2025-08-13T16:00:15-05:00 2024-09-30 010494526 BAKER NEWMAN & NOYES BOX 507 PORTLAND ME 04112 990 2023-10-01 020222157 Monadnock Community Hospital MONA 6039247191 452 Old Street Road Peterborough NH 03458 Richard D Scheinblum VP of Finance/CFO 6039247191 2025-08-11 1 0 Connor Smart P02285543 2078792100 2025-08-11 2023 2025-03-06 01:10:19Z Cynthia K McGuire 452 Old Street Road Peterborough NH 03458 128843194 0 X https://monadnockcommunityhospital.com/ X 1919 NH Critical access hospital serving the Monadnock region of the State of New Hampshire 18 16 687 83 0 0 2549679 829431 108750614 122697106 2995931 4431300 54045 50897 114350269 128008734 42599 105510 0 0 51084911 57617208 0 0 672528 56169084 64529690 107296594 122252408 7053675 5756326 178215506 203243687 58809075 57037087 119406431 146206600 X Monadnock Community Hospital is committed to improving the health and well-being of our community. We will elevate the health of our community by providing accessible, high quality and value based care. 0 1 108962532 105510 122697106 The primary purpose of Monadnock Community Hospital (MCH) is to ensure access to quality health care for patients in our community, regardless of their ability to pay. The following is a summary of the services MCH provides in an effort to fulfill its mission, together with key program statistics for fiscal year 2024.Inpatient Services - Includes: adult stays, maternity/births, and swing bed nursing. During the fiscal year, the Hospital admitted 1,177 patients and recorded 3,325 patient days. Emergency Services - MCH offers health services 24 hours per day, 7 days per week. Responsible for the immediate treatment of any medical or surgical emergency; for initiating life saving procedures in all types of emergency situations; and for providing emergency and initial evaluations and treatment for other conditions including minor illnesses and injuries, and sub-acute medical problems. During the year, there were 13,400 visits to the ER. Physician Practices - Family health services, programs, and education are integral components of healthcare at MCH. Inpatient and outpatient primary care includes: medical, surgical, psychological and specialist services, provided by physicians and mid-level practitioners. These are located at the Hospital and its four satellite practices located in Antrim, Jaffrey, New Ipswich, and Rindge. During the year, 58,818 primary care office visits were recorded. Surgical Services - Includes same day and short-term inpatient surgery. MCH provides surgery in the areas of orthopaedics, general surgery, OB/GYN, ophthalmology, urology, ENT, and podiatry. In addition, the Hospital offers some non-surgical procedures including colonoscopies, gastroscopies, and pain management injections. During the fiscal year, 3,461 procedures were performed. Radiology and Diagnostics - MCH provides advanced radiological technology and extensive imaging services including: bone density, MRI, CT, nuclear medicine, ultrasound, mammography, and other diagnostic procedures, both inpatient and outpatient. During the fiscal year, 34,644 exams were performed. Rehabilitation Services - Additionally, MCH serves the people of the Monadnock Region through its medical rehabilitation and fitness services. MCH offers rehabilitation programs for cardiac and diabetic rehabilitation, along with pulmonary fitness, which feature educational and exercise components. We also provide physical and occupational therapy, as well as speech rehabilitation. During the fiscal year, 73,151 procedures were recorded for these services. Monadnock Community Hospital's Financial Grant Program provides assistance with hospital and/or physician bills for qualifying patients. In fiscal year 2024, the Organization recorded $891,000 in charges foregone based on established rates. The estimated cost incurred to provide these services was $ . In addition, Monadnock Community Hospital provided other services to the community at no cost or reduced cost, such as screenings and clinics. The cost of providing these services was approximately $17,260,000 in fiscal year 2024. 108962532 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 112 0 1 687 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 16 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X Richard D Scheinblum 6039247191 452 Old Street Road Peterborough NH 03458 X Alexander J Walker Esq Ex-Officio (voting) (end 3/2024) 3.00 43.20 X 0 717524 351171 Terrence McNamara DO Trustee/Physician 41.50 0.00 X 455080 0 37929 Cynthia McGuire Chief Executive Officer 55.00 0.60 X X 435263 0 52064 Peter Cerroni DMD Trustee 3.00 0.00 X 0 0 0 Casandra Clark Trustee 3.00 0.00 X 0 0 0 Jeffrey R Crocker Esq Trustee 3.00 0.00 X 0 0 0 Carolyn Garretson Trustee 3.00 0.00 X 0 0 0 Steve Kim Trustee (start 1/2024) 3.00 0.00 X 0 0 0 Eric Lasky MD Ex-Officio (voting) 3.00 0.00 X 0 0 0 Leslie Lewis Trustee 3.00 0.00 X 0 0 0 Stephen Lehmkuhl DO Ex-Officio (voting) 3.00 0.00 X 0 0 0 Ed Madigan Trustee (start 1/2024) 3.00 0.00 X 0 0 0 Greg Neilley MD Trustee (start 1/2024) 3.00 0.00 X 0 0 0 Michael Shea Trustee (end 1/2024) 3.00 0.00 X 0 0 0 Iris Waitt Trustee 3.00 0.00 X 0 0 0 James Callahan Esq Chair (end 1/2024); Trustee 3.00 0.00 X X 0 0 0 Paul Faber VC (end 1/24); Chair (start 1/24) 3.00 0.00 X X 0 0 0 Paula Hunter Trustee; Vice Chair (start 1/2024) 3.00 0.00 X X 0 0 0 Thomas S Bates CPA Treasurer 3.00 0.00 X X 0 0 0 Patricia Shuster Clerk 3.00 0.00 X X 0 0 0 Richard D Scheinblum VP Finance/CFO 50.00 0.00 X 287766 0 25884 Vache Hambardzumyan MD Physician 41.50 0.00 X 596287 0 29310 Derek Anderson MD Physician 41.50 0.00 X 436575 0 39479 Daniel Perli MD Physician/Chief Medical Officer 50.00 0.00 X 442753 0 18202 Shawn Harrington MD Physician 41.50 0.00 X 401907 0 36429 Dmitry Tarasevich MD Physician 41.50 0.00 X 396554 0 18073 3452185 717524 608541 68 0 1 0 Catholic Medical Center 195 McGregor Street Manchester NH 03102 Contract Physician and Lab Services 2924273 Monadnock Region Emergency Physicians PL 107 Locke Road Hampton NH 03842 Contract Emergency Physician Group 2662000 AHSA LLC PO Box 70529 Dallas TX 75267 Contract Staffing Group 1955794 Hutter Construction Corp PO Box 257 New Ipswich NH 03071 General Contractor 1809236 Caring Nurses Staffing Agency LLC PO Box 278 New Boston NH 03070 Contract Staffing Group 1519407 37 X 39265 790166 16982 829431 Net patient service revenue 621400 113101031 113101031 Disproportionate share funding 621400 4790808 4790808 Other operating revenue 621400 4166271 4166271 Cafeteria/vending machine 722514 362893 362893 Employee pharmacy sales 456110 276103 276103 122697106 4674917 4674917 118826 67152 51674 51674 51674 495724 739341 -243617 -243617 -243617 25640 39265 27889 -2249 -2249 1550 78 1472 1472 128008734 122697106 0 4482197 41693 41693 63817 63817 1293986 493009 800977 45039569 40220909 4497419 321241 543340 504268 36070 3002 7955249 7039800 859073 56376 2785064 2468279 293725 23060 106681 106681 118883 118883 18073 18073 262097 262097 9014583 8116259 898324 154923 139485 15438 3633253 3271192 335128 26933 1398373 1259022 139351 3001464 2702361 299103 65636 59095 6252 289 221191 134450 22042 64699 955110 955110 4885924 4568950 316974 1287614 1134623 152991 Med. supplies/services 25500417 22959242 2390803 150372 Provision for bad debt 7623534 7623534 NH medicaid enhancement 5118534 5118534 Food/dietary supplies 387732 349094 38638 775668 694916 54196 26556 122252408 108962532 12617348 