2013-05-03T06:39:24-07:00 2012-09-30 WILLIAM STEELE & ASSOCIATES PC 40 STARK STREET MANCHESTER NH 03101 990 2011-10-01 020483054 SOUTHERN NEW HAMPSHIRE MEDICAL CENTER SOUT 6035772000 8 PROSPECT STREET PO BOX 2014 NASHUA NH 030612014 THOMAS E WILHELMSEN JR 6035772000 2013-05-01 2011 2016-02-25 16:41:14Z THOMAS E WILHELMSEN JR 8 PROSPECT STREET NASHUA NH 030612014 207159315 false X SNHMC.ORG X 1892 NH SOUTHERN NEW HAMPSHIRE MEDICAL CENTER IS COMMITTED TO IMPROVING, MAINTAINING, AND PRESERVING THE OVERALL HEALTH AND WELL-BEING OF INDIVIDUALS LIVING IN THE GREATER NASHUA AREA BY PROVIDING INFORMATION, EDUCATION, AND ACCESS TO EXCEPTIONAL HEALTH AND MEDICAL CARE SERVICES 14 13 1799 339 328629 816723 130522 200329966 194694882 304080 12276873 58885 57038 201509654 207159315 0 0 104377822 98610250 0 0 92728005 73818198 197105827 172428448 4403827 34730867 282484638 313156702 145486060 159975014 136998578 153181688 SOUTHERN NEW HAMPSHIRE MEDICAL CENTER IS COMMITTED TO IMPROVING, MAINTAINING, AND PRESERVING THE OVERALL HEALTH false false 125160750 194395340 PROVIDES ACUTE HEALTHCARE SERVICES TO A DIVERSE POPULATION BASE INCLUDING INDIGENT WITHIN SOUTHERN AND CENTRAL NEW HAMPSHIRE. SEE ATTACHED 2012 ANNUAL REPORT 10515500 CHARITY CARE ($5,603,650) AND OTHER UNCOMPENSATED CARE ($4,911,850) AT COST 2343189 27951 COMMUNITY HEALTH SERVICES AND HEALTH PROFESSIONAL EDUCATION 138019439 true true false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false true 142 0 true 1799 true true true false false false false false false false false false X 14 13 false false false false true true false true true false false true true true true true true true true false NH X MICHAEL ROSE 6035772004 8 PROSPECT STREET NASHUA NH 030612014 X PRAVEN K SUCHDEV MD 2.00 X X 0 0 0 TIMOTHY C SULLIVAN 2.00 X X 0 0 0 THOMAS E WILHELMSEN JR 40.00 X X 686245 0 225372 MICHAEL S ROSE 40.00 X 352152 0 52247 J TERRANCE BUCHANNAN MD 2.00 X 0 0 0 ROBERT B EISENBERG TRUSTEE 2.00 X 0 0 0 COLLEEN P GUIRY MD 2.00 X 0 0 0 HOLLY J HARMON-MORSE 2.00 X 0 0 0 CLIFFORD R KINGHORN JR JUDGE 2.00 X 0 0 0 LORI A LIBERTY 2.00 X 0 0 0 JOHN M MERCIER 2.00 X 0 0 0 MARTHA E O'NEIL 2.00 X 0 0 0 THOMAS A PURSCH 2.00 X 0 0 0 JAMES K STEINER 2.00 X 0 0 0 TIMOTHY J WHITAKER 2 X DAVID CAWLEY 40 X 196641 41395 SUSAN DESOCIO 40 X 293626 45139 RICHARD DUGUAY 40 X 229211 22587 MERRYLL ROSENFELD 40 X 203516 27925 COLETTE TILTON 40 X 233402 17341 STEPHANIE WOLF-ROSENBLUM 40 X 308192 64000 6658 ANDREW WATT 40 X 326099 21959 JOSEPH M LEAHY 40 X 357302 25981 COLIN H O'BRIEN 40 X 295977 24952 DANIEL WEIDNER 40 X 293944 32424 4354498 64000 581396 81 false true false SIEMENS MEDICAL SOLUTIONS DEPT AT 40065 ATLANTA GA 31192 SYSTEM SUPPORT 2825525 QUEST DIAGNOSTICS 5763 COLLECTION CTR DR CHICAGO IL 60693 LAB 1335031 FULCRUM ASSOCIATES 5 TECH CIRCLE AMHERST NH 03031 CONSTRUCTION 1088810 JIM ALLARD CONTRACTING 26 CHEROKEE AVE NASHUA NH 03062 CONSTRUCTION 791303 SODEXO INC 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 FOOD SERVICES 767040 30 130522 130522 HOSPITAL SERVICES 621110 194366253 ANCILLARY SERVICES (NE REHAB FOO 722210 256307 256307 ANCILLARY SERVICES (NE REHAB ENV 811000 67605 67605 ANCILLARY SERVICES (ANSWERING SE 900099 4717 4717 194694882 12191946 12191946 84927 84927 84927 84927 OTHER REVENUE 900099 57038 57038 57038 207159315 194423291 328629 12276873 0 0 0 0 3289707 0 3289707 0 77077154 61661723 15415431 0 1226614 981291 245323 0 11692809 9722746 1970063 0 5323966 4259173 1064793 0 287601 0 287601 0 136125 0 136125 0 1958623 0 1958623 0 773364 0 773364 0 1526987 1221590 305397 0 4153906 3323125 830781 0 36578 29262 7316 0 257486 205989 