2020-08-13T10:42:27-05:00 2019-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-10-01 020315693 Catholic Medical Center CATH 6036683545 100 McGregor Street Manchester NH 031023770 Edward L Dudley III Executive VP & CFO 6036683545 2020-08-10 1 Nicholas E Porto P01310283 2078792100 2020-08-10 208.105.168.164 2020-08-10 09:48:23 ED P BC8AE4E166BFDF24A7972DDCC457CE4FCF4C8ABA DA1D1F22D002DE74304CAE64996AD19EA354FE22 2018 2020-11-06 18:47:13Z Joseph Pepe MD 100 McGregor Street Manchester NH 031023770 543644825 0 0928 X www.catholicmedicalcenter.org X 1974 NH The heart of Catholic Medical Center is to carry out Christ's healing ministry by offering health, healing, and hope to every individual who seeks our care. 13 9 3308 261 37570 31061 3497316 5074621 464242919 481267408 5926206 4078866 64007 64034 473730448 490484929 529913 825151 0 0 190909684 220694101 16747 52527 554528 239415594 230643573 430871938 452215352 42858510 38269577 448191010 437721429 298091631 346964225 150099379 90757204 The heart of Catholic Medical Center is to carry out Christ's healing ministry by offering health, healing, and hope to every individual who seeks our care. 0 0 387788299 825151 472050181 Medical and surgical services provided to 12,510 inpatients and 516,127 outpatients during the year. 7718634 0 9395803 Various other services. Please see Schedule H.Catholic Medical Center (CMC), as an agency of the Roman Catholic Church, shall provide health care in a manner consistent with the ethical and religious directives for Catholic health care services as interpreted by the Roman Catholic Bishop of Manchester. CMC shall employ the highest quality health care professionals and the most appropriate technology to deliver an array of services either directly or through strategic alliances with compatible health care providers. With dignity and compassion, CMC shall treat the body, mind, and spirit of all who seek or provide care and comfort. Additional details provided in Schedule H. 395506933 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 255 0 1 3308 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 13 9 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NH X Edward Dudley 6036683545 c/o Finance Dept 100 McGregor Manchester NH 031023770 Rick Botnick Director (end 12/18) 1.10 0.80 X 0 0 0 Robert A Catania MD Director 1.30 40.40 X 0 580271 40921 Carolyn Claussen MD Director 0.90 40.60 X 0 191076 13387 Louis I Fink MD Director 1.60 40.60 X 0 624741 24200 Powen Hsu MD Director (end 12/18) 0.30 0.20 X 0 0 0 Susan M Kinney Director 1.10 0.20 X 0 0 0 Derek McDonald Director/Bishop's Delegate 1.20 1.20 X 0 0 0 John J Munoz MD President of Medical Staff 1.10 0.40 X 0 0 0 Catherine Provencher Director 1.20 0.40 X 0 0 0 Diane Murphy Quinlan Director/Bishop's Del.(end 12/18) 1.90 1.20 X 0 0 0 Timothy Riley Director 1.10 0.40 X 0 0 0 Fr Patrick Sullivan OSB RN Director (end 12/18) 0.40 0.40 X 0 0 0 John G Cronin Esq Chair 2.80 1.60 X X 0 0 0 Neil Levesque Vice Chair 2.70 1.40 X X 0 0 0 Matthew Kfoury Secretary 2.60 1.40 X X 0 0 0 Pamela Diamantis Treasurer 2.40 0.40 X X 0 0 0 Donald St Germain Treasurer (end 12/18) 0.20 1.00 X X 0 0 0 Maria C Mongan Immediate Past Chair (end 12/18) 1.10 1.00 X X 0 0 0 Joseph Pepe MD President & CEO 43.50 4.60 X X 966705 0 400783 Edward Dudley III Executive VP & CFO 41.20 2.70 X 555530 0 203991 Alexander Walker Jr Esq Executive VP & COO 41.10 2.60 X 605080 0 212505 William Goodman MD MPH VP, Medical Affairs/CMO 41.00 0.00 X 505248 0 39732 Tina Legere Sr. VP, Operations 40.90 0.00 X 363886 0 34774 Carolanne O'Sullivan Sr. VP, Provider Network 40.80 0.20 X 355279 0 47398 Ivan Ip MD MS MPH Chief of Medical Information 40.00 0.00 X 311537 0 17838 Thomas Della Flora VP, Chief Information Officer 40.00 0.00 X 301960 0 41481 Merryll Rosenfeld VP, Human Resources 40.40 0.00 X 277165 0 43539 4242390 1396088 1120549 222 0 1 0 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Medical services 18989738 Eisenberg Vital & Ryze LLC 155 Dow Street Suite 301 Manchester NH 03101 Marketing services 1385358 Aya Healthcare Inc 5930 Cornerstone Court W 300 San Diego CA 92121 Staffing/labor services 1324256 Anesthesia Care Group PC 68 South Service Road Suite 350 Melville NY 11747 Physician services 1144556 C & A Industries Inc 13609 California Street Omaha NE 68154 Staffing/labor services 877899 57 330597 1978118 2765906 37289 5074621 Patient service revenue 621400 449484087 449484087 Disproportionate Share Funding 621400 22566094 22566094 Miscellaneous revenues 621400 4909691 4909691 Cafeteria income 722210 2174600 2174600 Lab client revenue 621500 1696927 1696927 436009 436009 481267408 4157459 37570 4119889 52750600 52829193 -78593 -78593 -78593 70526 330597 185068 -114542 -114542 324211 145635 178576 178576 490484929 481445984 37570 3926754 783233 783233 41918 41918 3489574 2883712 605862 176059330 145132598 30492080 434652 7873769 6488258 1363170 22341 21915839 18110796 3805043 11355589 9359374 1966387 29828 641077 641077 204275 204275 50000 50000 52527 52527 171883 171883 13041819 10502050 2539769 1915111 1542162 372949 6793943 5451643 1328618 13682 8484967 6832601 1652366 17138412 13800871 3337541 1107159 891550 215609 881050 709474 171576 3913934 3178046 735888 15741819 10590234 5151585 