2018-05-21T08:20:03-05:00 2017-06-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2016-07-01 020315693 Catholic Medical Center CATH 6036683545 100 McGregor Street Manchester NH 031023770 Edward L Dudley III Exec. VP & CFO 6036683545 2018-05-21 1 Nicholas E Porto P01310283 2078792100 2018-05-04 2016 2022-09-23 18:48:47Z Joseph Pepe MD 100 McGregor Street Manchester NH 031023770 480206446 0 0928 X www.catholicmedicalcenter.org X 1974 NH The heart of Catholic Medical Center is to carry out Christ's healing ministry by offering health, healing, and hope to every individual who seeks our care. 17 13 2862 225 7223 5314 3322280 3391031 395326782 426993978 484672 4305758 1444922 -9417 400578656 434681350 52410 273556 0 0 157995914 169941977 0 0 424220 198961289 208421072 357009613 378636605 43569043 56044745 323864484 362532601 245633902 248359899 78230582 114172702 The heart of Catholic Medical Center is to carry out Christ's healing ministry by offering health, healing, and hope to every individual who seeks our care. 0 0 327790027 273556 418376768 Medical & Surgical services provided to 12,315 inpatients and 431,301 outpatients. 6751416 0 8617210 Various other services. Please see Schedule H.Catholic Medical Center (CMC), as an agency of the Roman Catholic Church, shall provide health care in a manner consistent with the ethical and religious directives for Catholic health care services as interpreted by the Roman Catholic Bishop of Manchester. CMC shall employ the highest quality health care professionals and the most appropriate technology to deliver an array of services either directly or through strategic alliances with compatible health care providers. With dignity and compassion, CMC shall treat the body, mind, and spirit of all who seek or provide care and comfort. Additional details provided in Schedule H. 334541443 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 248 0 1 2862 1 1 1 0 0 0 0 1 1 0 0 0 0 X 17 13 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 NH X Edward Dudley 6036683545 c/o Finance Dept 100 McGregor Manchester NH 031023770 Rick Botnick Director 1.00 3.00 X 0 0 0 Robert A Catania MD Director 1.00 43.00 X 0 534505 42719 Carolyn Claussen MD Director 1.00 42.00 X 0 110246 8266 Jeannette Davila Director (end 5/17) 1.00 2.00 X 0 0 0 Pamela Diamantis Director 1.00 2.00 X 0 0 0 Harry E Dumay PhD Director (end 5/17) 1.00 3.00 X 0 0 0 Louis I Fink MD Director 1.00 42.00 X 0 596732 25402 Powen Hsu MD Director 1.00 3.00 X 0 0 0 Susan Huard PhD Director 1.00 2.00 X 0 0 0 Matthew Kfoury Director 1.00 3.00 X 0 0 0 Paul S Moore Esq Director 1.00 2.00 X 0 0 0 Diane Murphy Quinlan Esq Director 1.00 3.00 X 0 0 0 Keith A Stahl MD Director (end 1/17) 1.00 42.00 X 0 321447 24616 Fr Patrick Sullivan OSB RN Director 1.00 3.00 X 0 0 0 John J Munoz MD Pres. Medical Staff 1.00 42.00 X 0 0 0 Thomas J Kleeman MD Pres. Medical Staff (end 4/17) 1.00 2.00 X 0 0 0 Maria C Mongan Chair 1.00 4.00 X X 0 0 0 John G Cronin Esq Vice Chair 1.00 3.00 X X 0 0 0 Neil Levesque Secretary 1.00 3.00 X X 0 0 0 Donald St Germain Treasurer 1.00 2.00 X X 0 0 0 Joseph Pepe MD President & CEO 40.00 6.00 X X 800886 0 59304 Edward Dudley III Exec. VP & CFO 40.00 6.00 X 504732 0 64362 Alexander Walker Esq Exec. VP, Operations 40.00 0.00 X 516960 0 72904 William Goodman MD Chief Medical Officer 40.00 0.00 X 457921 0 36570 Carolanne O'Sullivan VP of Physician Practices 40.00 0.00 X 326868 0 27373 Robert Duhaime Chief Nursing Officer 40.00 1.00 X 280393 0 41811 Merryll Rosenfield VP of Human Resources 40.00 0.00 X 252699 0 40403 Lucille Mulla VP Operations/Emergency Services 40.00 0.00 X 222200 0 21456 Thomas Della Flora VP Chief Information Officer 40.00 0.00 X 251152 0 38736 3613811 1562930 503922 135 0 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Medical Services 20004156 Integrity Healthcare Locums PO Box 823424 Philadelphia PA 191823424 Healthcare Staffing Services 1402566 Granite State Emergency Physicians 380 Lafayette Road Hampton NH 03842 Physician Services 973780 CHG Companies Inc PO Box 972651 Dallas TX 753972651 Healthcare Staffing Services 857693 Eisenberg Vital & Ryze LLC 155 Dow Street Manchester NH 03101 Marketing Services 810530 56 278803 12500 1895681 1204047 32672 3391031 Patient Service Revenue 621400 404876783 404876783 Disproportionate Share Funding 621400 13499985 13499985 Miscellaneous Rev. 621400 4725011 4725011 Cafeteria Income 722210 1780040 1780040 Lab Client Revenue 621500 1691334 1691334 420825 420825 426993978 2033229 7223 2026006 47476480 45203951 2272529 2272529 2272529 36530 278803 132521 -95991 -95991 380826 188624 192202 192202 Loss on Debt Extinguishment 900099 -105628 -105628 -105628 434681350 426993978 7223 4289118 273556 273556 2990290 2436607 553683 132783665 108012699 24544308 226658 7615844 6195949 1407939 11956 16992789 13846398 3146391 9559389 7775772 1766931 16686 743676 743676 155100 155100 86910 70818 16092 142523 142523 8928889 7275612 1653277 2127264 1733379 393885 10887648 8749160 1981302 157186 4582307 3733845 848462 8670594 7058530 1603948 8116 144731 117933 26798 335460 271317 61653 2490 1678968 1368090 310878 13158889 10722384 2436505 2565014 2090075 474939 Medical Supplies 81529348 81529348 Physician Fees 31250614 31250614 Medicaid Enhancement Ta 18142007 18142007 Bad Debt Expense 15714668 15714668 7576462 6172682 1402652 1128 378636605 334541443 