2017-05-12T13:44:17-05:00 2016-06-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2015-07-01 020226774 Speare Memorial Hospital SPEA 6035361120 16 Hospital Road Plymouth NH 03264 Michelle McEwen CEO 6035361120 2017-04-27 1 Barbara J McGuan CPA P00219457 2077752387 2017-04-27 2015 2021-01-29 14:40:06Z Michelle McEwen 16 Hospital Road Plymouth NH 03264 61913477 0 X www.spearehospital.com X 1899 NH To provide inpatient, outpatient, and physician health care services 14 13 458 56 0 0 662855 678808 44019492 52550495 790260 1157877 -174221 2573624 45298386 56960804 254379 234005 0 0 30957424 31883757 0 0 106385 22275411 21507158 53487214 53624920 -8188828 3335884 75972110 77205893 37961670 36862200 38010440 40343693 X To maintain a hospital and other such institutions within the state of New Hampshire, with facilities that include medical services to provide for the diagnosis and treatment of patients that may require inpatient, outpatient, emergency care and other pursuits designed to promote the general health of the community. SMH does not discriminate relative to race, religion or national origin, ability to pay and will assure that all patients receive the same level of care through quality assessment monitoring and improvement activities. 0 0 48479086 234005 52550495 SMH is a 25 bed acute-care hospital that provides inpatient and outpatient services to the surrounding community. 48479086 1 1 0 1 0 0 0 1 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 79 0 1 458 1 0 0 0 0 0 1 1 0 0 0 0 X 14 13 0 1 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 NH X Thomas Lenkowski 6035361120 16 Hospital Road Plymouth NH 03264 Clint Hutchins Past Chair 1.00 0.00 X X 0 0 0 Eldwin Wixson Director 1.00 1.00 X 0 0 0 Nancy Puglisi Director 1.00 0.00 X 0 0 0 Quentin Blaine Secretary 1.00 0.00 X X 0 0 0 Sam Brickley II Director 1.00 1.00 X 0 0 0 Linda Crawford MD Director 1.00 0.00 X 0 0 0 William Larsen Chair 1.00 0.00 X X 0 0 0 Robert Maloney Director 1.00 0.00 X 0 0 0 Alison Ritz Vice Chair 1.00 0.00 X X 0 0 0 Steve Taksar Past Treasurer 1.00 0.00 X X 0 0 0 Lisa Baker Director 1.00 0.00 X 0 0 0 Ronda Kilanowski Director 1.00 0.00 X 0 0 0 Patrick Miller Director 1.00 0.00 X 0 0 0 Margaret Turner Director 1.00 0.00 X 0 0 0 Kevin Young MD Director 1.00 0.00 X 0 0 0 Michelle McEwen CEO 40.00 1.00 X X 283999 0 51215 Thomas Lenkowski CFO 40.00 0.00 X 183699 0 19194 Joseph Ebner MD CMO 40.00 0.00 X 229766 0 48251 Joseph Casey MD General Surgeon 40.00 0.00 X 514383 0 67394 Steve Danosi MD ER Physician 40.00 0.00 X 487142 0 70449 Victor Gennaro MD Orthopedic Surgeon 40.00 0.00 X 481211 0 69335 Michael Giovan MD Orthopedic Surgeon 40.00 0.00 X 395407 0 40049 Ralph Broadwater MD ER Physician 40.00 0.00 X 418972 0 59407 2994579 0 425294 37 0 1 0 Plymouth Regional Rehab Services 60 Lyme Street Old Lyme CT 06371 Rehabilitation Mgmt 904648 Medical Reimbursement Specialists PO Box 486 Bristol NH 03222 Coding 188219 2 678808 2544 678808 Patient Service Revenue 624100 112960172 112960172 Other Operating Revenue 621400 1638716 1488310 150406 Provision for Bad Debts 621410 -5715934 -5715934 Contractual/Char. Adj. 624100 -56332459 -56332459 52550495 410480 410480 135533 0 135533 135533 135533 5630450 38527 4914058 7522 716392 31005 747397 747397 62723 31093 31630 31630 Gain on Inv. in Subsidiaries 900099 2349328 2349328 Bad Debt Recovery 900099 57133 57133 2406461 56960804 52400089 0 3881907 X 208294 208294 25711 25711 816124 816124 23990756 22392215 1549165 49376 1309466 1238155 68581 2730 4332382 3986627 336964 8791 1435029 1301571 130588 2870 14348 13013 1306 29 34828 34828 80939 80939 83217 83217 5923559 5372668 539044 11847 66935 60710 6091 134 1188241 1077735 108130 2376 660352 598939 60092 1321 1428008 1295203 129949 2856 99158 89937 9023 198 68379 62020 6222 137 316640 287192 28815 633 3013013 2732803 274184 6026 567191 514443 51614 1134 Medical Supplies 5002722 4537469 455248 10005 Medicaid Enhancement Ta 1951628 1770127 177598 3903 Miscellaneous Expenses 764440 693345 69563 1532 Common Area Fees 243560 220909 22164 487 53624920 48479086 5039449 106385 X 7165502 11502686 12748788 6308318 7560549 8004016 2388757 2355177 764624 905679 514798 538936 53987397 28648979 22843319 25338418 20264666 20218282 5000 1144204 1121815 576903 907566 75972110 77205893 4913680 4782928 19198722 18313038 33626 0 70498 56978 13745144 13709256 37961670 36862200 X 37231186 39488671 197885 276649 581369 578373 38010440 40343693 75972110 77205893 X 3335884 -999635 -2996 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10555 10555 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which is attributable to lobbying activities. 