2012-08-14T13:21:59-05:00 2011-09-30 WHITTLESEY & HADLEY PC 147 CHARTER OAK AVE HARTFORD CT 061065100 990 2010-10-01 222546079 EASTERN CONNECTICUT HEALTH NETWORK EAST 8606461222 71 HAYNES STREET MANCHESTER CT 06040 MICHAEL D VEILLETTE 8606461222 2012-08-14 ROBERT W MCCALL 8605223111 2010 2016-02-24 21:20:13Z MICHAEL D VEILLETTE 71 HAYNES STREET MANCHESTER CT 06040 29081189 0 X WWW.ECHN.ORG X 1995 CT INTEGRATED HEALTHCARE SYSTEM. 23 22 0 0 0 0 517126 311601 24502593 28879647 1829 0 0 -110059 25021548 29081189 0 0 0 0 0 0 0 0 0 24799052 28968969 24799052 28968969 222496 112220 24492174 22769648 17501105 17803991 6991069 4965657 X ECHN'S MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES WITH COMPETENCE AND COMPASSION. WE WILL PROVIDE HEALTH CARE SERVICES THAT EXCEED THE EXPECTATIONS OF OUR PATIENTS, PHYSICIANS AND COMMUNITY. 0 0 28968969 28672095 EASTERN CONNECTICUT HEALTH NETWORK, INC. (ECHN) AND AFFILIATES (COLLECTIVELY, THE NETWORK) IS A NONPROFIT LOCALLY GOVERNED HEALTH SYSTEM CREATED ON SEPTEMBER 12, 1995, THROUGH THE MERGER OF THE CORPORATE PARENTS OF MANCHESTER MEMORIAL HOSPITAL (MMH) AND ROCKVILLE GENERAL HOSPITAL, INC. (RGH). ITS PURPOSE IS TO PROVIDE A HEALTH CARE SYSTEM FOR THE COMMUNITIES IT SERVES, WITH QUALITY MEDICAL CARE AT A REASONABLE COST, TO FOSTER AN ENVIRONMENT CONDUCIVE TO HEALTH AND WELL-BEING, WHETHER IN THE HOME OR IN THE COMMUNITY, AND TO ENABLE THE HEALTH CARE SYSTEM TO EXPAND TO MEET THE FUTURE NEEDS OF ITS COMMUNITIES. ECHN, THROUGH ITS AFFILIATES (OR MEMBERS), PROVIDES HEALTH CARE, HEALTH EDUCATION, AND COMMUNITY SERVICES TO RESIDENTS OF MORE THAN 20 TOWNS IN EASTERN CONNECTICUT, REGARDLESS OF THEIR ABILITY TO PAY. ECHN PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED AND CONTRACTUAL RATES. ECHN DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; SUCH AS, THESE AMOUNTS ARE NOT REPORTED AS REVENUE. CHARITY CARE FOR FY 2011 WAS $5,660,092, FOR 2,781 TOTAL APPROVED APPLICANTS AT MMH AND RGH. EXPENSES RELATED TO SERVICES PERFORMED FOR PATIENTS OF ECHN, INC. CONTRIBUTE IMPORTANTLY TO ITS EXEMPT PURPOSE BECAUSE THE EXPENSES ARE INCURRED IN THE DIAGNOSIS, CURE, MITIGATION, TREATMENT AND PREVENTION OF DISEASE, AND FOR MEDICAL PURPOSES AFFECTING THE STRUCTURE OR FUNCTION OF THE HUMAN BODY.ECHN, INC. PROVIDED NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF ANY INDIVIDUALS ABILITY TO PAY. AT MMH AND RGH, ELEVEN THOUSAND SEVEN HUNDRED NINETY SIX (11,796) INPATIENTS WERE CARED FOR IN FY11 REPRESENTING 55,845 PATIENT DAYS; THREE HUNDRED SIXTEEN THOUSAND THREE HUNDRED SIXTEEN (316,316) OUTPATIENT VISITS WERE RECORDED.INCLUDED IN THE 11,796 INPATIENTS WERE 7,379 GOVERNMENT RELATED PATIENTS. THE GOVERNMENT INPATIENTS FALL INTO THE FOLLOWING GROUPS.MEDICARE 4,368MEDICARE MANAGED CARE 839MEDICAID 1,042MEDICAID MANAGED CARE 1,080CHAMPUS 50TOTAL GOV PATIENTS 7,379TOTAL NON GOV PATIENTS 4,417TOTAL PATIENTS 11,796 INCLUDED IN THE 316,316 OUTPATIENT VISITS THE FOLLOWING WERE GOVERNMENT