2018-08-13T13:44:49-05:00 2017-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2016-10-01 020222131 Frisbie Memorial Hospital FRIS 6033325211 11 Whitehall Road Rochester NH 03867 Jocelyn Caple MD Interim President/CEO 6033325211 2018-08-10 1 Nicholas E Porto P01310283 2078792100 2018-08-10 2016 2022-09-23 18:48:47Z Jocelyn Caple MD 11 Whitehall Road Rochester NH 03867 163061010 0 X www.frisbiehospital.com X 1941 NH To excel at caring for the community. 13 12 1174 132 438881 23925 240621 187397 146141383 147306971 963134 2167515 533527 -666763 147878665 148995120 109542 219240 0 0 79081033 87123256 0 0 160968 65332413 82870094 144522988 170212590 3355677 -21217470 136936545 131957524 49123520 68412836 87813025 63544688 X To excel at caring for the community by providing safe, effective, equitable, timely healthcare services. We will ally ourselves with other community healthcare providers to enhance our mutual ability to improve the health of our community, and the quality of life for the people we serve. 0 0 134472619 219240 146873540 Frisbie Memorial Hospital is a nonprofit community hospital that continuously evaluates and addresses the comprehensive healthcare needs of Rochester, NH and the surrounding communities. In response to these healthcare needs, the hospital coordinates, develops, and provides high-quality, affordable, preventative, educational, acute, and chronic care services. In fiscal year ending September 30, 2017, 28,913 patients were treated in our emergency department, 15,319 ambulance calls were made, 3,374 inpatients were cared for, and surgeries on 8,027 patients were performed. Additionally, 307 newborns were welcomed into the world, 22,838 radiology procedures/tests provided, 57,742 rehabilitative treatments were provided, 373,741 laboratory tests were performed, and 4,487 oncology patients were treated. 6699685 Frisbie Memorial Hospital provided uncompensated care for those in need. Frisbie ranks among the top in New Hampshire for the money value of charity care provided to patients. 544420 Frisbie Memorial Hospital presented or sponsored numerous community programs which assisted with the special needs of our most vulnerable at risk population groups. These programs improved education and health awareness in the community, and provided greater access to health services. 141716724 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 59 0 1 1174 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NH X Robert Cochrane 6033325211 11 Whitehall Road Rochester NH 03867 X John Britton MD Trustee 2.00 0.00 X 0 0 0 Mark Farrell Trustee 2.00 0.00 X 0 0 0 John Hall Trustee 2.00 0.00 X 0 0 0 James Jalbert Trustee 2.00 0.00 X 0 0 0 Frank Jones Trustee 2.00 0.00 X 0 0 0 Julie Reynolds Trustee 2.00 0.00 X 0 0 0 Lisa Stanley Trustee 2.00 2.00 X 0 0 0 Brian Szymanski MD Trustee 2.00 0.00 X 0 0 0 Greg Smith Trustee (part year) 2.00 0.00 X 0 0 0 Leslie Simpson Trustee (part year) 2.00 0.00 X 0 0 0 Brian Hughes Chairman, Trustee 3.00 3.00 X X 0 0 0 TJ Jean Vice Chairman, Trustee 3.00 2.00 X X 0 0 0 William Cormier Secretary, Trustee 3.00 3.00 X X 0 0 0 Jeanette Poulin Treasurer, Trustee 3.00 0.00 X X 0 0 0 Ron Poulin Former Chariman, Trustee 3.00 2.00 X X 0 0 0 John Marzinsik CEO 40.00 5.00 X 752721 0 33454 Steve Guimond CFO (end 3/17) 40.00 5.00 X 295032 0 0 Robert Cochrane VP Finance, CFO 40.00 5.00 X 0 0 0 Amy Dumont VP Operations 40.00 0.00 X 235785 0 26701 Carol Themelis VP Human Resources (end 3/17) 40.00 0.00 X 185709 0 2646 Paula Mahoney VP Physician Practices 40.00 0.00 X 213404 0 84478 Joseph Shields Senior VP 40.00 0.00 X 411678 0 75903 Trevor Eide MD Physician 40.00 0.00 X 488233 0 22465 John Freese MD Physician 40.00 0.00 X 456229 0 17749 Mathurin Malby MD Physician 40.00 0.00 X 468889 0 37202 Michael Metzger MD Physician 40.00 0.00 X 392151 0 26951 Michael Southworth MD Physician 40.00 0.00 X 489207 0 27944 Nick Samilo Former CFO 0.00 0.00 X 264209 0 17880 4653247 0 373373 94 1 1 1 HealthNET Systems Consulting 20 Burlington Mall Road Burlington MA 01803 IT Consulting 3134027 Crothall Healthcare 13028 Collections Center Drive Chicago IL 60693 Facilities Management 2852616 Surgical Associates of Rochester 21 Whitehall Road Suite 3 Rochester NH 03867 Physician Practice 1683465 Unidine Corporation PO Box 360639 Pittsburgh PA 152516639 Dietary Services 1559358 Navine Haffty & Associates LLC 1900 West Park Drive Suite 