MONADNOCK COMMUNITY HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- MONADNOCK COMMUNITY HOSPITAL (EIN 02-0222157)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201612289349300141
- Schema version
- 2014v6.0
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T08:09:33-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | BOX 507 | AddressLine1Txt |
| City | PORTLAND | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222157 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MONA | BusinessNameControlTxt |
| Phone | 6039247191 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Richard D Scheinblum | PersonNm |
| Person Title | VP of Finance/CFO | PersonTitleTxt |
| Phone | 6039247191 | PhoneNum |
| Signature | 2016-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 2078792100 | PhoneNum |
| Preparation | 2016-08-11 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Cynthia K McGuire | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $79,842,154 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.monadnockcommunityhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1919 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Critical access hospital serving the Monadnock region of the State of New Hampshire | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 777 | TotalEmployeeCnt |
| Total Volunteers | 151 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $916,625 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,299,530 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $79,776,991 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $76,857,288 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,205,315 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,605,715 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,419 | PYOtherRevenueAmt |
| CY Other Revenue | $4,390 | CYOtherRevenueAmt |
| PY Total Revenue | $81,905,350 | PYTotalRevenueAmt |
| CY Total Revenue | $79,766,923 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $21,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $40,760,738 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $39,259,408 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $387,608 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,619,692 | PYOtherExpensesAmt |
| CY Other Expenses | $41,027,368 | CYOtherExpensesAmt |
| PY Total Expenses | $79,395,430 | PYTotalExpensesAmt |
| CY Total Expenses | $80,307,776 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,509,920 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$540,853 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $104,528,486 | TotalAssetsBOYAmt |
| Total Assets EOY | $107,855,800 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,153,660 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $48,663,461 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $59,374,826 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $59,192,339 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Monadnock Community Hospital is committed to improving the health and well-being of our community. We will elevate the health of our community by providing accessible, high quality and value based care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $71,145,368 | ExpenseAmt |
| Grant | $21,000 | GrantAmt |
| Revenue | $76,857,288 | RevenueAmt |
| Desc | The primary purpose of Monadnock Community Hospital (MCH) is to ensure access to quality health care for patients in our community, regardless of their ability to pay. The following is a summary of the services MCH provides in an effort to fulfill its mission, together with key program statistics for fiscal year 2015.Inpatient Services - Includes: intensive care unit, adult stays, pediatric stays, maternity/births, and skilled nursing. During the fiscal year, the Hospital admitted 1,474 patients and recorded 4,735 patient days. Emergency Services - MCH offers health services 24 hours per day, 7 days per week. Responsible for the immediate treatment of any medical or surgical emergency; for initiating lifesaving procedures in all types of emergency situations; and for providing emergency and initial evaluations and treatment for other conditions including minor illnesses and injuries, and sub-acute medical problems. During the year, there were 14,142 visits to the ER. Physician Practices - Family health services, programs, and education are integral components of healthcare at MCH. Inpatient and outpatient primary care includes: medical, surgical, psychological and specialist services, provided by physicians and mid-level practitioners. These are located at the Hospital and its five satellite practices located in Antrim, Jaffrey, New Ipswich, Peterborough, and Rindge. During the year, 71,280 primary care office visits were recorded. Surgical Services - Includes same day and short-term inpatient surgery. MCH provides surgery in the areas of orthopaedics, general surgery, OB/GYN, ophthalmology, urology, ENT, and podiatry. In addition, the Hospital offers some non-surgical procedures including colonoscopies, gastroscopies, and pain management injections. During the fiscal year, 3,423 procedures were performed. Radiology and Diagnostics - MCH provides advanced radiological technology and extensive imaging services including: bone density, MRI, CT, nuclear medicine, ultrasound, mammography, and other diagnostic procedures, both inpatient and outpatient. During the fiscal year, 29,548 exams were performed. Rehabilitation Services - Additionally, MCH serves the people of the Monadnock Region through its medical rehabilitation services. MCH offers rehabilitation programs for cardiac, pulmonary and diabetic rehabilitation which feature educational and exercise components. We also provide physical and occupational therapy, as well as speech rehabilitation. During the fiscal year 49,759 procedures were recorded for these services. Wellness Services - Community members wanting to improve and maintain their health have access to an award-winning, medically-based fitness facility. During the fiscal year, 18,111 member months were recorded.Monadnock Community Hospital's Financial Grant Program provides assistance with hospital and/or physician bills for qualifying patients. In FY 2015, the Organization recorded $2,286,000 in charges foregone based on established rates. The estimated cost incurred to provide these services was $1,192,000. In addition, Monadnock Community Hospital provided other services to the community at no cost or reduced cost, such as screenings and clinics. The cost of providing these services was approximately $1,895,000 in 2015. | Desc |
| Total Program Service Expenses | $71,145,368 | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 106 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 777 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 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 | Nicole Humphrey | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6039247191 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Thomas Bates | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Cyndy Burgess | |||||||||
| Trustee (part yr) | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Diane Cherwin | |||||||||
| Ex-Officio w/voting rights (part yr) | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert Boyd | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Barbara R Duckett | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Peter L Forssell MD | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Richard Frechette MD | |||||||||
| Ex-Officio w/voting rights | 3.00 | 0.00 | Yes (X) | $217,763 | $0 | $34,049 | |||
| David A Hedstrom DDS | |||||||||
| Trustee (part yr) | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Gregory Kriebel MD | |||||||||
| Ex-Officio w/voting rights | 50.00 | 0.00 | Yes (X) | $224,803 | $0 | $27,840 | |||
