2014-08-15T12:14:41-05:00 2013-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-10-01 020222171 New London Hospital Association Inc NEWL 6035265339 273 County Road New London NH 03257 Donald Griffin 6035265339 2014-08-14 1 Barbara J McGuan CPA P00219457 2077752387 2014-08-14 2012 2015-11-30 17:44:51Z Bruce King 273 County Road New London NH 03257 62739233 0 X www.newlondonhospital.org X 1918 NH NLHA is a rural community Critical Access Hospital with an extended care center. 14 11 677 188 131098 -31537 1496917 919293 55920753 53564090 570976 976640 1515 1994 57990161 55462017 0 22865 0 0 32624497 33261010 0 0 347883 22199230 23666236 54823727 56950111 3166434 -1488094 62092733 61121031 33399049 31839700 28693684 29281331 X New London Hospital is a 25-bed rural community Critical Access Hospital with a 58-bed long term extended care center dedicated to serving the Lake Sunapee region in central New Hampshire.New London Hospital provides safe quality care for every patient, every time in partnership with patients, families and healthcare providers. 0 0 31906366 22865 41902335 Hospital services to patients: New London Hospital Association, Inc. (NLHA) is the principal provider of primary and secondary health care for 15 towns in Sullivan and Merrimack counties in New Hampshire. The hospital provides acute and primary health care - from emergency services to family medical practice to surgical care - and essential wellness and prevention services for the 34,000 residents in its service area, a significant proportion of whom are uninsured, underinsured and/or dependent on Medicaid/Medicare benefits. This includes a large elderly population and a significant number of rural, low-income families. 10198688 7513246 Physician practices: In a recent community health needs assessment access to primary care is identified as a central community need. As a result, the hospital is committed to providing care in central locations throughout the service area, specifically Newport and New London. NLHA employs forty-one providers. Twenty-three provide primary care including pediatrics, and eighteen are specialists covering general surgery, anesthesiology, orthopaedics, neurology, emergency medicine, hospitalists, gynecology, rheumatology, and ear, nose and throat. 3761291 4017411 Nursing Home: The Clough Center is a 58-bed extended nursing care facility located within New London Hospital. The Clough Center provides a warm and caring environment for its residents who benefit from health services personalized to meet their individual needs, including special meals, physical, occupational and speech therapy, personalized exercise sessions, and individual attention by highly skilled providers who have immediate access to the comprehensive services of a hospital and pharmacy. 45866345 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 141 0 1 677 1 1 1 0 0 0 0 0 0 0 0 0 X 14 11 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NH X Donald Griffin 6035265372 273 County Road New London NH 03257 Anne Holmes 8.00 X X 0 0 0 Bruce P King 50.00 X X 481580 0 59042 Celeste C Cook 2.00 X 0 0 0 David Marshall 8.00 X X 0 0 0 Douglas W Lyon 2.00 X 0 0 0 Eileen Kirk MD 50.00 X 233858 0 15584 Jane Rastallis 2.00 X 0 0 0 John C Ferries 2.00 X 0 0 0 John Kirk MD 2.00 X 166369 0 7283 John R Butterly MD 2.00 X 0 0 0 Kris Eschbach DO 40.00 X 0 0 0 Peter E Hager 2.00 X 0 0 0 Robert M Rex 2.00 X 0 0 0 Sage Chase 2.00 X 0 0 0 Stanley I Cundey Jr 8.00 X X 0 0 0 Stephen Jordan MD 50.00 X 107742 0 2475 Susan Reeves 8.00 X X 0 0 0 Donald J Griffin 50.00 X 142650 0 12152 James Murphy MD 50.00 X 251993 0 3097 Margie Limmorison 50.00 X 46510 0 5637 Patricia Sweezey 50.00 X 121278 0 12609 Sally Patton 50.00 X 20642 0 0 Steven Powell MD MPH 50.00 X 451897 0 9121 Teresa LeBlanc 50.00 X 145978 0 2264 Adnan Khan MD 50.00 X 380168 0 1460 Donald A Eberly MD 50.00 X 284235 0 13137 Michael Madan MD 50.00 X 283749 0 7551 Stephen Bissah MD 50.00 X 278224 0 18101 Thomas F Lucas MD 50.00 X 280886 0 7654 3677759 0 177167 44 0 1 1 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Physician Staffing & Lab Services 1165362 Upper Valley Neurology Neurosurgery PC 106 Hanover St Lebanon NH 03766 Physician Services 870544 New England Alliance for Health LLC 1 Medical Center Drive Lebanon NH 03756 Management Services 743448 Quest Diagnostics PO Box 51048 Los Angeles CA 90074 Lab Services 278558 New Hampshire Imaging Services 1 Pillsbury St Concord NH 03301 Diagnostic Imaging Services 278080 13 56269 128452 734572 18372 919293 Patient Revenue 621400 97314506 97314506 Physician Services 621110 2632577 2632577 Other Revenue 900099 444102 313004 131098 Provision for Bad Debts 621400 -2458172 -2458172 Contractual/Char. Adj. 621400 -44368923 -44368923 