51497 0 4520083 3616066 904017 0 11257307 9005846 2251461 0 1471735 1177388 294347 0 NH MEDICAID ENHANCEMENT TAX 10115857 10115857 0 0 SERVICE CONTRACTS 3216003 2572802 643201 0 PURCHASED SERVICES 5353177 4817094 536083 0 SUPPLIES 23236686 20645868 2590818 0 5516680 4663619 853061 0 172428448 138019439 34409009 0 51519812 52106037 17878976 21136572 2801125 2614903 2865323 2765253 225857693 111717298 109783380 114140395 86479257 106523261 730357 679454 10426408 13190827 282484638 313156702 27817116 37291296 94560036 93490966 1082219 750094 22026689 28442658 145486060 159975014 X 134626503 150775973 16562 50202 2355513 2355513 136998578 153181688 282484638 313156702 34730867 -18547757 X false true true X false X 0 0 0 0 0 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 28129 false false false 28129 false Pt II-B Line 1i None Pt II-B Line 1f 22.96% OF DUES TO AMERICAN HOSPITAL ASSOCIATION, 23.76% OF DUES TO NEW HAMPSHIRE HOSPITAL ASSOCIATION, ALONG WITH DIRECT PAYMENTS THROUGH NEW HAMPSHIRE HOSPITAL ASSOCIATION WERE USED FOR LOBBYING ACTVITES. 51079549 9503822 60583371 50596135 483414 51079549 46166746 4429389 50596135 0.96110 0.03890 false false 8239003 8239003 129532687 58738633 70794054 1916274 1385278 530996 71786170 51593387 20192783 14383559 14383559 114140395 M.O.B. RECVB. L.T. 5897903 INVESTMENT IN NASHUA REGIONAL CANCER CENTER 2295025 INVESTMENT IN PHO 72646 SECURITY / WORKING FUND DEPOSITS 354269 RECRUITMENT 232619 SENTRY INSURANCE / DENTAL INSURANCE 966400 MALPRACTICE INSURANCE RECEIVABLE LT 3186639 OTHER 185326 13190827 UNEARNED INCOME - MOB 159567 INSURANCE RESERVES 1076813 OTHER LIABILITIES SERP 1631374 ACCRUED PENSION EXPENSE-LT 20950493 457 (B) DEFERRED COMP PLAN 1437772 MALPRACTICE INSURANCE RECEIVABLE LT 3186639 28442658 Pt V Line 4 Prior to 2011 certain funds were moved from operating cash to investments as Board Designated. These funds were reclassified as unrestricted investments as of 9/30/2011. Adjustments have been made to prior year balances to remain consistent with the current year. Pt V Line 4 The intended uses of the organization's endowment funds are to fulfill donor's intentions on the Permanently Restricted Funds and for future plant replacement and technology investments from Board Designated Funds. 990 Part IV Line 11F THE SYSTEM, MEDICAL CENTER AND FOUNDATION ARE NOT-FOR -PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT EVALUATED THE SYSTEM'S TAX POSITIONS AND CONCLUDED THE SYSTEM HAS MAINTAINED ITS TAX-EXEMPT STATUS, DOES NOT HAVE ANY SIGNIFICANT UNRELATED BUSINESS INCOME AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE CONSOLIDATED FINANCIAL true true true X 225.00000 false true true false true true 5603650 5603650 0.03250 24896471 7527457 17369014 0.10070 30500121 7527457 22972664 0.13320 404852 27951 376901 0.00220 1436666 1436666 0.00830 1664462 1137627 526835 0.00310 33825 33825 0.00020 414340 414340 0.00240 3954145 1165578 2788567 0.01620 34454266 8693035 25761231 0.14940 26964 26964 0.00020 44346 44346 0.00030 710 710 0.00000 3966 3966 0.00000 5471 5471 0.00000 81457 81457 0.00050 true 6643148 4911850 41498466 47589604 -6091138 X true true 1 1 SOUTHERN NEW HAMPSHIRE MEDICAL CENTER

8 PROSPECT STREET PO BOX 2014 NASHUA NH 030612014