| Marcia Ober | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| William James Jr | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael Shea | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Thomas Ward | |||||||||
| Ex-Officio w/voting rights | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Fletcher R Wilson MD | |||||||||
| Ex-Officio w/voting rights (part yr) | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Terrence McNamara DO | |||||||||
| Ex-Officio w/voting rights | 50.00 | 0.00 | Yes (X) | $504,745 | $0 | $29,127 | |||
| Robert L Edwards | |||||||||
| Trustee | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Carole Monroe | |||||||||
| Chair | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Steven H Reynolds | |||||||||
| Vice Chair | 8.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Jamie Trowbridge | |||||||||
| Treasurer | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Norman H Makechnie Esq | |||||||||
| Secretary | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Cynthia McGuire | |||||||||
| Chief Executive Officer | 60.00 | 0.00 | Yes (X) | $215,776 | $0 | $14,011 | Yes (X) | ||
| Richard D Scheinblum | |||||||||
| VP Finance/CFO | 50.00 | 0.00 | $170,776 | $0 | $13,316 | Yes (X) | |||
| Philip Vuocolo MD | |||||||||
| Physician | 50.00 | 0.00 | $394,231 | $0 | $33,906 | Yes (X) | |||
| Ronald Michalak MD | |||||||||
| Physician | 50.00 | 0.00 | $475,270 | $0 | $28,127 | Yes (X) | |||
| Douglas Weiss MD | |||||||||
| Physician | 50.00 | 0.00 | $474,710 | $0 | $12,289 | Yes (X) | |||
| Shawn Harrington MD | |||||||||
| Physician | 50.00 | 0.00 | $388,589 | $0 | $28,836 | Yes (X) | |||
| Robert C Knowles MD FACS | |||||||||
| Physician | 50.00 | 0.00 | $408,988 | $0 | $22,766 | Yes (X) | |||
| Peter L Gosline | |||||||||
| Former Chief Executive Officer | 0.00 | 0.00 | $271,160 | $0 | $18,609 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,746,811 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $262,876 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 49 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Monadnock Region Emergency Physicians PL | |||||
| 380 Lafayette Road | Hampton | NH | 03842 | Contract Emergency Physician Group | $1,925,504 |
| Hutter Construction Corp | |||||
| PO Box 257 | New Ipswich | NH | 03071 | General Contractor | $1,882,461 |
| Monadnock Anesthesia Associates | |||||
| C/O Surgical Suite | Peterborough | NH | 03458 | Anesthesiologist Services | $1,400,016 |
| McKesson | |||||
| PO Box 98347 | Chicago | IL | 60693 | IS Vendor | $1,133,329 |
| Catholic Medical Center | |||||
| 195 McGregor Street | Manchester | NH | 03102 | Contract Hospitalist Group | $970,045 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $43,705 | FundraisingAmt |
| Government Grants | $20,906 | GovernmentGrantsAmt |
| All Other Contributions | $1,234,919 | AllOtherContributionsAmt |
| Noncash Contributions | $123,299 | NoncashContributionsAmt |
| Total Contributions | $1,299,530 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 621400 | $71,607,317 | $71,607,317 |
| Other Operating Revenue | 621400 | $4,154,666 | $4,154,666 |
| Disproportionate Share Funding | 621400 | $612,325 | $612,325 |
| Cafeteria/Vending Machine | 722210 | $341,819 | $341,819 |
| Employee Pharmacy Sales | 446110 | $141,161 | $141,161 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $76,857,288 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $638,012 | TotalRevenueColumnAmt |
| Exclusion | $638,012 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,021,758 | SecuritiesAmt |
| Other | $4,996 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $33,063 | SecuritiesAmt |
| Other | $25,988 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $988,695 | SecuritiesAmt |
| Other | -$20,992 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $967,703 | TotalRevenueColumnAmt |
| Exclusion | $967,703 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $20,570 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $43,705 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $16,180 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,390 | TotalRevenueColumnAmt |
| Exclusion | $4,390 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $79,766,923 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $76,857,288 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,610,105 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,000 | TotalAmt |
| Program Services | $6,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,493,210 | TotalAmt |
| Program Services | $1,042,113 | ProgramServicesAmt |
| Management And General | $451,097 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,836,209 | TotalAmt |
| Program Services | $27,711,939 | ProgramServicesAmt |
| Management And General | $2,892,214 | ManagementAndGeneralAmt |
| Fundraising | $232,056 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $334,753 | TotalAmt |
| Program Services | $297,496 | ProgramServicesAmt |
| Management And General | $35,756 | ManagementAndGeneralAmt |
| Fundraising | $1,501 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,451,717 | TotalAmt |
| Program Services | $3,886,753 | ProgramServicesAmt |
| Management And General | $543,566 | ManagementAndGeneralAmt |
| Fundraising | $21,398 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,143,519 | TotalAmt |
| Program Services | $1,895,317 | ProgramServicesAmt |
| Management And General | $230,293 | ManagementAndGeneralAmt |
| Fundraising | $17,909 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,338 | TotalAmt |
| Management And General | $82,338 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,000 | TotalAmt |
| Management And General | $54,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,824 | TotalAmt |
| Management And General | $171,106 | ManagementAndGeneralAmt |
| Fundraising | $2,718 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,502,485 | TotalAmt |
| Program Services | $4,869,937 | ProgramServicesAmt |
| Management And General | $632,548 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,859 | TotalAmt |
| Program Services | $75,859 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,159,886 | TotalAmt |
| Program Services | $1,037,658 | ProgramServicesAmt |
| Management And General | $1,088,306 | ManagementAndGeneralAmt |
| Fundraising | $33,922 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,312,132 | TotalAmt |
| Program Services | $1,144,464 | ProgramServicesAmt |
| Management And General | $167,668 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,895,036 | TotalAmt |
| Program Services | $2,603,979 | ProgramServicesAmt |
| Management And General | $291,057 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,434 | TotalAmt |
| Program Services | $53,984 | ProgramServicesAmt |
| Management And General | $19,710 | ManagementAndGeneralAmt |
| Fundraising | $740 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,785 | TotalAmt |
| Program Services | $44,558 | ProgramServicesAmt |
| Management And General | $11,367 | ManagementAndGeneralAmt |
| Fundraising | $24,860 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,137,174 | TotalAmt |
| Management And General | $1,137,174 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,436,947 | TotalAmt |
| Program Services | $4,254,744 | ProgramServicesAmt |
| Management And General | $182,203 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,335 | TotalAmt |
| Program Services | $405,163 | ProgramServicesAmt |
| Management And General | $168,172 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Med & Pharm Supplies | $9,451,489 | $9,448,754 | $2,735 | |
| Other Med Exp/Service C | $4,795,923 | $4,306,418 | $449,712 | $39,793 |
| Provision for Bad Debt | $4,049,279 | $4,049,279 | ||
| NH Medicaid Enhancement | $3,356,434 | $3,356,434 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816,008 | TotalAmt |
