2018-06-25T14:00:38-05:00 2017-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2016-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott Sloane Senior VP, CFO, & Treasurer 6032284677 2018-04-30 Nicholas E Porto P01310283 2078792100 2018-04-30 2016 2022-09-23 18:48:47Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 563648941 0 X www.concordhospital.org X 1944 NH Hospital 17 15 3940 400 2086150 -898151 4971807 4759894 454166541 490926175 27684561 9212215 374717 360563 487197626 505258847 293077 294700 0 0 262280773 275652996 0 0 0 186380833 201355745 448954683 477303441 38242943 27955406 519420194 562669503 271871191 242554355 247549003 320115148 Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 0 0 395287355 294700 489216219 Various hospital services; see Schedule HIn FYE 2017, Concord Hospital invested more than $76 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. 395287355 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 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 227 0 1 3940 1 1 1 0 0 0 0 0 0 0 0 0 X 17 15 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 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 Michelle Chicoine Trustee 1.00 0.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 Muriel Schadee CPA Trustee 1.00 4.10 X 0 0 0 Robert Segal Trustee 1.00 1.00 X 0 0 0 David Stevenson MD Trustee 50.00 1.00 X 247631 0 54321 Robert Thomson MD Medical Staff President 1.00 0.00 X 0 0 0 Jeffrey Towle Trustee 1.00 2.00 X 0 0 0 Philip Boulter MD Trustee 1.00 5.10 X 0 0 0 Peter Cook Trustee 1.00 0.00 X 0 0 0 Philip Emma Trustee 1.00 0.00 X 0 0 0 Manisha Patel DDS Trustee 1.00 0.00 X 0 0 0 Claudia Walker Trustee (end 1/17) 1.00 1.00 X 0 0 0 David Ruedig Chair 1.00 5.10 X X 0 0 0 Sol Asmar Vice Chair 1.00 3.00 X X 0 0 0 William Chapman Esq Secretary 1.00 1.00 X X 0 0 0 Mary Boucher Secretary (end 1/17) 1.00 1.00 X X 0 0 0 Robert P Steigmeyer President & CEO 55.00 5.10 X X 838660 0 180041 Bruce R Burns Treasurer (end 11/16) 55.00 5.10 X 416138 0 53016 Scott Sloane Senior VP/CFO & Treasurer 55.00 5.10 X 279637 0 61260 David Green MD Senior VP/Chief Medical Officer 50.00 0.00 X 521100 0 68726 Timothy P Jones Senior VP/Chief Operating Officer 50.00 0.00 X 496570 0 21218 Gerald Sardella MD Physician 50.00 0.00 X 595541 0 50878 Todd Burdette MD Physician 50.00 0.00 X 567679 0 61564 Wayne K Stadelmann MD Physician 50.00 0.00 X 484548 0 68790 Charles Wicks MD Physician 50.00 0.00 X 462072 0 41388 Adam Chodosh MD Physician 50.00 0.00 X 524015 0 43225 5433591 0 704427 432 0 1 0 Concord Emergency Medical Assoc 540 Lafayette Road Hampton NH 03842 Physician services 9661637 Elliot Hospital 1070 Holt Avenue Suite 2100 Manchester NH 03109 Healthcare services 1878103 ARUP Laboratories PO Box 27964 Salt Lake City UT 84127 Laboratory Services 1747181 Angelica PO Box 535122 Atlanta GA 303535122 Laundry Services 1241683 Workday Inc PO Box 396106 San Francisco CA 941396106 IT Consulting 1201300 36 4759894 4759894 Net Patient Service 621400 468105168 468105168 Disproportionate Share Funding 621400 12717088 12717088 Other Operating Revenue 621400 5785886 4836142 949744 Food Services 722210 3982577 2861802 1120775 ARRA-HI-TECH 621400 204464 204464 130992 130992 490926175 4263904 15631 4248273 360563 0 360563 360563 360563 63338405 58231901 158193 5106504 -158193 4948311 4948311 505258847 489216219 2086150 9196584 294700 294700 3238318 689617 2548701 216276471 179334641 36941830 13958190 11682186 2276004 27449302 22602327 4846975 14730715 12099087 2631628 1469580 224567 1245013 360220 360220 209250 209250 78816 78816 793767 793767 21779397 17232825 4546572 213200 73647 139553 9270435 6727074 2543361 11965588 4474796 7490792 12724692 8777292 3947400 329043 179785 149258 884836 757007 127829 2916421 2041495 874926 22746141 15922299 6823842 6043423 6043423 Medical/Surgical Suppli 58196516 58196516 Medicaid Enhancement Ta 20311207 20311207 Bad Debt Expense 20039478 20039478 Repairs/Maintenance 3948169 3084059 864110 7075566 4499327 2576239 477303441 395287355 82016086 0 9486725 7473285 19512276 7551607 52115572 51229669 1261983 1776639 4900762 5610145 443944652 279322673 142902747 164621979 142874766 139912923 117268117 151507173 4854804 7842554 24242442 25143529 519420194 562669503 56184600 69312072 93969212 85323515 121717379 87918768 271871191 242554355 X 247549003 320115148 247549003 320115148 519420194 562669503 X 27955406 24508881 20101858 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 30816 0 0 1 48000 78816 0 Part II-B, Line 1: Concord Hospital was a member of the American Hospital Association & New Hampshire Hospital Association in the fiscal year ended 9/30/17. 