2017-05-09T13:29:13-05:00 2016-06-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2015-07-01 020232673 The Elliot Hospital of the City of Manchester ELLI 6036632033 1 Elliot Way Manchester NH 03103 Joseph Ingold CFO 6036632033 2017-05-05 1 Nicholas E Porto P01310283 8002447444 2017-05-05 2015 2021-01-29 14:40:06Z Douglas F Dean 1 Elliot Way Manchester NH 03103 507158027 0 X www.elliothospital.org X 1942 NH Hospital Services 19 16 3686 332 9538676 -1677814 1196842 1171829 411772355 426398994 4196222 3459070 4252195 4274207 421417614 435304100 354008 710000 0 0 192741584 195250737 0 0 0 184695100 189779135 377790692 385739872 43626922 49564228 418736519 415062492 280279657 287041331 138456862 128021161 The Elliot Hospital of the City of Manchester, a leader in healthcare, is dedicated to providing its community with excellent services offered with dignity, caring, and respect. 0 0 308686647 0 416855850 Medical services provided to 14,450 in-patients and 518,746 out-patients including free care in the amount of $7,200,993 (at cost) and contributions to community programs. 710000 710000 0 Contributions to Manchester Community Health Center and the Child Advocacy Center in Manchester, New Hampshire. 341276 0 0 Community benefits including educational programs, health screenings, health publications and other health information services, and cash and in-kind contributions to community agencies. 309737923 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 1 0 0 0 0 0 1 1 1 0 0 1 301 0 1 3686 1 1 1 0 0 0 0 0 0 0 0 0 X 19 16 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Joseph Ingold 6036632033 1 Elliot Way Manchester NH 03103 X Danielle T Albushies MD Trustee 1.00 1.00 X 0 0 0 R Scott Bacon Trustee (until 1/16) 1.00 1.00 X 0 0 0 Howard Brodsky Trustee 1.00 3.00 X 0 0 0 Christopher S Calhoun MD Trustee (until 1/16) 1.00 41.00 X 0 169922 33620 Reverend John A Cerrato Jr Trustee 1.00 1.00 X 0 0 0 Gus Emmick MD Trustee 1.00 41.00 X 0 257384 30792 Lawrence M Hoepp MD Trustee 1.00 41.00 X 0 905445 25685 Paul W Hoff PhD Trustee 1.00 1.00 X 0 0 0 Joseph Hyatt MD Trustee 1.00 1.00 X 0 0 0 Joseph R Lachance Jr Trustee 1.00 1.00 X 0 0 0 Maryann Leclair Trustee 1.00 1.00 X 0 0 0 Dianne M Mercier Trustee 1.00 1.00 X 0 0 0 Daniel M Monfried Trustee 1.00 1.00 X 0 0 0 Anita R Ritenour MD Trustee (until 1/16) 41.00 4.00 X 366060 0 41494 Charles F Rolecek Trustee 1.00 2.00 X 0 0 0 David RA Steadman Trustee 1.00 1.00 X 0 0 0 Adrian J Thomas MD Trustee 1.00 1.00 X 0 0 0 John F Weeks Trustee 1.00 3.00 X 0 0 0 James C Hood Esq Chair 1.00 1.00 X X 0 0 0 John A Hession Vice Chair & Treasurer 1.00 3.00 X X 0 0 0 Mary Sargent Secretary 1.00 3.00 X X 0 0 0 Ann G Remus Secretary (until 1/16) 1.00 4.00 X X 0 0 0 James L Woodward CEO 41.00 4.10 X X 912315 0 221732 Jeffrey Rooney CFO 41.00 4.00 X 0 0 0 Richard A Elwell CFO (until 12/15) 40.00 4.00 X 545414 0 95283 John E Friberg Jr Senior VP, General Counsel 40.00 0.00 X 413134 0 52893 William G Baxter Senior VP, Medical Affairs 40.00 0.10 X 499788 0 61074 Craig Williams COO 40.00 0.00 X 416974 0 449 Alexander W Petron MD Physician 40.00 0.00 X 372271 0 31030 James Kulle MD Physician 40.00 0.00 X 277546 0 14404 Marc Cullerot VP of Finance 40.00 0.00 X 291135 0 472 Douglas F Dean Former President & CEO 0.00 0.00 X 251909 0 58768 Richard Phelps Former President & COO 0.00 0.00 X 534037 0 11106 4880583 1332751 678802 173 1 1 0 Cardon Healthcare Holdings 557 E Pikes Peak Ave Colorado Springs CO 80903 Patient Credit and Collection 2494685 Arup Laboratories Inc 500 Chipeta Way Salt Lake City UT 84108 Lab Services 1552542 PriceWaterhouseCoopers LLP PO Box 7247-8001 Philadelphia PA 19170 Professional Services 605939 Harger Howe and Associates 111 S Bedford St Ste 201 Burlington MA 01803 Executive Recruitment 462061 Amoskeag Anesthesia PLLC One Elliot Way Manchester NH 03103 Physician Services 383036 38 1171829 1171829 Net Patient Services 621110 344843608 344843608 Laboratory Services 621500 47799986 44094830 3705156 Pharmacy Services 623000 16576506 14808375 1768131 Miscellaneous Program Services 621110 9057511 9057511 Management and Consulting 541610 4587423 940443 3646980 3533960 3111083 422877 426398994 2260739 -4468 2265207 4274207 0 4274207 4274207 4274207 73052258 71815381 38546 1236877 -38546 1198331 1198331 435304100 416855850 9538676 7737745 X 710000 710000 2648325 407554 2240771 149809694 113668903 36140791 13255678 10177345 3078333 19039915 14311407 4728508 10497125 7872844 2624281 3360278 3360278 831878 831878 103587 103587 267256 267256 620729 620729 28037498 21584704 6452794 1994084 25292 1968792 11015326 7540203 3475123 6888577 6263969 624608 12126399 9094799 3031600 303586 274053 29533 748809 561607 187202 8056995 6042746 2014249 14343631 10757723 3585908 1314823 986117 328706 Medical Supplies 58982121 58982121 Medicaid Enhancement Ta 21584396 21584396 Provision For Bad Debts 14411000 14411000 Patient Expenses 3604014 3604014 1184148 877126 307022 385739872 309737923 76001949 0 54377006 68845611 22684216 14084827 44489099 48000445 979300 954278 2985254 3040664 5481704 4993405 391936540 235095744 155053210 156840796 73565697 41122071 7924094 59696055 1200026 1100100 49996913 16384240 418736519 415062492 39087561 35642611 139775707 134930206 2594394 2611008 98821995 113857506 