2018-08-14T10:19:26-05:00 2017-09-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2016-10-01 222674014 Exeter Hospital Inc EXET 6035806695 5 Alumni Drive Exeter NH 03833 KEVIN J O'LEARY CFO/Treasurer 6035806695 2018-08-08 1 Timothy R Hepburn P00182393 8002447444 2018-08-08 2016 2022-09-23 18:48:47Z Kevin J Callahan 5 Alumni Drive Exeter NH 03833 271097838 0 X www.exeterhospital.com X 1907 NH The mission of Exeter Hospital is to improve the health of the community. This mission will be principally accomplished without compromising Exeter Hospital's own sustainability through the provision of health services and information to the community in collaboration with Exeter Health Resources' other affiliates which share this mission. 13 11 1644 110 10352 7937 116885 199723 231800530 241741049 4461681 11880423 3518 19999 236382614 253841194 706135 933417 0 0 93803094 101882996 0 0 0 109933868 114701262 204443097 217517675 31939517 36323519 274105488 284364235 112078919 100299810 162026569 184064425 X The mission of Exeter Hospital is to improve the health of the community. This mission will be principally accomplished without compromising Exeter Hospital's own sustainability through the provision of health services and information to the community in collaboration with Exeter Health Resources' other affiliates which share this mission. Exeter Hospital works to accomplish this mission through the provision of comprehensive medical and surgical health care services including, but not limited to breast health, maternal/infant and reproductive medicine, cardiovascular, gastroenterology, sleep medicine, occupational and employee health, oncology, orthopedics and emergency care services. 0 0 198018657 933417 241794734 In Fiscal Year 2017, Exeter Hospital served the community by providing care to 5,313 acute inpatients, 166,703 outpatient visits, 29,784 emergency room visits and 631 births. In 2017, Exeter Hospital supported its mission by supporting $7,635,189 in community outreach, benefits and financial assistance to the community excluding $33,056,102 in uncovered Medicare and Medicaid expenses. Exeter Hospital supports health care access in its service area by offering a robust financial assistance program that covers the cost of up to 100% of care provided to area residents based on income and family size. In 2017, the charity care program helped people access the health system as Exeter Hospital incurred a cost of $993,124 to provide financial assistance. In addition we provide support to vital community programs like our Healthreach Diabetes and Paramedicine programs and for providing access to contracted mental health professionals in our emergency room. We also supported access to the health system and the development of healthy life styles through our community education programs and our financial support of important healthcare related community based not for profits such as Lamprey Healthcare and Families First. Exeter Hospital's acute care program provides acute inpatient and outpatient observation level care in our 99 staffed inpatient beds. Our inpatient services treat emergent, acute, elective surgical and palliative care patients. Approximately 75% of our admissions come from the emergency room. We offer inpatient acute services for medical and surgical diagnoses for adults as well as pediatric and obstetrical inpatient services. Exeter Hospital is fully accredited by DNV Healthcare, Inc. (an officially deemed Medicare and Medicaid Credentialing agency), earned the Magnet designation from the American Nurses Credentialing Center, which is the most prestigious distinction a healthcare organization can receive for nursing excellence and high quality patient care as well as many other service level specific national accreditations. Our practice model is guided by a series of collaborative Best Practice Committees that engage nurses and physicians in the development of the best possible evidence based care protocols. Exeter Hospital supports the safety of our patients and the efficiency of the care provided through the deployment of a 24/7 Hospitalist program that manages the majority of the medical needs of our patients during their admission. In our 10 bed ICU we also use an intensivest service to ensure that our most acute patients receive the most highly coordinated care possible, resulting in significantly lower than expected infection rates, ICU readmission rates and shorter ICU stays. For our patients at the end of their lives we ensure their safety and comfort through a physician led, highly coordinated palliative care program. Exeter Hospital's Surgical program provides a full range of both inpatient and outpatient surgical services for patients of all ages from across our service area. Available surgical specialties include; orthopedics, general, ENT, gynecological, urological, plastics, ophthalmologic and vascular. The Center for Cancer Care at Exeter Hospital provides cancer patients and their families with comprehensive inpatient and outpatient services. Accredited by the American College of Surgeon's Commission on Cancer with commendation, the Center provides area residents with a leading, comprehensive approach to cancer treatment. The Center offers medical oncology, radiation oncology, surgery, clinical trials, multidisciplinary clinics and integrative oncology services. The Center is proud to have a relationship with the Massachusetts General Physician Organization for the provision of medical and radiation oncology services to patients. The medical oncology service supports a 13 chair infusion center. This unique clinical collaboration brings radiation oncologists from the world's leading academic medical center to Exeter Hospital's Center for Cancer Care. This affiliation allows Exeter Hospital's Center for Cancer Care to offer state-of-the-art radiation therapy services to patients including: Intraoperative Radiation Therapy (IORT), CT Simulation, Partial Breast Irradiation, Image Guided Radiation Therapy, Intensity Modulated Radiation Therapy and Linear Accelerator delivered treatments. The Center's affiliated surgeons work collaboratively with affiliated pathologists, the medical oncologists and with the radiation oncologists to develop the most comprehensive treatment plans for our patients.Exeter Hospital's Cardiology Department offers acute cardiac care, heart catheterization, angioplasty, angiography, implanted cardioverter defibrillators, permanent pacemaker placement and a three phase cardiac rehabilitation program. Exeter Hospital's affiliated fellowship-trained interventional cardiologists and its cardiac team have received international recognitions for their ongoing successful use of emergency angioplasty and interventional cardiology procedures. 