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 portions of dues used for lobbying by the American Hospital Association and New Hampshire Hospital Association were $8,715 and $22,100, respectively. Concord Hospital has hired an outside consultant to perform services to further Concord Hospital's mission. This consultant was paid $48,000 in the year ended 9/30/17. 239892180 33431692 567561 272756311 232130222 1940394 6298683 477119 239892180 243015224 1036824 -9845448 2076378 232130222 210537884 19493511 13878348 894519 243015224 159691844 28914868 22620824 689652 210537884 1.00000 0.00000 0.00000 0 1 1 18996 18996 157477913 80142899 77335014 4027553 912531 3115022 243695033 198267243 45427790 38725157 38725157 164621979 Alternative Investments 151507173 F 151507173 Estimated 3rd Party Settlements 27382386 Accrued Pension & Other Long-Term Liabilities 60536382 87918768 X 541487651 24508881 13097735 37606616 503881035 793767 584045 1377812 505258847 475925629 0 475925629 793767 584045 1377812 477303441 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 13,097,735. Part XI, Line 4b - Other Adjustments: Board Designated Spending 584,045. Part XII, Line 4b - Other Adjustments: Board Designated Spending 584,045. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments - FMV as of 9/30/17 None 65457000 0 0 0 0 0 0 65457000 0 65457000 0 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 9 5251 3668902 3668902 0.00800 46676591 21930939 24745652 0.05410 9 5251 50345493 21930939 28414554 0.06210 10 520975 2788422 638451 2149971 0.00470 6 7209 11372493 6974584 4397909 0.00960 25 394961 88504667 48184898 40319769 0.08820 1 47 82623 82623 0.00020 5 752154 752154 0.00160 47 923192 103500359 55797933 47702426 0.10430 56 928443 153845852 77728872 76116980 0.16640 45000 45000 0.00010 45000 45000 0.00010 1 7046283 750999 149476732 213018381 -63541649 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 15 1 0 0 1 X See Part V, Section C X X 1 15 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: An abbreviated Community Benefits Report was included in the Hospital's annual report that was mailed to nearly 24,000 households within the communities that the Hospital serves. Additionally, an expanded report was mailed to 2,500 households. It is also available on the State of New Hampshire's DOJ website and Concord Hospital's website. The Hospital's Community Health Needs Assessment was 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 to see how Concord Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this tax filing.The one need where the Hospital had limited involvement was in the area of food insecurity, although the Hospital did engage with local food banks to improve healthy choices available. 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 the underserved and low income individuals and families; our financial assistance program is well understood by those agencies who often refer people to the program. Finally, our Financial Assistance staff reach out personally to the homeless through the monthly clinic at the homeless resource center to connect them to regular medical care. Currently, the Hospital's Financial Assistance Policy is only available online in English. However, for non-English speaking patients, interpreters are provided. The Hospital is currently working to redesign their website that will incorporate a widget that will allow the Finanical Assistance Policy to be readily translated into non-English language. Schedule H, Part V, Section B, Line 7a & 10a: The CHNA is available at the Hospital facility's website:http://www.concordhospital.org/about/community-benefits/ Implementation Strategy:http://www.concordhospital.org/app/files/public/811/CBP-Plan.pdf as well as the most recent Plan available online:https://giveto.concordhospital.org/file/2016-2018-Community-Benefits-Action-Plan.pdf Schedule H, Part V, Section B, Line 16b: The Hospital's Financial Assistance Policy, Application, and Plain Language Summary can be found onlne at:www.concordhospital.org/patients-visitors/patient-financial-services/financial-assistance/ 