280279657 287041331 X 124119397 113834410 1244235 1186304 13093230 13000447 138456862 128021161 418736519 415062492 X 49564228 -5898325 -54101604 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 267256 267256 267256 267256 385472616 555920432 385739872 556187688 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 156539 9572 257097 267256 690464 250000 250000 250000 250000 1000000 1500000 14337465 -136806 13908 14186751 15425677 182 131222 1219616 14337465 14066355 360570 998752 15425677 13591808 474547 14066355 13860491 -268683 13591808 0.00000 0.91640 0.08360 0 0 6681464 6681464 182635730 73604780 109030950 2074517 2011449 63068 191553462 159479515 32073947 8991367 8991367 156840796 Alternative Investments 7087945 F Private Investment Funds 52608110 F 59696055 Payable To Third Party Payors 8011643 Interest Payable 1922028 Accrued Pension 89731351 Workers Comp Reserves & Other 1378153 Employee Benefit Plans 12714331 Security Deposit 100000 113857506 X 435512847 -5898325 7473232 1574907 433937940 656160 710000 1366160 435304100 386121186 1747474 1747474 384373712 656160 710000 1366160 385739872 Part V, Line 4: Income from the endowment funds can be used for operating and capital expenditures. Part X, Line 2: Elliot Hospital, EPN and EPS 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 has evaluated the Hospital's tax positions and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: Revenue allocated to EHS Professional & General Liability Insurance Trust 7,320,638. Unrealized Gains to EHS Professional & General Liability Insurance Trust 152,594. Part XI, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 710,000. Part XII, Line 2d - Other Adjustments: Expenses allocated to EHS Professional & General Liability Insurance Trust 1,747,474. Part XII, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 710,000. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments through Elliot Common Trust Fund 4879000 0 0 0 0 0 0 4879000 0 4879000 1 0 1 1 0 0 Schedule F, Part I, Line 3: The legal owner of Elliot Hospital's foreign investments is a related organization, Elliot Common Trust Fund. Since a portion of the total foreign investments are allocated to the Hospital's assets on the financial statements, those allocated investments have been disclosed on Schedule F, Part I, Line 3 of Elliot Hospital's Form 990. Schedule F, Part IV, Line 3: The Elliot Hospital of the City of Manchester did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Schedule F, Part IV, Line 4: The Elliot Hospital of the City of Manchester meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Hospital. 1 1 1 X 1 X 1 1 0 1 1 33192 7200993 0 7200993 0.01940 66418 78410144 42318056 36092088 0.09720 0 0 0 99610 85611137 42318056 43293081 0.11660 11 1302 270468 0 270468 0.00070 7 472 277895 0 277895 0.00070 5 0 9879266 5464993 4414273 0.01190 1 0 6901 0 6901 0.00000 7 5 496012 0 496012 0.00130 31 1779 10930542 5464993 5465549 0.01460 31 101389 96541679 47783049 48758630 0.13120 2 107620 107620 0.00030 2 107620 107620 0.00030 0 14411000 0 102081777 122745245 -20663468 X 1 1 1 1 Elliot Hospital of City of Manchester 1 Elliot Way Manchester NH 03103 www.elliothospital.org 00018 X X X X Elliot Hospital of City of Manchester 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X See Part VI, Section C X See Part VI, Section C X 1 15 1 https://www.catholicmedicalcenter.org/uploads/CHIS_October_2016_final.pdf 1 0 1 X 200.000000000000 300.000000000000 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 1 X 0 X X X X 1 X 0 0 Elliot Hospital of City of Manchester Part V, Section B, Line 5: Elliot Hospital is a key participant of the Manchester Health Advisory Council, a regional network of stakeholders who share the commitment to improving health in the greater Manchester community. The primary focus of this council over the last two years (2014-2016) has been to conduct a community needs assessment and health improvement strategy for Manchester. This collaborative effort was coordinated under the direction of the City of Manchester Health Department and the Greater Manchester Regional Public Health Network.Elliot's 2016 Greater Manchester Community Health Needs Assessment (completed during tax year 2015) is built upon the 2014 Manchester Neighborhood Health Improvement Strategy, at: http://www.manchesternh.gov/health/NeighborhoodHealthImprovementStrategy.pdf and the 2016 Greater Manchester, New Hampshire Health Improvement Plan, at:https://www.manchesternh.gov/Portals/2/Departments/health/GManCHIP.pdf.The processes, findings, and recommendations associated with this work formed the foundation of our list of community needs. In addition, we have revisited secondary data sources presented in the Community Health Needs Assessment (that was effective in tax year 2013) to evaluate their status to date. Finally, Elliot Hospital conducted several key-informant interviews with area town administrators, public health officials, and others to discuss the health needs in their communities and determine if there were additional needs and priorities beyond those identified for the City of Manchester. We also took the opportunity to discuss new and emerging trends in the health of greater Manchester communities. Elliot Hospital of City of Manchester Part