198018657 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 1 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 140 0 1 1644 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X Kevin J O'Leary 6035806695 5 Alumni Drive Exeter NH 03833 Amy Case Trustee 1.00 1.00 X 0 0 0 Susan Y Desjardins Trustee 1.00 1.00 X 0 0 0 David Donsker MD Trustee 1.00 1.00 X 0 0 0 Suzanne Foster Trustee (as of April 2017) 1.00 1.00 X 0 0 0 Ross Gittell PhD Trustee 1.00 1.00 X 0 0 0 Steve Hermans Trustee 1.00 1.00 X 0 0 0 Richard Hollister MD Ex-Officio Member 1.00 41.00 X 0 467163 28303 Katie Delahaye Paine Trustee 1.00 1.00 X 0 0 0 Major General Joseph Simeone Trustee 1.00 1.00 X 0 0 0 Sally Ward Trustee (as of April 2017) 1.00 1.00 X 0 0 0 William Schleyer Chair (as of April 2017)/Vice Chair (end Mar 2017) 1.00 1.00 X X 0 0 0 Glenn McKenzie Chairman (end March 2017) 1.00 1.00 X X 0 0 0 Robert Schoenberger Vice Chairman (as of APril 2017) 1.00 1.00 X X 0 0 0 Kevin J Callahan CEO/Trustee 2.00 43.00 X X 0 2348957 192874 Kevin J O'Leary CFO/Treasurer 2.00 43.00 X 0 514025 93114 Constance D Sprauer Sr. VP Legal Affairs/Secretary 2.00 41.00 X 0 329420 32993 Brian Campbell VP Ambulatory Care 40.00 0.00 X 298117 0 39452 Donna McKinney VP Acute Care 40.00 0.00 X 293791 0 37960 Jonathan Jackson Physicist 40.00 0.00 X 249335 0 30903 Jane Peterson Director 40.00 0.00 X 194433 0 12022 Susan Callahan Director 40.00 0.00 X 186538 0 19851 Joan Raczy Pharmacist 40.00 0.00 X 183977 0 35021 Deanna King Director 40.00 0.00 X 182199 0 35359 1588390 3659565 557852 77 0 1 0 Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 Administrative Management Fees 7043819 Core Physician Services LLC 5 Alumni Drive Exeter NH 03833 Physician Services 5494651 ASHA LLC PO Box 945 Traverse City MI 49685 Temporary Labor 2133048 Mass General Physician Organization PO Box 3662 Boston MA 022413864 Physician Services 1883534 GE Healthcare Inc PO Box 96483 Chicago IL 60693 Equipment Maintenance 1411137 54 55287 144436 9748 199723 Net Patient Services 621300 232183240 232183240 Disproportionate Share Funding 621300 6461110 6461110 Cafeteria 722210 1499225 1499225 Other Programs 621300 1264931 1264931 Gift Shop 453220 121708 121708 210835 210835 241741049 1610851 10352 1600499 75671 21986 53685 53685 53685 27434291 32603 17197322 0 10236969 32603 10269572 10269572 3650 55287 37336 -33686 -33686 253841194 241794734 10352 11836385 X 876031 876031 57386 57386 669320 597489 71831 76723805 68489823 8233982 3060707 2732233 328474 15915262 14207240 1708022 5513902 4922151 591751 140339 140339 66000 66000 22902996 20445050 2457946 560682 500510 60172 847613 756647 90966 340634 304077 36557 6077161 5424961 652200 269542 240615 28927 938331 837630 100701 10942861 9768476 1174385 1135824 1013928 121896 Supplies 21459043 19156063 2302980 Drugs 18418660 18418660 Medicaid Enhancement Ta 11570541 11570541 Bad Debt Expense 6620562 6620562 12410473 11078584 1331889 217517675 198018657 19499018 0 27946727 37984098 32067171 17256883 18947421 19106438 3143804 3663197 4522461 4379763 134673483 78218125 58398227 56455358 54535778 53046458 68298364 85604290 6245535 6867750 274105488 284364235 18597403 17450903 56108478 52689148 37373038 30159759 112078919 100299810 X 144999059 166992668 258189 302436 16769321 16769321 162026569 184064425 274105488 284364235 X 36323519 1648103 -15933766 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21979 21979 0 Part II-B, Line 1: Association Dues Allocated to Lobbying: A portion of annual membership dues paid to the American Hospital Association and the New Hampshire Hospital Association are considered lobbying expenses. For fiscal year ending September 30, 2017, the amounts deemed for lobbying were $6,334 and $15,645, respectively. 17027510 154049 109802 17071757 16993856 107531 73877 17027510 17004799 69258 80201 16993856 17006133 53100 54434 17004799 17008827 41887 44581 17006133 0.01770 0.98230 0.00000 0 1 1 142400 142400 75023983 46115144 28908839 394212 186909 207303 54693412 30088428 24604984 4419476 1827644 2591832 56455358 Limited Partnerships 61749985 F Alternative Investments 23854305 F 85604290 Due to Third Party Payors 4510264 Accrued Pension Liability 14575741 Swap Valuation Liability 6504280 Reserve for Professional Liability Claims 4569474 30159759 X 257995010 1648103 2557504 4205607 253789403 51791 51791 253841194 217575686 109802 109802 217465884 51791 51791 217517675 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. The quasi-endowments are funds which have been donated to the organization for a purpose specified by the donor. These funds are held until used for the purpose intended by the donor. Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code, and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the tax positions of the Hospital and has concluded that it has maintained its tax-exempt status, does not have any significant unrelated business income, and has taken no uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: Impact of Interest Rate Swaps 2,403,455. Net Assets Released from Restricted Gifts 154,049. Part XI, Line 4b - Other Adjustments: Income Included in Expenses on Audited Financial Statements 51,791. Part XII, Line 2d - Other Adjustments: Net Assets Released from Restricted Gifts 109,802. Part XII, Line 4b - Other Adjustments: Income Included in Expenses on Audited Financial Statements 51,791. 1 Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments in funds domiciled in the region 21682452 Sub-Saharan Africa - Angola, Benin, Botswana, Burkina Faso, 0 0 Grants to recipients located in region Contribution of medical equipment and supplies to hospitals and clinics who serve the needy in countries outside the United States 57386 0 0 0 0 0 0 21739838 0 21739838 Sub-Saharan Africa - Angola, Benin, Botswana, Burkina Faso, 0 57386 Contribution of medical equipment and supplies to hospitals and clinics who serve the needy in countries outside the United States Book Value 1 0 0 0 0 0 0 0 Part I, Line 2: All requests for grants/contributions/sponsorships over $5,000 require the approval of at least the Vice President of Strategy, Community Relations and Development to ensure that they are consistent with our mission, values and strategic plan. 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. That subcommittee and the larger Exeter Health Resources, Inc.'s (parent company) Board of Trustees are regularly updated on our community support initiatives. The only grantee reported on Schedule F is a 501(c)(3) domestic organization located in Massachusetts that provides medical equipment and supplies to needy foreign hospitals and clinics. Schedule F, Part I, 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. Caring Hands 19900 16250 3650 3905 2710 5277 200 2363 Kites Cancer 26629 26629 14714 1 12408 12408 8167 58937 55287 3650 3905 2710 5277 200 25244 37336 -33686 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 the respective events. However, when the charitable contributions are considered and added back, these three events had a positive net revenue of $21,601. 1 1 1 X 320.000000000000 0 1 1 0 1 1 978 993124 993124 0.00470 4910 22269679 6461110 15808569 0.07500 5888 23262803 6461110 16801693 0.07970 15286 949906 32979 916927 0.00430 125 848728 1041 847687 0.00400 1936 3722561 402212 3320349 0.01570 782 389206 14766 374440 0.00180 931518 931518 0.00440 18129 6841919 450998 6390921 0.03020 24017 30104722 6912108 23192614 0.10990 85937 85937 0.00040 165207 165207 0.00080 251144 251144 0.00120 0 2674423 2170722 73920615 96277579 -22356964 X 1 1 1 1 Exeter Hospital Inc 5 Alumni Drive Exeter NH 03833 www.exeterhospital.com 1761 X X X Exeter Hospital Inc 1 0 0 1 X X X X X X X X 15 1 0 1 1 X See Schedule H, Part V, Section C X 1 15 1 See Schedule H, Part V, Section C 0 1 X 320.000000000000 X X X X 1 1 X X X X 1 X See Schedule H, Part V, Section C X See Schedule H, Part V, Section C X See Part V, Section C 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: Every three years, Exeter Hospital, in collaboration with its community partners, conducts a community needs assessment to identify, prioritize, and develop a plan to address critical health issues. The last community needs assessment was completed in FYE 2016. The purpose of the assessment was to engage community members through key leader interviews and Community Forums, and to achieve the following objectives:1) Educate and inform key leaders and Community Forum participants of the results of the FYE 2013 Community Needs Assessment and achievements to date to meet