2020-06-22T10:25:31-05:00 2019-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2018-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott Sloane Senior VP, CFO, & Treasurer 6032284677 2020-06-02 1 Nicholas E Porto P01310283 2078792100 2020-06-02 208.105.168.164 2020-06-02 12:04:55 ED P BC8AE4E166BFDF24A7972DDCC457CE4FCF4C8ABA 82E1BC1B10DC50A6477F14E190E1DC816259D1F0 2018 2021-01-29 14:40:06Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 616520956 0 X www.concordhospital.org X 1944 NH Hospital 17 9 4093 284 2464690 0 4654766 4140490 517361113 537005328 14710104 -2353291 520610 333542 537246593 539126069 80000 0 0 0 283748271 309051282 0 0 432770 231888478 222927545 515716749 531978827 21529844 7147242 636262707 620279215 289400733 306755875 346861974 313523340 Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 0 0 442512202 0 534903202 Various hospital services; see Schedule HIn FYE 2019, Concord Hospital invested more than $82 million for community benefit programs, services, and other expenses. The largest areas of support were charitable care services, medical education and subsidized programs and services. Our investment enhances the Hospital's ability to provide quality patient care, respond to identified community health needs and address the Hospital's charitable mission overall. 442512202 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 0 1 321 0 1 4093 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 17 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X X Scott Sloane Senior VP CFO 6032277000 250 Pleasant Street Concord NH 033017539 Valerie Acres Esq Trustee 1.00 1.00 X 0 0 0 Philip Boulter MD Trustee (end 1/19) 1.00 3.00 X 0 0 0 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 Michelle Chicoine Trustee 1.00 0.00 X 0 0 0 Peter Cook Trustee 1.00 0.00 X 0 0 0 Rosemary M Heard Trustee (eff. 1/19) 1.00 0.00 X 0 0 0 Lucy Karl Esq Trustee (eff. 1/19) 1.00 0.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 Manisha Patel DDS Trustee 1.00 0.00 X 0 0 0 Muriel Schadee CPA Trustee 1.00 3.00 X 0 0 0 Robert Segal Trustee 1.00 2.00 X 0 0 0 Lon Setnik MD Trustee 50.00 0.00 X 74062 0 725 David Stevenson MD Trustee 50.00 1.00 X 228532 0 67457 Jeffrey Towle Trustee 1.00 2.00 X 0 0 0 Sol Asmar Chair 1.00 4.00 X X 0 0 0 David Ruedig Chair (end, 1/19)/Trustee 1.00 4.00 X X 0 0 0 Philip Emma Vice Chair (eff 1/19) 1.00 0.00 X X 0 0 0 William Chapman Esq Secretary 1.00 1.00 X X 0 0 0 Robert P Steigmeyer President & CEO 56.00 4.00 X X 1023633 0 228446 Scott Sloane Treasurer 56.00 4.00 X 389135 0 91264 Pamela Puleo Executive Director 40.00 1.00 X 256345 0 101364 David Green MD Senior VP/Chief Medical Officer (end 6.19) 50.00 0.00 X 545876 0 94437 Timothy P Jones Senior VP/Chief Operating 50.00 0.00 X 499645 0 68922 Gerald Sardella MD Physician (end 4/19) 50.00 0.00 X 707087 0 66393 Shahab Moossavi MD Physician 50.00 0.00 X 544541 0 62413 Adam Chodosh MD Physician 50.00 0.00 X 537318 0 68148 Wayne Carlisle Stadelmann MD Physician 50.00 0.00 X 520081 0 80275 Michael Ferguson MD Physician 50.00 0.00 X 497663 0 41935 5823918 0 971779 581 0 1 0 Harvey Construction Corp 10 Harvey Road Bedford NH 03110 Construction Services 4916304 Elliot Hospital 1070 Holt Avenue Suite 2100 Manchester NH 03109 Healthcare services 3898925 Anesthesia Associates PA 1 Pillsbury Street Suite 202 Concord NH 03301 Healthcare services 3244696 Elevating Informatics 511 Prairie Lake Drive Fern Park FL 32730 Professional Services 2495564 Lavallee Brensinger LLC 155 Dow Street Suite 400 Manchester NH 03101 Professional Services 2062595 36 4140490 4140490 Net Patient Service 621400 507275950 507275950 Disproportionate Share Funding 621400 19215103 19215103 Other Operating Revenue 621400 6165463 4955716 1209747 Food Services 722210 4128167 2902246 1225921 Answering Service 541900 100870 100870 119775 119775 537005328 6413755 29022 6384733 333542 0 333542 333542 333542 68596946 30895 77329185 65702 -8732239 -34807 -8767046 -8767046 539126069 534903202 2464690 -2382313 3312133 2755433 556700 245154636 203949378 41205258 9893119 8230278 1662841 37580388 31263856 6316532 13111006 10907301 2203705 1605646 1605646 435469 435469 327250 327250 44000 44000 799232 799232 20320862 17136149 3184713 253217 217259 35590 368 7485704 4386588 3083755 15361 12416551 9386294 2983730 46527 14645865 12436792 2184906 24167 937493 804364 131768 1361 849877 729190 119453 1234 4676939 3138068 1489421 49450 24649614 16459100 7930408 260106 6308433 5412605 886671 9157 Medical/Surgical Suppli 70915768 60845388 10070380 Bad Debt Expense 23740364 23740364 Medicaid Enhancement Ta 22441769 22441769 Repairs/Maintenance 4689871 3520758 1150987 18126 5383621 4707268 669440 6913 531978827 442512202 89033855 432770 7554078 10295916 30553332 23227665 69847777 67891509 1978868 2295949 4931830 6334189 443325074 271934040 157627161 171391034 164564006 153877789 172825770 153431957 8191481 9824258 18188404 21708949 636262707 620279215 68196146 69370178 137523672 128097738 83680915 109287959 289400733 306755875 X 346861974 313523340 346861974 313523340 636262707 620279215 X 7147242 4661705 -45147581 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 36419 0 0 1 44000 80419 0 Part II-B, Line 1: Concord Hospital was a member of the American Hospital Association & the New Hampshire Hospital Association in the fiscal year ended 9/30/19. A portion of the dues paid to these organizations were available for lobbying expenditures on behalf of Concord Hospital and the other member organizations in furtherance of their exempt purposes. The portion of the dues used for lobbying by the American Hospital Association and the New Hampshire Hospital Association were $9,556 and $26,863, respectively. Concord Hospital has hired an outside consultant to perform services to further Concord Hospital's mission. This consultant was paid $44,000 in the year ended 9/30/19. 