V, Section B, Line 6a: Catholic Medical Center Elliot Hospital of City of Manchester Part V, Section B, Line 6b: Manchester Health Department Elliot Hospital of City of Manchester Part V, Section B, Line 11: See attached Implementation Plan for CHNA in effect during tax year 2015. Elliot Hospital of City of Manchester Part V, Section B, Line 22d: The hospital utilized a look back method using Medicare and all other payors to determine a maximum amount that could be charged to FAP individuals. Schedule H, Part V, Section B, Line 7a & 7b: The CHNA available at the Hospital facility's website at:(http://elliothospital.org/website/downloads/QualitativeNeedsAssessment.pdf)Additionally, it is also available on Catholic Medical Center's website at:https://www.catholicmedicalcenter.org/uploads/Greater_Manchester_Community_Health_Needs_Assessment_June_2016.pdf. Schedule H, Part V, Section B, Line 13: The Elliot Hospital of the City of Manchester's Financial Assistance Policy requires that applicants reside in the State of New Hampshire, except in the case of non-New Hampshire residents who experience an emergeny medical condition in New Hampshire and require immediate care. Schedule H, Part V, Section B, Line 16a, 16b, & 16c: The Hospital's Financial Assistance Policy, Plain Language Summary, and Financial Assistance Application can be found at:https://elliothospital.org/website/pay-my-bill-charitable-care-policy.php 23 1 - Elliot Endoscopy Center Rivers Edge 185 Queen City Avenue Manchester NH 03101 Ambulatory Surgical Center 2 - Elliot Urgent Care at Rivers Edge 185 Queen City Avenue Manchester NH 03101 Non-Emergency Walk-In Care Center 3 - Elliot Urgent Care Londonberry 40 Buttrick Road Londonberry NH 03053 Non-Emergency Walk-In Care Center 4 - Elliot Stat Lab at Hooksett 200 Technology Drive Hooksett NH 03106 Laboratory 5 - Elliot 1-Day Surgery Center Lab 185 Queen City Avenue Manchester NH 03101 Laboratory 6 - Elliot Hospital Lab at Manchester CHC 145 Hollis Street Manchester NH 03101 Laboratory 7 - Elliot After Hours at Raymond 15 Freetown Road 8 Raymond NH 03077 Non-Emergency Walk-In Care Center 8 - Elliot Lab at Elliot MC Londonberry 40 Buttrick Road Londonberry NH 03053 Laboratory 9 - Elliot Senior Health Primary Care 138 Webster Street Manchester NH 03104 Laboratory 10 - Elliot Hospital-4 Elliot Way 4 Elliot Way Manchester NH 03103 Collection Station 11 - Elliot River's Edge Urgent Care Lab 185 Queen City Avenue Manchester NH 03101 Laboratory 12 - Elliot Hospital-Tarrytown Road 190 Tarrytown Road Manchester NH 03103 Collection Station 13 - Elliot Collection Sta at Rivers Edge 185 Queen City Avenue Manchester NH 03101 Collection Station 14 - Elliot DS at Hooksett Ambulatory Care 1256 Hooksett Road Hooksett NH 03106 Collection Station 15 - Elliot Draw Station at Cypress Center 445 Cypress Street Manchester NH 03103 Collection Station 16 - Elliot Hospital at Bedford Commons 701 River Place Bedford NH 03110 Collection Station 17 - Elliot Medical Center at Londonberry 40 Buttrick Road Londonberry NH 03053 Laboratory 18 - Elliot Lab NE Rehab Hospital-Salem 70 Butler Street Salem NH 03079 Collection Station 19 - Urgent Care Center Laboratory 40 Buttrick Road Londonberry NH 03053 Laboratory 20 - Elliot Lab Easter Seals 555 Auburn Street Manchester NH 03103 Collection Station 21 - Hooksett Lab Draw Station 200 Technology Drive Hooksett NH 03106 Collection Station 22 - Londonberry Lab Draw Station 40 Buttrick Road Londonberry NH 03053 Collection Station 23 - EH Lab Manchester Community Health Ctr 145 Hollis Street Manchester NH 03101 Collection Station Part I, Line 7: Financial assistance and means tested costs used RCC derived from medicare cost report; other benefits costs derived from actual costs and internal cost accounting system. 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 $ 14,411,000. Part II, Community Building Activities: The health of the community we serve is promoted through Elliot Hospital's building activities with organizations such as the Child Advocacy Center, the Homeless Shelter and others. In probably the most important and basic manner, namely, we directly impact basic living (and in some cases survival) needs. Children, young adults, adults and the elderly share the need for basic nutrition, safety, and shelter. The organizations we choose to support offer and provide some of these necessities for a large portion of the population in the greater Manchester area. Further, we provide support for organizations that understand the importance of education and provide the skills, tools and the information to people so that they can access everything from food for the hungry, shelter, safety from physical and mental harm as well as health care. EH treats many of these individuals in our emergency department. In working with these people to help them recover from illnesses or injuries, we have come to understand the importance and the role other organizations play in the lives of these same people. By supporting these organizations, we know that basic needs are being met, and improved health and wellness for everyone regardless of personal hardship or status may be achieved. Part III, Line 2: Bad debt expense is determined based on analysis of historical activity. Self pay accounts are given an automatic 