FMH Wind-Down Company: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FMH Wind-Down Company (EIN 02-0222131)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-08
- IRS object ID
- 201422209349300432
- Schema version
- 2012v2.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-08T09:35:36-07:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222131 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRISBIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FRIS | NameControl |
| Phone | 6033325211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WHITEHALL RD | AddressLine1 |
| City | ROCHESTER | City |
| State | NH | State |
| ZIP Code | 03867 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN A MARZINZIK | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 6033325211 | Phone |
| Date Signed | 2014-07-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN A MARZINZIK | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WHITEHALL RD | AddressLine1 |
| City | ROCHESTER | City |
| State | NH | State |
| ZIP Code | 03867 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 147324082 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.frisbiehosiptal.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1941 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | To excel at caring for the community by providing safe, effective, equitable, timely healthcare services. We will ally ourselves with other community healcare providers to enhance our mutual ability to improve the health of our community and the quality of life for the people we serve. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1103 | TotalNbrEmployees |
| Total Nbr Volunteers | 226 | TotalNbrVolunteers |
| Total Gross UBI | 8400 | TotalGrossUBI |
| Contributions Grants Prior Year | 186422 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 128941 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 119509000 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 122362506 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1093576 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2979278 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1744208 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 122533206 | TotalRevenuePriorYear |
| Total Revenue Current Year | 125470725 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 67689648 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 66243193 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 121725 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 58076799 | OtherExpensePriorYear |
| Other Expenses Current Year | 57291623 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 125766447 | TotalExpensesPriorYear |
| Total Expenses Current Year | 123534816 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3233241 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1935909 | RevenuesLessExpensesCY |
| Total Assets BOY | 126806905 | TotalAssetsBOY |
| Total Assets EOY | 127347179 | TotalAssetsEOY |
| Total Liabilities BOY | 45436535 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 42138909 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 81370370 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 85208270 | NetAssetsOrFundBalancesEOY |
| Mission Description | To excel at caring for the community by providing safe, effective, equitable,and | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 106079162 | Expense |
| Revenue | 122362506 | Revenue |
| Description | FRISBIE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT COMMUNITY HOSPITAL THAT CONTINUOSLY EVALUATES AND ADDRESSES THE COMPREHENSIVE HEALTHCARE NEEDS OF ROCHESTER, NH AND THE SURROUNDING COMMUNITIES. IN RESPONSE TO THESE HEALTHCARE NEEDS, THE HOSPITAL COORDINATES, DEVELOPS, AND PROVIDES HIGH QUALITY, AFFORADABLE, PREVENTATIVE, EDUACTIONAL, ACUTE AND CHRONIC CARE SERVICES. IN FY2013 27,837 PATIENTS WERE TREATED IN OUR EMERGENCY DEPARTMENT, 5,660 AMBULANCE CALLS WERE MADE, 3,721 INPATIENTS WERE CARED FOR, AND SURGERY PERFORMED ON 12,707 PATIENTS. 391 NEWBORNS WERE WELCOMED INTO THE WORLD,47,669 RADIOLOGY PROCEDURES/TESTS PROVIDED, GAVE 64,972 REHABILITATIVE TREATMENTS, PERFORMED 424,163 LABORATORY TESTS AND TREATED 5,407 ONCOLOGY PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7270609 | Expense |
| Description | FRISBIE MEMORIAL HOSPITAL PROVIDED UNCOMPENSATED CARE FOR THOSE IN NEED. FRISBIE RANKS AMOUNG THE TOP IN NEW HAMPSHIRE FOR THE MONEY VALUE OF CHARITY CARE PROVIDED TO PATIENTS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 604277 | Expense |
| Description | FRISBIE MEMORIAL HOSPITAL PRESENTED OR SPONSORED NUMEROUS COMMUNITY PROGRAMS WHICH ASSISTED WITH THE SPECIAL NEEDS OF OUR MOST VULNERABLE AT RISK POPULATION GROUPS. THESE PROGRAMS IMPROVED EDUCATION AND HEALTH AWARENESS IN THE COMMUNITY AND PROVIDED GREATER ACCESS TO HEALTH SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 113954048 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 51 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1103 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOHN A MARZINZIK | NamePerson |
| Telephone Number | 6033325211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WHITEHALL RD | AddressLine1 |
| City | ROCHESTER | City |
| State | NH | State |
| ZIP Code | 03867 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| GREGORY SMITH | ||||||||
