MEMORIAL HOSPITAL: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL (EIN 02-0222156)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-12
- IRS object ID
- 202132249349301233
- Schema version
- 2019v5.1
- 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 H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-12T11:34:08-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222156 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 6033565461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1Txt |
| City | North Conway | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03860 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Art Mathisen | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6033565461 | PhoneNum |
| Signature | 2021-08-04 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Art Mathisen | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1Txt |
| City | North Conway | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03860 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $81,332,481 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.memorialhospitalnh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1910 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 554 | TotalEmployeeCnt |
| Total Volunteers | 68 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $273,207 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,427,573 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $74,756,817 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $71,038,653 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$301,547 | PYInvestmentIncomeAmt |
| CY Investment Income | $325,777 | CYInvestmentIncomeAmt |
| PY Other Revenue | $123,327 | PYOtherRevenueAmt |
| CY Other Revenue | $125,442 | CYOtherRevenueAmt |
| PY Total Revenue | $74,851,804 | PYTotalRevenueAmt |
| CY Total Revenue | $75,917,445 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $21,863 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $36,393,857 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,969,870 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $128,244 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,326,247 | PYOtherExpensesAmt |
| CY Other Expenses | $38,093,621 | CYOtherExpensesAmt |
| PY Total Expenses | $74,720,104 | PYTotalExpensesAmt |
| CY Total Expenses | $75,085,354 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $131,700 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $832,091 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $91,169,798 | TotalAssetsBOYAmt |
| Total Assets EOY | $104,466,558 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,735,905 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $54,145,534 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $45,433,893 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $50,321,024 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington Valley area of New Hampshire as well as Western Maine. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $69,477,743 | ExpenseAmt |
| Grant | $21,863 | GrantAmt |
| Revenue | $71,225,975 | RevenueAmt |
| Desc | Memorial Hospital provides healthcare services to the residents and visitors of the Mount Washington Valley area of New Hampshire and the Western Region of Maine. Memorial Hospital is a 25 Bed Critical Access Hospital. The Hospital provides Acute Inpatient Services including general medical and surgical, Obstetrics and Intensive Care Units. The Hospital had 3,192 Acute Patient Days in 2020. The Hospital also provides a variety of outpatient services such as Imaging, Laboratory, Diabetes, Oncology, Physical Rehab, Emergency Medicine, Primary Care, Orthopedics and General Surgery. The Hospital had 38,310 Outpatient Visits and 51,233 Clinic Visits in 2020. | Desc |
| Total Program Service Expenses | $69,477,743 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | 0 | 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 |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 554 | 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 |
| 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | Yes (1) | 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 |
| Other Website | Yes (X) | OtherWebsiteInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Diana McLaughlin | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033560613 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1Txt |
| City | North Conway | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03860 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Laura Jawitz | |||||||||
| Former Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Barbara Hopkins | |||||||||
| Former Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Ed Kelly | |||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Michelle O'Donnell | |||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Mary DeVeau | |||||||||
