2025-08-15T11:57:15-05:00 2024-09-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2023-10-01 222674014 EXETER HOSPITAL INC EXET 6035806694 CO BILH TAX 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 RAFAEL HERNANDEZ VP, BILH CORPORATE TREASURER 6035806694 2025-08-14 0 0 ANGELA M MOORE P00244342 3174648600 2025-08-12 2023 2025-03-06 01:10:19Z X KEVIN TABB MD C/O BILH TAX 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 340743882 0 X WWW.EXETERHOSPITAL.COM X 1907 NH SEE SCHEDULE O 12 9 1952 16 88204 0 2242742 3318440 313032596 330124783 4253315 2516067 51911 78996 319580564 336038286 550364 1659007 0 0 135697875 138845842 94374 98157 98157 171220623 167382612 307563236 307985618 12017328 28052668 257188839 272025403 77598435 72081544 179590404 199943859 X SEE SCHEDULE O 0 0 267372269 1659007 330215601 SEE SCHEDULE O SEE SCHEDULE O SEE SCHEDULE O 267372269 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 168 0 1 1952 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 12 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X KAREN WOLFSON AVP TAXATION 7817448924 BILH SCHRAFFTS CITY CTR 4TH FL 529 CHARLESTOWN MA 02129 ROWAN MICHAEL TTEE(CEO DESIG) EVP HOS&AMBSVCS BILH 1.00 64.00 X 0 2302117 2401778 SHORETT PETER TTEE (SR EXECUTIVE VP & COO, BILH) 1.00 64.00 X 0 1559476 48246 CRESTA DEBRA TRUSTEE & PRESIDENT (PRESIDENT, EHR) 1.00 58.00 X X 0 1098754 16277 HOLLISTER MD RICHARD TRUSTEE (PRESIDENT, MEDICAL STAFF) 1.00 56.00 X 0 629092 52610 PANGAN MD MICHAEL TRUSTEE 1.00 56.00 X 0 344226 54171 CASE AMY TRUSTEE & VICE CHAIR 1.00 1.00 X X 0 0 0 EBERLE ROBERT CHAIR & TRUSTEE 1.00 2.00 X X 0 0 0 CARUCCI DEAN TTEE (BILH DIV PRESIDENT, COMMUNITY) 1.00 12.00 X 0 0 0 DESJARDINS RET MAJ GEN SUSAN Y TRUSTEE 1.00 1.00 X 0 0 0 DOMINGUEZ PHD CYNTHIA TRUSTEE 1.00 1.00 X 0 0 0 FALCK ESQ DAVID TRUSTEE 1.00 1.00 X 0 0 0 FARMER JR CHARLES DAVIS TRUSTEE 1.00 1.00 X 0 0 0 HEVERT ROBERT TRUSTEE 1.00 1.00 X 0 0 0 TOUMPAS NICK TRUSTEE 1.00 1.00 X 0 0 0 TABB MD KEVIN CHIEF EXECUTIVE OFFICER (CEO, BILH) 1.00 64.00 X 0 4313387 1097028 RIOS CINDY TREAS (EXECUTIVE VP & CFO, BILH) 1.00 64.00 X 0 1471427 217736 KATZ ESQ JAMIE CLERK; GENERAL COUNSEL, BILH 1.00 63.00 X 0 1270175 32002 CASASSA ALLISON J ASSISTANT TREASURER & CFO 1.00 58.00 X 0 685247 23250 SPRAUER ESQ CONSTANCE D ASSISTANT CLERK (SVP LEGAL AFFAIRS) 1.00 56.00 X 0 535449 35480 BOYD ESQ STEPHEN ASST CLERK (DIV VP DEP GC COMM BILH) 1.00 59.00 X 0 314060 15921 ABRAMSON ESQ MICHAEL S ASST CLERK (ASSOC GEN COUNSEL, BILH) 1.00 2.00 X 0 0 0 MCKINNEY DONNA VP ACUTE CARE, CHIEF NURSING EXEC 55.00 1.00 X 573403 0 51557 O'NEIL SEAN COO & VP, AMBULATORY CARE 55.00 0.00 X 520947 0 63560 BRINDAMOUR MD LUKE CHIEF MEDICAL OFFICER 55.00 0.00 X 412776 0 29587 LEVESQUE SHANNON VP, HUMAN RESOURCES 1.00 57.00 X 0 394924 45108 GARGANTA AARON SENIOR DIR ENG. & PHYS. ENVIRONMENT 55.00 1.00 X 234718 0 14383 SAVOIE MICHELLE INTERIM VP ACUTE CARE, CHIEF NURSE 55.00 0.00 X 197845 0 43012 THOMAS CHARLES EXECUTIVE DIRECTOR, HUMAN RESOURCES 55.00 0.00 X 286382 0 61925 CALLAHAN SUSAN DIRECTOR, COMPENSATION AND BENEFITS 55.00 0.00 X 281326 0 45517 GAGNE NOLAN PHYSICIST CHIEF 55.00 0.00 X 275529 0 50760 MEISNER JEFFREY SENIOR DIRECTOR, REHAB SERVICES 55.00 0.00 X 258126 0 61147 WAGNER ABIGAIL SENIOR DIRECTOR, SURGICAL SERVICES 55.00 0.00 X 242868 0 44408 CALLAHAN KEVIN J FORMER TRUSTEE, CEO & PRESIDENT 0.00 0.00 X 0 1749071 367707 3283920 16667405 4873170 385 1 1 0 EXETER HEALTH RESOURCES INC 5 ALUMNI DRIVE EXETER NH 03833 ADMINISTRATIVE MGMT FEES 10108096 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET OMAHA NE 68114 TEMPORARY STAFFING 4267750 NORTH AMERICAN PARTNERS IN ANESTHESIA 1305 WALT WHITMAN ROAD MELVILLE NY 11747 ANESTHESIA CONTRACTOR 2986821 MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET BOSTON MA 02114 PHYSICIAN SERVICES 2229833 ENGELBERTH CONSTRUCTION INC 150 WATER TOWER CIRCLE COLCHESTER VT 05446 BUILDING CONTRACTOR 2208165 80 100804 2826022 391614 3318440 NET PATIENT SERVICES 622110 319695422 319695422 DISPROPORTIONATE SHARE 621300 7888278 7888278 CAFETERIA 722514 1286837 1286837 AUXILLARY HOSPITAL SER 622110 1177907 1091357 86550 GIFT SHOP 459420 76339 76339 330124783 1215626 1654 1213972 120118 29300 90818 90818 90818 5937935 4637494 1300441 1300441 1300441 26980 100804 38802 -11822 -11822 336038286 330129051 88204 2502591 1659007 1659007 2141788 1845526 296262 108808103 93776275 15031828 693580 596479 97101 19288074 16623681 2664393 7914297 6820938 1093359 10108096 10108096 4191 4191 65000 65000 34431 34431 98157 98157 26265317 24369051 1896266 426931 362950 63981 646735 549814 96921 225580 191774 33806 6657058 5659420 997638 161264 137096 24168 1507429 1296389 211040 5076334 4345342 730992 588093 499960 88133 DRUGS 38332914 38332914 SUPPLIES 27217001 23138216 4078785 OTHER EXPENSES 19465224 16566423 2898801 MET 16677176 16677176 13923838 13923838 307985618 267372269 40515192 98157 14827164 5885264 10563992 8643767 361004 280576 31190396 30910232 8442075 8140964 26714700 32942612 105329545 53274692 49771017 52054853 29897624 35905748 70900175 83282607 9132820 8066045 5387872 5912735 257188839 272025403 26500018 28522816 30651491 27117912 20446926 16440816 77598435 72081544 X 158799452 175433113 20790952 24510746 179590404 199943859 257188839 272025403 X 28052668 16038907 -616120 -23122000 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 34431 34431 0 PART II-B, LINE 1: A PORTION OF ANNUAL MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, THE NEW HAMPSHIRE HOSPITAL ASSOCIATION, AND THE ASSOCIATION OF COMMUNITY CANCER CENTERS ARE CONSIDERED LOBBYING EXPENSES. FOR FISCAL YEAR ENDING SEPTEMBER 30, 2024, THE AMOUNTS DEEMED FOR LOBBYING WERE $10,529, $23,889, AND $13, RESPECTIVELY. 20790952 1907431 4480814 2668450 24510747 19938414 1248286 1505324 1901072 20790952 26115362 630764 -3870191 2937521 19938414 20702145 2025164 5161715 1773662 26115362 17319951 578733 2996535 193074 20702145 0.06710 0.93290 0.00000 0 1 1 3300000 3300000 59884071 30204804 29679267 261411 261411 0 34727301 21639073 13088228 7156762 1169404 5987358 52054853 83282607 C 83282607 DUE TO THIRD PARTY PAYORS 4996359 CLAIMS 874291 SWAP VALUATION LIABILITY 1257907 CURRENT PORTION LEASE LIABILITY 2056500 LEASE LIABILITY 6248000 DEFERRED COMPENSATION 1007759 16440816 X PART V, LINE 4: THE GOAL OF THE PERMANENT ENDOWMENT FUND IS TO PROVIDE A SOURCE OF FINANCIAL SUPPORT TO EXETER'S PATIENT CARE ACTIVITIES. THESE FUNDS ARE INVESTED IN A PRUDENT MANNER WITH REGARD TO PRESERVING PRINCIPAL WHILE PROVIDING REASONABLE RETURNS. THESE RETURNS ARE THEN USED FOR CAPITAL EXPENDITURES, OTHER MAJOR PROGRAM NEEDS, AND TO GENERALLY INCREASE THE FINANCIAL STRENGTH OF THE ORGANIZATION. PART X, LINE 2: BETH ISRAEL LAHEY HEALTH, INC., WHICH SERVES AS THE PARENT OF THE SYSTEM, HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE AN ORGANIZATION DESCRIBED UNDER INTERNAL REVENUE CODE (THE "CODE") SECTION 501(C)(3) AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ALSO DETERMINED THAT THE OTHER ENTITIES IN THE SYSTEM, EXCLUDING ITS FOR-PROFIT SUBSIDIARIES, QUALIFY AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, MEET THE CODE'S REQUIREMENTS UNDER SECTION 509(A), AND THEREFORE ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION HAS BEEN RECORDED FOR INCOME TAXES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE SYSTEM DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS FOR THE YEARS ENDED SEPTEMBER 30, 2024 AND 2023, RESPECTIVELY. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 12658642 0 0 0 0 0 0 12658642 0 12658642 0 0 1 1 1 0 SCHEDULE F, PART I, LINE 1 AND LINE 3: THE LEGAL OWNER OF EXETER HOSPITAL, INC.'S FOREIGN INVESTMENTS IS A RELATED ORGANIZATION, EXETER HEALTH RESOURCES, INC. SINCE A PORTION OF EXETER HEALTH RESOURCES, INC.'S TOTAL FOREIGN INVESTMENTS ARE ALLOCATED TO THE HOSPITAL'S ASSETS ON THE FINANCIAL STATEMENTS, THOSE ALLOCATED INVESTMENTS HAVE BEEN DISCLOSED ON SCHEDULE F, PART I, LINE 3 OF EXETER HOSPITAL, INC.'S FORM 990. HOWEVER, ANY REQUIRED IRS FORMS 926 AND OTHER FOREIGN TAX REPORTING OBLIGATIONS ARE FILED BY THE LEGAL OWNER, EXETER HEALTH RESOURCES, INC. (EIN:02-0222126) SCHEDULE F, PART IV, LINE 3: EXETER HOSPITAL, INC. DID NOT HAVE AN OWNERSHIP INTEREST IN ANY FOREIGN CORPORATION THAT WAS GREATER THAN THE 10% OWNERSHIP FILING THRESHOLD. ACCORDINGLY, IRS FORM(S) 5471 IS NOT REQUIRED TO BE FILED. SCHEDULE F, PART IV, LINE 4: EXETER HOSPITAL, INC. MEETS THE EXCEPTION FOR TAX-EXEMPT ORGANIZATIONS WITH RESPECT TO FILING FORM 8621. ACCORDINGLY, FORM 8621 IS NOT REQUIRED TO BE FILED FOR THE HOSPITAL. SCHEDULE F, PART IV, LINE 5: EXETER HOSPITAL, INC. DID NOT HAVE AN OWNERSHIP INTEREST IN ANY FOREIGN PARTNERSHIP THAT WAS GREATER THAN THE 10% OWNERSHIP FILING THRESHOLD; DID NOT HAVE CONTROL OVER ANY FOREIGN PARTNERSHIPS; DID NOT TRANSFER $100,000 OR MORE TO A FOREIGN PARTNERSHIP DURING THE REPORTING PERIOD; AND DID NOT EXPERIENCE A FORM 8865 REPORTABLE EVENT. ACCORDINGLY, IRS FORM(S) 8865 IS NOT REQUIRED TO BE FILED. X X X X X X 1 HEALTH PHILANTHROPY SERVICES PO BOX 60 POWELL OH 43065 PHILANTHROPY COUNSELING 0 0 53327 -53327 BCG CONNECT LLC 1 JEWEL DRIVE SUITE 105 WILMINGTON MA 01887 APPEALS & DONOR MAILINGS 0 0 44830 -44830 98157 -98157 NH TRICK OR TREAT TROT 62914 48534 14380 1153 1885 375 12505 GOLF TOURNAMENT 53990 41390 12600 4205 7344 5328 804 1 10880 10880 5203 127784 100804 26980 5358 7344 7213 375 18512 38802 -11822 SCHEDULE G, PART I, PROFESSIONAL FUNDRAISERS DURING THE PERIOD COVERED BY THIS FORM 990, EXETER HOSPITAL ENGAGED TWO SEPARATE INSTITUTIONS TO PROVIDE VARIOUS FUNDRAISER SERVICES, AS BROADLY DEFINED BY THE IRS WITHIN THE FORM 990 INSTRUCTIONS. FOR TRANSPARENCY PURPOSES AND IN AN EFFORT TO FILE THIS FORM 990 AS COMPLIANTLY AS POSSIBLE, EXETER HOSPITAL HAS ELECTED TO DISCLOSE THESE ENTITIES AS PROFESSIONAL FUNDRAISERS, AND TO LIST SUCH ENTITIES ON THIS FORM 990, SCHEDULE G, PART I. A FULL DESCRIPTION OF THE SERVICES PERFORMED BY EACH ENTITY IS PROVIDED IN DETAIL BELOW. DUE TO THE NATURE OF THE SERVICES OFFERED, EXETER HOSPITAL IS UNABLE TO ESTIMATE AN AMOUNT OF GROSS RECEIPTS DIRECTLY GENERATED BY EACH PROFESSIONAL FUNDRAISER, THROUGH IT IS EXETER HOSPITAL'S POSITION THAT THE SERVICES RENDERED BY THESE PROFESSIONALS PROVIDED AN OVERALL NET POSITIVE BENEFIT TO EXETER HOSPITAL'S FUNDRAISING EFFORTS. - HEALTH PHILANTHROPY: PROVIDED EXTERNAL COUNSEL AND GUIDANCE FOR EXETER HOSPITAL'S PHILANTHROPIC ACTIVITIES. THIS ENTITY HAS ALSO FILLED SOME OPEN DIRECTOR POSITIONS AND PROVIDED FUNDRAISING SUPPORT SERVICES. - BCG CONNECT: PROVIDED ASSISTANCE WITH EXETER HOSPITAL'S GENERAL DONOR-APPEAL MAILINGS, AS WELL AS EXETER HOSPITAL'S BI-ANNUAL NEWSLETTER AND DONOR SURVEYS. SCHEDULE G, PART II, FUNDRAISING EVENTS IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR THE REPORTING OF INCOME ON SCHEDULE G, EVENT REVENUE DEEMED TO BE CHARITABLE CONTRIBUTIONS HAS BEEN REPORTED ON LINE 2, THUS REDUCING THE TOTAL GROSS EVENT INCOME ON LINE 3. THIS PRESENTATION GIVES THE APPEARANCE ON SCHEDULE G OF A LOSS FROM THESE EVENTS. HOWEVER, WHEN THE CHARITABLE CONTRIBUTIONS ARE CONSIDERED AND ADDED BACK, THESE EVENTS HAD A PROFIT OF $88,984. 1 1 1 X 320.000000000000 0 1 1 0 1 1 368237 368237 0.00130 27707686 8505644 19202042 0.06530 28075923 8505644 19570279 0.06660 554534 17763 536771 0.00180 1262784 1262784 0.00430 4143126 557826 3585300 0.01220 263719 15081 248638 0.00080 1349135 1349135 0.00460 7573298 590670 6982628 0.02370 35649221 9096314 26552907 0.09030 226577 226577 0.00080 2000 2000 0.00000 228577 228577 0.00080 0 4015387 106581193 150357375 -43776182 X 1 1 1 1 EXETER HOSPITAL INC 5 ALUMNI DRIVE EXETER NH 03833 WWW.EXETERHOSPITAL.COM X X X EXETER HOSPITAL INC 1 0 0 1 X X X X X X X X 21 1 0 1 1 X SEE PART VI X 1 21 1 SEE PART VI 0 1 X 320.000000000000 X X X X 1 1 X X X X 1 X SEE PART VI X SEE PART VI X SEE PART VI X X X X X X X 1 X 0 X X X 1 X 0 0 EXETER HOSPITAL, INC. PART V, SECTION B, LINE 5: EXETER HOSPITAL, INC.:PART V, SECTION B, LINE 5: PLEASE REFER TO THE SUPPLEMENTAL INFORMATIONREPORTED ON THIS FORM 990, SCHEDULE H, PART VI. EXETER HOSPITAL, INC. PART V, SECTION B, LINE 11: EXETER HOSPITAL, INC.:PART V, SECTION B, LINE 11: PLEASE REFER TO THE SUPPLEMENTAL INFORMATIONREPORTED ON THIS FORM 990, SCHEDULE H, PART VI. 15 1 - CENTER FOR ORTHOPEDICS AND MOVEMENT 7 ALUMNI DRIVE EXETER NH 03833 REHABILATION SERVICES, CARDIAC REHABILIATION, MASSAGE 2 - CENTERS FOR SLEEP & WOUND HEALING 4 ALUMNI DRIVE EXETER NH 03833 SLEEP LAB, WOUND CARE, DRIVEABILITY 3 - EPPING REGIONAL HEALTH CENTER 212 CALEF HIGHWAY EPPING NH 03042 PEDIATRIC AND ADULT REHABILATION SERVICES, RADIOLOGY, MAMMOGRAPHY 4 - PLAISTOW REGIONAL HEALTH CENTER 127 PLAISTOW ROAD PLAISTOW NH 03865 PEDIATRIC AND ADULT REHABILATION SERVICES, MAMMOGRAPHY 5 - CENTER FOR REPRODUCTIVE CARE 118 PORTSMOUTH AVENUE STRATHAM NH 03885 REPRODUCTIVE SERVICES 6 - CTR FOR OCCUP & EMPLOYEE HEALTH 6 HAMPTON ROAD EXETER NH 03833 OCCUPATIONAL HEALTH 7 - KINGSTON ATHLETICARE 53 CHURCH STREET KINGSTON NH 03848 PHYSICAL THERAPY, OCCUPATIONAL THERAPY 8 - ORTHO & SPORTS PHYS THERAPY CTR 311 WINNACUNNET ROAD HAMPTON NH 03842 PHYSICAL THERAPY AND ATHLETIC PERFORMANCE CENTER 9 - DIAGNOSTIC IMAGING - SALTONSTALL 9 BUZELL AVENUE EXETER NH 03833 RADIOLOGY 10 - REHAB & DIAGNOSTIC SERVICES RAYMOND 128 ROUTE 27 RAYMOND NH 03077 PHYSICAL THERAPY, RADIOLOGY, MAMMOGRAPHY 11 - REHAB & DIAGNOSTIC SERVICES LAMPREY 207 SOUTH MAIN STREET NEWMARKET NH 03857 PHYSICAL THERAPY, RADIOLOGY, MAMMOGRAPHY 12 - EXETER DIAGNOSTIC SERVICES AT HAMPTON 879 LAFAYETTE ROAD HAMPTON NH 03842 RADIOLOGY, MAMMOGRAPHY 13 - PHYSICAL THERAPY AT PORTSMOUTH 95 BREWERY LANE UNIT 15 PORTSMOUTH NH 03801 ADULT & PEDIATRIC PHYSICAL THERAPY 14 - HEALTHREACH DIAB ENDOCRIN & NUT CTR 881 LAFAYETTE ROAD HAMPTON NH 03842 DIABETES AND NUTRITION, EDUCATION 15 - EPPING ATHLETIC PERFORMANCE CENTER 88 SHIRKING ROAD HAMPTON NH 03842 ATHLETIC PERFORMANCE CENTER FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITSCOMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSEXETER HOSPITAL AFFILIATIONON JULY 1, 2023, BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF EXETER HEALTH RESOURCES, INC., WHICH SERVES AS THE SOLE MEMBER OF EXETER HOSPITAL AND ITS OPERATING AFFILIATES CORE PHYSICIANS AND ROCKINGHAM VISITING NURSE ASSOCIATION & HOSPICE. THE BILH NETWORK OF AFFILIATES IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND PARTS OF SOUTHERN NEW HAMPSHIRE AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS, AND ADDICTION TREATMENT PROGRAMS. THE BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,700 PHYSICIANS AND 39,000 EMPLOYEES. AT THE HEART OF BILH IS THE BELIEF THAT EVERYONE DESERVES HIGH-QUALITY, AFFORDABLE HEALTH CARE AND THIS BELIEF IS WHAT DRIVES EACH AFFILIATE TO WORK WITH COMMUNITY PARTNERS ACROSS THE REGION TO PROMOTE HEALTH, EXPAND ACCESS AND DELIVER THE BEST CARE IN THE COMMUNITIES BILH SERVES. BILH'S COMMUNITY BENEFITS STAFF ARE COMMITTED TO WORKING COLLABORATIVELY WITH BILH'S COMMUNITIES TO ADDRESS THE LEADING HEALTH ISSUES AND CREATE A HEALTHY FUTURE FOR INDIVIDUALS, FAMILIES AND COMMUNITIES.BILH'S PURPOSE STATEMENT ARTICULATES THE IMPACT BILH AND EACH AFFILIATE STRIVES TO MAKE IN THE COMMUNITIES SERVED. BILH'S SHARED VALUES GUIDE DAILY EFFORTS, KEEP BILH AND EACH AFFILIATE ALIGNED IN THE PURSUIT OF PURPOSE AND SHOW HOW BILH CARES FOR PATIENTS, EACH OTHER AND OUR COMMUNITIES.PURPOSE STATEMENT: BILH CREATES HEALTHIER COMMUNITIES ONE PERSON AT A TIME THROUGH SEAMLESS CARE AND GROUND-BREAKING SCIENCE, DRIVEN BY EXCELLENCE, INNOVATION AND EQUITY.EXETER HOSPITAL MISSION STATEMENT PURPOSE STATEMENT: WE CREATE HEALTHIER COMMUNITIES ONE PERSON AT A TIME THROUGH SEAMLESS CARE AND GROUND-BREAKING SCIENCE, DRIVEN BY EXCELLENCE, INNOVATION AND EQUITY.MISSION: WE POSITIVELY IMPACT THE LIVES OF THOSE WHO ENTRUST US WITH THEIR HEALTH.VISION: TO BE THE MOST INNOVATIVE AND VIBRANT COMMUNITY HEALTHCARE ORGANIZATION IN OUR REGION, LEADING WITH THE HIGHEST QUALITY CARE.VALUES "WE CARE": WELLBEING. WE PROVIDE A HEALTH-FOCUSED WORKPLACE AND SUPPORT A HEALTHY WORK-LIFE BALANCE.- EMPATHY. WE DO OUR BEST TO UNDERSTAND OTHERS' FEELINGS, NEEDS AND PERSPECTIVES.- COLLABORATION. WE WORK TOGETHER TO ACHIEVE EXTRAORDINARY RESULTS.- ACCOUNTABILITY. WE HOLD OURSELVES AND EACH OTHER TO BEHAVIORS NECESSARY TO ACHIEVE OUR COLLECTIVE GOALS.- RESPECT. WE VALUE DIVERSITY AND TREAT ALL MEMBERS OF OUR COMMUNITY WITH DIGNITY AND INCLUSIVENESS.- EQUITY. EVERYONE HAS THE OPPORTUNITY TO ATTAIN THEIR FULL POTENTIAL IN OUR WORKPLACE AND THROUGH THE CARE WE PROVIDE.EXETER HOSPITAL FULFILLS ITS MISSION BY: - INVOLVING EXETER HOSPITAL'S STAFF, INCLUDING ITS LEADERSHIP AND DOZENS OF COMMUNITY PARTNERS, IN THE CHNA PROCESS AS WELL AS IN THE DEVELOPMENT, IMPLEMENTATION AND OVERSIGHT OF THE THREE-YEAR IMPLEMENTATION STRATEGY;- ENGAGING AND LEARNING FROM RESIDENTS THROUGHOUT THE HOSPITAL'S COMMUNITY BENEFITS SERVICE AREA (CBSA) IN THE COMMUNITY BENEFITS PROCESS, WITH SPECIAL ATTENTION FOCUSED ON ENGAGING DIVERSE PERSPECTIVES, FROM THOSE, PATIENTS AND NON-PATIENTS ALIKE, WHO ARE OFTEN LEFT OUT OF SIMILAR ASSESSMENT, PLANNING AND PROGRAM IMPLEMENTATION PROCESSES;- ASSESSING UNMET COMMUNITY NEED BY COLLECTING PRIMARY AND SECONDARY DATA (BOTH QUANTITATIVE AND QUALITATIVE) TO UNDERSTAND UNMET HEALTH-RELATED AND IDENTIFY COMMUNITIES AND POPULATIONS SEGMENTS IMPACTED BY HEALTH ISSUES AND OTHER SOCIAL AND ECONOMIC FACTORS;- IMPLEMENTING COMMUNITY HEALTH PROGRAMS AND SERVICES IN EXETER HOSPITAL'S CBSA THAT ADDRESS THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH, BARRIERS TO ACCESSING CARE, AND PROMOTE HEALTH EQUITY;- PROMOTING HEALTH EQUITY BY ADDRESSING SOCIAL AND INSTITUTIONAL INEQUITIES AND ENSURING THAT ALL PATIENTS ARE WELCOMED AND RECEIVE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE; AND- FACILITATING COLLABORATION AND PARTNERSHIP WITHIN AND ACROSS SECTORS (E.G., STATE/LOCAL PUBLIC HEALTH AGENCIES, HEALTHCARE PROVIDERS, SOCIAL SERVICE ORGANIZATIONS, BUSINESSES, ACADEMIC INSTITUTIONS, COMMUNITY HEALTH COLLABORATIVES, AND OTHER COMMUNITY HEALTH ORGANIZATIONS) TO ADVOCATE FOR, SUPPORT AND IMPLEMENT EFFECTIVE HEALTH POLICIES, COMMUNITY PROGRAMS AND SERVICES.COMMUNITY BENEFITS FINANCIAL SUMMARY DURING THE FISCAL YEAR COVERED BY THIS FILING, EXETER HOSPITAL PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFITS OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $1,885,906 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY BENEFITS LEADERSHIP/TEAM PRIOR TO JOINING BILH, AND CONTINUING FORWARD, EXETER'S BOARD OF TRUSTEES ALONG WITH ITS CLINICAL AND ADMINISTRATIVE STAFF HAVE BEEN AND REMAIN COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF RESIDENTS THROUGHOUT ITS CBSA AND BEYOND. AS A COMMUNITY CENTERED HEALTH CARE PROVIDER THE PROVISION OF THE HIGHEST POSSIBLE CLINICAL EXPERTISE AND QUALITY, CONTINUALLY IMPROVING PATIENT EXPERIENCES, EDUCATION, AND A COMMITMENT TO IMPROVING ACCESS AND HEALTH EQUITY FOR OUR POPULATION ARE THE PRIMARY TENETS OF OUR MISSION. HISTORICALLY, UNDER THE OVERSIGHT OF THE EXETER BOARD OF TRUSTEES, THE COMMUNITY BENEFITS AND ENGAGEMENT PROGRAMS HAVE BEEN LED BY A COMBINATION OF EXETER'S COMMUNITY RELATIONS TEAM, ITS FINANCE TEAM AND THE OPERATIONAL LEADERSHIP AS WELL AS LEADERSHIP AT ITS OPERATING AFFILIATES CORE PHYSICIANS AND ROCKINGHAM VISITING NURSE ASSOCIATION & HOSPICE, PARTICULARLY COORDINATING WITH CORE PHYSICIANS OFFICE OF POPULATION HEALTH. THE COMMUNITY RELATIONS TEAM ROUTINELY ENGAGED AND COLLABORATED WITH OUTSIDE COMMUNITY LEADERS AND ALIGNED ORGANIZATIONS, IN ORDER TO MEET ITS COMMUNITY BENEFITS OBLIGATIONS. HOSPITAL SENIOR LEADERSHIP IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF PROGRAMS AND SERVICES AIMED AT ADDRESSING OUR IDENTIFIED COMMUNITY NEEDS AND, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES. PRIOR TO THE AFFILIATION WITH BILH, THE EXETER COMMUNITY BENEFITS PROGRAM WAS SPEARHEADED BY A TEAM OF SENIOR LEADERS INCLUDING THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND ADVANCEMENT, THE DIRECTOR OF COMMUNITY RELATIONS AND THE COMMUNITY ENGAGEMENT OFFICER. THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND ADVANCEMENT, HAD DIRECT ACCESS TO AND WAS ACCOUNTABLE TO THE EXETER PRESIDENT. IT WAS THE RESPONSIBILITY OF THESE LEADERS TO ENSURE THAT COMMUNITY BENEFITS WERE ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF COHORTS WHO HAVE BEEN HISTORICALLY UNDERSERVED ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. SINCE JULY 1, 2023, WHEN EXETER HOSPITAL BECAME A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES, THAT WORK HAS ALSO INCLUDED THE BILH VICE PRESIDENT OF COMMUNITY BENEFITS. IN FY24, THE EXETER HOSPITAL COMMUNITY BENEFITS AND COMMUNITY RELATIONS TEAM BECAME FULLY INTEGRATED INTO THE BILH SYSTEM SERVICES DEPARTMENT, UNDER THE LEADERSHIP OF THE VICE PRESIDENT OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, WITH STRATEGIC SUPPORT FROM THE DIRECTOR OF COMMUNITY BENEFITS OF BILH'S COMMUNITY HOSPITAL, AND DAY-TO-DAY SUPPORT FROM A DIRECTOR OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS. IN JUNE 2024, EXETER HOSPITAL CONVENED ITS INAUGURAL COMMUNITY BENEFITS ADVISORY COMMITTEE (CBAC). THE EXETER HOSPITAL CBAC WORKS IN COLLABORATION WITH EXETER HOSPITAL LEADERSHIP, INCLUDING THE HOSPITAL'S GOVERNING BOARD AND SENIOR MANAGEMENT TO SUPPORT EXETER HOSPITAL'S COMMUNITY BENEFITS MISSION TO SERVE ITS PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM, THEIR FAMILIES, AND EXETER HOSPITAL'S COMMUNITY. THE CBAC PROVIDES INPUT INTO THE DEVELOPMENT AND IMPLEMENTATION OF EXETER HOSPITAL'S COMMUNITY BENEFITS PROGRAMS IN FURTHERANCE OF EXETER HOSPITAL'S COMMUNITY BENEFITS MISSION. THE MEMBERSHIP OF EXETER HOSPITAL'S CBAC ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND PRIORITY COHORTS SERVED BY EXETER HOSPITAL'S PROGRAMMATIC ENDEAVORS, AS WELL AS THOSE FROM CORPORATE AND NON-PROFIT COMMUNITY ORGANIZATIONS. EXETER HOSPITAL'S CBAC MEMBERS INCLUDE: - BORJA ALVARAZ DE TOLEDO, PRESIDENT/CEO, WAYPOINT- WILL ARVELO, EXECUTIVE DIRECTOR, CROSS ROADS HOUSE- MADISON BAILEY, HEALTH OFFICER, TOWN OF EXETER- DAVID BUONO. M.D., MEDICAL DIRECTOR, CORE PHYSICIANS, PRIMARY CARE- JAY COUTURE, PRESIDENT, SEACOAST MENTAL HEALTH CENTER- DEBRA CRESTA, PRESIDENT, EXETER HOSPITAL- DAVIS FARMER, BOARD OF TRUSTEES, EXETER HOSPITAL- CAROL GULLA, EXECUTIVE DIRECTOR, TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS- BOBBY KELLY, M.D, MEDICAL DIRECTOR OF ADDICTION TREATMENT SERVICES, BILH- NICHOLAS TOUMPAS, RETIRED, FORMER COMMISSION OF THE NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES- ROBERT TORRES, DIRECTOR OF COMMUNITY BENEFITS AND COMMUNITY RELATIONS, BILH- JENNIFER WHEELER, PRESIDENT, EXETER AREA CHAMBER OF COMMERCE- GREG WHITE, CO-EXECUTIVE DIRECTOR, LAMPREY HEALTH CENTERCOMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGYMOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTINTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY (IS OR CHIP) PURSUANT TO FEDERAL GUIDELINES, IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. EXETER HOSPITAL COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER OF 2022. THAT CHNA WAS APPROVED BY THE EXETER HOSPITAL'S BOARD OF TRUSTEES ON SEPTEMBER 30, 2022. THE ACCOMPANYING COMMUNITY BENEFITS ACTION PLAN (IMPLEMENTATION STRATEGY OR IS) FOR THE MOST RECENT CHNA WAS ALSO ADOPTED BY THE BOARD ON SEPTEMBER 30, 2022, WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER 501(R). THE CHNA AND THE ASSOCIATED IS REPRESENT THE CULMINATION OF A YEAR OF WORK AND WERE BORNE LARGELY OF EXETER HOSPITAL'S COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA (CBSA) WITH AN EMPHASIS ON THOSE WHO ARE MOST IN NEED. THE PROJECT WAS ALSO DESIGNED TO FULFILL THE NH ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS THAT REQUIRE THAT EXETER HOSPITAL ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW EXETER HOSPITAL, IN COLLABORATION WITH THE COMMUNITY, WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE CHNA. COMMUNITY HEALTH NEEDS ASSESSMENTPRIORITY GEOGRAPHY AND COHORTS AS NOTED ABOVE, EXETER HOSPITAL COMPLETED ITS LAST ASSESSMENT IN SEPTEMBER OF 2022. EXETER HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED USING THE FOCUS AREA CONSISTENT WITH ITS SYSTEM OF CARE PRACTICE LOCATIONS IN ROCKINGHAM COUNTY, AS COUNTY LEVEL DATA IS PRIMARILY USED AND MANY STATISTICS ARE ONLY AVAILABLE AT THAT LEVEL. AS SUCH, THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT ENCOMPASSES THE FOLLOWING CITIES AND TOWNS: - CENTRAL REGION BRENTWOOD, EXETER, NEWFIELDS, NEWMARKET- EAST SOUTH EAST HAMPTON, HAMPTON FALLS, NORTH HAMPTON, SEABROOK- NORTH EAST GREENLAND, NEW CASTLE, NEWINGTON, PORTSMOUTH, RYE, STRATHAM- SOUTH WEST ATKINSON, DANVILLE, EAST HAMPSTEAD, EAST KINGSTON, HAMPSTEAD, KENSINGTON, KINGSTON, NEWTON, NEWTON JUNCTION, PLAISTOW, SANDOWN- WEST DEERFIELD, EPPING, FREMONT, NOTTINGHAM, RAYMONDCOMMUNITY HEALTH ISSUES AND PRIORITY COHORTS FOR EXETER HOSPITAL'S COMMUNITY BENEFITS INITIATIVES ARE IDENTIFIED THROUGH A COLLABORATIVE COMMUNITY ENGAGEMENT AND PLANNING PROCESS FROM A CHNA THAT IS CONDUCTED EVERY THREE YEARS IN ACCORDANCE WITH THE REQUIREMENTS UNDER IRC SECTION 501(R).EXETER HOSPITAL'S COMMUNITY BENEFITS INVESTMENTS AND RESOURCES FOCUS ON IMPROVING THE HEALTH STATUS OF THOSE WHO ARE MEDICALLY-UNDERSERVED, EXPERIENCED POVERTY OR FACE THE GREATEST HEALTH DISPARITIES, AS FOLLOWS:- OLDER ADULTS- INDIVIDUALS EXPERIENCING SOCIAL AND ECONOMIC DISADVANTAGES- INDIVIDUALS FROM UNDERREPRESENTED COMMUNITIES, IN PARTICULAR MEMBERS OF THE LGBTQIA+ COMMUNITY- INDIVIDUALS LIVING WITH DISABILITIES- INDIVIDUALS WITH BEHAVIORAL AND MENTAL HEALTH ISSUES, INCLUDING SUBSTANCE USE DISORDERSCOMMUNITY HEALTH NEEDS ASSESSMENTSUMMARY OF APPROACH AND METHODSEXETER HOSPITAL'S CHNA APPROACH INVOLVED EXTENSIVE DATA COLLECTION ACTIVITIES, SUBSTANTIAL EFFORTS TO ENGAGE THE HOSPITAL'S PARTNERS AND COMMUNITY RESIDENTS, AND THOUGHTFUL PRIORITIZATION, PLANNING, AND REPORTING PROCESSES. THROUGHOUT THE CHNA PROCESS, EFFORTS WERE MADE TO UNDERSTAND THE NEEDS OF THE COMMUNITIES ENCOMPASSING EXETER HOSPITAL'S CBSA, ESPECIALLY THE POPULATION SEGMENTS THAT ARE OFTEN DISADVANTAGED, FACE DISPARITIES IN HEALTH-RELATED OUTCOMES, AND HAVE BEEN HISTORICALLY UNDERSERVED. EXETER HOSPITAL'S UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM COLLECTING A WIDE RANGE OF QUANTITATIVE DATA TO IDENTIFY DISPARITIES AND CLARIFY THE NEEDS OF SPECIFIC COMMUNITIES AND COMPARING IT AGAINST DATA COLLECTED AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVELS WHEREVER POSSIBLE TO SUPPORT ANALYSIS AND THE PRIORITIZATION PROCESS, AS WELL AS EMPLOYING A VARIETY OF STRATEGIES TO ENSURE COMMUNITY MEMBERS WERE INFORMED, CONSULTED, INVOLVED, AND EMPOWERED THROUGHOUT THE ASSESSMENT PROCESS. TO COMPLETE THE CHNA, EXETER CONVENED A COLLABORATIVE STEERING COMMITTEE IN JANUARY 2022 COMPOSED OF SEACOAST AREA LEADERS WITH DEEP WORKING KNOWLEDGE OF COMMUNITY HEALTH NEEDS. STEERING COMMITTEE MEMBERS- JO-ANN BAKER, ADVANCEMENT REPRESENTATIVE, EXETER HOSPITAL- SENECA BERNARD, ASSOCIATE EXECUTIVE DIRECTOR, GATHER- KATHY FLYGARE, EXETER ROTARY- PATI FREW-WATERS, EXECUTIVE DIRECTOR, SEACOAST FAMILY PROMISE- TRACY FULLER, REGIONAL EXECUTIVE DIRECTOR, PLAISTOW COMMUNITY YMCA- CAROL GULLA, EXECUTIVE DIRECTOR, TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS DARREN A. GUY, DO, CHIEF POPULATION HEALTH OFFICER, CORE PHYSICIANS, LLC; EXECUTIVE DIRECTOR, NH-CARES ACO, LLC- KELLY HARTNETT, VICE PRESIDENT, COMMUNITY RELATIONS, SEACOAST MENTAL HEALTH CENTER- KEN LAVALLEY, VICE PROVOST, OUTREACH & ENGAGEMENT, DIRECTOR UNH EXTENSION, UNH- MARK LEFEBVRE, DIRECTOR, COMMUNITY ENGAGEMENT, PINETREE INSTITUTE- CAIT MCALLISTER, ADMINISTRATIVE INTERN, EXETER HEALTH RESOURCES- JENNIFER MCGOWAN, COMMUNITY IMPACT OFFICER, EXETER HEALTH RESOURCES - KEN MENDIS, CHAIR, RACIAL UNITY TEAM- ELIZABETH MILLER, PROGRAM DIRECTOR, PINETREE INSTITUTE- KIMBERLY MEYER, CHIEF EXECUTIVE OFFICER, EXETER AREA YMCA- ANITA ROZEFF, GRANTS AND CONTRACTS MANAGER/COMPLIANCE OFFICER, LAMPREY HEALTH CARE- PEGGY SMALL-PORTER, DEVELOPMENT COORDINATOR, WAYPOINT AT THE RICHIE MCFARLAND CHILDREN'S CENTER- LORI WALTZ-GAGNON, EXECUTIVE DIRECTOR, LEADERSHIP SEACOAST- DEBRA VASAPOLLI, DIRECTOR, PUBLIC RELATIONS, EXETER HEALTH RESOURCES- MOLLY ZIRILLO, EXECUTIVE DIRECTOR, SOCIETY OF ST. VINCENT DE PAUL EXETER COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSKEY INFORMANT KEY INFORMANT INTERVIEWS WITH INTERNAL AND EXTERNAL STAKEHOLDERS (SCHEDULE H, PART V, SECTION B, LINE 5)BETWEEN APRIL 2022 AND AUGUST 2022, EXETER WORKED WITH COMMUNITY PARTNERS TO CONDUCT 27 KEY LEADER INTERVIEWS THAT ENGAGED COMMUNITY-BASED ORGANIZATIONS, CLINICAL AND SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH OFFICIALS, ELECTED/APPOINTED OFFICIALS AND OTHER KEY COLLABORATORS THROUGHOUT EXETER'S CBSA. DISCUSSIONS EXPLORED INTERVIEWEES' EXPERIENCES ADDRESSING COMMUNITY NEEDS AND OPPORTUNITIES FOR FUTURE ALIGNMENT, COORDINATION AND EXPANSION OF SERVICES, INITIATIVES AND POLICIES. A LIST OF KEY LEADER INTERVIEW PARTICIPANTS IS INCLUDED IN APPENDIX D OF THE CHNA REPORT THAT IS POSTED ON EXETER'S WEBSITE. THESE INDIVIDUALS WERE CHOSEN TO AMASS A REPRESENTATIVE GROUP OF PEOPLE WHO HAD THE EXPERIENCE NECESSARY TO PROVIDE INSIGHT ON THE HEALTH OF COMMUNITIES IN EXETER'S CBSA. INTERVIEWS WERE CONDUCTED BOTH IN PERSON AND VIRTUALLY USING A STANDARD INTERVIEW GUIDE INCLUDED IN APPENDIX E OF THE CHNA POSTED ON EXETER'S WEBSITE. INTERVIEWS FOCUSED ON IDENTIFYING THE MOST SIGNIFICANT HEALTH-RELATED CONCERNS/ISSUES, AS WELL AS THE BARRIERS AND/OR CHALLENGES TO ACCESSING RESOURCES AND SERVICES AMONG THOSE THEY SERVE AND/OR THOSE LIVING IN THE COMMUNITY, INCLUDING POSSIBLE STRATEGIES TO ADDRESS THOSE CONCERNS.COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSFOCUS GROUPS AND COMMUNITY FORUMS (SCHEDULE H, PART V, SECTION B, LINE 5)COMMUNITY HEALTH FORUMS FOUR COMMUNITY FORUMS WERE PLANNED AND PROMOTED TO THE PUBLIC VIA EMAIL, SOCIAL MEDIA AND PAID ADVERTISEMENT. IN TOTAL 38 PARTICIPANTS ATTENDED THE FOUR FORUMS, WITH THE HIGHEST PARTICIPATION RECORDED AT EXETER HOUSING AUTHORITY'S 277 WATER STREET LOCATION. 