277852367 -13045293 595350 264211724 272756311 5743785 647729 277852367 239892180 33431692 567561 272756311 232130222 1940394 6298683 477119 239892180 243015224 1036824 -9845448 2076378 232130222 1.00000 0.00000 0.00000 0 1 1 18996 18996 159920592 92874829 67045763 4801754 2874186 1927568 239849263 176185025 63664238 38734469 38734469 171391034 Alternative investments 153431957 F 153431957 Estimated 3rd party settlements 34569480 Accrued pension & other long-term liabilities 74718479 109287959 X 497220231 4661705 -42521542 -37859837 535080068 799232 3246769 4046001 539126069 530558865 0 530558865 799232 620730 1419962 531978827 Part V, Line 4: The intended use of the endowment funds is to fund capital expenditures for medical equipment/provide healthcare prevention and services for the uninsured population in the service area. Part X, Line 2: The Hospital, CRHCDC, CRHVC, CH/DHC and the Trust are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 2d - Other Adjustments: Pension actuarial gain/(loss) -49,984,108. Equity transfers from affiliates 7,462,566. Part XI, Line 4b - Other Adjustments: Board designated spending 620,730. Net periodic pension cost 2,626,039. Part XII, Line 4b - Other Adjustments: Board designated spending 620,730. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments - FMV as of 9/30/19 None 69922000 0 0 0 0 0 0 69922000 0 69922000 1 0 1 1 0 0 Part IV, Line 3: This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Part IV, Line 4: The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital. 1 1 1 X 225.000000000000 1 X 500.000000000000 1 1 1 0 1 1 8 5525 4696155 4696155 0.00920 51287439 21604000 29683439 0.05840 8 5525 55983594 21604000 34379594 0.06760 10 562683 2743530 553222 2190308 0.00430 6 9096 10547126 7672893 2874233 0.00570 23 443086 90982650 48552072 42430578 0.08350 1 37 83688 83688 0.00020 5 638233 638233 0.00130 45 1014902 104995227 56778187 48217040 0.09500 53 1020427 160978821 78382187 82596634 0.16260 40455 40455 0.00010 40455 40455 0.00010 1 8017715 857895 172929798 241973838 -69044040 X 1 1 1 1 Concord Hospital 250 Pleasant Street Concord NH 03301 01098 X X X X Concord Hospital 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X See Part V, Section C X X 1 18 1 See Part V, Section C 1 0 1 X 225.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Concord Hospital Part V, Section B, Line 5: See the narrative for Schedule H, Part VI, line 2. Concord Hospital Part V, Section B, Line 7d: The Community Benefits Report (2019 Charitable Achievements) was included in the Hospital's annual report that was mailed to nearly 24,000 households within the communities that the Hospital serves. It is also available on the State of New Hampshire's Department of Justice, Office of the Attorney General, Charitable Trusts Unit website and Concord Hospital's website. The Hospital's 2015 and 2018 Health Needs Assessments are on the Hospital's website with instructions on how to obtain a printed copy. Concord Hospital Part V, Section B, Line 11: See attached 2016-2018 Community Benefits Action Plan, as well as the recently issued 2019-2021 Community Benefits Action Plan, to see how Concord Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this tax filing. Concord Hospital Part V, Section B, Line 16j: The Hospital includes information about charitable care services in many publications that go to the community. In addition, we collaborate with many community organizations that support vulnerable populations, including low-income individuals and families; our financial assistance program is well understood by those agencies who often refer people to the program. The Hospital's Financial Assistance Policy is available online in English, and is able to be translated to other languages on the Concord Hospital website. Concord Hospital Part V, Section B, Line 20e: Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the community it serves. It is the established policy of Concord Hospital to provide services on the sole basis of the medical necessity of such services as determined by the medical staff without reference to race, color, ethnicity, national origin, sexual orientation, marital status, religion, age, gender, disability, or inability to pay for such services. As such, patients requiring urgent or emergent services shall not be denied those services based on ability to pay.Concord Hospital has a generous financial assistance program. Individuals who cannot afford to pay for their medical care are encouraged to apply for financial assistance. Financial assistance is available to individuals who are uninsured and