2019-07-12T12:28:06-05:00 2018-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2017-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott Sloane Senior VP, CFO, & Treasurer 6032284677 2019-06-18 1 Nicholas E Porto P01310283 2078792100 2019-06-18 208.105.168.164 2019-06-18 13:56:58 ED P 3452BD8595D9AC820B41F271E29CE8BF50AD3EDC 86AD5A998A217BD7885303F5109AB5202568ED7D 2017 2019-02-21 02:37:17Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 558487164 0 X www.concordhospital.org X 1944 NH Hospital 17 15 3977 250 2383542 -690254 4759894 4654766 490926175 517361113 9212215 14710104 360563 520610 505258847 537246593 294700 80000 0 0 275652996 283748271 0 0 0 201355745 231888478 477303441 515716749 27955406 21529844 562669503 636262707 242554355 289400733 320115148 346861974 Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 0 0 434015420 80000 515514386 Various hospital services; see Schedule HIn FYE 2018, Concord Hospital invested more than $76 million for community benefit programs, services, and other expenses. The largest areas of support were charitable care services, medical education and subsidized programs and services. Our investment enhances the Hospital's ability to provide quality patient care, respond to identified community health needs and address the Hospital's charitable mission overall. 434015420 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 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 1 0 1 360 0 1 3977 1 1 1 0 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X X Scott Sloane Senior VP CFO 6032277000 250 Pleasant Street Concord NH 033017539 Valerie Acres Esq Trustee 1.00 1.00 X 0 0 0 Philip Boulter MD Trustee 1.00 3.00 X 0 0 0 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 Michelle Chicoine Trustee 1.00 0.00 X 0 0 0 Peter Cook Trustee 1.00 0.00 X 0 0 0 Philip Emma Trustee 1.00 0.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 Manisha Patel DDS Trustee 1.00 0.00 X 0 0 0 Muriel Schadee CPA Trustee 1.00 3.00 X 0 0 0 Robert Segal Trustee 1.00 2.00 X 0 0 0 Lon Setnik MD Trustee 1.00 0.00 X 0 0 0 David Stevenson MD Trustee 50.00 1.00 X 211563 0 60208 Robert Thomson MD Medical Staff President (end 1/18) 1.00 1.00 X 0 0 0 Jeffrey Towle Trustee 1.00 2.00 X 0 0 0 David Ruedig Chair 1.00 4.00 X X 0 0 0 Sol Asmar Vice Chair 1.00 3.00 X X 0 0 0 William Chapman Esq Secretary 1.00 1.00 X X 0 0 0 Robert P Steigmeyer President & CEO 56.00 4.00 X X 924848 0 215500 Scott Sloane Treasurer 56.00 4.00 X 322039 0 81528 David Green MD Senior VP/Chief Medical Of 50.00 0.00 X 522197 0 90361 Timothy P Jones Senior VP/Chief Operating 50.00 0.00 X 492225 0 56841 Gerald Sardella MD Physician 50.00 0.00 X 634853 0 62952 Todd Burdette MD Physician 50.00 0.00 X 514205 0 68557 Adam Chodosh MD Physician 50.00 0.00 X 537673 0 64895 Shahab Moossavi MD Physician 50.00 0.00 X 505734 0 51292 Michael Ferguson MD Physician 50.00 0.00 X 493168 0 40635 5158505 0 792769 417 0 1 0 Concord Emergency Medical Assoc 540 Lafayette Road Hampton NH 03842 Physician services 10040952 Elliot Hospital 1070 Holt Avenue Suite 2100 Manchester NH 03109 Healthcare services 6247188 Anesthesia Associates PA 1 Pillsbury Street Suite 202 Concord NH 03301 Healthcare services 2592146 Elevating Informatics 511 Prairie Lake Drive Fern Park FL 32730 Professional Services 2466657 Medefis Consolidated PO Box 5068 New York NY 10087 Professional Services 1898339 24 4654766 4654766 Net Patient Service 621400 491948223 491948223 Disproportionate Share Funding 621400 14327206 14327206 Other Operating Revenue 621400 6736810 5508660 1228150 Food Services 722210 4109509 2970322 1139187 ARRA-HI-TECH 621400 125155 125155 114210 114210 517361113 4072572 16205 4056367 520610 0 520610 520610 520610 31793209 84894 21240022 549 10553187 84345 10637532 10637532 537246593 515514386 2383542 14693899 80000 80000 2977310 678340 2298970 229519706 192372611 37147095 8304790 7162035 1142755 27928798 23279826 4648972 15017667 12489611 2528056 1314023 92624 1221399 587302 587302 56876 56876 87203 87203 848668 848668 17040208 12439312 4600896 243807 60520 183287 7739108 5394079 2345029 18177988 12842801 5335187 14334697 10048683 4286014 372000 219171 152829 791002 689972 101030 4872730 3410911 1461819 26082596 18257817 7824779 5685489 5685489 Medical/Surgical Suppli 71463029 71463029 Bad Debt Expense 29321616 29321616 Medicaid Enhancement Ta 20975018 20975018 Repairs/Maintenance 5494714 3773889 1720825 6400404 3278066 3122338 515716749 434015420 81701329 0 7473285 7554078 7551607 30553332 51229669 69847777 1776639 