CONCORD HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CONCORD HOSPITAL INC (EIN 22-2594672)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-06-08
IRS object ID
201231609349300508
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-06-08T10:22:46-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BAKER NEWMAN & NOYES LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1BOX 507AddressLine1
CityPORTLANDCity
StateMEState
ZIP Code04112ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN222594672EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CONCORD HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCONCNameControl
Phone6032284677Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 PLEASANT STREETAddressLine1
CityCONCORDCity
StateNHState
ZIP Code03301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRUCE R BURNSName
TitleTREASURER/SR VP FINANCE/CFOTitle
Phone6032284677Phone
Date Signed2012-05-29DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameE Drew CheneyName
Phone2078792100Phone
Date Prepared2012-05-29DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL B GREENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1250 PLEASANT STREETAddressLine1
CityCONCORDCity
StateNHState
ZIP Code03301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts525795602GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.concordhospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1944YearFormation
State Legal DomicileNHStateLegalDomicile
Activity Or Mission DescriptionHOSPITALActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees3620TotalNbrEmployees
Total Nbr Volunteers452TotalNbrVolunteers
Total Gross UBI2057969TotalGrossUBI
Net Unrelated Business Txbl Income-678884NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5283082ContributionsGrantsPriorYear
Contributions Grants Current Year2685572ContributionsGrantsCurrentYear
Program Service Revenue Prior Year346293115ProgramServiceRevenuePriorYear
Program Service Revenue CY395532591ProgramServiceRevenueCY
Investment Income Prior Year6959457InvestmentIncomePriorYear
Investment Income Current Year11582680InvestmentIncomeCurrentYear
Other Revenue Prior Year10891966OtherRevenuePriorYear
Other Revenue Current Year4879474OtherRevenueCurrentYear
Total Revenue Prior Year369427620TotalRevenuePriorYear
Total Revenue Current Year414680317TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year149261GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY276562GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year196980410SalariesEtcPriorYear
Salaries Etc Current Year205162383SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year153349899OtherExpensePriorYear
Other Expenses Current Year182843532OtherExpensesCurrentYear
Total Expenses Prior Year350479570TotalExpensesPriorYear
Total Expenses Current Year388282477TotalExpensesCurrentYear
Revenues Less Expenses Prior Year18948050RevenuesLessExpensesPriorYear
Revenues Less Expenses CY26397840RevenuesLessExpensesCY
Total Assets BOY367447662TotalAssetsBOY
Total Assets EOY397005467TotalAssetsEOY
Total Liabilities BOY199013530TotalLiabilitiesBOY
Total Liabilities EOY237414229TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY168434132NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY159591238NetAssetsOrFundBalancesEOY
Mission DescriptionConcord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense327238693Expense
Grants276562Grants
Revenue398354096Revenue
DescriptionVarious hospital services; see Schedule HIn 2011, Concord Hospital invested more than $52 million for community benefit programs, services, and other expenses. The largest areas of support were charitable care services, medical education and subsidized programs and services. Our investment enhances the Hospital's ability to provide quality patient care, respond to identified community health needs and address the Hospital's mission overall.Description
Total Program Service Expense327238693TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org1TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096260NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3620NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNHStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SCOTT SLOANE VP FINANCEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6032277000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1250 PLEASANT STREETAddressLine1
CityCONCORDCity
StateNHState
ZIP Code03301ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
AKEY MD D THOMAS
CHAIR40.00XX279374056433
SCHADEE CPA MURIEL D
VICE CHAIR1.00XX000
BURNS BRUCE R
TREASURER60.00X395114076708
BOUCHER MARY
SECRETARY1.00XX000
ASMAR SOL
TRUSTEE1.00X000
BLACKMER ESQ JILL K
TRUSTEE1.00X000
BOULTER MD PHILIP
TRUSTEE1.00X000
BROWN C THOMAS
TRUSTEE1.00X000
CHAPMAN ESQ WILLIAM L
TRUSTEE1.00X000
CHICOINE MICHELLE
TRUSTEE1.00X000
GREEN MICHAEL B
PRESIDENT & CEO60.00XX6613220169901
HALLOWELL MD CHRISTIAN
TRUSTEE1.00X000
IMGRUND MD STEPHEN
MEDICAL STAFF PRESIDENT40.00X000
JONES MD GARY S
TRUSTEE1.00X000
KIPPERMAN CPA JEFFREY S
TRUSTEE1.00X000
ROWE RACHEL M
TRUSTEE1.00X000
RUEDIG DAVID
TRUSTEE1.00X000
STEVENSON MD DAVID A
TRUSTEE40.00X257563059339
SULLIVAN HON MICHAEL
TRUSTEE1.00X000
WALKER CLAUDIA
TRUSTEE1.00X000
WOOD ALLEN RN DIANE E
TRUSTEE40.00X222385068755
SARDELLA MD GERALD
PHYSICIAN40.00495623043302X
CONLEY JOSEPH M
COO40.00395343080557X