2022 FORUMS:- TUESDAY, JUNE 14, 2022, 12:00 PM 1:00 PM, VIRTUAL- WEDNESDAY, JUNE 15, 2022, 5:30 PM 6:30 PM, EXETER AREA YMCA - WEDNESDAY, JUNE 22, 2022, 5:30 PM 6:30 PM, PLAISTOW YMCA- THURSDAY, MAY 19, 2022, 12:00 PM 1:30 PM, 277 WATER STREET, EXETER HOUSING AUTHORITY DURING EACH COMMUNITY FORUM, AN OVERVIEW OF THE CHNA REQUIREMENTS AND THE PROCESS FOR GATHERING INFORMATION WAS REVIEWED. THE OVERVIEW INCLUDED THE TIMELINE, THEMES FROM 2019, AND NOTIFICATION ABOUT HOW TO REVIEW THE DRAFT ON EXETER HOSPITAL'S WEBSITE FOR FEEDBACK. FOLLOWING THE OVERVIEW, COMMUNITY MEMBERS ENGAGED IN AN OPEN DISCUSSION AND PROVIDED INSIGHT INTO THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. THEMES FROM THE FORUMS ARE LISTED BELOW.FORUM DISCUSSION THEMES:- MENTAL AND BEHAVIORAL HEALTH- AVAILABILITY AND COST OF TRANSPORTATION- NEED FOR MORE SPECIALIZED GERIATRIC CARE IN SERVICE AREA- LACK OF AFFORDABLE HOUSING- BEHAVIORAL HEALTH- TIMELY ACCESS TO CARE FROM PRIMARY AND SPECIALTY CARE PHYSICIANS- COST OF DENTAL SERVICES GERIATRIC MENTAL HEALTH AND SPECIALISTS IN DEMENTIA- COST OF INSURANCE PREMIUMS AND DEDUCTIBLES- AFFORDABILITY OF PRESCRIPTION AND OVER THE COUNTER MEDICATIONSDATA SOURCES -- EXETER HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY HEALTH SURVEYEXETER HOSPITAL RELEASED AN ONLINE COMMUNITY HEALTH SURVEY TO THE PUBLIC THAT WAS OPEN FROM MAY 10, 2022 TO AUGUST 17, 2022. THE SURVEY CONSISTED OF 12 QUESTIONS AND ALLOWED FOR ADDITIONAL COMMENTS. THE SURVEY TOOK UNDER FIVE MINUTES TO COMPLETE AND WAS INTENTIONALLY BRIEF TO MAXIMIZE PARTICIPATION. IN TOTAL, 1,255 PEOPLE COMPLETED THE SURVEY. RESPONDENTS REPORTED RECEIVING THE SURVEY FROM 23 ORGANIZATIONS, MOST NOTABLY EXETER HOSPITAL, EXETER SCHOOL DISTRICT/SAU-16, AND LAMPREY HEALTH CARE. ADDITIONAL DATA SOURCES:EXETER HOSPITAL RELIED ON NUMEROUS PRIMARY AND SECONDARY DATA SOURCES TO ANALYZE THE HEALTH STATUS AND NEED LEVEL THROUGHOUT THEIR CBSA. EXETER HOSPITAL COLLECTED DATA FROM A NUMBER OF SOURCES INCLUDING PRIMARY QUANTITATIVE AND QUALITATIVE DATA, AS WELL AS SECONDARY DATA. EXAMPLES OF SECONDARY DATA SOURCES THAT EXETER HOSPITAL LEVERAGED INCLUDED: - COUNTY HEALTH RANKINGS (2022)- HEALTHY AGING DATA REPORT HIGHLIGHTS FROM NEW HAMPSHIRE (2019)- NEW HAMPSHIRE 10 YEAR MENTAL HEALTH PLAN (2019)- THE COMMONWEALTH FUND (2018)- ROBERT WOOD JOHNSON COUNTRY HEALTH RANKINGS (2021)- THE STATE OF MENTAL HEALTH IN AMERICA (2022)- NEW HAMPSHIRE HEALTH AND HUMAN SERVICES DATA PORTAL- ECONOMIC IMPACT OF COVID-19 ON NEW HAMPSHIRE (2022)- EXETER POLICE DEPARTMENT'S BEHAVIORAL HEALTH DATA (2022)COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSREVIEWING RESULTS AND COMPILING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY DOCUMENTS.EXETER TOOK THE FOLLOWING STEPS TO COLLECT INFORMATION RELATED TO COMMUNITY NEEDS, COLLABORATIVELY ASSESS THEIR IMPACT, GET INPUT FROM THE BROADER COMMUNITY AND DEVELOP AN IMPLEMENTATION PLAN.- FORMED AN INTERNAL WORK TEAM- ESTABLISHED A COLLABORATIVE STEERING COMMITTEE WITH MULTIPLE MEMBERS OF THE COMMUNITY- COLLECTED SECONDARY RESEARCH- CONDUCTED PRIMARY RESEARCH ON COMMUNITY NEEDS WITH OVER 1200 PARTICIPANTS- HOSTED MULTIPLE COMMUNITY FORUMS- CONDUCTED GUIDED COMMUNITY LEADER INTERVIEWS- DRAFTED THE CHNA- IDENTIFIED KEY FINDINGS- SOLICITED INPUT FROM BOTH PARTICIPANTS AND THE GENERAL PUBLIC - REVIEWED FINDINGS WITH THE BOARD OF TRUSTEES' COMMUNITY BENEFITS COMMITTEE- RECEIVED APPROVAL OF CHNA AND ADOPTION OF THE IS BY THE FULL BOARD OF TRUSTEES- POSTED THE CHNA REPORT FOR THE PUBLIC AND ON-GOING SOLICITATION OF INPUT- PRESENTED THE FINDINGS AND RESULTS ON THE EXETER COMMUNITY CALL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS - KEY FINDINGS THE FY22 EXETER HOSPITAL CHNA RESULTED IN THE FOLLOWING TOP FIVE HEALTH ISSUES. MENTAL & BEHAVIORAL HEALTH SUBSTANCE USE DISORDER AND MENTAL HEALTH SERVICES REMAIN SIGNIFICANT CONCERNS FOR SEACOAST RESIDENTS. ACCORDING TO THE 2022 STATE OF MENTAL HEALTH IN AMERICA, NEW HAMPSHIRE IS RANKED 6TH IN THE COUNTRY FOR YOUTH MENTAL ILLNESS AND ACCESS TO CARE, INDICATING A HIGHER PREVALENCE OF MENTAL ILLNESS AND LOWER AVAILABILITY OF SERVICES.ACCESS TO CARETHE COMMUNITY HEALTH SURVEY CLEARLY SHOWED PEOPLE CANNOT AFFORD PREVENTATIVE CARE AND DELAY APPOINTMENTS. OBESITY IN ROCKINGHAM COUNTY INCREASED 14% FROM 2019-2022 WHILE PREVENTATIVE WELLNESS VISITS WERE DOWN BY 20%.TRANSPORTATIONTRANSPORTATION REMAINS BOTH A HEALTH NEED PRIORITY AND A BARRIER TO CARE, MOST PROMINENTLY FOR OLDER ADULTS AND DISABLED COMMUNITY MEMBERS. WHEN ASKED ABOUT THE PRIMARY REASON SEACOAST RESIDENTS ARE NOT ABLE TO ACCESS HEALTHCARE, THE SECOND LEADING ANSWER IN 2022 (20%) WAS TRANSPORTATION. THIS IS MORE THAN DOUBLE FROM 2016, WHEN 9% OF RESPONDENTS CHOSE THAT CATEGORY. LACK OF TRANSPORTATION LEADS TO SOCIAL ISOLATION AND DECLINING HEALTH OUTCOMES.SOCIAL DETERMINANTS OF HEALTHGOOD HEALTH CANNOT BE ATTRIBUTED SOLELY TO HIGH QUALITY MEDICAL CARE. WE NOW KNOW THAT SOCIAL AND ECONOMIC FACTORS CONTRIBUTE UP TO 80% OF AN INDIVIDUAL'S HEALTH STATUS. FOR EXAMPLE, INDIVIDUALS UNDER FINANCIAL STRAIN ARE MORE LIKELY TO BE DEPRESSED AND MAY FORGO MEDICAL CARE OR PRESCRIPTIONS. NEEDS OF OLDER ADULTS & OTHER UNDERSERVED POPULATIONSNEW HAMPSHIRE HAS THE SECOND-OLDEST POPULATION IN THE NATION, WITH ONE OUT OF EVERY FIVE RESIDENTS CURRENTLY OVER THE AGE OF 60. THIS TREND IS SET TO CONTINUE. MEMBERS OF THE LGBTQIA+ COMMUNITY HAVE SPECIFIC HEALTH CARE CONCERNS AND OFTEN FIND IT DIFFICULT TO FIND A PROVIDER TO MEET THEIR NEEDS. THE CHNA THAT WAS COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AND THE ASSOCIATED IMPLEMENTATION STRATEGY ADOPTED FROM THAT PROCESS, WERE DESIGNED TO INFORM EXETER HOSPITAL'S COMMUNITY BENEFITS INITIATIVES DURING THE FISCAL YEARS ENDED SEPTEMBER 30, 2023, SEPTEMBER 30, 2024, AND SEPTEMBER 30, 2025. THE IMPLEMENTATION STRATEGY WAS UPDATED IN SEPTEMBER 2024 TO ALIGN WITH OTHER BILH HOSPITALS. THE IMPLEMENTATION STRATEGY PRIORITIES REMAINED THE SAME AND CONTINUE TO SUPPORT THE NEEDS IDENTIFIED IN THE FY22 CHNA. THE IMPLEMENTATION STRATEGY WAS UPDATED AND ADOPTED BY THE EXETER HOSPITAL BOARD OF TRUSTEES ON SEPTEMBER 13, 2024COMMUNITY HEALTH NEEDS ASSESSMENTMAKING THE CHNA AND IMPLEMENTATION STRATEGY WIDELY AVAILABLEEXETER HOSPITAL STRIVES TO ADDRESS THE PRIORITY AREAS IN ITS CHNA AND IMPLEMENTATION STRATEGY.AS NOTED ABOVE, EXETER HOSPITAL COMPLETED ITS MOST RECENT CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THAT CHNA AND APPENDIX WITH DETAILED INFORMATION IS AVAILABLE ON THE EXETER HOSPITAL WEBSITE AT:HTTPS://WWW.EXETERHOSPITAL.COM/ABOUT-US/COMMUNITY-BENEFITS IN ADDITION TO THE CHNA, EXETER HOSPITAL COMPLETED ITS MOST RECENT IMPLEMENTATION STRATEGY DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2022 (TAX YEAR 2021). THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE EXETER HOSPITAL'S WEBSITE AT:HTTPS://WWW.EXETERHOSPITAL.COM/ABOUT-US/COMMUNITY-BENEFITS .EXETER HOSPITAL COMPLETED ITS PREVIOUS CHNA DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2019 (TAX YEAR 2018). THAT CHNA IS AVAILABLE ON THE EXETER HOSPITAL WEBSITE AT HTTPS://WWW.EXETERHOSPITAL.COM/ABOUT-US/COMMUNITY-BENEFITS CONSISTENT WITH EXETER HOSPITAL'S STANDARD PRACTICE, A DRAFT OF THE 2022 CHNA WAS POSTED ON ITS WEBSITE FOR PUBLIC REVIEW AND COMMENT IN ADVANCE OF THE BOARD'S APPROVAL. THE DRAFT WAS ALSO CIRCULATED TO EACH PARTICIPATING COLLABORATOR. A FINAL CHNA REPORT AND IMPLEMENTATION STRATEGY WERE POSTED ON THE WEBSITE AFTER THE BOARD VOTED TO APPROVE THE CHNA AND ADOPT THE IMPLEMENTATION STRATEGY. EACH OF THESE DOCUMENTS IS ALSO AVAILABLE ON REQUEST (SCHEDULE H, PART V, SECTION B, LINE 7A).COMMUNITY HEALTH NEEDS ASSESSMENTADDRESSING COMMUNITY HEALTH NEEDS(SCHEDULE H, PART V, SECTION B, LINE 11)AS NOTED ABOVE, EXETER HOSPITAL'S MOST RECENT CHNA AND IMPLEMENTATION STRATEGY WERE CONDUCTED AND APPROVED BY THE BOARD DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022 AND A SUMMARY OF EXETER HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES THAT ADDRESS THE NEEDS IDENTIFIED IN THAT CHNA AND PRIORITIZED IN THE RELATED IMPLEMENTATION STRATEGY ARE PROVIDED HERE ALONG WITH THE ENTITIES THAT THE HOSPITAL PARTNERS WITH ON THESE EFFORTS. GIVEN THE COMPLEX HEALTH ISSUES IN THE COMMUNITY, EXETER HOSPITAL HAS BEEN STRATEGIC IN IDENTIFYING ITS RESPONSE TO THE KEY FINDINGS TO MAXIMIZE THE IMPACT OF ITS COMMUNITY BENEFITS PROGRAM AND WORK TO IMPROVE THE OVERALL HEALTH AND WELLNESS OF RESIDENTS IN ITS CBSA WITHOUT COMPROMISING THE PROVISION OF ITS CORE SERVICES.GOALS FOR EACH PRIORITY AREA ARE LISTED BELOW.PRIORITY 1: ACCESS TO CARE- GOAL: PROVIDE COMPREHENSIVE ACCESS TO HIGH-QUALITY HEALTH CARE SERVICES INCLUDING PRIMARY CARE AND SPECIALTY CARE PARTICULARLY FOR THOSE WHO FACE CULTURAL, LINGUISTIC, AND ECONOMIC BARRIERS.PRIORITY 2: TRANSPORTATION- GOAL: PROVIDE ACCESS TO CARE THROUGH TRANSPORTATION SERVICES.PRIORITY 3: SOCIAL DETERMINANTS OF HEALTH (PARTICULARLY FOOD SECURITY AND HOUSING)- GOAL: ENHANCE THE BUILT, SOCIAL, AND ECONOMIC ENVIRONMENTS WHERE PEOPLE LIVE, WORK, PLAY, AND LEARN IN ORDER TO IMPROVE HEALTH AND QUALITY-OF-LIFE OUTCOMES.PRIORITY 4: MENTAL HEALTH AND SUBSTANCE USE- GOAL: PROMOTE SOCIAL AND EMOTIONAL WELLNESS BY FOSTERING RESILIENT COMMUNITIES AND BUILDING EQUITABLE, ACCESSIBLE, AND SUPPORTIVE SYSTEMS OF CARE TO ADDRESS MENTAL HEALTH AND SUBSTANCE USE.PRIORITY 5: OLDER ADULTS AND OTHER UNDERSERVED POPULATIONS- GOAL: ENHANCE ACCESS TO SCREENING, REFERRAL SERVICES, COORDINATED HEALTH AND SUPPORT SERVICES FOR OLDER ADULTS AND OTHER UNDERSERVED POPULATIONS. COMMUNITY HEALTH NEEDS ASSESSMENT - APPROACH TO ADDRESSING HEALTH NEEDS EXETER HOSPITAL HAS TAKEN A HOLISTIC AND STRATEGIC APPROACH IN ADDRESSING THE HEALTH PRIORITIES IDENTIFIED IN THE CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY BY CREATING, SUPPORTING AND INVESTING IN HEALTH PROGRAMMING AND INITIATIVES THROUGHOUT THEIR CBSA. BELOW IS A SUMMARY OF SOME OF THE COMMUNITY BENEFITS PROGRAMS AND INITIATIVES EXETER HOSPITAL OPERATES AND SUPPORTS TO IMPROVE HEALTH OUTCOMES AMONG THEIR TARGET POPULATIONS THROUGHOUT THEIR PRIORITY NEIGHBORHOODS.1. MENTAL HEALTH AND SUBSTANCE USE: CONSISTENT WITH PUBLISHED SECONDARY DATA AT THE STATE AND NATIONAL LEVEL, SUBSTANCE USE DISORDER AND MENTAL HEALTH SERVICES REMAIN SIGNIFICANT CONCERNS FOR THOSE COMMUNITIES SERVED BY EXETER HOSPITAL. MENTAL HEALTH CARE (INCLUSIVE OF SUBSTANCE USE) ACCESS WAS SUPPORTED BY EXETER HOSPITAL PARTNERING WITH SEACOAST MENTAL HEALTH TO OFFER SERVICES TO PATIENTS AND THEIR CAREGIVERS IN THE EMERGENCY DEPARTMENT AND THE CENTER FOR CANCER CARE. SUBSTANCE USE DISORDERS (SUD) WERE FOUND TO HAVE A PROFOUND IMPACT ON RESIDENTS IN ROCKINGHAM COUNTY, AND EXETER HOSPITAL EXPANDED ITS SERVICES IN ITS EMERGENCY DEPARTMENT AND INPATIENT UNITS, OFFERING THERAPEUTIC INTERVENTIONS AND PEER SUPPORT THROUGH A NEW RELATIONSHIP WITH SOS PEER SUPPORT. THE HOSPITAL ALSO IMPLEMENTED A PET THERAPY PROGRAM FOCUSED ON SUPPORTING PATIENTS TO REDUCE ANXIETY IN THE EMERGENCY DEPARTMENT, AMONG BEHAVIORAL HEALTH PATIENTS, AS WELL AS PATIENTS OBTAINING CARE ON NURSING FLOORS AND IN THE CANCER CENTER. IN FY24, EXETER HOSPITAL PROVIDED GRANT FUNDING TO LOCAL COMMUNITY-BASED ORGANIZATIONS TO EXPAND AND ENHANCE MENTAL HEALTH AND SUBSTANCE USE SERVICES. ORGANIZATIONS THAT RECEIVED FUNDING INCLUDE SOS RECOVERY COMMUNITY ORGANIZATIONS, AUSTIN17 HOUSE, NAMI NEW HAMPSHIRE, ARTS IN REACH, CHASE HOUSE, HAVEN, BIG BROTHERS BIG SISTERS NEW HAMPSHIRE, GIRLS ON THE RUN, KEY COLLECTIVE, CONNORS CLIMB, WAYPOINT, AND SEACOAST MENTAL HEALTH.2. ACCESS TO CARE: ACCESS TO CARE CONTINUES TO BE A NOTABLE CONCERN. THE 2022 COMMUNITY HEALTH SURVEY SHOWED A DECLINE IN HOW PEOPLE PRIORITIZED THEIR HEALTH DUE TO ISSUES RELATED TO COSTS, LIMITATIONS IMPOSED BY INSURANCE, TRANSPORTATION BARRIERS, WAIT TIMES, AND LACK OF PHYSICAL MOBILITY. PARTNERING WITH CORE PHYSICIANS LLC, EXETER HOSPITAL'S DEDICATED NOT-FOR-PROFIT MULTISPECIALTY GROUP PRACTICE, AND LAMPREY HEALTH CARE (LOCALLY FEDERALLY QUALIFIED HEALTH CENTER), EXETER HOSPITAL ADDRESSES ACCESS TO CARE BY ENHANCING PROVIDER CAPACITY, AND ASSISTING WITH THE COST OF ACCESS THROUGH OUR VARIOUS FINANCIAL ASSISTANCE, DISCOUNTED AND FREE CARE PROGRAMS.3. TRANSPORTATION: TRANSPORTATION REMAINS BOTH A HEALTH NEED PRIORITY AND A BARRIER TO CARE, MOST PROMINENTLY IN THE EXETER HOSPITAL SERVICE AREA FOR OLDER ADULTS AND PEOPLE LIVING WITH DISABILITIES. TRANSPORTATION WAS LISTED AS A TOP BARRIER WHEN ASKED WHY RESIDENTS CANNOT ACCESS HEALTHCARE. 20% OF RESPONDENTS LISTED TRANSPORTATION, WHICH IS MORE THAN DOUBLE FROM 2016, WHEN 9% OF RESPONDENTS CHOSE THAT CATEGORY. LACK OF TRANSPORTATION LEADS TO SOCIAL ISOLATION AND DECLINING HEALTH OUTCOMES. EXETER HOSPITAL PROVIDES ACCESS TO TAXI VOUCHERS AND RIDE PROGRAMS FOR THOSE PATIENTS THAT REQUIRE ASSISTANCE AND PARTNERS WITH A NUMBER OF COMMUNITY-BASED ORGANIZATIONS PROVIDING SERVICES TO UNDER-SERVED AND AT RISK POPULATIONS. EXETER HOSPITAL PROVIDED GRANT FUNDING TO TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS (TASC), AND THE COOPERATIVE ALLIANCE FOR SEACOAST TRANSPORTATION (COAST). EXETER HOSPITAL ALSO PARTICIPATES IN COMMUNITY EFFORTS TO SUPPORT ORGANIZATIONS INVOLVED WITH ADDRESSING GAPS IN TRANSPORTATION.4. SOCIAL DETERMINANTS OF HEALTH (SDOH): SDOHS WERE IDENTIFIED IN AGGREGATE AS HAVING A MAJOR IMPACT ON HEALTH IN THE EXETER HOSPITAL COMMUNITY INCLUDING:- ECONOMIC STABILITY -EMPLOYMENT - FOOD INSECURITY - HOUSING INSTABILITY - POVERTY - EDUCATION - EARLY CHILDHOOD EDUCATION AND DEVELOPMENT - ENROLLMENT IN HIGHER EDUCATION - HIGH SCHOOL GRADUATION - LANGUAGE AND LITERACY - SOCIAL AND COMMUNITY CONTEXT - COMMUNITY PARTICIPATION - SOCIAL CONNECTION - HEALTH AND HEALTH CARE - ACCESS TO HEALTH CARE - ACCESS TO PRIMARY CARE - HEALTH LITERACY - NEIGHBORHOOD AND BUILT ENVIRONMENT - ACCESS TO HEALTHY FOODS - VIOLENCE & TRAUMA - ENVIRONMENTAL CONDITIONS - QUALITY OF HOUSINGEXETER HOSPITAL WORKS TO ADDRESS MANY OF THESE COMPLEX AND LONG-STANDING DETERMINANTS OF HEALTH THROUGH PARTNERSHIPS WITH COMMUNITY-BASED ORGANIZATIONS. EXETER HOSPITAL FINANCIALLY SUPPORTS ORGANIZATIONS THROUGH A FOCUSED COMMUNITY GRANT PROGRAM AND DIRECT DONATIONS. IN FY24, EXETER HOSPITAL GAVE GRANT FUNDS TO ST. VINCENT DE PAUL TO ADDRESS FOOD INSECURITY, AND GRANITE UNITED WAY TO SUPPORT AFFORDABLE HOUSING. NEEDS OF OLDER ADULTS AND OTHER UNDERSERVED POPULATIONS: NEW HAMPSHIRE HAS THE SECOND-OLDEST POPULATION IN THE NATION, WITH ONE OUT OF EVERY FIVE RESIDENTS CURRENTLY OVER THE AGE OF 60. ACCORDING TO AARP, 1 IN 5 AMERICANS OVER THE AGE OF 65 DOES NOT DRIVE. THAT EQUATES TO 75,000 NON-DRIVING OLDER ADULTS IN NEW HAMPSHIRE BY 2030, BASED ON POPULATION PROJECTIONS.IN ADDITION, THE 2022 CHNA IDENTIFIED INDIVIDUALS LIVING WITH DISABILITIES, MEMBERS OF THE LGBTQIA+ COMMUNITY, AND MINORITY GROUPS AS PRIORITY POPULATIONS, DUE TO THEIR RISK FOR ADVERSE HEALTH OUTCOMES AND HISTORICAL UNDERINVESTMENT. A FULL UPDATE ON EXETER HOSPITAL'S HEALTH PRIORITIES AND ASSOCIATED GOALS IS INCLUDED BELOW FY24 SCHEDULE H - IMPLEMENTATION STRATEGY UPDATE THE HOSPITAL'S FY23-25 IMPLEMENTATION STRATEGY ("COMMUNITY NEEDS ACTION PLAN") WHICH WAS ADOPTED BY THE EXETER BOARD OF TRUSTEES ON 9/30/22 AT THE SAME TIME AS THE CHNA WAS APPROVED, AND CAN BE FOUND HERE: HTTPS://WWW.EXETERHOSPITAL.COM/ABOUT-US/COMMUNITY-BENEFITSPRIORITY 1: ACCESS TO CAREGOAL: PROVIDE COMPREHENSIVE ACCESS TO HIGH-QUALITY HEALTH CARE SERVICES INCLUDING PRIMARY CARE AND SPECIALTY CARE PARTICULARLY FOR THOSE WHO FACE CULTURAL, LINGUISTIC, AND ECONOMIC BARRIERS. STRATEGIES:1.1 PROMOTE ACCESS TO HEALTH CARE, HEALTH INSURANCE, PATIENT FINANCIAL COUNSELORS, AND NEEDED MEDICAL SERVICES FOR PATIENTS WHO ARE UNINSURED AND OR UNDERINSURED. 1.2 PROMOTE EQUITABLE CARE, HEALTH EQUITY, AND HEALTH LITERACY . COHORTS:- LOW-RESOURCED POPULATIONS- LGBTQIA+- RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONSINITIATIVES:- PATIENT FINANCIAL COUNSELORS- PRIMARY CARE SUPPORT- SUPPORTING ACCESS TO PRIMARY MEDICAL AND BEHAVIORAL HEALTH CARE FOR UNDERSERVED POPULATIONSMETRICS AND STATUS UPDATE:- # OF PARAMEDICS/EMTS ATTENDING TRAINING (BASELINE: 5 INDIVIDUALS TRAINED; YEAR 1: 10 INDIVIDUALS TRAINED). - IN FY24, EXETER HOSPITAL PROVIDED ENHANCED ACCESS THROUGH ITS THE UNINSURED CARE DISCOUNT/HOSPITAL ACCESS PLUS PROGRAM PATIENTS WHO ARE UNINSURED WILL NOT BE CHARGED MORE THAN AMOUNTS GENERALLY BILLED TO PATIENTS WHO HAVE INSURANCE COVERING THE SAME CARE. EXETER HOSPITAL, PRIOR TO BILLING THE PATIENTS, APPLIES A DISCOUNT TOWARDS GROSS CHARGES FOR PATIENTS WHO ARE UNINSURED. THIS DISCOUNT IS NOT VALID FOR PATIENTS WHO HAVE HEALTH INSURANCE COVERAGE, INCLUDING BUT NOT LIMITED TO MEDICARE, MEDICAID, MEDPAY, THIRD-PARTY LIABILITY, OR ANY OTHER STATE OR FEDERAL PROGRAMS (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE). - FINANCIAL ASSISTANCE PROVIDED TO UNINSURED AND UNDER-INSURED PATIENTS WHO MEET INCOME AND ASSET GUIDELINES, AND WHO LIVE IN THEIR SERVICE AREA (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE). - IN FY24, EXETER HOSPITAL OFFERED A CATASTROPHIC CARE PROGRAM THAT PROVIDES FINANCIAL RELIEF FOR PATIENTS WHO DO NOT QUALIFY FOR THE FINANCIAL ASSISTANCE PROGRAM, BUT ARE FACED WITH SUBSTANTIAL DEBT DUE TO A SERIOUS ILLNESS OR INJURY (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE).- OF INDIVIDUALS PARTICIPATING IN DIABETES EDUCATION AND TRAINING THROUGH INDIVIDUAL CONSULTATIONS, GROUP EDUCATION CLASSES, INSULIN PUMP AND CONTINUOUS GLUCOSE MONITORING PROGRAMS, FITNESS CLASSES, AND COMMUNITY EDUCATION (BASELINE: 762 PEOPLE PARTICIPATED; YEAR 1: 710 PEOPLE PARTICIPATED). - IN FY24, EXETER HOSPITAL CONTINUED TO UNDERWRITE GOVERNMENT SPONSORED HEALTH COSTS EXCEEDING REIMBURSEMENT (MEDICARE AND MEDICAID), INCLUDING: $19,202,042 IN SUBSIDIZED SERVICES TO MEDICAID PATIENTS AND $43,776,182 IN SUBSIDIZED SERVICES TO MEDICARE PATIENTS.- # OF INDIVIDUALS SERVED THROUGH COMMUNITY-BASED PARAMEDIC INTERCEPT PROGRAM (BASELINE: 425 INDIVIDUALS SERVICED; YEAR 1: 437 INDIVIDUALS SERVED).- # OF INDIVIDUALS PARTICIPATING IN FAMILY CENTER CLASSES AND SUPPORT GROUPS (BASELINE: 1,814 INDIVIDUALS PARTICIPATED; YEAR 1: 707 PEOPLE PARTICIPATED).- #OF INDIVIDUALS PARTICIPATING IN SCHOOL-BASED PROGRAMMING RELATED TO AVOIDING AND TREATING SPORTS-RELATED INJURIES AND OF INDIVIDUALS PARTICIPATING IN CANCER WELL FIT PROGRAM. (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE)PRIORITY 2: TRANSPORTATIONGOAL: PROVIDE ACCESS TO CARE THROUGH TRANSPORTATION SERVICESSTRATEGY: REDUCE BARRIERS TO CARE BY PROVIDING/SUPPORTING FREE OR REDUCED COST TRANSPORTATION FOR HOMEBOUND RESIDENTS NEEDING CARE. COHORTS:- LOW-RESOURCED POPULATIONS- RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS- LGBTQIA+INITIATIVES:- SUBSIDIZATION OF THE PARAMEDICINE PROGRAM INTERCEPT VEHICLE- TAXI VOUCHER PROGRAM- COMMUNITY GRANTS TO SUPPORT TRANSPORTATION ACCESS AND INFRASTRUCTUREMETRICS AND STATUS UPDATE:- # OF INDIVIDUALS SERVED IN RIDE SERVICES AND TAXI VOUCHER PROGRAM (BASELINE: 390 INDIVIDUALS SERVED; YEAR 1: 305 INDIVIDUALS SERVED). - IN FY24, EXETER HOSPITAL PROVIDED GRANT FUNDING TO TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS AND COOPERATIVE ALLIANCE FOR SEACOAST TRANSPORTATION TO ENHANCE AND EXPAND TRANSPORTATION OPTIONS FOR SEACOAST RESIDENTS (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE). PRIORITY 3: SOCIAL DETERMINANTS OF HEALTH (PARTICULARLY FOOD SECURITY AND HOUSING)GOAL: ENHANCE THE BUILT, SOCIAL, AND ECONOMIC ENVIRONMENTS WHERE PEOPLESTRATEGY: SUPPORT IMPACTFUL PROGRAMS THAT ADDRESS ISSUES ASSOCIATED WITH THE SOCIAL DETERMINANTS OF HEALTH. COHORTS:- YOUTH- LOW-RESOURCED POPULATIONS- RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS- LGBTQIA+INITIATIVES:- SUBSIDIZATION OF THE PARAMEDICINE PROGRAM INTERCEPT VEHICLE- TAXI VOUCHER PROGRAM- COMMUNITY GRANTS TO SUPPORT EMERGENCY FOOD TO LOW-INCOME INDIVIDUALS AND FAMILIES, SENIORS ONLY FOOD PANTRY, SENIOR FOOD DELIVERY AND EMERGENCY FINANCIAL ASSISTANCEMETRICS AND STATUS UPDATE- IN FY24, EXETER HOSPITAL CONTINUED TO PARTNER WITH THE NEW HAMPSHIRE HOSPITAL ASSOCIATION ON ADVOCACY RELATED TO INCREASING BEHAVIORAL HEALTH CAPACITY, ACCESS TO PRIMARY CARE, AND EXPANDING INTERVENTIONS THAT ADDRESS THE SOCIAL DETERMINANTS OF HEALTH (BASELINE: CONTRIBUTION MADE; YEAR 1: CONTRIBUTION MADE).- IN FY24, EXETER HOSPITAL PROVIDED GRANT FUNDING TO THE SOCIETY OF ST. VINCENT DE PAUL TO EXPAND FOOD ACCESS OPPORTUNITIES, CROSS ROADS HOUSE, AND GRANITE UNITED WAY TO ADDRESS HOUSING INSTABILITY (BASELINE: DATA NOT AVAILABLE; YEAR 1: GRANTS DISTRIBUTED). FY24 SCHEDULE H - IMPLEMENTATION STRATEGY UPDATE (CONTINUED) PRIORITY 4: MENTAL HEALTH SUBSTANCE USEGOAL: PROMOTE SOCIAL AND EMOTIONAL WELLNESS BY FOSTERING RESILIENT COMMUNITIES AND BUILDING EQUITABLE, ACCESSIBLE, AND SUPPORTIVE SYSTEMS OF CARE TO ADDRESS MENTAL HEALTH AND SUBSTANCE USE.STRATEGY: SUPPORT IMPACTFUL PROGRAMS THAT PROMOTE HEALTHY DEVELOPMENT AND INCREASE MENTAL HEALTH TO CHILDREN, YOUTH, FAMILIES, AND COMMUNITY RESIDENTS.COHORTS:- YOUTH- LOW-RESOURCED POPULATIONS- RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS- LGBTQIA+INITIATIVES:- SUPPORT FOR MENTAL HEALTH SERVICES PROVIDED BY SEACOAST MENTAL HEALTH IN EXETER'S EMERGENCY DEPARTMENT- MENTAL HEALTH FIRST AID TRAININGS- COMMUNITY GRANTS TO SUPPORT BEHAVIORAL HEALTH ACCESS AND SUICIDE PREVENTIONMETRICS AND STATUS UPDATES:- IN FY24, EXETER HOSPITAL MAINTAINED ITS CONTRACT WITH SEACOAST MENTAL HEALTH TO PROVIDE SUBSIDIZED SERVICES TO PATIENTS IN THEIR EMERGENCY ROOM AND INPATIENT UNITS (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE).- IN FY24, EXETER HOSPITAL MADE A $258,007 CONTRIBUTION TO THE NH DRUG AND ALCOHOL FUND, JOINING OTHER HOSPITALS ACROSS THE STATE IN HELPING TO FUND STATE SPONSORED SUBSTANCE USE INITIATIVES (BASELINE: DATA NOT AVAILABLE; YEAR 1: DATA NOT AVAILABLE).- IN FY24, EXETER HOSPITAL PROVIDED GRANT FUNDING TO LOCAL COMMUNITY-BASED ORGANIZATIONS TO EXPAND AND ENHANCE MENTAL HEALTH AND SUBSTANCE USE SERVICES. ORGANIZATIONS THAT RECEIVED FUNDING INCLUDE SOS RECOVERY COMMUNITY ORGANIZATIONS, AUSTIN17 HOUSE, NAMI NEW HAMPSHIRE, ARTS IN REACH, CHASE HOUSE, HAVEN, BIG BROTHERS BIG SISTERS NEW HAMPSHIRE, GIRLS ON THE RUN, KEY COLLECTIVE, CONNORS CLIMB, WAYPOINT, AND SEACOAST MENTAL HEALTH (BASELINE YEAR: DATA NOT AVAILABLE; YEAR 1: GRANTS DISTRIBUTED).PRIORITY 5: OLDER ADULTS AND OTHER UNDERSERVED POPULATIONSGOAL: ENHANCE ACCESS TO SCREENING, REFERRAL SERVICES, COORDINATED HEALTH AND SUPPORT SERVICES FOR OLDER ADULTS AND OTHER UNDERSERVED POPULATIONS. STRATEGY: PROVIDE PREVENTATIVE HEALTH INFORMATION, SERVICES, AND SUPPORT FOR OLDER ADULTS AND OTHER UNDERSERVED POPULATIONS. COHORTS:- YOUTH- LOW-RESOURCED POPULATIONS- RACIALLY, ETHNICALLY, AND LINGUISTICALLY DIVERSE POPULATIONS- LGBTQIA+INITIATIVES:- COMMUNITY GRANTS SUPPORT FOR BEHAVIORAL SENIOR LUNCHEONS, HEALTH, WELLNESS AND FITNESS CLASSES, SENIOR TRIPS AND STAFF SUPPORTMETRICS AND STATUS UPDATES: - OF PEOPLE ATTENDING CLASSES (BASELINE: 755 PEOPLE ATTENDED CLASSES; YEAR 1: 710 PEOPLE ATTENDED CLASSES).- OF UNDERGRADUATE STUDENTS PURSUING CAREERS IN HEALTHCARE (BASELINE: 149 STUDENTS PARTICIPATED; YEAR 1: 150 STUDENTS PARTICIPATED). - GRANT FUNDING PROVIDED TO THE EXETER SENIOR CENTER TO ADDRESS SOCIAL ISOLATION, ACCESS TO HEALTHY FOOD, AND SUPPORT HOLISTIC PROGRAMMING FOR OLDER ADULTS (BASELINE: DATA NOT AVAILABLE; YEAR 1: GRANT DISTRIBUTED) COMMUNITY PARTNERS EXETER HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH AND WELLBEING OF RESIDENTS WITHIN ITS SERVICE AREA BY COLLABORATING WITH A DIVERSE GROUP OF COMMUNITY PARTNERS. THE HOSPITAL WORKS WITH THESE PARTNERS TO REDUCE BARRIERS TO HEALTH, INCREASE PREVENTION AND/OR SELF-MANAGEMENT OF CHRONIC DISEASE AND INCREASE THE EARLY DETECTION OF ILLNESS, AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH. THE HOSPITAL'S COMMUNITY PARTNERS INCLUDE:- AMERICAN FOUNDATION FOR SUICIDE PREVENTION- AMERICAN INDEPENDENCE MUSEUM- ARTS IN REACH- AUSTIN17HOUSE- BIG BROTHERS BIG SISTERS NEW ENGLAND- BIRCHTREE CENTER- BREATH NEW HAMPSHIRE- CENTER FOR LIFE MANAGEMENT- CHASE HOME- CONNOR'S CLIMB FOUNDATION- COOPERATIVE ALLIANCE FOR SEACOAST TRANSPORTATION (COAST)- CHILDREN'S MUSEUM OF NH- CROSS ROADS HOUSE- END 68 HOURS OF HUNGER- EQUALITY HEALTH CENTER- EXETER AREA WOMENADE - EXETER CHAMBER OF COMMERCE- EXETER HISTORICAL SOCIETY- EXETER PARKS AND RECREATION (FOR 277 WATER STREET)- EXETER ROTARY- EXETER YMCA- GATHER- GIRLS ON THE RUN- GREATER SEACOAST COMMUNITY HEALTH- HAMPTON CHAMBER OF COMMERCE- HAMPTON ROTARY- HAVEN- HOPE ON HAVEN HILL- KEY COLLECTIVE- KREMPELS CENTER- LAMPREY HEALTHCARE (FQHC)- LEADERSHIP SEACOAST- MY BREAST CANCER SUPPORT- NAMI NEW HAMPSHIRE- NEW GENERATION, INC.- NEW HAMPSHIRE CANCER COLLABORATIVE- NEW HAMPSHIRE CHILDREN'S TRUST- NEW HAMPSHIRE HOSPICE & PALLIATIVE CARE- NORTHEAST PASSAGE- ON BELAY- ONE SKY COMMUNITY SERVICES- PINETREE INSTITUTE- PINE STREET PLAYERS- PLAISTOW YMCA- PORTSMOUTH CHAMBER COLLABORATIVE - RACIAL UNITY TEAM- RAYMOND COALITION FOR YOUTH- RIVERWOODS EXETER - ROCKINGHAM MEALS ON WHEELS- SAINT VINCENT DE PAUL, EXETER- SEACOAST EAT LOCAL- SEACOAST FAMILY PROMISE- SEACOAST MENTAL HEALTH- SEACOAST OUTRIGHT- SEACOAST VELO KIDS- SOCIETY OF ST. VINCENT DE PAUL HAMPTON- SOROCK- SOS RECOVERY- TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS- WAYPOINT- WORKFORCE HOUSING COALITION- ZEBRA CROSSINGAS DESCRIBED IN DETAIL IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, EXETER HOSPITAL IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. HOWEVER, IN RESPONSE TO SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE MOST RECENT CHNA THAT ARE NOT SPECIFICALLY INCLUDED OR SUBSTANTIALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY. THOSE NEEDS ARE CHILDCARE AND IN FY23, HOUSING. WHILE THESE ISSUES ARE IMPORTANT, EXETER HOSPITAL DECIDED IT WAS OUTSIDE OF THE ORGANIZATION'S SPHERE OF INFLUENCE AND INVESTMENT. HOWEVER, IN FY 24, EXETER HOSPITAL EARMARKED GRANT FUNDING TO SUPPORT HOUSING STABILITY INITIATIVES IN ITS SERVICE AREA AND REMAINS OPEN AND WILLING TO WORK WITH OTHER BILH HOSPITALS AND/OR COMMUNITY PARTNERS TO ADDRESS THESE ISSUES.AS NOTED IN DETAIL ABOVE, EXETER HOSPITAL'S PRIMARY TOOL FOR ASSESSING THE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND IS (SCHEDULE H PART VI QUESTION 2).FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATIONTHE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW EXETER HOSPITAL CARES FOR ITS COMMUNITY BY PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS. AS DEMONSTRATED IN THIS SCHEDULE H, 9.03% OF EXETER HOSPITAL'S TOTAL EXPENSES AS REPORTED ON FORM 990 PART IX, LINE 24, ARE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. COMMUNITY BENEFITSANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, EXETER HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY WERE COMPLETED AND APPROVED BY THE BOARD OF TRUSTEES DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFITS REPORT THAT IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE AND ON THE HOSPITAL WEBSITE AT: HTTPS://WWW.EXETERHOSPITAL.COM/ABOUT-US/COMMUNITY-BENEFITS THERE ARE SOME DIFFERENCES BETWEEN THE NEW HAMPSHIRE ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. AS SUCH, THERE MAY BE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT EXETER HOSPITAL FILED WITH THE ATTORNEY GENERAL'S OFFICE. EMERGENCY CARE ACCESSIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, EXETER HOSPITAL IS A GENERAL MEDICAL AND SURGICAL HOSPITAL, PROVIDING 24-HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEEXETER HOSPITAL'S NET COST OF CHARITY CARE, WAS $368,237 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024 AND HAS BEEN REPORTED ON THIS SCHEDULE H, PART I, LINE 7A.AS PREVIOUSLY NOTED IN THIS FORM 990, EXETER HOSPITAL IS ONE OF ELEVEN HOSPITALS WITHIN THE BETH ISRAEL LAHEY HEALTH NETWORK. COMBINED THESE HOSPITALS' NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST, WAS $52 MILLION FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. OTHER UNCOMPENSATED CHARITY CAREMEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, EXETER HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW-INCOME FAMILIES, INCLUDING PARTICULARLY THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. NEW HAMPSHIRE'S MEDICAID EXPANSION, KNOWN AS GRANITE ADVANTAGE, IS DESIGNED TO PROVIDE COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS THAT INSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, EXETER HOSPITAL GENERATED $8,505,644 RELATED TO TREATING MEDICAID PATIENTS WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY EXETER HOSPITAL FOR SUCH SERVICES BY $19,202,042 AS REPORTED ON THIS SCHEDULE H, PART I LINE 7B. DURING THE FISCAL PERIOD COVERED BY THIS FILING, THE COST OF PROVIDING CARE TO MEDICAID PATIENTS ACROSS BILH EXCEEDED PAYMENTS RECEIVED FOR PROVIDING THAT CARE RESULTING IN A COMBINED SHORTFALL EXCEEDING $35.5 MILLION RELATED TO TREATING MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS, AND EXETER HOSPITAL PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, EXETER HOSPITAL GENERATED $106,581,193 RELATED TO TREATING MEDICARE PATIENTS. THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS EXCEEDED REVENUE BY $43,776,182. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH EXETER HOSPITAL CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE SHORTFALL RELATED TO TREATING MEDICARE PATIENTS IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, EXETER HOSPITAL HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, AS REQUIRED. HOWEVER, IF THE MEDICARE SHORTFALL WERE INCLUDED IN THE SCHEDULE H PART I LINE 7 CALCULATION, IT WOULD INCREASE TO 23,92%.SCHEDULE H QUESTION 7 PERCENTAGE METHODOLOGY THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. BAD DEBTS IN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, EXETER HOSPITAL ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. COSTS FOR THOSE SERVICES DURING THE FISCAL PERIOD COVERED BY THIS FILING OF $4,015,387 AND ARE REPORTED AS BAD DEBT ON FORM 990, SCHEDULE H, PART III, LINE 2. AS REQUIRED BY THE INSTRUCTIONS TO THIS FORM 990 SCHEDULE H, LOSSES RELATED TO BAD DEBTS HAVE NOT BEEN INCLUDED IN THE CALCULATION OF FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS IN SCHEDULE H PART I LINE 7. RATHER IT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED. THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. (BILH) AND AFFILIATES FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024 INCLUDE THE ACCOUNTS OF: BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION (LCF) , LAHEY CLINIC (LCI), LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NORTHEAST), ANNA JAQUES HOSPITAL (AJH), EXETER HEALTH RESOURCES, INC. (EHRI), EXETER HOSPITAL (EH), BETH ISRAEL LAHEY HEALTH PHARMACY, JOSLIN DIABETES CENTER AND THEIR AFFILIATES. THE FINANCIAL STATEMENTS OF THE SYSTEM ALSO INCLUDE A CONTROLLED AFFILIATE, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP). FINANCIAL STATEMENT FOOTNOTES: REVENUE RECOGNITION THE SYSTEM'S PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE SYSTEM EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING MANAGED CARE PAYORS AND GOVERNMENT PROGRAMS), AND OTHERS AND INCLUDE AN ESTIMATE OF VARIABLE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, THE SYSTEM BILLS THE PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED FROM THE SYSTEM'S FACILITY.REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE SYSTEM. REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED (OR ACTUAL) CHARGES. THE SYSTEM BELIEVES THAT THIS METHOD PROVIDES A REASONABLE REPRESENTATION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO INPATIENT SERVICES. THE SYSTEM MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL, OR COMMENCEMENT OF A PATIENT SERVICE, TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE OR COMPLETION OF THE OUTPATIENT SERVICES. PATIENT ENCOUNTERS AND RELATED EPISODES OF CARE AND PROCEDURES QUALIFY AS DISTINCT GOODS AND SERVICES, PROVIDED SIMULTANEOUSLY TOGETHER WITH OTHER READILY AVAILABLE RESOURCES, IN A SINGLE INSTANCE OF SERVICE, AND THEREBY CONSTITUTE A SINGLE PERFORMANCE OBLIGATION FOR EACH PATIENT ENCOUNTER AND, IN MOST INSTANCES, OCCUR AT READILY DETERMINABLE TRANSACTION PRICES. ALL SERVICES PROVIDED ARE EXPECTED TO RESULT IN CASH FLOWS AND ARE THEREFORE REFLECTED AS NET REVENUE IN THE CONSOLIDATED FINANCIAL STATEMENTS.THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. THE ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS ARE BASED ON CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES AND HISTORICAL CASH COLLECTION EXPERIENCE. DIFFERENCES BETWEEN STANDARD CHARGES AND ESTIMATED TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE AND ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. ADJUSTMENTS ARISING FROM A CHANGE IN THE TRANSACTION PRICE WERE NOT SIGNIFICANT DURING THE YEARS ENDED SEPTEMBER 30, FOR 2024 OR 2023. REVENUES UNDER THE TRADITIONAL FEE FOR SERVICE MEDICARE AND MEDICAID PROGRAMS ARE BASED PRIMARILY ON PROSPECTIVE PAYMENT SYSTEMS. RETROSPECTIVELY DETERMINED COST-BASED REVENUES UNDER THESE PROGRAMS, WHICH WERE MORE PREVALENT IN EARLIER PERIODS, AND CERTAIN OTHER PAYMENTS, SUCH AS DISPROPORTIONATE SHARE HOSPITAL AND BAD DEBT EXPENSE REIMBURSEMENT, WHICH ARE BASED ON OUR HOSPITALS COST REPORTS, ARE ESTIMATED USING HISTORICAL TRENDS AND CURRENT FACTORS. COST REPORT SETTLEMENTS UNDER THESE PROGRAMS ARE SUBJECT TO AUDIT BY MEDICARE AND MEDICAID AUDITORS AND ADMINISTRATIVE AND JUDICIAL REVIEW, AND IT CAN TAKE SEVERAL YEARS UNTIL FINAL SETTLEMENT OF SUCH MATTERS IS DETERMINED AND COMPLETELY RESOLVED. THE SYSTEM RECORDS ACCRUALS TO REFLECT THE EXPECTED FINAL SETTLEMENTS ON COST REPORTS. FOR FILED COST REPORTS, THE ACCRUAL IS RECORDED BASED ON THOSE COST REPORTS AND SUBSEQUENT ACTIVITY. THE ACCRUAL FOR PERIODS FOR WHICH A COST REPORT IS YET TO BE FILED IS RECORDED BASED ON ESTIMATES OF WHAT THE SYSTEM EXPECTS TO REPORT ON THE FILED COST REPORTS. AFTER THE COST REPORT IS FILED, THE ACCRUAL MAY NEED TO BE ADJUSTED. SETTLEMENTS WITH THIRD-PARTY PAYORS FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO AUDITS, REVIEWS OR INVESTIGATIONS ARE CONSIDERED VARIABLE CONSIDERATION AND ARE INCLUDED IN THE DETERMINATION OF THE ESTIMATED TRANSACTION PRICE FOR PROVIDING PATIENT CARE USING THE MOST LIKELY OUTCOME METHOD. THESE SETTLEMENTS ARE ESTIMATED BASED ON THE TERMS OF THE PAYMENT AGREEMENT WITH THE PAYOR, CORRESPONDENCE FROM THE PAYOR AND HISTORICAL SETTLEMENT ACTIVITY, INCLUDING AN ASSESSMENT TO ENSURE THAT IT IS PROBABLE THAT A SIGNIFICANT REVERSAL IN THE AMOUNT OF CUMULATIVE REVENUE RECOGNIZED WILL NOT OCCUR WHEN THE UNCERTAINTY ASSOCIATED WITH THE RETROACTIVE ADJUSTMENT IS SUBSEQUENTLY RESOLVED. ESTIMATED SETTLEMENTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN, OR AS YEARS ARE SETTLED OR ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.THE SYSTEM IS NOT AWARE OF ANY MATERIAL CLAIMS, DISPUTES, OR UNSETTLED MATTERS WITH ANY PAYORS THAT WOULD AFFECT REVENUES THAT HAVE NOT BEEN ADEQUATELY PROVIDED FOR AND DISCLOSED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. BECAUSE THE LAWS, REGULATIONS, INSTRUCTIONS AND RULE INTERPRETATIONS GOVERNING MEDICARE AND MEDICAID REIMBURSEMENT ARE COMPLEX, SUBJECT TO INTERPRETATION AND CAN CHANGE FREQUENTLY, THE ESTIMATES RECORDED COULD CHANGE BY MATERIAL AMOUNTS.CONSISTENT WITH THE SYSTEM'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (E.G., COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE SYSTEM EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. PATIENTS WHO MEET THE SYSTEM'S CRITERIA FOR CHARITY CARE ARE PROVIDED CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE SYSTEM HAS DETERMINED THAT IT HAS PROVIDED SUFFICIENT IMPLICIT PRICE CONCESSIONS FOR THESE ACCOUNTS. PRICE CONCESSIONS, INCLUDING CHARITY CARE, ARE NOT REPORTED AS REVENUE.PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED CO-PAYS, CO-INSURANCE AND DEDUCTIBLES, WHICH VARY IN AMOUNT. THE SYSTEM ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH CO-PAYS, CO-INSURANCE AND DEDUCTIBLES AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL COLLECTION EXPERIENCE AND CURRENT MARKET CONDITIONS. THE DISCOUNT OFFERED TO CERTAIN UNINSURED PATIENTS IS RECOGNIZED AS A CONTRACTUAL ALLOWANCE, WHICH REDUCES NET OPERATING REVENUES AT THE TIME THE SELF-PAY ACCOUNTS ARE RECORDED. THE UNINSURED PATIENT ACCOUNTS, NET OF CONTRACTUAL ALLOWANCES RECORDED, ARE FURTHER REDUCED TO THEIR NET REALIZABLE VALUE AT THE TIME THEY ARE RECORDED THROUGH IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION TRENDS FOR SELF-PAY ACCOUNTS AND OTHER FACTORS THAT AFFECT THE ESTIMATION PROCESS. ALTHOUGH OUTCOMES VARY, THE SYSTEM'S POLICY IS TO ATTEMPT TO COLLECT AMOUNTS DUE FROM PATIENTS, INCLUDING CO-PAYS, CO-INSURANCE AND DEDUCTIBLES DUE FROM PATIENTS WITH INSURANCE, AT THE TIME OF SERVICE WHILE COMPLYING WITH ALL FEDERAL AND STATE STATUTES AND REGULATIONS.OTHER REVENUE INCLUDES CONTRIBUTIONS AND NET ASSETS RELEASED FROM RESTRICTIONS AS WELL AS CAFETERIA AND PARKING INCOME. ADDITIONALLY, PHARMACY SALES AND OTHER CONTRACTS RELATED TO HEALTH CARE SERVICES ARE INCLUDED IN OTHER REVENUE AND CONSIST OF CONTRACTS WHICH VARY IN DURATION AND IN PERFORMANCE. REVENUE IS RECOGNIZED WHEN THE PERFORMANCE OBLIGATIONS IDENTIFIED WITHIN THE INDIVIDUAL CONTRACTS ARE SATISFIED AND COLLECTIONS ARE PROBABLE. OTHER REVENUE FOR THE YEARS ENDED SEPTEMBER 30, 2024 AND 2023 ALSO INCLUDED FUNDING RECEIVED FROM FEDERAL AND STATE SOURCES RELATED TO THE COVID-19 PANDEMIC AMOUNTING TO $17,500 AND $6,100, RESPECTIVELY. EMERGENCY CARE ACCESS THE EXETER HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE PROVIDES MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO THIS FACILITY 24 HOURS A DAY, 7 DAYS A WEEK, AND 365 DAYS A YEAR. FINANCIAL ASSISTANCE POLICYINTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE EXETER HOSPITAL IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THIS FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR OUR SERVICE AREA. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RECEIVE DISCOUNTED CARE FROM EXETER HOSPITAL AS WELL AS PROVIDERS WHO FOLLOW EXETER HOSPITAL'S FINANCIAL ASSISTANCE POLICY. A LIST OF ALL PROVIDERS WHO PROVIDE CARE WITHIN EXETER HOSPITAL AS WELL AS INFORMATION INDICATING IF THE LISTED PROVIDERS FOLLOW EXETER HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS INCLUDED IN THE FINANCIAL ASSISTANCE POLICY. EXETER HOSPITAL DOES NOT DISCRIMINATE WHEN DETERMINING ELIGIBILITY.FINANCIAL ASSISTANCE POLICY, CREDIT AND COLLECTION POLICY AND EMERGENCY CARE POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) THAT APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY. (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE FAP ALSO INCLUDES THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. THE PROVIDER LIST IS UPDATED NOT LESS THAN QUARTERLY. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY. (SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). THE HOSPITAL'S FAP AND CREDIT & COLLECTION POLICY WERE ADOPTED BY AN AUTHORIZED BODY AS REQUIRED PURSUANT TO THE IRC SECTION 501(R) TREASURY REGULATIONS EFFECTIVE ON OR ABOUT DECEMBER 26, 2024.FINANCIAL ASSISTANCE POLICYAPPLYING FOR ASSISTANCE THE HOSPITAL'S FAP INCLUDES INFORMATION ON THE METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE UNDER THE FAP. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION INCLUDES A LIST OF INFORMATION/DOCUMENTATION REQUIRED AS PART OF A PATIENT'S APPLICATION FOR FINANCIAL ASSISTANCE. (SCHEDULE H PART V SECTION B QUESTION 15)FINANCIAL ASSISTANCE POLICYELIGIBILITY GUIDELINES THE HOSPITAL'S FAP USES THE FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARE. (SCHEDULE H PART I QUESTION 3A AND 3B AND PART V SECTION B QUESTION 13). IN ADDITION, THE HOSPITAL'S FAP PROVIDES FOR FINANCIAL ASSISTANCE BASED ON MEDICAL HARDSHIP AND ASSET LEVEL (SCHEDULE H PART I QUESTIONS 3C AND 4, PART V SECTION B QUESTION 13 AND PART VI QUESTION 3). FINALLY, THE HOSPITAL UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT/GUARANTOR'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE APPLICATION FORM. OTHER INFORMATION MAY BE USED BY THE HOSPITAL TO DETERMINE WHETHER A PATIENT/GUARANTOR'S ACCOUNT IS UNCOLLECTIBLE, AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY AS OUTLINED IN THE HOSPITAL'S FAP. (SCHEDULE H PART I QUESTIONS 3C).FINANCIAL ASSISTANCEPUBLIC ASSISTANCE PROGRAMS (SCHEDULE H PART I QUESTION 3C)IN ADDITION TO FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FAP, FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN-PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE.HOSPITAL PATIENTS MAY BE ELIGIBLE FOR FREE OR REDUCED COST OF HEALTH CARE SERVICES THROUGH VARIOUS STATE PUBLIC ASSISTANCE PROGRAMS AS WELL AS THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS (INCLUDING BUT NOT LIMITED TO MEDICAID, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM AND MEDICAL HARDSHIP). SUCH PROGRAMS ARE INTENDED TO ASSIST LOW-INCOME PATIENTS TAKING INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL, WHEN REQUESTED, HELP THEM WITH APPLYING FOR EITHER COVERAGE THROUGH PUBLIC ASSISTANCE PROGRAMS OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.FINANCIAL ASSISTANCE POLICYTRANSLATIONS THE HOSPITAL'S FAP, CREDIT AND COLLECTION POLICY AND PLAIN LANGUAGE SUMMARY OF THE FAP (SEE DETAIL BELOW) HAVE ALL BEEN TRANSLATED INTO THE LANGUAGES SPOKEN BY THOSE IN THE HOSPITAL'S COMMUNITY WHO MAY COMMUNICATE IN A LANGUAGE OTHER THAN ENGLISH. THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE LANGUAGES OF LIMITED ENGLISH PROFICIENCY (LEP) OF ITS PATIENTS, 5% OF THE POPULATION OR 1000 PERSONS, WHICHEVER IS LESS, IN ACCORDANCE WITH THE REGULATIONS PROMULGATED UNDER IRC SECTION 501(R). BASED ON THE HOSPITAL'S REVIEW OF THIS SAFE HARBOR, THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO SPANISH. (SCHEDULE H PART V SECTION B QUESTION 16I) FINANCIAL ASSISTANCE POLICY - WIDELY PUBLICIZING AND AVAILABILITY COPIES OF THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN BOTH ENGLISH AND ALL LEP LANGUAGES AT THE HOSPITAL, BY MAIL FREE OF CHARGE AND/OR ON THE HOSPITAL'S WEBSITE: (SCHEDULE H PART V SECTION B QUESTIONS 16A, 16B, 16C, 16D, 16E, 16H) AT HTTPS://WWW.EXETERHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE. IN ADDITION, THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN THE HOSPITAL'S EMERGENCY DEPARTMENT AND FINANCIAL COUNSELING OFFICE. (SCHEDULE H PART V SECTION B QUESTION 16F AND SCHEDULE H PART VI QUESTION 3).THE HOSPITAL MAINTAINS SIGNAGE AND CONSPICUOUS PUBLIC DISPLAYS ABOUT FINANCIAL ASSISTANCE AND THE FAP DESIGNED TO ATTRACT THE ATTENTION OF PATIENTS AND VISITORS, INCLUDING BOTH THE EMERGENCY DEPARTMENT AND ADMISSIONS. SUCH SIGNAGE IS POSTED BOTH IN ENGLISH AND THE LEP LANGUAGES NOTED ABOVE. IN ADDITION, FINANCIAL COUNSELING PERSONNEL ROUTINELY VISIT LOCATIONS DESIGNATED FOR SIGNAGE TO ENSURE THAT SUCH SIGNAGE REMAINS VISIBLE TO PATIENTS AND VISITORS AS ATTENDED. THE HOSPITAL PROVIDES INFORMATION ABOUT THE FAP TO PATIENTS BEFORE DISCHARGE AND CONSPICUOUSLY WITHIN BILLING STATEMENTS. INFORMATION PROVIDED TO PATIENTS IN THESE COMMUNICATIONS INCLUDE CONTACT INFORMATION FOR THOSE THAT CAN HELP PROVIDE ADDITIONAL INFORMATION ABOUT THE FAP, INFORMATION ON THE APPLICATION PROCESS AND THE WEBSITE WHERE THE FAP CAN BE OBTAINED. ADDITIONALLY, A PLAIN LANGUAGE SUMMARY OF THE FAP IS PROVIDED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS. (SCHEDULE H PART V SECTION B QUESTION 16G). FINANCIAL ASSISTANCE POLICYPLAIN LANGUAGE SUMMARYAS NOTED IN THIS NARRATIVE SUPPORT TO THE FORM 990 SCHEDULE H, THE HOSPITAL HAS A PLAIN LANGUAGE SUMMARY OF ITS FAP. THIS IS A WRITTEN STATEMENT DESIGNED TO NOTIFY PATIENTS AND VISITORS THAT THE HOSPITAL HAS A WRITTEN FAP AND PROVIDES FINANCIAL ASSISTANCE. THIS PLAIN LANGUAGE SUMMARY INCLUDES INFORMATION ON FREE AND DISCOUNTED CARE, HOW TO OBTAIN A COPY OF THE FAP POLICY AND APPLICATION, INCLUDING THE WEBSITE ADDRESS, THE LOCATION AND PHONE NUMBER OF THE FINANCIAL COUNSELING OFFICE. THE PLAIN LANGUAGE SUMMARY ALSO INCLUDES THE LIST OF LANGUAGES INTO WHICH THE FAP AND SUMMARY HAVE BEEN TRANSLATED AS WELL AS HOW TO ACCESS INFORMATION ON PROVIDERS NOT COVERED BY THE FAP AND TO WHICH OTHER RELATED HOSPITALS APPROVAL UNDER THE FAP WILL APPLY. LINKS TO FINANCIAL ASSISTANCE POLICY AND RELATED DOCUMENTSTHE LINK TO THE EXETER HOSPITAL FINANCIAL ASSISTANCE POLICY (FAP) AND THE FOLLOWING RELATED DOCUMENTS CAN BE FOUND ON THE HOSPITAL'S WEBSITE. - CREDIT AND COLLECTION POLICY- APPLICATION FOR FINANCIAL ASSISTANCE- MEDICAL HARDSHIP APPLICATION- FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY ADDITIONAL INFORMATION ON PATIENT FINANCIAL ASSISTANCE AND BILLING, ALL IN ENGLISH AND SPANISH, CAN BE FOUND ON THE EXETER HOSPITAL WEBSITE AT: HTTPS://WWW.EXETERHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE. LIMITATION ON CHARGESINTERNAL REVENUE CODE SECTION 501(R)(5)LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE-ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. AMOUNTS GENERALLY BILLEDLOOK BACK METHODTHE HOSPITAL CALCULATES ITS AGB, USING THE LOOK BACK METHOD, DIVIDING THE TOTAL PAYMENTS RECEIVED FROM ALL COMMERCIAL PLANS AND MEDICARE BY THE TOTAL CHARGES SENT TO THOSE SAME PAYERS FOR THE PREVIOUS FISCAL YEAR. CALCULATED AGB IS INCLUDED IN THE HOSPITAL'S FAP AS REQUIRED UNDER THE REGULATIONS DETAILING THE REQUIREMENTS UNDER IRC SECTION 501(R)(5). (SCHEDULE H PART V SECTION B QUESTION 22). PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAN EXCEEDS THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS501(R)(6) EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. IN ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS. THE HOSPITAL MAY DEFER OR REQUIRE PAYMENT BEFORE PROVIDING MEDICALLY NECESSARY SERVICES (OTHER THAN EMERGENCY MEDICAL SERVICES) TO PATIENTS WITH UNPAID BALANCES WHO HAVE FAILED TO PROVIDE REQUESTED INFORMATION FOR PROCESSING A FINANCIAL ASSISTANCE APPLICATION OR WITH RESPECT TO A PAYMENT PLAN. THE HOSPITAL DOES NOT PROVIDE A 30-DAY WRITTEN NOTICE IN ADVANCE OF TAKING SUCH ACTION, AS SUCH NOTICE IS NOT REQUIRED BY THE SECTION 501(R) REGULATIONS. (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS RESEARCHAS NOTED THROUGHOUT THIS FORM 990, EXETER HOSPITAL BECAME PART OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES EFFECTIVE JULY 1, 2023. ALTHOUGH EXETER HOSPITAL DOES NOT DIRECTLY ENGAGE IN RESEARCH, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), LAHEY CLINIC, NEW ENGLAND BAPTIST HOSPITAL AND JOSLIN DIABETES CENTER ALL ENGAGE IN RESEARCH ACTIVITIES DESIGNED TO CARE FOR PATIENTS NOT ONLY AT THESE HOSPITALS, BUT ACROSS THE COMMUNITIES SERVED BY BILH AND BEYOND. BIDMC HAS THE LARGEST RESEARCH OPERATIONS ACROSS BILH AND DURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER INCURRED OVER $370 MILLION IN RESEARCH EXPENSES, MORE THAN $91 MILLION OF WHICH WERE INTERNALLY FUNDED. ALTHOUGH THE RESEARCH ACTIVITIES OF THESE BIDMC AND OTHER BILH AFFILIATES ARE NOT QUANTIFIED HERE IN EXETER HOSPITAL'S FORM 990 SCHEDULE H, PART I, 7H, AS ALREADY NOTED, THESE ACTIVITIES ARE IMPORTANT TO THE COMMUNITIES SERVED BY EXETER HOSPITAL, BILH AND BEYOND. INFORMATION ON THE RESEARCH ENGAGED IN AT BIDMC AND JOSLIN, SISTER ENTITIES TO EXETER HOSPITAL, DURING THE PERIOD COVERED BY THIS FILING, IS INCLUDED BELOW. BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC OR MEDICAL CENTER) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER PROVIDING LEADING EDGE PATIENT CARE, IS A WORLD CLASS RESEARCH INSTITUTION AND IS DEVOTED TO TEACHING AND TRAINING THE MEDICAL PROFESSIONALS OF TOMORROW, EMBRACING TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION. TO THAT END, PART OF THE MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. THE RESEARCH PROGRAM STRIVES TO BE RENOWNED FOR ITS BENCH-TO-BEDSIDE MODEL OF TRANSLATIONAL RESEARCH AND FOR ITS COLLABORATION WITH INDUSTRY AS A PATHWAY FOR TRANSFERRING THE FRUITS OF RESEARCH INTO PRODUCTS AND TREATMENTS THAT IMPROVE THE QUALITY OF LIFE.THE MEDICAL CENTER'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP TIER OF INDEPENDENT HOSPITALS IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING. THE MEDICAL CENTER SCIENTISTS CONTINUE TO SEARCH FOR IMPROVED UNDERSTANDING OF DISEASES AND BETTER TREATMENTS FOR PATIENTS, WHICH IN TURN DIRECTLY IMPACT THE LIVES OF OUR PATIENTS AND IMPROVE THE MEDICAL CENTER'S PATIENT CARE. DURING THE FISCAL PERIOD COVERED BY THIS FILING, MORE THAN 1,220 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,500 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 280 PRINCIPAL INVESTIGATORS, THE MAJORITY OF WHOM ARE HARVARD MEDICAL SCHOOL FACULTY. THE KEY AREAS OF RESEARCH INCLUDE VASCULAR BIOLOGY, MOLECULAR IMAGING, TRANSPLANTATION, SIGNAL TRANSDUCTION, CANCER BIOLOGY, METABOLIC DISEASE, NEUROBIOLOGY, AIDS, VACCINE DEVELOPMENT AND VIROLOGY, INFECTION CONTROL AND INFECTIOUS DISEASES AND CARDIOLOGY/CARDIAC SURGERY. AS NOTED IN THIS FILING, THE MEDICAL CENTER IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE; TO MAINTAINING MODERN, HIGH-QUALITY FACILITIES, AND TO TAKING FULL ADVANTAGE OF THE UNIQUE RELATIONSHIPS THAT EXIST AMONG THE HARVARD MEDICAL SCHOOL AND THE HARVARD TEACHING HOSPITALS. THE MEDICAL CENTER DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN THE INSTITUTION. THE MEDICAL CENTER ALSO COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD-RENOWNED EXPERTS IN VARIOUS FIELDS IN AN EFFORT TO TRANSLATE NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. THE MEDICAL CENTER PARTICIPATES IN HARVARD CATALYST, THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER, WHICH BRINGS TOGETHER THE INTELLECTUAL FORCE, TECHNOLOGIES, AND CLINICAL EXPERTISE AT HARVARD UNIVERSITY AND ITS ACADEMIC, HEALTH CARE, AND COMMUNITY PARTNERS TO CREATE CONNECTIONS, ENABLE RESEARCH AT THE CUTTING EDGE OF DISCOVERY, AND NURTURE CLINICAL AND TRANSLATIONAL RESEARCHERS WITH THE GOAL OF IMPROVING HUMAN HEALTH.STUDIES BY MEDICAL CENTER RESEARCHERS ARE ROUTINELY PUBLISHED IN THE WORLD'S LEADING SCIENTIFIC JOURNALS, INCLUDING NATURE, SCIENCE, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION AND THE NEW ENGLAND JOURNAL OF MEDICINE, WHICH HELPS TO BRING THE RESEARCH FINDINGS TO CLINICIANS AND PATIENTS BEYOND THE MEDICAL CENTER. THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES:- ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE - EMERGENCY MEDICINE - MEDICINE - ALLERGY AND INFLAMMATION - CARDIOVASCULAR MEDICINE - CENTER FOR VASCULAR BIOLOGY RESEARCH - CLINICAL INFORMATICS - CLINICAL NUTRITION - ENDOCRINOLOGY - EXPERIMENTAL MEDICINE - GASTROENTEROLOGY - GENERAL MEDICINE AND PRIMARY CARE - GENETICS - GERONTOLOGY - HEMATOLOGY AND ONCOLOGY - HEMOSTASIS AND THROMBOSIS - IMMUNOLOGY - INFECTIOUS DISEASE - INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGY - MOLECULAR AND VASCULAR MEDICINE - NEPHROLOGY - PULMONOLOGY - RHEUMATOLOGY - SIGNAL TRANSDUCTION - TRANSLATIONAL RESEARCH - TRANSPLANT IMMUNOLOGY- NEONATOLOGY - NEUROLOGY - OBSTETRICS AND GYNECOLOGY - ORTHOPAEDIC SURGERY - PATHOLOGY - PSYCHIATRY - RADIOLOGY - SURGERY - CARDIAC SURGERY - CENTER FOR MINIMALLY INVASIVE SURGERY - NEUROSURGERY - PLASTIC AND RECONSTRUCTIVE SURGERY - VASCULAR SURGERY- TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER INCURRED OVER $370 MILLION IN RESEARCH EXPENSES, MORE THAN $91 MILLION OF WHICH WERE INTERNALLY FUNDED AND REPORTED ON THE BIDMC SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE.RESEARCH ENGAGED IN AT THE MEDICAL CENTERTHE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE. DETAIL ON RESEARCH EFFORTS WHICH WERE UNDERTAKEN AT BIDMC. DETAIL ON RESEARCH EFFORTS WHICH WERE UNDERTAKEN AT BIDMC DURING THE FISCAL PERIOD COVERED BY THIS FILING ARE BELOW. 1. FIRST-OF-ITS-KIND STUDY FINDS HIDDEN CLUES TO RARE TYPE OF PANCREATIC CANCER, OPENS DOORS TO NEW THERAPIESPANCREATIC NEUROENDOCRINE TUMORS (PANNETS) ARE A RARE KIND OF CANCER THAT FORMS IN THE PANCREAS. PHYSICIANS STILL HAVE DIFFICULTY PREDICTING HOW THE DISEASE WILL AFFECT INDIVIDUAL PATIENTS AND HOW BEST TO TREAT IT.BIDMC SCIENTISTS USED PROTEOGENOMICS, THE INTEGRATED LARGE-SCALE STUDY OF GENES AND PROTEINS IN CANCER CELLS, TO LEARN MORE ABOUT THESE TUMORS. USING 37 TUMOR SAMPLES, THE TEAM DISCOVERED FOUR PREVIOUSLY UNDESCRIBED PANNETS. TWO OF THESE SUBTYPES SHOWED HIGH RECURRENCE RATES, SUGGESTING A PREVIOUSLY UNRECOGNIZED CLINICAL AGGRESSIVENESS. THESE TUMORS ALSO SHOWED SIGNS OF LOW OXYGEN LEVELS AND INFLAMMATIONBOTH LINKED TO MORE AGGRESSIVE CANCERS.THE SCIENTISTS ALSO FOUND CHANGES IN HOW THE CANCER CELLS USE ENERGY AND HOW THEY HIDE FROM THE IMMUNE SYSTEM, FINDINGS WHICH COULD HELP RESEARCHERS DEVELOP NEW TREATMENTS.IMPORTANTLY, THE RESEARCHERS ADD, THESE PROTEOMIC SUBTYPES WOULD NOT HAVE BEEN DISCOVERABLE USING PRIOR GENOMICS-BASED APPROACHES TO PANNETS OR CURRENT STATE-OF-THE-ART CLINICOPATHOLOGICAL PANNET SUBTYPING. LEAD AUTHOR MICHAEL ROEHRL, CHIEF OF THE DEPARTMENT OF PATHOLOGY AND PI AT BIDMC SAID: "PROTEOGENOMICS REPRESENTS A SIGNIFICANT STEP FORWARD IN UNDERSTANDING PANCREATIC NEUROENDOCRINE TUMORS, AND OUR PUBLICLY AVAILABLE PROTEOMIC PANNET DATASET SHOULD BE OF IMMEDIATE INTEREST TO SCIENTISTS AND PHYSICIANS AROUND THE WORLD." 2. RESEARCHERS HALT PROGRESSION IN PARKINSON'S DISEASE MOUSE MODEL, OPENING THE DOOR TO POTENTIAL DISEASE-MODIFYING TREATMENT FOR PATIENTS WITH PARKINSON'S DISEASEINVESTIGATORS AT BIDMC SHED NEW LIGHT ON KEY CELLULAR PROCESSES INVOLVED IN THE PROGRESSION OF PARKINSON'S DISEASE (PD). AFFECTING AROUND 10 MILLION PEOPLE WORLDWIDE, PARKINSON'S DISEASE IS A NEURODEGENERATIVE DISORDER CAUSED BY THE PROGRESSIVE LOSS OF THE GROUP OF BRAIN CELLS RESPONSIBLE FOR PRODUCING DOPAMINE, A NEUROTRANSMITTER THAT PLAYS A CRITICAL ROLE IN REGULATING MOVEMENT AND COORDINATION. AS THESE NEURONS DEGENERATE AND DOPAMINE LEVELS DECREASE, INDIVIDUALS WITH PARKINSON'S DISEASE EXPERIENCE A WIDE RANGE OF SYMPTOMS, INCLUDING TREMORS, STIFFNESS AND DIFFICULTIES WITH BALANCE AND COORDINATION.RESEARCHERS IN THE LAB OF SENIOR AUTHOR DAVID K. SIMON, MD, PHD, DIRECTOR OF THE PARKINSON'S DISEASE & MOVEMENT DISORDERS CENTER, IN COLLABORATION WITH COLLEAGUES AT THE UNIVERSITY OF CAMBRIDGE AND MISSION THERAPEUTICS, PERFORMED TWO SETS OF COMPLEMENTARY EXPERIMENTS SHOWING THAT INHIBITING A SPECIFIC ENZYME IN A MOUSE MODEL PROTECTS THE DOPAMINE-PRODUCING NEURONS THAT ARE NORMALLY LOST AS PD PROGRESSES, EFFECTIVELY HALTING THE PROGRESSION OF THE DISEASE. THE FINDINGS OPEN THE DOOR TO THE DEVELOPMENT OF NOVEL THERAPEUTICS TARGETING THE ENZYME THAT MAY SLOW OR PREVENT THE PROGRESSION OF PARKINSON'S DISEASE IN PEOPLEA MAJOR UNMET NEED. "OUR LAB IS FOCUSED ON WORKING OUT THE ORIGINS OF PARKINSON'S DISEASE AND IT IS OUR HOPE THATONE DAYWE WILL BE ABLE TO SLOW DOWN OR EVEN PREVENT DISEASE PROGRESSION IN PATIENTS," SAID FIRST AUTHOR TRACY-SHI ZHANG FANG, PHD, AN INSTRUCTOR IN SIMON'S LAB. "THE CURRENT STUDY'S FINDINGS PAVE THE WAY TOWARD THAT FUTURE."3. AI CHATBOT SHOWS POTENTIAL AS DIAGNOSTIC PARTNER, RESEARCHERS FINDPHYSICIAN-INVESTIGATORS AT BIDMC COMPARED A CHATBOT'S PROBABILISTIC REASONING TO THAT OF HUMAN CLINICIANS. THE FINDINGS, PUBLISHED IN JAMA NETWORK OPEN, SUGGEST THAT ARTIFICIAL INTELLIGENCE COULD SERVE AS USEFUL CLINICAL DECISION SUPPORT TOOLS FOR PHYSICIANS.BASING THEIR STUDY ON A PREVIOUSLY PUBLISHED NATIONAL SURVEY OF MORE THAN 550 PRACTITIONERS PERFORMING PROBABILISTIC REASONING ON FIVE MEDICAL CASES, ADAM RODMAN, MD, AN INTERNAL MEDICINE PHYSICIAN AND INVESTIGATOR IN THE DEPARTMENT OF MEDICINE, AND COLLEAGUES FED THE PUBLICLY AVAILABLE LARGE LANGUAGE MODEL (LLM), CHAT GPT-4, THE SAME SERIES OF CASES AND RAN AN IDENTICAL PROMPT 100 TIMES TO GENERATE A RANGE OF RESPONSES.THE CHATBOTJUST LIKE THE PRACTITIONERS BEFORE THEMWAS TASKED WITH ESTIMATING THE LIKELIHOOD OF A GIVEN DIAGNOSIS BASED ON PATIENTS' PRESENTATION. THEN, GIVEN TEST RESULTS SUCH AS CHEST RADIOGRAPHY FOR PNEUMONIA, MAMMOGRAPHY FOR BREAST CANCER, STRESS TEST FOR CORONARY ARTERY DISEASE AND A URINE CULTURE FOR URINARY TRACT INFECTION, THE CHATBOT PROGRAM UPDATED ITS ESTIMATES.WHEN TEST RESULTS WERE POSITIVE, IT WAS SOMETHING OF A DRAW; THE CHATBOT WAS MORE ACCURATE IN MAKING DIAGNOSES THAN THE HUMANS IN TWO CASES, SIMILARLY ACCURATE IN TWO CASES AND LESS ACCURATE IN ONE CASE. BUT WHEN TESTS CAME BACK NEGATIVE, THE CHATBOT SHONE, DEMONSTRATING MORE ACCURACY IN MAKING DIAGNOSES THAN HUMANS IN ALL FIVE CASES.BUT RODMAN IS LESS INTERESTED IN HOW CHATBOTS AND HUMANS PERFORM TOE-TO-TOE THAN IN HOW HIGHLY SKILLED PHYSICIANS' PERFORMANCE MIGHT CHANGE IN RESPONSE TO HAVING THESE NEW SUPPORTIVE TECHNOLOGIES AVAILABLE TO THEM IN THE CLINIC, ADDED RODMAN."HUMANS STRUGGLE WITH PROBABILISTIC REASONING, THE PRACTICE OF MAKING DECISIONS BASED ON CALCULATING ODDS," SAID RODMAN. "WE CHOSE TO EVALUATE PROBABILISTIC REASONING IN ISOLATION BECAUSE IT IS A WELL-KNOWN AREA WHERE HUMANS COULD USE SUPPORT. HUMANS SOMETIMES FEEL THE RISK IS HIGHER THAN IT IS AFTER A NEGATIVE TEST RESULT, WHICH CAN LEAD TO OVERTREATMENT, MORE TESTS AND TOO MANY MEDICATIONS."4. BIDMC'S COMPLEX HYPERTENSION CENTER IS THE REGION'S ONLY AMERICAN HEART ASSOCIATION-CERTIFIED COMPREHENSIVE CARE CENTER PHYSICIAN-SCIENTISTS AT BIDMC, LED BY ERIC A. SECEMSKY, MD, ARE AT THE FOREFRONT OF A BREAKTHROUGH TREATMENT FOR PATIENTS WITH TREATMENT-RESISTANT HYPERTENSIONDANGEROUSLY HIGH BLOOD PRESSURE THAT PERSISTS DESPITE TAKING THREE OR MORE MEDICATIONS. FOR THESE HIGH-RISK PATIENTS, BIDMC IS AMONG THE FIRST IN THE NATION TO OFFER RENAL DENERVATION (RDN), A MINIMALLY INVASIVE PROCEDURE THAT TARGETS OVERACTIVE NERVES NEAR THE KIDNEYS TO HELP LOWER BLOOD PRESSURE.SECEMSKY, DIRECTOR OF VASCULAR INTERVENTION AT BIDMC, PIONEERED THE USE OF RDN AT THE MEDICAL CENTER AND SERVES AS SITE PRINCIPAL INVESTIGATOR ON MAJOR CLINICAL TRIALS THAT HELPED SECURE FDA APPROVAL FOR TWO CATHETER-BASED RDN DEVICES. THE PROCEDURE INVOLVES THREADING A DEVICE THROUGH THE GROIN TO REACH THE RENAL ARTERIES. ONE USES HEAT-FILLED BALLOONS; THE OTHER, RADIOFREQUENCY ABLATIONBOTH DESIGNED TO DISRUPT NERVE SIGNALS THAT RAISE BLOOD PRESSURE.SO FAR, SECEMSKY AND HIS TEAM HAVE PERFORMED RDN ON SIX PATIENTS THROUGH BIDMC'S COMPLEX HYPERTENSION CLINIC, WHICH BRINGS TOGETHER A MULTIDISCIPLINARY TEAM TO CARE FOR PATIENTS WITH THE MOST DIFFICULT-TO-CONTROL BLOOD PRESSURE. ON AVERAGE, PATIENTS CAN EXPECT A 710 MMHG DROP IN BLOOD PRESSUREENOUGH TO MEANINGFULLY REDUCE THE RISK OF HEART ATTACK AND STROKE OVER TIME."THIS DEVICE IS NOVEL AND STATE-OF-THE ART, BUT MORE IMPORTANTLY, HAVING SOMETHING TO OFFER PEOPLE WITH TREATMENT RESISTANT BLOOD PRESSURE REPRESENTS ONE PART OF OUR OPPORTUNITY TO BUILD ONE OF THE LARGEST HYPERTENSION CENTERS IN NEW ENGLAND. 5. NEW AI MODEL FLAGS 3.5 TIMES AS MANY PATIENTS AT RISK FOR PANCREATIC CANCER AS CURRENT SCREENING GUIDELINES; COULD LEAD TO EARLIER DETECTION OF PANCREATIC CANCERHOVERING AT JUST 11 PERCENT, PANCREATIC CANCER HAS THE LOWEST FIVE-YEAR RELATIVE SURVIVAL RATE OF ANY CANCER DIAGNOSIS, LARGELY BECAUSE THE DISEASE IS TYPICALLY CAUGHT IN ITS ADVANCED STAGES. IF CAUGHT IN ITS EARLIEST STAGES, FIVE-YEAR SURVIVAL RATES CAN REACH AS HIGH AS 80 PERCENT; HOWEVER, CURRENT SCREENING GUIDELINES APPLY ONLY TO ABOUT 10 PERCENT OF THE 62,000 PANCREATIC CANCER CASES THAT ARE DIAGNOSED EACH YEAR IN THE UNITED STATES. INVESTIGATORS AT BIDMC BUILT AND VALIDATED A RISK PREDICTION MODEL TO HELP PHYSICIANS IDENTIFY PATIENTS WHO ARE AT HIGH RISK FOR DEVELOPING PANCREATIC CANCER. THE TEAM'S MODEL, A NEURAL NETWORK TRAINED ON DE-IDENTIFIED DATA FROM ELECTRONIC HEALTH RECORDS FROM 55 U.S. HEALTH CARE ORGANIZATIONS, FLAGGED PATIENTS AS AT RISK OF DEVELOPING PANCREATIC CANCER UP TO 18 MONTHS BEFORE DIAGNOSIS IN PATIENTS 40 YEARS OR OLDER AND CAUGHT 3.5 TIMES AS MANY CASES THAN CURRENT SCREENING GUIDELINES WOULD IF APPLIED TO THE SAME GROUP. THEIR FINDINGS APPEAR IN EBIOMEDICINE, PART OF LANCET DISCOVERY SCIENCE.NAMED PRISMNN, THE TEAM'S MACHINE LEARNING MODEL WAS TRAINED ON DATA FROM MORE THAN 1.5 MILLION EHR PROVIDED BY INDUSTRY PARTNER TRINETX. THE DATA SET INCLUDED AN AVERAGE OF 13 YEARS OF HISTORICAL DATA ABOUT DEMOGRAPHICS, DOCTOR'S VISITS, DIAGNOSES, LAB WORK, PROCEDURES AND MEDICATIONS FOR MORE THAN 35,000 PATIENTS WHO EVENTUALLY DEVELOPED PANCREATIC CANCER AND MORE THAN 1.5 MILLION CONTROLS. THE MODEL FLAGGED PATIENTS AT HIGH RISK FOR DEVELOPING CANCER BASED ON 87 FEATURES IT AUTOMATICALLY SELECTED BASED ON THE INPUT TRAINING DATA."THERE ARE SIGNALS IN THE DATA THAT'S BEING ROUTINELY COLLECTED ALREADY WHEN PEOPLE SEE THEIR PRIMARY CARE PHYSICIAN OR GO TO THE ED WITH A BROKEN ANKLESYMPTOMS THAT SHOW UP, SUCH AS CERTAIN MEDICATIONS OR CHANGES IN LAB VALUES," LIMOR APPELBAUM, AN INVESTIGATOR AT BIDMC, SAID. "TAKEN TOGETHER, THESE ARE ALL SIGNALS THAT CAN PREDICT PANCREATIC CANCER BEFORE THE CANCER IS ACTUALLY DETECTED, AND THAT GIVES US THE OPPORTUNITY TO CATCH THOSE CANCERS EARLY, BEFORE IT HAS SPREAD."6. PLASMA PROTEIN CLUES COULD HELP PREDICT WHO WILL DEVELOP HYPERTENSIONEXERCISE TESTING CAN SERVE AS A POWERFUL PHYSIOLOGIC PROBE TO UNMASK SUBCLINICAL CARDIOVASCULAR ABNORMALITIES WELL BEFORE DISEASE ONSET. FOR EXAMPLE, BLOOD PRESSURE CHANGES DURING EXERCISE (EBP) CAN REVEAL A LATENT TENDENCY TOWARD FUTURE DEVELOPMENT OF HYPERTENSION. AT PRESENT, THERE IS NO RELIABLE CIRCULATING BIOMARKERA PROTEIN OR OTHER MOLECULE PRESENT IN THE BLOOD STREAMINDICATIVE OF FUTURE RISK OF HYPERTENSION.INVESTIGATORS AT BIDMC IDENTIFIED UNIQUE CIRCULATING PROTEINS THAT REFLECT EBP AND THAT MAY, IN TURN, BE EARLY INDICATORS OF FUTURE RISK OF HYPERTENSION. LED BY ROBERT E. GERSZTEN, MD, DIRECTOR OF BIDMC'S NATIONALLY RECOGNIZED PROGRAM IN PERSONAL GENOMICS AND CARDIOMETABOLIC DISEASE, JEREMY ROBBINS, MD, AND MARK SARZYNSKI, PHD, THE SCIENTISTS PERFORMED LARGE-SCALE PROTEOMIC PROFILING AND EBP MEASUREMENTS AMONG 681 HEALTHY ADULTS WHO UNDERWENT CARDIOPULMONARY EXERCISE TESTING BEFORE AND AFTER 20 WEEKS OF ENDURANCE EXERCISE TRAINING.THE STUDY TEAM, INCLUDING LEAD AUTHOR PRASHANT RAO, MBBS, IDENTIFIED 37 PROTEINS ASSOCIATED WITH EBP, MANY OF WHICH WOULD NOT HAVE BEEN IDENTIFIED THROUGH PROFILING RESTING BP ALONE. SEVERAL OF THESE PROTEINS WERE RELEVANT TO VASCULAR BIOLOGY.THE INVESTIGATORS DEMONSTRATED THAT THE EBP-ASSOCIATED PLASMA PROTEIN KNOWN AS TGFBR3 IS A NOVEL CIRCULATING BIOMARKER ASSOCIATED WITH A LOWER RISK OF INCIDENT HYPERTENSION. GENETICALLY PREDICTED LEVELS OF THIS PLASMA PROTEIN WERE INVERSELY ASSOCIATED WITH FUTURE HYPERTENSION RISK IN A DIVERSE POPULATION AND MAY PROTECT AGAINST THE DEVELOPMENT OF CVD. THIS WORK MAY HELP IN DETERMINING WHICH PATIENTS MIGHT BENEFIT FROM EARLY CLINICAL INTERVENTIONS TO REDUCE THE IMPACT OF CARDIOVASCULAR DISEASE.7. DYNAMIC DUO: COMBINING CHOLESTEROL-LOWERING STATINS WITH EXISTING CANCER DRUG SHOWS POTENT EFFECT AGAINST AGGRESSIVE SUBTYPE OF BREAST CANCER IN PRE-CLINICAL MODELSIN A NEW TRANSLATIONAL RESEARCH STUDY, INVESTIGATORS AT BIDMC EXPLORED THE POTENTIAL OF STATINS COMMONLY USED MEDICATIONS FOR MANAGING CHOLESTEROL LEVELS TO WORK IN CONJUNCTION WITH AKT INHIBITORS, A CLASS OF DRUGS THAT TARGET A KEY PATHWAY INVOLVED IN CANCER CELL SURVIVAL AND GROWTH. RESEARCHERS DISCOVERED THAT THIS DRUG COMBINATION POTENTLY KILLED TRIPLE NEGATIVE BREAST CANCER (TNBC) CELLS IN PRECLINICAL MODELS. THE FINDINGS SUGGEST THE DRUG COMBINATION MAY PROVIDE A NEW, EFFECTIVE TREATMENT FOR TNBC, A SUBTYPE OF BREAST CANCER KNOWN FOR ITS AGGRESSIVENESS AND LIMITED TREATMENT OPTIONS AND THAT AFFECTS UP TO 15 PERCENT OF BREAST CANCER PATIENTS.THE BIDMC INVESTIGATORS AND THEIR COLLEAGUES USED A CRISPR-BASED SCREENING APPROACH IN TNBC TO IDENTIFY GENES THAT COULD BE TARGETED IN COMBINATION WITH A RECENTLY FDA-APPROVED AKT-INHIBITOR CALLED CAPIVASERTIB. THE SCREEN IDENTIFIED GENES IN CHOLESTEROL METABOLISM AS CANDIDATES, REVEALING A TNBC-SPECIFIC VULNERABILITY TO THE COMBINATION OF STATINSCHOLESTEROL-LOWERING DRUGS THAT TARGET CELLS' CHOLESTEROL METABOLISMAND AKT INHIBITORS.AS THE SCIENTISTS EXPECTED, THE COMBINATION KILLED TNBC CELLS IN A PANEL OF CELL LINES, PATIENT-DERIVED ORGANOIDS AND MOUSE MODELS. THE FINDINGS PAVE THE WAY FOR CLINICAL TRIALS TO DETERMINE THE SAFETY AND EFFECTIVENESS OF THIS COMBINATION IN PATIENTS. IF SUCCESSFUL, THIS BASIC, DISCOVERY SCIENCE APPROACH COULD LEAD TO A NEW TREATMENT OPTION FOR PATIENTS WITH TNBC, PROVIDING A MUCH-NEEDED ADVANCEMENT IN THE FIGHT AGAINST THIS AGGRESSIVE CANCER. RESEARCH AT JOSLIN DIABETES CENTER THE JOSLIN DIABETES CENTER (JDC), IN CONJUNCTION WITH ITS AFFILIATE THE JOSLIN CLINIC, PROVIDES WORLD CLASS LEADING EDGE PATIENT CARE IN THE SPECIALTY AREA OF DIABETES AND CARING FOR PATIENTS THROUGH A RELENTLESS TEAM OF CLINICIANS, SKILLED HEALTH EDUCATORS, AND ACCESS TO PIONEERING DIABETES RESEARCH. JOSLIN IS AFFILIATED WITH HARVARD MEDICAL SCHOOL AND OFFERS A RICH EDUCATIONAL ENVIRONMENT INVOLVING COURSES, LECTURES, FELLOWSHIP OPPORTUNITIES AND CME COURSES. JDC ALSO PROVIDES INFRASTRUCTURE, MANAGEMENT AND SUPPORT SERVICES TO ITS AFFILIATE, THE JOSLIN CLINIC. IN ADDITION, JOSLIN'S MISSION IS NOT ONLY TO PROVIDE OUTSTANDING PATIENT CARE, BUT ALSO TO BRING BEST PRACTICES TO THE LARGER MEDICAL COMMUNITY. JOSLIN ENGAGES IN RESEARCH RELATED TO BETTER UNDERSTANDING DIABETES, HOW TO TREAT IT AND HOW TO HELP PATIENTS MANAGE AND LIVE HEALTHIER LIVES WITH THE DISEASE. JOSLIN DIABETES RESEARCH CENTER IS ONE OF ONLY 16 NIH-DESIGNATED DIABETES RESEARCH CENTERS IN THE UNITED STATES. JOSLIN'S RESEARCH TEAM IS WORLD-RENOWNED AND PASSIONATE ABOUT IMPROVING THE LIVES OF PEOPLE WITH DIABETESMILLIONS OF PEOPLE WITH DIABETES THROUGHOUT THE WORLD BENEFIT DIRECTLY FROM BASIC AND CLINICAL RESEARCH CONDUCTED AT THE CENTER. APPROXIMATELY 300 RESEARCHERS EMPLOYED AT THE JOSLIN DIABETES CENTER ARE WORKING ON VARIOUS ASPECTS OF DIABETES, SEARCHING FOR WAYS TO PREVENT AND TREAT DIABETES IN ALL ITS FORMS AND ULTIMATELY FIND A CURE FOR THE DISEASE.THE RESEARCH ENGAGED IN AT JDC HELPS IMPROVES THE LIVES AT JDC, ACROSS BILH AND IN THE WIDER COMMUNITY BEYOND EASTERN MASSACHUSETTS AND SOUTHERN NEW HAMPSHIRE COMMUNITIES. AS NOTED ABOVE RELATED TO BIDMC, ALTHOUGH JOSLIN'S RESEARCH ACTIVITIES ARE NOT QUANTIFIED HERE IN THIS HOSPITAL'S FORM 990 SCHEDULE H, PART I, 7H, AS ALREADY NOTED, THESE ACTIVITIES ARE IMPORTANT TO THE COMMUNITIES SERVED BY THIS HOSPITAL, ALL OF BILH AND BEYOND. SOME EXAMPLES OF RESEARCH ENGAGED IN BY JOSLIN DURING THE PERIOD COVERED BY THIS FILING ARE BELOW. 