identified needs.2) Validate Priority Health Needs identified in the FYE 2013 Community Needs Assessment and further define these needs in FYE 2016 from the stakeholders' perspective.3) Identify unmet needs that have emerged since the FYE 2013 Community Needs Assessment.4) Engage key leaders and Community Forum participants in a discussion to identify solutions to address community health needs.5) Share the findings of the UNH Survey Center Household Telephone Survey.6) Where appropriate, motivate key leaders and Community Forum participants to participate in efforts to address community health needs going forward.7) Serve as a continuing foundation for the development of a Community Benefits Plan, as mandated under RSA 7:32-e.The FYE 2016 Community Needs Assessment included telephone surveys, open community forums, online surveys, key leader interviews, outreach to support agencies and the review of relevant secondary data sources. Information was solicited from a broad cross-section of the hospital's service area and included government welfare, public health, transportation, police, education and emergency preparedness officials, as well as outreach agencies that serve military & veterans, children & families, youth, elderly and the low-income. Legislators were invited to attend community forums. Providers of medical care to low-income minority population and mental health services were included. Exeter Hospital, Inc. Part V, Section B, Line 6b: Representatives from the following organizations collaborated on the hospital's community needs assessment: Exeter Area YMCA, Easter Seals NH, Lamprey Health Care, Families First Health and Support Center, Richie-McFarland Children's Center, Seacoast Mental Health Center, United Way of the Greater Seacoast as well as affiliates Core Physicians and Rockingham VNA & Hospice. Exeter Hospital, Inc. Part V, Section B, Line 11: The needs identified in the FYE 2016 Community Health Needs Assessment are:Access to care due to insurance coverage cost barriers, Substance Abuse and Addiction, Mental Health Services, Youth Suicide/Substance and Prescription drug abuse, Transportation, Affordable Housing/Homelessness and Elder Care and Support Services. The community benefit spending in FYE 2017 directly related to the FYE 2016 identified needs which were: Access to care due to insurance coverage cost barriers, Substance Abuse and Addiction, Mental Health Services, Youth Suicide/Substance and Prescription drug abuse, Transportation, Affordable Housing/Homelessness and Elder Care and Support Services. Exeter Hospital addressed these needs by promoting community health and access to primary care by providing: 1) Charity care of $993,124 (calculated at cost) during fiscal year 2017 which served 978 people.2) Financial assistance through its health care access program which has three components: a) 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. b) The Financial Assistance Program (FAP) is a community-based program available to uninsured and under-insured patients who meet income and asset guidelines, and who live in our service area. To qualify, patients must first have applied for all other sources of coverage, including the Healthcare Exchange and the New Hampshire Health Protection Program. c) Exeter's Catastrophic Care Program provides financial relief for those patients who do not qualify for our Financial Assistance Program, but who are faced with a substantial debt due to a serious illness or injury. This program is calculated based on a percentage of the patient's gross income.3) Telehealth Services which provided $338,009 in telehealth monitoring services serving 10,226 persons in fiscal year 2017.4) Transportation which is an important health care support service provided by the Hospital in response to an identified community need. Each year the program enhances access for hundreds of patients who otherwise would not be able to obtain needed health care and health related support services. During fiscal year 2017 Exeter Hospital provided 241 transports at a cost of $26,522.5) Support for Youth Suicide/Substance and Prescription Drug Abuse prevention and education services by: a) The Hospital making financial contributions to Haven of New Hampshire in fiscal year 2017 of $40,000 specifically designated to support their efforts in addressing public health through violence prevention and improving the well-being of children and families. b) The Hospital providing support in the amount of $17,000 to Connor's Climb Foundation which is dedicated to preventing youth suicide. All of the funds raised directly impact programs for suicide awareness, education and prevention in the New Hampshire community.6) Community Education Programs offered by the Hospital that provided community education services at an expense of $383,077 serving 2,727 persons in fiscal year 2017.7) Cancer Wellness and Diabetes Support Programs offered by the Hospital served 704 people by providing cancer and diabetes programs at an expense of $1,110,161 in fiscal year 2017.8) Participation in research studies by the "The Center for Cancer Care" at Exeter Hospital through several national research groups sponsored by the National Cancer Institute. This enables the Center to offer clinical trials to patients undergoing treatment at the Hospital that allows patients to voluntarily take part in leading edge research that does not necessitate travel outside of the Seacoast area. During fiscal year 2017, the Hospital provided $374,440 for clinical trials and research that served 782 patients. Exeter Hospital, Inc. Part V, Section B, Line 16j: The financial assistance policy (FAP), financial assistance application and plain language summary can be found on our website, and are advertised and paper copies are available to patients. Semi-annually, we publish an ad in the local paper which outlines our financial assistance program. Within our phone system, we have a recording which outlines the financial assistance program when patients, family members etc. are on hold during a call to Exeter Hospital. We present each patient with a copy of the Plain Language Summary at Registration. Currently we have a financial counselor located in the checkout area in our Emergency Department and an Inpatient Financial Counselor to visit inpatients who are uninsured, to inform them of our program and or if they request more information about needing assistance to pay for services. Signage in public locations notifies patients about our Financial Assistance Program. We have also collaborated with our community partners to have this information publically available and accessible at their locations to reach members of our community who are most likely to need financial assistance. Exeter Hospital, Inc. Part V, Section B, Line 20e: During fiscal year 2017, we notified Emergency Department patients during discharge about our financial assistance program. Upon admission, we visit all self pay and any other patient who wishes to discuss their coverage and or balances due and inform them of our program. The Plain Language Summary is presented during registration of all patients. This information regarding the financial assistance program is on each patient billing statement as well as available on our website. Schedule H, Part V, Section B, Line 7a: The Hospital's FYE 2016 CHNA is available at: https://www.exeterhospital.com/getmedia/26f68ce4-0cd6-447f-a137-e839dd5dcc4c/2016-Community-Health-Needs.pdf.aspx Schedule H, Part V, Section B, Line 10a: The Hospital's FYE 2016 Implementation Strategy is available at: https://www.exeterhospital.com/getmedia/da22bb1b-97ec-48b2-96a6-02b9f9219607/Exeter-Hospital-Community-Health-Needs-Assessment-Implementation-Plan.pdf.aspx Schedule H, Part V, Section B, Line 16a-c: The Hospital's Financial Assistance Policy is available at:https://www.exeterhospital.com/getmedia/9b45d4eb-d6bd-4155-9712-7718a510b5f2/LD326-04-2018.pdf.aspxThe Hospital's Financial Assistance Application is available at:https://www.exeterhospital.com/getmedia/55329600-c7fd-45fd-8e56-3dc1b5abe0ea/1639-Fin-Assist-App-03-2018_4.pdf.aspxThe Hospital's Plain Language Summary is available at:https://www.exeterhospital.com/getmedia/6476920e-bac4-4370-bddc-57641c722915/1641-Fin-Assist-Summary-04-2018.pdf.aspx 15 1 - Center for Orthopaedics and Movement 7 Alumni Drive Exeter NH 03833 Rehabilitation Services, Cardiac Rehabilitation, Massage 2 - Centers for Sleep & Wound Healing 4 Alumni Drive Exeter NH 03833 Sleep Lab, Wound Care, Drivability 3 - Epping Regional Health Center 212 Calef Highway Epping NH 03042 Pediatric and Adult Rehabilitation Services, Radiology, Mammmography 4 - Center for Reproductive Care 118 Portsmouth Avenue Stratham NH 03885 Reproductive Services 5 - Diagnostic Imaging & Physical Therapy 24 Plaistow Road Plaistow NH 03865 Physical Therapy, Radiology 6 - Ctr for Occupational & Employee Health 6 Hampton Road Exeter NH 03833 Occupational Health 7 - Kingston Athleticare 53 Church Street Kingston NH 03848 Physical Therapy 8 - Orthopaedic & Sports Physical Therapy 311 Winnacunnet Road Hampton NH 03842 Physical Therapy and Athletic Performance Center 9 - Exeter Diagnostic Serv at Hampton 879 Lafayette Road Hampton NH 03842 Radiology, Mammography 10 - Rehab & Diagnostic Serv of Exeter Hosp 128 Route 27 Raymond NH 03077 Physical and Occupational Therapy, Radiology, Mammography 11 - Rehab & Diagnostic Serv at Lamprey 207 South Main Street Newmarket NH 03857 Physical and Occupational Therapy, Radiology, Mammography 12 - Diagnostic Imaging - Saltonstall 9 Buzzell Avenue Exeter NH 03833 Radiology 13 - Physical Therapy at Portsmouth 95 Brewery Lane Portsmouth NH 03801 Physical Therapy 14 - HealthReach Diabetes Nutrition & Educ 881 Lafayette Road Hampton NH 03842 Diabetes and Nutrition 15 - Sports and Physical Therapy Practice 40 Industrial Drive 1 Exeter NH 03833 Athletic Performance Center Part I, Line 3c: All eligible financial assistance recipients receive 100% free care. Patients who do not qualify for financial assistance and are uninsured receive a discount that is equal to AGB = 42% (amounts generally billed) using the lookback method.There are several factors regarding eligibility for Financial Assistance. The applicant must reside in our service area, a geographic location consisting of approximately 40 surrounding towns, listed on our website, Financial Assistance policy and Plain Language Summary. The other factor is combined income and assets (as defined in our Financial Assistance policy) are compared to the FPG. Part I, Line 7: A ratio of patient cost to charge was calculated utilizing Worksheet 2. The ratio of cost to charge was utilized in calculating line 7a total net community benefit expense for charity care. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 6,620,562. Part II, Community Building Activities: The majority of the remaining community benefit activities reported as community building activities are cash donations to community organizations for the purpose of furthering community support and advocacy for community health improvement. Part III, Line 2: The amount reported represents total bad debt expense as reported on the audited financial statement of $8,000,070 x 33.43% (ratio of patient cost to charge) to equal $2,674,423. This amount does not include any estimated provisions which are in bad debt expense reported on the audited financial statements. Part III, Line 3: The amount reported represents $6,493,336 of charges included in total bad debt write offs for patient eligible for financial assistance x 33.43% (ratio of patient cost to charge) to equal $2,170,722. Part III, Line 4: Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which accounts for patients who are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.The Hospital's allowance for doubtful accounts for self-pay patients decreased from 120% of self-pay accounts receivable at September 30, 2016 to 101% of self-pay accounts receivable at September 30, 2017. The Hospital's self-pay bad debt write-offs decreased approximately $1,319,000 from $4,905,000 in 2016 to $3,586,000 in 2017. The net change in the allowance as a percentage of self-pay accounts receivable and bad debt write-offs was a result of collection trends and a shift in payor mix, resulting from the Medicaid expansion and health insurance exchange. Part III, Line 8: Medicare costs are not counted as a Community Benefit per New Hampshire or IRS guidance, therefore the cost figure of $22,356,964 is not included in the Total Unreimbursed Community Benefit Expense. The ratio of cost to charge was utilized in calculating the amount. Part III, Line 9b: If an account is sent to a collection agency and the patient applies for financial assistance within 240 days from first bill, the account will be placed on hold with the agency through the consideration process. If the patient is approved for financial assistance, the account will be retracted from the collection agency and financial assistance will be applied to the accounts. Exeter Hospital only contracts with collection agencies that follow Fair Debt Collection Practices and do not engage in Extraordinary Collection Activities.The Bad Debt/Collection Policy can be located online at:https://www.exeterhospital.com/getmedia/dea9264c-9d03-4f28-803f-0bbc4b103f1b/LD327-09-2016.pdf.aspx Part VI, Line 2: Every three years, Exeter Hospital, in collaboration with its community partners, conducts a community needs assessment to identify, prioritize, and develop a plan to address critical health issues. The last community needs assessment was completed in FYE 2016. The purpose of the assessment was to engage community members through key leader interviews and Community Forums, and to achieve the following objectives:1) Educate and inform key leaders and Community Forum participants of the results of the FYE 2013 Community Needs Assessment and achievements to date to meet identified needs.2) Validate Priority Health Needs identified in the FYE 2013 Community Needs Assessment and further define these needs in FYE 2016 from the stakeholders' perspective.3) Identify unmet needs that have emerged since the FYE 2013 Community Needs Assessment.4) Engage key leaders and Community Forum participants in a discussion to identify solutions to address community health needs.5) Share the findings of the UNH Survey Center Household Telephone Survey.6) Where appropriate, motivate key leaders and Community Forum participants to participate in efforts to address community health needs going forward.7) Serve as a continuing foundation for the development of a Community Benefits Plan, as mandated under RSA 7:32-e.The FYE 2016 Community Needs Assessment included telephone surveys, open community forums, online surveys, key leader interviews, outreach to support agencies and the review of relevant secondary data sources. Information was solicited from a broad cross-section of the hospital's service area and included government welfare, public health, transportation, police, education and emergency preparedness officials, as well as outreach agencies that serve military & veterans, children & families, youth, elderly and the low-income. Legislators were invited to attend community forums. Providers of medical care to low-income minority population and mental