2011-08-10T15:28:54-05:00 2010-09-30 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2009-10-01 020222171 New London Hospital Association Inc NEWL 6035265339 273 County Road New London NH 03257 Donald Griffin 6035265339 2011-08-09 1 Rachel Williamson CPA 6036697337 2011-07-27 2009 2016-02-24 21:20:13Z Bruce King 273 County Road New London NH 03257 62710281 0 X www.newlondonhospital.org X 1918 NH New London Hospital is a 25-bed rural community hospital, a federally qualified Critical Access hospital, with a 58-bed long-term extended care center dedicated to serving the Lake Sunapee region in central New Hampshire. NLH offers ambulance & emergency services, rehabilitation, diagnostic imaging, laboratory, surgical services & wellness programs. See community benefits reports for more detailed information. 19 15 694 159 106921 -39130 927062 842260 54633534 57804552 91212 305390 1605 1520 55653413 58953722 0 0 32067500 34487289 0 297752 22691557 24646763 54759057 59134052 894356 -180330 56245280 56339585 29867906 30809084 26377374 25530501 New London Hospital provides safe quality care for every patient, every time in partnership with patients, families and healthcare providers. 0 0 34185346 44347587 Hospital services to patients: New London Hospital Association, Inc. (NLHA) is the principal provider of primary and secondary health care for 15 towns in Sullivan and Merrimack counties in New Hampshire. The towns in the NLHA service area are: Andover, Bradford, Croydon, Danbury, Goshen, Grantham, Lempster, Newbury, New London, Newport, Springfield, Sunapee, Sutton, Washington, and Wilmot and are largely representative of the state's rural population. The hospital provides acute and primary health care - from emergency services to family medical practice to neurosurgical care - and essential wellness and prevention services for the 34,000 residents in the area, a significant proportion of whom are uninsured, underinsured and/or dependent on Medicaid/Medicare benefits. This includes a large elderly population and a significant number of rural, low-income families.New London Hospital is a Critical Access Hospital with 25 beds and an extended care facility with 58 beds. NLHA also employs 44 providers. Twenty-three provide primary care in three practices, one of which is a pediatric practice, and 21 are specialists, including anesthesiologists, neurology, emergency medicine, hospitalists, gynecology and ear, nose and throat.In addition to the access to care and programs mentioned above, NLHA provided $1,068,321 in charity care in order to care for community members.New Hampshire does not require towns to provide ambulance service and the NLHA ambulance service covers seven towns--New London, Sunapee, Springfield, Newbury, Sutton, Wilmot and Grantham providing $98,428 of support with a paramedic level ambulance. In addition, the ambulance service makes transfers, non-transport runs and Dartmouth-Hitchcock Medical Center assists. Paramedics intercept and assist area volunteer ambulance and FAST squads when needed. Emergency Medical Services education and training is provided by the hospital at a cost of $32,609. As a small community hospital, NLHA is also involved in the provision of medical education and student internships in order to encourage healthcare professionals to remain as providers in rural environment. In addition to supporting continuing medical education for its employees, NLHA also provided $146,801 of community benefits in a variety of clinical internships including nursing, radiology, laboratory and physical therapy.A variety of health care support services comprises a significant area of community benefits for NLHA. To assure that patients can continue to have access to primary care, NLHA supports an initiative to enroll eligible