25% discount off charges; self pay accounts that do not make payment are transferred to bad debt. Cost of bad debt is derived from internal cost accounting system. Part III, Line 3: Bad debt and charity care cost determined using internal cost accounting system; self pay accounts given automatic 25% discount off charges; self pay accounts that do not make payment are transferred to bad debt. Organization is not currently determining bad debt accounts that may have been charitable care. Part III, Line 4: See Footnote 2 of the attached audited financial statements. Part III, Line 8: Allowable costs determined using CMS methodology utilized in completing cost report; Medicare shortfall from Part III, Line 7 should be included in community benefits as costs are not fully reimbursed. Part III, Line 9b: Collections are not pursued on charity care patients. Collections agencies are supplied information that allows them to identify only those accounts upon which collection efforts should be pursued. Part VI, Line 2: The Greater Manchester Community Health Needs Assessment conducted by Catholic Medical Center and the Elliot Health System, with the assistance of the Manchester Health Department, was completed in June 2016. The assessment began with a review of the 2014 Manchester Neighborhood Health Improvement Strategy, http://www.manchesternh.gov/health/NeighborhoodHealthImprovementStrategy.pdf and the 2016 Greater Manchester, New Hampshire Health Improvement Plan https://www.manchesternh.gov/Portals/2/Departments/health/GManCHIP.pdf.A variety of secondary data sources were accessed. They included the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services, NH HealthWRQS and the City of Manchester Department of Health. During February, March, and April of 2016, the hospitals conducted several key-informant interviews with area town administrators, public health officials, and others to discuss the health needs in their communities and determine if there were additional needs and priorities beyond those identified for the City of Manchester. They also took the opportunity to discuss new and emerging trends in the health of greater Manchester communities. Part VI, Line 3: Elliot Health System posts the Financial Assistance and Collections Policy on their website at: http://elliothospital.org/website/downloads/Financial-Assistance-Policy.pdf. Additionally, financial assistance plain language summaries are posted in patient waiting rooms and locations throughout the Elliot Health System, and are available on the website in English, Spanish, and French. Elliot Health System also employs Financial Advocates who are available to meet with patients to assist them with applying for state and federal programs and financial assistance. Part VI, Line 4: The 2016 Greater Manchester Community Health Needs Assessment focused on the Health Service Area (HSA) of Greater Manchester, a market that is primarily served by Catholic Medical Center and Elliot Hospital. The Greater Manchester HSA is home to approximately 180,000 residents and is composed of the towns of Auburn, Bedford, Candia, Deerfield, Goffstown, Hooksett, New Boston, and the City of Manchester. These towns are located in three different counties (Hillsborough, Rockingham, and Merrimack) within the state of New Hampshire, with 62% of the residents of the HSA living within the City of Manchester. The population of the Greater Manchester HSA is changing. The HSA is aging and becoming a more diverse population, with residents reflecting a variety of nationalities, languages, ethnic traditions, religious beliefs, and ideologies. The 65+ population within the HSA is projected to realize a 22% growth through 2019, and many other towns within the HSA will experience over 30% growth in the 65+ age group. This is significant given a 2012 report from the University of New Hampshire Carsey Institute, which notes that the aging population will increase the cost of providing state and local services. Unlike the increase in the 65+ population, the pediatric population (ages 0-17) within the Greater Manchester HSA (excluding the City of Manchester) is projected to realize a slight decline over the next five years. In contrast to the HSA, the City of Manchester's pediatric population is projected to realize an increase of about 2%. As stated above, the HSA is becoming a more diverse population, with residents reflecting a variety of nationalities, languages, ethnic traditions, religious beliefs, and ideologies. Manchester continues to welcome refugees into the city. Since 2008, Manchester has welcomed over 1,500 refugees. The majority of racial diversity in the Greater Manchester HSA is within the city of Manchester, as the city has nearly 86% of the minority population of the HSA residing within its boundaries. One outcome of the increase in refugees over the past seven years is that 80 languages are now spoken in the Manchester school system. Over the past five years an average of 1,800 students in the Manchester school system are considered to have Limited English Proficiency (LEP). This number has been trending down over the past five years. A person with LEP may have difficulty speaking or reading English and thus have difficulty communicating effectively in school. The median