43670942 424220 39176245 64656894 32768957 33652974 47860095 41913543 711093 0 3199310 3319600 6314657 8089897 243439687 161518622 81712922 81921065 54150978 71557153 49015159 47860563 8955068 9560912 323864484 362532601 45329172 54491755 405913 388760 62516312 58974184 4892038 3575406 132490467 130929794 245633902 248359899 X 69990495 104679892 395655 941180 7844432 8551630 78230582 114172702 323864484 362532601 X 56044745 7529172 -27631797 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 26910 0 0 1 60000 86910 0 Part II-B, Line 1: Catholic Medical Center is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of CMC and the other organizations in furtherance of their exempt purposes. CMC does not directly perform any lobbying activities. Portion of dues paid that constitutes lobbying is as follows: NHHA: $17,346 AHA: $9,564 Devine, Millimet, & Branch, PA provided lobbying services which included providing information regarding public policy pending before the legislature. Devine, Millimet, & Branch, PA participated in the administrative rule-making process with respect to rules concerning the certificate of needs board. They also provided general communication with elected officials. CMC paid Devine, Milliment, & Branch $60,000 for these services. 8240087 666127 783730 197134 9492810 8646641 182178 -470680 118052 8240087 8690560 94278 155862 294059 8646641 7473844 500599 880858 164741 8690560 7047069 72536 590318 236079 7473844 0.00000 0.90090 0.09920 0 0 1024690 1024690 83554418 40645131 42909287 6808587 4693192 2115395 141631883 109986260 31645623 10420109 6194039 4226070 81921065 Investment in Affiliates 1412287 F Private Investment Funds 46448276 F 47860563 Accrued Pension & Other Liabilities 129679854 Due to Affiliates 1249940 130929794 X Part V, Line 4: Proceeds from the Organization's endowment funds are used in operations. Part X, Line 2: Catholic Medical Center changed its fiscal year end from June 30 to September 30 in 2017, and received audited financial statements for the fifteen-month period beginning June 30, 2016 and ending September 30, 2017. Tax returns are being filed for both the twelve-month fiscal year ending June 30, 2017 and the three-month short year from July 1, 2017-September 30, 2017. Both filing periods are covered by the audited financial statements. The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the Medical Center's tax positions and concluded the Medical Center 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 the consolidated financial statements. CAHS is a for-profit organization and, in accordance with federal and state tax laws, files income tax returns, as applicable. There was no provision for income taxes for the fifteen-month period ended September 30, 2017 and this organization was dissolved in September 2017. There are no significant deferred tax assets or liabilities. CAHS has concluded there are no significant uncertain tax positions requiring disclosure and there is no material liability for unrecognized tax benefits. CAHS's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in income tax expense. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 1466000 0 0 0 0 0 0 1466000 0 1466000 0 0 1 1 0 0 Schedule F, Part IV, Lines 3 & 4: The Medical Center has an ownership interest in several foreign corporate holdings as well as being an indirect shareholder of several passive foreign investment companies (PFIC) by way of their ownership in various alternative investments. The Medical Center's interest in these foreign corporations did not surpass the filing threshold for Form 5471. Additionally, the Medical Center had no unrelated business income related to its PFIC interest and therefore is not required to file Form 8621. Gala 178229 167720 10509 79 11385 42841 1900 14820 Golf Tournament 89350 63329 26021 23940 408 11197 1 47754 47754 500 22787 2664 315333 278803 36530 79 35825 66036 1900 28681 132521 -95991 1 1 1 X 225.000000000000 1 X 1 1 1 0 1 1 4908902 4908902 0.01350 54798111 35103958 19694153 0.05430 59707013 35103958 24603055 0.06780 26 23589 4545609 143494 4402115 0.01210 3 0 1418131 2050 1416081 0.00390 5 263 7541478 3005368 4536110 0.01250 3 0 52254 720 51534 0.00010 5 374 569054 569054 0.00160 42 24226 14126526 3151632 10974894 0.03020 42 24226 73833539 38255590 35577949 0.09800 101488 26280 75208 0.00020 3051 3051 0.00000 75130 75130 0.00020 179669 26280 153389 0.00040 1 4564140 0 133560029 162054888 -28494859 X 1 1 1 1 Catholic Medical Center 100 McGregor Street Manchester NH 03102 00646 X X X Catholic Medical Center 1 0 0 1 X X X X X X X X X 16 1 1 0 1 X see Part V, Section C X see Part V, Section C X X 1 16 1 see Part V, Section C 0 1 X 225.000000000000 300.000000000000 X X X X X 1 1 X 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 X 1 X 0 X X X 1 X 0 0 Catholic Medical Center Part V, Section B, Line 5: A variety of different secondary data sources were accessed. They included but were not limited to the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services (NHDHHS), Youth Behavioral Risk Factor Surveillance Survey, City of Manchester, Census data, and local town data. Representatives from CMC and Elliot Health System (EHS) interviewed key leaders from towns in our service area to ascertain the key health related issues that they were facing and dealing with in their local communities. The towns that