2015-05-14T14:42:06-05:00 2014-06-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2013-07-01 020232673 THE ELLIOT HOSPITAL OF THE CITY OF MANCHESTER ELLI 6036632033 1 ELLIOT WAY MANCHESTER NH 03103 RICHARD ELWELL CFO 6036632033 2015-05-13 1 WILLIAM G STEELE JR P00233103 8002447444 2015-05-13 2013 2016-02-25 16:41:14Z DOUGLAS DEAN 1 ELLIOT WAY MANCHESTER NH 03103 400655790 0 X ELLIOT-HS.ORG X 1942 NH HOSPITAL SERVICES 23 17 3355 410 4214701 -236087 1241795 1495386 367118203 370619166 3892829 3909059 15836211 24632179 388089038 400655790 515623 348005 0 0 174301641 179041231 0 0 0 212102353 208105273 386919617 387494509 1169421 13161281 364558416 386720826 257877350 261493814 106681066 125227012 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 296663421 348005 382533644 MEDICAL SERVICES PROVIDED TO 14,428 IN-PATIENTS AND 508,833 OUT-PATIENTS INCLUDING FREE CARE IN THE AMOUNT OF $11,321,496 (AT COST) AND CONTRIBUTIONS TO COMMUNITY PROGRAMS 510171 CONTRIBUTIONS TO MANCHESTER COMMUNITY HEALTH CENTER AND I IMAGINE 652502 COMMUNITY BENEFITS INCLUDING EDUCATIONAL PROGRAMS, HEALTH SCREENINGS, HEALTH PUBLICATIONS AND OTHER HEALTH INFORMATION SERVICES 297826094 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 263 0 1 3355 1 1 1 0 0 0 0 0 0 0 0 0 X 23 17 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X MARC CULLEROT 6036632033 1070 HOLT AVENUE UNIT 1 SUITE 2100 MANCHESTER NH 03109 DOUGLAS F DEAN PRESIDENT & CEO 40.00 4.00 X X 1123034 0 49296 R SCOTT BACON TRUSTEE 1.00 1.00 X X 0 0 0 JAMES C HOOD ESQ VICE CHAIR 1.00 1.00 X 0 0 0 ANN REMUS SECRETARY 1.00 2.00 X 0 0 0 LOUISE FORSEZE TRUSTEE 1.00 1.00 X 0 0 0 LAWRENCE M HOEPP MD TRUSTEE 1.00 41.00 X 0 916820 20254 HOWARD BRODSKY TRUSTEE 1.00 1.00 X 0 0 0 DANIEL M MONFRIED TRUSTEE 1.00 1.00 X 0 0 0 REVEREND JOHN A CERRATO JR TRUSTEE 1.00 1.00 X 0 0 0 DIANNE M MERCIER CHAIR 1.00 1.00 X 0 0 0 DAVID R A STEADMAN TRUSTEE 1.00 3.00 X 0 0 0 ANITA RITENOUR MD ASST VP MEDICAL AFFAIRS 40.00 1.00 X 312225 0 34861 JAMES F FITZGERALD MD TRUSTEE 1.00 43.00 X 0 187312 23877 RICHARD L WINNEG TRUSTEE 1.00 2.00 X 0 0 0 BARBARA A RAND TRUSTEE 1.00 3.00 X 0 0 0 GUS EMMICK MD TRUSTEE 1.00 43.00 X 0 320276 26378 CHARLES ROLECEK TRUSTEE 1.00 2.00 X 0 0 0 JOHN A HESSION TREASURER 1.00 2.00 X X 0 0 0 JOHN F WEEKS TRUSTEE 1.00 3.00 X 0 0 0 CHRISTOPHER S CALHOUN MD TRUSTEE 1.00 41.00 X 0 148094 27155 PAUL W HOFF PHD TRUSTEE 1.00 1.00 X 0 0 0 JOSEPH R LACHANCE JR TRUSTEE 1.00 1.00 X 0 0 0 MARY SARGENT TRUSTEE 1.00 1.00 X 0 0 0 ROBER M LAVERY MD TRUSTEE THRU JAN 2014 1.00 1.00 X 0 574058 19925 SELMA NACCAH-HOFF TRUSTEE THRU JAN 2014 1.00 2.00 X 0 0 0 RICK PHELPS COO 40.00 4.00 X 606201 0 102457 RICHARD ELWELL CFO 40.00 4.00 X 487314 0 228846 JOHN FRIBERG SENIOR VP, GENERAL COUNSEL 40.00 X 361684 0 55413 ALEXANDER W PETRON CHIEF MEDICAL INFO OFFICER 40.00 X 349160 0 24649 WILLIAM BAXTER SENIOR VP MEDICAL AFFFAIRS 40.00 2.00 X 374021 0 59878 KEVIN B COUGHLIN SENIOR VP PHYSICIAN SERVICES 40.00 0.00 X 352696 0 23972 JUERGEN H BLUDEAU PHYSICIAN 40.00 0.00 X 285581 0 4620 RACHEL D VERVILLE VP OF REVENUE CYCLE 40.00 0.00 X 264715 0 18840 4516631 2146560 720421 137 0 1 0 PRICE WATERHOUSE COOPERS LLP PO BOX 7247-8001 PHILADELPHIA PA 19170 PROFESSIONAL SERVICES 1723937 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84108 LAB SERVICES 1540282 NH NEUROSPINE INSTITUTE 4 HAWTHORNE