2022-07-20T16:24:19-05:00 2021-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2020-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott Sloane Senior VP, CFO, & Treasurer 6032284677 2022-06-29 1 Scott Sloane 999009999 Connor Smart P02285543 2078792100 2022-06-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 664034000 0 X www.concordhospital.org X 1944 NH Hospital 16 13 4096 130 1826694 0 34343347 8446813 508086018 589259049 13966988 19101710 -676244 6001945 555720109 622809517 0 0 0 0 311080973 332886259 0 0 1121915 228416199 250069747 539497172 582956006 16222937 39853511 697377820 790822441 387848012 377586755 309529808 413235686 X Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 1 0 482512162 0 593279744 Various hospital services; see Schedule HIn FYE 2021, Concord Hospital invested almost $79 million in community benefit programs, services, and other expenses. The largest areas of support were charitable care services, medical education and subsidized programs and services. Our investment enhances the Hospital's ability to provide quality patient care, respond to identified community health needs and address the Hospital's charitable mission overall. 482512162 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 0 1 242 0 1 4096 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X X Scott Sloane Senior VP CFO 6032277000 250 Pleasant Street Concord NH 033017539 Robert P Steigmeyer President & CEO, Member Ex-Officio 56.00 7.00 X X 1208058 0 258370 David Stevenson MD Trustee (end 1/2021) 50.00 1.00 X 238340 0 80949 Joseph Meyer MD Trustee 50.00 0.00 X 313408 0 85883 Tanya Vanderlinde MD Trustee 50.00 0.00 X 283458 0 94226 Sol Asmar Trustee 1.00 6.00 X 0 0 0 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 Charles Fanaras Trustee 1.00 2.00 X 0 0 0 Rosemary M Heard Trustee (end 12/2020) 1.00 0.00 X 0 0 0 Lucy Hodder Trustee (eff. 7/2021) 1.00 1.00 X 0 0 0 Lucy Karl Esq Trustee 1.00 1.00 X 0 0 0 Linda Lorden Trustee 1.00 1.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 David Ruedig Trustee (end 7/2021) 1.00 1.00 X 0 0 0 Muriel Schadee CPA Trustee (end 1/2021) 1.00 4.00 X 0 0 0 Robert Segal Trustee 1.00 4.00 X 0 0 0 Jeffrey Towle Trustee 1.00 2.00 X 0 0 0 Don Welford Trustee 1.00 1.00 X 0 0 0 Philip Emma Chair 1.00 7.00 X X 0 0 0 Manisha Patel DDS Vice Chair 1.00 6.00 X X 0 0 0 William Chapman Esq Secretary 1.00 3.00 X X 0 0 0 Scott Sloane Treasurer 56.00 7.00 X 529605 0 87526 Matthew Gibb Chief Clinical Officer 50.00 2.00 X 750059 0 56498 Nicola Francalancia MD Physician 50.00 0.00 X 808364 0 43904 Moosavi Shahab MD Physician 50.00 0.00 X 598877 0 63252 Adam Chodosh MD Physician 50.00 0.00 X 598028 0 70211 Stephen Greer DDS Physician 50.00 0.00 X 539000 0 3591 Michael Ferguson MD Physician 50.00 0.00 X 517696 0 57340 Timothy Jones Former VP/COO (ended 6/2020) 0.00 0.00 X 504408 0 38682 6889301 0 940432 519 1 1 0 Harvey Construction Corp 10 Harvey Road Bedford NH 03110 Construction services 10570755 Anesthesia Associates PA 1 Pillsbury Street Concord NH 03301 Healthcare services 3975004 Engelberth Construction Inc 150 Water Tower Circle Colchester VT 05446 Construction services 1907478 Concord Orthopaedics PA 264 Pleasant Street Concord NH 03301 Healthcare services 1742880 Angelica-Worcester PO Box 532268 Atlanta GA 30353 Professional services 1226926 46 4240384 4206429 8446813 Net Patient Service 621400 558623775 558623775 Disproportionate Share Funding 621400 23453162 23453162 Food Services 722210 2888261 2027671 860590 Other Operating Revenue 621400 2359928 1198968 1160960 Child Care Center 624410 973242 973242 960681 960681 589259049 6478834 -194856 6673690 1747958 0 1747958 1747958 1747958 53655210 4884 41037218 0 12617992 4884 12622876 12622876 368065 187265 180800 180800 NH Cares ACO LLC 621400 4073187 4073187 4073187 622809517 593239444 1826694 19296566 3986380 3319849 661541 4990 257338702 214179626 42705353 453723 14101044 11736076 2340128 24840 44283935 36856820 7349107 78008 13176198 10966342 2186646 23210 2073946 2073946 319539 319539 362059 362059 48000 48000 966548 966548 33870436 24376568 9402623 91245 161358 134461 26750 147 5409791 4508112 896757 4922 1888811 1573961 313131 1719 13701896 11417898 2271531 12467 569462 474537 94407 518 1416761 1180598 234874 1289 3834390 2571591 1221806 40993 24321460 16336777 7727228 257455 7613688 6344546 1262214 6928 Drugs/medical supplies 94431792 78690755 15741037 NH MET 24279074 24279074 Provision for bad debts 20907242 20907242 Repairs/maintenance 5585645 4654562 926001 5082 8307849 7954767 238703 114379 582956006 482512162 99321929 1121915 32968058 31989258 73907494 66524862 65601365 71904819 2769606 3944273 6597293 7609210 488282478 302266853 192133200 186015625 133628876 207061871 164923589 195111013 5508866 6442532 19339473 14218978 697377820 790822441 71062538 74520896 121741320 160770378 195044154 142295481 387848012 377586755 X 309529808 413235686 309529808 413235686 697377820 790822441 X 39853511 49302058 14550309 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 44744 0 0 1 48000 92744 0 Part II-B, Line 1: Concord Hospital was a member of the American Hospital Association & the New Hampshire Hospital Association in the fiscal year ended 9/30/2021. A portion of the dues paid to these organizations were available for lobbying expenditures on behalf of Concord Hospital and the other member organizations in furtherance of their exempt purposes. The portion of the dues used for lobbying by the American Hospital Association and the New Hampshire Hospital Association were $11,068 and $33,676, respectively. Concord Hospital hired outside consultants to perform services to further Concord Hospital's mission and communications. Concord Hospital paid $48,000 to the firm Dennehy & Bouley LLC for such consulting services during the period covered by this tax return. 