2017-11-07T16:20:31-06:00 2016-12-31 BDO USA LLP TWO INTERNATIONAL PLACE BOSTON MA 02110 990 2016-01-01 020260334 Wentworth-Douglass Hospital % PETER E WALCEK WENT 6037425252 789 Central Avenue Dover NH 03820 PETER E WALCEK CFO/V.P. of Finance 6037425252 2017-08-15 true Brian Vigneault P00540650 6174220700 162.249.80.3 04123920173115000004 2017-11-07 P 6CCC3C025DBC962C57DC39F77614343EB29704E0 BBC3B4FE2B4BE7D467FE8DB8FE274F6332A7211F 2016 2021-01-29 14:40:06Z Gregory J Walker 789 Central Avenue Dover NH 03820 385478695 false X www.wdhospital.com X 1905 NH Help individuals and their families attain their highest level of health. 16 11 2106 181 359401 185995 397761 295574889 326595372 3201407 8026968 3991739 3412048 302954030 338432149 601106 573161 0 0 122756613 137386856 0 0 0 131817023 141157155 255174742 279117172 47779288 59314977 458061852 489751477 191124100 194937183 266937752 294814294 X Wentworth-Douglass Hospital's mission is to partner with individuals and their families to help them attain their highest level of health. Wentworth-Douglass Hospital is the largest acute care hospital in the Seacoast region of New Hampshire and Southern Maine, specializing in Trauma and Emergency Services, Surgery, Cancer Care, Birthing, Orthopedic Services, Cardiovascular Services, Sleep Disorders, Pain Management, Wound Healing, Wellness and Prevention Programs, plus extensive diagnostic services. A healthcare leader in the Seacoast region since 1906, Wentworth-Douglass Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations, achieved Magnet recognition from the American Nurses Credentialing Center in 2016, and received the 2016 Distinguished Hospital Award for Clinical Excellence from Healthgrades which recognizes the top 5% of hospitals with superior clinical quality and patient outcomes across a broad spectrum of services. false false 244076511 573161 328112460 Wentworth-Douglass Hospital (WDH or the Hospital) is an acute care hospital located in Dover, New Hampshire. WDH is a not-for-profit organization, as described in Section 501(c)(3) of the Internal Revenue Code. Wentworth-Douglass Hospital is the largest acute care hospital in the Seacoast region of New Hampshire and Southern Maine, specializing in Trauma and Emergency Services, Surgery, Cancer Care, Birthing, Orthopedic Services, Cardiovascular Services, Sleep Disorders, Rehabilitation, Pain Management, Wound Healing, Wellness, and Prevention Programs plus extensive diagnostic services. A healthcare leader in the Seacoast since 1906, Wentworth-Douglass Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. (continued on Schedule O). 244076511 true true false true false false false false false true true true false false true true false true false false true false false false false false true true true false true true false false false false false true false true false false false false false false true true true false false false true 315 0 true 2106 true true true false false false false false false false false false X 16 11 false false true false true true true true true false false true true true true true true true true true true NH X X PETER E WALCEK 6037402804 789 CENTRAL AVENUE Dover NH 03820 Michael Bolduc Esq Trustee 0.5 1.0 X 0 0 0 Gerald Daley EdD Trustee 0.5 1.0 X 0 0 0 Peter J Dirksmeier MD Trustee 2.0 1.0 X 68047 0 12938 David Flavin MD Trustee 2.0 1.0 X 2814 0 0 Neil Garvey Trustee 1.5 1.0 X 0 0 0 Anne Kalter MD Trustee 0.5 43.5 X 54112 228215 36072 Ingo Roemer Trustee 0.5 1.0 X 0 0 0 John Novello MD Trustee 0.5 50.0 X 0 350363 32392 Donna Rinaldi Trustee 0.5 1.0 X 0 0 0 Roger Hamel Chairman 3.0 4.0 X X 0 0 0 Carol Bailey Vice Chairman 3.0 2.0 X X 0 0 0 Michael Steinberg Treasurer 1.0 4.0 X X 0 0 0 John Salmon Secretary 3.0 2.0 X X 0 0 0 Gregory J Walker President/CEO 50.0 5.0 X X 820180 0 149567 Theodore Ristaino Trustee 0.5 1.0 X 0 0 0 Steven C Webb Trustee 0.5 1.0 X 0 0 0 Peter E Walcek CFO/VP Finance 50.0 5.0 X 451233 0 90080 Paul R Cass DO VP Medical Affairs/CMO 50.0 5.0 X 465716 0 94298 Ellen L Caille FACHE Executive Vice President 50.0 5.0 X 403334 0 87458 Malcom D Rosenson MD Chief of Quality & Safety Offi 50.0 0.0 X 344689 0 32043 Sheila M Woolley CNO/VP Patient Care 50.0 0.0 X 445527 0 59745 Daniel N Dunn COO/Sr. VP Operations 50.0 0.0 X 293268 0 34422 3348920 578578 629015 166 false true false Center Health Services Inc 51 Valley Stream Parkway MALVERN PA 19355 Healthcare IT Suppor 3453358 Sodexo Inc Affiliates 9801 Washington Boulevard GAITHERSBURG MD 20878 Food Services/Manage 1758060 American Healthcare Services Associ PO Box 845 TRAVERSE CITY MI 49685 Staffing Services 1573956 Mass General Physician Org Inc 55 Fruit Street BOSTON MA 02114 Physician Services 1570973 ARUP Laboratories 500 Chipeta Way SALT LAKE CITY UT 84108 Laboratory Services 1217853 86 288280 109481 397761 PATIENT SERVICE REVENUE 021400 308154511 308154511 DISPROPORTIONATE SHARE FUNDING 021400 12989293 12989293 MISCELLANEOUS REVENUE 021400 2969444 2889299 80145 CAFETERIA 722302 1435672 1392909 42763 CHILD CARE SERVICE 624410 1046452 1046452 326595372 4091726 236493 3855233 0 0 2108122 272970 1835152 0 1835152 1835152 50654608 54210 46742360 31216 3912248 22994 3935242 3935242 0 0 0 0 0 0 0 0 0 GRANITE SHIELD 621990 1190824 1190824 TRANSCRIPTION 621400 340813 340813 MEANINGFUL USE 621400 45259 45259 1576896 338432149 328049360 359401 9625627 573161 573161 0 0 0 1831966 164239 1667727 0 104120183 88502156 15618027 3522874 2994443 528431 18437401 15671791 2765610 9474432 8053267 1421165 0 933388 933388 133383 133383 0 0 162533 162533 16108633 15311253 797380 2003991 2003991 4271173 3630497 640676 0 0 3779633 2967012 812621 203605 152704 50901 0 305408 229056 76352 6926818 6580477 346341 0 17037953 14482260 2555693 2215297 2104532 110765 MEDICAL SUPPLIES/EQUIPMENT 24681081 20978919 3702162 PHARMACY 22914284 22914284 NHMET 15894986 15894986 PROVISION FOR BAD DEBT 13149341 13149341 10435648 7718142 2717506 279117172 244076511 35040661 0 84377 89648 40667833 38096499 0 0 31561120 37006895 731397 760653 0 0 0 0 3612673 3714233 11453491 13384674 398470973 234817017 145040517 163653956 136797516 125906269 49573127 73109145 19258742 23022356 1156022 1259165 18125037 9747984 458061852 489751477 53623283 62958581 0 0 4098670 4715844 104391195 109843430 0 0 0 0 10555094 0 0 0 18455858 17419328 191124100 194937183 X 262706459 290296190 1980760 2119304 2250533 2398800 266937752 294814294 458061852 489751477 X 59314977 -834749 -30603686 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 22566 false false false 22566 false Part II-B, Line 1, Lobbying Activities NHHA - portion of dues allocated to lobbying $15,670 AHA - portion of dues allocated to lobbying $6,896 183003785 12438998 6260859 821480 166665 200715497 184151455 6020457 -4955781 2011173 201173 183003785 155843253 24445585 4767464 720042 184805 184151455 141970819 7535354 17191881 10712136 142665 155843253 131278421 14909922 11895737 16019486 93775 141970819 0.97170 0.00410 0.02420 false false 3292772 3292772 171758706 60861056 110897650 19739976 7786871 11953106 157259073 129126152 28132921 46420446 37042940 9377507 163653956 ALTERNATIVE INVESTMENTS 73109145 F 73109145 0 EST. THIRD-PARTY PAYOR SETTLEMENT 17419328 17419328 X 306607780 306607780 162533 31661836 31824369 338432149 279117172 279117172 279117172 PART V, LINE 4: TO FURTHER THE HOSPITAL'S CHARITABLE MISSION. PART X, LINE 2: WDHS, THE HOSPITAL, WDPC AND THE 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 PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT EVALUATED THESE NOT-FOR-PROFIT CORPORATIONS' TAX POSITIONS AND CONCLUDED THESE NOT-FOR-PROFIT CORPORATIONS HAVE MAINTAINED THEIR TAX-EXEMPT STATUS, DO NOT HAVE ANY SIGNFICANT UNRELATED BUSINESS INCOME AND HAVE TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENTS IN JOINT VENTURE $30,075,318 COMMUNITY BENEFIT AND OTHER EXPENSE $1,586,518 TOTAL TO SCHEDULE D, PART XI, L $31,661,836 Central America and the Caribbean 0 0 Investments NONE 29990088 0 0 0 0 29990088 29990088 true false true true false false PART IV, LINE 3: THIS ORGANIZATION DID NOT HAVE AN OWNERSHIP OF ANY FOREIGN CORPORATION THAT WOULD BE GREATER THAN THE 10% OWNERSHIP FILING THRESHOLD. ACCORDINGLY, THE IRS FORM(S) 5471 IS NOT REQUIRED TO BE FILED. PART IV, LINE 4: THE ORGANIZATION MEETS THE EXCEPTION FOR TAX-EXEMPT ORGANIZATIONS WITH RESPECT TO FILING FORM 8621. FORM 8621 IS NOT REQUIRED TO BE FILED FOR THE HOSPITAL. true true true X 250. false true true false true true 2062950 2062950 0.00780 39690278 30417577 9272701 0.03490 41753228 30417577 11335651 0.04260 1183509 1183509 0.00440 25094 25094 0.00010 684163 684163 0.00260 1892766 1892766 0.00710 43645994 30417577 13228417 0.04970 false 13149341 914075 77254450 112501014 -35246564 X true true 1 1 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 www.wdhospital.com 00010 X X X Wentworth-Douglass Hospital 1 false false true X X X X X X X X 16 true false true true X See Part V, Section C X true 16 true See Part V, Section C false false true X 250. 