DR BEDFORD NH 03110 NEUROSURGERY LOCUMS COVERAGE 597500 ROPES & GRAY PO BOX 414265 BOSTON MA 02241 LEGAL CONSULTING 494400 CHAMBERLIN EDMONDS 3535 PIEDMONT ROAD SUITE 800 ATLANTA GA 30305 SELF PAY PATIENT BILLING PROVIDER 356057 26 1495386 1495386 PROG.SERV.REVENUE-RELATED-990 621110 370619166 370619166 370619166 1992370 -83609 2075979 2359287 0 2359287 2359287 2359287 1916689 0 1916689 1916689 1916689 MISCELLANEOUS OTHER 900099 13031115 13031115 LABORATORY SERVICES 621500 3903429 3903429 PHARMACY 446110 3305256 306331 2998925 2033092 88550 1944542 22272892 400655790 383650281 4214701 11295422 X 346205 346205 1800 1800 3667863 3667863 135408776 101556582 33852194 12329523 9247142 3082381 17589740 13192305 4397435 10045329 7533997 2511332 849015 849015 131000 131000 2121690 2121690 5742567 4306925 1435642 133903 100427 33476 471750 353813 117937 8719939 6539954 2179985 21811712 21811712 14091443 10568582 3522861 6364099 4773074 1591025 SUPPLIES 26228813 26228813 PROVISION FOR BAD DEBTS 23878308 23878308 MEDICAID ENHANCEMENT TA 17095883 17095883 DRUGS & PHARMACEUTICUL 16428295 16428295 64036856 50958160 13078696 387494509 297826094 89668415 0 25662626 36827783 6188637 6243747 40411820 40888876 2405426 2429569 4028986 3823713 365415895 208245036 159910123 157170859 99938667 108916522 26012131 30419757 364558416 386720826 33268898 35823111 150115157 143285006 74493295 82385697 257877350 261493814 X 92614711 109801334 1801521 2444027 12264834 12981651 106681066 125227012 364558416 386720826 X 13161281 8159649 -2774983 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 9572 9572 9572 9572 300572828 414234899 300582400 414244471 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 344636 188723 156539 9572 699470 250000 250000 250000 250000 1000000 1500000 33158 33158 14066355 360570 998752 15425677 13591808 474547 14066355 13860491 -268683 13591808 12771028 50000 1039463 13860491 12420985 174500 175543 12771028 0.15840 0.84160 0 0 6681464 6681464 170730567 58782192 111948375 4236186 1910887 2325299 174463095 143547518 30915577 9304583 4004439 5300144 157170859 BOARD DESIGNATED & DONOR RESTRICTED 108916522 F 108916522 FUNDS HELD BY TRUSTEE 2621420 UNAMORTIZED BOND ISSUANCE COSTS 1795804 PENSION CASH SURRENDER VALUE 1157661 DEPOSITS 10580943 OTHER RECEIVABLES 11771256 DUE FROM AFFILIATES 2492673 30419757 PAYABLE TO THIRD PARTY PAYORS 6155949 INTEREST PAYABLE 1941486 ACCRUED PENSION & OTHER 48835575 SELF-INSURANCE RESERVES & OTHER 23131185 CURRENT PORTION OF LONG-TERM DEBT 2321502 82385697 X 408227121 8159649 8159649 400067472 588318 588318 400655790 365094480 0 365094480 22400030 22400030 387494510 PART V, LINE 4: INCOME OF THE FUNDS HAS BEEN USED FOR OPERATING AND CAPITAL EXPENDITURES PART X, LINE 2: PART X, INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS WAS THE FOLLOWING, "MANAGEMENT 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." PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECLASS 588,318. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECLASS 588,318. PAYMENTS TO AFFILIATES 21,811,712. 