2016-05-13T11:02:09-05:00 2015-06-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-07-01 020232673 The Elliot Hospital of the City of Manchester ELLI 6036632033 1 Elliot Way Manchester NH 03103 Jeffrey Rooney CFO 6036632033 2016-05-12 1 Timothy R Hepburn P00182393 8002447444 2016-05-12 2014 2016-08-17 19:52:53Z James Woodward 1 Elliot Way Manchester NH 03103 421449282 0 X www.elliothospital.org X 1942 NH Hospital Services 22 17 3495 340 8614265 -187867 1495386 1196842 370619166 411772355 3909059 4196222 24632179 4252195 400655790 421417614 348005 354008 0 0 179041231 192741584 0 0 0 208105273 184695100 387494509 377790692 13161281 43626922 386720826 418736519 261493814 280279657 125227012 138456862 The Elliot Hospital of the City of Manchester, a leader in healthcare, is dedicated to providing it's community with excellent services offered with dignity, caring, and respect. 0 0 303261788 0 403440990 Medical services provided to 14,799 in-patients and 512,475 out-patients including free care in the amount of $7,803,214 (at cost) and contributions to community programs. 354008 354008 0 Contributions to Manchester Community Health Center, Child Health Services, and I Imagine. 789528 0 280 Community benefits including educational programs, health screenings, health publications and other health information services, and cash and in-kind contributions to community agencies. 304405324 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 280 0 1 3495 1 1 1 0 0 0 0 0 0 0 0 0 X 22 17 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Jeffrey Rooney 6036632033 1 Elliot Way Manchester NH 03103 R Scott Bacon Trustee 1.00 1.00 X 0 0 0 Howard Brodsky Trustee 1.00 3.00 X 0 0 0 Christopher S Calhoun MD Trustee 1.00 41.00 X 0 161284 28012 Reverend John A Cerrato Jr Trustee 1.00 1.00 X 0 0 0 Gus Emmick MD Trustee 1.00 41.00 X 0 309934 28258 James F Fitzgerald Trustee (until 1/21/15) 1.00 41.00 X 0 222940 25926 Louise Forseze Trustee (until 10/16/14) 1.00 1.00 X 0 0 0 Lawrence M Hoepp MD Trustee 1.00 41.00 X 0 903841 24777 Paul W Hoff PhD Trustee 1.00 1.00 X 0 0 0 Joseph Hyatt MD Trustee (begin 2/19/15) 1.00 1.00 X 0 0 0 Joseph R Lachance Jr Trustee 1.00 1.00 X 0 0 0 Maryann Leclair Trustee 1.00 1.00 X 0 0 0 Daniel M Monfried Trustee 1.00 1.00 X 0 0 0 Barbara A Rand Trustee 1.00 1.00 X 0 0 0 Anita R Ritenour MD Trustee 41.00 1.00 X 349304 0 37565 Charles F Rolocek Trustee 1.00 2.00 X 0 0 0 Mary Sargent Trustee 1.00 3.00 X 0 0 0 David RA Steadman Trustee 1.00 1.00 X 0 0 0 John F Weeks Trustee 1.00 3.00 X 0 0 0 Richard I Winneg Trustee 1.00 2.00 X 0 0 0 Dianne M Mercier Chair 1.00 1.00 X X 0 0 0 James C Hood Vice Chair 1.00 1.00 X X 0 0 0 John A Hession Treasurer 1.00 2.00 X X 0 0 0 Ann G Remus Secretary 1.00 2.00 X X 0 0 0 James Woodward CEO (begin 8/1/14) 40.00 4.00 X X 283595 0 37558 Douglas F Dean President & CEO (until 8/1/14) 40.00 4.00 X X 934341 0 55063 Richard Phelps President & COO (until 6/20/14) 40.00 4.00 X 1250999 0 46389 Richard A Elwell CFO 40.00 4.00 X 507499 0 133327 John E Friberg Jr Senior VP, General Counsel 40.00 X 373832 0 60651 William G Baxter Senior VP, Medical Affairs 40.00 X 424555 0 65175 Kevin B Coughlin Senior VP, Physician Services 40.00 X 465402 0 15523 Alexander W Petron Physician 40.00 X 345973 0 29239 Juergen H Bludau Physician 40.00 X 285581 0 5995 Denise Purington Physician 40.00 X 287601 0 3335 5508682 1597999 596793 163 0 1 0 PriceWaterhouseCoopers LLP PO Box 7247-8001 Philadelphia PA 19170 Professional Services 1620706 Arup Laboratories Inc 500 Chipeta Way Salt Lake City UT 84108 Lab Services 1560479 Cardon Healthcare Holdings LLC 557 East Pikes Peak Avenue Colorado Springs CO 80903 Patient Account Credit and Collection 911715 NH Neurospine Inst 4 Hawthorne Dr Bedford NH 03110 Neurosurgery Locums Coverage 401500 Amoskeag Anesthesia PLLC One Elliot Way Manchester NH 03103 Physician Services 352456 33 953819 225341 17682 1196842 Net Patient Services 621110 325281421 325281421 Laboratory Services 621500 48830523 45165122 3665401 Pharmacy Services 623000 15141130 14657104 484026 Miscellaneous Program Services 621110 14892104 14892104 Management and Consulting 541610 4390381 76995 4313386 3236796 3085344 151452 411772355 2263335 2263335 3969015 0 3969015 3969015 3969015 1964555 0 31668 1964555 -31668 1932887 1932887 283180 283180 283180 421417614 403441270 8614265 8165237 X 353808 353808 200 200 4070123 4070123 144672658 111279171 33393487 13838907 10603661 3235246 19561508 14724565 4836943 10598388 7948791 2649597 2638761 2638761 727636 727636 138050 138050 617946 617946 21823604 18919823 2903781 2173668 5468 2168200 17440525 12283607 5156918 6255544 5774129 481415 12327935 9245951 3081984 334790 305255 29535 629481 472111 157370 8120767 6090575 2030192 13605303 10203977 3401326 5916272 4437204 1479068 Medical and Pharmaceuti 55714391 55714391 Medicaid Enhancement Ta 17568030 17568030 Provision For Bad Debts 14808502 14808502 Other Patient Expenses 3452986 3452986 400909 213119 187790 377790692 304405324 73385368 0 36827783 54377006 6243747 22684216 40888876 44489099 979300 2429569 2985254 3823713 5481704 376220765 221167555 157170859 155053210 73565697 108916522 7924094 1200026 30419757 49996913 386720826 418736519 35823111 39087561 143285006 139775707 2594394 82385697 98821995 261493814 280279657 X 109801334 124119397 2444027 1244235 12981651 13093230 125227012 138456862 386720826 418736519 X 43626922 -361776 174274 -30209570 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 257097 257097 257097 257097 377790692 493319017 378047789 493576114 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 188723 156539 9572 257097 611931 250000 250000 250000 250000 1000000 1500000 15425677 182 131222 1219616 14337465 14066355 360570 998752 15425677 13591808 474547 14066355 13860491 -268683 13591808 12771028 50000 1039463 13860491 0.08680 0.91320 0 0 6681464 6681464 179158959 68091657 111067302 2074517 1971050 103467 179696908 151104848 28592060 8608917 8608917 155053210 Funds held by trustee 14111390 Unamortized Bond issuance Costs 1710926 Pension Cash Surrender Value 1157661 Deposits 10000 