2018-10-22T07:42:28-05:00 2017-12-31 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2017-01-01 020222215 ST JOSEPH HOSPITAL STJO 6038823000 172 KINSLEY ST NASHUA NH 030612013 RICHARD J PLAMONDON VP OF FINANCE 6038823000 2018-10-09 E DREW CHENEY P00182972 8002447444 2018-10-09 208.105.168.164 2018-10-09 09:18:20 ED P A744FCA080835C7073C58A40247746B207170AF7 1A5629331B211F1215381247DCB1B4E65CFF0DD3 2017 2018-06-14 16:35:46Z RICHARD J PLAMONDON 172 KINSLEY ST NASHUA NH 030612013 208414508 0 X STJOSEPHOSPITAL.COM X 1943 NH HEALTHCARE SERVICES TO ANYONE NEEDING CARE. 12 9 1931 252 75885 -90489 345584 997078 202283879 203567435 -378612 3665088 -106771 -147460 202144080 208082141 0 0 0 0 93876589 92574574 0 0 0 107933671 114298799 201810260 206873373 333820 1208768 272195459 293828520 133557172 140685304 138638287 153143216 WE ARE A CATHOLIC HEALTH MINISTRY, PROVIDING HEALING AND CARE FOR THE WHOLE PERSON, IN SERVICE TO ALL IN OUR COMMUNITIES. 0 0 33651420 53156425 INPATIENT MEDICAL, SURGICAL AND REHABILITATIVE SERVICES TO ANYONE NEEDING CARE IN THE GREATER NASHUA AREA. 93816080 148193668 OUTPATIENT SERVICES INCLUDING SURGERY, RADIOLOGY, LABORATORY, REHABILITATIVE, CARDIOVASCULAR, BREAST HEALTH, CARDIAC REHAB, AND MENTAL HEALTH TO ANYONE NEEDING SERVICES IN THE GREATER NASHUA AREA. 35969175 EACH YEAR ST. JOSEPH HOSPITAL PROVIDES MILLIONS OF DOLLARS WORTH OF CHARITY CARE AND COMMUNITY SERVICES REFLECTING OUR HEALING MISSION AND OUR VALUES. ST. JOSEPH HOSPITAL FOLLOWS THE METHODOLOGY RECOMMENDED BY THE CATHOLIC HEALTH ASSOCATION FOR CALCULATING THE COST OF CHARITY CARE AND COMMUNITY BENEFITS. COMMUNITY BENEFIT REPORT FOR 2017 IS THE BASIS FOR THE EXPENSES ASSOCIATED WITH THESE ACTIVITIES. 2108061 2217342 2108061 2217342 165544736 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 207 0 1 1931 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X RICHARD PLAMONDON 6038823000 172 KINSLEY ST NASHUA NH 030612013 RICHARD BOEHLER MD FORMER PRESIDENT/CEO END AUG 2017 38.00 2.00 X X 421416 0 24575 RICHARD PLAMONDON TREASURER & VP FINANCE 38.00 2.00 X X 358610 0 31078 LOUISE TROTTIER IMMEDIATE PAST CHAIR 3.00 X X 0 0 0 MAURICE AREL CHAIRMAN 1.00 X X 0 0 0 SR PAULA MARIE BULEY IHM VICE CHAIRMAN 1.00 X X 0 0 0 JOHN PAROLIN SECRETARY 1.00 X X 0 0 0 DOUGLAS TISDALE MD DIRECTOR 1.00 39.00 X 0 386029 39599 DANIEL P MOEN INTERIM SVP, PRESIDENT BEG SEPT 2017 40.00 X 0 0 0 CHRISTINE C HALLOCK DIRECTOR 1.00 X 0 0 0 RALPH JENKINS DIRECTOR 1.00 X 0 0 0 MARY MURPHY DIRECTOR 1.00 X 0 0 0 DONNALEE LOZEAU DIRECTOR 1.00 X 0 0 0 JUDITH DUNBAR DIRECTOR 1.00 X 0 0 0 JAMES MCKENNA VP AMBULATORY SERVICES 40.00 X 278958 0 30466 ARCIERICYNTHIA VP PATIENT CARE END NOV 2017 40.00 X 253491 0 40725 GREGORY ZUERCHER MD PHYSICIAN 40.00 X 356808 0 16069 ELIZABETH SPATOLA MD PHYSICIAN 32.00 X 298424 0 2831 