SPEARE MEMORIAL HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SPEARE MEMORIAL HOSPITAL (EIN 02-0226774)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-07
IRS object ID
201220989349300102
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-07T10:28:52-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line119 MORGAN DRIVEAddressLine1
CityLEBANONCity
StateNHState
ZIP Code03766ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN020226774EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameMICHELLE MCEWENName
TitlePRESIDENT/CEOTitle
Phone6035361120Phone
Date Signed2012-03-19DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameW JAY SIMMSName
Phone6036530044Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line116 HOSPITAL ROADAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
Gross Receipts53086318GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteSPEAREHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1899YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE INPATIENT, OUTPATIENT AND PHYSICIAN HEALTH CARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees461TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year178498ContributionsGrantsPriorYear
Contributions Grants Current Year164713ContributionsGrantsCurrentYear
Program Service Revenue Prior Year46319533ProgramServiceRevenuePriorYear
Program Service Revenue CY50484604ProgramServiceRevenueCY
Investment Income Prior Year418915InvestmentIncomePriorYear
Investment Income Current Year89775InvestmentIncomeCurrentYear
Other Revenue Prior Year371777OtherRevenuePriorYear
Other Revenue Current Year398985OtherRevenueCurrentYear
Total Revenue Prior Year47288723TotalRevenuePriorYear
Total Revenue Current Year51138077TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year310000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY310000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year21156458SalariesEtcPriorYear
Salaries Etc Current Year22144814SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year133722TotalFundrsngExpCurrentYear
Other Expense Prior Year26462902OtherExpensePriorYear
Other Expenses Current Year27686727OtherExpensesCurrentYear
Total Expenses Prior Year47929360TotalExpensesPriorYear
Total Expenses Current Year50141541TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-640637RevenuesLessExpensesPriorYear
Revenues Less Expenses CY996536RevenuesLessExpensesCY
Total Assets BOY55545738TotalAssetsBOY
Total Assets EOY59183953TotalAssetsEOY
Total Liabilities BOY24116856TotalLiabilitiesBOY
Total Liabilities EOY25075585TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY31428882NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY34108368NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO MAINTAIN A HOSPITAL AND OTHER SUCH INSTITUTIONS WITHIN THE STATE OF NEW HAMPSHIRE, WITH FACILITIES THAT INCLUDE MEDICAL SERVICES TO PROVIDE FOR THE DIAGNOSIS AND TREATMENT OF PATIENTS THAT MAY REQUIRE INPATIENT, OUTPATIENT, EMERGENCY CARE AND OTHER PURSUITS DESIGNED TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. SMH DOES NOT DISCRIMINATE RELATIVE TO RACE, RELIGION OR NATIONAL ORIGIN, ABILITY TO PAY AND WILL ASSURE THAT ALL PATIENTS RECEIVE THE SAME LEVEL OF CARE THROUGH QUALITY ASSESSMENT MONITORING AND IMPROVEMENT ACTIVITIES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense45521428Expense
Grants310000Grants
Revenue50484604Revenue
DescriptionSMH IS A 25-BED ACUTE-CARE HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES TO THE SURROUNDING COMMUNITY.Description
Total Program Service Expense45521428TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art1DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees461NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KATHLEEN BERIAU-DIRECTOR OF FINANCEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6032382160TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1SPEARE MEMORIAL HOSPITALAddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
MICHELLE MCEWEN
HOSPITAL PRESIDENT/CEO40.00XX201999041984
COLLEEN BRICKLEY
CHAIR1.00XX000
BRIAN CHALMERS
TREASURER1.00XX000
ELDWIN WIXSON
MEMBER1.00X000
SUSAN KARKHECK
SECRETARY1.00XX000
STANLEY LEE FREEMAN
AST. TREASURER1.00XX000
QUENTIN BLAINE
MEMBER1.00X000
CLINT HUTCHINS
MEMBER1.00X000
WILLIAM LARSEN
VICE CHAIR1.00XX000
ALISON RITZ
MEMBER1.00X000
DAVID TALBOT
MEMBER1.00X000
RONALD SIBLEY
MEMBER1.00X000
LINDA CRAWFORD MD
MEMBER1.00X000
STEVE TAKSAR
MEMBER1.00X000
RICHARD F WERKOWSKI
CFO40.00X122289015233
TIMOTHY LYONS MD
PHYSICIAN40.00307835037488X
MICHAEL P GIOVAN MD
PHYSICIAN40.00420935060140X
CLIFFORD A CHAPIN
PHYSICIAN40.00315264037244X
VICTOR GENNARO MD
PHYSICIAN40.00400721060101X
JOSEPH CASEY
PHYSICIAN40.00315893051070X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2084936TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation303260TotalOtherCompensation
Number Individuals GT100 K27NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HARVEY CONSTRUCTION CORP OF NHBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110 HARVEY ROADAddressLine1
CityBEDFORDCity
StateNHState
ZIP Code03110ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONSTRUCTIONDescriptionOfServices
Compensation735952Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events2045FundraisingEvents
All Other Contributions162668AllOtherContributions
Noncash Contributions67183NoncashContributions
Total Contributions164713TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6241004978690449786904
OTHER OPERATING REVENU900099697700697700
FieldValueIRS element (for citing)
Total Program Service Revenue50484604TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column358386TotalRevenueColumn
Exclusion$358,386ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real35718Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real35718Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column35718TotalRevenueColumn
Exclusion$35,718ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1663588Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1519474Securities
Other412725Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities144114Securities
Other-412725Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-268611TotalRevenueColumn
Exclusion-$268,611ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events36260GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events2045CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses16042FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column20218TotalRevenueColumn
Exclusion$20,218ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PHARMACY INCOME446110211280$211,280
CAFETERIA INCOME722210131594$131,594
GIFT COUNTER INCOME453220175$175
FieldValueIRS element (for citing)
Total Other Revenue343049TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column51138077TotalRevenueColumn
Related Or Exempt Function Income50484604RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$488,760ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total310000Total
Program Services310000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total409570Total
Management And General409570ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15482728Total
Program Services13233477ProgramServices
Management And General2183480ManagementAndGeneral
Fundraising65771Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1172908Total
Program Services1004395ProgramServices
Management And General163521ManagementAndGeneral
Fundraising4992Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3790985Total
Program Services3191598ProgramServices
Management And General583525ManagementAndGeneral
Fundraising15862Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1288623Total
Program Services1076899ProgramServices
Management And General206372ManagementAndGeneral
Fundraising5352Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total58644Total
Management And General58644ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total28250Total
Management And General28250ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total63474Total
Management And General63474ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total100091Total
Program Services100091ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4482461Total
Program Services4383941ProgramServices
Management And General61907ManagementAndGeneral
Fundraising36613Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1251217Total
Program Services1175872ProgramServices
Management And General75345ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total100942Total
Program Services80445ProgramServices
Management And General17649ManagementAndGeneral
Fundraising2848Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total8971Total
Program Services8971ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total955201Total
Program Services955201ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2700745Total
Program Services2700745ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT44547014454701
PHYSICIAN FEES & WAGES43008684300868
PURCHASED SERVICES39236653853296688251544
PROVIDER TAX STATE OF N21038632103863
COST OF DRUGS20030942003094