patients in Public Programs such as Medicaid at a cost of $41,200. The hospital also supports many local service agencies through participation on governing boards, with a value of $56,614. Cash donations to other non profits in the healthcare industry total $7,610. NLHA also provides meeting space to community non-profits at a value of $16,068.For more detailed descriptions of individual community benefit programs provided by New London Hospital Association, Inc., please go to www.newlondonhospital.org/about_us/community_benefit/ 9872413 8965617 Physician practices: NLHA identified access to primary care as a central community need. As a result, the hospital is committed to providing care in central locations throughout the service area, specifically Newport and New London. The hospital subsidized the delivery of primary care to the community in the amount of $3,085,479 in FY 2010. In addition, the hospital provided a Medication Bridge Program at a cost of $20,335 that works with patients to ensure that prescription medication is available at an affordable cost. Due to limited access to mental health services in the service area, NLHA partnered with West Central Behavioral Health to give patients access to care at a cost of $112,436. Other community benefit programs provided by NLHA include a Breast & Cervical Cancer Program and Mammography Fund valued at $10,311; two community health fairs valued at $11,000; Safe Sitter classes valued at $1,685.NLHA had several programs in the schools in response to past needs assessments that continue to address health concerns in our service area. The Tiger Treatment Center (TTC) provides prevention and acute care treatment, sports physicals, nutrition counseling and health education to middle and high school students in Newport. Staffing the TTC was a community benefit valued at $38,769. The Athletic Trainer program at Kearsarge Regional High School provides trained personnel for all JV and varsity practices and games to work with student athletes in injury prevention, treatment and follow-up. This provides a community benefit to area students valued at $37,980. 3838705 4798258 Nursing Home: The Clough Center is a 58-bed extended nursing care facility located within New London Hospital. The Clough Center provides a warm and caring environment for its residents who benefit from health services personalized to meet their individual needs, including special meals, physical, occupational and speech therapy, personalized exercise sessions, and individual attention by highly skilled providers who have immediate access to the comprehensive services of a hospital and pharmacy. 47896464 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 91 0 1 694 1 1 1 0 0 0 0 0 0 0 0 19 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Donald Griffin 6035265372 273 County Road New London NH 03257 Bruce P King 50.00 X X 358332 0 28701 James G McGuire MD 40.00 X X 149824 0 48525 Eileen Kirk MD 40.00 X 238580 0 34225 Dudley Smith 8.00 X X 0 0 0 John F Robb MD 8.00 X X 0 0 0 Patricia Tilley 8.00 X X 0 0 0 G William Helm Jr 8.00 X X 0 0 0 David E Marshall 8.00 X X 0 0 0 Sage Chase 2.00 X 0 0 0 Celeste C Cook 2.00 X 0 0 0 Stanley I Cundey Jr 2.00 X 0 0 0 John C Ferries 2.00 X 0 0 0 Peter E Hager 2.00 X 0 0 0 Anne B Holmes 2.00 X 0 0 0 Stephen Jordan MD 2.00 X 123689 0 8285 Beverly S Payne 2.00 X 0 0 0 Jane Rastallis 2.00 X 0 0 0 Susan A Reeves 2.00 X 0 0 0 Robert M Rex 2.00 X 0 0 0 Tina Naimie 50.00 X 157756 0 9014 Theresa LeBlanc 50.00 X 147746 0 7815 Gregory Q Curtis MD 40.00 X 254448 0 38723 Thomas F Lucas MD 40.00 X 322776 0 40004 Kenneth Call MD 40.00 X 317063 0 12034 Donald Eberly MD 40.00 X 278560 0 38267 Steven Powell MD 40.00 X 271481 0 1887 Sean Bears MD 40.00 X 266462 0 34612 2886717 0 302092 42 0 1 1 Upper Valley Neurology