2016-04-01T12:51:51-05:00 2015-09-30 010494526 Baker Newman & Noyes LLC 650 Elm Street Suite 302 Manchester NH 03101 990 2014-10-01 020483054 Southern New Hampshire Medical Center SOUT 6035772000 8 Prospect Street PO Box 2014 Nashua NH 030612014 Thomas E Wilhelmsen Jr President / CEO 6035772000 2016-03-16 1 Timothy R Hepburn P00182393 8002447444 2016-03-16 2014 2016-08-17 19:52:53Z Thomas E Wilhelmsen Jr 8 Prospect Street PO Box 2014 Nashua NH 030612014 224631255 0 X www.snhhs.org X 1892 NH Southern New Hampshire Medical Center is committed to improving, maintaining, and preserving the overall health and well being of individuals living in the Greater Nashua area by providing information, education and access to exceptional health and medical care services. 13 12 1802 304 401424 -22839 171063 293728 204823470 213170148 10496444 -2689345 447973 441826 215938950 211216357 0 0 0 0 97414267 103950972 0 0 0 79720718 79583408 177134985 183534380 38803965 27681977 349867545 349230949 150055996 157826444 199811549 191404505 X Southern New Hampshire Medical Center is committed to improving, maintaining, and preserving the overall health and well being of individuals living in the Greater Nashua area by providing information, education and access to exceptional health and medical care services. 0 0 142013252 0 213203242 Provides acute healthcare services to a diverse population base including indigent within southern and central New Hampshire. Southern New Hampshire Medical Center is a nonprofit hospital, serving all who need care, regardless of ability to pay. Medical services provided included 9,030 inpatient admissions, 228,065 outpatient registrations, 41,073 emergency room visits, 4,800 surgical procedures and 1,218 births. 5233135 0 0 Charity Care ($2,685,616) and other uncompensated care ($2,547,519) at cost. 1458634 0 7308 Community health services and health professional education. 148705021 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 298 0 1 1802 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X Michael Rose 6035772004 8 Prospect Street Nashua NH 030612014 J Terrance Buchannan MD Trustee 1.00 0.00 X 0 0 0 Robert B Eisenberg Trustee 1.00 2.00 X 0 0 0 Colleen P Guiry MD Trustee 1.00 0.00 X 0 0 0 Holly J Harmon-Morse Trustee 1.00 2.00 X 0 0 0 Judge Clifford R Kinghorn Jr Trustee 1.00 2.00 X 0 0 0 John M Mercier Trustee 1.00 2.00 X 0 0 0 Martha E O'Neill Esq Trustee 1.00 2.00 X 0 0 0 Thomas A Pursch Trustee 1.00 2.00 X 0 0 0 James K Steiner Trustee 1.00 2.00 X 0 0 0 Praveen K Suchdev MD Trustee 1.00 2.00 X 0 0 0 Timothy C Sullivan Esq Chair 1.00 2.00 X X 0 0 0 Timothy J Whitaker Vice Chair 1.00 2.00 X X 0 0 0 Thomas E Wilhelmsen Jr President & CEO/Secretary 40.00 2.00 X X 786799 0 140624 Michael S Rose Treasurer 40.00 2.00 X 406442 0 91146 Susan Desocio President FMP 40.00 2.00 X 346374 0 69581 Richard Duguay VP Clinical Services (part year) 40.00 0.00 X 232544 0 26713 Colette Tilton VP Patient Care Services 40.00 0.00 X 243680 0 28785 Stephanie Wolf-Rosenblum VP Med Affairs/Physician 40.00 8.00 X 329405 70073 6801 Andrew Watt Ass. VP Med. Inf./Physician 40.00 0.00 X 370956 0 34427 Scott A Cote VP Facilities 40.00 0.00 X 200131 0 32272 Linda Rossi VP Human Resources (part year) 40.00 0.00 X 233742 0 4366 Joseph M Leahy Physician 40.00 0.00 X 424037 0 42425 Dilip Yorabothu Physician 40.00 0.00 X 329918 0 38694 Daniel Weidner Physician 40.00 0.00 X 328120 0 43417 William A Plerhoples Physician 40.00 0.00 X 327274 0 41177 Harold Range Hutson Physician 40.00 0.00 X 322208 0 22942 4881630 70073 623370 92 0 1 0 Fulcrum Associates 5 Tech Circle Amherst NH 03031 Construction 3365294 Siemens Medical Solutions Dept At 40065 Atlanta GA 31192 System Support 1540558 Sodexo Inc 9801 Washington Blvd Gaithersburg MD 20878 Food Services 954745 GE Healthcare 301 Ballardvale Street Wilmington MA 01887 Diagnostic Imaging 620262 McKesson Technology Inc 5995 Windward Parkway Alpharetta GA 30005 System Support 507525 25 X 293728 293728 Hospital Services 621110 213170148 213170148 213170148 -2635999 -2635999 13291366 70186 13414898 0 -123532 70186 -53346 -53346 Ancillary-NE Rehab Food Services 722210 322849 322849 Ancillary-NE Rehab Environmental 811000 73375 73375 Other Revenue 900099 45602 40402 5200 441826 