672528 1682 4731 30354114 26649849 9105689 11076250 940993 861377 1462118 1557225 1290843 1780257 111907015 70799544 38954948 41107471 89688993 113120776 5919721 6791711 289509 87144 206896 206896 178215506 203243687 9912425 11718260 10945 9336 21265883 20551113 145664 24520 27474158 24733858 58809075 57037087 X 104705702 128694052 14700729 17512548 119406431 146206600 178215506 203243687 X 5756326 20455492 588351 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 18073 0 0 0 18073 0 Part II-B, Line 1: Monadnock Community Hospital is a member of the New Hampshire Hospital Association (NHHA) and the American Hospital Association (AHA). A portion of the dues paid to these organizations was made available for lobbying expenditures on behalf of Monadnock Hospital in furtherance of its exempt purpose. Monadnock Hospital does not directly perform any lobbying activities. A detail of dues paid to these associations by the Hospital during this tax year is as follows: - NHHA, portion of dues available for lobbying: $11,372 - AHA, portion of dues available for lobbying: $6,701 In addition, MCH hosts an annual legislative breakfast, which is a bipartisan event to which legislators, local politicians, and other public officials are invited to discuss health care issues in New Hampshire. The breakfast was held virtually this year and therefore did not incur any related expenses. 14700729 171128 3369979 729288 17512548 13791242 169000 1687615 947128 14700729 17052611 595517 -2789108 1067778 13791242 14658179 320443 2714995 641006 17052611 13707881 205145 1372618 627465 14658179 0.00000 0.62966 0.37034 1 0 964622 964622 36412050 24520690 11891360 842848 842536 312 68798684 45436318 23362366 4888811 4888811 41107471 Estimated third-party settlements 24284840 Operating lease liabilities 87622 Interest rate swap agreements 293936 Fianance lease liabilities 67460 24733858 X 140561795 20455492 655728 21111220 119450575 262097 8296062 8558159 128008734 113761626 67377 67377 113694249 262097 8296062 8558159 122252408 Part V, Line 4: Temporarily restricted assets are available for health care services, including the purchase of equipment and providing health education and programs. The income and dividends on permanently restricted net assets are generally used to support health care services and for capital purchases of property and equipment. Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Hospital's tax positions and concluded the Hospital 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 financial statements. Part XI, Line 2d - Other Adjustments: Increase in fair value of perpetual trust interest 1,222,837. Decrease in fair value of interest rate swap agreement -644,783. Rental property expenses 67,152. Increase in fair value of equipment due to lease-transfer 10,297. Combination expenses to Part IX 225. Part XI, Line 4b - Other Adjustments: Provision for bad debt, net against revenues 7,623,534. Fundraising expenses, unrelated to fundraising events 672,528. Part XII, Line 2d - Other Adjustments: Rental property expenses 67,152. Combination expenses to Part IX 225. Part XII, Line 4b - Other Adjustments: Provision for bad debt, net against revenues 7,623,534. Fundraising expenses, unrelated to fundraising events 672,528. MCH Golf Classic 64905 39265 25640 1080 9566 7132 5758 0 4353 64905 39265 25640 1080 9566 7132 5758 4353 27889 -2249 1 1 1 X 275.000000000000 1 X 1 1 0 1 1 444508 444508 0.00390 5311678 4983952 327726 0.00290 5756186 4983952 772234 0.00680 492000 492000 0.00430 28951841 12517814 16434027 0.14340 300000 300000 0.00260 29743841 12517814 17226027 0.15030 35500027 17501766 17998261 0.15710 1 3803702 75300 26309050 26739090 -430040 X 1 1 1 1 Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 02507 X X X X Monadnock Community Hospital 1 0 0 1 X X X X X X X X X 23 1 0 0 1 X see Part V, Section C X 1 23 1 See Part V, Section C 1 0 1 X 275.000000000000 400.000000000000 X X X 1 1 X 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 X 1 X 0 X X X X X 1 X 0 0 Monadnock Community Hospital Part V, Section B, Line 5: Monadnock Community Hospital (MCH) used a methodology that was highly focused on identifying needs among underserved populations. The approach used was designed to elicit perspective from a broad range of community stakeholders - especially those representing higher risk groups. MCH used a multi-phased methodology to achieve the objectives of the assessment. MCH reached out to a group of individuals to participate in its Community Health Needs Assessment (CHNA) to contribute insights from patients, community service organizations, and staff. Each person provided project feedback regarding perceptions of area health needs, data evaluation, and other guidance during the CHNA process. The individuals had a breadth of community health vision, knowledge, and leadership to impact the well-being of the service area.The CHNA methodology includes a combination of quantitative and qualitative research methods designed to evaluate perspectives and opinions of area stakeholders and healthcare consumers - especially those from underserved populations. The methodology used helped prioritize the needs and establish a basis for continued community engagement - in addition to simply developing a broad, community-based list of needs. The major sections of the methodology include the following: - Strategic Secondary Research. A comprehensive analysis of previously published materials and existing data to provide insight into the community profiles and health-related measures. - Stakeholder Interviews and Focus Groups. Qualitative, primary research involving one-on-one interviews and focus group discussions with the MCH CHNA Leadership Group, community service providers, and healthcare consumers representing diverse perspectives across the service area. - Community Survey. Crescendo conducted an online survey with over 530 community members. The survey results and analysis are included in this report. - Needs Prioritization Process. The needs prioritization methodology included a Modified Delphi Technique. First, MCH CHNA Leadership Group met to review early research results and the potential list of community needs. Second, after completing the secondary research, interviews, focus groups, and community survey, a list of 33 key community health issues was formalized. The Leadership Group then participated in a two-phase prioritization process in which they quantitatively evaluated (i.e., ranked) each of the 33 identified needs and shared insight regarding their rationale for the ranking priorities. This process resulted in a prioritized analysis of community needs.To ensure broad and deep community engagement in the CHNA, MCH compiled a group of community leaders, which represented public health and diverse community interests.To complement the Environmental Analysis, extensive qualitative research was conducted throughout the MCH service area. The interviews provided an opportunity to have in-depth discussions with community members to better understand the community, its strengths and valued resources, prioritized needs, and other insights. To review the Interview Guide (interviews) and Moderator's Guide (focus group discussions), please see Appendix B and Appendix C.The qualitative research included five focus group discussions and interviews with over 20 stakeholders. In total, across both qualitative research stages, participants from various