67183 X 0 270206 270206 270207 16 17 270206 270204 8 5 270207 270198 6 270204 271045 7 854 270198 0.98490 0.01510 1 0 549583 549583 30279851 14691357 15588494 17688088 13251423 4436665 5469875 706199 4763676 25338418 Estimated Third-Party Payor Settlements 13760142 Investment in Subsidiary - Boulder Point -50886 13709256 Part III, Line 4: The Hospital's artwork is intended to provide artistic pleasure and a calming appearance for patients of the Hospital to enjoy during their stay. Golf Tournament 62723 62723 18224 11290 1579 62723 62723 18224 11290 1579 31093 31630 1 1 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 2157797 465601 1692196 0.03160 9230966 5294665 3936301 0.07340 11388763 5760266 5628497 0.10500 125350 7700 117650 0.00220 246735 246735 0.00460 372085 7700 364385 0.00680 11760848 5767966 5992882 0.11180 6400 0 6400 0.00010 939 0 939 0.00000 7339 7339 0.00010 1 2962960 10284221 10222840 61381 X 1 1 1 Plymouth Regional Rehabilitation Services Physical Therapy, Occupational Therapy & Medical Fitness 0.50000 1 1 Speare Memorial Hospital 16 Hospital Road Plymouth NH 03264 www.spearehospital.com 6283 X X X X Speare Memorial Hospital 0 0 1 X X X X X X X 14 1 0 1 1 X www.spearehospital.com X www.pemibakercommunityhealth.org & www.midstatehealth.org X 1 14 1 http://spearehospital.com/about-speare/community-benefits/ 0 0 1 X 125.000000000000 225.000000000000 X X X X X 1 1 X X X 1 X spearehospital.com/patient-relations/financial-assistance/ X spearehospital.com/patient-relations/financial-assistance/ X X X 1 X 0 X X X 1 X 0 0 Speare Memorial Hospital Part V, Section B, Line 5: A series of six focus groups were convened in the spring of 2014 as part of an effort by the members of the Central New Hampshire Health Partnership to understand the health-related needs of the community and to plan programs and services that address those needs. The purpose of the discussions was to get input on health issues that matter to the community and thoughts and perceptions about the health of the community. Discussion groups were formed representing a variety of important community sectors and perspectives. A total of 40 community members participated in discussion groups representing the following sectors: - Head Start Community (4 participants) - Senior Community (7 participants) - Mental Health Community (11 participants) - Education Community (10 participants) - Business Community (5 participants) - Faith Community (3 participants) Speare Memorial Hospital Part V, Section B, Line 6b: Speare conducted the most recent assessment in conjunction with: - Community Action Program Belknap-Merrimack Counties - Communities for Alcohol- and Drug-free Youth (CADY) - Genesis Behavioral Health - Mid-State Health Center - Newfound Area Nursing Association - Pemi-Baker Community Health Speare Memorial Hospital Part V, Section B, Line 11: A particular focus area was addressing and discussing the key community needs of physical activity, nutrition education and obesity. Through a multi-pronged approach involving schools and school nurses, our registered dietitian, and community outreach, Speare sought to create greater community awareness and education of options and opportunities for improving individual and population health by adopting the 5-2-1-0 Healthy NH initiative. A program promoted by the Foundation for Healthy Communities, 5-2-1-0 focuses in on four key messages to help kids and their families live healthier lives: Eat five or more servings of fruits and vegetables a day; limit screen time (television, computer/tablets, gaming) to two hours or less a day; get at least one hour of physical activity/active play each day; and don't drink surgery drinks. Other community needs that Speare continues to address are access to: dental care services, health insurance and mental health. Specifically our Dental Health Program works in partnership with SAU 48, Plymouth Pediatrics, Plymouth OB/GYN and the Pemi Bridge House to provide free dental screenings and fluoride varnish applications; dental cleanings and sealants to school-aged children on a sliding fee scale, to "at risk" pregnant women and the homeless; restorative care for children who are in pain from decay and infection; and case management and financial assistance are available to those in need. Speare has hosted Healthcare Navigators to assist our community with enrolling in the Healthcare Marketplace Exchange to get appropriate insurance coverage. To assist with our communities' access to mental health we have brought on a psychiatrist who meets with patients of Speare Primary Care as prescribed by their providers.Additionally Speare has been an active partner in the Plymouth Area Community Conversations, working to create synergy between central New Hampshire organizations and agencies working to address social service and lifestyle