MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL (EIN 02-0222156)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-02-06
- IRS object ID
- 201330439349300643
- Schema version
- 2011v1.2
- 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 D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-06T13:42:44-07:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222156 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 6033565461 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 038605001 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Roger Clapp | Name |
| Title | Treasurer | Title |
| Phone | 6033565461 | Phone |
| Date Signed | 2013-01-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Scott McKinnon President and CEO | BusinessNameLine1 |
| Business Name Line2 | Same Address | BusinessNameLine2 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 72775610 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.thememorialhospital.org/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | Memorial Hospital provides Healthcare Services to the residents and visitors of the Mount Washington Valley area of New Hampshire. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 533 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 138066 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 173102 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 66202243 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 68927414 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 405020 | InvestmentIncomePriorYear |
| Investment Income Current Year | 565551 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 418877 | OtherRevenuePriorYear |
| Other Revenue Current Year | 575987 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 67164206 | TotalRevenuePriorYear |
| Total Revenue Current Year | 70242054 | 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 | 26637412 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 27563896 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 863221 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 36881732 | OtherExpensePriorYear |
| Other Expenses Current Year | 40504315 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 63519144 | TotalExpensesPriorYear |
| Total Expenses Current Year | 68068211 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3645062 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2173843 | RevenuesLessExpensesCY |
| Total Assets BOY | 68611842 | TotalAssetsBOY |
| Total Assets EOY | 71845152 | TotalAssetsEOY |
| Total Liabilities BOY | 23662522 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 25192746 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 44949320 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 46652406 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Memorial Hospital provides Healthcare Services to the residents and visitors of the Mount Washington Valley area of New Hampshire. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 57958318 | Expense |
| Grants | 0 | Grants |
| Revenue | 69616690 | Revenue |
| Description | Memorial Hospital provides Healthcare Services to the residents and visitors of the Mount Washington area of New Hampshire. Memorial Hospital is a 25 bed Critical Access Hospital and a 45 bed Intermediate Care Facility (Merriman House). The Hospital provides Med/Surg, ICU, ICF, Obstetrics, Radiology/Imaging, Oncology/Infusion, Cardiac Rehab, Wound Care, Specialty Care, ED and Primary Care. The Hospital had 4,729 Acute Inpatient Days, 15,337 ICF Inpatient Days and 12,584 ED Outpatient Visits in Fiscal Year 2012. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 57958318 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 0 | 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 | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 81 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 533 | 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 | 0 | QuidProQuoContributions |
| 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 | 15 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Vera Schumann SVP-CFO | NamePerson |
| Telephone Number | 6033565461 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mtn Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 038605001 | ZIPCode |
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 | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Gene Bergoffen | ||||||||
| Chairman | 1 | X | X | 0 | 0 | 0 | ||
| Bayard Kennett | ||||||||
| 1st Vice President | 1 | X | X | 0 | 0 | 0 | ||
| Phil Davies | ||||||||
| 2nd Vice President | 1 | X | X | 0 | 0 | 0 | ||
| John Stratton | ||||||||
| Secretary | 1 | X | X | 0 | 0 | 0 | ||
| Roger Clapp | ||||||||
| Treasurer | 1 | X | X | 0 | 0 | 0 | ||
| Daphne Wall | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Melissa Myers | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Janice Crawford | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Barbara Hopkins | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Thaire Bryant | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Laura Jawitz | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| George Epstein | ||||||||
| Board Member | 1 | X | 0 | 0 | 0 | |||
| Scott McKinnon | ||||||||
| President & CEO | 40 | X | X | 288054 | 0 | 34081 | ||
| Raymond Rabideau | ||||||||
| Chief Medical Officer | 40 | X | 1000 | 258729 | 27050 | X | ||
| Allen Stam MD | ||||||||
| Medical Staff President | 40 | X | 158070 | 0 | 23324 | X | ||
| John Newton | ||||||||
| Vice President & CFO | 40 | X | 317879 | 0 | 19384 | |||
| David Riss MD | ||||||||
| Physician | 40 | 3000 | 408034 | 31899 | X | |||
| Douglas Taylor MD | ||||||||
| Physician | 40 | 4000 | 484609 | 27050 | X | |||
| Morice Dennery MD | ||||||||
| Physician | 40 | 0 | 555575 | 34400 | X | |||
| Victor Lazaron MD | ||||||||
| Physician | 40 | 4000 | 419163 | 43500 | X | |||
| Robert Tilney MD | ||||||||
