MONADNOCK COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MONADNOCK COMMUNITY HOSPITAL (EIN 02-0222157)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-13
- IRS object ID
- 201322259349301702
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-13T10:03:27-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010494526 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | BOX 507 | AddressLine1 |
| City | PORTLAND | City |
| State | ME | State |
| ZIP Code | 04112 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222157 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MONA | NameControl |
| Phone | 6039247191 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1 |
| City | Peterborough | City |
| State | NH | State |
| ZIP Code | 034581263 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Richard Scheinblum | Name |
| Title | VP of Finance/CFO | Title |
| Phone | 6039247191 | Phone |
| Date Signed | 2013-08-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Timothy R Hepburn CPA | Name |
| PTIN | P00182393 | PTIN |
| Phone | 2078792100 | Phone |
| Date Prepared | 2013-08-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Peter L Gosline | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1 |
| City | Peterborough | City |
| State | NH | State |
| ZIP Code | 034581263 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 79832925 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.monadnockhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | Critical Access Hospital serving the Monadnock Region of the State of New Hampshire. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 777 | TotalNbrEmployees |
| Total Nbr Volunteers | 133 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1878155 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 816591 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 73391780 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 75233641 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 611666 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1384191 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 788518 | OtherRevenuePriorYear |
| Other Revenue Current Year | 700842 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 76670119 | TotalRevenuePriorYear |
| Total Revenue Current Year | 78135265 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 37836736 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 39571490 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 42108 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 63069 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 450384 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 36056567 | OtherExpensePriorYear |
| Other Expenses Current Year | 39666510 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 73935411 | TotalExpensesPriorYear |
| Total Expenses Current Year | 79301069 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2734708 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1165804 | RevenuesLessExpensesCY |
| Total Assets BOY | 89519561 | TotalAssetsBOY |
| Total Assets EOY | 92323694 | TotalAssetsEOY |
| Total Liabilities BOY | 43706613 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 45242384 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 45812948 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 47081310 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Monadnock Community Hospital is committed to improving the health and well-being of our community. We create exceptional experiences that engage and inspire our community to achieve the highest level of health and well-being. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 70372119 | Expense |
| Revenue | 75929573 | Revenue |
| Description | The primary purpose of Monadnock Community Hospital (MCH) is to ensure access to quality health care for patients in our community, regardless of their ability to pay. Following is a summary of the services MCH provides in an effort to fulfill its mission, together with key program statistics for fiscal year 2012.Inpatient Services - includes intensive care, adult stays, pediatric stays, maternity/births, and skilled nursing. During the fiscal year the Hospital admitted 1,377 patients and recorded 4,928 patient days. Emergency Services - MCH offers health services 24 hours per day, 7 days per week. The ER is responsible for the immediate treatment of any medical or surgical emergency; for initiating life-saving procedures in all types of emergency situations; and for providing emergency and initial evaluations and treatment for other conditions, including minor illnesses and injuries and sub-acute medical problems. During the year, there were 14,805 visits to the ER.Physician Practices - family health services, programs, and education are integral components of health care at MCH. Inpatient and outpatient primary care includes medical, surgical, psychological, and specialist services provided by physicians and mid-level practitioners. These are located at the Hospital and its five satellite practices located in Antrim, Jaffrey, New Ipswich, Peterborough, and Rindge. During the year, 132,374 office visits were recorded.Surgical Services - includes same-day and short-term inpatient surgery. MCH provides surgery in the areas of orthopaedics, general surgery, OB/GYN, ophthalmology, urology, ENT, and podiatry. In addition, the Hospital offers some non-surgical procedures, including colonoscopies, gastroscopies, and pain management injections. During the fiscal year, 2,898 procedures were performed.Radiology and Diagnostics - MCH provides advanced radiological technology and extensive imaging services, including bone density, MRI, CT, nuclear medicine, ultrasound, mammography and other diagnostic procedures, both inpatient and outpatient. During the fiscal year, 30,748 exams were performed.Rehabilitation Services - additionally, MCH serves the people of the Monadnock Region through its medical rehabilitation services. MCH offers rehabilitation programs for cardiac, pulmonary, and diabetic rehabilitation that feature educational and exercise components. MCH also provides physical and occupational therapy, as well as speech rehabilitation. During the fiscal year, 44,755 procedures were recorded for these services.Wellness Services - community members wanting to improve and maintain their health have access to an award-winning, medically based fitness facility. During the fiscal year, 92,297 member visits were recorded.Monadnock Community Hospital's Financial Assistance Program provides assistance with hospital and/or physician bills for qualifying patients. In fiscal year 2012, the organization recorded $2,945,000 in charges foregone based on established rates. The estimated cost incurred to provide these services was $1,911,000. In addition, MCH provided other services to the community at no cost or reduced cost, such as screenings and clinics. The cost of providing these services was approximately $2,012,000 in 2012. | Description |