SNYDER MD PAUL
PHYSICIAN40.00412430061330X
TRIACA MD VERONICA
PHYSICIAN40.00424263038280X
YAP MD RONALD
PHYSICIAN40.00421989039150X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3965406TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation693755TotalOtherCompensation
Number Individuals GT100 K263NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CONCORD EMERGENCY MEDICAL ASSOC
540 LAFAYETTE ROADHAMPTONNH03842PHYSICIAN SERVICES9643977
DARTMOUTH HITCHCOCK CLINIC
PO BOX 810HANOVERNH03755PHYSICIAN SERVICES4191489
RIVERBEND COMMUNITY MENTAL HEALTH
5 MARKET LANECONCORDNH03301PHYSICIAN & PSYCH SERVICES2182857
ELLIOT HOSPITAL
1070 HOLT AVENUE SUITE 2100MANCHESTERNH03109HEALTHCARE SERVICES1472966
CONCORD IMAGING CENTER
ONE PILLSBURY STREETCONCORDNH03301RADIOLOGY SERVICES1453888
FieldValueIRS element (for citing)
Number Of Contractors GT100 K30NumberOfContractorsGT100K
Related Organizations2486189RelatedOrganizations
All Other Contributions199383AllOtherContributions
Total Contributions2685572TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Patient service900099370459080370459080
Disproportionate share9000992053666720536667
Other operating900099453684434977331039111
FieldValueIRS element (for citing)
Total Program Service Revenue395532591TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column597003TotalRevenueColumn
Exclusion$597,003ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real386530Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real386530Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column386530TotalRevenueColumn
Related Or Exempt Function Income386530RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities122100962Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities110946340Securities
Other168945Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities11154622Securities
Other-168945Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column10985677TotalRevenueColumn
Exclusion$10,985,677ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Food services722210334719023283321018858
Child care center624410824900824900
Answering service541900320854320854
FieldValueIRS element (for citing)
Total Other Revenue4492944TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column414680317TotalRevenueColumn
Related Or Exempt Function Income398354096RelatedOrExemptFunctionIncome
Unrelated Business Revenue2057969UnrelatedBusinessRevenue
Exclusion$11,582,680ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total276562Total
Program Services276562ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2036361Total
Program Services808519ProgramServices
Management And General1227842ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total160735950Total
Program Services132112246ProgramServices
Management And General28623704ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7474008Total
Program Services6141227ProgramServices
Management And General1332781ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total23110155Total
Program Services18996625ProgramServices
Management And General4113530ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total11805909Total
Program Services9628536ProgramServices
Management And General2177373ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total711808Total
Program Services273179ProgramServices
Management And General438629ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total183021Total
Management And General183021ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total144382Total
Management And General144382ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total27000Total
Management And General27000ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total730784Total
Management And General730784ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total30596434Total
Program Services28199013ProgramServices
Management And General2397421ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total258668Total
Program Services114379ProgramServices
Management And General144289ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total48460731Total
Program Services46206217ProgramServices
Management And General2254514ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5893304Total
Program Services3148351ProgramServices
Management And General2744953ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total11476888Total
Program Services9045823ProgramServices
Management And General2431065ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total515951Total
Program Services349979ProgramServices
Management And General165972ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total775981Total
Program Services556449ProgramServices
Management And General219532ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5390156Total
Program Services3665306ProgramServices
Management And General1724850ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total21281062Total
Program Services14471122ProgramServices
Management And General6809940ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2665821Total
Program Services2665821ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT2392668223926682
MEDICAID ENHANCEMENT TA2154198721541987
REPAIRS/MAINTENANCE32499682514381735587

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5012904Total
Program Services2596289ProgramServices