1978868 5610145 4931830 461339381 303712220 164621979 157627161 139912923 164564006 151507173 172825770 7842554 8191481 25143529 18188404 562669503 636262707 69312072 68196146 85323515 137523672 87918768 83680915 242554355 289400733 X 320115148 346861974 320115148 346861974 562669503 636262707 X 21529844 1422073 3794909 X X 0 1 X 1 0 X 0 0 0 0 0 1 39203 0 0 1 48000 87203 0 Part II-B, Line 1: Concord Hospital was a member of the American Hospital Association & New Hampshire Hospital Association in the fiscal year ended 9/30/18. A portion of the dues paid to these organizations were available for lobbying expenditures on behalf of Concord Hospital and the other member organizations in furtherance of their exempt purposes. The portions of dues used for lobbying by the American Hospital Association and New Hampshire Hospital Association were $9,196 and $30,007, respectively. Concord Hospital has hired an outside consultant to perform services to further Concord Hospital's mission. This consultant was paid $48,000 in the year ended 9/30/18. 272756311 5743785 647729 277852367 239892180 33431692 567561 272756311 232130222 1940394 6298683 477119 239892180 243015224 1036824 -9845448 2076378 232130222 210537884 19493511 13878348 894519 243015224 1.00000 0.00000 0.00000 0 1 1 18996 18996 161515060 88788730 72726330 4903336 2816209 2087127 287857717 212107281 75750436 7044272 7044272 157627161 Alternative Investments 172825770 F 172825770 Estimated 3rd Party Settlements 35378442 Accrued Pension & Other Long-Term Liabilities 48302473 83680915 X 541925013 1422073 7598647 9020720 532904293 850415 3491885 4342300 537246593 514254829 0 514254829 850415 611505 1461920 515716749 Part V, Line 4: The intended use of the endowment funds is to fund capital expenditures for medical equipment/provide healthcare prevention and services for the uninsured population in the service area. Part X, Line 2: The Hospital, CRHCDC, CRHVC, CH/DHC and the Trust are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 2d - Other Adjustments: Pension Actuarial Gain 7,598,647. Part XI, Line 4b - Other Adjustments: Board Designated Spending 611,505. Net Periodic Pension Cost 2,880,380. Part XII, Line 4b - Other Adjustments: Board Designated Spending 611,505. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments - FMV as of 9/30/18 None 60869000 0 0 0 0 0 0 60869000 0 60869000 1 0 1 1 0 0 Part IV, Line 3: This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Part IV, Line 4: The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital. 1 1 1 X 225.000000000000 1 X 500.000000000000 1 1 1 0 1 1 9 4700 4527355 4527355 0.00930 39782720 15219136 24563584 0.05050 9 4700 44310075 15219136 29090939 0.05980 10 521038 2682267 551212 2131055 0.00440 6 7661 11055734 7459354 3596380 0.00740 24 324325 90012455 49416971 40595484 0.08350 1 31 91389 91389 0.00020 5 605222 605222 0.00120 46 853055 104447067 57427537 47019530 0.09670 55 857755 148757142 72646673 76110469 0.15650 12460 5000 7460 0.00000 12460 5000 7460 0.00000 1 10245804 1096301 168330140 229319523 -60989383 X 1 1 1 1 Concord Hospital 250 Pleasant Street Concord NH 03301 01098 X X X X Concord Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Part V, Section C X X 1 15 1 See Part V, Section C 0 1 X 225.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Concord Hospital Part V, Section B, Line 5: See the narrative for Schedule H, Part VI, line 2. Concord Hospital Part V, Section B, Line 7d: The Community Benefits Report (2018 Charitable Achievements) was included in the Hospital's annual report that was mailed to nearly 24,000 households within the communities that the Hospital serves. It is also available on the State of New Hampshire's Department of Justice, Office of the Attorney General, Charitable Trusts Unit website and Concord Hospital's website. The Hospital's 2015 and 2018 Community Health Needs Assessments are on the Hospital's website with instructions on how to obtain a printed copy. Concord Hospital Part V, Section B, Line 11: See attached 2016-2018 Community Benefits Action Plan to see how Concord Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this tax filing.The one need where the Hospital had limited involvement was in the area of food insecurity, although the Hospital did engage with local food banks to improve healthy choices available. Concord Hospital Part V, Section B, Line 16j: The Hospital includes information about charitable care services in many publications that go to the community. In addition, we collaborate with many community