| President | 3.00 | X | X | 0 | 0 | 0 | ||
| RONALD POULIN | ||||||||
| Vice Chair | 3.00 | X | X | 0 | 0 | 0 | ||
| PETER GOWELL | ||||||||
| Treasurer | 3.00 | X | X | 0 | 0 | 0 | ||
| BRIAN HUGHES | ||||||||
| Secretary | 3.00 | X | X | 0 | 0 | 0 | ||
| ALVIN FELGAR | ||||||||
| CEO | 40.00 | X | 492096 | 0 | 109107 | |||
| JOHN MARZINZIK | ||||||||
| SVP Finance/CFO | 40.00 | X | 251992 | 0 | 54505 | |||
| JOSEPH BERE | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| JOHN BRITTON MD | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| ROBERT HARRIGAN MD | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| MARK HOURIHANE | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| DAVID KEEFE | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| JOSEPH MORONE | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| JEANETTE POULIN | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| STEVEN POGGI | ||||||||
| Trustee | 2.00 | X | 0 | 0 | 0 | |||
| MICHAEL RIGALLE | ||||||||
| Trustee | 2 | X | ||||||
| ROBERT STEELE | ||||||||
| Trustee | 2 | X | ||||||
| CAROL THEMELIS | ||||||||
| VP Human Resources | 40 | 578355 | 54695 | X | ||||
| PAULA MAHONEY | ||||||||
| VP Physician Practices | 40 | 170277 | 46397 | X | ||||
| MICHAEL METZGER | ||||||||
| MD | 40 | 394246 | 16492 | X | ||||
| JAY BURNS | ||||||||
| MD | 40 | 390342 | 7286 | X | ||||
| SACHIN SAKSENA | ||||||||
| MD | 40 | 388512 | 9035 | X | ||||
| MATHURIN MALBY | ||||||||
| MD | 40 | 371927 | 30702 | X | ||||
| TRICIA MENDOZA | ||||||||
| MD | 40 | 371717 | 15038 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3409464 | TotalReportableCompFromOrg |
| Total Other Compensation | 343257 | TotalOtherCompensation |
| Number Individuals GT100 K | 94 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CROTHALL FACILITIES MGMT | |||||
| 13028 COLLECTIONS CTR | CHICAGO | IL | 60693 | Facilities Management | 3166457 |
| SURGICAL ASSOCIATES | |||||
| 21 WHITEHALL RD | ROCHESTER | NH | 03867 | Physician Practice | 1605202 |
| UNIDINE CORP | |||||
| 1000 WASHINGTON ST | BOSTON | MA | 03867 | Dietary Services | 1678901 |
| LABCORP OF AMERICA | |||||
| PO BOX 470 | PORTSMOUTH | NH | 03802 | LAboratory Services | 610600 |
| ALLIANCE HEALTHCARE | |||||
| PO BOX 96485 | CHICAGO | IL | 60693 | MRI/PET Imaging | 877985 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 22 | NumberOfContractorsGT100K |
| Fundraising Events | 24918 | FundraisingEvents |
| All Other Contributions | 104023 | AllOtherContributions |
| Total Contributions | 128941 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|
| Net Patient Service Revenue | 622110 | 118220089 | |
| Other Operating Revenue | 900099 | 2028358 | 8400 |
| Net Assets Released from Restriction | 900099 | 241213 | |
| Meaningful Use | 900099 | 1872846 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 122362506 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 593769 | TotalRevenueColumn |
| Exclusion | $593,769 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 24238866 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 21853357 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2385509 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2385509 | TotalRevenueColumn |
| Exclusion | $2,385,509 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 24918 | CntrbtnsRprtdFundraisingEvents |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 125470725 | TotalRevenueColumn |
| Related Or Exempt Function Income | 122354106 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 8400 | UnrelatedBusinessRevenue |
| Exclusion | $2,979,278 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1157881 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 1157881 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51498890 | Total |
| Program Services | 50186469 | ProgramServices |
| Management And General | 1227242 | ManagementAndGeneral |
| Fundraising | 85179 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1375529 | Total |
| Program Services | 1336152 | ProgramServices |
| Management And General | 36822 | ManagementAndGeneral |
| Fundraising | 2555 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8716700 | Total |
| Program Services | 8506712 | ProgramServices |
| Management And General | 196359 | ManagementAndGeneral |
| Fundraising | 13629 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3494193 | Total |
| Program Services | 3393921 | ProgramServices |
| Management And General | 93884 | ManagementAndGeneral |
| Fundraising | 6388 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152837 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 152837 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72150 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 72150 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12544 | Total |
| Program Services | 12544 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14653403 | Total |
| Program Services | 12706255 | ProgramServices |
| Management And General | 1944368 | ManagementAndGeneral |
| Fundraising | 2780 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 466058 | Total |
| Program Services | 25802 | ProgramServices |
| Management And General | 440256 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1114249 | Total |
| Program Services | 466414 | ProgramServices |