RELATED. THE VISITS ARE A PRODUCT OF GROSS REVENUE RELATIONSHIP TO TOTAL VISITS.MEDICARE 93,664MEDICARE MANAGED CARE 22,755MEDICAID 18,485MEDICAID MANAGED CARE 29,103CHAMPUS 1,407TOTAL GOV PATIENTS 165,414TOTAL NON GOV PATIENTS 150,902TOTAL OUTPATIENTS 316,316MMH AND RGH PROVIDED UNCOMPENSATED CARE TO 56,286 MEDICAID PATIENTS FOR A NET COMMUNITY BENEFIT AMOUNT OF $8,011,371 AFTER MEDICAID REIMBURSEMENT. ADDITIONAL INFORMATION REGARDING PROGRAMS FOR THE COMMUNITY AT MMH AND RGH: COMMUNITY BENEFIT SERVICES / BENEFIT / PERSONS SERVED COMMUNITY HEALTH IMPROVEMENT SERVICES COMMUNITY HEALTH EDUCATION $ 754,053 135,484COMMUNITY BASED CLINICAL SERVICES $ 50,464 1,855HEALTH CARE SUPPORT SERVICES $ 55,942 4,079TOTAL $ 860,459 141,418 HEALTH PROFESSIONS EDUCATION PHYSICIANS/MEDICAL STUDENTS $ 189,600 69NURSES/NURSING STUDENTS $ 1,251,802 253OTHER HEALTH PROFESSIONAL ED $ 142,593 126TOTAL $ 1,583,995 448 SUBSIDIZED HEALTH SERVICES NEONATAL INTENSIVE CARE $ 1,462,939 180TOTAL $ 1,462,939 180 RESEARCH OTHER RESEARCH $ 363,230 0 TOTAL $ 363,230 0 FINANCIAL AND IN-KIND CONTRIBUTIONS CASH DONATIONS $ 10,773 0 IN-KIND DONATIONS $ 149,494 12,365TOTAL $ 160,267 12,365 COMMUNITY BUILDING ACTIVITIES ECONOMIC DEVELOPMENT $ 887 0COMMUNITY SUPPORT $ 1,376,193 7,048COALITION BUILDING $ 12,733 0WORKFORCE DEVELOPMENT $ 4,833 172TOTAL $ 1,394,646 7,220 COMMUNITY BENEFIT OPERATIONS DEDICATED STAFF $ 182,469 0 TOTAL $ 182,469 0 GRAND TOTAL $ 6,008,005 161,631 FINANCIAL SERVICES DETAIL / BENEFIT / PERSONS SERVED TRADITIONAL CHARITY CARE $ 2,100,957 2,781 UNPAID COSTS OF MEDICAID $ 8,376,995 56,286TOTAL COMMUNITY BENEFIT $ 16,485,957 220,698 SEE SCHEDULE 0 FOR CONTINUTION 28968969 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 CJ 0 0 0 0 0 0 0 0 0 0 X 23 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JAMES RAY 8606461222 71 HAYNES STREET MANCHESTER CT 06040 PAUL BERTE 1.00 X 0 0 0 GORON BRODIE MD 1.00 X 0 0 0 GLORIA BROOKS 1.00 X 0 0 0 THOMASINA CLEMONS 1.00 X 0 0 0 MICHELE CONLON MD 1.00 X 0 0 0 ANTHONY DISTEFANO MD 1.00 X 0 0 0 MILTON DOREMUS 1.00 X 0 0 0 JOY DORIN 1.00 X 0 0 0 DAVID ENGELSON 1.00 X 0 0 0 DAVID GONCI 1.00 X 0 0 0 HARRIET HASLETT 1.00 X 0 0 0 JEFFREY HEIDTMAN 1.00 X X 0 0 0 REBECCA JANENDA 1.00 X 0 0 0 JOSEPH JEAMEL JR 1.00 X 0 0 0 JOYCE JORDAN 1.00 X 0 0 0 CRAIG LAPPEN 1.00 X X 0 0 0 PAMELA LEWIS MD 1.00 X 0 0 0 ROBIN MURDOCK MEGGERS 1.00 X X 0 0 0 CLAUDIO MILITE MD 1.00 X 0 0 0 PETER MULLIGAN 1.00 X 0 0 0 DENNIS O'NEILL MD 1.00 X X 0 0 0 ROSEMARIE PAPA 1.00 X 0 0 0 THOMAS SCANLON 1.00 X 0 0 0 LENORA WILLIAMS MD 1.00 X 0 0 0 PETER J KARL 37.50 X 0 929933 112267 KEVIN MURPHY 37.50 X 0 534368 56722 MICHAEL D VEILLETTE 37.50 X 0 215551 39089 CHARLES COVIN 37.50 X 0 206158 14446 LEONA CROSSKEY 37.50 X 0 162470 14280 DEBORAH GOGLIETTINO 37.50 X 0 281471 36526 DENNIS MCCONVILLE 37.50 X 0 314751 30074 DEBORAH PARKER 37.50 X 0 309351 37853 JOEL REICH MD 37.50 X 0 487101 65400 KATHLEEN SIMS 37.50 X 0 205348 20838 