2018-04-16T09:33:26-05:00 2017-09-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2016-10-01 020483054 Southern New Hampshire Medical Center SOUT 6035772000 8 Prospect Street PO Box 2014 Nashua NH 030612014 Michael S Rose President/CEO 6035772000 2018-03-30 Nicholas E Porto P01310283 8002447444 2018-03-30 208.105.168.164 2018-03-30 14:35:46 ED P 46219B110BB01DB00818597C9DEF2B5BDD04BE5D 2CC4C4610C7CE537855CCDE76D04A8640C960E3E 2016 2021-01-29 14:40:06Z Michael S Rose 8 Prospect Street PO Box 2014 Nashua NH 030612014 250235829 0 X www.snhhealth.org X 1892 NH Southern New Hampshire Medical Center is committed to improving, maintaining, and preserving the overall health and well being of individuals living in the Greater Nashua area by providing information, education, and access to exceptional health and medical care services. 15 14 1850 320 411335 -32692 631273 343654 216295203 234127511 12705355 8628371 4396815 1809131 234028646 244908667 0 0 0 0 107973735 111429737 0 0 0 79465985 84930116 187439720 196359853 46588926 48548814 381247568 404931478 175961043 159273739 205286525 245657739 X Southern New Hampshire Medical Center is committed to improving, maintaining, and preserving the overall health and well being of individuals living in the Greater Nashua area by providing information, education, and access to exceptional health and medical care services. 0 0 152710538 237345804 Provides acute healthcare services to a diverse population base including indigent within southern and central New Hampshire. Southern New Hampshire Medical Center is a nonprofit hospital, serving all who need care, regardless of ability to pay. Medical services provided included 9,652 inpatient admissions, 232,444 outpatient registrations, 41,053 emergency room visits, 4,873 surgical procedures, and 1,248 births. 5820421 Charity Care ($3,008,719) and other uncompensated care ($2,811,702) at cost. 2865237 Community health services and health professional education. 161396196 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 222 0 1 1850 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X Paul Trainor 6032819290 8 Prospect Street Nashua NH 03061 X Robert B Eisenberg Trustee 1.00 2.00 X 0 0 0 Colleen P Guiry MD Trustee 1.00 2.00 X 0 0 0 Holly J Harmon-Morse Trustee 1.00 2.00 X 0 0 0 Mary Jordan Trustee 1.00 2.00 X 0 0 0 Judge Clifford R Kinghorn Jr Trustee 1.00 2.00 X 0 0 0 Martha E O'Neill Esq Trustee 1.00 2.00 X 0 0 0 Thomas A Pursch Trustee 1.00 2.00 X 0 0 0 Marc Sadowsky MD Trustee 1.00 2.00 X 0 0 0 Marlene Santiago MD Trustee 1.00 2.00 X 0 0 0 James K Steiner Trustee 1.00 2.00 X 0 0 0 Charla B Stevens Esq Trustee 1.00 2.00 X 0 0 0 Praveen K Suchdev MD Trustee 1.00 2.00 X 0 0 0 Joseph M Leahy DO Trustee (end 1/17) 40.00 2.00 X 428850 0 43452 Timothy C Sullivan Esq Board Chair 2.00 1.00 X X 0 0 0 Timothy J Whitaker Board Vice Chair 2.00 1.00 X X 0 0 0 Michael S Rose Pres./CEO & Secretary 40.00 2.00 X X 490283 0 102677 Paul Trainor Treasurer 40.00 2.00 X 260793 0 12363 Bernard M Bettencourt Jr DO Physician 40.00 0.00 X 365120 0 29327 Harold Range Hutson MD Physician 40.00 0.00 X 352725 0 23834 Brett J Sweeney MD Physician 40.00 0.00 X 344926 0 6564 Daniel Weidner MD Physician 40.00 0.00 X 341418 0 40752 Andrew Watt MD VP Medical Infomatics/Physician 40.00 0.00 X 380356 0 33035 Thomas E Wilhelmsen Pres./CEO & Secretary (thru 7.1.16) 0.00 0.00 X 4155561 0 107043 7120032 0 399047 116 1 1 0 Fulcrum Associates 5 Tech Circle Amherst NH 03031 Construction 3673926 Cerner Corporation 51 Sawyer Road Waltham MA 02453 System Support 1502657 Weatherby Locum 6451 North Federal Highway Suite 8 Fort Lauderdale FL 33308 Healthcare Staffing 1368191 Sodexo Inc 9801 Washington Boulevard Gaithersburg MD 20878 Food Services 989263 Arup Laboratory 500 Chipeta Way Salt Lake City UT 84108 Lab Services 861076 29 343654 343654 Hospital Services 621110 243975103 243975103 Provision for Bad Debt 621110 -9847592 -9847592 234127511 8260513 8260513 4269783 0 4269783 4269783 3206340 1063443 5695020 5317980 9182 377040 -9182 367858 367858 Ancillary- NE Rehab Food Services 722210 327229 327229 Ancillary- NE Rehab Environmental 811000 77866 77866 Loss on Bond Refunding 900099 -2883940 -2883940 18193 11953 6240 -2460652 244908667 237345804 411335 6807874 1338418 472302 