| Total Program Service Expense | 70372119 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 74 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 777 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 0 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Nicole Humphrey | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6039247191 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1 |
| City | Peterborough | City |
| State | NH | State |
| ZIP Code | 034581263 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Robert L Edwards | |||||||
| Chair | 7.00 | X | X | 0 | 0 | 0 | |
| Cyndy Burgess | |||||||
| Chair (part year) | 5.00 | X | X | 0 | 0 | 0 | |
| Carole Monroe | |||||||
| Vice Chair (part year) | 4.00 | X | X | 0 | 0 | 0 | |
| Steven H Reynolds | |||||||
| Treasurer | 1.60 | X | X | 0 | 0 | 0 | |
| Norman H Makechnie Esq | |||||||
| Clerk | 0.90 | X | X | 0 | 0 | 0 | |
| Robert J Condon Jr | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Barbara R Duckett | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| David A Hedstrom DDS | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Peter L Gosline | |||||||
| Chief Executive Officer | 55.00 | X | X | 289979 | 0 | 64563 | |
| Amy Pfeil | |||||||
| Ex-Officio w/Voting Rights | 1.00 | X | 0 | 0 | 0 | ||
| James D Potter MD | |||||||
| Ex-Officio w/Voting Rights | 1.00 | X | 119847 | 0 | 20991 | ||
| Charles J Seigel MD | |||||||
| Ex-Officio w/Voting Rights | 1.00 | X | 0 | 0 | 0 | ||
| Robert Taft Esq | |||||||
| Trustee (part year) | 1.00 | X | 0 | 0 | 0 | ||
| Jamie Trowbridge | |||||||
| Trustee (part year) | 1.00 | X | 0 | 0 | 0 | ||
| Fletcher R Wilson MD | |||||||
| Ex-Officio w/Voting Rights | 1.00 | X | 0 | 0 | 0 | ||
| Richard Scheinblum | |||||||
| VP Finance/CFO | 50.00 | X | 164050 | 0 | 14701 | ||
| Stephen Coffman MD | |||||||
| Physician | 50.00 | 444070 | 0 | 18377 | X | ||
| Phillip Vuocolo MD | |||||||
| Physician | 50.00 | 270611 | 0 | 21014 | X | ||
| Jennifer Peppers MD | |||||||
| Physician | 50.00 | 256736 | 0 | 13382 | X | ||
| Lucas Shippee DO | |||||||
| Physician | 50.00 | 228307 | 0 | 22752 | X | ||
| Gregory Kriebel MD | |||||||
| Physician | 50.00 | 214444 | 0 | 24994 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1988044 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 200774 | TotalOtherCompensation |
| Number Individuals GT100 K | 38 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Monadnock Orthopaedic Associates | |||||
| 458 Old Street Road Suite 200 | Peterborough | NH | 03458 | Physician fees | 3086263 |
| Monadnock Region Emergency Physicians | |||||
| 540 Lafayette Road | Hampton | NH | 03842 | Contract emergency physician group | 1721992 |
| Monadnock Anesthesia Associates | |||||
| C/O Surgical Suite | Peterborough | NH | 03458 | Contract anesthesiologist group | 1129845 |
| Hutter Construction | |||||
| PO Box 257 810 Turnpike Road | New Ipswich | NH | 03071 | General contractor | 1080313 |
| McKesson | |||||
| PO Box 98347 | Chicago | IL | 60693 | IS vendor | 1013846 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 24 | NumberOfContractorsGT100K |
| Fundraising Events | 16670 | FundraisingEvents |
| Government Grants | 75602 | GovernmentGrants |
| All Other Contributions | 724319 | AllOtherContributions |
| Total Contributions | 816591 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient Service Re | 900099 | 73652417 | 73652417 |
| Other Operating Revenu | 900099 | 1581224 | 1581224 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 75233641 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 432429 | TotalRevenueColumn |
| Exclusion | $432,429 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2380881 | Securities |
| Other | 251191 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1326286 | Securities |
| Other | 354024 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1054595 | Securities |
| Other | -102833 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 951762 | TotalRevenueColumn |
| Exclusion | $951,762 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 22260 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 16670 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 17350 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4910 | TotalRevenueColumn |
| Exclusion | $4,910 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Cafeteria/Vending Mach | 900099 | 360945 | 360945 |
| Employee Pharmacy Sale | 900099 | 334987 | 334987 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 695932 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 78135265 | TotalRevenueColumn |
| Related Or Exempt Function Income | 75929573 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,389,101 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 650167 | Total |
| Program Services | 145140 | ProgramServices |
| Management And General | 505027 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31011839 | Total |
| Program Services | 27886301 | ProgramServices |
| Management And General | 2906038 | ManagementAndGeneral |
| Fundraising | 219500 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 398218 | Total |
| Program Services | 355036 | ProgramServices |
| Management And General | 40315 | ManagementAndGeneral |