were included in the interview process were Auburn, Bedford, Candia, Hooksett, Goffstown, Deerfield, and New Boston. Though the overall needs were similar the priority of them varies between the towns. Overall, the common themes were substance use, the availability of behavioral health services, transportation (especially in the elderly populations and the more rural areas of New Boston and Deerfield), self-care and management of chronic disease, and access to health care for the low income populations and communities. Communications on community needs were collected via discussions with local leaders in the health care field. These leaders consisted of individuals from: Catholic Medical Center, Dartmouth-Hitchcock Clinic, Public Health Department - City of Manchester, NH, Elliot Health System, and Community Health & Mission. Catholic Medical Center Part V, Section B, Line 6a: Elliot Health System in Manchester, NH. Catholic Medical Center Part V, Section B, Line 7d: The Catholic Medical Center "Healthy Living News", the Medical Center's community newsletter, provides a summary report of the community benefits that the Medical Center provides. The Healthy Living News is distributed to our primary and secondary service areas, approximately 120,000 people. Catholic Medical Center Part V, Section B, Line 11: Catholic Medical Center has addressed the needs identified in the 2016 CHNA through the implementation of programs and services throughout the Manchester health service area (HSA). Mental illness and violence are often intrinsically intertwined. CMC has increased services within our Behavioral Health Department and developed the Opioid Use/Misuse Resource. This is an online tool available to all CMC staff to create consistency of care in the treatment and recovery of this public health epidemic. Health Care for the Homeless (HCH) of CMC provides behavioral health services and substance abuse counseling to the homeless throughout the Manchester HSA. CMC has improved the mental health assessment tool in Primary Care, a key component in the early identification and treatment of mental illness. In collaboration with Governor Hassan's Senior Director of Substance Misuse and Behavioral Health and Boston University School of Medicine, CMC conducted the third annual "State-of-the art Management of the Opiate-dependent Patient, Pain Treatment and the Heroin Epidemic". The targeted audience for this conference included prescribers, nurses, allied health professionals, pharmacists and social service agencies. The program addressed many facets of substance abuse within our community, hospitals, and practices.Ambulatory Care, chronic disease, including asthma and aging issues have all been addressed through various means. Catholic Medical Center's Primary Care has implemented The Patient-Centered Medical Home (PCMH) Model, a proactive approach to preventative medicine through the introduction of care coordinators to the primary care practices. All care managers work with the practices' most high risk patients (asthma, diabetes, COPD, etc) to ensure they understand their medications and follow-up care. The PCMH Model encourages patients to become involved and educated in their personal care plan. CMC offers free health screenings, chronic disease, and self-management classes to the community. These programs provide the opportunity for early detection of chronic disease; referral based follow-up care and education on adopting healthy lifestyle behaviors, communicating with the healthcare team, problem solving, and goal setting. To aid with aging issues, CMC's Parish Nurse Program provides nurse consultations, education, referrals, and screenings at Parishes throughout the Greater Manchester Area.In order to address the barriers to access of health care services related to poverty (lack of insurance, cost, transportation and education on accessing care, and lack of medical home) CMC provides comprehensive care to Manchester's underserved and refugee populations. Health Care for the Homeless provides primary medicine and behavioral health care to over 1,700 homeless patients. CMC's Certified Application Counselors (CAC) provide outreach and enrollment services to the communities' uninsured. CACs provide information on a full range of qualified health plan (QHP) options and assist individuals in applying for coverage through a QHP in the ACA's Marketplace Exchange. CMC has staffed the emergency department with a community health worker to improve primary care access for the homeless population, provide education on accessing care, and transportation support. CMC provides shuttle support to CMC Ancillary Services to those in need, at no cost. CMC assists patients through the Medication Assistance Program to obtain medications they would otherwise not be able to afford and has developed a prescription delivery program with Rite Aid Pharmacy to assist patients with filling their medications upon discharge.CMC's Poisson Dental Facility has expanded access to oral health services to patients of the Pregnancy Care Center and Manchester Community Health Center (MCHC). The Poisson Dental Facility provides access to exams and treatment planning for women from the Pregnancy Care Center and access to oral health care during the first post-partum year until their treatment plan has been completed. CMC's Poisson