| Physician | 40 | 3000 | 419181 | 32033 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 779003 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2545291 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 272721 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | 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 |
|---|---|---|---|---|---|
| MWV Healthcare Assoc Inc | |||||
| PO Box 2540 | North Conway | NH | 03860 | Physician Services | 8135142 |
| Glen Builders Inc | |||||
| PO Box 1880 | North Conway | NH | 03860 | Building Contractor | 358860 |
| NORDX | |||||
| 102 Campus Drive | Scarborough | ME | 04074 | Lab Services | 288344 |
| Burgess Advertising & Marketing | |||||
| 1290 Congress St | Portland | ME | 04102 | Advertising & Marketing | 222333 |
| Navix Diagnostics | |||||
| PO Box 3698 | Boston | MA | 02241 | Nuclear Imaging Services | 142476 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 40995 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 132107 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 173102 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Hospital Services | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 68927414 | TotalRevenueColumn |
| Related Or Exempt Function Income | 68927414 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 68927414 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 120609 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $120,609 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 114732 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 228021 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -113289 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -113289 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | -$113,289 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2724199 | Securities |
| Other | 0 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2279257 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 444942 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 444942 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $444,942 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 26278 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 40995 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 26278 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 0 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 0 | GrossSalesOfInventory |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Employee Prescriptions | 446110 | 45622 | 45622 | 0 | $0 |
| Cafeteria & Vending | 722210 | 226182 | 226182 | 0 | $0 |
| Community Health Staff Support | 621300 | 153350 | 153350 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 264122 | TotalRevenueColumn |
| Related Or Exempt Function Income | 264122 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 689276 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 70242054 | TotalRevenueColumn |
| Related Or Exempt Function Income | 69616690 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $452,262 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1004497 | Total |
| Program Services | 219451 | ProgramServices |
| Management And General | 785046 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18194121 | Total |
| Program Services | 14402543 | ProgramServices |
| Management And General | 3575091 | ManagementAndGeneral |
| Fundraising | 216487 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380277 | Total |
| Program Services | 301029 | ProgramServices |
| Management And General | 74723 | ManagementAndGeneral |
| Fundraising | 4525 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6626560 | Total |
| Program Services | 5242105 | ProgramServices |
| Management And General | 1305660 | ManagementAndGeneral |
| Fundraising | 78795 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1358441 | Total |
| Program Services | 1055913 | ProgramServices |
| Management And General | 286457 | ManagementAndGeneral |
| Fundraising | 16071 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146069 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 146069 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102617 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 102617 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28105 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 28105 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10512004 | Total |
| Program Services | 10391181 | ProgramServices |
| Management And General | 120823 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9012 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 9012 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1374248 | Total |
| Program Services | 25043 | ProgramServices |
| Management And General | 844724 | ManagementAndGeneral |
| Fundraising | 504481 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259015 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 259015 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3430688 | Total |
| Program Services | 2943151 | ProgramServices |
| Management And General | 461869 | ManagementAndGeneral |
| Fundraising | 25668 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116202 | Total |
| Program Services | 82307 | ProgramServices |
| Management And General | 33491 | ManagementAndGeneral |
| Fundraising | 404 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10901 | Total |
| Program Services | 10901 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3585837 | Total |
| Program Services | 3127811 | ProgramServices |
| Management And General | 441236 | ManagementAndGeneral |
| Fundraising | 16790 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 772734 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 772734 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Medical Supplies | 9083427 | 9083427 | 0 | 0 |
| Bad Debt | 6428589 | 6428589 | 0 | 0 |
| Medicaid Enhancement Tax | 2813347 | 2813347 | 0 | 0 |
| Equipment Lease & Maintenance | 1073022 | 1073022 | 0 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 758498 | Total |
| Program Services | 758498 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68068211 | Total |