211216357 213210550 401424 -2689345 3584788 3584788 84837200 68624785 16212415 1651935 1336250 315685 7900335 6390578 1509757 5976714 4834562 1142152 224553 224553 144522 144522 9513990 8032640 1481350 947749 947749 876539 876539 1997065 1615425 381640 4901149 3964538 936611 34658 28035 6623 275180 222593 52587 4418933 3574474 844459 3015548 3015548 11867789 9599851 2267938 1467302 1186900 280402 Supplies 22499130 20344120 2155010 New Hampshire Medicaid 10749745 10749745 Repairs and Maintenance 1523937 1232712 291225 Contracted Medical Serv 1153925 1153925 3971694 2798340 1173354 183534380 148705021 34829359 0 21273529 10266285 23144260 23211926 21748812 22050698 2878114 3358215 3213939 4202539 256550692 138440457 118093787 118110235 146788200 153334822 4362986 5835396 584485 541414 7779433 8319419 349867545 349230949 43563226 41301860 89437273 86361695 168739 5311 16886758 30157578 150055996 157826444 X 197372151 188973754 73884 65237 2365514 2365514 199811549 191404505 349867545 349230949 X 27681977 -36089021 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 17856 0 0 0 17856 0 Part II-B, Line 1: 22.80% of dues to American Hospital Association and 22.96% of dues to New Hampshire Hospital Association are available for lobbying expenses. 75259613 -1194302 74065311 68039314 7220299 75259613 60583371 7455943 68039314 51079549 9503822 60583371 50596135 483414 51079549 0.96810 0.03190 0.00000 0 0 13671517 13671517 151580523 72133636 79446887 2684080 1630172 1053908 82495758 64676649 17819109 6118814 6118814 118110235 Unearned Income - MOB 132972 Insurance Reserves 2979402 Other Liabilities SERP 3562160 Accrued Pension Expense - LT 21233447 457 (B) Deferred Comp Plan 2249597 30157578 X Part V, Line 4: The intended uses of the Organization's endowment funds are to fulfill donors' intentions on the permanently restricted funds and for future plant replacement and technology investments from board designated funds. Part X, Line 2: The System, Medical Center and 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 on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. With few exceptions, the System is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2012. 1 1 1 X 225.000000000000 0 1 1 0 1 1 2735616 50000 2685616 0.01460 33928745 18714962 15213783 0.08290 36664361 18764962 17899399 0.09750 131578 7308 124270 0.00070 971175 0 971175 0.00530 3463712 1616651 1847061 0.01010 57992 0 57992 0.00030 221808 0 221808 0.00120 4846265 1623959 3222306 0.01760 41510626 20388921 21121705 0.11510 16135 0 16135 0.00010 17010 0 17010 0.00010 34724 0 34724 0.00020 3519 0 3519 0.00000 4693 0 4693 0.00000 76081 76081 0.00040 1 9837439 2547519 47231920 52064734 -4832814 X 1 1 1 1 Southern New Hampshire Medical Center 8 Prospect Street PO Box 2014 Nashua NH 030612014 www.snhhs.org 02496 X X X X Southern New Hampshire Medical Center 1 0 0 1 X X X X X X X 14 1 1 1 1 X www.snhhs.org/chna X 1 14 1 www.snhhs.org/chna 0 0 1 X 225.000000000000 0 1 X X X 1 X http://www.snhhs.org/Charitable-Care X http://www.snhhs.org/Financial-Assistance X X X 1 X 0 X X X X 1 X 0 1 Southern New Hampshire Medical Center Part V, Section B, Line 5: During the process of developing the Community Health Needs Assessment, Nashua residents, medical providers and key leaders in the community were asked to rank the health of the community and to prioritize the needs. The process through which this Assessment was conducted included ten focus groups with a total of 104 participants. The focus groups were comprised of a broad and diverse cross-section of the community and included residents, key leaders, and healthcare providers. The focus groups were assigned with the task of evaluating the health of the community and ranking and prioritizing identified needs.There were 10 focus groups, three were topic-specific focus groups with professionals and 7 were geographically organized with a combination of residents, key leaders, and healthcare providers. Below is a listing of the Focus Groups that were conducted, along with the number of participants: Oral Health Professionals, 8; Aging Population Professionals, 14; Youth Behavioral Health Professionals, 10; Milford Combined Group, 12; Milford Healthcare Professionals & Key Leaders, 12; Merrimack Combined Group #1, 