Dental facility provides oral health services to not-for-profit agencies in our community including, Mental Health Center of Greater Manchester, Moore Center Services, Manchester Health Department, and Health Care for the Homeless (HCH). The majority of HCH patients often arrive with very poor oral health. In an effort to meet the growing need for oral health services, CMC's Poisson Dental expanded services to include school-based dental care for children in need attending Manchester elementary and middle schools. This school-based program is made possible through collaboration with the City of Manchester Health Department and Easter Seals NH. Poisson Dental also provides onsite dentistry at Dartmouth Hitchcock Manchester by integrating these services within their pediatric practice. This allows for ease of access for the patients and direct communication amongst the providers of care.CMC's Fertility Education provides teens at local schools and parishes educational opportunities such as The Cradle Within, Ideal Dating, Sexual Risk Behavior, and Conflict Resolution. The goal is to equip adolescents with the tools to identify healthy relationships and the benefits of choosing sexual risk avoidance behaviors. The Pregnancy Care Center provides supportive prenatal care to all women, including teens, regardless of their ability to pay. Their mission is to improve pregnancy outcomes by serving those most in need and unable to access services in a traditional prenatal setting. The Pregnancy Care Center expanded services, adding Centering Group Prenatal Care; this program is a multifaceted model of group care that integrates the three major components of care: health assessment, education, and support. Visits promote greater patient engagement, personal empowerment, and community-building. Catholic Medical Center has a long history of providing services to the community and currently has programs in place to meet every identified need in the most recent CHNA. In addition to the programs we currently offer, we will expand many of our services in response to the needs of the community that have not been addressed. Catholic Medical Center Part V, Section B, Line 16j: Signs are posted throughout the hospital facility and physician practices that list the financial programs available and contact information for assistance. Part V, Line 7a & 7b: Hospital's Website URL for Community Health Needs Assessment: www.catholicmedicalcenter.org/about-us/Community-Health-Needs-Assessment.aspx The CHNA can also be found at:www.elliothospital.org/website/downloads/QualitativeNeedsAssessment.pdf Part V, Line 10a: Hospital's Website URL for Community Health Needs Assessment:www.catholicmedicalcenter.org/about-us/Community-Health-Implementation-Plan.aspx Schedule H, Part V, Section B, Line 16a-16c: Financial Assistance Information Can Be Obtained At: www.catholicmedicalcenter.org/patients-and-visitors/financial-assistance/ 61 1 - New England Heart Institute 100 McGregor Street Manchester NH 03102 Cardiovascular Health 2 - Hospital Medicine 100 McGregor Street Manchester NH 03102 Hospital Medicine 3 - Cardiothoracic Surgical Associates 100 McGregor Street Manchester NH 03102 Cardiothoracic Surgical Associates 4 - Women's Wellness & Fertility Center 88 McGregor Street Suite 106 Manchester NH 03102 Women's Health 5 - Behavioral Health 88 McGregor Street Suite 201 Manchester NH 03102 Behavioral Health 6 - Surgical Care Group 87 McGregor Street Suite 3100 Manchester NH 03102 Surgical Care 7 - Amoskeag Family Practice 1750 Elm Street Suite 201A Manchester NH 03101 Family Medicine 8 - Bedford Center Int Med & Pediatric 188 Route 101 Bedford NH 03110 Internal Medicine and Pediatrics 9 - Outpatient Rehabilitation 188 Route 101 Bedford NH 03110 Outpatient Rehabilitation 10 - Hooksett Internal Medicine 200 Alliance Way Manchester NH 03102 Primary Care services 11 - Family Physicians of Manchester 57 Webster Street Suite 110 Manchester NH 03104 Family Medicine 12 - Goffstown Family Practice 17A Tatro Drive Suite 201 Goffstown NH 03045 Family Medicine 13 - Granite State Internal Medicine 188 Route 101 Bedford NH 03110 Internal Medicine 14 - Amoskeag Family Practice 400 Mast Road Goffstown NH 03045 Primary Care services 15 - Hooksett Internal Medicine 11 Kimball Drive Unit 132 Hooksett NH 03103 Internal Medicine 16 - Highlander Way Internal Medicine 1 Highlander Way Manchester NH 03103 Internal Medicine 17 - Comprehensive Rheumatology at CMC 1 Highlander Way Manchester NH 03103 Comprehensive Rheumatology 18 - Lakeview Internal Medicine 27 Londonderry Turnpike Hooksett NH 03106 Internal Medicine 19 - Outpatient Rehabilitation 27 Londonderry Turnpike Hooksett NH 03106 Outpatient Rehabilitation 20 - Queen City Medical Associates 775 South Main Street Manchester NH 03102 Skilled Practitioners 21 - Willowbend Family Practice 5 Washington Place Suite 1A Bedford NH 03110 Family Medicine 22 - Webster Street Internal Medicine 57 Webster Street Manchester NH 03104 Internal Medicine 23 - Urgent Care at Bedford Medical Park 5 Washington Place Suite 1B Bedford NH 03110 Urgent Care 24 - Diagnostic Imaging 5 Washington Place Suite 1B Bedford NH 03110 Diagnostic Imaging 25 - New England Heart Institute 59 Page Hill Road Berlin NH 03570 Heart and Vascular services 26 - Surgical Care Group 59 Page Hill Road Berlin NH 03570 General Surgery services 