1 1 1 X 1 X 1 1 0 1 1 35201 11321496 11321496 0.02920 53910 51998846 19845390 32153456 0.08300 0 89111 63320342 19845390 43474952 0.11220 13 650 293560 315 293245 0.00080 9 280 348366 0 348366 0.00090 7 0 12155961 7620974 4534987 0.01170 1 0 10576 10576 0.00000 8 4 510171 510171 0.00130 38 934 13318634 7621289 5697345 0.01470 38 90045 76638976 27466679 49172297 0.12690 34468 34468 0.00010 34468 34468 0.00010 0 23878307 94800735 118059123 -23258388 X 1 1 1 1 THE ELLIOT HOSPITAL OF CITY OF MANCHSTR 1 ELLIOT WAY MANCHESTER NH 03103 00018 X X X X ELLIOT HOSPITAL OF CITY OF MANCHESTER 1 1 X X X X X X X X X 12 1 1 1 X HTTP://ELLIOTHOSPITAL.ORG/WEBSITE/ X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 ELLIOT HOSPITAL OF CITY OF MANCHESTER PART V, SECTION B, LINE 3: DURING MARCH, APRIL AND MAY OF 2013, THE HOSPITALS ALSO CONDUCTED SEVEN FOCUS GROUPS WHICH INCLUDED MEMBERS OF CLERGY, FIRST RESPONDERS, PREGNANT WOMEN, SCHOOL NURSES, 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 DIRECTOR, 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, WITH 50 RESPONSES BEING RETURNED. ALL OF THIS DATA WAS USED TO CREATE THE CHNA. THE FINAL LIST OF PRIORITY NEEDS AND HEALTH CONCERNS OF THE EHS COMMUNITY ARE DOCUMENTED UNDER SECTION 3. ELLIOT HOSPITAL OF CITY OF MANCHESTER PART V, SECTION B, LINE 4: CATHOLIC MEDICAL CENTER HOSPITAL OF MANCHESTER ELLIOT HOSPITAL OF CITY OF MANCHESTER PART V, SECTION B, LINE 7: THE HEALTH SYSTEM ADDRESSED MOST OF THE NEEDS IDENTIFIED IN THE CHNA, TO SOME DEGREE, PRIMARILY INVESTING IN BEHAVIORAL HEALTH, ACCESS TO CARE, ISSUES WITH AGING, CHRONIC DISEASE, DENTAL HEALTH AND PREVENTATIVE CARE. THE HEALTH SYSTEM DID NOT FULLY ADDRESS ALL IDENTIFIED ISSUES AS OTHER AGENCIES IN THE GREATER MANCHESTER SERVICE AREA WERE EITHER ALREADY ADDRESSING THESE NEEDS OR WERE BETTER POSITIONED TO ADDRESS THESE NEEDS. FOR EXAMPLE, THE HEALTH SYSTEM OFFERS CARE TO VICTIMS OF VIOLENCE AND CRIME AND WORKS WITH VICTIMS TO DIRECT THEM TO APPROPRIATE COMMUNITY SUPPORT PROGRAMS. THE HEALTH SYSTEM ALSO SUBSIDIZES PROGRAMS THAT TREAT VICTIMS, SUCH AS THE CHILD ADVOCACY CENTER. HOWEVER, IT IS OUTSIDE THE CAPABILITY OF THE HEALTH SYSTEM TO ADDRESS THE ROOT CAUSES OF VIOLENCE AND CRIME IN OUR NEIGHBORHOODS. ELLIOT HOSPITAL OF CITY OF MANCHESTER PART V, SECTION B, LINE 12I: DECEASED AND HOMELESS PERSONS ARE AUTOMATICALLY CONVERTED TO CHARITABLE CARE. CATASTROPHIC LIMIT CAP SET AT $50,000 FOR SELF-PAY. 16 ELLIOT ENDOSCOPY CENTER RIVERS EDGE 185 QUEEN CITY AVENUE MANCHESTER NH 031010000 AMBULATORY SURGICAL CENTER ELLIOT URGENT CARE AT RIVER'S EDGE 185 QUEEN CITY AVENUE MANCHESTER NH 031010000 NON-EMERGENCY WALK-IN CARE CENTER ELLIOT URGENT CARE LONDONDERRY 40 BUTTRICK ROAD LONDONDERRY NH 030530000 NON-EMERGENCY WALK-IN CARE CENTER ELLIOT STAT LAB AT HOOKSETT 1256 HOOKSETT ROAD HOOKSETT NH 031060000 LABORATORY ELLIOT LAB ELLIOT MED CNTR LONDONDERRY 40 BUTTRICK ROAD LONDONDERRY NH 030530000 LABORATORY ELLIOT HOSPITAL LAB MANCHESTER CHC 145 HOLLIS STREET MANCHESTER NH 03101 LABORATORY ELLIOT AT RIVER'S EDGE URGENT CARE LAB 185 QUEEN CITY AVENUE MANCHESTER NH 031010000 LABORATORY ELLIOT HOSPITAL-TARRYTOWN ROAD 275 MAMMOTH ROAD MANCHESTER NH 031090000 COLLECTING STATION ELLIOT COLLECTION STATION RIVERS EDGE 185 QUEEN CITY AVENUE MANCHESTER NH 031010000 COLLECTING STATION ELLIOT DS HOOKSETT AMBULATORY CARE CNT 1256 HOOKSETT ROAD HOOKSETT NH 031060000 COLLECTING STATION ELLIOT DRAW STATION CYPRESS CENTER 445 CYPRESS STREET MANCHESTER NH 03103 COLLECTING STATION ELLIOT HOSPITAL - 4 ELLIOT WAY 4 ELLIOT WAY MANCHESTER NH 031033599 COLLECTING STATION ELLIOT HOSPITAL BEDFORD COMMONS 25 SOUTH RIVER RD BEDFORD