| Management And General | 642346 | ManagementAndGeneral |
| Fundraising | 5489 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4780034 | Total |
| Program Services | 4417635 | ProgramServices |
| Management And General | 362399 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14938 | Total |
| Program Services | 8345 | ProgramServices |
| Management And General | 5896 | ManagementAndGeneral |
| Fundraising | 697 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 231075 | Total |
| Program Services | 202892 | ProgramServices |
| Management And General | 27845 | ManagementAndGeneral |
| Fundraising | 338 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1384403 | Total |
| Program Services | 1384403 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5885121 | Total |
| Program Services | 5885121 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1894675 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 1894675 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Repair & Maintenance | 2330638 | 1453365 | 877273 | 0 |
| Supplies | 17622595 | 17428178 | 190072 | 4345 |
| Equip Maint/Dues&Subs | 997724 | 860661 | 136738 | 325 |
| Medicaid Enhancement Tax | 5613736 | 5613736 | 0 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65443 | Total |
| Program Services | 65443 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123534816 | Total |
| Program Services | 113954048 | ProgramServices |
| Management And General | 9459043 | ManagementAndGeneral |
| Fundraising | 121725 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7756793 | BOY |
| EOY | 6664662 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 631696 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13907619 | BOY |
| EOY | 14634090 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2805317 | BOY |
| EOY | 2895987 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1273010 | BOY |
| EOY | 2430783 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 133786689 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 71693861 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64754966 | BOY |
| EOY | 62092828 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28561169 | BOY |
| EOY | 31102443 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1131612 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6616419 | BOY |
| EOY | 6894690 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126806905 | BOY |
| EOY | 127347179 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13466897 | BOY |
| EOY | 14883056 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24995192 | BOY |
| EOY | 22813896 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6974446 | BOY |
| EOY | 4441957 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45436535 | BOY |
| EOY | 42138909 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79573728 | BOY |
| EOY | 83342468 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73950 | BOY |
| EOY | 65110 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1722692 | BOY |
| EOY | 1800692 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81370370 | BOY |
| EOY | 85208270 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126806905 | BOY |
| EOY | 127347179 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1935909 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1901991 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Public Support Total170 | 0 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Pertcentage170 | 0 | PublicSupportPertcentage170 |
| Public Support Total509 | 0 | PublicSupportTotal509 |
| Public Support Percentage509 | 0 | PublicSupportPercentage509 |
| Investment Income Percentage | 0 | InvestmentIncomePercentage |
Schedule C IRS990ScheduleC
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Pt II-B Line 1i | Identifier |
| Explanation | Lobbying portion of hospital association dues | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 28491800 | BeginningOfYearBalance |
| Contributions | 78472 | Contributions |
| Investment Earnings Or Losses | 2898384 | InvestmentEarningsOrLosses |
| Other Expenditures | 241213 | OtherExpenditures |
| End Of Year Balance | 31227443 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 24732265 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 3759535 | InvestmentEarningsOrLosses |
| End Of Year Balance | 28491800 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 25552520 | BeginningOfYearBalance |
| Contributions | 59916 | Contributions |
| Investment Earnings Or Losses | -816743 | InvestmentEarningsOrLosses |
| Other Expenditures | 63428 | OtherExpenditures |
| End Of Year Balance | 24732265 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 23618029 | BeginningOfYearBalance |
| Contributions | 13042 | Contributions |
| Investment Earnings Or Losses | 2021449 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 100000 | GrantsOrScholarships |
| End Of Year Balance | 25552520 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 27248420 | BeginningOfYearBalance |
| Contributions | 24976 | Contributions |
| Investment Earnings Or Losses | 197883 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 100000 | GrantsOrScholarships |
| Other Expenditures | 3753250 | OtherExpenditures |
| End Of Year Balance | 23618029 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | true | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 181776 | OtherCostOrOtherBasis |