Other Receivables 18907444 Due From Affiliates 2360767 Employee Benefit Plans 11738725 49996913 Payable To Third Party Payors 5278527 Interest Payable 1932306 Accrued Pension 59549691 Self-Insurance Reserves & Other 20222746 Employee Benefit Plans 11738725 Security Deposit 100000 98821995 X 411702380 -361776 -8386108 -8747884 420450264 967350 967350 421417614 397888494 21820055 21820055 376068439 1722253 1722253 377790692 Part V, Line 4: Income from the endowment funds can be used for operating and capital expenditures. Part X, Line 2: Elliot Hospital, EPN and EPS are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management has evaluated the Hospital's tax positions and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. With few exceptions, the Hospital is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Pension Adjustment -8,389,520. Revenue allocated to EHS Professional & General Liability Insurance Trust 3,412. Part XI, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 967,350. Part XII, Line 2d - Other Adjustments: Transfer to Affiliates 21,820,055. Part XII, Line 4b - Other Adjustments: Expenses included in Revenue per Audited Financial Statements 967,350. Expenses allocated to EHS Professional & General Liability Insurance Trust 754,903. Central America and the Caribbean 0 0 Investments through Elliot Common Trust Fund 5809944 0 0 0 0 0 0 5809944 0 5809944 0 0 0 0 0 0 Schedule F, Part I, Line 3: The legal owner of Elliot Hospital's foreign investments is a related organization, Elliot Common Trust Fund. Since a portion of the total foreign investments are allocated to the Hospital's assets on the financial statements, those allocated investments have been disclosed on Schedule F, Part I, Line 3 of Elliot Hospital's Form 990. However, any required IRS Forms 926 and other foreign tax reporting obligations are filed by the legal owner, Elliot Common Trust Fund. Schedule F, Part IV, Line 3: The Elliot Hospital of the City of Manchester did not have an ownership interest in any foreign corporation that is greater than the 10% filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Schedule F, Part IV, Line 4: The Elliot Hospital of the City of Manchester meets the exception for tax-exempt organizations with respect to filing Form 8621. Accordingly, Form 8621 is not required to be filed for the Hospital. 1 1 1 X 1 X 1 1 0 1 1 26235 7803214 0 7803214 0.02150 72594 63196256 28268937 34927319 0.09620 0 98829 70999470 28268937 42730533 0.11770 12 1119 248785 280 248505 0.00070 9 298 339482 0 339482 0.00090 6 10447778 5425102 5022676 0.01380 1 5456 0 5456 0.00000 7 3 549813 0 549813 0.00150 35 1420 11591314 5425382 6165932 0.01690 35 100249 82590784 33694319 48896465 0.13460 2 219181 219181 0.00060 2 219181 219181 0.00060 0 14808502 0 101899007 122915882 -21016875 X 1 1 1 1 Elliot Hospital of City of Manchester 1 Elliot Way Manchester NH 03103 www.elliothospital.org 00018 X X X X Elliot Hospital of City of Manchester 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X http://elliothospital.org/website/downloads/QualitativeNeedsAssessment.pdf Multiple-please see response for Line 7d. X 1 13 0 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X https://elliothospital.org/website/downloads/Financial-Assistance-Policy.pd X https://elliothospital.org/website/downloads/20151020ApplicationEH-332_1104 X https://elliothospital.org/website/downloads/PlainLanguageSummary.pdf X X X X X 1 X 0 X X X X 1 X 0 0 Elliot Hospital of City of Manchester Part V, Section B, Line 5: During March, April and May of 2013, the hospitals conducted seven focus groups which included members of the clergy, first responders, pregnant women, school nurses, and Bhutanese refugees, as well as two seniors groups. A group discussion was conducted on March 25, 2013 with members of the Manchester Sustainable Access Project, which included the Public Health and Deputy Public Health Directors, Manchester Health Department; the President, Mental Health Center of Greater Manchester; the Chief Medical Officer and the Director of Community Health, Catholic Medical Center; Vice President of Planning and Business Development, Elliot Health System; and the Medical Director, Dartmouth-Hitchcock Manchester Clinic. During this same period of time, a survey was distributed to seniors at the Manchester Senior Center; the Rotary; and the clients, patients, and staff at The Mental Health Center of Greater Manchester. Fifty responses were returned. All of this data were used to create the CHNA. Elliot Hospital of City of Manchester Part V, Section B, Line 6a: Catholic Medical Center Elliot Hospital of City of Manchester Part V, Section B, Line 6b: Manchester Health Department Elliot Hospital of City of Manchester Part V, Section B, Line 7d: In addition to making the CHNA available on its own website, the 2013 CHNA is available on the following websites:http://www.library.unh.edu/digital/object/mrg:0103https://www.catholicmedicalcenter.org/uploads/2013%20CHNA%20FINAL%207-10-13.pdf Elliot Hospital of City of Manchester Part V, Section B, Line 11: The Elliot Hospital of the City of Manchester has addressed the needs identified in the 2013 CHNA through the implementation of new programs and services, as well as through continued operation of programs and services that were already in place throughout the Manchester health service area (HSA).-Behavioral Health Issues, including mental health services and access, substance abuse - specifically illicit drug use and tobacco use: Mental and behavioral health issues are a growing concern in the area. Therefore, Elliot Hospital and its related organizations have been working with local and state officials to address these issues. During the fiscal year, the organization subsidized outpatient behavioral health sessions by serving approximately 22,000 people in Elliot clinics and subsidizing Intensive Psychiatric Care in the amount of $727,411. In 2015, Elliot Health System started an integrated care program at three sites, which creates access to a therapist while patients visit their primary care providers, offering short term treatments of 6-8 therapy sessions to help patients get back on their feet.