TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Michael Bolduc Esq...................................................................... Trustee	0.50 ................. 1.00	X		0	0	0
(2) Gerald Daley EdD...................................................................... Trustee	0.50 ................. 1.00	X		0	0	0
(3) Peter J Dirksmeier MD...................................................................... Trustee	2.00 ................. 1.00	X		0	0	10,115
(4) David Flavin MD...................................................................... Trustee	2.00 ................. 1.00	X		10,505	0	5,202
(5) Neil Garvey...................................................................... Trustee	1.50 ................. 1.00	X		0	0	0
(6) Anne Kalter MD...................................................................... Trustee	0.50 ................. 43.50	X		92,707	248,620	29,275
(7) Terri Lally MD...................................................................... Trustee	1.00 ................. 1.00	X		15,117	0	13,703
(8) John Novello MD...................................................................... Trustee	5.00 ................. 50.00	X		0	310,617	29,492
(9) Donna Rinaldi...................................................................... Trustee	0.50 ................. 1.00	X		0	0	0
(10) Theodore Ristaino...................................................................... Trustee	0.50 ................. 1.00	X		0	0	0
(11) Steven C Webb...................................................................... Trustee	0.50 ................. 1.00	X		0	0	0
(12) Roger Hamel...................................................................... Chairman	3.00 ................. 4.00	X	X	0	0	0
(13) Carol Bailey...................................................................... Vice Chairman	3.00 ................. 2.00	X	X	0	0	0
(14) Michael Steinberg...................................................................... Treasurer	1.00 ................. 4.00	X	X	0	0	0
(15) John Salmon...................................................................... Secretary	3.00 ................. 2.00	X	X	0	0	0
(16) Gregory J Walker...................................................................... President/CEO	50.00 ................. 5.00	X	X	807,205	0	154,460
(17) Peter E Walcek...................................................................... CFO/VP Finance	50.00 ................. 5.00		X	438,479	0	96,082

(A) Name and business address	(B) Description of services	(C) Compensation
Cerner Health Services Inc 51 Valley Stream Parkway Malvern,PA19355	Healthcare IT Support	2,300,854
Sodexo Inc & Affiliates 9801 Washington Boulevard Gaithersburg,MD20878	Food Services/ Management	1,642,862
American Healthcare Services Association PO Box 845 Traverse City,MI49685	Staffing Services	1,433,611
Mass General Physicians Organization 55 Fruit Street Boston,MA02114	Physician Services	1,351,941
Audit Billing Center Inc 29 Winter Street Pembroke,MA02359	Billing Services	1,101,308
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 67

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Wentworth-Douglass Hospital

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Wentworth-Douglass Hospital		Employer identification number 02-0260334

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Wentworth-Douglass Hospital			Employer identification number 02-0260334
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

26,669

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

26,669

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	NHHA, portion of dues allocated to lobbying, $19,773 AHA, portion of dues allocated to lobbying, $6,896

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	184,151,455	155,843,253	141,970,819	131,278,421	99,989,314
b	Contributions ...				3,700	27,460,290
c	Net investment earnings, gains, and losses	1,064,676	29,213,049	24,584,570	26,708,184	3,851,272
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	2,011,173	720,042	10,712,136	16,019,486	22,455
f	Administrative expenses ....	201,173	184,805
g	End of year balance ......	183,003,785	184,151,455	155,843,253	141,970,819	131,278,421

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

96.920 %

Permanent endowment SchDMd Bullet

0.450 %

Temporarily restricted endowment SchDMd Bullet

2.630 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	3,292,772		3,292,772
b	Buildings	143,289,328	57,107,927	86,181,401
c	Leasehold improvements	19,739,976	6,636,443	13,103,533
d	Equipment ...	148,087,235	121,039,572	27,047,663
e	Other ...	55,486,604	40,071,456	15,415,148
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				145,040,517

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) Alternative Investments	49,573,127	F
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	49,573,127

