Return of Organization Exempt From Income Tax OM9No

Form 990 Under section SOI(c), 527, or 4947(a)(7) of the Internal Revenue Code (except hlack loop ' 2 0 benefit trust or private foundation) Q

ow~rtmen~ oi ;+e T~m+7 1 The organization may have to use a Copy of this return to satisfy stale reporting requirements

pan

e ltjo Imwn .l Rev... Smnw

A For the 2001 calendar year, or tax year pei

B cn~ a pea L Name of organization ePPICeMe ux IRS

and

°`'REDERICK MEMORIAL HOSPITAL, INC . ~"°a'°' cn~nW onnt°°" or

Orn~ s S. Number and street (or P 0 box A mail is not delivered to street address) sa~ftST 7TH STREET

mwm nor. City or town, slate or country, and ZIP t 4 ~"��"'"m'°°° FREDERICK , MD 21701 0^oPli°bo^ " Section 501(c)(3) organizations and 49a7(a)(1) nonexempt charitable trusts

°°°°i°° must attach a completed Schedule A (Form 990 or 990-EZ)

r, wan OP. "WWT9 . FMH .ORG

F Aswnvp,fvfmoa U cen U rmuei

Organization type i~dwc,,ei " OX SOi(c) ( 0 3 ) " rn~ ~oi L__] 4947(a)(1) or L-1 52 C_ ;_fi~n ~n ~ ;r~ rornintc are normalN not more than $25 000 The

organization need not file a return with the IRS but d tie organization received a Form 990 Package in tie mail it should file a return without financial data Some states require a complete return 1111.

M Check " U A tie organization is not required to attach Sch B (Form 990 990-EZ or 990-PF)

P31'L I HBVenUB G7I (1505 ef1U GnaIlAeS IA Net ASSB15 Of FUf10 Ca18f1CeS 1 Contnbutions gifts, grants, and similar amounts received

a Direct public support is 2, 17 46 D Indirect public support 1 to C Government contributions (gaols) 1c it Total (add lines la through 1c)

(cash S 2,082,508 . noncase5 93,952 . 2 Program service revenue including government fees and contracts (from Part VII line 93) 3 Membership dues and assessments 4 Interest on sarongs and temporary cash investments 5 Dividends and interest from secun6es 6 a Gross rents fia

h Less rental expenses 6b c Net rental income or (loss) (subtract line 6b from line 6a)

7 Other investment income (describe 111~ m 8 a Gross amount from sale of assets other A Securities B Other

than inventory 24 940 223 . Be 10 67 h Less cost or other basis and sales expenses 28 , 587 , 5 82 . Bb 28 t 5 2 c Gain or (loss) (attach schedule) < 3 647 , 359 . > ee

<87 85

o d Net gain or (loss) (combine line 8c, columns (A) and (e)) STMT 1 STMT 2 9 Special events and activities (attach schedule)

a Gross revenue (notincluding E 0 . of contributions reported on dine ia) 9a 98,70

7 h Less direct expenses other than tundroising expenses 9b 31 _L8 c Net income or (loss) from special events (subtract line 9D from one 9a) SEE STATEMENT 3

10 a Gross safes of inventory, less returns and allowances 10a 480,78 D Less cost of goods sold 106 297 , 07 c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) STMT

11 Other revenue (from Part VII fine 103) - -- 12 Total revenue ( add fines 1d 2 3 , 4 . 5 tic 7 Bd 9c 10c and 11

J 13 Program services (from line 44, column (B)) ,yl

(1F~~ ~ 14 Management and general (from line 44 column (C)) M ay Rags g

15 Fundraising (from line 44 column (0)) c1 L7iiT

ICE w 76 Payments loaffiliates (ariach schedule)

OGDEN, 17 Total ex penses add lines 76 and 44 column A 18 Excess or (deficil) for the year (subtract line 17 from line 12) N

m o 79 Net assets or fund balances at beginning of year (from line 73 column (A)) Z VI

20 Other changes in net assets or fund balances (attach explanation) SEE STATEMENT 5 a 21 Net assets of fund balances at end of year (combine lines 18, 79 and 20)

fw o~ LHA For Paperrort Reduction Act Notice, see tie separate Instruction :

2,176,460 .

ea

9c

101 ,i

<3,735,210 .>

183,715 . i <140,482 . >

98,281,785 . 35,626,839 . 53,659,677 .

89,281,516 . ~i 9,000,269 . 35,903,960 . I <3,734,954 . > 41,169,275 .

Form 990 (2001)

., " t . . ..

D Employer Identification number

52-0591612 Room/suite E Telephone number

13011 698-3350

H and I are not applicable to section 527 organizations H(a) Is this a group return for athliates7 0 Yes OX No H(b) It'Yes'enter number otaffiliates " H(c) Are all affiliates include07 NBA 0 Yes ~ No

(if 'No,' attach a lisp )

HBO) Is this a separate return filed by an or-

F,,nn vsoaro+i FREDERICK MEMORIAL HOSPITAL INC . 52-0591612 Page 2 Statement o All organizations must complete column (A) Columns (B) (C), and (D) are required for section 501(c)(3) and

C, Functional Expenses (4) organizations and section 4947(x)(1) nonexempt charitable trusts but Optional tOr others

(A) Total I Do no ;include amounts reporteo on line 6b, 8b, 96, 10b, or 16 0l Part I

22 Grants and allocations (attach schedule)

.n s nonwn s

23 SDecihc assistance to individuals (attach schedule) 24 Benefits paid to or for members (attach schedule) 25 Compensation of officers, directors, etc 26 Other salaries and wages 27 Pension plan contributions 28 Other employee benefits 29 Payroll taxes 30 Professional fundfaising fees 31 Accounting lees 32 Legal fees 33 Supplies 34 Telephone 35 Postage and shipping 36 Occupancy 37 Equipment rental and maintenance 38 Pinning and publications 39 Travel 40 Conferences conventions, and meetings 41 Interest 42 Depreciation, depletion, etc (attach schedule) 43 Other expenses not covered above (itemize)

a 0

d e SEE STATEMENT 6

44 Total IunctonY upenaas (Wa linen 1I Nnuph l3) QpenIZSCoroeompie4npmlumm(BF/D) carry Mass

(U) Fundraising

041 .1 749,16

788 669 . 4 , 052,0

240 722 . 240 , 7 027,611 . 10,131,4 630,170 . 315 074 . 499,377 . 074,120 . 712 172 .