sectors, including those listed below, contributed valuable insights: - Referring Partners - Healthcare Providers - Non-Profit Agencies - Social Service Organizations - Faith-Based Institutions - Educators - Community Volunteers - Users of Monadnock Community Hospital services - Higher-risk Community Representatives.The community survey was made available online in English and Spanish from July 17 through August 22, 2024. The questionnaire included closed-ended need-specific questions, open-ended questions, and demographic questions. Invitations to participate were distributed by Monadnock Community Hospital and its partners through channels including email and social media. Strategic outreach was conducted to ensure maximum participation from community members, especially in vulnerable communities.In total, there were 536 valid survey responses, all of which (100.0%) were to the English language survey. Special care was exercised to minimize the amount of non-sampling error through the assessment of design effects (e.g., question order, question-wording, response alternatives). The survey was designed to maximize accessibility and comprehensively evaluate respondents' insights. The survey served as a practical tool for capturing insights of individuals across Monadnock Community Hospital's service area. This was not a random sample, and findings should not be interpreted as representative of the full population. Monadnock Community Hospital Part V, Section B, Line 11: Please see attached implementation plan for how the Hospital is addressing (or any needs it is not addressing and why) the significant needs of the community in which it serves. Monadnock Community Hospital Part V, Section B, Line 16j: The complete financial assistance policy is available upon request and in the waiting rooms. Instructions on how to find out more about financial assistance are posted on the Hospital's website, on the back of all billing invoices, and published in a brochure that is available around the Hospital and in the admissions office. Monadnock Community Hospital Part V, Section B, Line 20e: The Hospital Patient Financial Services (PFS) Department shall develop and implement billing and collection procedures designed to maintain an adequate cash flow, keep accounts receivable at an acceptable level, and identify and write-off bad debts in a timely fashion. Monadnock Community Hospital contracts with an agency to process all self-pay accounts and self-pay after insurance balance statements/letters.I. Self-pay accounts and self-pay balances remaining after insurance adjudication shall be transferred to the agency on a weekly basis. The cycle for collections is three (3) statements and/or letters and two phone call series spaced approximately thirty (30) days apart. The statements shall include: a. Previous balance (unless this is the first statement). b. Activity since last statement (except those accounts that went to a $0.00 balance). c. Current balance due. d. Telephone number(s) for inquiries concerning the statement. e. Status or reminder message where appropriate. f. Availability for the use of a credit card for payment. g. Information regarding Financial Assistance and Medication Assistance Programs. h. Return envelope.II. In the event that statements or letters are returned by the postal service as undeliverable for reasons such as "moved, left no forwarding address," "forwarding order expired, or "no such address" the agency will indicate on the daily report "mail returned." PFS staff will review system for the correct address and will make corrections within the computer system and correspondence will be re-mailed. If no correct or current information can be obtained, the specific account(s) shall be flagged for referral to an outside collection agency equipped to handle this type of situation (see bad debt processing footnote).In addition, during an emergency room visit if a patient is classified as self-pay, a Financial Assistance application is either given to the patient and/or guarantor at the visit or a Financial Assistance application is put in the mail to the patient and/or guarantor. Determination of eligibility is contingent upon receiving a completed application and required documentation from the patient and/or guarantor. Schedule H, Part V, Section B, Line 7a & 10a: The Hospital's current and prior Community Health Needs Assessments and Implementation Plans can be found at the following address:https://monadnockcommunityhospital.com/about-us/community-health-needs-and-benefits/A direct link to the 2023 CHNA (for fiscal years ending in 2024-2026) is:https://monadnockcommunityhospital.com/wp-content/uploads/2024/11/2024-MCH-CHNA-FINAL.pdfA direct link to the 2020 CHNA (for fiscal years ending 2021-2023) is:https://monadnockcommunityhospital.com/wp-content/uploads/2022/08/2021CHNA-FINAL.pdfA direct link to the 2023 CHNA Implementation Plan (for fiscal years ending in 2024-2026) is:https://monadnockcommunityhospital.com/wp-content/uploads/2025/06/2024-MCH-Implementation-Plan-12.20.24.pdfA direct link to the 2020 CHNA Implementation Plan (for fiscal years ending in 2021-2023) is:https://monadnockcommunityhospital.com/wp-content/uploads/2022/08/MCH-Implementation-Plan-FINAL.pdf Schedule H, Part V, Section B, Line 16b: The complete financial assistance policy is available upon request and in the waiting rooms. Instructions on how to find out more about financial assistance are posted on the Hospital's website, on the back of all billing invoices, and published in a brochure that is available around the Hospital and in the admissions office.The Hospital's Financial Assistance Policy, Plain Language Summary, Financial Assistance Application, and additional financial assistance information is available on the Hospital's website at:https://monadnockcommunityhospital.com/financial-services/financial-assistance/A direct link to the Hospital's assistance policy is:http://monadnockhosp.wpenginepowered.com/wp-content/uploads/2020/11/MCH-FAP-Policy.pdfA direct link to the Hospital's assistance application is:http://monadnockhosp.wpenginepowered.com/wp-content/uploads/2023/03/MCH-FAP-Application-FY23.pdfA direct link to the Hospital's plain language summary is:http://monadnockhosp.wpenginepowered.com/wp-content/uploads/2023/03/Financial-Assistance-Eligibility-Summary-Plain-Language-Summary-FY23.pdfA direct link to the Hospital's statement and explanation for Amounts Generally Billed ("AGB") is:https://monadnockcommunityhospital.com/wp-content/uploads/2024/03/Appendix-A-Amount-Generally-Billed.pdfA direct link to the Hospital's statement of participating providers under the financial assistance policy is:https://monadnockcommunityhospital.com/wp-content/uploads/2024/03/Appendix-C-Participating-Providers.pdfLastly, a direct link to a statement of services ineligble for charity care under the Hospital's financial assistance policy is:https://monadnockcommunityhospital.com/wp-content/uploads/2024/03/Appendix-B-Ineligible-Services.pdf 13 1 - Monadnock Orthopedic Associates 458 Old Street Road Wellness Center Peterborough NH 03458 Physician practice 2 - Monadnock Regional Pediatrics 454 Old Street Road MAB Building Peterborough NH 03458 Physician practice 3 - Monadnock Internal Medicine 454 Old Street Road MAB Building Peterborough NH 03458 Physician practice 4 - Jaffrey Family Medicine 82 Peterborough Road Jaffrey NH 03452 Physician practice 5 - Monadnock Behavioral