FMH Wind-Down Company: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- FMH Wind-Down Company (EIN 02-0222131)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-15
- IRS object ID
- 202232279349302403
- Schema version
- 2020v4.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-15T10:31:02-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | 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 | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222131 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FMH Wind-Down Company | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FMHW | BusinessNameControlTxt |
| Phone | 6033326840 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CO HRCU 133 Brock Street | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brian Hughes | PersonNm |
| Person Title | Board of Trustees Chairman | PersonTitleTxt |
| Phone | 6033326840 | PhoneNum |
| Signature | 2022-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Brian | PersonFirstNm |
| Person Last | Hughes | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Connor Smart | PreparerPersonNm |
| PTIN | P02285543 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Preparation | 2022-08-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brian Hughes | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O HRCU 133 Brock Street | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,929,256 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.fmhwdc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1941 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Former hospital undergoing divestiture. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 23 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $452,369 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $50,583,459 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $603,176 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$8,011,598 | PYInvestmentIncomeAmt |
| CY Investment Income | $964,755 | CYInvestmentIncomeAmt |
| PY Other Revenue | $152,262 | PYOtherRevenueAmt |
| CY Other Revenue | $538,450 | CYOtherRevenueAmt |
| PY Total Revenue | $43,176,492 | PYTotalRevenueAmt |
| CY Total Revenue | $2,106,381 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,106 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $576 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,425,631 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $35,248,365 | PYOtherExpensesAmt |
| CY Other Expenses | $4,175,681 | CYOtherExpensesAmt |
| PY Total Expenses | $67,677,102 | PYTotalExpensesAmt |
| CY Total Expenses | $4,176,257 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$24,500,610 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,069,876 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,470,306 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,971,416 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,571,983 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,516,586 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,898,323 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,545,170 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,583,735 | ExpenseAmt |
| Grant | $576 | GrantAmt |
| Revenue | $1,141,626 | RevenueAmt |
| Desc | 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. 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 mostly of cash and restricted investments 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). | Desc |
| Total Program Service Expenses | $3,583,735 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | 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 | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 23 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | InvestmentInJointVentureInd |
| 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 | Douglas M Johnson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4044965291 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 Galleria Parkway SE Suite 1400 | AddressLine1Txt |
| City | Atlanta | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30339 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| Frank Jones | ||||||||
| Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Brian Hughes | ||||||||
| Chair, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| James Jalbert | ||||||||
| Vice Chair, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| William Cormier | ||||||||
| Secretary, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| John Hall | ||||||||
| Treasurer, Trustee | 3.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Jocelyn Caple MD | ||||||||
| Former President & CEO | 0.00 | 0.00 | $570,000 | $0 | $0 | Yes (X) | ||
| Christi Green | ||||||||
| Former VP HR | 0.00 | 0.00 | $100,266 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $670,266 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Warbird Consulting Partners | |||||
| 600 Galleria Pkwy SE Ste 1400 | Atlanta | GA | 30339 | Consulting and management | $692,350 |
| Nixon Peabody LLP | |||||
| PO Box 28012 | New York | NY | 100878012 | Legal and Consulting | $453,377 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Former patient collections | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $603,176 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $603,176 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $603,176 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,046 | TotalRevenueColumnAmt |