56 1 - Capital Orthopaedic Srgry Ctr-Concord 264 Pleasant Street Concord NH 03301 Outpatient Surgery 2 - Concord Imaging Center 248 Pleasant Street Suite 106 Concord NH 03301 Imaging Services 3 - Concord Hospital Cardiac Associates 246 Pleasant Street Suite 103 Concord NH 03301 Outpatient Physician Services 4 - Center for Urologic Care 246 Pleasant Street Suite G2 Concord NH 03301 Outpatient Physician Services 5 - Concord Ambulatory Surgery Center 60 Commercial Street Suite 301 Concord NH 03301 Outpatient Surgery 6 - Concord Endoscopy Center 60 Commercial Street Concord NH 03301 Outpatient Endoscopy Services 7 - Concord Imaging Center 60 Commercial Street Suite 101 Concord NH 03301 Imaging Services 8 - Concord Obstetrics and Gynecology 189 North Main Street Concord NH 03301 Outpatient Physician Services 9 - Concord Surgical Associates 246 Pleasant Street Suite 205 Concord NH 03301 Outpatient Physician Services 10 - Capital Orthopaedic Srgry Ctr-Derry 14 Tsienneto Road Suite 100 Derry NH 03836 Outpatient Surgery 11 - Concord Hosp Family Health Center 250 Pleasant Street Concord NH 03301 Outpatient Physician Services 12 - Concord Pulmonary Medicine 248 Pleasant Street Suite G100 Concord NH 03301 Outpatient Physician Services 13 - Center for Sports Med & Ortho Rehab 264 Pleasant Street Concord NH 03301 Rehabilitation Services 14 - Rehabilitation Services at Warner 2 East Main Street Warner NH 03278 Rehabilitation Services 15 - Rehab Serv Fam Health Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Rehabilitation Services 16 - Concord Family Medicine 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 17 - Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 18 - Concord Hospital Sleep Center 18 Foundry Street Suite 103 Concord NH 03301 Outpatient Sleep Services 19 - Concord Plastic Surgery 246 Pleasant Street Suite 210 Concord NH 03301 Outpatient Physician Services 20 - Concord Hospital Urgent Care 60 Commercial Street Concord NH 03301 Walk-in Urgent Care 21 - Concord Hospital Cardiac Ass-Laconia 85 Spring Street Suite 2A1 Laconia NH 03246 Outpatient Physician Services 22 - Penacook Family Physicians 4 Crescent Street Peacock NH 03303 Outpatient Physician Services 23 - Neurology Associates 248 Pleasant Street Suite G200 Concord NH 03301 Outpatient Physician Services 24 - Family Tree Healthcare Hopkinton 19 Farrington Corner Road Hopkinton NH 03229 Outpatient Physician Services 25 - Family Care Of Concord 248 Pleasant Street Suite 2600 Concord NH 03301 Outpatient Physician Services 26 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 27 - Epsom Family Medicine 1990 Dover Road Epsom NH 03234 Outpatient Physician Services 28 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 29 - Rehab Serv CH Med Off-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 30 - CardiacThoracic Surgery 246 Pleasant Street Concord NH 03301 Outpatient Physician Services 31 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 32 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 33 - Rehab Serv CH Med Off-East 1990 Dover Road Suite 201 Epsom NH 03234 Rehabilitation Services 34 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 35 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 36 - Concord Imaging Center 1990 Dover Road Epsom NH 03234 Imaging Services 37 - Family Tree Healthcare Warner 2 East Main Street Warner NH 03278 Outpatient Physician Services 38 - Rehabilitation Services at Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 39 - Family Tree Healthcare Concord 81 Hall Street Concord NH 03301 Outpatient Physician Services 40 - Lab-Memorial Medical Office Building 246 Pleasant Street Concord NH 03301 Outpatient Laboratory Services 41 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 42 - Capital Region Palliative Care & Hospice 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 43 - Anti-Coag Clinic Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 44 - Center for Health Promotion 49 South Main Street Concord NH 03301 Health Promotion Services 45 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 46 - Concord Hosp Fam Hlth Ctr Dntl Clinic 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 47 - Lab CH Medical Offices-East 1990 Dover Road Epsom NH 03234 Outpatient Laboratory Services 48 - Concord Family Medicine Havenwood 149 East Side Drive Concord NH 03301 Outpatient