2021-07-20T14:24:20-05:00 2020-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2019-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott Sloane Senior VP, CFO, & Treasurer 6032284677 2021-06-14 1 Nicholas E Porto P01310283 2078792100 2021-06-10 2019 2022-09-23 18:48:47Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 631289206 0 X www.concordhospital.org X 1944 NH Hospital 15 11 4161 300 2082567 0 4140490 34343347 537005328 508086018 -2353291 13966988 333542 -676244 539126069 555720109 0 0 0 0 309051282 311080973 0 0 367263 222927545 228416199 531978827 539497172 7147242 16222937 620279215 697377820 306755875 387848012 313523340 309529808 Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 0 0 448543123 0 506599625 Various hospital services; see Schedule HIn FYE 2020, Concord Hospital invested more than $84 million for 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. 448543123 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 1 281 0 1 4161 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 15 11 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 56.00 5.00 X X 1149547 0 249118 Shahab Moossavi MD Physician 50.00 0.00 X 583128 0 68975 Timothy P Jones Senior VP/COO (end 6/2020) 50.00 0.00 X 565483 0 72722 Adam Chodosh MD Physician 50.00 0.00 X 536173 0 71723 Scott Sloane Treasurer 56.00 4.00 X 498728 0 94773 Wayne Carlisle Stadelmann MD Physician 50.00 0.00 X 507868 0 84847 Gerald Sardella MD Former Physician 50.00 0.00 X 559360 0 7950 Michael Ferguson MD Physician 50.00 0.00 X 493636 0 43490 Alexandru Vaida MD Physician 50.00 0.00 X 501539 0 19839 David Green MD Senior VP/Chief Medical Officer 50.00 0.00 X 419963 0 77307 Lon Setnik MD Trustee (end 1/2020) 50.00 0.00 X 377294 0 44292 Pamela Puleo Executive Director 50.00 1.00 X 313827 0 107385 David Stevenson MD Trustee 50.00 1.00 X 259314 0 72628 Tanja Vanderlinde MD Trustee (eff. 1/2020) 50.00 0.00 X 261901 0 25920 Matthew Gibb Chief Clinical Officer 50.00 0.00 X 165568 0 3610 Valerie Acres Esq Trustee (end 9/2020) 1.00 1.00 X 0 0 0 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 Michelle Chicoine Trustee (end 1/2020) 1.00 0.00 X 0 0 0 Peter Cook Trustee (end 1/2020) 1.00 0.00 X 0 0 0 Rosemary M Heard Trustee 1.00 0.00 X 0 0 0 Lucy Karl Esq Trustee 1.00 0.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 Manisha Patel DDS Trustee 1.00 1.00 X 0 0 0 Muriel Schadee CPA Trustee 1.00 4.00 X 0 0 0 David Ruedig Trustee 1.00 1.00 X 0 0 0 Robert Segal Trustee 1.00 2.00 X 0 0 0 Jeffrey Towle Trustee 1.00 2.00 X 0 0 0 Sol Asmar Chair 1.00 4.00 X X 0 0 0 Philip Emma Vice Chair 1.00 2.00 X X 0 0 0 William Chapman Esq Secretary 1.00 1.00 X X 0 0 0 7193329 0 1044579 472 1 1 0 Harvey Construction Corp 10 Harvey Road Bedford NH 03110 Construction services 30227987 Anesthesia Associates PA 1 Pillsbury Street Concord NH 03301 Healthcare services 3852056 Concord Orthopaedics PA 264 Pleasant Street Concord NH 03301 Healthcare services 1951324 Medicus Emergency Room Service LL 22 Roulston Road Windham NH 03087 Healthcare services 1297501 Angelica-Worcester PO Box 532268 Atlanta GA 30353 Professional services 1279773 46 4757082 29586265 34343347 Net Patient Service 621400 480196009 480196009 Disproportionate Share Funding 621400 18201760 18201760 Other Operating Revenue 621400 6321926 5203390 1118536 Food Services 722210 3145228 2222202 923026 Answering Service 541900 104741 104741 116354 116354 508086018 5022343 41005 4981338 340688 0 340688 340688 340688 84313415 75343790 24980 8969625 -24980 8944645 8944645 414808 200327 214481 214481 Loss on debt extinguishment 525990 -1231413 -1231413 -1231413 555720109 506599625 2082567 12694570 4759380 3943929 815451 239422836 198401085 41021751 11760875 9745851 2015024 42169627 34944586 7225041 12968255 10746367 2221888 1600415 1600415 239387 239387 342145 342145 48000 48000 786737 786737 21301931 16087122 5214809 180795 158678 21979 138 6942752 5644249 1288454 10049 13191789 8372940 4774970 43879 14181713 12124244 2043217 14252 694664 609684 84448 532 498603 437607 60614 382 2576237 1743303 806129 26805 23320456 15667938 7406435 246083 5420969 4757810 659011 4148 Drugs/medical supplies 77778138 68263364 9514774 NH MET 26602052 26602052 Provision for bad debts 22571803 22571803 Repairs/maintenance 5212577 3273986 1920889 17702 4925036 4398525 523218 3293 539497172 448543123 90586786 367263 10295916 32968058 23227665 73907494 67891509 65601365 2295949 2769606 6334189 6597293 470369201 278236001 171391034 192133200 153877789 133628876 153431957 164923589 9824258 5508866 21708949 19339473 620279215 697377820 69370178 71062538 128097738 121741320 109287959 195044154 306755875 387848012 X 313523340 309529808 313523340 309529808 620279215 697377820 X 16222937 -2303655 -17912814 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 45872 0 0 1 48000 93872 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 9/30/20. 