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Est. Third-Party Payor Settlement	18,455,858
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	18,455,858
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	265,760,926
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-6,695,351
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	-6,695,351
3	Subtract line 2e from line 1..................			3	272,456,277
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	156,062
b	Other (Describe in Part XIII.) ...........	4b	30,341,691
c	Add lines 4a and 4b....................			4c	30,497,753
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	302,954,030

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	253,214,050
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	253,214,050
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	156,062
b	Other (Describe in Part XIII.) ............	4b	1,804,630
c	Add lines 4a and 4b.....................			4c	1,960,692
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	255,174,742

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4:	To further the Hospital's charitable mission.
Part X, Line 2:	WDHS, the Hospital, WDPC and the Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Management evaluated these not-for-profit corporations' tax positions and concluded these not-for-profit corporations have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements.
Part XI, Line 4b - Other Adjustments:	Investments in Joint Ventures 28,537,061. Community Benefit and Other Expense 1,804,630.
Part XII, Line 4b - Other Adjustments:	Community Benefit and Other Expense 1,804,630.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers.Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	Central America and the Caribbean -	0	0	Investments - FMV as of December 31, 2015	NONE	26,649,168
















3a	Sub-total .....	0	0			26,649,168
b	Total from continuation sheets to Part I ...	0	0			0
c	Totals (add lines 3a and 3b)	0	0			26,649,168

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(a)(c) Region	(b)(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
Part IV, Line 3:	This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed.
Part IV, Line 4:	The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital.

Schedule F (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	3,029,667		3,029,667	1.240 %
b	Medicaid (from Worksheet 3, column a) . . . . .	35,722,908	17,810,310	17,912,598	7.340 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	38,752,575	17,810,310	20,942,265	8.580 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	952,975		952,975	0.390 %
f	Health professions education (from Worksheet 5) . . .	19,583		19,583	0.010 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	27,398		27,398	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	700,870		700,870	0.290 %
j	Total. Other Benefits . .	1,700,826		1,700,826	0.700 %
k	Total. Add lines 7d and 7j .	40,453,401	17,810,310	22,643,091	9.280 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

11,142,070

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

1,167,649

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

69,942,010

Enter Medicare allowable costs of care relating to payments on line 5.....

99,954,721

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-30,012,711

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Wentworth-Douglass Hospital 789 Central Avenue Dover,NH038202526 www.wdhospital.com 00010	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Wentworth-Douglass Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Section C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Wentworth-Douglass Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.000000000000% and FPG family income limit for eligibility for discounted care of 250.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Section C

The FAP application form was widely available on a website (list url):