2554558 2057082 497476 Medical supplies 97530886 97363461 167425 Medicaid Enhancement Ta 21382132 21382132 Provision for bad debt 20972163 20972163 Physician fees 14463678 14275014 188664 3654707 3158561 494648 1498 452215352 395506933 56153891 554528 57668500 46658265 42874944 18017902 0 1651449 54074988 83681232 3583228 4600802 9150610 6335880 314185180 195495104 109898233 118690076 104272134 94420016 57168017 53673754 9500356 9992053 448191010 437721429 60837616 71094367 1304941 1135012 112889925 114487719 6470603 3857711 116588546 156389416 298091631 346964225 X 139672561 79512313 1190721 2094880 9236097 9150011 150099379 90757204 448191010 437721429 X 38269577 1041441 -98653193 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 34405 0 0 1 50000 84405 0 Part II-B, Line 1: Catholic Medical Center (CMC) 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 in the fiscal year ending September 30, 2019 was available for lobbying expenditures on behalf of CMC and the other member-organizations in furtherance of their exempt purposes. The portion of the dues paid that constituted lobbying was as follows: NHHA: $23,919 AHA: $10,486 Also in the fiscal year, the Hospital paid Devine, Millimet, & Branch, PA for lobbying services, which included providing information regarding public policy pending before the legislature. Devine, Millimet, & Branch, PA participated in the administrative rule-making process with respect to rules concerning the certificate of needs board. They also provided general communication with elected officials. CMC paid Devine, Milliment, & Branch $50,000 for these services. 10426818 1536316 -63353 654890 11244891 9726007 646924 430243 376356 10426818 9492810 169811 112670 49284 9726007 8240087 666127 783730 197134 9492810 8646641 182178 -470680 118052 8240087 0.00000 0.81370 0.18630 0 0 672812 672812 107234410 47566276 59668134 9694467 6124407 3570060 180736559 134112959 46623600 15846932 7691462 8155470 118690076 Investment in affiliates 1877471 F Private investment funds 51796283 F 53673754 Accrued pension & other liabilities 155178344 Due to affiliates 991062 Interest rate swap liability 220010 156389416 X 438603620 1041441 -51967966 -50926525 489530145 171883 782901 954784 490484929 451591271 330703 330703 451260568 171883 782901 954784 452215352 Part V, Line 4: Proceeds from the Organization's endowment funds are used in operations. Part X, Line 2: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center 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 the consolidated financial statements. Part XI, Line 2d - Other Adjustments: Special event expenses 185,068. Gift Shop cost of goods sold 145,635. Change in FMV of perpetual trust -110,168. Change in FMV of interest rate swap agreement -482,735. Pension related changes net of periodic costs -51,705,766. Part XI, Line 4b - Other Adjustments: Donations to others included in income on the audited financial statements 782,901. Part XII, Line 2d - Other Adjustments: Special event expenses 185,068. Gift Shop cost of goods sold 145,635. Part XII, Line 4b - Other Adjustments: Donations to others included in income on the audited financial statements 782,901. X X X X X X 1 Accordant Philanthropy 195 Teal Nest Court Ponte Vedra Beach FL 32082 Fundraising research and capital campaigns 0 1100000 32127 1067873 Eleni Eliades 5 Masefield Drive Nashua NH 03062 Fundraising research and capital campaigns 0 180000 20400 145918 1280000 52527 1213791 NH Gala 209025 179155 29870 0 85 7500 57267 12234 27404 Golf Tournament 123043 91652 31391 2175 8702 21297 5101 0 11857 1 69055 59790 9265 0 0 16874 8250 0 6322 401123 330597 70526 2175 8787 45671 70618 12234 45583 185068 -114542 1 1 1 X 225.000000000000 1 X 1 1 0 1 1 5271458 0 5271458 0.01220 61760965 40853339 20907626 0.04850 67032423 40853339 26179084 0.06070 1880235 148743 1731492 0.00400 1124286 0 1124286 0.00260 13092493 7580360 5512133 0.01280 23561 1260 22301 0.00010 757014 324885 432129 0.00100 16877589 8055248 8822341 0.02050 83910012 48908587 35001425 0.08120 300 300 0.00000 8366 8366 0.00000 80518 80518 0.00020 63638 63638 0.00010 152822 152822 0.00030 1 6060955 0 109038722 143047926 -34009204 X 1 1 1 1 Catholic Medical Center 100 McGregor Street Manchester NH 03102 00646 X X X Catholic Medical Center 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X see Part V, Section C X see Part V, Section C X X 1 18 1 see Part V, Section C 0 1 X 225.000000000000 300.000000000000 X X 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 1 X 0 0 Catholic Medical Center Part V, Section B, Line 5: A variety of different secondary data sources were accessed. They included but were not limited to the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services (NHDHHS), Youth Behavioral Risk Factor Surveillance Survey, City of Manchester, Census data, and local town data. Representatives from CMC, Elliot Health System (EHS) and Manchester Health interviewed key leaders from towns in our service area to ascertain the key health related issues that they were facing and dealing with in their local communities. The towns that were included in the interview process were Auburn, Bedford, Candia, Hooksett, Goffstown, Deerfield, and New Boston. Though the overall needs were similar the priority