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 $10,098 and $35,774, respectively. Concord Hospital has hired an outside consultant to perform services to further Concord Hospital's mission. This consultant was paid $48,000 in the year ended 9/30/20. 264211724 11916474 591942 275536256 277852367 -13045293 595350 264211724 272756311 5743785 647729 277852367 239892180 33431692 567561 272756311 232130222 1940394 6298683 477119 239892180 1.00000 0.00000 0.00000 0 1 1 18996 18996 205192821 98571239 106621582 4782249 3189522 1592727 250681197 176475240 74205957 9693938 9693938 192133200 Alternative investments 164923589 F 164923589 Accrued pension and other long-term liabilities 146652495 Estimated third-party settlements 48391659 195044154 X 507493761 -2303655 1530247 -773408 508267169 786737 46666203 47452940 555720109 511487293 0 511487293 786737 27223142 28009879 539497172 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, 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. Part XI, Line 2d - Other Adjustments: Equity transfers from affiliates 1,530,247. Part XI, Line 4b - Other Adjustments: Provision for bad debts 26,602,052. Pension actuarial loss 16,511,585. Net periodic pension cost 2,931,476. Board designated spending 621,090. Part XII, Line 4b - Other Adjustments: Provision for bad debts 26,602,052. Board designated spending 621,090. Central America and the Caribbean - Cayman Islands 0 0 Investments - FMV as of 9/30/2020 None 69822000 Europe (Including Iceland & Greenland) - Ireland 0 0 Investments - FMV as of 9/30/2020 None 4981000 0 0 0 0 0 0 74803000 0 74803000 1 0 1 1 0 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 8 4843 3561849 116547 3445302 0.00670 68330029 37010703 31319326 0.06110 8 4843 71891878 37127250 34764628 0.06780 9 480491 1975513 393654 1581859 0.00310 5 5515 9697549 7393692 2303857 0.00450 24 368816 81705997 36838800 44867197 0.08750 1 15 81037 15 81022 0.00020 6 1069169 240048 829121 0.00160 45 854837 94529265 44866209 49663056 0.09690 53 859680 166421143 81993459 84427684 0.16470 1081691 1081691 1081691 1081691 0 0.00000 1 8561099 916038 165061380 236937931 -71876551 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 1 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 (2020 Charitable Achievements) was included in the Hospital's annual report that was mailed to nearly 24,000 households within the communities that the Hospital serves. It is also available on the State of New Hampshire's Department of Justice, Office of the Attorney General, Charitable Trusts Unit website and Concord Hospital's website. The Hospital's 2015 and 2018 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 attached 2016-2018 Community Benefits Action Plan, as well as the 2019-2021 Community Benefits Action Plan, which 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 20d, the Hospital also takes additional measures to ensure that patients eligible for financial assistance do not have an Extraodinary 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 (2016-2018):https://giveto.concordhospital.org/file/2016-2018-Community-Benefits-Action-Plan.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/patients-visitors/billing-insurance-financial-assistance/financial-assistance/financial-assistance-policy-plain-language-summary/ 68 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 - Family Care Of Concord 248 Pleasant Street Suite 2600 Concord NH 03301 Outpatient Physician Services 22 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 23 - Epsom Family Medicine 1990 Dover Road Suite 201 Epsom NH 03234 Outpatient Physician Services 24 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 25 - Rehab Services CH Med Office-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 26 - Concord Hosp Cardiothoracic Surgery 246 Pleasant St Ground Floor Concord NH 03301 Outpatient Physician Services 27 