MEMORIAL HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL (EIN 02-0222156)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-01-21
- IRS object ID
- 201100219349300010
- Schema version
- 2009v1.2
- 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 B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-01-21T09:32:05-07:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | 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 | 2011-01-21 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Scott Mckinnon | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3073 White Mtn Highway | AddressLine1 |
| City | North Conway | City |
| State | NH | State |
| ZIP Code | 03860 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 65193589 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| 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 | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 521 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 218478 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 263252 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 59143229 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 60311639 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -364637 | InvestmentIncomePriorYear |
| Investment Income Current Year | 622555 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 541875 | OtherRevenuePriorYear |
| Other Revenue Current Year | 478814 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 59538945 | TotalRevenuePriorYear |
| Total Revenue Current Year | 61676260 | 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 | 27955899 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 26564314 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 30748 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 735878 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 31558789 | OtherExpensePriorYear |
| Other Expenses Current Year | 33374589 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 59545436 | TotalExpensesPriorYear |
| Total Expenses Current Year | 59938903 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -6491 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1737357 | RevenuesLessExpensesCY |
| Total Assets BOY | 64202118 | TotalAssetsBOY |
| Total Assets EOY | 66074571 | TotalAssetsEOY |
| Total Liabilities BOY | 24911479 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 25349880 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 39290639 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 40724691 | NetAssetsOrFundBalancesEOY |
| 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 | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 0 | Expense |
| Grants | 0 | Grants |
| Revenue | 0 | Revenue |
| Description | Ambulatory & Primary Health Care: Memorial Hospital provided care for 38,248 Outpatients and 13,065 Emergency Room patients. Program service expenses and revenues are included with Inpatient Care | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 0 | Expense |
| Grants | 0 | Grants |
| Revenue | 0 | Revenue |
| Description | Ambulatory & Primary Health Care: Memorial Hopsital operates Physician practices that provide Primary Care as well as Womens Health, Orthopedics, and several other specialties. Program service expenses and revenues are included with Inpatient Care. (51,693 visits) | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 51065554 | Expense |
| Grants | 0 | Grants |
| Revenue | 60905281 | Revenue |
| Description | Inpatient Care: Provided care for 1,915 admissions during FY '09. (The cost for the Outpatient, Emergency Room, and Physician Practices are included. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 51065554 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | 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 |
| 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 82 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 521 | 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 |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | 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 | John Newton | 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 (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Calvin Hunnsicker | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Scott CoteCrosskill | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Ellen Schwartz | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Daphne Wall | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Gene Bergoffen | |||||||||
| Chairman | 0 | X | 0 | 0 | 0 | X | |||
| Bayard Kennett | |||||||||
| 1st Vice President | 0 | X | 0 | 0 | 0 | X | |||
| Judy Kennedy | |||||||||
| Secretary | 0 | X | 0 | 0 | 0 | X | |||
| Roger Clapp | |||||||||
| Treasurer | 0 | X | 0 | 0 | 0 | X | |||
| Phil Davies | |||||||||
| 2nd Vice President | 0 | X | 0 | 0 | 0 | X | |||
| Melissa Myers | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| James Mallon MD | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Janice Crawford | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| John Stratton | |||||||||
| Board Member | 0 | X | 0 | 0 | 0 | ||||
| Scott McKinnon | |||||||||
| President & CEO | 40 | 117716 | 0 | 11028 | X | ||||
| Gary Poquette | |||||||||
| CEO & President | 40 | 248676 | 0 | 16236 | X | X | |||
| Raymond Rabideau | |||||||||
| Chief Medical Officer | 40 | 10800 | 269117 | 30248 | X | ||||
| Allen Stam MD | |||||||||
| Medical Staff President | 40 | 171343 | 0 | 20764 | X | ||||
| Diane Snow MD | |||||||||
| President of the Medical Staff | 40 | 32200 | 322651 | 32458 | X | ||||