-Obesity, including diabetes, poor eating habits, lack of physical activity: Elliot Hospital offered comprehensive diabetic care and subsidized services in its Diabetes and Endocrinology Clinics in the amount of over $500,000 during the fiscal year. -Aging Issues, including stroke, Alzheimer's, pneumonia, transportation, medication coordination, caregiver support, inadequate out of home care: The number of adults age 65 and older is expected to increase 18% through the year 2018, with many of the towns within the Hospital's service area experiencing over 30% growth in this age group. Elliot Hospital and related organizations provided more than $2.3 million in subsidized services for this population during the filing period, including a geropsychiatric program, a medication management program, and the Pearl Manor Fund. Managed by one of the Hospital's affiliate organizations, the Pearl Manor Fund supports efforts that benefit elderly residents in the area. -Chronic disease, especially heart disease, cancer, COPD and Asthma: Elliot Hospital and affiliates offer support groups for managing chronic illnesses, including cancer and chronic pain, and subsidize cardiac rehabilitation services, pulmonary services, rheumatology services, and palliative care. Within this care area, Elliot Health System recognizes that asthma is a growing issue in the region, and is working on a multi-year, multi-step Asthma Collaborative. The goals of this initiative include increasing patient identification through standardized diagnosis, increasing provider and patient education, and improving patient care through standardized care guidelines and decreased emergency department usage. The collaborative is designed to meet the needs of patients of all ages.-Barriers to access of health care services related to poverty: Elliot Hospital and its affiliates provide cash and in-kind donations to community access agencies, including Manchester Community Health Center (MCHC), a Federally Qualified Health Center, and Child Health Services (CHS). In kind donations and services include providing support services in Finance, Accounting, Engineering, and Laboratory work; and providing space for MCHC's 2nd FQHC site on the Hospital's main campus. The organizations also provide consultations with an Ambulatory Social Work department and subsidize services in primary care and community health services regardless of a patient's ability to pay. Finally, Elliot Health System is committed to education future healthcare professionals and serves as a primary teaching site for medical, nursing, and allied health professionals in the region.Additional needs identified in the 2013 CHNA include the following:-Teen Pregnancy: Elliot Hospital and its affiliates are not specifically addressing this community need above and beyond what is done in the normal course of business, as it is being addressed by other community organizations, including partner in the CHNA, Catholic Medical Center.-STD's, specifically chlamydia: These needs are addressed through Elliot Primary Care primarily through education, vaccination, early detection and treatment. For patients outside Elliot Health System's network, other local CHNA partners address these issues through clinics and/or education.-Dental services/access, specifically for adults: This need is addressed by other community organizations, including partner in the CHNA, Catholic Medical Center. Additionally, Elliot Hospital provides oral/maxillofacial services to patients in need of advanced medical/dental treatment and repair through the Center for Oral & Maxillofacial Surgery, which is open to all patients regardless of their ability to pay. Other CHNA partners provide preventative dental care through their programs.-Violence & Crime, including neglect and abuse, safe neighborhoods, suicide, youth crime: Although outside Elliot Hospital's primary scope of work, Elliot does support agencies through subsidies that serve in this capacity including the Child Advocacy Center and the Manchester Community Health Center. Moreover, Elliot does address many of the underlying factors contributing to violence and crime through its emergency, acute inpatient, and outpatient behavioral health care services. Elliot Hospital of City of Manchester 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. The Elliot Hospital of the City of Manchester has always been in full compliance with the laws of the State of New Hampshire, and is currently working to ensure the hospital is in full compliance with final 501(r) regulations prior to the deadline in areas where federal regulations differ from or are more stringent than those issued by the state. Schedule H, Part V-B, Line 13: The Elliot Hospital of the City of Manchester's Financial Assistance Policy requires that applicants reside in the State of New Hampshire, except in the case of non-New Hampshire residents who experience an emergeny medical condition in New Hampshire and require immediate care. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Elliot Hospital of City of Manchester Part V, Section B, line 16a website: https://elliothospital.org/website/downloads/Financial-Assistance-Policy.pd Elliot Hospital of City of Manchester Part V, Section B, line 16b website: https://elliothospital.org/website/downloads/20151020ApplicationEH-332_1104 Elliot Hospital of City of Manchester Part V, Section B, line 16c website: https://elliothospital.org/website/downloads/PlainLanguageSummary.pdf 17 Elliot Urgent Care at Rivers Edge 185 Queen City Avenue Manchester NH 03101 Non-Emergency Walk-In Care Center Elliot Endoscopy Center Rivers Edge 185 Queen City Avenue Manchester NH 03101 Ambulatory Surgical Center Elliot Urgent Care at Londonberry 40 Buttrick Road Londonberry NH 03053 Non-Emergency Walk-In Care Center Elliot Hospital-4 Elliot Way 4 Elliot Way Manchester NH 03103 Collecting Station Elliot Lab at Elliot MC Londonberry 40 Buttrick Road Londonberry NH 03053 Laboratory Elliot Hospital Lab at Manchester CHC 145 