| Program Services | $639,519 | ProgramServicesAmt |
| Management And General | $163,778 | ManagementAndGeneralAmt |
| Fundraising | $12,711 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,307,776 | TotalAmt |
| Program Services | $71,145,368 | ProgramServicesAmt |
| Management And General | $8,774,800 | ManagementAndGeneralAmt |
| Fundraising | $387,608 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,064 | BOYAmt |
| EOY | $5,732 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,904,373 | BOYAmt |
| EOY | $18,080,723 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $677,841 | BOYAmt |
| EOY | $681,106 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,513,721 | BOYAmt |
| EOY | $6,954,225 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $92,838 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,767 | BOYAmt |
| EOY | $171,396 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,257,506 | BOYAmt |
| EOY | $1,199,012 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $682,936 | BOYAmt |
| EOY | $1,159,462 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $87,200,513 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $48,172,015 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,437,191 | BOYAmt |
| EOY | $39,028,498 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,316,218 | BOYAmt |
| EOY | $35,550,447 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,735,792 | BOYAmt |
| EOY | $3,887,633 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,168 | BOYAmt |
| EOY | $126,451 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $678,909 | BOYAmt |
| EOY | $918,277 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,528,486 | BOYAmt |
| EOY | $107,855,800 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,100,470 | BOYAmt |
| EOY | $7,372,803 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,450,980 | BOYAmt |
| EOY | $25,971,797 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $835,553 | BOYAmt |
| EOY | $643,132 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,766,657 | BOYAmt |
| EOY | $14,675,729 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,153,660 | BOYAmt |
| EOY | $48,663,461 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,964,278 | BOYAmt |
| EOY | $48,138,603 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,455,314 | BOYAmt |
| EOY | $2,946,661 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,955,234 | BOYAmt |
| EOY | $8,107,075 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,374,826 | BOYAmt |
| EOY | $59,192,339 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,528,486 | BOYAmt |
| EOY | $107,855,800 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$540,853 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $818,319 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$459,953 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $12,874 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $274 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $13,148 | 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 | Monadnock Community Hospital is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Monadnock Hospital in furtherance of its exempt purpose. Monadnock Hospital does not directly perform any lobbying activities. NHHA, Portion of dues available for lobbying: $9,637 AHA, Portion of dues available for lobbying: $3,237 In addition, MCH hosts an annual legislative breakfast, which is a bipartisan event to which legislators, local politicians, and other public officials are invited to discuss health care issues in New Hampshire. Topics for the 2015 breakfast included the MET Settlement Agreement Implementation, the New Hampshire Health Protection Plan, Business Enterprise Tax, Reauthorize Certificate of Need, and Medicaid DSH. The cost of this forum was $274. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,410,548 | BeginningYearBalanceAmt |
| Contributions | $1,026,702 | ContributionsAmt |
| Investment Earnings Or Losses | $489,797 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,873,313 | OtherExpendituresAmt |
| End Year Balance | $11,053,734 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,304,146 | BeginningYearBalanceAmt |
| Contributions | $526,809 | ContributionsAmt |
| Investment Earnings Or Losses | $924,772 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $345,179 | OtherExpendituresAmt |
| End Year Balance | $11,410,548 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,591,510 | BeginningYearBalanceAmt |
| Contributions | $1,127,458 | ContributionsAmt |
| Investment Earnings Or Losses | $819,722 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $234,544 | OtherExpendituresAmt |
| End Year Balance | $10,304,146 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,314,205 | BeginningYearBalanceAmt |
| Contributions | $486,841 | ContributionsAmt |
| Investment Earnings Or Losses | $948,400 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,157,936 | OtherExpendituresAmt |
| End Year Balance | $8,591,510 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,031,251 | BeginningYearBalanceAmt |
| Contributions | $884,501 | ContributionsAmt |
| Investment Earnings Or Losses | $93,759 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,695,306 | OtherExpendituresAmt |
| End Year Balance | $8,314,205 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.73340 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.26660 | 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 | $964,622 | OtherCostOrOtherBasisAmt |
| Book Value | $964,622 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,541,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,748,042 | DepreciationAmt |
| Book Value | $16,793,338 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $975,844 | OtherCostOrOtherBasisAmt |
| Depreciation | $582,803 | DepreciationAmt |
| Book Value | $393,041 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,275,650 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,841,170 | DepreciationAmt |
| Book Value | $18,434,480 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,443,017 | OtherCostOrOtherBasisAmt |
| Book Value | $2,443,017 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $39,028,498 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Interest Rate Swap Agreements | $3,373,544 |
| Estimated Third-Party Settlements | $11,302,185 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,675,729 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $79,566,575 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $818,319 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $818,319 | RevenueNotReportedAmt |
| Revenue Subtotal | $78,748,256 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $171,106 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $847,561 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,018,667 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $79,766,923 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $79,749,062 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $79,749,062 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $171,106 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $387,608 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $558,714 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $80,307,776 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Temporarily restricted assets are available for health care services, including the purchase of equipment and providing health education and programs. The income and dividends on permanently restricted net assets are generally used to support health care services and for capital purchases of property and equipment. |
| Part X, Line 2: | The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Hospital's tax positions and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying financial statements. With few exceptions, the Hospital is no longer subject to tax examination by the U.S. federal or state tax authorities for years prior to 2012. |