organizations that support the underserved and low-income individuals and families; our financial assistance program is well understood by those agencies who often refer people to the program. Finally, our Financial Assistance staff reach out personally to the homeless through the monthly clinic at the homeless resource center to connect them to regular medical care. Currently, the Hospital's Financial Assistance Policy is only available online in English. However, for non-English speaking patients, interpreters are provided. The Hospital is currently working to launch a new website that will incorporate a widget that will allow the Financial Assistance Policy to be readily translated into non-English languages. Schedule H, Part V, Section B, Line 7a & 10a: The CHNA is available at the Hospital facility's website:https://www.concordhospital.org/app/files/public/1232/Capital-Region-Community-Health-Needs-Assessment-2015.pdf Implementation Strategy:https://giveto.concordhospital.org/file/2016-2018-Community-Benefits-Action-Plan.pdf Schedule H, Part V, Section B, Line 16a-c: The Hospital's Financial Assistance Policy, Application, and Plain Language Summary can be found online at:Financial Assistance Policy:https://www.concordhospital.org/app/files/public/1358/Financial-Assistance-Policy.pdf Financial Assistance Application: https://www.concordhospital.org/app/files/public/812/Financial-Assistance-Application-Form.pdf Plain Language Summary:https://www.concordhospital.org/patients-visitors/patient-financial-services/financial-assistance/financial-assistance-policy-plain-language-summary/ 56 1 - Capital Orthopaedic Srgry Ctr-Concord 264 Pleasant Street Concord NH 03301 Outpatient Surgery 2 - Concord Imaging Center 248 Pleasant Street Suite 106 Concord NH 03301 Imaging Services 3 - Concord Hospital Cardiac Associates 246 Pleasant Street Suite 103 Concord NH 03301 Outpatient Physician Services 4 - Center for Urologic Care 246 Pleasant Street Suite G2 Concord NH 03301 Outpatient Physician Services 5 - Concord Ambulatory Surgery Center 60 Commercial Street Suite 301 Concord NH 03301 Outpatient Surgery 6 - Concord Endoscopy Center 60 Commercial Street Concord NH 03301 Outpatient Endoscopy Services 7 - Concord Imaging Center 60 Commercial Street Suite 101 Concord NH 03301 Imaging Services 8 - Concord Obstetrics and Gynecology 189 North Main Street Concord NH 03301 Outpatient Physician Services 9 - Concord Surgical Associates 246 Pleasant Street Suite 205 Concord NH 03301 Outpatient Physician Services 10 - Capital Orthopaedic Srgry Ctr-Derry 14 Tsienneto Road Suite 100 Derry NH 03836 Outpatient Surgery 11 - Concord Hosp Family Health Center 250 Pleasant Street Concord NH 03301 Outpatient Physician Services 12 - Concord Pulmonary Medicine 248 Pleasant Street Suite G100 Concord NH 03301 Outpatient Physician Services 13 - Center for Sports Med & Ortho Rehab 264 Pleasant Street Concord NH 03301 Rehabilitation Services 14 - Rehabilitation Services at Warner 2 East Main Street Warner NH 03278 Rehabilitation Services 15 - Rehab Serv Fam Health Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Rehabilitation Services 16 - Concord Family Medicine 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 17 - Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 18 - Concord Hospital Sleep Center 18 Foundry Street Suite 103 Concord NH 03301 Outpatient Sleep Services 19 - Concord Plastic Surgery 246 Pleasant Street Suite 210 Concord NH 03301 Outpatient Physician Services 20 - Concord Hospital Urgent Care 60 Commercial Street Concord NH 03301 Walk-in Urgent Care 21 - Concord Hospital Cardiac Ass-Laconia 85 Spring Street Suite 2A1 Laconia NH 03246 Outpatient Physician Services 22 - Penacook Family Physicians 4 Crescent Street Peacock NH 03303 Outpatient Physician Services 23 - Neurology Associates 248 Pleasant Street Suite G200 Concord NH 03301 Outpatient Physician Services 24 - Family Tree Healthcare Hopkinton 19 Farrington Corner Road Hopkinton NH 03229 Outpatient Physician Services 25 - Family Care Of Concord 248 Pleasant Street Suite 2600 Concord NH 03301 Outpatient Physician Services 26 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 27 - Epsom Family Medicine 1990 Dover Road Epsom NH 03234 Outpatient Physician Services 28 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 29 - Rehab Serv CH Med Off-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 30 - CardiacThoracic Surgery 246 Pleasant Street Concord NH 03301 Outpatient Physician Services 31 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 