needs of our communities. These include fragile families/stress, education and poverty. Speare's financial contributions to several of these social service agencies support initiatives aimed at addressing these other community needs that do not fall directly within the scope of Speare's mission. Speare Memorial Hospital Part V, Section B, Line 16i: The application process is outlined in patient admission packets as well as monthly statements. Part I, Line 7: An accounting system was used to calculate the amounts reported in this table. The accounting system addresses all patient segments. A cost-to-charge ratio was used. Community Relations programs and charity care given to uninsured patients were also considered in calculating amounts disclosed. Part II, Community Building Activities: Speare further promotes community health with its Community Education and Outreach program, as well as through online and social media.The backbone of Speare's Community Outreach and Education program consisted of four major events: The Community Grant Program, Shamrock Shuffle 5K Health Walk/Run, Wine, Women & Wisdom, a women's health event and It's a Guy Thing, a men's health event. Each of these focused on/drilled down into specifics on particular health issues identified by the community through ongoing engagement outside the formal assessment process.Additionally, Speare used its online and social media channels to connect our community with information about various health and wellness topics, specific to Speare initiatives and in general, to create discussion and information sharing. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable. Credit is extended without collateral.In evaluating the collectibility of accounts receivable, the Organization analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Organization analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Organization records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or on the basis of discounted rates, by State law, or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.During 2016, the Organization increased its estimate from $3,902,231 to $4,793,706 in the allowance for doubtful accounts relating to self-pay patients and during 2015 the Organization decreased its estimate from $4,129,465 to $3,902,231 in the allowance for doubtful accounts relating to self-pay patients. During 2016, self-pay write-offs decreased from $5,771,998 to $5,244,510 and during 2015 self-pay write-offs decreased from $7,488,563 to $5,771,998. Such changes in write-off amounts resulted from trends experienced in the collection of amounts from self-pay patients and the aging of the receivable balances. Part III, Line 9b: Speare Memorial Hospital has both a collections policy, and a charity care policy that describes charity eligibility and the steps to be completed before a patient's account is written off to bad debt. Part VI, Line 2: In addition to the discussion groups described in Part V - Section C, Speare has ongoing discussions with key community leaders about the identified needs, how they are being addressed and other opportunities for action. These include our legislators, municipal leaders, police and fire, local health departments, Plymouth State University, community centers and area clergy. Part VI, Line 3: Patients are educated at time of registration or through educational materials that are distributed through the hospital's website or by community outreach. Speare Memorial Hospital is a member of a state-wide community health network that provides assistance, support, and education relating to eligibility assistance. Part VI, Line 4: Speare Memorial Hospital best defines its community as those towns comprising South Eastern Grafton County based on our patient origin information and market share data published by the New Hampshire Hospital Association.Speare Memorial Hospital is located in the mountain and lakes region of New Hampshire and primarily serves constituents in Grafton County. Grafton County population size is approximately 86,000 within its 40 distinct municipalities. Its service area includes 17 towns with an approximate total population of 30,000. Part VI, Line 5: Speare Memorial Hospital provides prescription medication assistance, primary-care clinics, multiple support groups, community education programs, school dental program, etc. and has affiliations and partnerships with many community organizations; an open medical staff and community board. Operating funds are used for ongoing capital expenditures. Part VI, Line 7, Reports Filed With States NH 1 Mid-State Health Center 101 Boulder Point Drive No 1 Plymouth NH 03264 020487172 501(c)(3) 208294 FMV To support a portion of the otherwise uncompensated care costs incurred by Mid-State in providing comprehensive preventive and primary health services (and related enabling services) to residents of its service area in Grafton County. 