated at the amount Pt III Line 4 expects to collect from outatanding balances. Management provides for probable Pt III Line 4 uncollectable amounts through a charge to operations and a credit to a valuation Pt III Line 4 allowance based on its assessment of individual accounts and historical adjustments. Pt III Line 8 Medicare costs are not counted as community benefit in accordance with IRS guidance Pt III Line 8 so are not included in the total unreimbursed community benefit expense. Pt VI Line 2 Frisbie Memorial Hospital conducts a Community Needs Assessment every five years, the most recent completed in 2008. Pt VI Line 2 FMH worked with Cresendo Consulting Group to bring together healthcare and Pt VI Line 2 and public service stakeholders, collecting quantitative and qualitative data. Pt VI Line 4 FMH's PSA is urban consisting of northern Stafford, NH and western York, ME counties. Pt VI Line 4 Population served is over 70,000 with a medium income of $47,626 and 4.7% of community Pt VI Line 4 residents living below the federal poverty guidelines. Pt V Sec B 21 The maximum amount charged to FAP-eligible individuals is gross charge less 15% Pt VI Line 7 NH X X X X false true false false false false false false false ALVIN FELGAR 352045 50000 820289 108895 1331229 JOHN MARZINZIK 217342 32500 49623 299465 KAREN DUTCHER 172668 18000 493484 50324 734476 DEBORAH SHIPMAN 160244 15000 20538 195782 CAROL THEMELIS 164108 15000 52874 231982 PAULA MAHONEY 152826 15000 41795 209621 MICHAEL METZGER 417516 600 16342 434458 JAY BURNS 219624 195581 22044 437249 SACHIN SAKSENA 404757 600 8873 414230 RALPH BROADWATER 223934 150632 25202 399768 MATHURIN MALBY 209538 151421 24768 385727 Pt I Line 4a The hospital has a 457(f) deffered compensation plan which covers highly compensated employees. Pt I Line 4b The organization incurred liabilities relating 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 employee's date certain, which is elected by the employee. Alvin Felgar and Karen Dutcher received lump sums distributions in the amounts of 820,289 and 493,484 respectively in calendar year 2011. NHHEFA 020279866 644614KT5 2005-03-04 10650000 Refunding Series 2003 Bonda false false false NHHEFA 020279866 644614QD4 2006-07-27 25000000 Building Construction false false false 10650000 10385167 270950 2005 true false true true 25000000 386805 24613195 2008 true false true true false false false false true true false false false false true true false false false false false false false false false false false false false false JOHN BRITTON MD Trustee 1512674 Subsidy false JOHN BRITTON MD Trustee -1220962 Transfer of AR true Pt VI, Line 11a A complete copy of the final form 990 is provided to each voting Pt VI, Line 11a member of the board prior to filing with the IRS. Pt VI, Line 12c In accordance with the writted conflict of interest policy the office of the President Pt VI, Line 12c annually secures a signed copy of the Trustee/Officer Conflict of interest statement and maintains on file. Pt VI, Line 15 Each year the executive compensation committee comprised of four members of the FMH Board Pt VI, Line 15 reviews the hospital CEO performance and compensation. Senior manangement compensation is also reviewed by Pt VI, Line 15 the committee, but compensation is determined by the CEO. The VP of Human Resources Pt VI, Line 15 presents the compensation committee with comparative salary and benefit data. Pt VI, Line 19 The Hospital will provide its governing documents, financial statements, Pt VI, Line 19 and conflict of interest policy upon written request based on the Pt VI, Line 19 intent and purpose of the request Pt IX Line 24d The New Hampshire Medicaid Enhancement (MET) tax is a 5.5% tax on net patient Pt IX Line 24d service revenue paid by hospitals to the State of New Hampshire. Unlike previous years where the Pt IX Line 24d State provided hospitals with uncompensated care payments towards the cost of care Pt IX Line 24d of patients without insurance from matching federal funds, uncompensated care payments Pt IX Line 24d were reduced or eliminated to hospitals. The impact to Frisbie Memorial Hospital Pt IX Line 24d in 2012 was payment of MET in the amount of $4,898,856. FRISBIE FOUNDATION 11 WHITEHALL RD ROCHESTER NH 03867 020465942 Coordinate Funds raised for hospital NH 501(c)(3) 11 false false false false false false false false false true false false false false false true false false FRISBIE FOUNDATION j 2642172 FMV FRISBIE FOUNDATION p 131220 FMV