Hollis Street Manchester NH 03101 Laboratory Elliot Stat Lab at Hooksett 1256 Hooksett Road Hooksett NH 03106 Laboratory Elliot 1-Day Surgery Center Lab 185 Queen City Avenue Manchester NH 03101 Laboratory Elliot River's Edge Urgent Care Lab 185 Queen City Avenue Manchester NH 03101 Laboratory Elliot Hospital-Tarrytown Road 275 Mammoth Road Manchester NH 03109 Collecting Station Elliot Collection Sta at Rivers Edge 185 Queen City Avenue Manchester NH 03101 Collecting Station Elliot DS at Hooksett Ambulatory Care 1256 Hooksett Road Hooksett NH 03106 Collecting Station Elliot Draw Station at Cypress Center 445 Cypress Street Manchester NH 03103 Collecting Station Elliot Hospital at Bedford Commons 25 South River Road Bedford NH 03110 Collecting Station Elliot Medical Center at Londonberry 40 Buttrick Road Londonberry NH 03053 Laboratory Elliot Senior Health Primary Care 138 Webster Street Manchester NH 03104 Laboratory Elliot After Hours at Raymond 15 Freetown Road 8 Raymond NH 03077 Non-Emergency Walk-In Care Center Part I, Line 7: Financial assistance and means tested costs used RCC derived from medicare cost report; other benefits costs derived from actual costs and internal cost accounting system. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 14,808,502. Part II, Community Building Activities: The health of the community we serve is promoted through Elliot Hospital's building activities with organizations such as the Child Advocacy Center, the Homeless Shelter and others in probably the most important and basic manner. Namely, we directly impact basic living (and in some cases survival) needs. Children, young adults, adults and the elderly share the need for basic nutrition, safety, and shelter. The organizations we choose to support offer and provide some of these necessities for a large portion of the population in the greater Manchester area. Further, we provide support for organizations that understand the importance of education and provide the skills, tools and the information to people so that they can access everything from food for the hungry, shelter, safety from physical and mental harm as well as health care. Elliot Hospital treats many of these individuals in our emergency department. In working with these people to help them recover from illnesses or injuries, we have come to understand the important role other organizations play in the lives of these same people. By supporting these organizations, we know that basic needs are being met, and improved health and wellness for everyone regardless of personal hardship or status may be achieved. Part III, Line 2: Bad debt expense is determined based on analysis of historical activity. Self pay accounts are given an automatic 25% discount off charges; self pay accounts that do not make payment are transferred to bad debt. Cost of bad debt is derived from internal cost accounting system. Part III, Line 4: The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. The Hospital records a provision for bad debts in the period services are provided related to self-pay patients, including both insurance patients and patients with deductible and copayment balances due for which third-party coverage exists for a portion of their balance.Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for doubtful accounts. The decrease in the provision for bad debts in 2015 is driven primarily by revisions made in fiscal year 2014 to the Hospital's charity care policy eligibility and an overall reduction in self pay accounts receivable. Accounts receivable are written off after collection efforts have been followed in accordance with internal policies. Part III, Line 8: Allowable costs determined using CMS methodology utilized in completing cost report; Medicare shortfall from Part III, Line 7 should be included in community benefits as costs are not fully reimbursed. Part III, Line 9b: Collections are not pursued on charity care patients. Collections agency is supplied information that allows them to identify only those accounts upon which collection efforts should be pursued. Part VI, Line 2: The Manchester HSA Community Health Needs Assessment conducted by Catholic Medical Center and the Elliot Health System, with the assistance of the Manchester Health Department, was completed in June 2013. The assessment began with a review of the 2009 Community Health Needs Assessment, Believe in a Healthy Community.A variety of different secondary data sources were accessed. They included the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services, NH HealthWRQS and the City of Manchester Department of Health. Healthy People 2020 (HP 2020) is a CDC initiative to track health behaviors and trends across the country. Part of this program is the creation of health related targets and goals that communities and states strive to meet. The Community Health Needs Assessment (CHNA) utilized as many of those targets as were available and applicable.During March, April and May of 2013, the hospitals also conducted seven focus groups which included members of the clergy, first responders, pregnant women, school nurses, and Bhutanese refugees, as well as two seniors groups. A group discussion was conducted on March 25, 2013 with members of the Manchester Sustainable Access Project, which included the Public Health and Deputy Public Health Directors, Manchester Health Department; the President, Mental Health Center of Greater Manchester; the Chief Medical Officer and the Director of Community Health, Catholic Medical Center; Vice President of Planning and Business Development, Elliot Health System; and the Medical Director, Dartmouth-Hitchcock Manchester Clinic. During this same period of time, a survey was distributed to seniors at the Manchester Senior Center; the Rotary; and the clients, patients, and staff at The Mental Health Center of Greater Manchester. Fifty responses were returned. All of this data was used to create the CHNA. The Final list of priority needs and health concerns of the Elliot Health System community are documented under Section 3. Part VI, Line 3: Elliot