2015-05-11T11:32:39-05:00 2013-09-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2012-10-01 222674014 EXETER HOSPITAL INC EXET 6035806695 5 ALUMNI DRIVE EXETER NH 03833 KEVIN J O'LEARY 6035806695 2015-04-28 1 TIMOTHY R HEPBURN CPA P00182393 8002447444 2012 2016-02-25 16:41:14Z X KEVIN CALLAHAN 5 ALUMNI DRIVE EXETER NH 03833 195312301 0 X WWW.EXETERHOSPITAL.COM X 1907 NH THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY WITHIN THE RESOURCES AVAILABLE. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. 13 10 1568 96 63482 62482 142275 89544 194263943 185485823 3241645 5099754 1743388 4423633 199391251 195098754 1274587 830991 0 0 88164767 89839927 0 0 14573 101614082 98905098 191053436 189576016 8337815 5522738 285432823 270991066 106991448 95925723 178441375 175065343 X THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY WITHIN THE RESOURCES AVAILABLE. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. 0 0 169601736 830991 189918782 THE MISSION OF EXETER HOSPITAL IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THIS MISSION IS PRINCIPALLY ACCOMPLISHED THROUGH THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY WITHIN THE RESOURCES AVAILABLE. EXETER HOSPITAL WORKS TO ACCOMPLISH THIS MISSION THROUGH THE PROVISION OF DIAGNOSTIC TESTING, THERAPEUTIC INPATIENT AND OUTPATIENT SERVICES, COMMUNITY EDUCATION AND OUTREACH, AND ACUTE EMERGENCY, INPATIENT AND SURGICAL SERVICES AS WELL AS OBSTETRICAL SERVICES. IN FISCAL YEAR 2013, EXETER HOSPITAL SERVED THE COMMUNITY BY PROVIDING CARE TO 5,529 ACUTE INPATIENTS, 135,676 OUTPATIENT VISITS, 29,819 EMERGENCY ROOM VISITS AND 621 BIRTHS. IN 2013 EXETER HOSPITAL SUPPORTED ITS MISSION BY SUPPORTING $16,375,625 IN COMMUNITY OUTREACH, BENEFITS AND FINANCIAL SUPPORT TO THE COMMUNITY EXCLUDING $26,685,670 IN UNCOVERED MEDICARE EXPENSES. EXETER HOSPITAL SUPPORTS HEALTH CARE ACCESS IN ITS SERVICE AREA BY OFFERING A ROBUST FINANCIAL ASSISTANCE PROGRAM THAT COVERS THE COST OF UP TO 100% OF CARE PROVIDED TO AREA RESIDENTS BASED ON INCOME AND FAMILY SIZE. IN 2013, THE CHARITY CARE PROGRAM HELPED PEOPLE ACCESS THE HEALTH CARE SYSTEM AS EXETER HOSPITAL INCURRED A COST OF $4.6 MILLION DOLLARS TO PROVIDE FINANCIAL ASSISTANCE. IN ADDITION WE PROVIDE SUPPORT TO VITAL COMMUNITY PROGRAMS LIKE OUR HEALTHREACH DIABETES PROGRAM, OUR PARAMEDICINE PROGRAM AND FOR PROVIDING ACCESS TO CONTRACTED MENTAL HEALTH PROFESSIONALS IN OUR EMERGENCY ROOM. WE ALSO SUPPORTED ACCESS TO THE HEALTH SYSTEM AND THE DEVELOPMENT OF HEALTHY LIFE STYLES THROUGH OUR COMMUNITY EDUCATION PROGRAMS AND OUR FINANCIAL SUPPORT OF IMPORTANT HEALTHCARE RELATED COMMUNITY BASED NOT FOR PROFITS SUCH AS FAMILIES FIRST, SEACARE AND LAMPREY HEALTHCARE. EXETER HOSPITAL'S ACUTE CARE PROGRAM PROVIDES ACUTE INPATIENT AND OUTPATIENT OBSERVATION LEVEL CARE IN OUR 99 STAFFED INPATIENT BEDS. OUR INPATIENT SERVICES TREAT EMERGENT, ACUTE, ELECTIVE SURGICAL AND PALLIATIVE CARE PATIENTS. APPROXIMATELY 78% OF OUR ADMISSIONS COME FROM THE EMERGENCY ROOM. WE OFFER INPATIENT ACUTE SERVICES FOR MEDICAL AND SURGICAL DIAGNOSES FOR ADULTS AS WELL AS PEDIATRIC AND OBSTETRICAL INPATIENT SERVICES. EXETER HOSPITAL IS FULLY ACCREDITED BY DNV HEALTHCARE, INC. (AN OFFICIALLY DEEMED MEDICARE AND MEDICAID CREDENTIALING AGENCY), EARNED THE MAGNET DESIGNATION FROM THE AMERICAN NURSES CREDENTIALING CENTER, WHICH IS THE MOST PRESTIGIOUS DISTINCTION A HEALTHCARE ORGANIZATION CAN RECEIVE FOR NURSING EXCELLENCE AND HIGH QUALITY PATIENT CARE AS WELL AS MANY OTHER SERVICE LEVEL SPECIFIC NATIONAL ACCREDITATIONS. OUR PRACTICE MODEL IS GUIDED BY A SERIES OF COLLABORATIVE BEST PRACTICE COMMITTEES THAT ENGAGE NURSES AND PHYSICIANS IN THE DEVELOPMENT OF THE BEST POSSIBLE EVIDENCE BASED CARE PROTOCOLS. EXETER HOSPITAL SUPPORTS THE SAFETY OF OUR PATIENTS AND THE EFFICIENCY OF THE CARE PROVIDED THROUGH THE DEPLOYMENT OF A 24/7 HOSPITALIST PROGRAM THAT MANAGES THE MAJORITY OF THE MEDICAL NEEDS OF OUR PATIENTS DURING THEIR ADMISSION. IN OUR 10 BED ICU WE ALSO USE AN INTENSIVEST SERVICE TO ENSURE THAT OUR MOST ACUTE PATIENTS RECEIVE THE MOST HIGHLY COORDINATED CARE POSSIBLE, RESULTING IN SIGNIFICANTLY LOWER THAN EXPECTED INFECTION RATES, ICU READMISSION RATES AND SHORTER ICU STAYS. FOR OUR PATIENTS AT THE END OF THEIR LIVES WE ENSURE THEIR SAFETY AND COMFORT THROUGH A PHYSICIAN LED, HIGHLY COORDINATED PALLIATIVE CARE PROGRAM. EXETER HOSPITAL'S SURGICAL PROGRAM PROVIDES A FULL RANGE OF BOTH INPATIENT AND OUTPATIENT SURGICAL SERVICES FOR PATIENTS OF ALL AGES FROM ACROSS OUR SERVICE AREA. AVAILABLE SURGICAL SPECIALTIES INCLUDE; ORTHOPEDICS, VASCULAR, GENERAL, PLASTICS, PODIATRIC, ONCOLOGY, COLORECTAL, GYNECOLOGICAL AND ENT SURGERY. THE CENTER FOR CANCER CARE AT EXETER HOSPITAL PROVIDES CANCER PATIENTS AND THEIR FAMILIES WITH COMPREHENSIVE IN-PATIENT AND OUTPATIENT SERVICES. ACCREDITED BY THE AMERICAN COLLEGE OF SURGEON'S COMMISSION ON CANCER WITH COMMENDATION, THE CENTER PROVIDES AREA RESIDENTS WITH A LEADING, COMPREHENSIVE APPROACH TO CANCER TREATMENT. THE CENTER OFFERS MEDICAL ONCOLOGY, RADIATION ONCOLOGY, SURGERY, CLINICAL