Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 97,654,740 | 98,456,732 | 102,625,995 | 106,314,095 | 114,160,768 | 519,212,330 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 97,654,740 | 98,456,732 | 102,625,995 | 106,314,095 | 114,160,768 | 519,212,330 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 519,212,330 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 97,654,740 | 98,456,732 | 102,625,995 | 106,314,095 | 114,160,768 | 519,212,330 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 97,654,740 | 98,456,732 | 102,625,995 | 106,314,095 | 114,160,768 | 519,212,330 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | The sole corporate member of the Foundation is Southern New Hampshire Health System, Inc. |
| Form 990, Part VI, Section A, line 7a | Southern New Hampshire Health System, Inc. is the sole corporate member of the Foundation Medical Partners, Inc. and the two organizations have overlapping boards with one additional member on the Foundation Medical Partners Inc.'s board--the President of the Foundation Medical Partners, Inc. who serves as ex-officio but not on the board of Southern New Hampshire Health Systems, Inc. |
| Form 990, Part VI, Section A, line 7b | The sole Member, Southern New Hampshire Health System, Inc. (SNHHS), may consider any issue that may properly come before any meeting of Foundation Medical Partners (the Foundation). In addition, after due consultation with the Board of Trustees of the Foundation, the sole Member shall: (a) appoint and remove, the President/Chief Executive Officer of the Foundation, subject to ratification of the Board of Trustees of the Foundation; (b) conduct system-wide strategic planning encompassing all corporations of which SNHHS is the sole corporate member and periodically develop, adopt, and periodically amend or revise a system-wide strategic plan; (c) conduct system-wide financial and capital planning encompassing all corporations of which SNHHS is the sole corporate member and periodically develop, adopt, and periodically amend or revise system-wide financial plans and operating and capital improvements budget; (d) periodically conduct by appropriate means an evaluation of the performance of each member of a board of trustees of all corporations of which SNHHS is the sole corporate member, the results of which shall be used to determine the Trustee's continued service on such board of trustees. The business and affairs of the Foundation shall be managed by its board of trustees. The Foundation's board, however, shall not, without approval of SNHHS (a) elect or appoint the members of the Foundation's Board of Trustees or remove such person serving from time to time in that capacity; (b) adopt or amend the Foundation's Mission Statement; (c) adopt, amend or waive any material provision of the Foundation's strategic plan or any annual operating plan or budget; (d) incur indebtedness for borrowed money or enter into any capital lease obligation, in either case, that has not been specifically set forth in a written operating budget approved previously by the Member where the amount of the obligation exceeds $1,000,000 in amount; (e) enter into, or agree to enter into or otherwise approve of any transaction including a merger, consolidation, affiliation, dissolution, liquidation or sale of substantially all of the assets of the Foundation; (f) authorize expenditures contained in a capital and operating budget, even if previously approved by the Board of Trustees of the Foundation; (g) approve, adopt or enter into a professional or general services contract where the annual expense to the Foundation exceeds $1,000,000 and that has not previously been approved in the Foundation's annual budget; (h) amend the Articles of Agreement or these Bylaws; (i) acquire or agree to acquire by merging, consolidating with or by purchasing substantially all of the assets of any business or corporation, partnership, joint venture, association, business organization or division thereof, except with respect to an entity that is engaged in operating or maintaining a medical practice; and (j) elect or remove officers of the Foundation. |
| Form 990, Part VI, Section B, line 11b | A copy of the 990 was presented to the full Board and approved by the Finance Committee of the Board of Trustees prior to submission. |
| Form 990, Part VI, Section B, line 12c | The organization requires all its personnel, including Leaders, to formally acknowledge that they have read and will abide by the Code of Conduct, which includes the conflict of interest policy. The Foundation monitors compliance of its conflict of interest process, which requires completion of disclosure forms by all Leaders on an annual basis or on a reappointment basis (every two years) for medical/allied staff, to ensure full compliance. Interim disclosures are also required and reviewed should a subsequent conflict arise. Any related party disclosures require review and approval by a designated committee. An annual compliance report is provided to the Foundation's compliance committee and Board of Trustees. |
| Form 990, Part VI, Section B, line 15 | A market analysis is performed for all key employees including the FMP President/CEO on an annual basis. Once the Southern New Hampshire Health System CEO and CFO approve the final compensation figures for key employees, the CEO reports these figures to the chairperson and vice chairperson of the Board. |
| Form 990, Part VI, Section C, line 19 | The organization makes its 990 available for inspection upon request. The code of conduct is available on the organization's website. The code of Conduct addresses certain corporate policies including confidentiality, conflicts of interest, patient rights, and governing policies. |
| Form 990, Part VII: | Katherine E. Bellemare, who served as the Organization's VP of Finance, retired in April of 2018. Ms. Bellemare has been listed as current officer of the Organization in accordance with IRS instructions. |
| Form 990, Part XI, line 9: | Transfer From Affiliate 34,426,855. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the prior year. |
| Form 990: | On October 30, 2017, the system signed a combination agreement with Elliot Health System to form a new company. After meeting all applicable obligations and conditions of the definitive agreement on April 30, 2018, the health systems closed the transaction and formed SolutioNHealth, which became the sole-corporate member of Southern New Hampshire Health System, Inc. which is the sole-corporate member of Southern New Hampshire Medical Center and Foundation Medical Partners. SolutionHealth allows the system to establish a regional healthcare organization in New Hampshire that combines resources and skill-sets from both Elliot Health System and Southern New Hampshire Health System, Inc. This strategic collaboration allows the two Systems to: - support and facilitate an integrated community-based, regional health care delivery system among the Hospital Systems; - align the missions and economic interests of the Hospital Systems to enhance care for the communities served; - engage in collaborative regional planning relating to the delivery of health care services in southern New Hampshire; - create a high degree of interdependence and cooperation in a health care network so as to control costs, increase value, ensure quality, and improve access in the communities served by the Hospital Systems; - enhance regional access for those served by the Hospital Systems; - support, protect and enhance the ability of the Hospital Systems to perform their existing historic charitable mission in the future; and - strengthen the charitable missions of the Hospital Systems, embracing a commitment to southern New Hampshire as a region. |
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