27 - Comprehensive Neurological Care 59 Page Hill Road Berlin NH 03570 TeleNeurology services 28 - New England Heart Institute 452 Old Street Road Peterborough NH 03458 Heart and Vascular services 29 - Surgical Care Group 452 Old Street Road Peterborough NH 03458 General Surgery services 30 - Surgical Care Group 452 Old Street Road Peterborough NH 03458 Vascular Surgery services 31 - Comprehensive Rheumatology 452 Old Street Road Peterborough NH 03458 Rheumatology services 32 - Hospital Medicine services 452 Old Street Road Peterborough NH 03458 Hospitalists 33 - New England Heart Institute 173 Middle Street Lancaster NH 03584 Heart and Vascular services 34 - Surgical Care Group 173 Middle Street Lancaster NH 03584 General Surgery services 35 - Comprehensive Neurological Care CMC 769 South Main Street Suite 301 Manchester NH 03102 Comprehensive Neurological Care 36 - Outpatient Rehabilitation 769 South Main Street Suite 201 Manchester NH 03102 Outpatient Rehabilitation 37 - Diagnostic Imaging 25 South River Road Bedford NH 03110 Diagnostic Imaging 38 - New England Heart Institute 181 Corliss Lane Colebrook NH 03576 Heart and Vascular services 39 - Hospital Medicine services 181 Corliss Lane Colebrook NH 03576 Hospitalists 40 - Cholesterol Management Center 195 McGregor Street Suite 312 Manchester NH 03102 Cholesterol Management services 41 - Cholesterol Management 6 Tsienneto Road Derry NH 03038 Cholesterol Management services 42 - New England Heart Institute 6 Tsienneto Road Derry NH 03038 Heart and Vascular services 43 - Surgical Care Group 6 Tsienneto Road Derry NH 03038 Vascular Surgery services 44 - New England Heart Institute 160 South River Road Bedford NH 03110 Heart and Vascular services 45 - Surgical Care Group 160 South River Road Bedford NH 03110 General Surgery services 46 - Vein and Vascular Specialists 160 South River Road Bedford NH 03110 Vein and Vascular Specialists 47 - New England Heart Institute 7 Holland Way Exeter NH 03833 Heart and Vascular services 48 - New England Heart Institute 240 S Main Street Wolfeboro NH 03894 Heart and Vascular services 49 - Surgical Care Group 240 S Main Street Wolfeboro NH 03894 General Surgery services 50 - New England Heart Institute 369 Hounsell Avenue 5 Gilford NH 03249 Heart and Vascular services 51 - New England Heart Institute 101 Boulder Point Drive Suite 1 Plymouth NH 03264 Heart and Vascular services 52 - Cholesterol Management 166 Kinsley Street Suite 301 Nashua NH 03060 Cholesterol Management services 53 - New England Heart Institute-Nashua 166 Kinsley Street Suite 301 Nashua NH 03060 NEHI Nashua 54 - Bedford Ambulatory Surgical Center 11 Washington Place 1 Bedford NH 03110 Gastroenterology services 55 - Surgical Care Group 11 Washington Place 1 Bedford NH 03110 General Surgery services 56 - New England Heart Institute 1 Parkland Drive Derry NH 03038 Heart and Vascular services 57 - New England Heart Institute 172 Kinsley Street Nashua NH 03060 Heart and Vascular services 58 - Surgical Care Group 172 Kinsley Street Nashua NH 03060 Vascular Surgery services 59 - New England Heart Institute 16 Hospital Road Plymouth NH 03264 Heart and Vascular services 60 - Surgical Care Group 16 Hospital Road Plymouth NH 03264 General Surgery services 61 - New England Heart Institute 31 Stiles Road Salem NH 03079 Heart and Vascular services 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 $ 15,714,668. Part II, Community Building Activities: The Medical Center participates in a wide range of community building activities, committees, boards, and partnerships to promote the health of the communities it serves, including City Year, Granite United Way, and New Hampshire Charities, among others. The Medical Center sponsors emergency service efforts through planning hours for emergency preparedness and bioterrorism preparedness safety management. Part III, Line 2: Costing methodology ratio of cost to charge is used to arrive at cost of bad debt expense. Part III, Line 3: Patients deemed eligible for financial asssistance follow CMC's financial assistance policies. Therefore, no bad debt expense related to patients eligible under the Hospital's financial assistance policy is included as a community benefit. Part III, Line 4: See Footnote 2 on Page 9 of the attached audited financial statements. Part III, Line 8: The entire Medicare shortfall is reported in our Community Benefit Report to the State of New Hampshire. The Medicare shortfall represents costs incured by the Hospital for providing care to Medicare patients in the Hospital's service area that were not reimbursed by the federal government. The Hospital considers this amount to be a significant shortfall for providing healthcare-related services to these patients which ultimately benefits the community it serves. Part III, Line 9b: CMC is a charitable healthcare organization that treats patients for emergency or medically necessary care regardless of their financial status. CMC's Collections Policy and Procedures addresses the procedures for patients who choose not to make payment or work with CMC to make payment arrangements for their bill. The policy contains specific language that applies to those patients who may qualify for financial assistance. CMC will hold collection activities where the patient has submitted a completed financial assistance application. CMC makes reasonable