| Program Services | 57958318 | ProgramServices |
| Management And General | 9246672 | ManagementAndGeneral |
| Fundraising | 863221 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9680140 | BOY |
| EOY | 11668040 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10086647 | BOY |
| EOY | 9569980 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7676147 | BOY |
| EOY | 7338200 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1895249 | BOY |
| EOY | 1906329 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105102 | BOY |
| EOY | 23319 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 61863376 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 33289841 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30897841 | BOY |
| EOY | 28573535 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7599753 | BOY |
| EOY | 8348027 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385565 | BOY |
| EOY | 366950 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 285398 | BOY |
| EOY | 4050772 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68611842 | BOY |
| EOY | 71845152 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3388295 | BOY |
| EOY | 4082435 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19513257 | BOY |
| EOY | 19106647 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 760970 | BOY |
| EOY | 542664 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1461000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23662522 | BOY |
| EOY | 25192746 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44053700 | BOY |
| EOY | 45694398 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 282257 | BOY |
| EOY | 344645 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 613363 | BOY |
| EOY | 613363 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44949320 | BOY |
| EOY | 46652406 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68611842 | BOY |
| EOY | 71845152 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2173843 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -470757 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6639144 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 100888 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 6740032 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3575593 | BeginningOfYearBalance |
| Contributions | 2400000 | Contributions |
| Investment Earnings Or Losses | 663551 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 6639144 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3311669 | BeginningOfYearBalance |
| Contributions | 0 | Contributions |
| Investment Earnings Or Losses | 263924 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 3575593 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3205137 | BeginningOfYearBalance |
| Contributions | 640000 | Contributions |
| Investment Earnings Or Losses | -533468 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 0 | GrantsOrScholarships |
| Other Expenditures | 0 | OtherExpenditures |
| Administrative Expenses | 0 | AdministrativeExpenses |
| End Of Year Balance | 3311669 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.89 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.09 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.02 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 598483 | OtherCostOrOtherBasis |
| Book Value | 598483 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 43263018 | OtherCostOrOtherBasis |
| Depreciation | 21194315 | Depreciation |
| Book Value | 22068703 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 16224442 | OtherCostOrOtherBasis |
| Depreciation | 10867594 | Depreciation |
| Book Value | 5356848 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1777433 | OtherCostOrOtherBasis |
| Depreciation | 1227932 | Depreciation |
| Book Value | 549501 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28573535 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Est Third Party Settlement and Other Assets | Description |
| Book Value | 4050772 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4050772 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Contigent Liabilities | Description |
| Amount | $1,461,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1461000 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchD_P05_S00_L04 | Identifier |
| Return Reference | Schedule D, Part V, Line 4 | ReturnReference |
| Explanation | The Endowment Fund contains permanently restricted funds with income available for general purposes. Also a portion of the earnings are to be used to assist patients with free care. The remainder of the fund is board designated. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Annual Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 67273 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 40995 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 26278 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 0 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 21006 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 0 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 0 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 5272 | OtherDirectExpensesEvent1 |
| Food And Beverage Other Events | 0 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Gross Receipts Total | 67273 | GrossReceiptsTotal |
| Charitable Contributions Total | 40995 | CharitableContributionsTotal |
