2012-05-15T07:35:37-05:00 2011-09-30 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2010-10-01 222674014 EXETER HOSPITAL INC EXET 6035806695 5 ALUMNI DRIVE EXETER NH 03833 KEVIN J O'LEARY 6035806695 2012-05-09 1 MICHAEL A BARBARITA CPA 6036228881 2010 2016-02-24 21:20:13Z KEVIN CALLAHAN 5 ALUMNI DRIVE EXETER NH 03833 207228049 0 X WWW.EXETERHOSPITAL.COM X 1907 NH THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. 11 8 1667 105 0 0 169922 156691 217655856 200448522 -1252617 4941482 1666761 1643500 218239922 207190195 1352334 1270200 0 0 91239029 91114907 0 0 14261 106358653 103005305 198950016 195390412 19289906 11799783 281810222 280288030 105165067 105318138 176645155 174969892 X THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. 0 0 170747981 202104534 THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. IN FISCAL YEAR 2011 EXETER HOSPITAL SERVED THE COMMUNITY BY PROVIDING CARE TO 5,781 ACUTE INPATIENTS, 140,636 OUTPATIENT VISITS, 34,574 EMERGENCY ROOM VISITS AND 708 BIRTHS. IN 2011 EXETER HOSPITAL SUPPORTED ITS MISSION BY SUPPORTING $18,619,893 IN COMMUNITY OUTREACH, BENEFITS AND FINANCIAL SUPPORT TO THE COMMUNITY EXCLUDING $17,406,591 IN UNCOVERED MEDICARE EXPENSES. EXETER HOSPITAL SUPPORTS HEALTH CARE ACCESS IN ITS SERVICE AREA BY OFFERING A ROBUST FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COST OF UP TO 100% OF CARE PROVIDED TO AREA RESIDENTS BASED ON INCOME AND FAMILY SIZE. IN 2011, THE CHARITY CARE PROGRAM HELPED PEOPLE ACCESS THE HEALTH CARE SYSTEM BY PROVIDING $5.0 MILLION DOLLARS OF FINANCIAL ASSISTANCE. IN ADDITION WE PROVIDE SUPPORT TO VITAL COMMUNITY PROGRAMS LIKE OUR HEALTHREACH DIABETES PROGRAM, OUR PARAMEDICINE PROGRAM AND FOR PROVIDING ACCESS TO CONTRACTED MENTAL HEALTH PROFESSIONALS IN OUR EMERGENCY ROOM. WE ALSO SUPPORTED ACCESS TO THE HEALTH SYSTEM AND THE DEVELOPMENT OF HEALTHY LIFE STYLES THROUGH OUR COMMUNITY EDUCATION PROGRAMS AND OUR FINANCIAL SUPPORT OF IMPORTANT HEALTHCARE RELATED COMMUNITY BASED NOT FOR PROFITS SUCH AS FAMILIES FIRST, SEACARE AND LAMPREY HEALTHCARE EXETER HOSPITAL'S ACUTE CARE PROGRAM PROVIDES ACUTE INPATIENT AND OUTPATIENT OBSERVATION LEVEL CARE IN OUR 99 LICENSED INPATIENT BEDS. OUR INPATIENT SERVICES TREAT EMERGENT, ACUTE, ELECTIVE SURGICAL AND PALLIATIVE CARE PATIENTS. APPROXIMATELY 76% OF OUR ADMISSIONS COME FROM THE EMERGENCY ROOM. WE OFFER INPATIENT ACUTE SERVICES FOR MEDICAL AND SURGICAL DIAGNOSES FOR ADULTS AS WELL AS PEDIATRIC AND OBSTETRICAL INPATIENT SERVICES. EXETER HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION FOR THE ACCREDITATION OF HEALTH CARE ORGANIZATIONS AS WELL AS MANY OTHER SERVICE LEVEL SPECIFIC NATIONAL ACCREDITATIONS. OUR PRACTICE MODEL IS GUIDED BY A SERIES OF COLLABORATIVE BEST PRACTICE COMMITTEES THAT ENGAGE NURSES AND PHYSICIANS IN THE DEVELOPMENT OF THE BEST POSSIBLE EVIDENCE BASED CARE PROTOCOLS. EXETER HOSPITAL SUPPORTS THE SAFETY OF OUR PATIENTS AND THE EFFICIENCY OF THE CARE PROVIDED THROUGH THE DEPLOYMENT OF A 24/7 HOSPITALIST PROGRAM THAT MANAGES THE MAJORITY OF THE MEDICAL NEEDS OF OUR PATIENTS DURING THEIR ADMISSION. IN OUR 10 BED ICU WE ALSO USE AN INTENSIVEST SERVICE TO ENSURE THAT OUR MOST ACUTE PATIENTS RECEIVE THE MOST HIGHLY COORDINATED CARE POSSIBLE, RESULTING IN SIGNIFICANTLY LOWER THAN EXPECTED INFECTION RATES, ICU READMISSION RATES AND SHORTER ICU STAYS. FOR OUR PATIENTS AT THE END OF THEIR LIVES WE ENSURE THEIR SAFETY AND COMFORT THROUGH A PHYSICIAN LEAD, HIGHLY COORDINATED PALLIATIVE CARE PROGRAM. EXETER HOSPITAL'S SURGICAL PROGRAM PROVIDES A FULL RANGE OF BOTH INPATIENT AND OUTPATIENT SURGICAL SERVICES FOR PATIENTS OF ALL AGES FROM ACROSS OUR SERVICE AREA. AVAILABLE SURGICAL SPECIALTIES INCLUDE; ORTHOPEDICS, VASCULAR, GENERAL, PLASTICS, PODIATRIC, ONCOLOGY, COLORECTAL, GYNECOLOGICAL AND ENT SURGERY. RECENTLY EXETER HOSPITAL RECEIVED RECOGNITION FOR ITS JOINT REPLACEMENT PROGRAM IN ORTHOPEDICS WITH THE BLUE DISTINCTION AWARD FOR THE QUALITY AND EFFECTIVENESS OF OUR PROGRAM. ANESTHESIOLOGY COVERAGE IS PROVIDED BY AN INDEPENDENT GROUP OF ANESTHESIOLOGISTS WHO HAVE WORKED WITH OUR SURGEONS AND NURSES FOR YEARS. THE CENTER FOR CANCER CARE AT EXETER HOSPITAL PROVIDES CANCER PATIENTS AND THEIR FAMILIES WITH COMPREHENSIVE IN-PATIENT AND OUTPATIENT SERVICES. ACCREDITED BY THE AMERICAN COLLEGE OF SURGEON'S COMMISSION ON CANCER WITH COMMENDATION, THE CENTER PROVIDES AREA RESIDENTS WITH A LEADING, COMPREHENSIVE APPROACH TO CANCER TREATMENT. THE CENTER OFFERS MEDICAL ONCOLOGY, RADIATION ONCOLOGY, SURGERY, CLINICAL TRIALS, MULTIDISCIPLINARY CLINICS AND INTEGRATIVE ONCOLOGY SERVICES. THE CENTER IS PROUD TO HAVE A RELATIONSHIP WITH NEW HAMPSHIRE ONCOLOGY-HEMATOLOGY PROFESSIONAL ASSOCIATION (NHOH PA), AN AFFILIATE OF DANA FARBER CANCER INSTITUTE FOR THE PROVISION OF MEDICAL ONCOLOGY SERVICES TO PATIENTS. THE MEDICAL ONCOLOGY SERVICE SUPPORTS A 13 CHAIR INFUSION CENTER. OUR UNIQUE CLINICAL COLLABORATION WITH THE MASSACHUSETTS