| Exclusion | $40,046 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $12,747,584 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,822,875 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $924,709 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $924,709 | TotalRevenueColumnAmt |
| Exclusion | $924,709 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Equity Earnings in Benevera, LLC | Desc |
| Business | 523000 | BusinessCd |
| Total Revenue Column | $538,450 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $538,450 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $538,450 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,106,381 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,141,626 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $964,755 | 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 | $576 | TotalAmt |
| Program Services | $576 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,292 | TotalAmt |
| Management And General | $103,292 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,670 | TotalAmt |
| Management And General | $14,670 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $402,416 | TotalAmt |
| Management And General | $402,416 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,386 | TotalAmt |
| Management And General | $5,386 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,408 | TotalAmt |
| Management And General | $3,408 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DSH Settlements | $3,469,947 | $3,469,947 | |
| Benefit Payouts | $150,949 | $113,212 | $37,737 |
| Tax Settlements | $25,613 | $25,613 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,176,257 | TotalAmt |
| Program Services | $3,583,735 | ProgramServicesAmt |
| Management And General | $592,522 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $411,404 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,457,186 | BOYAmt |
| EOY | $3,809,963 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,559 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,792,052 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $800,105 | BOYAmt |
| EOY | $161,453 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,470,306 | BOYAmt |
| EOY | $3,971,416 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,455,470 | BOYAmt |
| EOY | $249,355 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,116,513 | BOYAmt |
| EOY | $6,267,231 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,571,983 | BOYAmt |
| EOY | $6,516,586 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$644,261 | BOYAmt |
| EOY | -$2,545,170 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,542,584 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,898,323 | BOYAmt |
| EOY | -$2,545,170 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,470,306 | BOYAmt |
| EOY | $3,971,416 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,069,876 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$404,222 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$2,969,395 | 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 | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $8,000,000 | BeginningBalanceAmt |
| Additions During Year | $4,403 | AdditionsDuringYearAmt |
| Distributions During Year | $8,004,403 | DistributionsDuringYearAmt |
| Ending Balance | $0 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,568,813 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $543,386 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,112,199 | OtherExpendituresAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,614,425 | BeginningYearBalanceAmt |
| Contributions | $93,845 | ContributionsAmt |
| Investment Earnings Or Losses | $253,844 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,052,305 | OtherExpendituresAmt |
| Administrative Expenses | $340,996 | AdministrativeExpensesAmt |
| End Year Balance | $3,568,813 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $14,647,540 | BeginningYearBalanceAmt |
| Contributions | $21,325 | ContributionsAmt |
| Investment Earnings Or Losses | $33,680 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,009,104 | OtherExpendituresAmt |
| Administrative Expenses | $79,016 | AdministrativeExpensesAmt |
| End Year Balance | $9,614,425 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $17,792,984 | BeginningYearBalanceAmt |
| Contributions | $206,456 | ContributionsAmt |
| Investment Earnings Or Losses | $1,327,943 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,600,638 | OtherExpendituresAmt |
| Administrative Expenses | $79,205 | AdministrativeExpensesAmt |
| End Year Balance | $14,647,540 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party payor settlements | Desc |
| Amt | $6,267,231 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,267,231 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The FMH Wind-Down Company (the "Company", formerly the Frisbie Memorial Hospital) was previously the sole member of the Greater Rochester Community Health Foundation ("GRCHF", formerly the Frisbie Foundation). Over the previous tax years, the Company underwent an affiliation agreement with HCA. As part of the asset purchase agreement, the parties had until August 31, 2021 to settle and finalize the collection of outstanding patient receivables as of the transaction date. Pending the settlement of these receivables, the Company was required to hold a balance in escrow. The escrow agreement stated that if the final amount of receivables collected was less than the target amount, the shortfall was