| Board Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Bob Irwin | |||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Mary Vigeant | |||||||||
| Medical Staff President | 50.00 | 0.00 | Yes (X) | $200,384 | $0 | $22,616 | |||
| Corinne Ray | |||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Linda Terry | |||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Art Mathisen | |||||||||
| President | 50.00 | 0.00 | Yes (X) | $228,930 | $0 | $9,008 | Yes (X) | ||
| Angus Badger | |||||||||
| Former Medical Staff President | 50.00 | 0.00 | Yes (X) | $314,606 | $0 | $34,179 | |||
| Richard W Petersen | |||||||||
| President, MaineHealth | 1.00 | 50.00 | Yes (X) | $0 | $1,810,862 | $113,239 | |||
| Zach Chase | |||||||||
| Board Member | 50.00 | 0.00 | Yes (X) | $244,846 | $0 | $34,787 | |||
| Tim Scott | |||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Matthew Dunn | |||||||||
| CMO | 50.00 | 0.00 | $363,414 | $0 | $22,937 | Yes (X) | |||
| John Cox | |||||||||
| Former Regional CFO | 1.00 | 50.00 | $0 | $273,298 | $34,159 | Yes (X) | |||
| Kristine Dascoulias | |||||||||
| Chief Nursing Officer | 50.00 | 0.00 | $107,940 | $0 | $32,975 | Yes (X) | |||
| Diana McLaughlin | |||||||||
| CFO | 50.00 | 0.00 | $190,613 | $0 | $42,041 | Yes (X) | |||
| Morice Dennery MD | |||||||||
| Surgeon | 50.00 | 0.00 | $457,745 | $0 | $41,916 | Yes (X) | |||
| Victor Lazaron MD | |||||||||
| Physician | 50.00 | 0.00 | $358,880 | $0 | $35,358 | Yes (X) | |||
| Douglas Taylor MD | |||||||||
| Orthopaedic Surgeon | 50.00 | 0.00 | $563,896 | $0 | $43,752 | Yes (X) | |||
| Raymond Rabideau MD | |||||||||
| Physician; Former CMO | 50.00 | 0.00 | $467,855 | $0 | $42,053 | Yes (X) | |||
| Marni Madnick MD | |||||||||
| Physician | 50.00 | 0.00 | $368,502 | $0 | $41,586 | Yes (X) | |||
| Scott McKinnon | |||||||||
| Former President | 50.00 | 0.00 | $266,269 | $0 | $0 | Yes (X) | |||
| Lee Myles | |||||||||
| Former Interim President | 0.00 | 50.00 | $0 | $135,377 | $0 | Yes (X) | |||
| Ethnee Garner | |||||||||
| Former Chief Nursing Officer | 50.00 | 0.00 | $172,312 | $0 | $21,139 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,306,192 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,219,537 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $571,745 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 53 | 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 |
|---|---|---|---|---|---|
| BARTON ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 022417844 | Locum Tenens | $218,584 |
| MAINE RECOVERY SERVICES INC | |||||
| 37 DOUGLAS RD | LIMINGTON | ME | 04049 | Billing/Coding | $173,795 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,360,727 | GovernmentGrantsAmt |
| All Other Contributions | $66,846 | AllOtherContributionsAmt |
| Total Contributions | $4,427,573 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 621110 | $68,632,675 | $68,632,675 |
| Other revenue | 621110 | $2,405,978 | $2,405,978 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $71,038,653 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $263,897 | TotalRevenueColumnAmt |
| Exclusion | $263,897 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $167,602 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $42,160 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $125,442 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $125,442 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $125,442 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,434,756 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,335,814 | SecuritiesAmt |
| Other | $37,062 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $98,942 | SecuritiesAmt |
| Other | -$37,062 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,880 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $61,880 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,917,445 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $71,225,975 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $263,897 | 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 | $21,863 | TotalAmt |
| Program Services | $21,863 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,348,885 | TotalAmt |
| Program Services | $1,985,391 | ProgramServicesAmt |
| Management And General | $363,494 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,641,265 | TotalAmt |
| Program Services | $25,022,790 | ProgramServicesAmt |
| Management And General | $2,516,945 | ManagementAndGeneralAmt |
| Fundraising | $101,530 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $732,115 | TotalAmt |
| Program Services | $665,205 | ProgramServicesAmt |
| Management And General | $66,910 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,429,443 | TotalAmt |
| Program Services | $4,024,622 | ProgramServicesAmt |
| Management And General | $404,821 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,818,162 | TotalAmt |
| Program Services | $1,651,994 | ProgramServicesAmt |