272,911 . 769,388 . 884,6 163 .780 . 3 .581 .8

6 Joint Casts Check " U A you are following SOP 98-2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services " 0 Yes 0 No If Yes,' enter /Q the aggregate amount of these point costs $ , (II) the amount allocated to Program services E

Form 990 (2001) 02 02

(C)

630,170 315,074

884

What is tie organization's primary exempt purposes IN, TO PROVIDE HOSPITAL SERVICES MI orynixaoons must Cecnbe TNr exempt purpose, sCswwnenb In a dear end wnase manner State Me numbw of dianb served! publications issued etc on achu~vments bet are not meuu2Ele /SecLOn 501(c)('J) end (9) oryaniiBOOns and 4947(e)/1) nonmempt chanlable trusts must ISO ends Me unount of grants and

a rxuvlur~b INPATIENT

b

c

d

and allocations S

Program Service Expenses

quireC for 501 (c)[J/ and orpa enaa9a71N(t)

f Eul oo7onN br oMen

39 .

it=i 01 02 oz

n

Form 990(200i) FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612 Page 3

part V Balance Sheets

Note Where required, attached schedules and amounts within the description column (A) (B) should be for end-of-year amounts onty Beginning of year End of year

45 Cash-non-interest-bearing 7 , 656 , 953 . 45 2,376,768 . 46 Savings and temporary cash investments 11 627 640 . 46 4 ' 89-4 , 636 .

47 a Accounts receivable 47a 34 , 883 , 461 . b Less allowance fordoubtful accounts e7o 6 , 336,075 . 28 006 355 . alt 28 547 386 .

48 a Pledges receivable 48a 3 , 617 , 600 .

h less allowance for doubtful accounts 48b 3 , 775 , 965 . ~aec 3 , 617 , 600 . 49 Grants receivable 49 50 Hecervables from officers, directors trustees,

and key employees 50 m 51 a Other notes and loans receivable N

b Less allowance lordoubttulaccounts 51b 51c 52 Inventories forsale oruse 2,819,697 . 52 2 , 843, 307 . 53 Prepaid expenses and deferred charges 2,224 , 397 . 53 2 524 7 31 . 54 Investments -securities STMT 7 STMT 8 . 0 Cost 0 FMV 68 , 137 , 682 . 54 56 , 492 , 2 54 . SS a Investments-land buildings, and

equipment basis 55a

b Less accumulated depreciation SSb 55c 56 investments-other SEE STATEMENT 9 8, 551 450 . 56 22 841 109 . 57a Land buildings and equipment basis 57a 154 966 824 .

. o Less accumulated depreciation STMT 10 57b 71, 159 863 . 69, 032, 511 . 57c 83 , 806 , 961 58 Other assets (describe " SEE STATEMENT 11 ) 8233,264 . 58 7,000,832 .

60 Accounts payable and accrued expenses 1 / 1 1 u 4 / 3 . 60 1 7 7 4 4 , 7 7 / .

61 Grants payable 61

62 0 62 Deterred revenue = 63 Loans from officers directors trustees, and key employees 63 8 '° 69 a Tax-exempt bond liabilities 64a

o Mortgages and other notes payable 57 , 051 , 481 . bap 54 , 231 , 352 . 65 Older liabilities (describe ~ 65

66 Total liabilities aAdlines 60through 65 74 161 954 . ss 73 776 309 . Organizations that follow SFAS 117, check here 1 ~ and complete lines 67 trough

69 and lines 73 and 74 67 Unrestricted 118 577,521 . 67 122 375 087 . 68 Temporarily restricted 16,233,643 . Be 17,701 392 .

m 69 Permanently restricted 1 , 092,796 . 69 1 , 092 , 796 . Organizations that do not follow SFAS 117, check here 1 ~ and complete lines

70 through 74 70 Capital stock, bust principal, or current funds 70

71 Paid-in or capital surplus, or land, building, and equipment fund 71 N a 72 Retained earnings, endowment, accumulated income or other funds 72

73 Total net assets or fund balances (add lines 67 through 69 OR lines 70 through 72, z column (A)must equal line 19 column (B)must equal line 21) 135 903 960 . Td 141 169 275 .

74 Total liabilities and net assets / find balances (ado ones 66 and 73) 210 0 6 5 914 . 74

214 9 4 5 584 . Forth 990 is available for public inspection and for some people, serves as tie primary or sole source of information about a particular organization How the public

perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, tie organization s programs and accomplishments

Form 990 200 FREDERICK MEMORIAL HOSPITAL INC . 52-0591612 Page 4 Part IV-A Reconciliation of Revenue per Audited Part IV-B Reconciliation of Expenses per Audited

Financial Statements with Revenue per Financial Statements With Expenses per Return Return

a Total revenue, pains and other support a Total expenses and losses per - "' peraudited financial statements " a 171453849 . audited financial statements " a 166421 934 .

D Amounts included on line a but nod on h Amounts included on line a but not on line 17 Form 990

line 72, Form 990 (1) Donated services "" (1) Net unrealized gains and use of facilities $

on investments s <3,734,954 . , . (2) Prior year adjustments (2) Donated services reported on line 20,

and use of faulRies f ~ , Form 990 $ (3) Recoveries of prior (3) Losses reported on

year grants $ T ~ line 20, Farm 990 $ (4) Other (specify) (4) Other (specify) STMT 12 f 179,166 . STMT 13 $ 508,225 . Adaamounts onlines (t) through (4) " b 3, 555 788 . pUdamountsonlines(t) through (4) " h 508 225 .

c Line a minus line b " c 175009632 . c Line aminus line D " c 165913709 . D Amounts included an tine 12, Fumi ~ r d Omn,.nk InfIl14EA on line 17 Form

990 but not on line a 990 but not on line a

(1) Investment expenses (1) Investment expenses not included on -- not included on line 6b, Form 990 S line 6D, Form 990 S

(2) Other (specify) (2) Other (specify) STMT 14 f 23,272,153 . ' . STMT 15 6 23,367,807 . Add amounts onlines (t) and (2) " u23,272 153 . Adoamounts onlines (t) and (2) " e 3 367 807 .

e Total revenue per line 12 Form 990 a Total expenses per line 17 Forth 990 (pine c plus pine d) pi~ B 19 82 817 8 5 . (line e opus pine d) lli~ 8 18 9 2 81516 .

part d List of Officers, Directors, Trustees, and Key Employees (List each one even e not compensated) (8) Title and average hours (C)Compensation (D~c«~mwooi+to (E) Expense

(IV) Name and address per week devoted to (II not pD i , enter p�°,~;a a ,°�̀ ,`,°d~ account and osRion -0- wm ,.oo~ other allowances

SEE STATEMENT # (g-

--------------------------------- S NEEDED 0 . 0 . 0 .

JAMES KLUTTZ RESIDENT 400 WEST SEVENTH STREET FREDERICK MD . 21702 40+ HRS WEEK 407 931 . 11 , 472 . 0 .