payable by the Company to HCA. The Company was required to deposit a total of $8,000,000 into an escrow account at closing for any potential repayment. This amount was included within trustee held funds on the Frisbie consolidated balance sheet at September 30, 2020. GRCHF maintained these trustee held funds directly, and reported the funds on its own separate balance sheet through its affiliation with New Hampshire Charitable Foundation ("NHCF") in September, 2021. The $8,000,000 escrow balance was planned to be released in March of 2022, subsequent to the settlement and collection of the outstanding receivables. However, the various organizations decided to maintain the escrow balance due to uncertainty surrounding DSH payment claims; therefore, as of the tax year ending September 30, 2021, these funds were still maintained in escrow with JP Morgan. Any future claims for or against the funds held in escrow are at this time strictly the responsibility of the GRCHF. On September 1, 2021, membership of GRCHF changed from the Company to NHCF. Given uncertainty on when these funds would be released to the Foundation, GRCHF ceased to carry or report the escrow balance on its own books and records as of the September 1 transaction date. However, because GRCHF exercises signature authority over the escrow account, the Foundation continues to report the escrow on its own Form 990, Schedule D, for transparency purposes. GRCHF may ultimately recognize these funds in its own books and records when and if the funds are released from escrow and deposited within the accounts held under control by GRCHF; in accordance with the 7th Circuit Court's previous approval of the membership transfer from the Company to NHCF, the balance of funds held in escrow will be due to the GRCHF as the balance is liquidated. The Company was the sole member of GRCHF through its September 2021 affiliation with NHCF, and until that time shared an identical Board of Directors with the Foundation. Therefore, the Company held signature authority over the escrow account through part of this tax year, until the change in GRCHF's membership. In accordance with IRS Instructions, the escrow arrangement has been disclosed on this tax return for transparency purposes, given the Company's part-year control of the Foundation and the funds. That said, as of the end of this tax year, the Company ceased to be the sole member of the Foundation, and the Company ceased to exercise any control or signature authority over the escrow account. The Company is also not responsible for any DSH claims that may need to be settled using these funds. Therefore, the end-of-year balance in the escrow as shown on this Schedule D is reported as $0, with the balance being shown as distributed during the year. |
| Part V, Line 4: | The Organization's endowment funds were originally used in furtherance of the Hospital's charitable mission. As of the year ending September 30, 2021, all donor restricted and endowment funds held by the Organization have been either liquidated, or have been transferred out to the Greater Rochester Community Health Foundation, formerly the Frisbie Foundation. The amount reported on this Schedule D, Part V, 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. |
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 | 0 | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jocelyn Caple MD | ||||||||||||||
| Former President & CEO | $0 | $0 | $0 | $0 | $570,000 | $0 | $0 | $0 | $0 | $0 | $570,000 | $0 | $0 | $0 |
| Christi Green | ||||||||||||||
| Former VP HR | $0 | $0 | $0 | $0 | $100,266 | $0 | $0 | $0 | $0 | $0 | $100,266 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4a | FormAndLineReferenceDesc |
| Explanation | Christi Green, the Organization's Former VP of Human Resources, and Dr. Jocelyn Caple, the Organization's Former President & CEO, each received severance payments during the 2020 calendar year in the amounts of $100,266 and $570,000, respectively. The severance payments were made during the fiscal year covered by the previous year's tax return (FYE 9.30.2020) but after December 31, 2019. In accordance with IRS instructions, the severance payments have been reflected on the Organization's 2020 Form 990 filing in Schedule J, Part II, Column B(iii) as part of the recipients' Box 5 2020 Form W-2 taxable wages. | ExplanationTxt |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail (2 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| Greater Rochester Community Health Foundation | |||||||||
| Equity transfers to affiliates | 2021-09-01 | $3,248,203 | Book value per draft financial statements | 020465942 | 11 Whitehall Road | Rochester | NH | 03867 | 501(c)(3) |
| Skyhaven Surgery Center LLC | |||||||||
| Equity transfers to affiliates | 2021-02-24 | $264,475 | Book value per draft financial statements | 463885261 | 11 Whitehall Road | Rochester | NH | 03867 | Partnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | Yes (1) | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part II, Line 2e: | Person(s) Involved: Schedule N, Part II, Line 2a, List of Persons Involved:Brian Hughes; John Hall; Bill Cormier; Frank Jones; and James Jalbert. |