Management And General2416615ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total388282477Total
Program Services327238693ProgramServices
Management And General61043784ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY8766546BOY
EOY10686440EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY14357164BOY
EOY20367895EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY36706507BOY
EOY41863115EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY518876BOY
EOY772929EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3187280BOY
EOY4001515EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis321054266LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec182069957LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY137407052BOY
EOY138984309EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY71952823BOY
EOY96521676EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY70564644BOY
EOY59744000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY23986770BOY
EOY24063588EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY367447662BOY
EOY397005467EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY36104525BOY
EOY42946055EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY103555580BOY
EOY117196810EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY59353425BOY
EOY77271364EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY199013530BOY
EOY237414229EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY167319828BOY
EOY158553844EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY248068BOY
EOY162463EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY866236BOY
EOY874931EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY168434132BOY
EOY159591238EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY367447662BOY
EOY397005467EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses26397840ReconcilationRevenueExpenses
Reconcilation Other Changes-35240734ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$28,308OtherActivitiesAmount
Total Lobbying Expenditures IIB28308TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i:ReturnReference
ExplanationConcord Hospital is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Concord Hospital and the other member organizations in furtherance of their exempt purposes. The portion of dues used for lobbying were $20,291 (NHHA) and $8,017 (AHA). Concord Hospital does not directly perform any lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance135685338BeginningOfYearBalance
Contributions8067297Contributions
Investment Earnings Or Losses-4399718InvestmentEarningsOrLosses
Other Expenditures305697OtherExpenditures
End Of Year Balance139047220EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance108562857BeginningOfYearBalance
Contributions17123371Contributions
Investment Earnings Or Losses10185474InvestmentEarningsOrLosses
Other Expenditures186364OtherExpenditures
End Of Year Balance135685338EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance100022624BeginningOfYearBalance
Contributions2482944Contributions
Investment Earnings Or Losses6568016InvestmentEarningsOrLosses
Other Expenditures510727OtherExpenditures
End Of Year Balance108562857EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.99270BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00600PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00130TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis18996OtherCostOrOtherBasis
Book Value18996BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis128417617OtherCostOrOtherBasis
Depreciation56852241Depreciation
Book Value71565376BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis188118574OtherCostOrOtherBasis
Depreciation125217716Depreciation
Book Value62900858BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4499079OtherCostOrOtherBasis
Book Value4499079BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings138984309TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionALTERNATIVE INVESTMENTSDescription
Book Value59744000BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities59744000TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
BOND ISSUANCE COSTS2564105
INTERCOMPANY RECEIVABLES19442099
OTHER2057384
FieldValueIRS element (for citing)
Total Book Value Other Assets24063588TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED 3RD PARTY SETTLEMENTS$8,510,816
ACCRUED PENSION & OTHER LONG-TERM LIABILITIES$68,760,548
FieldValueIRS element (for citing)
Total Of Amounts77271364TotalOfAmounts
Total Revenue414680317TotalRevenue
Total Expenses388282477TotalExpenses
Excess Or Deficit For Year26397840ExcessOrDeficitForYear
Net Unrealized GL On Investments-18087295NetUnrealizedGLOnInvestments
Other-$17,153,439OtherAmount
Total Adjustments-35240734TotalAdjustments
Excess Or Deficit Per FS-8842894ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt414680317TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal414680317RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990414680317TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt388282477TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal388282477ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990388282477TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The intended use of the endowment funds is to fund capital expenditures for medical equipment/provide healthcare prevention and services for the uninsured population in the service area.