250. X X true true X X X X true X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X true X false X X X X true false false Part V, Section B, Line 5: Wentworth-Douglass Hospital held twenty-one (21) focus groups and interviews to engage consumers, providers and key leaders in the Community Health Needs Assessment (CHNA). Participants were identified and recruited by the Hospital, including members of the public, community organizations, local government officials, and health, education and social service providers. Participants were from geographic areas that represent our community or who represent various stakeholder groups such as public health representatives, first responders, the local housing authority, school nurses, and others. Groups also included physicians, nurses, social workers, and program directors. A summary of the themes from the stakeholder interviews, as well as demographic characteristics of respondents and their ratings are included in the 2016 CHNA report. Part V, Section B, Line 6b: The Hospital's most recent CHNA was conducted with Wentworth-Douglass Physician Corp (WDPC), a related 501(c)(3) entity. Part V, Section B, Line 11: The Community Health Needs identified in the 2016 CHNA include Affordability of Care and Insurance Barriers; Community Health Education; Dental Health and Access to Dental Health Care; General Healthcare and Access to Primary Care Services; Mental Health and Access to Mental Health Services; Needs of the Aging Population; Obesity, Nutrition, and Physical Activity; Poverty and Lack of Economic Opportunity; Substance Misuse and Access to Substance Misuse Treatment Services; and Transportation. WDH has organized and implemented the following services and programs to begin to address these needs. 1. Affordability of Care and Insurance Barriers: In order to address barriers to affordability of care and insurance, Wentworth-Douglass Hospital (WDH) has continued to provide financial assistance to individuals and families receiving services from WDH and other providers within the Wentworth-Douglass system. This includes offering financial assistance, continuing to provide Marketplace and Medicaid enrollment assistance, and development of educational resources to improve insurance literacy, support Medicare enrollment of eligible individuals, and to provide education regarding the availability of financial recources. 2. Community Health Education: Expanded education and prevention programs were identified as a need. In response, WDH offered a variety of education/prevention programs for the community. A sampling of these education/prevention programs include: health screenings(e.g. skin cancer screening, hand pain, vascular, nutrition, and more), nutrition, health, and wellness lectures(e.g. heart health, sexual health, and anti-cancer), health fairs (e.g. diabetes, women's health, communication access), support groups (e.g. cancer survivors, grief support, caregiver support), and children's camps and programs (e.g. Camp Hot Shot, Camp Lance-A-Lot, CHaD story time), and insurance marketplace education and support. Additionally, WDH created a Simulation Center to enhance health care delivery of providers and first responders and increase health knowledge of community members. 3. Dental Health and Access to Dental Health Care: Dental health and access to care has historically been identified as an ongoing community need. To address this issue, WDH has continued to operate the Wentworth Community Dental Center, which treats approximately 3,000 patients per year and improves access to dental care for community members who may not otherwise be able to afford care. 4. General Healthcare and Access to Primary Care Services: Various initiatives were implemented in 2014 and expanded in 2015 and 2016 to help address the community need for greater access to primary care serivices. The first initiative focused on improving access to primary care by reducing wait times for appointments and promoting practices accepting new patients. The second initiative focused on extending same day access for primary care services. WDH opened its second walk-in, urgent care facility, Wentworth-Douglass Express Care in Dover, New Hampshire on June 30, 2014. This location expanded access to acute, non-emergent care and continues to experience increasing volumes in 2015. In addition to this initiative, WDPC also opened a new walk-in primary care service, Prompt Care, to improve access for existing WDPC patients in 2015 and opened a second site open to all patients in 2016. The third initiative focused on implementing a patient portal to extend patient access to primary care by providing patients the ability to view and share their medical record, request prescription refills, schedule appointments, and ask a provider a question on their computer. 5. Mental Health and Access to Mental Health Services Mental and behavioral health was identified as the top community health need in the 2013 CHNA, and continue to be identified as a high priority in the 2016 CHNA. The recommendation was to expand access to mental and behavioral health services to meet the "urgent need" for these services by increasing the integration of mental health services and primary care services. In 2014, two new behavioral health services were funded. The first expanded access to behavioral health counselors in the Wentworth-Douglass Hospital's primary care practices within WDPC. These services were expanded in collaboration with Great Bay Mental Health (GBMH) Services and Goodwin Community Health (the local Federally Qualified Health Center), and made access to behavioral health counselors available to patients at all WDPC primary care practices. In 2015, this program expanded to include an additional psychiatric nurse practitioner. The second service included the addition of a full-time psychiatric caseworker to provide case management of behavioral health patients waiting for long periods in the Emergency Department for evaluation and placement/treatment. In 2016, Great Bay Mental Health transitioned to a WDPC practice, and additional staff members were hired to support GBMH, embedded care providers in WDPC, and to support care provision for mental health patients in the Emergency Department. Additionally, WDH participated in the community-based 1115 Transformation Waiver in New Hampshire. This program is designed to align resources and improve communication between care providers focused on improving the quality and availability of mental health and substance misuse prevention care across the state. 6. Needs of the Aging Population With New Hampshire's rapidly growing number of residents over the age of sixty-five (65), the needs of the aging population were identified as a community need for the first time. To address the needs of this population, WDH continued to offer and expand Supportive and Palliative Care services. In partnership with WDPC, WDH also completed a project to improve education regarding the importance of advanced care planning. 