GENERAL HOSPITAL CANCER CENTER BRINGS RADIATION ONCOLOGISTS FROM THE WORLD'S LEADING ACADEMIC MEDICAL CENTER TO EXETER HOSPITAL'S CENTER FOR CANCER CARE. THIS AFFILIATION ALLOWS EXETER HOSPITAL'S CENTER FOR CANCER CARE TO OFFER STATE-OF-THE-ART RADIATION THERAPY SERVICES TO PATIENTS INCLUDING: ELECTRONIC BRACHYTHERAPY, PARTIAL BREAST IRRADIATION, INTENSITY MODULATED RADIATION THERAPY, CT SIMULATION AND IMAGE GUIDED RADIATION THERAPY. THE CENTER'S AFFILIATED SURGEONS WORK COLLABORATIVELY WITH AFFILIATED PATHOLOGISTS, THE MEDICAL ONCOLOGISTS AND WITH THE RADIATION ONCOLOGISTS TO DEVELOP THE MOST COMPREHENSIVE TREATMENT PLANS FOR OUR PATIENTS.EXETER HOSPITAL'S CARDIOLOGY DEPARTMENT OFFERS ACUTE CARDIAC CARE, HEART CATHETERIZATION, ANGIOPLASTY, CARDIOVERSION, AND IMPLANTATION OF CARDIOVERTER DEFIBRILLATORS, PERMANENT PACEMAKER PLACEMENT AND A THREE PHASE CARDIAC REHABILITATION PROGRAM. EXETER HOSPITAL'S AFFILIATED FELLOWSHIP-TRAINED INTERVENTIONAL CARDIOLOGISTS AND ITS CARDIAC TEAM HAVE RECEIVED NATIONAL RECOGNITION FOR THEIR "DOOR TO BALLOON" TIMES AND ONGOING SUCCESSFUL IMPLEMENTATION OF COMMUNITY BASED EMERGENCY ANGIOPLASTY AND INTERVENTIONAL CARDIOLOGY PROCEDURES. 170747981 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 147 0 1 1667 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X KEVIN J O'LEARY 6035806695 5 ALUMNI DRIVE EXETER NH 03833 KEVIN J CALLAHAN 2.00 X X 0 763615 196848 GLENN MCKENZIE 1.00 X X 0 0 0 ROBERT A EBERLE 1.00 X X 0 0 0 LARRY S PRESSMAN MD 1.00 X 0 98644 44767 KATIE DELAHAYE PAINE 1.00 X 0 0 0 ROSS GITTELL 1.00 X 0 0 0 JOSEPH ARMY 1.00 X 0 0 0 WILLIAM SCHLEYER 1.00 X 0 0 0 J BONNIE NEWMAN 1.00 X 0 0 0 MAJ GEN JOSEPH SIMEONE 1.00 X 0 0 0 NANCY BRAESE DO 1.00 X 0 148560 26914 KEVIN J O'LEARY 2.00 X 0 407282 100431 CONSTANCE D SPRAUER 2.00 X 0 294345 32331 ANNE MARIE BULARZIK 40.00 X 301887 0 15951 BRIAN CAMPBELL 40.00 X 257504 0 36537 JONATHAN A JACKSON 40.00 X 208766 0 30149 JOAN RACZY 40.00 X 140559 0 34831 JANE PETERSON 40.00 X 183593 0 12879 DEANNA KING 40.00 X 149963 0 32954 JUDY RINES 40.00 X 151901 0 30793 1394173 1712446 595385 51 0 1 0 EXETER HEALTH RESOURCES 5 ALUMNI DRIVE EXETER NH 03833 ADMINISTRATIVE MANAGEMENT SERVICES 5262366 CORE PHYSICIAN SERVICES LLC 5 ALUMNI DRIVE EXETER NH 03833 PHYSICIAN SERVICES 3644847 HARVEY CONSTRUCTION 10 HARVEY RD BEDFORD NH 03110 BUILDING CONTRACTOR 2423495 GE HEALTH CARE INC PO BOX 640200 PITTSBURGH PA 15426 EQUIPMENT MAINTENANCE 1647148 NH ONCOLOGY HEMATOLOGY PA 200 TECHNOLOGY DRIVE CENTRAL PARK I HOOKSETT NH 03106 PHYSICIAN SERVICES 1443337 50 156691 156691 NET PATIENT SVCS 621300 190927133 190927133 DISPROPORTIONATE SHARE 621300 7417253 7417253 ARRA FUNDS 621300 1500000 1500000 OTHER PROGRAM REVENUE 621300 604136 604136 200448522 1850487 1850487 21434 37854 -16420 -16420 -16420 3078483 12512 3078483 12512 3090995 12512 3078483 CAFETERIA INCOME 621300 1354489 1354489 MISCELLANEOUS 621300 185127 185127 GIFT SHOP INCOME 621300 120304 120304 1659920 207190195 202104534 0 4928970 1270200 1270200 806593 701736 104857 65333248 56839926 8493322 3870062 3366954 503108 16321316 14199545 2121771 4783688 4161809 621879 456551 456551 60500 60500 88402 88402 326530 284081 42449 1056642 919279 137363 536319 466598 69721 4962110 4317036 645074 252607 219768 32839 2029778 1765907 263871 3530735 3071739 458996 12006628 10445766 1560862 1861577 1619572 242005 SUPPLIES 15129745 13162878 1966867 BAD DEBT EXPENSE 12161820 12161820 MEDICAID ENHANCEMENT TA 10483866 10483866 DRUGS 9492158 9492158 SERVICE CONTRACTS 6313828 5493030 820798 22255509 16304313 5936935 14261 195390412 170747981 24628170 14261 39926892 56059709 18962118 18087321 2567476 2683803 1199801 2877278 141036669 63770473 81873178 77266196 133505345 119728573 3775412 3585150 281810222 280288030 14457684 18552706 62936316 61163801 27771067 25601631 105165067 105318138 X 159581890 157968770 293944 231801 16769321 16769321 176645155 174969892 281810222 280288030 X 11799783 -13475046 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 63722 0 1 24680 88402 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF MEMBERSHIP DUES AND MANAGEMENT FEES ARE CONSIDERED LOBBYING EXPENSES. 17063265 49281 -111424 17001122 17030198 37433 4366 17063265 16940024 213038 122864 17030198 0.01360 0.98640 0 1 1 102400 102400 74385480 26343559 48041921 432103 299043 133060 61384409 35656298 25728111 4732277 1471573 3260704 77266196 CASH & SHORT-TERM INVESTMENTS 9560012 F FIXED INCOME SECURITIES 35349200 F MARKETABLE EQUITY SECURITIES 40650874 F LIMITED PARTNERSHIPS 33593566 F OTHER 574921 C 119728573 DUE TO THIRD PARTY PAYORS 3705726 ACCRUED INTEREST 1051984 ACCRUED PENSION LIABILITY 8523842 SWAP VALUATION LIABILITY 12267751 DEFERRED COMPENSATION 52328 25601631 207190195 195390412 11799783 -4535001 -8940045 -13475046 -1675263 207211287 21092 21092 207190195 0 207190195 195411237 20825 20825 195390412 0 195390412 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE GOAL OF THE PERMANENT ENDOWMENT FUND IS TO PROVIDE A SOURCE OF FINANCIAL SUPPORT TO EXETER'S PATIENT CARE ACTIVITIES. THESE FUNDS ARE INVESTED IN A PRUDENT MANNER WITH REGARD TO PRESERVING PRINCIPAL WHILE PROVIDING REASONABLE RETURNS. THESE RETURNS ARE THEN USED FOR CAPITAL EXPENDITURES, OTHER MAJOR PROGRAM NEEDS, AND TO GENERALLY INCREASE THE FINANCIAL STRENGTH OF THE ORGANIZATION. THE QUASI-ENDOWMENTS ARE FUNDS WHICH HAVE BEEN DONATED TO THE ORGANIZATION FOR A PURPOSE SPECIFIED BY THE DONOR. THESE FUNDS ARE HELD UNTIL USED FOR THE PURPOSE INTENDED BY THE DONOR. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFERS BETWEEN RELATED ENTITIES -15,063,668. ADJ TO MIN PENSION LIABILITY 6,235,047. ASSETS RELEASED -111,424. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS EXPENSES 20,825. OTHER 267. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE RECLASS 20,825. X X X X 1 1 1 X 275.000000000000 1 X 1 1 1 0 1 1 2304 4829235 4829235 0.02640 3408 6955362 6955362 0.03800 5712 11784597 11784597 0.06440 61343 1437367 31418 1405949 0.00770 692 956825 956825 0.00520 2711 3512890 630085 2882805 0.01570 340 198587 36725 161862 0.00090 1302443 1302443 0.00710 65086 7408112 698228 6709884 0.03660 70798 19192709 698228 18494481 0.10100 30773 30773 0.00020 4000 4000 0.00000 20874 20874 0.00010 5791 5791 0.00000 61438 61438 0.00030 0 5643084 1434220 56464407 73873998 -17409591 X 1 1 1 1 EXETER HOSPITAL

5 ALUMNI DRIVE EXETER NH 03833

X X X NOT REQUIRED 1 PART I, LINE 7: A RATIO OF PATIENT COST TO CHARGE WAS CALCULATED UTILIZING WORKSHEET 2. THE RATIO OF COST TO CHARGE WAS UTILIZED IN CALCULATING LINE 7A TOTAL NET COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE. 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 $ 12161820. PART II: THE MAJORITY OF THE REMAINING COMMUNITY BENEFIT ACTIVITIES REPORTED AS COMMUNITY BUILDING ACTIVITIES ARE CASH DONATIONS TO COMMUNITY ORGANIZATIONS FOR THE PURPOSE OF FURTHERING WORKFORCE DEVELOPMENT, ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT, LEADERSHIP AND ECONOMIC DEVELOPMENT. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION 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). 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 HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH ACCOUNTS FOR MANY PATIENTS WHO ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE PATIENT COST TO CHARGE FROM WORKSHEET 2 WAS APPLIED TO DETERMINE THE AMOUNT OF THE ORGANIZATIONS BAD DEBT EXPENSE AT COST. PART III, LINE 8: MEDICARE COSTS ARE NOT COUNTED AS A COMMUNITY BENEFIT PER NH OR IRS GUIDANCE, THEREFORE THE COST FIGURE OF $17,409,591 IS NOT INCLUDED IN THE TOTAL UNREIMBURSED COMMUNITY BENEFIT EXPENSE. THE RATIO OF COST TO CHARGE WAS UTILIZED IN CALCULATING THE AMOUNT. PART III, LINE 9B: IF A PATIENT HAS BEEN APPROVED FOR FINANCIAL ASSISTANCE AND THEIR ACCOUNT WAS SENT TO A COLLECTION AGENCY, THE ACCOUNT WILL BE RETRACTED FROM THE COLLECTION AGENCY AND FINANCIAL ASSISTANCE WILL BE APPLIED TO THE ACCOUNT. PART VI, LINE 2: EVERY FIVE YEARS, EXETER HOSPITAL, IN COLLABORATION WITH ITS COMMUNITY PARTNERS, CONDUCTS A COMMUNITY NEEDS ASSESSMENT TO IDENTIFY, PRIORITIZE, AND ADDRESS CRITICAL HEALTH ISSUES. THE LAST COMMUNITY NEEDS ASSESSMENT WAS COMPLETED IN 2008. THE PURPOSE OF THE ASSESSMENT WAS TO ENGAGE COMMUNITY MEMBERS THROUGH KEY LEADER INTERVIEWS AND COMMUNITY FORUMS, AND TO ACHIEVE THE FOLLOWING OBJECTIVES:- EDUCATE AND INFORM KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS OF THE RESULTS OF THE 2003 COMMUNITY NEEDS ASSESSMENT AND ACHIEVEMENTS TO DATE TO MEET IDENTIFIED NEEDS- VALIDATE PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2003 COMMUNITY NEEDS ASSESSMENT AND FURTHER DEFINE THESE NEEDS IN 2008 FROM THE STAKEHOLDERS' PERSPECTIVE- IDENTIFY UNMET NEEDS THAT HAVE EMERGED SINCE THE 2003 COMMUNITY NEEDS ASSESSMENT- ENGAGE KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS IN A DISCUSSION TO IDENTIFY SOLUTIONS TO ADDRESS COMMUNITY HEALTH NEEDS- SHARE THE FINDINGS OF THE UNH SURVEY CENTER HOUSEHOLD TELEPHONE SURVEY WHERE APPROPRIATE, MOTIVATE KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS TO PARTICIPATE IN EFFORTS TO ADDRESS COMMUNITY HEALTH NEEDS GOING FORWARD- SERVE AS A CONTINUING FOUNDATION FOR THE DEVELOPMENT OF A COMMUNITY BENEFITS PLAN, AS MANDATED UNDER RSA 7:32-ETHE 2008 COMMUNITY NEEDS ASSESSMENT INCLUDED A TELEPHONE SURVEY, FOCUS GROUP AND KEY LEADER INTERVIEW COMPONENTS. THE REPORT IN ITS ENTIRETY CAN BE ACCESSED ON THE EXETER HOSPITAL WEBSITE: HTTP://WWW.EXETERHOSPITAL.COM/ABOUT-EXETER/COMMUNITY-BENEFITS/. PART VI, LINE 3: EXETER HOSPITAL PROVIDES ITS PATIENTS WITH INFORMATION REGARDING THE ORGANIZATIONS FINANCIAL ASSISTANCE PROGRAM, AND A SUMMARY OF THE ORGANIZATIONS POLICY, ON THE BACK OF EVERY BILLING STATEMENT. ON THE EXETER HOSPITAL WEBSITE (HTTP://EXETERHOSPITAL.COM), PATIENTS AND THE GENERAL PUBLIC CAN FIND INFORMATION ON THE