| Management And General | $166,168 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,586 | TotalAmt |
| Management And General | $75,586 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,965 | TotalAmt |
| Management And General | $71,965 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,141,524 | TotalAmt |
| Program Services | $8,306,050 | ProgramServicesAmt |
| Management And General | $835,474 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,942 | TotalAmt |
| Program Services | $8,082 | ProgramServicesAmt |
| Management And General | $813 | ManagementAndGeneralAmt |
| Fundraising | $2,047 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $691,378 | TotalAmt |
| Program Services | $608,290 | ProgramServicesAmt |
| Management And General | $61,185 | ManagementAndGeneralAmt |
| Fundraising | $21,903 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,189,582 | TotalAmt |
| Program Services | $1,080,861 | ProgramServicesAmt |
| Management And General | $108,721 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,975 | TotalAmt |
| Program Services | $128,472 | ProgramServicesAmt |
| Management And General | $12,923 | ManagementAndGeneralAmt |
| Fundraising | $580 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816,919 | TotalAmt |
| Program Services | $742,258 | ProgramServicesAmt |
| Management And General | $74,661 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,943,570 | TotalAmt |
| Program Services | $4,491,761 | ProgramServicesAmt |
| Management And General | $451,809 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,157,165 | TotalAmt |
| Program Services | $1,051,408 | ProgramServicesAmt |
| Management And General | $105,757 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medical Supplies | $9,341,705 | $9,341,705 | ||
| MMC Integrated Services | $5,582,303 | $5,582,303 | ||
| Medicaid Tax | $3,152,780 | $3,152,780 | ||
| Other | $1,776,227 | $1,611,908 | $162,135 | $2,184 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,085,354 | TotalAmt |
| Program Services | $69,477,743 | ProgramServicesAmt |
| Management And General | $5,479,367 | ManagementAndGeneralAmt |
| Fundraising | $128,244 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,451,762 | BOYAmt |
| EOY | $26,510,475 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,318,143 | BOYAmt |
| EOY | $16,458,948 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,822,178 | BOYAmt |
| EOY | $8,725,805 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,422,314 | BOYAmt |
| EOY | $1,945,157 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $460,318 | BOYAmt |
| EOY | $306,570 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $88,536,176 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $58,545,682 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,177,847 | BOYAmt |
| EOY | $29,990,494 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,944,743 | BOYAmt |
| EOY | $12,372,111 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,572,493 | BOYAmt |
| EOY | $8,156,998 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,169,798 | BOYAmt |
| EOY | $104,466,558 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,858,349 | BOYAmt |
| EOY | $15,531,160 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,465 | BOYAmt |
| EOY | $2,101,690 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,876,906 | BOYAmt |
| EOY | $13,343,453 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,144,274 | BOYAmt |
| EOY | $1,046,776 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,719,911 | BOYAmt |
| EOY | $22,122,455 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,735,905 | BOYAmt |
| EOY | $54,145,534 | 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 | $45,433,893 | BOYAmt |
| EOY | $50,321,024 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,433,893 | BOYAmt |
| EOY | $50,321,024 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,169,798 | BOYAmt |
| EOY | $104,466,558 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $832,091 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,089,540 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,965,500 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $16,232 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $16,232 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS DUES TO THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $27,262,886 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,385,162 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $28,648,048 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $21,050,013 | BeginningYearBalanceAmt |
| Contributions | $6,000,000 | ContributionsAmt |
| Investment Earnings Or Losses | $212,873 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $27,262,886 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,944,584 | BeginningYearBalanceAmt |