X X X SOUTHERN NEW HAMPSHIRE MEDICAL CENTER 1 true X X X X X X X X 12 true true true X X X X X X X X X X true true true 225 false false true true X X X X true X X X true X X X X X X X true X false true Pt I Line 3c The Medical Center offers a discount equal to the average of their three largest payors to all self pay patients. Pt I Line 7 The costing methodology used was the ratio of cost to charge as outlined in Worksheet 2 of the instructions. The only Pt I Line 7 exception to this was for subsidized service areas where the cost structure was specific to that service area. For those areas, our Cost Pt I Line 7 Accounting system was used. Pt II Southern New Hampshire Medical Center is committed to improving the health and well-being of the Greater Nashua area and our Pt II community building activities help us achieve this goal. Through our involvement in the Rotary Club and Nashua Chamber of Commerce, Pt II along with other community organizations, we are able to exchange ideas with areas leaders concerning health care issues and make Pt II informative decisions that best address the health needs of our community. We provide Medicare Counseling to area senior citizens giving Pt II them the guidance they need to make informed decisions about their healthcare coverage. Our support of the United Ways Day of Caring Pt II has resulted in a growing number of our employees going out into the area and helping members of the community with healthcare and Pt II other needs. We are strong in our commitment to the Greater Nashua area and plan to continue to support and grow community building Pt II activities that improve the overall health of the area. Pt III Line 4 On the basis of historical experience, a significant portion of the System's uninsured patients will be unable or unwilling to Pt III Line 4 pay for the services provided. Thus, the System records a significant provision for bad debts related to uninsured patients in the period the Pt III Line 4 services are provided. The FASB issued an Accounting Standards Update that states that a health care entity that recognizes significant Pt III Line 4 amounts of patient service revenue at the time services are rendered, even though it does not assess the patient's ability to pay, must Pt III Line 4 present bad debts as a reduction of net patient revenue and not as a separate item in operating expenses. The ratio of cost to charge Pt III Line 4 methodology was used to determine cost as outlined in worksheet 2 of the instructions. Consistent with the accounting treatment Pt III Line 4 mentioned above, since the System does not assess the patient's ability to pay, the costs of bad debt for those patients without any form of Pt III Line 4 insurance should be classified as community benefit. Pt III Line 8 The ratio of cost to charge methodology was used to determine cost as outlined in Worksheet 2 of the instructions. There Pt III Line 8 are service areas where government programs such as Medicare and Medicaid do not reimburse the organization adequate amounts to Pt III Line 8 cover the costs to provide those services. The hospital must provide those services regardless of the financial shortfall. Pt III Line 9b SNHMC recognizes that not all patients who qualify for financial assistance will follow through with an application for Pt III Line 9b financial assistance. Prior to placing any account with a collection agency, the Medical Center uses a financial assistance qualification Pt III Line 9b service to categorize patients based primarily on income and assets estimated from census tract data. Those patients whose estimated Pt III Line 9b income/assets fall within the Medical Centers financial assistance guidelines are awarded charity or free care assistance for their encounter. Pt V Sec B 3 The Southern New Hampshire Health System 2012 Community Health Needs Assessment and Implementation Strategy was Pt V Sec B 3 collaboration with the City of Nashua and other area health partners. The 2011 Creating a Healthier Community: City of Nashua Health Pt V Sec B 3 Assessment (the Assessment) was published by the City of Nashua Division of Public Health and Community Services on September 9, Pt V Sec B 3 2011. The program coordinators of the Assessment were Ashley Conley, epidemiologist, and Debbie Daniels, medical director from the Pt V Sec B 3 Nashua Department of Public Health. The assessment results include information gathered from a door-to-door survey of 833 households in Pt V Sec B 3 Nashua conducted in October and November of 2010. In conjunction with this, in March 2011, data were gathered from two focus groups, Pt V Sec B 3 one with area key leaders, the other consisting of medical partners from the greater Nashua area. Pt V Sec B 4 The hospital's Community Health Needs Assessment was a collaboration of City of Nashua Health Department and other Pt V Sec B 4 stakeholders, including St. Joseph Hospital. The Medical Center prepared its own separate assessment, based on that information. Pt V Sec B 10 The State of New Hampshire mandates a discount for all uninsured patients. This discount is equal to the average discount Pt V Sec B 10 negotiated by the top (by volume) three commercial insurers. This discount for the uninsured is automatic and applied to all balances prior Pt V Sec B 10 to sending the first billing statement to the patient. Pt V Sec B 17e See response for III.C.9b above. Prior to placing accounts with collection agencies, SNHMC culls out patients who qualify Pt V Sec B 17e for charity based on census tract data and does not place those accounts with an agency but rather, awards charity or free care assistance Pt V Sec B 17e for their encounter. Pt V Sec B 19d The State of New Hampshire mandates a discount for all uninsured patients. This discount is equal to the average discount Pt V Sec B 19d negotiated by the top (by volume) three commercial insurers. This discount for the uninsured is automatic and applied to all balances prior Pt V Sec B 19d to sending the first billing statement to the patient. Pt V Sec B 21 SNHMC may charge patients who are having cosmetic or experimental, non-covered services gross charges for that Pt V Sec B 21 encounter. Pt VI Line 2 The 2011 Creating a Healthier Community: City of Nashua Community Health Assessment was performed as a collaborative Pt VI Line 2 effort by the City of Nashua Public Health Department and community residents, medical providers, and key leaders. Pt VI Line 3 At each registration point, SNHMC has signage and brochures explaining our various forms of financial assistance, including Pt VI Line 3 charity care. Additionally, patient registrars offer the charity brochures to self pay patients. Patients who call regarding billing Pt VI Line 3 concerns are offered charity assistance. Additionally, verbiage regarding charity care is printed on each billing statement the patient Pt VI Line 3 receives. Also, charity care information is available on our hospital website. Pt VI Line 4 SNHHS's service area consists of nineteen New Hampshire and four Massachusetts towns. The service area is divided into a Pt VI Line 4 Primary Service Area (PSA) of twelve New Hampshire towns (Amherst, Brookline, Hollis, Hudson, Litchfield, Lyndeborough, Pt VI Line 4 Merrimack, Milford, Mont Vernon, Nashua, Pelham and Wilton), a Secondary Service Area (SSA) of seven New Hampshire towns (Derry, Pt VI Line 4 Greenville, Londonderry, New Boston, New Ipswich, Salem and Windham) and a Massachusetts Service Area (MSA) of four neighboring Pt VI Line 4 Massachusetts towns (Dunstable, Pepperell, Townsend and Tyngsboro). According to the 2009 needs assessment, the