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

75 Did any otficei, director, trustee or key employee receive aggregate compensation of more than $100,000 from your o,3r an, imation and all related organizations of which more than E10000 was provided by tie related organizations? It 'Yes' attach schedule " U Yec ~X No Forth 990(2001)

92 Section 4947(a)(i) nonexempt chanteble trusts filing Form 990 in Ireu of Form 1041 " Check here " 0 and enter the amount of tax-exempt interest received or accrued Cunna the tax year 1 1 92 ~ N/A

1zs°".. . cn.m con i9nn,)

990(2001 FREDERICK MEMORIAL HOSPITAL . INC . 52-0591612 Pace 5

76 Did the organization engage in any activity not previously reported to the IRS It 'Yes,' attach a detailed description of each activity 75 X 77 were any changes mane in the organizing or governing documents but not reported to the IRS 77 X

If 'Yes,' attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $7,000 or more during the year covered by this returns 78a X~

6 If Yes; has A filed a tax return on Form 990-T for this years 78b X 79 Was there a liquidation, dissolution, termination or substantial contraction aunng the years 79 X

N 'Yes ; attach a statement 80 a I5 the organization related (other than by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees officers, etc to any other exempt or nonexempt organizations 80a X

b It Yes; enter the name of the organization POP and check whether it is 0 exempt OR E] nonexempt

81 a Enter direct or indirect political expenditures Sae line 81 instructions 81a 0 . D Did the organization file Form 1120-POL for this years 816 X

.2 a Md one c.ve-_ar- ,arnrvr donated services or the use of materials, equipment or facilities at no charge Or at substantially less than fair rental valuel o2a X

b If Yes; you may indicate the value of these items here Do not include this amount as revenue in Part I or as an expense in Pan II (See instructions in Part III ) 82G

83 a Did the organization comply with the public inspection requirements for returns and exemption applications 83a ' X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions 83h X

84 a Did the organization solicit any contributions or gifts that were not tax deductible? N/A Boa h It "Yes' did the organization include with every solicitation an express statement that such contributions of pits were not

tax deductible9 NBA 84h 85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members9 N/A 85a

6 Did the organization make only in-house lobbying expenditures of $2,000 or less NBA BSb If 'Yes* was answered to either BSa or 85U do not complete BSc through BSn below unless the organization received a waiver for proxy tax owed for the poor year

c Dues assessments and similar amounts from members 85e N/A d Section 162(e) lobbying and political expenditures BSd N/A

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A_ t Taxable amount of lobbying and political expenditures (line 85d less Bye) 85f N/A p Does the organization elect to pay the section 6033(e) tax on the amount in 85n N/A &5 h If section 6033(e)(1 )(A) dues notices were sent does the organization agree to add the amount in 85110 its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following tax years N/A gsh 86 501(c)(7) organizations Enter a Initiation fees and capital contributions included on line 12 B6a NBA

D Gross receipts included on line 12, far public use of club facilities B6b N / A 87 507(c)(72) organizations Enter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (DO not net amounts due or paid to other sources against amounts due or received from them ) 87b NBA

88 At any time during the year did the organization own a 50% or greater interest m a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 3017701-39 It Yes; complete Part IX 88 X

89 a 507(c)(3) organrzanons Enter Amount of tax imposed on the organization during the year under section 4911 . 0 . , section 4972 . 0 . , section 4955 . 0 .

h 501(c)(3) and 507(c)(4) orgenrzahons Die the organization engage in any section 4958 excess benefit transaction during the year or did d become aware of an excess benefit transaction from a poor year If Yes; attach a statement explaining each transaction 89h X

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . 0 .

d Enter Amount o1 tax on line 89c, above reimbursed by the organization No. 0 . 90 a List the states with which a copy of tots return is tiled 1 MARYLAND

D Number of employees employed in the pay period that includes March 12 2001 ~ 90h ~ 2056

91 Thebooks areincareol "WILLIAM H . PUGH Teleohoneno " 301-698-3350

Locatedat 1 900 WEST 7TH STREET, FREDERICK, MARYLAND ziv*a " 21701

52-059161 Form 990 Part VII Analysis of Income-Producing Activities (See Specific instructions on pope 32 ) Note Enter gross errrounts unless otherwise Unrelated business income e.uu aea n .auon su sia o . 514

lndkoted Business Amount E"d" Related or exempt 93 Program service revenue code "~s Amount function income

a SEE STATEMENT 16 1,460 760 . 1,093 172 . 193 0, 828 1 2' h t O e I Medicare/Medicaid payments p Fees and contracts from government agencies

94 Membership dues and assessments 6 , 1 c 95 Interest on savings and temporary

cash investments 96 Dividends and interest from securities 14 3,342,228 . 97 Net rental income or (loss) from real estate

a debt-financed property D not debt-financed property

98 Net rental income or (loss) from personal property 99 Other investment income

100 Gain or (loss) from sales of assets other than inventory 18 <3 , 735,210 . >

101 Net income or (loss) from special events 01 66,7 16 . 702 Gross Profit or (loss) from sales of inventory 0 3 1 83,715 . 103 Other revenue

a JOINT VENTURES INCOME <190,4E h t O

r ioa Subtotal (addcolumns (s),(o)and(e)) [1,460,760 . -950,621 . 193,693,99 ios Total add line 104, columns (e) (o) and (e)) " 1-9-6-11-0-5-13-2 Note Line 105 plus line 1d, Part I, should equal the amount on line 12, Part I pad yp1Relationship of Activities to the Accomplishment of Exempt Purposes (see Specific instructions on page 32 ) Line No Explain how each activity tar which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization s

exempt purposes (other than by providing funds for such purposes) 17_ Lll1NG KUU'1'1Nb HiVll HiVC1LLH1(Y MtU1CAL 5h}iV1CG5 '1'U MEMI

instructions on page e suosiaianes ana uisre( (C)

of Nature of activities Name, address and EIN of partnership , or disega SEE STATEM

r income

7

unar pendua of penury I aeGVe met i nave aertuneo mis mwm mUUOing ar mo+ mrtecS Na mmp~ete Oaduslion of prepam lamer min o" is oneC on all inlomu

Please

Sign - fi,~ ISgnalu-re of oflhcer Date Here

PPP "'pa rer

. s

Paid P "pa "pa Preparer .s s,g"nPafufe

'," 5 narne (or RSM MCGLADREY, INC . Use Only ;N;~m'p,wad) '100 NORTH CHARLES STREET 12316; Will., . o,n� It , ZIP .a BALTIMORE, MARYLAND 2120

part X I Information Regarding Transfers Associated w (a) Did the organisation during the year receive any funds directly or indirectly, to (h) Die the organization during the year pay premiums, directly or indirectly on a i

01,113 No 15n5-0017

2001 SCHEDULER Organization Exempt Under Section 501(c)(3) (Form 890 or 990-EZ) (Except Private Foundation) and Section 501(e), 5011), 501(k),

501 (n), or Section 4947(a)(1) Nonexempt Charitable Trust

o~t of m.r~un Supplementary Information-(See separate instructions .) ,n��� , an.�u.s~ia " MUST De completed by tie above organizations and attached to their Form 990 or 99D-EZ

MEDICAL CONTRACTING SERVICES PROFESSIONAL

10300 NORTH CENTRAL EXPRESSWAYS DALLAS TX 75231 S ERVICES/STUDIES 698 210 . Total number of others receiving over $50 000 for professional services " 2 6 j LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ Schedule R (Form 990 or 990-EZ) 2001

,23101 ,2 zsoi

Name of the organization Employer identification number FREDERICK MEMORIAL HOSPITAL, INC . I 52 0591612

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one It there are none enter 'None ') (a) Name and address of each employee paid (U)

Trite and average hours (a) contnouuon

Io (g)

Expens550,000 per week devoted to c ComDensation °"o'°~'~ °°,:5

' p ( ) pT,~,~a~~�,a account and o more than nnSRInn allnwanrn~

DR ._KIMANH T--LE-_____---_------__~HYSCIAN

WEST 7TH STREET . FREDERICK, MD 21701 ULL 221,421 . 6,642 .

