2016-11-14T08:12:39-06:00 2015-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2015-01-01 020260334 Wentworth-Douglass Hospital WENT 6037425252 789 Central Avenue Dover NH 038202526 Peter E Walcek CFO/V.P. of Finance 6037422804 2016-10-26 1 Nicholas E Porto P01310283 2078792100 2016-10-26 2015 2017-02-10 21:41:12Z Gregory J Walker 789 Central Avenue Dover NH 038202526 319025664 0 X www.wdhospital.com X 1905 NH Help individuals and their families attain their highest level of health. 16 10 2046 182 271286 0 650214 185995 278986224 295574889 5600927 3201407 3174294 3991739 288411659 302954030 422784 601106 0 0 117782152 122756613 0 0 0 131218575 131817023 249423511 255174742 38988148 47779288 444140997 458061852 190257126 191124100 253883871 266937752 X Wentworth-Douglass is the largest acute care hospital in the Seacoast region of New Hampshire and Southern Maine, specializing in Trauma and Emergency Services, Surgery, Cancer Care, Birthing, Orthopedic Services, Cardiovascular Services, Sleep Disorders, Rehabilitation, Pain Management, Wound Healing, Wellness and Prevention Programs, plus extensive diagnostic services.A healthcare leader in the Seacoast region since 1906, Wentworth-Douglass Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. 0 0 222734850 601106 297602071 Wentworth-Douglass Hospital (WDH or the Hospital) is an acute care hospital located in Dover, New Hampshire. WDH is a not-for-profit organization, as described in Section 501(c)(3) of the Internal Revenue Code. Wentworth-Douglass Hospital is the largest acute care hospital in the Seacoast region of New Hampshire and Southern Maine, specializing in Trauma and Emergency Services, Surgery, Cancer Care, Birthing, Orthopedic Services, Cardiovascular Services, Sleep Disorders, Rehabilitation, Pain Management, Wound Healing, Wellness, and Prevention Programs plus extensive diagnostic services. A healthcare leader in the Seacoast since 1906, Wentworth-Douglass Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. (continued on Schedule O)At Wentworth-Douglass Hospital (WDH), we are committed to serving our community and addressing the needs of all our patients. Our community benefit programs are available to local residents with income at or below 250% of Federal Poverty Level guidelines, one of the most generous programs in the State of NH. WDH files an annual Community Benefits Report with the State of NH which outlines the community and charitable benefits provided. Numerous programs were developed to assist people in the area we serve, including Financial Aid, Behavioral Health Services, Family Resource Counselor Program, Financial Assistance Services, Physician Referral Services, Care-Van transportation services, and Wentworth-Douglass Community Dental Center. The Hospital provided $15,976,700 (as measured by gross charges) of community assistance programs in 2015. In total, the Hospital and WDPC together provided $16,792,000 (as measured by gross charges) of community assistance programs in 2015.The Hospital's core programs include our Cancer Center, Emergency Department, and Surgical Services. In addition, WDH offers other key services in the areas of Women's and Children's Services and Cardiology Services.1. The Seacoast Cancer Center at Wentworth-Douglass Hospital offers the most comprehensive cancer treatment services covering the Seacoast region of New Hampshire and Southern Maine. Founded over 30 years ago as a single room adjacent to the Emergency Department, the Cancer Center's services now include extensive, state of the art medical and radiation oncology diagnostic services with multiple treatment options. A multidisciplinary Chest Clinic, located in the Seacoast Cancer Center, saw its first patients in October 2008. The medical team focuses on timely access to services for patients with lung nodules and lung cancer. 2. The Emergency Department at Wentworth-Douglass Hospital has one of the highest volume of visits in the State of New Hampshire. Close linkages to local emergency services personnel and Fire & Rescue Departments continue to extend the skill and capabilities of the Department. Through internal and external education efforts, the Emergency Department focused on improving patient care for specific types of heart attack (STEMI) and stroke. The Department's efforts in the Fall of 2008, through a clinical collaboration with Massachusetts General Hospital, created the Stroke Initiative to form a center of excellence for stroke care. In October 2009 the American Heart/Stroke Association awarded WDH the Bronze Award for achieving its high standard, quality guidelines for six consecutive months. In 2011, the Hospital received a Gold Plus Award from The Joint Commission for 24 consecutive months of achievement at the Stroke Center.To accommodate increasing patients the Department also added additional space for six treatment rooms and opened a Walk-In Express Care Centers in both Dover and Lee, NH to support the growing population areas in the towns surrounding Dover and Lee.The Hospital's generous Charity Care Program offers emergency, walk-in and other hospital services at no charge for qualifying patients at 250% of the Federal Poverty Level. 3. Surgical Services at WDH include a wide array of services and technological advances frequently associated with larger medical centers. A renovation to enlarge operating rooms created digital ORs and space for new equipment such as the da Vinci Robotic Surgical System. Now in its eighth year, the robotic program began with OB/GYN surgeons, and now includes Thoracic, General Surgery and Urology. Another clinical collaboration with MGH at WDH brings a GYN/Oncology surgeon to WDH to perform "medical center" surgery in the community setting, eliminating the time and the frustration of travel to and parking at metropolitan cities.A range of minimally invasive procedures including Robotic Surgery, Single Incision Laparoscopic Surgery (SILS) used by general surgeons and Video Assisted Thoracic Surgery (VATS) procedures used by the thoracic surgeon offer patients the benefits of complex surgery with less blood loss, less infection and faster recovery.The Joint Replacement Program introduced in 2006 offers a unique approach to joint replacement surgery with pre-op group education and post-op group rehab. Surgeons, anesthesiologists, nursing, rehab and nutrition staff worked collaboratively to create this new approach to joint replacement care. In 2009, the Hospital created the Northern New England Spine Center, a partnership of specialists to coordinate and expedite the care of patients with neck and back pain. The Spine Center members include a spine surgeon, physiatry specialists, pain specialists, WDH rehab, behavioral health specialists and a WDH Spine Coordinator. The virtual center holds bimonthly multidisciplinary conferences to coordinate the care and treatment of Spine Center patients.Other Services:In addition to the services listed above, Wentworth-Douglass Hospital offers traditional services with non-traditional components. One example is The Birth Center. Currently The Birth Center is the fastest growing birthing service in the Seacoast area with over 1,000 births per year. In an effort to support a small but growing and young Indonesian population, The Birth Center translated all forms and information for new mothers into Indonesian. Local church groups welcomed Indonesian families into their communities.Cardiology Services recently replaced the cath lab with new equipment and the Department added Non-Invasive Cardiovascular Services at a new, offsite medical office building in Dover, extending the options now available for patients. A second cardiovascular interventional lab was opened late in 2010 to accommodate growing patient volume and urgent cases.All the Community Assistance (Benefit) Services support low income, uninsured individuals and families in the Hospital's service area with Charity Care (Financial Assistance), the Wentworth-Douglass Community Dental Center, and the Care-Van free patient transport service. 