2011-05-13T07:33:53-05:00 2010-09-30 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2009-10-01 222674014 EXETER HOSPITAL INC EXET 6035806695 5 ALUMNI DRIVE EXETER NH 03833 KEVIN J O'LEARY 6035806695 2011-05-10 1 Michael A Barbarita 6036228881 2009 2016-02-24 21:20:13Z KEVIN CALLAHAN 5 ALUMNI DRIVE EXETER NH 03833 221382321 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. 13 10 1681 110 0 0 314411 169922 212053074 217655856 -2451540 -1252617 1076840 1666761 210992785 218239922 1287318 1352334 0 86766195 91239029 0 5626 105675870 106358653 193729383 198950016 17263402 19289906 267974740 281810222 106782141 105165067 161192599 176645155 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 173842148 219325005 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 2010 Exeter Hospital served the community by providing care to 5,833 acute inpatients, 138,817 outpatient visits, 36,669 emergency room visits and 683 births. In 2010 Exeter Hospital supported its mission by supporting $17,170,026 in community outreach, benefits and financial support to the community excluding $13,812,296 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 100% of care provided to area residents based on income and family size. In 2010, the combination of our uninsured discount program and charity care program helped people access the health care system by providing $3.9 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 100 licensed inpatient beds. Our inpatient services treat emergenCY, acute, elective surgical and palliative care patients. Approximately 70% 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 led, 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 has 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 worlds leading academic medical center to Exeter Hospitals Center for Cancer Care. This affiliation allows Exeter Hospitals 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 centers 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 Hospitals 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. 173842148 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 207 0 1 1681 1 0 0 0 0 0 0 0 0 0 13 10 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 704207 36720 GLENN MCKENZIE 1.00 X X 0 0 0 STEVE HERMANSESQ 1.00 X X 0 0 0 RICHARD L LEVY MD 1.00 X 0 0 0 REV JOHN E DENSON JR 1.00 X 0 0 0 ROBERT A EBERLE 1.00 X 0 0 0 LARRY S PRESSMAN MD 1.00 X 0 154700 20343 katie delahaye paine 1.00 X 0 0 0 ross gittell 1.00 X 0 0 0 AMY CASE 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 166142 27375 KEVIN J O'LEARY 2.00 X 0 401588 32262 CONSTANCE D SPRAUER 2.00 X 0 261244 34298 ANNE MARIE BULARZIK 40.00 X 286003 0 16039 BRIAN CAMPBELL 40.00 X 255682 0 36508 JONATHAN A JACKSON 40.00 X 213287 0 30825 joan raczy 40.00 X 188522 0 37567 PETER J DEGNAN MD 40.00 X 204479 0 33066 JANE PETERSON 40.00 X 179335 0 11916 DEANNA KING 40.00 X 146455 0 29972 1473763 1687881 346891 49 0 1 0 EXETER HEALTH RESOURCES 5 ALUMNI DRIVE EXETER NH 03833 ADMINISTRATIVE MANAGEMENT SERVICES 5311164 CORE PHYSICIAN SERVICES llc 5 ALUMNI DRIVE EXETER NH 03833 PHYSICIAN SERVICES 2500541 GE HEALTH CARE INC PO BOX 640200 PITTSbURGH PA 15426 EQUIPMENT MAINTENANCE 1533361 NH ONCOLOGY HEMATOLOGY PA 200 TECHNOLOGY DRIVE CENTRAL PARK I HOOKSETT NH 03106 PHYSICIAN SERVICES 1322950 SEACOAST ANESTHESIA PA PO BOX 9645 MANCHESTER NH 03108 PHYSICIAN SERVICES 1182753 46 169922 169922 NET PATIENT SVCS 621300 206718239 206718239 Disproportionate share 621300 10485391 10485391 other program revenue 621300 452226 452226 217655856 1844107 1844107 43287 37910 5377 5377 5377 7765 3104489 -3104489 7765 -3096724 7765 -3104489 cafeteria income 621300 1375075 1375075 exempt function income 621300 167965 167965 gift shop income 621300 118344 118344 1661384 218239922 219325005 0 -1255005 1352334 1352334 541685 471266 70419 67259968 58516172 8743796 4288918 3731359 557559 14250921 12398302 1852619 4897537 4260857 636680 228901 228901 60000 60000 100407 100407 251080 218440 32640 1295908 1127440 168468 448733 390398 58335 4959729 4314964 644765 370626 322445 48181 2309589 2009342 300247 4019937 3497345 522592 12361664 10754648 1607016 101555 88353 13202 supplies 17128817 14902071 2226746 BAD DEBT EXPENSE 14056122 14056122 MEDICAID ENHANCEMENT TA 10485391 10485391 DRUGS 9230234 9230234 SERVICE CONTRACTS 6350319 5524778 825541 22599641 16189887 6404128 5626 198950016 173842148 25102242 5626 28032916 39926892 21231950 18962118 2548668 2567476 1415564 1199801 140925760 59052582 87155806 81873178 125802301 133505345 1787535 3775412 267974740 281810222 16838720 14457684 64821630 62936316 25121791 27771067 106782141 105165067 X 144162401 159581890 260877 293944 16769321 16769321 161192599 176645155 267974740 281810222 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 77039 0 1 23368 100407 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A PORTION OF MEMBERSHIP DUES AND MANAGEMENT FEES ARE CONSIDERED LOBBYING EXPENSES. 