FMH Wind-Down Company: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FMH Wind-Down Company (EIN 02-0222131)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-15
- IRS object ID
- 201742279349302439
- Schema version
- 2015v3.0
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-15T12:38:45-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222131 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FRIS | BusinessNameControlTxt |
| Phone | 6033325211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Rd | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | John Marzinzik | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6033325211 | PhoneNum |
| Signature | 2017-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne CPA | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2017-08-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | John Marzinzik | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Rd | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $154,628,413 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.frisbiehospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1941 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1123 | TotalEmployeeCnt |
| Total Volunteers | 133 | TotalVolunteersCnt |
| Total Gross UBI | $1,611,938 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $129,399 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $105,274 | PYContributionsGrantsAmt |
| CY Contributions Grants | $240,621 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $129,746,157 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $146,141,383 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,748,820 | PYInvestmentIncomeAmt |
| CY Investment Income | $963,134 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $533,527 | CYOtherRevenueAmt |
| PY Total Revenue | $131,600,251 | PYTotalRevenueAmt |
| CY Total Revenue | $147,878,665 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $109,542 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $73,413,667 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $79,081,033 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $127,222 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $59,367,062 | PYOtherExpensesAmt |
| CY Other Expenses | $65,332,413 | CYOtherExpensesAmt |
| PY Total Expenses | $132,780,729 | PYTotalExpensesAmt |
| CY Total Expenses | $144,522,988 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,180,478 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,355,677 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $120,840,917 | TotalAssetsBOYAmt |
| Total Assets EOY | $136,936,545 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $37,889,299 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $49,123,520 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $82,951,618 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $87,813,025 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To excel at caring for the community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $126,052,125 | ExpenseAmt |
| Grant | $109,542 | GrantAmt |
| Revenue | $146,674,910 | RevenueAmt |
| Desc | 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 FY 2016 29,093 patients were treated in our emergency department, 6,222 ambulance calls were made, 3,720 inpatients were cared for, and surgery performed on 13,136 patients. 329 newborns were welcomed into the world, 46,377 radiology procedures/tests provided, gave 68,297 rehabilitative treatments, performed 386,795 laboratory tests and treated 5,578 oncology patients. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,280,160 | ExpenseAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $510,329 | ExpenseAmt |
| Desc | Frisbie Memorial Hospital presented or sponsored numerous community programs which assisted with the special needs of our must vulnerable at risk population groups. These programs improved education and health awareness in the community, and provided greater access to health services. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $132,842,614 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1123 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Robert Cochrane | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033325211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochster | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Ron Poulin | |||||||||
| Chairman | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Brian Hughes | |||||||||
| Vice Chairman | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| William Cormier | |||||||||
| Secretary | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| TJ Jean | |||||||||
| Treasurer | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Greg Smith | |||||||||
| Immediate Past Chair | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| John Britton MD | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Peter Gowell | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Robert Harrington MD | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jim Jalbert | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Frank Jones | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jeanette Poulin | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Julie Reynolds | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Leslie Simpson | |||||||||
| Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joseph Behre | |||||||||