| John Newton | |||||||||
| Vice President & CFO | 40 | 344263 | 0 | 14880 | X | ||||
| Douglas Taylor | |||||||||
| Physician | 40 | 0 | 434123 | 36556 | X | ||||
| Morice Dennery | |||||||||
| Physician | 40 | 0 | 408508 | 35174 | X | ||||
| Victor Lazaron | |||||||||
| Physician | 40 | 5600 | 393022 | 35194 | X | ||||
| David Riss | |||||||||
| Physician | 40 | 0 | 376232 | 31943 | X | ||||
| Richard Noonan | |||||||||
| Physician | 40 | 315313 | 0 | 29993 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1245911 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2203653 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 294474 | TotalOtherCompensation |
| Number Individuals GT100 K | 20 | NumberIndividualsGT100K |
| Formers Listed | 1 | 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 | 6802903 |
| Specialty Laboratories | |||||
| PO Box 54920 | Loas Angeles | CA | 90054 | Lab Services | 255314 |
| NORDX | |||||
| 102 Campus Drive | Scarborough | ME | 04074 | Lab Services | 248968 |
| Navix Diagnostics | |||||
| PO Box 3698 | Boston | MA | 02241 | Nuclear Imaging Services | 197399 |
| Burgess Advertising & Marketing | |||||
| 1290 Congress St | Portland | ME | 04102 | Advertising & Marketing | 193834 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 28489 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 234763 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 263252 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Hospital Services | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 60311639 | TotalRevenueColumn |
| Related Or Exempt Function Income | 60311639 | 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 | 60311639 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 114828 | TotalRevenueColumn |
| Related Or Exempt Function Income | 114828 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | 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 | 143735 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 243998 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -100263 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -100263 | TotalRevenueColumn |
| Related Or Exempt Function Income | -100263 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3734970 | Securities |
| Other | 0 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3227243 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 507727 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 507727 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $507,727 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 46088 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 7701 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 46088 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| 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 | 216761 | 216761 | 0 | $0 |
| Cafeteria & Vending | 722210 | 200385 | 200385 | 0 | $0 |
| Community Health Staff Support | 621300 | 83600 | 83600 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 78331 | TotalRevenueColumn |
| Related Or Exempt Function Income | 78331 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 579077 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61676260 | TotalRevenueColumn |
| Related Or Exempt Function Income | 60905281 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $507,727 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 599300 | Total |
| Program Services | 31467 | ProgramServices |
| Management And General | 567833 | ManagementAndGeneral |
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 | 18230356 | Total |
| Program Services | 14846769 | ProgramServices |
| Management And General | 3166664 | ManagementAndGeneral |
| Fundraising | 216923 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 419818 | Total |
| Program Services | 341899 | ProgramServices |
| Management And General | 72924 | ManagementAndGeneral |
| Fundraising | 4995 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5964043 | Total |
| Program Services | 4829616 | ProgramServices |
| Management And General | 1063863 | ManagementAndGeneral |
| Fundraising | 70564 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1350797 | Total |
| Program Services | 1090840 | ProgramServices |
| Management And General | 243954 | ManagementAndGeneral |
| Fundraising | 16003 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30109 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 30109 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76772 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 76772 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29829 | Total |
| Management And General | 29829 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9220931 | Total |
| Program Services | 9100860 | ProgramServices |
| Management And General | 120071 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 251512 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 12353 | ManagementAndGeneral |
| Fundraising | 239159 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 915180 | Total |
| Program Services | 29457 | ProgramServices |
| Management And General | 738978 | ManagementAndGeneral |
| Fundraising | 146745 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 213893 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 213893 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3284377 | Total |
| Program Services | 2823294 | ProgramServices |
| Management And General | 436356 | ManagementAndGeneral |
| Fundraising | 24727 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169450 | Total |
