SPEARE MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SPEARE MEMORIAL HOSPITAL (EIN 02-0226774)
Tax period
2012-07-01 to 2013-06-30
Filed
2013-11-14
IRS object ID
201313189349304051
Schema version
2012v2.1
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T12:52:17-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN020476956EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1TYLER SIMMS & STSAUVEUR CPAS PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line119 MORGAN DRIVEAddressLine1
CityLEBANONCity
StateNHState
ZIP Code03766ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN020226774EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSPEANameControl
Phone6032382231Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line116 HOSPITAL ROADAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHELLE MCEWENName
TitlePRESIDENT/CEOTitle
Phone6035361120Phone
Date Signed2013-11-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameW JAY SIMMSName
PTINP00435321PTIN
Phone6036530044Phone
Date Prepared2013-11-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHELLE MCEWENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line116 HOSPITAL ROADAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
Gross Receipts61722054GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteSPEAREHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1899YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE INPATIENT, OUTPATIENT AND PHYSICIAN HEALTH CARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees454TotalNbrEmployees
Total Nbr Volunteers75TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year250331ContributionsGrantsPriorYear
Contributions Grants Current Year870980ContributionsGrantsCurrentYear
Program Service Revenue Prior Year55734614ProgramServiceRevenuePriorYear
Program Service Revenue CY57976992ProgramServiceRevenueCY
Investment Income Prior Year471707InvestmentIncomePriorYear
Investment Income Current Year754004InvestmentIncomeCurrentYear
Other Revenue Prior Year311738OtherRevenuePriorYear
Other Revenue Current Year263714OtherRevenueCurrentYear
Total Revenue Prior Year56768390TotalRevenuePriorYear
Total Revenue Current Year59865690TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year328000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY228000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year21926043SalariesEtcPriorYear
Salaries Etc Current Year22543915SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year121820TotalFundrsngExpCurrentYear
Other Expense Prior Year31231672OtherExpensePriorYear
Other Expenses Current Year30003704OtherExpensesCurrentYear
Total Expenses Prior Year53485715TotalExpensesPriorYear
Total Expenses Current Year52775619TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3282675RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7090071RevenuesLessExpensesCY
Total Assets BOY65430916TotalAssetsBOY
Total Assets EOY75507185TotalAssetsEOY
Total Liabilities BOY27993419TotalLiabilitiesBOY
Total Liabilities EOY31554594TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37437497NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY43952591NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO MAINTAIN A HOSPITAL AND OTHER SUCH INSTITUTIONS WITHIN THE STATE OF NEW HAMPSHIRE, WITH FACILITIES THAT INCLUDE MEDICAL SERVICES TO PROVIDE FOR THE DIAGNOSIS AND TREATMENT OF PATIENTS THAT MAY REQUIRE INPATIENT, OUTPATIENT, EMERGENCY CARE AND OTHER PURSUITS DESIGNED TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. SMH DOES NOT DISCRIMINATE RELATIVE TO RACE, RELIGION OR NATIONAL ORIGIN, ABILITY TO PAY AND WILL ASSURE THAT ALL PATIENTS RECEIVE THE SAME LEVEL OF CARE THROUGH QUALITY ASSESSMENT MONITORING AND IMPROVEMENT ACTIVITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense47608254Expense
Grants228000Grants
Revenue57976992Revenue
DescriptionSMH IS A 25-BED ACUTE-CARE HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES TO THE SURROUNDING COMMUNITY.Description
Total Program Service Expense47608254TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109651NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees454NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1FINANCE DIRECTORBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6032382160TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1SMH 16 HOSPITAL ROADAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MICHELLE MCEWEN
HOSPITAL PRESIDENT/CEO40.00XX283302048128
CLINT HUTCHINS
CHAIR1.00XX000
STANLEY LEE FREEMAN
TREASURER1.00XX000
ELDWIN WIXSON
MEMBER1.00X000
NANCY PUGLISI
MEMBER1.00XX000
STEVE TAKSAR
AST. TREASURER1.00XX000
QUENTIN BLAINE
SECRETARY1.00X000
SAM BRICKLEY II
MEMBER1.00X000
WILLIAM LARSEN
VICE CHAIR1.00XX000
ALISON RITZ
MEMBER1.00X000
JILL DUNCAN
MEMBER1.00X000
MARILYN SANDERSON
MEMBER1.00X000
LINDA CRAWFORD MD
MEMBER1.00X000
DANA MERRITHEW MD
MEMBER1.00X000
ROBERT MALONEY
MEMBER1.00X000
RICHARD F WERKOWSKI
CFO40.00X149571023751
MICHAEL P GIOVAN MD
PHYSICIAN40.00407883067128X
JOSEPH CASEY MD
PHYSICIAN40.00363118056248X
VICTOR GENNARO MD
PHYSICIAN40.00408483065446X
STEVE F DANOSI MD
PHYSICIAN40.00452390072332X
TIMOTHY R LYONS MD
PHYSICIAN40.00317196035488X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2381943TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation368521TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events300FundraisingEvents
Government Grants739949GovernmentGrants
All Other Contributions130731AllOtherContributions
Total Contributions870980TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6241005709333857093338
OTHER OPERATING REVENU900099883654883654
FieldValueIRS element (for citing)
Total Program Service Revenue57976992TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column551969TotalRevenueColumn
Exclusion$551,969ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real48706Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real45000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real3706Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column3706TotalRevenueColumn
Exclusion$3,706ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1984781Securities
Other4676Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1303846Securities
Other483576Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities680935Securities
Other-478900Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column202035TotalRevenueColumn