of them varies between the towns. Overall, the common themes were substance use, the availability of behavioral health services, transportation (especially in the elderly populations and the more rural areas of New Boston and Deerfield), self-care and management of chronic disease, and access to health care for the low income populations and communities. Communications on community needs were collected via discussions with local leaders in the health care field. These leaders consisted of individuals from: Catholic Medical Center, Dartmouth-Hitchcock Clinic, Public Health Department - City of Manchester, NH, Elliot Health System, and Community Health & Mission. Catholic Medical Center Part V, Section B, Line 6a: Elliot Health System in Manchester, NH. Catholic Medical Center Part V, Section B, Line 7d: The Catholic Medical Center "Healthy Living News", the Medical Center's community newsletter, provides a summary report of the community benefits that the Medical Center provides. The Healthy Living News is distributed to our primary and secondary service areas, approximately 120,000 people. Catholic Medical Center Part V, Section B, Line 11: Catholic Medical Center has addressed the needs identified in the June 30, 2019 (tax year 2018) CHNA through the implementation of programs and services throughout the Manchester health service area (HSA). Mental illness and violence are often intrinsically intertwined. CMC has increased services within our Behavioral Health Department and developed the Opioid Use/Misuse Resource. This is an online tool available to all CMC staff to create consistency of care in the treatment and recovery of this public health epidemic. Health Care for the Homeless (HCH) of CMC provides behavioral health services and substance abuse counseling to the homeless throughout the Manchester HSA. CMC has improved the mental health assessment tool in Primary Care, a key component in the early identification and treatment of mental illness. In collaboration with Governor Hassan's Senior Director of Substance Misuse and Behavioral Health and Boston University School of Medicine, CMC conducted the fourth annual "State-of-the Art Management of the Opiate-dependent Patient, Pain Treatment and the Heroin Epidemic". The targeted audience for this conference included prescribers, nurses, allied health professionals, pharmacists and social service agencies. The program addressed many facets of substance abuse within our community, hospitals, and practices. In addition, CMC hosted the Annual Summit on the Treatment of Opioid-Dependent Patients and Pain, added an Addiction Medicine Practice, and increased the number of providers utilizing medication assisted treatment.Ambulatory care, chronic disease, including asthma and aging issues have all been addressed through various means. Catholic Medical Center's Primary Care has implemented The Patient-Centered Medical Home (PCMH) Model, a proactive approach to preventative medicine through the introduction of care coordinators to the primary care practices. All care managers work with the practices' most high risk patients (asthma, diabetes, COPD, etc) to ensure they understand their medications and follow-up care. The PCMH Model encourages patients to become involved and educated in their personal care plan. CMC offers free health screenings, chronic disease, and self-management classes to the community. These programs provide the opportunity for early detection of chronic disease; referral based follow-up care and education on adopting healthy lifestyle behaviors, communicating with the healthcare team, problem solving, and goal setting. To aid with aging issues, CMC's Parish Nurse program provides nurse consultations, education, referrals, and screenings at Parishes throughout the Greater Manchester Area.In order to address the barriers to access of health care services related to poverty (lack of insurance, cost, transportation and education on accessing care, and lack of medical home) CMC provides comprehensive care to Manchester's underserved and refugee populations. Health Care for the Homeless provides primary medicine and behavioral health care to over 1,700 homeless patients. CMC's Certified Application Counselors (CAC) provide outreach and enrollment services to the communities' uninsured. CACs provide information on a full range of qualified health plan (QHP) options and assist individuals in applying for coverage through a QHP in the ACA's Marketplace Exchange. CMC has staffed the emergency department with a community health worker to improve primary care access for the homeless population, provide education on accessing care, and transportation support. CMC provides shuttle support at no cost to patients with offsite appointments such as primary care, outpatient PT, and other services that are not available at the Hospital. CMC assists patients through the Medication Assistance program to obtain medications they would otherwise not be able to afford and has developed a prescription delivery program with Rite Aid Pharmacy to assist patients with filling their medications upon discharge.CMC's Poisson Dental Facility has expanded access to oral health services to patients of the Pregnancy Care Center and Manchester Community