DR . KWOK C . LEE--_____-_______-_-_~PHYSCIAN

WEST 7TH STREET . FREDERICK MD 21701 FULL

JO NO 1~CI~ 224,735 . 6,742 . WEST 7THSTREETFREDERICK . MD 2170ULL

DR . BRIAN M . O'CONNOR [[[pppHYSCIAN

WEST 7TH STREET, FREDERICK, MD 21701~ULL 229 .606 . 6,888 .

DR . EUGENE B . CASAGRANDE ------------ PHYSICIAN

WEST 7TH STREET FREDERICK MD 21701 FULL 218 083 . 6 Total number of other employees paid

110. 414 __ Compensation of the Five Highest Paid Independent Contractors for Professional Services

(a) Name and address of each independent contractor paid more than $50 000 1 (h) Type of service I (c) Compensation

AMEC CONTRUCTION MANAGEMENT

7101 WISCONSIN AVE, BETHESDA . MD 20814 ~ONTRUCTION

MORGAN-KELLER, INC .

P .O . BOX 433, HAGERSTOWN . MD 21741 ~ONTRUCTION 5075678 .

NOELKER & HULL ASSOCIATES, INC . ~CHITECT

30 WEST KING STREET . CHAMHERSBURG . PA 17201 (SERVICES ~ 176474

RADIOLOGY ASSOCIATES OF FREDERICK DIOLOGY

198 THOMAS JOHNSON DR, FREDERICK, MD 21702 (SERVICES 729,175 .

HOSPITAL, INC . 52-059161 Schedule A (Form 990 or

Statements About Activities (See page 2 of the instructions ) No

X

X

X

X 3 Does the organization make grants for scholarships, fellowships, student loans etc 7 (See Note below ) 4 Do you have a section 403(b) annuity plan for your employeas7 Note Attach e statement to explain how the organization determines that indrviduals or organizations recervmg grants or loans from it in furtherance of its charitable programs 'quaftly" to receive payments

6 of the instructions ) (See

13 = An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5 through 12 above , or (2) section 501(c)(4) (S) or (6) If they meet the test of section 509(a)(2) (See section 509(a)(3)

Provide the following information about the supported organizations (See page 5 of the instructions )

(6) Line number from above (a) Name(s) of supported organization(s)

and operated to 14 I I An Schedule A (Form 990 or 990-EZ) 2001

123111 01- 07-02

During the year has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or reterendum9 If 'Yas' enter the total expenses paid or incurred in connection with the lobbying actrvrtes 1 $ E (Must equal amounts on line 38, Part VI-A,

or line i of Part VI-9 ) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other organizations checking Yes; must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities

During the year, has the organization either directly or indirectly engaged in any of the following acts with any substantial contributors,

trustees directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal Uenefiaary9 (It the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )

a Sale, exchange, or leasing at property?

D Lending of money or other extension of credR9

c Furnishing of goons, servicea, ui f,c1l165"

d Payment of compensation (or payment of reimbursement of expenses it more than $1,000) SEE PART V, FORM 9 90

e Transfer of any part of its income or assets

X

The organization is not a prnale foundation because R is (Please check only ONE applicable box ) 5 ~ A church, convention of churches, or association of churches Section 170(o)(t)(A)(i) fi ~ A school section 170(b)(1)(A)(n) (Also complete Pan V ) 7 ~X A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(ni) 8 ~ A Federal, state, or local government or governmental and Section 170(b)(1)(A)(v)

9 ~ A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ni) Enter the hospital's name, city,

and state 10 ~ An organization operated for the benefit of a college or unrversM owned or operated by a governmental and Section 170(b)(t)(A)(rv)

(Also complete the Support Schedule in Pail IV-A )

11a 0 An organization that normally receives a substantial part of its support from a governmental unit or from the general public Section 170(b)(1)(A)(h) (Also complete the Support Schedule in Part IV-A )

1113 0 A community trust Section 770(b)(t)(A)(vi) (Also complete the Support Schedule in Part IV-A 12 0 An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership tees, and gross

receipts from activities related to it charitable, etc functions " subject to certain exceptions, and (2) no more than 3310% of its support from gross investment income and unrelated business taxable income (less section 517 tax) from businesses acquired by the organization attar June 30 1975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A )

nfFOrm990or990-EZ12001 FREDERICK MEMORIAL HOSPITAL, INC .

Total Gift 15 prenb end conMbuoona ~Waa (Do not inciude unueuN pranb $w Unit 28 1

16 Membership tees received

17 Gross receipts from admissions merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc , purpose

78 Gross income from interest dividends, amounts received from payments on securities loans (sec- tion 512(a)(5)), rents, royalties and unrelated business taxable income (less section 511 fazes) from businesses acquired by the

-fin aft., bin. In t975

19 Net income from unrelated business

activities nod included in line 18 20 7m revenue lwlsE br tM organization s

DeneRt end eiMa pYU to it M upanOeO on in bendl

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or tacildies generally furnished to the public without charge

22 OM. Inoomn Ptictt a aC,aEttia Do not Include pun w po»/ hom wb of mpi W .ft

1 Public support percentage (line 26e (numerator) divided 6Y line 26s (denominator)) 11111, 1 2511 I tv / ti % 27 Organizations described on line 12 a Far amounts included in lines 15, 76, and 17 that were received from a'disqualrtied person,' prepare a list for your records

to show the name of and total amounts received in each year from, each 'Oisqualrhe0 person' Do not file this list with your return Enter the sum of such amounts for each year (2000) (1999) (7998) (1997)

b For any amount included in line 17 that was received from each peson (other than 'disqualified persons'), prepare a list for your records to show the name of and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2)$5 000 (Include in the list organizations described in lines 5 through 11, as well as individuals ) Do not file this list with your return After computing the dAterence between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year (2000) (1999) (1998) (1997)

c Add Amounts from column (e) for lines 15 16 - n 20 z, -

d Add Line 27a total and line 27o total e Public support (line 27c total minus line 27d total) 1 Total support for section 509(a)(2) test Enter amount on line 23 column (e) " 271

g Public support percentage (line 27e (numerator) divided by line 271 (denominator))

" 27c N/A 111'.