| Past Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Rich Hussey | |||||||||
| Past Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| David Keefe | |||||||||
| Past Trustee | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| John Marzinzik | |||||||||
| CEO | 40.00 | Yes (X) | $538,038 | $0 | $184,539 | ||||
| Steve Guimond | |||||||||
| Interim CFO | 40.00 | Yes (X) | $0 | $0 | $0 | ||||
| Nick Samilo | |||||||||
| Past CFO | 40.00 | Yes (X) | $69,569 | $0 | $24,870 | ||||
| Amy Dumont | |||||||||
| VP Patient Care | 40.00 | $258,641 | $0 | $49,031 | Yes (X) | ||||
| Carol Themelis | |||||||||
| VP Human Resources | 40.00 | $232,326 | $0 | $43,216 | Yes (X) | ||||
| Paula Mahoney | |||||||||
| VP Physician Practices | 40.00 | $200,100 | $0 | $44,338 | Yes (X) | ||||
| Joseph Shields | |||||||||
| Senior VP | 40.00 | $221,300 | $0 | $30,997 | Yes (X) | ||||
| John Freese MD | |||||||||
| Physician | 40.00 | $505,130 | $0 | $14,203 | Yes (X) | ||||
| Trevor Eide MD | |||||||||
| Physician | 40.00 | $501,731 | $0 | $14,919 | Yes (X) | ||||
| Mathurin Malby MD | |||||||||
| Physician | 40.00 | $499,479 | $0 | $29,531 | Yes (X) | ||||
| Liza Conley MD | |||||||||
| Physician | 40.00 | $414,475 | $0 | $24,087 | Yes (X) | ||||
| Sachin Saksena MD | |||||||||
| Physician | 40.00 | $407,110 | $0 | $3,038 | Yes (X) | ||||
| Alvin Felgar | |||||||||
| Past CEO | 0.00 | $495,855 | $0 | $1,238 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,343,754 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $464,007 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 109 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Corthall Facilities Management | |||||
| 13028 Collections Ctr | Chicago | IL | 60693 | Facilities Management | $3,513,856 |
| Healthnet Systems Consulting | |||||
| 20 Burlington Mall Road | Burlington | MA | 01803 | IT Consulting | $2,798,199 |
| Unidine Corp | |||||
| 1000 Washington St | Boston | MA | 03867 | Dietary Services | $2,206,919 |
| Surgical Associates of Rochester | |||||
| 21 Whitehall Road | Rochester | NH | 03867 | Physician Practice | $1,510,000 |
| Alliance Healthcare | |||||
| PO Box 96485 | Chicago | IL | 60693 | MRI/PET Imaging | $892,765 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $240,621 | AllOtherContributionsAmt |
| Total Contributions | $240,621 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Net Patient Service Revenue | 622110 | $153,768,017 | $153,768,017 | ||
| Other Operating Revenue | 900099 | $3,172,674 | $890,514 | $1,611,938 | $670,222 |
| Meaningful Use Revenue | 900099 | $761,431 | $761,431 | ||
| Provision for Bad Debts | 622110 | -$11,560,739 | -$11,560,739 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $146,141,383 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $462,882 | TotalRevenueColumnAmt |
| Exclusion | $462,882 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,250,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,749,748 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $500,252 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $500,252 | TotalRevenueColumnAmt |
| Exclusion | $500,252 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Equity Earnings in Affiliate | Desc |
| Business | 900001 | BusinessCd |
| Total Revenue Column | $533,527 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $533,527 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $533,527 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $147,878,665 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $144,392,750 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,611,938 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,633,356 | 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 | $109,542 | TotalAmt |
| Program Services | $109,542 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,698,889 | TotalAmt |
| Program Services | $79,962 | ProgramServicesAmt |
| Management And General | $1,618,927 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,042,710 | TotalAmt |
| Program Services | $58,458,140 | ProgramServicesAmt |
| Management And General | $1,491,094 | ManagementAndGeneralAmt |
| Fundraising | $93,476 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,937,008 | TotalAmt |
| Program Services | $1,889,471 | ProgramServicesAmt |
| Management And General | $44,733 | ManagementAndGeneralAmt |
| Fundraising | $2,804 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,213,725 | TotalAmt |
| Program Services | $10,960,194 | ProgramServicesAmt |
| Management And General | $238,575 | ManagementAndGeneralAmt |
| Fundraising | $14,956 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,188,701 | TotalAmt |
| Program Services | $4,067,621 | ProgramServicesAmt |
| Management And General | $114,069 | ManagementAndGeneralAmt |
| Fundraising | $7,011 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $282,529 | TotalAmt |
| Management And General | $282,529 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,857 | TotalAmt |
| Management And General | $48,857 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,796,883 | TotalAmt |
| Program Services | $13,138,718 | ProgramServicesAmt |
| Management And General | $2,651,665 | ManagementAndGeneralAmt |
| Fundraising | $6,500 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $621,818 | TotalAmt |
| Program Services | $11,847 | ProgramServicesAmt |
| Management And General | $609,971 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,043,847 | TotalAmt |