Health Center (MCHC). The Poisson Dental Facility provides access to exams and treatment planning for women from the Pregnancy Care Center and access to oral health care during the first post-partum year until their treatment plan has been completed. CMC's Poisson Dental facility provides oral health services to not-for-profit agencies in our community including Mental Health Center of Greater Manchester, Moore Center Services, Manchester Health Department, and Health Care for the Homeless (HCH). The majority of HCH patients often arrive with very poor oral health. In an effort to meet the growing need for oral health services, CMC's Poisson Dental expanded services to include school-based dental care for children in need attending Manchester elementary and middle schools. This school-based program is made possible through collaboration with the City of Manchester Health Department and Easter Seals NH. Poisson Dental also provides onsite dentistry at Dartmouth Hitchcock Manchester by integrating these services within their pediatric practice. This allows for ease of access for the patients and direct communication amongst the providers of care.CMC's Fertility Education provides teens at local schools and parishes educational opportunities such as The Cradle Within, Ideal Dating, Sexual Risk Behavior, and Conflict Resolution. The goal is to equip adolescents with the tools to identify healthy relationships and the benefits of choosing sexual risk avoidance behaviors. The Pregnancy Care Center provides supportive prenatal care to all women, including teens, regardless of their ability to pay. Their mission is to improve pregnancy outcomes by serving those most in need and unable to access services in a traditional prenatal setting. The Pregnancy Care Center expanded services, adding Centering Group Prenatal Care; this program is a multifaceted model of group care that integrates the three major components of care: health assessment, education, and support. Visits promote greater patient engagement, personal empowerment, and community-building. Veteran's Support: In June of 2018, Easter Seals and Catholic Medical Center launched a pilot program to provide Easter Seals' Military & Veteran Services (MVS) care coordination services onsite to veterans, service members, and their immediate family members (including CMC staff members). Easter Seals MVS provides care coordination services to veterans of all eras, regardless of branch, active duty status, length of service, or discharge status. Among other things, Easter Seals MVS can help patients (and staff members who are veterans) to determine eligibility for and connect to military and civilian benefits and resources, stabilize housing, and find employment support.Breast & Cervical Cancer Screening: Regular screenings and follow-up care can help prevent or more effectively treat breast and cervical cancers. The Let No Woman Be Overlooked Breast and Cervical Cancer Program allows women throughout New Hampshire who do not have access to essential, basic, preventive care access free screenings. Catholic Medical Center has a long history of providing services to the community and currently has programs in place to meet every identified need in the most recent CHNA. In addition to the programs we currently offer, we will expand many of our services in response to the needs of the community that have not been addressed. Catholic Medical Center Part V, Section B, Line 16j: Signs are posted throughout the hospital facility and physician practices that list the financial programs available and contact information for assistance. Part V, Line 7a & 7b: Hospital's Website URL for Community Health Needs Assessment: www.catholicmedicalcenter.org/about-cmc/in-the-community/community-health-needs-assessment The CHNA can also be found at:https://www.elliothospital.org/website/downloads/Manchester-Report-Final-compressed.pdf Part V, Line 10a: Hospital's Website URL for Community Health Implementation Plan:www.catholicmedicalcenter.org/about-cmc/in-the-community/community-health-implementation Schedule H, Part V, Section B, Line 16a-16c: The financial assistance policy, application, and plain language summary are available online: https://www.catholicmedicalcenter.org/patients-visitors/insurance-and-billing/financial-assistance 60 1 - New England Heart Institute 100 McGregor Street Manchester NH 03102 Cardiovascular Health 2 - Hospital Medicine 100 McGregor Street Manchester NH 03102 Hospital Medicine 3 - Cardiothoracic Surgical Associates 100 McGregor Street Manchester NH 03102 Cardiothoracic Surgical Associates 4 - Women's Wellness & Fertility Center 88 McGregor Street Suite 201 Manchester NH 03102 Women's Health 5 - Behavioral Health 88 McGregor Street Suite 105 Manchester NH 03102 Behavioral Health 6 - Surgical Care Group 87 McGregor Street Suite 3100 Manchester NH 03102 Surgical Care 7 - Amoskeag Family Practice 1750 Elm Street Suite 201A Manchester NH 03101 Family Medicine 8 - Bedford Center Int Med & Pediatric 188 Route 101 Bedford NH 03110 Internal Medicine and Pediatrics 9 - Outpatient Rehabilitation 188 Route 101 Bedford NH 03110 Outpatient Rehabilitation 10 - Family Physicians of Manchester 57 Webster Street Suite 110 Manchester NH 03104 Family Medicine 