for those individuals who have insurance, but cannot afford their out-of-pocket costs such as co-payments, co-insurance, and deductibles.In addition to the efforts taken as indicated in Schedule H, Part V, Lines 20a through 20c, the Hospital also takes additional measures to ensure that patients eligible for financial assistance do not have an Extraodinary Collection Action (ECA) levied against them. Each month, Concord Hospital reviews accounts prelisted for bad debt for potential referral to a collection attorney. Concurrent to referring the account(s) to the collection attorney, the supervisor of customer service or designee will provide the financial assistance supervisor a copy of the list of individuals and accounts to be referred. The financial assistance supervisor or designee will attempt to orally notify each responsible party of the availability of financial assistance and the application process. The financial assistance supervisor or designee will record in account notes the date and outcome of the call.Concurrent to referring the account(s) to a collection attorney, the supervisor of customer service or designee will send a written notice to the responsible party. This notice will include the following information:- Statement that account(s) are being placed with collection attorney- Statement of the ECA(s) that may be initiated- Deadline that the ECA(s) may be initiated, which will be no sooner than 120 days passed the mailing date of the first statement or 30 days passed the mailing date of the initiation notice, whichever is later- Statement that financial assistance is available and where to find the financial assistance policy and application The supervisor of customer service or designee will record in account notes the date the notice was mailed. He or she will also send a copy of the notice to be scanned to the patient's account(s).Prior to engaging in any legal or collection action, the collection attorney must receive written approval from the supervisor of customer service, manager of customer service, or director of patient financial services. These individuals may only authorize legal action if all of the following conditions are met: - The collection attorney has no reason to believe the responsible party is unable to pay the debt.- AND at least 120 days have passed since the mailing date of the first statement- AND at least 30 days have passed since the mailing date of the initiation notice- AND account notes indicate that CH has made at least one attempt to orally notify the individual about the financial assistance policy. Schedule H, Part V, Section B, Line 7a & 10a: The CHNA is available at the Hospital facility's website:https://www.concordhospital.org/app/files/public/836/Capital-Region-Health-Needs-Assessment-2018.pdfImplementation Strategy (2016-2018):https://giveto.concordhospital.org/file/2016-2018-Community-Benefits-Action-Plan.pdfImplementation Strategy (2019-2021):https://www.concordhospital.org/app/files/public/838/Community-Benefits-Action-Plan-2019-2021.pdf Schedule H, Part V, Section B, Line 16a-c: The Hospital's Financial Assistance Policy, Application, and Plain Language Summary can be found online at:Financial Assistance Policy:https://www.concordhospital.org/app/files/public/614/Financial-Assistance-Policy.pdf Financial Assistance Application: https://www.concordhospital.org/app/files/public/1036/Financial-Assistance-Application.pdf Plain Language Summary:https://www.concordhospital.org/patients-visitors/billing-insurance-financial-assistance/financial-assistance/financial-assistance-policy-plain-language-summary/ 64 1 - Concord Imaging Center 248 Pleasant Street Suite 102 Concord NH 03301 Imaging Services 2 - Concord Hospital Cardiac Associates 246 Pleasant Street Suite 103 Concord NH 03301 Outpatient Physician Services 3 - Concord Endoscopy Center 60 Commercial Street Suite 201 Concord NH 03301 Outpatient Endoscopy Services 4 - Concord Imaging Center 60 Commercial Street Suite 101 Concord NH 03301 Imaging Services 5 - Concord Obstetrics and Gynecology 189 North Main Street Concord NH 03301 Outpatient Physician Services 6 - Concord Surgical Associates 246 Pleasant Street Suite 205 Concord NH 03301 Outpatient Physician Services 7 - Capital Orthopaedic Srgry Ctr-Derry 14 Tsienneto Road Suite 100 Derry NH 03836 Outpatient Surgery 8 - Concord Hospital Family Health Center 250 Pleasant Street Concord NH 03301 Outpatient Physician Services 9 - Concord Pulmonary Medicine 248 Pleasant Street Suite G100 Concord NH 03301 Outpatient Physician Services 10 - Center for Sports Med & Ortho Rehab 264 Pleasant Street Concord NH 03301 Rehabilitation Services 11 - Rehabilitation Services at Warner 2 East Main Street Warner NH 03278 Rehabilitation Services 12 - Rehab ServicesFam Health Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Rehabilitation Services 13 - Concord Family Medicine 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 14 - Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 15 - Concord Hospital Sleep Center 18 Foundry Street Suite 103 Concord NH 03301 Outpatient Sleep Services 16 - Concord Plastic Surgery 246 Pleasant Street Suite 210 Concord NH 03301 Outpatient Physician Services 17 - Concord Hospital Urgent Care 