275536256 65833936 799972 340570220 264211724 11916474 591942 275536256 277852367 -13045293 595350 264211724 272756311 5743785 647729 277852367 239892180 33431692 567561 272756311 1.00000 0.00000 0.00000 0 1 1 18996 18996 219998454 105729459 114268995 4640533 3468736 1171797 258665033 193068658 65596375 4959462 4959462 186015625 Alternative investments 195111013 F 195111013 Accrued pension and other long-term liabilities 36009946 Estimated third-party settlements 94470982 Due to affiliates 6233576 Reserve for insurance deductibles 5580977 142295481 X 664171080 49302058 56761505 106063563 558107517 966548 63735452 64702000 622809517 560465202 0 560465202 966548 21524256 22490804 582956006 Part V, Line 4: The intended use of the endowment funds is to fund capital expenditures for medical equipment/provide healthcare prevention and services for the uninsured population in the service area. Part X, Line 2: The Hospital, CH-Laconia, CH-Franklin, CRHCDC, CRHVC, and the Trust are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. NHC is organized as a single member limited liability company and has elected to be treated as a disregarded entity for federal and state income tax reporting purposes. Accordingly, all income or losses and applicable tax credits are reported on the member's income tax returns, with the exception of taxes due to the State of New Hampshire. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. GSIE, NHC and CEC account for income taxes in accordance with Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Income Taxes. FASB ASC 740 is an asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of temporary differences between the tax and financial reporting basis of certain assets and liabilities. Resulting income tax expense and the temporary differences between the tax and financial reporting basis are not material. Part XI, Line 2d - Other Adjustments: Pension actuarial gain 56,761,505. Part XI, Line 4b - Other Adjustments: Equity transfers to affiliates 39,880,355. Provision for bad debts 20,907,242. Net periodic pension cost 2,330,841. Board designated spending 617,014. Part XII, Line 4b - Other Adjustments: Provision for bad debts 20,907,242. Board designated spending 617,014. Central America and the Caribbean - Cayman Islands 0 0 Investments - FMV as of 9/30/2021 None 72139000 Europe (Including Iceland & Greenland) 0 0 Investments - FMV as of 9/30/2021 None 9808000 0 0 0 0 0 0 81947000 0 81947000 1 0 1 1 1 0 Part III Accounting Method: Part IV, Line 3: This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Part IV, Line 4: The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital. 1 1 1 X 225.000000000000 1 X 500.000000000000 1 1 1 0 1 1 7 6005 3838408 3838408 0.00680 76553870 48998946 27554924 0.04900 7 6005 80392278 48998946 31393332 0.05580 9 599733 1704050 425732 1278318 0.00230 5 6775 8663548 7058753 1604795 0.00290 23 435610 79449039 35811815 43637224 0.07760 1 16 61813 61813 0.00010 6 1041722 105828 935894 0.00170 44 1042134 90920172 43402128 47518044 0.08460 51 1048139 171312450 92401074 78911376 0.14040 2999373 747902 2251471 0.00400 2999373 747902 2251471 0.00400 1 6107544 653507 195516085 260006671 -64490586 X 1 1 1 1 Concord Hospital 250 Pleasant Street Concord NH 03301 01098 X X X X Concord Hospital 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Section C X X 1 18 1 See Part V, Section C 0 1 X 225.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X X 1 X 0 0 Concord Hospital Part V, Section B, Line 5: See the narrative for Schedule H, Part VI, line 2. Concord Hospital Part V, Section B, Line 7d: The Community Benefits Report (2021 Charitable Achievements) was included in Concord Hospital's Annual Report that was mailed to nearly 25,000 households within the communities that the Hospital serves. Community members were sent a postcard inviting them to view on the Hospital's website or request a printed copy. The Report's availability was also promoted through newspaper ads. It is also available on the State of New Hampshire's Department of Justice, Office of the Attorney General, Charitable Trusts Unit website. The Hospital's 2018 and 2021 Health Needs Assessments are on the Hospital's website with instructions on how to obtain a printed copy. Concord Hospital Part V, Section B, Line 11: See the 2019-2021 Community Benefits Action Plan, which is available at: https://www.concordhospital.org/app/files/public/dadc7553-f0ba-4570-9a2b-cea310cc69cd/Community-Benefits-Action-Plan-2019-2021.pdf. The Plan outlines how Concord Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this tax filing. Concord Hospital Part V, Section B, Line 16j: The Hospital includes information about charitable care services in many publications that go to the community. In addition, we collaborate with many community organizations that support vulnerable populations, including low-income individuals and families; our financial assistance program is well understood by those agencies who often refer people to the program. The Hospital's Financial Assistance Policy is available online in English, and is able to be translated to other languages on the Concord Hospital website. Concord Hospital Part V, Section B, Line 20e: Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the community it serves. It is the established policy of Concord Hospital to provide services on the sole basis of the medical necessity of such services as determined by the medical staff without reference to race, color, ethnicity, national origin, sexual orientation, marital status, religion, age, gender, disability, or inability to pay for such services. As such, patients requiring urgent or emergent services shall not be denied those services based on ability to pay.Concord Hospital has a generous financial assistance program. Individuals who cannot afford to pay for their medical care are encouraged to apply for financial assistance. Financial assistance is available to individuals who are uninsured and for those individuals who have insurance, but cannot afford their out-of-pocket costs such as co-payments, co-insurance, and deductibles.In addition to the efforts taken as indicated in Schedule H, Part V, Lines 20a through 20c, the Hospital also takes additional measures to ensure that patients eligible for financial assistance do not have an Extraordinary Collection Action (ECA) levied against them. Each month, Concord Hospital reviews accounts prelisted for bad debt for potential referral to a collection attorney. Concurrent to referring the account(s) to the collection attorney, the manager of customer service or designee will provide the financial assistance supervisor a copy of the list of individuals and accounts to be referred. The financial assistance supervisor or designee will attempt to orally notify each responsible party of the availability of financial assistance and the application process. The