32 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 33 - Rehab Serv CH Med Off-East 1990 Dover Road Suite 201 Epsom NH 03234 Rehabilitation Services 34 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 35 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 36 - Concord Imaging Center 1990 Dover Road Epsom NH 03234 Imaging Services 37 - Family Tree Healthcare Warner 2 East Main Street Warner NH 03278 Outpatient Physician Services 38 - Rehabilitation Services at Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 39 - Family Tree Healthcare Concord 81 Hall Street Concord NH 03301 Outpatient Physician Services 40 - Lab-Memorial Medical Office Building 246 Pleasant Street Concord NH 03301 Outpatient Laboratory Services 41 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 42 - Capital Region Palliative Care & Hospice 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 43 - Anti-Coag Clinic Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 44 - Center for Health Promotion 49 South Main Street Concord NH 03301 Health Promotion Services 45 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 46 - Concord Hosp Fam Hlth Ctr Dntl Clinic 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 47 - Lab CH Medical Offices-East 1990 Dover Road Epsom NH 03234 Outpatient Laboratory Services 48 - Concord Family Medicine Havenwood 149 East Side Drive Concord NH 03301 Outpatient Physician Services 49 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging and Counseling service 50 - Radiology Srv Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Radiology Services 51 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 52 - Lab Penacook Family Physicians 4 Crescent Street Penacook NH 03303 Outpatient Laboratory Services 53 - Lab Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 54 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 55 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services 56 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services Part I, Line 7: Subsidized Health Services represents those activities that assure access to medical care and support for people with special medical needs and those who may be faced with chronic health conditions. Many of these activities also ensure access to needed health services, which might otherwise not be available without subsidized or special support. Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $29,321,616. Part II, Community Building Activities: The Hospital's Trauma Program launched a service area-wide educational initiative, "Stop the Bleed", to provide tourniquet kits for all school classrooms and also educate personnel on the proper use of tourniquets. The initiative, which will continue into 2019, is expected to provide 800 kits via a fundraising campaign to schools serving the Hospital's 28 communities in its service area. Part III, Line 2: The amount reported on Part III, Line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, Line 25, Column (A). Accounts Receivable: The allowance for doubtful accounts is provided based on an analysis by management of the collectability of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts. Accounts are charged against the allowance for doubtful accounts when deemed uncollectible. Charity Care: The System provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as community benefit. The amount on Line 3 is calculated by determining the revenue for all patients that have completed an application for financial assistance and only reporting the amount for those that did not complete the financial assistance process for any number of reasons and were then transferred to bad debt. Part III, Line 3: See narrative for Part III, Line 2. Part III, Line 4: See page 10 of the attached audited financial statements. Part III, Line 8: The Medicare shortfall of $60,989,383 represents the costs of unreimbursed services. In addition, many of the subsidized health services reported on line 7g include some revenue and expenses from services to Medicare patients, Medicare allowable costs on line 5 were determined using the Hospital's filed Medicare cost report, which determines cost via the cost to charge ratio methodology. The Hospital has not included its Medicare shortfall as a community benefit in Part I. Part III, Line 9b: The Hospital has a Financial Assistance policy in addition to, and complementing, the bad debt collection policy. The policy describes the Hospital's program of financial assistance for medically necessary services to