180 Westborough MA 01581 IT Consulting 838144 19 187397 187397 Net Patient Service Revenue 621110 135118860 135118860 Disproportionate Share Funding 621110 6392433 6392433 Miscellaneous Revenue 621110 4780863 4347432 433431 Cafeteria 561000 591578 591578 Meaningful Use 621110 423237 423237 147306971 513394 5450 507944 15720011 14065890 1654121 1654121 1654121 Equity Earnings in Affiliates 523000 147966 147966 Equity Earnings in Benevera, LLC 523000 -814729 -814729 -666763 148995120 146873540 438881 1495302 X 219240 219240 1646108 205716 1440392 65722989 53179083 12442852 101054 2549575 2020341 525410 3824 12935807 10250626 2665777 19404 4268777 3382676 879698 6403 295032 295032 177230 177230 123363 123363 14810 14810 124558 124558 17480467 12302196 5151586 26685 765784 7078 758706 2045272 943600 1098275 3397 8281162 6772071 1509091 134317 101554 32562 201 1214803 1214803 6930901 6930901 2166403 1371903 794500 Supplies 23370474 23186280 184194 Bad Debt Expense 12962566 12962566 NH Medicaid Enhancement 5350579 5350579 Equipment Maintenance 1395660 1278798 116862 36713 36713 170212590 141716724 28334898 160968 4901772 1209842 4401023 1991593 23417311 24784938 3577375 4040135 1842887 1326575 158886603 91269204 64354579 67617399 29486025 11243311 12843120 4955573 6900611 136936545 131957524 14142261 19385785 21670934 21587470 13313657 12048933 1000000 4995000 -1003332 10395648 49123520 68412836 X 85292631 61024294 603702 603702 1916692 1916692 87813025 63544688 136936545 131957524 X -21217470 568180 -3619047 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14810 14810 0 Part II-B, Line 1: The Hospital pays dues to various associations, a portion of which is attributable to lobbying expenses. 31526165 100889 2877676 16587188 124558 17792984 29464678 2195487 134000 31526165 34288142 -4823464 29464678 31227443 3323272 262573 34288142 28491800 78472 2898384 241213 31227443 0.86210 0.13790 0.00000 1 0 181776 181776 88602496 47474251 41128245 1510699 1059298 451401 66653564 41398668 25254896 1938068 1336987 601081 67617399 Corporate Bonds 6132595 F Assets Held in Employee Benefit Plans 6710525 F 12843120 DSH Revenue Receivable 1337645 Malpractice Claims Receivable 1271986 Other Assets 506759 Investment in Yankee Alliance, LLC 5000 Investment in Benevera Health, LLC 201835 Cash Surrender Value, Life Insurance 653948 Investment in Strafford Health Alliance 2923438 6900611 Estimated Third Party Payor Settlements 1216784 Due to Affiliates 652048 Malpractice Liability Claims Payable 1621986 Accrued Pension 6904830 10395648 X 149402029 568180 568180 148833849 124558 36713 161271 148995120 170051319 0 170051319 124558 36713 161271 170212590 Part V, Line 4: The Hospital's endowment funds are to be used in furtherance of the Hospital's charitable mission. Part X, Line 2: The Hospital and the Foundation are not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Hospital and Foundation's tax positions and concluded the Hospital and Foundation have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to the consolidated financial statements. Part XI, Line 4b - Other Adjustments: Unrelated Business Income Tax 36,713. Part XII, Line 4b - Other Adjustments: Unrelated Business Income Tax 36,713. 1 1 1 X 1 X 1 1 0 1 1 5510346 5510346 0.03500 8236996 1334854 6902142 0.04390 13747342 1334854 12412488 0.07890 470329 470329 0.00300 69000 69000 0.00040 1837058 1396156 440902 0.00280 226275 226275 0.00140 2602662 1396156 1206506 0.00760 16350004 2731010 13618994 0.08650 1 4718574 471857 30128825 52033264 -21904439 X 1 1 1 1 Frisbie Memorial Hospital 11 Whitehall Road Rochester NH 03867 www.frisbiehospital.com 00028 X X X Geropsychiatric Unit Frisbie Memorial Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X Please see Part V, Section C X 1 15 1 https://www.frisbiehospital.com 1 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X Please see Part V, Section C X Please see Part V, Section C X Please see Part V, Section C X X X X X X 1 X 0 X X X X X 1 X 0 0 Frisbie Memorial Hospital Part V, Section B, Line 5: Members of the committee were chosen based on their knowledge of local healthcare. Crescendo Consulting Group, LLC was also brought in to assist in the completion of the CHNA. Frisbie Memorial Hospital Part V, Section B, Line 11: Frisbie Memorial Hospital is empowering individuals to make healthy lifestyle choices and providing access to preventative care