CAROLYN MCKENNA 37.50 X 0 326095 39355 RICHARD SLUTSKY 37.50 X 0 145195 13368 0 4117792 480218 0 1 1 0 0 311601 311601 AFFILIATION CHARGE 900099 26209793 26209793 PARTNERSHIP AND OTHER 900099 1335234 1335234 OTHER HEALTHCARE RELAT 900099 1334620 1334620 28879647 OTHER 900099 97493 97493 NON-OPERATING GAIN/LOS 900099 -207552 -207552 -110059 29081189 28672095 0 97493 1009769 1009769 16501 16501 46500 46500 1219295 1219295 1432868 1432868 2003535 2003535 779335 779335 361583 361583 134639 134639 85575 85575 202857 202857 199046 199046 3433830 3433830 ALLOCATED WAGES AND BEN 12981963 12981963 REPAIRS/MAINTENANCE 2883674 2883674 OUTSIDE SERVICES 1072847 1072847 RECRUITING/RETENTION 454535 454535 HOSPITAL ASSOCIATION DU 345979 345979 304638 304638 28968969 28968969 0 0 360160 292977 123993 122030 253008 221955 1333934 1354342 498863 106899 463230 391964 3374960 3245067 9170783 8957726 9412106 8183587 24492174 22769648 246908 743227 3390797 3538609 13863400 13522155 17501105 17803991 X 5152954 4690416 1838115 275241 6991069 4965657 24492174 22769648 X 112220 -2137632 X 0 1 1 X 0 X X X 0 0 0 MANCHESTER MEMORIAL HOSPITAL 060646710 3 1 1 1 0 ROCKVILLE GENERAL HOSPITAL 060653151 3 1 1 1 0 ECHN ELDERCARE SERVICES INC 061149193 9 1 1 1 0 ECHN WELLNESS SERVICES INC 061360082 9 1 1 1 0 4 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 46500 0 0 46500 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: WE ARE MEMBERS AND PAY DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE CONNECTICUT HOSPITAL ASSOCIATION. THESE ASSOCIATIONS ENGAGE IN DIRECT COMMUNICATIONS WITH MEMBERS OF FEDERAL, STATE AND LOCAL GOVERNMENTS TO INFLUENCE LEGISLATION AFFECTING THE HEALTH CARE INDUSTRY. LOBBYING FEES OF $45,000 WERE PAID TO A LOBBYING FIRM TO INFLUENCE HEALTH CARE RELATED LEGISLATION. 123513 26467 97046 375350 80432 294918 391964 INVESTMENT IN JOINT VENTURES 8957726 C 8957726 BENEFICIAL INTEREST IN THE NET ASSETS OF ECHN COMM HEALTHCARE FOUNDATION 2348934 DUE FROM AFFILIATES 1425642 GOODWILL 4409011 8183587 DUE TO AFFILIATED ENTITIES 13522155 13522155 29081189 28968969 112220 -285821 -1851811 -2137632 -2025412 733764 -285821 -1851811 -2137632 2871396 26209793 26209793 29081189 2759176 0 2759176 26209793 26209793 28968969 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE NETWORK ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH PROVISIONS OF FASB ASC 740, INCOME TAXES WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS IN THEIR FINANCIAL STATEMENTS. THE NETWORK MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE NETWORK DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2011 AND 2010. AS OF SEPTEMBER 30, 2011 AND 2010, THE NETWORK DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFERS TO AFFILIATES, NET -1,603,519. CHANGE IN INTEREST RATE SWAP -248,292. PART XII, LINE 2D - OTHER ADJUSTMENTS: TRANSFERS TO AFFILIATES,NET -1,603,519. CHANGE IN INTEREST RATE SWAP -248,292. PART XII, LINE 4B - OTHER ADJUSTMENTS: ECHN ALLOCATION 26,209,793. PART XIII, LINE 4B - OTHER ADJUSTMENTS: ECHN ALLOCATION 26,209,793. X X X X X 0 0 0 1 1 0 0 0 0 PETER J KARL 0 929933 0 0 0 0 0 11318 0 100949 0 1042200 0 697450 KEVIN MURPHY 0 534368 0 0 0 0 0 8436 0 48286 0 591090 0 400776 MICHAEL D VEILLETTE 0 215551 0 0 0 0 0 8396 0 30693 0 254640 0 161663 CHARLES COVIN 0 206158 0 0 0 0 0 1379 0 13067 0 220604 0 154619 LEONA CROSSKEY 0 162470 0 0 0 0 0 1213 0 13067 0 176750 0 121853 DEBORAH GOGLIETTINO 0 281471 0 0 0 0 0 8853 0 27673 0 317997 0 211103 DENNIS MCCONVILLE 0 314751 0 0 0 0 0 1586 0 28488 0 344825 0 236063 DEBORAH PARKER 0 309351 0 0 0 0 0 8972 0 28881 0 347204 0 232013 JOEL REICH MD 0 487101 0 0 0 0 0 2506 0 62894 0 552501 0 365326 KATHLEEN SIMS 0 205348 0 0 0 0 0 7771 0 13067 0 226186 0 154011 CAROLYN MCKENNA 0 326095 0 0 0 0 0 9112 0 30243 0 365450 0 244571 RICHARD SLUTSKY 0 145195 0 0 0 0 0 301 0 13067 0 158563 0 108896 CONLON MICHELE MD EXECUTIVE, GOVERNANCE, MEC 395462 PARTNER, EASTERN CONNECTICUT PATHOLOGY CONSULTANTS - CONTRACT WITH ECHN TO PROVIDE LAB/ANATOMIC PATHOLOGY SERVICES 0 ONEILL DENNIS MD EXECUTIVE, GOVERNANCE, COMPENSATION, FINANCE, HEALTH SERVICES, ECPHO 395462 PARTNER, EASTERN CONNECTICUT PATHOLOGY CONSULTANTS - CONTRACT WITH ECHN TO PROVIDE LAB/ANATOMIC PATHOLOGY SERVICES 0 BRODIE GORDON MD EXECUTIVE, PA&I, PLANNING, ECPHO 325284 PARTNER, PRACTICE MANAGEMENT ADVISORS (HEALTHWISE) 0 WILLIAMS LENORA MD TRUSTEE 51830 MEDICAL DIRECTOR - ECHN MATERNITY SERVICES (ELLINGTON OB/GYN ASSOCIATES, PC) 0 DISTEFANO ANTHONY MD HEALTH SERVICES, PA&I, MEC 195000 OWNER AND BD MEMBER OF CONTINENTAL CONNECTICUT LITHOTRIPSY, LLC, WHICH PROVIDES SERVICES TO ECHN. 0 FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO THE FILING THE 990, THE FOLLOWING STEPS ARE TAKEN: 1) THE DIRECTOR OF ACCOUNTING AND TAXATION, TOGETHER WITH OTHER MEMBERS OF THE FINANCE DEPARTMENT, CONDUCT A REVIEW OF THE 990 ALONG WITH A REVIEW AND RECONCILATION OF THE 990 TO THE AUDITED FINANCIAL STATEMENTS; 2) DIRECTOR OF ACCOUNTING AND TAXATION CONDUCTS AN EXTENSIVE REVIEW AND DISCUSSION OF THE 990 WITH THE CPA FIRM THAT PREPARES THE RETURN; 3) AN ELECTRONIC COPY OF THE 990 IS MADE AVAILABLE TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD OF TRUSTEES (THE GOVERNING BOARD), AND SENIOR MANAGEMENT OF THE ORGANIZATION, FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT PROVIDES TO OFFICERS, DIRECTORS, OR TRUSTEES AND KEY EMPLOYEES THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND DISCLOSURE STATEMENT, AND EACH INDIVIDUAL IS REQUIRED TO RETURN TO THE DEPARTMENT, A SIGNED DOCUMENT, ACKNOWLEDGING RECEIPT OF THE POLICY AND DISCLOSURE STATEMENT AND DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. A SUMMARY OF THE DISCLOSURES IS SHARED WITH THE CHAIRMAN OF THE BOARD OF TRUSTEES AND WITH THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF THE BOARD. INDIVIDUALS WHO ARE IDENTIFIED AS HAVING A CONFLICT OF INTEREST ARE PROHIBITED IN PARTICIPATING