| Part XI, Line 4b - Other Adjustments: | Fundraising Expenses 387,608. Decrease in fair value of interest rate swap agreement 459,953. |
| Part XII, Line 4b - Other Adjustments: | Fundraising Expenses 387,608. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | MCH Golf Classic | Event1Nm |
| Gross Receipts Event1 | $64,275 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $43,705 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $20,570 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $217 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $5,370 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,960 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $3,650 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $1,983 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $64,275 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $43,705 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $20,570 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $217 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $5,370 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,960 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,650 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,983 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $16,180 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $4,390 | NetIncomeSummaryAmt |
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 |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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 | $1,192,052 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,192,052 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,944,726 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,448,437 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,496,289 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05900 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,136,778 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,448,437 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,688,341 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07460 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $815,547 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $815,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,821 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,821 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $902,209 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $902,209 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01180 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $171,440 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $171,440 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,895,017 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,895,017 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,031,795 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,448,437 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,583,358 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09940 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,111,413 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $190,960 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $21,597,746 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $21,457,421 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $140,325 | 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 | Monadnock Community Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 02507 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Community 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 |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | 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 | see Part V, Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | see Part V, Section C | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 | see Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Monadnock Community Hospital | Part V, Section B, Line 5: Monadnock Community Hospital (MCH) used a multi-phased methodology to achieve the objectives of the assessment. The methodology included the following stages: establishing a leadership team to provide project guidance and insight regarding local health resources and perspectives of community needs; strategic secondary research; four qualitative discussion groups with healthcare consumers, service providers, and other community opinion leaders; needs prioritization process. Establishing a Leadership Team - The MCH Leadership Group was established early in the project process in order to develop communication channels with, and to learn about the insights of, a diverse set of community stakeholders. In order to generate the information, MCH incorporated input from persons who represent the broad interest of the community served by the hospital facility, including those with special knowledge of our expertise in public health. Group members were selected based upon their perceived community health vision, knowledge, and power to impact the well-being of the community. The steering committee also offered critical feedback on quantitative data, refined the list of community needs, helped develop the database of available resources, and participated in quantitative and qualitative research methods to build the prioritized list of community needs identified in the report. Qualitative Discussion Groups - MCH conducted five discussion groups with individuals from a breadth of community groups regarding their perception of healthcare service gaps. The groups included in-depth discussion about topics such as community strengths, service gaps, needs prioritization, and ways that MCH may be able to help address community needs. The information gleaned was used to help triangulate statistical data and qualitative information collected through the other research modalities. The discussion groups included the following community segments: leadership group members (executives from a diverse range of organizations that have direct contact with healthcare consumers and/or provide affiliated services), healthcare consumers (consumer sectors included the homeless, people from diverse age groups and economic strata, and individuals with varying degrees of chronic illness), and community opinion leaders (healthcare consumers living in the MCH service area and also providing community services such as faith-based networking and in-school nursing). |
| Monadnock Community Hospital | Part V, Section B, Line 11: Given the tremendous participation from community leaders during the CHNA, the IP Team included many of the same individuals and organizations. In addition to establishing a steering committee, IP approach included the following tasks: 1- Implementing a Leadership Survey to evaluate perceptions regarding the impact on the community, the timeframe in which results may be seen, and the MCH role for each of the 40 CHNA-identified needs; 2- Conducting work sessions with stakeholders and hospital leaders to analyze survey results and map the needs to be addressed by the hospital (in conjunction with other community organizations where possible); 3 - Creating the IP document that identifies the needs that are to be addressed (and how) and which ones are not to be addressed at this time (and why).A need was defined as a sevice gap or inadequately met health issue that could benefit from additional support from The Hospital or affiliated organizations. For this reason, while many of the top chronic disease states, while highly important community health issues, are not listed as needs. For these disease states and other, focused programs currently exist within the community.There were 40 community needs identified in the CHNA, and all 40 are important. Various community organizations are