household income for the City of Manchester is $55,306. This is significantly lower than all others towns within the Greater Manchester HSA and is also lower than the median household income for New Hampshire, which is $64,664. The City of Manchester also has a significantly higher percent of individuals and families living below poverty, 14.3% and 10.8%, respectively, than other towns in the HSA and the state. Manchester residents living below the poverty level are concentrated in the East and West side center city. Since poverty is highly associated with increased health risk behaviors, low educational attainment, poor health status, unemployment, and a lower self-reported quality of life, this is important to understanding community needs.Low socioeconomic status for youth is associated with higher hospital admission rates, lower utilization of preventive services, and higher rates of chronic disease. A measurement to assess youth poverty is the number of students enrolled in free or reduced meal plans in schools. A student who is eligible for free-meal enrollment must come from a household where the total annual income per family falls below 130% of the federal poverty guidelines (e.g., for a family of four, this would equate to $29,965 or less annually). For a student to be eligible for reduced-meal enrollment, the total annual household income per family must fall below 185% of the federal poverty guidelines (e.g., for a family of four, this would equate to $42,643 or less.)Homeless children have a higher risk of health conditions than those with a stable home. According to childtrends.org, children who are homeless: - Suffer from hunger, poor physical and emotional health, and missed educational opportunities. - Are twice as likely to go hungry as children who are not homeless. - Are more likely than other children to have moderate to severe acute and chronic health problems, and less access to medical and dental care. - Have a higher prevalence of symptoms of asthma, hyperactivity/inattention, and behavior problems. - Have three times the rate of emotional and behavioral problems, such as anxiety, depression, sleep problems, withdrawal, and aggression. - Are twice as likely as others to repeat a school grade, be expelled or suspended, or drop out of high school. During the 2011-2012 school years the Manchester School District identified 1,115 students who were homeless, representing more than 7% of the total student population. Part VI, Line 5: Elliot Hospital believes strongly that our involvement in community organizations such as Child Health Services, Manchester Mental Health Center, YMCA and many more, is critical to our exempt purpose. We deploy hundreds of volunteers throughout the state to work with non-profit organizations that are doing their part to help eradicate illnesses and poor health conditions or improve the health and wellness of people. Many of our leaders serve on the boards of these organizations to share insight and to participate in helping them achieve their mission. In addition to the volunteer time and energy, Elliot Hospital also provides hundreds of thousands of dollars in financial support to ensure that the critical work of these organizations is achieved and people are helped with a range of issues from mental health care to obtaining food and shelter.Additionally, given our health care system and how widespread Elliot Hospital has become in the community, we open our doors and provide the staff and the resources for local issues that are unforeseen but create urgent situations. For example, when New Hampshire residents were stuck by power outages from an ice storm lasting days, Elliot Hospital kept patients (free of charge) in the hospital until power in the home as restored so that they would not suffer the hardship of living without heat and power. For day-to-day struggles, either with how to cope with the loss of a loved one or with how to cope with cancer, EH staff and professionals offer free community support groups and classes to reach people who are in need of help.Elliot Hospital prides itself on these acts of humanity because it does meet our purpose and mission and without question, promotes the health of the community. Part VI, Line 6: Elliot Health System (EHS) is the umbrella organization under which Elliot Hospital (EH), Elliot Physician Network (EPN), Elliot Professional Services (EPS), the Visiting Nurse Association of Manchester and Southern NH (VNA), and the Mary & John Elliot Charitable Foundation operate. Elliot Health System is a health care system that provides care to residents of southern New Hampshire, serving a regional population of over 250,000 residents and making it one of the largest providers of comprehensive health care services in southern New Hampshire. Each of these organizations plays a critical role in the continuum of care EHS delivers to the community thus promoting health. The cornerstone of EHS is Elliot Hospital, a private, not for profit hospital established in 1890, and now a 296-bed acute care facility located in Manchester (New Hampshire's largest city) on EHS's main campus. Elliot Hospital is a premier health care provider in many disciplines, serving as the designated trauma center for the Manchester HSA, and designated