NH 03110 COLLECTING STATION ELLIOT MEDICAL CENTER LONDONDERRY 40 BUTTRICK ROAD LONDONDERRY NH 030530000 LABORATORY ELLIOT SENIOR HEALTH PRIMARY CARE 138 WEBSTER STREET MANCHESTER NH 031040000 LABORATORY ELLIOT AFTER HOURS AT RAYMOND 15 FREETOWN RD 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 3C ELLIOT HOSPITAL USES FPG METHODOLOGY PART II, COMMUNITY BUILDING ACTIVITIES: THE HEALTH OF THE COMMUNITY WE SERVE IS PROMOTED THROUGH EH'S BUILDING ACTIVITIES WITH ORGANIZATIONS SUCH AS THE CHILD ADVOCACY CENTER, THE HOMELESS SHELTER AND OTHERS. IN PROBABLY THE MOST IMPORTANT AND BASIC MANNER, NAMELY, WE DIRECTLY IMPACT BASIC LIVING (AND IN SOME CASES SURVIVAL) NEEDS. CHILDREN, YOUNG ADULTS, ADULTS AND THE ELDERLY SHARE THE NEED FOR BASIC NUTRITION, SAFETY, AND SHELTER. THE ORGANIZATIONS WE CHOOSE TO SUPPORT OFFER AND PROVIDE SOME OF THESE NECESSITIES FOR A LARGE PORTION OF THE POPULATION IN THE GREATER MANCHESTER AREA. FURTHER, WE PROVIDE SUPPORT FOR ORGANIZATIONS THAT UNDERSTAND THE IMPORTANCE OF EDUCATION AND PROVIDE THE SKILLS, TOOLS AND THE INFORMATION TO PEOPLE SO THAT THEY CAN ACCESS EVERYTHING FROM FOOD FOR THE HUNGRY, SHELTER, SAFETY FROM PHYSICAL AND MENTAL HARM AS WELL AS HEALTH CARE. EH TREATS MANY OF THESE INDIVIDUALS IN OUR EMERGENCY DEPARTMENT. IN WORKING WITH THESE PEOPLE TO HELP THEM RECOVER FROM ILLNESSES OR INJURIES, WE HAVE COME TO UNDERSTAND THE IMPORTANCE AND THE ROLE OTHER ORGANIZATIONS PLAY IN THE LIVES OF THESE SAME PEOPLE. BY SUPPORTING THESE ORGANIZATIONS, WE KNOW THAT BASIC NEEDS ARE BEING MET, AND IMPROVED HEALTH AND WELLNESS FOR EVERYONE REGARDLESS OF PERSONAL HARDSHIP OR STATUS MAY BE ACHIEVED. PART III, LINE 4: BAD DEBT FOOTNOTE: "NET PATIENT SERVICE REVENUES - .... THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS, THE HOSPITAL PROVIDES A DISCOUNT APPROXIMATELY EQUAL TO THAT OF ITS LARGEST PRIVATE INSURANCE PAYORS. 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 PART III, LINE 8: ALLOWABLE COSTS DETERMINED USING CMS METHODOLOGY UTILIZED IN COMPLETING COST REPORT; MEDICARE SHORTFALL TO BE INCLUDED IN COMMUNITY BENEFITS 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 III, LINE 2 BAD DEBT EXPENSE IS DETERMINED BASED ON ANALYSIS OF HISTORICAL ACTIVITY. SELF PAY ACCOUNTS ARE GIVEN AN AUTOMATIC 25% DISCOUNT OFF CHARGES; SELF PAY ACCOUNTS THAT DO NOT MAKE PAYMENT ARE TRANSFERRED TO BAD DEBT. COST OF BAD DEBT IS DERIVED FROM INTERNAL COST ACCOUNTING SYSTEM. PART III, LINE 3 ORGANIZATION IS NOT CURRENTLY DETERMINING BAD DEBT ACCOUNTS THAT MAY HAVE BEEN CHARITABLE CARE. PART III, LINE 4 BAD DEBT AND CHARITY CARE COST DETERMINED USING INTERNAL COST ACCOUNTING SYSTEM; SELF PAY ACCOUNTS GIVEN AUTOMATIC 25% DISCOUNT OFF CHARGES; SELF PAY ACCOUNTS THAT DO NOT MAKE PAYMENT ARE TRANSFERRED TO BAD DEBT. ORGANIZATION NOT CURRENTLY DETERMINING BAD DEBT ACCOUNTS THAT MAY HAVE BEEN CHARITABLE CARE. 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 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 CLERGY, FIRST RESPONDERS, PREGNANT WOMEN, SCHOOL NURSES, 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 DIRECTOR, 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, WITH 50 RESPONSES BEING RETURNED. ALL OF THIS DATA WAS USED TO CREATE THE CHNA. THE FINAL LIST OF PRIORITY NEEDS AND HEALTH CONCERNS OF THE EHS COMMUNITY ARE DOCUMENTED UNDER SECTION 3. PART VI, LINE 3: THE ELLIOT HEALTH SYSTEM POSTS THE FINANCIAL ASSISTANCE AND COLLECTIONS POLICY ON THEIR WEBSITE AT: HTTP://ELLIOTHOSPITAL.ORG/WEBSITE/FINANCIAL-ASSISTANCE-POLICY.PHP. ADDITIONALLY, FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARIES ARE POSTED IN PATIENT WAITING ROOMS AND LOCATIONS THROUGHOUT THE ELLIOT HEALTH SYSTEM. 