working to address each of the needs - many of which are being addressed in conjunction with MCH. The Hospital has identified five Implementation Focus Areas based on the following prioritization rationale: Potential for positive impact on the community; Ability to more fully utilize existing strengths and relationships; Ability to engage partner organizations; Desire to quickly impact target populations; and The need to efficiently use limited time and resources.The Hospital will not directly address all the needs identified in the CHNA at the time of this filing. The community needs not addressed in the Hospital's implementation plan scored lower on the prioritization rationale, were determined as not being in the purview of the Hospital, and/or are better addressed by other community organizations. The needs not included in the Hospital's implementation plan include: parenting classes, lower insurance rates, and dental health services for adults and seniors.Each Implementation Focus Area and the associated activities address several of the 40 needs identified in the CHNA. The Focus Areas are designed to:Increase access to care by improving communications between service provides and interagency awareness of services - Focus Area AImprove services for drug and alcohol prevention, early detection, and treatment - Focus Area BFoster school based initiatives to address youth-oriented health issues - Focus Area CImprove the patient awareness of, and access to, behavioral health services - Focus Area DEnhance home health capabilities - Focus Area EFor a detailed listing of associated activities for each Focus Area and a matrix outlining which needs are identified by each of the IP Focus Areas, please refer to the complete IP included with this filing or on the home page of our website http://www.monadnockcommunityhospital.com/index.php under Community Resources. |
| Monadnock Community Hospital | Part V, Section B, Line 16i: The complete financial assistance policy is available upon request and in the waiting rooms. Instructions on how to find out more about financial assistance are posted on the Hospital's website, on the back of all billing invoices, and published in a brochure that is available around the Hospital and in the admissions office.Monadnock Community Hospital has had a section on their website related to financial assistance since March 2010; however, this did not include our full Financial Assistance Policy and Plain Language Summary. However, the Hospital did have a financial assistance policy that was made available to patients in other ways, as noted above. In addition, while Monadnock Community Hospital did not have a formal plain language summary, we believe that we made a reasonable and good faith effort to provide such a document because the back of each patient statement is a plain language summary of our policy. At the time of this filing, Monadnock Community Hospital was in complete compliance with question 16a, 16c, and 16f including posting the full policy and plain language summary on the organization's website at: http://monadnockcommunityhospital.com/services/financial/FinancialAssistance1.php. This is consistent with the guidance that the final regulations under section 501(r) apply to a hospital facility's taxable years beginning after December 29, 2015. |
| Monadnock Community Hospital | Part V, Section B, Line 20e: Description from Credit and Collections Policy:The Hospital Patient Financial Services (PFS) Department shall develop and implement billing and collection procedures designed to maintain an adequate cash flow, keep accounts receivable at an acceptable level, and identify and write-off bad debts in a timely fashion. Monadnock Community Hospital contracts with an agency to process all self-pay accounts and self-pay after insurance balance statements/letters. I. Self-pay accounts and self-pay balances remaining after insurance adjudication shall be transferred to the agency on a weekly basis. The cycle for collections is three (3) statements and/or letters and two phone call series spaced approximately thirty (30) days apart. The statements shall include:a. Previous balance (unless this is the first statement).b. Activity since last statement (except those accounts that went to a $0.00 balance).c. Current balance due.d. Telephone number(s) for inquiries concerning the statement.e. Status or reminder message where appropriate.f. Availability for the use of a credit card for payment.g. Information regarding Financial Assistance and Medication Bridge Programs.h. Return envelope.II. In the event that statements or letters are returned by the postal service as undeliverable for reasons such as "moved, left no forwarding address," "forwarding order expired, or "no such address" the agency will indicate on the daily report "mail returned." PFS staff will review system for the correct address and will make corrections within the computer system and correspondence will be re-mailed. If no correct or current information can be obtained, the specific account(s) shall be flagged for referral to an outside collection agency equipped to handle this type of situation (see bad debt processing footnote).In addition, on a weekly basis, the FAP staff run system reports to identify emergency room visits classified as self-pay. Based on the information in these reports, the guarantor of each visit is sent a financial assistance application in the mail. Determination of eligibility is contingent upon receiving a completed application and required documentation from the patient and/or guarantor. |
| Schedule H, Part V, Section B, Line 7a & 10a: | The CHNA is available at the Hospital facility's website: http://www.monadnockcommunityhospital.com/pdf/community-matters/Community%20Assessment%20Report%20-%20Monadnock%20Community-Hospital-Final-Version-with-Guide.pdf Implementation Strategy:http://monadnockcommunityhospital.com/pdf/MonadnockCommunityHospitalImplementationPlan.pdf |
| Schedule H, Part V, Section B, Line 16b: | The Hospital's Financial Assistance Policy Application:http://monadnockcommunityhospital.com/pdf/financial/FAP-download-application-2013-04-29.pdf |
| Schedule H, Part V, Section B, Line 22b: | Monadnock Community Hospital has historically calculated the discount for Self-Pay patients consistent with New Hampshire RSA 151:12-b-1. Monadnock Community Hospital is currently assessing the Limitation on Charges Section 501(r)(5)including the complexity, financial impact and method that makes the most sense to calculate the hospitals Amounts Generally Billed (AGB). MCH intends to be fully compliant by October 1, 2016. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Monadnock Community Hospital Part V, Section B, line 16b website: | see Part V, Section C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 13 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Bond Wellness Center | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Fitness center and rehabilitation services |
| Monadnock Orthopaedic Associates | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
| Monadnock Regional Pediatrics | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Jaffrey Family MedicinePT Satellite | ||||
| 82 Peterborough Road | Jaffrey | NH | 03452 | Physician practice with PT services |
| Monadnock Internal Medicine | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Monadnock Family Care | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Monadnock Surgical Associates | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Rindge Family Practice | ||||
| 145 US Route 202 | Rindge | NH | 03461 | Physician practice |
| Monadnock Behavioral Health | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
| North Meadow | ||||
| 154 Hancock Road | Peterborough | NH | 03458 | Physician practice |
| New Ipswich Family Medicine | ||||