| Contributions | $10,000,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$894,571 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $21,050,013 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $12,273,762 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$329,178 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $11,944,584 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,560,341 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $713,421 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $12,273,762 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,545,066 | OtherCostOrOtherBasisAmt |
| Book Value | $4,545,066 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $53,477,707 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,472,056 | DepreciationAmt |
| Book Value | $19,005,651 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,440,065 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,073,626 | DepreciationAmt |
| Book Value | $6,366,439 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $73,338 | OtherCostOrOtherBasisAmt |
| Book Value | $73,338 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,990,494 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other receivables | $418,810 |
| Receivable from affiliate | $881,555 |
| Estimated insurance recoveries | $835,952 |
| Investment in MHACO LLC | $231,645 |
| SeHR and systemwide assets | $5,789,036 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,156,998 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated third party settlements | $18,903,171 |
| Professional insurance payable | $1,834,564 |
| Due to affiliates | $1,384,720 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $22,122,455 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | FIN 48 FOOTNOTE THE HOSPITAL AND ITS SUBSIDIARIES ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION FOR INCOME TAXES AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS INCLUDING UNRELATED BUSINESS INCOME OR TAX STATUS. UNDER GUIDANCE ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB), ASSETS AND LIABILITIES ARE ESTABLISHED FOR UNCERTAIN TAX POSITIONS TAKEN OR POSITIONS EXPECTED TO BE TAKEN IN INCOME TAX RETURNS WHEN SUCH POSITIONS ARE JUDGED NOT TO MEET THE "MORE-LIKELY-THAN-NOT" THRESHOLD, BASED UPON THE TECHNICAL MERITS OF THE POSITION. ESTIMATED INTEREST AND PENALTIES, IF APPLICABLE, RELATED TO UNCERTAIN TAX POSITIONS ARE INCLUDED AS A COMPONENT OF INCOME TAX EXPENSE. THE HOSPITAL HAS EVALUATED THE POSITION TAKEN ON ITS FILED TAX RETURNS. THE HOSPITAL HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT SEPTEMBER 30, 2020. |
| PART V, LINE 4 - INTENDED USES FOR ENDOWMENT FUNDS | The endowed funds support community health initiatives for the Memorial Hospital service area and patients. They provide support for the Diabetes and Oncology Programs and assist purchasing capital assets for clinical areas of the Hospital. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $625,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $625,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,506,134 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,743,709 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,762,425 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,131,134 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,743,709 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,387,425 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04510 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $674,091 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $674,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00900 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,687,399 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,198,660 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,488,739 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05980 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,361,490 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,198,660 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,162,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06880 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,492,624 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,942,369 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,550,255 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11390 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,730,797 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $22,912,878 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $23,684,917 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$772,039 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1Txt |
| City | North Conway | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03860 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | mainehealth.org/Memorial-Hospital | WebsiteAddressTxt |