individuals and families who are uninsured, underinsured, or who experience a catastrophic healthcare event and do not quality for any other state or federal assistance programs. Patient education of eligibility for assistance is described below in the statement for Part VI, Line 3. Part VI, Line 2: Every three years, the Hospital conducts a comprehensive community health needs assessment, engaging numerous community organizations and health partners in the process, to identify far-reaching health needs faced by people in the communities served by the Hospital. Assessment methodologies address both quantitative and qualitative data and include stakeholder interviews, focus groups, community listening sessions, web survey, written surveys, telephone surveys and analysis of various data sets. Assessment results are shared with community members and serve as the basis to develop new or expanded services in response to need. The most recent assessment covered by this tax return was completed in the tax year of 2015. Shortly after the fiscal year covered by this return filing, the Hospital completed a new assessment in December 2018 and approved the 2019-2021 Implementation Plan which reflects the most recent identified priority health needs. Both the 2018 Community Health Needs Assessment and the 2019-2021 Implementation Plan will be more specifically addressed in the Hospital's 2018 Form 990, Schedule H and are available on the Hospital's website at: www.concordhospital.org/about-us/charitable-achievements/ Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paving their obligations to inform and work with them to understand what local programs are available to them, including how they can benefit from the Hospital's Financial Assistance program. Part VI, Line 4: Concord defines its Primary Service Area as 28 communities to which it has close geographic proximity and significant market share. According to the State of New Hampshire's "Concord Healthcare Service Area Regional Health Profile, 2001," the 28 communities that comprise the Hospital's PSA represent, in terms of square miles, the largest hospital service area in the State. Together, these communities cover an area of nearly 900 square miles. The Hospital serves all the residents of these towns as well as many others from across the State of New Hampshire through its regional and statewide referral for specialty care, including orthopaedic, cardiology, oncology, and urological care. Part VI, Line 5: Part I line 6A, Concord Hospital develops programs and services to address community health needs and invests annually in initiatives that align with the Hospital's charitable mission. A reasonable amount of Concord Hospital's community benefit investment remains in the area of charitable care to ensure that those without insurance or with limited insurance have access to needed medical care. The Hospital strives to address the needs of vulnerable populations, including our low-income neighbors and other vulnerable populations. The Hospital's Family Health Centers ensure access to primary, behavioral health, and dental care for our region's most vulnerable residents, which address identified community health needs. Those achievements are at the heart of our community benefit activity. Beyond that focus are programs and services that benefit every resident and support that far reaching goal of a healthier community. The Hospital continued its efforts toward promoting the health of the community by investing its surplus funds in new medical facilities to enhance patient care, by providing funding support to Capital Region Healthcare affiliates through the Community Services Fund for programs that address identified community needs and serve vulnerable populations, and by continuing to recruit new primary care physicians to enhance access in the community.Finally, per the IRS instructions to Schedule H, Part I, the Hospital has not included its $60,989,383 Medicare shortfall as a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care. Part VI, Line 7, Reports Filed With States NH 1 Riverbend Community Mental Health PO Box 2032 Concord NH 03301 020264383 501(c)(3) 60000 Support for: continuing education & training of staff, clinical staff at Concord Homeless Resource Center, and general operating support. Concord Regional Visiting Nurse Association Inc 30 Pilsbury Street Concord NH 03301 020222122 501(c)(3) 20000 Purchase of two i-stat machines for diagnostic testing. 