60 Commercial Street Suite 102 Concord NH 03301 Walk-in Urgent Care 18 - Concord Hospital Cardiac Ass-Laconia 85 Spring Street Suite 2A1 Laconia NH 03246 Outpatient Physician Services 19 - Penacook Family Physicians 4 Crescent Street Peacook NH 03303 Outpatient Physician Services 20 - Neurology Associates 248 Pleasant Street Suite G200 Concord NH 03301 Outpatient Physician Services 21 - Neurology Associates 248 Pleasant Street Suite 202 Concord NH 03301 Outpatient Physician Services 22 - Family Tree Healthcare Hopkinton 19 Farrington Corner Road Hopkinton NH 03229 Outpatient Physician Services 23 - Family Care Of Concord 248 Pleasant Street Suite 2600 Concord NH 03301 Outpatient Physician Services 24 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 25 - Epsom Family Medicine 1990 Dover Road Suite 2A Epsom NH 03234 Outpatient Physician Services 26 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 27 - Rehab Services CH Med Office-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 28 - CardiacThoracic Surgery 246 Pleasant Street Concord NH 03301 Outpatient Physician Services 29 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 30 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 31 - Rehab Services CH Medical Office-East 1990 Dover Road Suite 2B Epsom NH 03234 Rehabilitation Services 32 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 33 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 34 - Family Tree Healthcare Warner 2 East Main Street Warner NH 03278 Outpatient Physician Services 35 - Rehabilitation Services at Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 36 - Lab-Memorial Medical Office Building 246 Pleasant Street Suite 102 Concord NH 03301 Outpatient Laboratory Services 37 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 38 - Capital Region Palliative Care & Hosp 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 39 - Anti-Coagulation Clinic Internal Med 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 40 - Center for Health Promotion 49 South Main Street Concord NH 03301 Health Promotion Services 41 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 42 - Concord Hosp Fam Hlth Ctr Dental Clinic 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 43 - Lab CH Medical Offices-East 1990 Dover Road Suite 1A Epsom NH 03234 Outpatient Laboratory Services 44 - Concord Family Medicine Havenwood 149 East Side Drive Concord NH 03301 Outpatient Physician Services 45 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging & Counseling Services 46 - Radiology Srv Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Radiology Services 47 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 48 - Lab Penacook Family Physicians 4 Crescent Street Suite 1B Penacook NH 03303 Outpatient Laboratory Services 49 - Lab Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 50 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 51 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services 52 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 53 - Concord Dermatology 248 Pleasant St Suite 103 Concord NH 03301 Outpatient Physician Services 54 - Concord Endocrinology 18 Foundry Street Suite 102 Concord NH 03301 Outpatient Physician Services 55 - Family Tree Health Care - Concord 194 Pleasant Street Suite 7 Concord NH 03301 Outpatient Physician Services 56 - Concord Hospital Record Center 10 Ferry Street Concord NH 03301 Outpatient Services 57 - Center For Urologic Care - New London 273 County Road New London NH 03257 Urology Services 58 - Center For Urologic Care - Plymouth 103 Boulder Point Road Plymouth NH 03264 Urology Services 59 - Center For Urologic Care - Wolfeboro 240 South Main Street Wolfeboro NH 03894 Urology Services 60 - Concord Otolaryngology 194 Pleasant St Suites 12 Concord NH 03301 Outpatient Physician Services 61 - Cardiac Associates 15 Aiken St Franklin NH 03235 Outpatient Physician Services 62 - Cardiac Associates 246 Pleasant St Suite 105 Concord NH 03301 Outpatient Physician Services 63 - Pelvic Medicine Program 246 Pleasant St Suite 106 Concord NH 03301 Outpatient Physician Services 64 - Occupational Health 60 Commercial St Suite 302 Concord NH 03301 Outpatient Physician Services Part I, Line 7: Subsidized Health Services represents those activities that assure access to medical care and support for people with special medical needs and those who may be faced with chronic health conditions. Many of these activities also ensure access to needed health services, which might otherwise not be available without subsidized or special support. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 23,740,364. Part II, Community Building Activities: The Hospital's Trauma Program continued its service area-wide educational initiative, "Stop the Bleed", to provide tourniquet kits for all school classrooms and also educate personnel on the proper use of tourniquets. The initiative is expected to provide 800 kits via a fundraising campaign to schools serving the Hospital's 28 communities in its service area. Part III, Line 2: The amount reported on Part III, Line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, Line 25, Column (A). Accounts Receivable: The allowance for doubtful accounts is provided based on an analysis by management of the collectability of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts. Accounts are charged against the allowance for doubtful accounts when deemed uncollectible. Charity Care: The System provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as community benefit. The amount on Line 3 is calculated by determining the revenue for all patients that have completed an application for financial assistance and only reporting the amount for those that did not complete the financial assistance process for any number of reasons and were then transferred to bad debt. Part III, Line 3: See narrative for Part III, Line 2. Part III, Line 4: See page 10 of the attached audited financial statements. Part III, Line 8: The Medicare shortfall of $69,044,040 represents the costs of unreimbursed services. In addition, many of the subsidized health services reported on line 7g include some revenue and expenses from services to Medicare patients, Medicare allowable costs on line 5 were determined using the Hospital's filed Medicare cost report, which determines cost via the cost to charge ratio methodology. The Hospital has not included its Medicare shortfall as a community benefit in Part I. Part III, Line 9b: The Hospital has a Financial Assistance policy in addition to, and complementing, the bad debt collection policy. The policy describes the Hospital's program of financial assistance for medically necessary services to individuals and families who are uninsured, underinsured, or who experience a catastrophic healthcare event and do not quality for any other state or federal assistance programs. Patient education of eligibility for assistance is described below in the statement for Part VI, Line 3. Part VI, Line 2: Every three years, the Hospital conducts a comprehensive community health needs assessment, engaging numerous community organizations and health partners in the process, to identify far-reaching health needs faced by people in the communities served by the Hospital. Assessment methodologies address both quantitative and qualitative data and include stakeholder interviews, focus groups, community listening sessions, web survey, written surveys, telephone surveys and analysis of various data sets. Assessment results are shared with community members and serve as the basis to develop new or expanded services in response to need. The most recent assessment covered by this tax return was completed in the tax year of 2018. Both the 2018 Community Health Needs Assessment and the 2019-2021 Implementation Plan are more specifically addressed in the Hospital's 2018 Form 990, Schedule H and are available on the Hospital's website at: www.concordhospital.org/about-us/charitable-achievements/ Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paving their obligations to inform and work with them to understand what local programs are available to them, including how they can benefit from the Hospital's Financial Assistance program. Part VI, Line 4: Concord defines its Primary Service Area as 28 communities to which it has close geographic proximity and significant market share. According to the State of New Hampshire's "Concord Healthcare Service Area Regional Health Profile, 2001," the 28 communities that comprise the Hospital's PSA represent, in terms of square miles, the largest hospital service area in the State. Together, these communities cover an area of nearly 900 square miles. The Hospital serves all the residents of these towns as well as many others from across the State of New Hampshire through its regional and statewide referral for specialty care, including orthopaedic, cardiology, oncology, and urological care. Part VI, Line 5: Part I line 6A, Concord Hospital develops programs and services to address community health needs and invests annually in initiatives that align with the Hospital's charitable mission. A reasonable amount of Concord Hospital's community benefit investment remains in the area of charitable care to ensure that those without insurance or with limited insurance have access to needed medical care. The Hospital strives to address the needs of vulnerable populations, including our low-income neighbors and other vulnerable populations. The Hospital's Family Health Centers ensure access to primary, behavioral health, and dental care for our region's most vulnerable residents, which address identified community health needs. Those achievements are at the heart of our community benefit activity. Beyond that focus are programs and services that benefit every resident and support that far reaching goal of a healthier community. The Hospital continued its efforts toward promoting the health of the community by investing its surplus funds in new medical facilities to enhance patient care, by providing funding support to Capital Region Healthcare affiliates through the Community Services Fund for programs that address identified community needs and serve vulnerable populations, and by continuing to recruit new primary care physicians to enhance access in the community.Finally, per the IRS instructions to Schedule H, Part I, the Hospital has not included its $69,044,040 Medicare shortfall as a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care. Part