1 0 Matching grant for loan repayment 1 16000 0 Part I, Line 2: The Organization only pays grants to other Section 501(c)(3) organizations. Therefore, no additional monitoring is deemed necessary. Other assistance payments are reviewed on a periodic basis. X X X X X 0 0 0 0 0 0 0 1 0 Michelle McEwen CEO 241976 0 27600 0 14423 0 21224 0 29991 0 335214 0 0 0 Thomas Lenkowski CFO 183699 0 0 0 0 0 15617 0 3577 0 202893 0 0 0 Joseph Ebner MD CMO 211279 0 9069 0 9418 0 18802 0 29449 0 278017 0 0 0 Joseph Casey MD General Surgeon 388570 0 108841 0 16972 0 37403 0 29991 0 581777 0 0 0 Steve Danosi MD ER Physician 487142 0 0 0 0 0 40458 0 29991 0 557591 0 0 0 Victor Gennaro MD Orthopedic Surgeon 451801 0 2872 0 26538 0 39344 0 29991 0 550546 0 0 0 Michael Giovan MD Orthopedic Surgeon 238813 0 52370 0 104224 0 25054 0 14995 0 435456 0 0 0 Ralph Broadwater MD ER Physician 418972 0 0 0 0 0 29416 0 29991 0 478379 0 0 0 Part I, Line 7 Bonus compensation listed for Joseph Ebner, Joseph Casey, Michael Giovan and Victor Gennaro represents amounts paid for a productivity incentive. This incentive is based on exceeding an RVU target as defined in the employment contract. Each RVU above the target is paid at the RVU rate as defined by Medicare. Compensation for the CEO is determined via a compensation committee, compensation survey or study, comparison of other organizations, Form 990 information, board approval and written employment contract. A New Hampshire Health And Education Facilities Authority 020279866 2012-12-07 21100000 To pay off and provide advanced refunding for 2010 and 2004 Bonds 0 0 0 A 2786962 21100000 209815 4566977 16323208 2015 1 1 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 0 Form 990, Part VI, Section A, line 3 The rehabilitation department is managed by Plymouth Regional Rehabilitation Services. Dietary services are managed by Morrison Healthcare Managment Specialist Inc. Medical Records are supervised by Medical Reimbursement Specialists. The department of Wound Care and Hyperbaric is managed by Diversified Clincial Services of Jacksonville, FL. Form 990, Part VI, Section A, line 6 The Association consists of all persons who are members at the time of the adoption of the bylaws and other persons who may be elected. Form 990, Part VI, Section A, line 7a A candidate for membership may be elected by a majority vote of members present at any annual or special meeting of the Association provided that a quorum is present. Alternately, a candidate for membership may be elected by a two-thirds vote of the Board of Directors present at any regular or special meeting of the Board provided that a quorum is present. Form 990, Part VI, Section B, line 11 The Form 990 is presented to the organization's management and board for review and acceptance at the time of filing. Form 990, Part VI, Section B, line 12c Speare Memorial Hospital has a set of procedures to follow to avoid the possibility that those in positions of authority over the Organization may receive an inappropriate benefit. Any possible conflict of interest on the part of any member of the Board, Officer or Employee of the Organization, shall be disclosed in writing to the Board and made a matter of record through an annual procedure and also when the interest involves a specific issue before the Board. Form 990, Part VI, Section B, line 15a Compensation for the CEO is determined via a compensation committee, compensation survey or study, comparison of other organizations 990 information, board approval and written employment contract. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 5,372,668. Management and general expenses 539,044. Fundraising expenses 11,847. Total expenses 5,923,559. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Speare Memorial Hospital 16 Hospital Road Plymouth, NH 03264 EIN 02-0226774 Speare Memorial Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Beneficial Interest in Perpetual Trusts -2,996. Speare Memorial At Boulder Point Boulder Point Drive Plymouth NH 03264 263888977 Real Estate NH 501(c)(3) Line 11a, I Speare Memorial Hospital 1 Speare Health Network LLC 16 Hospital Road Plymouth NH 03264 043372339 Physician/Hospital Organization NH Speare Memorial Hospital C 177 20707 0.50000 0 Speare Health Ventures Inc 19 Avery Street Plymouth NH 03264 020366565 Healthcare Services NH Speare Memorial Hospital C 24165 301403 1.00000 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Speare Health Venture Inc D 274235 FMV Speare Memorial At Boulder Point D 2040520 FMV Speare Memorial At Boulder Point K 746018 FMV