| Fundraising | 2867 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5414844 | Total |
| Program Services | 4685381 | ProgramServices |
| Management And General | 707953 | ManagementAndGeneral |
| Fundraising | 21510 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2096422 | Total |
| Program Services | 1856447 | ProgramServices |
| Management And General | 225693 | ManagementAndGeneral |
| Fundraising | 14282 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 121370 | Total |
| Program Services | 1120 | ProgramServices |
| Management And General | 120250 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52500 | Total |
| Management And General | 52500 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63069 | Total |
| Fundraising | 63069 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5529162 | Total |
| Program Services | 5080896 | ProgramServices |
| Management And General | 444720 | ManagementAndGeneral |
| Fundraising | 3546 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74990 | Total |
| Program Services | 74990 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1634170 | Total |
| Program Services | 883724 | ProgramServices |
| Management And General | 727848 | ManagementAndGeneral |
| Fundraising | 22598 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 878928 | Total |
| Program Services | 762097 | ProgramServices |
| Management And General | 116831 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3363943 | Total |
| Program Services | 3135043 | ProgramServices |
| Management And General | 228900 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37982 | Total |
| Program Services | 24681 | ProgramServices |
| Management And General | 12806 | ManagementAndGeneral |
| Fundraising | 495 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70990 | Total |
| Program Services | 41588 | ProgramServices |
| Management And General | 11206 | ManagementAndGeneral |
| Fundraising | 18196 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1337157 | Total |
| Management And General | 1337157 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5138419 | Total |
| Program Services | 4962665 | ProgramServices |
| Management And General | 175754 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 575556 | Total |
| Program Services | 457759 | ProgramServices |
| Management And General | 117797 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Med & Pharm Supplies | 6810425 | 6806464 | 3961 | |
| NH Medicaid Enhancement | 4390173 | 4390173 | ||
| Provision for Bad Debts | 4271860 | 4271860 | ||
| Other Med Exp/Service C | 4018781 | 3641895 | 300740 | 76146 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1360104 | Total |
| Program Services | 908859 | ProgramServices |
| Management And General | 443070 | ManagementAndGeneral |
| Fundraising | 8175 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79301069 | Total |
| Program Services | 70372119 | ProgramServices |
| Management And General | 8478566 | ManagementAndGeneral |
| Fundraising | 450384 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9923746 | BOY |
| EOY | 2208239 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5360993 | BOY |
| EOY | 11778893 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 473874 | BOY |
| EOY | 161575 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5226529 | BOY |
| EOY | 5527100 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129269 | BOY |
| EOY | 196371 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1364053 | BOY |
| EOY | 1286731 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 604559 | BOY |
| EOY | 573132 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 79126832 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 39707027 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40689917 | BOY |
| EOY | 39419805 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21146279 | BOY |
| EOY | 26642255 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2736875 | BOY |
| EOY | 3135858 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1863467 | BOY |
| EOY | 1393735 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89519561 | BOY |
| EOY | 92323694 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6091799 | BOY |
| EOY | 5921028 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27914594 | BOY |
| EOY | 27234908 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 561375 | BOY |
| EOY | 690631 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9138845 | BOY |
| EOY | 11395817 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43706613 | BOY |
| EOY | 45242384 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37498743 | BOY |
| EOY | 38489800 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1357888 | BOY |
| EOY | 1236210 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6956317 | BOY |
| EOY | 7355300 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45812948 | BOY |
| EOY | 47081310 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89519561 | BOY |
| EOY | 92323694 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1165804 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2434166 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Direct Contact Legislators | $209 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $11,776 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 11985 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Lobbying Activities: | Identifier |
| Return Reference | Part II-B, Line 1: | ReturnReference |
| Explanation | Monadnock Community Hospital is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Monadnock Hospital in furtherance of its exempt purpose. Monadnock Hospital does not directly perform any lobbying activities. NHHA, Portion of dues available for lobbying: $8,453 AHA, Portion of dues available for lobbying: $3,323 In addition, MCH hosts an annual legislative breakfast, which is a bipartisan event to which legislators, local politicians and other public officials are invited to discuss health care issues in New Hampshire and current and proposed legislation. The total cost of this forum was $209. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 8314205 | BeginningOfYearBalance |