Exclusion$202,035ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events47861GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events300CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses23942FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column23919TotalRevenueColumn
Exclusion$23,919ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA INCOME722210136348$136,348
PHARMACY INCOME44611099741$99,741
FieldValueIRS element (for citing)
Total Other Revenue236089TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column59865690TotalRevenueColumn
Related Or Exempt Function Income57976992RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,017,718ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total228000Total
Program Services228000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total495400Total
Management And General495400ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16555341Total
Program Services14125662ProgramServices
Management And General2379370ManagementAndGeneral
Fundraising50309Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1345291Total
Program Services1145316ProgramServices
Management And General195896ManagementAndGeneral
Fundraising4079Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2789500Total
Program Services2343308ProgramServices
Management And General437846ManagementAndGeneral
Fundraising8346Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1358383Total
Program Services1129401ProgramServices
Management And General224960ManagementAndGeneral
Fundraising4022Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total25271Total
Management And General25271ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total83114Total
Management And General83114ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total88536Total
Management And General88536ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total98531Total
Program Services98531ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4635454Total
Program Services4564595ProgramServices
Management And General17283ManagementAndGeneral
Fundraising53576Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1254436Total
Program Services1188369ProgramServices
Management And General66067ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total113371Total
Program Services94254ProgramServices
Management And General17820ManagementAndGeneral
Fundraising1297Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total900Total
Program Services900ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total690325Total
Program Services690325ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2942504Total
Program Services2942504ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT66631076663107
PURCHASED SERVICES50903094906742183567
PHYSICIAN FEES & WAGES46974614697461
COST OF DRUGS21740872174087

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1446298Total
Program Services615692ProgramServices
Management And General830415ManagementAndGeneral
Fundraising191Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total52775619Total
Program Services47608254ProgramServices
Management And General5045545ManagementAndGeneral
Fundraising121820Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7777432BOY
EOY12652016EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4454001BOY
EOY1470060EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7260625BOY
EOY7717508EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2440850BOY
EOY2534011EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY758600BOY
EOY864005EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY453318BOY
EOY455790EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis47212795LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22794862LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24988466BOY
EOY24417933EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY13678453BOY
EOY16406439EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1609825BOY
EOY6603676EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1014765BOY
EOY999011EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY994581BOY
EOY1386736EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY65430916BOY
EOY75507185EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2655504BOY
EOY2176809EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY16098028BOY
EOY20979190EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY659554BOY
EOY230652EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8580333BOY
EOY8167943EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY27993419BOY
EOY31554594EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY36885858BOY
EOY43101817EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY285507BOY
EOY288948EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY266132BOY
EOY561826EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37437497BOY
EOY43952591EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY65430916BOY
EOY75507185EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7090071ReconcilationRevenueExpenses
Reconciliation Unrealized Invest1064476ReconciliationUnrealizedInvest
Reconcilation Prior Adjustment284898ReconcilationPriorAdjustment
Reconcilation Other Changes-1924350ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$11,723OtherActivitiesAmount
Total Lobbying Expenditures IIB11723TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationSPEARE MEMORIAL HOSPITAL IS A MEMBER OF THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF SPEARE MEMORIAL HOSPITAL AND THE OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSE. SPEARE MEMORIAL HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance270198BeginningOfYearBalance
Investment Earnings Or Losses6InvestmentEarningsOrLosses
End Of Year Balance270204EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance271045BeginningOfYearBalance
Investment Earnings Or Losses7InvestmentEarningsOrLosses
Other Expenditures-854OtherExpenditures
End Of Year Balance270198EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance248354BeginningOfYearBalance
Contributions25000Contributions
Investment Earnings Or Losses5InvestmentEarningsOrLosses
Other Expenditures2314OtherExpenditures
End Of Year Balance271045EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance223344BeginningOfYearBalance
Contributions25000Contributions