17030198 37433 4366 17063265 16940024 213038 122864 17030198 0.01720 0.92280 0 1 1 102400 102400 74893784 23729631 51164153 523937 357909 166028 62424007 33770645 28653362 2981632 1194397 1787235 81873178 CASH & SHORT-TERM INVESTMENTS 33077715 F FIXED INCOME SECURITIES 30247063 F MARKETABLE EQUITY SECURITIES 28759825 F LIMITED PARTNERSHIPS 41420742 F 133505345 DUE TO THIRD PARTY PAYORS 2077895 ACCRUED INTEREST 1297226 accrued pension liability 15316225 SWAP VALUATION LIABILITY 9072079 deferred compensation 7642 27771067 218239922 198950016 19289906 10033176 -13870526 -3837350 15452556 218201484 0 218201484 38438 38438 218239922 198911573 0 198911573 38443 38443 198950016 Part V, Line 4: Description of Intended Use of Endowment Funds: the goal of the endowment funds is to support future capital expenditures and other major program needs, and to generally increase the financial strength of the corporation. 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: -14924935. ADJ TO MIN PENSION LIABILITY: 1058775. other: -4366. Part XII, Line 4b - Other Adjustments: expense reclass to revenue: 38438. Part XIII, Line 4b - Other Adjustments: expense reclass to revenue: 38443. 1 1 1 X 275.000000000000 1 X 1 1 1 0 1 1 2071 3878471 3878471 0.02100 3503 6211205 6211205 0.03360 5574 10089676 10089676 0.05460 35814 1568517 51487 1517030 0.00820 547 1021823 9650 1012173 0.00550 3043 3432499 560257 2872242 0.01550 119 182771 59768 123003 0.00070 1440317 0 1440317 0.00780 39523 7645927 681162 6964765 0.03770 45097 17735603 681162 17054441 0.09230 100 100 0.00000 10735 10735 0.00010 29747 29747 0.00020 4400 4400 0.00000 1000 1000 0.00000 5869 5869 0.00000 51851 51851 0.00030 0 5896543 2679799 57916636 71728932 -13812296 X 1 1 EXETER HOSPITAL

5 ALUMNI DRIVE EXETER NH 03833

X X X 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 III, Line 4: 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 DEEMED UNCOLLECTIBLE ARE CHARGED OFF AGAINST THE ESTABLISHED ALLOWANCE.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 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 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 Hospitals financial assistance programs, twice a year the organization runs advertisements in community newspapers summarizing the organizations 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 231,225. Part VI, Line 5: Emergency preparedness officials at Exeter Hospital take part in many emergency and disaster planning activities throughout the region and state, helping to ensure the health and safety of Seacoast area residents. During FY 2010 officials from Exeter Hospital spent more than 1,100 hours participating in emergency preparedness development and training exercises, including Seacoast evacuation planning project meetings, decontamination drills, emergency preparedness planning meetings facilitated by the NH Hospital Association and a Mass Casualty Incidentdrill at Pease Airport. The costs associated with emergency management activities are reported in the community support category within community building activities. 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 VI, Line 6: Access to CareFinancial Assistance:Exeter Hospital has three components to its health care access program: The Financial Assistance Program is a community-based program foruninsured and under-insured patients who meet specific income,geographical and other guidelines, and who do not otherwise qualify for any state or federal assistance. The Uninsured Care Discount/Hospital Access Plus Program extends a 20%discount off total charges to patients who may not be able to access or afford health insurance. Exeters 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. This program is calculated based on a percentage of the patients gross income.Exeter Hospital provided $3,878,471 in charity care during FY 2010, a 23 percent increase over FY 2009. In FY 2010 the charity care program served 2,070 people for a total of 6,200 visits.Womens Wellness Clinic: Through a partnership with SeaCare Health Services,this clinic provides uninsured and underinsured women with needed breast and cervical cancer screenings. In FY 2010 the Womens Wellness Clinic served 70 women and Exeter Hospital provided $70,500 to continue this initiative.Beyond the Rainbow Fund: This Fund provides financial assistance to oncology patients in need, assisting patients with prescription expenses not covered by insurance, subsidizing rent and fuel bills, purchasing walkers and canes, and any other needs not covered