222734850 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 1 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 261 0 1 2046 1 1 1 0 0 0 0 0 0 0 0 0 X 16 10 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X X Peter E Walcek CFOVP of Finance 6037402804 789 Central Avenue Dover NH 038202526 X Michael Bolduc Esq Trustee 0.50 1.00 X 0 0 0 Gerald Daley EdD Trustee 0.50 1.00 X 0 0 0 Peter J Dirksmeier MD Trustee 2.00 1.00 X 0 0 10115 David Flavin MD Trustee 2.00 1.00 X 10505 0 5202 Neil Garvey Trustee 1.50 1.00 X 0 0 0 Anne Kalter MD Trustee 0.50 43.50 X 92707 248620 29275 Terri Lally MD Trustee 1.00 1.00 X 15117 0 13703 John Novello MD Trustee 5.00 50.00 X 0 310617 29492 Donna Rinaldi Trustee 0.50 1.00 X 0 0 0 Theodore Ristaino Trustee 0.50 1.00 X 0 0 0 Steven C Webb Trustee 0.50 1.00 X 0 0 0 Roger Hamel Chairman 3.00 4.00 X X 0 0 0 Carol Bailey Vice Chairman 3.00 2.00 X X 0 0 0 Michael Steinberg Treasurer 1.00 4.00 X X 0 0 0 John Salmon Secretary 3.00 2.00 X X 0 0 0 Gregory J Walker President/CEO 50.00 5.00 X X 807205 0 154460 Peter E Walcek CFO/VP Finance 50.00 5.00 X 438479 0 96082 Paul R Cass DO VP Medical Affairs/CMO 50.00 5.00 X 453027 0 90800 Ellen L Caille FACHE Executive Vice President 50.00 5.00 X 391139 0 84401 Malcolm D Rosenson MD Chief Quality & Safety Off 50.00 0.00 X 329250 0 38873 Sheila M Woolley CNO/VP Patient Care 50.00 0.00 X 334886 0 57105 Daniel N Dunn COO/Sr. VP Operations 50.00 0.00 X 294384 0 34147 3166699 559237 643655 120 0 1 0 Cerner Health Services Inc 51 Valley Stream Parkway Malvern PA 19355 Healthcare IT Support 2300854 Sodexo Inc & Affiliates 9801 Washington Boulevard Gaithersburg MD 20878 Food Services/ Management 1642862 American Healthcare Services Association PO Box 845 Traverse City MI 49685 Staffing Services 1433611 Mass General Physicians Organization 55 Fruit Street Boston MA 02114 Physician Services 1351941 Audit Billing Center Inc 29 Winter Street Pembroke MA 02359 Billing Services 1101308 67 46392 139603 185995 Patient service revenue 621400 286209621 286209621 Disproportionate Share Funding 621400 4815728 4815728 Miscellaneous Revenue 621400 2247806 2089100 158706 Cafeteria 722320 1300801 1259318 41483 Child care service 624410 1000933 1000933 295574889 3258317 71097 3187220 2139844 375476 1764368 1764368 1764368 15639248 15696158 -56910 -56910 -56910 Granite Shield 621990 1230397 1230397 Meaningful Use 621400 667928 667928 Transcription 621400 329046 329046 2227371 302954030 297602071 271286 4894678 X 601106 601106 1643575 147349 1496226 92605496 78765313 13840183 3160598 2686508 474090 16590273 14101732 2488541 8756671 7443170 1313501 1281544 1281544 83709 83709 156062 156062 14049072 13354765 694307 1712685 1712685 4139097 3518237 620860 3794559 2978729 815830 179136 134352 44784 268703 201527 67176 7095700 6740915 354785 16209746 13778284 2431462 2391588 2272009 119579 Medical Supplies/Equipm 23048851 19591523 3457328 Pharmacy 18905361 18905361 NH MET 14751461 14751461 Provision for bad debt 11142070 11142070 12607679 9907754 2699925 255174742 222734850 32439892 0 92262 84377 42956190 40667833 29261132 31561120 653033 731397 3075305 3612673 10904429 11453491 369895915 224855398 147219167 145040517 133603063 136797516 53841862 49573127 15319714 19258742 1203936 1156022 6010904 18125037 444140997 458061852 53553742 53623283 2894739 4098670 107114820 104391195 10752974 10555094 15940851 18455858 190257126 191124100 X 250640058 262706459 1629369 1980760 1614444 2250533 253883871 266937752 444140997 458061852 X 47779288 -6695351 -28030056 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 26669 0 0 0 26669 0 Part II-B, Line 1: NHHA, portion of dues allocated to lobbying, $19,773 AHA, portion of dues allocated to lobbying, $6,896 184151455 1064676 2011173 201173 183003785 155843253 29213049 720042 184805 184151455 141970819 24584570 10712136 155843253 131278421 3700 26708184 16019486 141970819 99989314 27460290 3851272 22455 131278421 0.96920 0.00450 0.02630 0 0 3292772 3292772 143289328 57107927 86181401 19739976 6636443 13103533 148087235 121039572 27047663 55486604 40071456 15415148 145040517 Alternative Investments 49573127 F 49573127 Est. Third-Party Payor Settlement 18455858 18455858 X 265760926 -6695351 -6695351 272456277 156062 30341691 30497753 302954030 253214050 0 253214050 156062 1804630 1960692 255174742 Part V, Line 4: To further the Hospital's charitable mission. Part X, Line 2: WDHS, the Hospital, WDPC and the Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Management evaluated these not-for-profit corporations' tax positions and concluded these not-for-profit corporations have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 4b - Other Adjustments: Investments in Joint Ventures 28,537,061. Community Benefit and Other Expense 1,804,630. Part XII, Line 4b - Other Adjustments: Community Benefit and Other Expense 1,804,630. Central America and the Caribbean - 0 0 Investments - FMV as of December 31, 2015 NONE 26649168 0 0 0 0 0 0 26649168 0 26649168 1 0 1 1 0 0 Part IV, Line 3: This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Part IV, Line 4: The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital. 1 1 1 X 250.000000000000 0 1 1 0 1 1 3029667 3029667 0.01240 35722908 17810310 17912598 0.07340 38752575 17810310 20942265 0.08580 952975 952975 0.00390 19583 19583 0.00010 27398 27398 0.00010 700870 700870 0.00290 1700826 1700826 0.00700 40453401 17810310 22643091 0.09280 0 11142070 1167649 69942010 99954721 -30012711 X 1 1 1 1 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 038202526 www.wdhospital.com 00010 X X X Wentworth-Douglass Hospital 1 0 0 1 X X X X X X X X 13 1 0 1 1 X See Part V, Section C X 1 13 1 See Part V, Section C 0 0 1 X 250.000000000000 250.000000000000 X X 1 1 X X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X 1 X 0 X X X X 1 X 0 0 Wentworth-Douglass Hospital Part V, Section B, Line 5: Wentworth-Douglass Hospital held five (5) focus groups to engage consumers, providers and key leaders in the Community Health Needs Assessment (CHNA). Participants were identified and recruited by