services. For more information, please see attached Community Health Needs Assessment. Frisbie Memorial Hospital Part V, Section B, Line 20e: Frisbie Memorial Hospital notified individuals of the financial assistance policy during the admissions process, prior to and during the patient discharge process, and in communications with the individuals when discussing the individuals' medical bills. Frisbie Memorial Hospital also documented its determination of whether individuals were eligible for financial assistance under the hospital's financial assistance policy. Part V, Section B, Line 7a, CHNA website: https://www.frisbiehospital.com/wp-content/uploads/2016/03/Frisbie_CommunityHealthNeedsAssessment.pdf Part V, Section B, Line 16a, FAP website: https://www.frisbiehospital.com/wp-content/uploads/2018/04/Frisbie-Memorial-Hospital-Financial-Assistance-Policy.pdf Part V, Section B, Line 16b, FAP Application website: https://www.frisbiehospital.com/wp-content/uploads/2018/04/Financial-Assistance-Application.pdf Part V, Section B, Line 16c, plain language summary website: http://www.frisbiehospital.com/patients-and-visitors/billing-insurance/financial-assistance/ 4 1 - Skyhaven Surgery Center LLC 11 Whitehall Road Rochester NH 03867 Ambulatory Surgery 2 - Seacoast Business & Health Clinic 11 Whitehall Road Rochester NH 03867 Occupational Health 3 - Granite State Lab LLC 11 Whitehall Road Rochester NH 03867 Laboratory Services 4 - Granite State Express LLC 11 Whitehall Road Rochester NH 03867 Express Care Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 12,962,566. Part II, Community Building Activities: Please see narrative for Part VI, Line 5. Part III, Line 2: The Medicare cost report ratio of cost to charge is used to determine cost of bad debt expense. Part III, Line 3: Frisbie Memorial Hospital estimates this percentage based upon historical data. This amount is reported at cost, and is not reported as a community benefit within Part 1, Line 7. Part III, Line 4: Please see Footnote 2, "Accounts Receivable and the Allowance for Doubtful Accounts" on page 12 of the attached audited financial statements. Part III, Line 8: Medicare shortfall is reported on the annual Community Benefit Report to the State of New Hampshire under "unreimbursed costs" government sponsored healthcare.In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact is considered a healthcare-related expenditure by the Hospital. Part III, Line 9b: Collection policy provides for accounts known to qualify for free care be removed from transfer to an outside agency for further collection activity. Part VI, Line 2: Frisbie Memorial Hospital (FMH) conducts a Community Needs Assessment every three years, the most recent completed in 2015. FMH worked with Health Strategies Plus to bring together health care and public services stakeholders. Part VI, Line 3: Frisbie Memorial Hospital is committed to providing quality health care that is affordable and accessible to all, regardless of ability to pay. We offer financial assistance to eligible patients and help patients apply for other programs that they may be eligible. Patients can learn more about these programs by visiting our website or contacting our Patient Accounts department. Beginning with the registration process and through the billing, patients can obtain an application for financial assistance or speak with a financial counselor. Part VI, Line 4: FMH's patient service area is urban, consisting of Northern Strafford, NH and Western York, ME counties. Population served is over 125,000 with a median income of $59,519 and 13.2% of community residents living below the federal poverty guidelines. Part VI, Line 5: Frisbie's Community Education & Conference Center is utilized by a multitude of community-based social and civic organizations as a convenient location for holding professional trainings and seminars, conferences, meetings, maternal classes, caregiver trainings and wellness events. The Conference Center is available at no charge to community nonprofit organizations for health promotion, disease prevention, and educational purposes. Part VI, Line 6: Through its affiliations, Frisbie Memorial Hospital and its partners work together to improve access to preventative health care services as well as those services put in place to address the following prioritized needs identified in 2015 Community Health Needs Assessment: Affordable medical care; mental health services; Substance abuse treatment services.