| Program Services | $449,854 | ProgramServicesAmt |
| Management And General | $592,993 | ManagementAndGeneralAmt |
| Fundraising | $1,000 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,291,903 | TotalAmt |
| Program Services | $6,518,346 | ProgramServicesAmt |
| Management And General | $1,773,557 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,447 | TotalAmt |
| Program Services | $12,500 | ProgramServicesAmt |
| Management And General | $7,747 | ManagementAndGeneralAmt |
| Fundraising | $1,200 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,557 | TotalAmt |
| Program Services | $272,619 | ProgramServicesAmt |
| Management And General | $24,863 | ManagementAndGeneralAmt |
| Fundraising | $75 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $941,787 | TotalAmt |
| Program Services | $941,787 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,331,479 | TotalAmt |
| Program Services | $5,331,479 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,539,326 | TotalAmt |
| Management And General | $1,539,326 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $23,504,191 | $23,331,261 | $172,930 | |
| Medicaid Enhancement Ta | $5,985,046 | $5,985,046 | ||
| Equipment Maintenance | $1,262,253 | $1,067,043 | $195,210 | |
| Dues & Subscriptions | $363,490 | $217,184 | $146,106 | $200 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,522,988 | TotalAmt |
| Program Services | $132,842,614 | ProgramServicesAmt |
| Management And General | $11,553,152 | ManagementAndGeneralAmt |
| Fundraising | $127,222 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,390,346 | BOYAmt |
| EOY | $4,901,772 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,361,058 | BOYAmt |
| EOY | $4,401,023 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,528,619 | BOYAmt |
| EOY | $23,417,311 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,231,018 | BOYAmt |
| EOY | $3,577,375 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,616,273 | BOYAmt |
| EOY | $1,842,887 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $148,860,283 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $84,505,704 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,180,969 | BOYAmt |
| EOY | $64,354,579 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,464,678 | BOYAmt |
| EOY | $29,486,025 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,067,956 | BOYAmt |
| EOY | $4,955,573 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,840,917 | BOYAmt |
| EOY | $136,936,545 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,198,521 | BOYAmt |
| EOY | $14,142,261 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,690,778 | BOYAmt |
| EOY | $21,670,934 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $13,313,657 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,000,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | -$1,003,332 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,889,299 | BOYAmt |
| EOY | $49,123,520 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,900,580 | BOYAmt |
| EOY | $85,292,631 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,346 | BOYAmt |
| EOY | $603,702 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,800,692 | BOYAmt |
| EOY | $1,916,692 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,951,618 | BOYAmt |
| EOY | $87,813,025 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,840,917 | BOYAmt |
| EOY | $136,936,545 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,355,677 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,505,730 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | $5,428 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,428 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to various associations, 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 | $29,464,678 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,195,487 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $134,000 | OtherExpendituresAmt |
| End Year Balance | $31,526,165 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $34,288,142 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$4,823,464 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,464,678 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,227,443 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,323,272 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $262,573 | OtherExpendituresAmt |
| End Year Balance | $34,288,142 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $28,491,800 | BeginningYearBalanceAmt |
| Contributions | $78,472 | ContributionsAmt |
| Investment Earnings Or Losses | $2,898,384 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $241,213 | OtherExpendituresAmt |
| End Year Balance | $31,227,443 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $24,732,265 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,759,535 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $28,491,800 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.92550 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.07450 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $181,776 | OtherCostOrOtherBasisAmt |
| Book Value | $181,776 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $88,502,602 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,935,808 | DepreciationAmt |
| Book Value | $43,566,794 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,397,958 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,001,595 | DepreciationAmt |