7. Obesity, Nutrition, and Physical Activity To address community concerns regarding obesity, nutrition, and physical activity, WDH partnered with its for-profit subsidiary The Works Family Health and Fitness Center (The Works) to increase access to medical weight loss programs. Additionally, WDH continues to offer education programming regarding weight management, nutrition, and other topics. 8. Substance Misuse and Access to Substance Misuse Treatment Services The increase in drug and alcohol abuse was listed as the top priority WDH's 2016 CHNA. In response, WDH has continued to participate in prevention activities, such as the New Hampshire Youth SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program which was partly funded with grant support from the New Hampshire Charitable Foundation and the Conrad N. Hilton Foundation. This program incorporates an evidence-based SBIRT approach to screening patients ages 12 to 22 to identify alcohol and drug use problems early when brief interventions are most effective and to foster appropriate referrals to early and effective treatment for substance abuse disorders. The SBIRT Program launched in 2015 as a pilot program. Additionally, WDH has continued to support the efforts of regional partners such Dover Youth to Youth (a teen peer substance misuse prevention program overseen by the Dover Police Department) and the Strafford County One Voice coalition. One Voice is a collaborative group of community agencies and individuals developed to address the challenges of substance misuse in Strafford County. This group developed the Strafford County Drug Task Force which meets monthly at Goodwin Community Health, the local Federally Qualified Health Center, and focuses on aligning the many efforts going on in this community. Since 2013, WDH has also hosted and supported the annual spring Strafford COunty Drug Summit with over 200 attendees from the county, the surrounding region and across the state. WDH has also provided support, including meeting space and materials to help expand a new service provided by SOS Recovery Community Organization and the Dover Police with collaboration with the Dover Fire Department. This new service allows individuals seeking services for substance misuse treatment to be transported from the Dover Police Station to the Hospital, where they then meet with one of the certified recovery coaches through the SOS Recovery Program. WDH also made substantial financial contributions to local agencies which support efforts to improve access to treatment, prevention, and peer support programs. These included a $50,000 restricted cash contribution to Hope on Haven Hill, a new residential facility in Rochester, New Hampshire that provides treatment and recovery services for pregnant women with substance use disorders and their babies up to twelve (12) months of age and a $110,793 restricted cash contribution to Goodwin Community Health to establish a Recovery Community Center in Dover, New Hampshire to increase community-based support services for individuals recovering from substanc Part V, Section B, Line 7a & 10a: The 2016 CHNA is available on the Hospital's website at: https://wdhospitalinternal.com/files/3314/7976/1169/Wentworth_Douglass_Hos pital_CHNA_FINAL.pdf The Implementation Strategy is available on the Hospital's website at: https://wdhospitalinternal.com/files/9214/7976/1451/Wentworth-Douglass_-_I mplementation_Strategy_-_FINAL.pdf Part V, Section B, Line 13b: In the 2016 Financial Assistance Policy, for all covered services (except for Dental Center services), eligibility was determined based on Income at 250% Federal Poverty Guidelines (FPG) and Asset Guidelines (see narrative for Part I, Line 3c), and eligibility was not contingent upon residency. Eligible patients received 100% free care. Part V, Section B, Line 15e: In the 2016 Financial Assistance Policy, Financial Assistance Representatives were available to assist with any questions regarding the Financial Assistance Application Process and/or Policy. The Financial Assistance Application Packet included a coversheet which outlined required documentation. Representatives were available over the phone at (603) 740-3234 or in person at the Financial Assistance Office: Wentworth-Douglass Business Systems Building, 121 Broadway Avenue, Dover, NH 03820. Part V, Section B, Line 16a, 16b & 16c: The Hospital's Financial Assistance Policy is available on its website at: https://wdhospitalinternal.com/files/1214/9157/5615/LD-71_-_Financial_Aid_ Program.pdf. The Plain Language version is available here: https://wdhospitalinternal.com/files/2214/9157/5658/Financial_Assistance_P olicy_-_Plain_Language.pdf The Financial Aid Application is also available on the website at: https://wdhospitalinternal.com/files/1214/9157/5615/LD-71_-_Financial_Aid_ Program.pdf Part V, Section B, Line 22d: FAP eligible patients are discounted 100% therefore no amounts are charged and free care is provided. The Hospital's Financial Assistance application form is available on its website at: https://www.wdhospital.com/files/1614/6227/3319/8241-41A.pdf The Hospital's Plain Language Summary can be accessed at: https://www.wdhospital.com/files/2214/5288/2473/Financial_Assistance_Polic y_-_Plain_Language.pdf 8 Seacoast Cancer Center 10 Members Way Suite 200 Dover NH 03820 Specialty Care Practice Lee OTPTImaging 65 Calef Highway Lee NH 03861 Occupational/Phyical Therapy/Imaging Express Care Dover 781 Central Avenue Dover NH 03820 Express Care WDH Professional Center 10 Members Way Dover NH 03820 Diagnostic Services Express Care Lee 10 Members Way Suite 200 Dover NH 03820 Express Care Diagnostic Cardiology 19 Old Rollinsford Road Dover NH 03820 Cardiology Services Durham Rehab & Sports Therapy Center 16 Jenkins Court Durham NH 03824 Specialty Care Practice WDH Early Learning Center 789 Central Avenue Dover NH 03820 Childcare Services Part I, Line 3c: In the 2016 Financial Assistance Policy, eligibility was determined based on Income and Assets. Income: To be eligible, an individual's gross annual income could not be greater than 250% of the Federal Poverty Guidelines (FPG), which inluded alimony, dividends, stipends, social security benefits, employment, self-employment/business income, child support, pensions, annuities/retirement income, rental income and interest income. Assets: To be eligible as a household of 1, combined asset limits could not exceed $5,000 and to be eligible as a household greater than 1, comined asset limits could not exceed $10,000. Assets considered were checking/savings bank accounts, Certificates of Deposits (CDs), money markets, stocks/bonds/mutual funds, trusts, additional properties, gambling winnings, capital gains, inheritances and retirement account(s) currently being contributed to. Part I, Line 7: The Hospital uses the ratio of cost to charge methodology to calculate the cost of the community benefits it provides. The ratio of cost to charge methodology was also used to reduce charity care charges down to costs and calculate the Medicaid shortfall. The Hospital includes the net impact of the New Hampshire Medicaid Enhancement Tax (MET) and Disproportionate Share Funding (DSH) in calculating the Ratio of Patient Care to Cost (RCC) to determine the percentage allocation to use in determining the financial assistance at cost and Medicaid net community benefit expense. Additionally, the Hospital includes the net MET/DSH impact as an expense in Part I, Line 7b in arriving total Medicaid-related costs. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $13,149,341. Part II, Community Building Activities: See Form 990, Part III, Line 4e. Part III, Line 2: In 2016, charges billed by the Hospital of $13,149,341 were to provide care to patients, for which the Hospital received no payments for services rendered. In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital is now reporting bad debt expense on a charge basis rather than on the cost basis. Part III, Line 3: In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital refined our approach to calculating the estimated amount of the Hospital's bad debt expense attributable to patients eligible under the organization's financial assistance policy. THe Hospital utilizes the precengate of applications that are denied under the Financial Assistance Policy due to incomplete applications as a reasonable basis for calculating the percentage of bad debt that may be considered as eligible under the Financial Assistance Policy. This amount is reported at cost, and is not reported as a community benefit within Part I, Line 7. Part III, Line 4: See Page 9 and 16 of the attached audited financial statements. Part III, Line 8: In 2016, the Hospital provided care costing $112,501,014 to Medicare patients, for which it was reimbursed $77,254,450, representing a loss on Medicare services of $35,246,564. This amount represents the amount by which the Hospital was underpaid (relative to cost) by the federal government for care provided to Medicare patients, who are 65 and older, regardless of income or disability. The Hospital includes the net New Hampshire Medicaid Enhancement Tax (MET)/Disproportionate Share Funding (DSH) impact as an expense within Part III, Section B. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure. Part III, Line 9b: Hospitals in New Hampshire work hard to make high-quality health care available, affordable, and accessible to all, regardless of ability to pay. Wentworth-Douglass Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community obtaining the health care services that he or she may need. If payment of health care expenses create a financial hardship for patients, our staff provides assistance to complete the financial application process. The Hospital follows the written policy and consistently applies the policy to all patients and treats all patients equally, regardless of ability to pay. As part of this financial application process, the Hospital will assess patients' eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and Maine Medicaid. If it is determined that patients may be eligible for one of these programs, the Hospital assists patients through the application process. Patients are required to supply the financial or medical documentation that is necessary to secure such insurance coverage. The Hospital understands that health care costs can come up unexpectedly. Whether patients are insured or uninsured, and whether or not patients qualify for financial assistance, we understand that patients may have difficult paying healthcare costs in full at the time of service or in a lump sum. Our billing team works with patients to set up interest-free payment plans to help ease the financial burden of health care costs. Part VI, Line 2: WDH assesses the health care needs of the communities it serves in many ways. The first of which includes the formal Community Health Needs Assessment process which is led by the Hospital's Community Benefit Task Force. The 2016 CHNA process included an extensive data analysis and community focus groups. The focus group findings were then evaluated in collaboration with the county level Adult Behavioral Risk Factor Surveillance data to identify the top community health needs. WDH, in collaboration with the New Hampshire Foundation for Healthy Communities, partnered (in Fall 2015) with RKM Research and Communications, Inc. to conduct a community needs telephonic survey. The purpose of this survey was to assist WDH in identifying the health care needs of the communities it serves. The findings from this survey were included in the 2016 Community Health Needs Assessment (CHNA) and reported in the Primary Data section of the report. In addition, WDH also accesses community need on an ongoing basis through both formal and informal channels. On a monthly basis, WDH receives input and feedback on community need from the WDH Patient and Family Advisory Board and the Hospital and Health System Board of Directors. Community need is also assessed on an annual basis as part of WDH's Strategic Planning process which includes a comprehensive assessment of health outcomes and health factors for the communities we serve, and in the Hospital's provider need assessment which includes an analysis of provider supply and demand to ensure adequate and appropriate resources are available to meet the need of our community. Part VI, Line 3: WDH and WDPC take an active role in assisting patients who may be interested and qualify for financial assistance, whether it is state, federal or our own charity care benefits. Our Family Resource/Community Benefits Department has several processes in place to ensure patients are aware of the financial assistance available to them. Patients can learn more about these programs by visiting our website, reading our Foundation newsletter, or contacting our Financial Assistance Office. From the time of registration through our billing process, patients have available the opportunity to obtain an application for financial assistance as well as our financial assistance policy. All self-pay patients at the time of registration are provided with our charity care cover letter and application, with information about the charity care program and details on how to contract our Financial Assistance Representative(s). Our representatives also see many patients while they are here for services. Social Work Services and Community Benefits team up to assist and make sure our patients are receiving the opportunities to get any and all assistance available to them. We send five billing statements to our patients with the financial assistance guidelines and contact information if patients feel they may meet these guidelines and need assistance with their bill(s). Part VI, Line 4: Wentworth-Douglass Hospital serves the Seacoast area of New Hampshire and Southern Maine - Strafford County. Rockingham County and York County, Maine. Our community includes a small but growing Indonesian population, welcomed by local church groups. The community also includes low-income, uninsured adults and children supported by the Hospital's Community Assistance Plan programs. Part VI, Line 5: In 2016, the Hospital had 6 trained Certified Application Counselors (CACs). Representatives at the main hospital and offsite locations were available to assist. The Hospital also published and marketed this information to the community so that they could be made aware of the Hospital's available trained professionals. The Hospital assists enrollees from start to finish with the process. All of the Hospital's CACs spend a great deal of time providing education to the Hospital's many patients. Hundreds of patients looking for help in understanding the ACA, ACA terminology, and the difference between plans offered to them were provided assistance in person or via telephone. Part VI, Line 6: The affiliates of Wentworth-Douglass Hospital include Wentworth-Douglass Physician Corporation, Wentworth-Douglass Community Health Corporation, the Wentworth-Douglass Hospital and Health Foundation, and Wentworth-Douglass Health System. Our affiliates serve to further our mission of helping our patients and their families attain their highest level of health. The Wentworth-Douglass Physician Corporation was formed in response to a community needs assessment that identified a lack of primary care services in the community. The formation of the Physician Corporation and recruitment of primary care physicians closed the gap by improving access to primary care medical services in our community. Today, WDPC also provides a vast array of specialty physician services to the community. Wentworth-Douglass Physician Corporation (WDPC), d/b/a Wentworth Health Partners, which