15; Merrimack Combined Group #2, 12; Hudson Combined Group, 2; Nashua Residents-South, 16; Nashua Residents-North, 3 Southern New Hampshire Medical Center Part V, Section B, Line 6a: Southern New Hampshire Medical Center's Community Health Needs Assessment was a collaboration of City of Nashua Health Department and other stakeholders, including St. Joseph Hospital. Southern New Hampshire Medical Center prepared its own separate assessment, based on that information. Southern New Hampshire Medical Center Part V, Section B, Line 6b: Southern New Hampshire Medical Center's Community Health Needs Assessment was a collaboration of City of Nashua Health Department and other stakeholders, including St. Joseph Hospital. Southern New Hampshire Medical Center prepared its own separate assessment, based on that information. Southern New Hampshire Medical Center Part V, Section B, Line 11: The top needs that were identified in the Community Health Needs Assessment were Mental Health/Substance Abuse, Access to and Coordination of Care, Opportunities for Healthy Living/Obesity. Southern New Hampshire Medical Center has addressed these needs in the following manner:Mental Health/Substance Abuse - Southern New Hampshire Medical Center recently expanded our inpatient behavioral health unit from 12 to 18 beds. We also expanded our Partial Hospital Program and opened an Intensive Outpatient Addiction program to address substance misuse in the community. Our Acute Community Crisis Evaluation System is available 24/7 to assist in assessment and triage of patients in crisis. There are staffed Psychiatrists that assist with treatment and evaluation of patients that are inappropriate for the voluntary unit. Lastly, we are in discussions with health partners regarding protocol screening and diagnosis for clinical depression.Access to and Coordination of Care - Southern New Hampshire Medical Center established multiple Immediate Care Locations within our service area to enhance access to timely care. Southern New Hampshire Medical Center plans to open new locations in Pepperrell, Mass and Amherst NH in 2016. There is staff available on site at the hospital to assist with Medicaid & Expanded Medicaid applications. We actively participate in Medicaid Exchange programs and a Prescription Assistance Program to help those with financial needs. Southern New Hampshire Medical Center has partnered with Massachusetts General Hospital to provide local access to over 35 Boston area specialists. Our OB/GYN Residency program expands access to Woman's Health for low income patients in collaboration with Lamprey. We also have Interpreter Services available 24/7 for those who need it.Opportunities for Health Living/Obesity - Southern New Hampshire Medical Center supports a variety of health programs in the community, such as Granite State Fit Kids, Prescribe the "Y and Fitness 4 Everybody. All Pediatric practices record weight and there is a protocol in the ED to record weight on all patients < 18 years old. Various health and fitness classes are offered to the public at our facility during the course of the year. Our Primary Care practices are providing community based programs and have partnered with Massachusetts General Hospital on a pediatric obesity project.For more information on how Southern New Hampshire Medical Center is addressing the needs identified in the CHNA, our Implementation Strategy is available on our website at www.SNHHS.org/CHNA. Southern New Hampshire Medical Center Part V, Section B, Line 20e: See response for Part III, Section C, Line 9b above. Prior to placing accounts with collection agencies, Southern New Hampshire Medical Center pulls out patients who qualify for charity based on census tract data and does not place those accounts with an agency but rather awards charity or free care assistance for their encounter. Southern New Hampshire Medical Center Part V, Section B, Line 22d: The State of New Hampshire mandates a discount for all uninsured patients. This discount is equal to the average discount negotiated by the largest (by dollar) three commercial insurers. This discount for the uninsured is automatic and applied to all balances prior to sending the first billing statement to the patient. Southern New