See Part V, Section C

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Wentworth-Douglass Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Wentworth-Douglass Hospital	Part V, Section B, Line 5: Wentworth-Douglass Hospital held five (5) focus groups to engage consumers, providers and key leaders in the Community Health Needs Assessment (CHNA). Participants were identified and recruited by the Hospital, including members of the public, community organizations, local government officials, and health, education and social service providers. Four of the groups were from geographic areas that represent our community. A provider group was comprised of physicians, nurses, social workers, and program directors. An invitation letter, confirmation letter, and focus group discussion guide were developed to recruit and facilitate the five (5) groups. All of these documents, as well as demographic characteristics of respondents and their ratings are tabulated in the appendices of the CHNA report.
Wentworth-Douglass Hospital	Part V, Section B, Line 6b: The Hospital's most recent CHNA was conducted with Wentworth-Douglass Physician Corp (WDPC), a related 501(c)(3) entity.
Wentworth-Douglass Hospital	Part V, Section B, Line 11: The Top Five Community Health Needs include Mental Health, Transportation, Drugs & Alcohol, Access to Primary Care, and Education/Nutrition Education. WDH has organized and implemented the following services and programs to begin to address these needs. 1. Mental Health and Behavioral Health: Mental and behavioral health was identified as the top community health need in the 2013 CHNA. The recommendation was to expand access to mental and behavioral health services to meet the "urgent need" for these services by increasing the integration of mental health services and primary care services. In 2014, two new behavioral health services were funded. The first expanded access to behavioral health counselors in the Wentworth-Douglass Health System's primary care practices within WDPC. These services were expanded, in collaboration with Great Bay Mental Health Services and Goodwin Community Health (the local Federally Qualified Health Center), and made access to behavioral health counselors available to patients at all WDPC primary care practices. In 2015, this program expanded to include an additional psychiatric nurse practitioner. The second service included the addition of a full-time psychiatric case worker to provide case management of behavioral health patients waiting for long periods in the Emergency Department for evaluation and placement/treatment. This position, through collaboration with community partners, helped patients being held longer than 24 hours in the emergency department, to receive appropriate services and avoid involuntary placement, if possible, by connecting the patients to community resources including the behavioral health counselors in WDPC's practices. This unique role has helped to reduce the number of days spent in the emergency room, prevent readmissions, and improve patient care. In 2015, WDH has been able to discharge 14% of qualified patients at least one day early. Each of these programs is a move forward in reducing the lack of services and stigma of mental health/behavior health while improving overall patient care in the community. 2. Transportation: Second to mental and behavioral health services, the need for transportation to physician practices was recommended by each focus group and identified as one of the top five community health needs. The recommendation was to develop and/or support a community Care-Van service to provide transportation for patients to and from physician practices. Due to legal restrictions and high demand for services, the Care-Van service has continued to limit service to hospital-based services only, but has increased visit volume by 5% and increased the number of miles traveled by 9% from 2014 to 2015. Additionally, WDH has continued to sponsor a community van service in collaboration with a local housing authority. 3. Drugs & Alcohol Abuse:The increase in drug and alcohol abuse was listed as one of the top five community health needs in WDH's 2013 CHNA. In response, WDH applied for and in 2014 was selected to participate in the New Hampshire Youth SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program which was partly funded with grant support from the New Hampshire Charitable Foundation and the Conrad N. Hilton Foundation. This program incorporates an evidence-based SBIRT approach to screening patients ages 12 to 22 to identify alcohol and drug use problems early when brief interventions are most effective and to foster appropriate referrals to early and effective treatment for substance abuse disorders. The SBIRT Program launched in 2015 as a pilot program. Additionally, WDH has continued to support the efforts of the Strafford County One Voice coalition. This group of community agencies and individuals has developed collaborative efforts to address the challenges of substance misuse in Strafford County. This group developed the Strafford County Drug Task Force which meets monthly at Goodwin Community Health, the local Federally Qualified Health Center, and focuses on aligning the many efforts going on in this community. Since 2013, WDH has also hosted and supported the annual spring Strafford County Drug Summit with over 200 attendees from the county, the surrounding region and across the state. WDH has also provided support, including meeting space and materials, to help expand a new service provided by SOS and the Dover Police with collaboration with the Dover Fire Department. This new service allows individuals seeking services for substance misuse treatment to be transported from the Dover Police Station to the Hospital, where they then meet with one of the certified recovery coaches through the SOS Recovery Program. 