files its own Form 990 (see Schedule R for more details), is owned 100% by WDHS. The Hospital oversees all of WDPC's primary care practices, specialty practices, behavioral health services and its dental clinic. WDPC supports numberous community based programs, including the Community Dental Center and Behavioral Health Services. In 2015, WDPC acquired Great Bay Mental Health as part of the continued initiative to expand the services offered for behavioral health. WDPC provided $953,100 of behavioral health care services to patients in 2016. The Wentworth-Douglass Community Dental Center is open to low-income, uninsured adults and children living in the Hospital's primary service are (Dover, Durham, Madbury, Lee, Barrington, Somersworth, Rollinsford, NH and Berwick and So. Berwick, ME) or patients of the physician practices who have a family income at or below 300% of the federal poverty level, based on the number of members in the household. Minimum payments are charged on a discounted fee schedule based on household income. In 2016, the Dental Center provided $561,255 of community-based clinic services. WDPC provies financial aid information and resources to assist patients with their healthcare bills. Medical care is provided at no charge for eligible patients at 250% of the federal poverty level. In 2016, WDPC provided $284,888 of financial aid (stated at cost). Medicaid Costs Exceeding Reimbursement totaled $2,946,849 for WDPC in 2016. The Hospital subsidizes WDPC primary care practices that operate at a loss. The subsidized losses of these primary care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $5,336,183 in 2016. The Hospital subsidizes certain WDPC specialty care practices that operate at a loss. The subsidized losses of these specialty care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimursement associated with these practices, and totaled $9,017,881 in 2016. Wentworth-Douglass Community Health Corproation (The Works), a for-profit taxable subsidiary of WDHS, serves to promote community health and wellness, while remaining family focused. The Works offers specially designed and supervised fitness programs, aimed to help manage diabetes, lower risk of heart disease, and improve quality of life. In addition, the Hospital collaborates with The Works to offer group exercise programs to our patients, including Cancer Center patients, who are provided a free three month membership and invited to participate in a program that combines rehabilitation and group exercise. The Works also donates memberships as well as the use of its facilities and staff time to benefit various community organizations in support of health care initiatives. The Wentworth-Douglass Hospital and Health Foundation serves to cultivate, secure and steward philanthropic gifts that will support the capital, programmatic and endowment needs of Wentworth-Douglass Hospital. Wentworth-Douglass Health System was established to support and further the charitable activities of Wentworth-Douglass Hospital and Wentworth-Douglass Physician Corporation. It provides planning, oversight and coordination of the charitable activities related to the promotion of health of these entities. Part VI, Line 7, List of States Receiving Community Benefit Report: NH true City of Dover Fire & Rescue 262 Sixth Street Dover NH 03820 government 30000 quality assurance and improvement training programs City of Dover Police 46 Chestnut Street Dover NH 03820 government 126458 Youth to Youth Program and Dover Coalition for Youth Dartmouth Hitchcock Memorial Hospital 1 Medical Center Drive Lebanon NH 03756 020222140 501(c)(3) 24992 Child advocacy Program Strafford Health Alliance 200Route 108 Suite 3 Somersworth NH 03878 020389434 501(c)(3) 102337 CFA-Athletic Training DHS New Hampshire Health Protection Program 125 Airport Road Concord NH 033017300 020275078 501(c)(3) 105229 Donation for funding of NHHPP Goodwin Community Health 311 Route 108 Somerworth NH 03878 020304203 501(c)(3) 110793 Primary Care Services Hope on Haven Hill PO Box 1272 Rochester NH 03867 474623824 501(c)(3) 50000 Substance abuse treatment and recovery for pregnant women. AIDS Response - Seacoast 7 Junkins Avenue Portsmouth NH 03801 222884488 501(c)(3) 7000 Support Program 8 PART I, LINE 2: DURING THE TAX YEAR 2016, WDH ONLY MADE CONTRIBUTIONS TO GOVERNMENTAL ENTITIES OR OTHER 501(C)(3) PUBLIC CHARITIES, ADDITIONAL MONITORING IS NOT DEEMED NECESSARY. X true true X X X X false true false false false false false true false Anne Kalter MD Trustee 152334 57420 54112 18461 5025 31047 54112 264287 John Novello MD Trustee 327071 21900 1392 11259 21133 382755 Gregory J Walker President/CEO 480654 146112 193414 126354 23213 969747 Peter E Walcek CFO/VP Finance 325475 63486 62272 68787 21293 541313 Paul R Cass DO VP Medical Affairs/CMO 392649 71675 1392 73503 20795 560014 Ellen L Caille FACHE Executive Vice President 287652 56877 58805 59070 28388 490792 Malcom D Rosenson MD Chief of Quality & Safety Offi 314661 28636 1392 13250 18793 376732 Sheila M Woolley CNO/VP Patient Care 258082 143319 44126 38402 21343 505272 Daniel N Dunn COO/Sr. VP Operations 244528 27005 21735 15197 19225 327690 PART 1, LINE 1A: CERTAIN RETIREMENT AND FRINGE BENEFITS FOR GREGORY J. WALKER (PRESIDENT/CEO) HAVE BEEN GROSSED-UP UTILIZING THE APPLICABLE MARGINAL FEDERAL TAX RATE AS THE MOST EFFICIENT AND COST EFFECTIVE MEANS TO FULFILL THE TARGET BENEFIT GOAL AT RETIREMENT. PART I, LINE 4B: GREGORY J. WALKER (PRESIDENT/CEO) - 2016 TOTAL CONTRIBUTIONS TO THE 457(F) PLAN = $113,104. THIS SUPPLEMENTAL RETIREMENT PLAN CONTRIBUTION IS INTENDED TO FUND BENEFITS ACCRUING AND PAYABLE AT RETIREMENT FOR MULTIPLE YEARS OF SERVICE THAT BEGAN IN CALENDAR YEAR 1997. IN 2016, THE HOSPITAL FUNDED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN WHICH PROVIDES BENEFITS TO OTHER QUALIFYING EXECUTIVES. THE CONTRIBUTIONS ARE INTENDED TO PROVIDE A FORFEITABLE SUPPLEMENTAL RETIREMENT BENEFIT AND ARE BEING PROVIDED IN CONSIDERATION FOR MANY YEARS OF SERVICE TO THE HOSPITAL. THE RESPECTIVE CONTRIBUTIONS FOR THE 2016 PLAN YEAR, FOR THOSE INDIVIDUALS IDENTIFIED IN SCHEDULE J - PART II, ARE AS FOLLOWS: PETER E. WALCEK = $52,887, PAUL R. CASS, DO = $60,253, ELLEN L. CAILLE = $46,941, AND SHEILA WOOLLEY = $46,941. THE FOLLOWING INDIVIDUALS VESTED IN THEIR 2011 457(F) CONTRIBUTIONS DURING 2016: PETER E. WALCEK = 41,483, ELLEN L. CAILLE = 38,813, AND SHEILA WOOLLEY = 21,640. THE 2011 AMOUNTS ARE REQUIRED TO BE REPORTED ON SCHEDULE J, IN COLUMN F AND AS PART OF THE TAXABLE W-2 COMPENSATION REPORTED IN COLUMN B(III) OF THIS FORM 990. WDH SPONSORS A A SPLIT-DOLLAR LIFE INSURANCE EMPLOYEE BENEFIT PROGRAM FOR CERTAIN OFFICERS AND KEY EMPLOYEES. SPLIT DOLLAR LIFE INSURANCE IS AN ARRANGEMENT IN WHICH THE EMPLOYEE IS THE OWNER OF THE LIFE INSURANCE POLICY AND THE PREMIUMS ARE PAID BY THE EMPLOYER. PURSUANT TO WDH'S SPLIT-DOLLAR AGREEMENT, AND THE COLLATERAL ASSIGNMENT THEREIN, THE EMPLOYER'S SHARE OF THE POLICY PREMIUMS PAID IS RECOVERED EITHER UPON TERMINATION OF THE POLICY OR AT THE DEATH OF THE PARTICIPANT. 