Health System posts the Financial Assistance and Collections Policy on their website at: http://elliothospital.org/website/downloads/Financial-Assistance-Policy.pdf. Additionally, financial assistance plain language summaries are posted in patient waiting rooms and locations throughout the Elliot Health System, and are available on the website in English, Spanish, and French. Elliot Health System also employs Financial Advocates who are available to meet with patients to assist them with applying for state and federal programs and financial assistance. Part VI, Line 4: Manchester and the surrounding towns of Auburn, Bedford, Candia, Deerfield, Goffstown, Hooksett and New Boston, make up what is known as the Manchester Health Service Area (HSA). The HSA has a population of 179,894 persons (2007) representing approximately 14% of the NH state population (1,315,829) and makes up most of the major service area of Elliot Health System, the umbrella organization under which Elliot Hospital operates. In 2006, the HSA experienced 11.3% of the state's total births and 10% of the state's total deaths. The City of Manchester is the largest community in northern New England. With a total population of 108,874 residents, Manchester represents 60.5% of the HSA and 8.3% of the state's total population.More people are living longer and individuals in the large "baby boomer" age group are now reaching the age of 65. In the next forty years, the number of people in the nation age 65 and older is expected to more than double and the population of the Manchester HSA is expected to experience the same type of growth. For example, the number of Manchester adults age 65 and older grew by 13% from 1980 to 2000. It is projected that this population will grow by another 85% from 2000 to 2020. The population of older adults in the other HSA towns grew by 82% from 1980 to 2000 and is projected to more than double from 2000 to 2020. This high growth rate of the elderly group in the Manchester HSA suggests health care leaders should anticipate and plan for an increased demand for services that adequately address the needs of older adults.Over the last decade, in addition to growing in size, Manchester HSA's population has become more diverse in its cultures, languages, religious beliefs and other ideologies. This is especially true for Manchester, which is a refugee resettlement site. As of 2007, nearly 10% of Manchester residents were born outside of the United States, which is twice the percent of people in all of NH who are foreign born. Over 17% of Manchester's residents speak a language other than English in the home. Around 5% of households are linguistically isolated, meaning that all members of the household ages 14 and older have at least some difficulty with English. Across the United States, family households take a variety of forms. Households may be headed by married or unmarried partners as well as by individuals. They may or may not have school-age children present. They may be headed by grandparents. They may contain foster children. Elliot Hospital's HSA mirrors this national trend; over the past seven years, the percent of households in Manchester composed of two married parents with their own school-aged children has decreased from 19.2% to 14.8%.Within the HSA, Bedford has the highest median household income and the City of Manchester has the lowest. Similarly, Manchester has the highest percentage of families living in poverty, while Deerfield has the lowest. In 2005 in Manchester, a family of four with both parents working needed to make $50,031 annually to meet basic needs. That same year the median household income in Manchester ($50,199) was a bit above the basic needs level. However, in 2007, only 55% of the households in Manchester reached the livable wage level, which had increased to $53,192 (equivalent wage of $12.79 per hour). According to the American Community Survey, the most common type of employment in Manchester is in educational services, health care, and social assistance (20.3%). Manchester makes up 8.2% of the state's labor force.The Manchester HSA has the largest population and number of jobs, but also has the lowest average income levels in the state. Increasingly, incomes are failing to meet the cost of living, including the cost of staying healthy and preparing for emergencies. Poverty is highly associated with risky behaviors, educational attainment, health status, employment, and self-reported quality of life. Residents experience discrepancies in health and health care access that are associated with their age, incomes, educational attainment and neighborhood. The assessment identifies a variety of health-related concerns in the City of Manchester and the Health Service Area including heart disease, mental health, ambulatory-care sensitive conditions, health risk behaviors, sexual health, substance abuse, emergency department use and premature death. Inadequate transportation, high cost of health care, and medically underserved areas exist in the region, as does under and overuse of existing health services resulting in a financial burden for the whole community. Part VI, Line 5: Elliot Hospital believes strongly that our involvement in community organizations such as Child Health Services, Manchester Mental Health Center, YMCA, and many more is critical to our exempt purpose. We deploy hundreds of volunteers throughout the state to work with non-profit organizations that are doing their part to help eradicate illnesses and poor health conditions or improve the health and wellness of people. Many of our leaders serve on the boards of these organizations to share insight and to participate in helping them achieve their mission. In addition to the volunteer time and energy, Elliot Hospital provides hundreds of thousands of dollars in financial support to ensure that the critical work of these organizations is achieved and people are helped with a range of issues from mental health care to obtaining food and shelter.Additionally, given our health care system and how widespread Elliot Hospital has