| 821 Turnpike Road | New Ipswich | NH | 03071 | Physician practice |
| Antrim Medical Group | ||||
| 12 Elm Street | Antrim | NH | 03440 | Physician practice |
| Neurology Center | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | N/A |
| Part I, Line 6a: | N/A |
| Part I, Line 7: | Charity care and means tested programs use the cost to charge ratio as their methodology. This Hospital calculates the ratio in a manner consistent with worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of cost to charges. |
| Part I, Line 7g: | Included in the subsidized health services activities reported for FY 2015 are unreimbursed costs of $424,605 attributed to an outpatient behavioral health practice and $410,850 related to emergency and trauma services. |
| 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 $ 4,049,279. |
| Part II, Community Building Activities: | See previous footnotes. |
| Part III, Line 2: | The amount reported on Part III, Line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, Line 25, Column (A) ($4,049,279). Accounts written off to bad debt include gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. The Hospital calculates the ratio in a manner consistent with Worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of costs to charges. |
| Part III, Line 3: | The estimated amount of charity care included in bad debt expense is based on the number of applications for charity care denied due to lack of complete documentation against the average charity care write off at cost per qualified patient. We believe the amount is minimal based on our extensive efforts to educate patients and staff about our various payment plans and financial grant programs to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances, a patient may be eligible for charity care, discounted care, payment programs, or a combination of the above. Due to these efforts, we believe that amounts written off to bad debt that could qualify as charity care is minimal. |
| Part III, Line 4: | See page 7 of the attached financial statements. |
| Part III, Line 8: | Medicare allowable costs for the Medicare cost report are reported in accordance with CMS guidelines using the cost to charge ratio methodology. |
| Part III, Line 9b: | As of 9/30/2011 Monadnock Community Hospital has a written credit and collection policy. Described within that policy are the collection practices and bad debt processes that are followed for patients who are known to qualify for charity care or financial assistance. The Organization maintains a Financial Assistance Program (FAP) database which is maintained by the Social Services Department of MCH. The Patient Financial Services (PFS) staff reference this database for approval status and eligibility amounts, identifying any account(s) where the discount will apply. Internal FAP insurance plans are applied to those accounts and related discount amounts are adjusted in the billing system. Remaining balances are expected to be paid in full by the patient. Payment plans may be requested by the patient and are established by the Financial Grant Coordinator based on the patient's available income and assets. Accounts are annotated to reflect payment arrangements. During bad debt processing, designated staff evaluate accounts listed as collection review for potential bad debt write off. This process includes an examination of account history for indication of FAP application. |
| Part VI, Line 2: | The State of NH, under RSA 7:32-f, requires every healthcare charitable trust, either alone or in conjunction with other healthcare charitable trusts in its community, to conduct a Community Health Needs Assessment to assist in determining the activities to be included in its community benefits plan. The needs assessment process includes consultation with members of the public, community organizations, service providers, and local government officials in the entity's service area to identify and prioritize the community needs that the health care entity can address directly or in collaboration with others. The Community Health Needs Assessment is updated at least every 5 years, most recently in 2015. In 2007, the Regional Community Benefits Steering Committee was first formed to prepare a single Community Benefits Needs Assessment for the Monadnock Region. The work group consisted of representatives from multiple organizations, including Monadnock Community Hospital. Based on the needs assessment and community engagement process, the priority needs and health concerns of the community MCH serves include access to care - driven by financial barriers and/or availability of primary care, availability of behavioral health care, general socioeconomic issues, and transportation services. Monadnock Community Hospital used this information to help focus its community benefit efforts to meet the priority needs identified in the community benefit plan. In addition, other needs or services not specifically identified in the community needs assessment, but addressed under the Organization's community benefit plan include availability of dental or oral health care (via the Organization's Monadnock Healthy Teeth to Toes program which focuses on dental hygiene and care, nutrition, and daily physical activity for children ages kindergarten to third grade) and availability of prescription medication (via the Organization's Medication Bridge program designed to help eligible patients apply for assistance programs that provide free or discounted prescription medications). |
| Part VI, Line 3: | MCH is committed to providing quality healthcare to anyone in need of services, regardless of ability to pay. We understand patients may not have the finances to pay for their healthcare services and medications, and do not want this to prevent anyone from receiving necessary treatment. As part of the Hospital's mission to the communities we serve, we have developed programs to help meet the needs of our patients who meet income eligibility. Through our Financial Assistance and Medication Bridge Programs, we have been providing financial assistance to those qualifying for many years. We reach out to our patients in many different ways to ensure they are aware that help is available and to guide them through the process. Brochures and signage are posted in high traffic areas and all employees of MCH are informed about the Financial Assistance Program during orientation. When a patient goes through the registration process at the Hospital the staff are trained to inform uninsured or underinsured patients about the Monadnock Community Hospital Financial Assistance and the New Hampshire Health Access programs and that there is assistance available within the Hospital to help with the application process. In addition, any time a patient calls customer service, the representative is trained to help identify and offer support to patients who may require financial assistance. Patients may qualify for free care, discounted care, payment plans or a combination of the above. Assistance is also provided in applying to federal and state programs for those who qualify. |
| Part VI, Line 4: | The Hospital's primary service area consists of 13 towns, including Antrim, Bennington, Dublin, Francestown, Greenfield, Greenville, Hancock, Jaffrey, New Ipswich, Peterborough, Rindge, Sharon, and Temple. The Hospital serves the general population of the primary service area referenced above. |