Hampshire Medical Center Part V, Section B, Line 24: Southern New Hampshire Medical Center may charge patients who are having cosmetic or experimental, non-covered services gross charges for that encounter. Schedule H, Part V, Section B, Line 14: Southern New Hampshire Medical Center does not currently include the amounts generally charged to patients within our financial assistance policy. Starting October 1, 2015 in anticipation of regulation 501(r) compliance, we calculated our uninsured discount based upon the discount given to our three largest health plans, as well as Medicare. This information will be incorporated into our FAP when the final version is released later this year. Schedule H, Part V, Section B, Line 15d: In January 2016, in anticipation of regulation 501(r) compliance, Southern New Hampshire Medical Center started to participate in the New Hampshire Health Access Network charitable assistance program. As such, patients can go to any NHHAN participating hospital to complete a financial assistance application as it has been standardized among the participants. Schedule H, Part V, Section B, Line 16c: Our Internet site is in the process of being redesigned. Once that is complete, we will be posting the plain language notices in anticipation of regulation 501(r) compliance. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Southern New Hampshire Medical Center Part V, Section B, line 16a website: http://www.snhhs.org/Charitable-Care Southern New Hampshire Medical Center Part V, Section B, line 16b website: http://www.snhhs.org/Financial-Assistance Part I, Line 3c: Southern New Hampshire Medical Center offers a discount equal to the average of their three largest payors to all self pay patients. Part I, Line 7: The costing methodolgy used was the ratio of cost to charge as outlined in Worksheet 2 of the instructions. The only exception to this was for subsidized service area where the cost structure was specific to that service area. For those areas, our Cost Accounting system was used. Part II, Community Building Activities: Southern New Hampshire Medical Center is committed to improving the health and well-being of the Greater Nashua area and our community building activities help us achieve this goal. Through our involvement in the Rotary Club and Nashua Chamber of Commerce, along with other community organizations, we are able to exchange ideas with area leaders concerning health care issues and make informative decisions that best address the health needs of our community. We provide Medicare Counseling to area senior citizens giving them the guidance they need to make informed decisions about their healthcare coverage. Our support of the United Way's Day of Caring has resulted in a growing number of our employees going out into the area and helping members of the community with healthcare and other needs. We are strong in our commitment to the Greater Nashua area and plan to continue to support and grow community building activities that improve the overall health of the area.A majority of the organization's Board of Trustees is comprised of persons who reside in the Primary Service Area (PSA) who otherwise have no relationship with the organization. Many members of the organization volunteer their time to other community agencies in the PSA. Part III, Line 2: Southern New Hampshire Medical Center's Bad Debt Expense includes accounts that have been referred to a collection agency after making reasonable attempts to determine eligibility under the financial assistance policy, along with estimates of current accounts receivable based in historical experience. Part III, Line 3: A significant portion of Southern New Hampshire Medical Center's uninsured patients will be unable or unwilling to pay for the services provided. Thus, Southern New Hampshire Medical Center records a significant provision for bad debts related to uninsured patients in the period the services are provided. The FASB issued an accounting standards update that states that a health care entity that recognizes significant amounts of patient service revenue at the time services are rendered, even though it does not assess the patient's ability to pay, must present bad debts as a reduction of net patient revenue and not