KIRK PERRY DIRECTOR OF CARDIOVASCULAR 40.00 X 223466 0 4461 CHENG JIE PHYSICIAN 40.00 X 245282 0 33384 JEANNE WILSON DIRECTOR OF LABORTORY SVS 40.00 X 215948 0 17694 2652403 386029 240882 122 0 1 0 LEIDOS HEALTH PO BOX 223866 PITTSBURGH PA 152512866 IT STAFFING 4818015 MEDEFIS INC PO BOX 5068 NEW YORK NY 100875068 NURSING STAFFING 2920075 HOSPITAL MEDICINE ASSOCIATES LLC PO BOX 634850 CINCINNATI OH 452634850 PHYSICAN SERVICES 1813313 LEADERS FOR TODAY 981 WORCESTER ST SUITE 1C WELLESLEY MA 02482 ADMINISTRATION STAFFING 860218 SODEXO OPERATIONS BOX 360170 PITTSBURGH PA 152516170 FOOD SERVICE MGMT 694226 42 15000 518030 464048 997078 PATIENT SERVICES 622110 198616385 198616385 SCHOOL OF NURSING 622110 2217342 2217342 ALL OTHER 622110 1174103 1174103 CAFETERIA 622110 914775 914775 PROGRAM FEES 622110 471780 471780 173050 173050 203567435 2072665 2072665 109022 332367 -223345 -223345 -223345 1521125 71298 0 0 1521125 71298 1592423 1592423 HOUSEKEEPING SERVICES 812900 53965 53965 ANSWERING SERVICES 517000 21920 21920 75885 208082141 203567435 75885 3441743 X 1344608 555336 789272 75728711 56796533 18932178 2292881 1719661 573220 7580131 5685098 1895033 5628243 4221182 1407061 2043927 1532945 510982 93336 93336 121820 121820 26101014 26101014 369563 277172 92391 2887527 2165645 721882 6194375 4645781 1548594 5380676 4035507 1345169 47601 35701 11900 63240 47430 15810 2952615 2214461 738154 4846391 4846391 7969416 5977062 1992354 3031941 2273956 757985 PATIENT BILLABLE SUPPLI 22576644 22576644 PURCHASED/CONTRACT SERV 10985599 8239199 2746400 MEDICAID TAX 9878294 9878294 MISCELLANEOUS 5583915 4187936 1395979 3170905 2378179 792726 206873373 165544736 41328637 0 1794313 1808600 18731408 23872839 17321894 20131895 2424278 2372182 1581097 1623139 2704172 2650359 208324993 144159253 64784137 64165740 73518659 87684094 58720764 58295476 12399328 14350801 18215409 16873395 272195459 293828520 23938088 25999577 15221 68868 86688531 92008956 22915332 22607903 133557172 140685304 X 137524511 151728174 749385 475338 364391 939704 138638287 153143216 272195459 293828520 X 1208768 11966736 1329425 X 0 1 X 1 1 1 X 0 0 0 0 0 0 1 24971 0 0 24971 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NH HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES. 1113776 894143 31108 623986 1415041 1092933 445602 49 424808 1113776 1097962 317867 47 322943 1092933 1087092 195972 47 185149 1097962 1055512 315089 47 283556 1087092 0.66410 0.33590 0 0 3620607 3620607 113929056 66530497 47398559 3076344 2920657 155687 86077339 74708099 11369240 1621647 1621647 64165740 58295476 F 58295476 OTHER ACCOUNT RECEIVABLE 185894 DUE FROM AFFILIATE 13696294 NASHUA REGIONAL CANCER CENTER 2414767 OTHER EQUITY INVESTMENTS 576440 16873395 DUE TO THIRD PARTY PAYORS 3646552 OTHER 1619488 MALPRACTICE TAIL LIABILITY 1202451 