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 EHS, THE UMBRELLA ORGANIZATION UNDER WHICH ELLIOT HOSPITAL (EH) 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. THE TABLE BELOW DISPLAYS HOW THE POPULATION IN MANCHESTER IS DISTRIBUTED BY AGE AND GENDER.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 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. 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%.WITH 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, WHOLE DEERFIELD HAS THE LOWEST. IN 2005 IN MANCHESTER, A FAMILY OF FOUR WITH BOTH PARENTS WORKING NEEDED TO MAKE $50,031 ANNUALLY ($12.03 PER HOUR) TO MEET BASIC NEEDS. THAT SAME YEAR THE MEDIAN HOUSEHOLD INCOME IN MANCHESTER ($50,199) WAS A BIT ABOVE THE BASIC NEEDS LEVEL ($50,404). 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 POPULATION OF THE GREATER MANCHESTER HSA IS GROWING IN SIZE, AND LIVING LONGER; IS INCREASINGLY MULTICULTURAL WITH RESIDENTS REFLECTING A VARIETY OF NATIONALITIES, LANGUAGES, ETHNIC TRADITIONS, RELIGIOUS BELIEFS AND IDEOLOGIES; AND IS COMPOSED OF MANY DIFFERENT FAMILY STRUCTURES. 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 AILING TO MEET THE COTS OF LIVING, INCLUDING THE COTS 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 VARIOUS 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: EH 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, EH ALSO PROVIDES HUNDREDS OF THOUSANDS OF DOLLARS IN FINANCIAL SUPPORT TO ENSURE THAT THE CRITICAL WORK OF THESE ORGANIZATIONS IS ACHIEVED AND PEOPLE ARE HELPED WITH A RANGE OF ISSUES FROM MENTAL HEALTH CARE TO OBTAINING FOOD AND SHELTER.ADDITIONALLY, GIVEN OUR HEALTH CARE SYSTEM AND HOW WIDESPREAD EH 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 NH RESIDENTS WERE STUCK BY POWER OUTAGES FROM AN ICE STORM LASTING DAYS, EH KEPT PATIENTS (FREE OF CHARGE) IN THE HOSPITAL UNTIL POWER IN THE HOME AS RESTORED SO THAT THEY WOULD NOT SUFFER THE HARDSHIP OF LIVING WITHOUT HEAT AND POWER. FOR DAY-TO-DAY STRUGGLES, EITHER WITH HOW TO COPE WITH THE LOSS OF A LOVED ONE OR WITH HOW TO COPE WITH CANCER, EH STAFF AND PROFESSIONALS OFFER FREE COMMUNITY SUPPORT GROUPS AND CLASSES TO REACH PEOPLE WHO ARE IN NEED OF HELP.EH 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: 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 NH SERVING A REGIONAL POPULATION OF OVER 250,000 RESIDENTS, MAKING IT ONE OF THE LARGEST PROVIDERS OF COMPREHENSIVE HEALTH CARE SERVICES IN SOUTHERN NH. 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 EH, A PRIVATE, NOT FOR PROFIT HOSPITAL ESTABLISHED IN 1890, AND NOW A 296-BED ACUTE CARE FACILITY LOCATED IN MANCHESTER (NH'S LARGEST CITY) ON EHS'S MAIN CAMPUS. EH 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 EH 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 EH 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.EH 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) 29551 16654 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 X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 