Description of Uncertain Tax Positions Under FIN 48:Part X:The verbatim paragraph pertaining to FIN 48 in the consolidated audited financial statements for Concord Hospital, Inc. and subsidiaries ("The System") is as follows: "The Hospital, CRHCDC, CRHVC, CRPGC, CH/DHC and the Trust are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. With few exceptions, the System is no longer subject to income tax examination by the U.S. federal or state tax authorities for years before 2008."
Part XI, Line 8 - Other Adjustments:Pension Actuarial Loss -16,395,699. Net transfer to affiliate -757,740.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage225.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served8410PersonsServed
Total Community Benefit Expense15648344TotalCommunityBenefitExpense
Net Community Benefit Expense15648344NetCommunityBenefitExpense
Percent Of Total Expense0.04290PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense29129000TotalCommunityBenefitExpense
Direct Offsetting Revenue14109000DirectOffsettingRevenue
Net Community Benefit Expense15020000NetCommunityBenefitExpense
Percent Of Total Expense0.04120PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served8410PersonsServed
Total Community Benefit Expense44777344TotalCommunityBenefitExpense
Direct Offsetting Revenue14109000DirectOffsettingRevenue
Net Community Benefit Expense30668344NetCommunityBenefitExpense
Percent Of Total Expense0.08410PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs11NumberOfActivitiesOrPrograms
Persons Served242543PersonsServed
Total Community Benefit Expense2669412TotalCommunityBenefitExpense
Direct Offsetting Revenue836633DirectOffsettingRevenue
Net Community Benefit Expense1832779NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served5650PersonsServed
Total Community Benefit Expense9080409TotalCommunityBenefitExpense
Direct Offsetting Revenue4598511DirectOffsettingRevenue
Net Community Benefit Expense4481898NetCommunityBenefitExpense
Percent Of Total Expense0.01230PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Persons Served36012PersonsServed
Total Community Benefit Expense62639930TotalCommunityBenefitExpense
Direct Offsetting Revenue48828836DirectOffsettingRevenue
Net Community Benefit Expense13811094NetCommunityBenefitExpense
Percent Of Total Expense0.03790PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served48PersonsServed
Total Community Benefit Expense310181TotalCommunityBenefitExpense
Direct Offsetting Revenue79886DirectOffsettingRevenue
Net Community Benefit Expense230295NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Total Community Benefit Expense1040271TotalCommunityBenefitExpense
Net Community Benefit Expense1040271NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs37NumberOfActivitiesOrPrograms
Persons Served284253PersonsServed
Total Community Benefit Expense75740203TotalCommunityBenefitExpense
Direct Offsetting Revenue54343866DirectOffsettingRevenue
Net Community Benefit Expense21396337NetCommunityBenefitExpense
Percent Of Total Expense0.05870PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs43NumberOfActivitiesOrPrograms
Persons Served292663PersonsServed
Total Community Benefit Expense120517547TotalCommunityBenefitExpense
Direct Offsetting Revenue68452866DirectOffsettingRevenue
Net Community Benefit Expense52064681NetCommunityBenefitExpense
Percent Of Total Expense0.14280PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense20900TotalCommunityBuildingExpense
Net Community Building Expense20900NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense20900TotalCommunityBuildingExpense
Net Community Building Expense20900NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$10,262,646BadDebtExpenseAmount
Amount Attributable To2036825AmountAttributableTo
Amount Reimbursed By Medicare108808695AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare149486000CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-40677305MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CONCORD HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1250 PLEASANT STAddressLine1
CityCONCORDCity
StateNHState
ZIP Code03301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Concord HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted08NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent225.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent500.000000000000FPGDiscountPercent
Explains Basis0ExplainsBasis
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1Concord Hospital Urgent CareBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line160 Commercial StreetAddressLine1
CityConcordCity
StateNHState
ZIP Code03301ZIPCode
FieldValueIRS element (for citing)
Facility TypeWalk-in urgent careFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 7: Subsidized Health Services represents those activities that assure access to medical care and support for people with special medical needs and who may be faced with chronic health conditions.