ENVIRONMENTAL LIABILITY 6326526 PENSION LIABILITY 5452336 LEASE PAYABLE 331072 REDISTRIBUTION 1000103 LOSS IN INVESTMENT 3029375 22607903 X PART V, LINE 4: FUNDS TO BE USED TO ASSIST THE NEEDY THROUGH EDUCATION AND/OR PROJECTS FOR THE POOR AS DETERMINED AND APPROVED BY THE BOARD PART X, LINE 2: COVENANT AND ITS MEMBER ORGANIZATIONS ARE CONSIDERED 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, EXCEPT AS NOTED BELOW. TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION FOR INCOME TAXES AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS INCLUDING UNRELATED BUSINESS INCOME OR TAX STATUS. UNDER GUIDANCE ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD, ASSETS AND LIABILITIES ARE ESTABLISHED FOR UNCERTAIN TAX POSITIONS TAKEN OR POSITIONS EXPECTED TO BE TAKEN IN INCOME TAX RETURNS WHEN SUCH POSITIONS ARE JUDGED TO NOT MEET THE "MORE-LIKELY-THAN-NOT" THRESHOLD, BASED UPON THE TECHNICAL MERITS OF THE POSITION. ESTIMATED INTEREST AND PENALTIES, IF APPLICABLE, RELATED TO UNCERTAIN TAX POSITIONS ARE INCLUDED AS A COMPONENT OF INCOME TAX EXPENSE. THE SYSTEM HAS EVALUATED THE POSITION TAKEN ON ITS FILED TAX RETURNS. THE SYSTEM HAS CONCLUDED NO UNCERTAIN INCOME TAX POSITIONS EXIST AT DECEMBER 31, 2017. 1 1 1 X 1 X 1 1 0 1 1 3577 705712 705712 0.00340 9837 6532352 6532352 0.03160 13414 7238064 7238064 0.03500 975850 975850 0.00470 975850 975850 0.00470 13414 8213914 8213914 0.03970 1 8713394 68968721 96723982 -27755261 X 1 1 1 FIRST CHOICE PHO PHYSICIAN HOSPITAL ORGANIZATION 0.50000 0.00000 0.50000 1 1 ST JOSEPH HOSPITAL 172 KINSLEY ST NASHUA NH 030612013 00023 X X X ST JOSEPH HOSPITAL 0 0 1 X X X X X X X X X 17 1 1 1 1 X SEE PART V, SECTION C X X 1 17 1 SEE PART V, SECTION C 0 1 X 200.000000000000 300.000000000000 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 ST. JOSEPH HOSPITAL PART V, SECTION B, LINE 5: ST JOSEPH HOSPITAL WORKED WITH THE CITY OF NASHUA DIVISION OF PUBLIC HEALTH OFFICIALS AND MEMBERS OF THE COMMUNITY INCLUDING: POLICE, FIRE, SCHOOL OFFICIALS, AMBULANCE SERVICE LEADERS, DIRECTORS OF COMMUNITY AGENCIES, HOSPITAL LEADERS, PHYSICIANS AND RESIDENTS THROUGH FOCUS GROUPS TO GATHER INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESMENT (CHNA) ST. JOSEPH HOSPITAL PART V, SECTION B, LINE 6A: SOUTHERN NEW HAMPSHIRE MEDICAL CENTER, DARTMOUTH HITCHCOCK CLINIC ST. JOSEPH HOSPITAL PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH THE FOLLOWING HEALTHCARE ORGANIZATIONS, ST JOSEPH HOSPITAL, SOUTHERN NH MEDICAL CENTER, DARTMOUTH HITCHOCK CLINIC, NASHUA, THE CITY OF NASHUA DIVISION OF PULBIC HEALTH & COMMUNITY SERIVCES AND SEVERAL OTHER LOCAL NON PROFIT AGENICES TOOK PART IN THE DEVELOPMENT OF THE CHNA. THE PUBLIC HEALTH ADVISORY COUNCIL (PHAC) PROVIDED OVERSIGHT AND DIRECTION,FOR THE DEVELOPMENT OF THE CHNA. ST JOSEPH HOSPITAL IS A MEMBER