| Contributions | 486841 | Contributions |
| Investment Earnings Or Losses | 948400 | InvestmentEarningsOrLosses |
| Other Expenditures | 1157936 | OtherExpenditures |
| End Of Year Balance | 8591510 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 10031251 | BeginningOfYearBalance |
| Contributions | 884501 | Contributions |
| Investment Earnings Or Losses | 93759 | InvestmentEarningsOrLosses |
| Other Expenditures | 2695306 | OtherExpenditures |
| End Of Year Balance | 8314205 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 10623404 | BeginningOfYearBalance |
| Contributions | 1266761 | Contributions |
| Investment Earnings Or Losses | 200900 | InvestmentEarningsOrLosses |
| Other Expenditures | 2059814 | OtherExpenditures |
| End Of Year Balance | 10031251 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 10282555 | BeginningOfYearBalance |
| Contributions | 1164871 | Contributions |
| Investment Earnings Or Losses | -100136 | InvestmentEarningsOrLosses |
| Other Expenditures | 723886 | OtherExpenditures |
| End Of Year Balance | 10623404 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.14390 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.85610 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 842124 | OtherCostOrOtherBasis |
| Book Value | 842124 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30819155 | OtherCostOrOtherBasis |
| Depreciation | 13957164 | Depreciation |
| Book Value | 16861991 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4529698 | OtherCostOrOtherBasis |
| Depreciation | 1260256 | Depreciation |
| Book Value | 3269442 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 42581777 | OtherCostOrOtherBasis |
| Depreciation | 24489607 | Depreciation |
| Book Value | 18092170 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 354078 | OtherCostOrOtherBasis |
| Book Value | 354078 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 39419805 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Interest Rate Swap Agreements | $4,895,166 |
| Estimated Third-Party Settlements | $6,500,651 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11395817 | TotalOfAmounts |
| Total Revenue | 78135265 | TotalRevenue |
| Total Expenses | 79301069 | TotalExpenses |
| Excess Or Deficit For Year | -1165804 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 2851431 | NetUnrealizedGLOnInvestments |
| Other | -$417,265 | OtherAmount |
| Total Adjustments | 2434166 | TotalAdjustments |
| Excess Or Deficit Per FS | 1268362 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 75847187 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 2851431 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 2851431 | RevenueNotRptdF990 |
| Revenue Subtotal | 72995756 | RevenueSubtotal |
| Other Revenues Not Included | 5139509 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 5139509 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 78135265 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 74578825 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 74578825 | ExpensesSubtotal |
| Other Expenses Not Included | 4722244 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4722244 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 79301069 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | Temporarily restricted assets are available for health care services, including the purchase of equipment and providing health education and programs. The income and dividends on permanently restricted net assets are generally used to support health care services and for capital purchases of property and equipment. |
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | The audited financial statements for the year ended September 30, 2012 contain the following paragraph pertaining to income taxes in Footnote 1: "The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Hospital's tax positions and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying financial statements. With few exceptions, the Hospital is no longer subject to tax examination by the U.S. federal or state tax authorities for years prior to 2009." |
| Part XI, Line 8 - Other Adjustments: | Change in fair value of interest rate swap agreements -417,265. | |
| Part XII, Line 4b - Other Adjustments: | Fundraising Expenses 450,384. Decrease in fair value of interest rate swap agreement 417,265. Provision for Bad Debts 4,271,860. | |
| Part XIII, Line 4b - Other Adjustments: | Fundraising Expenses 450,384. Provision for Bad Debts 4,271,860. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Solicitation Of Govt Grants | X | SolicitationOfGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
Name Of Organization NameOfOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ghiorsi & Sorrenti | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 Madison Avenue | AddressLine1 |
| City | Wyckoff | City |
| State | NJ | State |
| ZIP Code | 07481 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | See Schedule G, Part IV | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 0 | GrossReceipts |
| Amount Retained By Contractor | 63069 | AmountRetainedByContractor |
| Net To Organization | 0 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | 63069 | TotalRetainedByContractors |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | MCH Golf Classic | NameOfEvent1 |
| Gross Receipts Event1 | 38930 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 16670 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 22260 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 240 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 64 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 9240 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4399 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 3407 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 38930 | GrossReceiptsTotal |
| Charitable Contributions Total | 16670 | CharitableContributionsTotal |