866116 93523765 73951996 19571769 2605228 2157967 447261 7514906 6128634 1386272 6447420 5340538 1106882 565138 565138 150000 150000 11294498 9849183 1445315 1070276 1070276 716601 716601 2151984 1782535 369449 4859578 4025294 834284 34831 28851 5980 299107 247757 51350 3633686 3009861 623825 4762589 4762589 11747911 9731049 2016862 1224127 1013971 210156 Supplies 25155934 23041087 2114847 New Hampshire Medicaid 11415308 11415308 Repairs and Maintenance 1729147 1432290 296857 Food Services 913802 756922 156880 3205599 2248062 957537 196359853 161396196 34963657 0 29963038 26894181 14599176 14663521 21296553 24839833 3455619 3190760 5128657 5739154 278023530 161519199 119690993 116504331 170515567 199098734 6018217 5336788 10579748 8664176 381247568 404931478 46763811 46666467 1845556 93652708 92671034 35544524 18090682 175961043 159273739 X 202805412 243062962 115599 229263 2365514 2365514 205286525 245657739 381247568 404931478 X 48548814 7894852 -16072452 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 23645 0 0 0 23645 0 Part II-B, Line 1: 21.78% of dues to American Hospital Association and 16.36% of dues to New Hampshire Hospital Association are available for lobbying expenses. 81781493 10370559 92152052 74065311 7716182 81781493 75259613 -1194302 74065311 68039314 7220299 75259613 60583371 7455943 68039314 0.97430 0.02570 0.00000 0 0 14725459 14725459 161612826 82982765 78630061 3874406 2008987 1865419 94337668 76527447 17810221 3473171 3473171 116504331 Unearned Income - MOB 115243 Insurance Reserves 2980602 Other Liabilities SERP 1029149 Accrued Pension Expense - LT 10857965 457 (B) Deferred Comp Plan 3107723 18090682 X Part V, Line 4: The intended uses of the Organization's endowment funds are to fulfill donors' intentions on the permanently restricted funds and for future plant replacement and technology investments from board designated funds. Part X, Line 2: The System, Medical Center and Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. 1 1 1 X 225.000000000000 0 1 1 1 0 1 1 3008719 3008719 0.01530 34173262 23185474 10987788 0.05600 37181981 23185474 13996507 0.07130 151254 151254 0.00080 1851978 1851978 0.00940 3366337 1803427 1562910 0.00800 0 716078 716078 0.00360 6085647 1803427 4282220 0.02180 43267628 24988901 18278727 0.09310 25205 25205 0.00010 5660 5660 0.00000 46197 46197 0.00020 5137 5137 0.00000 82199 82199 0.00030 1 9847592 2811702 49629924 54583192 -4953268 X 1 1 1 1 Southern New Hampshire Medical Center 8 Prospect Street PO Box 2014 Nashua NH 030612014 www.snhhealth.org 02496 X X X X Southern New Hampshire Medical Center 0 0 1 X X X X X X X X 15 1 1 1 1 X www.snhhealth.org/community-health X 1 15 1 www.snhhealth.org/community-health 0 1 X 225.000000000000 X X X X X 1 1 X X X X 1 X http://www.snhealth.org/billing-and-insurance/charitable-care-policy X http://www.snhhealth.org/billing-and-insurance/get-help-paying-for-care X http://www.snhealth.org/billing-and-insurance/charitable-care-policy X X X X X 1 X 0 X 1 X 0 1 Southern New Hampshire Medical Center Part V, Section B, Line 5: During the process of developing the Community Health Needs Assessment, Nashua residents, medical providers and key leaders in the community were asked to rank the health of the community and to prioritize the needs.The process through which this Assessment was conducted included ten focus groups with a total of 104 participants. The focus groups were comprised of a broad and diverse cross-section of the community and included residents key leaders, and healthcare providers. The focus groups were assigned with the task of evaluating the health of the community and ranking and prioritizing identified needs. Of the 10 focus groups, three were topic-specific focus groups with professionals and 7 were geographically organized with a combination of residents, key leaders, and healthcare providers. Below is a listing of the Focus Groups that were conducted, along with the number of participants: Oral Health Professionals, 8; Aging Population Professionals, 14; YouthBehavioral Health Professionals, 10; Milford Combined Group, 12; Milford Healthcare Professionals & Key Leaders, 12; Merrimack Combined Group #1, 15; Merrimack Combined Group #2, 12; Hudson Combined Group, 2; Nashua Residents-South, 16; Nashua