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 $ 23926682.
Part II: In the absence of a public/private partnership and a significant emergency preparedness incident, Concord Hospital's community building investment was reduced in 2011. However, the organization continued its emergency preparedness initiatives, including drills.
Part III, Line 4: Accounts Receivable The allowance for doubtful accounts is provided based on an analysis by management of the collectibility of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts. Accounts are charged against the allowance for doubtful accounts when deemed uncollectible. Charity Care The system provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue.
Part III, Line 8: : The Medicare shortfall of $40,677,305 is funded through cost shifting to other payors. In addition, many of the subsidized health services reported on line 7g include some revenue and expenses from services to Medicare patients. Medicare allowable costs on line 5 were determined using the Hospital's filed Medicare cost report, which determines cost via the cost to charge ratio methodology.
Part III, Line 9b: The Hospital has a Financial Assistance policy in addition to, and complementing, the bad debt collection policy. The policy describes the Hospital's program of financial assistance for medically necessary services to individuals and families who are uninsured, underinsured or who experience a catastrophic healthcare event and who do not quality for any other state or federal assistance programs. Patient education of eligibility for assistance is described below in the statement for Part VI, Line 3.
Part V, Section B, Line 3: See the narrative for Schedule H, Part VI, line 2 below.Concord Hospital
Part V, Section B, Line 5c: The Community Health Needs Assessment was included in the Hospital's annual reports and mailed to residents of the communities that the Hospital serves. It is also available at the State of NH, DOJ web site.Concord Hospital
Part V, Section B, Line 21: State law requires the Hospital to bill Third Party liability claims (automobile insurance claims) at 100% of charges. The patient is responsible for paying the full amount and receiving payment from the insurance company.Concord Hospital
Part VI, Line 2: The Hospital regularly leads comprehensive community health needs assessments, engaging numerous community organizations and health partners in the process, to identify far-reaching health needs faced by people in the communities served by the Hospital. Assessment methodologies address both quantitative and qualitative data and include stakeholder interviews, focus groups, community listening sessions, web survey, written surveys, telephone surveys and analysis of various data sets. Assessment results are shared with the communities and serve as the basis to develop new or expanded services in response to need. The Hospital's next assessment will be conducted in 2012.
Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paying their obligations, to inform and work with them to understand what local programs are available to them, including how they can benefit from the Hospital's Financial Assistance program.
Part VI, Line 4: Concord defines its Primary Service Area as 23 communities to which it has close geographic proximity and significant market share. According to the State of New Hampshire's "Concord Healthcare Service Area Regional Health Profile, 2001," the 23 communities that comprise the Hospital's PSA represent, in terms of square miles, the largest hospital service area in the State. Together, these communities cover an area of nearly 900 square miles. The Hospital serves all the residents of these towns as well as many others from across the State of New Hampshire through its regional and statewide referral for specialty care, including Orthopedic, Cardiology, Oncology and Urological care.