| Gross Revenue Total Events | 22260 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 240 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 64 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 9240 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 4399 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 3407 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 17350 | DirectExpenseSummaryEvents |
| Net Income Summary | 4910 | NetIncomeSummary |
Form990 Schedule G Part IV Form990ScheduleGPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Explanation of Fundraising Payments | Identifier |
| Return Reference | Schedule G, Part I, Line 2b, Column (v) | ReturnReference |
| Explanation | Professional fees paid for capital campaign counsel and services. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1671994 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1671994 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02230 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7352797 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6257386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1095411 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01460 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9024791 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6257386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2767405 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03690 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 766938 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 766938 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 72078 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 72078 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1060899 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1060899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01410 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 112472 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 112472 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2012387 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2012387 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02680 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11037178 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6257386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4779792 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06370 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,424,916 | BadDebtExpenseAmount |
| Amount Attributable To | 187772 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 21380629 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 21249064 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 131565 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | 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 | Monadnock Community Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1 |
| City | Peterborough | City |
| State | NH | State |
| ZIP Code | 03458 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 14 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (14 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Bond Wellness Center | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Fitness center and rehabilitation services |
| Monadnock Orthopaedic Associates | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
| Monadnock Regional Pediatrics | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Jaffrey Family MedicinePT Satellite | ||||
| 82 Peterborough Street | Jaffrey | NH | 03452 | Physician practice with PT services |
| Monadnock Family Care | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| North Meadow | ||||
| 154 Hancock Road | Peterborough | NH | 03458 | Physician practice |
| Monadnock Internists | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Peterborough Internal Medicine | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Monadnock Behavioral Health | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
| New Ipswich Family MedicinePT Satellite | ||||
| 821 Turnpike Road | New Ipswich | NH | 03071 | Physician practice with PT services |
| Monadnock Surgical Associates | ||||
| 454 Old Street Road MAB Building | Peterborough | NH | 03458 | Physician practice |
| Antrim Medical Group | ||||
| 12 Elm Street | Antrim | NH | 03440 | Physician practice |
| Rindge Family Practice | ||||
| 145 US Route 202 | Rindge | NH | 03461 | Physician practice |
| Neurology Center | ||||
| 458 Old Street Road Wellness Center | Peterborough | NH | 03458 | Physician practice |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: N/A | ||
| Part I, Line 6a: N/A | ||
| Part I, Line 7: Charity Care and Means Tested Programs use the cost to charge ratio as their methodology. This hospital calculates the ratio in a manner consistent with worksheet 2, Patient Care Charges to Patient Care Expenses, to arrive at the ratio of cost to charges. | ||
| Part I, Line 7g: Included in the subsidized health services activities reported for FY 2012 are unreimbursed costs of $1,060,899 attributed to an Outpatient Behavioral Health Practice. | ||
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4271860. | ||
| Part II: N/A | ||
| Part III, Line 4: The amount reported on Part III line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, line 25, column (A) ($4,271,860). Accounts written off to bad debt include gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. The hospital calculates the ratio in a manner consistent with worksheet 2, Patient Care Charges to Patient Care Expenses, to arrive at the ratio of costs to charges. We estimated the amount of charity care in bad debt expense based on the number of applications for charity care denied due to lack of complete documentation against the average charity care write off at cost per qualified patient. We believe the amount is minimal based on our extensive efforts to educate patients and staff about our various payment plans and financial grant programs to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances a patient may be eligible for charity care, discounted care, payment programs, or a combination of the above. Due to these efforts, we feel that amounts written off to bad debt that could qualify as charity care is minimal.Footnote 1 to the audited financial statements of the hospital contains the following to address bad debt: Accounts Receivable - Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to the allowance for doubtful accounts based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the allowance for doubtful accounts and a credit to accounts receivable. | ||