Investment Earnings Or Losses10InvestmentEarningsOrLosses
End Of Year Balance248354EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance137808BeginningOfYearBalance
Contributions40000Contributions
Investment Earnings Or Losses45536InvestmentEarningsOrLosses
End Of Year Balance223344EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.98500BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.01500PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis646258OtherCostOrOtherBasis
Book Value646258BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis28420933OtherCostOrOtherBasis
Depreciation11305880Depreciation
Book Value17115053BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis922885OtherCostOrOtherBasis
Depreciation495366Depreciation
Book Value427519BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis16972996OtherCostOrOtherBasis
Depreciation10993616Depreciation
Book Value5979380BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis249723OtherCostOrOtherBasis
Book Value249723BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24417933TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionBOND FUNDSDescription
Book Value6603676BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities6603676TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
OTHER CURRENT LIABILITIES$2,464,766
EST. THIRD-PARTY PAYER SETTLEMENTS$4,230,015
INVESTMENT IN SUB-BOULDER$1,473,162
FieldValueIRS element (for citing)
Total Of Amounts8167943TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt52015377TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1064476NetUnrealizedGainsInvestments
Other Revenues-8636461OtherRevenues
Revenue Not Rptd F990-7571985RevenueNotRptdF990
Revenue Subtotal59587362RevenueSubtotal
Investment Expenses Not Included88536InvestmentExpensesNotIncluded
Other Revenues Not Included189792OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt278328RevenueNotRptdOnFinStmt
Total Revenue Per Form99059865690TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt45795977TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal45795977ExpensesSubtotal
Investment Expenses Not Included288536InvestmentExpensesNotIncluded2
Other Expenses Not Included6891107OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt6979643ExpensesNotRptdOnFinStmt
Total Expenses Per Form99052775620TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ENDOWMENT FUND IS USED TO SUPPORT OPERATIONS OF THE HOSPITAL.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE -6,663,107. LOSS ON EARLY EXTINGUISHMENT OF BOND -1,973,354.
PART XI, LINE 4B - OTHER ADJUSTMENTS:GRANT EXPENSE 228,000. BAD DEBT EXPENSE ON MSHC RECEIVABLE 6,792. RENTAL EXPENSES -45,000.
PART XII, LINE 4B - OTHER ADJUSTMENTS:GRANT EXPENSE 228,000. BAD DEBT EXPENSE 6,663,107.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event148161GrossReceiptsEvent1
Charitable Contributions Event1300CharitableContributionsEvent1
Gross Revenue Event147861GrossRevenueEvent1
Cash Prizes Event125CashPrizesEvent1
Non Cash Prizes Event19104NonCashPrizesEvent1
Rent Facility Costs Event14902RentFacilityCostsEvent1
Other Direct Expenses Event19911OtherDirectExpensesEvent1
Gross Receipts Total48161GrossReceiptsTotal
Charitable Contributions Total300CharitableContributionsTotal
Gross Revenue Total Events47861GrossRevenueTotalEvents
Cash Prizes Total Events25CashPrizesTotalEvents
Non Cash Prizes Total Events9104NonCashPrizesTotalEvents
Rent Facility Costs Total Events4902RentFacilityCostsTotalEvents
Other Direct Expenses Total Events9911OtherDirectExpensesTotalEvents
Direct Expense Summary Events23942DirectExpenseSummaryEvents
Net Income Summary23919NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage225.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1781754TotalCommunityBenefitExpense
Direct Offsetting Revenue1091185DirectOffsettingRevenue
Net Community Benefit Expense690569NetCommunityBenefitExpense
Percent Of Total Expense0.01310PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4526829TotalCommunityBenefitExpense
Direct Offsetting Revenue5757105DirectOffsettingRevenue
Net Community Benefit Expense-1230276NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense6308583TotalCommunityBenefitExpense
Direct Offsetting Revenue6848290DirectOffsettingRevenue
Net Community Benefit Expense-539707NetCommunityBenefitExpense
Percent Of Total Expense0.01310PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense202099TotalCommunityBenefitExpense
Net Community Benefit Expense202099NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense11500TotalCommunityBenefitExpense
Net Community Benefit Expense11500NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense334729TotalCommunityBenefitExpense
Net Community Benefit Expense334729NetCommunityBenefitExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense272485TotalCommunityBenefitExpense
Net Community Benefit Expense272485NetCommunityBenefitExpense
Percent Of Total Expense0.00520PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense820813TotalCommunityBenefitExpense
Net Community Benefit Expense820813NetCommunityBenefitExpense
Percent Of Total Expense0.01550PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense7129396TotalCommunityBenefitExpense
Direct Offsetting Revenue6848290DirectOffsettingRevenue
Net Community Benefit Expense281106NetCommunityBenefitExpense
Percent Of Total Expense0.02860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,992,673BadDebtExpenseAmount
Amount Attributable To95766AmountAttributableTo
Amount Reimbursed By Medicare16846659AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17093670CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-247011MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 PLYMOUTH REGIONAL REHABILITATION SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityPHYSICAL THERAPY, OCCUPATIONAL THERAPY & MEDICAL FITNESSDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line116 HOSPITAL ROADAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1YBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted11NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed1AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent100.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART III, LINE 4: SMH HAS NO APPROPRIATE FOOTNOTE IN THE APPLICABLE AUDITED FINANCIAL STATEMENT. SMH HAS USED A RATIO OF COSTS TO CHARGES OF 48% IN DETERMINING THE COST OF BAD DEBT EXPENSE.