as a separate item in the operating expense. The ratio of cost to charge methodology was used to determine costs of these services as outlined in worksheet 2 of the instructions. Consistent with the accounting treatment mentioned above, since the system does not assess the patient's ability to pay, the cost of bad debt for those patients without any form of insurance should be classified as community benefit, consistent with charity care. Part III, Line 4: Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the System analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the System analyzes contractually due amounts and provides an allowance for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the System records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.The System's allowance for doubtful accounts was 14% and 17% of accounts receivable as of September 30, 2015 and 2014, respectively. The System's self-pay bad debt writeoffs decreased $8.7 million from $25.2 million for fiscal year 2014 to $16.5 million for fiscal year 2015. The decrease in the bad debt write-offs was a result of an increased number of insured patients from the Affordable Care Act and Medicaid expansion. Part III, Line 8: The ratio of cost to charge methodology was used to determine cost as outlined in Worksheet 2 of the instructions. There are service areas where government programs such as Medicare and Medicaid do not reimburse the organization adequate amounts to cover the costs to provide those services. Southern New Hampshire Medical Center must provide those services regardless of the financial shortfall. Part III, Line 9b: Southern New Hampshire Medical Center recognizes that not all patients who qualify for financial assistance will follow through with an application for financial assistance. Prior to placing any account with a collection agency, Southern New Hampshire Medical Center uses a financial assistance qualification service to categorize patients based primarily on income and assets estimated from census tract data. Those patients whose estimated income/assets fall within Southern New Hampshire Medical Center's financial assistance guidelines are awarded charity or free care assistance for their encounter. Part VI, Line 2: Southern New Hampshire Medical Center's 2015 Community Health Needs Assessment and Implementation Strategy was a collaboration with the City of Nashua and other area health partners. The 2014 Working Together to Build a Healthier Greater Nashua - Community Health Assessment was published by the City of Nashua Division of Public Health and Community Services in October, 2014. The sponsors of the Needs Assessment were the City of Nashua, Southern New Hampshire Medical Center, and St. Joseph Hospital. The assessment results include information gathered from 10 focus groups consisting of 104 participants that represented a broad cross-section of the community. In conjunction with this, data was gathered from local agencies in Nashua including The Department of Health and Human Services and Environmental Services and national organizations such as the Centers for Disease Control. Part VI, Line 3: At each registration point, Southern New Hampshire Medical Center has signage and brochures explaining our various forms of financial assistance, including charity care. Additionally, patient registrars offer the charity brochures to self pay patients. Patients who call regarding billing concerns are offered charity assistance. Additionally, verbiage regarding charity care is printed on each billing statement the patient receives. Also, charity care information is available on our hospital website.There is staff available on site at the hospital to assist with Medicaid and Expanded Medicaid applications. We actively participate in Medicaid Exchange programs and a Prescription Assistance Program to help those with financial needs. Part VI, Line 4: Southern New Hampshire Medical Center's service area consists of nineteen New Hampshire and four Massachusetts towns. The service area is divided into a Primary Service Area (PSA) of thirteen New Hampshire towns (Amherst, Brookline, Hollis, Hudson, Litchfield, Lyndeborough, Mason, Merrimack, Milford, Mont Vernon, Nashua, Pelham and Wilton), a Secondary