| Part III, Line 8: Medicare allowable costs for the Medicare cost report are reported in accordance with CMS guidelines using the cost to charge ratio methodology. | ||
| Part III, Line 9b: As of 9/30/2011 Monadnock Community Hospital has a written Credit and Collection policy. Described within that policy are the collection practices and bad debt processes that are followed for patients who are known to qualify for charity care or financial assistance. The organization maintains a Financial Assistance Program (FAP) database which is maintained by the Social Services department of MCH. The Patient Financial Services (PFS) staff reference this database for approval status and eligibility amounts, identifying any account(s) where the discount will apply. Internal FAP insurance plans are applied to those accounts and related discount amounts are adjusted in the billing system. Remaining balances are expected to be paid in full by the patient. Payment plans may be requested by the patient and are established by the Financial Grant Coordinator based on the patient's available income and assets. Accounts are annotated to reflect payment arrangements. During bad debt processing, designated staff evaluate accounts listed as collection review for potential bad debt write off. This process includes an examination of account history for indication of FAP application. | ||
| Part V, Section B, Line 13g: The complete financial assistance policy is available upon request and in the waiting rooms and instructions on how to find out more about financial assistance are posted on the website, on the back of all billing invoices, and published in a brochure that is available around the hospital and in the admissions office.Additionally, the financial assistance program is communicated to all employees during the orientation process. | Monadnock Community Hospital | |
| Part V, Section B, Line 17e: Line E: Description from Credit and Collections Policy:The Hospital Patient Financial Services Department shall develop and implement billing and collection procedures designed to maintain an adequate cash flow, keep accounts receivable at an acceptable level, and identify and write-off bad debts in a timely fashion. Monadnock Community Hospital contracts with an Agency to process all self pay and self pay after insurance balance statements/letters. I. Self pay accounts and self-pay balances remaining after insurance adjudication shall be transferred to the Agency on a weekly basis. The cycle for collections is a three statements and/or letters and two phone call series spaced approximately thirty (30) days apart. The statements shall include:a. Previous balance (unless this is the first statement).b. Activity since last statement (except those accounts that went to a $0.00 balance).c. Current balance due.d. Telephone number(s) for inquiries concerning the statement.e. Status or reminder message where appropriate.f. Availability for the use of a credit card for payment.g. Information regarding Financial Assistance and Medication Bridge Programs.h. Return envelope.II. In the event that statements or letters are returned by the postal service as undeliverable for reasons such as "Moved, left no forwarding address","Forwarding order expired"or "No such address" the Agency will indicate on the daily report 'mail returned'. PFS staff will review system for correct address and will make corrections within the computer system and correspondence will be re-mailed. If no correct or current information can be obtained, the specific account(s) shall be flagged for referral to an outside collection agency equipped to handle this type of situation (see Bad Debt Processing).In addition, on a weekly basis, the Financial Assistance Program staff run system reports to identify outpatient visits classified as self-pay. Based on the information in these reports, the guarantor of each visit is sent a Financial Assistance application in the mail.Determination of eligibilty is contingent upon receiving a completed application and required documentation from the patient and/or guarantor. | Monadnock Community Hospital | |
| Part V, Section B, Line 21: The State of NH does not allow healthcare providers to bill auto insurance companies directly in regards to a Motor Vehicle accident. The patient, when treated, has the choice to either be billed directly and they will in turn bill their auto insurance company or we can bill their health insurance company directly. | Monadnock Community Hospital | |
| Part VI, Line 2: The State of NH, under RSA 7:32-f, requires every healthcare charitable trust, either alone or in conjunction with other healthcare charitable trusts in its community, to conduct a Community Needs Assessment to assist in determining the activities to be included in its community benefits plan. The needs assessment process includes consultation with members of the public, community organizations, service providers, and local government officials in the entity's service area to identify and prioritize the community needs that the health care entity can address directly or in collaboration with others. The Community Needs Assessment is updated at least every 5 years, most recently in 2008. In 2007, the Regional Community Benefits Steering Committee was formed to prepare a single 2008 Community Benefits Needs Assessment for the Monadnock Region. The work group consisted of representatives from multiple organizations, including Monadnock Community Hospital. Based on the needs assessment and community engagement process, the priority needs and health concerns of the community MCH serves include access to care - driven by financial barriers and/or availability of primary care, availability of behavioral health care, general socioeconomic issues, and transportation services. Monadnock Community Hospital used this information to help focus its community benefit efforts to meet the priority needs identified in the community benefit plan. In addition, other needs or services not specifically identified in the community needs assessment, but addressed under the organization's community benefit plan include availability of dental or oral health care (via the organization's Monadnock Healthy Teeth to Toes program which focuses on dental hygiene and care, nutrition, and daily physical activity for children ages kindergarten to third grade) and availability of prescription medication (via the organization's Medication Bridge program designed to help eligible patients apply for assistance programs that provide free or discounted prescription medications). | ||