TRIALS, MULTIDISCIPLINARY CLINICS AND INTEGRATIVE ONCOLOGY SERVICES. THE CENTER IS PROUD TO HAVE A RELATIONSHIP WITH THE MASSACHUSETTS GENERAL PHYSICIAN ORGANIZATION FOR THE PROVISION OF MEDICAL AND RADIATION ONCOLOGY SERVICES TO PATIENTS. THE MEDICAL ONCOLOGY SERVICE SUPPORTS A 13 CHAIR INFUSION CENTER. THIS UNIQUE CLINICAL COLLABORATION BRINGS RADIATION ONCOLOGISTS FROM THE WORLD'S LEADING ACADEMIC MEDICAL CENTER TO EXETER HOSPITAL'S CENTER FOR CANCER CARE. THIS AFFILIATION ALLOWS EXETER HOSPITAL'S CENTER FOR CANCER CARE TO OFFER STATE-OF-THE-ART RADIATION THERAPY SERVICES TO PATIENTS INCLUDING: ELECTRONIC BRACHYTHERAPY, PARTIAL BREAST IRRADIATION, INTENSITY MODULATED RADIATION THERAPY, CT SIMULATION AND IMAGE GUIDED RADIATION THERAPY. THE CENTER'S AFFILIATED SURGEONS WORK COLLABORATIVELY WITH AFFILIATED PATHOLOGISTS, THE MEDICAL ONCOLOGISTS AND WITH THE RADIATION ONCOLOGISTS TO DEVELOP THE MOST COMPREHENSIVE TREATMENT PLANS FOR OUR PATIENTS.EXETER HOSPITAL'S CARDIOLOGY DEPARTMENT OFFERS ACUTE CARDIAC CARE, HEART CATHETERIZATION, ANGIOPLASTY, CARDIOVERSION, AND IMPLANTATION OF CARDIOVERTER DEFIBRILLATORS, PERMANENT PACEMAKER PLACEMENT AND A THREE PHASE CARDIAC REHABILITATION PROGRAM. EXETER HOSPITAL'S AFFILIATED FELLOWSHIP-TRAINED INTERVENTIONAL CARDIOLOGISTS AND ITS CARDIAC TEAM HAVE RECEIVED NATIONAL RECOGNITION FOR THEIR "DOOR TO BALLOON" TIMES AND ONGOING SUCCESSFUL IMPLEMENTATION OF COMMUNITY BASED EMERGENCY ANGIOPLASTY AND INTERVENTIONAL CARDIOLOGY PROCEDURES. 169601736 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 147 0 1 1568 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X KEVIN J O'LEARY 6035806695 5 ALUMNI DRIVE EXETER NH 03833 KEVIN J CALLAHAN 2.00 44.00 X X 0 603669 194576 GLENN MCKENZIE 1.00 0.00 X X 0 0 0 ROBERT A EBERLE 1.00 0.00 X X 0 0 0 KATIE D PAINE 1.00 0.00 X 0 0 0 ROSS GITTELL PHD 1.00 0.00 X 0 0 0 JOSEPH ARMY 1.00 0.00 X 0 0 0 WILLIAM SCHLEYER 1.00 0.00 X 0 0 0 J BONNIE NEWMAN 1.00 0.00 X 0 0 0 MAJ GEN JOSEPH SIMEONE 1.00 0.00 X 0 0 0 NANCY BRAESE DO 1.00 41.00 X 0 168516 33016 ROBERT SCHOENBERGER 1.00 0.00 X 0 0 0 DAVID DONSKER MD 1.00 0.00 X 0 0 0 STEVE HERMANS 1.00 0.00 X 0 0 0 KEVIN J O'LEARY 2.00 44.00 X 0 349585 100989 CONSTANCE D SPRAUER 2.00 42.00 X 0 264743 33086 BRIAN CAMPBELL 40.00 0.00 X 195740 0 37223 JONATHAN A JACKSON 40.00 0.00 X 240828 0 32594 MICHAEL GRESSEL 40.00 0.00 X 151007 0 26300 JANE PETERSON 40.00 0.00 X 200059 0 14588 DEANNA KING 40.00 0.00 X 157781 0 39263 JUDITH RINES 40.00 0.00 X 155346 0 31040 ANNE MARIE BULARZIK 40.00 0.00 X 176063 0 0 1276824 1386513 542675 57 1 1 0 EXETER HEALTH RESOURCES INC 5 ALUMNI DRIVE EXETER NH 03833 ADMINISTRATIVE MANAGEMENT SERVICES 5857723 CORE PHYSICIAN SERVICES LLC 5 ALUMNI DRIVE EXETER NH 03833 PHYSICIAN SERVICES 5112541 GE HEALTHCARE INC PO BOX 640944 PITTSBURGH PA 15264 EQUIPMENT & MAINTENANCE 1471468 NIXON PEABODY LLP 100 SUMMER STREET BOSTON MA 02110 LEGAL FEES 1095790 SODEXHO INC PO BOX 360170 PITTSBURGH PA 15251 FOOD SERVICE MANAGEMENT 1062944 50 89544 89544 NET PATIENT SVCS 621300 183613156 183613156 OTHER PROGRAM REVENUE 621300 967609 967609 ARRA FUNDS 621300 905058 905058 185485823 1784363 1784363 55692 213547 -157855 -157855 -157855 3306065 9326 0 0 3306065 9326 3315391 9326 3306065 INTEREST RATE SWAP 621300 2822978 2822978 CAFETERIA INCOME 621300 1320003 1320003 MISCELLANEOUS 621300 263702 200220 63482 174805 174805 4581488 195098754 189855300 63482 5090428 X 830991 830991 195740 170294 25446 67811801 58996267 8815534 1995000 1735650 259350 14976796 13029813 1946983 4860590 4228713 631877 317243 317243 53504 53504 35420 35420 1566015 1362433 203582 1063071 924872 138199 651149 566500 84649 5139228 4471128 668100 199993 173994 25999 497567 432883 64684 3887457 3382088 505369 10647930 9263699 1384231 1590536 1383766 206770 SUPPLIES 15432909 13426631 2006278 BAD DEBT EXPENSE 12331212 12331212 DRUGS 10113071 10113071 MEDICAID ENHANCEMENT TA 9005628 9005628 26373165 23772103 2586489 14573 189576016 169601736 19959707 14573 37309229 18403121 19331301 20268282 2703495 2712209 3461761 3461103 136128588 70519258 70064513 65609330 150200615 158532179 2361909 2004842 285432823 270991066 22469112 18273061 57067636 58160952 27454700 19491710 106991448 95925723 X 161432548 158059210 239506 236812 16769321 16769321 178441375 175065343 285432823 270991066 X 5522738 6256198 -15154968 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 11204 0 1 24216 35420 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES AND MANAGEMENT FEES ARE CONSIDERED LOBBYING EXPENSES. 