| State License | #00009 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Pt V, Sec C, "Part V, Sec B, Line 7a" | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Pt V, Sec C, "Part V, Sec B, Line 7a" | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Memorial Hospital | Part V, Section B, Line 5: THE PLANNING COMMITTEE INCLUDED TWO REPRESENTATIVES FROM POPULATION HEALTH AT MEMORIAL HOSPITAL AND ONE REPRESENTATIVE FROM MAINEHEALTH SERVICES. ADDITIONAL UNRELATED MEMBERS OF THE COMMITTEE INCLUDED REPRESENTATIVES FROM THE FOLLOWING ENGAGED ORGANIZATIONS: -WHITE MOUNTAIN COMMUNITY HEALTH CENTER: PRIMARY CARE SERVICES AND HEALTH EDUCATION REGARDLESS OF ABILITY TO PAY-NORTHERN HUMAN SERVICES: MENTAL HEALTH CARE AND INDIVIDUALIZED SERVICES FOR DEVELOPMENTALLY DISABLED OR SUBSTANCE ABUSE COUNSELING-T MURRAY WELLNESS CENTER: DIET, EXERCISE, NUTRITION, AND TREATMENT SERVICES-CARROLL COUNTY COALITION FOR PUBLIC HEALTH-VISITING NURSE HOME CARE & HOSPICE OF CARROLL COUNTY & WESTERN MAINE: PERSONAL CARE, SKILLED NURSING, REHABILITATION, AND PALLIATIVE CARE AND HOSPICE SERVICES.-MINERAL SPRINGS: LONG-TERM CARE, ASSISTED LIVING, AND REHABILITATION CENTERTHE PLANNING COMMITTEE HELD A FORUM REPRESENTING THE FOLLOWING SECTORS: PUBLIC HEALTH, HEALTHCARE PROVIDERS, LOCAL/STATE GOVERNMENT, MEDICALLY UNDERSERVED, COMMUNITY HEALTH COALITION, NON-PROFIT AGENCIES, LOW INCOME, BUSINESS/CIVIC LEADERSHIP, COLLEGE/UNIVERSITY, PROFESSIONAL MEMBER ORGS, MINORITIES (RACIAL/ETHNIC), AND PUBLIC SCHOOLS. A NUMBER OF ADDITIONAL ENGAGEMENT ACTIVITIES WERE HELD IN SMALLER GROUPS. IN ADDITION TO THE ABOVE, AN ONLINE STAKEHOLDER SURVEY WAS DISSEMINATED TO CAPTURE OPINIONS OF HEALTH PROFESSIONALS AND COMMUNITY STAKEHOLDERS ON HEALTH ISSUES AND NEEDS OF COMMUNITIES ACROSS THE STATE. |
| Memorial Hospital | Part V, Section B, Line 6a: THE CHNA WAS CONDUCTED THROUGH A PARTNERSHIP BETWEEN MAINEHEALTH SERVICES, CENTRAL MAINE HEALTHCARE, NORTHERN LIGHT HEALTH, MAINEGENERAL HEALTH, MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THE NEW HAMPSHIRE DIVISION OF PUBLIC HEALTH SERVICES. |
| Memorial Hospital | Part V, Section B, Line 11: FOR THE 2019-2021 CHNA, THE ORGANIZATION HAS IDENTIFIED PRIORITIES AND DEVELOPED STRATEGIES TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND PROVIDED REASONS IF IDENTIFIED NEEDS ARE NOT BEING ADDRESSED. PLEASE SEE THE 2019-2021 CHNA AND ANNUAL IMPLEMENTATION UPDATE FY20 AT www.MaineHealth.org/chnaFOR DETAILS OF THE ACTIVITIES UNDERTAKEN BY THE ORGANIZATION. |
| PART V, SECTION B, LINE 7a: | THE CHNA AND IMPLEMENTATION STRATEGY ARE POSTED ON THESE WEBSITES: www.MaineHealth.org/chna |
| PART V, SECTION B, LINES 16a,b,c: | THE FINANCIAL ASSISTANCE POLICY (FREE CARE POLICY AND BILLING AND COLLECTION POLICY), FREE CARE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON THE FOLLOWING WEBSITE: https://mainehealth.org/patients-visitors/billing-insurance/financial-assistance/free-care. |
| PART V, SECTION B, LINE 16i: | THE ORGANIZATION HAS ESTABLISHED AN ANNUAL PROCESS TO EVALUATE ITS PATIENT DEMOGRAPHIC INFORMATION TO ENSURE THAT THE REQUIRED DOCUMENTS ARE TRANSLATED INTO THE NECESSARY LANGUAGES FOR 501(R)(4) COMPLIANCE. THE FY20 REVIEW DID NOT IDENTIFY ANY LIMITED PROFICIENCY POPULATIONS THAT COMPRISED OF THE LESSER OF 1,000 OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | MEMORIAL HOSPITAL'S COMMUNITY BENEFIT DATA IS CONTAINED IN A REPORT PREPARED BY MAINEHEALTH SERVICES (EIN 01-0431680), THE ORGANIZATION'S SOLE MEMBER. THE REPORT CAN BE FOUND AT THE LINK BELOW:https://annualreport.mainehealth.org/#community |
| Part I, Line 7: | A COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED INTHE TABLE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. ACOST-TO-CHARGE RATIO WAS USED. |
| PART I, LINE 3C: | CHARITY CARE LEVELS ARE DETERMINED BY A THREE PRONG TEST FOR ELIGIBILITY. RESIDENCY, INCOME LEVEL, AND HOUSEHOLD SIZE ARE EXAMINED TO DETERMINE LEVEL OF ELIGIBILITY. DISCOUNTED CARE IS REQUIRED BY NEW HAMPSHIRE STATE LAW FOR ALL UNINSURED SELF-PAY PATIENTS. THE DISCOUNT WAS 33% DURING THE TAX YEAR. |
| Part III, Line 2: | SEE PART III, LINE 4 - BAD DEBT EXPENSE FOOTNOTE TO FIN STATEMENTS |
| Part III, Line 8: | MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. MEMORIAL HOSPITAL BELIEVES THAT THE MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE MEMORIAL HOSPITAL HAS A CLEAR MISSION COMMITMENT TO SERVING ELDERLY PATIENTS AND ADULTS WITH DISABILITIES THROUGH THE PROVISION OF SPECIFIC SUBSIDIZED PROGRAMS DEVELOPED TO HELP IMPROVE THE HEALTH STATUS OF THESE PATIENTS. IF THESE CRITICAL SUBSIDIZED PROGRAMS WERE NOT PROVIDED BY MEMORIAL HOSPITAL, THEY WOULD BECOME THE OBLIGATION OF THE FEDERAL GOVERNMENT. |
| Part III, Line 9b: | PATIENTS WHO QUALIFY FOR FREE CARE HAVE THEIR ACCOUNT BALANCE ADJUSTED ACCORDINGLY ONCE FREE CARE HAS BEEN APPROVED. AS A TAX EXEMPT HOSPITAL, MEMORIAL HOSPITAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. |