Residents-North, 3 Southern New Hampshire Medical Center Part V, Section B, Line 6a: Southern New Hampshire Medical Center's Community Health Needs Assessment was a collaboration of City of Nashua Health Department and other stakeholders, including St. Joseph Hospital. Southern New Hampshire Medical Center prepared its own separate assessment, based on that information. Southern New Hampshire Medical Center Part V, Section B, Line 6b: The Hospital's Community Health Needs Assessment was a collaboration of City of Nashua Health Department and other stakeholders, including St. Joseph Hospital. Southern New Hampshire Medical Center prepared its own separate assessment, based on that information. Southern New Hampshire Medical Center Part V, Section B, Line 11: The top needs that were identified in the Community Health Needs Assessment were Mental Health/Substance Abuse, Access to and Coordination of Care, Opportunities for Healthy Living/Obesity. Southern New Hampshire Medical Center has addressed these needs in the following manner:Mental Health/Substance Abuse - Southern New Hampshire Health expanded our inpatient behavioral health unit from 12 to 18 beds. We also expanded our Partial Hospital Program and opened an Intensive Outpatient Addiction program to address substance misuse in the community. Our Acute Community Crisis Evaluation System is available 24/7 to assist in assessment and triage of patients in crisis. There are staffed psychiatrists that assist with treatment and evaluation of patients that are inappropriate for the voluntary unit. Southern New Hampshire Health is helping drive the transformation of our care delivery system by acting as the lead organization for the DSRIP Grant in the Greater Nashua Region, which focuses on behavioral health and substance uses disorders (SUD). Also hired a SUD Case Manager in the Emergency Department. Also, increased office based capacity for Medication management and Therapy services.Access to and Coordination of Care - Southern New Hampshire Health established multiple Immediate Care Locations within our service area to enhance access to timely care. Southern New Hampshire Health recently opened new locations in Pepperrell, MA and Amherst, NH. There is staff available on site at the hospital to assist with Medicaid & Expanded Medicaid applications. We actively participate in Medicaid Exchange programs and a Prescription Assistance Program to help those withFinancial needs. Southern New Hampshire Health has partnered withMassachusetts General Hospital to provide local access to over 35 Boston area specialists. Our OB/GYN Residency program expands access to Woman's Health for low income patients in collaboration with Lamprey. We also have Interpreter Services available 24/7 for those who need it. Opportunities for Health Living/Obesity - Southern New Hampshire Health supports a variety of health programs in the community, such as Granite State Fit Kids, Prescribe the "Y and Fitness 4 Everybody. All Pediatric practices record weight and there is a protocol in the ED to record weight on all patients < 18 years old. Various health and fitness classes are offered to the public at our facility during the course of the year. Our Primary Care practices are providing community based programs and have partnered with Massachusetts General Hospital on a pediatric obesity project. For more information on how Southern New Hampshire Medical Center is addressing the needs identified in the CHNA, our Implementation Strategy is available on our website at www.snhhealth.org/community-health Southern New Hampshire Medical Center Part V, Section B, Line 13b: Southern New Hampshire Medical Center offers a discount equal to theaverage of their three largest payors plus Medicare to all self pay patients. Southern New Hampshire Medical Center Part V, Section B, Line 20e: See response for Part III, Section C, Line 9babove. Prior to placing accounts with collection agencies, Southern NewHampshire Medical Center pulls out patients who qualify for charity basedon census tract data and does not place those accounts with an agency butrather awards charity or free care assistance for their encounter. Southern New Hampshire Medical Center Part V, Section B, Line 24: Southern New Hampshire Medical Center may charge patients who are having cosmetic or experimental, non-covered services gross charges for that encounter. 