17008827 41887 -44581 17006133 17001122 68831 -61126 17008827 17063265 49281 -111424 17001122 17030198 37433 4366 17063265 16940024 213038 122864 17030198 0.01390 0.98610 0.00000 0 1 1 142400 142400 75855074 33769192 42085882 289927 195836 94091 54810365 34372555 20437810 5030822 2181675 2849147 65609330 CASH & SHORT-TERM INVESTMENTS 24827056 F FIXED INCOME SECURITIES 32154944 F MARKETABLE EQUITY SECURITIES 55545191 F LIMITED PARTNERSHIPS 46311202 F OTHER -306214 C 158532179 DUE TO THIRD PARTY PAYORS 4070633 ACCRUED PENSION LIABILITY 7284170 SWAP VALUATION LIABILITY 8136907 19491710 X 195098754 0 195098754 0 195098754 189576016 0 189576016 0 189576016 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE GOAL OF THE PERMANENT ENDOWMENT FUND IS TO PROVIDE A SOURCE OF FINANCIAL SUPPORT TO EXETER'S PATIENT CARE ACTIVITIES. THESE FUNDS ARE INVESTED IN A PRUDENT MANNER WITH REGARD TO PRESERVING PRINCIPAL WHILE PROVIDING REASONABLE RETURNS. THESE RETURNS ARE THEN USED FOR CAPITAL EXPENDITURES, OTHER MAJOR PROGRAM NEEDS, AND TO GENERALLY INCREASE THE FINANCIAL STRENGTH OF THE ORGANIZATION. THE QUASI-ENDOWMENTS ARE FUNDS WHICH HAVE BEEN DONATED TO THE ORGANIZATION FOR A PURPOSE SPECIFIED BY THE DONOR. THESE FUNDS ARE HELD UNTIL USED FOR THE PURPOSE INTENDED BY THE DONOR. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: INCLUDED IN EXETER HOSPITAL INC.'S THE ENTITIES AUDITED FINANCIAL STATEMENTS IS THE FOLLOWING "MANAGEMENT EVALUATED THE TAX POSITIONS OF THE HOSPITAL AND HAS CONCLUDED THAT IT HAS MAINTAINED ITS TAX-EXEMPT STATUS, DOES NOT HAVE ANY SIGNIFICANT UNRELATED BUSINESS INCOME, AND HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS." 1 1 1 X 275.000000000000 1 X 1 1 0 1 1 1993 4580610 4580610 0.02420 3219 6002726 6002726 0.03170 5212 10583336 10583336 0.05590 16471 1014822 5055 1009767 0.00530 409 662284 15272 647012 0.00340 2126 3533166 477971 3055195 0.01610 122 149969 14612 135357 0.00070 870107 870107 0.00460 19128 6230348 512910 5717438 0.03010 24340 16813684 512910 16300774 0.08600 28983 28983 0.00020 36306 36306 0.00020 65289 65289 0.00040 0 5657560 1333833 53346423 80032093 -26685670 X 1 1 1 1 EXETER HOSPITAL

5 ALUMNI DRIVE EXETER NH 03833

X X X EXETER HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X X X 1 0 1 1 275.000000000000 1 400.000000000000 1 X X X 1 1 X X X X 1 0 1 X 0 0 PART I, LINE 7: A RATIO OF PATIENT COST TO CHARGE WAS CALCULATED UTILIZING WORKSHEET 2. THE RATIO OF COST TO CHARGE WAS UTILIZED IN CALCULATING LINE 7A TOTAL NET COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE. PART II: THE MAJORITY OF THE REMAINING COMMUNITY BENEFIT ACTIVITIES REPORTED AS COMMUNITY BUILDING ACTIVITIES ARE CASH DONATIONS TO COMMUNITY ORGANIZATIONS FOR THE PURPOSE OF FURTHERING WORKFORCE DEVELOPMENT, ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT, LEADERSHIP AND ECONOMIC DEVELOPMENT. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH ACCOUNTS FOR PATIENTS WHO ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE PATIENT COST TO CHARGE FROM WORKSHEET 2 WAS APPLIED TO DETERMINE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST. PART III, LINE 8: MEDICARE COSTS ARE NOT COUNTED AS A COMMUNITY BENEFIT PER NH OR IRS GUIDANCE, THEREFORE THE COST FIGURE OF $26,685,670 IS NOT INCLUDED IN THE TOTAL UNREIMBURSED COMMUNITY BENEFIT EXPENSE. THE RATIO OF COST TO CHARGE WAS UTILIZED IN CALCULATING THE AMOUNT. PART III, LINE 9B: IF A PATIENT HAS BEEN APPROVED FOR FINANCIAL ASSISTANCE AND THEIR ACCOUNT WAS SENT TO A COLLECTION AGENCY, THE ACCOUNT WILL BE RETRACTED FROM THE COLLECTION AGENCY AND FINANCIAL ASSISTANCE WILL BE APPLIED TO THE ACCOUNT. EXETER HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL USED AMOUNTS BASED ON FEDERAL POVERTY GUIDELINES AND SLIDING SCALE AS SHOWN BELOW.FAMILY DISCOUNT PERCENTAGESIZE 100% 80% 60% 40% 20% 1 23,340 23,341-32,676 32,677-37,344 37,345-42,012 42,013-46,680 2 31,460 31,461-44,044 44,045-50,336 50,337-56,628 56,629-62,9203 39,580 39,581-55,412 55,413-63,328 63,329-71,244 71,245-79,160 4 47,700 47,701-66,780 66,781-76,320 76,321-85,860 85,861-95,400 5 55,820 55,821-78,148 78,149-89,312 89,313-100,476 100,477-111,640 6 63,940 63,941-89,516 89,517- 102,305- 115,093- 102,304 115,092 127,880 7 72,060 72,061- 100,885- 115,297- 129,709- 100,884 115,296 129,708 144,1208 80,180 80,181- 112,253- 128,289- 144,325- 112,252 128,288 144,324 160,360 PART VI, LINE 2: EVERY FIVE YEARS, EXETER HOSPITAL, IN COLLABORATION WITH ITS COMMUNITY PARTNERS, CONDUCTS A COMMUNITY NEEDS ASSESSMENT TO IDENTIFY, PRIORITIZE, AND DEVELOP A PLAN TO ADDRESS CRITICAL HEALTH ISSUES. THE LAST COMMUNITY NEEDS ASSESSMENT WAS COMPLETED IN 2013. THE PURPOSE OF THE ASSESSMENT WAS TO ENGAGE COMMUNITY MEMBERS THROUGH KEY LEADER INTERVIEWS AND COMMUNITY FORUMS, AND TO ACHIEVE THE FOLLOWING OBJECTIVES: EDUCATE AND INFORM KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS OF THE RESULTS OF THE 2008 COMMUNITY NEEDS ASSESSMENT AND ACHIEVEMENTS TO DATE TO MEET IDENTIFIED NEEDS VALIDATE PRIORITY HEALTH NEEDS IDENTIFIED IN THE 2008 COMMUNITY NEEDS ASSESSMENT AND FURTHER DEFINE THESE NEEDS IN 2013 FROM THE STAKEHOLDERS' PERSPECTIVE IDENTIFY UNMET NEEDS THAT HAVE EMERGED SINCE THE 2008 COMMUNITY NEEDS ASSESSMENT ENGAGE KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS IN A DISCUSSION TO IDENTIFY SOLUTIONS TO ADDRESS COMMUNITY HEALTH NEEDS SHARE THE FINDINGS OF THE UNH SURVEY CENTER HOUSEHOLD TELEPHONE SURVEY WHERE APPROPRIATE, MOTIVATE KEY LEADERS AND COMMUNITY FORUM PARTICIPANTS TO PARTICIPATE IN EFFORTS TO ADDRESS COMMUNITY HEALTH NEEDS GOING