OF THE PHAC ST. JOSEPH HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL DID NOT HAVE THE 2017 COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE ON THE HOSPITAL WEBSITE AS OF THE END OF THE YEAR DUE TO AN OVERSIGHT. AT THE TIME OF THE FILING, ST. JOSEPH HOSPITAL WAS IN COMPLETE COMPLIANCE WITH SCHEDULE H, PART V, QUESTION 7A AT HTTPS://WWW.STJOSEPHHOSPITAL.COM/COMMUNITY-HEALTH/COMMUNITY-BENEFITS-REPORT ST. JOSEPH HOSPITAL PART V, SECTION B, LINE 11: ST JOSEPH HOSPITAL'S (SJH) "COMMUNITY BENEFITS IMPLEMENTATION PLAN" DESCRIBES HOW SJH IS ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA. THE IMPLEMENTATION PLAN CAN BE FOUND ON THE HOSPITAL WEBSITE AT HTTPS://WWW.STJOSEPHHOSPITAL.COM/MEDIA/FILE/COMMUNITY%20BENEFITS%20IMPLEMENTATION%20STRATEGY%202015-2017.PDF. SCHEDULE H, PART V, SECTION B, LINE 7: THE 2017 CHNA IS AVAILABLE ON ANOTHER WEBSITE AT: HTTPS://WWW.NASHUANH.GOV/1159/2017-COMMUNITY-HEALTH-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 10: THE HOSPITAL'S MOST RECENT IMPLEMENTATION PLAN IS AVAILABLE AT:HTTPS://WWW.STJOSEPHHOSPITAL.COM/MEDIA/FILE/COMMUNITY%20BENEFITS%20IMPLEMENTATION%20STRATEGY%202015-2017.PDF SCHEDULE H, PART V, SECTION B, LINE 16: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND PLAIN LANGUAGE SUMMARY CAN BE FOUND AT:FINANCIAL ASSISTANCE POLICY: HTTPS://WWW.STJOSEPHHOSPITAL.COM/MEDIA/FILE/SJH%20FINANCIAL%20ASSISTANCE%20POLICY%209_2015(1).PDFFINANCIAL ASSISTANCE APPLICATION: HTTPS://WWW.STJOSEPHHOSPITAL.COM/MEDIA/FILE/FINANCIAL%20APPLICATION%20NASHUA%20FINAL_100217.PDFPLAIN LANGUAGE SUMMARY: HTTPS://WWW.STJOSEPHHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSIST 7 1 - MILFORD URGENT CARE PT & OT RAD & MA 442 NASHUA STREET MILFORD NH 03055 URGENT CARE, PHYSICAL AND OCCUPATIONAL THERAPY, RADIOLOGY, MAMMOGRAPHY 2 - NE BLVD PT & OT 75 NORTHEASTERN BLVD NASHUA NH 03060 PHYSICAL AND OCCUPATIONAL THERAPY 3 - HUDSON PT OT AND RADIOLOGY 208 ROBINSON ROAD HUDSON NH 03051 PHYSICAL AND OCCUPATIONAL THERAPY, RADIOLOGY 4 - EXIT 8 PT & OT 2300 SOUTHWOOD DRIVE NASHUA NH 03063 PHYSICAL AND OCCUPATIONAL THERAPY 5 - AMHERST ST PT & OT 460 AMHERST STREET NASHUA NH 03060 PHYSICAL AND OCCUPATIONAL THERAPY 6 - MERRIMACK PT 382 DANIEL WEBSTER HWY MERRIMACK NH 03054 PHYSICAL THERAPY 7 - SO NASHUA RADIOLOGY 172 DANIEL WEBSTER HWY NASHUA NH 03060 RADIOLOGY PART I, LINE 7: COSTING METHODOLOGY IS AN OVERALL COST-TO-CHARGE RATIO BASED ON OPERATING EXPENSES AS A PERCENT OF GROSS REVENUE APPLIED TO THE RELATED GROSS CHARGES. LINE 7A IS BASED ON GROSS CHARGES WRITTEN OFF AS CHARITY CARE TIMES THE OVERALL COST-TO-CHARGE RATIO. LINE 7B IS BASED ON GROSS CHARGES OF PATIENTS WITH A PRIMARY PAYOR OF TRADITIONAL MEDICAID OR MEDICAID MANAGE CARE TIMES THE OVERALL COST-TO-CHARGE RATIO. LINE 7E USES VARIOUS METHODS TO AGGREGATE COSTS INCLUDING BUT NOT LIMITED TO - ACTUAL EXPENDITURES FOR STAFF, SUPPLIES, AND HOSPITAL SPACE USAGE BY COMMUNITY GROUPS AND CASH DONATIONS. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, REPRESENTING OVER FORTY DIFFERENT SPECIALTIES AND TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS WITH VARIED BACKGROUNDS AND INDUSTRIES. THE HOSPITAL UTILIZES ANY SURPLUS FUNDS TO FURTHER ITS MISSION BY PROVIDING FREE AND LOW COST HEALTHCARE SERVICES, EDUCATION OFFERINGS, FREE SCREENINGS, SUPPORT GROUPS, AND WORKS COLLABORATIVELY WITH OTHER HEALTHCARE AGENCIES TO MEET THE IDENTIFIED HEALTHCARE NEEDS OF OUR COMMUNITY. ST JOSEPH HOSPITAL IS AN AFFILIATE OF COVENANT HEALTH INC., TEWKSBURY, MA. IT IS THE RESPONSBILITY OF THE ENTIRE STAFF OF ST JOSEPH HOSPITAL TO SERVE AND PROMOTE THE HEALTH OF THE GREATER NASHUA COMMUNITY. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND ADJUSTED BASED ON COST TO CHARGE RATIO. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS PROVIDED BASED ON AN ANALYSIS BY MANAGEMENT OF THE COLLECTABILITY OF OUTSTANDING BALANCES. MANAGEMENT CONSIDERS THE AGE OF THE OUTSTANDING BALANCES AND PAST COLLECTION EFFORTS IN DETERMINING THE RESERVE FOR DOUBTFUL ACCOUNTS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED OFF AGAINST THE ESTABLISHED RESERVE. BAD DEBTS ARE REPORTED AS CHARGES. PART III, LINE 3: PATIENTS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE FOLLOW THE HOSPITAL'S FINANCIAL ASSISTANCE 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: BAD DEBT EXPENSE - TEXT OF THE FOOTNOTE IN FINANCIAL STATEMENT - "THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS PROVIDED BASED ON AN ANALYSIS BY MANAGEMENT OF THE COLLECTABILITY OF OUTSTANDING BALANCES. MANAGEMENT CONSIDERS THE AGE OF THE OUTSTANDING BALANCES AND PAST COLLECTION EFFORTS IN DETERMINING THE RESERVE FOR DOUBTFUL ACCOUNTS. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED OFF AGAINST THE ESTABLISHED RESERVE". PART III, LINE 8: NONE WERE REPORTED AS A COMMUNITY BENEFIT. COSTING METHODOLOGY IS AN OVERALL COST-TO-CHARGE RATIO BASED ON OPERATING EXPENSES AS A PERCENT OF GROSS REVENUE APPLIED TO THE GROSS CHARGES OF PATIENTS WITH A PRIMARY PAYOR OF TRADITIONAL MEDICARE OR MEDICARE ADVANTAGE. PART III, LINE 9B: EVERY STATEMENT SENT TO PATIENTS INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE, AND PROVIDES A PHONE NUMBER AND EMAIL CONTACT. ALL CUSTOMER SERVICE PERSONNEL ARE ATTUNED TO ASKING PATIENTS IF THEY NEED ASSISTANCE.FINANCIAL ASSISTANCE APPLICATION IS ALSO AVAILABLE ON-LINE BY VISITING THE FACILITY'S WEBSITE. PART VI, LINE 2: THE 2017 NEEDS ASSESSMENT WAS CONDUCTED AS A COLLABORATIVE EFFORT BETWEEN ST. JOSEPH HOSPITAL AND SEVERAL OTHER HEALTHCARE INSTITUTIONS, CIVIC AGENCIES AND OTHER NON PROFIT ENTITIES FROM THROUGHOUT GREATER NASHUA. THE ASSESSMENT INCLUDED QUANTITATIVE