| Part VI, Line 5: | Monadnock Community Hospital is a critical access hospital located in the Monadnock Region of NH. Our mission is to improve the health and well-being of our community. The Hospital is served by a board of trustees consisting of local citizens active in their community and its organizations. The majority of the board is not employed by the Hospital and consists of local community and business representatives as well as medical staff. The Hospital is committed to giving back to the community to the greatest extent possible. Monadnock Community Hospital supports thousands of individuals and families with free or reduced-fee services and programs. Our Financial Assistance Program administered by the Social Services Department helps families and individuals in need with access to health care and other available community services such as catastrophic care, fuel assistance, meals on wheels, food banks, and visiting nurses. Other examples of the Hospital's effort to reach our patients beyond traditional hospital services include access to free or reduced cost medications through our Medication Bridge program; educating children on the importance of good oral hygiene, eating health, and daily physical activity through our Monadnock Healthy Teeth to Toes program; training for community agencies such as local volunteer fire and rescue personnel; prevention and wellness education including nutrition, smoking cessation and dealing with stress; providing regular community seminars regarding timely health topics; and screenings for important health issues such as breast cancer. These are just a few of the many areas where we are reaching out to others to assure they are cared for well. |
| Part VI, Line 6: | N/A |
| 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
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Town of Peterborough | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Grove Street | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | Governmental | IRCSectionDesc |
| Cash Grant | $15,000 | CashGrantAmt |
| Purpose Of Grant | Cash contribution for the benefit of the Peterborough Ambulance. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships awarded in order to provide financial support to MCH employees who would like to further their careers in health care through educational advancement. | GrantTypeTxt |
| Recipient | 4 | RecipientCnt |
| Cash Grant | $6,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | During the tax year ending September 30, 2015, the Hospital made contributions to a governmental entity, the Town of Peterborough, additional monitoring is not deemed necessary with respect to this grant. Additionally, during the fiscal year, the Hospital established the Peter L. Gosline Employee Education Scholarship to support professional growth of Hospital employees. Both full and part-time employees are eligible to submit an application. The applicant must be a current Hospital employee in good standing who has been employed at MCH for at least 12 months. The applicant must also be currently enrolled in a degree or certificate program, provide a letter of recommendation from their current Hospital manager, as well provide a copy of their current college transcript. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Richard Frechette MD | ||||||||||||||
| Ex-Officio w/voting rights | $215,958 | $0 | $0 | $0 | $1,805 | $0 | $4,832 | $0 | $29,217 | $0 | $251,812 | $0 | $0 | $0 |
| Gregory Kriebel MD | ||||||||||||||
| Ex-Officio w/voting rights | $224,023 | $0 | $0 | $0 | $780 | $0 | $5,173 | $0 | $22,667 | $0 | $252,643 | $0 | $0 | $0 |
| Terrence McNamara DO | ||||||||||||||
| Ex-Officio w/voting rights | $402,490 | $0 | $87,617 | $0 | $14,638 | $0 | $5,980 | $0 | $23,147 | $0 | $533,872 | $0 | $0 | $0 |
| Cynthia McGuire | ||||||||||||||
| Chief Executive Officer | $203,993 | $0 | $0 | $0 | $11,783 | $0 | $0 | $0 | $14,011 | $0 | $229,787 | $0 | $0 | $0 |
| Richard D Scheinblum | ||||||||||||||
| VP Finance/CFO | $170,476 | $0 | $0 | $0 | $300 | $0 | $3,988 | $0 | $9,328 | $0 | $184,092 | $0 | $0 | $0 |
| Philip Vuocolo MD | ||||||||||||||
| Physician | $392,425 | $0 | $0 | $0 | $1,806 | $0 | $5,980 | $0 | $27,926 | $0 | $428,137 | $0 | $0 | $0 |
| Ronald Michalak MD | ||||||||||||||
| Physician | $474,640 | $0 | $0 | $0 | $630 | $0 | $5,980 | $0 | $22,147 | $0 | $503,397 | $0 | $0 | $0 |
| Douglas Weiss MD | ||||||||||||||
| Physician | $462,052 | $0 | $0 | $0 | $12,658 | $0 | $2,601 | $0 | $9,688 | $0 | $486,999 | $0 | $0 | $0 |
| Shawn Harrington MD | ||||||||||||||
| Physician | $385,866 | $0 | $2,093 | $0 | $630 | $0 | $5,980 | $0 | $22,856 | $0 | $417,425 | $0 | $0 | $0 |
| Robert C Knowles MD FACS | ||||||||||||||
| Physician | $393,905 | $0 | $0 | $0 | $15,083 | $0 | $619 | $0 | $22,147 | $0 | $431,754 | $0 | $0 | $0 |
| Peter L Gosline | ||||||||||||||
| Former Chief Executive Officer | $79,224 | $0 | $0 | $0 | $191,936 | $0 | $1,980 | $0 | $16,629 | $0 | $289,769 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Cynthia McGuire, President & CEO, received a housing allowance totaling $10,800 during the first six months of the 2014 calendar year to help her transition to her new role and the area. The allowance was part of an accountable plan pursuant to a written employment contract that was approved by the board. As part of the terms of the agreement, Ms. McGuire was required to submit copies of rent checks to receive reimbursement. The total housing allowance payments she received were reported as part of taxable wages in her W-2 and are included in Schedule J, Part II, Column B(iii). |
| Part I, Lines 4a-b | Peter L. Gosline served as Chief Executive Officer of the Hospital until April 2014. In the fiscal year covered by this filing, Mr. Gosline received severance payments totaling $86,084. Mr. Gosline received severance through mid-April, 2015. Cynthia McGuire, President & CEO, participates in a 457(f) plan with Monadnock Community Hospital. After a three-year vesting period which began in 2014, there will be a 457(f) amount included in W-2 wages for Ms. McGuire reported on Schedule J, Part II, Column B(iii). This amount will be comprised of interest and deferred compensation that was included in Schedule J, Part II, Column C. On May 19, 2015 $17,500 was deposited into Ms. McGuire's 457(f) plan account for calendar 2014 which will be reported on the Hospital's 9/30/16 Form 990, Schedule J, Part II, Column C. The 457(f) amount that will be included in W-2 wages after the three-year vesting period properly accounts for the elimination of substantial risk of forfeiture. |
| Part I, Line 7 | MCH compensates physicians utilizing productivity targets based on RVU (relative value units). In addition, the Compensation Committee recommends to the full board, annually, the variable pay award that may be issued to the Hospital's CEO. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the Organization. |
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 | NHBFA Revenue Bonds Series 2013 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 021304598 | BondIssuerEIN |
| Bond Issued | 2013-01-01 | BondIssuedDt |
| Issue Price | $27,240,000 | IssuePriceAmt |
| Purpose | refinance existing Series 2007 and 2009 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 |
| Total Proceeds | $27,240,000 | TotalProceedsAmt |
| Refunding Escrow | $27,057,466 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $182,534 | IssuanceCostsFromProceedsAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | Yes (1) | 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 | 0 | 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 | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | 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 | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule K, Part III, Line 9, Part IV, line 7 and Part V: | FormAndLineReferenceDesc |