| PART III, LINE 4: | MEMORIAL HOSPITAL DOES NOT HAVE A SPECIFIC FOOTNOTE IN THE FINANCIALSTATEMENTS THAT DESCRIBES "BAD DEBT EXPENSE." HOWEVER, REFERENCE ISMADE WITHIN THE FOOTNOTES TO THE TREATMENT OF BAD DEBT. WITHIN THE FOOTNOTE DESCRIBING "PATIENT ACCOUNTS RECEIVABLE", THE FOLLOWING EXPLAINS THE PROVISION FOR BAD DEBTS:PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF.WHEN THE HOSPITAL HAS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED SELF-PAY ALLOWANCES THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE. THE AMOUNT OF EXPENSE ASSOCIATED WITH THE PROVISION OF SERVICES, ULTIMATELY WRITTEN OFF AS BAD DEBT AT MEMORIAL, HAS BEEN CALCULATED AT$4,831,725 FOR THE CURRENT FISCAL YEAR. BAD DEBT EXPENSE REPRESENTS HEALTHCARE SERVICES MEMORIAL HAS PROVIDED WITHOUT COMPENSATION. AS A TAX-EXEMPT ORGANIZATION, MEMORIAL PROVIDES NECESSARY PATIENT CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICES. MEMORIAL CANNOT DETERMINE THE AMOUNT OF BAD DEBT EXPENSE THAT COULD BE REASONABLY ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES RELATED TO A PORTION OF OUR COMMUNITY BASED PATIENT POPULATION. THEIR MEDICAL BILLS OFTEN PLACE THESE INDIVIDUALS IN UNTENABLE POSITIONS WHERE THEY ARE NOT ABLE TO HANDLE THEIR PERSONAL DEBT AND THEN THEIR NEW MEDICAL DEBT. HOWEVER, BECAUSE OF THEIR INCOME LEVEL, THEY DO NOT QUALIFY FOR FREE CARE. BY PROVIDING NECESSARY HEALTHCARE SERVICES TO THOSE INDIVIDUALS EITHER WHO FAIL TO APPLY FOR FINANCIAL ASSISTANCE OR WHO ARE EXPERIENCING DIFFICULT PERSONAL OR ECONOMIC CIRCUMSTANCES, MEMORIAL BELIEVES THAT BAD DEBT EXPENSE SHOULD BE INCLUDED AS A COMMUNITY BENEFIT. |
| Part VI, Line 2: | THE ORGANIZATION PREPARES A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS. SEE www.MaineHealth.org/chna |
| Part VI, Line 6: | MAINEHEALTH SERVICES IS A NOT-FOR-PROFIT FAMILY OF LEADING HIGH-QUALITY PROVIDERS AND OTHER HEALTHCARE ORGANIZATIONS WORKING TOGETHER SO THEIR COMMUNITIES ARE THE HEALTHIEST IN AMERICA. RANKED AMONG THE NATION'S TOP 100 INTEGRATED HEALTHCARE DELIVERY NETWORKS, MAINEHEALTH SERVICES IS GOVERNED BY A BOARD OF TRUSTEES CONSISTING OF COMMUNITY AND BUSINESS LEADERS FROM ITS SOUTHERN, CENTRAL, AND WESTERN MAINE, AS WELL AS CARROLL COUNTY, NEW HAMPSHIRE REGIONAL SERVICE AREAS. THE COLLABORATION OF MAINEHEALTH SERVICES MEMBERS MAKES IT POSSIBLE TO OFFER AN EXTENSIVE RANGE OF CLINICAL INTEGRATION AND COMMUNITY HEALTH PROGRAMS, MANY AIMED AT IMPROVING ACCESS TO PREVENTIVE AND PRIMARY CARE SERVICES. MAINEHEALTH SERVICES INCLUDES THE FOLLOWING MEMBER ORGANIZATIONS: THE MEMORIAL HOSPITAL AT NORTH CONWAY, N.H., MAINEHEALTH CARE AT HOME, NORDX, AND MAINEHEALTH ACCOUNTABLE CARE ORGANIZATION. THE STRATEGIC AFFILIATES OF MAINEHEALTH SERVICES ARE MAINEGENERAL MEDICAL CENTER, MID COAST HOSPITAL AND ST. MARYS REGIONAL MEDICAL CENTER. |
| Part VI, Line 7, Reports Filed With States | ME,NH |
| PART VI, LINE 4: | THE CHNA DESCRIBES THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS ITSERVICES. SEEwww.MaineHealth.org/chna |
| PART VI, LINE 3: | MEMORIAL HOSPITAL'S POLICY OF CHARITY CARE AND FINANCIAL ASSISTANCE ISEASILY UNDERSTOOD, PROMINENTLY POSTED, AND PUBLICLY AVAILABLE. APROCESS EXISTS FOR OFFERING CHARITY CARE OR FINANCIAL ASSISTANCE TOPATIENTS WHO ARE UNABLE TO PAY AFTER THEY HAVE ALREADY BEEN BILLED. INADDITION TO MONITORING COLLECTION PRACTICES, COPIES OF THE CHARITY CAREPOLICY ARE MADE AVAILABLE TO PATIENTS AT ALL ENTRY POINTS(REGISTRATION, ED, ETC.) AND WITH BILL/COLLECTION NOTICES. MEMORIALHOSPITAL USES SIMPLE APPLICATION PROCEDURES FOR CHARITY CARE ORFINANCIAL ASSISTANCE THAT DO NOT INTIMIDATE OR CONFUSE APPLICANTS.MEMORIAL HOSPITAL'S EMPLOYEES WHO WORK IN ADMISSIONS, BILLING, ACCOUNTSRECEIVABLE, OR PATIENT SERVICES ARE FULLY INFORMED AND EDUCATED ABOUTALL FINANCIAL ASSISTANCE POLICIES. THESE STAFF MEMBERS IDENTIFY UNPAIDBILLS WHERE PERSONS ARE UNABLE TO PAY, AND SEPARATE THESE POTENTIAL"CHARITY CARE" BILLS FROM OTHER BAD DEBT ACCOUNTS. ON A CASE-BY-CASE BASIS, WE HAVE GRANTED ASSISTANCE TO INDIVIDUALS THAT MAY EARN ABOVE 200% OF THE FEDERAL POVERTY GUIDELINES BUT HAVE MET THE CATASTROPHIC ILLNESS PARAMETERS. |
| PART VI, LINE 5: | THE TAX EXEMPT PURPOSE OF THE ORGANIZATION TO IMPROVE THE HEALTH OF THECOMMUNITY IS PROMOTED AND ENHANCED IN THE FOLLOWING WAYS:- THE MAJORITY OF THE GOVERNING BODY IS COMPOSED OF PERSONS LIVINGWITHIN THE HOSPITAL SERVICE AREA THAT ARE NEITHER EMPLOYED BY, NOR HAVECONTRACTUAL RELATIONSHIPS WITH, THE HOSPITAL OR ITS AFFILIATES.- MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS INTHE COMMUNITY.- SOLICITATION OF COMMUNITY INPUT IN THE STRATEGIC PLANNING PROCESS.- COMMON GOVERNANCE OF THE HOSPITAL, LONG-TERM CARE AND PHYSICIANSERVICES PROVIDED IN THE COUNTY TO PROMOTE COMMON HEALTH CARE ANDIMPROVEMENT PLANNING AND CONTROL COSTS.- VOLUNTARY CAP ON INCOME FROM OPERATIONS TO RESTRAIN PRICES AND TOFUND HEALTH CARE AND HEALTH IMPROVEMENT ACTIVITIES.- SURPLUS FUNDS ARE REINVESTED IN CAPITAL EQUIPMENT AND IMPROVEMENTS TOENSURE HIGH QUALITY CARE. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Children's Unlimited Inc | |||||||