by insurance that may have become unmanageable for individuals or families during cancer treatment. Community PartnersExeter Hospital works extensively with other nonprofit agencies and organizations who strive to improve the health of the community in many ways. Some of these partnerships include:Lamprey Health Care: Exeter Hospital continued its annual financial support of Lamprey Health Care with a community benefit grant in the amount of $500,000.Lamprey Health Care is New Hampshires oldest and largest private, non-profit community health center with centers in Newmarket, Raymond, and Nashua that serve 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 healthcare management, Lamprey Health Care strives to keep both 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 annually supports SeaCare Health Services in the amount of $431,470. SeaCare utilizes funding from Exeter Hospital to provide medical care andcoordination, health education, and medication access to uninsured individuals in the community. During FY 2010 SeaCare provided medical access for 2,177 adults and 348 children. The Medication Bridge Program dispensed 4,717 prescriptions worth $2,219,747, and benefited 745 people.Families First Health and Support Center: In FY 2010 Exeter Hospital made afinancial contribution to Families First in the amount of $100,000.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 $75,000.New Outlook is a recreational, educational and prevention-oriented program 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.TransportationExeter Hospitals transportation program is an important health care support service provided in response to an identified community need. Each year the program enhances access for hundreds of patients who otherwise would not be able to obtain needed health care and health related support services. During FY 2010 Exeter Hospital provided 5,070 transports at a cost of $337,000.ResearchThe Center for Cancer Care at Exeter Hospital participates in several national research groups sponsored by the National Cancer Institute, which enables the Center to offer clinical trials to patients undergoing treatment at Exeter Hospital. These offerings allow patients to voluntarily take part in leading edge research that does not necessitate travel outside of the Seacoast area. During FY 2010 ExeterHospital provided $123,000 for clinical trials and research that served 119 patients. In FY 2010 the Center for Cancer Care was awarded a grant to undertake a study of its well established Well-fit Exercise Program for cancer survivors with advanced disease. The Cancer Well-fit program provides individualized exercise programs for cancer patients, instructed by oncology trained physical therapists and personal trainers. To date, more than 1,300 cancer survivors have utilized the services offeredthrough the Well-fit Program. 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 2010, Exeter Hospital, Core Physicians, Exeter Healthcare and Rockingham VNA & Hospice have continued the pursuit of their mission to improve the health of the community providing $27,635,312 in charity care and other community benefit programs and services to communities in the area it serves.Exeter Hospital is a 100-bed community-based hospital serving New Hampshires Seacoast region. Exeter Hospitals scope of care includes comprehensive health care services in breast health, birthing and reproductive medicine, cardiovascular, occupational and employee health, oncology, orthopedics, and emergency care. Exeter Hospital is accredited by the Joint Commission and is a member of the National QualityForum.Core Physicians is a community-based multi-specialty group practice. Over seventy physicians in over twenty-five locations provide high quality care through clinical competence and professional office administration.Exeter Healthcare is a sub acute and rehabilitation care facility offeringmultidisciplinary expertise that integrates; rehabilitation, nursing, nutritional management, sleep medicine, medical care and respiratory therapy.Rockingham Visiting Nurse Association and Hospice is a community-based, non-profit 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 NH 1 New Outlook PO Box 865 Exeter NH 03833 020468342 501(C)(3) 55000 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) 500000 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) 422118 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 222998 FUND CHARITABLE FITNESS MEMBERSHIPS Families First 100 Campus Drive Suite 12 Portsmouth NH 03801 222757341 501(C)(3) 105200 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. Design, Printing & Installation of Mobile Medical Van wrap THAT provides health care for the homeless. 