receiving facility for psychiatric patients in the region. In addition, Elliot Hospital provides maternity and pediatric services, newborn intensive care, surgery, pain management, wound management, cardiac care, and much more.EHS, through the EPN and EPS, both private, not for profit physician groups, provides primary care and specialty care via over 211 employed physicians as far north as Hooksett, east to Raymond, south to Windham and west to New Boston. The EPN has 27 physician practices in the Greater Manchester area. Providing access to providers throughout the local community is critical to supporting the need to help individuals become active in their health care and vigilant about their yearly exams, vaccines, and medications. EHS has a robust electronic medical record (EMR) linking all of these providers with Elliot Hospital, allowing the provider a complete understanding of anything that may have occurred through the emergency department or urgent care throughout the year. The EMR is complete with the latest laboratory results, diagnostic images, and other test results that may affect care given in the local provider's office.The VNA is one of the region's oldest and most comprehensive not for profit home health providers, dedicated to improving the health and well-being of our community since 1897. The VNA has helped individuals and their families face the challenges of recovering from surgery, physical disabilities, and short-term, chronic, and life-limiting illnesses. Through a TRACE program, EHS can ensure that older adults requiring care and with complex health care histories are given a care plan from the hospital to the nursing home (if necessary) and to the home. All of this care is also linked through the EMR and through our use of Tele-medicine; many patients are monitored "virtually" each day while in their home. Tele-medicine requires a patient in their home to connect to electronic devices that send information back to care providers showing such things as blood pressure, pulse, and respiratory function, so that should intervention be required, a health care team can be sent directly to the patient's home. Finally, the Mary & John Elliot Charitable Foundation is a not for profit, charitable organization created to provide financial support to the various needs of EHS. The Foundation is committed to building an ongoing circle of friends whose financial support will help EHS identify and meet emerging healthcare needs.Elliot Hospital and Affiliates (collectively EHS), work collaboratively and collectively (through the EMR), allowing EHS to serve the health care needs of people in the most efficient manner and has provided a platform for proactive plans for health management. Part VI, Line 7, Reports Filed With States NH 1 Child Advocacy Center of Hillsborough County 960 Auburn Street Manchester NH 03103 900524874 501(c)(3) 410000 0 To assist in meeting day-to-day operations. Manchester Community Health Center 1415 Elm Street Manchester NH 03101 020458174 501(c)(3) 300000 To assist in meeting day-to-day operations. 2 0 Part I, Line 2: Elliot Hospital maintains members on the Board of Directors for the Child Advocacy Center and Manchester Community Health Center. Additionally, activities of both organizations align with the Hospital's mission in the community and with the Hospital's implementation plan developed from its most recent CHNA. Additional monitoring is not deemed necessary. X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 Christopher S Calhoun MD Trustee (until 1/16) 0 169922 0 0 0 0 0 17062 0 16558 0 203542 0 0 Gus Emmick MD Trustee 0 257384 0 0 0 0 0 14451 0 16341 0 288176 0 0 Lawrence M Hoepp MD Trustee 0 887445 0 0 0 18000 0 13250 0 12435 0 931130 0 0 Anita R Ritenour MD Trustee (until 1/16) 326686 0 21374 0 18000 0 24226 0 17268 0 407554 0 0 0 James L Woodward CEO 677538 0 202583 0 32194 0 204256 0 17476 0 1134047 0 0 0 Richard A Elwell CFO (until 12/15) 402046 0 116667 0 26701 0 82653 0 12630 0 640697 0 0 0 John E Friberg Jr Senior VP, General Counsel 337201 0 70738 0 5195 0 35282 0 17611 0 466027 0 0 0 William G Baxter Senior VP, Medical Affairs 394179 0 87609 0 18000 0 43297 0 17777 0 560862 0 0 0 Craig Williams COO 381557 0 35417 0 0 0 0 0 449 0 417423 0 0 0 Alexander W Petron MD Physician 295046 0 59675 0 17550 0 13250 0 17780 0 403301 0 0 0 James Kulle MD Physician 244119 0 33427 0 0 0 3975 0 10429 0 291950 0 0 0 Marc Cullerot VP of Finance 251422 0 39713 0 0 0 0 0 472 0 291607 0 0 0 Douglas F Dean Former President & CEO 163169 0 0 0 88740 0 46298 0 12470 0 310677 0 70740 0 Richard Phelps Former President & COO 13122 0 47769 0 473146 0 0 0 11106 0 545143 0 13154 0 Part I, Line 1a Richard Elwell, CFO, had a social club membership during the filing period for which the Hospital paid $6,700. James Woodward, CEO, was provided a housing allowance of $8,444 for his relocation to the area during the fiscal year. The aforementioned fringe benefit amounts are included as additional taxable compensation for each employee. Part I, Lines 4a-b Richard Phelps received a severance payment of $459,992 in 2015. 