AND QUALITATIVE DATA ANALYSIS AND SIX FOCUS GROUPS OF PATIENTS AND KEY LEADERS REPRESENTING CITY/TOWN GOVERNMENT, EDUCATION, HEALTHCARE, BUSINESSES AND NON PROFIT INSTITUTIONS. PART VI, LINE 3: SIGNAGE AND BROCHURES ARE AT EVERY POINT OF REGISTRATION, WHICH EXPLAIN THE FREE CARE AND FINANCIAL ASSISTANCE POLICIES. THERE ARE DEDICATED FINANCIAL COUNSELORS WHO MEET IN PERSON OR ON THE TELEPHONE ASSISTING PATIENTS AND FAMILIES NEEDING FINANCIAL ASSISTANCE. INFORMATION CAN ALSO BE FOUND ON THE HOSPITAL WEB SITE, AS WELL AS IN HOSPITAL COMMUNITY NEWSLETTERS/QUARTERLY PUBLICATIONS. ALL CUSTOMER SERVICE AND REGISTRATION PERSONNEL ARE TRAINED TO ASK PATIENTS AND FAMILIES IF THEY NEED FINANCIAL ASSISTANCE. PART VI, LINE 4: ST JOSEPH HOSPITAL SERVES PEOPLE OF ALL AGES, RACE, GENDER, RELIGION, ETHNICITY REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL'S SERVICE AREA IS ALL OF NEW HAMPSHIRE. PART VI,LINE 5: THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, REPRESENTING OVER FORTY DIFFERENT SPECIALITES AND TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS WITH VARIED BACKGROUNDS AND INDUSTRIES. THE HOSPITAL UTILIZES ANY SURPLUS FUNDS TO FURTHER ITS MISSION BY PROVIDING FREE AND LOW COST HEALTHCARE SERVICES, EDUCATIONAL OFFERINGS, FREE SCREENINGS, SUPPORT GROUPS, AND WORKS COLLABORATIVELY WITH OTHER HEALTHCARE AGENCIES TO MEET THE IDENTIFIED HEALTHCARE NEEDS OF OUR COMMUNITY.ST JOSEPH HOSPITAL IS AN AFFILIATE OF COVENANT HEALTH SYSTEMS, TEWKSBURY, MA. IT IS THE RESPONSIBILITY OF THE ENTIRE STAFF OF ST JOSEPH HOSPITAL TO SERVE AND PROMOTE THE HEALTH OF THE GREATER NASHUA COMMUNITY. PART VI, LINE 6: ST JOSEPH HOSPITAL, A MEMBER OF COVENANT HEALTH, IS A 208-LICENSED BED ACUTE FACILITY. OUR MISSION IS TO CONTINUE THE HEALING MINISTRY OF THE CATHOLIC CHURCH IN THE SPIRIT OF ST MARGUERITE D'YOUVILLE BY PROVIDING PREVENTIVE, CURATIVE, RESTORATIVE, AND SUPPORTIVE SERVICES WITH COMPASSION AND RESPECT FOR EVERYONE. WE TAKE SERIOUSLY THE "PREVENTIVE" ASPECT OF THE MISSION STATEMENT BY OFFERING PREVENTION AND WELLNESS PROGRAMS FOR THE COMMUNITY, OFFER HEALTH SCREENINGS AND WORKING TO PROVIDE ACCESS TO HEALTHY FOOD THROUGH THE NUTRITION CENTER. HEALTH SYSTEM LEADERSHIP PARTICIPATE IN VARIOUS COMMUNITY GROUPS TO CONDUCT HEALTH CARE NEEDS ASSESSMENTS AND TO DEVELOP COMMUNITY INTERVENTIONS TO IMPROVE HEALTH. PART VI, LINE 7: NEW HAMPSHIRE X X X X 0 0 0 0 0 0 0 0 0 RICHARD BOEHLER MD FORMER PRESIDENT/CEO END AUG 2017 414270 0 0 0 7146 0 2700 0 21875 0 445991 0 0 0 RICHARD PLAMONDON TREASURER & VP FINANCE 355298 0 0 0 3312 0 2469 0 28609 0 389688 0 0 0 DOUGLAS TISDALE MD DIRECTOR 0 382884 0 0 0 3145 0 0 0 39599 0 425628 0 0 JAMES MCKENNA VP AMBULATORY SERVICES 276449 0 0 0 2509 0 2229 0 28237 0 309424 0 0 0 ARCIERICYNTHIA VP PATIENT CARE END NOV 2017 253141 0 0 0 350 0 1929 0 