health services were included.The report in its entirety can be accessed on the Exeter Hospital website:https://www.exeterhospital.com/getmedia/ab627f1a-3ed4-4290-a7e7-a2256955e010/1-EH-2017-Community-Health-Needs-(2).pdf.aspx Part VI, Line 3: Exeter Hospital provides its patients with information regarding the organization's financial assistance program, and a summary of the organization's policy at the time of registration, on the back of every billing statement, and when phone contact is made when there is a balance on the account. On the Exeter Hospital website (http://www. exeterhospital.com), patients and the general public can find information on the organization's financial assistance programs; financial assistance, uninsured care discount program, catastrophic care program; and state-wide programs. As an additional measure to ensure our community members are aware of Exeter Hospital's financial assistance programs, twice a year the organization may run advertisements in community newspapers summarizing the organization's financial assistance/charity care policy. Exeter Hospital employs financial counselors specifically dedicated to assisting patients with questions regarding their eligibility for financial assistance, and assisting patients through the qualification process as applicable. All inpatient self-pay patients are provided information and counseling regarding the eligibility for financial assistance programs at the time of service. Self-pay and underinsured patients in the Emergency Department, Surgical areas and Oncology are also informed of the hospital's financial assistance programs at time of service or discharge. Part VI, Line 4: Exeter Hospital services an area that encompasses 40 communities with an estimated population of 237,228. Part VI, Line 5: Exeter Hospital addressed these needs by promoting community health and access to primary care by providing: 1) Charity care of $ 993,124 (calculated at cost) during fiscal year 2017 which served 978 people.2) Financial assistance through its health care access program which has three components: a) 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. b) The Financial Assistance Program is a community-based program available to uninsured and under-insured patients who meet income and asset guidelines, and who live in our service area. To qualify, patients must first have applied for all other sources of coverage, including the Healthcare Exchange and the New Hampshire Health Protection Program.c) Exeter's Catastrophic Care Program provides financial relief for those patients who do not qualify for our Financial Assistance Program, but who are faced with a substantial debt due to a serious illness or injury. This program is calculated based on a percentage of the patient's gross income.3) Telehealth Services which provided $338,009 in telehealth monitoring services serving 10,226 persons in fiscal year 2017.4) Transportation which is an important health care support service provided by the Hospital in response to an identified community need. Each year the program enhances access for hundreds of patients who otherwise would not be able to obtain needed health care and health related support services. During fiscal year 2017 Exeter Hospital provided 241 transports at a cost of $26,522.5)Support for Youth Suicide/Substance and Prescription Drug Abuse prevention and education services by: a) The Hospital making financial contributions to Haven of New Hampshire in fiscal year 2017 of $40,000 specifically designated to support their efforts in addressing public health through violence prevention and improving the well-being of children and families. b) The Hospital providing support in the amount of $17,000 to Connor's Climb Foundation which is dedicated to preventing youth suicide. All of the funds raised directly impact programs for suicide awareness, education and prevention in the New Hampshire community.6) Community Education Programs offered by the Hospital that provided community education services at an expense of $383,077 serving 2,727 persons in fiscal year 2017.7)Cancer Wellness and Diabetes Support Programs offered by the Hospital served 704 people by providing cancer and diabetes programs at an expense of $1,110,161 in fiscal year 2017.8) Participation in research studies by the "The Center for Cancer Care" at Exeter Hospital through several national research groups sponsored by the National Cancer Institute. This enables the Center to offer clinical trials to patients undergoing treatment at the Hospital that allows patients to voluntarily take part in leading edge research that does not necessitate travel outside of the Seacoast area. During fiscal year 2017, the Hospital provided $374,440 for clinical trials and research that served 782 patients. Part VI, Line 6: Exeter Hospital, Inc. is one of three affiliates of Exeter Health Resources, Inc. Each of the affiliated companies are committed to providing health care services that are innovative, progressive and focused on quality and the well-being of patients. The mission of Exeter Health Resources, Inc. and its affiliates is to improve the health of the community. This mission will be principally accomplished without compromising Exeter Health Resources, Inc.'s sustainability by supporting the provision of health services and information to the community by the affiliated companies of Exeter Health Resources, Inc. During fiscal year 2017, Exeter Hospital, Core Physicians and Rockingham VNA & Hospice have continued the pursuit of this mission providing $67,312,514 in charity care and other community benefit programs and services to communities in the areas served. 1) Exeter Hospital is a 100-bed community-based hospital serving New Hampshire's Seacoast Region. The Hospital's scope of care includes comprehensive medical and surgical health care services including but not limited to breast health, maternal/child and reproductive medicine, cardiovascular, gastroenterology, sleep medicine, occupational and employee health, oncology, orthopedics, and emergency care services. Exeter Hospital is accredited by the DNV Healthcare, Inc. and is a Magnet-recognized hospital. Magnet designation from the American Nurses Credentialing Center is the most prestigious distinction a health care organization can receive for nursing excellence and high quality patient care.2) Core Physicians is a community-based, multi-specialty group practice affiliated with Exeter Health Resources, Inc. that provides comprehensive primary, specialty and pediatric dental care throughout the greater Seacoast region. Over 160 providers in 15 locations pursue exceptional patient satisfaction through clinical competence and professional office administration.3) Rockingham Visiting Nurse Association & Hospice is a community-based home health and hospice agency providing individuals and families with the highest quality home care, hospice and community outreach programs within Rockingham County and the surrounding towns of Barrington, Lee, Dover and Durham. Exeter Hospital works collaboratively with local non-profit agencies and organizations which strive to improve the health of the community. These relationships include:1) Lamprey Health Care: In fiscal year 2017, the Hospital continued its financial support with a community benefit grant in the amount of $380,500. Lamprey Health Care provides high quality primary medical care and health related services, with an emphasis on prevention and lifestyle management, to all individuals regardless of ability to pay. As New Hampshire's oldest community health care center it provides services at three centers located in Newmarket, Raymond, and Nashua. 