4 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 456384 0 161136 0 86687 0 14700 0 22020 0 740927 0 0 LARRY S PRESSMAN MD 0 123444 0 13336 0 17920 0 3916 0 16427 0 175043 0 0 NANCY BRAESE DO 0 118945 0 24393 0 22804 0 4289 0 23086 0 193517 0 0 KEVIN J O'LEARY 0 257446 0 95136 0 49006 0 14700 0 17562 0 433850 0 0 CONSTANCE D SPRAUER 0 168704 0 52636 0 39904 0 14700 0 19598 0 295542 0 0 ANNE MARIE BULARZIK 178782 0 77367 0 29854 0 14700 0 1339 0 302042 0 0 0 BRIAN CAMPBELL 155983 0 69067 0 30632 0 14696 0 21812 0 292190 0 0 0 JONATHAN A JACKSON 212865 0 136 0 286 0 13005 0 17820 0 244112 0 0 0 joan raczy 172572 0 136 0 15814 0 11792 0 25775 0 226089 0 0 0 PETER J DEGNAN MD 193504 0 436 0 10539 0 12382 0 20684 0 237545 0 0 0 JANE PETERSON 154566 0 14147 0 10622 0 10753 0 1163 0 191251 0 0 0 DEANNA KING 138223 0 7966 0 266 0 3496 0 26476 0 176427 0 0 0 Part I, Line 1a Tax indemnification and gross up payments were provided to nancy braese, kevin callahan, constance sprauer, kevin o'leary, anne marie bularzik, brian campbell 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 COMMITTEE COMPRISED OF DISINTERESTED PERSONS. Part I, Line 4a 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. KEVIN CALLAHAN - EXCESS ACCUMULATED VALUE - $55,376 kEVIN O'LEARY - EXCESS ACCUMULATED VALUE - $30,243 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, JOAN RACZY, PETER DEGNAN MD, JANE PETERSON and deanna king 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 644614GN6 2003-11-20 20000000 renovation and expansion projects on the hospital campus 0 1 20000000 19892600 256737 19635873 2006 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 1 1 0 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 13 OF THE 15 MEMBERS OF THE EXETER HEALTH RESOURCES 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. Form 990, Part VI, Section B, line 15 FORM 990, PART VI, SECTION B, LINE 15A & 15B THE ORGANIZATIONS 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 ORGANIZATIONS MISSION, TO RECOGNIZE INDIVIDUAL AND TEAM PERFORMANCE, AND TO COMPLY WITH THE ORGANIZATIONS 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 CEOS 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 INDIVIDUALS CONTRIBUTIONS TO A TEAM, THE PERFORMANCE OF THE ORGANIZATION IN WHOLE AND IN PART, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATIONS 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 CEOS, 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 ORGANIZATIONS PERFORMANCE RESULTS FOR QUALITY, OPERATING SYSTEM EXCELLENCE AND FINANCIAL PERFORMANCE. THE RESULTS OF THE COMMITTEES DELIBERATIONS ARE PRESENTED TO THE EXETER HEALTH RESOURCES BOARD AND INCLUDE RECOMMENDATIONS CONCERNING SALARY RANGE ADJUSTMENTS AND INCENTIVE AWARDS AND THE BASIS FOR THE COMMITTEES 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 CEOS PERFORMANCE AND DETERMINES IF THE ADJUSTMENTS AND AWARDS RECOMMENDED BY THE COMMITTEE FOR THE CEO ARE IN THE ORGANIZATIONS 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. EXETER HEALTH RESOURCES inc 5 alumni drive EXETER NH 03833 020222126 MANAGEMENT AND SUPPORTING ORGANIZATION, HOLDING COMPANY NH 501(c)(3) 11 eXETER HEALTHCARE 5 alumni drive EXETER NH 03833 020360966 SUBACUTE NURSING FACILITY NH 501(c)(3) 9 EXETER HEALTH RESOURCES INC CORE PHYSICIANS LLC 5 alumni drive EXETER NH 03833 870807914 PHYSICIAN PRACTICES NH 501(c)(3) 9 EXETER HEALTH RESOURCES INC ROCKINGHAM VISITING NURSE ASSOC 5 alumni drive EXETER NH 03833 020274905 HOME CARE, HOSPICE NH 501(c)(3) 9 EXETER HEALTH RESOURCES INC MATRIX HEALTH INC 5 alumni drive EXETER NH 03833 020473737 MANAGE RESOURCES NH 501(c)(3) 11 EXETER HEALTH RESOURCES INC EXETER MED REAL 5 alumni drive EXETER NH 03833 020418718 REAL ESTATE HOLDING NH 501(c)(25) eXETER HEALTH RESOURCES INC 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 convergent health systems inc 5 alumni drive exeter NH 03833 020469711 wellness center NH exeter health resources inc C -4758 270560 Vx HEALTH SERVICES 5 alumni drive Exeter NH 03833 020469712 FITNESS CENTER NH CONVERGENT HEALTH SYSTEMS INC C 3110 548001 EXETER MEDICAL SERVICES 5 alumni drive Exeter NH 03833 020419850 inactive PHYSICIAN PRACTICE NH CONVERGENT HEALTH SYSTEMS INC C 1000 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 0 1 1 0 VX HEALTH SERVICES B 222998 EXETER HEALTH RESOURCES Q 8300000 EXETER HEALTHCARE Q 1525169 CORE PHYSICIANS LLC Q 5099770 EXETER HEALTHCARE J 476531 EXETER HEALTH RESOURCES J 59424 EXETER MED REAL J 970106 CORE PHYSICIANS LLC J 13859 VX HEALTH SERVICES J 76911 EXETER HEALTH RESOURCES SI TRUST P 432807 EXETER HEALTH RESOURCES L 5468236 EXETER HEALTHCARE N 33873 CORE PHYSICIANS LLC K 1106375 EXETER MED REAL K 150682 ROCKINGHAM VNA K 163422 VX HEALTH SERVICES K 61695