| Program Services | 78922 | ProgramServices |
| Management And General | 90399 | ManagementAndGeneral |
| Fundraising | 129 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10064 | Total |
| Program Services | 10064 | ProgramServices |
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 | 3120436 | Total |
| Program Services | 2656498 | ProgramServices |
| Management And General | 447305 | ManagementAndGeneral |
| Fundraising | 16633 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 752932 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 752932 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Medical Supplies | 8202965 | 8202965 | 0 | 0 |
| Equipment Lease & Maint | 1190691 | 1117455 | 73236 | 0 |
| Community Support | 235509 | 235509 | 0 | 0 |
| Physician Recruitment & Support | 189173 | 189173 | 0 | 0 |
| Bad Debt | 5480766 | 5480766 | 0 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59938903 | Total |
| Program Services | 51065554 | ProgramServices |
| Management And General | 8137471 | ManagementAndGeneral |
| Fundraising | 735878 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7190883 | BOY |
| EOY | 11324383 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10147049 | BOY |
| EOY | 10404353 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7723791 | BOY |
| EOY | 6410450 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1713937 | BOY |
| EOY | 1900250 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 238514 | BOY |
| EOY | 50340 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 57747466 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26286519 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32520480 | BOY |
| EOY | 31460947 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4197760 | BOY |
| EOY | 4114714 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 162683 | BOY |
| EOY | 113501 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 307021 | BOY |
| EOY | 295633 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64202118 | BOY |
| EOY | 66074571 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4642936 | BOY |
| EOY | 4452042 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20268543 | BOY |
| EOY | 19899867 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 997971 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24911479 | BOY |
| EOY | 25349880 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38435892 | BOY |
| EOY | 39862284 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 241384 | BOY |
| EOY | 249044 | 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 | 39290639 | BOY |
| EOY | 40724691 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64202118 | BOY |
| EOY | 66074571 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| 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 Minus1 Year CurrentYearMinus1Year
| 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 | 0.8 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.17 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.03 | 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 | 39580322 | OtherCostOrOtherBasis |
| Depreciation | 15818957 | Depreciation |
| Book Value | 23761365 | 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 | 15791228 | OtherCostOrOtherBasis |
| Depreciation | 9679230 | Depreciation |
| Book Value | 6111998 | 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 | 788332 | Depreciation |
| Book Value | 989101 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 31460947 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 113501 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 113501 | TotalOfBookValueSecurities |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Unamortized Bond Issuance Costs | Description |
| Book Value | 295633 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 295633 | TotalBookValueOtherAssets |
| Total Revenue | 61676260 | TotalRevenue |
| Total Expenses | 59938903 | TotalExpenses |
| Excess Or Deficit For Year | 1737357 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -303302 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $0 | OtherAmount |
| Total Adjustments | -303302 | TotalAdjustments |
| Excess Or Deficit Per FS | 1434055 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 61587127 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -303302 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 0 | OtherRevenues |
| Revenue Not Rptd F990 | -303302 | RevenueNotRptdF990 |
| Revenue Subtotal | 61890429 | RevenueSubtotal |
| Investment Expenses Not Included | 29829 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | -243998 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -214169 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 61676260 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 60153072 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 243998 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 243998 | ExpensesNotRptdF990 |
| Expenses Subtotal | 59909074 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 29829 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 29829 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 59938903 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P05_S00_L04 | Schedule D, Part V, Line 4 | The Endowment Fund retains 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 restricted. |
| SchD_P12_S00_L04b | Schedule D, Part XII, Line 4b | Rental Expenses |