38796 0 294216 0 0 0 GREGORY ZUERCHER MD PHYSICIAN 355513 0 0 0 1295 0 2700 0 13369 0 372877 0 0 0 ELIZABETH SPATOLA MD PHYSICIAN 296731 0 0 0 1693 0 1630 0 1201 0 301255 0 0 0 KIRK PERRY DIRECTOR OF CARDIOVASCULAR 223082 0 0 0 384 0 1768 0 2693 0 227927 0 0 0 CHENG JIE PHYSICIAN 244368 0 0 0 914 0 2549 0 30835 0 278666 0 0 0 JEANNE WILSON DIRECTOR OF LABORTORY SVS 214751 0 0 0 1197 0 1214 0 16480 0 233642 0 0 0 A NH HEALTH & EDUCATION FACILITIES AUTHORITY 020279866 644614UG2 2007-10-30 53869522 RENOVATIONS & EQUIPMENT 0 0 1 B NH HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 575840QA4 2012-06-27 27000000 RENOVATIONS & IMPROVEMENTS 1 0 0 C NH HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 NOTAPPLIC 2014-07-17 16900000 REFUNDING ISSUE 0 0 0 D NH HEALTH & EDUCATION FACILITIES AUTHORITY 042456011 NOTAPPLIC 2017-03-21 7960000 RENOVATIONS & IMPROVEMENTS 0 0 0 A 53869522 4911229 681812 2008 0 1 1 1 B 27000000 572615 21991329 0 1 0 1 C 16900000 260000 2014 0 1 1 1 D 7960000 159200 0 0 1 1 A 0 0 0 0 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 D 0 0 0 0 1 0 1 A 1 0 0 0 0 0 B 1 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 PART IV, #7 & PART V: ALL BONDS ARE CAREFULLY AND CONSISTENTLY MONITORED FOR POTENTIAL VIOLATIONS OF FEDERAL TAX REQUIREMENTS, BUT THE PROCEDURES WERE NOT WRITTEN AS OF THE END OF THE YEAR COVERED BY THIS TAX RETURN. HOWEVER, THE ORGANIZATION IS CONSIDERING ADOPTING FORMAL POLICIES THAT SET FORTH THE ORGANIZATION'S METHODOLOGY FOR ENSURING POST-ISSUANCE COMPLIANCE WITH IRS REQUIREMENTS PERTAINING TO TAX-EXEMPT DEBT AND CONTAIN SPECIFIC LANGUAGE REGARDING ORGANIZATIONAL RESPONSIBILITY, RECORD RETENTION, PRIVATE BUSINESS USE, ARBITRAGE REBATE, AND REMEDIAL ACTION. ALTHOUGH FORMAL POLICIES ARE NOT IN PLACE IN REGARDS TO THE REMEDIATION OF OUR BONDS, THE MONITORING REQUIREMENTS OF SECTION 148, AND PROCEDURES TO ENSURE THAT VIOLATIONS ARE TIMELY IDENTIFIED AND CORRECTED, THE ORGANIZATION HAS COMPLIANCE CHECKS IN PLACE THAT SUBSTANTIATE THESE REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 3 DANIEL MOEN WAS THE INTERIM PRESIDENT BEGINNING SEPTEMBER 2017. LEADERS FOR TODAY WAS PAID $181,514 FOR HIS SERVICES IN 2017. FORM 990, PART VI, SECTION A, LINE 6 COVENANT HEALTH IS THE SOLE MEMBER OF ST. JOSEPH HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH IS THE SOLE MEMBER OF ST. JOSEPH HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B ST. JOSEPH HOSPITAL IS A MEMBER OF COVENANT HEALTH, AND AS SUCH, ALL DECISIONS ARE SUBJECT TO ITS REVIEW. FORM 990, PART VI, SECTION B, LINE 11B 990'S ARE PREPARED BY THE FINANCE DEPARTMENT AND REVIEWED BY AN INDEPENDENT TAX ACCOUNTANT, THEN REVIEWED BY THE ST. JOSEPH HOSPITAL FINANCE COMMITTEE AND BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR ST. JOSEPH HOSPITAL CONDUCTS A SURVEY