DOUGLAS F DEAN PRESIDENT & CEO 581126 0 184359 0 357549 0 38245 0 11051 0 1172330 0 306534 0 LAWRENCE M HOEPP MD TRUSTEE 0 865815 0 10505 0 40500 0 8895 0 11359 0 937074 0 0 ANITA RITENOUR MD ASST VP MEDICAL AFFAIRS 256234 0 21701 0 34290 0 19468 0 15393 0 347086 0 0 0 JAMES F FITZGERALD MD TRUSTEE 0 141210 0 30329 0 15773 0 8838 0 15039 0 211189 0 0 GUS EMMICK MD TRUSTEE 0 197301 0 105475 0 17500 0 11321 0 15057 0 346654 0 0 CHRISTOPHER S CALHOUN MD TRUSTEE 0 133090 0 5696 0 9308 0 11878 0 15277 0 175249 0 0 ROBER M LAVERY MD TRUSTEE THRU JAN 2014 0 534681 0 0 0 39377 0 8925 0 11000 0 593983 0 0 RICK PHELPS COO 453482 0 112219 0 40500 0 87122 0 15335 0 708658 0 0 0 RICHARD ELWELL CFO 349013 0 89820 0 48481 0 217795 0 11051 0 716160 0 0 0 JOHN FRIBERG SENIOR VP, GENERAL COUNSEL 292598 0 43605 0 25481 0 40137 0 15276 0 417097 0 0 0 ALEXANDER W PETRON CHIEF MEDICAL INFO OFFICER 267862 0 47300 0 33998 0 8925 0 15724 0 373809 0 0 0 WILLIAM BAXTER SENIOR VP MEDICAL AFFFAIRS 314340 0 24681 0 35000 0 44258 0 15620 0 433899 0 0 0 KEVIN B COUGHLIN SENIOR VP PHYSICIAN SERVICES 270319 0 40370 0 42007 0 8454 0 15518 0 376668 0 0 0 JUERGEN H BLUDEAU PHYSICIAN 262581 0 0 0 23000 0 3825 0 795 0 290201 0 0 0 RACHEL D VERVILLE VP OF REVENUE CYCLE 217201 0 39563 0 7951 0 3514 0 15326 0 283555 0 0 0 PART I, LINE 4B RICK PHELPS - $79,472; RICHARD ELWELL - $175,913; WILLIAM BAXTER - $35,333; JOHN E FRIBERG, JR. - $31,212 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. PART II THE SALARIES OF DOUGLAS DEAN, RICK PHELPS, AND RICHARD ELWELL REPRESENT SERVICES PROVIDED TO ALL RELATED ENTITIES. PART II LINE 1 DURING THE YEAR MR DEAN WITHDREW FUNDS FROM HIS DEFERRED COMPENSATION PLAN ($306,534) AS SUCH THIS AMOUNT IS REPORTED IN COLUMN B(III) AND IN PRIOR YEARS CONTRIBUTIONS TO HIS DEFERRED COMPENSATION PLAN WHICH SUPPORT THE CURRENT DISTRIBUTION WERE REPORTED IN COLUMN C. A BUSINESS FINANCE AUTHORITY OF THE STATE OF NH REVENUE BONDS - 2009A 020279866 64468KBQ8 2009-12-22 130000000 FINANCE/REFINANCE COSTS OF CONSTRUCTION, REFINANCE 2008 BONDS 0 0 0 A 127806119 11505106 6134168 30000000 1980498 78095644 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 A 0 0 0 0 0 0 0 0 1 A 1 JOHN FRIBERG JR EMPLOYEE LONG STANDING AND ONGOING ATTORNEY-CLIENT RELATIONSHIP BETWEEN EHS AND WADLEIGH LAW FIRM. JOHN FRIBERG JR'S FATHER IS EMPLOYED BY THE WADLEIGH FIRM AND HAS WORKED ON MEDICAL MALPRACTICE CLAIMS FOR THE HOSPITAL. 0 DIANNE MERCIER BOARD MEMBER DIANNE IS PRESIDENT OF PEOPLE'S UNITED BANK, WHICH IS A DEPOSITORY FOR GRANITE SHIELD INSURANCE EXCHANGE OF WHICH EHS IS A MEMBER 0 PETER KACHAVOS MD ELLIOT BAY MEDICAL ASSOCIATES EMPLOYEE 104264 THROUGH BMA REAL ESTATE (WHICH PETER IS A MEMBER/MANAGER WITH 50% OWNERSHIP), ELLIOT RENTS 4 ELLIOT WAY, SUITE 102, 104, 106 FOR $104,264 PER YEAR 0 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 HEALTH SYSYTEM IS THE SOLE MEMBER OF THE REPORTING ORGANIZATION, AND HAS BOARD MEMBERS WHO ARE ALSO BOARD MEMBERS OF THE REPORTING ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED 990 IS PRESENTED TO THE BOARD PRIOR TO FILING. SPECIFIC KEY SECTIONS OF THE 990 ARE SINGLED OUT FOR ADDITIONAL DISCUSSION AND INPUT FROM BOARD MEMBERS. 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 VP'S. AGAIN NATIONAL AND LOCAL BENCHMARKS FOR SALARIES ARE CONSULTED TO DETERMINE SALARY LEVELS FOR THESE VP'S. 