Health 458 Old Street Road Wellness Center Peterborough NH 03458 Physician practice 6 - Antrim Rural Health Clinic 12 Elm Street Antrim NH 03440 Physician practice 7 - Monadnock Family Care 454 Old Street Road MAB Building Peterborough NH 03458 Physician practice 8 - Rindge Family Practice 145 US Route 202 Rindge NH 03461 Physician practice 9 - Monadnock Surgical Associates 454 Old Street Road MAB Building Peterborough NH 03458 Physician practice 10 - New Ipswich Family Medicine 821 Turnpike Road New Ipswich NH 03071 Physician practice 11 - Monadnock Gastroenterology Associates 454 Old Street Road 107 Peterborough NH 03458 Physician practice 12 - Monadnock Rheumatology Associates 458 Old Street Road Wellness Center Peterborough NH 03458 Physician practice 13 - Monadnock Cardiology Associates 454 Old Street Road 207 Peterborough NH 03458 Physician practice Part I, Line 3c: N/A Part I, Line 6a: N/A Part I, Line 7: Charity care and means tested programs use the cost to charge ratio as their methodology. This Hospital calculates the ratio in a manner consistent with worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of cost to charges. Part I, Line 7g: Monadnock Community Hospital has several hospital clinical services and hospital-owned physician practices. In accordance with IRS Instructions for the Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practices that are subsidized during the completion of Schedule H. Furthermore, the definitions for Schedule H, Worksheet 6 indicate that operating a service at a loss may constitute subsidizing a health service. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operated at a loss, and their associated costs, in the calculations for the Hospital's total subsidized health services, as reported on this Schedule H.a - Hospital based rural health clinicb - Cardiac Rehabc - Monadnock Family Cared - New Ipswich Family Medicinee - Jaffrey Family Medicinef - Monadnock Behavioral Healthg - Monadnock Regional Pediatricsh - Monadnock Surgical Associatesi - Anticoag Clinicj - Orthopaedicsk - Rindge Family Practicel - Internal Medicinem - Monadnock Gastro Associatesn - Monadnock Rheumatology Associates o - Oncologyp - RivermeadThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $16.4 million. In addition, this community benefit-figure does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $16.4 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions and guidance contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to a cost-of-service basis. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized was in the preparation of this Schedule H, Part 1, Line 7, were the following:a. Schedule H Worksheet 6, Subsidized Health Services (the supporting worksheet for Part I, Line 7g): the Hospital did not utilize Worksheet 2 when calculating the percentage used when determining the profit or loss of each hospital clinical service and hospital-owned physician practice. Instead, when compiling the subsidized hospital clinical services and hospital-owned physician practices listed in 1c, the Hospital utilized the actual estimated costs on the modified Medicare cost report instead of applying the Worksheet 2 cost to charge percentage. b. Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c); and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, listed in line 1c above (which is part of the line 7g costs): the Hospital did not utilize the Worksheet 2 cost to charge percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the actual, filed Medicaid cost report for the allowable costs. 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 $ 7,623,534. Part II, Community Building Activities: Monadnock Community Hospital, a not-for-profit hospital, has a primary care network of physicians, nurse practitioners, psychiatrists, psychologists, and social workers. This network provides a wide range of primary and behavioral health care services for individuals and families with offices in Peterborough, Antrim, Jaffrey, New Ipswich and Rindge.Each year, MCH seeks to make the Monadnock Region a healthier place to live by identifying new and changing healthcare needs, then developing a strategy to address some of the most pressing issues. In addition, no one is turned away who is in need of medical care. Our mission is to provide health care for everyone in our community, regardless of their ability to pay. Some examples of our efforts to reach beyond traditional hospital services include: - Providing services to patients unable to pay - Offering access to medication, free or at reduced cost - millions of dollars in medicine has been dispensed since the Medication Assistance program was started in 2002. - Improving community access to dental care resources. - Provide training for community agencies, such as local volunteer fire and rescue personnel. - Offer prevention and wellness education, from smoking cessation to dealing with stress. - Screenings and clinics for important health issues such as breast cancer. - Supplying information and support regarding timely health topics. - Offer behavioral health (Substance use & mental health) trainings to the community through Be The Change - Offer space for community organization to meet, including local support groups. - The hospital has a Mobile Integrated Health department.MCH also offers a robust system of volunteer programs and services to engage its stakeholders, to bring people together in civic action, and to promote the wellbeing and success of its community. Volunteer Services responds to department requests for volunteer help and works with the requesting department to develop a written service description, if necessary. Every effort is made to fill the position(s) with qualified volunteers. Volunteers assist with all levels of the Hospital's operations, including materials management, blood drives, emergency department assistance, general support and maintenance, recycling, shuttle and transportation, and other related services. Lastly, the Hospital remains committed to improving not just the physical health but also the quality of life in its community. The Monadnock Region has a rich and vibrant history of support for the Arts. Here at Monadnock Community Hospital, we are in a unique position to help connect the world of healing and the world of art. Our intent is to host a venue for artists to exhibit in varied mediums, resulting in a visual experience which promotes the proven healing and restorative benefits of beautiful artwork. Our vision is to eventually develop a permanent art collection for the hospital which will be enjoyed for generations by patients and visitors to our campus. Our Healing Arts Committee is comprised of individuals representing a strong interest in the Healing Arts initiative and has convened to create and develop all aspects of the MCH Healing Arts Gallery as an established and vital venue going forward. The gallery holds three shows per year displaying work from all local artists. 