2 0 Part I, Line 2: The Hospital works with the Concord Hospital Trust to administer grants provided from funds available through the Community Services Funds. The Trust has an open application process for those entities that meet the grant requirements, and the Trust Board approves and recommends to the Hospital Board, all recommended granting actions. The Trust provides annual monitoring of compliance with expected spending requirements and gets updates as needed. X X X X X 0 1 0 0 0 0 0 1 0 David Stevenson MD Trustee 210572 0 0 0 991 0 37814 0 22394 0 271771 0 0 0 Robert P Steigmeyer President & CEO 609550 0 235000 0 80298 0 192904 0 22596 0 1140348 0 78750 0 Scott Sloane Treasurer 246638 0 74728 0 673 0 60339 0 21189 0 403567 0 0 0 David Green MD Senior VP/Chief Medical Of 410578 0 108600 0 3019 0 70296 0 20065 0 612558 0 0 0 Timothy P Jones Senior VP/Chief Operating 384856 0 105821 0 1548 0 35623 0 21218 0 549066 0 0 0 Gerald Sardella MD Physician 596837 0 35694 0 2322 0 37949 0 25003 0 697805 0 0 0 Todd Burdette MD Physician 359868 0 153754 0 583 0 43642 0 24915 0 582762 0 0 0 Adam Chodosh MD Physician 504102 0 32815 0 756 0 39669 0 25226 0 602568 0 0 0 Shahab Moossavi MD Physician 470101 0 35145 0 488 0 38640 0 12652 0 557026 0 0 0 Michael Ferguson MD Physician 459230 0 32815 0 1123 0 21669 0 18966 0 533803 0 0 0 Part I, Line 4b Robert P. Steigmeyer, President & CEO, participated in a 457(f) plan with Concord Hospital during the fiscal year. Under the terms of the plan, after a three-year vesting period there will be a 457(f) amount included in taxable W-2 wages for Mr. Steigmeyer. The calendar year ending within the Hospital's current reporting period ending September 30, 2018 (tax year 2017) was the first year where amounts previously set aside as deferred under his 457(f) plan had vested. Accordingly, $78,750 was included in Mr. Steigmeyer's 2017 W-2 taxable wage which was previously reported on Schedule J, Part II, Column C of the Hospital's Form 990 filing for fiscal year ending September 30, 2015. In accordance with IRS instructions, this amount has been included in Schedule J, Part II, Column B(iii) and Column F. There were additional contributions to Mr. Steigmeyer's 457(f) plan for fiscal years ended September 30, 2015, 2016, 2017, and 2018 of $115,000, $120,000, $125,000, and $162,500 respectively. Each contribution plus earnings will be reported in Mr. Steigmeyer's W-2 after a three-year vesting period. The amount included in Mr. Steigmeyer's deferred compensation amounts in Schedule J, Part II, Column C include the $125,000 contribution to his 457(f) plan plus $26,044 of earnings. Part I, Line 7 Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the performance of the CEO, CFO, COO, and CMO during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the executive's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions. A NH Health & Education Facilities Authority 020279866 644614K65 2011-03-01 50095322 Facility Improvements/Renovations 0 0 0 B NH Health & Education Facilities Authority 020279866 644614Z85 2013-02-01 48631000 Facility Improvement Project & Advance Refund Series 2001 NHHEFA Bonds 0 0 0 C NH Health & Education Facilities Authority 020279866 2013-04-01 32421000 Advance Refund the Series 2004 NHHEFA Hospital Revenue Bonds 0 0 0 D NH Health & Education Facilities Authority 020279866 2017-12-01 62004272 New Construction and Renovations 0 0 0 A 50095322 544891 2012 1 0 1 1 B 48631000 561439 2014 1 0 1 1 C 31800000 32421264 64503 2013 0 1 1 1 D 62004272 670083 2020 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 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 1 Naxis Funding Corp 1.800000000000 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 02/28/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 02/06/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 04/25/2018 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 11/30/2018 Form 990, Part VI, Section A, line 6 Capital Region Health Care Corporation, a charitable corporation, acting through its board of trustees, is the sole Member of the Hospital. Form 990, Part VI, Section A, line 7a The Board of Trustees shall be composed of not less than fourteen nor more than nineteen persons excluding ex-officio Trustees, the number to be established and elected by the Member. Form 990, Part VI, Section A, line 7b The affairs of the Hospital shall be managed by the Trustees who shall have and may exercise all the powers of the Hospital except those reserved to the Member by law, the Articles of Agreement, or the Bylaws. In addition: -Any