financial assistance supervisor or designee will record in account notes the date and outcome of the call.Concurrent to referring the account(s) to a collection attorney, the supervisor of customer service or designee will send a written notice to the responsible party. This notice will include the following information:- Statement that account(s) are being placed with collection attorney- Statement of the ECA(s) that may be initiated- Deadline that the ECA(s) may be initiated, which will be no sooner than 120 days passed the mailing date of the first statement or 30 days passed the mailing date of the initiation notice, whichever is later- Statement that financial assistance is available and where to find the financial assistance policy and application The supervisor of customer service or designee will record in account notes the date the notice was mailed. He or she will also send a copy of the notice to be scanned to the patient's account(s).Prior to engaging in any legal or collection action, the collection attorney must receive written approval from the supervisor of customer service, manager of customer service, or director of patient financial services. These individuals may only authorize legal action if all of the following conditions are met: - The collection attorney has no reason to believe the responsible party is unable to pay the debt.- AND at least 120 days have passed since the mailing date of the first statement- AND at least 30 days have passed since the mailing date of the initiation notice- AND account notes indicate that CH has made at least one attempt to orally notify the individual about the financial assistance policy. Schedule H, Part V, Section B, Line 7a & 10a: The CHNA is available at the Hospital facility's website:https://www.concordhospital.org/app/files/public/836/Capital-Region-Health-Needs-Assessment-2018.pdfImplementation Strategy (2019-2021):https://www.concordhospital.org/app/files/public/838/Community-Benefits-Action-Plan-2019-2021.pdf 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:Financial Assistance Policy:https://www.concordhospital.org/app/files/public/614/Financial-Assistance-Policy.pdf Financial Assistance Application: https://www.concordhospital.org/app/files/public/1036/Financial-Assistance-Application.pdf Plain Language Summary:https://www.concordhospital.org/app/files/public/eab7d7b2-fdc7-471c-b1f3-dbd157ca5231/Plain%20Language%20Summary%20of%20Financial%20Assistance%20Policy.pdfYou can also visit the Concord-Hospital's Patient Financial Services page at the URL below, and select the link to the Financial Assistance Policy, Financial Assistance Application, or the Plain Language Summary on the right. https://www.concordhospital.org/patients-visitors/billing-insurance-financial-assistance/financial-assistance-plain-language-summary/ 62 1 - Concord Imaging Center 248 Pleasant Street Suite 102 Concord NH 03301 Imaging Services 2 - Concord Hospital Cardiac Associates 246 Pleasant Street Suite 103 Concord NH 03301 Outpatient Physician Services 3 - Concord Endoscopy Center 60 Commercial Street Suite 201 Concord NH 03301 Outpatient Endoscopy Services 4 - Concord Imaging Center 60 Commercial Street Suite 101 Concord NH 03301 Imaging Services 5 - Concord Obstetrics and Gynecology 246 Pleasant St Floor 1 Concord NH 03301 Outpatient Physician Services 6 - Concord Surgical Associates 246 Pleasant Street Suite 205 Concord NH 03301 Outpatient Physician Services 7 - Capital Orthopaedic Srgry Ctr-Derry 14 Tsienneto Road Suite 100 Derry NH 03838 Outpatient Surgery 8 - Concord Hospital Family Health Center 250 Pleasant Street Concord NH 03301 Outpatient Physician Services 9 - Concord PulmonaryCrit Care Medicine 246 Pleasant Street Concord NH 03301 Outpatient Physician Services 10 - Center for Sports Med & Ortho Rehab 264 Pleasant Street Concord NH 03301 Rehabilitation Services 11 - Rehabilitation Services - Warner 2 East Main Street Warner NH 03278 Rehabilitation Services 12 - Rehabilitation Services - Hillsboro 15 Antrim Road Hillsboro NH 03244 Rehabilitation Services 13 - Concord Family Medicine 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 14 - Concord Hospital Sleep Center 18 Foundry Street Suite 103 Concord NH 03301 Outpatient Sleep Services 15 - Concord Plastic Surgery 246 Pleasant Street Suite 210 Concord NH 03301 Outpatient Physician Services 16 - Concord Hospital Urgent Care 60 Commercial Street Suite 102 Concord NH 03301 Walk-in Urgent Care 17 - Concord Hosp Cardiac Assoc-Laconia 85 Spring Street Suite 2A1 Laconia NH 03246 Outpatient Physician Services 18 - Penacook Family Physicians 4 Crescent Street Peacook NH 03303 Outpatient Physician Services 19 - Concord Hospital Neurology 246 Pleasant St Ground Floor Concord NH 03301 Outpatient Physician Services 20 - Family Tree Health Care - Hopkinton 19 Farrington Corner Road Hopkinton NH 03229 Outpatient Physician Services 21 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 22 - Epsom Family Medicine 1990 Dover Road Suite 201 Epsom NH 03234 Outpatient Physician Services 23 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 24 - Rehab Services CH Med Office-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 25 - Concord Hosp Cardiothoracic Surgery 246 Pleasant St Ground Floor Concord NH 03301 Outpatient Physician Services 26 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 27 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 28 - Rehab Services CH Medical Office-East 1990 Dover Road Suite 201 Epsom NH 03234 Rehabilitation Services 29 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 30 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 31 - Family Tree Health Care - Warner 2 East Main Street Unit 2 Warner NH 03278 Outpatient Physician Services 32 - Rehabilitation Services - Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 33 - Lab-Memorial Medical Office Building 246 Pleasant Street Suite 102 Concord NH 03301 Outpatient Laboratory Services 34 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 35 - Capital Region Palliative Care & Hosp 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 36 - Anti-Coagulation Clinic Internal Med 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 37 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 38 - CH Family Hlth Ctr Dental Clinic 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 39 - Lab