FORWARD SERVE AS A CONTINUING FOUNDATION FOR THE DEVELOPMENT OF A COMMUNITY BENEFITS PLAN, AS MANDATED UNDER RSA 7:32-ETHE 2013 COMMUNITY NEEDS ASSESSMENT INCLUDED TELEPHONE SURVEY, FOCUS GROUP AND KEY LEADER INTERVIEW COMPONENTS. THE REPORT IN ITS ENTIRETY CAN BE ACCESSED ON THE EXETER HOSPITAL WEBSITE: HTTP://WWW.EXETERHOSPITAL.COM/ABOUT-EXETER/COMMUNITY-BENEFITS/. PART VI, LINE 3: EXETER HOSPITAL PROVIDES ITS PATIENTS WITH INFORMATION REGARDING THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM, AND A SUMMARY THE ORGANIZATION'S POLICY, ON THE BACK OF EVERY BILLING STATEMENT. ON THE EXETER HOSPITAL WEBSITE (HTTP://WWW.EXETERHOSPITAL.COM), PATIENTS AND THE GENERAL PUBLIC CAN FIND INFORMATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAMS; FINANCIAL ASSISTANCE, UNINSURED CARE DISCOUNT PROGRAM, CATASTROPHIC CARE PROGRAM; AND STATE-WIDE PROGRAMS. AS AN ADDITIONAL MEASURE TO ENSURE OUR COMMUNITY MEMBERS ARE AWARE OF EXETER HOSPITAL'S FINANCIAL ASSISTANCE PROGRAMS, TWICE A YEAR THE ORGANIZATION MAY RUN ADVERTISEMENTS IN COMMUNITY NEWSPAPERS SUMMARIZING THE ORGANIZATION'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY. EXETER HOSPITAL EMPLOYS FINANCIAL COUNSELORS SPECIFICALLY DEDICATED TO ASSISTING PATIENTS WITH QUESTIONS REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE, AND ASSISTING PATIENTS THROUGH THE QUALIFICATION PROCESS AS APPLICABLE. ALL INPATIENT SELF-PAY PATIENTS ARE PROVIDED INFORMATION AND COUNSELING REGARDING THE ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS AT THE TIME OF SERVICE. SELF-PAY PATIENTS IN THE EMERGENCY DEPARTMENT, SURGICAL AREAS AND ONCOLOGY ARE ALSO INFORMED OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAMS AT TIME OF SERVICE OR DISCHARGE. PART VI, LINE 4: EXETER HOSPITAL SERVICES AN AREA THAT ENCOMPASSES 40 COMMUNITIES WITH AN ESTIMATED POPULATION OF 233,193. PART VI, LINE 5: ACCESS TO CAREFINANCIAL ASSISTANCE:EXETER HOSPITAL HAS THREE COMPONENTS TO ITS HEALTH CARE ACCESS PROGRAM. - THE UNINSURED CARE DISCOUNT/HOSPITAL ACCESS PLUS PROGRAM EXTENDS A 26% DISCOUNT OFF TOTAL CHARGES TO PATIENTS.- THE FINANCIAL ASSISTANCE PROGRAM IS A COMMUNITY-BASED PROGRAM FOR UNINSURED AND UNDERINSURED PATIENTS WHO MEET SPECIFIC INCOME, GEOGRAPHICAL AND OTHER GUIDELINES, AND WHO DO NOT OTHERWISE QUALIFY FOR ANY STATE OR FEDERAL ASSISTANCE. - EXETER'S CATASTROPHIC CARE PROGRAM PROVIDES FINANCIAL RELIEF FOR THOSE PATIENTS WHO DO NOT QUALIFY FOR OUR FINANCIAL ASSISTANCE PROGRAM, BUT WHO ARE FACED WITH A SUBSTANTIAL DEBT DUE TO A SERIOUS ILLNESS OR INJURY. THE FINANCIAL RELIEF IS CALCULATED BASED ON A PERCENTAGE OF THE PATIENT'S GROSS INCOME. EXETER HOSPITAL PROVIDED $4,580,610 (CALCULATED AT COST) IN CHARITY CARE DURING FY 2013. IN FY 2013 THE CHARITY CARE PROGRAM SERVED 1,993 PEOPLE.WOMEN'S WELLNESS CLINIC: THE CLINIC PROVIDED UNINSURED AND UNDERINSURED WOMEN WITH RECOMMENDED BREAST AND CERVICAL CANCER SCREENINGS. IN FY 2013 THE WOMEN'S WELLNESS CLINIC SERVED 57 WOMEN AND EXETER HOSPITAL PROVIDED $46,127 TOWARDS THIS INITIATIVE. THIS CLINIC CEASED OPERATIONS IN JUNE 2013. HOWEVER, WOMEN WILL CONTINUE TO HAVE ACCESS TO FINANCIAL SUPPORT FOR THESE IMPORTANT HEALTH SCREENINGS THROUGH PARTICIPATING IN EXETER HOSPITAL'S EXISTING FINANCIAL ASSISTANCE PROGRAM.COMMUNITY PARTNERS:EXETER HOSPITAL WORKS COLLABORATIVELY WITH LOCAL NON-PROFIT AGENCIES AND ORGANIZATIONS WHICH STRIVE TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE RELATIONSHIPS INCLUDE:LAMPREY HEALTH CARE: IN FY 2013 EXETER HOSPITAL CONTINUED ITS FINANCIAL SUPPORT OF LAMPREY HEALTH CARE WITH A COMMUNITY BENEFIT GRANT IN THE AMOUNT OF $350,500. LAMPREY HEALTH CARE IS NEW HAMPSHIRE'S OLDEST AND LARGEST PRIVATE, NON-PROFIT COMMUNITY HEALTH CENTER WITH LOCATIONS IN NEWMARKET, RAYMOND, AND NASHUA. THE ORGANIZATION SERVES OVER 16,500 PATIENTS OF ALL AGES EACH YEAR. AS A COMMUNITY HEALTH CENTER, THEY PROVIDE PRIMARY CARE AND HEALTH-RELATED SERVICES TO ALL INDIVIDUALS AND FAMILIES, REGARDLESS OF INSURANCE STATUS OR ABILITY TO PAY. BY FOCUSING ON PREVENTION AND HEALTH CARE MANAGEMENT, LAMPREY HEALTH CARE STRIVES TO KEEP INSURED AND UNINSURED PATIENTS HEALTHY. SEACARE HEALTH SERVICES: EXETER HOSPITAL SUPPORTED SEACARE HEALTH SERVICES IN THE AMOUNT OF $261,000. SEACARE IS THE OLDEST VOLUNTEER PROVIDER NETWORK PRESENTLY FUNCTIONING IN THE US. ORGANIZED IN 1989, SEACARE INITIALLY PROVIDED PRIMARY CARE FOR CHILDREN IN PORTSMOUTH BUT EXPANDED IN 1994 TO INCLUDE PRIMARY AND SPECIALTY HEALTH CARE COORDINATION SERVICES FOR PEOPLE OF ALL AGES IN 21 TOWNS IN THE SEACOAST REGION. SEACARE CEASED OPERATIONS IN NOVEMBER 2013.FAMILIES FIRST HEALTH AND SUPPORT CENTER: IN FY 2013 EXETER HOSPITAL MADE A FINANCIAL CONTRIBUTION TO FAMILIES FIRST IN THE AMOUNT OF $40,875. FAMILIES FIRST IS A COMMUNITY HEALTH CENTER OFFERING A WIDE VARIETY OF HEALTH SERVICES AND PROGRAMS INCLUDING PRIMARY CARE, PRENATAL CARE, DENTAL CARE, AND MOBILE HEALTH CARE FOR THE HOMELESS.NEW OUTLOOK TEEN CENTER: EXETER HOSPITAL CONTINUED ITS SUPPORT OF NEW OUTLOOK TEEN CENTER IN THE AMOUNT OF $25,000.NEW OUTLOOK IS A