VI, Line 7, Reports Filed With States NH X X X X 1 1 0 0 0 0 0 1 0 David Stevenson MD Trustee 222445 0 5000 0 1087 0 43817 0 23640 0 295989 0 0 0 Robert P Steigmeyer President & CEO 640785 0 260000 0 122848 0 205750 0 22696 0 1252079 0 121300 0 Scott Sloane Treasurer 299984 0 88350 0 801 0 68995 0 22269 0 480399 0 0 0 Pamela Puleo Executive Director 204460 0 50275 0 1610 0 79235 0 22129 0 357709 0 0 0 David Green MD Senior VP/Chief Medical Officer (end 429295 0 111196 0 5385 0 73621 0 20816 0 640313 0 0 0 Timothy P Jones Senior VP/Chief Operating 389746 0 108351 0 1548 0 46698 0 22224 0 568567 0 0 0 Gerald Sardella MD Physician (end 4/19) 616927 0 87838 0 2322 0 40387 0 26006 0 773480 0 0 0 Shahab Moossavi MD Physician 508781 0 35260 0 500 0 40612 0 21801 0 606954 0 0 0 Adam Chodosh MD Physician 502547 0 34010 0 761 0 41692 0 26456 0 605466 0 0 0 Wayne Carlisle Stadelmann MD Physician 394026 0 125080 0 975 0 54361 0 25914 0 600356 0 0 0 Michael Ferguson MD Physician 462540 0 33010 0 2113 0 23192 0 18743 0 539598 0 0 0 Part I, Lines 4a-b Robert P. Steigmeyer, President & CEO, participated in a 457(f) plan with Concord Hospital during the fiscal year. Under the terms of the plan, after a three-year vesting period a 457(f) amount is included in taxable W-2 wages for Mr. Steigmeyer. The calendar year ending within the Hospital's current reporting period ending September 30, 2019 (tax year 2018) was the second year where amounts previously set aside as deferred under his 457(f) plan had vested. Accordingly, $121,300 was included in Mr. Steigmeyer's 2018 W-2 taxable wage which was previously reported on Schedule J, Part II, Column C of the Hospital's Form 990 filing for fiscal years ending September 30, 2016, and September 30, 2017. In accordance with IRS instructions, this amount has been included in Schedule J, Part II, Column B(iii) and Column F. There were additional contributions to Mr. Steigmeyer's 457(f) plan for fiscal years ended September 30, 2015, 2016, 2017, 2018, and 2019 of $115,000, $120,000, $125,000, $130,000, and $140,000, respectively. Each contribution plus earnings will be reported in Mr. Steigmeyer's W-2 after a three-year vesting period. The amount included in Mr. Steigmeyer's deferred compensation amounts in Schedule J, Part II, Column C include the $130,000 contribution to his 457(f) plan plus $31,647 of earnings. Effective in April of 2019 and during the fiscal year covered by this return, Dr. Gerald Sardella ceased employment with Concord Hospital. As per the terms of his separation agreement, he was paid his regular salary for six months and one week as severance. As these payments were made to him after the calendar year ending within the current fiscal year, these payments are not reflected in Schedule J, Part II which reports compensation and benefits based on calendar yearend 2018. Dr. Sardella's total severance payments of $321,915.60 will reported in his 2019 Form W-2 as part of his Box 5 taxable wages. Part I, Line 7 Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the performance of the CEO, CFO, COO, and CMO during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the executive's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions. A NH Health & Education Facilities Authority 020279866 644614K65 2011-03-01 50095322 Facility Improvements/Renovations 0 0 0 B NH Health & Education Facilities Authority 020279866 644614Z85 2013-02-01 48631000 Facility Improvement Project & Advance Refund Series 2001 NHHEFA Bonds 0 0 0 C NH Health & Education Facilities Authority 020279866 2013-04-01 32421000 Advance Refund the Series 2004 NHHEFA Hospital Revenue Bonds 0 0 0 D NH Health & Education Facilities Authority 020279866 2017-12-01 62004272 New Construction and Renovations 0 0 0 A 50095322 544891 2012 1 0 1 1 B 48631000 561439 2014 1 0 1 1 C 31800000 32421264 64503 2013 0 1 1 1 D 62004272 670083 2020 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 1 Naxis Funding Corp 1.800000000000 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 02/28/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 02/06/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 04/25/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 11/30/2018 Frederick Briccetti MD Trustee 318864 Dr. Frederick Briccetti is a trustee on Concord Hospital's board of directors. Dr. Briccetti is also a partner in New Hampshire Oncology Hematology (NHOH). NHOH pays Concord Hospital rent for access to the Hospital Cancer Center's space and equipment, as well as for certain medical services to aid in its regular operations. Total payments made from NHOH to Concord Hospital for use of the Cancer Center and to cover director fees in the 2019 fiscal year, respectively, were $294,864 and $24,000. 0 Cynthia King MD Spouse of Lon Setnik, MD 180000 Cynthia Gale King, MD, is the spouse of Lon Setnik, MD. Dr. Setnik is a trustee on the board of directors for Concord Hospital, and Dr. King is employed by Concord Hospital as a physician serving in the Concord Hospital Family Health Center. Dr. King's 2018 calendar year compensation was approximately $180,000, which is considered the fair market value of a person's salary in her position and with her experience. 