| SchD_P13_S00_L02d | Schedule D, Part XIII, Line 2d | Rental Expenses |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Annual Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 58810 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 28489 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 30321 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 0 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 17817 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 0 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 0 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 12504 | OtherDirectExpensesEvent1 |
| Food And Beverage Other Events | 0 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Gross Receipts Total | 58810 | GrossReceiptsTotal |
| Charitable Contributions Total | 28489 | CharitableContributionsTotal |
| Gross Revenue Total Events | 30321 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 0 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 0 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 17817 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 0 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 0 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 12504 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 30321 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| 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 |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1863553 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 677 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1862876 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0311 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6574807 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4928721 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1646086 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0275 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 8438360 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4929398 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3508962 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0586 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 298122 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1650 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 296472 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0049 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0001 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| 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) |
|---|---|---|
| Total Community Benefit Expense | 1950 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1950 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00 | 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 | 306072 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1650 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 304422 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0050 | 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 | 8744432 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4931048 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3813384 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0636 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,008,941 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15161267 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15011155 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 150112 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
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 Hwy | 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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | In conjunction with the FPL guidelines the Hospital uses a Net Worth criteria. For an individual to qualify for a 100% discount the Net Worth must be at or below $200,000. | IncomeBasedCriteria |
| Costing Method Used | Worksheet 2 Ratio of Patient Care Cost to Charges was used to calculate cost | CostingMethodUsed |
| Bad Debt Footnote | No Footnote. Worksheet 2 was used to calculate cost. | BadDebtFootnote |
| Shortfall As Community Benefit | The filed 2010 Medicare Cost report was used to report Hospital costs and revenues | ShortfallAsCommunityBenefit |
| Debt Collection Policy | The policy include the following statement: With the exception of insurance coverage, collection activity shall not be initiated or pursued for any amounts approved under the Memorial Hospitals Healthcare Assistance Program | DebtCollectionPolicy |
| Needs Assessment | The members of the Memorial Deveopment Foundation and other local agencies, providers and businesses, came together to form the MWV Community Heathcare Collaborative to cooperatively search for solutions to local health needs. In January 2010 they began a Community Needs Assessment. The "Six-Step Community Health Assessment Process" developed by the Association of Community Health Improvement was recommended to build the core framework for the project. | NeedsAssessment |
| Patient Education Assistance | The Hospital uses several methods for communicating and educating patients regarding assistance with the bills. At our registration and credit and collections offices it is visible to all with handouts. Our webiste includes information regarding the Healthcare Assistance program. On all bills with a patient liability a note is recorded that informs the patient or guarantor of the availability of assistance. Also the State Hospital Association website has links to various programs at the state and local levels. | PatientEducationAssistance |