RECREATIONAL, EDUCATIONAL AND PREVENTION-ORIENTED PROGRAM LOCATED IN EXETER, NH OFFERING AFTER-SCHOOL AND SUMMER ADVENTURE PROGRAMS FOR MIDDLE AND HIGH SCHOOL YOUTH. NEW OUTLOOK SERVES MORE THAN 350 YOUTH IN THE TOWNS OF BRENTWOOD, EAST KINGSTON, EXETER, KENSINGTON, NEWFIELDS AND STRATHAM. BEHAVIORAL HEALTH CARE SEACOAST MENTAL HEALTH CENTER: EXETER HOSPITAL PARTNERS WITH SEACOAST MENTAL HEALTH TO OFFER MENTAL HEALTH SERVICES TO PATIENTS AND THEIR CAREGIVERS IN THE EMERGENCY DEPARTMENT AND CANCER CARE CENTER. IN FY 2013, EXETER HELPED TO UNDERWRITE MENTAL HEALTH SERVICES IN THE AMOUNT OF $392,995.TRANSPORTATIONEXETER HOSPITAL'S TRANSPORTATION PROGRAM IS AN IMPORTANT HEALTH CARE SUPPORT SERVICE PROVIDED IN RESPONSE TO AN IDENTIFIED COMMUNITY NEED. EACH YEAR THE PROGRAM ENHANCES ACCESS FOR HUNDREDS OF PATIENTS WHO OTHERWISE WOULD NOT BE ABLE TO OBTAIN NEEDED HEALTH CARE AND HEALTH RELATED SUPPORT SERVICES. DURING FY 2013 EXETER HOSPITAL PROVIDED 2,251 TRANSPORTS AT A COST OF $117,723.RESEARCHTHE CENTER FOR CANCER CARE AT EXETER HOSPITAL PARTICIPATES IN SEVERAL NATIONAL RESEARCH GROUPS SPONSORED BY THE NATIONAL CANCER INSTITUTE, WHICH ENABLES THE CENTER TO OFFER CLINICAL TRIALS TO PATIENTS UNDERGOING TREATMENT AT EXETER HOSPITAL. THESE OFFERINGS ALLOW PATIENTS TO VOLUNTARILY TAKE PART IN LEADING EDGE RESEARCH THAT DOES NOT NECESSITATE TRAVEL OUTSIDE OF THE SEACOAST AREA. DURING FY 2013, EXETER HOSPITAL PROVIDED $135,357 FOR CLINICAL TRIALS AND RESEARCH THAT SERVED 122 PATIENTS. PART VI, LINE 6: A NETWORK OF CARINGEXETER HOSPITAL, INC. IS ONE OF THREE AFFILIATES OF EXETER HEALTH RESOURCES. AT EACH OF THE AFFILIATED COMPANIES, EXETER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES THAT ARE INNOVATIVE, PROGRESSIVE AND FOCUSED ON QUALITY AND THE WELL-BEING OF PATIENTS. THE MISSION OF EXETER HEALTH RESOURCES AND ITS AFFILIATES IS TO IMPROVE THE HEALTH OF THE COMMUNITY BY SUPPORTING THE PROVISION OF HEALTH SERVICES AND INFORMATION TO THE COMMUNITY.DURING FISCAL YEAR 2013, EXETER HOSPITAL, CORE PHYSICIANS AND ROCKINGHAM VNA & HOSPICE HAVE CONTINUED THE PURSUIT OF THIS MISSION PROVIDING $24,220,756 IN CHARITY CARE AND OTHER COMMUNITY BENEFIT PROGRAMS AND SERVICES TO COMMUNITIES IN THE AREAS SERVED. EXETER HOSPITAL IS A 100-BED COMMUNITY-BASED HOSPITAL SERVING NEW HAMPSHIRE'S SEACOAST REGION. THE HOSPITAL'S SCOPE OF CARE INCLUDES COMPREHENSIVE MEDICAL AND SURGICAL HEALTH CARE SERVICES BUT NOT LIMITED TO BREAST HEALTH, MATERNAL/CHILD AND REPRODUCTIVE MEDICINE, CARDIOVASCULAR, GASTROENTEROLOGY, SLEEP MEDICINE, OCCUPATIONAL AND EMPLOYEE HEALTH, ONCOLOGY, ORTHOPAEDICS, AND EMERGENCY CARE SERVICES. EXETER HOSPITAL IS ACCREDITED BY DNV HEALTHCARE, INC. (AN OFFICIALLY DEEMED MEDICARE AND MEDICAID CREDENTIALING AGENCY) AND EARNED THE MAGNET DESIGNATION FROM THE AMERICAN NURSES CREDENTIALING CENTER, WHICH IS THE MOST PRESTIGIOUS DISTINCTION A HEALTH CARE ORGANIZATION CAN RECEIVE FOR NURSING EXCELLENCE AND HIGH QUALITY PATIENT CARE. CORE PHYSICIANS IS A COMMUNITY-BASED, MULTI-SPECIALTY GROUP PRACTICE PROVIDING COMPREHENSIVE PRIMARY, SPECIALTY AND PEDIATRIC DENTAL CARE THROUGHOUT THE GREATER SEACOAST REGION. OVER 160 PHYSICIANS IN 32 LOCATIONS PURSUE EXCEPTIONAL PATIENT SATISFACTION THROUGH CLINICAL COMPETENCE AND PROFESSIONAL OFFICE ADMINISTRATION.ROCKINGHAM VISITING NURSE ASSOCIATION & HOSPICE IS A COMMUNITY-BASED HOME HEALTH AND HOSPICE AGENCY PROVIDING INDIVIDUALS AND FAMILIES WITH THE HIGHEST QUALITY HOME CARE, HOSPICE AND COMMUNITY OUTREACH PROGRAMS WITHIN ROCKINGHAM COUNTY AND THE SURROUNDING TOWNS OF BARRINGTON, LEE AND DURHAM. REPORTS FILED WITH STATES PART VI, LINE 7 NH 1 NEW OUTLOOK PO BOX 865 EXETER NH 03833 020468342 501(C)(3) 25000 PROVIDE RECREATIONAL, EDUCATIONAL AND PREVENTION ORIENTED PROGRAMS IN AFTER SCHOOL AND SUMMER PROGRAMS. LAMPREY HEALTHCARE INC 207 SOUTH MAIN STREET NEWMARKET NH 03857 237305106 501(C)(3) 350500 SUPPORTS THE PROVISION OF VITAL HEALTH CARE SERVICES FOR THE INDIGENT AND UNINSURED POPULATIONS IN THE COMMUNITIES IT SERVES. SEACARE HEALTH SERVICES 11 DOWNING COURT EXETER NH 03833 050473406 501(C)(3) 261000 ASSISTANCE IN PROVIDING HEALTH CARE COORDINATION AND EDUCATION SERVICES, AS WELL AS MEDICATION ACCESS TO UNINSURED INDIVIDUALS IN THE COMMUNITIES IT SERVES. VX HEALTH SERVICES INC 7 ALUMNI DRIVE EXETER NH 03833 020469712 10616 FUND CHARITABLE FITNESS MEMBERSHIPS FAMILIES FIRST 100 CAMPUS DRIVE SUITE 12 PORTSMOUTH NH 03801 222757341 501(C)(3) 40875 ANNUAL FUNDING CONTRIBUTION THAT HELPS FAMILIES FIRST CONTINUE TO PROVIDE HEALTH SERVICES INCLUDING PRIMARY CARE, DENTAL, PRENATAL CARE AND MOBILE HEALTH CARE FOR THE HOMELESS. UNITED WAY OF THE GREATER SEACOAST 112 CORPORATE DR UNIT 3 PORTSMOUTH NH 03801 042382233 501(C)(3) 16000 GRANT TO SUPPORT HEALTHCARE RELATED PROGRAMMING AND VOLUNTEERISM. AMERICAN CANCER SOCIETY INC 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 10000 MAKING STRIDES SUPPORTER AND FLAGSHIP SPONSOR DARTMOUTH HITCHCOCK CLINIC ONE MEDICAL CENTER DR LEBANON NH 03756 222519596 501(C)(3) 117000 PROVIDE REGIONAL ACCESS IN THE GREATER EXETER SERVICE REGION TO DARTMOUTH HITCHCOCK'S PROGRAM THAT PROVIDES CLINICAL ASSESSMENTS FOR POSSIBLE CHILD VICTIMS OF MALTREATMENT. 