0 Form 990, Part VI, Section A, line 6 Capital Region Health Care Corporation, a charitable corporation, acting through its board of trustees, is the sole Member of the Hospital. Form 990, Part VI, Section A, line 7a The Board of Trustees shall be composed of not less than fourteen nor more than nineteen persons excluding ex-officio Trustees, the number to be established and elected by the Member. Form 990, Part VI, Section A, line 7b The affairs of the Hospital shall be managed by the Trustees who shall have and may exercise all the powers of the Hospital except those reserved to the Member by law, the Articles of Agreement, or the Bylaws. In addition: -Any voluntary dissolution, merger or consolidation of the Hospital or the sale or transfer of all or substantially all of the Hospital's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. -Any amendment of the Hospital's Bylaws or Articles of Agreement shall be subject to approval by the Member. -Any changes in the Hospital's non-profit status shall be subject to approval by the Member. Form 990, Part VI, Section B, line 11b The 990 is reviewed in detail with the Audit Committee of the Board of Trustees. All board members receive a copy of the 990 to review prior to filing the report. Form 990, Part VI, Section B, line 12c Each Trustee, officer and committee member, upon entering the duties of his/her office and annually thereafter, will be advised of this policy and shall sign a statement acknowledging his/her understanding of and agreement to this policy. Annual reviews will adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part VI, Section B, line 15 The evaluation of the performance of the Chief Executive Officer ("CEO") of Concord Hospital and its subsidiaries (collectively the "Hospital") is an important responsibility of the Board of Trustees (the "Board") and is vital in ensuring that the Hospital meets its mission. The Board has delegated the responsibility of initiating the process of conducting the CEO's performance evaluation and initiating the process of setting the CEO's compensation to the Board's Compensation Committee. The Compensation Committee also is charged with the responsibility of reviewing the appropriateness of the compensation of the Hospital's Chief Operating Officer, Chief Financial Officer, and Chief Medical Officer as proposed by the CEO. The Compensation Committee shall present its report of the CEO's annual performance to the Board for its further input and consideration. The Compensation Committee shall also make its recommendation to the Board concerning the CEO's compensation. Finally, the Compensation Committee shall make its recommendation to the Board concerning the compensation of the COO, CFO, and CMO. The Board shall review the recommendations of the Compensation Committee as to the compensation of the Hospital's CEO, COO, CFO, and CMO and shall set their compensation as the Board deems appropriate. Although the Hospital continues to value the role of Capital Region Health Care Corporation ("CRHC") and the Hospital's participation in that organization, the Board acknowledges that it is not the responsibility of the Board to evaluate or set the compensation of the Chief Executive Officer of CRHC. Neither is it the role of the Board of Trustees of CRHC to evaluate, or set the compensation of, the Hospital's CEO. Accordingly, CRHC's Board of Trustees is not involved in evaluating or setting the compensation of the Hospital's CEO. The Board acknowledges that the Hospital's CEO may also serve as the Chief Executive Officer of CRHC and that the Hospital may charge CRHC for these services. The Board may consider the comments of the Board of Trustees of CRHC, as outlined herein, when deemed relevant in evaluating the performance of the Hospital's CEO. The Board directs that the Compensation Committee and the Board itself, in their respective undertakings of recommending and setting the compensation of the Hospital's CEO, COO, CFO, and CMO, avoid conflicts of interest and be guided by the "rebuttable presumption of reasonableness" regulations under the so-called "Excess Benefit Transaction" provisions of the Internal Revenue Code ("IRC"). The Board authorizes the Compensation Committee to use such financial and advisory (e.g., legal counsel, consultant) resources as it reasonably deems appropriate to fulfill its duties in evaluating the CEO's performance and in making its recommendations to the Board regarding compensation for the CEO, COO, CFO, and CMO. Form 990, Part VI, Section C, line 19 Yes, the organization makes all of this information available to the public. Audited financial statements and the most recent quarter ended financial statements are posted on the Hospital's web site, www.concordhospital.org. In addition to this, the Hospital sends its annual report, including a financial summary, to members of the community via the US Postal service. Governing documents and conflicts of interest filings adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part XI, line 9: Pension actuarial gain -49,984,108. Equity transfer from affiliates 7,462,566. Net periodic pension cost -2,626,039. Form 990, Part XII, Line 2c There was no change in the process for oversight of the audit and