| Explanation | Although formal policies are not in place in regards to the remediation of our bond, the monitoring requirements of section 148, and procedures to ensure that violations are timely identified and corrected, Mondanock Community Hospital has compliance checks in place that substantiate these requirements. Below is a list of all compliance checks that Monadnock Community Hospital has in place to monitor the 2013 Bond Issue: 1. Covenant calculations performed monthly as part of the Financial Scorecard preparation which is reviewed by the MCH Board of Trustees 2. Covenant calculations are performed for each quarter and reported to the bond issuer, TD Bank 3. Covenant certificate is signed each quarter by the CFO and reported to the bond issuer, TD Bank 4. Financial statements and statistical reports are sent to the bond issuer, TD Bank, on a quarterly basis 5. Annual Operating and Capital budgets are reported to the bond issuer, TD Bank 6. A No Event of Default certificate is signed by the CFO annually and reported to the bond issuer, TD Bank 6. Annual Audited Financial statements are reported to the bond issuer, TD Bank Each of these items that are reported to TD Bank has a specific deadline for completion as outlined in the bond documents. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| Terrence McNamara DO | |||||||
| Trustee | Assistance to repay student loans | Yes (X) | $60,000 | $24,693 | 0 | Yes (1) | Yes (1) |
| Douglas Weiss MD | |||||||
| Highest Compensated EE | Assistance to repay student loans | Yes (X) | $50,000 | $30,975 | 0 | Yes (1) | Yes (1) |
| Robert C Knowles MD FACS | |||||||
| Highest Compensated EE | Malpractice Tail Coverage | Yes (X) | $60,000 | $37,170 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $92,838 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter L Forssell MD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Board Member | RelationshipDescriptionTxt |
| Transaction | $20,040 | TransactionAmt |
| Transaction | The Hospital rents a medical office space from Dr. Forssell. Though the transaction amount is below the threshold for disclosure, the Hospital is reporting it on Schedule L, Part IV for transparency purposes. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part II: | FormAndLineReferenceDesc |
| Explanation | The Hospital has entered into loan agreements with several physician employees. Three physicians listed in Form 990, Part VII have been involved in the loan program, though the Hospital has loans with other physician employees as well. In all instances, the loans were a part of a written policy that was pursuant to a written contract and approved by the board. The board also reviews on an annual basis the status of all physician loans not more than 180 days after the fiscal year end. Each loan will accrue interest at a rate of prime plus 1% or 2%. The loans will be forgiven over the terms of the notes. The amount of loan forgiveness, along with imputed interest, will be included in the recipients' W-2 or 1099 as taxable compensation in the year forgiven. The details of the loan forgiveness which is reported on Schedule J, Part II, Column B(iii) for the respective recipients as follows:Dr. McNamara - $13,560 (inclusive of $1,560 of interest)Dr. Weiss - $11,734 (inclusive of $1,734 of interest)Dr. Knowles - $14,080 (inclusive of $2,080 of interest) | ExplanationTxt |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 7 | ContributionCnt |
| Noncash Contributions Rpt F990 | $123,299 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (1) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 32b: | FormAndLineReferenceDesc |
| Explanation | The Hospital uses its third party investment broker to sell gifts of publicly traded securities. Donations of such securities are sold as soon as administratively possible. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | The Hospital's Form 990 is prepared with assistance by an independent public accounting firm. A draft of the Form 990 is initially reviewed in detail by key finance employees. Thereafter, the final draft is made available to the full board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | On an annual basis, the Organization provides all administrators/directors/managers, Board Members, and medical staff members with the conflict of interest policy. Said individuals are required to complete a new conflict of interest disclosure on an annual basis. Any conflicts of interest noted are reviewed by the Chair of the Board, in conjunction with the Corporate Compliance Officer. If the conflict of interest appears to meet the policy definitions requiring full Board review, the President of the Board takes this to the full Board meeting, and it is discussed, and appropriate action is taken (in compliance with state and federal requirements). The conflict of interest statement requires signatories to inform the Hospital of any conflict of interest that occurs at any time throughout the year. If a conflict of interest arises during the year, it is reviewed by the Compliance Officer, and if necessary, is taken to the Board President/Board. The Compliance Officer confers with legal counsel with regard to conflicts of interest, if there is any question regarding the potential conflict. |
| Form 990, Part VI, Section B, line 15 | The Organization has a written executive compensation policy and procedure. Under this policy, the Compensation Committee, comprised of delegated representatives of the Board of Trustees, has the power and responsibility to determine the Hospital's approach to executive compensation and review the performance of the CEO. The Compensation Committee has the responsibility to set, monitor and review the base salary of the CEO. The Committee maintains minutes of sessions and final recommendations and determinations in accordance with the Board of Trustee guidelines. Annually, market data is reviewed by the Committee to determine the appropriate salary for the Hospital's CEO based upon identified standards. At the end of the time period, the Committee reviews to what extent stated goals were met and recommends an amount for the variable pay award to be approved by the full board. |
| Form 990, Part VI, Section C, line 19 | Monadnock Community Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of pecuniary benefit transactions that have occurred between MCH and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-A, II(D). Current copies of the bylaws, conflict of interest Policy and Form 990 are on file with the Charitable Trust Unit. The Hospital also makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Form 990, Part VII, Section A, Column D: Director Compensation | The 2014 compensation reported for Dr. Kriebel, Dr. Frechette, and Dr. McNamara was paid by Monadnock Community Hospital for their services as physicians. No part of their compensation was remuneration for their services as an ex-officio voting members of MCH's Board of Trustees. |
| Form 990, Part VII, Section A, Column C: Officer Positions | Peter L. Gosline is being listed as a former officer in Part VII of Form 990. Mr. Gosline served as the Hospital's CEO until February of 2014 and in an advisory capacity through April and received reportable compensation and benefits for those services during 2014. In accordance with IRS instructions, he is being listed as a former officer as he did not serve at any point during the current fiscal year as an officer of the Hospital but did recieve reportable compensation during the calendar year 2014. |
| Form 990, Part XI, line 9: | Change in fair value of interest rate swap agreements -459,953. |
| Form 990, Part XI, Line 2c: Audit Review Process | The Audit Committee oversees the audit process for Monadnock Hospital. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for the fiscal years ended 9/30/14 and 9/30/15. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Health Services - INACTIVE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1Txt |
| City | Peterborough | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03458 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020420789 | EIN |
| Primary Activities | Inactive | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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