7 8 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL REQUESTS FOR GRANTS/CONTRIBUTIONS/SPONSORSHIPS OVER $5,000 REQUIRE THE APPROVAL OF AT LEAST THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND DEVELOPMENT TO ENSURE THAT THEY ARE CONSISTENT WITH OUR MISSION, VALUES AND STRATEGIC PLAN. LARGE GRANTS LIKE THOSE GIVEN TO LAMPREY, DARTMOUTH HITCHCOCK CLINIC, SEACARE, FAMILIES FIRST AND NEW OUTLOOK ARE ALSO REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER PRIOR TO APPROVAL. EACH OF THOSE REQUESTING ORGANIZATIONS EITHER PROVIDES A WRITTEN SUMMARY OF HOW THEY HAVE USED OUR PREVIOUS SUPPORT AS WELL AS THEIR SPECIFIC PLANS FOR ANY NEW REQUESTED FUNDING OR THEY MAKE A PRESENTATION IN PERSON USUALLY TO THE CHIEF FINANCIAL OFFICER, THE CHIEF EXECUTIVE OFFICER AND THE VICE PRESIDENT OF STRATEGY, COMMUNITY RELATIONS AND DEVELOPMENT. EACH YEAR A SUB COMMITTEE OF EXETER HEALTH RESOURCES' (PARENT COMPANY) BOARD OF TRUSTEES IS CHARGED WITH OVERSEEING OUR COMMUNITY BENEFITS PROGRAM AND OUR COMMUNITY NEEDS ASSESSMENT AND REVIEWS A DETAILED REPORT ON THE PREVIOUS YEAR'S GRANTS/ CONTRIBUTIONS/SPONSORSHIPS AND APPROVES THE CURRENT YEAR'S PLAN FOR COMMUNITY SUPPORT. THAT SUB COMMITTEE AND THE LARGER EXETER HEALTH RESOURCES' (PARENT COMPANY) BOARD OF TRUSTEES ARE REGULARLY UPDATED ON OUR COMMUNITY SUPPORT INITIATIVES. X X 0 1 X X X X 1 1 0 0 0 0 0 1 0 KEVIN J CALLAHAN 0 509869 0 0 0 93800 0 167500 0 27076 0 798245 0 0 NANCY BRAESE DO 0 125943 0 18916 0 23657 0 5305 0 27711 0 201532 0 0 KEVIN J O'LEARY 0 296066 0 0 0 53519 0 83000 0 17989 0 450574 0 0 CONSTANCE D SPRAUER 0 219965 0 0 0 44778 0 15000 0 18086 0 297829 0 0 BRIAN CAMPBELL 159422 0 0 0 36318 0 11857 0 25366 0 232963 0 0 0 JONATHAN A JACKSON 236357 0 4230 0 241 0 14619 0 17975 0 273422 0 0 0 MICHAEL GRESSEL 116148 0 12108 0 22751 0 9195 0 17105 0 177307 0 0 0 JANE PETERSON 161510 0 14944 0 23605 0 12124 0 2464 0 214647 0 0 0 DEANNA KING 145080 0 7130 0 5571 0 9969 0 29294 0 197044 0 0 0 JUDITH RINES 133610 0 13859 0 7877 0 6233 0 24807 0 186386 0 0 0 ANNE MARIE BULARZIK 0 0 0 0 176063 0 0 0 0 0 176063 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS UP PAYMENTS WERE PROVIDED TO KEVIN CALLAHAN, NANCY BRAESE, DO, KEVIN O'LEARY, CONSTANCE SPRAUER AND BRIAN CAMPBELL (FOR ACQUISITION OF SUPPLEMENTAL LONG TERM DISABILITY INSURANCE). THE BENEFIT WAS TREATED AS TAXABLE INCOME. TRUSTEES ARE ELIGIBLE FOR DISCOUNTED MEMBERSHIP FEES AT A WELLNESS CENTER OWNED BY A SUBSIDIARY OF EXETER HEALTH RESOURCES. THE BENEFIT IS REPORTED AS TAXABLE INCOME TO THE TRUSTEE. PART I, LINE 1B THERE WAS NO EXISTING POLICY CONCERNING TAX INDEMNIFICATION AND GROSS UP PAYMENTS. HOWEVER, IN THE INSTANCE OF SUCH ACTION RELATED TO THE ACQUISITION OF LONG TERM DISABILITY INSURANCE DESCRIBED ABOVE, THE TAX INDEMNIFICATION AND GROSS UP PAYMENTS WERE APPROVED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES EXECUTIVE COMMITTEE WHICH IS COMPRISED OF DISINTERESTED PERSONS. PART I, LINES 4A-B THE ORGANIZATION'S PARENT (EXETER HEALTH RESOURCES, INC.) MAINTAINS A SPLIT DOLLAR SUPPLEMENTAL RETIREMENT PLAN FOR TWO EXECUTIVES (LISTED BELOW WITH AMOUNTS) SELECTED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES. THE PLAN IS CLOSED TO FUTURE PARTICIPANTS. THE PLAN PROVIDES FOR ANNUAL PAYMENTS OF PREMIUMS FOR LIFE INSURANCE POLICIES INSURING THE LISTED INDIVIDUALS. THOSE LIFE INSURANCE PREMIUMS ARE COLLATERALLY ASSIGNED TO THE CORPORATION AND ANY EXCESS ACCUMULATED VALUE IN THE POLICIES (NET OF ACCUMULATED PREMIUM PAYMENTS) IS AVAILABLE TO BE PAID TO THE PARTICIPANT ONCE VESTED AT AGE 62. KEVIN CALLAHAN - EXCESS ACCUMULATED VALUE - $1,118,815 KEVIN O'LEARY - EXCESS ACCUMULATED VALUE - $466,844 CERTAIN OF THE LISTED EMPLOYEES PARTICIPATE IN A NONQUALIFIED DEFERRED COMPENSATION PLAN AS DESCRIBED IN INTERNAL REVENUE CODE SECTION 457(F) SPONSORED BY EXETER HEALTH RESOURCES. IN THE CALENDAR YEAR ENDED DEC 31, 2012 THE CONTRIBUTION TO THE PLAN FOR THE NON-VESTED BENEFIT OF KEVIN CALLAHAN WAS $160,000 AND THE CONTRIBUTION TO THE PLAN FOR THE NON-VESTED BENEFIT OF KEVIN O'LEARY WAS $68,000. PARTICIPANTS IN THE 457(F) PLAN DO NOT VEST UNTIL AGE 62. PART I, LINE 7 THE ORGANIZATION PROVIDES AN ANNUAL INCENTIVE COMPENSATION PLAN FOR EXECUTIVES SELECTED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES. THESE EXECUTIVES INCLUDE: KEVIN CALLAHAN, KEVIN O'LEARY, CONSTANCE SPRAUER AND BRIAN CAMPBELL. THE BOARD AND / OR ITS EXECUTIVE COMMITTEE APPROVES MEASURABLE ACHIEVEMENT CRITERIA FOR QUALITY, PATIENT SATISFACTION, PROCESS IMPROVEMENT, FINANCIAL PERFORMANCE, SERVICES INNOVATION AND OTHER COMPELLING AREAS OF STRATEGIC AND OPERATIONAL INTEREST. ADDITIONALLY, THE BOARD AND /OR ITS EXECUTIVE COMMITTEE ESTABLISHES MINIMUM, TARGETED AND MAXIMUM LEVELS FOR INCENTIVE AWARDS AND APPROVES ALL INCENTIVE AWARDS FOR PARTICIPATING EXECUTIVES. NANCY BRAESE DO IS COMPENSATED UNDER CORE PHYSICIANS, LLC'S COMPENSATION PROGRAM. COMPENSATION IS