| Part II, Line 2e: | Explanation of Involvement: Schedule N, Part II, Line 2a, Explanation of Involvement:The named individuals served as Trustees and Officers on the Board of Directors for both the FMH Wind-Down Company (the "Company") and the Greater Rochester Community Health Foundation ("GRCHF", f/k/a the Frisbie Foundation) during the fiscal year covered by this tax return. The listed persons received no benefits as part of the transfer of assets from the Company to the GRCHF, and the individuals occupied largely the same roles, position, and responsibilities on both boards. The listed individuals continued to serve on the GRCHF's Board subsequent to these transfers until the Company's controlling membership in the GRCHF was terminated, and the GRCHF's sole membership was transferred to the New Hampshire Charitable Foundation ("NHCF"). At such time the listed individuals ceased to serve on the Board of the GRCHF as it was formerly structured and operating. Brian Hughes and Frank Jones continued to serve on the GRCHF's new Board as legacy members after the GRCHF was under the purview of the NHCF. |
| Schedule N, Part II, Transfers to Affiliates: | The filing Organization (FMH Wind-Down Company, or, the "Company") was formerly known as Frisbie Memorial Hospital which was an acute care hospital located in Rochester, New Hampshire, including physician practices in Barrington, Farmington, Rochester, Somersworth, and Wakefield, New Hampshire. At the time of this tax return's filing, the Company has been undergoing wind-down procedures and has ceased to operate as a state licensed hospital. The majority of Frisbie Memorial Hospital's assets and liabilities have been either acquired or paid off, as outlined in the transactions discussed below. The Company's primary operations subsequent to these transaction have included wind down activities only.On October 18, 2019, the Organization entered into an asset purchase agreement with HCA Healthcare, Inc. (HCA) through its subsidiary, FMH Health Services, LLC, whereby HCA acquired certain assets and assumed certain liabilities of the Organization. On February 24, 2021, the 7th Circuit Court of the State of New Hampshire authorized, among other things, the transfer, custody, control and use of the net proceeds and donor restricted funds to the Frisbie Foundation in a manner consistent with the Foundation's charitable purposes. Additionally, the Court approved the FMH Wind-Down Company's plans to remit to the Foundation any funds received from the liquidation of remaining assets as well as monies not used for wind down activities upon conclusion of such activities. Lastly, the net proceeds and the donor restricted funds are to be invested and managed as a permanent endowment fund subject to the requirements of the Uniform Prudent Management of Institutional Funds Act, NH RSA Ch. 292.In accordance with the 7th Circuit Court's previous approval, on September 1, 2021 the Company and the Foundation entered into a stock transfer agreement (the Agreement) with New Hampshire Charitable Foundation (NHCF) whereby the Company transferred and assigned, for no consideration, all outstanding shares of the Foundation over to NHCF to become a Type 1 supporting Company of NHCF. Immediately after the consummation of the stock transfer, the Foundation changed its name to the Greater Rochester Community Health Foundation (GRCHF), and began to engage in charitable work to help improve the health and well-being and reduce the burden of illness of persons residing in Strafford County, New Hampshire. At this time the Company ceased its relationship with the Foundation.As part of the Company's eventual wind-down and termination, the Company dissolved the Skyhaven Surgery Center during this tax year. As part of this dissolution, the Company forgave an accrued $264,475 in total amounts due from the Surgery Center as related party receivables; the Company settled these balances due without actual receipt or payment. Accordingly, this amount is shown as a net equity transfer on this Schedule N, Part II. Amounts shown as equity transfers to the Greater Rochester Community Health Foundation represent the net amount of cash, short term investments, and restricted funds transferred out of the Company's accounts and control and to the Foundation for its future maintenance operations, in accordance with the 7th Circuit Court's approval and authorization.Operations of the Company are expected to be fully wound down within the next year, and it is the intent of the Board of the Company that any remaining assets or contingent liabilities will be transferred to the GRCHF once wind-down operations are completed. Once final dissolution of the Company occurs, any outstanding indemnified contingent liabilities agreed by definition and time limit in the asset purchase agreement will be required to be settled as necessary with Seller Proceeds previously transferred to the GRCHF.As of the extended filing due date for this Form 990, the Organization's audited financial statements for its year ending September 30, 2021 have not yet be completed or issued. In order to avoid late-filing its 2020 Form 990, the Organization has elected to file its 2020 Form 990 before its audited financial statements are issued. It is the intention of the Organization to amend its 2020 Form 990 once its audited financial statements are finalized and issued. The values shown on this Schedule N for significant disposition of assets are from the Organization's draft audited financial statements. These figures and values will be updated accordingly and if necessary once the final audited financial statements are issued. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 key financial staff. The 990 will be reviewed by the governing body after it has been filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | In accordance with the written conflict of interest policy, the office of the President annually secures a signed copy of the Trustee/Officer Conflict of Interest Statement and maintains them on file. |