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) ($7,623,534). Accounts written off to bad debt include gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. The Hospital calculates the ratio in a manner consistent with Worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of costs to charges. Part III, Line 3: The estimated amount of charity care included in bad debt expense is based on the number of applications for charity care denied due to lack of complete documentation against the average charity care write off at cost per qualified patient. We believe the amount is minimal based on our extensive efforts to educate patients and staff about our various payment plans and financial assistance programs to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances, a patient may be eligible for charity care, discounted care, payment programs, or a combination of the above. Due to these efforts, we believe that amounts written off to bad debt that could qualify as charity care is minimal. Part III, Line 4: Please see footnote 1 on page 8 of the attached audited financial statements. Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for the fiscal year ending September 30, 2024. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.As a critical access hospital, Monadnock Community Hospital is reimbursed at 101% of Medicare allowable cost. This greater than 100% reimbursement rate may from time-to-time result in reported revenue received from Medicare in excess of total Medicare allowable costs. Part III, Line 9b: As of September 30, 2011, Monadnock Community Hospital has a written credit and collection policy. Described within that policy are the collection practices and bad debt processes that are followed for patients who are known to qualify for charity care or financial assistance. The Organization utilizes a Financial Assistance Program (FAP) file which is maintained by the Patient Financial Assistance Program of MCH. Internal FAP insurance plans are applied to those accounts and related discount amounts are adjusted in the billing system. Remaining balances are expected to be paid in full by the patient. Payment plans may be requested by the patient and are established by the Patient Financial Services staff according to established criteria. Accounts are annotated to reflect payment arrangements. During bad debt processing, designated staff evaluate accounts listed as collection review for potential bad debt write off. This process includes an examination of account history for indication of FAP application. Part VI, Line 2: Monadnock Community Hospital (MCH) conducted a Community Health Needs Assessment (CHNA) to gather input from patients, community organizations, and staff. Participants shared perspectives on local health needs, helped evaluate data, and provided guidance throughout the process. Their collective knowledge shaped the assessment and its community impact.As required by the Affordable Care Act, non-profit hospitals must complete a CHNA every three years. The goal of MCH's CHNA is to identify and prioritize community health needs. This assessment will serve as a foundation for analyzing population health, refining outreach, fostering collaboration, and enhancing community health initiatives while meeting IRS requirements.In practical terms, the CHNA provides a research-based platform to guide hospital efforts, allowing MCH to address the most pressing health needs and make a meaningful impact.The major strength of MCH is found in the ability of our physicians and staff to offer extensive services utilizing state-of-the-art technology, while maintaining the personalized care of a community hospital. MCH is a 25-bed Critical Access Hospital offering Medical, Surgical and Intensive Care; Obstetrics; Pediatrics; and Mental Health services. In addition, a wide variety of outpatient services are available, including Pulmonary, Cardiac and Physical Rehabilitation; 24-hour Emergency Care; a fully equipped laboratory; and an extensive Radiology department. MCH is fortunate to have strong leadership and a dedicated community that allows us to meet the ever-changing requirements of today's healthcare environment. As that environment changes, MCH is also committed to changing and providing the communities we serve with appropriate and innovative programs.The top ways respondents find out about health care are through a physician or other healthcare worker (50.0%), a hospital's website (34.9%), medical websites including WebMD or Mayo Clinic (34.1%), and/or via word of mouth from friends or relatives (28.2%).MCH also utilizes secondary data resources, such as income, education, demographics, geographic location, and employment data to evaluate and estimate its community's access to care, healthcare literacy, and general wellbeing.The MCH CHNA Leadership Group worked to prioritize 33 community health-related needs, as identified in the primary and secondary research phases of the CHNA process. Based on the results of the Modified Delphi Technique, the ten highest priority community health-related needs include the following: 1. Mental health services for children 2. Mental health crisis care services 3. Urgent care and walk-in clinics 4. Doctors and others to provide primary care to adults and families 5. Mental health services for adults 6. Workforce development to help recruit and retain healthcare workforce 7. Public transportation (not necessarily for medical care) 8. Affordable housing 9. School and hospital collaboration to identify and care for students with medical or mental health needs 10. Economic development - job creation and training At a higher level, the top ten needs can be categorized into four groups: - Mental health care - Urgent care - Access to primary care (i.e., more primary care providers and school / hospital collaboration) - Social and community-based issues (e.g., economic development issues, housing, public transportation). Though not explicit in the prioritization survey, community leaders also include "Quality, affordable childcare" as a higher-priority community need.MCH currently addresses all, or most, of the community needs identified in the CHNA in some way. For each of the top 10 needs identified in the CHNA, MCH examined its current programs, outreach efforts and collaborations, as well as consideration for new initiatives such that each of the needs was assigned to one of the following groups: - Needs that are not part of MCH's purview (e.g., better addressed by other organizations). In this case, MCH will support and advocate for addressing the need but are not able to address the need directly. - Needs that MCH will address through collaboration with community partners. - Needs for which MCH will enhance existing programs or establish new ones. The hospital has current activities that may be able to be modified or expanded to address the community health need, or newly created activities or initiatives may be required to do so. Part VI, Line 3: MCH is committed to providing quality healthcare to anyone in need of services, regardless of ability to pay. We understand patients may not have the finances to pay for their healthcare services and medications, and do not want this to prevent anyone from receiving necessary treatment. As part of the Hospital's mission to the communities we serve, we have developed programs to help meet the needs of our patients who meet income eligibility. Through our Financial Assistance and Medication Assistance Programs, we have been providing financial assistance for many years to those who qualify. We reach out to our patients in many different ways to ensure that they are aware that help is available and to guide them through the process. Brochures and signage are posted in high traffic areas and all employees of MCH are informed about the Financial Assistance Program during orientation. When a patient