Part VI, Line 6: Part I line 6A; Concord Hospital develops programs and services to address community health needs and makes investments in initiatives that align with the Hospital's core mission. A significant amount of Concord Hospital's community benefit investment is in the area of charitable care to ensure that those without insurance or with limited insurance have access to needed medical care. The hospital strives to address the needs of vulnerable populations including our low-income neighbors and other vulnerable populations. The hospital's Family Health centers ensure access to primary, behavioral health and dental care for our region's most needy residents, which addresses identified community health needs. Those achievements are at the heart of our community benefit activity. Beyond that focus are programs and services that benefit every resident and support that far-reaching goal of a healthier community. The hospital continued its efforts toward promoting the health of the community by investing its surplus funds in new inpatient facilities to enhance patient care, by providing funding support to Capital Region Healthcare affiliates through the Community Services fund for programs that address identified community needs and serve vulnerable populations, and by continuing to recruit new primary care physicians to enhance access in the community.Finally, per the Instructions to Schedule H, Part I, the Hospital has not included its $40,677,305 Medicare shortfall as a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care.
NHReports Filed With StatesPart VI, Line 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)54478Providing parenting support & education for families
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)65000To support a 0.5 FTE medical director and 2 APRNs. RCA medication services seek to serve CHMG's most challenging psychiatric patients, so that PCPs are supported in providing quality service
Riverbend Community Mental Health - Memory Wellness Center
PO Box 2032ConcordNH03301020264383501(c)(3)25000Provide person-focused and flexible services for individuals with dementia and their caregivers
Concord Regional Visiting Nurse Association
PO Box 1797ConcordNH03301020222122501(c)(3)15000Help struggling parents learn to nurture their infants and children: trained home visitors mentor and guide parents
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)18782To fund nutrition and fitness memberships for adults with severe and persistent mental illness
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)39180Provide specialty geriatric psychiatry evaluation and treatment for Elders in the Concord area
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)20922PhD intern program to provide low-cost mental health services to adults in the Hillsboro area
Dame School
14 Canterbury RoadConcordNH03301020222164Municipality7000Grandfamilies Group: offers parenting classes and support for grandparents who are parenting for the second time
Child and Family Services Healthy Families Home Visiting Program
464 Chestnut Street PO Box 448ManchesterNH03105020222164501(c)(3)10200Program to serve at-risk women under the age of 25 who are pregnant with their first their first child to develop their parenting skills and enhance maternal and child health
Riverbend Community Mental Health
PO Box 2032ConcordNH03301020264383501(c)(3)10000Child parent psychotherapy: specialized treatment through the Dartmouth Dept. of Psychiatry and its partnership with the National Child Traumatic Stress Network
The Children's Place and Parent Education Center
27 Burns AvenueConcordNH03301020338647501(c)(3)6000Contribution to New Parents Support Group/Toddler Play Group, which offers a place in which families can come together in support of each other, serving to enhance the family unit, thus preventing child abuse and neglect
Concord Regional Visiting Nurse Association
PO Box 1797ConcordNH03301020222122501(c)(3)5000Contribution to Baby's First Homecoming, a program to support mothers at home following discharge, enabling early detection of problems with mother or baby

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: The Hospital works with the CH trust to administer grants provided from funds available through the Community Services Funds. The Trust has an open application process for those entities that meet the grant requirements, and the Trust Board approves and recommends to the Hospital Board, all recommended granting actions. The Trust provides annual monitoring of compliance with expected spending requirements and gets updates as needed.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
AKEY MD D THOMAS
27487404500000365010199320335807000
BURNS BRUCE R
312272082842000620920146160471822000
GREEN MICHAEL B
52444601345000237601537010162000831223000
STEVENSON MD DAVID A
204138053425000406790186600316902000
WOOD ALLEN RN DIANE E
190385032000000551880135670291140000
SARDELLA MD GERALD
49562300000215070217950538925000
CONLEY JOSEPH M
312501082842000620500185070475900000
SNYDER MD PAUL
354719057711000457200156100473760000
TRIACA MD VERONICA
36770205656100032868054120462543000
YAP MD RONALD
365428056561000179190212310461139000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 4bPart I, Line 4b: 457F PLAN --------- GREEN, MICHAEL B. 88,000
Part I, Line 7Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the CEO's performance during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the CEO's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
NH HEALTH & EDUCATION FACILITIES AUTHORITY
02027986664461TBVS2004-08-2545418290FACILITY IMPROVEMENTS000
NH HEALTH & EDUCATION FACILITIES AUTHORITY
020279866644614VY22008-04-2315102683CAPITAL PROJECTS000
NH HEALTH & EDUCATION FACILITIES AUTHORITY
020279866644614K652011-03-0150095322FACILITY IMPROVEMENTS/RENOVATIONS000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetiredAmount In Reserve FundAmountInReserveFund
4541829015504564386783420090011
15102683998791500280420080011
500953225448911081394910012799500011280647

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
000000
(no name)
000000
Naxis Funding Corp
0001001.8000000000000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section B, line 11The 990 is reviewed in detail with the Audit Committee of the Board of Trustees. All board members receive a copy of the 990 to review at a board meeting, prior to filing the report.