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 EMPLOYEE INCLUDES THE ANNUAL VALUE OF THE LIFE INSURANCE. TOTAL PREMIUMS PAID DURING THE YEAR ENDING 12/31/16 WERE $21,144 FOR PETER E. WALCEK, $58,352 FOR DANIEL N. DUNN, AND $38,168 FOR SHEILA M. WOOLEY. THE TAXABLE VALUE OF THE LIFE INSURANCE POLICY HAS BEEN INCLUDED IN EACH INDIVIDUALS' W-2. THE POLICIES ARE INTENDED TO PROVIDE AN ADDITIONAL RETIREMENT BENEFIT FOR THESE INDIVIDUALS' MULTIPLE YEARS OF SERVICE. PART I, LINE 7: AT-RISK COMPENSATION, WHICH IS SUBJECT TO REVIEW AND PAID ANNUALLY. IT IS BASED ON SEVERAL PREDEFINED METRICS, INCLUDING PATIENT SATISFACTION, QUALITY, AND FINANCIAL TARGETS. A NHHEFA AUTHORITY REVENUE BONDSWDH ISSUE SERIES 020279866 644614VAR 2011-04-06 87920000 REFINANCING BONDS & CONSTRUCTION false false false B NHHEFA AUTHORITY REVENUE BONDS WDHISSUE SERIES 2 020279866 644614m22 2016-03-28 22000000 REFINANING BONDS & CAPITAL EXPENDI false false false A 0 0 87825276 0 0 12476983 976169 0 0 44372124 0 0 2012 false false false true B 0 0 15815000 0 0 0 241500 0 0 5943500 0 0 2016 true false true true A false false false false 0 false false false true B false false false false 0 false false false true A false false false true false false 0 false 0 false false B false false false true true true PIPER JAFFRAY false 0 false true A true B true SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: NHHEFA AUTHORITY REVENUE BONDS/WDH ISSUE, SERIES 2011A (F) DESCRIPTION OF PURPOSE: REFINANCING BONDS & CONSTRUCTION OF NEW INPATIENT WING SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: (A) ISSUER NAME: NHHEFA AUTHORITY REVENUE BONDS/WDH ISSUE, SERIES 2011A DATE THE REBATE WAS PERFORMED 01/01/2013 PART IV, LINE 4C: THE BOND LISTED ON LINE B OF PART I IS SPLIT INTO APPROXIMATELY TWO EQUAL HEDGES, ONE WITH A TERM OF 11.8 YEARS (ENDING ON 01/01/2023) AND THE OTHER 19.8 YEARS (ENDING ON 01/01/2031) BOND REFINANCE: ON MARCH 28, 2016 THE SYSTEM REFINANCED ITS EXISTING SERIES 2011B REVENUE BONDS THROUGH THE ISSUANCE OF SERIES 2016A REVENUE BONDS TOTALING $16,000,000. ADDITIONALLY, SERIES 2016B REVENUE BONDS TODALING $6,000,000 were issued to reimburse for certain capital expenditures. The Series 2016A revenue bonds were directly placed with a financial institution and do not require a secured letter of credit. The series 2016A and 2016B revenue bonds mature on January 1, 2031 and January 1, 2026, respectively, and carry a weighted average interest rate of 3.1374%. Peter E Walcek CFO/VP Finance Retirement Benefits X 102663 106770 false true true Daniel N Dunn COO/Sr. VP Operations Retirement Benefits X 403260 419390 false true true Sheila M Wooley CNO/VP Patient Care Services Retirement Benefits X 225474 234493 false true true 760653 Gregory Walker Peter Walcek Sheil CFO, CEO, CNO 733901 Joint Ventures false Peter E Walcek CFO 47396 related to employee false Schedule L, Part II, Loans To and From Interested Persons: (a) Name of Person: Peter E. Walcek (b) Relationship with Organization: CFO/VP Finance (c) Purpose of Loan: Supplemental Retirement Benefits - Split Dollar Life Insurance (d) Loan to or from organization? From (e) Original Principal Amount $ 102,663. (f) Balance Due $ 106,770. (g) Loan in Default? = No (h) Approved by Board or Committee? = Yes (i) Written Agreement? = Yes (a) Name of Person: Daniel N. Dunn (b) Relationship with Organization: COO/SR. VP Operations (c) Purpose of Loan: Supplemental Retirement Benefits - Split Dollar Life Insurance (d) Loan to or from organization? = From (e) Original Principal Amount $ 403,260. (f) Balance Due $ 419,390. (g) Loan in Default? = No (h) Approved by Board or Committee? = Yes (i) Written Agreement? = Yes (a) Name of Person: Sheila M. Wooley (b) Relationship with Organization: CNO/VP Patient Care (c) Purpose of Loan: Supplemental Retirement Benefits - Split Dollar Life Insurance (d) Loan to or from organization? = From (e) Original Principal Amount $ 225,474. (f) Balance Due $ 234,493. (g) Loan in Default? = No (h) Approved by Board or Committee? = Yes (i) Written Agreement? = Yes Schedule L, Part IV, Business Transactions Involving Interested Persons: (a) Name of Interested Persons: Gregory J. Walker, Peter E. Walcek, & Sheila M. Wooley (b) Relationship Between Interested Persons and Organization: President/CEO, CFO/VP Finance, & CNO/VP Paitnet Care (d) Decription of Transaction: Joint Venture Gregory J. Walker, President/CEO, Peter E. Walcek, VFO/VP Finance, and Sheila M. Wooley, CNO/VP Patient Care of the Hospital serve on the board of managers of Wentworth Home Care & Hospice, LLC. The Hospital has 50% ownership interest in Wentworth HOme Care and Hospice, LLC. The Hospital accounts for its investment in joint ventures under the equity method. The 2016 income recorded for the Hospital's share of revenues equaled $733,901 from which is received a cash distributions of $637,500. In accordance with IRS instructions, this business relationship has been disclosed in Schedule L, Part IV, however Mr. Walker, Mr. Walcek, and Ms. Wooley received no direct or indirect monetary benefit as a result of this joint venture and all transactions were negotiated at arms-length. Schedule L, Part II: Amounts stated on Schedule L, Part II represent the net present value expected on the total premiums paid through 12/31/16 that is anticipated to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for the disqualified persons listed on Form 990, Part VII and as further reported on Schedule J. Total cumulative premiums paid through December 31, 2016 for disqualified persons are $317,160 for Peter E. Walcek, $875,280 for Daniel N. Dunn and $572,570 for Sheila M. Wooley. Total premiums paid during the year ended 12/31/16 were $21,144 for Peter E. Walcek $58,352 for Daniel N. Dunn, and $38,168 for Sheila M. Wooley. Pursuant to updated IRS instructions, the net present value of these split dollar premiums has been reported in Schedule L, Part II this year. Accordingly, the net present value premium amounts described above have been reported on Form 990, Part X, Line 5 in the End of Year column. Schedule L, Part IV, Business Transactions Involving Interested Persons (A) Name of Person: Peter E. Walcek (B) Relationship with Organization: CFO/VP Finance (D) Description of transaction: A family member of Peter E. Walcek is an employee at the hospital. In accordance with IRS instructions, this business relationship has been disclosed in Schedule L, Part IV and the total w-2 compensation of this employee is listed within column (c) of Schedule L, Part IV. Form 990, Part III, Line 4a, Program Service Accomplishments: At Wentworth-Douglass Hospital (WDH), we are committed to serving our community and addressing the needs of all our patients. Our community benefit programs are available to local residents with income at or below 250% of Federal Poverty Level guidelines, one of the most generous programs in the State of NH which outlines the community and charitable benefits provided, which includes community benefits of WDH and WDPC. Numerous programs were developed to assist people in the area we serve, including FInancial Aid, Behavioral Health Services, Family Resource Counselor Program, Financial Assistance Services, Physician Referral Services, Care-Van transportation services, and Wentworth-Douglass Community Dental Center. The Hospital provided $7,419,092 (as measured by gross charges) of charity care assistance programs in 2016. In total, the Hospital and WDPC together provided $7,878,740 (as measured by gross charges) of charity care assistance in 2016. The Hospital's core programs include our Cancer Center, Emergency Department, and Surgical Services. In addition, WDH offers other key services in the areas of Women's and Children's Services and Cardiology Services. 1. The Seacaost Cancer Center at Wentworth-Douglass Hospital offers the most comprehensive cancer treatment services covering the Seacoast region of New Hampshire and Southern Maine. Founded over 30 years ago as a single room adjacent to the Emergency Department, the Cancer Center's services now include extensive, state of the art medical and radiation oncology diagnostic services with multiple treatment options. In 2016, the Seacoast Cancer Center received the Outstanding Achievement Award from the Commission of Cancer (CoC) and accrediting body of the American College of Surgeons. This award recognizes cancer programs that achieve excellense in compliance to the CoC Standards and provide the highest quality care to cancer patients. 