| Book Value | $396,363 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,810,849 | OtherCostOrOtherBasisAmt |
| Depreciation | $37,305,668 | DepreciationAmt |
| Book Value | $9,505,181 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,967,098 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,262,633 | DepreciationAmt |
| Book Value | $10,704,465 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $64,354,579 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Third Party Payor Settlement | $1,387,568 |
| due from affiliates | -$2,390,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | -$1,003,332 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | To futher the Hospital's charitable mission. | ExplanationTxt |
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 | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 0 | 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 | $6,280,160 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,280,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04350 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,499,474 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,520,629 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,978,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04830 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,779,634 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,520,629 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,259,005 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09180 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $510,329 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $510,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $69,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $69,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,742,253 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,443,389 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $298,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $258,047 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $258,047 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,579,629 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,443,389 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,136,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00790 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,359,263 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,964,018 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,395,245 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09970 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,071,588 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $407,159 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $31,177,676 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $44,681,813 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$13,504,137 | 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 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Rd | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.frisbiehospital.com | WebsiteAddressTxt |
| State License | 00028 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Geropsychiatric Unit | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | www.frisbiehospital.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.frisbiehospital.com | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.frisbiehospital.com/patients-and-visitors/billing-insurance/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Selling Debt | Yes (X) | PermitSellingDebtInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: FMH is empowering individuals to make healthy lifestyle choices and providing access to preventative care services.For more information please see attached Commmunity Health Needs Assessment. |
| Frisbie Memorial Hospital | Part V, Section B, Line 22d: The maximum amount charged to FAP - eligible individuals is gross charge less 15%. |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | A community benefit report is prepared yearly and is available on the organizatons public website. |
| 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 4: | Financial Statement Footnote: 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 individual accounts and historical adjustments. 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.In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each major payor source of revenue for the purposes of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible |
| 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. |
| 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 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 service stakeholders |
| 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 64,000 with a medium income of $52,662 and 9% of community residents living below the federal poverty guidelines. |
| Part VI, Line 7, Reports Filed With States | NH |
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 |
|---|---|---|---|---|---|---|---|
| James W Foley Legacy Foundation Inc | |||||||
| 4 Conifer Circle | Rochester | NH | 03867 | 471759388 | 501(c)(3) | $10,000 | Financial support of organizations mission. |
| Roger Allen Recreation Association | |||||||
| PO Box 1844 | Rochester | NH | 03867 | 222539693 | 501(c)(3) | $7,500 | Financial support of organizations mission. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | All donations are tracked on excel spreadsheets and follow up calls are placed. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John Marzinzik | ||||||||||||||