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1150540Total
Program Services583971ProgramServices
Management And General565829ManagementAndGeneral
Fundraising740Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total50141541Total
Program Services45521428ProgramServices
Management And General4486391ManagementAndGeneral
Fundraising133722Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4078242BOY
EOY4967151EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY9402BOY
EOY2000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5923440BOY
EOY7123855EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2590151BOY
EOY2427998EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY717164BOY
EOY777014EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY408230BOY
EOY363056EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis45111802LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19555429LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25858278BOY
EOY25556373EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY11660773BOY
EOY12959711EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3221560BOY
EOY2826829EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY1032407EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1078498BOY
EOY1147559EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY55545738BOY
EOY59183953EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2782948BOY
EOY2397560EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY16815000BOY
EOY16544082EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1221045BOY
EOY920466EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3297863BOY
EOY5213477EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY24116856BOY
EOY25075585EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY30908631BOY
EOY33608916EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY279026BOY
EOY233320EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY241225BOY
EOY266132EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY31428882BOY
EOY34108368EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY55545738BOY
EOY59183953EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses996536ReconcilationRevenueExpenses
Reconcilation Other Changes1682950ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$9,153OtherActivitiesAmount
Total Lobbying Expenditures IIB9153TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance137808BeginningOfYearBalance
Contributions40000Contributions
Investment Earnings Or Losses45536InvestmentEarningsOrLosses
End Of Year Balance223344EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.98200PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.01800TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis564517OtherCostOrOtherBasis
Book Value564517BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis27758685OtherCostOrOtherBasis
Depreciation9075523Depreciation
Book Value18683162BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis924617OtherCostOrOtherBasis
Depreciation373150Depreciation
Book Value551467BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis15782622OtherCostOrOtherBasis
Depreciation10106756Depreciation
Book Value5675866BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis81361OtherCostOrOtherBasis
Book Value81361BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings25556373TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
OTHER CURRENT LIABILITIES$2,459,349
EST. THIRD-PARTY PAYER SETTLEMENTS$1,798,406
RELATED PARTY NOTE PAYABLE$335,426
INVESTMENT IN SUB-BOULDER$620,296
FieldValueIRS element (for citing)
Total Of Amounts5213477TotalOfAmounts
Total Revenue51138077TotalRevenue
Total Expenses50141541TotalExpenses
Excess Or Deficit For Year996536ExcessOrDeficitForYear
Net Unrealized GL On Investments1725987NetUnrealizedGLOnInvestments
Other-$43,037OtherAmount
Total Adjustments1682950TotalAdjustments
Excess Or Deficit Per FS2679486ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt46429412TotRevenueEtcAuditedFinclStmt
Other Revenues-4445551OtherRevenues
Revenue Not Rptd F990-4445551RevenueNotRptdF990
Revenue Subtotal50874963RevenueSubtotal
Investment Expenses Not Included63474InvestmentExpensesNotIncluded
Other Revenues Not Included199640OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt263114RevenueNotRptdOnFinStmt
Total Revenue Per Form99051138077TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt45313366TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal45313366ExpensesSubtotal
Investment Expenses Not Included263474InvestmentExpensesNotIncluded2
Other Expenses Not Included4764701OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt4828175ExpensesNotRptdOnFinStmt
Total Expenses Per Form99050141541TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ENDOWMENT FUND IS USED TO SUPPORT OPERATIONS OF THE HOSPITAL.
PART XI, LINE 8 - OTHER ADJUSTMENTS:BAD DEBT EXPENSE ON MSHC RECEIVABLE 110,360. RESTRICTED CONTRIBUTIONS 32,500. RESTRICTED PLEDGE LOSS -3,734. PRIOR PERIOD RECLASSIFICATION -182,163.
PART XII, LINE 2D - OTHER ADJUSTMENTS:NET ASSETS RELEASED FROM RESTRICTIONS 9,150. BAD DEBT EXPENSE -4,454,701.
PART XII, LINE 4B - OTHER ADJUSTMENTS:GRANT EXPENSE 310,000. BAD DEBT EXPENSE ON MSHC RECEIVABLE -110,360.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:GRANT EXPENSE 310,000. BAD DEBT EXPENSE 4,454,701.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event136260GrossReceiptsEvent1
Charitable Contributions Event12045CharitableContributionsEvent1
Gross Revenue Event134215GrossRevenueEvent1
Cash Prizes Event1690CashPrizesEvent1
Rent Facility Costs Event111904RentFacilityCostsEvent1
Other Direct Expenses Event13244OtherDirectExpensesEvent1
Gross Receipts Total36260GrossReceiptsTotal
Charitable Contributions Total2045CharitableContributionsTotal
Gross Revenue Total Events34215GrossRevenueTotalEvents
Cash Prizes Total Events690CashPrizesTotalEvents
Rent Facility Costs Total Events11904RentFacilityCostsTotalEvents
Other Direct Expenses Total Events3244OtherDirectExpensesTotalEvents
Direct Expense Summary Events15838DirectExpenseSummaryEvents
Net Income Summary18377NetIncomeSummary

