2012-08-13T13:44:51-05:00 2011-09-30 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2010-10-01 020222171 New London Hospital Association Inc NEWL 6035265339 273 County Road New London NH 03257 Donald Griffin 6035265339 2012-08-07 1 Rachel Williamson CPA 6036697337 2012-08-07 2010 2016-02-24 21:20:13Z Bruce King 273 County Road New London NH 03257 63528678 0 X www.newlondonhospital.org X 1918 NH NLHA is a rural community Critical Access Hospital with an extended care center. 19 15 694 170 120077 -27554 842260 1061718 57804552 56580492 305390 441947 1520 3460 58953722 58087617 0 0 0 0 34487289 32317756 0 0 218988 24646763 26029889 59134052 58347645 -180330 -260028 58465539 57974951 32250877 33308576 26214662 24666375 New London Hospital provides safe quality care for every patient, every time in partnership with patients, families and healthcare providers. 0 0 34598364 43420052 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. 9853756 8847082 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. Eighteen provide primary care including pediatrics, and twenty-three are specialists covering general surgery, anesthesiology, orthopaedics, neurology, emergency medicine, hospitalists, gynecology, rheumatology, and ear, nose and throat. 3999877 4758765 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. 48451997 1 1 0 1 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 1 0 0 0 0 1 0 0 0 0 1 73 0 1 694 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 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 B Holmes 2.00 X 0 0 0 Beverly S Payne 2.00 X 0 0 0 Bruce P King 50.00 X X 332030 0 11112 Celeste C Cook 2.00 X 0 0 0 David E Marshall 8.00 X X 0 0 0 Eileen Kirk MD 40.00 X 233942 0 19917 G William Helm Jr 8.00 X X 0 0 0 Jane Rastallis 2.00 X 0 0 0 John C Ferries 2.00 X 0 0 0 John F Robb MD 8.00 X X 0 0 0 John R Butterly MD 2.00 X 0 0 0 Lori D Richer MD 2.00 X 141453 0 25445 Patricia Tilley 8.00 X 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 2.00 X 0 0 0 Stephen Jordan MD 2.00 X 109290 0 4442 Susan A Reeves 2.00 X 0 0 0 Donald Griffin 50.00 X 102503 0 14926 Gregory Q Curtis MD 40.00 X 242203 0 31579 Patricia Sweezey 50.00 X 92834 0 18287 Teresa LeBlanc 50.00 X 143130 0 5113 Tina Naimie 50.00 X 145819 0 5106 Adnan Khan 40.00 X 293479 0 18779 Donald Eberly MD 40.00 X 282865 0 31073 Kenneth Call MD 40.00 X 313519 0 5322 Sean Bears MD 40.00 X 268156 0 27856 Thomas F Lucas MD 40.00 X 302040 0 30893 James G McGuire MD 2.00 X 157865 0 0 Dudley Smith 8.00 X 0 0 0 3161128 0 249850 39 1 1 1 New England Alliance for Health LLC 1 Medical Center Drive Lebanon NH 03756 Management services 833670 Dartmouth Hitchcock Clinic 1 Medical Center Drive Lebanon NH 03756 Physician Staffing & Lab Services 728359 Upper Valley Neurology Neurosurgery PC 106 Hanover St Lebanon NH 03766 Physician Services 719054 American Health Centers Inc 10 Commerce Park North Unit 10 Bedford NH 03110 Diagnostic Imaging Services 440411 Mary Hitchcock Memorial Hospital 1 Medical Center Drive Lebanon NH 03756 Management services 402851 5 106193 293250 662275 1061718 Net Patient Revenue 621400 55229287 55229287 Physician Services 621110 893350 893350 Cafeteria 900099 316361 196284 120077 Child Care 624410 141494 141494 56580492 355270 355270 5408122 24741 5311861 34325 96261 -9584 86677 86677 98335 106193 94875 3460 3460 58087617 56460415 120077 445407 1668974 945943 723031 25540227 20559883 4804439 175905 35919 28915 7004 3389434 2728494 645457 15483 1683202 1354978 314460 13764 6300 5072 1228 195350 157257 38093 73824 59428 14396 48624 39142 9482 5086270 4094447 991823 208850 168124 35115 5611 2162452 1740774 417753 3925 624109 502408 121701 1585672 1276466 308459 747 66936 53883 10749 2304 154928 124717 28962 1249 881667 709742 171925 162499 130812 31687 3778326 3041552 736774 543650 437638 106012 Bad Debt Expense 3546621 3546621 Medicaid Enhancement Ta 2413347 2413347 Medical Supplies 2025586 2025586 Drugs and Pharmaceutica 1654057 1654057 Other 810821 652711 158110 58347645 48451997 9676660 218988 4316368 6198610 769940 1435340 1058149 568429 8573324 6947286 975689 1002338 542863 543702 64230178 33035156 32633093 31195022 6365015 6782749 0 3231098 3301475 58465539 57974951 8020625 6481106 16750000 16415000 1239096 631306 6241156 9781164 32250877 33308576 X 24065531 22468215 221095 307685 1928036 1890475 26214662 24666375 58465539 57974951 X -260028 -1288259 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10927 10927 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: Per information provided by the NH Hospital Association (NHHA), the NHHA percentage of dues expended for lobbying purposed was 22.33%. The percentage of American Hospital Association dues expended for lobbying purposed was 24.42%. 