2) Families First Health and Support Center: In fiscal year 2017, the Hospital made financial contributions in the amount of $51,000. Families First is a community health center offering a wide variety of health services and programs including primary care, prenatal care, dental care, and mobile health care for the homeless.3) Seacoast Mental Health Center: The Hospital partners with Seacoast Mental Health Center to offer mental health services to patients and their caregivers in the Emergency Department and The Center for Cancer Care. In fiscal year 2017, Exeter helped to underwrite mental health services in the amount of $463,482 serving 541 people. 4) New Heights: In fiscal year 2017, the Hospital continued its support with contributions in the amount of $50,000. New Heights is an experiential learning organization for youth in grades 5-12 and focuses on the development and leadership of exciting, high quality summer and year-round programs designed to open young minds to new possibilities. Programs include adventure, arts & culture, STEM and team building activities.5) Haven of New Hampshire: The Hospital made financial contributions of $40,000 specifically designated to support their efforts in addressing public health through violence prevention and improving the well-being of children and families.6) Connors Climb: In fiscal year 2017, the Hospital provided support in the amount of $17,000 to The Connor's Climb Foundation which is dedicated to preventing youth suicide. The nonprofit raises funds locally to support suicide prevention and education programs in New Hampshire. All of the funds raised directly impact programs for suicide awareness, education and prevention in the New Hampshire Community. Part VI, Line 7, Reports Filed With States NH 1 Arts in Reach - Encouraging Growth Through the Arts PO Box 236 Portsmouth NH 03802 020507428 501(c)(3) 17500 Support organization's mission to provide support/service to disadvantaged teen-age girls Big Brothers Big Sisters of New Hampshire 25 Lowell Street Manchester NH 03101 020348477 501(c)(3) 12500 Support organization's mission to provide programs and services that promote positive change in children identified as being at risk Carriage Barn Equestrian Center Therapeutic Riding Program Inc PO Box 247 East Kingston NH 03827 050526877 501(c)(3) 25000 Support programs that seek to promote the health and well-being of disabled individuals of all ages Community Colleges of New Hampshire Foundation 26 College Drive Concord NH 03301 020516490 501(c)(3) 10000 Contribution to Great Bay Community College's Distinguished Leaders Fund Connors Climb Foundation PO Box 283 Exeter NH 03833 473553455 501(c)(3) 17000 Grant for suicide awareness and prevention Cooperative Alliance for Seacoast Transportation 42 Sumner Drive Dover NH 03820 020362579 501(c)(3) 5000 Public Transportation Core Physicians LLC 5 Alumni Drive Exeter NH 03833 870807914 501(c)(3) 11820 Reimbursement of expenses incurred supporting "Patient Assistance Program RX" (Medication Bridge) Exeter Junior Baseball and Softball League Inc PO Box 471 Exeter NH 03833 753241754 501(c)(3) 7000 Sponsors the organization's primary purpose which is to develop good sportsmanship among all players for the betterment of their emotional and social well-being Families First of the Greater Seacoast 100 Campus Drive Suite 12 Portsmouth NH 03801 222757341 501(c)(3) 52000 Annual funding contribution that helps Families First continue to provide a broad range of health and family services to all regardless of ability to pay Gather 210 West Road Portsmouth NH 03801 020226943 501(c)(3) 26000 Support organization's commitment to ending local hunger through collaboration and leadership Girls on the Run New Hampshire 137 Water Street Exeter NH 03833 020524090 501(c)(3) 15000 Support organization mission to elevate and prepare girls for a lifetime of self respect and healthy living Haven Violence Prevention and Support Services 20 International Drive Portsmouth NH 03801 020337620 501(c)(3) 40000 Support organization's mission to prevent sexual assualt, domestic violence and stalking Lamprey Healthcare Inc 207 South Main Street Newmarket NH 03857 237305106 501(c)(3) 390500 Supports the provision of high quality medical care and health related services to the communities it serves regardless of the patients' ability to pay NAMI New Hampshire 85 North State Street Concord NH 03301 222760743 501(c)(3) 6000 Support for people affected by mental illness New Heights Adventures for Teens 100 Campus Drive Suite 23 Portsmouth NH 03801 271918243 501(c)(3) 50000 Supports this comprehensive out-of-school program for young people to develop the competence, character, confidence and resiliency for a healthy successful adulthood Prescott Park Arts Festival Inc PO Box 4370 Portsmouth NH 03802 020370018 501(c)(3) 5000 Promote artistic excellence in the community Raymond Coalition for Youth 4 Epping Street Raymond NH 03077 020713987 501(c)(3) 11500 Mobilize resources to promote positive youth development, family strengthening, and community building activities Richie McFarland Children's Center 11 Sandy Point Road Stratham NH 03885 020302005 501(c)(3) 7000 Supports providing developmental and therapy services for children with and without special needs, support and education to their families and guidance in accessing community and health resources Seacoast Child Advocacy Center Inc 100 Campus Drive Portsmouth NH 03801 020510546 501(c)(3) 6500 Support to provide a safe, friendly environment for interviews and evaluation of alledged child abuse Seacoast Eat Local Inc 2 Washington Street Suite 331 Dover NH 03820 452547575 501(c)(3) 5080 To advocate for eating locally grown food for the health of our community, environment and economy Seacoast Family Promise 27 Hampton Road Exeter NH 03833 020529881 501(c)(3) 8000 2786 Book Value Various household appliances and furniture Empower families with children experiencing homelessness to achieve sustainable independence through community based response Seacoast Mental Health Center Inc 1145 Sagamore Avenue Portsmouth NH 03801 020262862 501(c)(3) 10000 Support organization's mission to provide high quality, effective accessible mental health services Seacoast Pathways PO Box 1528 Portsmouth NH 03802 462658558 501(c)(3) 5000 Support individuals living with the effects of mental illness Society of St Vincent de Paul Exeter Inc PO Box 176 Exeter NH 03833 203945985 501(c)(3) 20000 1614 Book Value Tray line food products Grant for substance abuse, transportation and food delivery to homebound seniors Southern District YMCA-Camp Lincoln Inc 56 Linden Street Exeter NH 03833 043383996 501(c)(3) 12500 Community benefits grant/suicide prevention Transportation Assistance for Seacoast Citizens 200 High Street Hampton NH 03842 262869209 501(c)(3) 5000 Donation to assist the provision of transportation to the seacoast community University of New Hampshire Foundation Inc Elliott Alumni Center 9 Edgewood Road Durham NH 03824 020437506 501(c)(3) 7500 Support Northeast Passage's adaptive sports and recreation programs Womenade of Greater Squamscott PO Box 653 Stratham NH 03885 202173469 501(c)(3) 6000 Grant to provide short term financial assistance to those in need/fundraiser sponsor 28 0 Part I, Line 2: All requests for grants/contributions/sponsorships over $5,000 require the approval of at least the Vice President of Strategy, Community Relations and Development to ensure that they are consistent with our mission, values and strategic plan. Large grants like those given to Carriage Barn, Families First, Gather, Haven, Lamprey, New Heights and Society of St. Vincent DePaul are also reviewed by the Chief Financial Officer and Chief Executive Officer prior to approval. Each of those requesting organizations either provides a written summary of how they have used our previous support as well as their specific plans for any new requested funding or they make a presentation in person usually to the Chief Financial Officer, the Chief Executive Officer and the Vice President of Strategy, Community Relations and Development. Each year a 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. That subcommittee and the larger Exeter Health Resources' (parent company) Board of Trustees are regularly updated on our community support initiatives. 