Service Area (SSA) of seven New Hampshire towns (Derry, Greenville, Londonderry, New Boston, New Ipswich, Salem and Windham) and a Massachusetts Service Area (MSA) of four neighboring Massachusetts towns (Dunstable, Pepperell, Townsend and Tyngsboro). The 2014 Assessment refers to the Greater Nashua Public Health Region which includes Amherst, Brookline, Hollis, Hudson, Litchfield, Lyndeborough, Mason, Merrimack, Milford, Mont Vernon, Nashua, Pelham, and Wilton, towns that are included in Southern New Hampshire Medical Center's PSA and reflect the communities that make up the PSA, SSA and MSA. The population of the Greater Nashua Region consists of 205,845 residents that are younger than the New Hampshire state average (52.5% under 40 years of age compared with 48.4% for the state), and also more culturally diverse than the rest of the state (85.7% identified as white versus 94.2% for the state). Part VI, Line 5: Southern New Hampshire Medical Center provides a variety of services that promote the health of the greater Nashua community. Throughout the year we hold Community Medical Education seminars that offer area residents an opportunity to look behind the scenes of medicine and learn more about the latest medical technology, research and advances. We also perform free public health screenings, such as impact testing for sports teams at local schools, and balance and hearing screenings for the elderly. Our commitment to community health is also evident in the time our leadership spends on the boards of several local health organizations to help improve and promote health services available to area residents. Part VI, Line 6: Southern New Hampshire Health System, Inc. is a not-for-profit entity organized to support Southern New Hampshire Medical Center and Foundation Medical Partners, Inc. Both Southern New Hampshire Medical Center and Foundation Medical Partners are not-for-profit entities, established to provide medical services to the people of the greater Nashua area. Part VI, Line 7, Reports Filed With States NH X 1 1 X X X X 0 1 0 0 0 0 0 1 0 Thomas E Wilhelmsen Jr President & CEO/Secretary 537763 0 185300 0 63736 0 118799 0 21825 0 927423 0 0 0 Michael S Rose Treasurer 291697 0 66647 0 48098 0 64320 0 26826 0 497588 0 0 0 Susan Desocio President FMP 272362 0 53875 0 20137 0 65855 0 3726 0 415955 0 0 0 Richard Duguay VP Clinical Services (part year) 177440 0 29252 0 25852 0 7990 0 18723 0 259257 0 0 0 Colette Tilton VP Patient Care Services 176178 0 23392 0 44110 0 8581 0 20204 0 272465 0 0 0 Stephanie Wolf-Rosenblum VP Med Affairs/Physician 240291 70073 35000 0 54114 0 5100 0 1701 0 336206 70073 0 0 Andrew Watt Ass. VP Med. Inf./Physician 318555 0 41800 0 10601 0 9165 0 25262 0 405383 0 0 0 Scott A Cote VP Facilities 162379 0 28000 0 9752 0 6095 0 26177 0 232403 0 0 0 Linda Rossi VP Human Resources (part year) 213279 0 17500 0 2963 0 3231 0 1135 0 238108 0 0 0 Joseph M Leahy Physician 371427 0 34300 0 18310 0 10200 0 32225 0 466462 0 0 0 Dilip Yorabothu Physician 282447 0 18900 0 28571 0 10200 0 28494 0 368612 0 0 0 Daniel Weidner Physician 265041 0 16900 0 46179 0 10200 0 33217 0 371537 0 0 0 William A Plerhoples Physician 281749 0 16900 0 28625 0 10200 0 30977 0 368451 0 0 0 Harold Range Hutson Physician 280744 0 14900 0 26564 0 9963 0 12979 0 345150 0 0 0 Part I, Line 1a Southern New Hampshire Medical Center uses the facilities at the Nashua Country Club for meetings and other business related purposes. The Club does not have a corporate membership, therefore, an individual associated with Southern New Hampshire Medical Center must be a member of the Club. The membership is titled in the CEO's name and invoices are addressed to the CEO, not Southern New Hampshire Medical Center. Southern New Hampshire Medical Center pays the annual dues and all related expenses incurred by the organization. The facilities are only available to Club members. Part I, Line 4b Southern New Hampshire Medical Center provides a Supplemental Executive Retirement Plan, a 457(f) plan, to certain executives. Funding for this plan during the year was: Susan DeSocio - $55,655, Michael S. Rose - $54,120, Thomas E. Wilhelmsen, Jr. - $108,599. Part I, Line 7 There is an additional compensation plan available to managers, directors