2023-03-16T14:27:37-05:00 2022-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2021-10-01 020222131 FMH Wind-Down Company FMHW 6032256641 CO NHCF 37 Pleasant Street Concord NH 03301 Brian Hughes Board of Trustees Chairman 6032256641 2023-03-08 1 Brian Hughes 999009999 Connor Smart P02285543 2078792100 2023-03-08 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X Brian Hughes C/O NHCF 37 Pleasant Street Concord NH 03301 48872 0 X www.fmhwdc.org X 1941 NH Former hospital undergoing divestiture. 5 5 1 5 0 0 0 0 603176 46515 964755 2357 538450 0 2106381 48872 576 0 0 0 0 0 0 0 0 4175681 278429 4176257 278429 -2069876 -229557 3971416 3696872 6516586 6439092 -2545170 -2742220 X While the Organization is undergoing divestiture and wind down operations at this time, the Organization's eventual termination and transfer of its assets and activities into other institutions will ultimately improve the quality of and the access to care in its community. 0 0 32335 0 46515 In January 2019, the Organization and HCA Healthcare, Inc. signed an intent to affiliate the organizations. Expected benefits of the affiliation include expanding the Organization's services in New Hampshire, expanding access to health care in rural communities, and increasing competition by delivering higher-quality, lower cost care. Since the affiliation, the Organization has ceased operating as a state-licensed hospital, no longer has any employees, and ceased to provide healthcare services. The operations of the Organization currently consist of wind down activities only. Remaining assets of the Organization consist of cash which will be used to settle the Organization's wind-down operations and to support the Greater Rochester Community Health Foundation (f/k/a Frisbie Foundation). 32335 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NH X Rebecca Carr CPA CMA 6032256641 C/O NHCF 37 Pleasant Street Concord NH 03301 X Frank Jones Trustee 3.00 X 0 0 0 Brian Hughes Chair, Trustee 3.00 X X 0 0 0 James Jalbert Vice Chair, Trustee 3.00 X X 0 0 0 William Cormier Secretary, Trustee 3.00 X X 0 0 0 John Hall Treasurer, Trustee 3.00 X X 0 0 0 0 0 0 0 0 0 0 Warbird Consulting Partners 600 Galleria Pkwy SE Ste 1400 Atlanta GA 30339 Consulting and management 238572 1 Wind-down collections 621110 46515 46515 46515 2357 2357 48872 46515 0 2357 X 22515 22515 9815 9815 203061 203061 3965 3965 Cost reports 32292 32292 Tax settlements 4567 4567 Abandoned properties 2171 2171 Benefit payouts 43 43 278429 32335 246094 0 3809963 3696872 161453 0 3971416 3696872 249355 0 6267231 6439092 6516586 6439092 X -2545170 -2742220 -2545170 -2742220 3971416 3696872 X -229557 32507 X 0 0 0 X 3568813 543386 4112199 9614425 93845 253844 6052305 340996 3568813 14647540 21325 33680 5009104 79016 9614425 17792984 206456 1327943 4600638 79205 14647540 1 0 Estimated third party payor settlements 6439092 6439092 Part V, Line 4: The Organization's endowment funds were originally used in furtherance of the Former Hospital's charitable mission. As of the year ending September 30, 2021, all donor restricted and endowment funds held by the Organization had been either liquidated, or had been transferred out to the Greater Rochester Community Health Foundation, formerly the Frisbie Foundation. The amount reported on this Schedule D, Part V, Prior Year, for other expenditures for facilities and programs ($4,112,199) is the net amount of funds consolidated and transferred to the Foundation. The Foundation is to maintain these funds as permanent endowments in furtherance of its new exempt mission: to promote the health and well-being of the citizens of Strafford County, New Hampshire. As of the year ending September 30, 2022, the Organization did not hold any Endowment Funds. Form 990, Part VI, Section B, line 11b The Form 990 is prepared with the assistance of the Organization's independent public accounting firm, and is thoroughly reviewed by the governing body and the Organization's liquidating trustees prior to filing. In its final years of operations, the Organization transferred the vast majority of its assets to the Greater Rochester Community Health Foundation, an affiliate of the New Hampshire Community Foundation. During these final wind-down years, senior accounting and finance personnel of the New Hampshire Community Foundation will also review the Form 990 prior to its filing with the IRS. Form 990, Part VI, Section B, line 12c In accordance with the written conflict of interest policy, the office of the President annually secures a signed copy of the Trustee/Officer Conflict of Interest Statement and maintains them on file. Form 990, Part VI, Section B, line 15 In January 2019, the Organization and HCA Healthcare, Inc. (HCA) signed a non-binding letter of intent (LOI) to affiliate the organizations. The transaction was approved by the New Hampshire Office of the Attorney General's Charitable Trust Unit and finalized effective February 29, 2020. Accordingly, the Organization only filed payroll forms for services rendered through the end of February, 2020, at which point the Organization ceased to maintain any employees and began to perform solely wind-down activities. Prior to this transaction, the executive compensation committee comprised of four members of the Company's Board reviewed the Hospital CEO performance and compensation. The VP of Human Resources presented the compensation committee with comparative salary and benefit data. Senior management compensation was also reviewed by the committee, but their compensation was determined by the CEO. Form 990, Part VI, Section C, line 19 Documents that are required to be open for public inspection are made available upon request within the timeframe required by law. Form 990, Part IX, line 11g Wind-down consulting and contractors: Program service expenses 0. Management and general expenses 203,061. Fundraising expenses 0. Total expenses 203,061. Form 990, Part XI, line 9: Reduction in insurance claims 5,370. Reduction in tax settlements 27,137.