Physician Services 49 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging and Counseling service 50 - Radiology Srv Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Radiology Services 51 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 52 - Lab Penacook Family Physicians 4 Crescent Street Penacook NH 03303 Outpatient Laboratory Services 53 - Lab Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 54 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 55 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services 56 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 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 who may be faced with chronic health conditions, many of these activities also ensure access to needed health services which might otherwise not be available without subsidized or special support. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 20,039,478. Part II, Community Building Activities: In fiscal year 2017, Concord Hospital continued its emergency preparedness initiatives by hosting a multi-agency emergency preparedness exercise to evaluate our own multi-modality response efforts. Program success was also measured by outside agency responders' ability to properly respond within the response parameters and mitigate the risk of damage, injury or fatality to the best level possible. 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 ascommunity 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 $63,541,649 is funded through cost shifting to other payors. 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 facilitates 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 2015 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 FinancialAssistance 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 orthopedic, 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 makes investments in initiatives that align with the Hospital's core 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 $63,541,649 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 1 Riverbend Community Mental Health PO Box 2032 Concord NH 03301 020264383 501(c)(3) 294700 Support to provide funding for: psychiatric care manager and psychiatric APRN, co-located care services at Concord Hospital Medical Group practices, and funds for discounts and scholarships to be awarded by RCMH for individuals in the Intensive Outpatient Therapy and Medication Assisted Therapy programs. 1 0 Part I, Line 2: The Hospital works with the Concord Hospital Trust to administer grants provided from funds available through the Community Services Funds. The Trust has an open application process for those entities that meet the grant requirements, and the Trust Board approves and recommends to the Hospital Board, all recommended granting actions. The Trust provides annual monitoring of compliance with expected spending requirements and gets updates as needed. X X X X X 0 1 0 0 0 0 0 1 0 David Stevenson MD Trustee 245398 0 1250 0 983 0 31927 0 22394 0 301952 0 0 0 Robert P Steigmeyer President & CEO 627832 0 210000 0 828 0 158575 0 21466 0 1018701 0 0 0 Bruce R Burns Treasurer (end 11/16) 315239 0 99026 0 1873 0 45310 0 7706 0 469154 0 0 0 Scott Sloane Senior VP/CFO & Treasurer 244088 0 35003 0 546 0 40071 0 21189 0 340897 0 0 0 David Green MD Senior VP/Chief Medical Officer 405783 0 112463 0 2854 0 48675 0 20051 0 589826 0 0 0 Timothy P Jones Senior VP/Chief Operating Officer 397022 0 98000 0 1548 0 0 0 21218 0 517788 0 0 0 Gerald Sardella MD Physician 579626 0 13593 0 2322 0 25875 0 25003 0 646419 0 0 0 Todd Burdette MD Physician 392579 0 174505 0 595 0 36649 0 24915 0 629243 0 0 0 Wayne K Stadelmann MD Physician 392467 0 91169 0 912 0 43875 0 24915 0 553338 0 0 0 Charles Wicks MD Physician 417663 0 44015 0 394 0 16460 0 24928 0 503460 0 0 0 Adam Chodosh MD Physician 448421 0 74927 0 667 0 18000 0 25225 0 567240 0 0 0 Part I, Line 4b Robert P. Steigmeyer, President & CEO, participated in a 457(f) plan with Concord Hospital during the fiscal year. After a three-year vesting period which began in 2014, there will be a 457(f) amount included in taxable W-2 wages for Mr. Steigmeyer reported on Schedule J, Part II, Column B(iii). This future amount will be comprised of earnings and deferred compensation that is included in Schedule J, Part II, Column C. On October 29, 2014 $78,750 was approved to be credited into