Neurosurgery PC 106 Hanover St Lebanon NH 03766 Physician Services 708571 New England Alliance for Health LLC 1 Medical Center Drive Lebanon NH 03756 Management services 640213 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Physician Staffing & Lab Services 595232 Mary Hitchcock Memorial Hospital 1 Medical Center Drive Lebanon NH 03756 Management services 524399 American Health Centers Inc 10 Commerce Park North Unit 10 Bedford NH 03110 Diagnostic Imaging Services 390676 16 153672 84460 604128 63784 842260 Net Patient Revenue 621400 56423955 56423955 Physician Services 621110 930602 930602 Child Care 624410 294886 187965 106921 Cafeteria 900099 155109 155109 57804552 296497 296497 3662602 15000 3650478 18231 12124 -3231 8893 8893 89370 153672 87850 1520 1520 58953722 57697631 106921 306910 1638042 870685 767357 25999867 20799893 4983278 216696 481822 385458 92166 4198 4707360 3765888 925900 15572 1660198 1328158 316181 15859 118576 94861 23715 161064 128851 32213 76250 61000 15250 46735 37388 9347 5484242 4387394 1096848 268112 214490 29840 23782 5748260 4598608 1142556 7096 529343 423474 105869 1624462 1299569 322601 2292 100635 80508 9130 10997 90093 72075 16758 1260 923504 738803 184701 131472 105178 26294 3628228 2902583 725645 553872 443098 110774 Bad Debt Expense 2617070 2617070 Medicaid Enhancement Ta 2527774 2527774 Other 17071 13658 3413 59134052 47896464 10939836 297752 1824220 4316368 2689162 769940 1634883 1058149 8228614 8573324 18480 901131 975689 448529 542863 61924468 29291375 33908403 32633093 4732907 6365015 1858951 1105144 56245280 56339585 7672995 8020625 16750000 16750000 1343055 1239096 4101856 4799363 29867906 30809084 X 25817647 24935540 185860 221094 373867 373867 26377374 25530501 56245280 56339585 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10348 10348 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Per information provided by the NH Hospital Association (NHHA), the NHHA percentage of dues expended for lobbying purposed was 22.96%. The percentage of American Hospital Association dues expended for lobbying purposed was 23.76%. 373867 33115 30386 2729 373867 373867 2996 132 2864 373867 1.00000 1 0 941274 941274 35612308 11291377 24320931 396287 259759 136528 23502278 17262231 6240047 1472321 478008 994313 32633093 Mortgage backed securities 245543 F U.S. Treasury Obligations 695056 F Marketable equity securities 3876425 F Corporate bonds 1144440 F International bonds 330397 F Equity mutual funds 26725 F Fixed income mutual funds 46429 F 6365015 Charitable Gift Annuities 40000 Capital Lease Obligations 873183 Other Liabilities 20000 Interest Rate Swap 3866180 4799363 58953722 59134052 -180330 349201 -1015744 -666543 -846873 58240445 349202 349202 57891243 46735 1015744 1062479 58953722 59087317 0 59087317 46735 46735 59134052 Part V, Line 4: Description of Intended Use of Endowment Funds: The income from the Endowment Funds is used to assist in the payment of the hospitals program-related expenses. Part XI, Line 8 - Other Adjustments: Unrealized Loss on Interest Rate Swap: -1015744. Part XII, Line 4b - Other Adjustments: Unrealized Loss on Interest Rate Swap: 1015744. Golf Tournament 64470 38874 25596 1300 8792 3720 10264 Charity Auction 125625 84581 41044 7477 24971 2500 6096 1 52947 30217 22730 4964 3954 500 13312 243042 153672 89370 1300 21233 32645 3000 29672 87850 1520 1 1 1 X 1 X 0 1 1 0 1 1 1068321 1068321 0.01890 6032412 5633127 399285 0.00710 7100733 5633127 1467606 0.02600 252208 252208 0.00450 146801 146801 0.00260 3316678 3316678 0.05870 0 59692 59692 0.00110 3775379 3775379 0.06690 10876112 5633127 5242985 0.09290 0 0 107741 107741 0.00190 0 0 20600 20600 0.00040 15450 15450 0.00030 6078 6078 0.00010 149869 149869 0.00270 1 1545642 13890728 15011647 -1120919 X 1 1 New London Hospital