PART III, LINE 8: 100% OF THE SHORTFALL FROM MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THE SOURCE USED TO DETERMINE THIS AMOUNT IS THE MEDICARE CHARGES LESS THE MEDICARE PAYMENTS MADE TO SPEARE MEMORIAL HOSPITAL. SERVICES THAT INCUR SUCH COSTS ARE PROVIDED BY THE HOSPITAL TO PROMOTE THE WELL-BEING OF THE COMMUNITY. THE SERVICES ARE RENDERED IN CONJUNCTION WITH THE HOSPITAL'S CHARITABLE TAX EXEMPT PURPOSE. TREATING THE SHORTFALL AS A COMMUNITY BENEFIT RELIEVES THE BURDEN ON LOCAL SOCIAL SERVICES AND GOVERNMENT SUPPORTED PROGRAMS.
PART III, LINE 9B: SPEARE MEMORIAL HOSPITAL HAS BOTH A COLLECTIONS POLICY, AND A CHARITY CARE POLICY THAT DESCRIBES CHARITY ELIGIBILITY AND THE STEPS TO BE COMPLETED BEFORE A PATIENT'S ACCOUNT IS WRITTEN OFF TO BAD DEBT.
PART V, SECTION B, LINE 1J: SPEARE MEMORIAL HOSPITAL CONDUCTED A COMMUNITY WIDE PUBLIC PRESENTATION OF THE NEEDS ASSESSMENT REPORT IN OCTOBER 2011.Y
PART VI, LINE 2: INFORMATION GATHERING THROUGH SURVEYS, FOCUS GROUPS, COMMUNITY REPRESENTATION, PUBLIC FORUMS, INPUT FROM HEALTH CARE PROVIDERS, INDUSTRY LEADERS, OUTSIDE CONSULTANTS,AND ANALYSIS OF INTERNAL DATA AND EXTERNAL DATA PROVIDED BY HOSPITAL ASSOCIATIONS, PAYERS, ETC.
PART VI, LINE 3: PATIENTS ARE EDUCATED AT TIME OF REGISTRATION OR THROUGH EDUCATIONAL MATERIALS THAT ARE DISTRIBUTED THROUGH THE HOSPITAL'S WEBSITE OR BY COMMUNITY OUTREACH. SPEARE MEMORIAL HOSPITAL IS A MEMBER OF A STATE-WID COMMUNITY HEALTH NETWORK THAT PROVIDES ASSISTANCE, SUPPORT,AND EDUCATION RELATING TO ELIGIBILITY ASSISTANCE.
PART VI, LINE 4: SPEARE MEMORIAL HOSPITAL IS LOCATED IN THE MOUNTAIN AND LAKES REGION OF NEW HAMPSHIRE AND PRIMARLY SERVES CONSTITUENTS IN GRAFTON COUNTY. GRAFTON COUNTY POPULATION SIZE IS APPROXIMATELY 86,000 WITHIN ITS 40 DISTINCT MUNICIPALITIES. ITS SERVICE AREA INCLUDES 17 TOWNS WITH AN APPROXIMATE TOTAL POPULATION OF 30,000.