ORGANIZATIONS FINANCIAL ASSISTANCE PROGRAMS; FINANCIAL ASSISTANCE, UNINSURED CARE DISCOUNT PROGRAM, CATASTROPHIC CARE PROGRAM, AND STATE-WIDE PROGRAMS. AS AN ADDITIONAL MEASURE TO ENSURE OUR COMMUNITY MEMBERS ARE AWARE OF EXETER HOSPITAL'S FINANCIAL ASSISTANCE PROGRAMS, TWICE A YEAR THE ORGANIZATION RUNS ADVERTISEMENTS IN COMMUNITY NEWSPAPERS SUMMARIZING THE ORGANIZATION'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY. EXETER HOSPITAL EMPLOYS FINANCIAL COUNSELORS SPECIFICALLY DEDICATED TO ASSISTING PATIENTS WITH QUESTIONS REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE, AND ASSISTING PATIENTS THROUGH THE QUALIFICATION PROCESS AS APPLICABLE. ALL INPATIENT SELF-PAY PATIENTS ARE PROVIDED INFORMATION AND COUNSELING REGARDING THE ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AT THE TIME OF SERVICE. SELF-PAY PATIENTS IN THE EMERGENCY DEPARTMENT, SURGICAL AREAS AND ONCOLOGY ARE ALSO INFORMED OF THE HOSPITALS FINANCIAL ASSISTANCE PROGRAMS AT TIME OF SERVICE OR DISCHARGE. PART VI, LINE 4: EXETER HOSPITAL SERVICES AN AREA THAT ENCOMPASSES 40 COMMUNITIES WITH AN ESTIMATED POPULATION OF 230,777. PART VI, LINE 6: ACCESS TO CAREFINANCIAL ASSISTANCE:EXETER HOSPITAL HAS THREE COMPONENTS TO ITS HEALTH CARE ACCESS PROGRAM. - THE UNINSURED CARE DISCOUNT/HOSPITAL ACCESS PLUS PROGRAM EXTENDS A 20% DISCOUNT OFF TOTAL CHARGES TO PATIENTS.- THE FINANCIAL ASSISTANCE PROGRAM IS A COMMUNITY-BASED PROGRAM FOR UNINSURED AND UNDERINSURED PATIENTS WHO MEET SPECIFIC INCOME, GEOGRAPHICAL AND OTHER GUIDELINES, AND WHO DO NOT OTHERWISE QUALIFY FOR ANY STATE OR FEDERAL ASSISTANCE. - EXETER'S CATASTROPHIC CARE PROGRAM PROVIDES FINANCIAL RELIEF FOR THOSE PATIENTS WHO DO NOT QUALIFY FOR OUR FINANCIAL ASSISTANCE PROGRAM, BUT WHO ARE FACED WITH A SUBSTANTIAL DEBT DUE TO A SERIOUS ILLNESS OR INJURY. THE FINANCIAL RELIEF IS CALCULATED BASED ON A PERCENTAGE OF THE PATIENT'S GROSS INCOME. EXETER HOSPITAL PROVIDED $4,990,463 (CALCULATED AT COST) IN CHARITY CARE DURING FY 2011, A 30 PERCENT INCREASE OVER FY 2010. IN FY 2011 THE CHARITY CARE PROGRAM SERVED 2,304 PEOPLE.WOMEN'S WELLNESS CLINIC: THROUGH A PARTNERSHIP WITH SEACARE HEALTH SERVICES, THIS CLINIC PROVIDES UNINSURED AND UNDERINSURED WOMEN WITH RECOMMENDED BREAST AND CERVICAL CANCER SCREENINGS. IN FY 2011 THE WOMEN'S WELLNESS CLINIC SERVED 121 WOMEN AND EXETER HOSPITAL PROVIDED $64,343 TO CONTINUE THIS INITIATIVE. COMMUNITY PARTNERS:EXETER HOSPITAL WORKS COLLABORATIVELY WITH LOCAL NON-PROFIT AGENCIES AND ORGANIZATIONS WHICH STRIVE TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE RELATIONSHIPS INCLUDE:LAMPREY HEALTH CARE: IN FY 2011 EXETER HOSPITAL CONTINUED ITS FINANCIAL SUPPORT OF LAMPREY HEALTH CARE WITH A COMMUNITY BENEFIT GRANT IN THE AMOUNT OF $500,250. LAMPREY HEALTH CARE IS NEW HAMPSHIRE'S OLDEST AND LARGEST PRIVATE, NON-PROFIT COMMUNITY HEALTH CENTER WITH LOCATIONS IN NEWMARKET, RAYMOND, AND NASHUA. THE ORGANIZATION SERVES OVER 16,000 PATIENTS OF ALL AGES EACH YEAR. AS A COMMUNITY HEALTH CENTER, THEY PROVIDE PRIMARY CARE AND HEALTH-RELATED SERVICES TO ALL INDIVIDUALS AND FAMILIES, REGARDLESS OF INSURANCE STATUS OR ABILITY TO PAY. BY FOCUSING ON PREVENTION AND HEALTH CARE MANAGEMENT, LAMPREY HEALTH CARE STRIVES TO KEEP THE INSURED AND UNINSURED HEALTHY, IMPROVING HEALTH OUTCOMES AND REDUCING HEALTH CARE COSTS FOR THEIR PATIENTS AND COMMUNITIES AS A WHOLE.SEACARE HEALTH SERVICES: EXETER HOSPITAL SUPPORTED SEACARE HEALTH SERVICES IN THE AMOUNT OF $324,750. SEACARE IS THE OLDEST VOLUNTEER PROVIDER NETWORK PRESENTLY FUNCTIONING IN THE US. ORGANIZED IN 1989, SEACARE INITIALLY PROVIDED PRIMARY CARE FOR CHILDREN IN PORTSMOUTH BUT EXPANDED IN 1994 TO INCLUDE PRIMARY AND SPECIALTY HEALTH CARE COORDINATION SERVICES FOR PEOPLE OF ALL AGES IN 21 TOWNS IN THE SEACOAST REGION. FAMILIES FIRST HEALTH AND SUPPORT CENTER: IN FY 2011 EXETER HOSPITAL MADE A FINANCIAL CONTRIBUTION TO FAMILIES FIRST IN THE AMOUNT OF $50,000. FAMILIES FIRST IS A COMMUNITY HEALTH CENTER OFFERING A WIDE VARIETY OF HEALTH SERVICES AND PROGRAMS INCLUDING PRIMARY CARE, PRENATAL CARE, DENTAL CARE, AND MOBILE HEALTH CARE FOR THE HOMELESS.NEW OUTLOOK TEEN CENTER: EXETER HOSPITAL CONTINUED ITS SUPPORT OF NEW OUTLOOK TEEN CENTER IN THE AMOUNT OF $90,237.NEW OUTLOOK IS A RECREATIONAL, EDUCATIONAL AND PREVENTION-ORIENTED PROGRAM LOCATED IN EXETER, NH OFFERING AFTER-SCHOOL AND SUMMER ADVENTURE PROGRAM SETTINGS FOR MIDDLE AND HIGH SCHOOL YOUTH. NEW OUTLOOK SERVES MORE THAN 350 YOUTH IN THE TOWNS OF BRENTWOOD, EAST KINGSTON, EXETER, KENSINGTON, NEWFIELDS AND STRATHAM. BEHAVIORAL HEALTH CARE SEACOAST MENTAL HEALTH CENTER: EXETER HOSPITAL PARTNERS WITH SEACOAST MENTAL HEALTH TO OFFER MENTAL HEALTH SERVICES TO PATIENTS AND THEIR CAREGIVERS IN THE EMERGENCY DEPARTMENT AND CANCER CARE CENTER. IN FY 2011 EXETER HELPED TO UNDERWRITE MENTAL HEALTH SERVICES. PART VI, LINE 7: A NETWORK OF CARINGEXETER HOSPITAL, INC. IS ONE OF FIVE AFFILIATES OF EXETER HEALTH