CH Medical Offices-East 1990 Dover Road Suite 1A Epsom NH 03234 Outpatient Laboratory Services 40 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging & Counseling Services 41 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 42 - Lab Penacook Family Physicians 4 Crescent Street Suite 1B Penacook NH 03303 Outpatient Laboratory Services 43 - Lab Heritage Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 44 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 45 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services 46 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 47 - Concord Dermatology 248 Pleasant St Suite 103 Concord NH 03301 Outpatient Physician Services 48 - Concord Endocrinology 18 Foundry Street Suite 102 Concord NH 03301 Outpatient Physician Services 49 - Concord Hospital Record Center 10 Ferry Street Concord NH 03301 Outpatient Services 50 - Concord Hosp Urologic Care-New London 273 County Road New London NH 03257 Urology Services 51 - Concord Hosp Urologic Care-Plymouth 103 Boulder Point Road Plymouth NH 03264 Urology Services 52 - Concord Hosp Urologic Care-Wolfeboro 240 South Main Street Wolfeboro NH 03894 Urology Services 53 - Concord Otolaryngology 60 Commercial St Suite 401 Concord NH 03301 Outpatient Physician Services 54 - Occupational Health 248 Pleasant St Suite 202 Concord NH 03301 Outpatient Physician Services 55 - CH Vascular Surgery - Laconia 85 Spring Street Suite 401 Laconia NH 03242 Outpatient Physician Services 56 - Concord Hospital Vascular Surgery 246 Pleasant St Ground Floor Concord NH 03301 Outpatient Physician Services 57 - Neighboring Emergency Health Clinic 248 Pleasant St Suite G100 Concord NH 03301 Outpatient Services 58 - Concord Hospital Urologic Institute 246 Pleasant St Floor 1 Concord NH 03301 Urology Services 59 - Capital Orthopaedic Srgry Ctr-Concord 116 Langley Parkway Unit LG-1 Concord NH 03301 Outpatient Surgery 60 - Concord Ambulatory Surgery Center 60 Commercial Street Concord NH 03301 Outpatient Surgery 61 - Granite Ledges 151 Langley Parkway Concord NH 03301 Genesis Healthcare Facility 62 - Concord Eye Center 248 Pleasant St Suite 1600 Concord NH 03301 Outpatient Surgery Part I, Line 7: Subsidized Health Services represents those activities that assure access to medical care and support for people with special medical needs and those who may be faced with chronic health conditions. Many of these activities also ensure access to needed health services, which might otherwise not be available without subsidized or special support. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 20,907,242. Part II, Community Building Activities: In 2021, Concord Hospital's Community Building Activities focused on responding to the pandemic. Part III, Line 2: The amount reported on Part III, Line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, Line 25, and Column (A). Accounts Receivable: The allowance for doubtful accounts is provided based on an analysis by management of the collectability of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts. Accounts are charged against the allowance for doubtful accounts when deemed uncollectible. Charity Care: The System provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as community benefit. The amount on Line 3 is calculated by determining the revenue for all patients that have completed an application for financial assistance and only reporting the amount for those that did not complete the financial assistance process for any number of reasons and were then transferred to bad debt. Part III, Line 3: See narrative for Part III, Line 2. Part III, Line 4: See page 12 of the attached audited financial statements. Part III, Line 8: The Medicare shortfall of $64,490,586 represents the costs of unreimbursed services. In addition, many of the subsidized health services reported on line 7g include some revenue and expenses from services to Medicare patients, Medicare allowable costs on line 5 were determined using the cost to charge ratio methodology. The Hospital has not included its Medicare shortfall as a community benefit in Part I. Part III, Line 9b: The Hospital has a Financial Assistance policy in addition to, and complementing, the bad debt collection policy. The policy describes the Hospital's program of financial assistance for medically necessary services to individuals and families who are uninsured, underinsured, or who experience a catastrophic healthcare event and do not quality for any other state or federal assistance programs. Patient education of eligibility for assistance is described below in the statement for Part VI, Line 3. Part VI, Line 2: Every three years, the Hospital conducts a comprehensive community health needs assessment, engaging numerous community organizations and health partners in the process, to identify far-reaching health needs faced by people in the communities served by the Hospital. Assessment methodologies address both quantitative and qualitative data and include stakeholder interviews, focus groups, community listening sessions, web survey, written surveys, telephone surveys and analysis of various data sets. Assessment results are shared with community members and serve as the basis to develop new or expanded services in response to need. The most recent assessment covered by this tax return was completed in the tax year of 2018. Both the 2018 Community Health Needs Assessment and the 2019-2021 Implementation Plan are more specifically addressed in the Hospital's 2018 Form 990, Schedule H and are available on the Hospital's website at: www.concordhospital.org/about-us/charitable-achievements/ In 2021, the Hospital conducted another health needs assessment. The CHNA for 2021 was finalized in FY 2022, and is available at the below link. The Implementation Strategy related to this CHNA is in development and will be available at the Hospital facility's website once approved, at the below link:https://www.concordhospital.org/about-us/charitable-achievements-and-health-needs-assessment/ Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paying their obligations to inform and work with them to understand what local programs are available to them, including how they can benefit from the Hospital's Financial Assistance program. Part VI, Line 4: Concord defines its Primary Service Area as 28 communities to which it has close