| Community Information | The hospital serves the northern part of Carroll County in NH and the western portion of Oxford County in Maine. The Mount Washington Valley is a four-season destination resort area and serves the tourists the frequent the area. | CommunityInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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 | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Gary Poquette | |||||||||||
| 185250 | 0 | 46183 | 0 | 17243 | 0 | 3250 | 0 | 12986 | 0 | 264912 | 0 |
| Scott McKinnon | |||||||||||
| 82500 | 0 | 22000 | 0 | 13216 | 0 | 0 | 0 | 11028 | 0 | 128744 | 0 |
| John Newton | |||||||||||
| 330000 | 0 | 15000 | 0 | -737 | 0 | 0 | 0 | 14880 | 0 | 359143 | 0 |
| Diane Snow MD | |||||||||||
| 0 | 261829 | 0 | 0 | 32200 | 60822 | 0 | 10284 | 0 | 22174 | 32200 | 355109 |
| Allen Stam MD | |||||||||||
| 143623 | 0 | 0 | 0 | 27720 | 0 | 6509 | 0 | 14255 | 0 | 192107 | 0 |
| Raymond Rabideau | |||||||||||
| 0 | 197007 | 0 | 60000 | 10800 | 12110 | 0 | 8074 | 0 | 22174 | 10800 | 299365 |
| Douglas Taylor | |||||||||||
| 0 | 412123 | 0 | 0 | 0 | 22000 | 0 | 14382 | 0 | 22174 | 0 | 470679 |
| Morice Dennery | |||||||||||
| 0 | 392008 | 0 | 0 | 0 | 16500 | 0 | 13000 | 0 | 22174 | 0 | 443682 |
| Victor Lazaron | |||||||||||
| 0 | 364022 | 0 | 0 | 5600 | 29000 | 0 | 13020 | 0 | 22174 | 5600 | 428216 |
| David Riss | |||||||||||
| 0 | 322660 | 0 | 31572 | 0 | 22000 | 0 | 12376 | 0 | 19567 | 0 | 408175 |
| Richard Noonan | |||||||||||
| 297087 | 0 | 0 | 0 | 18226 | 0 | 14031 | 0 | 15962 | 0 | 345306 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchJ_P01_S00_L01a | Identifier |
| Return Reference | Schedule J, Part I, Line 1a | ReturnReference |
| Explanation | The Hospital will reimburse for Travel for Companions if prior approval by the Chairman of the Board is granted. As part of the recruitment for a ne CEO a housing allowance was granted for a temporary period of time. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | New Hampshire 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 Facilities and Payoff Existing Debt | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 21069204 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Amount Defeased | 0 | AmountDefeased |
| Amount Unspent | 0 | AmountUnspent |
| Issuance Costs From Proceeds | 324775 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 20226123 | CapitalExpenditures |
| 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 |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| 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 (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | The sole member of The Memorial Hospital is The Memorial Development Foundation, a 501(c)(3) organization |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | The sole member Memorial Development Foundation ratifies the appointments to the Board of Trustees of the Memorial Hospital |
| F990_P06_S0B_L11 | Form 990, Part VI, Section B, Line 11 | The form 990 was provided to the Finance committee and the full Board of Trustees. It was reviewed by the Finance Committee on January 18, 2011, and then forwarded to the full Board of Trustees on January 19, 2011 for approval before submission. These reviews were led by the Treasurer. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Conflict of Interest declaration forms are submitted annually in January by members of the Board of Trustees and are distributed to the full board for information puposes, and reviewed in depth by the Governance Committee. It is the members responsibility to notify the board should any conflicts arise in between signings and of all members of the board to immediately raise any conflicts that they become aware of. Board members with conflicts will recuse themselves from discussions and votes on that 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 CEOs performance is reviewed against the targets set for the year and his semi annual bonus determination. The CEOs compensation is compared vs 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. |
| 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. |
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 |
|---|---|---|---|---|---|---|---|---|---|
| Memorial Development Foundation | |||||||||
| PO Box 5001 | North Conway | NH | 03860 | 223160795 | Coordinate healthcare | NH | 501(c)(3) | 509(a)(3) Type 1 | N/A |
| Visiting Nurse & Hospice Care Services of Northern Carroll County | |||||||||
| PO Box 432 | North Conway | NH | 03860 | 020311473 | Visiting Nurse & Hospice Services | NH | 501(c)(3) | 9 | N/A |
| White Mountain Community Health | |||||||||
| PO Box 2800 | Conway | NH | 03818 | 020358715 | Community Health Center | NH | 501(c)(3) | 7 | N/A |
| Carroll County Health & Home Care Services Inc | |||||||||
| PO Box 420 | Chocorua | NH | 03817 | 237337000 | Home Care Services | NH | 501(c)(3) | 7 | N/A |
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 | 100 | ShareOfEOYAssets |
| Percentage Ownership | 1 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | 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 | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| MWV Healthcare Assoc Inc | |
| a-iv | 15708 |
| MWV Healthcare Assoc Inc | |
| o | 7045987 |
| White Mountain Community Health | |
| i | 59004 |
| White Mountain Community Health | |
| p | 67727 |
| White Mountain Community Health | |
| o | 61050 |
| Carroll County Health & Home Care Services Inc | |
| p | 133609 |
| Carroll County Health & Home Care Services Inc | |
| o | 33063 |
| Visiting Nurse & Hospice Care Services of Northern Carroll County | |
| p | 116282 |
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