0 1 0 0 0 0 0 1 0 Richard Hollister MD Ex-Officio Member 0 322852 0 80554 0 63757 0 7950 0 20353 0 495466 0 0 Kevin J Callahan CEO/Trustee 0 609697 0 210000 0 1529260 0 167950 0 24924 0 2541831 0 1120000 Kevin J O'Leary CFO/Treasurer 0 382929 0 116625 0 14471 0 75950 0 17164 0 607139 0 0 Constance D Sprauer Sr. VP Legal Affairs/Secretary 0 279818 0 42500 0 7102 0 15900 0 17093 0 362413 0 0 Brian Campbell VP Ambulatory Care 211429 0 74536 0 12152 0 15900 0 23552 0 337569 0 0 0 Donna McKinney VP Acute Care 224361 0 59482 0 9948 0 15900 0 22060 0 331751 0 0 0 Jonathan Jackson Physicist 241205 0 7500 0 630 0 15192 0 15711 0 280238 0 0 0 Jane Peterson Director 178398 0 13649 0 2386 0 11738 0 284 0 206455 0 0 0 Susan Callahan Director 148659 0 19488 0 18391 0 11271 0 8580 0 206389 0 0 0 Joan Raczy Pharmacist 160627 0 0 0 23350 0 11539 0 23482 0 218998 0 0 0 Deanna King Director 168499 0 11598 0 2102 0 11365 0 23994 0 217558 0 0 0 Part I, Line 3 The CEO of Exeter Hospital, Inc. is compensated by a related organization, Exeter Health Resources, Inc. Exeter Health Resources, Inc. uses a compensation committee, an independent compensation consultant, a compensation survey and approval by the Board or Compensation Committee. Part I, Line 4b The organization's parent (Exeter Health Resources, Inc.) maintains a split dollar supplemental retirement plan for two executives (listed below with amounts) selected by the Exeter Health Resources Inc. Board of Trustees. The plan is closed to future participants. The Plan provides for annual payments of premiums for life insurance policies insuring the listed individuals. Those life insurance premiums are collaterally assigned to the corporation and any excess accumulated value in the policies (net of accumulated premium payments which are returned to the organization upon the executive attaining the age of 70 or at the death of the participant) is available to be paid to the participant once vested at age 62 and upon retirement from the organization. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance provided. Life insurance premium payments during tax year: Kevin Callahan $ 130,022 Kevin O'Leary $ 70,894 Excess Accumulated Value: Kevin Callahan $2,583,976 Kevin O'Leary $1,047,139 Certain of the listed employees participate in a nonqualified deferred compensation plan as described in Internal Revenue Code Section 457 (f) sponsored by Exeter Health Resources Inc., In the calendar year ended December 31, 2016 the contribution to the plan for the vested benefit of Kevin Callahan was $160,000 and the contribution to the plan for the non-vested benefit of Kevin O'Leary was $68,000. The contributions are intended to provide a forfeitable supplemental retirement benefit. Participants in the 457(f) plan do not vest until age 62 when it is payable to the participant. During the calendar year ended December 31, 2016, Kevin Callahan reached the age of 62 and received a total distribution equal to $1,487,265 from the 457(f) plan. It should be noted that this distribution includes plan contributions reported on prior years; Forms 990, Part VII, Column F and also on Schedule J, Column C as deferred compensation. Accordingly, the total amount of previously reported plan contributions, $1,120,000 is reflected on Schedule J, Part II, Column F so as to not overstate compensation in the current year that was earned over a period of many years. Part I, Line 7 The organization's parent (Exeter Health Resources, Inc.) provides an annual incentive compensation plan for executives selected by the Exeter Health Resources Board of Trustees. These executives include: Kevin Callahan, Kevin O'Leary, Constance Sprauer, Brian Campbell and Donna McKinney. The Board and / or its Executive Committee approves 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 establishes minimum, targeted and maximum levels for incentive awards and approves all awards for participating executives. Jonathan Jackson, Jane Peterson, Susan Callahan, and Deanna King participate in an annual incentive program which is administered by Exeter Hospital, Inc.'s Human Resources Department. The management of Exeter Hospital, Inc. approves measureable achievement criteria for Quality/Innovation, Patient Satisfaction, Process Improvement and Financial Performance on an annual basis that aligns with overall strategic interests of the company. The incentive award levels are established at minimum, target and maximum levels and those incentive awards are approved by operating management and Human Resources. A NH Health and Education Facilities Authority 020279866 NONEAVAIL 2012-02-09 32565000 Refinancing and refunding prior bond issuance 0 0 0 B NH Health and Education Facilities Authority 020279866 NONEAVAIL 2015-03-02 24020000 Refinancing and refunding prior bond issuance 0 0 0 A 32565000 215404 32349596 2012 0 0 1 1 B 24020000 162154 23857846 2015 0 0 1 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 A 1 1 0 0 0 1 B 1 1 0 0 0 1 A 1 B 1 Form 990, Part VI, Section A, line 6 Exeter Health Resources, Inc., a charitable organization acting through its Board of Trustees, is the sole member of the organization. Form 990, Part VI, Section A, line 7a The Board of Trustees shall consist of a number not to exceed fifteen (15) persons. Of this number, up to thirteen (13) persons shall have been elected by the Member from among the elected members of the Board of Trustees of the Member. Form 990, Part VI, Section A, line 7b The sole member, Exeter Health Resources, Inc. has the right to approve decisions of the governing body. Additionally, the Member shall have the power to change the corporate name, merge with or acquire any corporation organized under Chapter 292 of the Revised Statutes Annotated of New Hampshire, amend the articles of agreement, dissolve the Corporation, annually appoint an independent certified public accountant to perform an audit of the accounts of the Corporation, and such other powers and rights as may be reserved to it by law or the articles of agreement. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an outside tax accountant with information provided by the organization. The Form 990 is reviewed by the organization's Treasurer and then presented to the Board of Trustees before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The Board of Trustees has adopted a Conflict of Interest Policy that requires the disclosure of conflicts of interest either when the interest becomes a matter of possible action by the Board or during an annual disclosure process. Trustees, officers, and key employees, as well as all members of senior management, are part of the annual disclosure process, which is initiated by the issuance of a memorandum and accompanying questionnaire by the President and Chief Executive Officer (CEO). All disclosures are reviewed. Any trustee with a conflict of interest is required to abstain from voting and is not included in a quorum determination on the matter and any officer, key employee, or member of senior management with a conflict does not take part in making and is not present for any decision regarding the matter. The policy is monitored and enforced by both the President and CEO and the full Board. There are two additional conflicts of interest policies. One is applicable to all employees and contracted staff and the other is applicable to members of the Medical Staff and allied health professionals. The former policy is monitored and enforced by the Vice President of Human Resources and the Vice President of Corporate Integrity and Compliance and the latter is monitored and enforced by the President of the Medical Staff, President and CEO, General Counsel, and Compliance Officer. On an annual basis, staff within Human Resources survey all employees and contracted staff serving in a managerial role, as well as members of any committees that make recommendations or decisions regarding the purchase of goods or services by any of the corporations as a means to ensure that any conflict of interest is disclosed and appropriately managed. Employees otherwise are required to supplement or make any further written disclosure at the time a conflict arises. Form 990, Part VI, Section B, line 15 The organization's parent (Exeter Health Resources, Inc.) has a formal process for determining total compensation for the CEO and other listed officers that is intended to provide reasonable compensation for achieving the organization's mission, to recognize individual and team performance and to comply with the organization's obligations as a tax-exempt charitable organization. The Executive Committee of the Exeter Health Resources, Inc.'s Board of Trustees conducts an annual review of the compensation of the CEO, other listed officers and key employees. In doing so, the Committee retains a qualified independent compensation consultant to conduct competitive market analysis of the market ranges of base, incentive, and total cash compensation, and to provide advice concerning the reasonableness of the compensation of the CEO, other listed officers and key employees. The Committee utilizes that analysis and other appropriate information in connection with its annual review and makes recommendations to the full board of Exeter Health Resources, Inc. for adjustment of the CEO's compensation and the compensation for other listed officers. Information which the committee may consider can include but is not limited to the performance of an individual and/or that individual's contributions to a team, the performance of the organization in whole and in part, the elements of total compensation and salary history, the organization's compensation targets and comparability data, including the data prepared by the independent consultant and reviewed with the Committee. The Committee incorporates a performance appraisal process in the CEO's, other listed officers and key employees' compensation review. The CEO, other listed officers and key employees are not present when the committee discusses their respective compensation. In addition, the committee determines if the threshold requirements for incentive awards are met, consisting of the organization's performance results for quality, operating system excellence and financial performance. The results of the Committee's deliberations are presented to the Exeter Health Resources, Inc. Board and include recommendations concerning salary range adjustments and incentive awards and the basis for the Committee's decisions/recommendations. The deliberations of the Exeter Health Resources, Inc. Board are conducted in executive session with the independent members of the Board but do include the CEO only for that period of time in which the Exeter Health Resources, Inc. Board has questions concerning the performance of any listed officer or key employee other than the CEO. The Exeter Health Resources, Inc. Board reviews the CEO's performance and determines if the adjustments and awards recommended by the committee for the CEO are in the organization's best interest and for the benefit of the organization and its parent organization. For the other listed officer positions, adjustments and incentive awards are approved upon recommendation of the CEO by the Executive Committee within the Exeter Health Resources, Inc. Board approved parameters and ratified by the Exeter Health Resources, Inc. Board of Trustees. Adjustments and awards for other listed key employees are approved upon recommendation of the CEO by the Executive Committee within the Exeter Health Resources, Inc. Board approved parameters and reviewed by the Board. Form 990, Part VI, Section C, line 19 These documents are available upon request. Form 990, Part VI-B, Line 16b: Although written policies were not in place as of the end of the year covered by this tax return requiring the organization to evaluate its participation in joint venture arrangements under applicable federal law to ensure that the organization's exempt status is protected, the organization performed due diligence with respect to its joint venture arrangements to safeguard the organization's exempt status. Form 990, Part IX, line 11g Payment to Affiliate: Program service expenses 4,011,493. Management and general expenses 482,270. Fundraising expenses 0. Total expenses 4,493,763. Physician Fees: Program service expenses 7,058,882. Management and general expenses 848,633. Fundraising expenses 0. Total expenses 7,907,515. Contracted Services: Program service expenses 3,201,267. Management and general expenses 384,863. Fundraising expenses 0. Total expenses 3,586,130. Outside Fees: Program service expenses 3,027,481. Management and general expenses 363,970. Fundraising expenses 0. Total expenses 3,391,451. Contract/Temporary Labor: Program service expenses 2,479,098. Management and general expenses 298,042. Fundraising expenses 0. Total expenses 2,777,140. Consulting: Program service expenses 666,829. Management and general expenses 80,168. Fundraising expenses 0. Total expenses 746,997. Form 990, Part XI, line 9: Net Transfers to Affiliates -23,099,770. Pension Liability Adjustment 4,718,302. Impact of Interest Rate Swaps 2,403,455. Net Assets Released from Restriction 44,247. Form 990, Part XII, Line 2c: The organization is part of the consolidated operations of Exeter Health Resources, Inc. The Exeter Health Resources, Inc. Executive Committee is responsible for the oversight of the audit and the selection of an independent accountant. There has been no change in the audit process since the prior year. Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 020222126 Management and Supporting Organization; Holding Company NH 501(c)(3) Line 12a, I 0 Core Physicians LLC 5 Alumni Drive Exeter NH 03833 870807914 Physician Practices NH 501(c)(3) Line 10 Exeter Health Resources Inc 0 Rockingham Visiting Nurse Association 5 Alumni Drive Exeter NH 03833 020274905 Home Care, Hospice NH 501(c)(3) Line 10 Exeter Health Resources Inc 0 Matrix Health Inc 5 Alumni Drive Exeter NH 03833 020473737 Manage Resources NH 501(c)(3) Line 12b, II Exeter Health Resources Inc 0 Exeter Med Real Inc 5 Alumni Drive Exeter NH 03833 020418718 Real Estate Holding Company NH 501(c)(25) Exeter Health Resources Inc 0 Exeter Health Resources Self-Insurance Trust 5 Alumni Drive Exeter NH 03833 200753662 Self Insurance Trust NH 501(c)(3) Line 12a, I Exeter Health Resources Inc 0 Core Health Services of MA 5 Alumni Drive Exeter NH 03833 201598042 Inactive Physician Practice MA N/A C 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 1 Exeter Med Real Inc K 2035781 Cash Exeter Med Real Inc L 471649 Cash