population of greater Pt VI Line 4 Nashua is aging, is growing, and is becoming more diverse. Pt VI Line 5 A majority of the organization's Board of Trustees is comprised of persons who reside in the PSA who otherwise have no Pt VI Line 5 relationship with the organization. Many members of the organization volunteer their time to other community agencies in the PSA. Pt VI Line 6 Southern NH Health System, Inc. is a not-for-profit entity organized to support Southern NH Medical Center and Foundation Pt VI Line 6 Medical Partners, inc. Both the Medical Center and Foundation are not-for-profit entities, established to provide medical services to the Pt VI Line 6 people of the greater Nashua area. Pt VI Line 7 NH X true true X X X X false true false false false false false true false THOMAS E WILHELMSEN JR 478430 152927 54888 193802 31570 911617 MICHAEL S ROSE 247237 65000 39915 22792 29455 404399 DAVID CAWLEY 151719 15000 29922 17724 23671 238036 SUSAN DESOCIO 236048 40100 17478 11768 33371 338765 RICHARD DUGUAY 165511 39000 24700 22587 251798 MERRYLL ROSENFELD 158282 24400 20834 27925 231441 COLETTE TILTON 165559 19000 48843 17341 250743 STEPHANIE WOLF-ROSENBLUM 236956 64000 30000 41236 6658 314850 64000 ANDREW WATT 296318 20000 9781 21959 348058 JOSEPH M LEAHY 319992 20000 17310 25981 383283 COLIN H O'BRIEN 272735 23242 24952 320929 DANIEL WEIDNER 266134 27810 32424 326368 MARC DEBELL 281920 10466 13737 306123 PETER ROW 269065 16740 23679 309484 Pt I Line 1a Southern New Hampshire Medical Center uses the facilities at the Nashua Country Club for meetings and other business related purposes. The Club does not have corporate memberships, therefore, an individual associated with the Medical Center must be a member of the Club. The membership is titled in the CEOs name and invoices are addressed to the CEO, not SNHMC. SNHMC pays the annual dues and all related expenses incurred by the organization. The facilities are only available to Club members. Pt I Line 4b Funding for Supplemental Employee Retirement Plan - David Cawley - $17,724.00, Susan DeSocio - $11,768.00, Michael S. Rose - $ 22,792.00, and Thomas E. Wilhelmsen - $193,802.00 Pt I Line 7 There is an additional compensation plan available to managers, directors and senior management that is part of their annual performance plan. The plan takes into consideration quality measures, patient satisfaction, individual goals, budget adherence and overall organizational performance. The range and overall pool is reviewed and approved by the Board of Trustees' Executive Compensation Committee. The amounts designated for the CEO and CFO are considered in the compensation consultant's analysis of executive compensation reported on the 990 Part VI section B Line 15b. NHHEF AUTHORITY 020279866 644614SWO 2007-08-30 89836797 REFUNDING AND NEW CONSTRUCTION true false false NHHEF AUTHORITY 020279866 000000000 2010-12-15 5500000 EQUIPMENT PURCHASE false false false 89836797 49731438 949525 39155834 true true true true 5500000 25672 5474328 false false true true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true true false false false false false true false false false false false Pt VI, Line 6 Southern New Hampshire Health System, Inc., is the sole corporate member of Southern New Hampshire Medical Center Pt VI, Line 6 (SNHMC) and the two (2) organizations have identical boards with the exception of two (2) additional members serving Pt VI, Line 6 solely on the SNHMC board. These include a physician member and the current SNHMC chief of staff who is an ex-officio member. Pt VI, Line 7a The Medical Center is governed by the Board of