1928036 77754 90305 25010 1890475 1870163 90988 30386 2729 1928036 1870163 2996 132 2864 1870163 1.00000 1 0 941274 941274 35387029 12672479 22714550 405637 277095 128542 25945908 19491915 6453993 1550330 593667 956663 31195022 Estimated Third Party Settlements 2377722 Due from Affiliate 602608 Deferred financing costs 315079 Other Assets 6066 3301475 Charitable Gift Annuities 32338 Capital Lease Obligations 1250133 Other Liabilities 3892789 Interest Rate Swap 4605904 9781164 58087617 58347645 -260028 -161589 -37553 -1089117 -1288259 -1548287 56788287 -161589 -161589 56949876 48624 1089117 1137741 58087617 58299021 0 58299021 48624 48624 58347645 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. Part XI, Line 8 - Other Adjustments: Unrealized Loss on Interest Rate Swap -739,724. Write off of intangible assets -349,393. Part XII, Line 4b - Other Adjustments: Unrealized Loss on Interest Rate Swap 739,724. Write off of intangible assets 349,393. Golf Tournament 54860 26604 28256 1647 7957 5882 9310 Hospital Gala 103565 64534 39031 9271 21571 3690 4499 1 46103 15055 31048 507 7328 1761 1320 20132 204528 106193 98335 2154 24556 29214 5010 33941 94875 3460 1 1 1 X 1 X 0 1 1 0 1 1 1263567 1263567 0.02170 5943592 5663845 279747 0.00480 7207159 5663845 1543314 0.02650 82697 82697 0.00140 16415 16415 0.00030 2948491 2948491 0.05050 14820 14820 0.00030 3062423 3062423 0.05250 10269582 5663845 4605737 0.07900 72598 72598 0.00120 36385 36385 0.00060 7192 7192 0.00010 116175 116175 0.00190 1 1941066 15095392 15722754 -627362 X 1 1 1 1 New London Hospital

273 County Road New London NH 03257

X Not required 1 1 Newport Health Center

11 John Stark Hwy Newport NH 03773

Clinic Part I, Line 7g: The hospital subsidized the delivery of primary care to the community in the amount of $2,649,620 in FY 2011. In addition, the hospital provided a Medication Bridge Program at a cost of $20,676 that works with patients to ensure that prescription medication is available at an affordable cost. Due to limited access to mental health services in the service area, NLHA partnered with West Central Behavioral Health to give patients access to care at a cost of $145,849. New Hampshire does not require towns to provide ambulance service and the NLHA ambulance service covers seven towns including New London, Sunapee, Springfield, Newbury, Sutton, Wilmot and Grantham with a paramedic level ambulance. NLHA provided financial support totaling $132,346 for the ambulance service during FY 2011. Part II: A variety of healthcare support services comprises a significant area of community benefits for NLHA. The hospital supports many local service agencies through the participation of members of its management team on committees and governing boards and by supporting the cost of operating a childcare center that is open to community members. Part III, Line 4: The Hospital used the cost-to-charge ratio for reporting the bad debt expense at cost. Part III, Line 9b: The Collection Coordinator is reponsible for giving Financial Assistance Program applications, reviewing returned applications, securing financial data necessary, evaluating applications and making recommendations for approval to the Director of Patient Business Services and/or the Chief Financial Officer, and notifying the patients of eligibility determinations. When patients claim they cannot pay in full or meet installment plan guidelines due to a lack of resources, the Hospital can agree to an installment plan, refer the account to collections, write off the account as a bad debt or pursue a charity care application. Part VI, Line 2: The Affordable Care Act of 2010 requires not-for-profit hospitals to conduct a Community Health Needs Assessment (CHNA) every three years and the State of New Hampshire requires one to be completed every five years. The most recent community needs assessment was completed in May 2012 and involved New London Hospital (NLH) working with Crescendo Consulting Group (CCG) to bring together key healthcare and public service stakeholders, collect quantitative and qualitative data, and reach out to the community in order to elicit feedback directly from them and their service providers. In addition to performing quantitative analysis of existing survey data NLH and CCG conducted focus group discussions with a diverse set of community stakeholders including leadership group members, healthcare consumers and community opinion leaders.Subsequently, information gathered during the quantitative and qualitative phases of the research was used to establish an extensive list of community health needs. CCG then asked leadership group members (i.e. executives from service area organizations that have direct contact