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 28 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 29 - Rehab Services CH Medical Office-East 1990 Dover Road Suite 201 Epsom NH 03234 Rehabilitation Services 30 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 31 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 32 - Family Tree Health Care - Warner 2 East Main Street Unit 2 Warner NH 03278 Outpatient Physician Services 33 - Rehabilitation Services - Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 34 - Lab-Memorial Medical Office Building 246 Pleasant Street Suite 102 Concord NH 03301 Outpatient Laboratory Services 35 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 36 - Capital Region Palliative Care & Hosp 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 37 - Anti-Coagulation Clinic Internal Med 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 38 - Center for Health Promotion 49 South Main Street Concord NH 03301 Health Promotion Services 39 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 40 - CH Family Hlth Ctr Dental Clinic 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 41 - Lab CH Medical Offices-East 1990 Dover Road Suite 1A Epsom NH 03234 Outpatient Laboratory Services 42 - Concord Family Medicine Havenwood 149 East Side Drive Concord NH 03301 Outpatient Physician Services 43 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging & Counseling Services 44 - Radiology Srv Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Radiology Services 45 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 46 - Lab Penacook Family Physicians 4 Crescent Street Suite 1B Penacook NH 03303 Outpatient Laboratory Services 47 - Lab Heritage Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 48 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 49 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services 50 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 51 - Concord Dermatology 248 Pleasant St Suite 103 Concord NH 03301 Outpatient Physician Services 52 - Concord Endocrinology 18 Foundry Street Suite 102 Concord NH 03301 Outpatient Physician Services 53 - Family Tree Health Care - Concord 194 Pleasant Street Suite 7 Concord NH 03301 Outpatient Physician Services 54 - Concord Hospital Record Center 10 Ferry Street Concord NH 03301 Outpatient Services 55 - Concord Hosp Urologic Care-New London 273 County Road New London NH 03257 Urology Services 56 - Concord Hosp Urologic Care-Plymouth 103 Boulder Point Road Plymouth NH 03264 Urology Services 57 - Concord Hosp Urologic Care-Wolfeboro 240 South Main Street Wolfeboro NH 03894 Urology Services 58 - Concord Otolaryngology 60 Commercial St Suite 401 Concord NH 03301 Outpatient Physician Services 59 - Pelvic Medicine Program 246 Pleasant St Suite 106 Concord NH 03301 Outpatient Physician Services 60 - Occupational Health 248 Pleasant St Suite 202 Concord NH 03301 Outpatient Physician Services 61 - CH Vascular Surgery - Laconia 85 Spring Street Suite 401 Laconia NH 03242 Outpatient Physician Services 62 - Concord Hospital Vascular Surgery 246 Pleasant St Ground Floor Concord NH 03301 Outpatient Physician Services 63 - Neighboring Emergency Health Clinic 248 Pleasant St Suite G100 Concord NH 03301 Outpatient Services 64 - Concord Hospital Urologic Institute 246 Pleasant St Floor 1 Concord NH 03301 Urology Services 65 - Capital Orthopaedic Srgry Ctr-Concord 116 Langley Parkway Unit LG-1 Concord NH 03301 Outpatient Surgery 66 - Concord Ambulatory Surgery Center 60 Commercial Street Concord NH 03301 Outpatient Surgery 67 - Granite Ledges 151 Langley Parkway Concord NH 03301 Genesis Healthcare Facility 68 - 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 (d): The Direct Off-setting Revenue of $81,993,459 includes $4,415,512 of CARES Act funding received through the Department of Health and Human Services during the year ending September 30, 2020, which reduced the overall Net Community Benefit Expense provided by the Hospital. This CARES Act funding represents the portion of CARES Act funding which was attributable to lost revenues and/or additional costs related to the subsidized health services programs included in line 7(g). 