OF THE BOARD MEMBERS AND KEY MANAGEMENT MEMBERS TO DETERMINE WHETHER THERE ARE CONFLICTS OF INTEREST (ACTUAL OR POTENTIAL), BOARD MEMBERS AND KEY EMPLOYEES HAVE A CONTINUING OBLIGATION TO REPORT ANY PROPOSED TRANSACTIONS WHICH MAY BE PERCEIVED AS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EVERY 2-3 YEARS, THE COMPENSATION COMMITTEE OF THE COVENANT HEALTH'S BOARD OF DIRECTORS ENGAGES AN EXTERNAL CONSULTANT TO PROVIDE COMPETITIVE MARKET DATA FROM VARIOUS SURVEY SOURCES, WHICH IS USED TO DEVELOP RECOMMENDATIONS FOR CHANGES TO THE COMPENSATION PROGRAM. SINCE 2003 THE COMMITTEE HAS ENGAGED A HUMAN RESOURCES CONSULTING FIRM TO CONDUCT THIS ANALYSIS. OBJECTIVES OF THIS ANALYSIS ARE TO: ASSESS THE COMPOSITENESS OF THE CURRENT TOTAL CASH COMPENSATION LEVELS FOR THE SENIOR MANAGEMENT TEAM, DEVELOP MARKET BASED COMPETITIVE SALARY LEVELS FOR ALL EXECUTIVE POSITIONS AND ENSURE THAT THE ANNUAL INCENTIVE OPPORTUNITIES, IF ANY, ARE COMPETITIVE AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST THE ORGANIZATION WILL MAKE AVAILABLE CORPORATE DOCUMENTS AND FINANCIAL STATEMENTS. FORM 990, PART IX, LINE 11G TRANSCRIPTION SVS: PROGRAM SERVICE EXPENSES 334,772. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 334,772. COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 903,394. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 903,394. PHYSICIAN CONTRACT SVS: PROGRAM SERVICE EXPENSES 24,862,848. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,862,848. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 2,354,908. LOSS IN EQUITY OF SUBSIDIARIES -1,107,342. INVESTMENT IN YANKEE -612,485. RESTRICTED DONATIONS 301,269. NET ASSETS RELEASED FROM PPE 393,075. SJH SURGICENTER LLC 172 KINSLEY STREET NASHUA NH 030612013 204181845 INACTIVE OUTPATIENT SURGERY NH 0 0 ST JOSEPH HOSPITAL COVENANT HEALTH INC 100 AMES POND ROAD TEWKSBURY MA 01876 222484505 HEALTHCARE SERVICES MA 501(C)(3) 10 0 THE SURGICENTER AT ST JOSEPH HOSPITAL 172 KINSLEY STREET NASHUA NH 03060 020470528 OUTPATIENT SURGERY SERVICES NH 501(C)(3) 10 ST JOSEPH HOSPITAL 1 SOUHEGAN NURSING ASSOCIATION 24 NORTH RIVER ROAD MILFORD NH 03054 020222795 HOME HEALTH AND HOSPICE SERVICES NH 501(C)(3) 10 ST JOSEPH HOSPITAL 1 ST JOSEPH HOSPITAL CORPORATE SERVICES 172 KINSLEY STREET NASHUA NH 030612013 020405197 HOLDING COMPANY NH ST JOSEPH HOSPITAL C -1207031 34137376 1.00000 1 FIRST CHOICE PHO 172 KINSLEY STREET NASHUA NH 03060 020461536 PHYSICIAN HOSPITAL ORGANIZATION NH ST JOSEPH HOSPITAL C 370480 973564 0.50000 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 ST JOSEPH CORPORATE SERVICES K 972142 CASH ST JOSEPH CORPORATE SERVICES O 102733 CASH ST JOSEPH CORPORATE SERVICES P 23666214 CASH ST JOSEPH CORPORATE SERVICES Q 8400 CASH ST JOSEPH CORPORATE SERVICES R 187692 CASH SOUHEGAN NURSING ASSOCIATION R 21000 CASH