become in the community, we open our doors and provide the staff and the resources for local issues that are unforeseen but create urgent situations. For example, when New Hampshire residents experienced power outages from an ice storm lasting days, Elliot Hospital kept patients (free of charge) in the hospital until power in the home was restored so that they would not suffer the hardship of living without heat and power. For day-to-day struggles, either with how to cope with the loss of a loved one or with how to cope with cancer, Elliot Hospital staff and professionals offer free community support groups and classes to reach people who are in need of help.Elliot Hospital prides itself on these acts of humanity because it does meet our purpose and mission and without question, promotes the health of the community. Part VI, Line 6: Elliot Health System (EHS) is the umbrella organization under which Elliot Hospital (EH), Elliot Physician Network (EPN), Elliot Professional Services (EPS), the Visiting Nurse Association of Manchester and Southern NH (VNA), and the Mary & John Elliot Charitable Foundation operate. Elliot Health System is a health care system that provides care to residents of southern New Hampshire, serving a regional population of over 250,000 residents and making it one of the largest providers of comprehensive health care services in southern New Hampshire. Each of these organizations plays a critical role in the continuum of care EHS delivers to the community thus promoting health. The cornerstone of EHS is Elliot Hospital, a private, not for profit hospital established in 1890, and now a 296-bed acute care facility located in Manchester (New Hampshire's largest city) on EHS's main campus. Elliot Hospital is a premier health care provider in many disciplines, serving as the designated trauma center for the Manchester HSA, and designated receiving facility for psychiatric patients in the region. In addition, Elliot Hospital provides maternity and pediatric services, newborn intensive care, surgery, pain management, wound management, cardiac care, and much more.EHS, through the EPN and EPS, both private, not for profit physician groups, provides primary care and specialty care via over 211 employed physicians as far north as Hooksett, east to Raymond, south to Windham and west to New Boston. The EPN has 27 physician practices in the Greater Manchester area. Providing access to providers throughout the local community is critical to supporting the need to help individuals become active in their health care and vigilant about their yearly exams, vaccines, and medications. EHS has a robust electronic medical record (EMR) linking all of these providers with Elliot Hospital, allowing the provider a complete understanding of anything that may have occurred through the emergency department or urgent care throughout the year. The EMR is complete with the latest laboratory results, diagnostic images, and other test results that may affect care given in the local provider's office.The VNA is one of the region's oldest and most comprehensive not for profit home health providers, dedicated to improving the health and well-being of our community since 1897. The VNA has helped individuals and their families face the challenges of recovering from surgery, physical disabilities, and short-term, chronic, and life-limiting illnesses. Through a TRACE program, EHS can ensure that older adults requiring care and with complex health care histories are given a care plan from the hospital to the nursing home (if necessary) and to the home. All of this care is also linked through the EMR and through our use of Tele-medicine; many patients are monitored "virtually" each day while in their home. Tele-medicine requires a patient in their home to connect to electronic devices that send information back to care providers showing such things as blood pressure, pulse, and respiratory function, so that should intervention be required, a health care team can be sent directly to the patient's home. Finally, the Mary & John Elliot Charitable Foundation is a not for profit, charitable organization created to provide financial support to the various needs of EHS. The Foundation is committed to building an ongoing circle of friends whose financial support will help EHS identify and meet emerging healthcare needs.Elliot Hospital and Affiliates (collectively EHS), work collaboratively and collectively (through the EMR), allowing EHS to serve the health care needs of people in the most efficient manner and has provided a platform for proactive plans for health management. Part VI, Line 7, Reports Filed With States NH 1 Child Health Services 1245 Elm Street Manchester NH 03101 020348711 501(c)(3) 41212 12596 Fair Market Value Financial Reporting and Accounts Payable Services To assist in meeting day-to-day operations, provide support for the accounting and bookkeeping department. Manchester Community Health Center 1415 Elm Street Manchester NH 03101 020458174 501(c)(3) 300000 To assist in meeting day-to-day operations. 2 0 Part I, Line 2: Elliot Hospital maintains members on the Board of Directors for Child Health Services and Manchester Community Health Center. Additionally, activities of both organizations align with the Hospital's mission in the community and with the Hospital's implementation plan developed from its most recent CHNA. Additional monitoring is not deemed necessary. X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 Christopher S Calhoun MD Trustee 0 161284 0 0 0 0 0 12338 0 15674 0 189296 0 0 Gus Emmick MD Trustee 0 309934 0 0 0 0 0 12921 0 15337 0 338192 0 0 James F Fitzgerald Trustee (until 1/21/15) 0 222940 0 0 0 0 0 10582 0 15344 0 248866 0 0 Lawrence M Hoepp MD Trustee 0 903841 0 0 0 0 0 13000 0 11777 0 928618 0 0 Anita R Ritenour MD Trustee 319593 0 28511 0 1200 0 21874 0 15691 0 386869 0 0 0 James Woodward CEO (begin 8/1/14) 251894 0 25000 0 6701 0 32500 0 5058 0 321153 0 0 0 Douglas F Dean President & CEO (until 8/1/14) 460654 0 216000 0 257687 0 43667 0 11396 0 989404 0 251913 0 Richard Phelps President & COO (until 6/20/14) 389700 0 141185 0 720114 0 34500 0 11889 0 1297388 0 720114 0 Richard A Elwell CFO 395794 0 104884 0 6821 0 121931 0 11396 0 640826 0 0 0 John E Friberg Jr Senior VP, General Counsel 317045 0 49937 0 6850 0 44836 0 15815 0 434483 0 0 0 William G Baxter Senior VP, Medical Affairs 368026 0 56529 0 0 0 49039 0 16136 0 489730 0 0 0 Kevin B Coughlin Senior VP, Physician Services 315604 0 146232 0 3566 0 4560 0 10963 0 480925 0 0 0 Alexander W Petron Physician 299223 0 46750 0 0 0 13000 0 16239 0 375212 0 0 0 Juergen H Bludau Physician 285581 0 0 0 0 0 5200 0 795 0 291576 0 0 0 Denise Purington Physician 248841 0 35660 0 3100 0 0 0 3335 0 290936 0 0 0 Part I, Line 1a Richard Elwell, CFO, had a social club membership during the filing period for which the Hospital paid $6,700. James Woodward, CEO, was provided a housing allowance of $14,823 for his relocation to the area during the fiscal year. The aforementioned fringe benefit amounts are included as additional taxable compensation for each employee. Part I, Lines 4a-b Richard Phelps received a severance payment of $150,382 in 2014. 2014 contributions to the organization's 457(f) plan were: James Woodward-$32,500; Richard Elwell-$80,049; Richard Phelps-$34,500. Part I, Line 7 The Organization has adopted an incentive pay program that provides designated management employees an opportunity to earn a designated percentage of salary based on the achievement by the Organization of a number of critical success factors. The critical success factors are established annually by the independent executive compensation committee of the Board of Trustees with assistance from an independent national compensation consulting company. The maximum potential incentive payments under the plan are considered by the compensation consultant in ensuring that management compensation is reasonable. Schedule J, Part II, Lines 7 and 8: During the year Mr. Dean and Mr. Phelps withdrew funds from their deferred compensation plans ($251,913 and $720,114, respectively). These amounts are reported as taxable compensation in Part II, Column B(iii). It should be noted that amounts that were reported in prior years as deferred compensation in Part II, Column C. Accordingly, the prior year deferrals are also reflected in Part II, Column F. Form 990, Part VII-A and Schedule J, Part II: Douglas Dean served as CEO of Elliot Hospital until August 2014. After his retirement, he continued to serve on the Board and work with the Hospital and related organizations as a non-officer employee. Of his reported compensation, $76,155 was compensation paid as a non-officer employee. A Business Finance Authority of the State of NH 020279866 64468KBQ8 2009-12-22 130000000 Finance/refinance costs of construction; Refinance 2008 bonds 0 0 0 B NH Health & Education Facilities Authority 020279866 2013-09-30 17021000 Refund outstanding prinicipal of 2003 revenue bonds; pay issuance costs 0 0 0 A 700000 127806119 11505106 6134168 30000000 1980498 78095644 2011 1 1 1 1 B 1467061 17021000 132029 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/30/2015 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 09/30/2015 Dianne M Mercier Board Member Ms. Mercier is President of People's United Bank, which is a depository for Granite Shield Insurance Exchange of which Elliot Hospital was a member for part of the year. 0 James C Hood Esq Board Member 190908 Several attorneys at Nixon Peabody LLP have been consulted by Elliot Hospital regarding specialized claims and regulatory legal projects. Mr. Hood is a partner of Nixon Peabody. 0 Form 990, Part VI, Section A, line 4 The following reportable changes were made to the filing organization's bylaws during the fiscal year: 1. An Action by Writing paragraph was added, which reads "Any action required or permitted to be taken at any meeting of the Trustees may be taken without a meeting if all the Trustees consent to the action in writing and the written consents are filed with the records of the meetings of the Trustees. Unless otherwise provided by law or the Articles of Organization a "writing" shall include communication from a Trustee by electronic mail ("email"), facsimile, scan, or similar electronic communication. Such consents shall be treated for all purposes as a vote at a meeting." 2. A Presence Through Communications Equipment paragraph was added, which reads, "Unless otherwise provided by law or the Articles of Organization, Trustees may participate in a meeting of the Board of Trustees by means of a conference telephone or similar communications equipment by which all persons participating in the meeting can hear each other at the same time, and participation by such means shall constitute presence in person at a meeting." 3. The following powers/corporate actions were added to the Duties and Powers specifically reserved to the Board of Directors: a. Election or removal of any or all of the Trustees of the Corporation; b. Election or removal of any or all committee chairs of the Board of Trustees of the Corporation; c. Transfer of 5% or more of the assets of the Corporation; d. Financing transactions concerning the Corporation, including any mortgage, pledge, encumbrance or disposition of real property, except in the ordinary course of business; e. Merger, consolidation, sale, lease, mortgage, pledge, or other disposition of all or substantially all assets of the Corporation; f. Change in legal form of organization of the Corporation; g. Dissolution of the Corporation; h. Appointment or removal of external auditors; i. Filing for bankruptcy or receivership; j. Creation of a subsidiary; k. Formation of any partnership or joint venture. 4. Additionally, the following change was made in the Duties and Powers article of the by-laws: "The approval of the annual budget for the Corporation" was updated to "The approval of, and any amendment to, the annual budget for the Corporation." 