4A (Expenses $ 126906993 including grants of $ 255181) (Revenue $ 142268375)
Frisbie Memorial Hospital is a nonprofit community hospital that continuously evaluates and addresses the comprehensive healthcare needs of Rochester, NH and the surrounding communities. In response to these healthcare needs, the hospital coordinates, develops, and provides high-quality, affordable, preventative, educational, acute, and chronic care services. In fiscal year ending September 30, 2019, 25,530 patients were treated in our emergency department, 4,723 ambulance calls were made, 2,952 inpatients were cared for, and surgeries on 7,368 patients were performed. Additionally, 229 newborns were welcomed into the world, 25,371 radiology procedures/tests provided, 79,950 rehabilitative treatments were provided, 371,462 laboratory tests were performed, and 4,012 oncology patients were treated.

4B (Expenses $ 6322750 including grants of $ 0) (Revenue $ 0)
Frisbie Memorial Hospital provided uncompensated care for those in need. Frisbie ranks among the top in New Hampshire for the money value of charity care provided to patients.

4C (Expenses $ 513790 including grants of $ 0) (Revenue $ 0)
Frisbie Memorial Hospital presented or sponsored numerous community programs which assisted with the special needs of our most vulnerable at risk population groups. These programs improved education and health awareness in the community, and provided greater access to health services.

Frisbie Memorial Hospital
Part V, Section B, Line 5: Members of the committee were chosen based on their knowledge of local healthcare. Crescendo Consulting Group, LLC was also brought in to assist in the completion of the CHNA. Please see page 5 of the Hospital's 2018 CHNA for a detailed list of community members.

Frisbie Memorial Hospital
Part V, Section B, Line 11: Please see the attached Community Health Needs Assessment and Action Plan for how Frisbie Memorial Hospital is addressing the significant needs identified in its most recently conducted CHNA.Over the past several years, FMH has been exceedingly resource strapped from both a financial and a personnel standpoint and has, therefore, not been able to respond to the community needs assessment in the manner to which it has strived in the past.1. In the realm of mental illness prevention and treatment, FMH continues to maintain the 20 bed inpatient geropsychiatry unit as well as an outpatient service for geropsychiatry. FMH also provides social workers in its ambulatory practices, and provides behavioral health services in the emergency department. FMH has historically provided these programs, and FMHhas been committed to maintaining them, but FMH has not been able to increase services in this area in response to the 2019 needs assessment.2. With regard to substance misuse prevention and treatment, for several years, FMH has offered a medication assisted treatment program (MAT - Saboxone) which was championed by several FMH providers. Unfortunately, these providers chose to leave the organization over the past year. Since that time, FMH's MAT program has struggled with lack of provider leadership. Meanwhile, the ROAD to a Better Life MAT program has grown in capacity and offers a much more robust program than FMH ever had in the past. Recognizing the greater capacity and enhanced programming at ROAD to a Better Life MAT (they offer peer counseling groups and other wrap-around services), FMH will be referring new, acute patients to this program. https://roadtoabetterlifenh.com/locations/3. Although FMH prides itself on being an affordable health care option for its community and provides financial assistance to many members of the community, FMH has not been able to address directly the burden of the high cost of prescription medication for members of its community.

Frisbie Memorial Hospital
Part V, Section B, Line 20e: Frisbie Memorial Hospital notified individuals of the financial assistance policy during the admissions process, prior to and during the patient discharge process, and in communications with the individuals when discussing the individuals' medical bills. Frisbie Memorial Hospital also documented its determination of whether individuals were eligible for financial assistance under the hospital's financial assistance policy.

Schedule H, Part V, Section B, Line 7a & 10a:
The Hospital's latest CHNA and Implementation Strategy, released in January of 2019 for the 2018 tax year, is available on the Hospital's website at:https://www.fmhwdc.org/

Schedule H, Part V, Section B, Line 16a-c:
The Hospital's Financial Assistance Policy, Application, and Plain Language Summary can be found online at:https://www.fmhwdc.org/

Part I, Line 7:
"The Instructions for Form 990, Schedule H, Part I, contain a template, titled ""Worksheet 2"", that may be used to determine the overall cost to charge ratio. This ratio may be applied to the charges listed throughout the Schedule H in order to calculate their associated costs. Where applicable, the Hospital has utilized Worksheet 2 for various calculations; the Hospital utilized Worksheet 2 for all calculations on Part I, Line 7, except for the following specific instance:Schedule H, Worksheet 6 - Subsidized Health Services (the supporting worksheet for Part I, Line 7g). The Hospital did not utilize Worksheet 2 to determine the profit or loss for each of the hospital clinical services or hospital-owned physician practices. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in Part II, Community Building Activities, Line 1(c), total community building expense, the Hospital utilized the actual estimated costs on the modified Medicare cost report."

Part I, Line 7g:
"Frisbie Hospital has several hospital clinical services and hospital-owned physician practices. Per the instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may classify any applicable physician practices that the Hospital subsidizes or that operate at a loss, including service areas such as the Hospital's inpatient psychiatric unit, when completing Schedule H as ""subsidized health services"". Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that are either subsidized by the Hospital or that operate at a loss, and the associated costs of these practices, in its calculation of subsidized health services as presented on the 2018 Schedule H, Part I, Line 1g:a. Inpatient Psychiatric Unitb. Outpatient Psychiatric Servicesc. Oncologyd. Family Care of Somersworthe. Barrington Family Practicef. Rochester Pulmonary Medicineg. Internal Medicineh. Rheumatologyi. Rochester Infectous Diseasej. Rochester Vascular Surgeryk. Diabetes Servicesl. Strafford Cardiologym. Rochester Pediatricsn. Barrington Walk-In Clinico. OB/GYN Servicesp. White Mountain Medical q. Wound Care Clinicr. Emergency Room Servicess. Sanford Medical Servicest. Ambulance Servicesu. Family Care of FarmingtonThe above listed hospital clinical services and hospital-owned physician practices have an aggregate community benefit, otherwise categorized as an aggregate loss or subsidy from the Hospital, of approximately $33.59 million. In accordance with IRS Instructions for Schedule H, this community benefit figure does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $33.59 million is a conservative figure that reconciles to the community benefit reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e."