the Hospital, including members of the public, community organizations, local government officials, and health, education and social service providers. Four of the groups were from geographic areas that represent our community. A provider group was comprised of physicians, nurses, social workers, and program directors. An invitation letter, confirmation letter, and focus group discussion guide were developed to recruit and facilitate the five (5) groups. All of these documents, as well as demographic characteristics of respondents and their ratings are tabulated in the appendices of the CHNA report. Wentworth-Douglass Hospital Part V, Section B, Line 6b: The Hospital's most recent CHNA was conducted with Wentworth-Douglass Physician Corp (WDPC), a related 501(c)(3) entity. Wentworth-Douglass Hospital Part V, Section B, Line 11: The Top Five Community Health Needs include Mental Health, Transportation, Drugs & Alcohol, Access to Primary Care, and Education/Nutrition Education. WDH has organized and implemented the following services and programs to begin to address these needs. 1. Mental Health and Behavioral Health: Mental and behavioral health was identified as the top community health need in the 2013 CHNA. The recommendation was to expand access to mental and behavioral health services to meet the "urgent need" for these services by increasing the integration of mental health services and primary care services. In 2014, two new behavioral health services were funded. The first expanded access to behavioral health counselors in the Wentworth-Douglass Health System's primary care practices within WDPC. These services were expanded, in collaboration with Great Bay Mental Health Services and Goodwin Community Health (the local Federally Qualified Health Center), and made access to behavioral health counselors available to patients at all WDPC primary care practices. In 2015, this program expanded to include an additional psychiatric nurse practitioner. The second service included the addition of a full-time psychiatric case worker to provide case management of behavioral health patients waiting for long periods in the Emergency Department for evaluation and placement/treatment. This position, through collaboration with community partners, helped patients being held longer than 24 hours in the emergency department, to receive appropriate services and avoid involuntary placement, if possible, by connecting the patients to community resources including the behavioral health counselors in WDPC's practices. This unique role has helped to reduce the number of days spent in the emergency room, prevent readmissions, and improve patient care. In 2015, WDH has been able to discharge 14% of qualified patients at least one day early. Each of these programs is a move forward in reducing the lack of services and stigma of mental health/behavior health while improving overall patient care in the community. 2. Transportation: Second to mental and behavioral health services, the need for transportation to physician practices was recommended by each focus group and identified as one of the top five community health needs. The recommendation was to develop and/or support a community Care-Van service to provide transportation for patients to and from physician practices. Due to legal restrictions and high demand for services, the Care-Van service has continued to limit service to hospital-based services only, but has increased visit volume by 5% and increased the number of miles traveled by 9% from 2014 to 2015. Additionally, WDH has continued to sponsor a community van service in collaboration with a local housing authority. 3. Drugs & Alcohol Abuse:The increase in drug and alcohol abuse was listed as one of the top five community health needs in WDH's 2013 CHNA. In response, WDH applied for and in 2014 was selected to participate in the New Hampshire Youth SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program which was partly funded with grant support from the New Hampshire Charitable Foundation and the Conrad N. Hilton Foundation. This program incorporates an evidence-based SBIRT approach to screening patients ages 12 to 22 to identify alcohol and drug use problems early when brief interventions are most effective and to foster appropriate referrals to early and effective treatment for substance abuse disorders. The SBIRT Program launched in 2015 as a pilot program. Additionally, WDH has continued to support the efforts of the Strafford County One Voice coalition. This group of community agencies and individuals has developed collaborative efforts to address the challenges of substance misuse in Strafford County. This group developed the Strafford County Drug Task Force which meets monthly at Goodwin Community Health, the local Federally Qualified Health Center, and focuses on aligning the many efforts going on in this community. Since 2013, WDH has also hosted and supported the annual spring Strafford County Drug Summit with over 200 attendees from the county, the surrounding region and across the state. WDH has also provided support, including meeting space and materials, to help expand a new service provided by SOS and the Dover Police with collaboration with the Dover Fire Department. This new service allows individuals seeking services for substance misuse treatment to be transported from the Dover Police Station to the Hospital, where they then meet with one of the certified recovery coaches through the SOS Recovery Program. 4. Primary Care Access:Various initiatives were implemented in 2014 and expanded in 2015 to help address the community need for greater access to primary care services. The first initiative focused on improving access to primary care by reducing wait times for appointments and promoting practices accepting new patients. The second initiative focused on extending same day access for primary care services. WDH opened its second walk-in, urgent care facility, Wentworth-Douglass Express Care in Dover, New Hampshire on June 30, 2014. This location expanded access to acute, non-emergent care and continues to experience increasing volumes in 2015. In addition to this initiative, WDPC also opened a new walk-in primary care service, Prompt Care, to improve access for existing WDPC patients. Hours of operation are Monday-Friday 7:00 a.m. - 8:00 p.m. and Saturday and Sunday 8:00 a.m. - 4:00 p.m. The third initiative focused on implementing a patient portal to extend patient access to primary care by providing patients the ability to view and share their medical record, request prescription refills, schedule appointments, and ask a provider a question on their computer. 