geographic proximity and significant market share. According to the State of New Hampshire's "Concord Healthcare Service Area Regional Health Profile, 2001," the 28 communities that comprise the Hospital's PSA represent, in terms of square miles, the largest hospital service area in the State. Together, these communities cover an area of nearly 900 square miles. The Hospital serves all the residents of these towns as well as many others from across the State of New Hampshire through its regional and statewide referral for specialty care, including orthopaedic, cardiology, oncology, and urological care. Part VI, Line 5: Concord Hospital develops programs and services to address community health needs and invests annually in initiatives that align with the Hospital's charitable mission. A reasonable amount of Concord Hospital's community benefit investment remains in the area of charitable care to ensure that those without insurance or with limited insurance have access to needed medical care. The Hospital strives to address the needs of vulnerable populations, including our low-income neighbors and other vulnerable populations. The Hospital's Family Health Centers ensure access to primary, behavioral health, and dental care for our region's most vulnerable residents, which address identified community health needs. Those achievements are at the heart of our community benefit activity. Beyond that focus are programs and services that benefit every resident and support that far reaching goal of a healthier community. The Hospital continued its efforts toward promoting the health of the community by investing its surplus funds in new medical facilities to enhance patient care, by providing funding support to Capital Region Healthcare affiliates through the Community Services Fund for programs that address identified community needs and serve vulnerable populations, and by continuing to recruit new primary care physicians to enhance access in the community.Finally, per the IRS instructions to Schedule H, Part I, the Hospital has not included its $64,490,586 Medicare shortfall as a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care. Part VI, Line 6: Concord Hospital, Inc., (the Hospital) located in Concord, New Hampshire, is a not-for-profit acute care hospital. The Hospital provides inpatient, outpatient, emergency care and physician services for residents within its geographic region. Admitting physicians are primarily practitioners in the local area. During the year ending September 30, 2021, the Hospital completed several acqusitions to expand its affiliated health care system. Subsidiaries of the Hospital, including those acquired in 2021, are as follows:- Capital Region Health Care Development Corporation (CRHCDC) is a not-for-profit real estate corporation that owns and operates medical office buildings and other properties.- Capital Region Health Ventures Corporation (CRHVC) is a not-for-profit corporation that engages in health care delivery partnerships and joint ventures. It operates ambulatory surgery and diagnostic facilities independently and in cooperation with other entities.- NH Cares ACO, LLC (NHC) is a single member limited liability company that engages in providing medical services to Medicare beneficiaries as an accountable care organization. NHC has a perpetual life and is subject to termination in certain events.- Concord Hospital - Laconia (CH-Laconia) is a not-for-profit corporation formed to operate a licensed hospital providing inpatient, outpatient, emergency care and physician services for residents within its geographic region of Laconia, New Hampshire. The CH-Laconia facility includes 137 acute care beds and was designated a Rural Referral Center in 1986, and a Sole Community Hospital in 2009. Admitting physicians are primarily practitioners in the local area. CH-Laconia is controlled by the Hospital, and was acquired by the Hospital in 2021.- Concord Hospital - Franklin (CH-Franklin) is a not-for-profit corporation formed to operate a licensed hospital providing inpatient, outpatient, emergency care and physician services for residents within its geographic region of Franklin, New Hampshire. The CH-Franklin facility was designated a Critical Access Hospital effective July 1, 2004, and includes 25 acute care beds. CH-Franklin also operates a 10 bed designated psychiatric receiving facility. Admitting physicians are primarily practitioners in the local area. CH-Franklin is controlled by the Hospital, and was acquired by the Hospital in 2021.- Granite Shield Insurance Exchange and Subsidiaries (GSIE) was formed on December 20, 2010, in the State of Vermont as an industrial insured reciprocal insurance entity and unincorporated association. GSIE commenced underwriting activities on January 1, 2011. GSIE was formed to provide healthcare professional liability, general liability and medical stop loss insurance to its subscribers through GSI Services, LLC (GSI), the attorney-in-fact. GSI was formed in the State of Vermont as a limited liability company on December 14, 2010, and acts as an agent to enable the subscribers of GSIE to exchange insurance contracts. Through December 31, 2020, GSI was equally controlled by each of the subscribers of GSIE, all of which were health systems located in the State of New Hampshire, inclusive of the Hospital. Effective January 1, 2021, the Hospital became the sole voting member of GSIE.