IN THE GOVERNING BODIES DELIBERATIONS AND DECISIONS RELATED TO THE TRANSACTION. THE RETURNED STATEMENTS ARE RETAINED BY THE CORPORATE COMPLIANCE/INTERNAL AUDIT DEPARTMENT FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE TAKES THE FOLLOWING STEPS WITH AN INDEPENDENT COMPENSATION CONSULTANT (1) REVIEWS DATA RELATED TO CURRENT MARKET VALUES CONSISTENT FOR ORGANIZATIONS EXECUTIVES BY REVIEW OF COMPENSATION LEVELS AND PLANS CONSISTENT WITH HOSPITALS AND HEALTH SYSTEMS OF COMPARABLE SIZE AND LOCATION; (2) COMPLETES A REVIEW OF DATA ON CURRENT AND FUTURE PLANS FOR THE ORGANIZATION, INCLUDING STRUCTURE AND JOB DESCRIPTIONS; (3) REVIEWS AND APPROVES AND RECOMMEND SALARY RANGES FOR EACH POSITION, ALONG WITH RELATED BENEFITS; (4) REVIEWS AND APPROVES A TIERED EXECUTIVE STRUCTURE WITH APPROPRIATE INCENTIVE OPPORTUNITY, BENEFITS, AND COMPENSATION FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION, WILL, UPON REQUEST, ALLOW FOR REVIEW OF OUR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND MOST RECENT ANNUAL AUDITED FINANCIAL STATEMENTS AT AN OFFICE OF THE ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -285,821. TRANSFERS TO AFFILIATES, NET -1,603,519. CHANGE IN INTEREST RATE SWAP -248,292. TOTAL TO FORM 990, PART XI, LINE 5: -2,137,632. ECHN WELLNESS SERVICES INC 2800 TAMARACK AVENUE SOUTH WINDSOR CT 06074 061360082 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 MANCHESTER MEMORIAL HOSPITAL 71 HAYNES STREET MANCHESTER CT 06040 060646710 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 ROCKVILLE GENERAL HOSPITAL INC 31 UNION STREET ROCKVILLE CT 06066 060653151 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 ECHN COMMUNITY HEALTHCARE FOUNDATION INC 71 HAYNES STREET MANCHESTER CT 06040 222546080 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 ECHN ELDERCARE SERVICES INC 26 SHENIPSIT LAKE ROAD TOLLAND CT 06084 061149193 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 ECHN HEALTH SERVICES 71 HAYNES STREET MANCHESTER CT 06040 222546078 THE PROVISION OF HEALTH CARE CT 501(C)3 170(B)(1)(A) EASTERN CONNECTICUT HEALTH NETWORK INC 0 ECHN ENTERPRISES INC 71 HAYNES STREET MANCHESTER CT 06040 222546828 REAL ESTATE HOLDING CT EASTERN CONNECTICUT HEALTH COMPANY INC C HAYNES STREET PROPERTY MANAGEMENT LLC 71 HAYNES STREET MANCHESTER CT 06040 222546028 REAL ESTATE PROPERTY MANAGEMENT CT ECHN ENTERPRISES INC C 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 ROCKVILLE GENERAL HOSPITAL A 871814 DIRECT COST OF GOODS/SERVICES ROCKVILLE GENERAL HOSPITAL N 3747616 DIRECT COST OF GOODS/SERVICES ROCKVILLE GENERAL HOSPITAL O 4658525 DIRECT COST OF GOODS/SERVICES ECHN ELDERCARE SERVICES N 168743 DIRECT COST OF GOODS/SERVICES ECHN ELDERCARE SERVICES O 177273 DIRECT COST OF GOODS/SERVICES MANCHESTER MEMORIAL HOSPITAL A 2164567 DIRECT COST OF GOODS/SERVICES MANCHESTER MEMORIAL HOSPITAL N 9055832 DIRECT COST OF GOODS/SERVICES MANCHESTER MEMORIAL HOSPITAL O 11197083 DIRECT COST OF GOODS/SERVICES