- Granite State Lab: Offers lower cost laboratory services- Seacoast RediCare: Provides convenient access to health care services, which help to fill the gap between family physician and emergency room visits.- Women's Life Imaging: Provides convenient access to preventative mammography services.- Rochester Community Counseling: A joint effort between Community Partners and Frisbie Memorial Hospital to improve access to much behavioral health services in Rochester. Part VI, Line 7, Reports Filed With States NH,ME 1 Great Bay Community College 320 Corporate Drive Portsmouth NH 03801 900531902 501(c)(3) 10000 Financial support for the recipient organization's mission. Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 156845 Financial support for the recipient organization's mission. Leadership Greater Rochester 18 South Main Street Rochester NH 03867 020185370 501(c)(3) 5000 Financial support for the recipient organization's mission. Rochester Child Care Center 95 Charles Street Rochester NH 03867 020327002 501(c)(3) 5000 Financial support for the recipient organization's mission. James W Foley Legacy Foundation Inc 4 Conifer Circle Rochester NH 03867 471759388 501(c)(3) 10000 Financial support for the recipient organization's mission. 5 0 Part I, Line 2: All donations are tracked internally and follow up calls are placed to ensure funds have been used for the purposes of which they were intended. X X X 1 1 0 0 0 0 0 1 0 John Marzinsik CEO 412534 0 279481 0 60706 0 11231 0 22223 0 786175 0 0 0 Steve Guimond CFO (end 3/17) 295032 0 0 0 0 0 0 0 0 0 295032 0 0 0 Amy Dumont VP Operations 235785 0 0 0 0 0 7500 0 19201 0 262486 0 0 0 Carol Themelis VP Human Resources (end 3/17) 133334 0 15100 0 37275 0 1174 0 1472 0 188355 0 0 0 Paula Mahoney VP Physician Practices 181904 0 15000 0 16500 0 62229 0 22249 0 297882 0 0 0 Joseph Shields Senior VP 366068 0 33000 0 12610 0 53654 0 22249 0 487581 0 0 0 Trevor Eide MD Physician 256541 0 231692 0 0 0 8889 0 13576 0 510698 0 0 0 John Freese MD Physician 242855 0 213374 0 0 0 3301 0 14448 0 473978 0 0 0 Mathurin Malby MD Physician 281930 0 186959 0 0 0 9481 0 27721 0 506091 0 0 0 Michael Metzger MD Physician 391351 0 800 0 0 0 10600 0 16351 0 419102 0 0 0 Michael Southworth MD Physician 488407 0 800 0 0 0 0 0 27944 0 517151 0 0 0 Nick Samilo Former CFO 177209 0 5000 0 82000 0 0 0 17880 0 282089 0 0 0 Part I, Lines 4a-b Nick Samilo, was the organization's CFO through August 24, 2016. He received the following severance payments: $41,000 in October of 2016, and $20,500 in November and December of 2016. He also received severance payments of $20,500 in January and February of 2017. The Hospital has a 457(f) deferred compensation plan which covers highly compensated employees. The Organization incurred liabilities related to salary continuation agreements with highly compensated employees. Under the terms of the agreements they are entitled to receive a lump sum of their account balance, including earnings, within 30 days after the date elected by the employee. Payments received by employees under the 457(f) plan for the calendar year ending 12/31/16 and were included in Schedule J, Part II, Column C were as follows: Paula Mahoney - $38,484 Joseph Shields - $26,643 There were no distributions from anyone's plan during 2016. Part I, Line 7 The bonus compensation listed for the Organization's physicians is based on a Relative Value Unit-Based compensation system. Form 990, Part VII, Line 6: Steve Guimond served as interim CFO of the Hospital from August 2016 to March 2017 when a permanent CFO was hired. Mr. Guimond was a contracted professional who was leased through a managmenet company, Leaders for Today, an unrelated organization. The Hospital paid $295,032 to Leaders for Today for Mr. Guimond's services to the organization. A NHHEFA 020279866 644614QD4 2014-08-01 22475000 Refunding Series 2006 Bonds 0 0 0 A 575000 22475000 22475000 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 John Britton MD Board Member 1683465 Dr. Britton is a 33.33% owner of Surgical Associates of Rochester. The general surgeons at Surgical Associates of Rochester provide a wide range of services to patients of the Hospital, from minor office procedures to major surgery, done with both laparoscopic and open techniques, for adult and pediatric patients. During 2016, Frisbie Memorial Hospital paid $1,683,465 to Surgical Associates of Rochester for services rendered to the Hospital. All transactions were at arm's length. 