| 182 W Main Street | Conway | NH | 03818 | 020399161 | 501c3 | $7,446 | To provide weekly classes under the "Parenting from Prison" curriculum. |
| Saco River Medical Group PC | |||||||
| 7 Greenwood Avenue | Conway | NH | 03818 | 020487818 | $14,417 | The funding of a physician to support and provide medical assisted treatment services to an additional 60 - 80 patients with opioid dependence. | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The monitoring process included a committee consisting of representation from all grant recipients and met routinely throughout the funding cycle (generally monthly). Discussions included progress, barriers and shared information and resources. Reports of accomplishments and progress were also provided at the larger quarterly meetings which consisted of all the organizations who received funding and/or were involved in any of the grant's work and initiatives. The recipients submitted progress reports with supporting documentation. Payments were not released until this supporting documentation was received and reviewed. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mary Vigeant | ||||||||||||||
| Medical Staff President | $189,188 | $0 | $300 | $0 | $10,896 | $0 | $6,190 | $0 | $16,426 | $0 | $223,000 | $0 | $0 | $0 |
| Art Mathisen | ||||||||||||||
| President | $173,508 | $0 | $18,000 | $0 | $37,422 | $0 | $5,999 | $0 | $3,009 | $0 | $237,938 | $0 | $0 | $0 |
| Angus Badger | ||||||||||||||
| Former Medical Staff President | $313,364 | $0 | $0 | $0 | $1,242 | $0 | $8,400 | $0 | $25,779 | $0 | $348,785 | $0 | $0 | $0 |
| Richard W Petersen | ||||||||||||||
| President, MaineHealth | $0 | $927,273 | $0 | $270,000 | $0 | $613,589 | $0 | $81,636 | $0 | $31,603 | $0 | $1,924,101 | $0 | $0 |
| Zach Chase | ||||||||||||||
| Board Member | $221,190 | $0 | $20,000 | $0 | $3,656 | $0 | $7,113 | $0 | $27,674 | $0 | $279,633 | $0 | $0 | $0 |
| Matthew Dunn | ||||||||||||||
| CMO | $327,508 | $0 | $22,816 | $0 | $13,090 | $0 | $8,400 | $0 | $14,537 | $0 | $386,351 | $0 | $0 | $0 |
| John Cox | ||||||||||||||
| Former Regional CFO | $0 | $244,157 | $0 | $25,500 | $0 | $3,641 | $0 | $5,599 | $0 | $28,560 | $0 | $307,457 | $0 | $0 |
| Diana McLaughlin | ||||||||||||||
| CFO | $189,282 | $0 | $0 | $0 | $1,331 | $0 | $3,535 | $0 | $38,506 | $0 | $232,654 | $0 | $0 | $0 |
| Morice Dennery MD | ||||||||||||||
| Surgeon | $456,503 | $0 | $0 | $0 | $1,242 | $0 | $8,400 | $0 | $33,516 | $0 | $499,661 | $0 | $0 | $0 |
| Victor Lazaron MD | ||||||||||||||
| Physician | $356,558 | $0 | $0 | $0 | $2,322 | $0 | $8,400 | $0 | $26,958 | $0 | $394,238 | $0 | $0 | $0 |
| Douglas Taylor MD | ||||||||||||||
| Orthopaedic Surgeon | $560,282 | $0 | $0 | $0 | $3,614 | $0 | $8,400 | $0 | $35,352 | $0 | $607,648 | $0 | $0 | $0 |
| Raymond Rabideau MD | ||||||||||||||
| Physician; Former CMO | $281,665 | $0 | $125,000 | $0 | $61,190 | $0 | $8,400 | $0 | $33,653 | $0 | $509,908 | $0 | $0 | $0 |
| Marni Madnick MD | ||||||||||||||
| Physician | $367,279 | $0 | $300 | $0 | $923 | $0 | $8,400 | $0 | $33,186 | $0 | $410,088 | $0 | $0 | $0 |
| Scott McKinnon | ||||||||||||||
| Former President | $0 | $0 | $0 | $0 | $266,269 | $0 | $0 | $0 | $0 | $0 | $266,269 | $0 | $0 | $0 |
| Lee Myles | ||||||||||||||
| Former Interim President | $0 | $97,356 | $0 | $38,021 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $135,377 | $0 | $0 |
| Ethnee Garner | ||||||||||||||
| Former Chief Nursing Officer | $89,783 | $0 | $0 | $0 | $82,529 | $0 | $3,220 | $0 | $17,919 | $0 | $193,451 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4a | Scott McKinnon received severance payments totaling $266,269 during calendar year 2019. Ethnee Garner received severance payments totaling $70,602 during calendar year 2019. |
| PART 1, LINE 3 - RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION | TOP MANAGEMENT OFFICIALS ARE COMPENSATED BY RELATED ORGANIZATIONS. THESE ORGANIZATIONS USED ONE OR MORE OF THE METHODS SHOWN AT PART 1, LINE 3 TO ESTABLISH THE COMPENSATION OF TOP MANAGEMENT SEE DESCRIPTION OF PROCESS IN SCHEDULE O - FORM 990, PART VI, LINE 15A - COMPENSATION FOR TOP OFFICIAL |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | New Hampshire Health & Ed Facilities Auth | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 64461XAF2 | CUSIPNum |
| Bond Issued | 2016-12-22 | BondIssuedDt |
| Issue Price | $15,795,685 | IssuePriceAmt |
| Purpose | Refund bonds issued 06/14/2006 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,885,000 | RetiredAmt |
| Total Proceeds | $15,795,685 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $315,914 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $15,479,771 | OtherSpentProceedsAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jacqueline Martin | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | See Part V | RelationshipDescriptionTxt |
| Transaction | $46,079 | TransactionAmt |