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, LINE 24E MAINTENANCE & SERVICE CONTRACTS : PROGRAM SERVICE EXPENSES 7,975,169. MANAGEMENT AND GENERAL EXPENSES 2,658,389. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,633,558. IMPLANTS & PROTHESIS : PROGRAM SERVICE EXPENSES 7,902,834. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,902,834. OTHER PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 7,295,814. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,295,814. UTILITIES : PROGRAM SERVICE EXPENSES 3,282,640. MANAGEMENT AND GENERAL EXPENSES 1,094,213. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,376,853. SOFTWARE LICENSE FEES : PROGRAM SERVICE EXPENSES 3,937,905. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,937,905. CONSULTING FEES : PROGRAM SERVICE EXPENSES 3,906,876. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,906,876. EQUIPMENT RENTAL : PROGRAM SERVICE EXPENSES 2,808,842. MANAGEMENT AND GENERAL EXPENSES 936,281. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,745,123. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 3,414,354. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,414,354. MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,845,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,845,384. OTHER OPERATING COSTS : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,119,443. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,119,443. FOOD & DIETARY : PROGRAM SERVICE EXPENSES 2,021,588. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,021,588. MINOR EQUIPMENT PURCHASES : PROGRAM SERVICE EXPENSES 2,005,729. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,005,729. PURCHASED LABOR : PROGRAM SERVICE EXPENSES 1,992,395. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,992,395. MEDICAL SERVICES FEES : PROGRAM SERVICE EXPENSES 1,046,274. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,046,274. LAUNDRY & LINENS : PROGRAM SERVICE EXPENSES 1,006,092. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,006,092. TELEPHONE : PROGRAM SERVICE EXPENSES 723,755. MANAGEMENT AND GENERAL EXPENSES 241,251. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 965,006. COLLECTION FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 681,221. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 681,221. RECRUITMENT & RELOCATION FEES : PROGRAM SERVICE EXPENSES 612,430. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 612,430. TRUST FUND FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 588,317. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 588,317. PRINTING & PUBLICATIONS : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 519,118. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 519,118. ICD 10 PROJECT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 509,830. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 509,830. POSTAGE & SHIPPING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 436,575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 436,575. BANK & CREDIT CARD FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 382,490. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 382,490. PERMITS & FEES : PROGRAM SERVICE EXPENSES 328,684. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 328,684. EDUCATION & TRAINING : PROGRAM SERVICE EXPENSES 198,555. MANAGEMENT AND GENERAL EXPENSES 66,184. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 264,739. DUES & MEMBERSHIPS : PROGRAM SERVICE EXPENSES 228,898. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 228,898. VEHICLE EXPENSE : PROGRAM SERVICE EXPENSES 178,175. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 178,175. VALET PARKING : PROGRAM SERVICE EXPENSES 91,151. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,151. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT -4,131,381. UNREALIZED GAIN/LOSS - TEMPORARILY RESTRICTED FUNDS 642,508. UNREALIZED GAIN/LOSS - PERMANENTLY RESTRICTED FUNDS 713,890. ELLIOT HEALTH SYSTEM PROFESSIONAL & GENERAL LIABILITY INSURANCE TRUST 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 016217452 INSURANCE TRUST NH 501(C)3 LINE 11, TYPE II ELLIOT HOSPITAL 1 ELLIOT HEALTH SYSTEM 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020509911 HOLDING COMPANY NH 501(C)3 LINE 3 0 ELLIOT PHYSICIAN NETWORK 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020509589 PHYSICIAN SERVICES NH 501(C)3 LINE 3 ELLIOT HOSPITAL 1 ELLIOT PROFESSIONAL SERVICES 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 331003630 PHYSICIAN SERVICES NH 501(C)3 LINE 9 ELLIOT HOSPITAL 1 VNA OF MANCHESTER & SOUTHERN NH & SUBS 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020395296 VNA HOLDING COMPANY NH 501(C)3 LINE 7 ELLIOT HEALTH SYSTEM 0 JOHN & MARY ELLIOT CHARITABLE FOUNDATION 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020512229 FUNDRAISING NH 501(C)3 LINE 7 ELLIOT HEALTH SYSTEM 0 VNA HOME HEALTH & HOSPICE SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020222241 HOME CARE & HOSPICE SERVICES NH 501(C)3 LINE 11, TYPE II ELLIOT HEALTH SYSTEM 0 VNA COMMUNITY SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020396549 NURSING SERVICES NH 501(C)3 LINE 11, TYPE II ELLIOT HEALTH SYSTEM 0 VNA PERSONAL SERVICES INC 33 SOUTH COMMERCIAL STREET SUITE 40 MANCHESTER NH 03101 020395295 PRIVATE HEALTH & HOMEMAKER SERVICES NH 501(C)3 LINE 11, TYPE II ELLIOT HEALTH SYSTEM 0 ELLIOT COMMON TRUST FUND LLC 1 ELLIOT WAY MANCHESTER NH 03103 203653624 INVESTMENTS NH ELLIOT HOSPITAL N/A 4487161 86942706 0 0 0.86000 ELLIOT HEALTH SYSTEMS HOLDINGS & SUBSIDIARIES 1070 HOLT AVENUE UNIT 1 STE 2100 MANCHESTER NH 03109 020512224 MANAGEMENT NH C 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 ELLIOT PROFESSIONAL SERVICES NETWORK I 41387 CASH ELLIOT PROFESSIONAL SERVICES NETWORK K 226322 CASH ELLIOT PROFESSIONAL SERVICES NETWORK P 3775682 CASH ELLIOT PHYSICIAN NETWORK P 328973 CASH ELLIOT PROFESSIONAL SERVICES NETWORK Q 11286418 CASH ELLIOT PHYSICIAN NETWORK Q 15798539 CASH ELLIOT HEALTH SYSTEM 1070 HOLT AVE UNIT 1 SUITE 2100 MANCHESTER NH 03109 020509911 0 0 0 0 0 0 0 0 0 0 VNA OF MANCHESTER AND SOUTHERN NH INC & SUBSIDIARIES 33 SOUTH COMMERCIAL ST SUITE 401 MANCHESTER NH 03101 020395296 0 0 0 0 0 0 0 0 0 0 ELLIOT HOSPITAL 1 ELLIOT WAY MANCHESTER NH 03103 020232673 X 9572 0 9572 0 9572 1914 479 9093 7658 0 ELLIOT PROFESSIONAL SERVICES 1070 HOLT AVE UNIT 1 SUITE 2100 MANCHESTER NH 03109 331003630 0 0 0 0 0 0 0 0 0 0 ELLIOT PHYSICIAN NETWORK 1070 HOLT AVE 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 AVE UNIT 1 SUITE 2100 MANCHESTER NH 03109 020512224 0 0 0 0 0 0 0 0 0 0 JOHN & MARY ELLIOT CHARITABLE FOUNDATION 1070 HOLT AVE 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