and senior management that is part of their annual performance plan. The plan takes into consideration quality measures, patient satisfaction, individual goals, budget adherence and overall organizational performance. The range and overall pool is reviewed and approved by the Board of Trustees' Executive Compensation Committee. The amount designated for the CEO and CFO are considered in the compensation consultant's analysis of executive compensation reported on the 990 Part VI section B Line 15b. A NHHEF Authority 020279866 644614SWO 2007-08-30 89836797 Refunding and New Construction 1 0 0 B NHHEF Authority 020279866 2010-12-15 5500000 Equipment Purchase 0 0 0 A 89836797 49731438 949525 39155834 1 1 1 1 B 5500000 25672 5474328 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 0 A 1 B 1 Form 990, Part VI, Section A, line 6 Southern New Hampshire Health System, Inc., is the sole corporate member of Southern New Hampshire Medical Center and the two (2) organizations have identical boards with the exception of two (2) additional members serving solely on the Southern New Hampshire Medical Center board. These include a physician member and the current Southern New Hampshire Medical Center chief of staff who is an ex-officio member. Form 990, Part VI, Section A, line 7a Southern New Hampshire Medical Center is governed by the Board of Trustees, who are elected by the Trustees of its sole member Southern New Hampshire Health System, Inc. Form 990, Part VI, Section A, line 7b Southern New Hampshire Medical Center is governed by the Board of Trustees, who are elected by the Trustees of its sole member Southern New Hampshire Health System, Inc. Form 990, Part VI, Section B, line 11 A copy of the 990 was presented to the full Board and approved by the Finance Committee of the Board of Trustees prior to submission. Form 990, Part VI, Section B, line 12c The organization requires all its personnel, including Leaders, to formally acknowledge that they have read and will abide by our Code of Conduct, which includes our conflict of interest policy. Southern New Hampshire Medical Center monitors compliance of its conflict of interest process, which requires completion of disclosure forms by all Leaders on an annual basis or on a reappointment basis (every two years) for medical/allied staff, to ensure full compliance. Interim disclosures are also required and reviewed should a subsequent conflict arise. Any related party disclosures require review and approval by a designated committee. An annual compliance report is provided to Southern New Hampshire Medical Center's compliance committee and Board of Trustees. Form 990, Part VI, Section B, line 15 The compensation of the CEO and CFO is evaluated by an outside consultant. The compensation of the CEO is approved by the Executive Compensation Committee of the Board and the Board of Trustees. A market analysis is performed for all key employees on an annual basis. Once the CEO and CFO approve the final compensation figures for key employees, the CEO reports these figures to the chairperson and vice chairperson of the Board. Form 990, Part VI, Section C, line 19 The organization makes its 990 and 990-T available for inspection upon request. The Code of Conduct is also available on the organization's website. The Code of Conduct addresses certain corporate policies including confidentiality, conflict of interest, patient rights and other governing documents. The organization also makes all relevant documents available to the public upon request. Form 990, Part VIII, Line 3: Part VIII, Line 3 reflects all investment earnings including net losses of $6,996,744, net of investment management fees. Form 990, Part XI, line 9: Transfers to affiliates -23,953,412. Pension Adjustment -12,135,609. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Foundation Medical Partners Inc 8 Prospect Street Nashua NH 03060 020456218 Physician Services NH 501(c)(3) 9 SNHHS 0 Southern New Hampshire Health System Inc 8 Prospect Street Nashua NH 03060 020509221 Medical Services NH 501(c)(3) 11 N/A 0 Advantage Network PHO 10 Prospect Street Nashua NH 03060 040582950 Medical Services NH Southern NH Medical Center C 0.50000 1 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 1 1 1 0