1. MORE THAN HALF OF PATIENTS WITH VISION-THREATENING CONDITION UNAWARE THEY HAVE ITA LONG-RUNNING STUDY OF 27,000 PEOPLE WITH DIABETES SUGGESTS THERE'S A MAJOR COMMUNICATION GAP BETWEEN PATIENTS AND THEIR EYE CARE PROVIDERS. IN A TEN-YEAR OBSERVATIONAL STUDY, INVESTIGATORS AT JOSLIN DIABETES CENTER ASSESSED THE SELF-REPORTED AWARENESS OF THE PRESENCE OF DIABETIC RETINOPATHYA SERIOUS COMPLICATION OF BOTH TYPE 1 AND TYPE 2 DIABETESIN 26,876 PATIENTS WITH DIABETES WHO UNDERWENT RETINAL IMAGING DURING AN ENDOCRINOLOGY VISIT. THESE PARTICIPANTS WERE NOT RECEIVING EYE CARE AT JOSLIN.WITH PREVIOUS DIAGNOSTIC INFORMATION AVAILABLE FOR MORE THAN 94 PERCENT OF PARTICIPANTS, THE INVESTIGATORS FOUND SUBSTANTIAL DISCREPANCIESWHAT THEY CALL "LOW CONCORDANCE"BETWEEN PARTICIPANTS' CURRENT EYE HEALTH STATUS AND THEIR SELF-REPORTED EYE HEALTH. WHILE NEARLY ALL PATIENTS WITHOUT DIABETIC RETINOPATHY REPORTED NOT HAVING ANY EYE DISEASE, 89 PERCENT OF PATIENTS WITH MILD CASES AND 55 PERCENT OF PATIENTS WITH VISION-THREATENING DIABETIC RETINOPATHY ALSO REPORTED THAT THEY WERE UNAWARE OF ANY EYE DISEASE. A QUARTER OF THOSE WITH VISION-THREATENING DISEASE ALSO DID NOT REPORT PLANNED FOLLOWUP IN ACCORDANCE WITH NATIONAL GUIDELINES.INCREASING AWARENESS OF DIABETIC RETINOPATHY WAS LINKED TO INCREASING EYE CARE PROVIDER SPECIALIZATION. AMONG THOSE WITH VISION-THREATENING DIABETIC RETINOPATHY, PATIENTS WHO SAW A RETINA PHYSICIAN HAD HIGHEST AWARENESS OF THEIR DIABETIC RETINOPATHY AND THE HIGHEST CONCORDANCE WITH FOLLOW UP.2. PREVENTING BETA CELL DYSFUNCTIONDIABETES RESULTS FROM FAILURE OF BETA () CELLS IN PANCREATIC ISLETS TO RELEASE SUFFICIENT INSULIN TO REGULATE BLOOD SUGAR IN THE BODY. RESEARCHERS AT JOSLIN DIABETES CENTER REVEALED THAT THE CHRONICALLY HIGH SUGAR LEVELS THAT OCCUR EARLY DURING THE DEVELOPMENT OF DIABETES FURTHER UNDERMINE THE ABILITY OF BETA CELLS TO PRODUCE INSULIN BY REDUCING TRANSLATION OF SPECIFIC MRNAS THAT CONTAIN THE CELL'S GENETIC INSTRUCTIONS FOR MAKING AND SECRETING INSULIN. BLOCKING THIS RESPONSE TO HIGH SUGAR LEVELS COULD BE A NEW WAY TO PREVENT PROGRESSION OF EARLY DIABETES OR EVEN AN EFFECTIVE STRATEGY TO IMPROVE THE FUNCTION OF BETA CELLS IMPLANTED IN PATIENTS TO CURE DIABETES.THE TEAM LOOKED AT THE IMPACT OF SUSTAINED ELEVATED GLUCOSE LEVELS ON CELL MRNA TRANSLATION ACROSS THE ENTIRE GENOME USING HIGH-THROUGHPUT RIBOSOME PROFILING AND NASCENT PROTEOMICS IN MIN6 INSULINOMA CELLS AND THEN VERIFIED SPECIFIC CHANGES IN HUMAN ISLETS. THEY DEMONSTRATED THAT SUSTAINED HIGH GLUCOSE SELECTIVELY IMPAIRS TRANSLATION OF GENES THAT SERVE CRITICAL ROLES AT ALMOST EVERY STEP OF GLUCOSE METABOLISMCOUPLED INSULIN SECRETION IN PANCREATIC CELLS.THE RESEARCH UNCOVERED A TRANSLATIONAL REGULATORY CIRCUIT DURING CELL GLUCOSE TOXICITY THAT IMPAIRS EXPRESSION OF PROTEINS WITH CRITICAL ROLES IN CELL FUNCTION THAT MAY BE LEVERAGED TO DEVELOP NEW THERAPEUTIC STRATEGIES FOR THE TREATMENT OF DIABETES. 3. STUDY COMPARES THE EFFECTS OF BARIATRIC SURGERY VERSUS MEDICAL MANAGEMENT FOR PEOPLE WITH TYPE 2 DIABETES A LANDMARK STUDY CONDUCTED AT FOUR SITES, INCLUDING JOSLIN DIABETES CENTER, REPORTS THAT PEOPLE WITH TYPE 2 DIABETES WHO UNDERWENT BARIATRIC SURGERY ACHIEVED BETTER LONG-TERM BLOOD GLUCOSE CONTROL COMPARED TO PEOPLE WHO RECEIVED MEDICAL MANAGEMENT PLUS LIFESTYLE INTERVENTIONS. PARTICIPANTS WHO UNDERWENT BARIATRIC SURGERY, ALSO CALLED METABOLIC OR WEIGHT-LOSS SURGERY, WERE ALSO MORE LIKELY TO STOP NEEDING DIABETES MEDICATIONS AND HAD HIGHER RATES OF DIABETES REMISSION UP TO 12 YEARS POST-SURGERY. THE FINDINGS, PUBLISHED IN JAMA, SUGGEST THAT WEIGHT LOSS SURGERY MAY CARRY BENEFITS FOR PEOPLE WITH DIABETES, EVEN THOSE WHO ARE BELOW THE TRADITIONAL BMI THRESHOLD OF 35 FOR BARIATRIC SURGERY. AMONG THE FINDINGS, THE STUDY SHOWED THAT:- THE SURGERY GROUP EXPERIENCED AN AVERAGE 20 PERCENT WEIGHT LOSS COMPARED TO 8 PERCENT IN THE MEDICAL/LIFESTYLE GROUP.- THE PERCENT OF PARTICIPANTS USING MEDICATIONS TO TREAT DIABETES IN THE SURGERY GROUP DECREASED FROM 98 PERCENT TO 61 PERCENT YET REMAINED LARGELY UNCHANGED IN THE MEDICATION/LIFESTYLE GROUP.- 18 PERCENT OF PARTICIPANTS IN THE SURGERY GROUP WERE IN REMISSIONMEANING THEY NO LONGER REQUIRED MEDICATIONS TO CONTROL THEIR BLOOD GLUCOSE LEVELSFROM DIABETES, COMPARED TO 6 PERCENT OF PARTICIPANTS IN THE MEDICATION/LIFESTYLE GROUP.- THE RESULTS AND DIFFERENCES BETWEEN GROUPS REMAINED SIGNIFICANT AT 12 YEARS."WHEN WE TREAT DIABETES, WE'RE REALLY TRYING TO PREVENT COMPLICATIONS LIKE HEART DISEASE, KIDNEY DISEASE, STROKE, NERVE DAMAGE AND EYE DAMAGE," SAID SITE PI M. E. PATTI, ENDOCRINOLOGIST IN THE ADULT DIABETES SECTION, AND DIRECTOR OF THE HYPOGLYCEMIA CLINIC AT JOSLIN DIABETES CENTER. "WE AREN'T JUST LOOKING TO REDUCE BODY WEIGHT, WE ALSO WANT TO IMPROVE OVERALL HEALTH. THIS RANDOMIZED STUDY IS AN IMPORTANT MILESTONE SHOWING SURGERY PROVIDES SUSTAINED IMPROVEMENTS IN DIABETES CONTROL."4. SHIFTING FOCUS: INVESTIGATORS DESCRIBE CHANGES TO PANCREATIC CELL AT ONSET OF TYPE 1 DIABETESABOUT EIGHT MILLION PEOPLE LIVE WITH TYPE 1 DIABETES (T1D) WORLDWIDE, A CHRONIC AUTOIMMUNE CONDITION IN WHICH THE BODY ATTACKS AND DESTROYS ITS OWN INSULIN-PRODUCING -CELLS (PRONOUNCED "BETA") IN THE PANCREAS, LEADING TO A LACK OF INSULIN AND INABILITY TO REGULATE BLOOD SUGAR. IT'S NOT KNOWN WHY THE BODY SUDDENLY PERCEIVES ITS OWN -CELLS AS THE ENEMY; SOME LINES OF EVIDENCE SUGGEST ENVIRONMENTAL FACTORS SUCH AS VIRAL INFECTIONS MAY TRIGGER THE ONSET OF T1D, OTHERS SUGGEST GENETICS MAY ALSO PLAY SOME ROLE.GROUNDBREAKING RESEARCH BY INVESTIGATORS AT JOSLIN DIABETES CENTER SHEDS NEW LIGHT ON THE SPECIFIC CHANGES -CELLS GO THROUGH AT THE ONSET OF T1D. THEIR FINDINGSPUBLISHED IN NATURE CELL BIOLOGYOFFER NEW AVENUES FOR TARGETED INTERVENTIONS FOR THE CHRONIC AUTOIMMUNE CONDITION."IN THE FIELD OF TYPE 1 DIABETES, RESEARCH HAS LARGELY FOCUSED ON UNDERSTANDING THE IMMUNE COMPONENT, BUT OUR STUDY ARGUES THAT THE -CELL IS A SIGNIFICANT PLAYER," SAID ROHIT N. KULKARNI, MD, PHD, MARGARET A. CONGLETON CHAIR AND CO-HEAD OF THE SECTION ON ISLET & REGENERATIVE BIOLOGY AT JOSLIN DIABETES CENTER. "OUR FINDINGS SUGGEST THAT THE -CELL COULD BE INITIATING KEY EVENTS WHICH THEN PROMOTE THE AUTOIMMUNE MECHANISM TO GO AWRY. IT'S A PARADIGM SHIFTING APPROACH." 5. JOSLIN EXPERTS' PILOT STUDY SHOWS HYBRID CARE LEADS TO BETTER OUTCOMES FOR SOME WITH T1DFOR MOST YOUNG PEOPLE, LEAVING HOME AND LIVING INDEPENDENTLY FOR THE FIRST TIME MEANS SUDDENLY HAVING TO MANAGE THEIR OWN HEALTH, FROM SCHEDULING REGULAR DOCTOR APPOINTMENTS TO PREPARING HEALTHY MEALS. FOR YOUNG ADULTS WITH TYPE 1 DIABETES (T1D) WHO MUST MANAGE THEIR BLOOD SUGAR LEVELS 24/7 ON THEIR OWN, THE STAKES ARE ESPECIALLY HIGH. EVIDENCE SUGGESTS YOUNG ADULTS WITH T1D WITH SUBOPTIMAL GLYCEMIC CONTROL ARE AT HIGH RISK OF HOSPITALIZATION AND LONG-TERM COMPLICATIONS.TO ADDRESS MANY OF THE CHALLENGES TO DIABETES MANAGEMENT FACED BY YOUNG ADULTS WITH T1D, RESEARCHERS AT JOSLIN DIABETES CENTER DEVELOPED A PROGRAM THAT LEVERAGES TELEHEALTH AND PROVIDES SUPPORT FROM DEDICATED CASE MANAGERS WHO SERVE AS LIAISONS BETWEEN PATIENTS AND THEIR CARE TEAMS. IN A PAPER PUBLISHED IN ENDOCRINE PRACTICE, THE RESEARCHERS REPORTED THAT THEIR PILOT PROGRAM, KNOWN AS LEVERAGING INTENSIVE FOLLOW-UP TREATMENT IN YOUNG ADULTS (LIFT-YA) WAS ASSOCIATED WITH IMPROVED GLYCEMIC CONTROL AND AN INCREASE IN ADOPTION OF CONTINUOUS GLUCOSE MONITORS (CGM)TWO KEYS TO IMPROVED OUTCOMES FOR YOUNG ADULTS WITH DIABETES.AT THE END OF THE PILOT STUDY, THE RESEARCHERS COMPARED OUTCOMES OF THOSE ABLE TO COMPLETE THE PROGRAM AND THOSE ABLE TO ATTEND FEWER THAN HALF THE MEETINGS, AS WELL AS 33 PEOPLE WHO DID NOT PARTICIPATE. AS EXPECTED, THE "COMPLETERS" HAD A SIGNIFICANTLY HIGHER NUMBER OF TOTAL VISITS THAN THE OTHER TWO GROUPS.SIMILARLY, THE NUMBER OF CGM USERS INCREASED DRAMATICALLY BY 70 PERCENT AMONG THE COMPLETERS BUT REMAINED UNCHANGED IN THE OTHER TWO GROUPS. LIKEWISE, THE COMPLETERS SAW SIGNIFICANT REDUCTION IN THEIR HBA1C LEVELS, A MEASURE OF BLOOD SUGAR, WITHIN THEIR GROUP. "WE BELIEVE THE EFFORTS OF THE CASE MANAGERS TO OVERCOME OPERATIONAL HURDLES AND OTHER CLINICAL CHALLENGES BY COORDINATING EFFECTIVE COMMUNICATION BETWEEN PARTICIPANTS AND THE MULTIDISCIPLINARY CARE TEAM WERE PART OF THE REASON WE SAW THESE POSITIVE OUTCOMES," TOSCHI SAID. "LEVERAGING FREQUENT TELEHEALTH-BASED VISITS AND THE ANCHORING ROLE OF THE CASE MANAGERS PROVIDED ACTIONABLE SOLUTIONS FOR AT LEAST SOME OF THE SELF-REPORTED BARRIERS TO DIABETES CARE IN YOUNG ADULTS WITH T1D.SELECTED JOSLIN PUBLICATIONS FYE 9/30/24- HYBRID CARE MODEL: COMBINING TELEMEDICINE AND OFFICE VISITS FOR DIABETES MANAGEMENT IN OLDER ADULTS WITH TYPE 1 DIABETESMED RES ARCH / SEP 30 2024BILH AUTHORS ELENA TOSCHI, ATIF ADAM, REBECCA HURLBERT, CHRISTINE SLYNE, LORI LAFFEL, MEDHA MUNSHI - ROLE OF DIVALENT CATIONS IN INFECTIONS IN HOST-PATHOGEN INTERACTIONINT J MOL SCI / SEP 10 2024BILH AUTHORS JOHN A D'ELIA, LARRY A WEINRAUCH- CHARACTERIZING VASCULAR WALL AND LUMEN CALIBER IN EYES WITH DIABETIC RETINOPATHY BASED ON ADAPTIVE OPTICS SCANNING LASER OPHTHALMOSCOPYDIAGNOSTICS (BASEL) / SEP 12 2024BILH AUTHORS KONSTANTINA SAMPANI, JENNIFER K SUN-CAN INTRANASAL NALOXONE PREVENT HYPOGLYCEMIA-ASSOCIATED AUTONOMIC FAILURE?J CLIN ENDOCRINOL METAB / SEP 27 2024BILH AUTHORS HAMAYLE SAEED, MARY-ELIZABETH PATTI-M6A MRNA METHYLATION BY METTL14 REGULATES EARLY PANCREATIC CELL DIFFERENTIATIONEMBO J / SEP 25 2024BILH AUTHORS SEVIM KAHRAMAN, DARIO F DE JESUS, NATALIE K BROWN, JIANG HU, ROHIT N KULKARNI-EXERCISE ACTIVATES AMPK IN MOUSE AND HUMAN PANCREATIC ISLETS TO DECREASE SENESCENCENAT METAB / SEP 24 2024BILH AUTHORS PRISCILA CARAPETO, KANAKO IWASAKI, FRANCESKO HELA, JIHO KAHNG, ANA B ALVES-WAGNER, ROELAND J W MIDDELBEEK, MICHAEL F HIRSHMAN, LAURIE J GOODYEAR, CRISTINA AGUAYO-MAZZUCATO- POSTPRANDIAL METABOLOMICS ANALYSIS REVEALS DISORDERED SEROTONIN METABOLISM IN POST-BARIATRIC HYPOGLYCEMIAJ CLIN INVEST / SEP 12 2024BILH AUTHORS RAFAEL FERRAZ-BANNITZ, BERKCAN OZTURK, CAMERON CUMMINGS, VISSARION EFTHYMIOU, PILAR CASANOVA QUEROL, LINDSAY POULOS, HANNA WANG, VALERIE NAVARRETE, HAMAYLE SAEED, CHRISTOPHER M MULLA, HUI PAN, JONATHAN M DREYFUSS, MARY-ELIZABETH PATTI - CIRCULATING METABOLITE BIOMARKERS OF GLYCEMIC CONTROL IN YOUTH-ONSET TYPE 2 DIABETESJAMA OPHTHALMOL / SEP 1 2024BILH AUTHORS CHANG LU, JONATHAN M DREYFUSS, SHUNING ZHENG, DANIELLE WOLFS, ELVIRA ISGANAITIS- ULTRA-WIDEFIELD AND EARLY TREATMENT DIABETIC RETINOPATHY STUDY 7-FIELD GRADING OF DIABETIC RETINOPATHYJAMA OPHTHALMOL / SEP 2 2024BILH AUTHORS LLOYD PAUL AIELLO, JENNIFER K SUN- ASSESSMENT OF BASELINE ULTRAWIDEFIELD FLUORESCEIN ANGIOGRAPHIC QUANTITATIVE LEAKAGE PARAMETERS WITH ULTRAWIDEFIELD FUNDUS FEATURES AND CLINICAL PARAMETERS IN DIABETIC RETINOPATHY IN PROTOCOL AAOPHTHALMOL RETINA / AUG 30 2024BILH AUTHORS JENNIFER K SUN- NEURODEGENERATIVE BIOMARKERS IN DIFFERENT CHAMBERS OF THE EYE RELATIVE TO PLASMA: AN AGREEMENT VALIDATION STUDYALZHEIMERS RES THER / AUG 26 2024BILH AUTHORS KONSTANTINA SAMPANI- WHAT REALLY MATTERS?: HOW INSULIN DOSE, TIMING, AND DISTRIBUTION RELATE TO MEAL COMPOSITION IN FREE-LIVING PEOPLE WITH TYPE 1 DIABETESDIABETES TECHNOL THER / AUG 22 2024BILH AUTHORS ELENA TOSCHI, ASTRID ATAKOV-CASTILLO - ENDOTHELIN 3/EDNRB SIGNALING INDUCES THERMOGENIC DIFFERENTIATION OF WHITE ADIPOSE TISSUENAT COMMUN / AUG 22 2024BILH AUTHORS CHIH-HAO WANG, TADATAKA TSUJI, TIAN LIAN HUANG, MARI SATO, FARNAZ SHAMSI, YU-HUA TSENG- SCREENDMT REVEALS DIHOMES ARE REPLICABLY INVERSELY ASSOCIATED WITH BMI AND STIMULATE ADIPOCYTE CALCIUM INFLUXCOMMUN BIOL / AUG 14 2024BILH AUTHORS JONATHAN M DREYFUSS, HUI PAN - LIGHT-RESPONSIVE ADIPOSE-HYPOTHALAMUS AXIS CONTROLS METABOLIC REGULATIONNAT COMMUN / AUG 8 2024BILH AUTHORS TADATAKA TSUJI, YANG ZHANG, TIAN LIAN HUANG, HENRIQUE CAMARA, MEGHAN HALPIN, MATTHEW D LYNES- MATRISOME PROTEOMICS REVEALS NOVEL MEDIATORS OF MUSCLE REMODELING WITH AEROBIC EXERCISE TRAININGMATRIX BIOL PLUS / AUG 7 2024BILH AUTHORS PATTARAWAN PATTAMAPRAPANONT, EILEEN M COONEY, TARA L MACDONALD, HUI PAN, JONATHAN M DREYFUSS, SARAH J LESSARD- LIGNAN INTAKE AND TYPE 2 DIABETES INCIDENCE AMONG US MEN AND WOMENJAMA NETW OPEN / AUG 1 2024BILH AUTHORS QI SUN- EVERYTHING YOU WANTED TO KNOW ABOUT PANCREATIC DUCTS BUT DIDN'T KNOW WHERE TO LOOKGASTROENTEROLOGY / JUL 31 2024BILH AUTHORS ROHIT KULKARNI- FENOFIBRATE SHOWS PROMISE IN SLOWING DIABETIC RETINOPATHY PROGRESSIONNEJM EVID / JUL 23 2024BILH AUTHORS PAOLO S SILVA, LLOYD PAUL AIELLO- THE ARDUOUS PATH TOWARD EQUITABLE ACCESS TO ENDOCRINOLOGY CAREJ ENDOCR SOC / JUL 15 2024BILH AUTHORS GIULIO R ROMEO, TIZIANA CAPUTO- EXPRESSION PROFILING BY HIGH-THROUGHPUT SEQUENCING REVEALS GADD45, SMAD7, EGR-1 AND HOXA3 ACTIVATION IN MYOSTATIN (MSTN) AND GDF11 TREATED MYOBLASTSGENET MOL BIOL / JUL 15 2024BILH AUTHORS AMY J WAGERS- EXERCISE TRAINING AND COLD EXPOSURE TRIGGER DISTINCT MOLECULAR ADAPTATIONS TO INGUINAL WHITE ADIPOSE TISSUECELL REP / JUL 13 2024BILH AUTHORS MARIA VAMVINI, PASQUALE NIGRO, TIZIANA CAPUTO, KRISTIN I STANFORD, MICHAEL F HIRSHMAN, ROELAND J W MIDDELBEEK, LAURIE J GOODYEAR- MULTI-STEP REGULATION OF MICRORNA EXPRESSION AND SECRETION INTO SMALL EXTRACELLULAR VESICLES BY INSULINCELL REP / JUL 13 2024BILH AUTHORS MARSEL LINO, RUBEN GARCIA-MARTIN, VITOR ROSETTO MUOZ, GABRIEL PALERMO RUIZ, ALLAH NAWAZ, BRUNA BRASIL BRANDO, JONATHAN DREYFUS, HUI PAN, C RONALD KAHN- IMPACT OF A TUBELESS, DISPOSABLE INSULIN PUMP ON EMERGENCY DEPARTMENT VISITS AND INPATIENT ADMISSIONS AMONG A MEDICARE POPULATIONJ MANAG CARE SPEC PHARM / JUN 17 2024BILH AUTHORS MEDHA N MUNSHI- RATIONALE OF BASIC AND CELLULAR MECHANISMS CONSIDERED IN UPDATING THE STAGING SYSTEM FOR DIABETIC RETINAL DISEASEOPHTHALMOL SCI / MAR 27 2024BILH AUTHORS WARD FICKWEILER, GEORGE KING, LLOYD PAUL AIELLO FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS, FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL EDUCATION AS NOTED THROUGHOUT THIS FORM 990, EXETER HOSPITAL IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES. ALTHOUGH EXETER HOSPITAL DOES NOT DIRECTLY ENGAGE IN HEALTH PROFESSIONS EDUCATION / GRADUATE MEDICAL EDUCATION, BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), LAHEY CLINIC HOSPITAL, NEW ENGLAND BAPTIST HOSPITAL AND MOUNT AUBURN HOSPITAL ALL ENGAGE IN EDUCATIONAL ACTIVITIES DESIGNED TRAIN FUTURE PHYSICIANS AND OTHER FUTURE HEALTHCARE PRACTITIONERS. ACROSS BILH HOSPITALS, COSTS FOR TRAINING MEDICAL PROFESSIONALS EXCEEDED $210 MILLION. REIMBURSEMENT FROM MEDICARE FOR THESE ACTIVITIES WAS APPROXIMATELY $67 MILLION WHICH LEFT A COMBINED SHORTFALL RELATED TO THESE ACTIVITIES ACROSS BILH OF OVER $143 MILLION WHICH IS AN INVESTMENT IN THE HEALTH SYSTEM OF TOMORROW. ALTHOUGH THE EDUCATIONAL ACTIVITIES OF THESE BILH AFFILIATES ARE NOT QUANTIFIED HERE IN EXETER HOSPITAL'S FORM 990 SCHEDULE H, PART I, 7F, AS ALREADY NOTED THESE ACTIVITIES ARE IMPORTANT TO THE COMMUNITIES SERVED BY EXETER HOSPITAL AND BEYOND. IN ADDITION, INFORMATION ON THE TEACHING ACTIVITIES AT BIDMC, A SISTER ENTITY TO EXETER HOSPITAL, DURING THE PERIOD COVERED BY THIS FILING, IS INCLUDED BELOW. THE MEDICAL CENTER'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE THE MEDICAL CENTER A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. THE MEDICAL CENTER TRAINS HUNDREDS OF MEDICAL STUDENTS, INTERNS, RESIDENTS AND FELLOWS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 63 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 736 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 43 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 47 TRAINEES PER YEAR. STAFF PHYSICIANS AT THE MEDICAL CENTER WHO HOLD FACULTY APPOINTMENTS AT HARVARD MEDICAL SCHOOL INSTRUCT THE DOCTORS OF TOMORROW THROUGH SUPERVISION OF THEIR DAILY PATIENT CARE AND A RANGE OF INTERACTIVE LEARNING EXPERIENCES. CORE CLINICAL TRAINING PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS:- ANESTHESIOLOGY- EMERGENCY MEDICINE- EAR, NOSE AND THROAT (OTOLARYNGOLOGY)- INTERNAL MEDICINE- NEUROLOGY- NEUROSURGERY- OBSTETRICS AND GYNECOLOGY- PATHOLOGY- PLASTIC SURGERY - PSYCHIATRY- RADIOLOGY- SURGERY- TRANSITIONAL YEAR- UROLOGYRESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. MORE THAN HALF OF THESE PROGRAMS (47 OF 91) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS:- ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, ANESTHESIA FOR OUTPATIENT SURGERY, CRITICAL CARE MEDICINE, NEUROANESTHESIA, NEURO CRITICAL CARE, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA, PATIENT SAFETY AND QUALITY IMPROVEMENT IN ANESTHESIA, ANESTHESIA MEDICAL EDUCATION, ADVANCED CRITICAL CARE AND ULTRASOUND- DERMATOLOGY: CUTANEOUS ONCOLOGY, DERMATOLOGY RESEARCH FELLOWSHIP IN CLINICAL TRIALS AND OUTCOMES RESEARCH (CLEARS)- EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, MEDICAL EDUCATION IN EMERGENCY MEDICINE- INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOCRINE, DIABETES AND METABOLISM, ADVANCED ENDOSCOPY, ADVANCED INFECTIOUS DISEASE, ADVANCED NEPHROLOGY, CARDIAC MAGNETIC RESONANCE IMAGING, CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GERIATRIC AND DIABETES, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND MEDICAL ONCOLOGY, HEPATOLOGY, HOSPICE AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, STRUCTURAL HEART DISEASE, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY- NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY, NEURO CRITICAL CARE- OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, GYNECOLOGIC ONCOLOGY, MATERNAL FETAL MEDICINE, REPRODUCTIVE ENDOCRINOLOGY, UROGYNECOLOGY AND PELVIC RECONSTRUCTIVE SURGERY.- PATHOLOGY: BLOOD BANKING/TRANSFUSION MEDICINE, CYTOPATHOLOGY, DERMATOPATHOLOGY, HEMATOPATHOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY CPEP, NEUROPATHOLOGY, SELECTIVE PATHOLOGY - PSYCHIATRY: EARLY PSYCHOSIS, CONSULT LIAISON PSYCHIATRY- RADIOLOGY: DIAGNOSTIC, ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED, MRI, MUSCULOSKELETAL IMAGING (MSK), NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, ADVANCED CROSS-SECTIONAL IMAGING. - RADIATION ONCOLOGY: BRACHYTHERAPY, STEREOTATIC- SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, ACUTE CARE SURGERY, ANTERIOR SEGMENT OPHTHALMOLOGY, COLON AND RECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, HEAD & NECK SURGICAL ONCOLOGY & RECONSTRUCTION, INTERDISCIPLINARY BREAST SURGERY, LYMPHATIC SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, OTOLARYNGOLOGY FELLOWSHIP, PLASTIC SURGERY, PLASTIC SURGERY/AESTHETIC RECONSTRUCTION, PLASTIC SURGERY/BREAST RECONSTRUCTION, PODIATRY, SURGICAL CRITICAL CARE, THORACIC SURGERY, UROLOGY, UROLOGY MALE INFERTILITY/SEXUAL DYSFUNCTION, VASCULAR SURGERY, VASCULAR SURGERY-INTEGRATED, JOINTS FELLOWSHIP ADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS -- EXAMPLES BELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT THE MEDICAL CENTER:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY AT BIDMCTHE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HEALTH ALLIANCE, TUFTS MEDICAL CENTER, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL, SOUTH SHORE HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM.THE EDUCATIONAL GOALS OF THE RESIDENCY ARE TO PROMOTE EXCELLENCE IN THE CLINICAL, ACADEMIC, AND ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE. RESIDENTS ARE TAUGHT HOW TO BE OUTSTANDING CLINICIANS. THIS IS ACCOMPLISHED THROUGH CLINICAL EXPERIENCE IN SEVERAL BUSY EMERGENCY DEPARTMENTS AS WELL AS THROUGH A HIGH QUALITY DIDACTIC PROGRAM. DURING THE CLINICAL EXPERIENCE, THE RESIDENTS ARE CLOSELY SUPERVISED AND GIVEN GRADED RESPONSIBILITY FOR PATIENT CARE AND ULTIMATELY FOR PATIENT FLOW IN THE EMERGENCY DEPARTMENT. ADDITIONALLY, RESIDENTS ARE TAUGHT HOW TO SUPERVISE MEDICAL STUDENTS AND OTHER RESIDENTS AND HOW TO TEACH THE PRACTICE OF EMERGENCY MEDICINE. RESIDENTS TEACH MEDICAL STUDENTS AND PREHOSPITAL PERSONNEL AND CONTRIBUTE TO THE DIDACTIC PROGRAM. SENIOR RESIDENTS TAKE ON THE RESPONSIBILITY OF SUPERVISING JUNIOR RESIDENTS IN THE CLINICAL ARENA. THE FOCUS OF THE RESIDENCY PROGRAM IS ON TEACHING THE LEADERSHIP SKILLS NECESSARY TO DIRECT A BUSY EMERGENCY DEPARTMENT IN ANY SETTING.THE OTHER MAJOR EDUCATIONAL GOAL OF THE RESIDENCY IS TO DEVELOP THE RESEARCH AND ACADEMIC SKILLS REQUIRED FOR A CAREER IN ACADEMIC EMERGENCY MEDICINE. PARTICIPATION IN RESEARCH IS PROMOTED THROUGH A SYSTEM OF MENTORSHIP, JOURNAL CLUB PARTICIPATION, AND A DIDACTIC PROGRAM THAT TEACHES RESEARCH DESIGN AND STATISTICAL METHODS. RESIDENTS ARE REQUIRED TO COMPLETE A RESEARCH OR ACADEMIC PROJECT THAT RESULTS IN A PAPER SUITABLE FOR PUBLICATION. FUNDING IS AVAILABLE WITHIN THE DIVISION OF EMERGENCY MEDICINE AT HARVARD MEDICAL SCHOOL AND THE DEPARTMENT OF EMERGENCY MEDICINE AT BIDMC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BIDMC HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY. THROUGH AN EMS/ADMINISTRATIVE ROTATION AND A LONGITUDINAL EXPERIENCE IN PREHOSPITAL ADMINISTRATION, RESIDENTS GAIN EXPERIENCE IN RUNNING A LOCAL PREHOSPITAL SYSTEM.THIS PROGRAM TAKES ADVANTAGE OF THE UNIQUE ACADEMIC OPPORTUNITIES AT HARVARD MEDICAL SCHOOL, THE HARVARD TEACHING HOSPITALS, AND THE HARVARD SCHOOL OF PUBLIC HEALTH. THESE OPPORTUNITIES INCLUDE THE OUTSTANDING EXPERIENCE AVAILABLE THROUGH BOSTON CHILDREN'S HOSPITAL AND THE DEPARTMENTS OF MEDICINE, SURGERY, OBSTETRICS AND GYNECOLOGY, AND ANESTHESIA AT BETH ISRAEL DEACONESS MEDICAL CENTER. INTERNAL MEDICINE EDUCATION AT BIDMC THE GOAL OF THIS PROGRAM IS TO DEVELOP EACH RESIDENT'S JUDGMENT AND SKILLS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE. THE MEDICAL CENTER TRAINS RESIDENTS AS ACADEMIC INTERNISTS AND PROVIDES THE FOUNDATION FOR THE PRACTICE OF INTERNAL MEDICINE OR FOR SUBSEQUENT CLINICAL AND RESEARCH TRAINING IN MEDICAL SUBSPECIALTIES. RESIDENTS ARE EXPOSED TO A WIDE ARRAY OF PATIENTS IN VARIOUS INPATIENT AND OUTPATIENT SETTINGS, INCLUDING DIFFERENT UNITS WITHIN BIDMC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BIDMC AND IS COMPRISED OF FORMAL AND INFORMAL DAILY ROUNDS AND NOONTIME CONFERENCES. THIS TEACHING PROVIDES THE BASIS OF AN ORGANIZED CURRICULUM FOR ALL MEDICAL INTERNS AND RESIDENTS AT BIDMC.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR "AMBULATORY BLOCKS" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD AND FOURTH YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.JUNIOR AND SENIOR RESIDENCYRESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSESTAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL "TRACKS" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: - RESIDENTS ARE IN CHARGE OF RUNNING WARD ROUNDS. MEDICAL STUDENTS AND INTERNS PRESENT TO THE RESIDENT DURING ROUNDS. THE ATTENDING HOSPITALIST IS CONSIDERED THE RESIDENT'S CONSULTANT, WITH THE RESIDENT RETAINING THE PRIMARY DECISION-MAKING ROLE FOR THE PATIENTS ON THEIR SERVICE.- DURING THE MONTHS ON MEDICAL WARDS, THE CHIEF RESIDENTS AND FIRM CHIEFS ARE ASSIGNED TO DO WALK ROUND ONCE EACH WEEK WITH ONE OF THE RESIDENTS ON THEIR FIRM. THEY WILL OBSERVE THE RESIDENT RUNNING THE WARD ROUNDS AND PROVIDE FEEDBACK ON THE TEACHING SKILLS OBSERVED DURING ROUNDS.LEADING TEACHING ATTENDING ROUNDS: - DURING EVERY ROTATION ON THE MEDICAL WARDS, EACH RESIDENT WILL LEAD ONE TO THREE ATTENDING ROUNDS SESSIONS. THE TWO TEACHING ATTENDINGS HELP PROVIDE FEEDBACK ON THE RESIDENT'S SMALL GROUP DISCUSSION AND TEACHING SKILLS. SMALL GROUP PRESENTATIONS: - DURING AMBULATORY WEEKS, RESIDENTS WILL LEAD A MAJORITY OF THE PRE-CLINIC CONFERENCES, TYPICALLY PRESENTING EITHER A CHALLENGING AMBULATORY CASE OR AMBULATORY-BASED TOPIC.- ONCE DURING RESIDENCY, EACH JUNIOR RESIDENT WILL ALSO PRESENT A JOURNAL ARTICLE OF AMBULATORY CARE SIGNIFICANCE AT AMBULATORY JOURNAL CLUB TO A SMALL GROUP OF THEIR PEERS. INTERNAL MEDICINE GLOBAL HEALTH PROGRAMOUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS.PROGRAM OBJECTIVES - INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS - CONTRIBUTE TO THE HEALTH AND WELL-BEING OF POPULATIONS AROUND THE WORLD - ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS - EXPAND RESEARCH OPPORTUNITIES - ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS - BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. - VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. - ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH. NEUROLOGY EDUCATION AT BIDMC THE HARVARD MEDICAL SCHOOL NEUROLOGY PROGRAM AT BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL IN BOSTON, MASSACHUSETTS WAS FOUNDED IN 1996 AS THE SUCCESSOR TO THE HARVARD-LONGWOOD NEUROLOGY PROGRAM. THE PROGRAM CONCENTRATES ON THE TRAINING AND RESEARCH OPPORTUNITIES AVAILABLE ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS, BY COMBINING THE RESOURCES OF TWO MAJOR HARVARD TEACHING HOSPITALS, BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL. THESE COMBINED HOSPITALS, WITH OVER 800 INPATIENT BEDS AND EXTENSIVE OUTPATIENT CLINICS, PROVIDE THE SETTING FOR TRAINING PHYSICIANS IN THE ART AND SCIENCE OF CLINICAL NEUROLOGY.THE COMBINED FACULTY CONSISTS OF MORE THAN 80 NEUROLOGISTS AT THE TWO PARTICIPATING HOSPITALS, AND PROVIDES CORE EXPERIENCES IN INPATIENT AND OUTPATIENT NEUROLOGY, AS WELL AS TRAINING IN ELECTROPHYSIOLOGY (INCLUDING EEG, EMG, AND SLEEP POLYSOMNOGRAPHY) AND NEUROPATHOLOGY. THE KEY DISTINGUISHING FEATURE OF THE PROGRAM IS THE CLOSE RELATIONSHIP BETWEEN THE CLINICAL FACULTY, NEARLY ALL OF WHOM ARE FULL-TIME ACADEMIC NEUROLOGISTS ENGAGED IN SUBSTANTIVE RESEARCH AND TEACHING EFFORTS, AND A SELECT GROUP OF RESIDENTS WHO ARE KEENLY INTERESTED IN FORGING ACADEMIC CAREERS IN NEUROLOGY. VIRTUALLY ALL OF THE CLINICAL TRAINING TAKES PLACE WITHIN A 2 BLOCK RADIUS ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS. A CRITICAL COMPONENT OF THE PROGRAM IS THE OPPORTUNITY FOR RESIDENTS TO HAVE A MENTORED TEACHING EXPERIENCE AS WELL AS THE OPPORTUNITY TO UNDERTAKE A MENTORED PROJECT, WHICH MAY ENTAIL EITHER CLINICAL OR LABORATORY BASED INVESTIGATION OR PREPARATION OF INNOVATIVE TEACHING MATERIALS OR METHODS. PATHOLOGY EDUCATION AT BIDMCTHE DEPARTMENT OF PATHOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS COMMITTED TO PROVIDING STATE-OF-THE-ART TRAINING TO PREPARE PHYSICIANS FOR LEADERSHIP ROLES IN PATHOLOGY AND ACADEMIC MEDICINE. THE PROGRAM OFFERS THREE RESIDENT TRAINING PATHWAYS: FIRST, A COMBINED ANATOMIC PATHOLOGY/CLINICAL PATHOLOGY (AP/CP) PATHWAY PROVIDES COMPREHENSIVE TRAINING IN ALL AREAS OF TISSUE DIAGNOSTICS AND LABORATORY MEDICINE. SECOND, THE AP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS ACADEMIC SURGICAL PATHOLOGISTS. THIRD, THE CP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS FUTURE LEADERS IN LABORATORY MEDICINE. ALL PATHWAYS INCLUDE EXTENSIVE OPPORTUNITIES TO PARTICIPATE IN RESEARCH PROJECTS WITH WORLD-RENOWNED EXPERTS IN PATHOLOGY OR RELATED DISCIPLINES. KNOWLEDGE COMES THROUGH EXPERIENCE AND EXTENSIVE INTERACTION WITH FACULTY. IN ANATOMIC PATHOLOGY SIGN OUT, RESIDENTS PREPARE THEIR OWN DIAGNOSES AND ARE THEN IN A POSITION TO TAKE FULL ADVANTAGE OF SIGN OUT WITH STAFF MEMBERS. IN CLINICAL PATHOLOGY, RESIDENTS GAIN EXPERIENCE DURING DAILY ROUNDS WITH ATTENDINGS, SOCRATIC TUTORIALS, AND THROUGH POSITIONING OF RESIDENTS AS AN INTERMEDIARY BETWEEN CLINICIAN AND LABORATORY. THERE ARE DAILY TEACHING AND CASE MANAGEMENT CONFERENCES COVERING THE DIFFERENT PATHOLOGY SPECIALTIES. GIVEN THE IMPORTANT ROLE PATHOLOGISTS PLAY IN TEACHING MEDICAL STUDENTS AND COLLEAGUES IN OTHER SPECIALTIES, THE PROGRAM PROVIDES GUIDANCE FOR RESIDENTS AS THEY HONE THEIR TEACHING SKILLS. SUCH "RESIDENT-AS-TEACHER" PROGRAMS ARE COMMON IN OTHER SPECIALTIES BUT NOT AS WELL-DEVELOPED IN PATHOLOGY. THE CURRICULUM INCLUDES SESSIONS DESIGNED TO IMPROVE SKILLS RELATED TO GIVING FEEDBACK AND SMALL GROUP TEACHING. THERE IS A SESSION ON DEVELOPING PRESENTATION SKILLS WITH CLOSE MENTORING OF FIRST YEAR RESIDENTS, BY SPECIFIC FACULTY WHO HAVE ALSO BEEN THROUGH THE CURRICULUM, AS THEY PREPARE FOR THEIR FIRST PRESENTATION. THERE ARE ALSO OPPORTUNITIES FOR RESIDENTS TO TEACH MEDICAL STUDENTS BOTH WITHIN OUR DEPARTMENT AND AT HARVARD MEDICAL SCHOOL, AS WELL AS TO RECEIVE FEEDBACK ON THEIR TEACHING SKILLS. RECOGNIZING THE NEED TO INTEGRATE TECHNOLOGY INTO RESIDENCY TRAINING, ALL FIRST YEAR RESIDENTS ARE PROVIDED WITH IPADS. THESE TABLETS ALLOW RESIDENTS TO MORE EASILY PREVIEW THE SLIDES THAT ARE ROUTINELY SCANNED FOR OUR SURGICAL SLIDE CONFERENCE. GENOMIC TECHNOLOGY WILL AFFECT THE PRACTICE OF ALL MEDICAL PRACTITIONERS. AS THE PHYSICIANS WHO MANAGE THE HOSPITAL LABORATORIES, PATHOLOGISTS MUST UNDERSTAND NEXT-GENERATION SEQUENCING TECHNOLOGY AND ITS APPLICATION TO PATIENT CARE. IN 2009, THE PROGRAM CREATED, TO OUR KNOWLEDGE, THE FIRST GENOMIC PATHOLOGY CURRICULUM IN THE COUNTRY. THE CURRICULUM HAS BEEN PUBLISHED AND HAS SERVED AS THE BASIS FOR A COLLABORATIVE EFFORT TO DEVELOP A NATIONAL GENOMICS CURRICULUM (WWW.ASCP.ORG/TRIG).TRAINING IN EVIDENCE-BASED MEDICINE IS CRITICAL. A FIRST-YEAR RESIDENT JOURNAL CLUB ALLOWS AN INTRODUCTION TO CRITICAL REVIEW OF THE MEDICAL LITERATURE. IN LATER YEARS, RESIDENTS LEAD SMALL-GROUP DISCUSSIONS IN MONTHLY JOURNAL CLUBS. THERE IS ALSO AN EVIDENCE-BASED TRANSFUSION MEDICINE CURRICULUM TO HONE THESE SKILLS DURING CP TRAINING. RADIOLOGY EDUCATION AT BIDMC THE RADIOLOGY RESIDENCY PROVIDES FOUR YEARS OF TRAINING IN DIAGNOSTIC IMAGING. APPOINTMENTS ARE HELD JOINTLY AS A RESIDENT AT THE MEDICAL CENTER AND AS A CLINICAL FELLOW AT HARVARD MEDICAL SCHOOL. WITH A CENTRAL ROLE IN CLINICAL SERVICE, TEACHING, AND RESEARCH, THE RADIOLOGY DEPARTMENT PERFORMS OVER 400,000 RADIOLOGIC EXAMINATIONS EACH YEAR. THE DEPARTMENT PROVIDES RADIOGRAPHY, CT, ULTRASOUND, MRI, NUCLEAR MEDICINE, MAMMOGRAPHY, ANGIOGRAPHY, AND INTERVENTIONAL RADIOLOGY SERVICES TO BOTH THE MEDICAL CENTER AS WELL AS OUR AFFILIATED HEALTH CARE FACILITIES. A RADIOLOGY RESEARCH AND ANIMAL LABORATORY IS HOUSED ADJACENT TO THE RADIOLOGY DEPARTMENT. ALL RESIDENTS, FELLOWS, AND FACULTY HAVE APPOINTMENTS AT HARVARD MEDICAL SCHOOL. ALL RADIOLOGIC STUDIES ARE INTERPRETED UNDER THE SUPERVISION OF STAFF RADIOLOGISTS. THE NUCLEAR MEDICINE PROGRAM IS A PART OF THE JOINT PROGRAM IN NUCLEAR MEDICINE AT HARVARD MEDICAL SCHOOL. THE DEPARTMENT PLACES STRONG EMPHASIS ON THE QUALITY OF TEACHING-BOTH IN DIDACTIC LECTURES AND IN INDIVIDUAL CASE-BASED TEACHING.WITH THE ADVENT OF RECENT CHANGES IN RESIDENCY TRAINING, THE CURRICULUM HAS RECENTLY BEEN REVISED SO THAT RESIDENTS UNDERTAKE A COURSE OF STUDY WHICH WILL PERMIT THEM TO OBTAIN EXPERTISE NOT JUST IN CLINICAL SUBSPECIALTIES BUT ALSO IN OTHER KEY AREAS SUCH AS RESEARCH, EDUCATION, GLOBAL HEALTH, QUALITY IMPROVEMENT, AND HEALTH POLICY. RADIOLOGIC PHYSICS HAS BEEN INTEGRATED INTO DAILY DIDACTIC SESSIONS. IN ADDITION, MANY DIDACTIC SESSIONS UTILIZE AUDIENCE RESPONSE TECHNOLOGY, VIDEO-RECORDING, AND IPAD2 TECHNOLOGY.THERE ARE NINE FORMAL SECTIONS IN THE DEPARTMENT: ABDOMINAL IMAGING, BREAST IMAGING, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY (CVIR), MRI, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, AND THORACIC IMAGING. MOST NON-ANGIOGRAPHIC INTERVENTIONAL PROCEDURES ARE PERFORMED BY THE RESPECTIVE SERVICES. RESIDENTS ROTATING THROUGH THESE SECTIONS ARE PROVIDED WITH READING SUGGESTIONS AND MATERIAL. ACADEMIC ROTATIONS ARE MADE UP OF THIRTEEN 4-WEEK BLOCKS ANNUALLY. AT THE END OF EACH ROTATION RESIDENTS RECEIVE WRITTEN EVALUATIONS AND HAVE THE OPPORTUNITY TO EVALUATE THE STAFF.FIRST YEAR ROTATIONS EMPHASIZE FUNDAMENTALS AND COMMON RADIOLOGIC EXAMINATIONS IN PREPARATION FOR INPATIENT AND EMERGENCY DEPARTMENT RESPONSIBILITIES. PRIOR TO TAKING CALL, ALL FIRST YEAR RESIDENTS ROTATE THROUGH ABDOMINAL IMAGING, BREAST IMAGING, EMERGENCY RADIOLOGY, FLUOROSCOPY, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, THORACIC IMAGING, AND ULTRASOUND.DURING THE SECOND YEAR, RESIDENTS CONTINUE TO GAIN EXPERIENCE IN THESE SECTIONS, PERFORMING AND INTERPRETING MORE ADVANCED EXAMINATIONS AND INTERVENTIONS AS THEIR LEVELS OF EXPERTISE INCREASE. ADDITIONAL ROTATIONS IN MORE SPECIALIZED TOPICS OCCUR THROUGHOUT THE SECOND THROUGH FOURTH YEARS, INCLUDING INTERVENTIONAL RADIOLOGY, MRI, HEAD AND NECK IMAGING, AND PEDIATRIC RADIOLOGY. IN ADDITION, ALL RESIDENTS PARTICIPATE IN A TWO-WEEK ROTATION IN QUALITY ASSURANCE WHICH PROVIDES THEM WITH ESSENTIAL SKILLS FOR EVENTUAL BOARD RE-CERTIFICATION.ROTATIONS AT OTHER TRAINING LOCATIONS DURING THE SECOND AND THIRD YEARS OF TRAINING INCLUDE:- THREE MONTHS OF TRAINING IN PEDIATRIC RADIOLOGY AT THE BOSTON CHILDREN'S HOSPITAL DURING THE SECOND YEAR.