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 $ 26,602,052. Part II, Community Building Activities: The Hospital's Trauma Program continued its service area-wide educational initiative, "Stop the Bleed" to provide tourniquet kits for all school classrooms and also educate personnel on the proper use of tourniquets. The initiative is expected to provide 800 kits via a fundraising campaign to schools serving the Hospital's 28 communities in its service area.Part II, Line 3: The Direct Off-setting Revenues of $1,081,691 represents CARES Act funding received through the Department of Health and Human Services during the year ending September 30, 2020, which was utilized to offset certain Emergency Preparedness efforts by the Hospital. 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, 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 10 of the attached audited financial statements. Part III, Line 8: The Medicare shortfall of $71,876,551 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 Hospital's filed Medicare cost report, which determines cost via 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/ Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paving 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: Part I line 6A, 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 $71,876,551 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 7, Reports Filed With States NH X X X X 1 1 0 0 0 0 0 1 0 Robert P Steigmeyer President & CEO 731995 0 280000 0 137552 0 226422 0 22696 0 1398665 0 136004 0 Shahab Moossavi MD Physician 560367 0 22221 0 540 0 42493 0 26482 0 652103 0 0 0 Timothy P Jones Senior VP/COO (end 6/2020) 447380 0 115727 0 2376 0 48507 0 24215 0 638205 0 0 0 Adam Chodosh MD Physician 478534 0 56449 0 1190 0 43739 0 27984 0 607896 0 0 0 Scott Sloane Treasurer 388854 0 109046 0 828 0 72495 0 22278 0 593501 0 0 0 Wayne Carlisle Stadelmann MD Physician 413062 0 93002 0 1804 0 57029 0 27818 0 592715 0 0 0 Gerald Sardella MD Former Physician 226105 0 10625 0 322630 0 0 0 7950 0 567310 0 0 0 Michael Ferguson MD Physician 469077 0 22402 0 2157 0 24739 0 18751 0 537126 0 0 0 Alexandru Vaida MD Physician 462318 0 38606 0 615 0 0 0 19839 0 521378 0 0 0 David Green MD Senior VP/Chief Medical Officer 308507 0 109302 0 2154 0 74934 0 2373 0 497270 0 0 0 Lon Setnik MD Trustee (end 1/2020) 330965 0 46036 0 293 0 40335 0 3957 0 421586 0 0 0 Pamela Puleo Executive Director 255831 0 56305 0 1691 0 83247 0 24138 0 421212 0 0 0 David Stevenson MD Trustee 252737 0 5500 0 1077 0 46940 0 25688 0 331942 0 0 0 Tanja Vanderlinde MD Trustee (eff. 1/2020) 238469 0 22472 0 960 0 0 0 25920 0 287821 0 0 0 Matthew Gibb Chief Clinical Officer 138822 0 26198 0 548 0 0 0 3610 0 169178 0 0 0 Part I, Lines 4a-b Schedule J, Line 4a, Severance Payments: Effective in June of 2020 and during the fiscal year covered by this return, Timothy Jones ceased employment with Concord Hospital. As per the terms of his separation agreement, he was paid his regular salary for 26 weeks. As these payments were made to him after the calendar year ending within the current fiscal year, these payments are not reflected in Schedule J, Part II which reports compensation and benefits based on calendar year end 2019. Timothy Jones's total severance payments of $251,973 and $215,977 will be reported in his 2020 and 2021 Form W-2, as applicable, as part of his Box 5 taxable wages. Additionally, effective in April of 2019, Dr. Gerald Sardella ceased employment with Concord Hospital. As per the terms of his separation agreement, he was paid his regular salary for six months and one week as severance. Payments made to him, including severance, during the calendar year ending 2019 are reflected in Schedule J, Part II which reports compensation and benefits based on calendar year-end 2019. Dr. Sardella's total severance payments of $321,915.60 were reported in his 2019 Form W-2 as part of his Box 5 taxable wages, and are included on this Schedule J, Part II, Column B(iii). As Dr. Sardella did not serve on the Board at any time during the fiscal year ending September 30, 2020, he has been indicated as "Former" on both Schedule J, Part II, and on Part VII of the 2019 Form 990. 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, 2020 (tax year 2019) was the third year where amounts previously set aside as deferred under his 457(f) plan had vested. Accordingly, $136,004 was included in Mr. Steigmeyer's 2019 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, and September 30, 2018. 