| Part VI, Line 3: MCH is committed to providing quality healthcare to anyone in need of services, regardless of ability to pay. We understand patients may not have the finances to pay for their healthcare services and medications, and do not want this to prevent anyone from receiving necessary treatment. As part of the hospital's mission to the communities we serve, we have developed programs to help meet the needs of our patients who meet income eligibility. Through our Financial Assistance and Medication Bridge Programs, we have been providing financial assistance to those qualifying for many years. We reach out to our patients in many different ways to ensure they are aware that help is available and to guide them through the process. Brochures and signage are posted in high traffic areas and all employees of MCH are informed about the Financial Assistance Program during orientation. When a patient goes through the registration process at the hospital the staff are trained to inform uninsured or underinsured patients about the Monadnock Community Hospital Financial Assistance and the New Hampshire Health Access programs and that there is assistance available within the hospital to help with the application process. In addition, any time a patient calls customer service, the representative is trained to help identify and offer support to patients who may require financial assistance. Patients may qualify for free care, discounted care, payment plans or a combination of the above. Assistance is also provided in applying to federal and state programs for those who qualify. | ||
| Part VI, Line 4: The hospital's primary service area consists of 14 towns, including Antrim, Bennington, Dublin, Francestown, Greenfield, Greenville, Hancock, Jaffrey, Mason, New Ipswich, Peterborough, Rindge, Sharon, and Temple. The hospital serves the general population of the primary service area referenced above. | ||
| Part VI, Line 5: Monadnock Community Hospital is a critical access hospital located in the Monadnock Region of NH. Our mission is to improve the health and well-being of our community. The hospital is served by a board of trustees consisting of local citizens active in their community and its organizations. The majority of the board is not employed by the hospital and consists of local community and business representatives as well as medical staff. The hospital is committed to giving back to the community to the greatest extent possible. Monadnock Community Hospital supports thousands of individuals and families with free or reduced-fee services and programs. Our Financial Assistance Program administered by the Social Services department helps families and individuals in need with access to health care and other available community services such as catastrophic care, fuel assistance, meals on wheels, food banks and visiting nurses. Other examples of the hospital's effort to reach our patients beyond traditional hospital services include access to free or reduced cost medications through our Medication Bridge program; educating children on the importance of good oral hygiene, eating health, and daily physical activity through our Monadnock Healthy Teeth to Toes program; training for community agencies such as local volunteer fire and rescue personnel; prevention and wellness education including nutrition, smoking cessation and dealing with stress; providing regular community seminars regarding timely health topics; and screenings for important health issues such as breast cancer. These are just a few of the many areas where we are reaching out to others to assure they are cared for well. | ||
| Part VI, Line 6: N/A | ||
| NH | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Peter L Gosline | |||||||||||||
| 248637 | 0 | 20000 | 0 | 21342 | 0 | 47526 | 0 | 17037 | 0 | 354542 | 0 | 0 | 0 |
| Richard Scheinblum | |||||||||||||
| 163477 | 0 | 0 | 0 | 573 | 0 | 5781 | 0 | 8920 | 0 | 178751 | 0 | 0 | 0 |
| Stephen Coffman MD | |||||||||||||
| 440551 | 0 | 3130 | 0 | 389 | 0 | 0 | 0 | 18377 | 0 | 462447 | 0 | 0 | 0 |
| Phillip Vuocolo MD | |||||||||||||
| 244757 | 0 | 25000 | 0 | 854 | 0 | 0 | 0 | 21014 | 0 | 291625 | 0 | 0 | 0 |
| Jennifer Peppers MD | |||||||||||||
| 219032 | 0 | 0 | 0 | 37704 | 0 | 0 | 0 | 13382 | 0 | 270118 | 0 | 0 | 0 |
| Lucas Shippee DO | |||||||||||||
| 226013 | 0 | 0 | 0 | 2294 | 0 | 5678 | 0 | 17074 | 0 | 251059 | 0 | 0 | 0 |
| Gregory Kriebel MD | |||||||||||||
| 211678 | 0 | 0 | 0 | 2766 | 0 | 7529 | 0 | 17465 | 0 | 239438 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 4b | MCH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split-dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by both the employer and employee. Pursuant to MCH's split-dollar agreement, and the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance coverage. The present value of the policies is reported on MCH's balance sheet in Part X, Line 15 as an Other Asset. The reported present value of this asset as of 9/30/12 was $626,595. Premiums paid during the fiscal year ended 9/30/12 totaled $185,625, which included catch-up payments for the prior year. Included in Mr. Gosline's 2011 deferred compensation in Part VII and Schedule J, Part II, column (C) is $38,742, which represents the net increase as of FYE 9/30/12 in the cash surrender value (CSV) of his split-dollar life insurance policy over amounts previously reported on Form 990. Mr. Gosline was hired in 1999 and the policy was purchased in 2001. This policy is intended to provide an additional retirement benefit for Mr. Gosline's multiple years of service. |