5 1 - Southern New Hampshire Rehab - Hudson 300 Derry Road Hudson NH 03051 Rehab 2 - Southern NH Rehabilitation Services 696 Daniel Webster Highway Merrimack NH 03054 Rehab 3 - Southern New Hampshire Rehab - Milford 10 Jones Road Milford NH 03055 Rehab 4 - Southern NH Rehabilitation Center 460 Amherst Street Nashua NH 03063 Rehab 5 - Southern NH Rehabilitation Center 17 Prospect Street Nashua NH 03060 Rehab Part I, Line 3c: Southern New Hampshire Medical Center offers a discount equal to theaverage of their three largest payors plus Medicare to all self pay patients. Part I, Line 7: The costing methodology used was the ratio of cost to charge as outlined in Worksheet 2 of the instructions. The only exception to this was for subsidized service area where the cost structure was specific to that service area. For those areas, our Cost Accounting system was used. Part II, Community Building Activities: Southern New Hampshire Medical Center is committed to improving the health and well-being of the Greater Nashua area and our community building activities help us achieve this goal. Through our involvement in the Rotary Club and Nashua Chamber of Commerce, along with other community organizations, we are able to exchange ideas with area leaders concerning health care issues and make informative decisions that best address the health needs of our community. We provide Medicare Counseling to area senior citizens giving them the guidance they need to make informed decisions about their healthcare coverage. Our support of the United Way's Day of Caring has resulted in a growing number of our employees going out into the area and helping members of the community with healthcare and other needs. We are strong in our commitment to the Greater Nashua area and plan to continue to support and grow community building activities that improve the overall health of the area. A majority of the organization's Board of Trustees is comprised of persons who reside in the Primary Service Area (PSA) who otherwise have no relationship with the organization. Many members of the organization volunteer their time to other community agencies in the PSA. Part III, Line 2: Southern New Hampshire Medical Center's Bad Debt Expense includes accounts that have been referred to a collection agency after making reasonable attempts to determine eligibility under the financial assistance policy, along with estimates of current accounts receivable based in historical experience. Part III, Line 3: A significant portion of Southern New Hampshire Medical Center's uninsured patients will be unable or unwilling to pay for the services provided. Thus, Southern New Hampshire Medical Center records a significant provision for bad debts related to uninsured patients in the period the services are provided. The FASB issued an accounting standards update that states that a health care entity that recognizes significant amounts of patient service revenue at the time services are rendered, even though it does not assess the patient's ability to pay, must present bad debts as a reduction of net patient revenue and not as a separate item in the operating expense. The ratio of cost to charge methodology was used to determine costs of these services as outlined in worksheet 2 of the instructions. Consistent with the accounting treatment mentioned above, since the system does not assess the patient's ability to pay, the cost of bad debt for those patients without any form of insurance should be classified as community benefit, consistent with charity care. Part III, Line 4: See page 8 of the attached audited financial statements. Part III, Line 8: The ratio of cost to charge methodology was used to determine cost as outlined in Worksheet 2 of the instructions. There are service areas where government programs such as Medicare and Medicaid do not reimburse the organization adequate amounts to cover the costs to provide those services. Southern New Hampshire Medical Center must provide those services regardless of the financial shortfall. Part III, Line 9b: Southern New Hampshire Medical Center recognizes that not all patients who qualify for financial assistance will