27a N/A

110' 27e N/A

N 28 Unusual Grants For an organization described in line 10 11, or 12, that recerved any unusual prams during 1997 through 2000 prepare a lisp for your records to

show for each year, the name of the contributor the date and amount of the grant and a Cnet description of the nature of the grant 00 not life this list with your return Do not include these grants in line 15

Schedule A (Form 990 or 990-EZ) 2001 123121 12 7P01

Support Schedule (Complete only ff you checked a box on line 10, 11 or 12 ) Use cash method o1 acs Note You ma use the worksheet in the instructions !or convertin from the eccrval to the cash methoc

(arfiscal year " fill 2000 1b1 1999 Icl 1998 101 1997

-0591612 Page 3 tine N/A

23 Total of lines 15lhrouph 22 0 . 0 . 0 . 0 . 20 Line 23 minus line 17 25 Enter 1% al line 23 25 Organizations described on hoes 70 or 17 a Enter 2% of amount in column (e), line 24 1 26a N/A D Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental

unit or publicly supported organization) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a Do not file this list with your return Enter the total of all these excess amounts " 26h NBA

c Tout support for section 509(a)(1) test Enter line 24, column (e) " 26c N/A A Add Amounts from column (e) for lines 18 79

22 261b 1 26a NBA e Public support (line 26c minus line 26d total) 1 ~ 26e N/A

N/A I I ^~

34 a Does the organization receive any financial aid or assistance from a governmental agency h Has the organization's right to such aid ever been revoked or suspended

It you answered 'Yes' to either 34a or D, please explain using an attached statement 35 Does the organization certify that 9 has complied with the applicable requirements of sections 4 01 through 4 OS of Rev Proc 75-50,

1975-2 C 8 587 covenno racial nondiscnmination9 If 'NO' attach an exolanalion

Schedule A (Farm 990 or 990-E2) 2001

iza,ai ,z zo-o,

Schedule n(FOrm990or990-EZ)200t FREDERICK MEMORIAL HOSPITAL INC . 52-0591612 Pagea part y Pnvate School Questionnaire (See page 7 of the instructions ) N/A

(To be completed ONLY by schools that checked the box on line 6 in Part IV)

29 Does the organization nave a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing Yes No

instrument, or in a resolution of its governing body 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all as brochures catalogues

and other written communications with the public dealing with student admissions, programs, and scholarships 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of

solicitation for students or during the registration period it it has no solicitation program in a way that makes the policy known to all parts o1 the general community it serves 31 If 'Yes' please describe, rf'NO' please explain (If you need more space attach a separate statement )

32 Does the organization maintain the following a Records indicating the racial composition of the student body faculty and administrative 5laft') b Records documenting final scholarships and other financial assistance are awarded on a racially nondiscriminatory basis e Copies o1 all catalogues, brochures, announcements and other written communications to the public dealing with student

admissions programs, and scholarships 0 Copies of all material used by tie organization or on its Dehall to solicit contributions

If you answered *No* to any of the above please explain (11 you need more space attach a separate statement )

33 Does the organization discriminate by race in any way with respect is a Students' rights or privileges? b Admissions policies? c Employment of fatuity or administrative staff? d Scholarships or other financial assistance? e Educational policies I Use of facilities? g Athletic programs? In Other ex1racumcular activities?

It you answered Yes' to any of tie above please explain (I1 you need more space attach a separate statement )

52-OS

1 a n if tie organization Delonas to an affiliated group Check 1 (a) (b)

Affiliated group To be completed for ALL totals electing organizations

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying)

38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from tie following table-

II the amount on line 40 Is - The lobbying nontaxable amount is -

Not we $500 000 20% of me errwnt m line 40

Over f500000but not wnf1 000 000 5100000plus 15%of Neexcess ovaSSWUA!

Ovx 51 000000 out not ovs31 500000 $175000 grog 10% 01 the excess over f1 000000

O+af1500000eutnot wsS17000000 f173000plus 5%ofNeuceawe~51500000

NR $1 7 000 00o $+ 00101000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter -0 " if line 42 is more than line 36

44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38

1I

l

Caution If there is an amount on either line 43 or fine 44, you must file Form 4720

4-Year Averaging Period Under Section 501(h)

(Some organizations that made a section 501(h) election do not have to complete all of the five columns below See the instructions for lines 45 through 50 on page 11 01 tie instructions )

Lobbying Expenditures During 4-Year Averaging Period NBA

Calendar year (or (a) (b) W (d) (e) Natal year beginning In) 1 2001 2000 1999 1998 Total

45 Lobbying nontaxable 0 . amount

46 Lobbying ceiling amount

150% 01 line 45 e

47 Total lobbying

expenditures 0 .

aB Grassroots nontaxable

amount 0

49 Grassroots ceiling amount

150% of line 48(e)) 0

50 Grasstoots lobbying

ex enARures 0

Part VI-8 Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of the instructions

During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount

influence public opinion on a legislative matter or referendum through tie use of

a Volunteers

D Paid staff or management (Include compensation in expenses reported on lines e through A ) X

c Media advertisements

C Mailings to members legislators or the public X

e Publications, or published or broadcast statements X

1 Grants to other organizations for lobbying purposes X

p Direct contact with legislators their staffs government officials or a legislative body X

h Rallies demonstrations seminars conventions speeches lectures or any older means

I Total lobbying expend dures (Add lines c through In ) It 'Yes* to any of the above also attach a statement giving a detailed description 01 the lobbying activities

123141 2 29-01 Schedule A (Form 990 or 990-EZ) 2001

Schedulen(FOrm990or99D-EZ)2001 FREDERICK MEMORIAL HOSPITAL INC . part VI-A Lobbying Expenditures by Electing Public Charities (see page 9 of the instructions)

(TO be completed ONLY 6v an eligible oraanizalion that filed Form 5768)

Limits on Lobbying Expenditures term 'expenditures' means amounts paid or incurred

Schedule A(FOrm990or990-EZ) 2001 FREDERICK MEMORIAL HOSPITAL INC . 52-0591612 Page 6

Part VII Information Regarding Transfers To and Transactions and Relationships With Nonchantable

Exempt Organizations See page 12 of the instructions )

51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of tie Code (other than section 507(c)(3) organizations) or in section 527 relating to political orpanizations7

a Transfers from the reporting organization to a noncharRabie exempt organization o1 Yes No

51 a(l) X (i) Cash

(11) Other assets a(II) X

b Other transactions

(i) Sales or exchanges of assets with a nonchantable exempt organization b(i) X

(u) Purchases 01assets from anonchantableexempt organization bill) X

(iii) Rental of facilities equipment or other assets b(III) X (Iv) Reimbursement arrangements 0(1v) X

(v) Loans or loan guarantees h( Iv) X

(vl) Performance of services or membership or tunAraising solicitations b(VI) X

c Sharing o1 facilities, equipment, mailing lists, other assets, or paid employees c X

A It the answer to any of the above is 'Yes' complete tie following schedule Column (D) should always show the fair market value of the oal_ia ~n i gouus. uwei aaaeu. w >ei.ii,d5 giver, Cy t .c iyJi~ .°.y 0.^y . .~ .... ,. . . :' ; .". ;, ._ . "9C less ~n_~ ~~i ro, .bot vin,,

transaction or sharing arrangement show in column (A) the value of the goods other assets, or services received j1/p,

(a) (6) (s) (d) Line no Amount involved Name of noncnaritable exempt organization Description o1 transfers, transactions, and sharing arrangements

52 a Is the organization directly or indirectly affiliated with or related to, one or more lax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5277 Yes No

n If 'Yes .' comolele the following schedule N/A

lot Type of organization

(a) Name of organization

Schedule A (Form 990 or 990-EZ) 2001

Icl Description of relationship

FORM 990 PAGE 2 990

Reduction In Description Date Method Life No Unadjusted Bus % Basis- Basr, For Accumulated Current Amount 01

Acquired Cost Or Basis Ezcl ITC, 179, Depre( iauon Depreciation Sec 179 Depreciation Salvage

I LAND I .000 16 2421745 . 242'745 . 0 . " ; , LAND IMPROVEMENTS b

,2 tASEHOI,D IMPROVEMENTS ' I .000 16 861689 6 . 8616896 . 1843840 . 334,696 .