53564090 418711 418711 7743770 7250 7193091 0 550679 7250 557929 557929 86119 56269 84125 1994 1994 55462017 53432992 131098 978634 22865 22865 2073279 889272 1184007 26078120 20888574 4945548 243998 6657 5332 1325 3453610 2766342 653555 33713 1649344 1321125 310509 17710 417296 334254 83042 85514 68497 17017 61562 49311 12251 5557492 4451551 1105941 196422 157334 14620 24468 2748721 2201726 529680 17315 742316 594595 147721 1368719 1096344 268171 4204 102312 81952 15325 5035 173359 138861 33058 1440 764216 612137 152079 172396 138089 34307 3370943 2700125 670818 664363 532155 132208 Medicaid Enhancement Ta 2197391 2197391 Drugs and Pharmaceutica 1907209 1907209 Medical Supplies 1877131 1877131 Other 1258874 834173 424701 56950111 45866345 10735883 347883 7832625 3167830 2107677 2037303 221530 85719 7034343 6722367 988908 1022833 462985 815350 71546675 39764489 30021283 31782186 9705309 11444575 303792 292506 3414281 3750362 62092733 61121031 5292720 6387588 16175000 15855000 151601 94738 11779728 9502374 33399049 31839700 X 26286652 26843022 404043 385793 2002989 2052516 28693684 29281331 62092733 61121031 X -1488094 348285 1727456 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11231 11231 0 Explanation of Lobbying Activities: Part II-B, Line 1: Per information provided by the NH Hospital Association (NHHA), the NHHA percentage of dues expended for lobbying purposed was 23.45%. 2002989 172073 104101 18445 2052516 1890475 227326 96967 17845 2002989 1928036 77754 90305 25010 1890475 1870163 90988 30386 2729 1928036 1870163 2996 132 2864 1870163 0.00000 1.00000 0.00000 1 0 1660103 1660103 38265190 15478501 22786689 383787 312652 71135 29597454 23254439 6343015 1640141 718897 921244 31782186 Due from Affiliate 589772 Other Assets 6066 Deferred Compensation Plan Assets 1475875 Beneficial Interest in Perpetual Trust 1678649 3750362 Charitable Gift Annuities 22033 Capital Lease Obligations 1416756 Other Liabilities 20000 Interest Rate Swap 3095722 Estimated Third-Party Payor Settlements 3471988 Deferred Compensation 1475875 9502374 Description of Intended Use of Endowment Funds: Part V, Line 4: The income from the Endowment Funds is used to assist in the payment of the hospitals program-related expenses. Golf Tournament 53844 27057 26787 6615 9137 5922 3119 Hospital Gala 54910 21550 33360 3108 16729 8220 5303 1 33634 7662 25972 6932 1936 750 16354 142388 56269 86119 6615 19177 24587 8970 24776 84125 1994 1 1 1 X 1 X 1 1 1 0 1 1 979160 979160 0.01720 5774105 4669677 1104428 0.01940 6753265 4669677 2083588 0.03660 92988 92988 0.00160 26181 26181 0.00050 5273650 5273650 0.09260 22865 22865 0.00040 5415684 5415684 0.09510 12168949 4669677 7499272 0.13170 72002 72002 0.00130 53632 53632 0.00090 125634 125634 0.00220 1 1296121 25922 15571995 16602340 -1030345 X 1 1 1 1 New London Hospital

273 County Road New London NH 03257

X New London Hospital Association 1 1 X X X X X X X X X 11 1 1 1 X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X 1 0 X X X X 1 X X 0 0 1 Newport Health Center

11 John Stark Hwy Newport NH 03773

Clinic Part I, Line 7g: The Hospital is dedicated to serving and supporting the community it serves by ensuring access to programs that could not be provided without the organization subsidizing their services. In FY 2013, the Hospital subsidized health care to the community in the amount of $5,273,650. This included support for primary care services, the medication bridge program, ambulance services and mental health services.With a focus on wellness, primary care is of the utmost importance to our patients and their families. The Organization has locations for primary care in New London and Newport, NH to expand access within the communities we serve. Costs incurred for subsidizing primary care by the Hospital, were over $4.9 million dollars for fiscal year 2013.Due to limited access to mental health services within our service area, the Hospital partnered with West Central Behavioral Health to expand service availability to patients in need. These services were provided at a cost of $200,000 for fiscal year 2013.The ambulance service provides advanced life support services seven days a week, 24 hours a day to towns within our service area that would not otherwise have access to emergency medical transport. The ambulance responded to over 1,000 emergency calls in fiscal year 2013 at a cost of over $57,000 to the Hospital.The cost of prescription drugs is often beyond the means of many of residents in our community. The Hospital supports the medication bridge program which works with uninsured and underinsured patients to assist them in accessing prescription medication. Over 100 patients received assistance under this program, at a cost of $24,000 to the Hospital. Part II: The Hospital participates in a wide variety of community building activities including community support and community health improvement advocacy. The Hospital supports many local service agencies through the participation of members of its management team on committees and boards. The Hospital subsidizes the cost of operations for the ABC'S Childcare Center, which provides high quality childcare at affordable prices. The childcare center is open to full and part time employees of the Organization and to the community to provide a nurturing, safe and stimulating environment for the children of our community to grow and learn. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.The Association's allowance for doubtful accounts for self-pay patients increased from 82% of self-pay accounts receivable at September 30, 2012, to 85% of self-pay accounts receivable at September 30, 2013. In addition, the Association's self-pay accounts receivable increased from approximately $949,000 at September 30, 2012 to $1,670,000 at September 30, 2013. The Association has not changed its free care or uninsured discount policies during 2013. The Association does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant write-offs from third-party payors. The Association recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the service rendered. For uninsured patients that do not qualify for free care, the Association recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates, if negotiated or provided by policy). On the basis of historical experience, a portion of the Association's uninsured patients will be unable to or unwilling to pay for the services provided. Thus, the Association records a significant provision for bad debts related to uninsured patients in the period the services are provided.The Hospital used the cost-to-charge ratio for reporting the bad debt expense at cost.The estimate of bad debt attributable to charity care was based upon an internal review of records and specific information available for individual patients. The Hospital provides information about financial assistance policies upon admission, prior to discharge and throughout the billing process. Although the Hospital works diligently to provide financial options to patients, a small number of patients do not provide the information necessary to complete the financial aid application. Patients who do not respond to repeated attempts for assistance may be classified as bad debt due to insufficient information on eligibility for financial assistance programs. The Hospital did not include these amounts within its community benefit reporting due to the fact that adherence with the organizations charity care criteria could not be determined. Part III, Line 9b: Information concerning the Organization's financial assistance policy is available from a variety of sources from the website, upon admission and throughout the billing process. The Collection Coordinator is responsible for reviewing returned financial assistance applications, assisting patients with securing information necessary to complete the applications, evaluating the applications and making recommendations to the Director of Patient Business Services and/or the Chief Financial Officer, when applicable. The Collection Coordinator will notify patients of their eligibility and work with them to address any remaining balances. If a patient does not meet eligibility requirements for free or discounted care, the organization will work with the patient to create an installment plan that will allow payment over time of patient balances. New London Hospital Association Part V, Section B, Line 3: The most recent Community Needs Assessment was completed in May 2012. The New London Hospital Association Inc. worked with the Crescendo Consulting Group to bring together key healthcare and public stakeholders to elicit feedback on our local community needs. Input was received from persons who represent the broad interests of the community served by the hospital facility. This group included those with special knowledge of or expertise in public health, community opinion leaders (a diverse set of service providers) and healthcare consumers. New London Hospital Association Part V, Section B, Line 4: The New London Hospital Association Inc. conducted their community health needs assessment in collaboration with Valley Regional Hospital. New London Hospital Association Part V, Section B, Line 6i: During 2013, the Hospital commenced the development of a framework and strategic plan to guide the design, development and implementation of New London Hospital's Population Health Improvement Initiative. The initiative seeks to roll out health promoting activities and will leverage