follow through with an application for financial assistance. Prior to placing any account with a collection agency, Southern New Hampshire Medical Center uses a financial assistance qualification service to categorize patients based primarily on income and assets estimated from census tract data. Those patients whose estimated income/assets fall within Southern New Hampshire Medical Center's financial assistance guidelines are awarded charity or free care assistance for their encounter. Part VI, Line 2: Southern New Hampshire Health's 2015 Community Health Needs Assessment andImplementation Strategy was a collaboration with the City of Nashua andother area health partners. The 2014 Working Together to Build aHealthier Greater Nashua - Community Health Assessment was published bythe City of Nashua Division of Public Health and Community Services inOctober, 2014. The sponsors of the Needs Assessment were the City ofNashua, Southern New Hampshire Medical Center, and St. Joseph Hospital.The assessment results include information gathered from 10 focus groupsconsisting of 104 participants that represented a broad cross-section ofthe community. In conjunction with this, data was gathered from localagencies in Nashua including The Department of Health and Human Servicesand Environmental Services and national organizations such as the Centersfor Disease Control. Part VI, Line 3: At each registration point, Southern New Hampshire Medical Center hassignage and brochures explaining our various forms of financialassistance, including charity care. Additionally, patient registrarsoffer the charity brochures to self pay patients. Patients who callregarding billing concerns are offered charity assistance. Additionally,verbiage regarding charity care is printed on each billing statement thepatient receives. Also, charity care information is available on our hospital website. There is staff available on site at the hospital to assist with financial assistance, Medicaid, and Expanded Medicaid applications. We actively participate in Medicaid Exchange programs and a Prescription Assistance Program to help those with financial needs. Part VI, Line 4: Southern New Hampshire Health's service area consists of nineteen NewHampshire and four Massachusetts towns. The service area is divided intoa Primary Service Area (PSA) of thirteen New Hampshire towns (Amherst,Brookline, Hollis, Hudson, Litchfield, Lyndeborough, Mason, Merrimack,Milford, Mont Vernon, Nashua, Pelham and Wilton), a Secondary Service Area(SSA) of seven New Hampshire towns (Derry, Greenville, Londonderry, NewBoston, New Ipswich, Salem and Windham) and a Massachusetts Service Area(MSA) of four neighboring Massachusetts towns (Dunstable, Pepperell,Townsend and Tyngsboro). The 2014 Assessment refers to the Greater NashuaPublic Health Region which includes Amherst, Brookline, Hollis, Hudson,Litchfield, Lyndeborough, Mason, Merrimack, Milford, Mont Vernon, Nashua,Pelham, and Wilton, towns that are included in Southern New HampshireHealth's PSA and reflect the communities that make up the PSA, SSA andMSA. The population of the Greater Nashua Region consists of 205,845residents that are younger than the New Hampshire state average (52.5%under 40 years of age compared with 48.4% for the state), and also moreculturally diverse than the rest of the state (85.7% identified as whiteversus 94.2% for the state). Part VI, Line 5: Southern New Hampshire Medical Center provides a variety of services that promote the health of the greater Nashua community. Throughout the year we hold Community Medical Education seminars that offer area residents an opportunity to look behind the scenes of medicine and learn more about the latest medical technology, research and advances. We also perform free public health screenings, such as impact testing for sports teams at local schools, and balance and hearing screenings for the elderly. Our commitment to community health is also evident in the time our leadership spends on the boards of several local health organizations to help improve and promote health services available to area residents. Part VI, Line 6: Southern New Hampshire Health System, Inc. is a not-for-profit entity organized to support Southern NH Medical Center and Foundation Medical Partners, Inc. Both