Each Trustee, officer and committee member, upon entering the duties of his/her office and annually thereafter, will be advised of this policy and shall sign a statement acknowledging his/her understanding of and agreement to this policy. Annual reviews will adhere to state regulations that require public notice for any significant pecuniary transaction.Form 990, Part VI, Section B, line 12c
The evaluation of the performance of the Chief Executive Officer ("CEO") of Concord Hospital and its subsidiaries (collectively the "Hospital") is an important responsibility of the Board of Trustees (the "Board") and is vital in ensuring that the Hospital meets its mission. The Board has delegated the responsibility of initiating the process of conducting the CEO's performance evaluation and initiating the process of setting the CEO's compensation to the Board's Compensation Committee. The Compensation Committee also is charged with the responsibility of reviewing the appropriateness of the compensation of the Hospital's Chief Operating Officer and Chief Financial Officer as proposed by the CEO. The Compensation Committee shall present its report of the CEO's annual performance to the Board for its further input and consideration. The Compensation Committee shall also make its recommendation to the Board concerning the CEO's compensation. Finally, the Compensation Committee shall make its recommendation to the Board concerning the compensation of the COO and CFO. The Board shall review the recommendations of the Compensation Committee as to the compensation of the Hospital's CEO, COO and CFO and shall set their compensation as the Board deems appropriate. Although the Hospital continues to value the role of Capital Region Health Care Corporation ("CRHC") and the Hospital's participation in that organization, the Board acknowledges that it is not the responsibility of the Board to evaluate or set the compensation of the Chief Executive Officer of CRHC. Neither is it the role of the Board of Trustees of CRHC to evaluate, or set the compensation of, the Hospital's CEO. Accordingly, CRHC's Board of Trustees is not involved in evaluating or setting the compensation of the Hospital's CEO. The Board acknowledges that the Hospital's CEO may also serve as the Chief Executive Officer of CRHC and that the Hospital may charge CRHC for these services. The Board may consider the comments of the Board of Trustees of CRHC, as outlined herein, when deemed relevant in evaluating the performance of the Hospital's CEO. The Board directs that the Compensation Committee and the Board itself, in their respective undertakings of recommending and setting the compensation of the Hospital's CEO, COO and CFO, avoid conflicts of interest and be guided by the "rebuttable presumption of reasonableness" regulations under the so-called "Excess Benefit Transaction" provisions of the Internal Revenue Code ("IRC"). The Board authorizes the Compensation Committee to use such financial and advisory (e.g., legal counsel, consultant) resources as it reasonably deems appropriate to fulfill its duties in evaluating the CEO's performance and in making its recommendations to the Board regarding compensation for the CEO, COO and CFO.Form 990, Part VI, Section B, line 15