| Book Value | 181776 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 73621024 | OtherCostOrOtherBasis |
| Depreciation | 25914520 | Depreciation |
| Book Value | 47706504 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3201124 | OtherCostOrOtherBasis |
| Depreciation | 1800107 | Depreciation |
| Book Value | 1401017 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 41331199 | OtherCostOrOtherBasis |
| Depreciation | 30803843 | Depreciation |
| Book Value | 10527356 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15451566 | OtherCostOrOtherBasis |
| Depreciation | 13175391 | Depreciation |
| Book Value | 2276175 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 62092828 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Assets | 2177986 |
| Deferred Finance Costs | 216108 |
| Investment in Affiliates | 2482205 |
| Collateralization of Interest Rate Swap | 2018391 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 6894690 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Interest Rate Swap | Description |
| Amount | $4,441,957 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4441957 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Pt V Line 4 | Identifier |
| Explanation | To further the hospital's charitable mission | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7270609 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7270609 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05890 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17269062 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4539843 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 12729219 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10300 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 24539671 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4539843 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 19999828 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16190 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 604277 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 604277 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00490 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 200000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 200000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1517838 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 998974 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 518864 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 85000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 85000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2407115 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 998974 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1408141 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01140 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26946786 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5538817 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 21407969 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.17330 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $5,935,856 | BadDebtExpenseAmount |
| Amount Attributable To | 593586 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 26053009 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 35689779 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -9636770 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRISBIE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WHITEHALL RD | AddressLine1 |
| City | ROCHESTER | City |
| State | NH | State |
| ZIP Code | 03867 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | Geropsychiatric Unit | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRISBIE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200 | FPGFreePercent |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt I Line 3c | Organization uses 200% FPG to determine eligibility |
| Pt I Line 6a | A community benefit report is prepared yearly and is available on the organization public website |
| Pt III Line 2 | The Medicare cost report ratio of cost to charge is used to determine cost of bad debt expense |
| Pt III Line 9b | Collection policy provides for accounts known to qualify for free care |
| Pt III Line 9b | be removed from transfer to an outside agency for further collection activity |
| Pt III Line 4 | Financial Statement footnote: Patient Accounts Receivable are stated at the amount |
| Pt III Line 4 | expects to collect from outatanding balances. Management provides for probable |
| Pt III Line 4 | uncollectable amounts through a charge to operations and a credit to a valuation |
| Pt III Line 4 | allowance based on its assessment of individual accounts and historical adjustments. |
| Pt III Line 8 | Medicare shortfall is reported on the annual Community Benefit Report |
| Pt III Line 8 | to the state of New Hampshire under "unreimbursed costs" government sponsored healthcare. |
| Pt VI Line 2 | Frisbie Memorial Hospital conducts a Community Needs Assessment every five years, the most recent completed in 2013. |
| Pt VI Line 2 | FMH worked with Health Strategies Plus to bring together healthcare and |
| Pt VI Line 2 | and public service stakeholders, collecting quantitative and qualitative data. |
| Pt VI Line 4 | FMH's PSA is urban consisting of northern Stafford, NH and western York, ME counties. |