| CEO | $527,438 | $0 | $0 | $0 | $10,600 | $0 | $162,185 | $0 | $22,354 | $0 | $722,577 | $0 | $0 | $0 |
| Amy Dumont | ||||||||||||||
| VP Patient Care | $227,609 | $0 | $0 | $0 | $31,032 | $0 | $22,000 | $0 | $27,031 | $0 | $307,672 | $0 | $0 | $0 |
| Carol Themelis | ||||||||||||||
| VP Human Resources | $188,041 | $0 | $0 | $0 | $44,285 | $0 | $39,081 | $0 | $4,135 | $0 | $275,542 | $0 | $0 | $0 |
| Paula Mahoney | ||||||||||||||
| VP Physician Practices | $177,103 | $0 | $0 | $0 | $22,997 | $0 | $21,984 | $0 | $22,354 | $0 | $244,438 | $0 | $0 | $0 |
| Joseph Shields | ||||||||||||||
| Senior VP | $196,101 | $0 | $0 | $0 | $25,199 | $0 | $8,643 | $0 | $22,354 | $0 | $252,297 | $0 | $0 | $0 |
| John Freese MD | ||||||||||||||
| Physician | $244,520 | $0 | $260,610 | $0 | $0 | $0 | $0 | $0 | $14,203 | $0 | $519,333 | $0 | $0 | $0 |
| Trevor Eide MD | ||||||||||||||
| Physician | $247,649 | $0 | $249,895 | $0 | $4,187 | $0 | $0 | $0 | $14,919 | $0 | $516,650 | $0 | $0 | $0 |
| Mathurin Malby MD | ||||||||||||||
| Physician | $294,931 | $0 | $204,548 | $0 | $0 | $0 | $0 | $0 | $29,531 | $0 | $529,010 | $0 | $0 | $0 |
| Liza Conley MD | ||||||||||||||
| Physician | $227,682 | $0 | $186,793 | $0 | $0 | $0 | $0 | $0 | $24,087 | $0 | $438,562 | $0 | $0 | $0 |
| Sachin Saksena MD | ||||||||||||||
| Physician | $396,510 | $0 | $0 | $0 | $10,600 | $0 | $0 | $0 | $3,038 | $0 | $410,148 | $0 | $0 | $0 |
| Alvin Felgar | ||||||||||||||
| Past CEO | $405,350 | $0 | $0 | $0 | $90,505 | $0 | $0 | $0 | $1,238 | $0 | $497,093 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | 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 employee's date certain, which is elected by the employee. Alvin Felgar, Carol Themelis, and Amy Dumont received lump sum distributions in the amount of $90,505, $37,253, and $22,400 respectively. |
| 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 5: | John Britton, M.D., is compensated by Surgical Associates of Rochester, an unrelated organization, for services rendered to Frisbie Memorial Hospital. 2015 compensation amounts were not available as of this filing. Dr. Britton is a 33.33% owner of Surgical Associates of Rochester. During 2015 Frisbie Memorial Hospital paid $1,510,000 to Surgical Associates of Rochester for services rendered to the Hospital. |
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 | NHHEFA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 644614QD4 | CUSIPNum |
| Bond Issued | 2014-08-01 | BondIssuedDt |
| Issue Price | $22,475,000 | IssuePriceAmt |
| Purpose | Refunding Series 2006 Bonds | 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 | $575,000 | RetiredAmt |
| Total Proceeds | $22,475,000 | TotalProceedsAmt |
| Refunding Escrow | $22,475,000 | RefundingEscrowAmt |
| Substantial Completion | 2014 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| 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 |
| 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 | 0 | 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 | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Trustees Ron Poulin and Jeanette Poulin have a family relationship. |
| Form 990, Part VI, Section B, line 11 | The CFO reviews the 990 and brings it to the board. The CFO answers any questions from the board members. |
| 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 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 written request based on the intent and purpose of the request. |
| Form 990, Part IX, line 11g | Purchased Services : Program service expenses 13,138,718. Management and general expenses 2,651,665. Fundraising expenses 6,500. Total expenses 15,796,883. |
| Form 990, Part IX, line 24b | The New Hampshire Medicaid Enhancement tax (MET) is a 5.5% tax on net patient service revenue paid by hospitals to the State of New Hampshire. Unlike previous years where the State provided hospitals with uncompensated care payments towards the cost of care to patients without insurance from matching federal funds, uncompensated care payments were reduced or eliminated to hospitals. The FY 2016 impact to Frisbie Memorial Hospital was payment of MET in the amount of $5,985,046. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Road | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020465942 | EIN |
| Primary Activities | Coordinate Funds Raised for Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Skyhaven Surgery Center LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 Whitehall Rd | AddressLine1Txt |
| City | Rochester | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03867 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463885261 | EIN |
| Primary Activities | Ambulatory Surgery | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frisbie Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Share Of Total Income | -$1,818,287 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $2,565,427 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.86000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 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 | Yes (1) | 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 | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Frisbie Foundation | ||
| K | $2,524,128 | FMV |
| Frisbie Foundation | ||
| Q | $204,060 | FMV |
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