| Gross Revenue Total Events | 26278 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 0 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 0 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 21006 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 0 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 0 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 5272 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 26278 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 2.5 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 3425875 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1660729 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1765146 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0287 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 7581943 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6385023 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1196920 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0195 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 11007818 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8045752 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2962066 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0482 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 305543 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 304043 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.005 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 6000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00001 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 311543 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 310043 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00501 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 11319361 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8047252 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3272109 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05321 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,433,597 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15654939 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16890626 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1235687 | 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 | Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mountain Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | 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 | Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 250 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 1 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | Ratio of Patient Care Cost to Charges was used to calculate cost. |
| SchH_P01_S00_L072f | Schedule H, Part I, Line 7, Column f | The amount of Bad Debt excluded from the calculation was $6,390,466. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | FOOTNOTE 1-RECENT ACCOUNTING PRONOUNCEMENTS In July 2011, the FASB issued new guidance, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts. The guidance requires certain healthcare entities to present in certain circumstances the bad debt expense associated with patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) rather than operating expense. The guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2011, with early adoption permitted. The Hospital will adopt the presentation changes to the statement of operations in fiscal 2013. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | The as filed Medicare cost report was used to extract cost for Part A and Part B hospital services. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | With the exception of insurance coverage the collection activity shall not be initiated or pursued for any amount approved under the Memorial Hospital Healthcare Assistance Program. |
| SchH_P05_S0B_L03 | Schedule H, Part V, Section B, Line 3 | A community needs assessment survey was used to elicit community input and information. The Needs Assessment survey was distributed in the June 9, 2010 edition of the Conway Daily Sun and reached out to over 16,000 people in New Hampshire and Maine. An additional 2,000 copies were made available to and distributed by the members of the MWV community collaborative. In addition, the Gibson Center for Senior Services and the Mount Washington Valley Chamber of Commerce circulated the survey to their members. The survey resulted in 592 responses. |
| SchH_P05_S0B_L11 | Schedule H, Part V, Section B, Line 11 | 1) Documentation in the case of a civil union to determine household size. 2) Applicants that have Healthcare Savings Accounts must provide proof that the HSA has been spent down prior to applying for Healthcare Assistance. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | The MWV Community Healthcare Collaborative formed to cooperatively search for solutions to local health needs. In January 2010 they began a Community Needs Assessment. The Six Step Community Needs Assesssment Process developed by the Association of Community Health Improvement was utilized as the core framework for the project. The Assessment was completed in the fall of 2010. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | The Hospital utilizes several methods for communicating and educating patients regarding financial assistance with their hospital bills. At our registration and credit and collections offices it is visible to all with handouts. Our website includes information regarding the Healthcare Assistance Program. Hospital bills with a patient liability include information regarding the availability of financial assistance. Also the State Hospital Association website has links to various programs. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | The hospital serves the northern part of Carroll County in New Hampshire and the western portion of Oxford County in Maine. The Mount Washington Valley is a four season destination resort area and serves the tourists that frequent the area. |
| SchH_P06_S00_L07 | Schedule H, Part VI, Line 7 | The Hospital files an annual report with the State of New Hampshire. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Scott McKinnon | |||||||||||||
| 222648 | 0 | 55000 | 0 | 10406 | 0 | 7031 | 0 | 27050 | 0 | 322135 | 0 | 279036 | 0 |
| John Newton | |||||||||||||
| 298750 | 0 | 20000 | 0 | -871 | 0 | 0 | 0 | 19384 | 0 | 337263 | 0 | 387222 | 0 |
| Raymond Rabideau | |||||||||||||
| 0 | 222019 | 0 | 30000 | 1000 | 6710 | 0 | 0 | 0 | 27050 | 1000 | 285779 | 4900 | 304106 |
| Allen Stam MD | |||||||||||||
| 106882 | 0 | 0 | 0 | 51196 | 0 | 3866 | 0 | 19458 | 0 | 181402 | 0 | 214877 | 0 |
| Morice Dennery MD | |||||||||||||