| Transaction | See Part V | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Sch L, Part IV, Business Transactions Involving Interested Persons: | FormAndLineReferenceDesc |
| Explanation | Jacqueline Martin, daughter of Mary Vigeant (board member), is employed by Memorial Hospital. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINE 1a - | MaineHealth (EIN 01-0238552), acting on behalf of the MaineHealth System filed 1,687 Form 1099s for the calendar year 2019. |
| Form 990, Part VI, Section A, line 6 | THE SOLE MEMBER OF THE ORGANIZATION IS MAINEHEALTH SERVICES (EIN# 01-0431680). |
| Form 990, Part VI, Section A, line 7a | THE SOLE MEMBER OF THE ORGANIZATION ELECTS THE TRUSTEES OF THE ORGANIZATION. |
| Form 990, Part VI, Section A, line 7b | DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS AND MARKETING STRATEGIC PLANS, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL BY MAINEHEALTH SERVICES (EIN# 01-0431680). |
| Form 990, Part VI, Section B, line 11b | HIGHLIGHTS OF THE 990 ARE REVIEWED WITH THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE 990 IS REVIEWED IN DETAIL BY THE CFO AND MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO FILING. |
| Form 990, Part VI, Section B, line 12c | CONFLICT OF INTEREST DECLARATION FORMS ARE SUBMITTED IN JANUARY BY MEMBERS OF THE BOARD OF TRUSTEES AND ARE SHARED WITH THE FULL BOARD FOR INFORMATION PURPOSES AND REVIEWED IN DEPTH BY THE GOVERNANCE COMMITTEE. IT IS THE MEMBER'S RESPONSIBILITY TO NOTIFY THE BOARD OF ANY CONFLICTS THAT THEY BECOME AWARE OF AND TO RECUSE THEMSELVES FROM DISCUSSIONS AND VOTES ON THE ISSUE. |
| Form 990, Part VI, Section B, line 15 | The process followed for determining compensation of the CEO compensated by this or other related organization is a formal process performed annually by the Executive Committee of the Board of Directors. A related organization uses an outside firm, Sullivan Cotter, to perform an independent benchmark analysis for the CEO of Memorial Hospital, along with other executives in the MaineHealth Services system. The firm meets with the Executive Committee to review each executive's benchmark report. The Committee then deliberates on MaineHealth Services' written salary and incentive plan philosophy before making a final decision. All decisions and meetings are captured in minutes and there are appropriate approvals at all levels. |
| Form 990, Part VI, Section C, line 19 | DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST. |
| Form 990, Part IX, line 11g | Consulting: Program service expenses 18,989. Management and general expenses 1,910. Fundraising expenses 0. Total expenses 20,899. Contractual Services: Program service expenses 3,722,618. Management and general expenses 374,444. Fundraising expenses 0. Total expenses 4,097,062. Labs: Program service expenses 12,675. Management and general expenses 1,275. Fundraising expenses 0. Total expenses 13,950. Physician Recruitment: Program service expenses 46,845. Management and general expenses 4,712. Fundraising expenses 0. Total expenses 51,557. Purchased Services: Program service expenses 4,504,923. Management and general expenses 453,133. Fundraising expenses 0. Total expenses 4,958,056. |
| Form 990, Part XI, line 9: | Net equity transfers from controlled entities 2,875,500. Released to property, plant & equipment 90,000. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MaineHealth | |||||||||||
| 22 Bramhall Street | Portland | ME | 04102 | 010238552 | Hospital | ME | 501(c)(3) | Line 3 | MaineHealth services | 0 | |
| MaineHealth Care at Home | |||||||||||
| 15 Industrial Park | Saco | ME | 04072 | 222571902 | Home health | ME | 501(c)(3) | Line 10 | MaineHealth Services | 0 | |
| Memorial Hospital Foundation | |||||||||||
| 3073 White Mountain Highway | North Conway | NH | 03860 | 462137291 | Fundraising | NH | 501(c)(3) | Line 12a, I | The Memorial Hospital | Yes (1) | |
| NorDx | |||||||||||
| 301A US Route One | Scarborough | ME | 04074 | 010511356 | Lab | ME | 501(c)(3) | Line 10 | MaineHealth Services | 0 | |
| MaineHealth Services | |||||||||||
| 110 Free Street | Portland | ME | 04101 | 010431680 | Healthcare | ME | 501(c)(3) | Line 12c, III-FI | 0 | N/A | |
| Memorial Elder Health Services | |||||||||||
| 3073 White Mountain Highway | North Conway | NH | 03860 | 813653215 | Nursing Home | NH | 501(c)(3) | Line 10 | The Memorial Hospital | Yes (1) | |
| Mid Coast Parkview Health | |||||||||||
| 123 Medical Center Drive | Brunswick | ME | 04011 | 010430069 | Health Services | ME | 501(c)(3) | Line 12a, I | MaineHealth Services | 0 | |
| 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 | Yes (1) | 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 | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Memorial Hospital Foundation | ||
| S | $5,265,500 | Cash |
| Memorial Elder Health Services | ||
| R | $2,300,000 | Cash |
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