efforts to determine whether an individual is eligible for financial assistance under our Financial Assistance Policy (FAP). In order to determine whether a patient is eligible for financial assistance, CMC provides written notice that indicates the availability of financial assistance, provides a plain-language summary of the FAP, and attempts to notify the individual orally about the FAP and how the patient may get assistance with the application process. CMC also publishes the policy on our website, at patient registration locations, and provides notice to the community. Part VI, Line 2: In collaboration with the city of Manchester and other health care and social service agencies, Catholic Medical Center participates in a community needs assessment as required by the New Hampshire Attorney General's Office Division of Charitable Trusts.Since hospitals are required to assess the needs of their community every three years, CMC has completed a 2016 Needs Assessment and approved by the board and made widely available to the public during the fiscal year covered by the Hospital's 2016 Form 990. The previous Needs Assessment was completed in fiscal year 2013 by CMC and the Elliot Hospital of the City of Manchester. Additional information is obtained on an ongoing basis to assist the Organization in evaluating progress towards meeting our goals and the identification of new areas of need. This information is collected through community surveys, focus groups and discussions with community leaders, program evaluations and communication with those in the community who interact with our vulnerable populations. Part VI, Line 3: Patients are notified of CMC's FAP via notices upon registration, discharge, postings to our website, in the hospital, and physician practices. Signage is posted throughout the Hospital and physician practices highlighting Catholic Medical Center's financial assistance. CMC also communicates the policy to the community via mailings and other postings in relevant local support organizations. CMC also contacts patients verbally to inform them of the programs available. Part VI, Line 4: Catholic Medical Center's primary service area consists of the following towns and cities: Allenstown, Auburn, Bedford, Candia, Deerfield, Dunbarton, Goffstown, Hooksett, Manchester, and New Boston. Our secondary service area is made up of Amherst, Bow, Chester, Derry, Londonderry, Merrimack, Raymond, and Weare. Part VI, Line 5: Catholic Medical Center is involved in numerous community initiatives to improve the health outcomes of our community, including, but not limited to the following: DSRIP 1115 Waiver, N4H a federally funded program with the state of New Hampshire to transform care by integrating primary and behavioral health care to improve health outcomes; a collaboration with The Manchester Health Department, Easter Seals, and Catholic Medical Center to provide school-based dental care to school-aged children in need. Services are provided at all Manchester elementary and middle schools along with one of the high schools; partnership with Dartmouth Hitchcock Clinic for the integration of dental care within a pediatric clinic setting, improving oral health and overall health and a partnership with Manchester Community Health Center to provide oral health exams hygiene and a referral to a dental home for children ages 1-5; 500 Cities initiative with CMC's Parish Nurse Program and Manchester Health Department to offer assessments and services to high risk populations located within neighborhoods; primary care, specialty care and care coordination the homeless population via the HRSA grant; Medication Assistance Program offering free or reduced cost medication through the pharmaceutical companies and other low cost resources; emergency bioterrorism preparedness safety management. Part VI, Line 6: Catholic Medical Center operates as part of CMC Healthcare System. Under the System, CMC offers a range of healthcare services to the community. The System includes CMC as a licensed, 330 bed full-service, acute care hospital, physician practices, general care surgical capabilities, and advanced care for cardiac needs. Catholic Medical Center offers full medical-surgical care with more than 25 subspecialties, comprehensive orthopedic care, inpatient and outpatient rehabilitation services, a 24-hour emergency department, outpatient behavioral health services, and diagnostic imaging. In addition, Catholic Medical Center has the Special Care Nursery which is a state-of-the-art neonatal facility designed to meet the distinct needs of our babies and their families. Catholic Medical Center is also home to the nationally recognized New England Heart and Vascular Institute (NEHVI), which provides a full-range of cardiac services, and is a pioneer in offering innovative surgical procedures. The Institute is also a national center for advanced clinical trials and cardiovascular rehabilitation and wellness education to help patients recover in a multi-step program of exercise, education, risk factor management, and the development of healthy lifestyles. The System also participates in a joint venture, Bedford Ambulatory Surgical Center, through its wholly-owned entity, Alliance Ambulatory Services, and Tuft's Health Freedom Plan through the Granite Health Network.CMC has a deeply rooted history of providing care to those most in need through the Community Health Services department. CMC reaches beyond the walls of the hospital and into the community, assisting underserved individuals with health information and access to care. Community Health Services provides a wide variety of education, clinical services and resources for those in our primary and secondary markets. It is the home of the Pregnancy Care Center, the Poisson Dental Facility, the Health Care for the Homeless program, and the Parish Nurse program. We provide medication assistance, breast and cervical cancer screenings, health screenings, and fertility education. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 219672 New Hampshire Health Protection Program for Medicaid Expansion 1 0 Part I, Line 2: The Hospital only makes donations to 501(c)(3) public charities or governmental municipalities. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Robert A Catania MD Director 0 534505 0 0 0 0 0 18550 0 24169 0 577224 0 0 Louis I Fink MD Director 0 451443 0 145289 0 0 0 21200 0 4202 0 622134 0 0 Keith A Stahl MD Director (end 1/17) 0 320787 0 0 0 660 0 21200 0 3416 0 346063 0 0 Joseph Pepe MD President & CEO 565413 0 184246 0 51227 0 21200 0 38104 0 860190 0 0 0 Edward Dudley III Exec. VP & CFO 358414 0 102383 0 43935 0 15900 0 48462 0 569094 0 0 0 Alexander Walker Esq Exec. VP, Operations 349826 0 104707 0 62427 0 15900 0 57004 0 589864 0 0 0 William Goodman MD Chief Medical Officer 395492 0 0 0 62429 0 13255 0 23315 0 494491 0 0 0 Carolanne O'Sullivan VP of Physician Practices 238194 0 63729 0 24945 0 17814 0 9559 0 354241 0 0 0 Robert Duhaime Chief Nursing Officer 233670 0 40926 0 5797 0 19012 0 22799 0 322204 0 0 0 Merryll Rosenfield VP of Human Resources 209975 0 34752 0 7972 0 13310 0 27093 0 293102 0 0 0 Lucille Mulla VP Operations/Emergency Services 187280 0 29818 0 5102 0 15169 0 6287 0 243656 0 0 0 Thomas Della Flora VP Chief Information Officer 212665 0 38487 0 0 0 12087 0 26649 0 289888 0 0 0 Part I, Line 1a Catholic Medical Center provides certain fringe benefits that have gross-up calculations to cover taxes for a select few officers and/or highly compensated employees. In no case did this amount exceed $15,000 during the year for any one individual. Part I, Line 4b The following individuals take part in a section 457(f) forfeitable nonqualified deferred compensation plan. The following represents contributions for many years of service: Joseph Pepe: $244,989 Edward Dudley, III: $121,316 Alexander Walker: $110,346 The amounts above were paid during the fiscal year ending June 30, 2017. As IRS instructions require that Form 990, Part VII and Schedule J, Part II report compensation and benefits for the calendar year ending within the fiscal year, these amounts will be reflected on the organization's 2017 tax return filing. Part I, Line 7 A portion of compensation is at-risk and variable, and payment depends on the quality of job performance. A New Hampshire Health And Education Facilities Authority 020279866 64461TCV4 2006-05-24 33380829 Construction & Defeasance Escrow 1 0 0 B New Hampshire Health And Education Facilities Authority 020279866 644614x79 2012-12-19 38249382 See Part VI 0 0 0 C New Hampshire Health And Education Facilities Authority 020279866 2015-09-03 32720000 See Part VI 0 0 0 A 3050000 29860000 33380829 517960 20559500 2009 0 1 1 1 B 7825000 38249382 573155 3035221 2013 1 0 1 1 C 650000 32720000 257332 3828187 2016 1 1 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 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 Schedule K, Part I, Line B(f): Refinance of Series 2002A Bonds Refinance of Series 2002B Bank Placement Refinance of Series 2012 Capital Note Routine Capital Improvements Schedule K, Part I, Line C(f): Advance & Current refunding of Series 2006 Bonds, and Construction Schedule K, Part IV, Line 5: The 2006 series bonds were invested in a guaranteed investment contract during the fiscal year that expired on June 1, 2016. X 1 1021 Stock Exchange Price X 10 22262 Per Books X Gift Basket Items 5 6375 Per Books X Various Tickets 22 2764 Per Books X Desk 1 250 Per Books 0 1 0 Form 990, Part VI, Section A, line 4 The following updates were made to the bylaws of the filing organization during the fiscal year: 1. The number of members was changed from one to two by adding GraniteOne Health. 2. A "Reserved Powers of the Members" section was added to the bylaws, which outlines the role of the members in governance. 3. The maximum number of trustees was changed from 21 to 18. 4. The duties of the secretary, an organization officer, were updated to include, "cause to be kept accurate records of all meetings of the board of trustees." 5. The duties of the treasurer, an organization officer, were updated to include general oversight of "the integrity of CMC's financial affairs, funds and securities," as well as "through a delegation of authority to the chief financial officer, will cause to be kept accurate books of account of all corporate transactions, and will generally oversee the creation of an annual report reflecting the financial condition of CMC and the result of its annual operation and such other reports as the board may request." 6. A section was added that clarifies board officers receive no compensation other than reimbursement for actual costs incurred in the carrying out of official CMC duties. 