Schedule H IRS990ScheduleH

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

Other Percentage OtherPercentage

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

Discounted Other DiscountedOther

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

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3014798TotalCommunityBenefitExpense
Direct Offsetting Revenue2007527DirectOffsettingRevenue
Net Community Benefit Expense1007271NetCommunityBenefitExpense
Percent Of Total Expense0.02010PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4411604TotalCommunityBenefitExpense
Direct Offsetting Revenue2731057DirectOffsettingRevenue
Net Community Benefit Expense1680547NetCommunityBenefitExpense
Percent Of Total Expense0.03350PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense105071TotalCommunityBenefitExpense
Net Community Benefit Expense105071NetCommunityBenefitExpense
Percent Of Total Expense0.00210PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7531473TotalCommunityBenefitExpense
Direct Offsetting Revenue4738584DirectOffsettingRevenue
Net Community Benefit Expense2792889NetCommunityBenefitExpense
Percent Of Total Expense0.05570PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense610574TotalCommunityBenefitExpense
Net Community Benefit Expense610574NetCommunityBenefitExpense
Percent Of Total Expense0.01220PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense358800TotalCommunityBenefitExpense
Net Community Benefit Expense358800NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense348973TotalCommunityBenefitExpense
Net Community Benefit Expense348973NetCommunityBenefitExpense
Percent Of Total Expense0.00700PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1318347TotalCommunityBenefitExpense
Net Community Benefit Expense1318347NetCommunityBenefitExpense
Percent Of Total Expense0.02640PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8849820TotalCommunityBenefitExpense
Direct Offsetting Revenue4738584DirectOffsettingRevenue
Net Community Benefit Expense4111236NetCommunityBenefitExpense
Percent Of Total Expense0.08210PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,316,445BadDebtExpenseAmount
Amount Attributable To74126AmountAttributableTo
Amount Reimbursed By Medicare16445343AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16213777CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall231566MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL HOSPITALBusinessNameLine1