on the good work of community organizations that currently exist, build new capacity to address gaps relative to health priorities and issues, and formalize a process for addressing future population health improvement initiatives. New London Hospital Association Part V, Section B, Line 20d: The New London Hospital Association Inc. extends a 25% discount from gross charges to uninsured patients, which approximates the average of its three lowest negotiated commercial insurance rates. Part VI, Line 2: The Affordable Care Act of 2010 requires not-for-profit hospitals to conduct Community Health Needs Assessments every three years. The Organization completed its most recent Community Health Needs Assessment in May of 2012 in collaboration with Valley Regional Hospital with the help of Crescendo Consulting Group. Focus group discussions were held to elicit feedback from community members, public service officials and healthcare experts to identify community needs and prioritize the needs for our local community.The prioritization of community needs identified in the Community Needs Assessment include the following:1. availability of affordable healthcare, prescriptions and related services2. communication between healthcare providers and other community service provides regarding the breadth of services available3. primary care physician availability4. drug and alcohol detection and treatment5. insurance coverage rates6. chronic disease screenings7.coordination of care amongst provider organizations8.dementia spectrum issues/elder care services9. obesity, nutrition, exercise education and services. Part VI, Line 3: The Organization strives to educate patients on the availability of financial assistance in a variety of forums to widely publicize the programs and encourage patients to apply for assistance they may be eligible for. The Organization posts information in regards to financial assistance on the Hospital's website, upon admission, upon request and throughout the billing process to inform patients of assistance that may be available to them. Part VI, Line 4: The New London Hospital Association Inc. (NLHA) is the principal provider of primary and secondary healthcare for 15 towns in Sullivan and Merrimack counties in New Hampshire. The towns within our service area include: Andover, Bradford, Croydon, Danbury, Goshen, Grantham, Lempster, New London, Newbury, Newport, Springfield, Sunapee, Sutton, Washington and Wilmot. The services area has a population of 32,868 (per 2010 census) which approximates about 2.5% of New Hampshire's population. The percent of families living below the poverty level in New London's service area was approximately 11.8% compared to an 8.6% for the State of New Hampshire. Part VI, Line 5: The New London Hospital Association Inc. is dedicated to improving the health and well-being of our community and the people we serve. The Organization provides a wide array of services ranging from health education to subsidizing health services and access to care, to community building activities which improve the quality of life for all of those within our service area.The Organization provides health education classes including safe sitter, smoking cessation, healthy lifestyle, and programs to support new parents. Additional classes include CPR, EMS and health care provider education to allow emergency medical training to residents of our community.Many services provided by the Organization are subsidized to sustain necessary services for the community. Primary care is an area that has been identified as a community need in the most recent community benefit report. The Organization not only subsidized these services but also expanded access to care by increasing hours and locations within our community. Services include expanded hours of clinics, on site treatment at community locations and outreach programs at Hospital sponsored events. The Hospital also participates in the medication bridge program which allows access to necessary prescriptions that would otherwise be cost prohibitive to our patients. Financial assistance and charity care programs strive to remove financial barriers to care and encourage patients to seek regular medical care and focus upon wellness. The Organization supports many local community organizations with programs outside the scope of services provided by the Hospital with both in-kind and monetary donations. The Hospital subsidizes the ABC's childcare program to provide a safe, nurturing atmosphere where children can grow and learn and parents can feel confident that their children are well taken care of.During 2013 the Organization partnered with Dartmouth-Hitchcock to create a new Accountable Care Organization (ACO) with a focus on