7. An article was added to the bylaws differentiating corporate officers, which include the president & CEO and vice presidents, from the board officers. 8. The section outlining the responsibilities of the president and CEO was amended to include meeting with and advising the board of trustees, the executive committee, and all other committees, as well as noting this position is responsible for "the systematic preservation of all minutes and records of the CMC." 9. The section regarding loans was updated to note that any loans contracted by CMC have to be approved by both members. 10. The article regarding conflicts of interest was updated to clarify that all trustees must sign an annual statement. 11. A section was added to the article regarding conflicts of interest that states, "transactions between former trustees or officers of CMC and CMC or its affiliated entities are prohibited for two (2) consecutive years after the end of the former trustee or officer's term, unless the board of trustees voluntarily go through the conflict of interest process set forth in Section I of this Article X and compliance with the standards of NHRSA 7: 19-a." 12. The article regarding amendment of the bylaws was updated to reflect that both members must approve any amendments. Form 990, Part VI, Section A, line 6 The members of Catholic Medical Center are CMC Healthcare System and GraniteOne Health. Form 990, Part VI, Section A, line 7a Directors of CMC are appointed by the members. Form 990, Part VI, Section A, line 7b The members have reserved powers over CMC but do not approve each separate action taken by the CMC board. Form 990, Part VI, Section B, line 11b Form 990 is prepared by an independent tax accounting firm (Baker Newman Noyes). Upon completion, a draft of the Form 990 is sent to the Organization, where the CFO, Controller, and Director of Accounting perform a final in-house review prior to submission to the Board of Directors for final approval. Upon approval from Board, the Form 990 is filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c Officers and directors are required to complete a conflict of interest questionnaire annually. Form 990, Part VI, Section B, line 15 CMC utilizes a compensation committee of the board of directors to set compensation levels and determine bonus potential for its senior leadership team. The committee is assisted by an independent consultant who surveys like-sized and performing institutions to benchmark relevant salary scales for each position. The consultant's findings are presented to the compensation committee who considers that external data with actual performance against a list of pre-established goals per senior leaders to set prospective compensation levels and bonus values. Bonus amounts are determined by how well an executive achieves a pre-defined set of goals. These goals, in general, are tied to the achievement of a specific task or project. Some goals are attached to achieve overall financial performance and mission performance, not solely revenue generation. Form 990, Part VI, Section C, line 19 CMC makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Net Transfer (to) from Affiliates -39,256,500. Pension Related Changes Other than Net Periodic Cost 10,607,844. Change in Interest in Perpetual Trust 503,347. Change in Fair Market Value of Interest Rate Swap 423,212. Net Assets Released Used in Operations 90,300. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. CMC Ancillary Health Services LLC 100 McGregor Street Manchester NH 03102 464389318 Ancillary Health Services NH 23692 0 Catholic Medical Center Alliance Resources 100 McGregor Street Manchester NH 03102 020398138 Real Estate NH 501(c)(3) Line 12b, II CMC Healthcare System 0 Alliance Health Services 100 McGregor Street Manchester NH 03102 611508839 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 CMC Healthcare System 100 McGregor Street Manchester NH 03102 010568516 Parent NH 501(c)(3) Line 12b, II N/A 0 CMC Physician Practice Associates 100 McGregor Street Manchester NH 03102 020460245 Practices NH 501(c)(3) Line 10 CMC Healthcare System 0 St Peter's Home 100 McGregor Street Manchester NH 03102 020222228 Day Care Services NH 501(c)(3) Line 10 CMC Healthcare System 0 Alliance Ambulatory Services 100 McGregor Street Manchester NH 03102 020519436 Ambulatory Surgical Center NH 501(c)(3) Line 10 CMC Healthcare System 0 GraniteOne Health 100 McGregor Street Manchester NH 03102 814663563 Supporting Organization NH 501(c)(3) Line 12a, I N/A 0 Monadnock Community Hospital 452 Old Street Road Peterborough NH 03458 020222157 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 Huggins Hospital 240 South Main Street Wolfeboro NH 03894 020223332 Hospital NH 501(c)(3) Line 3 GraniteOne Health 0 McGregor Street MOB LLC 100 McGregor Street Manchester NH 03102 134347316 Medical Office Building NH N/A Bedford Ambulatory Surgical Center LLC 11 Washington Place Bedford NH 03110 020519727 Surgical Center NH N/A Alliance Enterprises 100 McGregor Street Manchester NH 03102 020386795 Real Estate NH Catholic Medical Center C 311804 2358406 1.00000 1 Doctors' Medical Association Inc 100 Mcgregor Street Manchester NH 03102 020340690 Medical Office Building NH N/A C 0 0 0 1 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 McGregor Street MOB LLC K 1149689 Actual Per Books