the Medical Center and Foundation are not-for-profit entities, established to provide medical services to the people of the greater Nashua area. Part VI, Line 7, Reports Filed With States NH X 1 1 X X X X 0 1 0 0 0 0 0 1 0 Joseph M Leahy DO Trustee (end 1/17) 389183 0 38425 0 1242 0 10600 0 32852 0 472302 0 0 0 Michael S Rose Pres./CEO & Secretary 394816 0 70562 0 24905 0 74060 0 28617 0 592960 0 0 0 Paul Trainor Treasurer 205500 0 26000 0 29293 0 7412 0 4951 0 273156 0 0 0 Bernard M Bettencourt Jr DO Physician 345765 0 18113 0 1242 0 0 0 29327 0 394447 0 0 0 Harold Range Hutson MD Physician 328409 0 20125 0 4191 0 10600 0 13234 0 376559 0 0 0 Brett J Sweeney MD Physician 312519 0 22375 0 10032 0 0 0 6564 0 351490 0 0 0 Daniel Weidner MD Physician 303203 0 20125 0 18090 0 10600 0 30152 0 382170 0 0 0 Andrew Watt MD VP Medical Infomatics/Physician 337066 0 42750 0 540 0 9605 0 23430 0 413391 0 0 0 Thomas E Wilhelmsen Pres./CEO & Secretary (thru 7.1.16) 298265 0 201464 0 3655832 0 96540 0 10503 0 4262604 0 3619326 0 Part I, Line 1a Southern New Hampshire Medical Center uses the facilities at the Nashua Country Club for meetings and other business related purposes. The Club does not have a corporate membership, therefore, an individual associated with Southern New Hampshire Medical Center must be a member of the Club. The membership is titled in the CEO's name and invoices are addressed to the CEO, not Southern New Hampshire Medical Center. Southern New Hampshire Medical Center pays the annual dues and all related expenses incurred by the organization. The facilities are only available to Club members. Part I, Line 4b Southern New Hampshire Medical Center provides a Supplemental Executive Retirement Plan, a 457(f) plan, to certain executives. Funding for this plan during the year was provided as follows: Michael S. Rose - $63,460, Thomas E. Wilhelmsen, Jr. - $85,940. Effective July 1, 2016 Thomas E. Wilhelmsen retired as President/CEO of the Health System. With his retirement, he received $3,619,326 in payouts from his Supplemental Executive Retirement Plan. This amount was reported as part of his taxable wages on his 2016 Form W-2 and are included in the amounts reported in Schedule J, Part II, Column B(iii). The contributions to this plan were reported in Schedule J, Part II, Schedule D as deferred compensation when paid. As contributions to this plan were reported as part of his total compensation on previously filed Form 990s, they have been further shown in Schedule J, Part II, Column F in accordance with IRS instructions. The Supplemental Executive Retirement Plan is provided to certain employees of the Health System to recognize many years of distinguished service to the organization. Part I, Line 7 There is an additional compensation plan available to managers, directors and senior management that is part of their annual performance plan. The plan takes into consideration quality measures, patient satisfaction, individual goals, budget adherence and overall organizational performance. The range and overall pool is reviewed and approved by the Board of Trustees' Executive Compensation Committee. The amount designated for the CEO and CFO are considered in the compensation consultant's analysis of executive compensation reported on the 990 Part VI section B Line 15b. Unrelated Organization Compensation Marc Sadowsky, is also the Medical Director of the Medical Center's Electro Convulsive Therapy (ECT) unit. Mr. Sadowsky receives a stipend from New England Neurological Association of $12,000 per year by ECT for his services to Southern New Hampshire Health System. A NHHEF Authority 020279866 644614SWO 2007-08-30 89836797 Refunding and New Construction 1 0 0 B NHHEF Authority 020279866 2016-06-07 10500000 Equipment Purchase 0 0 0 C NHHEF Authority 020279866 6446147E3 2016-11-01 59345000 Refunding 0 0 0 A 61300000 89836797 49731438 949525 39155834 0 1 1 1 B 10500000 25802 10474198 0 0 0 1 C 59345000 199985 59145015 0 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 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 Form 990, Part VI, Section A, line 6 Southern New Hampshire Health System, Inc., is the sole corporate member of Southern New Hampshire Medical Center (SNHMC) and the two (2) organizations