5. Expand Education/Prevention Programs: Expanded education and prevention programs were identified a one of the top five community needs. In response, WDH offered a variety of education/prevention programs for the community. A sampling of these education/prevention programs include: health screenings (e.g. skin cancer screening, hand pain, vascular, nutrition, and more), nutrition, health, and wellness lectures (e.g. heart health, sexual health, and anti-cancer), health fairs (e.g diabetes, women's health, communication access), support groups (e.g. cancer survivors, grief support, caregiver support), and children's camps and programs (e.g. Camp Hot Shot, Camp Lance-A-Lot, CHaD story time), and insurance marketplace education and support. Wentworth-Douglass Hospital Part V, Section B, Line 13b: In the 2015 Financial Assistance Policy, for all covered services (except for Dental Center services), eligibility was determined based on Income at 250% Federal Poverty Guidelines (FPG) and Asset Guidelines (see narrative for Part I, Line 3c), and eligibility was not contingent upon residency. Eligible patients received 100% free care. Wentworth-Douglass Hospital Part V, Section B, Line 15e: In the 2015 Financial Assistance Policy, Financial Assistance Representatives were available to assist with any questions regarding the Financial Assistance Application Process and/or Policy. The Financial Assistance Application Packet included a coversheet which outlined required documentation. Representatives were available over the phone at (603) 740-3234 or in person at the Financial Assistance Office: Wentworth-Douglass Business Systems Building, 121 Broadway Avenue, Dover, NH 03820. Wentworth-Douglass Hospital Part V, Section B, Line 22d: FAP eligible patients are discounted 100%, therefore no amounts are charged and free care is provided. Part V, Section B, Line 7a & 10a: The CHNA is available on the Hospital's website at:https://www.wdhospital.com/workfiles/WDH%20Community%20Health%20Needs%20Assessment%202013.pdfThe Implementation Strategy is available on the Hospital's website at: https://www.wdhospital.com/workfiles/2013%20CHNA%20Implementation%20Strategy(v3).pdf Part V, Section B, Line 16a, 16b, & 16c: The Hospital's Financial Assistance Policy is available on its website at: https://www.wdhospital.com/files/4114/5288/2465/Financial_Assistance_Policy_-_Full_Version.pdfThe Hospital's Financial Assistance application form is available on its website at: https://www.wdhospital.com/files/1614/6227/3319/8241-41A.pdfThe Hospital's Plain Language Summary can be accessed at: https://www.wdhospital.com/files/2214/5288/2473/Financial_Assistance_Policy_-_Plain_Language.pdf 8 1 - Seacoast Cancer Center 10 Members Way Suite 200 Dover NH 03820 Specialty Care Practice 2 - Lee OTPTImaging 65 Calef Highway Lee NH 03861 Occupational/Physical Therapy/Imaging 3 - Express Care Dover 781 Central Avenue Dover NH 03820 Express Care 4 - WDH Professional Center 10 Members Way Dover NH 03820 Diagnostic Services 5 - Express Care Lee 10 Members Way Suite 200 Dover NH 03820 Express Care 6 - Diagnostic Cardiology 19 Old Rollinsford Road Dover NH 03820 Cardiology Services 7 - Durham Rehab & Sports Therapy Center 16 Jenkins Court Durham NH 03824 Specialty Care Practice 8 - WDH Early Learning Center 789 Central Avenue Dover NH 03820 Childcare Services Part I, Line 3c: In the 2015 Financial Assistance Policy, eligibility was determined based on Income and Assets. Income: To be eligible, an individual's gross annual income could not be greater than 250% of the Federal Poverty Guidelines (FPG), which included alimony, dividends, stipends, social security benefits, employment, self-employment/business income, child support, pensions, annuities/retirement income, rental income and interest income. Assets: To be eligible as a household of 1, combined asset limits could not exceed $5,000 and to be eligible as a household greater than 1, combined asset limits could not exceed $10,000. Assets considered were checking/savings bank accounts, certificates of Deposits (CDs), money markets, stocks/bonds/mutual funds, trusts, additional properties, gambling winnings, capital gains, inheritances, and retirement account(s) currently being contributed to. Part I, Line 6a: N/A Part I, Line 7: The Hospital uses the ratio of cost to charge methodology to calculate the cost of the community benefits it provides. The ratio of cost to charge methodology was also used to reduce charity care charges down to costs and calculate the Medicaid shortfall.In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital refined our approach to calculating the RCC used to adjust charges to cost for reporting on Financial Assistance, Medicaid and Medicare allowable costs. The Hospital includes the net impact of the New Hampshire Medicaid Enhancement Tax (MET) and Disproportionate Share Funding (DSH) in calculating the Ratio of Patient Care to Cost (RCC) to determine the percentage allocation to use in determining the financial assistance at cost and Medicaid net community benefit expense. Additionally, the Hospital includes the net MET/DSH impact as an expense in Part I, Line 7b in arriving total Medicaid-related costs. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure. 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 $ 11,142,070. Part II, Community Building Activities: See Form 990, Part III, Line 4a. Part III, Line 2: In 2015, charges billed by the Hospital of $11,142,070 were to provide care to patients, for which the Hospital received no payments for services rendered. In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital is now reporting bad debt expense on a charge basis rather than on the cost basis. Part III, Line 3: In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital refined our approach to calculating the estimated amount of the Hospital's bad debt expense attributable to patients eligible under the organization's financial assistance policy. The Hospital utilizes the percentage of applications that are denied under the Financial Assistance Policy due to incomplete applications as a reasonable basis for calculating the percentage of bad debt that may be considered as eligible under the Financial Assistance Policy. This amount is reported at cost, and is not reported as a community benefit within Part 1, Line 7. Part III, Line 4: See Page 8 and 15 of the attached audited financial statements. Part III, Line 8: In 2015, the Hospital provided care costing $99,954,721 to Medicare patients, for which it was reimbursed $69,942,010, representing a loss on Medicare services of $30,012,711. This amount represents the amount by which the Hospital was underpaid (relative to cost) by the federal government for care provided to Medicare patients, who are 65 and older, regardless of income or disability. The Hospital includes the net New Hampshire Medicaid Enhancement Tax (MET)/Disproportionate Share Funding (DSH) impact as an expense within Part III, Section B. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure. Part III, Line 9b: Hospitals in New Hampshire work hard to make high-quality health care available, affordable, and accessible to all, regardless of ability to pay. Wentworth-Douglass Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community obtaining the health care services that he or she may need. If payment of health care expenses creates a financial hardship for patients, our staff provides assistance to complete the financial application process. The Hospital follows the written policy and consistently applies the policy to all patients and treats all patients equally, regardless of ability to pay.As part of this financial application process, the Hospital will assess patients' eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and Maine Medicaid. If it is determined that patients may be eligible for one of these programs, the Hospital assists patients through the application process. Patients are required to supply the financial or medical documentation that is necessary to secure such insurance coverage.The Hospital understands that health care costs can come up unexpectedly. Whether patients are insured or uninsured, and whether or not patients qualify for financial assistance, we understand that patients may have difficulty paying healthcare costs in full at the time of service or in a lump sum. Our billing team works with patients to set up interest-free payment plans to help ease the financial burden of health care costs. Part VI, Line 2: WDH assesses the health care needs of the communities it serves in many ways. The first of which includes the formal Community Health Needs Assessment process which is led by Hospital's Community Benefit Task Force. The 2013 CHNA process included an extensive data analysis and community focus groups. The focus group finding were then evaluated in collaboration with the county level Adult Behavioral Health Risk Factor Surveillance data to identify the top 5 community health needs. WDH, in collaboration with the New Hampshire Foundation for Healthy Communities, partnered (in Fall 2015) with RKM Research and Communications, Inc. to conduct a community needs telephonic survey. The purpose of this survey was to assist WDH in identifying the health care needs of the communities it serves. The findings from this survey will be included in the 2016 Community Health Needs Assessment (CHNA) and reported in the Primary Data section of the report. In addition, WDH also assesses community need on an ongoing basis through both formal and informal channels. On a monthly basis, WDH receives input and feedback on community need from the WDH Patient and Family Advisory Board and the Hospital and Health System Board of Directors. Community need is also assessed on an annual basis as part of WDH's Strategic Planning process which includes a comprehensive assessment of health outcomes and health factors for the communities we serve, and in the Health System's provider need assessment which includes an analysis of provider supply and demand to ensure adequate and appropriate resources are available to meet the need of our community. Part VI, Line 3: WDH and WDPC take an active role in assisting patients who may be interested and qualify for financial assistance, whether it is state, federal or our own charity care benefits. Our Family Resource/Community Benefits Department has several processes in place to ensure patients are aware of the financial assistance available to them.Patients can learn more about these programs by visiting our website, reading our Foundation newsletters, or contacting our Financial Assistance Office. From the time of registration through our billing process, patients have available the opportunity to obtain an application for financial assistance as well as our financial assistance policy. All self pay patients at the time of registration are provided with our charity care cover letter and application, with information about the charity care program and details on how to contact our Financial Assistance Representative(s). Our representatives also see many patients while they are here for services. Social Work Services and Community Benefits team up to assist and make sure our patients are receiving the opportunities to get any and all assistance available to them. We send five billing statements to our patients with the financial assistance guidelines and contact information if patients feel they may meet these guidelines and need assistance with their bill(s). Part VI, Line 4: Wentworth-Douglass Hospital serves the Seacoast area of New Hampshire and Southern Maine - Strafford County, Rockingham County and York County, Maine. Our community includes a small but growing Indonesian population, welcomed by local church groups. The community also includes low-income, uninsured adults and children supported by the Hospital's Community Assistance Plan programs. Part VI, Line 5: In 2015, the Hospital had 6 trained Certified Application Counselors (CACs). Representatives at the main hospital and offsite locations were available to assist. The Hospital also published and marketed this information to the community so that they could be made aware of the Hospital's available trained professionals. The Hospital assists enrollees from start to finish with the process. All of the Hospital's CACs spend a great deal of time providing education to the Hospital's many patients. Hundreds of patients looking for help in understanding the ACA, ACA terminology, and the differences between plans offered to them were provided assistance in person or via telephone. Part VI, Line 6: The affiliates of Wentworth-Douglass Hospital include Wentworth-Douglass Physician Corporation, Wentworth-Douglass Community Health Corporation, the Wentworth-Douglass Hospital and Health Foundation, and Wentworth-Douglass Health System. Our affiliates serve to further our mission of helping our patients and their families attain their highest level of health. The Wentworth-Douglass Physician Corporation was formed in response to a community needs assessment that identified a lack of primary care services in the community. The formation of the Physician Corporation and recruitment of primary care physicians closed the gap by improving access to primary care medical services in our community. Today, WDPC also provides a vast array of specialty physician services to the community.Wentworth-Douglass Physician Corporation (WDPC), d/b/a Wentworth Health Partners, which files its own Form 990 (see Schedule R for more details), is owned 100% by WDHS. The Hospital oversees all of WDPC's primary care practices, specialty practices, behavioral health services and its dental clinic. WDPC supports numerous community based programs, including the Community Dental Center and Behavioral Health Services. In 2015, WDPC acquired Great Bay Mental Health as part of the continued initiative to expand the services offered for behavioral health. WDPC provided $406,004 of behavioral health care services to patients.The Wentworth-Douglass Community Dental Center is open to low-income, uninsured adults and children living in the Hospital's primary service area (Dover, Durham, Madbury, Lee, Barrington, Somersworth, Rollinsford, NH and Berwick and So. Berwick, ME) or patients of the physician practices who have a family income at or below 300% of the federal poverty level, based on the number of members in the household. Minimum payments are charged on a discounted fee schedule based on household income. In 2015, the