Mr. Steigmeyer's 457(f) plan account for fiscal year ended September 30, 2014. This payment will vest in 2017 and will therefore be included in Mr. Steigmeyer's 2017 W-2. As this will be reportable compensation in 2017 it will be reflected on the Hospital's Form 990 filing in Schedule J, Part II, Column B(iii) next year. There were additional contributions to Mr. Steigmeyer's 457(f) plan for fiscal years ended September 30, 2015, 2016, and 2017 of $115,000, $120,000, and $125,000, respectively. Each contribution plus earnings will be reported in Mr. Steigmeyer's W-2 after a three-year vesting period. Part I, Line 7 Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the performance of the CEO, CFO, COO, and CMO during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the executive's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions. A NH Health & Education Facilities Authority 020279866 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 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 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 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 A 1 B 1 C 1 Date Rebate Computation Performed Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 03/17/2016 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 01/31/2016 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 06/30/2016 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 Loss 13,097,735. Equity Transfer from Affiliate 7,004,123. 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 9/30/16 and 9/30/17. Form 990, Part VII: Dr. David A. Stevenson is listed in Form 990, Part VII as a voting member of the Hospital's governing body. He was also employed by the Hospital as full-time physician and received compensation and benefits related to his services to the Hospital in his capacity as a physician. None of his compensation and benefits reflects remuneration in his capacity as a board member of the Hospital. In accordance with IRS instructions, he has not been listed as an independent board member in Form 990, Part VI, Line 1b. Form 990, Part IX, Column D: Although the Hospital is reporting contribution income on Form 990, Part VIII, Line 1 it is not reporting any fundraising expenses on Form 990, Part IX, Line 25, Column D. All philanthropic activity is conducted by the Hospital's affiliate, Concord Hospital Trust. All contribution revenue is first received by the Trust which is then granted to the Hospital. All fundraising expenses related to this solicitation of contribution revenue is reported on Concord Hospital Trust's Form 990, Part IX, Column D. 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 Physicians Group 250 Pleasant Street Concord NH 03301 020481705 Inactive NH 501(c)(3) Line 10 Concord Hospital 1 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 CHDHC Inc 250 Pleasant Street Concord NH 03301 020519680 Provide health services to Concord community NH 501(c)(3) Line 10 Concord Hospital 1 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 Ambulatory Surgery Center LLC 60 Commerical Street Concord NH 03301 201184704 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 50 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 1441707 Actual per books Capital Region Health Care Corp A 92153 Actual per books Capital Region Health Care Corp B 122521 Actual per books Capital Region Health Care Ventures Corp C 6506000 Actual per books Capital Region Health Care Services Corp C 611699 Actual per books Capital Region Health Care Development Corp K 2995866 Actual per books Capital Region Health Care Development Corp O 544296 Actual per books Capital Region Health Care Ventures Corp O 227795 Actual per books Concord Hospital Trust O 632617 Actual per books Capital Region Health Care Ventures Corp Q 332537 Actual per books Concord Hospital Trust Q 500941 Actual per books Schedule R, Part II: Two tax-exempt affiliated entities listed in Schedule R, Part II, Capital Region Physician Group, Inc. and CH/DHC, Inc., were legally dissolved during the fiscal year. 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. During the 2016 tax year, the hospital system invested in Granite Healthcare Asset Holding Company, LLC, a joint venture with several hospital facilities. The Hospital's investment in this entity does not otherwise meet the disclosure requirements for Schedule R, Part III.