| 0 | 539075 | 0 | 0 | 0 | 16500 | 0 | 7350 | 0 | 27050 | 0 | 589975 | 0 | 482472 |
| Douglas Taylor MD | |||||||||||||
| 0 | 462609 | 0 | 0 | 4000 | 22000 | 0 | 0 | 0 | 27050 | 4000 | 511659 | 4000 | 446149 |
| Victor Lazaron MD | |||||||||||||
| 0 | 407663 | 0 | 0 | 4000 | 11500 | 0 | 16500 | 0 | 27050 | 4000 | 462713 | 4000 | 445250 |
| Robert Tilney MD | |||||||||||||
| 0 | 397181 | 0 | 0 | 3000 | 22000 | 0 | 12575 | 0 | 19458 | 3000 | 451214 | 0 | 430064 |
| David Riss MD | |||||||||||||
| 0 | 386034 | 0 | 0 | 3000 | 22000 | 0 | 12441 | 0 | 19458 | 3000 | 439933 | 3000 | 379276 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchJ_P01_S00_L05 | Schedule J, Part I, Line 5 | A portion of the CEO and CMO compensation was based on achieving certain organizational goals including financial goals related to meeting target operational margin. |
| SchJ_P01_S00_L06 | Schedule J, Part I, Line 6 | A portion of the CEO and CMO compensation was based partially on achieving certain organizational goals including financial goals related to meeting target operating margin. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NH Health & Education Facilities Authority | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 020279866 | IssuerEIN |
| CUSIP Number | 644614QC6 | CUSIPNumber |
| Date Issued | 2006-06-14 | DateIssued |
| Issue Price | 21069204 | IssuePrice |
| Description Of Purpose | To Construct & Renovate Hospital Facility & Payoff Existing Debt | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 1848353 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 20955000 | TotalProceeds |
| Amount In Reserve Fund | 1725373 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 0 | RefundingEscrow |
| Issuance Costs From Proceeds | 324775 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 20630225 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P03_S00_L02 | Form 990, Part III, Line 2 | Memorial Hospital opened a Wound Care Clinic in FY 12 offering a new service to North Conway and surrounding area residents. |
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | The sole member of The Memorial Hospital is the Memorial Development Foundation. |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | The sole member of The Memorial Development Foundation ratifies the appointments to the Board of Trustees of The Memorial Hospital |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | The form 990 was provided to the Finance Committee and the full Board of Trustees. It was reviewed by the Finance Committee on January 15, 2013. It was then forwarded to the full Board of Trustees on January 16, 2013 for approval before the Executive Committee on February 6, 2013. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Confilct of Interest declaration forms are submitted annually in January by members of the Board of Trustees and are shared with the full board for information purposes and reviewed in depth by the Governance Committee. It is the members responsibility to notify the board should any conflict arise in between signing and of all members of the board to immediately raise any conflicts that they become aware of and the Board member with a conflict will recuse themselves from discussions and votes on the issue. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | The Compensation Committee of the board conducts the CEO evaluation and compensation process. The CEO's performance is reviewed against targets set for the year and his semi annual bonus determination. The CEO compensation is compared to the Sullivan Cotter and Associates information and periodically reviewed by our compensation consultant. No one with a conflict of interest relative to the hospital is involved in these discussions and minutes are recorded by the Secretary of the Board. Determining compensation for other officers and key employees included reference to professional association compensation data for comparable organizations and position scope. Compensation was reviewed and approved by the CEO and/or the Executive Committee of the Board of Trustees acting as the Compensation Committee. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The Memorial Hospital will make copies of such documents available to the general public upon request. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | Unrealized Gains on investments carried at Market Value. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Memorial Development Foundation | ||||||||||
| PO Box 5001 | North Conway | NH | 03860 | 223160795 | Coordinate healthcare | NH | 501(c)(3) | 509(a)(3) Type 1 | N/A | |
| VN & HCS of Northern Carroll Cty | ||||||||||
| PO Box 432 | North Conway | NH | 03860 | 020311473 | Visiting Nurse & Hospice Services | NH | 501(c)(3) | 9 | N/A | 0 |
| White Mountain Community Health | ||||||||||
| PO Box 2800 | Conway | NH | 03818 | 020358715 | Community Health Center | NH | 501(c)(3) | 9 | N/A | 0 |
| Carroll County Health & Home Care Services Inc | ||||||||||
| PO Box 420 | Chocorua | NH | 03817 | 237337000 | Home Care Services | NH | 501(c)(3) | 7 | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MWV Healthcare Assoc Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2540 | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020477066 | EIN |
| Primary Activity | Contract with Healthcare Professionals & Retail Pharmacy | PrimaryActivity |
| Legal Domicile State | NH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 100 | ShareOfTotalIncome |
| Share Of EOY Assets | -18615 | ShareOfEOYAssets |
| Percentage Ownership | 0 | PercentageOwnership |
| 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 | 1 | 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 | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| MWV Healthcare Assoc Inc | |
| o | 8360207 |
| White Mountain Community Health | |
| i | 59004 |
| White Mountain Community Health | |
| p | 90324 |
| White Mountain Community Health | |
| o | 60800 |
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