Dental Center provided $647,682 of community-based clinic services.WDPC provides financial aid information and resources to assist patients with their healthcare bills. Medical care is provided at no charge for eligible patients at 250% of the federal poverty level. In 2015, WDPC provided $422,134 of financial aid (stated at cost).Medicaid Costs Exceeding Reimbursement totaled $2,526,203 for WDPC in 2015.The Hospital subsidizes WDPC primary care practices that operate at a loss. The subsidized losses of these primary care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $5,171,668 in 2015. The Hospital subsidizes certain WDPC specialty care practices that operate at a loss. The subsidized losses of these specialty care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $3,334,725 in 2015. Wentworth-Douglass Community Health Corporation (The Works), a for-profit taxable subsidiary of WDHS, serves to promote community health and wellness, while remaining family focused. The Works offers specially designed and supervised fitness programs, aimed to help manage diabetes, lower risk of heart disease, and improve quality of life. In addition, the Hospital collaborates with The Works to offer group exercise programs to our patients, including Cancer Center patients, who are provided a free three month membership and invited to participate in a program that combines rehabilitation and group exercise. The Works also donates memberships as well as the use of its facilities and staff time to benefit various community organizations in support of health care initiatives.The Wentworth-Douglass Hospital and Health Foundation serves to cultivate, secure and steward philanthropic gifts that will support the capital, programmatic and endowment needs of Wentworth-Douglass Hospital.Wentworth-Douglass Health System was established to support and further the charitable activities of Wentworth-Douglass Hospital and Wentworth-Douglass Physician Corporation. It provides planning, oversight and coordination of the charitable activities related to the promotion of health of these entities. Part VI, Line 7, Reports Filed With States NH 1 City of Dover Fire and Rescue 262 Sixth Street Dover NH 03820 Government 138160 QA/AI program ECG Monitor and Defibrillation Equipment City of Dover Police 46 Chestnut Street Dover NH 03820 Government 125000 Youth to Youth Program and Dover Coalition for Youth Dartmouth Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 501(c)(3) 32340 Child Advocacy Program Strafford Health Alliance 200 Route 108 Suite 3 Somersworth NH 03878 020389434 501(c)(3) 132096 CFA-Athletic Training DHS Southern New Hampshire Service PO Box 5040 Manchester NH 03108 020268285 501(c)(3) 15000 Community Detox and Stabilization Services Goodwin Community Health 311 Route 108 Somersworth NH 03878 020304203 501(c)(3) 100000 Primary Care Services Amy's Treat PO Box 03821 Dover NH 03821 262350766 501(c)(3) 15000 Seacoast Cancer Center AIDS Response - Seacoast 7 Junkins Avenue Portsmouth NH 03801 222884488 501(c)(3) 7500 Support Program 8 0 Part I, Line 2: During the tax year 2015, WDH only made contributions to governmental entities or other 501(c)(3) public charities, additional monitoring is not deemed necessary. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 Anne Kalter MD Trustee 0 143846 0 86341 92707 18433 0 0 0 29275 92707 277895 0 0 John Novello MD Trustee 0 290691 0 18534 0 1392 0 9800 0 19692 0 340109 0 0 Gregory J Walker President/CEO 464287 0 145630 0 197288 0 125844 0 28616 0 961665 0 0 0 Peter E Walcek CFO/VP Finance 310787 0 60795 0 66897 0 66753 0 29329 0 534561 0 40500 0 Paul R Cass DO VP Medical Affairs/CMO 367330 0 69263 0 16434 0 71186 0 19614 0 543827 0 0 0 Ellen L Caille FACHE Executive Vice President 273673 0 53960 0 63506 0 55735 0 28666 0 475540 0 37500 0 Malcolm D Rosenson MD Chief Quality & Safety Off 298777 0 29081 0 1392 0 13699 0 25174 0 368123 0 0 0 Sheila M Woolley CNO/VP Patient Care 253000 0 33297 0 48589 0 36943 0 20162 0 391991 0 21320 0 Daniel N Dunn COO/Sr. VP Operations 246453 0 20928 0 27003 0 15035 0 19112 0 328531 0 0 0 Part I, Line 1a Certain retirement and fringe benefits for Gregory J. Walker (President/CEO) have been grossed-up utilizing the applicable marginal federal tax rate as the most efficient and cost effective means to fulfill the target benefit goal at retirement. Part I, Line 4b Gregory J. Walker (President/CEO) - 2015 total contributions to the 457(f) plan = $113,104. This supplemental retirement plan contribution is intended to fund benefits accruing and payable at retirement for multiple years of service that began in calendar year 1997. In 2015, the Hospital funded a supplemental executive retirement plan which provides benefits to other qualifying executives. The contributions are intended to provide a forfeitable supplemental retirement benefit and are being provided in consideration for many years of service to the Hospital. The respective contributions for the 2015 plan year, for those individuals identified in Schedule J - Part II, are as follows: Peter E. Walcek = $50,853, Paul R. Cass, DO = $57,936, Ellen L. Caille = $45,135, and Sheila Woolley = $24,702. The following individuals vested in their 2010 457(f) contributions during 2015: Peter E. Walcek = $40,500, Ellen L. Caille = $37,500, and Sheila Woolley = $21,320. The 2010 amounts are required to be reported on Schedule J, in Column F and as part of the taxable W-2 compensation reported in Column B(iii) of this Form 990. WDH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by the employer. Pursuant to WDH's split-dollar agreement, and the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance. Total premiums paid during the year ending 12/31/15 were $21,144 for Peter E. Walcek, $58,352 for Daniel N. Dunn, and $38,168 for Sheila M. Wooley. The taxable value of the life insurance policy has been included in each individuals' W-2. The policies are intended to provide an additional retirement benefit for these individuals' multiple years of service. Part I, Line 7 At-risk compensation, which is subject to review and paid annually. It is based on several predefined metrics, including patient satisfaction, quality, and financial targets. A NHHEFA Authority Revenue BondsWDH Issue Series 2011A 020279866 644614var 2011-04-06 87920000 Refinancing bonds & construction of new inpatient wing 0 0 0 B NHHEFA Authority Revenue BondsWDH Issue Series 2011B 020279866 644614M63 2011-04-06 18390000 Refinancing bonds 0 0 0 A 87825276 12476983 976169 44372124 2012 0 0 0 1 B 18390000 16673374 184826 1531800 2011 1 0 1 1 A 0 0 0 0 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 1 1 Piper Jaffray - See Part VI for more 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: NHHEFA Authority Revenue Bonds/WDH Issue, Series 2011A Date the Rebate Computation was Performed: 01/01/2013 Issuer Name: NHHEFA Authority Revenue Bonds/WDH Issue, Series 2011B Date the Rebate Computation was Performed: 01/01/2013 Part IV, Line 4c The $18,390,000 bond listed on line B of Part I is split into approximately