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, and 2020 of $115,000, $120,000, $125,000, $130,000, $140,000, and $150,000 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 $140,000 contribution to his 457(f) plan plus $34,774 of earnings. 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 644614K65 2011-03-01 50095322 Facility Improvements/Renovations 1 0 0 B NH Health & Education Facilities Authority 020279866 644614Z85 2013-02-01 48631000 Facility Improvement Project & Advance Refund Series 2001 NHHEFA Bonds 1 0 0 C NH Health & Education Facilities Authority 020279866 2013-04-01 32421000 Advance Refund the Series 2004 NHHEFA Hospital Revenue Bonds 0 0 0 D NH Health & Education Facilities Authority 020279866 2017-12-01 62004272 New Construction and Renovations 0 0 0 A 11780000 50095322 544891 2012 1 0 1 1 B 33875000 48631000 561439 2014 1 0 1 1 C 32421264 64503 2013 0 1 1 1 D 62004272 670083 2020 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 0 0 1 0 0 0 0 1 D 0 0 0 1 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: 02/28/2018 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: 04/25/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 11/30/2018 Frederick Briccetti MD Trustee 309585 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 2020 fiscal year were $309,585. 0 Lon Setnik MD Spouse of Trustee 192146 The spouse of Board of Turstees Member, Lon Setnik, MD is employed as a physician of the Hospital. Dr. Setnik's wife's 2019 calendar year compensation was $192,146, which is commensurate with the salary and benefits of similar persons in her position and with her experience at the Hospital. 0 Scott Sloane Daughter of Officer 29306 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 2019 compensation, as based on her 2019 Form W-2 filings, was $29,306, an amount which is commensurate with the salary and benefits of similar persons in her position with her experience at the Hospital. 0 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, Chief Financial Officer, and Chief Medical Officer 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 -16,511,585. Equity transfer from affiliates 1,530,247. Net periodic pension cost -2,931,476. 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 9/30/19 and 9/30/20. Form 990, Part VII: Dr. David A. Stevenson, Dr. Lon Setnik, and Dr. Tanja Vanderlinde are listed in Form 990, Part VII as voting members of the Hospital's governing body. They were also employed by the Hospital as full-time physicians and received compensation and benefits related to their services to the Hospital in their capacity as physicians. None of their compensation and benefits reflect remuneration in their capacities as board members of the Hospital. In accordance with IRS instructions, they have not been listed as independent board members 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, 2020, the Hospital also received direct grants from the United States Department of Health and Human Services). 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 208000 35000 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 Dormant During Tax Year NH 501(c)(3) Line 3 Concord Hospital 1 Concord Hospital - Laconia 250 Pleasant Street Concord NH 03301 851443782 Dormant During Tax Year 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 Capital Orthopedic Surgery Center 250 Pleasant Street Concord NH 03301 020522860 Provide medical care to community NH N/A Concord Endoscopy Center LLC 60 Commerical Street Concord NH 03301 201184756 Provide medical care to community NH N/A Concord Elliot ACO LLC 1 Elliot Way Manchester NH 03103 454803675 Accountable Care Org NH Elliot Hospital of the City of Manchester Related 0 1 0.16670 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 1 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 Capital Region Health Care Development Corp A 1441712 Actual per books Capital Region Health Care Ventures Corp C 2469832 Actual per books Capital Region Health Care Development Corp J 2870731 Actual per books Capital Region Health Care Development Corp O 584241 Actual per books Capital Region Health Care Ventures Corp O 1699045 Actual per books Concord Hospital Trust O 747724 Actual per books Capital Region Health Care Development Corp Q 1586593 Actual per books Capital Region Health Care Ventures Corp Q 780451 Actual per books Concord Hospital Trust Q 977894 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 $1,441,712 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.