improving the experience of care, improving quality and reducing cost. The Organization received clearance from the Attorney General and the Charitable Trusts Unit to proceed with affiliation with Dartmouth-Hitchcock during FY 2013. The affiliation will enhance and expand services available to the community while providing the highest quality personalized care. Reports Filed With States Part VI, Line 7 NH X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 Bruce P King 309772 0 0 0 171808 0 39000 0 20042 0 540622 0 0 0 Eileen Kirk MD 232892 0 0 0 966 0 0 0 15584 0 249442 0 0 0 John Kirk MD 161184 0 500 0 4685 0 0 0 7283 0 173652 0 0 0 Donald J Griffin 140431 0 500 0 1719 0 0 0 12152 0 154802 0 0 0 James Murphy MD 248971 0 250 0 2772 0 0 0 3097 0 255090 0 0 0 Steven Powell MD MPH 448477 0 3000 0 420 0 0 0 9121 0 461018 0 0 0 Adnan Khan MD 376790 0 3000 0 378 0 0 0 1460 0 381628 0 0 0 Donald A Eberly MD 283735 0 500 0 0 0 0 0 13137 0 297372 0 0 0 Michael Madan MD 280269 0 2850 0 630 0 0 0 7551 0 291300 0 0 0 Stephen Bissah MD 272304 0 5500 0 420 0 0 0 18101 0 296325 0 0 0 Thomas F Lucas MD 278926 0 250 0 1710 0 0 0 7654 0 288540 0 0 0 Supplemental Information Part III Mr. Bruce King, CEO of New London Hospital is paid by the Mary Hitchcock Memorial Hospital, an unrelated organization. New London Hospital purchases Mr. King's services from MHMH. Compensation amounts disclosed on Form 990 & Schedule J for Mr. King represent earnings from MHMH and taxable fringe benefits directly provided to Mr. King by NLHA. The amount disclosed as other reportable compensation for Mr. King (Schedule J, Part II) include benefits that were partially funded by MHMH for Mr. King's many years of service as a Vice President of MHMH. Mr. King also received club dues of $612 during the year from Mary Hitchcock Memorial Hospital, an unrelated organization, which was included in his compensation. A NH Health and Education Facilities Authority 020279866 644614SL4 2007-06-21 20000000 New medical office building construction & renovation of hospital facilities 0 0 0 A 4145000 20000000 363051 304750 75035 19250184 2009 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 1 Morgan Stanley 30.000000000000 0 0 1 Hypo Public Finance 1.830000000000 1 0 A 0 Form 990, Part I, Lines 8-18: Prior years numbers have been restated to present revenue net of bad debt expense. Form 990, Part VI, Section A, line 3 Mr. Bruce King, CEO, of New London Hospital Association (NLHA) is an employee of Mary Hitchcock Memorial Hospital (MHMH). NLHA purchases Mr. King's services from MHMH. Form 990, Part VI, Section B, line 11 NLHA posted a copy of the Form 990 on its trustee intranet site and solicited trustee comments before filing the return. The Schedule B provided did not include the names of the donors. Form 990, Part VI, Section B, line 12c Each year, as part of the preparation process for the Form 990, a written conflict of interest survey is sent to each Trustee inquiring about situations that could result in conflicts of interest. Form 990, Part VI, Section B, line 15 The CEO's compensation is determined by the New London Hospital Association (NLHA) Executive Committee and Mary Hitchcock Memorial Hospital, the CEO's employer, after considering compensation for CEOs of various sized hospitals in the region. Compensation levels for all other officers and key employees are reviewed periodically by NLHA's Senior Director of Human Resources and the CEO of NLHA. These reviews include comparisons of compensation levels to independent salary survey data for comparable positions in the region. Form 990, Part VI, Section C, line 19 NLHA makes this information available to the public upon request. Additionally, Form 990 is filed with the State of New Hampshire and is available to the public through the State. NLHA also maintians public inspection copies of the Form 990 that are available upon request and its Form 990 is also available through GuideStar. NLH files a Community Benefit Report annually with the State of NH. A summary of the Community Benefit Report and summary financial information is available on NLHA's website and in annual reports to donors. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 1,677,929. Change in Beneficial Interest in Perpetual Trust 49,527. Kearsarge Services Inc 273 County Road New London NH 03257 020460136 Real Estate NH New London Hospital Association C 179619 732852 1.00000 0 New London Medical Center East 273 County Road New London NH 03257 020480857 Real Estate NH New London Hospital Association C 49337 34264 1.00000 0 New London Physician Group Inc 273 County Road New London NH 03257 020494420 Physician Pratice NH New London Hospital Association C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0