Yes, the organization makes all of this information available to the public. Audited financial statements and the most recent quarter ended financial statements are posted on the Hospital's web site, www.concordhospital.org. In addition to this, the hospital sends its annual report, including a financial summary, to members of the community via the US Postal service. Governing documents and conflicts of interest filings adhere to state regulations that require public notice for any significant pecuniary transaction.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized losses on investments: -18,087,295. Pension Actuarial Loss -16,395,699. Net transfer to affiliate -757,740. Total to Form 990, Part XI, Line 5: -35,240,734.Form 990, Part XI, line 5:
There was no change in the process for oversight of the audit and compilation of financial statements for the fiscal year. The Board has a finance committee, which reviews the financial statements monthly. There is also an audit committee of the Board, which reviews the annual audit process and the selection of the independent accountant. The same independent firm of accountants performed the audit for the fiscal years ending 9/30/10 and 9/30/11.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
CAPITAL REGION HEALTH CARE CORPORATION
250 PLEASANT STREETCONCORDNH03301020222123PROMOTE COMPREHENSIVE HEALTH SERVICE SYSTEMNH501(C)(3)11 TYPE IN/A0
CAPITAL REGION HEALTH PHYSICIANS GROUP CORP
250 PLEASANT STREETCONCORDNH03301020481705PROVIDE MEDICAL CARE TO COMMUNITYNH501(C)(3)9N/A0
CAPITAL REGION HEALTH VENTURES CORP
250 PLEASANT STREETCONCORDNH03301020438264PROVIDE MEDICAL CARE TO COMMUNITYNH501(C)(3)11 TYPE IIN/A0
CAPITAL REGION HEALTH CARE DEVELOPMENT CORPORATION
250 PLEASANT STREETCONCORDNH03301020429749SUPPORT CONCORD HOSPITAL & OTHER AFFILIATESNH501(C)(2)N/A0
CONCORD REGIONAL VISITING NURSE ASSOCIATION INC
PO BOX 1797CONCORDNH033021797020222122HOME HEALTH CARE & HOSPICE SERVICESNH501(C)(3)9N/A0
RIVERBEND COMMUNITY MENTAL HEALTH INC
3-5 NORTH STATE STREETCONCORDNH033022032020264383MULTI-SERVICE TEAMNH501(C)(3)7N/A0
CHDHC INC
250 PLEASANT STREETCONCORDNH03301020519680PROVIDE HEALTH SERVICES TO CONCORD COMMUNITYNH501(C)(3)3N/A0
CONCORD HOSPITAL TRUST
250 PLEASANT STREETCONCORDNH03301260378710FUNDRAISINGNH501(C)(3)11 TYPE IN/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
CAPITAL REGION HEALTH SERVICES CORPORATION
250 PLEASANT STREETCONCORDNH03301020428631MEDICAL SERVICESNHN/AC
CAPITAL REGION PRIMARY CARE CORPORATION
250 PLEASANT STREETCONCORDNH03301020495275INACTIVENHN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CAPITAL REGION HEALTH CARE DEVELOPMENT CORP
A1441706Actual per books
CAPITAL REGION HEALTH CARE CORP
B142653Actual per books
CAPITAL REGION PHYSICIAN GROUP CORP
B1093898Actual per books
CHDHC
B52455Actual per books
CAPITAL REGION HEALTH CARE VENTURES CORP
C5750071Actual per books
CONCORD HOSPITAL TRUST
C199712Actual per books
CAPITAL REGION HEALTH CARE SERVICES CORP
C354752Actual per books
CAPITAL REGION HEALTH CARE DEVELOPMENT CORP
J2303142Actual per books
CAPITAL REGION HEALTH CARE DEVELOPMENT CORP
N332282Actual per books
CAPITAL REGION HEALTH CARE VENTURES CORP
N784345Actual per books
CAPITAL REGION PHYSICIAN GROUP CORP
N2809925Actual per books
CONCORD HOSPITAL TRUST
N354708Actual per books
CAPITAL REGION HEALTH CARE DEVELOPMENT CORP
P2177758Actual per books
CAPITAL REGION HEALTH CARE VENTURES CORP
P746724Actual per books
CAPITAL REGION PHYSICIAN GROUP CORP
P218267Actual per books
CONCORD HOSPITAL TRUST
P236639Actual per books

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