Address Address

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SPEARE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted10NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed1AllNeedsAddressed
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent100.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART III, LINE 4: SMH HAS NO APPROPRIATE FOOTNOTE IN THE APPLICABLE AUDITED FINANCIAL STATEMENT. THE HOSPITAL USED 2.2% (DETERMINED FOR SMALL CRITICAL ACCESS HOPSITALS), WHICH WAS GIVEN IN THE AHA SCHEDULE H PROJECT BENCHMARK REPORT FOR ITS RATIONALE TO ESTIMATE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO ELIGIBLE PATIENTS UNDER THE HOSPITAL'S CHARITY CARE POLICY. SMH HAS USED A RATIO OF COSTS TO CHARGES OF 52% IN DETERMINING THE COST OF BAD DEBT EXPENSE.
PART III, LINE 8: 100% OF THE SHORTFALL FROM MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THE SOURCE USED TO DETERMINE THIS AMOUNT IS THE MEDICARE CHARGES LESS THE MEDICARE PAYMENTS MADE TO SPEARE MEMORIAL HOSPITAL. SERVICES THAT INCUR SUCH COSTS ARE PROVIDED BY THE HOSPITAL TO PROMOTE THE WELL-BEING OF THE COMMUNITY. THE SERVICES ARE RENDERED IN CONJUNCTION WITH THE HOSPITAL'S CHARITABLE TAX EXEMPT PURPOSE. TREATING THE SHORTFALL AS A COMMUNITY BENEFIT RELIEVES THE BURDEN ON LOCAL SOCIAL SERVICES AND GOVERNMENT SUPPORTED PROGRAMS.
PART III, LINE 9B: SPEARE MEMORIAL HOSPITAL HAS BOTH A COLLECTIONS POLICY, AND A CHARITY CARE POLICY THAT DESCRIBES CHARITY ELIGIBILITY AND THE STEPS TO BE COMPLETED BEFORE A PATIENT'S ACCOUNT IS WRITTEN OFF TO BAD DEBT.
PART V, SECTION B, LINE 1J: SPEARE MEMORIAL HOSPITAL CONDUCTED A COMMUNITY WIDE PUBLIC PRESENTATION OF THE NEEDS ASSESSMENT REPORT IN OCTOBER 2011.SPEARE MEMORIAL HOSPITAL
PART VI, LINE 2: INFORMATION GATHERING THROUGH SURVEYS, FOCUS GROUPS, COMMUNITY REPRESENTATION, PUBLIC FORUMS, INPUT FROM HEALTH CARE PROVIDERS, INDUSTRY LEADERS, OUTSIDE CONSULTANTS,AND ANALYSIS OF INTERNAL DATA AND EXTERNAL DATA PROVIDED BY HOSPITAL ASSOCIATIONS, PAYERS, ETC.
PART VI, LINE 3: PATIENTS ARE EDUCATED AT TIME OF REGISTRATION OR THROUGH EDUCATIONAL MATERIALS THAT ARE DISTRIBUTED THROUGH THE HOSPITAL'S WEBSITE OR BY COMMUNITY OUTREACH. SPEARE MEMORIAL HOSPITAL IS A MEMBER OF A STATE-WIDE COMMUNITY HEALTH NETWORK THAT PROVIDES ASSISTANCE, SUPPORT,AND EDUCATION RELATING TO ELIGIBILITY ASSISTANCE.
PART VI, LINE 4: SPEARE MEMORIAL HOSPITAL IS LOCATED IN THE MOUNTAIN AND LAKES REGION OF NEW HAMPSHIRE AND PRIMARLY SERVES CONSTITUENTS IN GRAFTON COUNTY. GRAFTON COUNTY POPULATION SIZE IS APPROXIMATELY 86,000 WITHIN ITS 40 DISTINCT MUNICIPALITIES. ITS SERVICE AREA INCLUDES 17 TOWNS WITH AN APPROXIMATE TOTAL POPULATION OF 30,000.
PART VI, LINE 6: SPEARE MEMORIAL HOSPITAL PROVIDES PRESCRIPTION MEDICATION ASSISTANCE, PRIMARY-CARE CLINCS, MULTIPLE SUPPORT GROUPS, COMMUNITY EDUCATION PROGRAMS, SCHOOL DENTAL PROGRAM, ETC. AND HAS AFFLIATIONS AND PARTNERSHIPS WITH MANY COMMUNITY ORGANIZATIONS; AN OPEN MEDICAL STAFF AND COMMUNITY BOARD. OPERATING FUNDS ARE USED FOR ONGOING CAPITAL EXPENDITURES.
NHREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