- Concord Endoscopy Center, LLC (CEC) is a New Hampshire limited liability company that engages in providing gastrointestinal services, including the diagnosis and treatment of digestive and liver diseases. CEC has a perpetual life, is subject to termination in certain events. In 2021, CRHVC increased it's ownership in CEC from 30% to 70%.The Hospital, its subsidiaries and the Trust are collectively referred to as the System. Part VI, Line 7, Reports Filed With States NH X X X X 1 1 0 0 0 0 0 1 0 Robert P Steigmeyer President & CEO, Member Ex-Officio 777907 0 258000 0 172151 0 222419 0 35951 0 1466428 0 151044 0 Nicola Francalancia MD Physician 746148 0 53862 0 8354 0 27315 0 16589 0 852268 0 0 0 Matthew Gibb Chief Clinical Officer 621705 0 120000 0 8354 0 27315 0 29183 0 806557 0 0 0 Adam Chodosh MD Physician 473331 0 99310 0 25387 0 31824 0 38387 0 668239 0 0 0 Moosavi Shahab MD Physician 543248 0 30636 0 24993 0 24927 0 38325 0 662129 0 0 0 Scott Sloane Treasurer 416838 0 92407 0 20360 0 56630 0 30896 0 617131 0 0 0 Michael Ferguson MD Physician 481488 0 29316 0 6892 0 31824 0 25516 0 575036 0 0 0 Timothy Jones Former VP/COO (ended 6/2020) 221568 0 0 0 282840 0 24700 0 13982 0 543090 0 0 0 Stephen Greer DDS Physician 539000 0 0 0 0 0 3591 0 0 0 542591 0 0 0 Joseph Meyer MD Trustee 273582 0 20000 0 19826 0 63004 0 22879 0 399291 0 0 0 Tanya Vanderlinde MD Trustee 261873 0 17970 0 3615 0 63164 0 31062 0 377684 0 0 0 David Stevenson MD Trustee (end 1/2021) 222767 0 12183 0 3390 0 44422 0 36527 0 319289 0 0 0 Part I, Lines 4a-b Schedule J, Line 4a, Severance Payments: Effective in June of 2020 and during the Hospital's previous fiscal year, Timothy Jones ceased employment with Concord Hospital. As per the terms of his separation agreement, he was paid his regular salary for 26 weeks during a period starting in 2020 and ending in 2021. In accordance with IRS Instructions, these payments will therefore be reflected in Schedule J, Part II in 2020 and 2021. Timothy Jones's total severance payments of $251,973 and $215,977 are reported in his 2020 and 2021 Form W-2, as applicable, as part of his Box 5 taxable wages. As Timothy Jones did not serve the organization as an active or current Key Employee at any time during the period covered by this tax return, he has been designated as a Former Key Employee on this year's Form 990, Part VII, and Schedule J. Schedule J, Line 4b, Supplemental Non-Qualified Retirement Plans: Robert P. Steigmeyer, President & CEO, participated in a 457(f) plan with Concord Hospital during the fiscal year. Under the terms of the plan, after a three-year vesting period a 457(f) amount is included in taxable W-2 wages for Mr. Steigmeyer. The calendar year ending within the Hospital's current reporting period ending September 30, 2021 (tax year 2020) was the fourth year where amounts previously set aside as deferred under his 457(f) plan had vested. Accordingly, $151,044 was included in Mr. Steigmeyer's 2020 W-2 taxable wage which was previously reported on Schedule J, Part II, Column C of the Hospital's Form 990 filing for fiscal years ending September 30, 2017, 2018, and 2019. In accordance with IRS instructions, this amount has been included in Schedule J, Part II, Column B(iii) and Column F. There were additional contributions to Mr. Steigmeyer's 457(f) plan for fiscal years ended September 30, 2015, 2016, 2017, 2018, 2019, 2020, and 2021 of $115,000, $120,000, $125,000, $130,000, $140,000, $150,000, and $156,800, respectively. Each contribution plus earnings will be reported in Mr. Steigmeyer's W-2 after a three-year vesting period. The amount included in Mr. Steigmeyer's deferred compensation amounts in Schedule J, Part II, Column C include the $150,000 contribution to his 457(f) plan plus $37,779 of earnings. During this fiscal year, the Hospital established a Supplemental Executive Retirement Plan (SERP) for the Senior Vice Presidents of Concord Hospital. Scott Sloane, Senior VP, CFO and Treasurer, and Matthew Gibb Chief Clinical Officer, began participating in this plan effective January 1, 2021. Under the terms of this SERP, the Hospital credits the Senior Executive's account at the end of each fiscal year, and the credit shall vest and become payable on the third anniversary of the date such hospital credit is credited to the account, provided the Senior Executive remains continuously employed through the applicable vesting date. The three-year vesting period SERP amount will be included in taxable W-2 wages upon vesting and payment. As this plan was effective January 1, 2021, partial credits of $26,462 were contributed to Scott Sloane's SERP for fiscal year 2021, and partial credits of $36,900 were contributed to Matthew Gibb's SERP for fiscal year 2021. Each contribution, plus earnings, will be reported in their respective W-2s after a three-year vesting period. Part I, Line 7 Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the performance of the CEO, CFO, COO, and CMO during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the executive's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions. A NH Health & Education Facilities Authority 020279866 644614Z85 2013-02-01 48631000 Facility Improvement Project & Advance Refund Series 2001 NHHEFA Bonds 1 0 0 B NH Health & Education Facilities Authority 020279866 2017-12-01 62004272 New Construction and Renovations 0 0 0 C NH Health & Education Facilities Authority 020279866 2020-03-17 12520000 Advance Refund Series 2011 NHHEFA Revenue Bonds 0 0 0 D NH Health & Education Facilities Authority 020279866 2021-07-14 51498124 Facility Improvement & Equipment 0 0 0 A 33875000 48631000 561439 2014 1 0 1 1 B 62004272 670083 2020 0 0 0 1 C 12520000 65206 1 0 1 1 D 51498124 32137953 717985 12607328 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 1 Naxis Funding Corp 1.800000000000 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 02/06/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 11/30/2018 Frederick Briccetti MD Trustee 311921 Dr. Frederick Briccetti is a trustee on Concord Hospital's Board of Trustees. Dr. Briccetti is also a partner in New Hampshire Oncology Hematology (NHOH). NHOH pays Concord Hospital rent for access to the Hospital Cancer Center's space and equipment, as well as for certain medical services to aid in its regular operations. Total payments made from NHOH to Concord Hospital for use of the Cancer Center and to cover director fees in the 2021 fiscal year were $311,921. 0 Scott Sloane Daughter of Officer 33287 Scott Sloane serves Concord Hospital as the Organization's Treasurer and is an Officer on the Hospital's Board of Directors. The daughter of Scott Sloane is employed by the Hospital. Her calendar year 2020 compensation, as based on her 2020 Form W-2 filings, was $33,287, an amount which is commensurate with the salary and benefits of similar persons in her position with her experience at the Hospital. 0 Lucy Hodder Trustee 525338 Lucy Hodder serves on the Hospital's Board of Directors. The husband of Lucy Hodder is employed by the Hospital. His calendar year 2021 compensation, as based on his 2021 Form W-2 filings, was $525,338, an amount which is commensurate with the salary and benefits of similar persons in his position with his experience at the Hospital. Lucy Hodder's husband did not begin his employment with the Hospital until January, 2021; accordingly, he was not issued a 2020 Form W-2. His 2021 Form W-2 compensation has been reported here instead for transparency purposes. 