voluntary dissolution, merger or consolidation of the Hospital or the sale or transfer of all or substantially all of the Hospital's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. -Any amendment of the Hospital's Bylaws or Articles of Agreement shall be subject to approval by the Member. -Any changes in the Hospital's non-profit status shall be subject to approval by the Member. Form 990, Part VI, Section B, line 11b The 990 is reviewed in detail with the Audit Committee of the Board of Trustees. All board members receive a copy of the 990 to review prior to filing the report. Form 990, Part VI, Section B, line 12c Each Trustee, officer and committee member, upon entering the duties of his/her office and annually thereafter, will be advised of this policy and shall sign a statement acknowledging his/her understanding of and agreement to this policy. Annual reviews will adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part VI, Section B, line 15 The evaluation of the performance of the Chief Executive Officer ("CEO") of Concord Hospital and its subsidiaries (collectively the "Hospital") is an important responsibility of the Board of Trustees (the "Board") and is vital in ensuring that the Hospital meets its mission. The Board has delegated the responsibility of initiating the process of conducting the CEO's performance evaluation and initiating the process of setting the CEO's compensation to the Board's Compensation Committee. The Compensation Committee also is charged with the responsibility of reviewing the appropriateness of the compensation of the Hospital's Chief Operating Officer, Chief Financial Officer, and Chief Medical Officer as proposed by the CEO. The Compensation Committee shall present its report of the CEO's annual performance to the Board for its further input and consideration. The Compensation Committee shall also make its recommendation to the Board concerning the CEO's compensation. Finally, the Compensation Committee shall make its recommendation to the Board concerning the compensation of the COO, CFO, and CMO. The Board shall review the recommendations of the Compensation Committee as to the compensation of the Hospital's CEO, COO, CFO, and CMO and shall set their compensation as the Board deems appropriate. Although the Hospital continues to value the role of Capital Region Health Care Corporation ("CRHC") and the Hospital's participation in that organization, the Board acknowledges that it is not the responsibility of the Board to evaluate or set the compensation of the Chief Executive Officer of CRHC. Neither is it the role of the Board of Trustees of CRHC to evaluate, or set the compensation of, the Hospital's CEO. Accordingly, CRHC's Board of Trustees is not involved in evaluating or setting the compensation of the Hospital's CEO. The Board acknowledges that the Hospital's CEO may also serve as the Chief Executive Officer of CRHC and that the Hospital may charge CRHC for these services. The Board may consider the comments of the Board of Trustees of CRHC, as outlined herein, when deemed relevant in evaluating the performance of the Hospital's CEO. The Board directs that the Compensation Committee and the Board itself, in their respective undertakings of recommending and setting the compensation of the Hospital's CEO, COO, CFO, and CMO, avoid conflicts of interest and be guided by the "rebuttable presumption of reasonableness" regulations under the so-called "Excess Benefit Transaction" provisions of the Internal Revenue Code ("IRC"). The Board authorizes the Compensation Committee to use such financial and advisory (e.g., legal counsel, consultant) resources as it reasonably deems appropriate to fulfill its duties in evaluating the CEO's performance and in making its recommendations to the Board regarding compensation for the CEO, COO, CFO, and CMO. Form 990, Part VI, Section C, line 19 Yes, the organization makes all of this information available to the public. Audited financial statements and the most recent quarter ended financial statements are posted on the Hospital's web site, www.concordhospital.org. In addition to this, the Hospital sends its annual report, including a financial summary, to members of the community via the US Postal service. Governing documents and conflicts of interest filings adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part XI, line 9: Pension Actuarial Loss 7,598,647. Equity Transfer to Affiliate -923,358. Net Periodic Pension Cost -2,880,380. Form 990, Part XII, Line 2c There was no change in the