11 - Goffstown Family Practice 17A Tatro Drive Suite 201 Goffstown NH 03045 Family Medicine 12 - Granite State Internal Medicine 188 Route 101 Bedford NH 03110 Internal Medicine 13 - Hooksett Internal Medicine 11 Kimball Drive Unit 132 Hooksett NH 03103 Internal Medicine 14 - Highlander Way Internal Medicine 1 Highlander Way Manchester NH 03103 Internal Medicine 15 - Comprehensive Rheumatology at CMC 160 South River Road Bedford NH 03110 Comprehensive Rheumatology 16 - Lakeview Internal Medicine 27 Londonderry Turnpike Hooksett NH 03106 Internal Medicine 17 - Outpatient Rehabilitation 27 Londonderry Turnpike Hooksett NH 03106 Outpatient Rehabilitation 18 - Queen City Medical Associates 775 South Main Street Manchester NH 03102 Skilled Practitioners 19 - Willowbend Family Practice 5 Washington Place Suite 1A Bedford NH 03110 Family Medicine 20 - Webster Street Internal Medicine 57 Webster Street Manchester NH 03104 Internal Medicine 21 - Urgent Care at Bedford Medical Park 5 Washington Place Suite 1B Bedford NH 03110 Urgent Care 22 - Diagnostic Imaging 5 Washington Place Suite 1B Bedford NH 03110 Diagnostic Imaging 23 - New England Heart Institute 59 Page Hill Road Berlin NH 03570 Heart and Vascular services 24 - Surgical Care Group 59 Page Hill Road Berlin NH 03570 General Surgery services 25 - Comprehensive Neurological Care 59 Page Hill Road Berlin NH 03570 TeleNeurology services 26 - New England Heart Institute 452 Old Street Road Peterborough NH 03458 Heart and Vascular services 27 - Surgical Care Group 452 Old Street Road Peterborough NH 03458 General Surgery services 28 - Surgical Care Group 452 Old Street Road Peterborough NH 03458 Vascular Surgery services 29 - Comprehensive Rheumatology 452 Old Street Road Peterborough NH 03458 Rheumatology services 30 - Hospital Medicine Services 452 Old Street Road Peterborough NH 03458 Hospitalists 31 - New England Heart Institute 173 Middle Street Lancaster NH 03584 Heart and Vascular services 32 - Surgical Care Group 173 Middle Street Lancaster NH 03584 General Surgery services 33 - Comprehensive Neurological Care CMC 1 Highlander Way Manchester NH 03103 Comprehensive Neurological Care 34 - Outpatient Rehabilitation 769 South Main Street Suite 201 Manchester NH 03102 Outpatient Rehabilitation 35 - Diagnostic Imaging 25 South River Road Bedford NH 03110 Diagnostic Imaging 36 - New England Heart Institute 181 Corliss Lane Colebrook NH 03576 Heart and Vascular services 37 - Hospital Medicine services 181 Corliss Lane Colebrook NH 03576 Hospitalists 38 - Cholesterol Management Center 195 McGregor Street Suite 312 Manchester NH 03102 Cholesterol Management services 39 - Cholesterol Management 6 Tsienneto Road Derry NH 03038 Cholesterol Management services 40 - New England Heart Institute 6 Tsienneto Road Derry NH 03038 Heart and Vascular services 41 - Surgical Care Group 6 Tsienneto Road Derry NH 03038 Vascular Surgery services 42 - New England Heart Institute 160 South River Road Bedford NH 03110 Heart and Vascular services 43 - Surgical Care Group 160 South River Road Bedford NH 03110 General Surgery services 44 - Vein and Vascular Specialists 160 South River Road Bedford NH 03110 Vein and Vascular Specialists 45 - New England Heart Institute 7 Holland Way Exeter NH 03833 Heart and Vascular services 46 - New England Heart Institute 240 S Main Street Wolfeboro NH 03894 Heart and Vascular services 47 - Surgical Care Group 240 S Main Street Wolfeboro NH 03894 General Surgery services 48 - New England Heart Institute 369 Hounsell Avenue 5 Gilford NH 03249 Heart and Vascular services 49 - New England Heart Institute 401 Boulder Point Drive Suite 1 Plymouth NH 03264 Heart and Vascular services 50 - Cholesterol Management 166 Kinsley Street Suite 301 Nashua NH 03060 Cholesterol Management services 51 - New England Heart Institute-Nashua 166 Kinsley Street Suite 301 Nashua NH 03060 NEHI Nashua 52 - Bedford Ambulatory Surgical Center 9 Washington Place Suite 204 Bedford NH 03110 Gastroenterology services 53 - Surgical Care Group 160 South River Road Bedford NH 03110 General Surgery services 54 - New England Heart Institute 1 Parkland Drive Derry NH 03038 Heart and Vascular services 55 - New England Heart Institute 172 Kinsley Street Nashua NH 03060 Heart and Vascular services 56 - Surgical Care Group 172 Kinsley Street Nashua NH 03060 Vascular Surgery services 57 - New England Heart Institute 16 Hospital Road Plymouth NH 03264 Heart and Vascular services 58 - Surgical Care Group 16 Hospital Road Plymouth NH 03264 General Surgery services 59 - New England Heart Institute 31 Stiles Road Salem NH 03079 Heart and Vascular services 60 - Dr Diehl Physician Practices Office 305 Riverway Place Bedford NH 03110 Family Medicine Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 20,972,163. Part II, Community Building Activities: Catholic Medical Center participates in a wide range of community building activities, committees, boards, and partnerships to promote the health of the communities it serves, including City Year, Granite United Way, and New Hampshire Charities, among others. The Medical Center sponsors emergency service efforts through planning hours for emergency preparedness and bioterrorism preparedness safety management. Part III, Line 2: Costing