PART VI, LINE 5: SPEARE MEMORIAL HOSPITAL PROVIDES PRESCRIPTION MEDICATION ASSISTANCE, PRIMARY-CARE CLINCS, MULTIPLE SUPPORT GROUPS, COMMUNITY EDUCATION PROGRAMS, SCHOOL DENTAL PROGRAM, ETC. AND HAS AFFLIATIONS AND PARTNERSHIPS WITH MANY COMMUNITY ORGANIZATIONS; AN OPEN MEDICAL STAFF AND COMMUNITY BOARD. OPERATING FUNDS ARE USED FOR ONGOING CAPITAL EXPENDITURES.
NHREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1MID-STATE HEALTH CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 BOULDER POINT DRIVE NO 1AddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient020487172EINOfRecipient
IRC Section501 (C)(3)IRCSection
Amount Of Cash Grant228000AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation
Purpose Of GrantCOMMUNITY BENEFIT GRANTPurposeOfGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHELLE MCEWEN
HOSPITAL PRESIDENT/CEO28330200000297540183740331430000
RICHARD F WERKOWSKI
CFO1495710000019340044110173322000
MICHAEL P GIOVAN MD
PHYSICIAN40788300000497480173800475011000
JOSEPH CASEY MD
PHYSICIAN36311800000388680173800419366000
VICTOR GENNARO MD
PHYSICIAN40848300000495560158900473929000
STEVE F DANOSI MD
PHYSICIAN45239000000571440151880524722000
TIMOTHY R LYONS MD
PHYSICIAN31719600000183680171200352684000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN020279866IssuerEIN
Date Issued2012-12-07DateIssued
Issue Price21100000IssuePrice
Description Of PurposeTO PAY OFF AND PROVIDE ADVANCED REFUNDING FOR 2010 AND 2004 BONDSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Bond Defeased16323208AmountBondDefeased
Total Proceeds21100000TotalProceeds
Refunding Escrow12612773RefundingEscrow
Issuance Costs From Proceeds209815IssuanceCostsFromProceeds
Capital Expenditures4566977CapitalExpenditures
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed1Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2THE COMMUNITY RELATIONS DIRECTOR IS THE SPOUSE OF A BOARD MEMBER.
FORM 990, PART VI, SECTION A, LINE 3THE REHABILITATION DEPARTMENT IS NOW MANAGED BY ORTHOPEDIC HEALTH SERVICES. INC.
FORM 990, PART VI, SECTION A, LINE 6THE PROVISIONS OF SMH GOVERNING DOCUMENTS PROVIDE THE BOARD OF DIRECTORS AND IS COMPRISED OF ASSOCIATION MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7ATHE ASSOCIATION MEMBERS ELECT THE BOARD MEMBERS
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED BY THE HOSPITAL CFO AND THE PRESIDENT/CEO AND THE FINANCE COMMITTEE. THE TAX FORM 990 IS MADE AVAILABLE FOR REVIEW TO THE BOARD OF DIRECTORS. THE FORM 990 IS THEN SIGNED AND FILED.
FORM 990, PART VI, SECTION B, LINE 12CANNUAL COMPLIANCE FORM COMPLETED BY EACH MEMBER OF THE BOARD
FORM 990, PART VI, SECTION B, LINE 15ACOMPENSATION FOR THE CEO IS DETERMINED VIA A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, COMPARISON OF OTHER ORGANIZATIONS 990 INFORMATION, BOARD APPROVAL AND WRITTEN EMPLOYMENT CONTACT.
FORM 990, PART VI, SECTION C, LINE 19UPON REQUEST
FORM 990, PART XI, LINE 9:BAD DEBT EXPENSE ON MSHC RECEIVABLE -6,792. RENTAL EXPENSE 55,796. LOSS ON EARLY EXTINGUISHMENT OF BOND -1,973,354.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL AT BOULDER POINTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1BOULDER POINT DRAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
EIN263888977EIN
Primary ActivitiesREAL ESTATEPrimaryActivities
Legal Domicile StateNHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipControlled OrgControlledOrg
SPEARE HEALTH VENTURE
16 HOSPITAL ROADPLYMOUTHNH03264020366565HEALTHCARE SERVICESNHC51602397461.000000
SPEARE HEALTH NETWORK LLC
16 HOSPITAL ROADPLYMOUTHNH03264043372339PHYSICIAN/HOSPITAL ORGANIZATIONNHC57211450.500000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SPEARE MEMORIAL AT BOULDER POINT-LEASES ALL OF ITS SPACE TO SMH
K502582ACTUAL
SPEARE HEALTH VENTURE
D244355FAIR MARKET VALUE
SPEARE MEMORIAL AT BOULDER POINT
D2040520FAIR MARKET VALUE
SPEARE MEMORIAL AT BOULDER POINT
Q8266ACTUAL

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