| Part I, Line 7 | MCH compensates physicians utilizing productivity targets based on RVU (relative value units). In addition, the Compensation Committee recommends to the full board annually the variable pay award that may be issued to the Hospital's CEO. The payment of the award is discretionary and is subject to meeting the pre-determined goals of the organization. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| NHBFA Revenue Bonds Series 2009 | |||||||
| 021304598 | 999999DA0 | 2009-08-01 | 9750000 | Funding capital projects | 0 | 0 | 0 |
| NHBFA Revenue Bonds Series 2007 | |||||||
| 021304598 | 64468KBH8 | 2007-10-15 | 20230000 | Advance refunding of the Series 1997 & 2004 revenue bonds & refinance note | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Refunding EscrowRefundingEscrow |
|---|---|---|---|---|---|---|---|---|
| 9750000 | 101086 | 9648914 | 2011 | 0 | 0 | 1 | 1 | |
| 20230000 | 201040 | 4928915 | 2010 | 0 | 1 | 1 | 1 | 15100045 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate | Term Of GICTermOfGIC | Regulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied |
|---|---|---|---|---|---|---|---|
| (no name) | |||||||
| 0 | 1 | 0 | 0 | 0 | 0 | ||
| TRANSAMERICA | |||||||
| 1 | 1 | 0 | 1 | 0 | 0 | 1.166700000000 | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Patti Potter | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Spouse to Trustee | Relationship |
| Amount Of Transaction | 21093 | AmountOfTransaction |
| Description Of Transaction | Mrs. Patti Potter is the spouse of Dr. James Potter, who is a trustee on MCH's Board and listed in Part VII. Mrs. Potter is compensated as an employee of MCH. The W-2 compensation paid is in accordance with MCH'S standard employment practices and policies. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | A draft of the Form 990 is initially reviewed in detail by key finance employees. Thereafter, the final draft is presented to the full board prior to filing with the IRS. Each member of the board is provided with a draft of the Form 990 in advance of the board meeting. | |
| Form 990, Part VI, Section B, line 12c | On an annual basis, the organization provides all administrators/directors/managers, Board members and medical staff members with the Conflict of Interest policy. Said members are required to complete a new Conflict of Interest disclosure on an annual basis. Any conflicts of interest noted are reviewed by the Chair of the Board, in conjunction with the Corporate Compliance Officer. If the conflict of interest appears to meet the policy definitions requiring full Board review, the President of the Board takes this to the full Board meeting, and it is discussed, and appropriate action is taken (in compliance with state and federal requirements). The conflict of interest statement requires signatories to inform the Hospital of any conflict of interest that occurs at any time throughout the year. If a conflict of interest arises during the year, it is reviewed by the Compliance Officer, and if necessary, is taken to the Board President/Board. The Compliance Officer confers with legal counsel with regard to conflicts of interest, if there is any question regarding the potential conflict. | |
| Form 990, Part VI, Section B, line 15 | The organization has a written executive compensation policy and procedure. Under this policy, the Compensation Committee, delegated representatives of the Board of Trustees, has the power and responsibility to determine the Hospital's approach to executive compensation and review the performance of the CEO. The Compensation Committee has the responsibility to set, monitor and review the base salary of the CEO. The Committee maintains minutes of sessions and final recommendations and determinations in accordance with the Board of Trustee guidelines. Annually, market data is reviewed by the Committee to determine the appropriate salary for the Hospital's CEO based upon identified standards. At the end of the time period, the Committee reviews to what extent stated goals were met and recommends an amount for the variable pay award to be approved by the full board. | |
| Form 990, Part VI, Section C, line 19 | Monadnock Community Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of pecuniary benefit transactions that have occurred between MCH and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-A, II(D). Current copies of the Bylaws, Conflict of Interest Policy and Form 990 are on file with the Charitable Trust Unit. | |
| Form 990, Part VII, Section A, Column D | The 2011 compensation reported for Dr. Potter was paid by Monadnock Community Hospital for his services as a part-time physician. Dr. Potter was not compensated for his services as an ex-officio voting member of MCH'S Board of Trustees. | Reportable Compensation for Services as Physician |
| Form 990, Part XI, line 5: | Net unrealized gains on investments: 2,851,431. Change in fair value of interest rate swap agreements -417,265. Total to Form 990, Part XI, Line 5: 2,434,166. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XI, Line 2C | The Audit Committee oversees the audit process for Monadnock Hospital. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for the fiscal years ended 9/30/11 and 9/30/12. | Audit Review Process |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Monadnock Health Services - INACTIVE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 452 Old Street Road | AddressLine1 |
| City | Peterborough | City |
| State | NH | State |
| ZIP Code | 03458 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020420789 | EIN |
| Primary Activities | Inactive | PrimaryActivities |
| Legal Domicile State | NH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11 Type I | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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