process for oversight of the audit and compilation of financial statements for the fiscal year. The Board has a finance committee, which reviews the financial statements monthly. There is also an audit committee of the Board, which reviews the annual audit process and the selection of the independent accountant. The same independent firm of accountants performed the audit for the fiscal years ending 9/30/17 and 9/30/18. Form 990, Part VII: Dr. David A. Stevenson is listed in Form 990, Part VII as a voting member of the Hospital's governing body. He was also employed by the Hospital as full-time physician and received compensation and benefits related to his services to the Hospital in his capacity as a physician. None of his compensation and benefits reflects remuneration in his capacity as a board member of the Hospital. In accordance with IRS instructions, he has not been listed as an independent board member in Form 990, Part VI, Line 1b. Form 990, Part IX, Column D: Although the Hospital is reporting contribution income on Form 990, Part VIII, Line 1 it is not reporting any fundraising expenses on Form 990, Part IX, Line 25, Column D. All philanthropic activity is conducted by the Hospital's affiliate, Concord Hospital Trust. All contribution revenue is first received by the Trust which is then granted to the Hospital. All fundraising expenses related to this solicitation of contribution revenue is reported on Concord Hospital Trust's Form 990, Part IX, Column D. Capital Region Health Care Corporation 250 Pleasant Street Concord NH 03301 020222123 Promote comprehensive health service system NH 501(c)(3) Line 12a, I N/A 0 Capital Region Health Ventures Corp 250 Pleasant Street Concord NH 03301 020438264 Provide medical care to community NH 501(c)(3) Line 12b, II Concord Hospital 1 Capital Region Health Care Development Corporation 250 Pleasant Street Concord NH 03301 020429749 Support Concord Hospital & other affiliates NH 501(c)(2) Concord Hospital 1 Concord Regional Visiting Nurse Association Inc PO Box 1797 Concord NH 033021797 020222122 Home health care & hospice services NH 501(c)(3) Line 10 Capital Region Health Care Corp 0 Riverbend Community Mental Health Inc 3-5 North State Street Concord NH 033022032 020264383 Multi-service team NH 501(c)(3) Line 7 N/A 0 Concord Hospital Trust 250 Pleasant Street Concord NH 03301 260378710 Fundraising NH 501(c)(3) Line 12a, I Concord Hospital 1 Concord Imaging Center LLC 2 1/2 Beacon Street Concord NH 03301 020436605 Provide radiology services to community NH N/A Capital Orthopedic Surgery Center 250 Pleasant Street Concord NH 03301 020522860 Provide medical care to community NH N/A Concord Endoscopy Center LLC 60 Commerical Street Concord NH 03301 201184756 Provide medical care to community NH N/A Concord Elliot ACO LLC 1 Elliot Way Manchester NH 03103 454803675 Accountable Care Org NH Elliot Hospital of the City of Manchester Related 0 1 0.16670 Concord Ambulatory Surgery Center LLC 60 Commerical Street Concord NH 03301 201184704 Provide medical care to community NH N/A Capital Region Health Services Corporation 250 Pleasant Street Concord NH 03301 020428631 Medical services NH N/A C 0 Capital Region Primary Care Corporation 250 Pleasant Street Concord NH 03301 020495275 Inactive NH Concord Hospital C 1.00000 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 Capital Region Health Care Development Corp A 1441708 Actual per books Capital Region Health Care Ventures Corp C 4201287 Actual per books Capital Region Health Care Development Corp J 3162824 Actual per books Capital Region Health Care Development Corp O 545016 Actual per books Capital Region Health Care Ventures Corp O 225485 Actual per books Concord Hospital Trust O 625074 Actual per books Capital Region Health Care Ventures Corp Q 898118 Actual per books Concord Hospital Trust Q 1080187 Actual per books Schedule R, Part III: In accordance with IRS instructions, the partnerships listed in Part III are being reported due to their control relationship with Capital Region Health Ventures Corp and the Hospital's control relationship with Capital Region Health Ventures Corp. During the 2017 tax year, the hospital system invested in Granite Healthcare Asset Holding Company, LLC, a joint venture with several hospital facilities. The Hospital's investment in this entity does not otherwise meet the disclosure requirements for Schedule R, Part III. During the 2017 tax period, Concord Ambulatory Surgery Center, LLC became a single member LLC of Capital Region Health Ventures Corp.