have identical boards with the exception of two (2) additional members serving solely on the SNHMC board. These include a physician member and the current SNHMC chief of staff who is an ex-officio member. Form 990, Part VI, Section A, line 7a Southern New Hampshire Medical Center is governed by the Board of Trustees, who are elected by the Trustees of its sole member Southern New Hampshire Health System, Inc. Form 990, Part VI, Section A, line 7b Southern New Hampshire Medical Center is governed by the Board of Trustees, who are elected by the Trustees of its sole member Southern New Hampshire Health System, Inc. Form 990, Part VI, Section B, line 11b A copy of the 990 was presented to the full Board and approved by the Finance Committee of the Board of Trustees prior to submission. Form 990, Part VI, Section B, line 12c The organization requires all its personnel, including Leaders, to formally acknowledge that they have read and will abide by our Code of Conduct, which includes our conflict of interest policy. SNHHS/SNHMC monitors compliance of its conflict of interest process, which requires completion of disclosure forms by all Leaders on an annual basis or on a reappointment basis (every two years) for medical/allied staff, to ensure full compliance. Interim disclosures are also required and reviewed should a subsequent conflict arise. Any related party disclosures require review and approval by a designated committee. Compliance reports are provided to SNHHS/SNHMC's compliance committee and Board of Trustees. Form 990, Part VI, Section B, line 15 The compensation of the CEO and CFO is evaluated by an outside consultant. The compensation of the CEO is approved by the Executive Compensation Committee of the Board and the Board of Trustees. A market analysis is performed for all key employees on an annual basis. Once the CEO and CFO approve the final compensation figures for key employees, the CEO reports these figures to the chairperson and vice chairperson of the Board. Form 990, Part VI, Section C, line 19 The organization makes its 990 and 990-T available for inspection upon request. The Code of Conduct is also available on the organization's website. The Code of Conduct addresses certain corporate policies including confidentiality, conflict of interest, patient rights and other governing documents. The organization also makes all relevant documents available to the public upon request. Form 990, Part VII: Effective July 1, 2016, the organization's President and CEO, Thomas E. Wilhelmsen, Jr. retired. Michael S. Rose, who had previously served as Senior Vice President and Chief Financial Officer of the organization, assumed the role of President and CEO. Paul Trainor, who had previously served as Vice President of Finance, assumed the role of Senior Vice President and Chief Financial Officer. IRS instructions stipulate that compensation be reported in Form 990, Part VII and Schedule J, Part II based on the calendar year ending within the reporting entity's current tax year. Thomas E. Wilhelmsen received compensation from the Hospital in 2016 up until his retirement in July though he did not serve in his capacity as an officer of the Health System during the fiscal year covered by this Form 990 return filing. In accordance with IRS instructions, Mr. Wilhelmsen has been listed in Form 990, Part VII as a former officer and his 2016 compensation has been further disclosed in Schedule J, Part II. Form 990, Part XI, line 9: Transfers to affiliates -28,495,572. Pension Adjustment 12,423,120. Form 990, Part XII, Line 2c: The audit process has not changed from the prior year. Form 990: On October 30, 2017, the system signed a combination agreement with Elliot Health System to form a new company, Solution Health, which would become the sole member of the two healthcare systems. As of the filing date of this return, the combination agreement is pending approval by the State of New Hampshire Attorney General's office. Foundation Medical Partners Inc 8 Prospect Street Nashua NH 03060 020456218 Physician Services NH 501(c)(3) Line 10 SNHHS 0 Southern New Hampshire Health System 8 Prospect Street Nashua NH 03060 020509221 Medical Service NH 501(c)(3) Line 12a, I N/A 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 1 1 1 0