- FOUR WEEK PROGRAM IN RADIOLOGIC-PATHOLOGIC CORRELATION AT THE ARMED FORCES INSTITUTE OF PATHOLOGY (AIRP) SPONSORED BY THE AMERICAN COLLEGE OF RADIOLOGY IN SILVER SPRINGS, MARYLAND DURING THE THIRD YEAR.- ONE MONTH ROTATION AT THE MASSACHUSETTS EYE AND EAR INFIRMARY IN HEAD-AND-NECK RADIOLOGY DURING THE THIRD YEAR.UPON COMPLETION OF THE SECOND YEAR OF RESIDENCY TRAINING, RESIDENTS SELECT AN AREA OF ACADEMIC FOCUS FOR THEIR FOURTH YEAR WHICH WILL GUIDE CHOICES FOR THE 3-MONTH MINI-FELLOWSHIPS AND THE OTHER TWO MONTHS OF ELECTIVE TIME.OUR UNIQUE EDUCATIONAL TRACKSCURRENTLY, SIX TRACKS ARE OFFERED:- CLINICAL- EDUCATION- RESEARCH- GLOBAL HEALTH- QUALITY IMPROVEMENT- HEALTH POLICY/HEALTH ECONOMICSEACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION. SURGERY EDUCATION AT BIDMC THE ROBERTA AND STEPHEN R. WEINER DEPARTMENT OF SURGERY OFFERS EDUCATION OPPORTUNITIES FOR RESIDENTS, FELLOWS AND MEDICAL STUDENTS IN CARDIAC SURGERY, GENERAL SURGERY, NEUROSURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, PODIATRY, TRAUMA SURGERY, MINIMALLY INVASIVE SURGERY, UROLOGY, AND VASCULAR SURGERY. RESIDENTS AND FELLOWS LEARN THE MOST ADVANCED TECHNIQUES IN A STATE-OF-THE-FACILITY. RESIDENTS AND FELLOWS ALSO HAVE THE OPPORTUNITY TO LEARN MINIMALLY INVASIVE TECHNIQUES AT THE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER, THE FIRST OF ITS KIND TO BE ACCREDITED IN THE COUNTRY AND LOCATED WITHIN THE MEDICAL CENTER.THE MEDICAL CENTER'S DEPARTMENT OF SURGERY IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. AT ALL LEVELS, THE HOUSESTAFF GAIN TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE PROGRAM EMPHASIZES RESIDENT-FACULTY INTERACTION FOR EDUCATIONAL PURPOSES. TEACHING CONFERENCES AND SEMINARS FOR THE HOUSESTAFF CAPITALIZE ON WORKING RELATIONSHIPS DEVELOPED WITH THE ATTENDING STAFF. UPON COMPLETION OF FIVE YEARS OF SURGICAL TRAINING, RESIDENTS ARE ELIGIBLE FOR THE AMERICAN BOARD OF SURGERY EXAMINATION. DIDACTIC TEACHINGTHE PROGRAM HAS DEDICATED EDUCATION TIME, INCLUDING A STRONG DIDACTIC CONFERENCE SCHEDULE, TO PROVIDE A BASIC FOUNDATION OF SURGICAL KNOWLEDGE AND SKILLS. REQUIRED WEEKLY CONFERENCES INCLUDE:- RESIDENT CURRICULUM CONFERENCE / MIS SKILLS LAB - SURGICAL SERVICE MORBIDITY/MORTALITY & SURGICAL GRAND ROUNDS - COMBINED GI CONFERENCETHROUGHOUT TRAINING, A PRIMARY RESPONSIBILITY OF SENIOR RESIDENTS IS TEACHING MORE JUNIOR RESIDENTS AND THE STUDENTS ON THEIR SERVICE. THEY ARE ALSO RESPONSIBLE FOR THE ASSIGNMENT OF CASES, CLINICAL SUPERVISION OF MEDICAL STUDENTS AND RESIDENTS, AND PREPARING MATERIAL FOR SERVICE AND TEACHING CONFERENCES.FORM 990 SCHEDULE H PART VI - IRC 501(R) REPORTING UNDER REVENUE PROCEDURE 2015-21:DURING A REVIEW OF EXETER HOSPITAL, INC.'S SECTION 501(R) COMPLIANCE IN FY24, IT WAS DETERMINED THAT CERTAIN INFORMATION IN THE HOSPITAL'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT AND IMPLEMENTATION STRATEGY, AS WELL AS WITH RESPECT TO ITS FINANCIAL ASSISTANCE POLICY (FAP), PLAIN LANGUAGE SUMMARY (PLS), EMERGENCY MEDICAL CARE POLICY AND DEBT COLLECTIONS POLICY (DCP) REQUIRED CLARIFICATION OR CORRECTION. IN ACCORDANCE WITH THE PROCEDURES SET FORTH IN REVENUE PROCEDURE 2015-21, EACH OF THOSE ITEMS IS LISTED ALONG WITH THE METHOD OF CORRECTION. EXETER HOSPITAL HAS DETERMINED THAT NO INDIVIDUALS WERE ADVERSELY AFFECTED.WITH RESPECT TO ITS 2022 CHNA, (1) ALTHOUGH THE HOSPITAL SOLICITED WRITTEN COMMENTS WITH RESPECT TO ITS MOST RECENTLY COMPLETED CHNA AND IMPLEMENTATION STRATEGY WHEN CONDUCTING ITS 2022 CHNA, THE 2022 CHNA REPORT DID NOT DESCRIBE THE EFFORTS THE HOSPITAL TOOK TO SOLICIT SUCH INPUT AND (2) THE CHNA REPORT DID NOT INCLUDE AN EVALUATION OF THE IMPACT OF ACTIONS THAT WERE TAKEN SINCE THE HOSPITAL FINISHED CONDUCTING ITS IMMEDIATELY PRECEDING CHNA, TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL'S PRIOR CHNA. WITH RESPECT TO THE IMPLEMENTATION STRATEGY ADOPTED BY THE HOSPITAL'S BOARD FOR ITS 2022 CHNA, THE STRATEGY DID NOT CLEARLY IDENTIFY WHICH OF THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA REPORT THE HOSPITAL PLANNED TO ADDRESS AND WHICH IT DID NOT. THE HOSPITAL HAS DETERMINED THAT THESE ISSUES ALL CONSTITUTE MINOR COMPLIANCE ISSUES, AND THAT CORRECTION IS MOST REASONABLY ACHIEVED BY ENSURING THAT THE 2025 CHNA REPORT AND ACCOMPANYING IMPLEMENTATION STRATEGY ADDRESS THESE ISSUES. ADDITIONALLY, THE HOSPITAL LEARNED THAT IT HAD NOT POSTED ITS IMPLEMENTATION STRATEGY ON ITS WEBSITE, WHICH IT READILY CORRECTED.WITH RESPECT TO ITS FAP, PLS, EMERGENCY MEDICAL CARE POLICY AND DCP: (1) WHILE THE FAP SET INCOME AND ASSETS LIMITS FOR FINANCIAL ASSISTANCE, IT DID NOT CLEARLY EXPLAIN THAT INDIVIDUALS WHO SATISFY THOSE INCOME AND ASSETS LIMITS WOULD BE ELIGIBLE FOR FREE HEALTH SERVICES WITH A CO-PAYMENT. THE FAP HAS BEEN CLARIFIED ACCORDINGLY. (2) ALTHOUGH THE FAP PROVIDED THE TELEPHONE AND ADDRESS OF THE PATIENT ACCOUNTS DEPARTMENT, THE FAP DID NOT CLEARLY STATE THAT PATIENT ACCOUNTS CAN PROVIDE ASSISTANCE WITH THE FAP APPLICATION. THE FAP HAS BEEN REVISED TO STATE THAT PATIENT ACCOUNTS CAN PROVIDE ASSISTANCE WITH THE FAP APPLICATION. (3) THE FAP DID NOT SPECIFY HOW MEMBERS OF THE PUBLIC COULD READILY OBTAIN A COPY OF THE HOSPITAL'S DEBT COLLECTION POLICY, INCLUDING BY SPECIFYING THE DIRECT WEBSITE AND THE PHYSICAL ADDRESS WHERE THAT SEPARATE POLICY COULD BE OBTAINED. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (4) WHILE THE HOSPITAL HAD NOT BEEN ENGAGING IN ANY EXTRAORDINARY COLLECTION ACTIONS (ECAS), ITS FAP DID NOT INCLUDE A DESCRIPTION OF THE OFFICE, DEPARTMENT OR COMMITTEE WITH FINAL AUTHORITY FOR DETERMINING THAT REASONABLE EFFORTS HAD BEEN MADE TO DETERMINE FAP ELIGIBILITY BEFORE ENGAGING IN ANY ECAS. THE FAP HAS BEEN REVISED TO EXPLICITLY PROHIBIT THE HOSPITAL FROM ENGAGING IN ECAS.(5) AN AUTHORIZED BODY OF THE HOSPITAL HAD NOT ADOPTED A WRITTEN EMERGENCY MEDICAL CARE POLICY, EITHER AS PART OF ITS FAP OR AS A SEPARATE POLICY, THAT REQUIRES THE HOSPITAL TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR ELIGIBILITY UNDER THE FAP AND THAT PROHIBITS THE HOSPITAL FROM ENGAGING IN ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE FAP HAS BEEN REVISED TO INCLUDE THIS LANGUAGE.(6) THE PLS DID NOT INCLUDE INSTRUCTIONS ON WHERE TO OBTAIN COPIES OF THE FAP. THE PLS HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (7) ALTHOUGH THE PLS PROVIDED THE TELEPHONE AND ADDRESS OF THE PATIENT ACCOUNTS DEPARTMENT THE PLS DID NOT CLEARLY STATE THAT PATIENT ACCOUNTS CAN PROVIDE ASSISTANCE WITH THE FAP APPLICATION. THE PLS HAS BEEN REVISED TO CLARIFY THAT PATIENT ACCOUNTS CAN PROVIDE ASSISTANCE WITH THE FAP APPLICATION. EXETER HOSPITAL HAS ADOPTED PROCEDURES THAT REQUIRE IT TO REVIEW, ON A REGULAR BASIS, ITS POLICIES AND PROCEDURE TO ENSURE COMPLIANCE WITH THE REQUIREMENTS OF SECTION 501(R) AND THE REGULATIONS ISSUED THEREUNDER. THOSE PROCEDURES INCLUDE REVIEWING A SECTION 501(R) COMPLIANCE CHECKLIST. ADDITIONAL INFORMATION REGARDING PROMOTING THE HEALTH OF THE COMMUNITY OPEN MEDICAL STAFFTHE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND AS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. AFFILIATED HEALTH CARE SYSTEM AND ACCOMPLISHMENTSAS NOTED THROUGHOUT THIS FORM 990, EXETER HOSPITAL IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES. AS NOTED IN VARIOUS NARRATIVE DISCLOSURES THAT SUPPORT THIS FORM 990 AND RELATED SCHEDULES FOR THE PERIOD COVERED BY THIS FILING, BILH IS A MASSACHUSETTS NON-PROFIT CORPORATION EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. BETH ISRAEL LAHEY HEALTH'S (BILH) MISSION IS TO SUPPORT ITS AFFILIATES AND THOSE AFFILIATES' MISSIONS TO IMPROVE THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. BILH STRIVES TO ACCOMPLISH THIS MISSION BY PROVIDING SERVICES TO ITS AFFILIATES WHICH SUPPORT THE DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO ACCESS SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE.THE BILH CORE VALUES AND PRINCIPALS ARE LISTED HERE AS WELL AS NETWORK-WIDE ACCOMPLISHMENTS DURING THE FISCAL PERIOD COVERED BY THIS FILING. THE BILH NETWORK IS DELIVERING ON THE PROMISE TO BILH PATIENTS AND COMMUNITIES TO EXPAND ACCESS AND PROVIDE EXTRAORDINARY CARE, WHILE ALSO ADVANCING MEDICINE THROUGH DISCOVERY AND EDUCATION. THE BILH PURPOSE STATEMENT ARTICULATES THE IMPACT THAT EACH BILH AFFILIATE STRIVES TO MAKE IN THE COMMUNITIES SERVED. THESE SHARED VALUES GUIDE EACH ENTITY'S DAILY EFFORTS AND KEEP EACH AFFILIATE ALIGNED IN THE PURSUIT OF THE BILH PURPOSE, SHOWING HOW "WE CARE" FOR PATIENTS, EACH OTHER AND THE COMMUNITIES SERVED.PURPOSE STATEMENT: BILH CREATES HEALTHIER COMMUNITIES ONE PERSON AT A TIME THROUGH SEAMLESS CARE AND GROUND-BREAKING SCIENCE, DRIVEN BY EXCELLENCE, INNOVATION AND EQUITY.BILH WE CARE VALUES:WELLBEING. WE PROVIDE A HEALTH-FOCUSED WORKPLACE AND SUPPORT A HEALTHY WORK-LIFE BALANCE.EMPATHY. WE DO OUR BEST TO UNDERSTAND OTHERS' FEELINGS, NEEDS AND PERSPECTIVES.COLLABORATION. WE WORK TOGETHER TO ACHIEVE EXTRAORDINARY RESULTS.ACCOUNTABILITY. WE HOLD OURSELVES AND EACH OTHER TO BEHAVIORS NECESSARY TO ACHIEVE OUR COLLECTIVE GOALS.RESPECT. WE VALUE DIVERSITY AND TREAT ALL MEMBERS OF OUR COMMUNITY WITH DIGNITY AND INCLUSIVENESS.EQUITY. EVERYONE HAS THE OPPORTUNITY TO ATTAIN THEIR FULL POTENTIAL IN OUR WORKPLACE AND THROUGH THE CARE WE PROVIDE.BILH IS ACCOMPLISHING THIS MISSION BY PROVIDING SUPPORT TO ITS AFFILIATES WHICH INCLUDE:1. A PHYSICIAN ENTERPRISE THAT ENCOMPASSES THE SYSTEM'S NETWORK OF EMPLOYED PRIMARY CARE AND SPECIALTY PHYSICIANS LOCATED THROUGHOUT OUR REGION;2. A HOSPITAL AND AMBULATORY SERVICES GROUP THAT INCLUDES WORLD-CLASS ACADEMIC MEDICAL CENTERS AND TEACHING HOSPITALS WITH AFFILIATIONS WITH HARVARD MEDICAL SCHOOL, UM AND TUFTS UNIVERSITY SCHOOL OF MEDICINE; LEADING COMMUNITY HOSPITALS; A RENOWNED ORTHOPEDICS HOSPITAL; AND COMPREHENSIVE AMBULATORY CENTERS;3. A POPULATION HEALTH ENTERPRISE THAT EMBRACES A MODEL OF CARE TO IMPROVE THE HEALTH OF ALL THOSE SERVED BY BILH; THE POPULATION HEALTH DOMAIN INCLUDES THE SYSTEM'S CLINICALLY INTEGRATED NETWORK OF AFFILIATED PROVIDERS AND VITAL SERVICES, INCLUDING BEHAVIORAL HEALTH AND HOME CARE SERVICES; 4. A ROBUST NETWORK OF ADMINISTRATIVE AND OPERATIONAL SERVICES TO ADVANCE STRATEGIC GOALS, BOTH LOCALLY AND AT THE SYSTEM LEVEL, THAT OFFERS EXPERTISE AND STANDARDIZED RESOURCES BASED ON BEST PRACTICES.DURING THE FISCAL PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH (BILH) SERVED AS THE SOLE MEMBER OF BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), ANNA JAQUES HOSPITAL (AJH), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN), THE JOSLIN DIABETES CENTER, EXETER HEALTH RESOURCES, INC (EHRI) AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC), EHRI IN TURN SERVED AS THE SOLE MEMBER OF EXETER HOSPITAL AND LHSS IN TURN SERVED AS THE SOLE MEMBER OF BETH ISRAEL LAHEY HEALTH PRIMARY CARE. THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. SEE FORM 990 SCHEDULE R FOR ADDITIONAL AFFILIATED ENTITIES. BILH PROVIDES CENTRALIZED SUPPORT TO ITS NETWORK OF SUPPORTED ORGANIZATIONS. BILH SUPPORT INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING SERVICES: DEVELOPMENT AND FUNDRAISING, STRATEGIC PLANNING, COMPLIANCE, GOVERNANCE AND LEGAL SUPPORT, HUMAN RESOURCES, PATIENT CARE PAYOR CONTRACTING, OPERATIONAL SUPPORT SUCH AS PROCESSING PAYROLL AND ACCOUNTS PAYABLE, NETWORK-WIDE BENEFIT PLAN STRUCTURING AND NETWORK-WIDE CASH MANAGEMENT. BILH OVERSEES THE FINANCIAL WELL-BEING OF ITS AFFILIATES, INCLUDING PROVIDING MANAGEMENT, LEADERSHIP, DEBT STRUCTURING SUPPORT, FINANCING OF CAPITAL PROJECTS THROUGH ITS OBLIGATED GROUP DEBT AND FINANCIAL SUPPORT SERVICES, INCLUDING INTERNAL AND EXTERNAL AUDIT, TREASURY, INSURANCE AND TAX SERVICES. FOR THE FISCAL PERIOD COVERED BY THIS FILING BILH, INC. PROVIDED SERVICES AND SUPPORT TO ITS AFFILIATES, IN THE AMOUNT OF $15,835,226,845.ADDITIONAL DETAIL ABOUT ACCOMPLISHMENTS ACROSS BILH ARE BELOW. BILH NETWORK ACCOMPLISHMENTS AND ACTIVITIES BILH NETWORK ACCOMPLISHMENTS AND ACTIVITIES FISCAL YEAR ENDED SEPTEMBER 30, 2024BILH'S SUPPORT OF ITS AFFILIATES ENABLES THE NETWORK AS A WHOLE TO ACCOMPLISH ITS PRIMARY MISSION OF IMPROVING THE HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITIES SERVED. AS NOTED PREVIOUSLY IN THIS FILING, BILH STRIVES TO ACCOMPLISH THIS MISSION BY DELIVERING THE HIGH-QUALITY HEALTH CARE THAT EVERY PATIENT DESERVES. BILH BELIEVES THAT EFFECTIVE CARE IS EASILY ACCESSIBLE AND SIMPLE TO USE SO IT IS BILH'S FOCUS TO PROVIDE PATIENTS WITH CARE THAT IS IN CLOSE PROXIMITY AND CONVENIENT REGARDLESS OF WHERE PATIENTS LIVE, THEIR HEALTH HISTORY OR STAGE OF LIFE AND BILH IS ACCOMPLISHING THIS GOAL BY PROVIDING SUPPORT TO EACH OF ITS AFFILIATES, PROVIDING AN ORGANIZATIONAL STRUCTURE AND OPERATING MODEL WHICH IS DRIVEN BY FOUR DEEPLY INTERCONNECTED DOMAINS DESIGNED TO ADVANCE MEANINGFUL PARTNERSHIPS ACROSS ORGANIZATIONS, CARE SETTINGS, SPECIALTIES, AND GEOGRAPHIES TO ENSURE BILH PATIENTS RECEIVE THE CARE THEY NEED IN THE COMMUNITIES WHERE THEY LIVE AND WORK.PATIENT CARE DELIVERY ACROSS THE BILH NETWORK -- FISCAL YEAR ENDED SEPTEMBER 30, 2024HOSPITAL CARE:DURING THE PERIOD COVERED BY THIS FILING, THE BILH HOSPITALS PROVIDED CARE TO PATIENTS IN A FULL SPECTRUM OF SPECIALTIES AND UTILIZING A WIDE RANGE OF MODALITIES. BELOW ARE A SAMPLE OF THE HOSPITAL CARE PROVIDED TO BILH PATIENTS. DURING THE FISCAL YEAR COVERED BY THIS FILING, BILH HOSPITALS HAD APPROXIMATELY 4.9 MILLION OUTPATIENT ENCOUNTERS. APPROXIMATELY 80,000 OUTPATIENT/AMBULATORY SURGERIES AND OVER 100,000 ENDOSCOPIES WERE PERFORMED, IN ADDITION, ACROSS BILH HOSPITALS PATIENTS HAD MORE THAN 141,000 ONCOLOGY VISITS AND ALMOST 111,000 ONCOLOGY INFUSIONS, 268,000 EKGS, OVER 59,000 ORTHOPEDIC PROCEDURES, MORE THAN 758,000 RADIOLOGY EXAMS, OVER 312,000 CT EXAMS, MORE THAN 177,000 ULTRASOUND PROCEDURES, OVER 142,000 MRIS, OVER 221,000 OUTPATIENT BREAST IMAGING EXAMS, APPROXIMATELY 312,000 OUTPATIENT REHABILITATION AND PHYSICAL THERAPY VISITS AND MORE THAN 11.7 MILLION OUTPATIENT LAB TESTS WERE PERFORMED. THE BILH HOSPITALS ALSO HAD APPROXIMATELY 432,000 EMERGENCY DEPARTMENT VISITS, MORE THAN 35,000 OBSERVATION CASES AND MORE THAN 137,000 INPATIENT DISCHARGES WITH APPROXIMATELY 729,000 INPATIENT DAYS, INCLUDING MORE THAN 44,000 INPATIENT PSYCH DAYS. DURING THIS PERIOD MORE THAN 31,000 INPATIENT SURGERIES WERE PERFORMED AND APPROXIMATELY 14,000 NEWBORNS WERE DELIVERED AND THERE WERE APPROXIMATELY 52,000 PAIN CLINIC VISITS. BILH HOSPITALS ALSO HAD MORE THAN 75,000 URGENT CARE VISITS DURING THIS PERIOD. NON-HOSPITAL PHYSICIAN CARE:DURING THE PERIOD COVERED BY THIS FILING, THE BILH PHYSICIANS PROVIDED CARE TO PATIENTS OUTSIDE OF THE HOSPITALS AND IN PHYSICIAN OFFICE OR OTHER CLINICAL SETTINGS. BELOW ARE A SAMPLE OF THE NON-HOSPITAL PHYSICIAN SERVICES PROVIDED TO BILH PATIENTS. DURING THE FISCAL YEAR COVERED BY THIS FILING, MORE THAN 470 PRIMARY CARE AND FAMILY PRACTICE PROVIDERS HAD APPROXIMATELY 843,000 PATIENT VISITS AND PROVIDERS ACROSS THE FULL SPECTRUM OF SPECIALTIES HAD MORE THAN 624,000 PATIENT VISITS. IN ADDITION, JOSLIN DIABETES CENTER HAD MORE THAN 27,000 PATIENT VISITS RELATED TO DIABETES CARE AND THERE WERE MORE THAN 53,000 URGENT CARE VISITS TO NON-HOSPITAL URGENT CARE LOCATIONS. COMMUNITY BENEFITS, UNCOMPENSATED CARE, COSTS TO PROVIDE CARE TO MEDICAID AND MEDICARE PATIENTS FISCAL YEAR ENDED SEPTEMBER 30, 2024DURING THE FISCAL YEAR COVERED BY THIS FILING BILH HOSPITALS PROVIDED MORE THAN $52 MILLION IN NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO THE HEALTH SAFETY NET TRUST.IN ADDITION TO THE CHARITY CARE REPORTED ABOVE, EACH OF THE BILH HOSPITALS ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW-INCOME FAMILIES, INCLUDING PARTICULARLY THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS THAT ENSURE LOW-INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, THE COST OF PROVIDING CARE TO MEDICAID PATIENTS ACROSS BILH EXCEEDED PAYMENTS RECEIVED FOR PROVIDING THAT CARE RESULTING IN A COMBINED SHORTFALL EXCEEDING $35.5 MILLION RELATED TO TREATING MEDICAID PATIENTS. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS. PAYMENTS FROM MEDICARE DO NOT COVER THE COST OF SERVICES PROVIDED. ALL BILH HOSPITALS PROVIDE CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, THE COST OF PROVIDING CARE TO MEDICARE PATIENTS ACROSS BILH EXCEEDED PAYMENTS RECEIVED FOR PROVIDING THAT CARE, RESULTING IN A COMBINED SHORTFALL EXCEEDING $161 MILLION RELATED TO TREATING MEDICARE PATIENTS. IN ADDITION TO THE COSTS NOTED ABOVE, DURING THE FISCAL YEAR COVERED BY THIS FILING BILH HOSPITALS PROVIDED COMBINED COMMUNITY BENEFITS, COMMUNITY HEALTH IMPROVEMENT SERVICES, CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY HEALTH CENTERS AND OTHER GROUPS AS WELL AS COSTS INCURRED RELATED TO SUBSIDIES FOR PRIMARY AND SPECIALTY CARE ACCESS, BEHAVIORAL HEALTH CARE AND OTHER CARE PROVIDED AT A LOSS TOTALING OVER $150 MILLION. FOR ADDITIONAL INFORMATION ON THESE ACTIVITIES AS WELL AS EACH HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY, PLEASE SEE FORM 990 SCHEDULE H FOR EACH OF THE BILH HOSPITALS. EDUCATION AND RESEARCH FISCAL YEAR ENDED SEPTEMBER 30, 2024RESEARCH ACTIVITIES ACROSS BILH SERVE PATIENT CARE BOTH AT BILH AND BEYOND AS PART OF THE ADVANCEMENT OF SCIENCE. BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC OR MEDICAL CENTER) IS A TERTIARY CARE ACADEMIC MEDICAL CENTER PROVIDING LEADING EDGE PATIENT CARE, IS A WORLD CLASS RESEARCH INSTITUTION AND IS DEVOTED TO TEACHING AND TRAINING THE MEDICAL PROFESSIONALS OF TOMORROW, EMBRACING TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION AND TO THAT END, PART OF THE MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. BIDMC HAS THE LARGEST RESEARCH OPERATIONS ACROSS BILH AND DURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER INCURRED OVER $370 MILLION IN RESEARCH EXPENSES, MORE THAN $91 MILLION OF WHICH WERE INTERNALLY FUNDED.ACROSS BILH HOSPITALS, COSTS FOR TRAINING MEDICAL PROFESSIONALS EXCEEDED $210 MILLION. REIMBURSEMENT FROM MEDICARE FOR THESE ACTIVITIES WAS APPROXIMATELY $67 MILLION WHICH LEFT A COMBINED SHORTFALL RELATED TO THESE ACTIVITIES ACROSS BILH OF OVER $143 MILLION WHICH IS AN INVESTMENT IN THE HEALTH SYSTEM OF TOMORROW. ADDITIONAL BILH NETWORK ACTIVITIES EXPANDING ACCESS AND SERVICES; CONTINUING TO PROVIDE HIGH QUALITY CARE AT A LOWER COST; BEHAVIORAL HEALTH; COMMUNITY INVESTMENTS FISCAL YEAR ENDED SEPTEMBER 30, 2024THROUGHOUT THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH ("BILH") REMAINED COMMITTED TO DELIVERING HIGH-QUALITY CARE AT A LOWER COST BY LEVERAGING COMMUNITY SETTINGS AND MAINTAINING CARE WITHIN THE BILH PERFORMANCE NETWORK ("BILHPN"), WHEN APPROPRIATE. THE FOLLOWING HIGHLIGHTS SOME OF THESE ONGOING EFFORTS. IN ADDITIONAL TO THE ACCOMPLISHMENTS NOTED ABOVE, BILH CONTINUED THIS COMMITMENT WITH THE FOLLOWING ACTIVITIES: ENHANCING THE BILHPN OPERATING MODELBILH PERFORMANCE NETWORK ("BILHPN") IS BILH'S CLINICALLY INTEGRATED NETWORK OF PHYSICIANS, CLINICIANS, AND HOSPITALS THAT WORK TOGETHER TO PROVIDE HIGH-QUALITY, COST-EFFECTIVE CARE FOR PATIENTS. BILHPN ACHIEVED ITS GOAL OF BECOMING A FULLY INTEGRATED CLINICALLY INTEGRATED NETWORK ("CIN") IN FY 2024. THIS MOVE POSITIONED ITS PROVIDERS TO IMPROVE CARE QUALITY AND SUCCEED IN A VALUE-BASED DELIVERY SYSTEM. ALONGSIDE THIS TRANSFORMATION, BILHPN HAS REDEFINED ITS OPERATING MODEL TO PRIORITIZE HIGH-QUALITY CARE, IMPROVE THE HEALTH OF THE POPULATIONS BILH SERVES, ENHANCE PERFORMANCE, AND PROMOTE WELL-BEING ACROSS ITS NETWORK. THROUGHOUT FY 2024, BILHPN CONCENTRATED ON QUALITY IMPROVEMENT INITIATIVES, SUCH AS REDUCING DISPARITY GAPS, LOWERING READMISSION RATES, IMPROVING DIABETES AND HYPERTENSION MANAGEMENT, AND ENHANCING SKILLED NURSING CARE VISITS. IMPROVING PHARMACY ACCESSTHROUGHOUT FY 2024, BILH PHARMACY EXPERIENCED SIGNIFICANT EXPANSION THAT REFLECTS ITS ONGOING COMMITMENT TO IMPROVING ACCESS TO CARE AND REDUCING THE COST OF CARE. ITS ACHIEVEMENTS INCLUDE:- EXPANDED ACCESS TO 8,000 ADDITIONAL PATIENTS, INCLUDING 5,700 MEDICAID PATIENTS;- IMPROVED PATIENT FINANCIAL ASSISTANCE SERVICES;- LAUNCHED CLINICS FOCUSED ON WEIGHT LOSS AND IRRITABLE BOWEL SYNDROME AND EXPANDED ACCESS TO ANTICOAGULATION MANAGEMENT THROUGH THE CENTRALIZED ANTICOAGULATION MANAGEMENT PROGRAM;- LAUNCHED INSCRIPT TO PROVIDE PHARMACY BENEFIT MANAGEMENT ("PBM") SERVICES TO FULLY INSURED AND SELF-FUNDED HEALTH PLANS, RESULTING IN HEALTH PLAN MEMBERS SAVING OVER 20% IN OUT-OF-POCKET COSTS AND GREATER ACCESS TO MEDICATION; AND, - EXPANDED PHARMACY PRESENCE IN CLINICS TO IMPROVE ACCESS TO MEDICATIONS FOR TREATING DIABETES AND CARDIOVASCULAR DISEASES.INCREASING ACCESS TO BEHAVIORAL HEALTH SERVICESIN FY 2024, BILH AWARDED $1.2 MILLION TO FOUR COMMUNITY-BASED ORGANIZATIONS TO IMPLEMENT BEHAVIORAL HEALTH NAVIGATOR PROGRAMS THAT WILL FUND THE HIRING, TRAINING, AND SUPPORT OF COMMUNITY-BASED BEHAVIORAL HEALTH NAVIGATORS WHO WILL WORK TO IDENTIFY, UNDERSTAND, AND EFFECTIVELY CONNECT RESIDENTS EXPERIENCING MENTAL HEALTH AND SUBSTANCE USE ISSUES TO APPROPRIATE SUPPORT AND ASSISTANCE. THE FOUR NONPROFIT ORGANIZATIONS IN THE GATEWAY MUNICIPALITIES OF HAVERHILL, LYNN, PEABODY, AND QUINCY HAVE BEEN GIVEN $300,000 EACH FROM FY 2024 TO 2027 TO LAUNCH THESE PROGRAMS IN THEIR COMMUNITIES. LABORATORY SERVICES EXPANSION AND OPTIMIZATIONBILH TRANSITIONED TO CENTRALIZED OVERSIGHT OF ALL LABORATORY DRAW SITES IN FY 2024 AND CREATED 11 NEW COMMUNITY-BASED LAB DRAW STATIONS, WHICH INCREASES PATIENT ACCESS TO LAB SERVICES AND IMPROVES BOTH PATIENT AND PROVIDER SATISFACTION. THE CENTRALIZED OVERSIGHT MODEL BETTER ENABLES BILH TO FOCUS ON QUALITY, SERVICE, AND PHLEBOTOMIST RECRUITMENT. IN ADDITION, BILH CONTINUES TO REFINE TRANSPORTATION ROUTES FOR LAB SPECIMENS, MAINTAINING HIGH STANDARDS FOR TURNAROUND TIMES AND EFFICIENCY, WHICH FURTHER IMPROVES THE OVERALL QUALITY OF LABORATORY SERVICES.ENHANCEMENT OF CARE DELIVERY ACROSS PRIMARY CARE PRACTICESBILH PRIMARY CARE ("BILHPC") CONTINUED TO ENHANCE CARE DELIVERY AND ELEVATE THE QUALITY OF CARE THROUGHOUT ITS PRACTICES, AS DEMONSTRATED BY THE FOLLOWING INITIATIVES:- PARTNERED WITH A BILHPN PHARMACIST AND LOCAL DIABETES NURSE EDUCATORS TO LAUNCH A DIABETES HUB AND SPOKE MODEL IN THE MILTON AND NEEDHAM PRIMARY CARE REGIONS, WHERE A DIABETES-SPECIALIZED ADVANCED PRACTICE PRACTITIONER IS EMBEDDED IN THE PRACTICE; - COLLABORATED WITH BILH PHARMACY TO PLAN THE EXPANSION OF REMOTE BLOOD PRESSURE MONITORING FOR IMPROVED HYPERTENSION MANAGEMENT;- EXPANDED THE VIRTUALIST PROGRAM, ENHANCING ACCESS TO ACUTE AND OVERFLOW CARE; AND - INTRODUCED A SELF-SCHEDULING TOOL FOR NEW PATIENTS SEEKING TO ESTABLISH CARE WITH A PRIMARY CARE PROVIDER.EDUCATION AND AWARENESS EFFORTS TO PROMOTE ACCESS TO CAREIN FY 2024, BILH WORKED TO IMPROVE ACCESS FOR MASSHEALTH PATIENTS IN EASTERN MASSACHUSETTS THROUGH VARIOUS COMMUNICATIONS INITIATIVES. A KEY EFFORT WAS LAUNCHING A MONTHLY NEWSLETTER, AVAILABLE IN SEVEN LANGUAGES, TO ENGAGE PATIENTS AND SHARE HEALTH INFORMATION. NEW ENGLAND BAPTIST HOSPITAL ("NEBH") HOSTED INFORMATION SESSIONS TO EDUCATE UNDERSERVED POPULATIONS ABOUT ITS SERVICES. NEBH ALSO PERFORMED OUTREACH TO COMMUNITY HOUSING FACILITIES, PARTICIPATED IN BOSTON MAYOR WU'S HISPANIC HERITAGE MONTH LUNCHEON, AND PARTNERED WITH NEIGHBORHOOD ASSOCIATIONS AND MAIN STREET BOARDS. 1 FOUNDATION FOR HEALTH COMMUNITIES 125 AIRPORT ROAD CONCORD NH 03301 020275078 501(C)(3) 258007 0 THIS CONTRIBUTION THROUGH THE NH FOUNDATION FOR HEALTHY COMMUNITIES HELPS TO SUPPORT THE NH BUREAU OF DRUG AND ALCOHOL SERVICES FOR THEIR PROGRAMS TO COMBAT ADDICTION AND SUBSTANCE MISUSE DISORDER. LAMPREY HEALTH CARE 207 S MAIN STREET NEWMARKET NH 03857 237305106 501(C)(3) 380000 0 GRANT WILL FOCUS ON THE LACK OF ACCESS TO PRIMARY CARE AND BEHAVIORAL HEALTH CARE GENERALLY, WITH A FOCUS ON COMMUNITIES THAT HAVE HISTORICALLY BEEN CHALLENGED TO ACCESS CARE: INDIVIDUALS WITHOUT INSURANCE/ADEQUATE INSURANCE OR MEDICAID IN THE ROCKINGHAM COUNTY REGION, WITH A FOCUS ON RAYMOND, NEWMARKET AND THE SURROUNDING COMMUNITIES. A PARTICULAR FOCUS ON THOSE LIVING WITH ADDICTION, THE HOMELESS, THE ELDERLY AND THE LGBTQ+ COMMUNITY. USING OUR MEDICAL HOME MODEL, LAMPREY ADDRESSES THE CHALLENGES OUR COMMUNITY USING A PATIENT-CENTERED APPROACH TO MEET THE NEEDS OF INDIVIDUALS. MUCH OF THEIR WORK CENTERS ON THE AVAILABILITY OF TRAINED, COMPASSIONATE STAFF WHO ARE AT THE FOREFRONT OF SERVICE PROVISION. NURSES, MEDICAL ASSISTANTS, CARE MANAGERS, BEHAVIORAL HEALTH CLINICIANS AND MEDICAL PROVIDERS ARE ALL PART OF THE TEAM APPROACH USED TO SUPPORT THEIR PATIENT-CENTERED MODEL. SOCIETY OF ST VINCENT DE PAUL 53 LINCOLN STREET EXETER NH 03833 203945985 501(C)(3) 150000 0 THIS GRANT WILL SUPPORT FOOD ACCESS AT ST. VINCENT DE PAUL THROUGH THE SUPPORT OF THE FOLLOWING OFFERINGS: 1)FOOD PANTRY- OUR FOOD PANTRY IS OPEN FOR FOUR SESSIONS EACH WEEK, FIFTY-TWO WEEKS A YEAR (EXCLUDING SOME HOLIDAYS).2. SENIOR PANTRY FOR OLDER ADULTS (60 YEARS OLD+) 3. SENIOR DELIVERY- ONCE A MONTH THEY PROVIDE ON SITE DELIVERY TO ELIGIBLE SENIORS. THEY DELIVER CRITICAL FOODS AND PERSONAL CARE ITEMS TO LOW-INCOME CLIENTS THAT RESIDE AT BOTH 277 WATER STREET AND MEETING PLACE EXETER, NH. 4. EMERGENCY FINANCIAL ASSISTANCE: WITH THIS ASSISTANCE THEY PREVENT HOMELESSNESS, UTILITY SHUT OFFS, COLD OR HOT HOMES AND A BROKEN DOWN CAR. SEACOAST MENTAL HEALTH 1145 SAGAMORE AVENUE PORTSMOUTH NH 03801 020262862 501(C)(3) 92500 0 TO SPONSOR THE ORGANIZATION'S MISSION TO PROVIDE HIGH QUALITY, EFFECTIVE AND ACCESSIBLE MENTAL HEALTH SERVICES TO RESIDENTS OF THE EASTERN HALF OF ROCKINGHAM COUNTY. COOPERATIVE ALLIANCE FOR SEACOAST TRANSPORTATION (COAST) 42 SUMNER DR DOVER NH 03820 020362579 501(C)(3) 90000 0 COAST WILL USE THE GRANT FUNDS FOR 3 RELATED PROJECTS. 1) ROUTE 7 ON DEMAND WILL BE EXPANDED TO 5 DAYS PER WEEK. FUNDS WILL BE USED AS THE 7.5% LOCAL MATCH FOR PURCHASING 4 SMALL CUTAWAY VEHICLES. 2) THE TRIPLINK COMMON APPLICATION AND WEBSITE WILL BE UPGRADED TO CURRENT STANDARDS. 