2. The Emergency Department at Wentworth-Douglass Hospital has one of the highest volume of visits in the State of New Hampshire. Close linkages to local emergency services personnel and Fire & Rescue Departments continue to extend the skill and capabilities of the Department. Through internal and external education efforts, the Emergency Department focused on improving patient care for specific types of hear attack (STEMI) and stroke. The Department's efforts in the Fall of 2008, through a clinical collaboration with Massachusetts General Hospital, created the Stroke Initiative to form a center of excellence for stroke care. In October 2009 the American Heart/Stroke Association awarded WDH the Bronze Award for achieving its high standard, quality guidelines for six consecutive months. In 2011, the Hospital received a Gold Plus Award from the Joint Commission for 24 consecutive months of achievement at the Stroke Center. In addition, Wentworth-Douglass Hospital was the first hospital in New Hampshire to earn Primary Stroke Center Advanced Certification by The Joint Commission, the nation's leading healthcare accrediting agency. To accomodate increasing patients the Department also added additional space for six treatment rooms and opened a Walk-In Express Care Centers in both Dover and Lee, NH to support the growing population areas in the towns surrounding Dover and Lee. The Hospital's generous Charity Care Program offers emergency, walk-in and other hospital services at no charge for qualifying patients at 250% of the Federal Poverty Level. 3. Surgical Services at WDH include a wide array of services and technological advances frequently associated with larger medical centers. A renovation to enlarge operating rooms created digital ORs and space for new equipment such as the da Vinci Robotic Surgical System. Now in its ninth year, the robotic program began with OB/GYN surgeons, and now includes Thoracic, General Surgery and Urology. Another clinical collarboartion with MGH at WDH brings a GYN/Oncology surgeon to WDH to perform "medical center" surgery in the community setting, eliminating the time and the frustration of travel to and parking at metropolican cities. A range of minimally invasive procedures including Robotic Surgery, Single Incision Laparoscopic Surgery (SILS) used by general surgeons and Video Assisted Thoracic Surgery (VATS) procedures used by the thoracic surgeon offer patients the benefits of complex surgery with less blood loss, less infection and faster recovery. The Joint Replacement Program introduced in 2006 offers a unique approach to joint replacement surgery with pre-op group education and post-op group rehab. Surgeons, anesthesiologists, nursing, rehab and nutrition staff worked collaboratively to create this new approach to joint replacement care. In 2009, the Hospital created the Northern New England Spine Center, a partnership of specialists to coordinate and expedite the care of patients with neck and back pain. The Spine Center members include a spine surgeon, physiatry specialists, pain specialists, WDH rehab, behavioral health specialists and a WDH Spine Coordinator. The virtual center holds bimonthly multidisciplinary conferences to coordinate the care and treatment of Spine Center patients. Other Services: In addition to the services listed above, Wentworth-Douglass Hospital offers traditional services with non-traditional components. One example is The Birth Center. Currently The Birth Center is the fastest growing birthing service in the Seacoast area with over 1,000 births per year. Wentworth-Douglass Hospital is a recognized Baby Friendly facility for our efforts to provide an optimum level of care for breast feeding mothers and their babies. The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization and the United Nation's Children's Fund. In addition, WDH received the Women's Choice Award for creating exceptional patient experiences in the areas of Obsterics, Cancer Care, Orthopedics and overall patient satisfaction. In an effort to support a small but growing and young Indonesian population, the Birth Center translated all forms and information for new mothers into Indonesian. Local church groups welcomed Indonesian families into their communities. Cardiology Services recently replaced the cath lab with new equipment and the Department added Non-Invasive Cardiovascular Services at a new, offsite medical office building in Dover, extending the options now available for patients. A second cardiovascular inventional lab was opened late in 2010 to accommodate growing patient volume and urgent cases. All the Community Assistance (Benefit) Services support low income, uninsured individuals and families in the Hospital's service area with Charity Care (Financial Assistance), the Wentworth-Douglass COmmunity Dental Center, and the Care-Van free patient transport service. Form 990, Part III: Effective January 1, 2017, Massachusetts General Hospital (MGH) became the sole corporate member and parent organization of the Hospital. Contemporaneously, the Hospital became the sole corporate member and parent organization of Wentworth-Douglass Hospital and Health Foundation (WDHHF), Wentworth-Douglass Physician Corporation (WDPC), and the Wentworth-Douglass Community Health Corporation (WDCHC). As part of the transaction, Wentworth-Douglass Health System (WDHS) was spun off with the purpose of monitoring the integration of the Hospital into MGH. Form 990, Part VI, Section A, Line 4 and Line 6: WDHS, a New Hampshire nonprofit corporation, was formed in 2012 as the result of the corporate restructuring of WDH into an integrated health system. WDHS serves as the parent company of WDH and its affiliates WDDHF and WDPC, all of which are New Hampshire nonprofit corporations that have been recognized as being 501(C)(3) organizations. These corporations share a common mission with the Hospital. WDHS is intended to act as a supporting organization of WDH, serving in the role of the "parent compeny" of the Hospital and the affiliates. WDHS is the sole member of WDH. As part of the MGH transaction effective January 1, 2017, the Hospital became the sole corporate member and parent organzation of WDPC, WDCHC and the Foundation and the governing documents were updated to reflect this change. WDHS was spun off with the purpose of monitoring the integration of the Hospital into MGH. Form 990, Part VI, Section A, Line 7a: WDHS will appoint the Board members for WDH. Effective January 1, 2017, with MGH becoming the sole corporate member and parent organization of WDH, WDHS no longer appoints the board members for WDH. Form 990, Part VI, Section A, Line 7b: Wentworth-Douglass Health System has the power to appoint and remove directors of WDH, and all actions pertaining to the property, business, and affairs of WDH, including WDH's annual budget, are subject to the approval of WDHS. Effective January 1, 2017, with MGH becoming the sole corporate member and parent organization of WDH, WDHS no longer holds these powers and serves for the purpose of monitoring the integration of the Hospital into MGH. Form 990, Part VI, Section B, Line 11: A draft of the Form 990 is initially reviewed in detail by the Finance Committee and the key Finance employees. Thereafter, the final draft is presented to the full Board prior to filing with the IRS. Each member of the Board and Finance Committee is provided with a complete draft of the Form 990 in advance of each meeting. Form 990, Part VI, Section B, Line 12c: A copy of the Hospital's conflict of interest policy is distributed annually to all officers, trustees, medical staff officers and committee members, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with State of New Hamshire RSA 7:19-A in the local newspaper and submitted to the New Hampshire Attorney General. Form 990, Part VI, Section B, Line 15: CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted, and voted on by all independent members of the Board annually. Every other year, a national independent consulting firm is engaged by the Board to provide comparative market compensation data for executive and management positions at the Hospital. The Board uses the data provided to compare Wentworth-Douglass's CEO compensation with that of other