two equal hedges, one with a term of 11.8 years (ending on 1/1/2023) and the other 19.8 years (ending on 1/1/2031). Bond Refinance: On March 28, 2016, the System refinanced its existing Series 2011B revenue bonds through the issuance of Series 2016A revenue bonds totaling $16,000,000. Additionally, Series 2016B revenue bonds totaling $6,000,000 were issued to reimburse for certain capital expenditures and replenish cash used to payoff the WDCHC note payable described above, which comes due in May 2016. The Series 2016A revenue bonds were directly placed with a financial institution and do not require a secured letter of credit. The Series 2016A and 2016B revenue bonds mature on January 1, 2031 and January 1, 2026, respectively, and carry a weighted average interest rate of 3.1374%. Peter E Walcek CFO/VP Finance Supplemental Retirement Benefits - Split Dollar Life Insurance X 102663 102663 0 1 1 Daniel N Dunn COO/SR. VP Operations Supplemental Retirement Benefits - Split Dollar Life Insurance X 403260 403260 0 1 1 Sheila M Wooley CNO/VP Patient Care Supplemental Retirement Benefits - Split Dollar Life Insurance X 225474 225474 0 1 1 731397 Gregory J Walker Peter E Walcek President/CEO, CFO/VP Finance, & CNO/VP Patient Care 891429 Joint VentureGregory J. Walker, President/CEO, Peter E. Walcek, CFO/VP Finance, and Sheila M. Woolley, CNO/VP Patient Care of the Hospital serve on the board of managers of Wentworth Home Care & Hospice, LLC. The Hospital has a 50% ownership interest in Wentworth Home Care and Hospice, LLC. The Hospital accounts for its investment in joint ventures under the equity method. The 2015 income recorded for the Hospital's share of revenues equaled $891,429 from which is received a cash distribution of $787,500.In accordance with IRS instructions, this business relationship has been disclosed in Schedule L, Part IV, however, Mr. Walker, Mr. Walcek, and Ms. Woolley received no direct or indirect monetary benefit as a result of this joint venture and all transactions were negotiated at arms-length. 0 Schedule L, Part II: Amounts stated on Schedule L, Part II represent the net present value expected on the total premiums paid through 12/31/15 that is anticipated to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for the disqualified persons listed on Form 990, Part VII and as further reported on Schedule J. Total cumulative premiums paid through December 31, 2015 for disqualified persons are $102,663 for Peter E. Walcek, $403,260 for Daniel N. Dunn, and $225,474 for Sheila M. Wooley. Total premiums paid during the year ending 12/31/15 were $21,144 for Peter E. Walcek, $58,352 for Daniel N. Dunn, and $38,168 for Sheila M. Wooley.Pursuant to updated IRS instructions, the net present value of these split dollar premiums has been reported in Schedule L, Part II this year. Accordingly, the net present value premium amounts described above have been reported on Form 990, Part X, Line 5 in the End of Year column. Form 990, Part III: In April 2016, the Boards of WDHS and Massachusetts General Hospital (MGH) voted to have the Hospital become a subsidiary of MGH. Under a letter of intent signed by both organizations, MGH will become the parent organization of the Hospital. The Hospital will become the parent organization of WDPC, WDCHC and the Foundation. At the time of this filing, the definitive agreements were signed and approved by the Boards of WDHS and MGH. The transaction is subject to confirmatory due diligence, and notice to and (where required) approval by state and federal agencies. Form 990, Part VI, Section A, line 4 The following significant changes were made to Wentworth-Douglass Hospital's bylaws on April 6, 0215: -The article regarding management of the corporation was revised to read that the Board of Trustees must obtain the approval of the Member's Board of Directors before action on certain matters of governance can be considered final. Previously, the filing organization was required to obtain approval of the member organization, but it was not specified that approval must come from the member's Board of Directors. -The following sentence was added to the bylaws as it relates to the Board of Trustees and the organization's management: Nothing herein shall limit the Wentworth-Douglass Health System Board of Directors, as Member, from unilaterally taking any of the actions identified above which impact the Corporation." Form 990, Part VI, Section A, line 6 Wentworth-Douglass Health System (WDHS), a New Hampshire nonprofit corporation, was formed in 2012 as the result of the corporate restructuring of Wentworth-Douglass Hospital (WDH) into an integrated health system. WDHS serves as the parent company of WDH and its affiliates Wentworth-Douglass Hospital and Health Foundation and Wentworth-Douglass Physician Corporation, all of which are New Hampshire nonprofit corporations that have been recognized as being 501(c)(3) organizations. These corporations share a common mission with WDH. WDHS is intended to act as a supporting organization of WDH, serving in the role of the "parent company" of the Hospital and the affiliates. WDHS is the sole member of WDH. Form 990, Part VI, Section A, line 7a WDHS will appoint the Board members for WDH. Form 990, Part VI, Section A, line 7b Wentworth-Douglass Health System has the power to appoint and remove directors of WDH, and all actions pertaining to the property, business, and affairs of WDH, including WDH's annual budget, are subject to the approval of WDHS. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is initially reviewed in detail by the Finance Committee and key Finance employees. Thereafter, the final draft is presented to the full Board prior to filing with the IRS. Each member of the Board and Finance Committee is provided with a complete draft of the Form 990 in advance of each meeting. Form 990, Part VI, Section B, line 12c A copy of the Hospital's conflict of interest policy is distributed annually to all officers, trustees, medical staff officers and committee members, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with State of New Hampshire RSA 7:19-A in the local newspaper and submitted to the New Hampshire Attorney General. Form 990, Part VI, Section B, line 15 CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted, and voted on by all independent members of the Board annually. Every other year, a national independent consulting firm is engaged by the Board to provide comparative market compensation data for executive and management positions at the Hospital. The Board uses the data provided to compare Wentworth-Douglass's CEO compensation with that of other hospital executives nationally and in the Northeast region to determine the CEO's total compensation. On alternate years, when the consulting firm is not engaged, the Board uses salary ranges established the prior year and market economic data to validate that the CEO's salary is competitive and make market adjustments. Additional factors taken into account to determine the CEO's salary are based on several predefined