2015 contributions to the 457(f) plan during the year were: James Woodward-$191,006; Richard Elwell-$82,653. Part I, Line 7 The Organization has adopted an incentive pay program that provides designated management employees an opportunity to earn a designated percentage of salary based on the achievement by the Organization of a number of critical success factors. The critical success factors are established annually by the independent executive compensation committee of the Board of Trustees with assistance from an independent national compensation consulting company. The maximum potential incentive payments under the plan are considered by the compensation consultant in ensuring that management compensation is reasonable. Form 990, Part VII-A and Schedule J, Part II: Jeffrey Rooney, who served as Chief Financial Officer during the fiscal year covered by this 990 filing, was a contracted employee through Martinville Dunn, LLC, an unrelated organization. Compensation, totaling $291,819, was paid to the LLC by the Hospital for his services. As the fees paid to Martinville Dunn, LLC were paid for Mr. Rooney's services to the entire related party system, an accurate breakdown of this fee relative to the filing organization is not readily determinable. In accordance with IRS instructions, this fee is not to be reported as compensation on Form 990, Part VII-A or Schedule J, Part II. Rather, it is disclosed in Schedule O for Form 990, Part Part VI, Line 3 and further described in the supplemental information section of Schedule J, Part III. See also, Schedule L. Schedule J, Part II: During the year Mr. Dean and Mr. Phelps withdrew funds from their deferred compensation plans ($70,740 and $13,154, respectively). These amounts are reported as taxable compensation in Part II, Column B(iii). It should be noted that these amounts were reported in prior years as deferred compensation in Part II, Column C. Accordingly, these amounts are also reflected in Part II, Column F. A Business Finance Authority of the State of NH 020279866 64468KBQ8 2009-12-22 130000000 Finance/refinance costs of construction; Refinance 2008 bonds 0 0 0 B NH Health & Education Facilities Authority 020279866 2013-09-30 17021000 Refund outstanding prinicipal of 2003 revenue bonds; pay issuance costs 0 0 0 A 930000 127806119 11499845 6134168 30000000 1980498 78095644 2011 1 1 1 1 B 2362583 17021000 132029 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/30/2016 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 09/30/2016 Dianne M Mercier Board Member 0 Ms. Mercier is President of People's United Bank, which is a depository for Granite Shield Insurance Exchange of which Elliot Hospital was a member for part of the year. 0 Martinville Dunn LLC Chief Financial Officer 291819 Jeffrey Rooney, who served as Chief Financial Officer during the reporting period, was an officer of Martinville Dunn, LLC, an unrelated organization paid by Elliot Hospital for Mr. Rooney's services as CFO to the entire health system. As the fees paid to Martinville Dunn, LLC were paid by the Hospital for Mr. Rooney's services to the entire related party system, an accurate breakdown of this fee relative to the filing organization is not readily determinable. Therefore, the entire payment made to Martinville Dunn, LLC has been disclosed here. 0 Form 990, Part VI, Section A, line 3 Jeffrey Rooney, who served as Chief Financial Officer during the fiscal year covered by this 990 filing, was a contracted employee through Martinville Dunn, LLC, an unrelated organization. Compensation, totaling $291,819, was paid to the LLC by the Hospital for his services. As the fees paid to Martinville Dunn, LLC were paid for Mr. Rooney's services to the entire related party system, an accurate breakdown of this fee relative to the filing organization is not readily determinable. In accordance with IRS instructions, this fee is not to be reported as compensation on Form 990, Part VII-A or Schedule J, Part II. Rather, it is disclosed in Schedule O for Form 990, Part Part VI, Line 3 and further described in the supplemental information section of Schedule J, Part III. See also, Schedule L. Form 990, Part VI, Section A, line 6 Elliot Health System is the sole member of The Elliot Hospital of the City of Manchester. Form 990, Part VI, Section A, line 7a Elliot Hospital is governed by a Board of Trustees identical in composition to its sole member, Elliot Health System. Form 990, Part VI, Section B, line 11 The completed Form 990 is presented to the full Board prior to filing. Board members can review the draft and bring any questions forward for discussion prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors, and key employees are required to sign a conflict of interest form annually, which reports any potential conflict of interest arrangements with the organization. Form 990, Part VI, Section B, line 15 The compensation committee of the Board utilizes outside compensation consultants to evaluate the salaries for the CEO, CFO, and COO. The consultants utilize their internal data along with national and local benchmark data from the industry to develop salary levels. Recommendations of the consultant are reviewed by the compensation committee, who recommends compensation levels to the full Board for approval. An outside consulting firm is also used by the organization to review the compensation of the remainder of the Vice Presidents. Again, national and local