0 Form 990, Part VI, Section A, line 2 Trustees Ronald Poulin and Jeanette Poulin have a family relationship. Form 990, Part VI, Section A, line 3 Steve Guimond served as interim CFO of the Hospital from August 2016 to March 2017 when a permanent CFO was hired. Mr. Guimond was a contracted professional who was leased through a managmenet company, Leaders for Today, an unrelated organization. The Hospital paid $295,032 to Leaders for Today for Mr. Guimond's services to the organization. Form 990, Part VI, Section B, line 11b The Form 990 is prepared with the assistance of the Hospital's independent public accounting firm and is thoroughly reviewed by key financial staff. The CFO then reviews the 990 and brings it to the board for discussion and comment. After any questions are answered, the return is filed with the Internal Revenue Service. 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 Each year, the executive compensation committee comprised of four members of the FMH Board reviews the Hospital CEO performance and compensation. The VP of Human Resources presents the compensation committee with comparative salary and benefit data. Senior management compensation is also reviewed by the committee, but their compensation is determined by the CEO. Form 990, Part VI, Section C, line 19 The Hospital will provide its governing documents, financial statements, and conflict of interest policy upon. Form 990, Part VII: Nick Samilo, was the organization's CFO through August 24, 2016. At the conclusion of his tenure, Steve Guimond served as interim-CFO on a subcontract basis until March of 2017 when Robert Cochrane was hired as Vice President of Finance & CFO. IRS instructions indicate that Part VII of Form 990 and Part II of Schedule J should report compensation information based on the calendar year falling within the reportable fiscal year. Accordingly, these sections have been prepared utilizing 2016 compensation information. As Mr. Samilo received compensation and benefits from the Hospital during 2016 as an officer, he is required to have his 2016 compensation disclosed. As his tenure with the organization terminated before the fiscal year covered by this return, he is being listed as a former officer of the organization. Similarly, as Mr. Cochrane did not begin his tenure with the organization until 2017, no compensation is being reported for him in Form 990, Part VII, or Schedule J, Part II. The Hospital's 2017 Form 990 will be the first year to report any compensation for Mr. Cochrane. Form 990, Part IX, line 11g Purchased Services: Program service expenses 12,302,196. Management and general expenses 5,151,586. Fundraising expenses 26,685. Total expenses 17,480,467. Form 990, Part XI, line 9: Equity Transfer to Affiliate -3,619,047. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990, Part VI, Line 16b: The Hospital does not have a formal joint venture policy in written format. However, any joint venture agreement the Hospital may consider is thoroughly vetted by the board or subcommittee to ensure that the joint venture significantly improves and furthers the Hospital's exempt charitable mission. On-going monitoring is also conducted to safeguard the Hospital's invested assets from private benefit or other misappropriation. Granite State Lab LLC 11 Whitehall Road Manchester NH 03867 464121424 Laboratory Services NH -210913 237758 Frisbie Memorial Hospital Granite State Express LLC 11 Whitehall Road Manchester NH 03867 464115911 Express Care NH 0 0 Frisbie Memorial Hospital Frisbie Foundation 11 Whitehall Road Rochester NH 03867 020465942 Coordinate Funds Raised for Hospital NH 501(c)(3) Line 12b, II Frisbie Memorial Hospital 1 Skyhaven Surgery Center LLC 11 Whitehall Road Rochester NH 03867 463885261 Ambulatory Surgery NH Frisbie Memorial Hospital Related -1558788 2062557 0 1 0.90000 Seacoast Business & Health Clinic Seacoast Redicare 396 High Street Somersworth NH 03878 020375898 Occupational Health NH Frisbie Memorial Hospital C -49410 1131623 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 Skyhaven Surgery Center LLC B 3778167 Actual per Books Granite State Lab LLC L 201953 Actual per Books Skyhaven Surgery Center LLC L 1114392 Actual per Books