0 Form 990, Part III, line 2 On October 19, 2020, the Hospital entered into an asset purchase agreement (the Agreement) with LRGHealthcare (the Seller) to acquire certain assets and assume certain liabilities of Lakes Region General Hospital in Laconia, New Hampshire, and Franklin Regional Hospital in Franklin, New Hampshire. Upon execution of the Agreement, the Seller filed a voluntary case under Chapter 11 of the United States bankruptcy code. As a result, the Agreement was subject to bankruptcy proceedings, including a formal bid process and auction, as well as subsequent regulatory approvals. The Hospital's bid was accepted and approved by the State of New Hampshire during 2021. The transaction was completed effective May 1, 2021. As a result of the acquisition, two new Hospitals were licensed and began operations out of the previous LRGH facilities: Concord Hospital - Laconia and Concord Hospital - Franklin. Concord Hospital Inc. is the sole member of these two organizations. Form 990, Part VI, Section A, line 6 Capital Region Health Care Corporation, a charitable corporation, acting through its board of trustees, is the sole Member of the Hospital. Form 990, Part VI, Section A, line 7a The Board of Trustees shall be composed of not less than fourteen nor more than nineteen persons excluding ex-officio Trustees, the number to be established and elected by the Member. Form 990, Part VI, Section A, line 7b The affairs of the Hospital shall be managed by the Trustees who shall have and may exercise all the powers of the Hospital except those reserved to the Member by law, the Articles of Agreement, or the Bylaws. In addition: -Any voluntary dissolution, merger or consolidation of the Hospital or the sale or transfer of all or substantially all of the Hospital's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. -Any amendment of the Hospital's Bylaws or Articles of Agreement shall be subject to approval by the Member. -Any changes in the Hospital's non-profit status shall be subject to approval by the Member. Form 990, Part VI, Section B, line 11b The 990 is reviewed in detail with the Audit Committee of the Board of Trustees. All board members receive a copy of the 990 to review prior to filing the report. Form 990, Part VI, Section B, line 12c Each Trustee, officer and committee member, upon entering the duties of his/her office and annually thereafter, will be advised of this policy and shall sign a statement acknowledging his/her understanding of and agreement to this policy. Annual reviews will adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part VI, Section B, line 15 The evaluation of the performance of the Chief Executive Officer ("CEO") of Concord Hospital and its subsidiaries (collectively the "Hospital") is an important responsibility of the Board of Trustees (the "Board") and is vital in ensuring that the Hospital meets its mission. The Board has delegated the responsibility of initiating the process of conducting the CEO's performance evaluation and initiating the process of setting the CEO's compensation to the Board's Compensation Committee. The Compensation Committee also is charged with the responsibility of reviewing the appropriateness of the compensation of the Hospital's Chief Operating Officer (COO), Chief Financial Officer (CFO), and Chief Medical Officer (CMO) as proposed by the CEO. The Compensation Committee shall present its report of the CEO's annual performance to the Board for its further input and consideration. The Compensation Committee shall also make its recommendation to the Board concerning the CEO's compensation. Finally, the Compensation Committee shall make its recommendation to the Board concerning the compensation of the COO, CFO, and CMO. The Board shall review the recommendations of the Compensation Committee as to the compensation of the Hospital's CEO, COO, CFO, and CMO and shall set their compensation as the Board deems appropriate. Although the Hospital continues to value the role of Capital Region Health Care Corporation ("CRHC") and the Hospital's participation in that organization, the Board acknowledges that it is not the responsibility of the Board to evaluate or set the compensation of the Chief Executive Officer of CRHC. Neither is it the role of the Board of Trustees of CRHC to evaluate, or set the compensation of, the Hospital's CEO. Accordingly, CRHC's Board of Trustees is not involved in evaluating or setting the compensation of the Hospital's CEO. The Board acknowledges that the Hospital's CEO may also serve as the Chief Executive Officer of CRHC and that the Hospital may charge CRHC for these services. The Board may consider the comments of the Board of Trustees of CRHC, as outlined herein, when deemed relevant in evaluating the performance of the Hospital's CEO. The Board directs that the Compensation Committee and the Board itself, in their respective undertakings of recommending and setting the compensation of the Hospital's CEO, COO, CFO, and CMO, avoid conflicts of interest and be guided by the "rebuttable presumption of reasonableness" regulations under the so-called "Excess Benefit Transaction" provisions of the Internal Revenue Code ("IRC"). The Board authorizes the Compensation Committee to use such financial and advisory (e.g., legal counsel, consultant) resources as it reasonably deems appropriate to fulfill its duties in evaluating the CEO's performance and in making its recommendations to the Board regarding compensation for the CEO, COO, CFO, and CMO. Form 990, Part VI, Section C, line 19 Yes, the organization makes all of this information available to the public. Audited financial statements and the most recent quarter ended financial statements are posted to the Electronic Municipal Market Access (EMMA) website. In addition to this, the Hospital sends its annual report, including a financial summary, to members of the community via the US Postal service. Governing documents and conflicts of interest filings adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part XI, line 9: Pension actuarial gain 56,761,505. Equity transfer to affiliates -39,880,355. Net periodic pension cost -2,330,841. Form 