goes through the registration process at the Hospital the staff are trained to inform uninsured or underinsured patients about the Monadnock Community Hospital Financial Assistance program and that there is assistance available within the Hospital to help with the application process. In addition, any time a patient calls customer service, the representative is trained to help identify and offer support to patients who may require financial assistance. Patients may qualify for free care, discounted care, payment plans or a combination of the above. Resources are also provided in applying to federal and state programs for those who qualify. Part VI, Line 4: Monadnock Community Hospital is a 25-bed acute care facility serving a geographically distinctive market in the Greater Monadnock region of New Hampshire, whose population of 38,371 includes 13 towns in Cheshire and Hillsborough counties.The Social Vulnerability Index (SVI) was developed by the U.S. Centers for Disease Control and Prevention as a metric for analyzing population data to identify vulnerable populations. The SVI may be used to rank overall population well-being and mobility relative to county and state QA data. The SVI can also be used to determine the most vulnerable populations during disaster preparedness and public health emergencies, including pandemics.The Hospital's most recent CHNA indicates the following findings from the SVI: - The Monadnock service area is defined by its high senior citizen population. 20% of Monadnock service area residents are age 65 and over, a slightly higher percentage than the state (19%) and county (16.3%) average. - Median incomes are strong in the Monadnock service area ($92,476), and poverty rates are slightly lower (5.4%) than the Hillsborough County average (6.9%). By town, high poverty rates are noteworthy in Temple (13%), Dublin (9.8%), Greenfield (8.1%), Greenville (7.8%), Francestown (7.7%). Poverty rates are low in Hancock (3.3%), New Ipswich (3.4%), and Peterborough (3.2%). - While Hillsborough County experiences higher population diversity compared with the New Hampshire average, which is not reflected in the Monadnock service area. Just 8.7% of the service area population identifies as an ethnic minority, well below county (18.1%) and state (11.7%) averages. - Youth (i.e., age 17 or younger) make up 20.6% of the Monadnock service area population similar to the county average (20.0%) and slightly higher than the state average (18.6%). Part VI, Line 5: Monadnock Community Hospital is a critical access hospital located in the Monadnock Region of NH. Our mission is to improve the health and well-being of our community. The Hospital is served by a board of trustees consisting of local citizens active in their community and its organizations. The majority of the board is not employed by the Hospital and consists of local community and business representatives as well as medical staff. Each year, MCH seeks to make the Monadnock Region a healthier place to live by identifying new and changing healthcare needs, then developing a strategy to address some of the most pressing issues. In addition, no one is turned away who is in need of medical care. Our mission is to provide health care for everyone in our community, regardless of their ability to pay. The Hospital is committed to giving back to the community to the greatest extent possible. Monadnock Community Hospital supports thousands of individuals and families with free or reduced-fee services and programs. Our Financial Assistance Program administered by the Social Services Department helps families and individuals in need with access to health care and other available community services such as catastrophic care, fuel assistance, meals on wheels, food banks, and visiting nurses. Other examples of the Hospital's effort to reach our patients beyond traditional hospital services include access to free or reduced cost medications through our Medication Assistance program; training for community agencies such as local volunteer fire and rescue personnel; offering prevention and wellness education including nutrition, smoking cessation and dealing with stress; providing regular community seminars regarding timely health topics; screenings and clinics for important health issues such as breast cancer; offer behavioral health (substance use & mental health) trainings to the community through Be The Change. These are just a few of the many areas where we are reaching out to others to assure they are cared for well. Part VI, Line 6: GraniteOne Health was a non-profit, New Hampshire-based healthcare system consisting of Catholic Medical Center (CMC) in Manchester, Huggins Hospital (HH) in Wolfeboro, and Monadnock Community Hospital (MCH) in Peterborough. GraniteOne Health drew on the resources and expertise of these strong, trusted hospitals to enhance collaboration, strengthen clinical partnerships and meet the health needs of the communities by providing greater access to high-quality care and a seamless patient experience.However, On June 16, 2023, the parties submitted a Joint Notice to the Director of Charitable Trusts pursuant to New Hampshire RSA 7:19-b to the State of New Hampshire and received the Director of Charitable Trusts no action report on December 1, 2023, clearing the way for the parties to complete the disaffiliation. The parties' respective boards each approved changes to their governing documents to unwind the reserved powers and dissolve GraniteOne. On May 30, 2024, the parties filed amendments to their respective governing documents with the New Hampshire Secretary of State as well as the Statement of Dissolution of GraniteOne to complete the wind-down requirements of the GraniteOne system. Accordingly, as of the end of the period covered by this Form 990, Monadnock Community Hospital is no longer part of this Affiliated Health Care System, though the Hospital was a member of this System at the beginning and through and a portion of this tax year. Part VI, Line 7, Reports Filed With States NH 1 Town of Peterborough 1 Grove Street Peterborough NH 03458 Government 15000 0 For the benefit of the Peterborough Ambulance Contoocook Valley School District 106 Hancock Road Peterborough NH 03458 Government 8693 0 Support the Hope Squad Basic Program Community Volunteer Transportation Company 375 Jaffrey Road Suite 3 Peterborough NH 03458 262838428 501(c)(3) 8000 0 Support no-fee transportation to those in need in the Monadnock Region 3 0 Dr. Mark Luedke Memorial Scholarship Fund 1 4317 Dr. Herbert E. Flewelling Scholarship 2 4000 Norma A. Houghton Nursing Scholarship 1 1500 Nursing Education Fund 13 52500 Peter L Gosline Scholarship 1 1500 Part I, Line 2: During the fiscal year ending September 30, 2024, the Hospital made contributions to governmental entities and 501(c)(3) public charities located in the Hospital's geographic region. The Hospital continued the Dr. Mark Luedke Memorial Scholarship Fund in memory of the Organization's former Radiology Medical Director. The fund is to support clinical education and certification for members of MCH's Radiology Department, and is disbursed with the input of the Director of Radiology, the Chief Nursing Officer, and the VP of Human Resources. The Hospital also continued the Dr. Herbert E. Flewelling Scholarship to honor the memory of Dr. Flewelling, who practiced both in Peterborough and Jaffrey. Scholarships are usually awarded each year