3) THIS PROJECT WILL ADD MORE SERVICE FOR USERS IN EXETER AND NEWMARKET, STREAMLINE AND IMPROVE THE ABILITY OF RESIDENTS TO APPLY FOR DEMAND RESPONSE SERVICES IN THE REGION, AND ENSURE THAT COAST CAN PROVIDE SERVICE IN SAFE, RELIABLE VEHICLES. WAYPOINT 464 CHESTNUT STREET MANCHESTER NH 03105 020222164 501(C)(3) 56000 0 THIS GRANT WILL SUPPORT A CONTINUUM OF PROGRAMS TO SUPPORT YOUTH, CHILDREN AND FAMILIES IN ROCKINGHAM COUNTY. SERVICES INCLUDE SUPPORT FOR FAMILIES WITH CHILDREN WHO HAVE AN IDENTIFIED DEVELOPMENTAL DELAY, HOME VISITING SERVICES, FAMILY AND CHILDREN'S PROGRAMS AND OUTREACH AND CASE MANAGEMENT FOR YOUTH WHO ARE HOMELESS. THE OVERARCHING GOAL OF THE WORK IS TO IMPROVE THE WELL-BEING OF THE FAMILY AND YOUNG PEOPLE.WAYPOINT ANTICIPATES SERVING 600 FAMILIES THROUGH EARLY SUPPORTS SERVICES, 50 THROUGH HOME VISITING, AND 50 YOUTH EXPERIENCING HOMELESSNESS OR AT-RISK. WE EXPECT THAT 150 FAMILIES WILL PARTICIPATE IN FAMILY RESOURCE CENTER GROUPS, EVENTS, ACTIVITIES. SOS RECOVERY COMMUNITY ORG 14 SIGNAL ST ROCHESTER NH 03867 920814462 501(C)(3) 55000 0 THIS PROJECT AIMS TO ENHANCE ACCESS TO AND GROW THE RECOVERY SUPPORT COMMUNITY AND SERVICES IN EXETER BY IMPLEMENTING COMMUNITY-CATERED PROGRAMMING AND COMPREHENSIVE HARM REDUCTION STRATEGIES, INCLUDING HEPATITIS C SCREENINGS, MOBILE OUTREACH, AND AWARENESS EVENTS. BIG BROTHERS BIG SISTERS OF NH 3 PORTSMOUTH AVENUE 2 STRATHAM NH 03885 020348477 501(C)(3) 52500 0 FUNDING TO SUPPORT A COMMUNITY-BASED YOUTH MENTORING PROGRAM. HAVEN 20 INTERNATIONAL DRIVE SUITE NH 03801 020337620 501(C)(3) 52500 0 EVENT SPONSORSHIPS TO HELP SUPPORT ORGANIZATION'S MISSION TO PREVENT SEXUAL ASSAULT, DOMESTIC VIOLENCE AND STALKING, AND TO SUPPORT AND EMPOWER ALL WOMEN, MEN, NON-BINARY AND TRANSGENDER ADULTS, YOUTH AND FAMILIES TO HEAL FROM ABUSE AND REBUILD THEIR LIVES. CHASE HOME 698 MIDDLE ROAD PORTSMOUTH NH 03801 823657987 501(C)(3) 50000 0 THE CHASE HOME WILL USE THIS FUNDING TO TO HIRE OUR FIRST EVER IN-HOUSE MENTAL HEALTH CLINICIAN TO IMPROVE THEIR RESIDENTIAL TREATMENT SERVICES FOR YOUTH AGES 11-18. CONNORS CLIMB FOUNDATION PO BOX 283 EXETER NH 03833 473553455 501(C)(3) 50000 0 FUNDING WILL SUPORT CONNORS CLIMB'S PROGRAM FOCUSED ON SUICIDE PREVENTION THAT TEACHES ABOUT THE RELATIONSHIP BETWEEN SUICIDE AND MENTAL ILLNESS. THE PROJECT SERVES NEW HAMPSHIRE YOUTH AGED 10-24, FOCUSING ON SUICIDE PREVENTION. CROSS ROADS HOUSE 600 LAFAYETTE RD PORTSMOUTH NH 03801 222549963 501(C)(3) 50000 0 GRANT FUNDING WILL HELP SUPPORT THE HOUSING SUCCESS PROGRAM. GRANITE UNITED WAY 22 CONCORD STREET FLOOR 4 MANCHESTER NH 03101 026006033 501(C)(3) 47500 0 FUNDING WILL SUPPORT THE AFFORDABLE HOUSING INCENTIVE PROGRAM (AHIP), WHICH BRINGS TOGETHER LANDLORDS AND SOCIAL SERVICE PROVIDERS TO MOVE INDIVIDUALS OUT OF HOMELESSNESS AND INTO SUSTAINABLE HOUSING. AUSTIN17HOUSE 263 ROUTE 125 BRENTWOOD NH 03833 364864665 501(C)(3) 42500 0 FUNDING WILL SUPPORT YOUTH APPRENTICES WHO ATTEND THE A17H, WHO SHARE AN INTEREST IN WANTING TO BECOME A MORE CONFIDENT INDIVIDUAL, WHO POSSESS LEADERSHIP QUALITIES, OR WHO HAVE BEEN A PARTICIPANT AT THE CENTER AND WANT A WAY TO GIVE BACK. KEY COLLECTIVE PO BOX 149 EXETER NH 03833 832341999 501(C)(3) 40000 0 THE KEY COLLECTIVE IS USING GRANT FUNDING FROM EXETER TO INCREASE THE NUMBER OF PROGRAM PARTICPANTS, INCREASE THE NUMBER OF PARTNERS THEY COLLABORATE WITH TO OFFER A WIDER VARIETY OF PROGRAMS AND ACTIVITIES FOR FREE OR AT A REDUCED COST, AND INCREASE THE NUMBER OF SCHOLARSHIPS, SO THAT NO CHILD IS LEFT OUT FROM PARTICIPATING IN AN ACTIVITY THAT THEY ARE INTERESTED IN. ARTS IN REACH PO BOX 236 PORTSMOUTH NH 03802 020507428 501(C)(3) 32500 0 THIS FUNDING IS SUPPORTING TEEN MENTAL HEALTH THROUGH PROGRAM DEVELOPMENT PROMOTING PRO-SOCIALITY, EMOTIONAL LITERACY, BEHAVIORAL HEALTH, CIVIC-MINDEDNESS, AND CRITICAL THINKING; VISITS TO ARTISTS' STUDIOS AND CULTURAL VENUES AND SERVICE-LEARNING OPPORTUNITIES TO CONNECT YOUTH WITH THE LOCAL COMMUNITY; MENTORSHIP AND EXPERIENCES PROMOTING PERSONAL REFLECTION AND CAREER EXPOSURE AND A MENTAL HEALTH PRACTITIONER PARTICIPATING IN PROGRAMS ALONGSIDE THE TEENS. EXETER TOWN 10 FRONT STREET EXETER NH 03833 026000268 GOVERNMENT ENTITY 30000 0 EXETER PARKS & RECREATION IS USING THE FUNDING TO HOST SENIOR LUNCHEONS, HEALTH, WELLNESS & FITNESS CLASSES, SENIOR TRIPS, AND FOR A PART-TIME PROGRAM COORDINATOR. TRANSPORTATION ASSISTANCE FOR SEACOAST CITIZENS 200 HIGH STREET HAMPTON NH 03842 262869209 501(C)(3) 30000 0 FUNDING SUPPORTS THE ORGANIZATION'S MISSION WITH HELPING PEOPLE MAINTAIN THEIR HEALTH, INDEPENDENCE AND DIGNITY BY PROVIDING RIDES TO ELIGIBLE RESIDENTS OF NH SEACOAST COMMUNITIES. GIRLS ON THE RUN NEW HAMPSHIRE 117 WATER STREET UNIT 9 EXETER NH 03833 020524090 501(C)(3) 22500 0 FUNDING SUPPORTS GIRLS ON THE RUN'S EXPERIENCE-BASED CURRICULUM DESIGNED TO HELP GIRLS ACROSS ROCKINGHAM COUNTY THROUGH RUNNING-BASED PROGRAMMING. NAMI 85 NORTH STATE STREET CONCORD NH 03301 222760743 501(C)(3) 22500 0 FUNDING SUPPORTS THE CONNECT YOUTH LEADER PROGRAM THAT ENGAGES A CORE GROUP OF YOUTH LEADERS, IN PARTNERSHIP WITH TRAINED ADULTS, TO CO-FACILITATE THE CONNECT CURRICULUM FOR THEIR PEERS. AMERICAN CANCER PO BOX 6704 HAGERSTOWN MD 21741 131788491 501(C)(3) 10000 0 ANNUAL EVENT SPONSORSHIP TO HELP FUND THE FUTURE OF BREAST CANCER RESEARCH AND SUPPORT PROGRAM. CHILDRENS MUSEUM OF NH 6 WASHINGTON ST DOVER NH 03820 020363746 501(C)(3) 7500 0 ANNUAL EVENT SPONSORSHIP SEACOAST FAMILY PROMISE 27 HAMPTON ROAD EXETER NH 03833 020529881 501(C)(3) 7500 0 ANNUAL EVENT SPONSORSHIP 23 0 PART I, LINE 2: "THE GRANT PROGRAM SUPPORTS PROGRAMMING AND EVENTS IN ROCKINGHAM COUNTY. PROPOSALS FROM A WIDE VARIETY OF ORGANIZATIONS ARE CONSIDERED. PREFERENCE IS GIVEN TO PROGRAMS THAT FIT WITHIN THE PRIORITIES OUTLINED IN EXETER HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT. THE 2023 - 2026 PRIORITY AREAS ARE: MENTAL & BEHAVIORAL HEALTH, ACCESS TO HEALTHCARE, TRANSPORTATION, SOCIAL DETERMINANTS OF HEALTH, ELDER CARE SUPPORT SERVICES AND OTHER UNDERSERVED POPULATIONS. IN ADDITION, WE HAVE HISTORICALLY IDENTIFIED SEVERAL COMMUNITY PARTNERS THAT FURTHER ITS MISSION OF PROVIDING QUALITY MEDICAL SERVICES TO THE ENTIRE COMMUNITY, REGARDLESS OF INCOME. APPLICANTS MUST BE RECOGNIZED AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ORGANIZATIONS ARE ELIGIBLE TO APPLY FOR ONE GRANT PER CALENDAR YEAR, BUT MAY ALSO APPLY FOR SPONSORSHIP SUPPORT. IF AN ORGANIZATION HAS RECEIVED FUNDING IN THE PREVIOUS YEAR OR HAS AN ACTIVE GRANT, A GRANT REPORT MUST BE SUBMITTED TO BE CONSIDERED FOR ADDITIONAL FUNDING. APPROVAL PROCESS AND AUTHORIZATION 1. SMALL GRANTS AND SPONSORSHIPS UP TO $5,000 WITH ANNUAL COMMITMENTS ARE APPROVED BY THE VP OF STRATEGY, COMMUNITY RELATIONS AND ADVANCEMENT 2. LARGE GRANTS, UP TO $40,000 PER YEAR AND FOR UP TO THREE YEARS REQUIRE, IN ADDITION, THE APPROVAL OF THE CHIEF EXECUTIVE OFFICER OR CHIEF FINANCIAL OFFICER IN THEIR ABSENCE EXETER HOSPITAL CHARITABLE CONTRIBUTION FUNDING MAY NOT BE USED FOR FUNDING FOR INDIVIDUALS OR FAMILIES, INDIVIDUAL FUNDRAISING INITIATIVES, RELIGIOUS ORGANIZATIONS AND CHURCH PROGRAMS OR EVENTS, PUBLIC SCHOOLS OR POLITICAL, LABOR, OR FRATERNAL ORGANIZATIONS, POLITICAL CANDIDATES, CIVIC CLUBS, MUNICIPAL, COUNTY, OR STATE GOVERNMENT. EACH YEAR A SUBCOMMITTEE OF EXETER HEALTH RESOURCES, INC.'S (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 AND RECOMMENDS AN ALLOCATION TO SUPPORT THE COMING YEAR'S GRANT PROGRAM TO THE FULL BOARD FOR APPROVAL AS PART OF THE BUDGET. THAT SUBCOMMITTEE AND THE LARGER EXETER HEALTH RESOURCES, INC.'S (PARENT COMPANY) BOARD OF TRUSTEES ARE REGULARLY UPDATED ON OUR COMMUNITY SUPPORT INITIATIVES. INFORMATION ABOUT THE COMMUNITY NEEDS ASSESSMENT OR THE ANNUAL GRANT PROGRAM CAN BE FOUND ON THE WWW.EXETERHOSPITAL.COM WEBPAGE." X 1 1 1 1 0 0 0 0 0 1 0 TABB MD KEVIN CHIEF EXECUTIVE OFFICER (CEO, BILH) 0 2183284 0 1588566 0 541537 0 1052595 0 44433 0 5410415 0 0 ROWAN MICHAEL TTEE(CEO DESIG) EVP HOS&AMBSVCS BILH 0 1190402 0 617208 0 494507 0 2372445 0 29333 0 4703895 0 0 CALLAHAN KEVIN J FORMER TRUSTEE, CEO & PRESIDENT 0 506089 0 722202 0 520780 0 348250 0 19457 0 2116778 0 0 RIOS CINDY TREAS (EXECUTIVE VP & CFO, BILH) 0 926412 0 523188 0 21827 0 182509 0 35227 0 1689163 0 0 SHORETT PETER TTEE (SR EXECUTIVE VP & COO, BILH) 0 902677 0 453262 0 203537 0 14020 0 34226 0 1607722 0 0 KATZ ESQ JAMIE CLERK; GENERAL COUNSEL, BILH 0 820540 0 322850 0 126785 0 23170 0 8832 0 1302177 0 0 CRESTA DEBRA TRUSTEE & PRESIDENT (PRESIDENT, EHR) 0 557394 0 386150 0 155210 0 0 0 16277 0 1115031 0 0 CASASSA ALLISON J ASSISTANT TREASURER & CFO 0 411665 0 247271 0 26311 0 19800 0 3450 0 708497 0 0 HOLLISTER MD RICHARD TRUSTEE (PRESIDENT, MEDICAL STAFF) 0 605118 0 22828 0 1146 0 9150 0 43460 0 681702 0 0 MCKINNEY DONNA VP ACUTE CARE, CHIEF NURSING EXEC 339592 0 207935 0 25876 0 19800 0 31757 0 624960 0 0 0 O'NEIL SEAN COO & VP, AMBULATORY CARE 318499 0 182569 0 19879 0 19800 0 43760 0 584507 0 0 0 SPRAUER ESQ CONSTANCE D ASSISTANT CLERK (SVP LEGAL AFFAIRS) 0 330346 0 174789 0 30314 0 19800 0 15680 0 570929 0 0 BRINDAMOUR MD LUKE CHIEF MEDICAL OFFICER 338509 0 51512 0 22755 0 0 0 29587 0 442363 0 0 0 LEVESQUE SHANNON VP, HUMAN RESOURCES 0 286307 0 102500 0 6117 0 0 0 45108 0 440032 0 0 PANGAN MD MICHAEL TRUSTEE 0 264848 0 77878 0 1500 0 9150 0 45021 0 398397 0 0 THOMAS CHARLES EXECUTIVE DIRECTOR, HUMAN RESOURCES 216825 0 47187 0 22370 0 17901 0 44024 0 348307 0 0 0 BOYD ESQ STEPHEN ASST CLERK (DIV VP DEP GC COMM BILH) 0 254712 0 52448 0 6900 0 13450 0 2471 0 329981 0 0 CALLAHAN SUSAN DIRECTOR, COMPENSATION AND BENEFITS 175694 0 51516 0 54116 0 17077 0 28440 0 326843 0 0 0 GAGNE NOLAN PHYSICIST CHIEF 275412 0 0 0 117 0 17124 0 33636 0 326289 0 0 0 MEISNER JEFFREY SENIOR DIRECTOR, REHAB SERVICES 202559 0 45617 0 9950 0 16283 0 44864 0 319273 0 0 0 WAGNER ABIGAIL SENIOR DIRECTOR, SURGICAL SERVICES 196637 0 45927 0 304 0 14922 0 29486 0 287276 0 0 0 GARGANTA AARON SENIOR DIR ENG. & PHYS. ENVIRONMENT 188176 0 38811 0 7731 0 14083 0 300 0 249101 0 0 0 SAVOIE MICHELLE INTERIM VP ACUTE CARE, CHIEF NURSE 177580 0 12803 0 7462 0 12358 0 30654 0 240857 0 0 0 PART I, LINE 1A FROM TIME TO TIME AND UNDER CERTAIN CIRCUMSTANCES, EXETER HOSPITAL INC OR ONE OF IT'S AFFILIATES MAY CHOOSE TO GROSS-UP A PAYMENT TO MAKE THE EMPLOYEE WHOLE FROM A TAX PERSPECTIVE. AS EXPLAINED FURTHER BELOW, ACROSS BILH THESE SITUATIONS ARE REVIEWED ON A CASE-BY-CASE BASIS AND THE COST OF ANY GROSS-UP IS CONSIDERED WHEN REVIEWING AN EMPLOYEE'S OVERALL COMPENSATION PACKAGE FOR REASONABLENESS. EXAMPLES OF THE TYPES OF EXPENSES WHICH MAY FALL INTO THIS CATEGORY ARE REIMBURSEMENT FOR RELOCATION AND TEMPORARY HOUSING. PART I, LINES 4A-B BILH AND ITS AFFILIATES MAINTAIN CERTAIN SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS. DURING THE PERIOD COVERED BY THIS FILING, ONE OR MORE INDIVIDUALS LISTED IN THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, MAY HAVE PARTICIPATED IN ONE OR MORE OF THE FOLLOWING PLANS, WHICH UNDER THE DEFINITION TO THIS FORM 990 ARE SUPPLEMENTAL NONQUALIFIED PLANS: BETH ISRAEL DEACONESS MEDICAL CENTER EXECUTIVE RETIREMENT PROGRAM, BETH ISRAEL LAHEY HEALTH, INC. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, LAHEY CLINIC FOUNDATION, INC. 457(F) NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN PHYSICIANS, SENIOR MANAGEMENT AND DEFINED MEDICAL STAFF, THE JORDAN HEALTH SYSTEMS, INC. 457(F) DEFERRED COMPENSATION PLAN. IN ADDITION, DURING THE PERIOD COVERED BY THIS FILING, ONE OR MORE INDIVIDUALS LISTED IN THIS FORM 990, SCHEDULE J, COMPENSATION INFORMATION, MAY HAVE PARTICIPATED IN ONE OR MORE OF THESE ADDITIONAL IRC 457(B) PLANS AND BENEFITS FROM PARTICIPATING IN ONE OF THESE PLANS IS ALSO REPORTED IN THIS FORM 990: BETH ISRAEL DEACONESS MEDICAL CENTER 457(B) PLAN, BETH ISRAEL LAHEY HEALTH, INC. 457(B) DEFERRED COMPENSATION PLAN, EXETER HEALTH RESOURCES, INC. 457(B) RETIREMENT SAVINGS PLAN THESE PLANS ARE NON-QUALIFIED DEFERRED COMPENSATION PLANS AND PURSUANT TO THE PLANS, ELIGIBLE EMPLOYEES RECEIVE CERTAIN RETIREMENT BENEFITS. AMOUNTS RECEIVED BY PARTICIPANTS, DEFERRED BY PARTICIPANTS AND THE CHANGE IN VALUE OF THE PLAN BENEFITS RELATED TO THESE PARTICIPANTS'' ACCOUNTS ARE INCLUDED IN FORM 990 SCHEDULE J, PART II, COLUMN B(III), OTHER REPORTABLE COMPENSATION AND/OR FORM 990, SCHEDULE J, PART II, COLUMN C, DEFERRED COMPENSATION IN ACCORDANCE WITH THE INSTRUCTIONS TO THIS FORM 990. ADDITIONAL INFORMATION IS INCLUDED WITH THE EXPLANATORY NOTES TO SCHEDULE J BELOW. PART I, LINE 7 AS REQUIRED BY THIS FORM 990 AND AS REPORTED IN THE FORM 990 SCHEDULE J, ALTHOUGH THIS FILING COVERS THE FISCAL PERIOD OCTOBER 1, 2023 TO SEPTEMBER 30, 2024, COMPENSATION REPORTED IN THIS FILING IS CALENDAR YEAR 2023 COMPENSATION. IN ADDITION, AS REPORTED IN THE PRIOR YEAR FORM 990 FOR EXETER HOSPITAL INC, EFFECTIVE JULY 1, 2023, BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF EXETER HEALTH RESOURCES, INC. (EHRI) AND EHRI IS THE SOLE MEMBER OF EXETER HOSPITAL INC . IN ADDITION, AS DESCRIBED ABOVE, COMPENSATION FOR SOME INDIVIDUALS REPORTED IN THIS FORM 990 SCHEDULE J WAS SET PRIOR TO JULY 1, 2023 BY THE EHRI EXECUTIVE COMMITTEE AND BOARD AND THE COMPENSATION FOR OTHER INDIVIDUALS REPORTED IN THIS FORM 990 SCHEDULE J WAS SET EFFECTIVE OR SUBSEQUENT TO JULY 1, 2023 BY THE BILH COMPENSATION COMMITTEE AND BOARD. FOR INDIVIDUALS WHOSE COMPENSATION WAS SET BY EHRI: EHRI AS SOLE MEMBER OF EXETER HOSPITAL INC PROVIDES AN ANNUAL INCENTIVE COMPENSATION PLAN FOR EXECUTIVES SELECTED BY THE EHRI BOARD OF TRUSTEES. SUCH PERSONS AND THEIR INCENTIVE COMPENSATION ARE DISCLOSED ON THIS FORM 990, PART VII, AND THIS SCHEDULE J. THE EHRI BOARD AND/OR ITS EXECUTIVE COMMITTEE APPROVED MEASURABLE 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 ESTABLISHED MINIMUM, TARGETED AND MAXIMUM LEVELS FOR INCENTIVE AWARDS AND APPROVES ALL AWARDS FOR PARTICIPATING EXECUTIVES. FOR INDIVIDUALS WHOSE COMPENSATION WAS SET BY BILH: AS NOTED ABOVE, THE BILH COMPENSATION COMMITTEE ESTABLISHES THE POLICIES AND THE COMPENSATION STRUCTURE, INCLUDING BENEFITS, FOR THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES INCLUDING THE BILH CHIEF EXECUTIVE OFFICER AS WELL AS OTHER MEMBERS OF SENIOR MANAGEMENT AT BILH AND ITS AFFILIATES. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS IS FAIR AND REASONABLE USING CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION AND IS RESPONSIBLE FOR ENSURING COMPLIANCE WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. THE BILH COMPENSATION COMMITTEE IS COMPOSED OF INDEPENDENT MEMBERS OF ITS BOARD OF TRUSTEES. DURING THE 2023 CALENDAR YEAR, BILH MAINTAINED EXECUTIVE COMPENSATION PACKAGES WHICH INCLUDED OPPORTUNITIES TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF VARIOUS FACTORS, INCLUDING BUT NOT LIMITED TO, MEETING OR EXCEEDING THE EMPLOYING ENTITY'S OBJECTIVES FOR QUALITY AND PATIENT SAFETY, BUDGETED CONSOLIDATED OPERATING MARGIN, AND MEETING INDIVIDUAL GOALS AND OBJECTIVES. IN EACH CASE, INCENTIVE COMPENSATION WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, AND FOR THE BILH CEO AS NOTED ABOVE, THE FULL BILH BOARD OF TRUSTEES. ADDITIONAL INFORMATION IS INCLUDED IN THE EXPLANATORY NOTES TO THIS SCHEDULE J. SCHEDULE J ADDITIONAL EXPLANATORY FOOTNOTES: DIRECTORS AND TRUSTEES SERVE WITHOUT COMPENSATION: ALL DIRECTORS/TRUSTEES SERVE WITHOUT COMPENSATION OR BENEFITS. COMPENSATION PAID TO OFFICERS, DIRECTORS/TRUSTEES OR KEY EMPLOYEES WAS EARNED FOR WORK PERFORMED IN A CAPACITY OTHER THAN THAT OF DIRECTOR/TRUSTEE, AS DENOTED BY THE LISTED TITLES IN THE NOTES BELOW. REPORTING PERIOD: AS REQUIRED BY FORM 990, COMPENSATION REPORTED IN THE FILING FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024 IS CALENDAR YEAR 2023 COMPENSATION. COMPENSATION SOURCES: COMPENSATION REPORTED FOR INDIVIDUALS MAY INCLUDE COMPENSATION PAID BY THE REPORTING ENTITY, AN AFFILIATE OF THE REPORTING ENTITY AND IN SOME CASES UNRELATED ENTITIES AS REQUIRED BY FORM 990. REPORTABLE COMPENSATION: REPORTABLE COMPENSATION LISTED IN FORM 990 PART VII INCLUDES BASE COMPENSATION, INCENTIVE COMPENSATION AND OTHER REPORTABLE COMPENSATION AS REPORTED IN FORM 990 SCHEDULE J. OTHER COMPENSATION: OTHER COMPENSATION LISTED IN FORM 990 PART VII INCLUDES DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS AS REPORTED IN FORM 990 SCHEDULE J. BASE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN BASE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: ORDINARY WAGES, EMPLOYEE DEFERRALS TO A 401(K) AND/OR 403(B) PLAN OTHER REPORTABLE COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED IN THIS RETURN BUT QUANTIFIED IN OTHER REPORTABLE COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: TAXABLE EMPLOYER SUBSIDIZED PARKING; TAXABLE LIFE, DISABILITY, OR LONG-TERM CARE INSURANCE. DEFERRED COMPENSATION: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN DEFERRED COMPENSATION INCLUDE AMOUNTS FROM ONE OR MORE OF THE FOLLOWING ITEMS: EMPLOYER CONTRIBUTIONS TO 401(K) RETIREMENT PLAN, EMPLOYER CONTRIBUTIONS TO 403(B) RETIREMENT PLAN, EMPLOYER CONTRIBUTION TO PENSION PLAN AND/OR THE CHANGE IN ACTUARIAL VALUE OF THE PENSION PLAN BENEFIT. NON-TAXABLE BENEFITS: AMOUNTS NOT OTHERWISE SEPARATELY NOTED BUT QUANTIFIED IN NON-TAXABLE BENEFITS INCLUDE, AMONG OTHER THINGS, AMOUNTS FROM ONE OR MORE OF THE FOLLOWING NON-TAXABLE BENEFITS: EMPLOYEE CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYER CONTRIBUTIONS TO HEALTH INSURANCE, EMPLOYEE CONTRIBUTIONS TO FLEXIBLE SPENDING ACCOUNTS FOR DEPENDENT CARE AND/OR MEDICAL REIMBURSEMENT, ADOPTION ASSISTANCE, TUITION ASSISTANCE PURSUANT TO AN EMPLOYER PLAN, GROUP TERM LIFE INSURANCE, DISABILITY INSURANCE ADDITIONAL INDIVIDUAL SPECIFIC INFORMATION IS INCLUDED BELOW. SCHEDULE J FOOTNOTES (CONTINUED): ABRAMSON, ESQ., S. MICHAEL ASSOCIATE GENERAL COUNSEL - BETH ISRAEL LAHEY HEALTH, INC. ASSISTANT CLERK (EX-OFFICIO) - EXETER HOSPITAL, INC. - TERM BEGAN ON MAY 30, 2024 ASSISTANT CLERK (EX-OFFICIO) - EXETER HEALTH RESOURCES. INC. - TERM BEGAN ON MAY 30, 2024 ASSISTANT CLERK (EX-OFFICIO) - CORE PHYSICIANS. LLC - TERM BEGAN ON MAY 30, 2024 AS NOTED, MR. ABRAMSON SERVED IN THE POSITIONS ABOVE DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. ACCORDINGLY, SINCE MR. ABRAMSON DID NOT BEGIN SERVING IN HIS POSITIONS UNTIL CALENDAR YEAR 2024, THERE IS NO COMPENSATION TO REPORT IN THIS FILING. BOYD, ESQ, STEPHEN ASSISTANT CLERK (EX-OFFICIO) (DIVISIONAL VICE PRESIDENT, DEPUTY GENERAL COUNSEL FOR COMMUNITY DIVISION) - ANNA JAQUES HOSPITAL, INC. - TERM BEGAN ON SEPTEMBER 26, 2024 ASSISTANT CLERK (DIVISIONAL VICE PRESIDENT, DEPUTY GENERAL COUNSEL FOR COMMUNITY DIVISION) - SEACOAST AFFILIATED GROUP PRACTICE, INC. - TERM BEGAN ON SEPTEMBER 26, 2024 IN ADDITION, MR. BOYD HELD FOLLOWING ROLES TERM STARTED JANUARY 29, 2024 AND ENDED MAY 29, 2024. ASSISTANT CLERK (EX-OFFICIO) (DIVISIONAL VICE PRESIDENT, DEPUTY GENERAL COUNSEL FOR COMMUNITY DIVISION) - CORE PHYSICIANS, LLC ASSISTANT CLERK (EX-OFFICIO) (DIVISIONAL VICE PRESIDENT, DEPUTY GENERAL COUNSEL FOR COMMUNITY DIVISION) - EXETER HEALTH RESOURCES, INC. ASSISTANT CLERK (DIVISIONAL VICE PRESIDENT, DEPUTY GENERAL COUNSEL FOR COMMUNITY DIVISION) - EXETER HOSPITAL, INC. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. BRINDAMOUR, M.D., LUKE DR, BRINDAMOUR BEGAN THE FOLLOWING POSITION ON SEPTEMBER 15, 2024 CHIEF MEDICAL OFFICER - EXETER HOSPITAL, INC. INCENTIVE COMPENSATION FOR DR, BRINDAMOUR INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $12,500 CALLAHAN, KEVIN J. FORMER CHIEF EXECUTIVE OFFICER, PRESIDENT, AND TRUSTEE - EXETER HEALTH RESOURCES, INC. FORMER CHIEF EXECUTIVE OFFICER, PRESIDENT, AND TRUSTEE - EXETER HOSPITAL, INC. FORMER PRESIDENT, CLERK AND TRUSTEE - EXETER MED REAL, INC. FORMER MANAGING MEMBER AND SYSTEM MANAGER - CORE PHYSICIANS, LLC FORMER CHAIR & TRUSTEE (EX-OFFICIO) - ROCKINGHAM VISITING NURSE ASSOC & HOSPICE MR. CALLAHAN'S TERM ENDED IN THE ABOVE POSITIONS ON JULY 1, 2023 DURING THE PRIOR FISCAL PERIOD. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. INCENTIVE COMPENSATION FOR MR. CALLAHAN INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $500,000. OTHER REPORTABLE COMPENSATION FOR MR. CALLAHAN INCLUDES PAYMENTS FOR SEVERANCE RECEIVED IN 2023 AND PTO CASHED OUT IN THE AMOUNT OF $282,083 AND $155,559, RESPECTIVELY. OTHER REPORTABLE COMPENSATION ALSO INCLUDES PREMIUM PAYMENTS RELATED TO SPLIT-DOLLAR LIFE INSURANCE IN THE AMOUNT OF $49,778. DEFERRED COMPENSATION FOR MR. CALLAHAN INCLUDES DEFERRED SEVERANCE PAYMENTS IN THE AMOUNT OF $348,250 TO BE PAID AFTER DECEMBER 31, 2023. CALLAHAN, SUSAN DIRECTOR OF COMPENSATION AND BENEFITS - EXETER HOSPITAL, INC. INCENTIVE COMPENSATION FOR MS. CALLAHAN INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $34,079 AND OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR PTO CASHED OUT IN THE AMOUNTS OF $29,710. CARUCCI, DEAN MR. CARUCCI BEGAN SERVING IN THE FOLLOWING ROLES ON AUGUST 5, 2024, UNLESS OTHERWISE NOTED BELOW: DIVISIONAL PRESIDENT, COMMUNITY - BETH ISRAEL LAHEY HEALTH, INC. - TERM BEGAN ON JULY 29, 2024 TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. - TERM BEGAN ON AUGUST 4, 2024 TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC TRUSTEE - BID - MILTON PHYSICIAN ASSOCIATES, INC. TRUSTEE - COMMUNITY PHYSICIANS ASSOCIATES, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - EXETER HEALTH RESOURCES, INC. TRUSTEE - EXETER HOSPITAL, INC. TRUSTEE - JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - NORTHEAST HOSPITAL CORPORATION TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - WINCHESTER HOSPITAL AS NOTED, MR. CARUCCI SERVED IN THE POSITIONS ABOVE DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. ACCORDINGLY, SINCE MR. CARUCCI DID NOT BEGIN SERVING IN HIS POSITIONS UNTIL CALENDAR YEAR 2024, THERE IS NO COMPENSATION TO REPORT IN THIS FILING. CASASSA, ALLISON J. UNLESS OTHERWISE NOTED, MS. CASASSA SERVED IN THE FOLLOWING POSITIONS DURING THE PERIOD ENDED SEPTEMBER 30, 2024: CHIEF FINANCIAL OFFICER & ASSISTANT TREASURER (EX-OFFICIO) - EXETER HEALTH RESOURCES, INC. CHIEF FINANCIAL OFFICER & ASSISTANT TREASURER - EXETER HOSPITAL, INC. TRUSTEE - ROCKINGHAM VISITING NURSE ASSOC & HOSPICE CHIEF FINANCIAL OFFICER, TRUSTEE & TREASURER - EXETER MED REAL, INC. MANAGING MEMBER & ASSISTANT TREASURER (EX-OFFICIO) - CORE PHYSICIANS, LLC AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. INCENTIVE COMPENSATION FOR MS. CASASSA INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $124,500 AND OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR PTO CASHED OUT IN THE AMOUNTS OF $12,769. CRESTA, DEBRA UNLESS OTHERWISE NOTED BELOW, MS. CRESTA HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDING SEPTEMBER 30, 2024: TRUSTEE (EX-OFFICIO) & PRESIDENT - EXETER HEALTH RESOURCES, INC. PRESIDENT & TRUSTEE - EXETER HOSPITAL, INC. PRESIDENT, TRUSTEE, BOARD CHAIR & SECRETARY - EXETER MED REAL, INC. - TERM AS SECRETARY ENDED ON SEPTEMBER 30, 2024 MANAGING MEMBER (EX-OFFICIO) - CORE PHYSICIANS, LLC CHAIR & TRUSTEE (EX-OFFICIO) - ROCKINGHAM VISITING NURSE ASSOC & HOSPICE AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. INCENTIVE COMPENSATION FOR MS. CRESTA INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $176,100 AND OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR PTO CASHED OUT AND GROUP TERM LIFE INSURANCE IN THE AMOUNT OF $120,609 AND $11,409, RESPECTIVELY. GAGNE, NOLAN PHYSICIST CHIEF - EXETER HOSPITAL, INC. GARGANTA. AARON SENIOR DIRECTOR ENGINEERING AND PHYSICAL ENVIRONMENT - EXETER HOSPITAL SENIOR DIRECTOR ENGINEERING AND PHYSICAL ENVIRONMENT - EXETER MED REAL, INC. INCENTIVE COMPENSATION FOR MR. GARGANTA INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $28,226. HOLLISTER, M.D., RICHARD PHYSICIAN, PULMONOLOGIST - CORE PHYSICIAN LLC TRUSTEE (PRESIDENT, MEDICAL STAFF) - EXETER HOSPITAL, INC. TRUSTEE (EX-OFFICIO),(PRESIDENT, MEDICAL STAFF) - EXETER HEALTH RESOURCES, INC. INCENTIVE COMPENSATION FOR MR. HOLLISTER INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $20,000. SCHEDULE J FOOTNOTES (CONTINUED): KATZ, J.D., JAMIE UNLESS OTHERWISE NOTED BELOW, MR. KATZ HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDED SEPTEMBER 30, 2024: GENERAL COUNSEL AND CLERK (EX-OFFICIO), - BETH ISRAEL LAHEY HEALTH, INC. CLERK (EX-OFFICIO) - BETH ISRAEL DEACONESS MEDICAL CENTER, INC. CLERK (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. CLERK (EX-OFFICIO) - MOUNT AUBURN HOSPITAL CLERK (EX-OFFICIO) - NEW ENGLAND BAPTIST HOSPITAL CLERK (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. CLERK - COMMUNITY PHYSICIANS ASSOCIATES, INC. CLERK - BID - MILTON PHYSICIAN ASSOCIATES, INC. CLERK (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. CLERK - JORDAN PHYSICIAN ASSOCIATES, INC. CLERK - THE JORDAN HEALTH SYSTEMS, INC. CLERK (EX-OFFICIO) - ANNA JAQUES HOSPITAL CLERK - SEACOAST AFFILIATED GROUP PRACTICE, INC. TRUSTEE AND CLERK (EX-OFFICIO) - LAHEY HEALTH SHARED SERVICES, INC. TRUSTEE AND CLERK (EX-OFFICIO) - ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) - NORTHEAST HEALTH SYSTEM, INC. TRUSTEE AND CLERK (EX-OFFICIO) - NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE (EX-OFFICIO) AND CLERK (EX-OFFICIO) - NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE AND CLERK (EX-OFFICIO) - SEACOAST NURSING AND REHABILITATION CENTER, INC. TRUSTEE AND CLERK (EX-OFFICIO) - WINCHESTER HOSPITAL FOUNDATION, INC. CLERK - WINCHESTER HEALTHCARE MANAGEMENT, INC. CLERK (EX-OFFICIO) - LAHEY CLINIC FOUNDATION, INC. CLERK - LAHEY CLINIC, INC. CLERK - LAHEY CLINIC HOSPITAL, INC.D/B/A LAHEY HOSPITAL & MEDICAL CENTER CLERK (EX-OFFICIO) - NORTHEAST HOSPITAL CORPORATION TRUSTEE AND CLERK (EX-OFFICIO) - NORTHEAST MEDICAL PRACTICE INC. (NOW KNOWN AS BETH ISRAEL LAHEY HEALTH SPECIALTY CARE, INC.) TRUSTEE AND CLERK - CAB HEALTH AND RECOVERY SERVICES, INC. TRUSTEE AND CLERK - HEALTH AND EDUCATION HOUSING SERVICES, INC. CLERK (EX-OFFICIO) - WINCHESTER HOSPITAL CLERK - JOSLIN CLINIC, INC. CLERK (EX-OFFICIO) - JOSLIN DIABETES CENTER, INC. CLERK (EX-OFFICIO) - MOUNT AUBURN PROFESSIONAL SERVICES, INC. CLERK - MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION D/B/A BETH ISRAEL LAHEY HEALTH PRIMARY CARE A/K/A AFFILIATED PHYSICIANS GROUP CLERK (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PHARMACY, INC. CLERK (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. CLERK (EX-OFFICIO) - EXETER HEALTH RESOURCES, INC. CLERK - EXETER HOSPITAL, INC. CLERK (EX-OFFICIO) - CORE PHYSICIANS, LLC AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR MR. KATZ INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $76,930. IN ADDITION, MR. KATZ OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR GROUP TERM LIFE INSURANCE IN THE AMOUNTS OF $29,355. LEVESQUE, SHANNON VICE PRESIDENT, HUMAN RESOURCES - ROCKINGHAM VISITING NURSE ASSOCIATION AND HOSPICE VICE PRESIDENT, HUMAN RESOURCES - EXETER HEALTH RESOURCES, INC. VICE PRESIDENT, HUMAN RESOURCES - EXETER HOSPITAL, INC. VICE PRESIDENT, HUMAN RESOURCES - EXETER MED REAL, INC. INCENTIVE COMPENSATION FOR MS. LEVESQUE INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $102,500 MCKINNEY, DONNA MS. MCKINNEY TERM ENDED ON THE BELOW POSITIONS ON SEPTEMBER 6, 2024 VICE PRESIDENT ACUTE CARE, CHIEF NURSING EXECUTIVE EXETER HOSPITAL, INC.TRUSTEE AND SECRETARY - ROCKINGHAM VISITING NURSE ASSOCIATION AND HOSPICE INCENTIVE COMPENSATION FOR MS. MCKINNEY INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $104,302 AND OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR PTO CASHED OUT IN THE AMOUNTS OF $15,044. MEISNER, JEFFREY SENIOR DIRECTOR REHABILITATION SERVICES - EXETER HOSPITAL INC. INCENTIVE COMPENSATION FOR MR. MEISNER INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $32,372 O'NEIL, SEAN VICE PRESIDENT AND CHIEF OPERATING OFFICER , AMBULATORY CARE - EXETER HOSPITAL, INC. INCENTIVE COMPENSATION FOR MR. O'NEIL INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $97,537. PANGAN, M.D., MICHAEL CHAIR & MANAGING MEMBER, CLINICIAN MANAGER - CORE PHYSICIANS LLC TRUSTEE - EXETER HOSPITAL, INC. TRUSTEE - EXETER HEALTH RESOURCES, INC. RIOS, CINDY MS. RIOS SERVED IN THE FOLLOWING POSITIONS FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2024: EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER & TREASURER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH, INC. TREASURER - MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION D/B/A BETH ISRAEL LAHEY HEALTH PRIMARY CARE A/K/A AFFILIATED PHYSICIANS GROUP TREASURER - NORTHEAST PROFESSIONAL REGISTRY OF NURSES, INC. TRUSTEE & TREASURER - CAB HEALTH AND RECOVERY SERVICES, INC. TREASURER (EX-OFFICIO) - ANNA JAQUES HOSPITAL, INC. TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TREASURER (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. TREASURER - BID - MILTON PHYSICIAN ASSOCIATES, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PHARMACY, INC. TREASURER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. TREASURER - COMMUNITY PHYSICIANS ASSOCIATES, INC. TREASURER - JOSLIN CLINIC, INC. TREASURER (EX-OFFICIO) - JOSLIN DIABETES CENTER, INC. TREASURER - THE JORDAN HEALTH SYSTEMS, INC. TREASURER - JORDAN PHYSICIAN ASSOCIATES, INC. TREASURER (EX-OFFICIO) - LAHEY CLINIC FOUNDATION, INC. TREASURER - LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER TREASURER - LAHEY CLINIC, INC. TREASURER (EX-OFFICIO) - MOUNT AUBURN HOSPITAL TREASURER (EX-OFFICIO) - MOUNT AUBURN PROFESSIONAL SERVICES, INC. TREASURER (EX-OFFICIO) - NEW ENGLAND BAPTIST HOSPITAL TREASURER (EX-OFFICIO) - NORTHEAST HOSPITAL CORPORATION TREASURER - SEACOAST AFFILIATED GROUP PRACTICE, INC. TRUSTEE & TREASURER (EX-OFFICIO) - WINCHESTER HOSPITAL FOUNDATION, INC. TREASURER - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE & TREASURER (EX-OFFICIO) ADDISON GILBERT SOCIETY, INC. TRUSTEE & TREASURER - HEALTH AND EDUCATION HOUSING SERVICES, INC. TRUSTEE & TREASURER - LAHEY HEALTH SHARED SERVICES, INC. TRUSTEE & TREASURER (EX-OFFICIO) - NORTHEAST BEHAVIORAL HEALTH CORPORATION TRUSTEE & TREASURER (EX-OFFICIO) - NORTHEAST HEALTH SYSTEM, INC. TRUSTEE & TREASURER (EX-OFFICIO) - NORTHEAST MEDICAL PRACTICE, INC. (NOW KNOWN AS BETH ISRAEL LAHEY HEALTH SPECIALTY CARE, INC.) TRUSTEE & TREASURER (EX-OFFICIO) - NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE & TREASURER (EX-OFFICIO) - SEACOAST NURSING & REHABILITATION CENTER, INC. TREASURER (EX-OFFICIO) - WINCHESTER HOSPITAL TREASURER (EX-OFFICIO) - EXETER HEALTH RESOURCES, INC. TREASURER - EXETER HOSPITAL, INC. TREASURER - EXETER MED REAL, INC. TRUSTEE & TREASURER (EX-OFFICIO) - ROCKINGHAM VISITING NURSE ASSOC AND HOSPICE TREASURER (EX-OFFICIO) - CORE PHYSICIANS, LLC AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. DEFERRED COMPENSATION IN THE AMOUNT OF $125,000 RELATES TO A MILESTONE PAYMENT WHICH, AS OF DECEMBER 31, 2023, WAS NOT FUNDED, WAS NOT VESTED AND FOR WHICH THERE WAS NO GUARANTEE OF PAYMENT. THIS AMOUNT IS INCLUDED HERE AS DEFERRED COMPENSATION AS REQUIRED BASED ON THE INSTRUCTIONS TO THE FORM 990. IN ADDITION, DEFERRED COMPENSATION INCLUDES AN UNVESTED CONTRIBUTION TO A NONQUALIFIED PLAN IN THE AMOUNT OF $52,757. SCHEDULE J FOOTNOTES (CONTINUED): ROWAN, MICHAEL MR. ROWAN SERVED IN THE FOLLOWING POSITIONS THROUGH HIS RETIREMENT ON DECEMBER 31, 2023: EXECUTIVE VICE PRESIDENT, HOSPITAL AND AMBULATORY SERVICES - BETH ISRAEL LAHEY HEALTH, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - BETH ISRAEL LAHEY HEALTH PHARMACY, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. TRUSTEE (CEO DESIGNATE) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - NORTHEAST HOSPITAL CORPORATION TRUSTEE - COMMUNITY PHYSICIANS ASSOCIATES, INC. TRUSTEE - THE JORDAN HEALTH SYSTEMS, INC. TRUSTEE - JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE - BID - MILTON PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - JOSLIN CLINIC, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - JOSLIN DIABETES CENTER, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - ANNA JAQUES HOSPITAL, INC. TRUSTEE (CEO DESIGNEE) - SEACOAST AFFILIATED GROUP PRACTICE, INC. TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - WINCHESTER HOSPITAL TRUSTEE (EX-OFFICIO) (CEO DESIGNATE) - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (CEO DESIGNATE) - EXETER HOSPITAL, INC TRUSTEE (CEO DESIGNATE) - EXETER HEALTH RESOURCES, INC. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR MR. ROWAN INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $429,049. PART OR ALL OF THE PAYMENTS REPRESENT AMOUNTS REPORTED IN PRIOR YEARS AS OTHER REPORTABLE COMPENSATION OR DEFERRED COMPENSATION. IN ADDITION, MR. ROWAN'S OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR GROUP TERM LIFE INSURANCE IN THE AMOUNTS OF $44,958. DEFERRED COMPENSATION FOR MR. ROWAN INCLUDES DEFERRED SEVERANCE PAYMENTS IN THE AMOUNT OF $2,353,850 TO BE PAID AFTER DECEMBER 31, 2023. SAVOIE, MICHELLE MS. SAVOIE BEGAN SERVING IN THE FOLLOWING ROLE ON SEPTEMBER 8, 2024: INTERIM VICE PRESIDENT ACUTE CARE, CHIEF NURSING EXECUTIVE - EXETER HOSPITAL, INC. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. SHORETT, PETER SENIOR EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER - BETH ISRAEL LAHEY HEALTH, INC. -TERM BEGAN DECEMBER 10, 2023 EXECUTIVE VICE PRESIDENT AND CHIEF STRATEGY OFFICER - BETH ISRAEL LAHEY HEALTH, INC. -TERM ENDED DECEMBER 9, 2023 TRUSTEE (EX-OFFICIO, CEO DESIGNATE) - MOUNT AUBURN HOSPITAL -TERM ENDED ON JANUARY 31, 2024. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - ANNA JAQUES HOSPITAL, INC. -TERM BEGAN ON JANUARY 1, 2024 TRUSTEE - SEACOAST AFFILIATED GROUP PRACTICE, INC. -TERM BEGAN ON JANUARY 1, 2024 TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS MEDICAL CENTER, INC. -TERM BEGAN ON FEBRUARY 1, 2024 TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - LAHEY CLINIC FOUNDATION, INC. -TERM BEGAN ON FEBRUARY 1, 2024 TRUSTEE - LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER -TERM BEGAN ON FEBRUARY 1, 2024 TRUSTEE - LAHEY CLINIC, INC. -TERM BEGAN ON FEBRUARY 1, 2024 TRUSTEE (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC. -TERM ENDED ON MARCH 29, 2024. TRUSTEE - MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION D/B/A BETH ISRAEL LAHEY HEALTH PRIMARY CARE A/K/A AFFILIATED PHYSICIANS GROUP -TERM ENDED ON MARCH 29, 2024. IN ADDITION, MR. SHORETT SERVED IN THE FOLLOWING ROLES TERM DURING THE PERIOD JANUARY 1, 2024 AND ENDED AUGUST 4, 2024: TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. TRUSTEE - BID - MILTON PHYSICIAN ASSOCIATES, INC. TRUSTEE - COMMUNITY PHYSICIANS ASSOCIATES, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - EXETER HEALTH RESOURCES, INC. TRUSTEE - EXETER HOSPITAL, INC. TRUSTEE - JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - NORTHEAST HOSPITAL CORPORATION TRUSTEE - THE JORDAN HEALTH SYSTEMS, INC. TRUSTEE - WINCHESTER HEALTHCARE MANAGEMENT, INC. TRUSTEE (EX-OFFICIO, CEO DESIGNEE) - WINCHESTER HOSPITAL MR. SHORETT SERVED IN THE POSITIONS ABOVE DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR MR. SHORETT INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $179,843. PART OR ALL OF THE PAYMENTS REPRESENT AMOUNTS REPORTED IN PRIOR YEARS AS OTHER REPORTABLE COMPENSATION OR DEFERRED COMPENSATION. SPRAUER, ESQ., CONSTANCE D. SENIOR VICE PRESIDENT LEGAL AFFAIRS AND ASSISTANT CLERK - EXETER HEALTH RESOURCES, INC. -TERM ENDED ON JANUARY 26, 2024 ASSISTANT CLERK (SENIOR VICE PRESIDENT LEGAL AFFAIRS) - CORE PHYSICIANS, LLC -TERM ENDED ON JANUARY 26, 2024 ASSISTANT CLERK (SENIOR VICE PRESIDENT LEGAL AFFAIRS) - EXETER HOSPITAL, INC. -TERM ENDED ON JANUARY 26, 2024 INCENTIVE COMPENSATION FOR MS. SPRAUER INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $106,500. SCHEDULE J FOOTNOTES (CONTINUED): TABB, M.D., KEVIN UNLESS OTHERWISE NOTED BELOW, DR. TABB HELD THE FOLLOWING POSITIONS FOR THE FULL FISCAL PERIOD ENDING SEPTEMBER 30, 2024: PRESIDENT AND CHIEF EXECUTIVE OFFICER; TRUSTEE (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH, INC. CHIEF EXECUTIVE OFFICER AND TRUSTEE (EX-OFFICIO) - BETH ISRAEL DEACONESS MEDICAL CENTER, INC. -TRUSTEE (EX-OFFICIO) ROLE ENDED ON JANUARY 31, 2024 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE TRUSTEE (EX OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER -TRUSTEE (EX-OFFICIO) ROLE ENDED ON JANUARY 31, 2024 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE TRUSTEE (EX OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - LAHEY CLINIC, INC. -TRUSTEE (EX-OFFICIO) ROLE ENDED ON JANUARY 31, 2024 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE TRUSTEE (EX OFFICIO) AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - LAHEY CLINIC FOUNDATION, INC. - TRUSTEE (EX-OFFICIO) ROLE ENDED ON JANUARY 31, 2024 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO), PRESIDENT AND CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - LAHEY HEALTH SHARED SERVICES, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - BETH ISRAEL LAHEY HEALTH PHARMACY, INC. PRESIDENT (EX-OFFICIO) AND TRUSTEE (EX-OFFICIO) - ADDISON GILBERT SOCIETY, INC. TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO) AND PRESIDENT (EX-OFFICIO) - NORTHEAST HEALTH SYSTEM, INC. TRUSTEE (EX-OFFICIO), BOARD CHAIR (EX-OFFICIO) AND PRESIDENT (EX-OFFICIO) - NORTHEAST SENIOR HEALTH CORPORATION TRUSTEE, BOARD CHAIR (EX-OFFICIO) AND PRESIDENT (EX-OFFICIO) - SEACOAST NURSING AND REHABILITATION CENTER, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - WINCHESTER HOSPITAL TRUSTEE AND PRESIDENT (EX-OFFICIO) - WINCHESTER HOSPITAL FOUNDATION, INC. CHIEF EXECUTIVE OFFICER - WINCHESTER HEALTHCARE MANAGEMENT, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - NORTHEAST HOSPITAL CORPORATION CHIEF EXECUTIVE OFFICER (EX-OFFICIO) AND TRUSTEE (EX-OFFICIO) NORTHEAST BEHAVIORAL HEALTH CORPORATION -TRUSTEE (EX-OFFICIO) ROLE ENDED ON OCTOBER 31, 2023 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE CHIEF EXECUTIVE OFFICER AND TRUSTEE - CAB HEALTH AND RECOVERY SERVICES, INC. -TRUSTEE ROLE ENDED ON OCTOBER 31, 2023 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE CHIEF EXECUTIVE OFFICER AND TRUSTEE - HEALTH AND EDUCATION HOUSING SERVICES, INC. -TRUSTEE ROLE ENDED ON OCTOBER 31, 2023 AT WHICH TIME HE APPOINTED A DESIGNEE TO THIS ROLE CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. CHIEF EXECUTIVE OFFICER - BID - MILTON PHYSICIAN ASSOCIATES, INC. CHIEF EXECUTIVE OFFICER - COMMUNITY PHYSICIANS ASSOCIATES, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - MOUNT AUBURN HOSPITAL CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - NEW ENGLAND BAPTIST HOSPITAL CHIEF EXECUTIVE OFFICER - THE JORDAN HEALTH SYSTEMS, INC. CHIEF EXECUTIVE OFFICER - JORDAN PHYSICIAN ASSOCIATES, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - ANNA JAQUES HOSPITAL, INC. CHIEF EXECUTIVE OFFICER - SEACOAST AFFILIATED GROUP PRACTICE, INC. CHIEF EXECUTIVE OFFICER - JOSLIN CLINIC, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - JOSLIN DIABETES CENTER, INC. CHIEF EXECUTIVE OFFICER (EX-OFFICIO) - EXETER HEALTH RESOURCES, INC. CHIEF EXECUTIVE OFFICER - EXETER HOSPITAL, INC. IN ADDITION TO THE POSITIONS NOTED ABOVE, DR. TABB HELD THE FOLLOWING POSITIONS FOR WHICH HE WAS ENTITLED TO AND DID APPOINT A DESIGNEE WHO THEN BECAME THE VOTING TRUSTEE IN HIS PLACE: TRUSTEE (EX-OFFICIO) NORTHEAST HOSPITAL CORPORATION TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL MILTON, BID-MILTON PHYSICIAN ASSOCIATES AND COMMUNITY PHYSICIANS ASSOCIATES TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL NEEDHAM TRUSTEE (EX-OFFICIO) BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, THE JORDAN HEALTH SYSTEMS, INC AND JORDAN PHYSICIAN ASSOCIATES, INC. TRUSTEE (EX-OFFICIO) - MOUNT AUBURN HOSPITAL TRUSTEE (EX-OFFICIO) - NEW ENGLAND BAPTIST HOSPITAL TRUSTEE (EX-OFFICIO) - WINCHESTER HOSPITAL AND WINCHESTER HEALTHCARE MANAGEMENT TRUSTEE (EX-OFFICIO) - ANNA JAQUES HOSPITAL, INC. AND SEACOAST AFFILIATED GROUP PRACTICE TRUSTEE (EX-OFFICIO) - JOSLIN DIABETES CENTER TRUSTEE (EX-OFFICIO) - JOSLIN CLINIC TRUSTEE (EX-OFFICIO) - EXETER HEALTH RESOURCES, INC. TRUSTEE (EX-OFFICIO) - EXETER HOSPITAL, INC. TRUSTEE (EX-OFFICIO) - BETH ISRAEL DEACONESS MEDICAL CENTER, INC. TRUSTEE (EX-OFFICIO) - LAHEY CLINIC FOUNDATION, INC. TRUSTEE (EX-OFFICIO) - LAHEY CLINIC HOSPITAL, INC. D/B/A LAHEY HOSPITAL & MEDICAL CENTER TRUSTEE (EX-OFFICIO) - LAHEY CLINIC, INC. TRUSTEE (EX-OFFICIO) - CAB HEALTH AND RECOVERY SERVICES, INC. TRUSTEE (EX-OFFICIO) - HEALTH AND EDUCATION HOUSING SERVICES, INC. TRUSTEE (EX-OFFICIO) - NORTHEAST BEHAVIORAL HEALTH CORPORATION ALTHOUGH DR. TABB SERVED IN THE POSITIONS ABOVE FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. AS REQUIRED IN THIS FORM 990, COMPENSATION REPORTED HERE IS CALENDAR YEAR 2023 COMPENSATION. BASE COMPENSATION, INCENTIVE COMPENSATION, OTHER REPORTABLE COMPENSATION, DEFERRED COMPENSATION AND NON-TAXABLE BENEFITS ARE REPORTED AS REQUIRED IN FORM 990, SCHEDULE J. OTHER REPORTABLE COMPENSATION FOR DR. TABB INCLUDES COMBINED PAYMENTS FROM NONQUALIFIED RETIREMENT PLANS IN THE AMOUNT OF $497,673. PART OR ALL OF THE PAYMENTS REPRESENT AMOUNTS REPORTED IN PRIOR YEARS AS OTHER REPORTABLE COMPENSATION OR DEFERRED COMPENSATION. IN ADDITION, DR. TABB'S OTHER REPORTABLE COMPENSATION INCLUDES PAYMENTS FOR GROUP TERM LIFE INSURANCE IN THE AMOUNTS OF $23,364. DEFERRED COMPENSATION IN THE AMOUNT OF $1,034,000 IS INCLUDED IN THIS FILING FOR DR. TABB. THIS AMOUNT RELATES TO A MILESTONE PAYMENT WHICH, AS OF DECEMBER 31, 2023, WAS NOT FUNDED, WAS NOT VESTED AND FOR WHICH THERE WAS NO GUARANTEE OF PAYMENT. THIS AMOUNT IS INCLUDED HERE AS DEFERRED COMPENSATION AS REQUIRED BASED ON THE INSTRUCTIONS TO THE FORM 990. THOMAS, CHARLES EXECUTIVE DIRECTOR, HUMAN RESOURCES - EXETER HOSPITAL, INC. INCENTIVE COMPENSATION FOR MR. THOMAS INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $34,318 AND OTHER REPORTABLE COMPENSATION INCLUDES A PAYMENT TO CASH OUT PTO IN THE AMOUNT OF $19,799. WAGNER, ABIGAIL SENIOR DIRECTOR, SURGICAL SERVICES - EXETER HOSPITAL, INC. INCENTIVE COMPENSATION FOR MS. WAGNER INCLUDES A MILESTONE PAYMENT IN THE AMOUNT OF $30,369 A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584Y7K9 2023-12-12 442970000 MDFA - SERIES 2023M - SEE PART VI 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584YTK5 2019-07-31 211922775 MDFA - SERIES 2019K - SEE PART VI 0 0 0 C MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584YJW0 2018-06-26 479594374 MDFA - SERIES 2018J-1,J-2 - SEE PART VI 0 0 0 D MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584XMT5 2016-05-12 257611877 MDFA - SERIES 2016I - SEE PART VI 0 0 0 A 452893704 3559000 305961081 143373623 0 0 0 1 B 33635000 211922775 2931137 19714020 189277618 2019 0 0 1 1 C 17085000 504358641 4594374 499764267 2021 0 0 1 1 D 61215000 257618370 2515889 19006493 236095988 2016 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 D 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 0 0 1 0 0 0 1 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 BOND A, ENTITY 1: PART I, ROW A, COLUMN F: THE ISSUE'S PROCEEDS WILL BE USED TO FINANCE PROJECTS AND PAY ISSUANCE COSTS. BOND B, ENTITY 1: PART I, ROW B, COLUMN F: FOR TAX PURPOSES (PURSUANT TO PROPOSED TREASURY REGULATIONS SECTION 1.150-1(D)(2)(II)(C)), THE ISSUE'S PROCEEDS OTHER THAN THOSE ALLOCATED TO COSTS OF ISSUANCE WERE ALLOCATED TO CAPITAL EXPENDITURES ON THE DATE OF CLOSING. THE PRESENTATION SHOWN HERE DEPARTS FROM THE TAX TREATMENT, REFLECTING THE CHARACTERIZATION OF THE TRANSACTION FOR OTHER PURPOSES, AND IS MORE IN ACCORDANCE TO THE FINANCIAL ACCOUNTING PRESENTATION. PART IV, COLUMN B, LINE 2C: ARBITRAGE REBATE CALCULATION PERFORMED ON 11/12/2024 BOND C, ENTITY 1: PART I, ROW C, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE AN OUTPATIENT AMBULATORY CARE BUILDING, FACILITY UPGRADES, AND COMPUTER UPGRADES AT CERTAIN BIDMC AFFILIATES. PART II, COLUMN C, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $24,764,267 OF INVESTMENT EARNINGS. PART IV, COLUMN C, LINE 2C: FINAL REBATE CALCULATION SHOWING NO REBATE DUE COMPLETED ON 09/30/2023. BOND D, ENTITY 1: PART I, ROW D, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 6/9/2008; 7/13/2004; 2/11/1998. PART II, COLUMN D, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $6,493 OF INVESTMENT EARNINGS. PART II, COLUMN D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE THAT ARE NO LONGER IN ESCROW. PART IV, COLUMN D, LINE 2C: ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON 09/30/2021. BOND A, ENTITY 2: PART I, ROW A, COLUMN F: THE ISSUE'S PURPOSE WAS TO FINANCE CAPITAL PROJECTS AND REFUND ISSUES DATED 08/17/2007 AND 07/14/2005. PART II, COLUMN A, LINE 3: THE TOTAL PROCEEDS EXCEED THE ISSUE PRICE DUE TO THE $125,030 OF INVESTMENT EARNINGS. PART IV, COLUMN A, LINE 2C: ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON 09/30/2021. BOND B, ENTITY 2: PART I, ROW B, COLUMN F: THE ISSUE'S PURPOSE WAS TO REFINANCE SEVERAL DIFFERENT ISSUES (DATED 06/09/2008; 11/30/2005; 07/16/2003; AND 06/04/1998), FUND TERMINATION PAYMENTS, AND FUND BUILDING IMPROVEMENTS, EQUIPMENT AND LAND IMPROVEMENTS. PART II, COLUMN B, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE NO LONGER IN ESCROW PART IV, COLUMN B, LINE 2(C): ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 29, 2019. BOND C, ENTITY 2: PART I, ROW C, COLUMN A: NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY. PART I, ROW C, COLUMN F: REFINANCING AND REFUNDING PRIOR BONDS ISSUED ON 11/20/2003 AND 12/19/2001. PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE NO LONGER IN ESCROW. BOND D, ENTITY 2: PART I, ROW D, COLUMN A: NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY. PART I, ROW D, COLUMN F: REFINANCING AND REFUNDING PRIOR BOND ISSUANCE 12/19/2001. PART II, COLUMN D, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE NO LONGER IN ESCROW. BOND A, ENTITY 3: PART I, ROW A, COLUMN A: MASSACHUSETTS HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PART I, ROW A, COLUMN F: DESCRIPTION OF PURPOSE - REFUND ISSUE DATED 06/28/2000. PART II, COLUMN A, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE NO LONGER IN ESCROW. PART IV, ROW 2C, COLUMN A: ARBITRAGE REBATE & YIELD RESTRICTION LIABILITY CALCULATION PERFORMED ON OCTOBER 10, 2009. PART III, LINE 9 AND PART IV, LINE 7: THIS FORM 990 SCHEDULE K REPRESENTS TAX-EXEMPT DEBT OF ALL MEMBERS OF THE BETH ISRAEL LAHEY HEALTH (BILH) OBLIGATED GROUP WHICH WAS ORIGINALLY FORMED IN JUNE 2020 AND EXPANDED WITH THE ADDITION OF EXETER HOSPITAL (EIN: 22-2674014) IN JULY 2024. THE MAJORITY OF BILH OBLIGATED GROUP MEMBERS HAVE ADOPTED FORMAL WRITTEN POLICIES AND PROCEDURES TO REVIEW AND MONITOR ARRANGEMENTS WHICH COULD GENERATE PRIVATE USE OF BOND FINANCED AND COMPLIANCE RELATED TO INTERNAL REVENUE CODE (IRC) SECTION 141 AND ARBITRAGE RULES UNDER IRC SECTION 148. ALTHOUGH NOT EVERY MEMBER OF THE BILH OBLIGATED GROUP HAS FORMALLY ADOPTED THESE WRITTEN POLICIES AND PROCEDURES, THOSE THAT HAVE NOT NEVERTHELESS FOLLOW THE POLICIES AND PROCEDURES ADOPTED BY OTHER MEMBERS OF THE BILH OBLIGATED GROUP TO ENSURE COMPLIANCE WITH THESE SECTIONS OF THE IRC AND THE REGULATIONS PROMULGATED THEREUNDER. SUCH POLICIES AND PROCEDURES INCLUDE, AMONG OTHER THINGS, THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS, IF ANY, ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION ISN'T AVAILABLE UNDER APPLICABLE REGULATIONS. THIS FORM 990 SCHEDULE K REPRESENTS TAX-EXEMPT DEBT OF ALL MEMBERS OF THE BETH ISRAEL LAHEY HEALTH (BILH) OBLIGATED GROUP. THE OBLIGATED GROUP INCLUDES THE FOLLOWING ENTITIES: BETH ISRAEL DEACONESS MEDICAL CENTER, INC., MOUNT AUBURN HOSPITAL, BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC., NEW ENGLAND BAPTIST HOSPITAL, BETH ISRAEL DEACONESS HOSPITAL MILTON, INC., BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC., MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION, MOUNT AUBURN PROFESSIONAL SERVICES, INC., LAHEY CLINIC FOUNDATION, INC., LAHEY CLINIC, INC., LAHEY CLINIC HOSPITAL, INC., NORTHEAST HOSPITAL CORPORATION, WINCHESTER HOSPITAL, ANNA JAQUES HOSPITAL AND EXETER HOSPITAL. THE OBLIGATED GROUP IS AWARE OF THE INSTRUCTIONS TO SCHEDULE K THAT STATE THAT "IF THE ORGANIZATION HAS ONE OR MORE RELATED ORGANIZATIONS (FOR EXAMPLE, PARENT AND SUBSIDIARY RELATIONSHIP), IT MUST COMPLETE SCHEDULE K (FORM 990) CONSISTENT WITH THE FILINGS(S) OF ITS RELATED ORGANIZATION(S). THE SAME LIABILITY SHOULDN'T BE REPORTED BY MORE THAN ONE OF THE RELATED ORGANIZATIONS." THE OBLIGATED GROUP IS CURRENTLY WORKING TOWARD A DETERMINATION REGARDING THE REPORTING OF TAX-EXEMPT DEBT AMONG ITS MEMBERS WITH RESPECT TO SCHEDULE K. IN THE ABSENCE OF SUCH A DETERMINATION, FOR THE REPORTING PERIOD ENDING ON 09/30/2024, THE OBLIGATED GROUP HAS INCLUDED ALL TAX-EXEMPT BOND ISSUES ON EACH OF ITS MEMBER'S FORM 990 SCHEDULES K, WHICH IS CONSISTENT WITH THE APPROACH THAT HAS BEEN TAKEN SINCE THE OBLIGATED GROUP'S FORMATION. A MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584XFW6 2015-10-21 262828878 MDFA - LAHEY SERIES F - SEE PART VI 0 0 0 B MASSACHUSETTS DEVELOPMENT FINANCE AGENCY 043431814 57584XDH1 2015-09-02 203702204 MDFA - SERIES 2015 H-1 - SEE PART VI 0 0 0 C NH HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 000000000 2015-03-02 24020000 EXETER SERIES 2015 - SEE PART VI 0 0 0 D NH HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 000000000 2012-03-09 32565000 EXETER SERIES 2012 - SEE PART VI 0 0 0 A 35800000 262953908 4857465 3129474 94764737 160202232 2021 1 1 1 1 B 122805000 203702204 2348479 201353725 1 1 1 1 C 14435000 24020000 162154 23857846 2015 1 0 1 1 D 14885000 32565000 215404 32349596 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00100 0.00000 0.00100 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 1 1 B 0 0 0 1 0 0 0 0 1 C 1 1 0 0 0 1 D 1 1 0 0 0 1 A 1 B 1 C 1 D 1 A MASS HEALTH & EDUCATIONAL FACILITIES AUTHORITY 042456011 57586CDD4 2004-07-08 30340000 MHEFA - WINCHESTER F - ADV REFUND 0 0 0 A 10595000 30340000 365445 47003 29927552 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 MORGAN STANLEY 20.000000000000 0 0 0 0 1 A 1 FORM 990, PART I, LINE 1 & PART III, LINE 1: THE MISSION OF THE EXETER HOSPITAL INC. (EHI OR HOSPITAL) IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING HIGH QUALITY, PERSONALIZED HEALTH CARE WITH COMPASSION, DIGNITY AND RESPECT FOR PATIENT RIGHTS IN A COST EFFECTIVE AND SAFE ENVIRONMENT. EHI PROVIDES CARE TO PATIENTS IN THE COMMUNITIES WHERE THEY LIVE AND WORK AND PROVIDES CARE TO MEDICARE, MEDICAID AND ALL OTHER PATIENTS REGARDLESS OF THEIR RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, ANCESTRY, AGE, OR DISABILITY. EHI ACCOMPLISHES THIS MISSION IN CLOSE CONNECTION WITH THE OTHER MEMBERS OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. IN ADDITION, AS PART OF ITS DEDICATION TO PROVIDING COMMUNITY BENEFITS, EHI IS COMMITTED TO WORKING IN PARTNERSHIP WITH RESIDENTS AND COMMUNITY LEADERS AS WELL AS CIVIC, SOCIAL AND MEDICAL ORGANIZATIONS FROM THE COMMUNITIES IT SERVES. EHI IS DEDICATED TO THE PLANNING, DEVELOPMENT, IMPLEMENTATION AND MONITORING OF PROGRAMS THAT ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITY AND OFFER CLINICAL, EDUCATIONAL AND FINANCIAL RESOURCES. THESE PROGRAMS ARE DESIGNED TO IMPROVE AWARENESS OF THE HEALTH CARE ISSUES IN THE COMMUNITIES SERVED AND INCREASE PARTICIPATION IN WELLNESS AND PREVENTATIVE HEALTH ACTIVITIES. FOR ADDITIONAL DETAIL, SEE FORM 990 SCHEDULE H. DURING THE FISCAL PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH (BILH) SERVED AS THE SOLE MEMBER OF ANNA JAQUES HOSPITAL (AJH), BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN), EXETER HEALTH RESOURCES INC. (EHRI) AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC) AND EXETER HEALTH RESROUCES INC SERVED AS THE SOLE MEMBER OF EXETER HOSPITAL. EACH OF THE ENTITIES LISTED HERE MAY HAVE ALSO, IN TURN, SERVED AS MEMBER TO OTHER NETWORK AFFILIATES. BILH IS AN INTEGRATED HEALTH CARE SYSTEM COMMITTED TO EXPANDING ACCESS TO EXTRAORDINARY PATIENT CARE ACROSS EASTERN MASSACHUSETTS AND SOUTHERN NEW HAMPSHIRE AND ADVANCING THE SCIENCE AND PRACTICE OF MEDICINE THROUGH GROUNDBREAKING RESEARCH AND EDUCATION. THE BILH SYSTEM IS COMPRISED OF ACADEMIC AND TEACHING HOSPITALS, A PREMIER ORTHOPEDICS HOSPITAL, PRIMARY CARE AND SPECIALTY CARE PROVIDERS, AMBULATORY SURGERY CENTERS, URGENT CARE CENTERS, COMMUNITY HOSPITALS, HOMECARE SERVICES, OUTPATIENT BEHAVIORAL HEALTH CENTERS AND ADDICTION TREATMENT PROGRAMS. BILH'S COMMUNITY OF CLINICIANS, CAREGIVERS AND STAFF INCLUDES APPROXIMATELY 4,700 PHYSICIANS AND 39,000 EMPLOYEES. FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: OUTPATIENT CLINICS AND SERVICES EXETER HOSPITAL, INC. (EH) IS PART OF BETH ISRAEL LAHEY HEALTH, IS A 100-BED TAX EXEMPT, COMMUNITY-BASED HOSPITAL AND ONE OF THREE AFFILIATES OF EXETER HEALTH RESOURCES. EH IS COMMITTED TO PROVIDING HEALTH CARE SERVICES THAT ARE INNOVATIVE, PROGRESSIVE, AND FOCUSED ON QUALITY AND THE WELL-BEING OF PATIENTS. EXETER HOSPITAL'S SCOPE OF CARE ALLOWS IT TO OFFER COMPREHENSIVE HEALTH CARE SERVICES IN BREAST HEALTH, BIRTHING AND REPRODUCTIVE MEDICINE, CARDIOVASCULAR, OCCUPATIONAL AND EMPLOYEE HEALTH, ONCOLOGY AND ORTHOPEDICS. BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC OR MEDICAL CENTER), IS A NATIONALLY RECOGNIZED TERTIARY CARE ACADEMIC MEDICAL CENTER, IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND A SISTER HOSPITAL OF EH. BIDMC IS EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND IS RECOGNIZED NATIONALLY FOR THE CLINICAL EXCELLENCE OF ITS FACULTY AND THE PATIENT CARE PROVIDED, AS WELL AS FOR THE MAGNITUDE AND BREADTH OF ITS RESEARCH AND FOR ITS COMMITMENT TO MEDICAL EDUCATION. MANY BIDMC PHYSICIANS ALSO HOLD APPOINTMENTS AT HARVARD OR OTHER MAJOR MEDICAL SCHOOLS AND ARE TIED CLOSELY WITH THEIR COLLEAGUES AT OTHER ACADEMIC MEDICAL CENTERS. PATIENTS AT BIDN HAVE SEAMLESS ACCESS TO BIDMC WHEN NEEDED. DURING THE PERIOD COVERED BY THIS FILING, EXETER HOSPITAL HAD 235,968 OUTPATIENT ENCOUNTERS. THIS INCLUDED 1,430 OBSERVATION CASES, 1,995 PAIN CLINIC VISITS, 4,385 WOUND CENTER VISITS, 5,536 OUTPATIENT AMBULATORY SURGERIES, 7,831 OUTPATIENT ENDOSCOPY VISITS, 29,225 OUTPATIENT ONCOLOGY VISITS, 15,996 OUTPATIENT ONCOLOGY INFUSIONS, 3,947 OUTPATIENT EKG EXAMS, 1,691 OUTPATIENT ORTHOPEDIC PROCEDURES, 27,897 OUTPATIENT RADIOLOGY EXAMS, 18,559 OUTPATIENT CT SCANS, 16,175 OUTPATIENT ULTRASOUNDS, 7,478 OUTPATIENT MRIS, 1,114 OTHER NUCLEAR MEDICINE TESTS, 15,389 BREAST IMAGING EXAMS, 430,848 OUTPATIENT LAB TESTS, 88,718 OUTPATIENT REHABILITATION/PHYSICAL THERAPY VISITS, AND 46,996 OTHER TESTS AND PROCEDURES. FORM 990, PART III, LINE 4B, DESCRIPTION OF PROGRAM SERVICE: INPATIENT MEDICAL / SURGICAL AND INTENSIVE CARE EH PROVIDES A WIDE RANGE OF INPATIENT CARE INCLUDING SURGICAL SERVICES, INTENSIVE AND CARDIAC CARE AND COMPLETE DIAGNOSTIC FACILITIES. EH'S INPATIENT FACILITIES INCLUDE MEDICAL/SURGICAL BEDS AS WELL AS INTENSIVE AND CARDIAC CARE BEDS. SURGICAL SERVICES ARE AVAILABLE 24 HOURS A DAY FOR CRITICALLY ILL OR INJURED PATIENTS REQUIRING IMMEDIATE SURGICAL INTERVENTION, OR FOR OTHER PATIENTS ON A NON-EMERGENT OR ELECTIVE BASIS. EH'S HIGHLY QUALIFIED SURGEONS PERFORM A WIDE RANGE OF SURGERIES COVERING MANY SURGICAL SUBSPECIALTIES. PATIENTS ARE UNDER THE CARE OF MEDICAL STAFF, HOSPITALISTS AND/OR GENERAL SURGEONS ALONG WITH NURSES WHO ARE TRAINED IN CARING FOR PATIENTS WITH COMPLEX MEDICAL NEEDS. THE NURSING CARE TEAM CONSISTS OF REGISTERED NURSES, SURGICAL TECHNICIANS AND QUALIFIED ANCILLARY PERSONNEL WORKING COLLABORATIVELY WITH SURGICAL AND ANESTHESIA PHYSICIANS. THE SCOPE OF NURSING PRACTICE IN THE PERIOPERATIVE AREA INCLUDES PREOPERATIVE ASSESSMENT AND PLANNING, INTRA-OPERATIVE INTERVENTION, POSTOPERATIVE ASSESSMENT AND INTERVENTION, DISCHARGE PLANNING AND DOCUMENTATION TO ENSURE HIGH QUALITY PATIENT CARE AND SAFETY. DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2024 BIDN HAD 5,297 INPATIENT DISCHARGES WITH 24,334 PATIENT DAYS, PERFORMED 862 INPATIENT SURGERIES, AND 619 NEWBORN DELIVERIES. FORM 990, PART III, LINE 4C, DESCRIPTION OF PROGRAM SERVICE: EMERGENCY DEPARTMENT EH OPERATES AN EMERGENCY DEPARTMENT (ED) WHICH IS OPEN TO ALL PATIENTS IN NEED OF EMERGENT CARE, REGARDLESS OF ABILITY TO PAY. THE ED IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR. DURING THE FISCAL YEAR COVERED BY THIS FILING, EH HAD 28,447 EMERGENCY DEPARTMENT VISITS. IN ADDITION TO THE PROGRAM SERVICE ACCOMPLISHMENTS NOTED ABOVE, THE BILH NETWORK HAD SIGNIFICANT ACTIVITIES ACROSS ENTITIES RELATED TO BOTH BEHAVIORAL HEALTH AND OTHER HEALTHCARE INITIATIVES. SEE THE NARRATIVE SUPPORT FOR SCHEDULE H FOR ADDITIONAL DETAILS. FORM 990, PART IV, LINE 12: THE BOSTON, MA OFFICE OF KPMG ISSUED AN UNQUALIFIED OPINION ON THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE BETH ISRAEL LAHEY HEALTH, INC. AND AFFILIATES FOR FISCAL PERIOD ENDED SEPTEMBER 30, 2024. THESE STATEMENTS WERE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND INCLUDED THE ACCOUNTS OF THE BETH ISRAEL LAHEY HEALTH, INC. (BILH), AND THE ENTITIES FOR WHICH BETH ISRAEL LAHEY HEALTH, INC. (BILH) SERVED AS SOLE MEMBER DURING THE FISCAL PERIOD COVERED BY THIS FILING, (ANNA JAQUES HOSPITAL (AJH), BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL -- MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL -- NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL -- PLYMOUTH, INC. (PLYMOUTH), LAHEY HEALTH SHARED SERVICES (LHSS), LAHEY CLINIC FOUNDATION (LCF), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NHC) WHICH INCLUDES BEVERLY, ADDISON GILBERT AND BAYRIDGE HOSPITALS, NORTHEAST BEHAVIORAL CORPORATION (NBHC), THE BETH ISRAEL LAHEY HEALTH PERFORMANCE NETWORK (BILHPN), THE JOSLIN DIABETES CENTER, EXETER HEALTH RESOURCES, INC. (EHRI) AND THE BETH ISRAEL LAHEY HEALTH PHARMACY. THE LAHEY CLINIC FOUNDATION IN TURN SERVED AS THE SOLE MEMBER OF LAHEY CLINIC INC, AND LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC). EHRI IN TURN SERVED AS THE SOLE MEMBER OF EXETER HOSPITAL AND OTHER AFFILIATES OF EHRI. EACH OF THESE BILH AFFILIATES MAY IN TURN SERVE AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE NETWORK OF AFFILIATES, AND WHOSE ACCOUNTS ARE INCLUDED IN THE BILH AUDITED FINANCIAL STATEMENTS. IN ADDITION, THE BILH FINANCIAL STATEMENTS ALSO INCLUDE THE ACCOUNTS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF BETH ISRAEL DEACONESS MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC AND OTHER AFFILIATES IN THE BILH NETWORK ACCOMPLISH THEIR CHARITABLE PURPOSES. THE ACCOUNTS OF THE ENTITIES FOR WHICH HMFP SERVES AS MEMBER ARE ALSO INCLUDED IN THE HMFP AND BILH AUDITED FINANCIAL STATEMENTS. THE AUDIT AND COMPLIANCE COMMITTEE OF BILH'S BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE CONSOLIDATED AUDIT FOR THE NETWORK AS A WHOLE. FORM 990, PART IV, LINE 24A: AS DESCRIBED IN THIS FORM 990 AND FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED AND SERVED AS A SUPPORT ORGANIZATION OF AND DIRECT OR INDIRECT SOLE MEMBER OF EXETER HOSPITAL INC. DURING THIS SAME PERIOD, EXETER HOSPITAL INC WAS A MEMBER OF THE BILH OBLIGATED GROUP WHICH HAS ISSUED TAX-EXEMPT BOND FINANCING THROUGH EITHER THE BILH OBLIGATED GROUP OR THROUGH A PREVIOUS OBLIGATED GROUP WHICH IS NOW A PART OF THE BILH OBLIGATED GROUP. THE SCHEDULE K AS INCLUDED IN THIS FORM 990 INCLUDES ALL OF THE BILH OBLIGATED GROUP OUTSTANDING TAX-EXEMPT DEBT FOR BONDS ISSUED AFTER DECEMBER 31, 2002, ONLY A PORTION OF WHICH IS ALLOCABLE TO AND REPORTED ON EXETER HOSPITAL INC'S BALANCE SHEET. FORM 990, PART IV, LINE 24B: AS REPORTED ON THE FORM 990 SCHEDULE K, THE LAHEY HEALTH SYSTEM INC. (LHSI) SERIES F BONDS WHICH WERE ISSUED IN 2015 ARE NOW PART OF THE BETH ISRAEL LAHEY HEALTH (BILH) OBLIGATED GROUP DEBT. THE BONDS WERE ISSUED IN 2015 AND AS OF SEPTEMBER 30, 2023 THERE WAS A BALANCE REMAINING IN THE CONSTRUCTION FUND. PROCEEDS IN THE CONSTRUCTION FUND WERE UNEXPECTEDLY HELD BEYOND THE THREE-YEAR TEMPORARY PERIOD, AND WERE YIELD RESTRICTED IN COMPLIANCE WITH FEDERAL TAX REQUIREMENTS. ALTHOUGH THESE BONDS ARE NOT ON THE EXETER HOSPITAL INC'S BALANCE SHEET, EXETER HOSPITAL INC IS INCLUDING THIS DISCLOSURE IN ITS FORM 990 BECAUSE EXETER HOSPITAL INC IS A MEMBER OF THE BILH OBLIGATED GROUP. FORM 990, PART V, LINE 7G: EXETER HOSPITAL DID NOT RECEIVE ANY CONTRIBUTIONS OF INTELLECTUAL PROPERTY AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 8899. FORM 990, PART V, LINE 7H: EXETER HOSPITAL DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES AND AS SUCH, WAS NOT REQUIRED TO FILE FORM 1098-C. FORM 990, PART VI, SECTION A, LINE 2 FOR THE PERIOD COVERED BY THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. (BILH) SERVED AS DIRECT OR INDIRECT SOLE MEMBER OF: BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (BIDMC), MOUNT AUBURN HOSPITAL (MAH), NEW ENGLAND BAPTIST HOSPITAL (NEBH), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (MILTON), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (PLYMOUTH), LAHEY CLINIC FOUNDATION (LCF) , LAHEY CLINIC (LCI), LAHEY CLINIC HOSPITAL D/B/A LAHEY HOSPITAL AND MEDICAL CENTER (LHMC), WINCHESTER HOSPITAL (WINCHESTER), NORTHEAST HOSPITAL CORPORATION (NORTHEAST), ANNA JAQUES HOSPITAL (AJH), BETH ISRAEL LAHEY HEALTH PHARMACY, JOSLIN DIABETES CENTER, EXETER HEALTH RESOURCES, INC. (EHRI) AND EXETER HOSPITAL. EACH OF THESE AFFILIATES MAY HAVE, IN TURN, SERVED AS MEMBER OF ADDITIONAL ENTITIES WITHIN THE BILH NETWORK OF AFFILIATES. IN ADDITION, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP) IS THE DEDICATED PHYSICIAN PRACTICE OF BIDMC AND AN ENTITY INTEGRALLY RELATED TO HELPING BIDMC AND OTHER AFFILIATES IN THE BILH NETWORK ACCOMPLISH THEIR CHARITABLE PURPOSES. FOR THIS SAME PERIOD HMFP SERVED AS THE SOLE MEMBER OF AFFILIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (APHMFP) AS WELL AS THE DIRECT OR INDIRECT MEMBER OF SEVERAL ADDITIONAL ENTITIES. TWO OR MORE OF THE PERSONS LISTED IN THIS FORM 990 PART VII HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF SITTING ON ONE OR MORE BOARDS OF DIRECTORS/TRUSTEES OR BY SERVING IN AN EMPLOYMENT RELATIONSHIP WITH ONE OR MORE ENTITIES WITHIN THE NETWORK OF THE AFFILIATED ORGANIZATIONS NOTED ABOVE. ADDITIONAL DETAIL IS PROVIDED IN THE EXPLANATORY NOTES TO THIS FORM 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 6 EXETER HEALTH RESOURCES, INC. (EHRI) IS THE SOLE MEMBER OF EXETER HOSPITAL (EH). FORM 990, PART VI, SECTION A, LINE 7A BETH ISRAEL LAHEY HEALTH, INC. (BILH OR SYSTEM MEMBER) IS THE SOLE MEMBER OF EHRI. BILH, AS SYSTEM MEMBER HAS THE FOLLOWING RIGHTS RELATED TO ELECTING/ APPOINTING THE EHRI BOARD: THE EXCLUSIVE AUTHORITY, AFTER CONSULTATION WITH THE CHAIR OF THE BOARD AND THE PRESIDENT OF THE CORPORATION AND REVIEW OF RECOMMENDATIONS, IF ANY, MADE BY THE BOARD, TO (A) APPOINT AND REAPPOINT TRUSTEES, (B) FILL ANY VACANCIES IN THE OFFICES OF TRUSTEES, AND (C) ACTING BY VOTE OF NOT LESS THAN THREE QUARTERS (3/4) OF THE MEMBER'S TRUSTEES THEN IN OFFICE, REMOVE, WITH OR WITHOUT CAUSE, A TRUSTEE. NOTWITHSTANDING THE FOREGOING, ANY REMOVAL SHALL BE FOLLOWING NOTICE TO THE CHAIR (OR THE VICE-CHAIR IF THE CHAIR IS THE SUBJECT OF REMOVAL) AND AN OPPORTUNITY FOR THE CHAIR TO BE HEARD BY THE MEMBER'S BOARD OR A STANDING OR AD HOC COMMITTEE THEREOF, EXCEPT IN CIRCUMSTANCES WHERE THE MEMBER DETERMINES THAT IMMEDIATE REMOVAL IS IN THE BEST INTEREST OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B EXETER HEALTH RESOURCES, INC. (EHRI) IS THE SOLE MEMBER OF EXETER HOSPITAL (EH). IN ADDITION, AS BETH ISRAEL LAHEY HEALTH, INC. (BILH OR SYSTEM MEMBER) IS THE