RESOURCES. AT EACH OF THE AFFILIATED COMPANIES, EXETER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES THAT ARE INNOVATIVE, PROGRESSIVE AND FOCUSED ON QUALITY AND THE WELL-BEING OF PATIENTS. THE MISSION OF EXETER HEALTH RESOURCES AND ITS AFFILIATES IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY SUPPORTED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY. DURING FISCAL YEAR 2011, EXETER HOSPITAL, CORE PHYSICIANS, EXETER HEALTHCARE AND ROCKINGHAM VNA & HOSPICE HAVE CONTINUED THE PURSUIT OF THIS MISSION TO IMPROVE THE HEALTH OF THE COMMUNITY PROVIDING $29,079,120 IN CHARITY CARE AND OTHER COMMUNITY BENEFIT PROGRAMS AND SERVICES TO COMMUNITIES IN THE AREAS SERVED. EXETER HOSPITAL IS A 99-BED COMMUNITY-BASED HOSPITAL SERVING NEW HAMPSHIRES SEACOAST REGION. EXETER HOSPITAL'S SCOPE OF CARE INCLUDES COMPREHENSIVE MEDICAL AND SURGICAL HEALTH CARE SERVICES IN BREAST HEALTH, MATERNAL/CHILD AND REPRODUCTIVE MEDICINE, CARDIOVASCULAR, SLEEP MEDICINE, OCCUPATIONAL AND EMPLOYEE HEALTH, ONCOLOGY, ORTHOPAEDICS, AND EMERGENCY CARE. EXETER HOSPITAL IS ACCREDITED BY THE JOINT COMMISSION IN FISCAL YEAR 2011 AND IS A MEMBER OF THE NATIONAL QUALITY FORUM. CORE PHYSICIANS IS A COMMUNITY-BASED, MULTI-SPECIALTY GROUP PRACTICE. OVER 100 PHYSICIANS IN TWENTY-FIVE LOCATIONS PURSUE EXCEPTIONAL PATIENT SATISFACTION THROUGH CLINICAL COMPETENCE AND PROFESSIONAL OFFICE ADMINISTRATION.EXETER HEALTHCARE IS A SUB ACUTE AND REHABILITATION CARE FACILITY OFFERING MULTIDISCIPLINARY EXPERTISE THAT INTEGRATES REHABILITATION, NURSING, NUTRITIONAL MANAGEMENT, MEDICAL CARE AND RESPIRATORY THERAPY. ROCKINGHAM VISITING NURSE ASSOCIATION & HOSPICE IS A COMMUNITY-BASED HOME HEALTH AND HOSPICE AGENCY PROVIDING INDIVIDUALS AND FAMILIES WITH THE HIGHEST QUALITY HOME CARE, HOSPICE AND COMMUNITY OUTREACH PROGRAMS WITHIN ROCKINGHAM COUNTY AND THE SURROUNDING TOWNS OF BARRINGTON, LEE AND DURHAM. SYNERGY HEALTH AND FITNESS CENTER IS A STATE-OF-THE-ART, FULL SERVICE HEALTH AND FITNESS FACILITY WHICH IS OPEN TO THE COMMUNITY ON A MEMBERSHIP BASIS REPORTS FILED WITH STATES PART VI, LINE 7 NH 1 NEW OUTLOOK PO BOX 865 EXETER NH 03833 020468342 501(C)(3) 90237 PROVIDE RECREATIONAL, EDUCATIONAL AND PREVENTION ORIENTED PROGRAMS IN AFTER SCHOOL AND SUMMER PROGRAMS. LAMPREY HEALTHCARE INC 207 SOUTH MAIN STREET NEWMARKET NH 03857 237305106 501(C)(3) 500250 SUPPORTS THE PROVISION OF VITAL HEALTH CARE SERVICES FOR THE INDIGENT AND UNINSURED INDIVIDUALS IN THE COMMUNITY. SEACARE HEALTH SERVICES 11 DOWNING COURT EXETER NH 03833 050473406 501(C)(3) 324750 ASSISTANCE IN PROVIDING HEALTH CARE COORDINATION AND EDUCATION SERVICES, AS WELL AS MEDICATION ACCESS TO UNINSURED INDIVIDUALS IN THE COMMUNITY IT SERVES. VX HEALTH SERVICES INC 7 ALUMNI DRIVE EXETER NH 03833 020469712 291669 FUND CHARITABLE FITNESS MEMBERSHIPS FAMILIES FIRST 100 CAMPUS DRIVE SUITE 12 PORTSMOUTH NH 03801 222757341 501(C)(3) 50000 ANNUAL FUNDING CONTRIBUTION THAT HELPS FAMILIES FIRST CONTINUE TO PROVIDE HEALTH SERVICES INCLUDING PRIMARY CARE, DENTAL, PRENATAL CARE AND MOBILE HEALTH CARE FOR THE HOMELESS. UNITED WAY OF THE GREATER SEACOAST 112 CORPORATE DR PORTSMOUTH NH 03801 042382233 501(C)(3) 25000 VOLUNTEER ACTION CENTER SPONSORSHIP 5 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL REQUESTS FOR GRANTS,CONTRIBUTIONS, OR SPONSORSHIPS OVER $5,000 REQUIRE THE APPROVAL OF AT LEAST THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND DEVELOPMENT TO ENSURE THAT THEY ARE CONSISTENT WITH OUR MISSION, VALUES AND STRATEGIC PLAN. LARGER GRANTS LIKE THOSE PROVIDED TO LAMPREY, SEACARE AND NEW OUTLOOK TEEN CENTER ARE ALSO REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER PRIOR TO APPROVAL. EACH OF THOSE REQUESTING ORGANIZATIONS EITHER PROVIDES A WRITTEN SUMMARY OF HOW THEY HAVE USED OUR PREVIOUS SUPPORT AS WELL AS THEIR SPECIFIC PLANS FOR ANY NEW REQUESTED FUNDING OR THEY MAKE A PRESENTATION IN PERSON USUALLY TO THE CHIEF FINANCIAL OFFICER, THE CHIEF EXECUTIVE OFFICER AND THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND DEVELOPMENT. EACH YEAR A SUB COMMITTEE OF EXETER HEALTH RESOURCES' (PARENT COMPANY) BOARD OF TRUSTEES IS CHARGED WITH OVERSEEING OUR COMMUNITY BENEFITS PROGRAM AND OUR COMMUNITY NEEDS ASSESSMENT AND REVIEWS A DETAILED REPORT ON THE PREVIOUS YEAR'S GRANTS/ CONTRIBUTIONS/SPONSORSHIPS AND APPROVES THE CURRENT YEAR'S PLAN FOR COMMUNITY SUPPORT. THAT SUB COMMITTEE AND THE LARGER EXETER HEALTH RESOURCES' (PARENT COMPANY) BOARD OF TRUSTEES ARE REGULARLY UPDATED ON OUR COMMUNITY SUPPORT INITIATIVES. X X 0 1 X X X X 0 1 0 0 0 0 0 1 0 KEVIN J CALLAHAN 0 490965 0 175136 0 97514 0 174700 0 22148 0 960463 0 0 NANCY BRAESE DO 0 98109 0 26862 0 23589 0 4620 0 22294 0 175474 0 0 KEVIN J O'LEARY 0 267031 0 90019 0 50232 0 82700 0 17731 0 507713 0 0 CONSTANCE D SPRAUER 0 198860 0 52636 0 42849 0 14700 0 17631 0 326676 0 0 ANNE MARIE BULARZIK 197398 0 76470 0 28019 0 14700 0 1251 0 317838 0 0 0 BRIAN CAMPBELL 154408 0 