990, Part XII, Line 2c: There was no change in the process for oversight of the audit of financial statements for the fiscal year. The Board has a finance committee, which reviews the financial statements monthly. There is also an audit committee of the Board, which reviews the annual audit process and the selection of the independent accountant. The same independent firm of accountants performed the audit for the fiscal years ending 9/30/2020 and 9/30/2021. Form 990, Part VII: Dr. David A. Stevenson is listed in Form 990, Part VII as a voting member of the Hospital's governing body through January 2021. Dr. Stevenson was also employed by the Hospital as a full-time physician and received compensation and benefits related to his services to the Hospital in his capacity as a physician. None of his compensation and benefits reflect remuneration in his capacity as a board member of the Hospital. In accordance with IRS instructions, he has not been listed as an independent board member in Form 990, Part VI, Line 1b. Form 990, Part IX, Column D: Although the Hospital is reporting contribution income on Form 990, Part VIII, Line 1, predominantly all direct philanthropic activities and fundraising events are conducted and hosted by the Hospital's affiliate, Concord Hospital Trust. Historically, all contribution revenue that enters the Concord Hospital system is first received by the Trust and is then granted to the Hospital (for its year ending September 30, 2021, the Hospital also received direct grants through the State of New Hampshire for Federal Emergency Management Agency (FEMA), for funding related to COVID-19). Concord Hospital Trust is responsible for the majority of the system's fundraising expenditures, as the generation and maintenance of grants for the Hospital is the Trust's primary fucntion. A portion of the expenses incurred directly by the Hospital, as well as some of the other Concord Hospital affiliated entities, also aid in general fundraising processes and operations. Therefore, a portion of the Hospital's annual expenses have been allocated to Form 990, Part IX, Column D. NH Cares ACO LLC 250 Pleasant Street Concord NH 03301 830777970 To provide medical services to Medicare beneficiaries. NH 4073187 16175 Concord Hospital Inc Concord Hospital ACO LLC 250 Pleasant Street Concord NH 03301 870880602 Operation of an accountable care organization NH 0 0 Concord Hospital Inc Capital Region Health Care Corporation 250 Pleasant Street Concord NH 03301 020222123 Promote comprehensive health service system NH 501(c)(3) Line 12a, I N/A 0 Capital Region Health Ventures Corp 250 Pleasant Street Concord NH 03301 020438264 Provide medical care to community NH 501(c)(3) Line 12b, II Concord Hospital 1 Capital Region Health Care Development Corporation 250 Pleasant Street Concord NH 03301 020429749 Support Concord Hospital & other affiliates NH 501(c)(2) Concord Hospital 1 Concord Regional Visiting Nurse Association Inc PO Box 1797 Concord NH 033021797 020222122 Home health care & hospice services NH 501(c)(3) Line 10 N/A 0 Riverbend Community Mental Health Inc 3-5 North State Street Concord NH 033022032 020264383 Multi-service team NH 501(c)(3) Line 7 N/A 0 Concord Hospital Trust 250 Pleasant Street Concord NH 03301 260378710 Fundraising NH 501(c)(3) Line 12a, I Concord Hospital 1 Concord Hospital - Franklin 250 Pleasant Street Concord NH 03301 851433123 Hospital NH 501(c)(3) Line 3 Concord Hospital 1 Concord Hospital - Laconia 250 Pleasant Street Concord NH 03301 851443782 Hospital NH 501(c)(3) Line 3 Concord Hospital 1 Concord Imaging Center LLC 2 1/2 Beacon Street Concord NH 03301 020436605 Provide radiology services to community NH N/A 0 0 Capital Orthopedic Surgery Center 250 Pleasant Street Concord NH 03301 020522860 Provide medical care to community NH N/A 0 0 Concord Endoscopy Center LLC 60 Commerical Street Concord NH 03301 201184756 Provide medical care to community NH N/A 0 0 Capital Region Health Services Corporation 250 Pleasant Street Concord NH 03301 020428631 Medical services NH N/A C 0 Capital Region Primary Care Corporation 250 Pleasant Street Concord NH 03301 020495275 Inactive NH Concord Hospital C 1.00000 1 Lakes Region Medical Office Building 250 Pleasant Street Concord NH 03301 020409867 Rental properties and condominiums NH N/A C 0 Hillside Medical Park Condo Association 250 Pleasant Street Concord NH 03301 863920257 Rental properties and condominiums NH N/A C 0 CH Memorial West Condominium Association 250 Pleasant Street Concord NH 03301 372006095 Rental properties and condominiums NH Concord Hospital C 1.00000 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 Capital Region Health Care Development Corp A 1441709 Actual per books Concord Hospital Trust C 4240384 Actual per books Capital Region Healthcare Development Corp J 1741929 Actual per books Capital Region Healthcare Development Corp O 584241 Actual per books Capital Region Healthcare Ventures Corp O 1509927 Actual per books Concord Hospital Trust O 785743 Actual per books Capital Region Healthcare Ventures Corp Q 1452598 Actual per books Capital Region Healthcare Services Corp Q 156255 Actual per books Capital Region Health Care Development Corp Q 992533 Actual per books Concord Hospital Trust Q 2134506 Actual per books Concord Hospital - Laconia R 40000000 Actual per books Capital Region Health Care Development Corporation R 4027306 Actual per books Schedule R, Part III: In accordance with IRS instructions, the partnerships listed in Part III are being reported due to their control relationship with Capital Region Health Ventures Corp and the Hospital's control relationship with Capital Region Health Ventures Corp. Schedule R, Part V, Transaction Type A: On its Form 990, Schedule R, Part V, Line 1a and 2, Concord Hospital is reporting $1,441,709 for transaction type "A", receipt of interest, annuities, royalties, or rents from a controlled organization. Capital Region Health Care Development Corp, the controlled organization, does not have any unrelated business income (UBI) reportable on Form 990-T. Accordingly, the interest paymanets made by the controlled entity to the Hospital are not being used to offset taxable UBI of Capital Region Health Care Development Corp. Therefore, in accordance with 512(b)(13) these interest receipts do not need to be reported as UBI to the Hospital.