| Form 990, Part VI, Section B, line 15 | 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 VI, Section A, Line 6, Change in Membership Disclosure: | In January 2019, the Hospital and HCA Healthcare, Inc. (HCA) signed a non-binding letter of intent (LOI) to affiliate the organizations. The transaction was finalized and effective February 29, 2020. Subsequent to the transaction, all actions taken by FMH Wind-Down Company (formerly the Frisbie Memorial Hospital) have and will continue to consist of closing activities only; the Company ceased to perform any medical or health services at the time of this transaction. Aside from certain set-aside and excluded assets to be used for wind-down operations or for funding the Greater Rochester Community Health Foundation, HCA took material and significant control over the Organization's assets and former operations. On previous Forms 990, HCA was reported on the disclosures on Part VI, Section A, Line 6, and on Schedule R; however, HCA does not have membership in the Company, does not control the election or appointment of the Company's Board of Directors, does not have control over the governance decisions of the Company, and does not influence the actions taken by the Company's Board. Accordingly, it has been determined that HCA is not a member of the Company, that HCA does not have a control relationship with the Company, and that HCA is not considered a related organization. |
| Form 990, Payroll and Employee Disclosures | In January 2019, the Organization and HCA Healthcare, Inc. (HCA) signed a non-binding letter of intent (LOI) to affiliate the organizations. Expected benefits of the affiliation include expanding the Organization's primary and specialty services in New Hampshire, expanding access to health care in rural communities, and increasing competition by delivering higher-quality, lower cost care. 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. In other words, the Organization had no payroll or employee expenses for the fiscal year covered by this tax return: October 1, 2020 through September 31, 2021. In accordance with IRS Instructions, the Organization has provided the number of individuals employed during the 2020 calendar year and has disclosed individuals paid in excess of $100,000 during the 2020 calendar year, though the Organization did not have any employee or payroll costs to report on its Form 990, Part IX, during the period covered by this tax return. |
| Form 990, Part XI, line 9: | Reduction in insurance claims 282,021. Reduction in disputed vendor fees 261,262. Transfers to affiliates -3,512,678. |
| Form 990, Part IV, Lines 12a and 12b | For its year ending September 30, 2021, the Organization engaged the same independent accounting firm to audit its financial statements and to provide tax preparation services as it did in the previous year. The audit was also subject to the same review and oversight procedures utilized in the prior year, by the same responsible parties. However, as of the extended filing due date for this Form 990, the Organization's audited financial statements for its year ending September 30, 2021 have not yet be completed or issued. Accordingly, the Organization has reported "no" to Form 990, Part IV, Lines 12a and 12b; and to Form 990, Part XII, Lines 2a, 2b, and 2c. In order to avoid late-filing its 2020 Form 990, the Organization has elected to file its 2020 Form 990 before its audited financial statements are issued. It is the intention of the Organization to amend its 2020 Form 990 once its audited financial statements are finalized and issued; the amended Form 990 will include corrections for any changes to its financial statements and underlying transactions, and will adjust for the narratives and disclosures described above. A complete list of changes between this original 2020 Form 990 and any amended versions will be included with the amended return when filed. The amended Form 990 will also include any footnotes in the audited financial statements that address the Organization's liability for uncertain tax positions under FIN 48 (ASC 740) in accordance with IRS Instructions. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Greater Rochester Community Health Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 37 Pleasant Street | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 033014005 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020465942 | EIN |
| Primary Activities | Charitable and community support | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | New Hampshire Charitable Foundation | 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 (dissolved) | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FMH Wind-Down Company | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.98000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | 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 | Yes (1) | 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 | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Greater Rochester Community Health Fnd | ||
| R | $3,248,203 | Actual per Books |
| Skyhaven Surgery Center LLC | ||
| R | $264,475 | Actual per Books |
| Greater Rochester Community Health Fnd | ||
| M | $4,952 | Actual per Books |
Comments