273 County Road New London NH 03257

X Newport Health Center

11 John Stark Hwy Newport NH 03773

X New London Pediatric Care Ctr

6 Holmes Lane Georges Mills NH 03751

X New London Family Care Ctr

120 Route 10 Grantham NH 03753

X Part I, Line 7g: Subsidized health services did not include physician practices. Part III, Line 4: The Hospital used the cost-to-charge ratio for reporting the bad debt expense at cost. Part III, Line 9b: The Collection Coordinator is reponsible for giving Financial Assistance Program applications, reviewing returned applications, securing financial data necessary, evaluating applications and making recommendations for approval to the Director of Patient Business Services and/or the Chief Financial Officer, and notifying the patients of eligibility determinations. When patients claim they cannot pay in full or meet installment plan guidelines due to a lack of resources, the Hospital can agree to an installment plan, refer the account to collections, write off the account as a bad debt or pursue a charity care application. Part VI, Line 2: The Hospital participated in the Upper Valley United Way 2008 Needs and Assets Assessment Project, which collected data for fourteen indicators in communities within our service area. In addition to data analysis, the project conducted focus groups in a variety of communities. Part VI, Line 3: Information packets are available in the Credit and Collection Coordinator's office. Part VI, Line 4: The Hospital has identified the following communities in its service area: Andover, Bradford, Croydon, Danbury, Goshen, Grantham, Lempster, Newbury, New London, Newport, Springfield, Sunapee, Sutton, Washington and Wilmot. Part VI, Line 5: The Hospital is actively engaged in working to build community collaborations through leadership and participation in such activities as the Tiger Treatment Center program at Newport Middle High School, the Newport Enrichment Team, the Sullivan County Oral Health Collaborative, senior advocacy programs and the Rock Dental school-based dental screening program. In addition, the Hospital continues its leadership role in the C5 District for Emergency Services, working with the Town of New London on mock disaster drills and participation in all activities related to emergency preparedness. NH X 1 1 X X X X X 0 0 0 0 0 1 0 0 0 Bruce P King 273012 0 85320 0 0 0 8721 0 19980 0 387033 0 0 0 James G McGuire MD 149824 0 0 0 0 0 29279 0 19246 0 198349 0 0 0 Eileen Kirk MD 237614 0 0 0 966 0 14127 0 20098 0 272805 0 0 0 Tina Naimie 145653 0 11813 0 290 0 7272 0 1742 0 166770 0 0 0 Theresa LeBlanc 135858 0 11262 0 626 0 4810 0 3005 0 155561 0 0 0 Gregory Q Curtis MD 234714 0 19362 0 372 0 10386 0 28337 0 293171 0 0 0 Thomas F Lucas MD 321810 0 0 0 966 0 11667 0 28337 0 362780 0 0 0 Kenneth Call MD 316097 0 0 0 966 0 9208 0 2826 0 329097 0 0 0 Donald Eberly MD 275788 0 0 0 2772 0 10180 0 28087 0 316827 0 0 0 Steven Powell MD 271481 0 0 0 0 0 1496 0 391 0 273368 0 0 0 Sean Bears MD 266042 0 0 0 420 0 10162 0 24450 0 301074 0 0 0 Part I, Line 1a Social club dues: New London Hospital paid $910 of the Lake Sunapee Country Club membership fee for the Chief Executive Officer as part of the development effort to encourage other members to contribute to our tax-exempt organization. Supplemental Information Part III Senior leadership incentive goals are predicated upon meeting specific patient satisfaction scores, along with patient safety and medical staff Q1 goals. Senior management must appropriately respond to extraordinary events while working toward achievement of the operating budget. Senior management is also responsible for achieving specific fund-raising goals and for continued progress in implementing the electronic health information system. Bruce King, CEO is paid by the Mary Hitchcock Memorial Hospital, an unrelated organization. Mr. King's total compensation from MHMH for the 2009 calendar year was $297,238, the remainder of his compensation was paid directly by NHLA. Dr. James McGuire is paid by the Dartmouth Hitchcock Clinic, an unrelated organization. Dr. McGuire's total compensation from DHC for the 2009 calendar year was $196,564, the remainder of his compensation was paid directly by NHLA. NH Health and Education Facilities Authority 020279866 644614SL4 2007-06-21 20000000 New medical office building construction & renovation of hospital facilities 0 0 20000000 207997 304750 5000000 19829500 2009 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 1 Morgan Stanley 30.000000000000 1 Hypo Public Finance 1.830000000000 1 0 1 X 6 63784 Fair Market Value 0 1 0 Form 990, Part VI, Section A, line 3 Mr. Bruce King, CEO, of New London Hospital (NLH) is an employee of Mary Hitchcock Memorial Hospital (MHMH). NLH purchases his services from MHMH. Form 990, Part VI, Section B, line 11 The Form 990 is presented and discussed with the Board of Trustees at one of their meetings prior to the filing of the 990. Form 990, Part VI, Section B, line 12c Each year, as part of the preparation of the 990, a written questionnaire is sent to each Trustee inquiring about conflict-of-interest situations. Members are asked quarterly at Board of Trustee meetings if any new situations have arisen. Form 990, Part VI, Section B, line 15 The CEO's compensation is determined by the New London Hospital Association (NLHA) Executive Committee and Mary Hitchcock Memorial Hospital, the CEO's employer, after considering compensation for CEOs of various sized hospitals in the region. Compensation levels for all other officers and key employees are reviewed periodically by NLHA's Senior Director of Human Relations and CEO of NLHA. These reviews include comparisons of compensation levels to independent salary survey data for comparable positions in the region. Form 990, Part VI, Section C, line 19 NLH makes this information available to the public upon resquest. In addition, Form 990 is filed with the State of NH and is available to the public through the State. NLH files a Community Benefit Report annually with the State of NH. NLH includes summarized financials with its annual reports to donors. Part XI, Line 2c The organization has not changed its oversight or selection process during the tax year. Form 990, Part I Prior year The prior year revenue and expense was restated to report patient revenue net of contractual allowances and to remove those contractual allowances from the program expenses. Kearsage Community Services 273 County Road New London NH 03257 020460136 Real Estate NH New London Hospital Association C -29486 745910 1.00000 New London Medical Center East 273 County Road New London NH 03257 020480857 Real Estate NH New London Hospital Association C -5688 28673 1.00000 New London Physician Group Inc 273 County Road New London NH 03257 020494420 Physician Pratice NH New London Hospital Association C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0