methodology ratio of cost to charge is used to arrive at cost of bad debt expense. Part III, Line 3: Patients deemed eligible for financial asssistance follow CMC's charity care policies. Therefore, no bad debt expense related to patients eligible under the Hospital's financial assistance policy is included as a community benefit. Part III, Line 4: See Footnote 2 on Page 11 of the attached audited financial statements. Part III, Line 8: The entire Medicare shortfall is reported in our Community Benefit Report to the State of New Hampshire. The Medicare shortfall represents costs incured by the Hospital for providing care to Medicare patients in the Hospital's service area that were not reimbursed by the federal government. The Hospital considers this amount to be a significant shortfall for providing healthcare-related services to these patients which ultimately benefits the community it serves. Part III, Line 9b: CMC is a charitable healthcare organization that treats patients for emergency or medically necessary care regardless of their financial status. CMC's Collections Policy and Procedures addresses the procedures for patients who choose not to make payment or work with CMC to make payment arrangements for their bill. The policy contains specific language that applies to those patients who may qualify for financial assistance. CMC will hold collection activities where the patient has submitted a completed financial assistance application. CMC makes reasonable efforts to determine whether an individual is eligible for financial assistance under our Financial Assistance Policy (FAP). In order to determine whether a patient is eligible for financial assistance, CMC provides written notice that indicates the availability of financial assistance, provides a plain-language summary of the FAP, and attempts to notify the individual orally about the FAP and how the patient may get assistance with the application process. CMC also publishes the policy on our website, at patient registration locations, and provides notice to the community. Part VI, Line 2: In collaboration with the city of Manchester and other health care and social service agencies, Catholic Medical Center participates in a community needs assessment as required by the New Hampshire Attorney General's Office Division of Charitable Trusts.Since hospitals are required to assess the needs of their community every three years, CMC has completed a 2019 Needs Assessment and approved by the board and made widely available to the public during the fiscal year covered by the Hospital's 2018 Form 990. The previous Needs Assessment was completed in fiscal year 2016 by CMC and the Elliot Hospital of the City of Manchester. Additional information is obtained on an ongoing basis to assist the Organization in evaluating progress towards meeting our goals and the identification of new areas of need. This information is collected through community surveys, focus groups and discussions with community leaders, program evaluations and communication with those in the community who interact with our vulnerable populations. Part VI, Line 3: Patients are notified of CMC's FAP via notices upon registration, discharge, postings to our website, in the hospital, and physician practices. Signage is posted throughout the Hospital and physician practices highlighting Catholic Medical Center's financial assistance. CMC also communicates the policy to the community via mailings and other postings in relevant local support organizations. CMC also contacts patients verbally to inform them of the programs available. Part VI, Line 4: Catholic Medical Center's primary service area consists of the following towns and cities: Allenstown, Auburn, Bedford, Goffstown, Hooksett, Manchester, and Boston. Our sercondary service area is made up of Amherst, Concord, Derry, Litchfield, Londonderry, Merrimack, Milford, Nashua, Peterborough, Raymond, Salem and Weare. Part VI, Line 5: Catholic Medical Center is involved in numerous community initiatives to improve the health outcomes of our community, including, but not limited to the following: DSRIP 1115 Waiver, N4H a federally funded program with the state of New Hampshire to transform care by integrating primary and behavioral health care to improve health outcomes; a collaboration with The Manchester Health Department, Easter Seals, and Catholic Medical Center to provide school-based dental care to school-aged children in need. Services are provided at all Manchester elementary and middle schools along with one of the high schools; partnership with Dartmouth Hitchcock Clinic for the integration of dental care within a pediatric clinic setting, improving oral health and overall health and a partnership with Amoskeag Health Center to provide oral health exams and hygiene and a referral to a dental home for children ages 1-5; 500 Cities initiative with CMC's Parish Nurse Program and Manchester Health Department to offer assessments and services to high risk populations located within neighborhoods; primary care, specialty care and care coordination the homeless population via the HRSA grant; Medication Assistance Program offering free or reduced cost medication through the pharmaceutical companies and other low cost