| Pt VI Line 4 | Population served is over 70,000 with a medium income of $47,626 and 4.7% of community |
| Pt VI Line 4 | residents living below the federal poverty guidelines. |
| Pt V Sec B 21 | The maximum amount charged to FAP-eligible individuals is gross charge less 15% |
| Pt VI Line 7 | NH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|---|---|---|
| ALVIN FELGAR | ||||||
| 372446 | 25000 | 94650 | 89505 | 19602 | 601203 | 89355 |
| JOHN MARZINZIK | ||||||
| 235742 | 16250 | 27332 | 27173 | 306497 | 34004 | |
| CAROL THEMELIS | ||||||
| 173616 | 7500 | 397239 | 39081 | 15614 | 633050 | 43914 |
| PAULA MAHONEY | ||||||
| 162777 | 7500 | 21984 | 24413 | 216674 | 26179 | |
| MICHAEL METZGER | ||||||
| 393946 | 300 | 16492 | 410738 | |||
| JAY BURNS | ||||||
| 235762 | 154580 | 7286 | 397628 | |||
| SACHIN SAKSENA | ||||||
| 388212 | 300 | 9035 | 397547 | |||
| MATHURIN MALBY | ||||||
| 214746 | 157181 | 30702 | 402629 | |||
| TRICIA MENDOZA | ||||||
| 167546 | 204171 | 15038 | 386755 | |||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Pt I Line 4b | Identifier |
| Explanation | The hospital has a 457(f) deffered compensation plan which covers highly compensated employees. The organization incurred liabilities relating to salary continuation agreements with highly compensated employees. Under the terms of the agreements they are entitled to receive a lump sum of their account balance, including earnings, within 30 days after the employee's date certain, which is elected by the employee. Alvin Felgar and Carol Themelis received lump sums distributions in the amounts of 94,650 and 397,239 respectively in calendar year 2012. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| NHHEFA | ||||||||
| A | 020279866 | 644614KT5 | 2005-03-04 | 10650000 | Refunding Series 2003 Bonda | false | false | false |
| NHHEFA | ||||||||
| B | 020279866 | 644614QD4 | 2006-07-27 | 25000000 | Building Construction | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceeds | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Capital ExpendituresCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|---|
| A | 10650000 | 10385167 | 270950 | 2005 | true | false | true | true | |
| B | 25000000 | 386805 | 2008 | true | false | true | true | 24613195 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|
| A | false | false | false | false | true | true |
| B | false | false | false | false | true | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Regulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied | Gross Proceeds InvestedGrossProceedsInvested |
|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false |
| B | false | false | false | false | false | false |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JOHN BRITTON MD | |||
| Trustee | 1897738 | Subsidy | false |
| JOHN BRITTON MD | |||
| Trustee | -1427087 | Transfer of AR | true |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (20 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt VI, Line 11b | The final form 990 is reviewed by each member of the board audit/finance committee and CFO. |
| The form 990 is made available to the board of directors prior to filing. | |
| Pt VI, Line 12c | In accordance with the writted conflict of interest policy the office of the President |
| annually secures a signed copy of the Trustee/Officer Conflict of interest statement and maintains on file. | |
| Pt VI, Line 15a | Each year the executive compensation committee comprised of four members of the FMH Board |
| reviews the hospital CEO performance and compensation. | |
| The VP of Human Resources presents the compensation committee with | |
| comparative salary and benefit data. | |
| Pt VI, Line 19 | The Hospital will provide its governing documents, financial statements, |
| and conflict of interest policy upon written request based on the | |
| intent and purpose of the request | |
| Pt VI, Line 2 | Trustees Ronald Poulin and Jeanette Poulin are husband and wife. |
| Pt VI, Line 15b | Senior manangement compensation is also reviewed by |
| the committee, but compensation is determined by the CEO. | |
| Pt IX Line 24d | The New Hampshire Medicaid Enhancement (MET) tax is a 5.5% tax on net patient |
| Pt IX Line 24d | service revenue paid by hospitals to the State of New Hampshire. Unlike previous years where the |
| Pt IX Line 24d | State provided hospitals with uncompensated care payments towards the cost of care |
| Pt IX Line 24d | of patients without insurance from matching federal funds, uncompensated care payments |
| Pt IX Line 24d | were reduced or eliminated to hospitals. The impact to Frisbie Memorial Hospital |
| Pt IX Line 24d | in 2012 was payment of MET in the amount of $5,613,736. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRISBIE FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 WHITEHALL RD | AddressLine1 |
| City | ROCHESTER | City |
| State | NH | State |
| ZIP Code | 03867 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020465942 | EIN |
| Primary Activities | Coordinate Funds raised for hospital | PrimaryActivities |
| Legal Domicile State | NH | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 11 | PublicCharityStatus |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| FRISBIE FOUNDATION | ||
| j | 2642172 | FMV |
| FRISBIE FOUNDATION | ||
| p | 131220 | FMV |
Comments