69067 0 34029 0 14696 0 21841 0 294041 0 0 0 JONATHAN A JACKSON 208290 0 136 0 340 0 12711 0 17438 0 238915 0 0 0 JOAN RACZY 122156 0 3136 0 15267 0 8922 0 25909 0 175390 0 0 0 JANE PETERSON 143344 0 16752 0 23497 0 11049 0 1830 0 196472 0 0 0 DEANNA KING 141798 0 7865 0 300 0 6324 0 26630 0 182917 0 0 0 JUDY RINES 131092 0 13073 0 7736 0 9303 0 21490 0 182694 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS UP PAYMENTS WERE PROVIDED TO NANCY BRAESE, LARRY PRESSMAN, KEVIN CALLAHAN, CONSTANCE SPRAUER, KEVIN O'LEARY, ANNE MARIE BULARZIK, BRIAN CAMPBELL JONATHAN JACKSON, JUDY RINES AND JANE PETERSON (FOR ACQUISITION OF SUPPLEMENTAL LONG TERM DISABILITY INSURANCE). THE BENEFIT WAS TREATED AS TAXABLE INCOME. TRUSTEES ARE ELIGIBLE FOR DISCOUNTED MEMBERSHIP FEES AT A WELLNESS CENTER OWNED BY A SUBSIDIARY OF EXETER HEALTH RESOURCES. THE BENEFIT IS REPORTED AS TAXABLE INCOME TO THE TRUSTEE. PART I, LINE 1B THERE WAS NO EXISTING POLICY CONCERNING TAX INDEMNIFICATION AND GROSS UP PAYMENTS. HOWEVER, IN THE INSTANCE OF SUCH ACTION RELATED TO THE ACQUISITION OF LONG TERM DISABILITY INSURANCE DESCRIBED ABOVE, THE TAX INDEMNIFICATION AND GROSS UP PAYMENTS WERE APPROVED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES EXECUTIVE COMMITTEE WHICH IS COMPRISED OF DISINTERESTED PERSONS. PART I, LINE 4B THE ORGANIZATION'S PARENT (EXETER HEALTH RESOURCES, INC.) MAINTAINS A SPLIT DOLLAR SUPPLEMENTAL RETIREMENT PLAN FOR 2 EXECUTIVES (LISTED BELOW WITH AMOUNTS)SELECTED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES. THE PLAN IS CLOSED TO FUTURE PARTICIPANTS. THE PLAN PROVIDES FOR ANNUAL PAYMENTS OF PREMIUMS FOR LIFE INSURANCE POLICIES INSURING THE LISTED INDIVIDUALS. THOSE LIFE INSURANCE PREMIUMS ARE COLLATERALLY ASSIGNED TO THE CORPORATION AND ANY EXCESS ACCUMULATED VALUE IN THE POLICIES (NET OF ACCUMULATED PREMIUM PAYMENTS) ARE AVAILABLE TO BE PAID TO THE PARTICIPANT ONCE VESTED AT AGE 62. KEVIN CALLAHAN - EXCESS ACCUMULATED VALUE - $37,726 KEVIN O'LEARY - EXCESS ACCUMULATED VALUE - $10,615 CERTAIN OF THE LISTED EMPLOYEES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN AS DESCRIBED IN INTERNAL REVENUE CODE SECTION 457(F) SPONSORED BY EHR. IN THE CALENDAR YEAR ENDED DEC 31, 2010 THE CONTRIBUTION TO THE PLAN FOR THE NON-VESTED BENEFIT OF KEVIN CALLAHAN WAS $168,000 AND THE CONTRIBUTION TO THE PLAN FOR THE NON-VESTED BENEFIT OF KEVIN O'LEARY WAS $68,000. PARTICIPANTS IN THE 457(F) PLAN DO NOT VEST UNTIL AGE 62. PART I, LINE 7 THE ORGANIZATION PROVIDES AN ANNUAL INCENTIVE COMPENSATION PLAN FOR EXECUTIVES SELECTED BY THE EXETER HEALTH RESOURCES INC. BOARD OF TRUSTEES. THESE EXECUTIVES INCLUDE: KEVIN CALLAHAN, KEVIN O'LEARY, CONSTANCE SPRAUER, ANNE MARIE BULARZIK AND BRIAN CAMPBELL. THE BOARD AND/OR ITS EXECUTIVE COMMITTEE APPROVES MEASUREABLE ACHIEVEMENT CRITERIA FOR QUALITY, PATIENT SATISFACTION, PROCESS IMPROVEMENT, FINANCIAL PERFORMANCE, SERVICES INNOVATION AND OTHER COMPELLING AREAS OF STRATEGIC AND OPERATIONAL INTEREST. ADDITIONALLY THE BOARD AND/OR ITS EXECUTIVE COMMITTEE ESTABLISHES MINIMUM, TARGETED AND MAXIMUM LEVELS FOR INCENTIVE AWARDS AND APPROVES ALL AWARDS FOR PARTICIPATING EXECUTIVES. LARRY PRESSMAN MD AND NANCY BRAESE DO ARE COMPENSATED UNDER CORE PHYSICIANS, LLC'S COMPENSATION PROGRAM. COMPENSATION IS DETERMINED USING SURVEYS OF CURRENT COMPENSATION WITHIN COMPARABLE MARKETS AND THE ADVICE OF OUTSIDE CONSULTANTS. THE PHYSICIANS' COMPENSATION IS APPROVED BY CORE PHYSICIANS, LLC'S COMPENSATION COMMITTEE WHICH IS COMPRISED OF SYSTEM MANAGERS WHO ARE APPROVED BY THE EXETER HEALTH RESOURCES INC. BOARD OF TRUSTEES. JONATHAN JACKSON, JANE PETERSON, DEANNA KING, JUDY RINES AND JOAN RACZY PARTICIPATE IN AN ANNUAL INCENTIVE PROGRAM WHICH IS ADMINISTERED BY EXETER HOSPITAL'S HUMAN RESOURCES DEPARTMENT. THE PROGRAM INCLUDES MEASURABLE ACHIEVEMENT CRITERIA FOR PERFORMANCE AND SERVICE INNOVATION. NH HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 644614GH6 2003-11-20 20000000 RENOVATION AND EXPANSION PROJECTS ON THE HOSPITAL CAMPUS 0 1 0 20000000 19892600 256727 19635873 2006 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 1 1 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 EXETER HEALTH RESOURCES, INC., A CHARITABLE ORGANIZATION ACTING THROUGH ITS BOARD OF TRUSTEES IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EXETER HEALTH RESOURCES, INC. ELECTS 9 OF THE 11 MEMBERS OF THE EXETER HOSPITAL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, EXETER HEALTH RESOURCES, INC., HAS THE RIGHT TO APPROVE DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY AN OUTSIDE TAX ACCOUNTANT WITH INFORMATION PROVIDED BY THE ORGANIZATION. THE 990 IS REVIEWED BY THE ORGANIZATION'S TREASURER THEN PRESENTED TO THE BOARD OF TRUSTEES BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT REQUIRES THE DISCLOSURE OF CONFLICTS OF INTEREST EITHER WHEN THE INTEREST BECOMES A MATTER OF POSSIBLE ACTION BY THE BOARD OR DURING AN ANNUAL DISCLOSURE