resources; emergency bioterrorism preparedness safety management. Part VI, Line 6: Catholic Medical Center operates as part of CMC Healthcare System. Under the System, CMC offers a range of healthcare services to the community. The System includes CMC as a licensed, 330 bed full-service, acute care hospital, physician practices, general care surgical capabilities, and advanced care for cardiac needs. Catholic Medical Center offers full medical-surgical care with more than 25 subspecialties, comprehensive orthopedic care, inpatient and outpatient rehabilitation services, a 24-hour emergency department, outpatient behavioral health services, and diagnostic imaging. In addition, Catholic Medical Center has the Special Care Nursery which is a state-of-the-art neonatal facility designed to meet the distinct needs of our babies and their families. Catholic Medical Center is also home to the nationally recognized New England Heart and Vascular Institute (NEHVI), which provides a full-range of cardiac services, and is a pioneer in offering innovative surgical procedures. The Institute is also a national center for advanced clinical trials and cardiovascular rehabilitation and wellness education to help patients recover in a multi-step program of exercise, education, risk factor management, and the development of healthy lifestyles. The System also participates in two joint ventures, Bedford Ambulatory Surgical Center and Alliance Urgent Care Services, through its wholly-owned entity, Alliance Ambulatory Services, and Tuft's Health Freedom Plan through the Granite Health Network.CMC has a deeply rooted history of providing care to those most in need through the Community Health and Mission department. CMC reaches beyond the walls of the hospital and into the community, assisting underserved individuals with health information and access to care. Community Health and Mission provides a wide variety of education, clinical services and resources for those in our primary and secondary markets. It is the home of the Pregnancy Care Center, the Poisson Dental Facility, the Health Care for the Homeless program, and the Parish Nurse program. We provide medication assistance, breast and cervical cancer screenings, and health screenings. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 721892 NH Hospital Association, NH Medicaid Expansion, Drug and Alcohol Abuse Prevention Initiatives New Hampshire Department of Education 101 Pleasant Street Concord NH 033013860 026000618 Government 14791 Retail value AED Medical Devices To provide onsite AEDs in order to improve and promote public safety. St Pius X Roman Catholic Church Inc 575 Candia Road Manchester NH 03109 020237015 501(c)(3) 14791 Retail value AED Medical Devices To provide onsite AEDs in order to improve and promote public safety. St Catherine School 206 North Street Manchester NH 03104 020412824 501(c)(3) 14791 Retail value AED Medical Devices To provide onsite AEDs in order to improve and promote public safety. Mill Falls Charter School Foundation 36 Salmon Street Manchester NH 03104 800797746 501(c)(3) 16968 Retail value AED Medical Devices To provide onsite AEDs in order to improve and promote public safety. 5 0 Hermsdorf Scholarships - financial assistance for the training of worthy and needy students who are employees of CMC. 12 4655 Mary Sanford Scholarships - financial assistance for individuals pursuing a career in nursing. 4 4000 Yvette Gaumont Scholarship - financial support for LNAs employed by CMC to pursue a degree as an LPN or RN 2 795 BSN or Higher Scholarships - financial assistance to employees who wish to improve their performance and proficiency in the nursing field. 4 2000 Caring for Co-workers program to provide general assistance to individuals in need. 40 30468 0 Part I, Line 2: The Hospital will only makes donations to 501(c)(3) public charities or governmental municipalities. The Hospital may award grants to individuals living in the United States if the recipient-individuals are employees of the Catholic Medical Center system, and if the recipient-individuals meet certain merit and financial-need eligibility requirements. Grants to individuals are awarded in the form of scholarships to pursue higher education and skills in the healthcare field while also working for the Hospital. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Robert A Catania MD Director 0 535153 0 45118 0 0 0 18850 0 22071 0 621192 0 0 Carolyn Claussen MD Director 0 157914 0 33162 0 0 0 13376 0 11 0 204463 0 0 Louis I Fink MD Director 0 495306 0 129435 0 0 0 21500 0 2700 0 648941 0 0 Joseph Pepe MD President & CEO 713027 0 213513 0 40165 0 372862 0 27921 0 1367488 0 0 0 Edward Dudley III Executive VP & CFO 413216 0 109381 0 32933 0 162547 0 41444 0 759521 0 0 0 Alexander Walker Jr Esq Executive VP & COO 421127 0 132968 0 50985 0 156267 0 56238 0 817585 0 0 0 William Goodman MD MPH VP, Medical Affairs/CMO 419262 0 85986 0 0 0 16500 0 23232 0 544980 0 0 0 Tina Legere Sr. VP, Operations 262977 0 88891 0 12018 0 13184 0 21590 0 398660 0 0 0 Carolanne O'Sullivan Sr. VP, Provider Network 257864 0 80400 0 17015 0 18429 0 28969 0 402677 0 0 0 Ivan Ip MD MS MPH Chief of Medical Information 311537 0 0 0 0 0 16500 0 1338 0 329375 0 0 0 Thomas Della Flora VP, Chief