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

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 BOULDER POINT DRIVE NO 1AddressLine1
CityPLYMOUTHCity
StateNHState
ZIP Code03264ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient020487172EINOfRecipient
IRC Section501 (C)(3)IRCSection
Amount Of Cash Grant310000AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation
Purpose Of GrantCOMMUNITY BENEFIT GRANTPurposeOfGrant

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHELLE MCEWEN
20199900000191510228330243983000
TIMOTHY LYONS MD
30783500000140790234090345323000
MICHAEL P GIOVAN MD
42093500000367310234090481075000
CLIFFORD A CHAPIN
31526400000140260232180352508000
VICTOR GENNARO MD
40072100000366920234090460822000
JOSEPH CASEY
31589300000282910227790366963000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY
02027986664461TCH52004-11-0113520000CONSTRUCTION AND RENOVATION PROJECT000
NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY
02027986664461TCH52010-05-194000000CONSTRUCTION AND RENOVATION PROJECT000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
135200009781813187681320123220070011
400000058963394103720100011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
100000
000000

Schedule M IRS990ScheduleM

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99067183NoncashContribsRptdF990
Method Of Determining RevenuesFMV- APPRAISALMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used1ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2THE COMMUNITY RELATIONS DIRECTOR IS THE SPOUSE OF A BOARD MEMBER.
FORM 990, PART VI, SECTION A, LINE 3THE REHABILITATION DEPARTMENT IS NOW MANAGED BY ORTHOPEDIC HEALTH SERVICES. INC.
FORM 990, PART VI, SECTION A, LINE 6THE PROVISIONS OF SMH GOVERNING DOCUMENTS PROVIDES THE BOARD OF DIRECTORS IS COMPRISED OF ASSOCIATION MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7ATHE ASSOCIATION MEMBERS ELECT THE BOARD MEMBERS
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED BY THE HOSPITAL CFO, THE PRESIDENT/CEO, AND THE FINANCE COMMITTEE WITH A REPORT TO THE FULL BOARD OF DIRECTORS. THE FORM 990 IS THEN SIGNED AND FILED.
ANNUAL COMPLIANCE FORM COMPLETED BY EACH MEMBER OF THE BOARDFORM 990, PART VI, SECTION B, LINE 12C
COMPENSATION FOR THE CEO IS DETERMINED VIA A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, COMPARISON OF OTHER ORGANIZATIONS 990 INFORMATION, BOARD APPROVAL AND WRITTEN EMPLOYMENT CONTACT.FORM 990, PART VI, SECTION B, LINE 15A
UPON REQUESTFORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 1,725,987. BAD DEBT EXPENSE ON MSHC RECEIVABLE 110,360. RESTRICTED CONTRIBUTIONS 32,500. RESTRICTED PLEDGE LOSS -3,734. PRIOR PERIOD RECLASSIFICATION -182,163. TOTAL TO FORM 990, PART XI, LINE 5: 1,682,950.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

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

Address US AddressUS

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

Direct Controlling Entity Name DirectControllingEntityName

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

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
SPEARE HEALTH VENTURE
16 HOSPITAL ROADPLYMOUTHNH03264020366565HEALTHCARE SERVICESNHC49042399951.00000
SPEARE HEALTH NETWORK LLC
16 HOSPITAL ROADPLYMOUTHNH03264043372339PHYSICIAN/HOSPITAL ORGANIZATIONNHC743263440.50000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SPEARE MEMORIAL AT BOULDER POINT-LEASES ALL OF ITS SPACE TO SMH
J693188ACTUAL
SPEARE HEALTH VENTURE
D215673FAIR MARKET VALUE
SPEARE MEMORIAL AT BOULDER POINT
D2040520FAIR MARKET VALUE
SPEARE MEMORIAL AT BOULDER POINT
P8550ACTUAL
SSPEAR MEMORIAL AT BOULDER POINT
E335426FAIR MARKET VALUE

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