SOLE MEMBER OF EHRI. SUBJECT TO THE PROVISIONS OF THE EH ARTICLES OF AGREEMENT AND THE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, BOTH POSITIVE AND NEGATIVE, CONFERRED BY NEW HAMPSHIRE REVISED STATUTES ANNOTATED ("NH RSA"), AS AMENDED TO DATE, ON MEMBERS OR SHAREHOLDERS OF CORPORATIONS ORGANIZED UNDER NH RSA CHAPTER 292. IN ADDITION, EXCEPT AS ARE EXPRESSLY GRANTED TO THE EH BOARD OF TRUSTEES IN THE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO EXERCISE ALL POWERS, POSITIVE AND NEGATIVE, CONFERRED BY NH RSA ON BOARDS OF CORPORATIONS ORGANIZED UNDER NH RSA CHAPTER 292. THE POWERS RESERVED TO THE MEMBER ARE THE POWERS TO APPROVE AND/OR INITIATE ACTIONS SUBJECT TO BOARD AUTHORITY UNDER NH RSA, PROVIDED, THAT TO THE EXTENT THAT AN AFFIRMATIVE VOTE OF THE BOARD IS REQUIRED UNDER NH RSA CHAPTER 292, THE MEMBER SHALL ONLY ACT IN ACCORDANCE WITH THE LIMITATIONS AS PROVIDED IN THE BY-LAWS. IN ADDITION, THE BOARD'S POWER TO EXERCISE ITS AUTHORITY AS A MEMBER OF ANOTHER LEGAL ENTITY SHALL BE SUBJECT TO THE FOLLOWING LIMITATIONS: (X) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER LEGAL ENTITY UNDER NEW HAMPSHIRE LAW MAY BE EXERCISED BY THE CORPORATION ONLY AT THE EXPRESS AND EXPLICIT DIRECTION OF, AND WITH THE APPROVAL OF, THE MEMBER; (Y) ALL STATUTORY POWERS THAT RESIDE IN THE CORPORATION AS A MEMBER OF ANOTHER LEGAL ENTITY UNDER NEW HAMPSHIRE LAW MAY BE EXERCISED DIRECTLY BY THE MEMBER AFTER CONSULTATION WITH THE CHAIR BUT OTHERWISE WITHOUT THE APPROVAL OR PARTICIPATION OF THE CORPORATION; AND (Z) OTHER THAN STATUTORY POWERS, THE CORPORATION SHALL HAVE ONLY THOSE POWERS AND AUTHORITIES OVER AND WITH RESPECT TO THE LEGAL ENTITIES OF WHICH IT IS A MEMBER AS ARE EXPRESSLY AND EXPLICITLY DELEGATED OR DIRECTED TO THE CORPORATION BY ACTION OF THE MEMBER'S BOARD. FORM 990, PART VI, SECTION B, LINE 11B AS NOTED IN VARIOUS DISCLOSURES THROUGHOUT THIS FILING, BETH ISRAEL LAHEY HEALTH, INC. (BILH) IS THE DIRECT OR INDIRECT SOLE MEMBER OF EXETER HOSPITAL INC . THIS FORM 990 IS PREPARED BY THE BILH TAX DEPARTMENT IN CONJUNCTION WITH DELOITTE TAX, LLP (DELOITTE). AS PART OF THIS PROCESS, THE BILH TAX DEPARTMENT WORKS WITH OTHER DISCIPLINES AND FUNCTIONS WITHIN BILH AND EXETER HOSPITAL INC TO ENSURE THAT ALL FINANCIAL AND NON-FINANCIAL DISCLOSURES ARE COMPLETE AND ACCURATE. EXAMPLES OF SUCH DEPARTMENTS INCLUDE BUT ARE NOT LIMITED TO: FINANCE AND ACCOUNTING, HUMAN RESOURCES AND PAYROLL, TREASURY, COMPLIANCE, LEGAL, COMMUNITY BENEFITS, FINANCIAL ASSISTANCE AND REIMBURSEMENT, GOVERNANCE, DEVELOPMENT, GRADUATE MEDICAL EDUCATION, GOVERNMENT RELATIONS, RESEARCH AND/OR RESEARCH FINANCE. EXETER HOSPITAL INC 'S FORM 990 IS REVIEWED INTERNALLY BY THE BILH ASSISTANT VICE PRESIDENT, TAXATION AND EXTERNALLY BY DELOITTE. EXETER HOSPITAL INC 'S FORM 990, ALONG WITH THE FORMS 990 OF ALL ENTITIES IN THE BILH NETWORK, ARE DISCUSSED WITH THE BILH AUDIT AND COMPLIANCE COMMITTEE. DELOITTE SIGNS THE FINAL RETURNS. A COPY OF THE COMPLETE RETURN IS THEN PROVIDED TO EACH MEMBER OF EXETER HOSPITAL INC 'S BOARD OF TRUSTEES PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C AS NOTED THROUGHOUT THIS FILING, EXETER HOSPITAL INC IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) SYSTEM OF AFFILIATES. ALL ENTITIES IN THE BILH NETWORK ADHERE TO THE BILH CONFLICT OF INTEREST POLICY AND MAINTAIN A WRITTEN, COMPREHENSIVE CONFLICT OF INTEREST POLICY AT THE ENTITY LEVEL. PURSUANT TO THESE POLICIES, BILH ENTITIES' OFFICERS, TRUSTEES AND KEY EMPLOYEES AS WELL AS CERTAIN OTHER INDIVIDUALS ARE REQUIRED TO COMPLETE THE ANNUAL CONFLICT OF INTEREST AND TAX QUESTIONNAIRE (COI-TQ). THE COI-TQ IS DESIGNED TO REQUIRE DISCLOSURE OF ANY BUSINESS AND FAMILY RELATIONSHIPS AND AFFILIATIONS MAINTAINED BY OFFICERS, TRUSTEES, OR KEY EMPLOYEES AND THEIR FAMILY MEMBERS AND WHICH MAY RESULT IN A REAL OR PERCEIVED CONFLICT OF INTEREST. THE BILH OFFICE OF INTEGRITY AND COMPLIANCE, IN CONJUNCTION WITH THE BILH TAX DEPARTMENT, ADMINISTERS THE COI-TQ PROCESS ANNUALLY. BILH INTEGRITY AND COMPLIANCE COLLECTS AND REVIEWS ALL DISCLOSURES. DISCLOSURES FOR BILH EXECUTIVES AND KEY EMPLOYEES ARE ASSIGNED APPROPRIATE FOLLOW-UP ACTION IN ACCORDANCE WITH THE BILH POLICY. A SUMMARY OF POSITIVE RESPONSES FOR EACH BILH AFFILIATE IS PROVIDED TO THE COMPLIANCE OFFICER FOR THAT ENTITY FOR REVIEW FINAL DETERMINATION OF ANY POTENTIAL OR ACTUAL CONFLICT. ANY ACTIVITY THAT REQUIRES ACTION UNDER THE CONFLICT OF INTEREST POLICIES IS SUBJECT TO ONGOING REVIEW BY EXETER HOSPITAL INC AS WELL AS THE BILH INTEGRITY AND COMPLIANCE OFFICE. PURSUANT TO THE BILH CONFLICT OF INTEREST POLICY, CERTAIN ACTIVITIES WHICH COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED WHILE OTHER TYPES OF RELATIONSHIPS ARE PERMITTED, SUBJECT TO COMPLIANCE WITH A MANAGEMENT PLAN TO REQUIRE DISCLOSURE AND RECUSAL, INCLUDING APPROPRIATE DOCUMENTATION IN THE MINUTES. IN ADDITION, AS NOTED ABOVE, THE ANNUAL COI-TQ PROCESS OUTLINED ABOVE IS JOINTLY ISSUED BY THE BILH TAX DEPARTMENT, TO ENSURE THAT THE QUESTIONNAIRE IS DISTRIBUTED TO ALL CURRENT AND FORMER MEMBERS OF THE EXETER HOSPITAL INC BOARD OF TRUSTEES AS WELL AS FORMER OFFICERS AND KEY EMPLOYEES. THE COI-TQ PROCESS IS DESIGNED TO GATHER THE INFORMATION NECESSARY FOR EXETER HOSPITAL INC TO COMPLETELY AND ACCURATELY COMPLETE FORM 990 SCHEDULE L, TRANSACTIONS WITH INTERESTED PERSONS AND FORM 990, PART VI, QUESTION 2, FAMILY AND BUSINESS RELATIONSHIPS BETWEEN OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 AS REQUIRED BY THIS FORM 990 AND AS REPORTED IN THE FORM 990 SCHEDULE J, ALTHOUGH THIS FILING COVERS THE FISCAL PERIOD OCTOBER 1, 2023 TO SEPTEMBER 30, 2024, COMPENSATION REPORTED IN THIS FILING IS CALENDAR YEAR 2023 COMPENSATION. IN ADDITION, AS REPORTED IN THE PRIOR YEAR FORM 990, EFFECTIVE JULY 1, 2023, BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF EXETER HEALTH RESOURCES, INC. (EHRI) AND EHRI IS THE SOLE MEMBER OF EXETER HOSPITAL (EH). COMPENSATION FOR THE EHRI CEO, WHO IS ALSO THE EH AND BILH CEO, AND COMPENSATION OF OTHER EH OFFICERS AND TRUSTEES WHOSE POSITIONS COMMENCED ON OR AFTER JULY 1, 2023 AND WHO ARE EMPLOYED BY BILH, WAS SET BY THE BILH COMPENSATION COMMITTEE AND/OR BOARD. THE EHRI PRESIDENT ALSO SERVES AS THE EH PRESIDENT. COMPENSATION FOR THE EHRI / EH PRESIDENT WHO COMMENCED IN THAT ROLE EFFECTIVE JULY 1, 2023 WAS ALSO SET BY THE BILH COMPENSATION COMMITTEE. COMPENSATION OF OTHER EHRI OFFICERS, TRUSTEES AND KEY EMPLOYEES WAS SET PRIOR TO BILH BECOMING THE SOLE MEMBER OF EHRI AND WAS SET BY THE EHRI COMPENSATION COMMITTEE AND BOARD. BOTH COMPENSATION COMMITTEES ENGAGED IN PROCESSES INTENDED TO ENSURE THAT ALL OFFICERS, DIRECTORS/TRUSTEES AND KEY EMPLOYEES RECEIVED REASONABLE COMPENSATION PACKAGES. ADDITIONAL DETAIL IS BELOW. BILH COMPENSATION COMMITTEE PROCESS: AS NOTED IN THIS FORM 990, BETH ISRAEL LAHEY HEALTH (BILH) BECAME THE SOLE MEMBER OF EHRI EFFECTIVE JULY 1, 2023 AND THE PRESIDENT OF EHRI BECAME AN EMPLOYEE OF BILH AT THAT TIME. IN THIS CAPACITY, THE BILH COMPENSATION COMMITTEE SETS COMPENSATION FOR THE PRESIDENT OF EHRI WHO STARTED IN THE ROLE EFFECTIVE JULY 1, 2023. THE COMPENSATION SETTING PROCESS FOR THE EHRI PRESIDENT WHO SERVED THROUGH JUNE 30, 2023 AS WELL AS OFFICERS AND SYSTEM MANAGERS WHOSE POSITIONS COMMENCED BEFORE JULY 1, 2023 IS DESCRIBED BELOW. THE BILH COMPENSATION COMMITTEE ESTABLISHES THE POLICIES AND THE COMPENSATION STRUCTURE, INCLUDING BENEFITS, FOR THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES INCLUDING THE BILH CHIEF EXECUTIVE OFFICER AS WELL AS OTHER MEMBERS OF SENIOR MANAGEMENT AT BILH AND ITS AFFILIATES. THE COMPENSATION COMMITTEE IS RESPONSIBLE FOR ASSURING THAT THE TOTAL COMPENSATION PROVIDED TO THESE INDIVIDUALS IS FAIR AND REASONABLE USING CURRENT AND CREDIBLE MARKET PRACTICE INFORMATION AND IS RESPONSIBLE FOR ENSURING COMPLIANCE WITH APPLICABLE LEGAL AND REGULATORY GUIDELINES. THE BILH COMPENSATION COMMITTEE IS COMPOSED OF INDEPENDENT MEMBERS OF ITS BOARD OF TRUSTEES IN SETTING COMPENSATION, THE COMPENSATION COMMITTEE RELIES UPON PUBLISHED COMPENSATION SURVEYS AND STUDIES PRODUCED BY INDEPENDENT COMPENSATION CONSULTING FIRMS THAT REGULARLY ASSESS EXECUTIVE COMPENSATION AND BENEFITS OF SUBSTANTIALLY SIMILAR ORGANIZATIONS. THE COMPENSATION COMMITTEE MEETS TO REVIEW THE COMPENSATION STRUCTURE OF THE INDIVIDUALS DESCRIBED ABOVE AND AT THAT TIME REVIEWS THE COMPENSATION SURVEY DETAILS PREPARED BY THE INDEPENDENT COMPENSATION CONSULTING FIRM. FOR SOME CATEGORIES OF POSITIONS, THE COMPENSATION COMMITTEE WILL REVIEW THE COMPENSATION STRUCTURE AND TARGETS AS A GROUP, RATHER THAN BY INDIVIDUAL. COMPENSATION FOR THE BILH CEO AND OTHER SENIOR EXECUTIVES IS REVIEWED ON AN INDIVIDUAL BASIS. THE COMPENSATION COMMITTEE THEN VOTES TO APPROVE THE COMPENSATION ARRANGEMENTS OF ALL INDIVIDUALS DESCRIBED ABOVE EXCEPT FOR THE BILH CEO. THE COMPENSATION PACKAGE FOR THE BILH CEO AS VOTED BY THE COMPENSATION COMMITTEE IS SUBMITTED TO THE FULL BILH BOARD OF TRUSTEES FOR APPROVAL. ALL DELIBERATIONS FOR BOTH THE COMPENSATION COMMITTEE AND THE BOARD OF TRUSTEES ARE CONTEMPORANEOUSLY DOCUMENTED IN MINUTES. THE COMPENSATION COMMITTEE PROCESSES AND PROCEDURES AS DESCRIBED ABOVE ARE DESIGNED TO MEET THE REQUIREMENTS OF TREASURY REGULATION SECTION 53.4958-6(C), REBUTTABLE PRESUMPTION THAT A TRANSACTION IS NOT AN EXCESS BENEFIT TRANSACTION. EHRI EXECUTIVE COMMITTEE COMPENSATION SETTING PROCESS: PRIOR TO JULY 1, 2023, THE EHRI BOARD OF TRUSTEES' EXECUTIVE COMMITTEE WAS RESPONSIBLE FOR MAINTAINING A FORMAL PROCESS FOR SETTING TOTAL AND REASONABLE COMPENSATION FOR THE ENTITY'S PRESIDENT, OTHER LISTED OFFICERS AND KEY EMPLOYEES. AS NOTED ABOVE, EHRI IS THE SOLE MEMBER OF EH. THE COMMITTEE WAS STAFFED WITH INDEPENDENT MEMBERS OF THE EHRI BOARD AND THE COMMITTEE'S PURPOSE WAS TO PROVIDE REASONABLE COMPENSATION TO THE ENTITY'S EXECUTIVES FOR ACHIEVING THE ORGANIZATION'S MISSION AND TO COMPLY WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE COMMITTEE CONDUCTED AN ANNUAL REVIEW OF THE PRESIDENT'S COMPENSATION AS WELL AS THE COMPENSATION PACKAGES FOR OTHER OFFICERS. THE COMMITTEE RETAINED A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT A COMPETITIVE MARKET ANALYSIS, TO PROVIDE RANGES FOR BASE, INCENTIVE, AND TOTAL COMPENSATION AND TO PROVIDE ADVICE CONCERNING THE REASONABLENESS OF THE TOTAL COMPENSATION PACKAGES FOR THESE INDIVIDUALS. IN ADDITION, AS PART OF THE ANNUAL PROCESS, THE COMMITTEE DETERMINED IF THE THRESHOLD REQUIREMENTS FOR INCENTIVE AWARDS WERE MET, INCLUDING A REVIEW OF CONSISTING OF THE ORGANIZATION'S PERFORMANCE RESULTS FOR QUALITY, OPERATING SYSTEM EXCELLENCE AND FINANCIAL PERFORMANCE. THE COMMITTEE UTILIZED THAT ANALYSIS ALONG WITH PERFORMANCE APPRAISALS AND OTHER APPROPRIATE INFORMATION, INCLUDING BOTH PERSONAL AND ENTITY GOALS, IN CONNECTION WITH ITS ANNUAL COMPENSATION REVIEW. THE COMMITTEE THEN MADE RECOMMENDATIONS TO THE FULL EHRI BOARD RELATED TO THE COMPENSATION PACKAGES FOR THESE INDIVIDUALS. NONE OF THE INDIVIDUALS WHOSE COMPENSATION WAS BEING DISCUSSED WERE PRESENT DURING EXECUTIVE COMMITTEE DELIBERATIONS. THE COMMITTEE THEN PRESENTED ITS PROCESS, DELIBERATIONS AND RECOMMENDATIONS TO THE INDEPENDENT EHRI BOARD IN EXECUTIVE SESSION. THE PRESIDENT WAS PRESENT ONLY FOR THE PORTION OF EXECUTIVE SESSION IN WHICH THE EHRI BOARD HAD QUESTIONS CONCERNING THE PERFORMANCE OF ANY LISTED OFFICER KEY EMPLOYEE OTHER THAN THE PRESIDENT. FOR THESE OTHER INDIVIDUALS', ADJUSTMENTS AND INCENTIVE AWARDS ARE APPROVED UPON RECOMMENDATION OF THE PRESIDENT BY THE EXECUTIVE COMMITTEE WITHIN BOARD APPROVED PARAMETERS AND RATIFIED BY THE BOARD OF TRUSTEES. THE EHRI BOARD THEN REVIEWED THE PRESIDENT'S PERFORMANCE AND THE EXECUTIVE COMMITTEE'S RECOMMENDATIONS RELATED TO THE PRESIDENT'S COMPENSATION, AFTER THE PRESIDENT HAD LEFT EXECUTIVE SESSION AND VOTED ON DECISIONS WITHOUT THE PRESIDENT'S PRESENCE. FORM 990, PART VI, SECTION C, LINE 19 AS NOTED THROUGHOUT THIS FILING, EXETER HOSPITAL INC IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH (BILH) NETWORK OF AFFILIATES WITH BILH SERVING AS EXETER HOSPITAL INC 'S SOLE MEMBER, OR IF NOT AS DIRECT SOLE MEMBER, INDIRECTLY AS THE MEMBER IN ITS CAPACITY AS PARENT OF THE BETH ISRAEL LAHEY HEALTH NETWORK. EXETER HOSPITAL INC 'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST AT THE FOLLOWING LOCATION: BETH ISRAEL LAHEY HEALTH TAX DEPARTMENT SCHRAFFT'S CITY CENTER, 4TH FLOOR, 529 MAIN STREET CHARLESTOWN, MA 02129 FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS 222,000. CHANGE IN FUNDED STATUS OF BENEFIT PLANS 3,028,000. DUE TO AFFILIATES -26,150,000. NET ASSETS RELEASED FOR CAPITAL 1,194,000. TRANSFER OF NET ASSETS -1,416,000. RESTRICTED FUND ADJUSTMENT 0. FORM 990, PART XII, LINE 2C: AS NOTED THROUGHOUT THIS FORM 990, EXETER HOSPITAL, INC. IS A MEMBER OF THE BETH ISRAEL LAHEY HEALTH NETWORK OF AFFILIATES. BETH ISRAEL LAHEY HEALTH (BILH) SERVES AS THE DIRECT OR INDIRECT MEMBER OF EXETER HOSPITAL, INC. AND EXETER HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF BETH ISRAEL LAHEY HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE OF BILH'S BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE CONSOLIDATED AUDIT FOR THE NETWORK AS A WHOLE. ADDISON GILBERT SOCIETY INC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 464371382 PROFESSIONAL SERVICES & FINANCIAL SUPPORT MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 ANNA JAQUES HOSPITAL 25 HIGHLAND AVE NEWBURYPORT MA 01950 042104338 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 ASSOC PHYS HARVARD MED FAC PHY AT BIDMC 375 LONGWOOD AVE BOSTON MA 02215 320058309 TO PROVIDE EMERGENCY MEDICAL SERVICES MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BAIM INSTITUTE FOR CLINICAL RESEARCH INC DBA BAIM INSTITUTE 930 COMMONWEALTH AVE BOSTON MA 02215 043521077 SCIENTIFIC & MEDICAL RESEARCH MA 501(C)(3) 7 N/A 0 BETH ISRAEL ANAESTHESIA FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042997215 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL COMMUNITY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042776678 INACTIVE CORPORATION MA 501(C)(3) 3 N/A 0 BETH ISRAEL DEACONESS DEPARTMENT OF EMERGENCY MEDICINE FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 364803234 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF MEDICINE FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043079630 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF NEONATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 208253452 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF NEUROLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043030397 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF ORTHOPAEDIC SURGERY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 204974585 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF RADIATION ONCOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 873655583 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HMFP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS DEPARTMENT OF SURGERY FOUNDATION INC 110 FRANCIS ST BOSTON MA 02215 020671240 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL DEACONESS HOSPITAL MILTON INC 199 REEDSDALE RD MILTON MA 02186 042103604 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL NEEDHAM INC 148 CHESTNUT ST NEEDHAM MA 02492 043229679 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC 275 SANDWICH ST PLYMOUTH MA 02360 222667354 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DEACONESS MEDICAL CENTER INC 330 BROOKLINE AVE BOSTON MA 02215 042103881 THE OPERATION OF A WORLD CLASS ACADEMIC MEDICAL CENTER IN BOSTON, MA MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 BETH ISRAEL DERMATOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 043117601 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BETH ISRAEL LAHEY HEALTH PHARMACY INC 80 WILSON WAY WESTWOOD MA 02090 822526816 TO OPERATE A SPECIALTY PHARMACY AND 340B PROGRAM FOR BIDMC MA 501(C)(3) 10 BETH ISRAEL DEACONESS MEDICAL CENTER INC 1 BETH ISRAEL LAHEY HEALTH PRIMARY CARE 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 472248298 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 BETH ISRAEL LAHEY HEALTH INC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 832671600 MANAGEMENT PROFESSIONAL & IT SUPPORT SERVICES MA 501(C)(3) 12C, III-FI N/A 0 BIDMC AND CHILDREN'S HOSPITAL MEDICAL CARE CORP 300 LONGWOOD AVE BOSTON MA 02215 043200113 OUTPATIENT AMBULATORY CENTER - INACTIVE MA 501(C)(3) 12A, I N/A 0 BIDMC OBSTETRICS AND GYNECOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042794855 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BID-MILTON PHYSICIAN ASSOCIATES INC 199 REEDSDALE ROAD MILTON MA 02186 222566792 PROMOTE HEALTHCARE MA 501(C)(3) 10 BETH ISRAEL DEACONESS HOSPITAL - MILTON 1 BIH PATHOLOGY FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 222548374 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 BIH RADIOLOGIC FOUNDATION INC 330 BROOKLINE AVE BOSTON MA 02215 042571853 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 CAB HEALTH AND RECOVERY SERVICES INC 199 ROSEWOOD DRIVE DANVERS MA 01923 042400270 SUBSTANCE ABUSE - INACTIVE MA 501(C)(3) 10 NORTHEAST BEHAVIORAL HEALTH CORPORATION 1 CENTER FOR MEDICAL SIMULATION 100 FIRST AVE BUILDING 39 4TH CHARLESTOWN MA 02129 043486127 TO IMPROVE PATIENT SAFETY AND HEALTH CARE QUALITY MA 501(C)(3) 10 BETH ISRAEL ANAESTHESIA FOUNDATION INC 1 COMMUNITY PHYSICIANS ASSOCIATES INC 199 REEDSDALE RD MILTON MA 02186 043243146 OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) 3 BETH ISRAEL DEACONESS HOSPITAL - MILTON 1 CONTINUING EDU PROGRAM DBA BID DEPT OF PSYCH FDN 375 LONGWOOD AVE BOSTON MA 02215 043242952 SUPPORT PATIENT CARE, RESEARCH AND TEACHING MISSIONS OF BIDMC, HFMP AND HMS MA 501(C)(3) 12A, I HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER 1 CORE PHYSICIANS LLC 5 ALUMNI DRIVE EXETER NH 03833 870807914 PHYSICIAN PRACTICES NH 501(C)(3) 10 EXETER HEALTH RESOURCES INC 1 CPHCH INC DBA BILH AT HOME - WATERTOWN C/O NRPN 600 CUMMINGS CTR BEVERLY MA 01915 473111453 HOME CARE & HOSPICE - INACTIVE MA 501(C)(3) 12A, I NORTHEAST SENIOR HEALTH CORPORATION 1 EXETER HEALTH RESOURCES SELF-INSURANCE TRUST 5 ALUMNI DRIVE EXETER NH 03833 200753662 SELF-INSURANCE TRUST NH 501(C)(3) 12A, I EXETER HEALTH RESOURCES INC 1 EXETER HEALTH RESOURCES INC 5 ALUMNI DRIVE EXETER NH 03833 020222126 SUPPORT COMMUNITY HEALTH & NETWORK MGMT SVCS NH 501(C)(3) 12A, I BETH ISRAEL LAHEY HEALTH INC 1 EXETER MED REAL INC 5 ALUMNI DRIVE EXETER NH 03833 020418718 REAL ESTATE HOLDING COMPANY NH 501(C)(25) EXETER HEALTH RESOURCES INC 1 HARVARD MEDICAL FACULTY PHYSICIANS AT BIDMC INC 375 LONGWOOD AVE BOSTON MA 02215 222768204 GENERAL AND SPECIALIZED MEDICAL SERVICES TO THE PATIENTS OF BIDMC AND OTHERS MA 501(C)(3) 10 BETH ISRAEL DEACONESS MEDICAL CENTER INC 1 HEALTH AND EDUCATION HOUSING SERVICES INC 199 ROSEWOOD DRIVE DANVERS MA 01923 223232914 HUD HOUSING - INACTIVE MA 501(C)(3) 10 NORTHEAST BEHAVIORAL HEALTH CORPORATION 1 JORDAN PHYSICIAN ASSOCIATES INC 275 SANDWICH ST PLYMOUTH MA 02360 043228556 OUTPATIENT AND PRIMARY CARE SERVICES MA 501(C)(3) 10 BETH ISRAEL DEACONESS HOSPITAL-PLYMOUTH INC 1 JOSLIN CLINIC INC ONE JOSLIN PLACE BOSTON MA 02215 222984590 PREVENTION, TREATMENT, AND CURE OF DIABETES MA 501(C)(3) 12A, I JOSLIN DIABETES CENTER INC 1 JOSLIN DIABETES CENTER INC ONE JOSLIN PLACE BOSTON MA 02215 042203836 PREVENTION, TREATMENT, AND CURE OF DIABETES MA 501(C)(3) 7 BETH ISRAEL LAHEY HEALTH INC 1 LAHEY CLINIC CANADIAN FOUNDATION 130 KING ST WEST TORONTO ONTARIO CA FUNDRAISING ORG CA N/A 0 LAHEY CLINIC FOUNDATION INC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 042323457 FINANCIAL & OPERATIONAL SUPPORT TO LCI AND LCH MA 501(C)(3) 7 BETH ISRAEL LAHEY HEALTH INC 1 LAHEY CLINIC HOSPITAL INC DBA LAHEY HOSPITAL & MEDICAL CENTER AND LMC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 042704686 HEALTHCARE MA 501(C)(3) 3 LAHEY CLINIC FOUNDATION INC 1 LAHEY CLINIC INC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 042704683 HEALTHCARE MA 501(C)(3) 10 LAHEY CLINIC FOUNDATION INC 1 LAHEY HEALTH SHARED SERVICES INC 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 043178972 ADMIN MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH INC 1 MED CARE OF BOSTON MGMT CORP DBA BILH PRIMARY CARE 464 HILLSIDE AVE NEEDHAM MA 02494 042810972 OUTPATIENT, PRIMARY CARE AND SPECIALTY SERVICES MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH PRIMARY CARE 1 MOUNT AUBURN HOSPITAL 330 MOUNT AUBURN ST CAMBRIDGE MA 02138 042103606 HOSPITAL FOR THE TREATMENT, CARE AND RELIEF OF SICK AND SUFFERING PERSONS MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 MOUNT AUBURN PROFESSIONAL SERVICES INC 330 MOUNT AUBURN ST CAMBRIDGE MA 02138 043026897 OFFERING MEDICAL CARE IN GENERAL AND SPECIALIZED PRACTICES MA 501(C)(3) 12A, I MOUNT AUBURN HOSPITAL 1 NEW ENGLAND BAPTIST HOSPITAL 125 PARKER HILL AVE BOSTON MA 02120 042103612 ORTHOPEDIC SPECIALTY HOSPITAL MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 NEW ENGLAND BAPTIST MEDICAL ASSOCIATES INC 125 PARKER HILL AVE BOSTON MA 02120 043235796 OUTPATIENT MEDICAL SERVICES TO THE VARIOUS COMMUNITIES SERVICED BY NEBH MA 501(C)(3) 3 NEW ENGLAND BAPTIST HOSPITAL 1 NORTHEAST BEHAVIORAL HEALTH CORP DBA BILH BEHAVIORAL HEALTH SERVICES 199 ROSEWOOD DRIVE DANVERS MA 01923 042777145 HEALTHCARE MA 501(C)(3) 10 BETH ISRAEL LAHEY HEALTH INC 1 NORTHEAST HEALTH SYSTEMS INC 85 HERRICK ST BEVERLY MA 01915 043240453 FINANCIAL & OPERATIONAL SUPPORT MA 501(C)(3) 12B, II LAHEY HEALTH SHARED SERVICES INC 1 NORTHEAST HOSPITAL CORPORATION 85 HERRICK ST BEVERLY MA 01915 042121317 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 NORTHEAST MEDICAL PRACTICE INC 85 HERRICK ST BEVERLY MA 01915 043201853 HEALTHCARE MA 501(C)(3) 10 NORTHEAST HOSPITAL CORPORATION 1 NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC DBA BILH AT HOME 800 CUMMINGS CENTER BEVERLY MA 01915 201287349 HEALTHCARE MA 501(C)(3) 10 NORTHEAST SENIOR HEALTH CORPORATION 1 NORTHEAST SENIOR HEALTH CORPORATION 85 HERRICK ST BEVERLY MA 01915 042731137 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 ROCKINGHAM VISITING NURSE ASSOCIATION AND HOSPICE 5 ALUMNI DRIVE EXETER NH 03833 020274905 HOME CARE & HOSPICE NH 501(C)(3) 10 EXETER HEALTH RESOURCES INC 1 SEACOAST AFFILIATED GROUP PRACTICE INC 25 HIGHLAND AVE NEWBURYPORT MA 01915 043485648 PHYSICIAN GROUP MA 501(C)(3) 10 ANNA JAQUES HOSPITAL INC 1 SEACOAST NURSING AND REHABILITATION CENTER INC 300 WASHINGTON ST GLOUCESTER MA 01930 041305001 HEALTHCARE MA 501(C)(3) 10 LAHEY HEALTH SHARED SERVICES INC 1 THE JORDAN HEALTH SYSTEMS INC 275 SANDWICH ST PLYMOUTH MA 02360 042103805 PROMOTE HEALTHCARE MA 501(C)(3) 7 BETH ISRAEL DEACONESS MEDICAL CENTER INC 1 WINCHESTER COMMUNITY ACCOUNTABLE CARE ORGANIZATION INC 41 HIGHLAND AVE WINCHESTER MA 01890 223137856 ACO - INACTIVE MA 501(C)(3) 12A, I WINCHESTER HEALTHCARE MANAGEMENT INC 1 WINCHESTER HEALTHCARE MANAGEMENT INC 41 HIGHLAND AVE WINCHESTER MA 01890 222701817 MANAGEMENT MA 501(C)(3) 12A, I LAHEY HEALTH SHARED SERVICES INC 1 WINCHESTER HOSPITAL 41 HIGHLAND AVE WINCHESTER MA 01890 042104434 HEALTHCARE MA 501(C)(3) 3 BETH ISRAEL LAHEY HEALTH INC 1 WINCHESTER HOSPITAL FOUNDATION INC 41 HIGHLAND AVE WINCHESTER MA 01890 043399570 PROFESSIONAL SERVICES & FINANCIAL SUPPORT MA 501(C)(3) 12A, I WINCHESTER HEALTHCARE MANAGEMENT INC 1 BETH ISRAEL LAHEY HEALTH SURGERY CENTER PLYMOUTH LLC 41 RESNIK ROAD PLYMOUTH MA 02360 883871838 SURGERY CENTER MA N/A 0 0 BIDCO HOSPITAL LLC 247 STATION DRIVE NORTHWEST 1 WESTWOOD MA 02090 461643790 COORDINATED SAFE AND COST EFFECTIVE PATIENT CARE AT BIDMC MA N/A 0 0 BIDCO PHYSICIAN LLC 600 UNICORN PARK DRIVE 4TH FL WOBURN MA 01801 461589743 COORDINATED SAFE AND COST EFFECTIVE PATIENT CARE AT BILH MA N/A 0 0 BILH INVESTMENT PARTNERSHIP LLP 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 043278109 INVESTMENT PARTNERSHIP MA N/A 0 0 NEBSC HOSPITAL HOLDINGS LLC 125 PARKER HILL AVE BOSTON MA 02120 874293833 INVESTMENT PARTNERSHIP MA N/A 0 0 NEW ENGLAND BAPTIST SURGERY CENTER LLC 100 AVON MEADOW LANE AVON MA 06001 874311329 AMBULATORY SURGERY CENTER MA N/A 0 0 PHYSICIANS PROFESSIONAL SERVICES LLP 200 RIVERS EDGE DRIVE MEDFORD MA 02155 043275078 TO PROVIDE MEDICAL BILLING SERVICES MA N/A 0 0 SHIELDS IMAGING AT ANNA JAQUES HOSPITAL LLC 700 CONGRESS ST STE 204 QUINCY MA 02169 383989358 MRI SERVICES MA N/A 0 0 WINCHESTER HOSPITALSHIELDS MRI LLC 700 CONGRESS ST STE 204 QUINCY MA 02169 462523117 MRI SERVICES MA N/A 0 0 GREATER NEWBURYPORT MANAGEMENT SERVICES ORGANIZATION INC 25 HIGHLAND AVE NEWBURYPORT MA 01950 161744477 MANAGEMENT SERVICES MA N/A C 0 HUNTINGFIELD CORPORATION C/O LCF 529 MAIN ST 4TH FL CHARLESTOWN MA 02129 520717412 TO HOLD OWNERSHIP OF SUBTERRANEAN RIGHTS DE N/A C 0 LAHEY CLINIC INSURANCE CO LTD CRAIG APPIN HOUSE PO BOX HM 2450 HAMILTON BD INSURANCE BD N/A C 0 LEDGEWOOD HEALTH CARE CORPORATION 87 HERRICK STREET BEVERLY MA 01915 042855189 NURSING HOME MA N/A C 0 NORTHEAST PROPRIETARY CORP 85 HERRICK STREET BEVERLY MA 01915 042855191 MEDICAL SERVICES MA N/A C 0 WINCHESTER HEALTHCARE ENTERPRISES INC 41 HIGHLAND AVE WINCHESTER MA 01890 042932059 MANAGEMENT SERVICES MA N/A C 0 WINCHESTER PHYSICIAN ASSOCIATES INC 41 HIGHLAND AVE WINCHESTER MA 01890 043262963 MANAGEMENT SERVICES MA N/A C 0 WINCHESTER PHYSICIAN HOSPITAL ORGANIZATION INC 41 HIGHLAND AVE WINCHESTER MA 01890 472646454 INACTIVE MA N/A C 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 SEE PART VII R 491631 FMV SEE PART VII S 1640200 FMV SEE PART VII D 2114215000 FMV SEE PART VII E 27118000 FMV SEE PART VII J 76114 FMV SEE PART VII K 59424 FMV SEE PART VII K 2658432 FMV SEE PART VII L 860242 FMV SEE PART VII L 3733179 FMV SEE PART VII L 438080 FMV SEE PART VII L 397581 FMV SEE PART VII M 158709 FMV SEE PART VII M 11055362 FMV SEE PART VII M 8034687 FMV SEE PART VII R 67834327 FMV SEE PART VII R 19150000 FMV SEE PART VII S 5299547 FMV SEE PART VII S 107934 FMV FORM 990, SCH R, PART V, LN 1S - OTHER TRANSFER OF CASH/PROP FROM RO AS NOTED THROUGHOUT THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THAT RELATIONSHIP, ONE OR MORE OF ITS AFFILIATED ENTITIES MADE CASH PAYMENTS TO EH AS PART OF NETWORK-WIDE CASH MANAGEMENT AND IN FURTHERANCE OF THE EXEMPT PURPOSE OF BILH AND ITS AFFILIATES. DURING THE PERIOD COVERED BY THIS FILING, THE FOLLOWING CASH OR PROPERTY WAS TRANSFERRED TO EH BY ITS TAX-EXEMPT AFFILIATES: 1. BETH ISRAEL LAHEY HEALTH CASH AND REBATE TRANSFERS: $5,229,547 2. EXETER HEALTH RESOURCES, INC. - SPECIFIC PURPOSE FUNDS TRANSFERRED: $1,640,200 3. EXETER HEALTH RESOURCES SELF-INSURANCE TRUST REFUNDING OF PAYMENTS TO SELF INSURANCE TRUST: $107,934 FORM 990, SCH R, PART V, LN 1D LOANS/LOAN GUARANTEES TO/FOR RO EXETER HOSPITAL ("EH") IS A MEMBER OF THE BILH OBLIGATED GROUP AND AS SUCH IS JOINTLY AND SEVERALLY LIABLE FOR ALL DEBT OF THE OBLIGATED GROUP. IN THIS CAPACITY, EH HAS MADE LOAN GUARANTEES TO THE FOLLOWING OTHER MEMBERS OF THE OBLIGATED GROUP TOTALING $ 2,114,215,000: -ANNA JAQUES HOSPITAL -LAHEY CLINIC FOUNDATION -MOUNT AUBURN HOSPITAL -NORTHEAST HOSPITAL CORP -WINCHESTER HOSPITAL -BETH ISRAEL DEACONESS MEDICAL CENTER -BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH -NEW ENGLAND BAPTIST HOSPITAL -BETH ISRAEL DEACONESS HOSPITAL MILTON -BETH ISRAEL DEACONESS HOSPITAL NEEDHAM FORM 990, SCH R, PART V, LN 1E LOANS/LOAN GUARANTEES BY RO EH IS A MEMBER OF THE BILH OBLIGATED GROUP AND AS SUCH ALL OTHER MEMBERS OF THE BILH OBLIGATED GROUP ARE JOINTLY AND SEVERALLY LIABLE FOR THE OBLIGATED GROUP DEBT OUTSTANDING AT EH. IN THIS CAPACITY, THE ENTITIES LISTED BELOW HAVE LOAN GUARANTEES TO EH TOTALING $ 27,118,000: -ANNA JAQUES HOSPITAL -LAHEY CLINIC FOUNDATION -LAHEY CLINIC HOSPITAL -LAHEY CLINIC, INC. -MOUNT AUBURN HOSPITAL -MOUNT AUBURN PROFESSIONAL SERVICES -NORTHEAST HOSPITAL CORP. -WINCHESTER HOSPITAL -BETH ISRAEL DEACONESS MEDICAL CENTER -BETH ISRAEL DEACONESS HOSPITAL - PLYMOUTH -NEW ENGLAND BAPTIST HOSPITAL -BETH ISRAEL DEACONESS HOSPITAL - MILTON -BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM -MEDICAL CARE OF BOSTON MANAGEMENT CORP. D/B/A BETH ISRAEL LAHEY HEALTH PRIMARY CARE FORM 990, SCH R, PART V, LN 1J - LEASE OF FAC/EQUIP/OTHER ASSETS TO RO AS NOTED ELSEWHERE IN THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THE CLOSE CONNECTION BETWEEN EH AND CORE PHYSICIANS, LLC ("CORE," A RELATED ENTITY EXEMPT UNDER IRC 501(C)(3)), CORE LEASES SPACE FROM EH TO USE IN FURTHERANCE OF THEIR TAX-EXEMPT PURPOSES. CORE PAID EH $76,114 FOR SPACE RENTAL. FORM 990, SCH R, PART V, LN 1K LEASE OF FAC/EQUIP/OTHER ASSETS FROM RO AS NOTED ELSEWHERE IN THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THE CLOSE CONNECTION BETWEEN EH, EXETER HEALTH RESOURCES, INC. ("EHR," A RELATED ENTITY EXEMPT UNDER IRC 501(C)(3)), AND EXETER MED REAL, INC. ("EMR," A RELATED ENTITY EXEMPT UNDER IRC 501(C)(3)), EH LEASES SPACE FROM EHR AND EMR TO USE IN FURTHERANCE OF THE EH, EHR, EMR, AND BILH TAX-EXEMPT PURPOSES. EH PAID EHR AND EMR $ 59,424 AND $ 2,658,432, RESPECTIVELY, FOR SPACE RENTAL. FORM 990, SCH R, PART V, LN 1L PERF OF SVCS/MEMBERSHIP/FUNDRAISING FOR RO AS NOTED THROUGHOUT THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THAT RELATIONSHIP, EH PROVIDES SERVICES TO OTHER NETWORK ENTITIES IN FURTHERANCE OF ITS EXEMPT PURPOSE AND IN FURTHERANCE OF THE EXEMPT PURPOSE OF ITS AFFILIATES. DURING THE PERIOD COVERED BY THIS FILING, EH PROVIDED THE FOLLOWING SERVICES TO ITS TAX EXEMPT AFFILIATES: 1. BETH ISRAEL LAHEY HEALTH, INC. EPIC IMPLEMENTATION: $ 860,242 2. CORE PHYSICIANS, LLC - MAINTENANCE, CONSTRUCTION, QUALITY ASSURANCE, LEAN FACILITATOR, CENTRAL STERILIZATION, HR, IS, SECURITY, STOREROOM AND LAB SERVICES, AND FACILITY FEES: $ 3,809,293 3. ROCKINGHAM VISITING NURSE ASSOCIATION AND HOSPICE - MAINTENANCE, CONSTRUCTION, HOUSEKEEPING, LEAN FACILITATOR, HR, AND IS SERVICES: $ 438,080 4. EXETER MED REAL, INC. - FINANCE, HOUSEKEEPING, AND MAINTENANCE SERVICES: $ 397,581 FORM 990, SCH R, PART V, LN 1M - PERF OF SVCS/MEMBERSHIP/FUNDRAISING BY RO AS NOTED THROUGHOUT THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THAT RELATIONSHIP, ONE OR MORE OF EH'S AFFILIATES PROVIDED SERVICES TO EH IN FURTHERANCE OF THE EXEMPT PURPOSE OF EH AND ITS AFFILIATES. DURING THE PERIOD COVERED BY THIS FILING, EH RECEIVED THE FOLLOWING SERVICES FROM ITS TAX-EXEMPT AFFILIATES: 1. LAHEY CLINIC, INC PHYSICIAN SERVICES: $ 158,709 2. CORE PHYSICIANS, LLC PHYSICIAN SERVICES: $ 11,055,362 3. EXETER HEALTH RESOURCES, INC. MANAGEMENT FEES: $ 8,034,687 FORM 990, SCH R, PART V, LN 1R OTHER TRANSFER OF CASH/PROP TO RO AS NOTED THROUGHOUT THIS FILING, EH IS A MEMBER OF THE BILH NETWORK OF AFFILIATES. AS PART OF THAT RELATIONSHIP, EH TRANSFERRED CASH TO ONE OR MORE OF ITS AFFILIATED ENTITIES AS PART OF NETWORK-WIDE CASH MANAGEMENT AND IN FURTHERANCE OF THE EXEMPT PURPOSE OF ITS EH AND ITS AFFILIATES. DURING THE PERIOD COVERED BY THIS FILING, EH TRANSFERRED THE FOLLOWING CASH OR PROPERTY TO ITS TAX-EXEMPT AFFILIATES: 1. BETH ISRAEL LAHEY HEALTH CASH TRANSFERRED: $30,000,000 2. BETH ISRAEL LAHEY HEALTH REIMBURSEMENTS FOR INSURANCE AND FRINGE BENEFITS: $ 37,834,327 3. EXETER HEALTH RESOURCES, INC. CASH TRANSFERRED: $19,150,000 4. EXETER HEALTH RESOURCES SPECIFIC PURPOSE FUNDS ACCOUNTED FOR AT EHR: $491,631