PROCESS. TRUSTEES, OFFICERS, AND KEY EMPLOYEES, AS WELL AS ALL MEMBERS OF SENIOR MANAGEMENT, ARE PART OF THE ANNUAL DISCLOSURE PROCESS, WHICH IS INITIATED BY THE ISSUANCE OF A MEMORANDUM AND ACCOMPANYING QUESTIONNAIRE BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (CEO). ALL DISCLOSURES ARE REVIEWED. ANY TRUSTEE WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING AND IS NOT INCLUDED IN A QUORUM DETERMINATION ON THE MATTER AND ANY OFFICER, KEY EMPLOYEE, OR MEMBER OF SENIOR MANAGEMENT WITH A CONFLICT DOES NOT TAKE PART IN MAKING AND IS NOT PRESENT FOR ANY DECISION REGARDING THE MATTER. THE POLICY IS MONITORED AND ENFORCED BY BOTH THE PRESIDENT AND CEO AND THE FULL BOARD. THERE ARE TWO ADDITIONAL CONFLICTS OF INTEREST POLICIES. ONE IS APPLICABLE TO ALL EMPLOYEES AND CONTRACTED STAFF AND THE OTHER IS APPLICABLE TO MEMBERS OF THE MEDICAL STAFF AND ALLIED HEALTH PROFESSIONALS. THE FORMER POLICY IS MONITORED AND ENFORCED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND THE VICE PRESIDENT OF CORPORATE INTEGRITY AND COMPLIANCE AND THE LATTER IS MONITORED AND ENFORCED BY THE PRESIDENT OF THE MEDICAL STAFF, PRESIDENT AND CEO, GENERAL COUNSEL, AND COMPLIANCE OFFICER. ON AN ANNUAL BASIS, STAFF WITHIN HUMAN RESOURCES SURVEY ALL EMPLOYEES AND CONTRACTED STAFF SERVING IN A MANAGERIAL ROLE, AS WELL AS MEMBERS OF ANY COMMITTEES THAT MAKE RECOMMENDATIONS OR DECISIONS REGARDING THE PURCHASE OF GOODS OR SERVICES BY ANY OF THE CORPORATIONS AS A MEANS TO ENSURE THAT ANY CONFLICT OF INTEREST IS DISCLOSED AND APPROPRIATELY MANAGED. EMPLOYEES OTHERWISE ARE REQUIRED TO SUPPLEMENT OR MAKE ANY FURTHER WRITTEN DISCLOSURE AT THE TIME A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A & 15B THE ORGANIZATION'S PARENT (EXETER HEALTH RESOURCES) HAS A FORMAL PROCESS FOR DETERMINING TOTAL COMPENSATION FOR THE CEO AND OTHER LISTED OFFICERS THAT IS INTENDED TO PROVIDE REASONABLE COMPENSATION FOR ACHIEVING THE ORGANIZATION'S MISSION, TO RECOGNIZE INDIVIDUAL AND TEAM PERFORMANCE, AND TO COMPLY WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE EXETER HEALTH RESOURCES' BOARD OF TRUSTEES CONDUCTS AN ANNUAL REVIEW OF THE COMPENSATION OF THE CEO AND OTHER LISTED OFFICERS AND KEY EMLOYEES. IN DOING SO, THE COMMITTEE RETAINS A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE MARKET RANGES OF BASE, INCENTIVE, AND TOTAL CASH COMPENSATION, AND TO PROVIDE ADVICE CONCERNING THE REASONABLENESS OF THE COMPENSATION OF THE CEO AND OTHER LISTED OFFICERS AND KEY EMPLOYEES. THE COMMITTEE UTILIZES THAT ANALYSIS AND OTHER APPROPRIATE INFORMATION IN CONNECTION WITH ITS ANNUAL REVIEW AND MAKES RECOMMENDATIONS TO THE FULL BOARD OF EXETER HEALTH RESOURCES FOR ADJUSTMENT OF THE CEO'S COMPENSATION AND THE COMPENSATION FOR OTHER LISTED OFFICERS. INFORMATION WHICH THE COMMITTEE MAY CONSIDER CAN INCLUDE BUT IS NOT LIMITED TO THE PERFORMANCE OF AN INDIVIDUAL AND/OR THAT INDIVIDUAL'S CONTRIBUTIONS TO A TEAM, THE PERFORMANCE OF THE ORGANIZATION IN WHOLE AND IN PART, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATION'S COMPENSATION TARGETS, AND COMPARABILITY DATA,INCLUDING THE DATA PREPARED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE COMMITTEE. THE COMMITTEE INCORPORATES A PERFORMANCE APPRAISAL PROCESS IN THE CEO'S, AND THE LISTED OFFICERS' AND KEY EMPLOYEES' COMPENSATION REVIEW. THE CEO, AND OTHER LISTED OFFICERS AND KEY EMPLOYEES ARE NOT PRESENT WHEN THE COMMITTEE DISCUSSES THEIR RESPECTIVE COMPENSATION. IN ADDITION, THE COMMITTEE DETERMINES IF THE THRESHOLD REQUIREMENTS FOR INCENTIVE AWARDS ARE MET, CONSISTING OF THE ORGANIZATION'S PERFORMANCE RESULTS FOR QUALITY, OPERATING SYSTEM EXCELLENCE AND FINANCIAL PERFORMANCE. THE RESULTS OF THE COMMITTEE'S DELIBERATIONS ARE PRESENTED TO THE EXETER HEALTH RESOURCES BOARD AND INCLUDE RECOMMENDATIONS CONCERNING SALARY RANGE ADJUSTMENTS AND INCENTIVE AWARDS AND THE BASIS FOR THE COMMITTEE'S DECISIONS / RECOMMENDATIONS. THE DELIBERATIONS OF THE EXETER HEALTH RESOURCES BOARD ARE CONDUCTED IN EXECUTIVE SESSION WITH THE INDEPENDENT MEMBERS OF THE BOARD BUT DO INCLUDE THE CEO ONLY FOR THAT PERIOD OF TIME IN WHICH THE EXETER HEALTH RESOURCES BOARD HAS QUESTIONS CONCERNING THE PERFORMANCE OF ANY LISTED OFFICER OR KEY EMPLOYEE OTHER THAN THE CEO. THE EXETER HEALTH RESOURCES BOARD REVIEWS THE CEO'S PERFORMANCE AND DETERMINES IF THE ADJUSTMENTS AND AWARDS RECOMMENDED BY THE COMMITTEE FOR THE CEO ARE IN THE ORGANIZATION'S BEST INTEREST AND FOR THE BENEFIT OF THE ORGANIZATION AND THE PARENT ORGANIZATION. FOR THE LISTED OFFICER POSITIONS, ADJUSTMENTS AND INCENTIVE AWARDS ARE APPROVED UPON RECOMMENDATION OF THE CEO BY THE EXECUTIVE COMMITTEE WITHIN THE EXETER HEALTH RESOURCES BOARD APPROVED PARAMETERS AND RATIFIED BY THE BOARD OF TRUSTEES. ADJUSTMENTS AND AWARDS FOR OTHER LISTED KEY EMPLOYEES ARE APPROVED UPON RECOMMENDATION OF THE CEO BY THE EXECUTIVE COMMITTEE WITHIN THE EXETER HEALTH RESOURCES BOARD APPROVED PARAMETERS AND REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24F PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,312,103. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,312,103. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,924,386. MANAGEMENT AND GENERAL EXPENSES 586,461. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,510,847. INTEREST RATE SWAP: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,777,747. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,777,747. OUTSIDE FEES: PROGRAM SERVICE EXPENSES 1,763,145. MANAGEMENT AND GENERAL EXPENSES 263,459. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,026,604. EQUIPMENT RENTAL: PROGRAM SERVICE EXPENSES 704,189. MANAGEMENT AND GENERAL EXPENSES 105,224. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 809,413. CONSULTING: PROGRAM SERVICE EXPENSES 786,711. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 786,711. PROJECT/DESIGN COSTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 731,084. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 731,084. COLLECTION FEES: PROGRAM SERVICE EXPENSES 710,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 710,431. LAUNDRY/LINEN: PROGRAM SERVICE EXPENSES 537,392. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 537,392. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 317,586. MANAGEMENT AND GENERAL EXPENSES 52,219. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 369,805. FINANCING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 323,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,440. MAINTENANCE: PROGRAM SERVICE EXPENSES 272,880. MANAGEMENT AND GENERAL EXPENSES 40,775. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 313,655. DUES/SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 228,806. MANAGEMENT AND GENERAL EXPENSES 34,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 262,995. MEDICAL LEADERSHIP/ FEES: PROGRAM SERVICE EXPENSES 197,559. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 197,559. STORAGE: PROGRAM SERVICE EXPENSES 175,254. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,254. REFRESHMENTS: PROGRAM SERVICE EXPENSES 149,484. MANAGEMENT AND GENERAL EXPENSES 22,337. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,821. FREIGHT AND TRANSPORTATION: PROGRAM SERVICE EXPENSES 170,397. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 170,397. PATIENT TRANSPORT/SUPPORT GROUPS: PROGRAM SERVICE EXPENSES 53,990. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,990. FUNDRAISING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 14,261. TOTAL EXPENSES 14,261. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,535,001. TRANSFERS BETWEEN RELATED ENTITIES -15,063,668. ADJ TO MIN PENSION LIABILITY 6,235,047. ASSETS RELEASED -111,424. TOTAL TO FORM 990, PART XI, LINE 5: -13,475,046. EXETER HEALTH RESOURCES INC 5 ALUMNI DRIVE EXETER NH 03833 020222126 MANAGEMENT AND SUPPORTING ORGANIZATION, HOLDING COMPANY NH 501(C)(3) 11 0 EXETER HEALTHCARE 5 ALUMNI DRIVE EXETER NH 03833 020360966 SUBACUTE NURSING FACILITY NH 501(C)(3) 9 EXETER HEALTH RESOURCES INC 0 CORE PHYSICIANS LLC 5 ALUMNI DRIVE EXETER NH 03833 870807914 PHYSICIAN PRACTICES NH 501(C)(3) 9 EXETER HEALTH RESOURCES INC 0 ROCKINGHAM VISITING NURSE ASSOC 5 ALUMNI DRIVE EXETER NH 03833 020274905 HOME CARE, HOSPICE NH 501(C)(3) 9 EXETER HEALTH RESOURCES INC 0 MATRIX HEALTH INC 5 ALUMNI DRIVE EXETER NH 03833 020473737 MANAGE RESOURCES NH 501(C)(3) 11 EXETER HEALTH RESOURCES INC 0 EXETER MED REAL 5 ALUMNI DRIVE EXETER NH 03833 020418718 REAL ESTATE HOLDING NH 501(C)(25) EXETER HEALTH RESOURCES INC 0 EXETER HEALTH RESOURCES SELF INSURANCE TRUST 5 ALUMNI DRIVE EXETER NH 03833 200753662 SELF INSURANCE TRUST NH 501(C)(3) 11 EXETER HEALTH RESOURCES INC 0 CONVERGENT HEALTH SYSTEMS INC 5 ALUMNI DRIVE EXETER NH 03833 020469711 WELLNESS CENTER NH EXETER HEALTH RESOURCES INC C VX HEALTH SERVICES 5 ALUMNI DRIVE EXETER NH 03833 020469712 FITNESS CENTER NH CONVERGENT HEALTH SYSTEMS INC C EXETER MEDICAL SERVICES 5 ALUMNI DRIVE EXETER NH 03833 020419850 INACTIVE PHYSICIAN PRACTICE NH CONVERGENT HEALTH SYSTEMS INC C CORE HEALTH SERVICES OF MA 5 ALUMNI DRIVE EXETER NH 03833 201598042 INACTIVE PHYSICIAN PRACTICE MA EXETER HEALTH RESOURCES INC C 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 VX HEALTH SERVICES B 291669 CASH EXETER HEALTH RESOURCES Q 7350000 CASH EXETER HEALTHCARE Q 1922785 CASH CORE PHYSICIANS LLC Q 5790883 CASH EXETER HEALTHCARE J 474591 CASH EXETER HEALTH RESOURCES J 59424 CASH EXETER MED REAL J 993115 CASH CORE PHYSICIANS LLC J 13988 CASH VX HEALTH SERVICES J 76911 CASH EXETER HEALTH RESOURCES SI TRUST P 1120240 CASH EXETER HEALTH RESOURCES L 5089246 CASH EXETER HEALTHCARE N 35771 CASH EXETER HEALTH RESOURCES N 173120 CASH EXETER MED REAL K 1261012 CASH ROCKINGHAM VNA K 199993 CASH VX HEALTH SERVICES K 64351 CASH EXETER HEALTH RESOURCES K 63613 CASH EXETER MED REAL K 178433 CASH CORE PHYSICIANS LLC L 3644847 CASH