Trustees, who are elected by the Trustees of it sole member Southern New Hampshire Pt VI, Line 7a Health System, Inc. Pt VI, Line 11a A copy of the 990 was presented to the Full Board and approved by the Finance committee of the Board of Trustee prior to submission. Pt VI, Line 12c The organization requires all its personnel, including Leaders, to formally acknowledge that they have read & will abide by Pt VI, Line 12c our Code of Conduct, which includes our conflict of interest policy. SNHHS/SNHMC monitors compliance of its conflict of Pt VI, Line 12c interest process, which requires completion of disclosure forms by all Leaders on an annual basis or on a reappointment Pt VI, Line 12c basis (every two years) for medical/allied staff, to ensure full compliance. Interim disclosures are also required and Pt VI, Line 12c reviewed should a subsequent conflict arise. Any Related Party disclosures require review and approval by a designated Pt VI, Line 12c committee. An annual compliance report is provided to SNHHS/SNHMCs compliance committee and Board of Trustees. Pt VI, Line 15 The compensation of the CEO and CFO is evaluated by an outside consultant. The compensation of the CEO is approved by the Executive Pt VI, Line 15 Compensation Committee of the Board and the Board of Trustees. A market analysis is performed for all key employees Pt VI, Line 15 on an annual basis. Once the CEO and CFO approved the final compensation figures for key employees, the CEO reports Pt VI, Line 15 these figures to the chairperson and vice chairperson of the Board. Pt VI, Line 19 The organization makes its 990 and 990T available for inspection and provides an Annual Report that is available on its Pt VI, Line 19 website. The Code of Conduct is also available on the organization's website. The Code of Conduct addresses certain Pt VI, Line 19 corporate policies including confidentiality, conflicts of interest, patient rights and other governing documents. The organization also Pt VI, Line 19 makes all relevant documents available to the public upon request. 990 Part I Line 9 & 17 Per FASB ASU No 2011-07, bad debt is recognized as a reduction in revenue 990 Part I Line 9 & 17 and not as operating expenses in fiscal year 2012. 990 Part VII Section A Column B The average hours per week devoted to the Foundation Medical Partners, a related organization by Key employee Stephanie 990 Part VII Section A Column B Wolf- Rosenblum, VP of Medical Affairs, is 8 hours. 900 Part XI Line 5 FAS157 and FAS159 Pension Adjustment - (10,553,801), Transfer to Affiliates - (12,838,344) and Pension Curtailment 4,844,388. FOUNDATION MEDICAL PARTNERS INC 8 PROSPECT STREET NASHUA NH 03060 020456218 PHYSICIAN SERVICES NH 501(c)(3) 9 SNHHS false SOUTHERN NEW HAMPSHIRE HEALTH SYSTEM 8 PROSPECT STREET NASHUA NH 03060 020509221 MEDICAL SERVICES NH 501(c)(3) 11 NA false ADVANTAGE NETWORK PHO 10 PROSPECT STREET NASHUA NH 03060 020482950 MEDICAL SERVICE NH SNHMC C 36831 82831 0.50000 SOUTHERN NH HEALTH VENTURES INC 8 PROSPECT STREET NASHUA NH 03060 020499623 MEDICAL SERVICE NH SNHMC C 1.00000 false false false true false true true false true true true true false true true true true false FOUNDATION MEDICAL PARTNERS INC d 600074 FM Value FOUNDATION MEDICAL PARTNERS INC f 132235 Cost FOUNDATION MEDICAL PARTNERS INC i 1609144 FM Value FOUNDATION MEDICAL PARTNERS INC j 171105 FM Value FOUNDATION MEDICAL PARTNERS INC k 2843156 Cost FOUNDATION MEDICAL PARTNERS INC l 1079222 FOUNDATION MEDICAL PARTNERS INC n 124449 FOUNDATION MEDICAL PARTNERS INC o 64349919 FOUNDATION MEDICAL PARTNERS INC p 51611516 FOUNDATION MEDICAL PARTNERS INC q 12838343