to graduates of local area high schools. The scholarships are given to outstanding students who are furthering their education in the medical field. The actual cash award is made upon satisfactory completion of six months of education. The Hospital also continued the Norma A. Houghton Nursing Scholarship to honor the memory of Norma A. Houghton, who devoted her profession to being an RN certified as a lactation consultant, and who served the birthing suite at the Hospital from 1977-2006. Scholarships are usually awarded each year to graduates of local area high schools. The scholarships are given to outstanding students who are furthering their education in the nursing field. The Hospital also continued the Peter L. Gosline Employee Education Scholarship Fund to honor Peter Gosline, the president and CEO of the Hospital from 1998 to 2014. The Scholarship provides financial assistance to eligible employees pursuing higher education and skills development within health services professions. X X X 0 1 0 0 0 0 0 1 0 Alexander J Walker Esq Ex-Officio (voting) (end 3/2024) 0 649284 0 0 0 68240 0 270586 0 80585 0 1068695 0 0 Vache Hambardzumyan MD Physician 594337 0 1000 0 950 0 0 0 29310 0 625597 0 0 0 Terrence McNamara DO Trustee/Physician 436058 0 18572 0 450 0 6600 0 31329 0 493009 0 0 0 Cynthia McGuire Chief Executive Officer 343108 0 69719 0 22436 0 24100 0 27964 0 487327 0 17500 0 Derek Anderson MD Physician 434625 0 1000 0 950 0 6600 0 32879 0 476054 0 0 0 Daniel Perli MD Physician/Chief Medical Officer 440953 0 1000 0 800 0 6558 0 11644 0 460955 0 0 0 Shawn Harrington MD Physician 399717 0 1000 0 1190 0 6600 0 29829 0 438336 0 0 0 Dmitry Tarasevich MD Physician 395104 0 1000 0 450 0 6600 0 11473 0 414627 0 0 0 Richard D Scheinblum VP Finance/CFO 263630 0 23446 0 690 0 5396 0 20488 0 313650 0 0 0 Part I, Line 4b Schedule J, Page 1, Line 4b, supplemental non-qualified retirement plans: Cynthia McGuire, President & CEO, participates in a 457(f) plan with Monadnock Community Hospital. After a three year vesting period, amounts previously contributed to her by Monadnock Community Hospital are reported as part of her W-2 wages. In calendar year 2023, a total of $17,500 was deposited into Ms. McGuire's 457(f) plan account, which is included in the amount reported on Schedule J, Part II, Column C for this current fiscal year Form 990 filing. Additionally, $18,626 of compensation is reported in Column B(iii), which represents the vested 2020 contribution of $17,500 and earnings of $1,126. The $17,500 has also been reported on this Schedule J, Part II, Column F, as compensation deferred in a previous period which became taxable during this filing period (calendar year 2023 for purposes of income and benefit reporting). Alexander Walker, Jr. takes part in a section 457(f) forfeitable nonqualified deferred compensation plan administered by Catholic Medical Center. In calendar year 2023, Mr. Walker received contributions of $258,386 from Catholic Medical Center into his 457(f) Plan. Such contributions are included in the total deferred compensation reported for Mr. Walker on this Schedule J, Part II, Column C. Part I, Line 7 MCH may from time-to-time compensate physicians utilizing quality and productivity targets based on WRVU (work relative value units). In addition, the Compensation Committee may recommend to the full board, annually, the variable pay award that may be issued to the Hospital's CEO. The payment of any such awards are discretionary and are subject to meeting the pre-determined goals of the Organization. A NHBFA Revenue Bonds Series 2013 021304598 2013-01-01 27240000 refinance existing Series 2007 and 2009 bonds 0 0 0 A 6688887 27240000 27057466 182534 2013 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Schedule K, Part III, Line 9, Part IV, line 7 and Part V: Although formal policies are not in place in regards to the remediation of our bond, the monitoring requirements of Section 148, and procedures to ensure that violations are timely identified and corrected Monadnock Community Hospital has compliance checks in place that substantiate these requirements. Below is a list of all compliance checks that Monadnock Community Hospital has in place to monitor the 2013 Bond Issue: 1. Covenant calculations performed monthly as part of the Financial Scorecard preparation which is reviewed by the MCH Board of Trustees. 2. Covenant calculations are performed for each quarter and reported to the bond issuer, TD Bank. 3. Covenant certificate is signed each quarter by the CFO and reported to the bond issuer, TD Bank. 4. Financial statements and statistical reports are send to the bond issuer, TD Bank, on a quarterly basis. 5. Annual Operating and Capital budgets are reported to the bond issuer, TD Bank. 6. A No Event of Default certificate is signed by the CFO annually and reported to the bond issuer, TD Bank. 7. Annual Audited Financial statements are reported to the bond issuer, TD Bank. Each of these items that are reported to TD Bank has a specific deadline for completion as outlined in the bond documents. Michael Shea Lessor of Rental Property 141220 Michael Shea served as a Trustee on the Hospital's board of directors. Mr. Shea is also the president and part owner of Belletetes, Inc. Monadnock Community Hospital leases a building in Jaffrey, NH for the Jaffrey Family Medicine Practice which is owned by Belletetes, Inc. Terms are at arms-length. The total amount reported in Column C represents rental payments ($141,220) as well as payments for property taxes and common area maintenance. 0 Form 990, Part III, line 3 On December 30, 2016, the Hospital became affiliated with Catholic Medical Center (CMC), a 330-bed acute care hospital in Manchester, New Hampshire, and Huggins Hospital (HH), a 25-bed critical access hospital in Wolfeboro, New Hampshire, through the formation of a common parent, GraniteOne Health (GraniteOne). GraniteOne is a New Hampshire voluntary corporation that is recognized as being a Section 501(c)(3) tax-exempt and "supporting organization" within the meaning of Section 509(a)(3). However, pursuant to the Affiliation Agreement that formed GraniteOne, the CMC, HH and MCH each had a right, after two years of participation in GraniteOne, to evaluate whether they would continue participation in the system. Upon review, each participant within GraniteOne concluded it was best to withdraw from GraniteOne and subsequently provided the required notice on October 28, 2022. On June 16, 2023, the parties submitted a Joint Notice to the Director of Charitable Trusts pursuant to New Hampshire RSA 7:19-b to the State of New Hampshire and received the Director of Charitable Trusts no action report on December 1, 2023, clearing the way for the parties to complete the disaffiliation. The parties' respective boards each approved changes to their governing documents to unwind the reserved powers and dissolve GraniteOne. On May 30, 2024, the parties filed amendments to their respective governing documents with the New Hampshire Secretary of State as well as the Statement of Dissolution of GraniteOne to complete the wind-down requirements of the GraniteOne system. Form 990, Part VI, Section A, line 2 James Callahan, Esq., and Michael Shea, who each served on the Hospital's Board during this tax year, share a business relationship. Form 990, Part VI, Section A, line 4 During the period covered by this Form 990 tax return, Monadnock Community