compilation of financial statements for the fiscal year. The Board has a finance committee, which reviews the financial statements monthly. There is also an audit committee of the Board, which reviews the annual audit process and the selection of the independent accountant. The same independent firm of accountants performed the audit for the fiscal years ending 9/30/18 and 9/30/19. Form 990, Part VII: Dr. David A. Stevenson and Dr. Lon Setnik are listed in Form 990, Part VII as voting members of the Hospital's governing body. They were also employed by the Hospital as full-time physicians and received compensation and benefits related to their services to the Hospital in their capacity as physicians. None of their compensation and benefits reflect remuneration in their capacities as board members of the Hospital. In accordance with IRS instructions, they have not been listed as independent board members in Form 990, Part VI, Line 1b. Form 990, Part IX, Column D: Although the Hospital is reporting contribution income on Form 990, Part VIII, Line 1, predominantly all direct philanthropic activities and fundraising events are conducted and hosted by the Hospital's affiliate, Concord Hospital Trust. All contribution revenue that enters the Concord Hospital system is first received by the Trust and is then granted to the Hospital. Concord Hospital Trust is responsible for the majority of the system's fundraising expenditures, as the generation and maintenance of grants for the Hospital is the Trust's primary fucntion. A portion of the expenses incurred directly by the Hospital, as well as some of the other Concord Hospital affiliated entities, also aid in general fundraising processes and operations. Therefore, a portion of the Hospital's annual expenses have been allocated to Form 990, Part IX, Column D. NH Cares ACO LLC 250 Pleasant Street Concord NH 03301 999999999 To provide medical services to Medicare beneficiaries. NH 32000 32000 Concord Hospital Inc Capital Region Health Care Corporation 250 Pleasant Street Concord NH 03301 020222123 Promote comprehensive health service system NH 501(c)(3) Line 12a, I N/A 0 Capital Region Health Ventures Corp 250 Pleasant Street Concord NH 03301 020438264 Provide medical care to community NH 501(c)(3) Line 12b, II Concord Hospital 1 Capital Region Health Care Development Corporation 250 Pleasant Street Concord NH 03301 020429749 Support Concord Hospital & other affiliates NH 501(c)(2) Concord Hospital 1 Concord Regional Visiting Nurse Association Inc PO Box 1797 Concord NH 033021797 020222122 Home health care & hospice services NH 501(c)(3) Line 10 Capital Region Health Care Corp 0 Riverbend Community Mental Health Inc 3-5 North State Street Concord NH 033022032 020264383 Multi-service team NH 501(c)(3) Line 7 N/A 0 Concord Hospital Trust 250 Pleasant Street Concord NH 03301 260378710 Fundraising NH 501(c)(3) Line 12a, I Concord Hospital 1 Concord Imaging Center LLC 2 1/2 Beacon Street Concord NH 03301 020436605 Provide radiology services to community NH N/A Capital Orthopedic Surgery Center 250 Pleasant Street Concord NH 03301 020522860 Provide medical care to community NH N/A Concord Endoscopy Center LLC 60 Commerical Street Concord NH 03301 201184756 Provide medical care to community NH N/A Concord Elliot ACO LLC 1 Elliot Way Manchester NH 03103 454803675 Accountable Care Org NH Elliot Hospital of the City of Manchester Related 0 1 0.16670 Capital Region Health Services Corporation 250 Pleasant Street Concord NH 03301 020428631 Medical services NH N/A C 0 Capital Region Primary Care Corporation 250 Pleasant Street Concord NH 03301 020495275 Inactive NH Concord Hospital C 1.00000 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 Capital Region Health Care Development Corp A 1441708 Actual per books Capital Region Health Care Ventures Corp C 7176000 Actual per books Capital Region Health Care Development Corp J 3161045 Actual per books Capital Region Health Care Development Corp O 545016 Actual per books Capital Region Health Care Ventures Corp O 249515 Actual per books Concord Hospital Trust O 705626 Actual per books Capital Region Health Care Development Corp Q 274490 Actual per books Capital Region Health Care Ventures Corp Q 1679387 Actual per books Concord Hospital Trust Q 1120193 Actual per books Schedule R, Part III: In accordance with IRS instructions, the partnerships listed in Part III are being reported due to their control relationship with Capital Region Health Ventures Corp and the Hospital's control relationship with Capital Region Health Ventures Corp. Schedule R, Part V, Transaction Type A: On its Form 990, Schedule R, Part V, Line 1a and 2, Concord Hospital is reporting $1,441,708 for transaction type "A", receipt of interest, annuities, royalties, or rents from a controlled organization. Capital Region Health Care Development Corp, the controlled organization, does not have any unrelated business income (UBI) reportable on Form 990-T. Accordingly, the interest paymanets made by the controlled entity to the Hospital are not being used to offset taxable UBI of Capital Region Health Care Development Corp. Therefore, in accordance with 512(b)(13) these interest receipts do not need to be reported as UBI to the Hospital.