DETERMINED USING SURVEYS OF CURRENT COMPENSATION WITHIN COMPARABLE MARKETS AND THE ADVICE OF OUTSIDE CONSULTANTS. THE PHYSICIANS' COMPENSATION IS APPROVED BY CORE PHYSICIANS, LLC'S COMPENSATION COMMITTEE WHICH IS COMPRISED OF SYSTEM MANAGERS WHO ARE APPROVED BY THE EXETER HEALTH RESOURCES INC. BOARD OF TRUSTEES. JONATHAN JACKSON, JANE PETERSON, DEANNA KING, JUDITH RINES AND MICHAEL GRESSEL PARTICIPATE IN AN ANNUAL INCENTIVE PROGRAM WHICH IS ADMINISTERED BY EXETER HOSPITAL'S HUMAN RESOURCES DEPARTMENT. THE PROGRAM INCLUDES MEASURABLE ACHIEVEMENT CRITERIA FOR PERFORMANCE AND SERVICE INNOVATION. A NH HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 644614GH6 2003-11-20 20000000 RENOVATION AND EXPANSION PROJECTS ON THE HOSPITAL CAMPUS 0 1 0 B NH HEALTH AND EDUCATION FACILITIES AUTHORITY 020279866 NONEAVAIL 2012-02-09 32565000 REFINANCING AND REFUNDING PRIOR BOND ISSUANCE 0 1 0 A 20000000 19892600 256727 19635873 2006 0 0 1 1 B 32565000 215404 32349596 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 A 1 1 0 0 0 1 B 1 1 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 6 EXETER HEALTH RESOURCES, INC., A CHARITABLE ORGANIZATION ACTING THROUGH ITS BOARD OF TRUSTEES IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EXETER HEALTH RESOURCES, INC. ELECTS 11 OF THE 13 MEMBERS OF THE EXETER HOSPITAL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, EXETER HEALTH RESOURCES, INC., HAS THE RIGHT TO APPROVE DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY AN OUTSIDE TAX ACCOUNTANT WITH INFORMATION PROVIDED BY THE ORGANIZATION. THE 990 IS REVIEWED BY THE ORGANIZATION'S TREASURER THEN PRESENTED TO THE BOARD OF TRUSTEES BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES HAS ADOPTED A CONFLICT OF INTEREST POLICY THAT REQUIRES THE DISCLOSURE OF CONFLICTS OF INTEREST EITHER WHEN THE INTEREST BECOMES A MATTER OF POSSIBLE ACTION BY THE BOARD OR DURING AN ANNUAL DISCLOSURE PROCESS. TRUSTEES, OFFICERS, AND KEY EMPLOYEES, AS WELL AS ALL MEMBERS OF SENIOR MANAGEMENT, ARE PART OF THE ANNUAL DISCLOSURE PROCESS, WHICH IS INITIATED BY THE ISSUANCE OF A MEMORANDUM AND ACCOMPANYING QUESTIONNAIRE BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER (CEO). ALL DISCLOSURES ARE REVIEWED. ANY TRUSTEE WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING AND IS NOT INCLUDED IN A QUORUM DETERMINATION ON THE MATTER AND ANY OFFICER, KEY EMPLOYEE, OR MEMBER OF SENIOR MANAGEMENT WITH A CONFLICT DOES NOT TAKE PART IN MAKING AND IS NOT PRESENT FOR ANY DECISION REGARDING THE MATTER. THE POLICY IS MONITORED AND ENFORCED BY BOTH THE PRESIDENT AND CEO AND THE FULL BOARD. THERE ARE TWO ADDITIONAL CONFLICTS OF INTEREST POLICIES. ONE IS APPLICABLE TO ALL EMPLOYEES AND CONTRACTED STAFF AND THE OTHER IS APPLICABLE TO MEMBERS OF THE MEDICAL STAFF AND ALLIED HEALTH PROFESSIONALS. THE FORMER POLICY IS MONITORED AND ENFORCED BY THE VICE PRESIDENT OF HUMAN RESOURCES AND THE VICE PRESIDENT OF CORPORATE INTEGRITY AND COMPLIANCE AND THE LATTER IS MONITORED AND ENFORCED BY THE PRESIDENT OF THE MEDICAL STAFF, PRESIDENT AND CEO, GENERAL COUNSEL, AND COMPLIANCE OFFICER. ON AN ANNUAL BASIS, STAFF WITHIN HUMAN RESOURCES SURVEY ALL EMPLOYEES AND CONTRACTED STAFF SERVING IN A MANAGERIAL ROLE, AS WELL AS MEMBERS OF ANY COMMITTEES THAT MAKE RECOMMENDATIONS OR DECISIONS REGARDING THE PURCHASE OF GOODS OR SERVICES BY ANY OF THE CORPORATIONS AS A MEANS TO ENSURE THAT ANY CONFLICT OF INTEREST IS DISCLOSED AND APPROPRIATELY MANAGED. EMPLOYEES OTHERWISE ARE REQUIRED TO SUPPLEMENT OR MAKE ANY FURTHER WRITTEN DISCLOSURE AT THE TIME A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PARENT (EXETER HEALTH RESOURCES) HAS A FORMAL PROCESS FOR DETERMINING TOTAL COMPENSATION FOR THE CEO AND OTHER LISTED OFFICERS THAT IS INTENDED TO PROVIDE REASONABLE COMPENSATION FOR ACHIEVING THE ORGANIZATION'S MISSION, TO RECOGNIZE INDIVIDUAL AND TEAM PERFORMANCE, AND TO COMPLY WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE EXETER HEALTH RESOURCES' BOARD OF TRUSTEES CONDUCTS AN ANNUAL REVIEW OF THE COMPENSATION OF THE CEO, OTHER LISTED OFFICERS AND KEY EMLOYEES. IN DOING SO, THE COMMITTEE RETAINS A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE MARKET RANGES OF BASE, INCENTIVE, AND TOTAL CASH COMPENSATION, AND TO PROVIDE ADVICE CONCERNING THE REASONABLENESS OF THE COMPENSATION OF THE CEO, OTHER LISTED OFFICERS AND KEY EMPLOYEES. THE COMMITTEE UTILIZES THAT ANALYSIS AND OTHER APPROPRIATE INFORMATION IN CONNECTION WITH ITS ANNUAL REVIEW AND MAKES RECOMMENDATIONS TO THE FULL BOARD OF EXETER HEALTH RESOURCES FOR ADJUSTMENT OF THE CEO'S COMPENSATION AND THE COMPENSATION FOR OTHER LISTED OFFICERS. INFORMATION WHICH THE COMMITTEE MAY CONSIDER CAN INCLUDE BUT IS NOT LIMITED TO THE PERFORMANCE OF AN INDIVIDUAL AND/OR THAT INDIVIDUAL'S CONTRIBUTIONS TO A TEAM, THE PERFORMANCE OF THE ORGANIZATION IN WHOLE AND IN PART, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATION'S COMPENSATION TARGETS, AND COMPARABILITY DATA,INCLUDING THE DATA PREPARED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE COMMITTEE. THE COMMITTEE