hospital executives nationally and in the Northeast region to determine the CEO's total compensation. On alternate years, when the consulting firm is not engaged, the Board uses salary ranges established the prior year and market economic data to validate that the CEO's salary is competitive and make market adjustments. Additional factors taken into account to determine the CEO's salary are based on several predefined metrics, including patient satisfaction, quality, and financial targets. The CEO is excused from Board discussion and voting on issues surrounding his compensation and benefits. Compensation of Key Employees: The CEO reviews the salaries of key employees annually and recommends compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. The CEO presents salary range data for key employees to the Board annually for approval. Using the BOard approved salary range data, the CEO recommends salary increases for vice presidents to the Board for approval and the vice presidents recommend salary increases for Directors and other management positions to the CEO for approval. All compensation for vice presidents and above requires final approval by the independent Board Members. Form 990, Part VI, Section C, Line 19: Wentworth-Douglass Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between the Foundation and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-a, II(d). Current copies of the Bylaws, Conflict of Interest Policy, and Form 990 are on file with the Charitable Trust Unit. The Organization also makes these documents available upon request. Form 990, Part VI, Section A, Line 1a and Line 1b: Governing Body and Management: Steven C. Webb is a trustee of the Hospital and an executive at TD Bank. The Hospital maintains operating and payroll accounts with TD Bank. Transactions in 2016 were in excess of $10,000. An exact figure cannot be stated due to daily account activity and balance changes. Both accounts were active prior to Mr. Webb joining the Board and all transactions with TD Bank are at a fair market rate. For 2016, Mr. Webb has been classified as an independent board member. Form 990, Part VII, Section A, Column D: Reportable Compensation from the Organization: The 2016 compensation reported for Dr. Anne Kalter and Dr. John Novello was paid by a related organization (Wentworth-Douglass Physician Corporation) for their full-time services as members of the medical staff. Neither individual is compensated for their services as a trustee of WDH. Dr. Anne Kalter is also a 50% owner of Gynecologic Paradox (formerly Gynecology & Infertility Associates). During 2016, Wentworth-Douglass Hospital made payments to Gynecologic Paradox of $54,112 for rent. These amounts have been reported to her on a 1099 and included in Schedule J, Part II, Column B(iii). Additionally, Dr. Dirksmeier received a contribution during 2016 to WDH's Call Pay Plan which is available to independent physician contractors who provide on call services to the Hospital. This amount has been reported in Part VII, Column (F). In 2016, Dr. Dirksmeier and Dr. Flavin received distributions from their Call Pay Plan which was reported to them on a 1099-MISC. These distributions have been added to Column D of Part VII of Form 990 and Column B(iii) on Schedule J, Part II. As outlined above, these distributions have been reported in Part VII, Column (F) of prior 990s when they were contributed to each individual's plan.reported in Part VII, Column (F) of prior 990s when they were contributed to each individual's plan. Form 990, Part IX, Line 24d: Under the State of New Hampshire's tax code, the State imposes a Medicaid Enhancement Tax (MET) equal to 5.40% of net patient service revenues in State fiscal year 2017, 5.45% for State Fiscal year 2016, and 5.50% in State fiscal year 2015, with certain exclusions. Hospital's have been paying the MET since 1991, but in previous years, after the State had received matching federal funds, it provided the hospital's uncompensated care payments towards the cost of care of patients without insurance and those covered by Medicaid. The net effect was that most of the MET was returned to the hospitals. In the fall of 2010, in order to remain in compliance with stated federal regulations, the State of New Hampshire adopted a new approach related to Medicaid disproportionate share (DSH) funding retroactive to July 1, 2010. Unlike the former funding method, the State's approach led to a payment that was not directly based on, and did not equate to, the level of tax imposed. For 2016, Wentworth-Douglass paid $15,894,987 in MET (see Part IX, Line 24d) and recorded $12,989,293, of disproportionate share uncompensated care. Form 990, Part XII, Line 2c: Audit Review Process: The Finance Committee oversees the audit process for Wentworth-Douglass Hospital and all related organiazations. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2015 and 2016. Form 990, Part IX, Column D: Fundraising expenses: Wentworth-Douglass Hospital and Health Foundation (a related organization) performs all fundraising activities on behalf of Wentworth-Douglass Hospital. All fundraising expenses are reported on the Foundation's separate Form 990. Form 990, Part X, Line 5: Amounts separately stated on Form 990, Part X, Line 5 represent the net present value expected on the total cumulative premiums paid through 12/31/16 that is expected to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for various disqualified persons listed on Form 990, Part VII and as reported on Schedule L and J. Form 990, Part XI, Line 9 Loss on investment in joint venture -30,075,318 Accrued earnings on J.V. owned by affiliate -408,921 Loss on Bond Financing -119,447 73 Corporate Drive at Pease LLC 95 Market Street Manchester NH 03101 Acquisition NH WDH Cocheco Development LLC 95 Market Street Manchester NH 03101 Acquisition NH 300737 WDH Central Avenue Acquisition Company LLC 95 Market Street Manchester NH 03101 Acquisition NH 945786 WDH WD Hospital & Health Foundation 789 Central Avenue Dover NH 03820 510491062 fundraising NH 501(c)(3) Line 11b ii WDHS false Wentworth-Douglass Physician Corporation 789 Central Avenue Dover NH 03820 020497927 Health Care NH 501(c)(3) Line 3 WDHS false Wentworth-Douglass Health System 789 Central Avenue Dover NH 03820 461635259 Support NH 501(c)(3) Line 11b,II NA false Wentworth Surgery Center LLC PO Box 71 Somersworth NH 03878 900975583 Surgery Center NH NA N/A 0 0 false 0 false 0.00000 Wentworth-Douglass Community & Health Co 789 Central Avenue Dover NH 03820 020399963 Fitness Center NH NA C-Corp 0 0 0.00000 false true true true false false false false false false true true true true true true false true true true Wentworth-Douglass Community Health Corporati L 120853 Actual per Book Wentworth Surgery Center Q 83822 Actual per Book Wentworth-Douglass Community Health Corporati A 152671 Actual per Book Part II, Identification of Related Tax-Exempt Organization: Name of Related Organization: Wentworth-Douglass Health System Primary-Activity: Support and further charitable activities of Hospital and related entities. Schedule R, Part III: The Hospital system invested in Granite Healthcare Asset Holding Company, LLC, a joint venture with several hospital facilities. The Hospital's investment in this entity does not otherwise meet the disclosure requirements for Schedule R, Part III. Schedule R, Part II: Although not listed in Schedule R, Part II, Wentworth-Douglass HOspital owns 100 shares (50% of shares issued and outstanding) of non par value corporate stock in Strafford Health Alliance, a 501(C)(3) public charity. Strafford Health Alliance provides physical therapy, occupational therapy, and breast imaging services to residents of southeast New Hampshire. Due to a lack of a control relationship by Wentworth-Douglass Hospital; Strafford Health Alliance has not been listed as a related organization in Schedule R, Part II in accordance with IRS instructions.