5. The phrase "with vote" was added the sentence "The CEO shall serve as an ex officio member of the Board of Directors with vote and all the rights, privileges, and obligations incident thereto." in the article outlining the responsibilities of the Chief Executive Officer. Form 990, Part VI, Section A, line 6 Elliot Health System is the sole member of the reporting organization. Form 990, Part VI, Section A, line 7a Elliot Hospital is governed by a Board of Trustees identical in composition to its sole member, Elliot Health System. Form 990, Part VI, Section B, line 11 The completed Form 990 is provided to the full Board for questions, comments, and review prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors, and key employees are required annually to sign a conflict of interest form which requires reporting any potential conflict of interest arrangements with the organization. Form 990, Part VI, Section B, line 15 The compensation committee of the Board utilizes outside compensation consultants to evaluate the salaries for the CEO, CFO, and COO. The consultants utilize their internal data along with national and local benchmark data from the industry to develop salary levels. Recommendations of the consultant are reviewed by the compensation committee, who recommends compensation levels to the full Board for approval. An outside consulting firm is also used by the organization to review the compensation of the remainder of the Vice Presidents. Again, national and local benchmarks for salaries are consulted to determine salary levels for these positions. Form 990, Part VI, Section C, line 19 Each of these documents is filed with the New Hampshire Secretary of State and is available upon request. Form 990, Part IX, Column D: The Mary and John Elliot Charitable Foundations performs all fundraising activities on behalf of The Elliot Hospital of the City of Manchester. All fundraising expenses are reported on the Foundation's separate Form 990. Form 990, Part XI, line 9: Pension Adjustment -8,389,515. Transfer to Affiliates -21,820,055. Form 990, Part XII, Line 2c: The audit process did not change from the prior year. Form 990, Parts VIII-XI: The consolidated audited financial statements for The Elliot Hospital of the City of Manchester and subsidiaries report various revenue, expense, asset, and net asset amounts for the Hospital inclusive of a related organization, Elliot Health System Professional & General Liability Trust (EIN: 01-6217452). All revenue, expense, and balance sheet items related to Elliot Health System Professional & General Liability Trust have been extracted from amounts reported for the Hospital on this Form 990 and all accompanying schedules. Elliot Health System Professional & General Liability Trust is a separate legal entity filing its own Form 990, and items related to it have been reported there. Elliot Health System 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509911 Management NH 501(c)(3) Line 11b, II 0 Elliot Health System Professional & GEneral LIT 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 016217452 Insurance Trust NH 501(c)(3) Line 11b, II Elliot Hospital 1 Elliot Hospital Associates 1 Elliot Way Manchester NH 031033599 026006214 Auxiliary NH 501(c)(3) Line 11d, III-O 0 Elliot Physician Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509589 Physician Services NH 501(c)(3) Line 3 Elliot Hospital 1 Elliot Professional Services Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 Physician Services NH 501(c)(3) Line 9 Elliot Hospital 1 Everwell Inc 1 Medical Center Drive Lebanon NH 03756 352506275 Supporting Organization NH 501(c)(3) Line 11a, I N/A 0 Mary and John Elliot Charitable Foundation 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512229 Fundraising NH 501(c)(3) Line 7 Elliot Health System 0 VNA Community Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020396549 Nursing Services NH 501(c)(3) Line 9 Elliot Health System 0 VNA Home Health and Hospice Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020222241 Home Care and Hospice NH 501(c)(3) Line 9 Elliot Health System 0 VNA of Manchester & Southern NH & Subs 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395296 VNA Holding Company NH 501(c)(3) Line 11b, II Elliot Health System 0 VNA Personal Services Inc 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020395295 Private Health and Homemaker Services NH 501(c)(3) Line 9 Elliot Health System 0 Elliot Common Trust Fund LLC 1 Elliot Way Manchester NH 03103 203653624 Investments NH Elliot Hospital Investment 3090744 89491818 0 -4541 0 0.86000 Elliot Health System Holdings & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512224 Management NH N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 Elliot Professional Services Network K 221108 Cash Elliot Professional Services Network P 3467449 Cash Elliot Physician Network P 250953 Cash Elliot Professional Services Network Q 11251322 Cash Elliot Physician Network Q 16643257 Cash Schedule R, Part II: Everwell, Inc. was formed in 2014 as a 501(c)(3) organization. It is a joint venture between Elliot Health System and Dartmouth-Hitchcock Health, with each entity having equal representation on the Board of Directors. Elliot Health System 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509911 0 0 0 0 0 0 0 0 0 0 VNA of Manchester & Southern NH & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03101 020395296 0 0 0 0 0 0 0 0 0 0 The Elliot Hospital of the City of Manchester 1 Elliot Way Manchester NH 03103 020232673 X 0 257097 257097 0 257097 51419 12855 0 205678 0 Elliot Professional Services Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 331003630 0 0 0 0 0 0 0 0 0 0 Elliot Physician Network 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020509589 0 0 0 0 0 0 0 0 0 0 Elliot Health System Holdings Inc & Subsidiaries 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512224 0 0 0 0 0 0 0 0 0 0 Mary and John Elliot Charitable Foundation 1070 Holt Avenue Unit 1 Suite 2100 Manchester NH 03109 020512229 0 0 0 0 0 0 0 0 0 0 Elliot Common Trust Fund LLC 1 Elliot Way Manchester NH 03103 023653624 0 0 0 0 0 0 0 0 0 0 Elliot Health System Professional & General Liability Insurance Trust 1 Elliot Way Manchester NH 03101 016217452 0 0 0 0 0 0 0 0 0 0