Part I, Ln 7 Col(f):
The Hospital's total bad debt expense for the fiscal year is reported on the Hospital's Form 990, Part IX, Line 24(c), as $5,209,669. The Hospital's total bad debt expense as reported on Form 990, Part IX, is also subtracted for purposes of calculating the percentage in this column (please see the attached financial statements, page 30).

Part II, Community Building Activities:
Please see narrative for Part VI, Line 5.

Part III, Line 2:
The Hospital utilized Worksheet 2 from the IRS Instructions for Schedule H to determine the ratio of patient-care to cost-to-charge (approximately 37.61% for fiscal year 2019). This ratio is then multiplied by the Hospital's total bad debt expense of $5,209,669 to determine the Schedule H, Part III, Line 2, bad debt expense of $1,959,098.

Part III, Line 3:
Frisbie Memorial Hospital estimates this percentage based upon historical data. This amount is reported at cost, and is not reported as a community benefit within Schedule H, Part I, Line 7.

Part III, Line 4:
"Please see Footnote 2, ""Accounts Receivable and the Allowance for Doubtful Accounts"" on page 11 of the attached audited financial statements."

Part III, Line 8:
Form 990, Schedule H instructions and guidance contain a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost, including costs related to Medicare charges. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 7 was Schedule H, Section B, Line 5 and and Line 6, total revenue received from Medicare and Medicare allowable costs, respectively. The Hospital utilized its Medicare cost reports to derive the estimated costs and payments for these services.As previously described in the the Hospital's supplemental disclosure for Schedule H, Part I, Line 7g, the Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and inpatient psychiatric units should all be considered community benefits; these services, facilities, and programs provide a benefit to community members and are both offered and subsidized by the Hospital.Medicare shortfall is reported to the State of New Hampshire in the Community Benefits Report, under Section 4, Unreimbursed Costs, Government-Sponsored Health Care.In prior years, the State of New Hampshire used MET dollars to service the general fund of the State. However, recently the State has used these dollars to directly fund medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact is considered a healthcare-related expenditure by the Hospital.

Part III, Line 9b:
The Hospital's collection policy allows accounts which are known to qualify for free care to be removed from internal records of outstanding debts, and for such accounts to be transferred to an outside agency for further collection activity and procedures.

Part VI, Line 3:
Frisbie Memorial Hospital is committed to providing quality health care that is affordable and accessible to all, regardless of the care-recipient's ability to pay. The Hospital offers financial assistance to eligible patients and help patients apply for other programs that they may be eligible. Patients can learn more about these programs by visiting the Hospital's website or contacting the Hospital's Patient Accounts department. Beginning with patient registration and through the billing process, patients can obtain an application for financial assistance or speak with a financial counselor.

Part VI, Line 4:
Frisbie Memorial Hospital's patient service area is urban, consisting of Northern Strafford, NH and Western York, ME counties. Population served for our Strafford County (upon which Frisbie is located in) is over 128,000 with a median income of $50,759 and 11.7% of community residents living below the federal poverty guidelines.

Part VI, Line 5:
Frisbie's Community Education & Conference Center is utilized by a multitude of community-based social and civic organizations as a convenient location for holding professional trainings and seminars, conferences, meetings, maternal classes, caregiver trainings and wellness events. The Conference Center is available at no charge to community nonprofit organizations for health promotion, disease prevention, and educational purposes. In light of the facts and circumstances surrounding the Community Center's varied purposes, the Hospital has claimed 50% of the expenses for this area as a benefit to the community.

Part VI, Line 2:
Frisbie Memorial Hospital (FMH) conducts a Community Needs Assessment every three years, the most recent completed in January of 2019. FMH worked with Health Strategies Plus to bring together health care and public services stakeholders.The Frisbie Memorial Hospital CHNA methodology includes a combination of quantitative and qualitative research methods designed to evaluate perspectives and opinions of area stakeholders and healthcare consumers - including those from underserved populations. The methodology used helps prioritize the needs and establish a basis for continued community engagement.The major sections of the methodology include the following: - Strategic secondary research - Qualitative discussion groups with Leadership Team members - Community surveys - Needs prioritization using a modified Delphi process

Part VI, Line 6:
Through its affiliations, Frisbie Memorial Hospital and its partners work together to improve access to preventative health care services as well as those services put in place to address the following prioritized needs identified in 2015 Community Health Needs Assessment: Affordable medical care; mental health services; Substance abuse treatment services.- Granite State Lab: offers lower cost laboratory services- Seacoast RediCare: provides convenient access to health care services, which help to fill the gap between family physician and emergency room visits.- Women's Life Imaging: provides convenient access to preventative mammography services.- Rochester Community Counseling: a joint effort between Community Partners and Frisbie Memorial Hospital to improve access to much behavioral health services in Rochester.

Part VI, Line 7, Reports Filed With States
NH,ME