INCORPORATES A PERFORMANCE APPRAISAL PROCESS IN THE CEO'S, OTHER LISTED OFFICERS' AND KEY EMPLOYEES' COMPENSATION REVIEW. THE CEO, OTHER LISTED OFFICERS AND KEY EMPLOYEES ARE NOT PRESENT WHEN THE COMMITTEE DISCUSSES THEIR RESPECTIVE COMPENSATION. IN ADDITION, THE COMMITTEE DETERMINES IF THE THRESHOLD REQUIREMENTS FOR INCENTIVE AWARDS ARE MET, CONSISTING OF THE ORGANIZATION'S PERFORMANCE RESULTS FOR QUALITY, OPERATING SYSTEM EXCELLENCE AND FINANCIAL PERFORMANCE. THE RESULTS OF THE COMMITTEE'S DELIBERATIONS ARE PRESENTED TO THE EXETER HEALTH RESOURCES BOARD AND INCLUDE RECOMMENDATIONS CONCERNING SALARY RANGE ADJUSTMENTS AND INCENTIVE AWARDS AND THE BASIS FOR THE COMMITTEE'S DECISIONS / RECOMMENDATIONS. THE DELIBERATIONS OF THE EXETER HEALTH RESOURCES BOARD ARE CONDUCTED IN EXECUTIVE SESSION WITH THE INDEPENDENT MEMBERS OF THE BOARD BUT DO INCLUDE THE CEO ONLY FOR THAT PERIOD OF TIME IN WHICH THE EXETER HEALTH RESOURCES BOARD HAS QUESTIONS CONCERNING THE PERFORMANCE OF ANY LISTED OFFICER OR KEY EMPLOYEE OTHER THAN THE CEO. THE EXETER HEALTH RESOURCES BOARD REVIEWS THE CEO'S PERFORMANCE AND DETERMINES IF THE ADJUSTMENTS AND AWARDS RECOMMENDED BY THE COMMITTEE FOR THE CEO ARE IN THE ORGANIZATION'S BEST INTEREST AND FOR THE BENEFIT OF THE ORGANIZATION AND ITS PARENT ORGANIZATION. FOR THE OTHER LISTED OFFICER POSITIONS, ADJUSTMENTS AND INCENTIVE AWARDS ARE APPROVED UPON RECOMMENDATION OF THE CEO BY THE EXECUTIVE COMMITTEE WITHIN THE EXETER HEALTH RESOURCES BOARD APPROVED PARAMETERS AND RATIFIED BY THE EXETER HEALTH RESOURCES BOARD OF TRUSTEES. ADJUSTMENTS AND AWARDS FOR OTHER LISTED KEY EMPLOYEES ARE APPROVED UPON RECOMMENDATION OF THE CEO BY THE EXECUTIVE COMMITTEE WITHIN THE EXETER HEALTH RESOURCES BOARD APPROVED PARAMETERS AND REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 24E PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 7,732,517. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,732,517. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 5,789,131. MANAGEMENT AND GENERAL EXPENSES 865,043. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,654,174. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,093,297. MANAGEMENT AND GENERAL EXPENSES 611,642. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,704,939. OUTSIDE FEES: PROGRAM SERVICE EXPENSES 1,926,839. MANAGEMENT AND GENERAL EXPENSES 287,919. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,214,758. EQUIPMENT RENTAL: PROGRAM SERVICE EXPENSES 913,124. MANAGEMENT AND GENERAL EXPENSES 136,444. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,049,568. COLLECTION FEES: PROGRAM SERVICE EXPENSES 622,996. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 622,996. LAUNDRY/LINEN: PROGRAM SERVICE EXPENSES 506,609. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 506,609. CONSULTING: PROGRAM SERVICE EXPENSES 478,492. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 478,492. MAINTENANCE: PROGRAM SERVICE EXPENSES 376,926. MANAGEMENT AND GENERAL EXPENSES 56,322. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 433,248. PROJECT/DESIGN COSTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 354,207. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 354,207. FREIGHT AND TRANSPORTATION: PROGRAM SERVICE EXPENSES 323,916. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,916. MEDICAL LEADERSHIP/ FEES: PROGRAM SERVICE EXPENSES 290,031. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 290,031. DUES/SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 240,813. MANAGEMENT AND GENERAL EXPENSES 35,984. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 276,797. STORAGE: PROGRAM SERVICE EXPENSES 202,501. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 202,501. FINANCING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 199,560. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 199,560. REFRESHMENTS: PROGRAM SERVICE EXPENSES 152,991. MANAGEMENT AND GENERAL EXPENSES 22,861. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 175,852. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 71,545. MANAGEMENT AND GENERAL EXPENSES 15,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,206. PATIENT TRANSPORT/SUPPORT GROUPS: PROGRAM SERVICE EXPENSES 50,375. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,375. FUNDRAISING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 14,573. TOTAL EXPENSES 14,573. MEDICAL DEVICE TAX: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 846. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 846. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFERS BETWEEN RELATED ENTITIES -16,898,654. PENSION ADJUSTMENT 4,185,464. ASSETS RELEASED -44,581. LOSS FROM DISCONTINUED OPERATIONS -232,107. EXETER HEALTHCARE MERGER -2,165,090. AMENDED RETURN FORM 990,PART VIII, LINE 11C FOR THE YEAR ENDED SEPTEMBER 30, 2013 HAS BEEN AMENDED TO REFLECT THE UNRELATED BUSINESS INCOME OF $63,482 FROM THE LATE ARRIVING SCHEDULE K-1 FROM YANKEE ALLIANCE SUPPLY CHAIN SOLUTIONS, LLC ( EIN: 46-2047077). 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