3 BUILDINGS I .000 16 39180301 . 39180301 .14338233 . 1189168 .

~!~","=r4 IXED~~~EQUYPMENT ' T .000 16 15317694 . 15317694 .11133183 . 597,152 .

5 MOVABLE EQUIPMENT VARIES .000 16 8971003 . 8971003 .36616111 . 4890258 .

~-6 APTTALIZED PURCHASES I .000 16 ,1170157 . 1170157 . 64,,716 . 152,506 .

7 RENOVATIONS VARIES .000 16 9289028 . 9289028 . 0 .

',`°"`` TOTAL 990 PAGE ; 2 DEPR 154966824 0 .154966824 3996083 . 0 . 7163780 . .,

� . � , . , .

r

taro 01 (D) - Asset disposed

)O7 DEPRECIATION ANO AMORTIZATION REPORT

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

STATEMENT S) 1

FORM 990 GAIN (LOSS) FROM PUBLICLY TRADED SECURITIES STATEMENT 1

GROSS COST OR EXPENSE NET GAIN DESCRIPTION SALES PRICE OTHER BASIS OF SALE OR (LOSS)

SALE OF INVESTMENTS 24,940,223 . 28,587,582 . 0 . <3,647,359 .>

TO FORM 990, PART I, LINE 8 24,940,223 . 28,587,582 . 0 . <3,647,359 .>

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

FORM 990 GAIN (LOSS) FROM SALE OF OTHER ASSETS STATEMENT 2

DATE DATE DESCRIPTION ACQUIRED SOLD

SALE OF ASSETS VARIOUS VARIOUS

GROSS COST OR EXPENSE NAME OF BUYER SALES PRICE OTHER BASIS OF SALE

10,675 . 98,526 . 0 .

TO FM 990, PART I, LN 8 10,675 . 98,526 . 0 .

METHOD ACQUIRED

PURCHASED

NET GAIN DEPREC OR (LOSS)

0 . <87,851 .>

0 . <87,851 .>

STATEMENT S) 2, 3

FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 3

GROSS CONTRIBUT . GROSS DIRECT NET DESCRIPTION OF EVENT RECEIPTS INCLUDED REVENUE EXPENSES INCOME

CHRISTMAS BAZAAR 8,986 . 8,986 . 3,794 . 5,192 . SNOWBALL DANCE 78,826 . 78,826 . 26,468 . 52,358 . TREE OF LIGHTS 10,890 . 10,890 . 1,729 . 9,166 .

TO FM 990, PART I, LINE 9 98,702 . 98,702 . 31,986 . 66,716 .

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

STATEMENT S) 4

FORM 990 INCOME AND COST OF GOODS SOLD STATEMENT 4 INCLUDED ON PART I, LINE 10

INCOME

1 . GROSS RECEIPTS . . . . . . . . . . . . . . . 480,788 2 . RETURNS AND ALLOWANCES . . . . . . . . . . . 3 . LINE 1 LESS LINE 2 . . . . . . . . . . . . . 480,788

4 . COST OF GOODS SOLD (LINE 13) . . . . . . . . 297,073 5 . GROSS PROFIT (LINE 3 LESS LINE 4) . . . . . 183,715

COST OF GOODS SOLD

6 . INVENTORY AT RF_rTNN7iJr hg yrro . . 2,819,697 7 . MERCHANDISE PURCHASED . . . . . . . . . . . 320,683 B . COST OF LABOR . . . . . 9 . MATERIALS AND SUPPLIES . . . . . . . . . . .

10 . OTHER COSTS . . . . . . 11 . ADD LINES 6 THROUGH 10 . . . . . . . . . . . 3,140,380

12 . INVENTORY AT END OF YEAR . . . . . . . . . . 2,843,307 13 . COST OF GOODS SOLD (LINE 11 LESS LINE 12) . . 297,073

52-0591612 FREDERICK MEMORIAL HOSPITAL, INC .

FORM 990 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 5

TOTAL TO FORM 990, PART I, LINE 20

!Al !('1 PROGRAM MANAGEMENT SERVICES AND GENERAL

63,095 . 123,246 .

55,395,253 . 13,762,626 . TOTAL TO FM 990, LN 43 69, 157,879

STATEMENT S) 5, 6

DESCRIPTION

UNREALIZED APPRECIATION OF INVESTMENTS

FORM 990

DESCRIPTION

PROFESSIONAL FEES-M .D . CONSULTING INSURANCE MEDICAL EQUIPMENT DUES AND LICENSES DRUGS X-RAYS FOOD AND CATERING BLOOD PROCESSING LINEN AND BEDDING CLEANING AUTO DEFERRED FINANCE COSTS BOND AMORTIZATION MISCELLANEOUS ALLOWANCE FOR UNCOLLECTIBLES TREASURER'S FUND RECRUITMENT PROMOTION CONTRACT SERVICES CONTRACTUAL AND OTHER ALLOWANCES PROFESSIONAL FEES

!AI

TOTAL

1,074,586 . 622,495 . 705,655 . 711,459 . 278,315 .

18,786,388 . 306,017 .

1,178,924 . 1,239,999 . 169,050 . 310,719 . 261,080 .

63,095 . 123,246 . 79,219 .

7,601,536 . 15,212 .

661,719 . 324,399 .

11,159,848 .

23,367,807 . 122,111 .

OTHER EXPENSES

705,655 .

1,178,924 .

164,050 . 310,719 . 261,080 .

79,219 .

7,601,536 . 15,212 .

661,719 . 324,399 .

1,220,310 . 9,939,538 .

23,367,807 . 122,111 .

1,074,586 . 622,495 .

711,459 . 278,315 .

18,786,388 . 306,017 .

1,239,999 .

AMOUNT

<3,734,954 .>

<3,734,954 .>

STATEMENT 6

Ini 1-1

FUNDRAISING

52-0591612 FREDERICK MEMORIAL HOSPITAL, INC .

FORM 990 NON-GOVERNMENT SECURITIES STATEMENT 7

CORPORATE SECURITY DESCRIPTION STOCKS

8 .111 .

36,733,385 . 9,632,068 . 3,616,505 . 49,981,958 . TO 990, LN 54 COL B

FORM 990 GOVERNMENT SECURITIES STATEMENT 8

STATE AND LOCAL GOV T

U .S . GOVERNMENT

6,510,296 . 6,510,296 .

6,510,296 .