Hospital ("MCH") adopted the following significant changes to its governing bylaws: 1. Effective February 2024, MCH is no longer part of the GraniteOne Health hospital system. Previously, GraniteOne Health was the sole member of MCH. 2. Previously, as the sole member, GraniteOne Health was able to exercise certain powers and responsibilities over MCH's governance and operations. Upon its dissociation from GraniteOne Health, the responsibilities and duties for all MCH governance and Board composition decisions became vested with the MCH Board of Trustees, and GraniteOne Health ceased to have influence over such duties within MCH. 3. The former bylaws previously allowed that the GraniteOne Health CEO would be an ex-officio of the MCH Board of Trustees. The amended and newly adopted bylaws removed such privileges from the GraniteOne Health CEO. Additionally, the newly adopted bylaws update the terms for ex-officio trustees in general, stating that there shall now be allowed two members of the active MCH Medical Staff to be ex-officio Trustees (previously one was allowed), and that the Monadnock Health Partners Medical Director is not necessarily by default treated as such an ex-officio Trustee of the Board (previously, such privileges were given to the Medical Director). Form 990, Part VI, Section B, line 11b The Hospital's Form 990 is prepared with assistance by an independent public accounting firm. A draft of the Form 990 is initially reviewed in detail by key finance employees. Thereafter, the draft is made available to the full board for review and comment prior to filing with the IRS. Form 990, Part VI, Section B, line 12c On an annual basis, the Organization provides all administrators/directors/managers, Board Members, and medical staff members with the conflict of interest policy. Said individuals are required to complete a new conflict of interest disclosure on an annual basis. Any conflicts of interest noted are reviewed by the Chair of the Board, in conjunction with the Corporate Compliance Officer. If the conflict of interest appears to meet the policy definitions requiring full Board review, the Chair of the Board takes this to the full Board meeting, and it is discussed, and appropriate action is taken (in compliance with state and federal requirements). The conflict of interest statement requires signatories to inform the Hospital of any conflict of interest that occurs at any time throughout the year. If a conflict of interest arises during the year, it is reviewed by the Compliance Officer, and if necessary, is taken to the Board Chair/Board. The Compliance Officer confers with legal counsel with regard to conflicts of interest, if there is any question regarding the potential conflict. Form 990, Part VI, Section B, line 15 The Organization has a written executive compensation policy and procedure. Under this policy, the Compensation Committee, comprised of delegated representatives of the Board of Trustees, has the power and responsibility to determine the Hospital's approach to executive compensation and review the performance of the CEO. The Compensation Committee has the responsibility to set, monitor and review the base salary of the CEO. The Committee maintains minutes of sessions and final recommendations and determinations in accordance with the Board of Trustee guidelines. Annually, market data is reviewed by the Committee to determine the appropriate salary for the Hospital's CEO based upon identified standards. At the end of the time period, the Committee reviews to what extent stated goals were met and recommends an amount for the variable pay award to be approved by the full board. Form 990, Part VI, Section C, line 19 Monadnock Community Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of pecuniary benefit transactions that have occurred between MCH and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-A, II(D). Current copies of the bylaws, conflict of interest policy and Form 990 are on file with the Charitable Trust Unit. The Hospital also makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part VII, Section A, Column D: Director Compensation The 2023 compensation reported for Terrence McNamara, DO, as paid by Monadnock Community Hospital, was paid in return for medical services provided by Terrence McNamara as an employee of the Hospital. No part of Terrence McNamara's compensation was remuneration in return for services as a voting member of the Hospital's Board of Trustees. Form 990, Part VIII, Line 7: Realized Capital Gains The amount reported on lines 7c and 7d as realized gains agrees to reporting from the Hospital's custodian bank and third party investment managers. Due to the volume of investment activity, the Hospital relies on the custodian bank and third party investment managers to track the sale of investments at the individual asset level. Therefore the ability to track and report proceeds and basis of the sales is extremely difficult. Form 990, Part XI, line 9: Decrease in fair value of interest rate swap agreement -644,783. Increase in fair value of perpetual trust interest 1,222,837. Increase in fair value of equipment due to lease-transfer 10,297. Form 990, Part XI, Line 2c: Audit Review Process The Audit Committee oversees the audit process for Monadnock Hospital. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for the fiscal years ended 9/30/2023 and 9/30/2024. Alliance Ambulatory Services 100 McGregor Street Manchester NH 03102 020519436 Ambulatory Surgical Center NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 12b, II CMC Healthcare System 0 Catholic Medical Center 100 McGregor Street Manchester NH 03102 020315693 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Parent NH 501(c)(3) Line 12b, II N/A 0 CMC Physician Practice Associates 100 McGregor Street Manchester NH 03102 020460245 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 GraniteOne Health 100 McGregor Street Manchester NH 03102 814663563 Supporting Organization NH 501(c)(3) Line 12a, I N/A 0 Huggins Hospital 240 South Main Street Wolfeboro NH 03894 030223332 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 Monadnock Health Services - INACTIVE 452 Old Street Road Peterborough NH 03458 020420789 Inactive NH 501(c)(3) Line 12a, I Monadnock Community Hospital 1 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Day Care Services NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Urgent Services 100 McGregor Street Manchester NH 03102 831238167 Health Care Services NH N/A 0 0 Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A 0 0 NH Value Care ACO LLC 100 McGregor Street Manchester NH 03102 832029076 Health Care Services NH N/A 0 0 Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 Form 990, Schedule R, Parts II and IV: Many of the entities listed as related organizations of Monadnock Community Hospital ("MCH") on this Form 990, Schedule R, are related to MCH through shared memberships and associations with GraniteOne Health. However, during the period covered by this Form 990, MCH ended its relationship with GraniteOne Health, and GraniteOne Health ceased to be the sole member of MCH. As a result, as of the end of this tax year ending September 30, 2024, are, in fact, no longer connected or related to MCH. In accordance with IRS Instructions for the Form 990 and Schedule R, these entities have still been disclosed as related organizations, though the dissociation occurred in February 2024.