metrics, including patient satisfaction, quality, and financial targets. The CEO is excused from Board discussion and voting on issues surrounding his compensation and benefits. Compensation of Key Employees: The CEO reviews the salaries of key employees annually and recommends compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. The CEO presents salary range data for key employees to the Board annually for approval. Using the Board approved salary range data. The CEO recommends salary increases for vice presidents to the Board for approval and the vice presidents recommend salary increases for Directors and other management positions to the CEO for approval. All compensation for vice presidents and above requires final approval by the independent Board Members. Form 990, Part VI, Section C, line 19 Wentworth-Douglass Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between the Foundation and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-a, II(d). Current copies of the Bylaws, Conflict Of Interest Policy, and Form 990 are on file with the Charitable Trust Unit. The Organization also makes these documents available upon request. Form 990, Part VI, Section A, Line 1a and Line 1b: Governing Body and Management: Steven C. Webb is a trustee of the Hospital and an executive at TD Bank. The Hospital maintains operating and payroll accounts with TD Bank. Transactions in 2015 were in excess of $10,000. An exact figure cannot be stated due to daily account activity and balance changes. Both accounts were active prior to Mr. Webb joining the Board and all transactions with TD Bank are at a fair market rate. For 2015, Mr. Webb has been classified as an independent board member. Form 990, Part VII, Section A, Column D: Reportable Compensation from the Organization: The 2015 compensation reported for Dr. Anne Kalter and Dr. John Novello was paid by a related organization (Wentworth-Douglass Phsycian Corporation) for their full-time services as members of the medical staff. Neither individual is compensated for their services as a trustee of WDH. Dr. Anne Kalter is also a 50% owner of Gynecologic Paradox (formerly Gynecology & Infertility Associates). During 2015, Wentworth-Douglass Hospital made payments to Gynecologic Paradox of $92,707 for consulting services, call services, and rent. These amounts have been reported to her on a 1099 and included in Schedule J, Part II, Column B(iii) and further disclosed on the Hospital's Schedule L, Part IV. Additionally, Dr. Dirksmeier, Dr. Lally, and Dr. Flavin each received a contribution during 2015 to WDH's Call Pay Plan which is available to independent physician contractors who provide on call services to the Hospital. These amounts have been reported in Part VII, Column (F). In 2015, Dr. Lally and Dr. Flavin received distributions from their Call Pay Plan which was reported to them on a 1099-MISC. These distributions have been added to Column D of Part VII of Form 990 and Column B(iii) on Schedule J, Part II. As outlined above, these distributions have been reported in Part VII, Column (F) of prior 990s when they were contributed to each individual's plan. Part IX, Line 24d: The New Hampshire Medicaid Enhancement Tax (MET) is a tax on net patient service revenue paid by hospitals to the State of New Hampshire (the tax rate for State fiscal year 2016 was 5.45% and was 5.5% for State fiscal year 2015). Hospitals have been paying the MET since 1991, but in previous years, after the State had received matching federal funds, it provided the hospitals uncompensated care payments towards the cost of care of patients without insurance and those covered by Medicaid. The net effect was that most of the MET was returned to the hospitals. Accordingly, in 2010 Wentworth-Douglass Hospital paid $11,257,754 in MET and received $10,520,601 in uncompensated care payments from the State. However, beginning in 2011, the State reduced and/or eliminated payments to the hospitals for uncompensated care. For 2015, Wentworth-Douglass Hospital paid $14,751,461 in MET (see Part IX, line 24d) and recorded $4,815,728 of disproportionate share uncompensated care. Form 990, Part XI, line 9: Net Loss on Investments in Joint Ventures & Related Organizations -28,537,061. Accrued Earnings in Joint Ventures Owned by Affiliates 507,005. Form 990, Part XII, Line 2c: Audit Review Process: The Finance Committee oversees the audit process for Wentworth-Douglass Hospital and all related organizations. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2014 and 2015. Form 990, Part IX, Column D: Fundraising expenses: Wentworth-Douglass Hospital and Health Foundation (a related organization) performs all fundraising activities on behalf of Wentworth-Douglass Hospital. All fundraising expenses are reported on the Foundation's separate Form 990. Form 990, Part X, Line 5: Amounts separately stated on Form 990, Part X, Line 5 represent the net present value expected on the total cumulative premiums paid through 12/31/15 that is expected to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for various disqualified persons listed on Form 990, Part VII and as reported on Schedule L and J. 73 Corporate Drive at Pease LLC 95 Market Street Manchester NH 03101 Acquisition, Ownership, & Development of Real Property NH 0 5086416 Wentworth-Douglass Hospital Wentworth-Douglass Physician Corporation 789 Central Avenue Dover NH 03820 020497927 Health care NH 501(c)(3) Line 3 Wentworth-Douglass Health System 0 Wentworth-Douglass Hospital & Health Foundation 789 Central Avenue Dover NH 03820 510491062 Philanthropic fund raising & stewardship NH 501(c)(3) Line 11b, II Wentworth-Douglass Health System 0 Wentworth-Douglass Health System 789 Central Avenue Dover NH 03820 461635259 Support and further charitable activities of Hospital and related entities NH 501(c)(3) Line 11b, II N/A 0 Wentworth Surgery Center LLC PO Box 71 Somersworth NH 03878 900975592 Surgery Center NH N/A Wentworth-Douglass Community Health Corporation 789 Central Avenue Dover NH 03820 020399963 Health fitness center NH N/A C 0 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 Wentworth-Douglass Community Health Corporation L 158706 Actual per books Wentworth-Douglass Community Health Corporation O 75568 Actual per books Wentworth-Douglass Community Health Corporation Q 37618 Actual per books Wentworth-Douglass Community Health Corporation A 22731 Actual per books Schedule R, Part III: 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. Schedule R, Part II: Although not listed in Schedule R, Part II, Wentworth-Douglass Hospital owns 100 shares (50% of shares issued and outstanding) of non par value corporate stock in Strafford Health Alliance, a 501(c)(3) public charity. Strafford Health Alliance provides physical therapy, occupational therapy, and breast imaging services to residents of southeastern New Hampshire. Due to a lack of a control relationship by Wentworth-Douglass Hospital, Strafford Health Alliance has not been listed as a related organization in Schedule R, Part II in accordance with IRS instructions.