U . S . GOV T OBLIGATIONS

TOTAL TO FORM 990, LINE 54, COL B 6,510,296 .

FORM 990 OTHER INVESTMENTS STATEMENT 9

TOTAL TO FORM 990, PART IV, LINE 56, COLUMN B

STATEMENT S) 7, B, 9

BONDS CONSTRUCTION INVESTMENTS MARKETABLE EQUITY SECURITIES MARKETABLE 4FC`IIR TTTFS

36,725,274 .

OTHER PUBLICLY TOTAL

CORPORATE TRADED OTHER NON-GOV'T BONDS SECURITIES SECURITIES SECURITIES

9,632,068 . 9,632,068 .

3,616,505 . 3,616,505 .

36,725,274 .

8,111 .

DESCRIPTION TOTAL GOV T SECURITIES

DESCRIPTION

INVESTMENT IN SUBSIDIARY LAND

VALUATION METHOD AMOUNT

COST 22,298,959 . COST 542,150 .

22,841,109 .

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

FORM 990 DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT STATEMENT 10

TOTAL TO FORM ooh nom r~r , c~ v~ ivy u i~ ,, 1JY~7VU~OGY . t33, iSUb, y61 . 71,159,863 .

FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 12

TOTAL TO FORM 990, PART IV-A 179,166 .

FORM 990 OTHER EXPENSES NOT INCLUDED ON FORM 990 STATEMENT 13

TOTAL, TO FORM 990, PART IV-B

STATEMENT S) 10, 11, 12, 13

COST OR DESCRIPTION OTHER BASIS

LAND 2,421,745 . LAND IMPROVEMENTS & LEASEHOLD IMPROVEMENTS 8,616,896 . BUILDINGS 39,180,301 . FIXED EQUIPMENT 15,317,694 . MOVABLE EQUIPMENT 58,971,003 . CAPITALIZED PURCHASES 1,170,157 . RENOVATIONS 29,289,028 .

ACCUMULATED DEPRECIATION

0 .

2,178,536 . 15,527,401 . 11,730,335 . 41,506,369 .

217,222 . 0 .

BOOK VALUE

2,421,745 .

6,438,360 . 23,652,900 . 3,587,359 . 17,464,634 .

952,935 . 29,289,028 .

FORM 990 OTHER ASSETS STATEMENT 11

DESCRIPTION AMOUNT

DUE FROM AFFILIATES 6,360,779 . INTANGIBLE ASSETS 690,053 .

TOTAL TO FORM 990, PART IV, LINE 58, COLUMN B 7,000,832 .

DESCRIPTION

INTERFUND APPROPRIATIONS

AMOUNT

179,166 .

DESCRIPTION

SPECIAL EVENT EXPENSES - NETTED ON LINE 9B COST OF GOODS SOLD - NETTED ON LINE lOB INTERFUND APPROPRIATIONS

AMOUNT

31,986 . 297,073 . 179,166 .

508,225 .

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

~~pM Ooh nmHFA FXPFNGFS TNrT,11nFD ON FORM 990 STATEMENT 15

TOTAL TO FORM 990, PART IV-B 23,367,807 .

FORM 990 PROGRAM SERVICE REVENUE STATEMENT 16

BUS UNRELATED EXCL EXCLUDED CODE BUSINESS INC CODE AMOUNT

OUTPATIENT REVENUE INPATIENT REVENUE CAFETERIA b COFFEE SHOP OTHER PATIENT SERVICES PROFESSIONAL FEES STAFF SERVICES DISCOUNTS ON PURCHASES FLOWER SERVICE BABY PHOTOS LIFE MEMBERS UNIFORMS MISCELLANEOUS RECRUITING & RETENTION MEMBERSHIP MEETING RETAIL PHARMACY PREMIUM REVENUE PARTNERSHIP INCOME RELATED TO PROGRAM SERV

03 1,093,172 . 312,075 . 554,591 . 578,524 . 36,536 . 1,014 . 8,955 . 1,795 . 1,144 .

10,597 . 756 .

2,711 . 1,610,511 . 566,049 .

446110 1,463,991 .

541900

TO FORM 990, PART VII, LINE 93 1,460,760

STATEMENT S) 19, 15, 16

FORM 990 OTHER REVENUE INCLUDED ON FORM 990 STATEMENT 19

DESCRIPTION AMOUNT

ALLOWANCE NETTED AGAINST REVENUE 23,367,807 . SPECIAL EVENT EXPENSES - NETTED ON LINE 9B <31,986 .> COST OF GOODS SOLD - NETTED ON LINE lOB <297,073 .> PRIOR PERIOD ADJUSTMENT 233,905 .

TOTAL TO FORM 990, PART IV-A 23,272,153 .

DESCRIPTION

ALLOWANCE NETTED AGAINST REVENUE

AMOUNT

23,367,807 .

DESCRIPTION

<2,681 .>

RELATED OR EXEMPT FUNC-TION INCOME

90,602,724 . 99,540,250 .

1,093,172 . 193,828,232 .

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612

FORM 990 PART IX STATEMENT 17 INFORMATION REGARDING TAXABLE SUBSIDIARIES

NAME, ADDRESS 6 ID NUMBER OF CORP OR PARTNERSHIP

FREDERICK SURGICAL SERVICES CORP, 915 TOLLHOUSE AVE ., EIN 52-1642334 FREDERICK HEALTH SERVICES CORP ., W . 7TH ST ., FREDERICK, MD . 21701 FIN 57_1 A51_fi(,1_ EMMITSBURG PROPERTIES, LLC, W 7TH ST ., FREDERICK, MD 21701 EIN 52-1910823

100 .00$ HEALTH SERVICES 139,494 . 3,794,418 .

100 .00$ HEALTH SERVICES <3,215,170 .> 16,473,704 .

99 .00$ PROPERTY RENTAL <80,956 .> 1,697,664 .

STATEMENT S) 17

PCT NATURE OF OWN BUSINESS

TOTAL END-OF-YEAR INCOME ASSETS

DEWALT J WILLIARD, JR FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

MARIE HUFFMAN FMHA PRESIDENT FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

T \TAXCLIENTSkF\Fred Memnal\DIRECTOR502 XLS(Sneetl)

FREDERICK MEMORIAL HOSPITAL, INC EIN 52-0591612 ATTACHMENT TO FORM 990, FOR JUNE 30, 2002

STATEMENT # IS PART V

BOARD OF DIRECTORS

J RAY RAMSBURG CHAIRMAN OF THE BOARD FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

J BRIAN GAENG VICE CHAIRMAN FIaFf1FRl('l! hACnAnDIA` unCoiTn" i~~~

WEST 7TH STREET FREDERICK, MD 21701

GEORGE E DREDDEN SECRETARY 8 TREASURER FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

STEVEN BRAND, M D CHIEF OF STAFF FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

GENE ASHE, M D VICE CHIEF OF STAFF FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

ANDREW DONELSON, M D PAST CHIEF OF STAFF FREDERICK MEMORIAL HOSPITAL INC WEST 7TH STREET FREDERICK, MD 21701

PETER H PLAMONDON, SR FREDERICK MEMORIAL HOSPITAL INC WEST 7TH STREET FREDERICK, MD 21701

A WADE MANNING FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FRED CRII.K, IVIV L I /U I