Information Officer 248628 0 42249 0 11083 0 13994 0 27487 0 343441 0 0 0 Merryll Rosenfeld VP, Human Resources 236104 0 34007 0 7054 0 15566 0 27973 0 320704 0 0 0 Part I, Line 1a Catholic Medical Center provides certain fringe benefits that have gross-up calculations to cover taxes for a select few officers and/or highly compensated employees. In no case did this amount exceed $15,000 during the year for any one individual. Part I, Line 4b The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. The amounts listed represent calendar year 2018 contributions for many years of service: Joseph Pepe: $351,362 Edward Dudley, III: $146,047 Alexander Walker, Jr., Esq.: $139,767 Part I, Line 7 A portion of compensation is at-risk and variable, and payment depends on the quality of job performance. A New Hampshire Health And Education Facilities Authority 020279866 644614x79 2012-12-19 38249382 See Part VI 0 0 0 B New Hampshire Health And Education Facilities Authority 020279866 2015-09-03 32720000 See Part VI 0 0 0 C New Hampshire Health And Education Facilities Authority 020279866 64461XBT1 2017-09-21 65363417 See Part VI 0 0 0 A 15475000 38249382 573155 3035221 2013 1 0 1 1 B 3010000 32720000 257332 3828187 2016 1 1 1 1 C 65363417 785623 48519781 17250276 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 A 0 0 1 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Schedule K, Part I, Line A(f): Refinance of Series 2002A Bonds Refinance of Series 2002B Bank Placement Refinance of Series 2012 Capital Note Routine Capital Improvements Schedule K, Part I, Line B(f): Advance & Current refunding of Series 2006 Bonds, and Construction Schedule K, Part I, Line C(f): To finance various construction projects. Thomas Della Flora Family Member Compensation 32767 The wife of Catholic Medical Center, Inc. highest compensated employee, Thomas Della Flora, received $32,767 in compensation as an employee (Registered Nurse) of CMC. Compensation paid to Mr. Della Flora's wife is in line with the salary structure for similarly employed persons at the Hospital and does not represent higher than market rate compensation due to her familial relationship with Mr. Della Flora. 0 X 165 Per books X 1 1097 Market Value X 15 25454 Per Books X Event tickets 37 7673 Per Books X Office goods 2 1525 Per Books X Auction items 1 1100 Per Books X Med. supplies 1 275 Per Books 0 1 0 Form 990, Part VI, Section A, line 6 The members of Catholic Medical Center are CMC Healthcare System and GraniteOne Health. Form 990, Part VI, Section A, line 7a Directors of CMC are appointed by the members. Form 990, Part VI, Section A, line 7b The members have reserved powers over CMC but do not approve each separate action taken by the CMC board. Form 990, Part VI, Section B, line 11b Form 990 is prepared by an independent tax accounting firm (Baker Newman Noyes). Upon completion, a draft of the Form 990 is sent to the Organization, where the CFO, Controller, and Director of Accounting perform a final in-house review prior to submission to the Board of Directors for final approval. Upon approval from Board, the Form 990 is filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Officers and directors are required to complete a conflict of interest questionnaire annually. Form 990, Part VI, Section B, line 15 CMC utilizes a compensation committee of the board of directors to set compensation levels and determine bonus potential for its senior leadership team. The committee is assisted by an independent consultant who surveys like-sized and performing institutions to benchmark relevant salary scales for each position. The consultant's findings are presented to the compensation committee who considers that external data with actual performance against a list of pre-established goals per senior leaders to set prospective compensation levels and bonus values. Bonus amounts are determined by how well an executive achieves a pre-defined set of goals. These goals, in general, are tied to the achievement of a specific task or project. Some goals are attached to achieve overall financial performance and mission performance, not solely revenue generation. Form 990, Part VI, Section C, line 19 CMC makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Change in fair market value of perpetual trust -110,168. Net assets released for operations -220,880. Change in fair market value of interest rate swap -482,735. Net transfers to affiliates -46,133,644. Pension related changes net of periodic costs -51,705,766. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. 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 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 Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Day Care Services NH 501(c)(3) Line 10 CMC Healthcare System 0 Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A Alliance Urgent Care Services 100 McGregor Street Manchester NH 03102 831238167 Health Care Services NH N/A NH Value Care ACO LLC 100 McGregor Street Manchester NH 03102 832029076 Health Care Services NH N/A Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH N/A C 1 Doctors' Medical Association Inc 100 Mcgregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 0 0 1 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1