with healthcare consumers) to complete a survey to evaluate each of the community needs identified and then CCG ranked the survey scores to order the list of 30 community needs. Part VI, Line 3: Information packets are available in the Credit and Collection Coordinator's office. Part VI, Line 4: 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 towns in the NLHA service area (HSA) are: Andover, Bradford, Croydon, Danbury, Goshen, Grantham, Lempster, New London, Newbury, Newport, Springfield, Sunapee, Sutton, Washington and Wilmot. The HSA has a population of 32,868 persons (2010) representing approximately 2.5% of the NH State population (1,316,470). The percent of families living below the proverty line in New London Hospital's HSA was 11.8% compared to 8.6% for the State of NH. The prioritization of community needs identified in the Community Needs Assessment include the following: (1) availability of affordable healthcare, prescriptions, and related services, (2) communication between healthcare providers and other community service providers regarding the bredth of services available, (3) primary care physician availability, (4) drug and alcohol abuse early detection and treatment, (5) insurance coverage rates, (6) chronic disease screenings (hypertension, cancer, heart disease), (7) coordination of care among provider organizations, (8) dementia spectrum issues / elder care services, (9) obesity, nutrition, and exercise education and services. Reports Filed With States Part VI, Line 7 NH X 1 1 X X X X X 0 0 0 0 0 1 0 0 0 Bruce P King 275256 0 47500 0 9274 0 8935 0 2177 0 343142 0 0 0 Eileen Kirk MD 232941 0 35 0 966 0 2500 0 17417 0 253859 0 0 0 Lori D Richer MD 131159 0 10035 0 259 0 4338 0 21107 0 166898 0 0 0 Gregory Q Curtis MD 241783 0 0 0 420 0 6960 0 24619 0 273782 0 0 0 Tina Naimie 145356 0 35 0 428 0 3379 0 1727 0 150925 0 0 0 Adnan Khan 283108 0 10035 0 336 0 2500 0 16279 0 312258 0 0 0 Donald Eberly MD 280058 0 35 0 2772 0 6454 0 24619 0 313938 0 0 0 Kenneth Call MD 312518 0 35 0 966 0 3029 0 2293 0 318841 0 0 0 Sean Bears MD 267701 0 35 0 420 0 6243 0 21613 0 296012 0 0 0 Thomas F Lucas MD 301039 0 35 0 966 0 6274 0 24619 0 332933 0 0 0 James G McGuire MD 157865 0 0 0 0 0 0 0 0 0 157865 0 0 0 Supplemental Information Part III Bruce King, CEO is paid by the Mary Hitchcock Memorial Hospital, an unrelated organization. Mr. King's total compensation from MHMH for the 2010 calendar year was $309,020, the remainder of his compensation was paid directly by NHLA. The compensation paid by NHLA consisted of continuity of service payments paid under the terms of an executive incentive agreement and an allowance for business use of his personal automobile. NH Health and Education Facilities Authority 020279866 644614SL4 2007-06-21 20000000 New medical office building construction & renovation of hospital facilities 0 0 0 335000 20000000 268294 304750 5000000 14426956 2009 0 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 1 Morgan Stanley 30.000000000000 0 0 1 Hypo Public Finance 1.830000000000 1 0 1 X 3 38103 Fair Market Value 0 1 0 Net Assets Part I, Line 22 In FY11, New London Hospital restated their prior year financial statements. As of October 1, 2009 permanently restricted net assets increased by $1,496,296 due to recording a beneficial interest in perpetual trust. During 2010, the market value of the perpetual trust increased by $57,873. There was also a restatement for the correction of an error relating to the calculation of estimated third-party settlements. The result was a decrease to net patient service revenue and unrestricted net assets by $870,000. The restatements changed net assets on the 2009 and 2010 in the following way: the 2009 Current Year Part I, Line 22 net assets was $25,530,501. The 2010 Prior Year Part I, Line 22 net assets is $26,214,662. 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. Prior to this a draft version of the Form 990 was reviewed with NLHA's Audit Committee. 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. Additionally, trustees are asked quarterly at Board of Trustee meetings if any new situations have arisen 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 5: Net unrealized losses on investments: -161,589. Prior period adjustments: -37,553. Unrealized Loss on Interest Rate Swap -739,724. Write off of intangible assets -349,393. Total to Form 990, Part XI, Line 5: -1,288,259. Kearsage Community Services 273 County Road New London NH 03257 020460136 Real Estate NH New London Hospital Association C 1.00000 New London Medical Center East 273 County Road New London NH 03257 020480857 Real Estate NH New London Hospital Association C 1.00000 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