benchmarks for salaries are consulted to determine salary levels for these positions. Form 990, Part VI, Section C, line 19 Each of these documents is filed with the New Hampshire Secretary of State and is available upon request. Form 990, Part VII: In March of 2017, former Elliot Health System's Chief Executive Officer, Douglas F. Dean, came out of retirement to again resume this role that he previously had held before retiring in June 2014. As this event occurred after the fiscal year covered by this Form 990 filing, he is being listed in Part VII as a "former officer" in accordance with IRS instructions. Form 990, Part IX, Column D: The Mary and John Elliot Charitable Foundations performs all fundraising activities on behalf of The Elliot Hospital of the City of Manchester. All fundraising expenses are reported on the Foundation's separate Form 990. Form 990, Part XI, line 9: Pension Adjustment -28,286,604. Transfer to Affiliates -25,815,000. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990, Parts VIII-XI: The consolidated audited financial statements for The Elliot Hospital of the City of Manchester and subsidiaries report various revenue, expense, asset, and net asset amounts for the Hospital inclusive of a related organization, Elliot Health System Professional & General Liability Trust (EIN: 01-6217452). All revenue, expense, and balance sheet items related to Elliot Health System Professional & General Liability Trust have been extracted from amounts reported for the Hospital on this Form 990 and all accompanying schedules. Elliot Health System Professional & General Liability Trust is a separate legal entity filing its own Form 990, and items related to it have been reported there. Elliot Health System 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509911 Management NH 501(c)(3) Line 11b, II N/A 0 Elliot Health System Professional & General LIT 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 016217452 Insurance Trust NH 501(c)(3) Line 11b, II Elliot Hospital 1 Elliot Hospital Associates 1 Elliot Way Manchester NH 031033599 026006214 Auxiliary NH 501(c)(3) Line 11d, III-O 0 Elliot Physician Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509589 Physician Services NH 501(c)(3) Line 3 Elliot Hospital 1 Elliot Professional Services Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 Physician Services NH 501(c)(3) Line 9 Elliot Hospital 1 Everwell Inc 1 Medical Center Drive Lebanon NH 03756 352506275 Supporting Organization NH 501(c)(3) Line 11a, I N/A 0 Mary and John Elliot Charitable Foundation 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512229 Fundraising NH 501(c)(3) Line 7 Elliot Health System 0 VNA Community Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020396549 Nursing Services NH 501(c)(3) Line 9 Elliot Health System 0 VNA Home Health and Hospice Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020222241 Home Care and Hospice NH 501(c)(3) Line 9 Elliot Health System 0 VNA of Manchester & Southern NH & Subs 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395296 VNA Holding Company NH 501(c)(3) Line 11b, II Elliot Health System 0 VNA Personal Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395295 Private Health and Homemaker Services NH 501(c)(3) Line 9 Elliot Health System 0 Elliot Common Trust Fund LLC 1 Elliot Way Manchester NH 03103 203653624 Investments NH Elliot Hospital Excluded 2696192 86063263 0 -4468 0 0.86000 Elliot Health System Holdings & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512224 Management NH N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 Elliot Professional Services Network K 206617 Cash Elliot Professional Services Network P 4048815 Cash Elliot Physician Network P 243454 Cash Elliot Professional Services Network Q 11264055 Cash Elliot Physician Network Q 17156355 Cash Elliot Hospital Associates P 108000 Cash Schedule R, Part II: Everwell, Inc. was formed in 2014 as a 501(c)(3) organization. It is a joint venture between Elliot Health System and Dartmouth-Hitchcock Health, with each entity having equal representation on the Board of Directors. Elliot Health System 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509911 0 0 0 81 81 16 4 0 0 0 VNA of Manchester & Southern NH & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03101 020395296 0 0 0 17646081 17646081 1000000 250000 0 0 0 The Elliot Hospital of the City of Manchester 1 Elliot Way Manchester NH 03103 020232673 X 0 267256 267256 385472616 385739872 1000000 250000 0 0 0 Elliot Professional Services Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 0 0 0 83291784 83291784 1000000 250000 0 0 0 Elliot Physician Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509589 0 0 0 38703077 38703077 1000000 250000 0 0 0 Elliot Health System Holdings Inc & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512224 0 0 0 26161662 26161662 1000000 250000 0 0 0 Mary and John Elliot Charitable Foundation 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512229 0 0 0 2191342 2191342 259567 64892 0 0 0 Elliot Common Trust Fund LLC 1 Elliot Way Manchester NH 03103 023653624 0 0 0 706315 706315 130947 32737 0 0 0 Elliot Health System Professional & General Liability Insurance Trust 1 Elliot Way Manchester NH 03101 016217452 0 0 0 1747474 1747474 237374 59344 0 0 0