PATRICIA STANLEY FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

SEYMOUR B STERN FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

CHARLES R ZIMMERMAN FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

KENNETH G MCCOMBS FREDERICK MEMORIAL HOSPITAL, INC WEST 7TH STREET FREDERICK, MD 21701

NONE OF THE ABOVE ARE COMPENSATED IN ANY WAY

.. ., . . .,

,heal 07 1601

Form 8868 I Application for Extension of Time To File an (December 2000) Exempt Organization Return OMB No 15451709 Depvtnent of Me Trqsury im~n arm~~ s~w.x 1 File a separate application for each return

II you are fling for an Automatic 3-Month Extension, complete only Part I and check this box 1 OX If you are fling for an Additional (not automatic) 3-Month Extension, complete only Pert II (on page 2 of this loan)

Note Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form BBBB

part 1 Automatic 3-Month Extension of Time - Only suborn original ono copies needed)

Note Forth 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only All other corporations (including Form 990.C (tars) must use Form 7004 to request en extension of bore to file income tax returns Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to (b Form 1065, 7066, or 1041

Type or Name o1 Exempt Organization Employer clentiTication number print

FREDERICK MEMORIAL HOSPITAL, INC . 52-0591612 File by Me aue oete for Number, sheet, and room or suite no It a P O box, see instructions filing rwr WEST 7TH STREET reNm See .Of City , town or post office state and ZIP COCIH For R f(»Plgn a_1Nroee e__ n=1~i~u~..~

FREDERICK, MD 21701

Check type of return to be filed(flle a separate application for each return)

~X Form 990 ~ Forth 990-T (corporation) ~ Form 4720 0 Form 990-BL O Form 990-T (sec 401(e) or 40B(a) trust) D Form 5227

Form 990~EZ 0 Form 990 T (trust other than above) ~ Forth 6069 Form 99O-PF ~ Form 1041 A ~ Forth 8870

If the organization does not have an office or place o1 business in the UnneO States, check this box PO. = It this is for a Group Return, enter the organization's four digit Group Exemption Number (GEM I1 this is for the whole group, check this

box " 0 If it is for part of the group, check this box 1 0 and attach a list wnh the names and EINs of all members the extension will cover

1 I request an automatic 3-month (6-month, for 990-7 corporation) extension of time until FEBRUARY 18, 2003 to file the exempt organization return for the organization named above the extension is for the organization's return for

calendar year a " ~X tax year beginning JUL 1, 2001 , and ending JUN 30, 2002

2 H this tan year is for less than 12 months, check reason ~ Initial return 0 Final return 0 Change to accounting period

3a If this application is for Form 990 BL . 99PPF, 990-7, 4720, or 6069, enter the tantalite tax, less any nonrefundable credits See instructions

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit

c Balance Due Subtract line 3b from line 3a Include your payment with this form, or, it required, deposit with FrD coupon or, d required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $ N/A

Signature and Verification

Under penalties of penury, I declare that I have examined this form including accompanying schedules and statements, and to the best of my knowledge and beret. R is true correct and complete and that I am authorized to prepare this loan

LHA For Paperwork Reduction Act Notice, see instruction Form 8868 (12-2000)

r . . F

STOP Do not complete Part II H you were not already granted an automatic 3-month extension on a previously filed Form 8888

If the organization does not have an office or place of business in the United States check this box

4 I request an additional 3-month extension of time until MAY 15, 2003 5 For calendar year , or other tax year beginning JUL 1 ,

200' and ending JUN 30, 2002

6 I1 this tax year is for less than 12 months check reason = Initial return ~ Foal return L-1 Change in accounting period 7 State in detail why you need the extension

ADDITIONAL TIME IS NE SARY

D

Director Dale

Alternate Mailing Address - Enter the address ff you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above

Name RSM MCGLADREY, INC . (SPK

Type Number and street (include suite, room, or apt no ) Or a P O box number orpnnt 100 NORTH CHARLES STREET, SUITE 1300

City or town, province or state, and country Including postal or ZIP code) BALTIMORE, MD 21201

Form 8868 (12-2000)

form 8868(12-2000 Paae 2

If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check the box " X Note Only complete Part II i1 you have already been granted an automatic 3-month extension on a previously tiled Form 8888

N you are tiling for an Automatic 3-Month Extension, complete only Part I (on page 1) Part il Additional (not automatic) 3-Month Extension of Time - Must file Original and One Co

Name of Exempt Organization Employer identification number Type or pool FREDERICK MEMORIAL HOSPITAL, INC . 52-059161? F,le by the extended Number, street, and room or suite no II a P O box, see instructions For IRS use only a.. 0.1e Tar EST 7TH STREET filing Me . . . . 2i,m see City, town or post office, state, and ZIP code For a foreign address see instructions '"""""°"' FREDERICK, MD 21701 Check type of return to be filed (File a separate application for each return)

Form 990 Ej Form 990 EZ 0 Form 990 T (sec 401(x) or 408(x) trust) ~ Form 7041~A ~ Form 5227 ElForm 8870 0 Form 990 BL = Form 990 PF ~ Form 990 T (trust other than above) 0 Form 4720 0 Form 6069

- . . u. .5 .5 7J

o

' ..f....y r",c:afl, cid2f the Jfydfn2auvii6 i.oi .iyn viuuy uempUqn rvumoer kUtlv) 17 tots 15 for the whole group, check this

box "" 0 It rt is for part of the group, check this box " = and attach a list with the names and EINs o1 all members the extension is for

Ba N this application is for Form 990 BL, 990 PF, 990 T, 4720 or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b If this application is for Form 990 PF, 990~T, 4720, or 6069, enter any refundable credits and estimated tax payments made Include any poor year overpayment allowed as a credo and any amount paid previously with Form 8868

c Balance Due Subtract line Bb from line 8a Include your payment with this form, or, if required, deposit wnh FTD coupon or, 6 required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $ NBA

Signature and Verification Under penalises of penury, I declare that I have examined this form, including accompanying schedules and statements and to the best of my knowledge and belief, d is true correct, and complete, and that I am oluthoiized to prepare this form

Notice to Applicant - To Be Completed by the IRS D We have approved this application Please attach this form to the organization's return

We have not approved this appl~calnr F+c""" e,"er, ve he " e gr~' "e` z 10-clay grace pe-lc.". Iron !7e laser c" ;he date cDho~wnr~ be~'~-,ti 7i I I16 did date o1 the organization's return (including any prior extensions) This grace period is considere~~~~1~9otf~1V~F+~1e'for elections otherwise required to be made on a timely return Please attach this form to the organization's return We have not approved this application After consiaering the masons stated in item 7, we cannot graf

C rrtRy Zqeej"3n extension of time to

file We are not granting the 10-day grace period 0 We cannot consider this application because n was tiled after the due date o1 the return for wq~,eqppp,Mgi~q9~f,

Other SUBMISSION PROCESS ING, OGDEM

By