4. Primary Care Access:Various initiatives were implemented in 2014 and expanded in 2015 to help address the community need for greater access to primary care services. The first initiative focused on improving access to primary care by reducing wait times for appointments and promoting practices accepting new patients. The second initiative focused on extending same day access for primary care services. WDH opened its second walk-in, urgent care facility, Wentworth-Douglass Express Care in Dover, New Hampshire on June 30, 2014. This location expanded access to acute, non-emergent care and continues to experience increasing volumes in 2015. In addition to this initiative, WDPC also opened a new walk-in primary care service, Prompt Care, to improve access for existing WDPC patients. Hours of operation are Monday-Friday 7:00 a.m. - 8:00 p.m. and Saturday and Sunday 8:00 a.m. - 4:00 p.m. The third initiative focused on implementing a patient portal to extend patient access to primary care by providing patients the ability to view and share their medical record, request prescription refills, schedule appointments, and ask a provider a question on their computer. 5. Expand Education/Prevention Programs: Expanded education and prevention programs were identified a one of the top five community needs. In response, WDH offered a variety of education/prevention programs for the community. A sampling of these education/prevention programs include: health screenings (e.g. skin cancer screening, hand pain, vascular, nutrition, and more), nutrition, health, and wellness lectures (e.g. heart health, sexual health, and anti-cancer), health fairs (e.g diabetes, women's health, communication access), support groups (e.g. cancer survivors, grief support, caregiver support), and children's camps and programs (e.g. Camp Hot Shot, Camp Lance-A-Lot, CHaD story time), and insurance marketplace education and support.
Wentworth-Douglass Hospital	Part V, Section B, Line 13b: In the 2015 Financial Assistance Policy, for all covered services (except for Dental Center services), eligibility was determined based on Income at 250% Federal Poverty Guidelines (FPG) and Asset Guidelines (see narrative for Part I, Line 3c), and eligibility was not contingent upon residency. Eligible patients received 100% free care.
Wentworth-Douglass Hospital	Part V, Section B, Line 15e: In the 2015 Financial Assistance Policy, Financial Assistance Representatives were available to assist with any questions regarding the Financial Assistance Application Process and/or Policy. The Financial Assistance Application Packet included a coversheet which outlined required documentation. Representatives were available over the phone at (603) 740-3234 or in person at the Financial Assistance Office: Wentworth-Douglass Business Systems Building, 121 Broadway Avenue, Dover, NH 03820.
Wentworth-Douglass Hospital	Part V, Section B, Line 22d: FAP eligible patients are discounted 100%, therefore no amounts are charged and free care is provided.
Part V, Section B, Line 7a & 10a:	The CHNA is available on the Hospital's website at:https://www.wdhospital.com/workfiles/WDH%20Community%20Health%20Needs%20Assessment%202013.pdfThe Implementation Strategy is available on the Hospital's website at: https://www.wdhospital.com/workfiles/2013%20CHNA%20Implementation%20Strategy(v3).pdf
Part V, Section B, Line 16a, 16b, & 16c:	The Hospital's Financial Assistance Policy is available on its website at: https://www.wdhospital.com/files/4114/5288/2465/Financial_Assistance_Policy_-_Full_Version.pdfThe Hospital's Financial Assistance application form is available on its website at: https://www.wdhospital.com/files/1614/6227/3319/8241-41A.pdfThe Hospital's Plain Language Summary can be accessed at: https://www.wdhospital.com/files/2214/5288/2473/Financial_Assistance_Policy_-_Plain_Language.pdf

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address		Type of Facility (describe)
1	1 - Seacoast Cancer Center 10 Members Way Suite 200 Dover,NH03820	Specialty Care Practice
2	2 - Lee OTPTImaging 65 Calef Highway Lee,NH03861	Occupational/Physical Therapy/Imaging
3	3 - Express Care Dover 781 Central Avenue Dover,NH03820	Express Care
4	4 - WDH Professional Center 10 Members Way Dover,NH03820	Diagnostic Services
5	5 - Express Care Lee 10 Members Way Suite 200 Dover,NH03820	Express Care
6	6 - Diagnostic Cardiology 19 Old Rollinsford Road Dover,NH03820	Cardiology Services
7	7 - Durham Rehab & Sports Therapy Center 16 Jenkins Court Durham,NH03824	Specialty Care Practice
8	8 - WDH Early Learning Center 789 Central Avenue Dover,NH03820	Childcare Services
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c:	In the 2015 Financial Assistance Policy, eligibility was determined based on Income and Assets. Income: To be eligible, an individual's gross annual income could not be greater than 250% of the Federal Poverty Guidelines (FPG), which included alimony, dividends, stipends, social security benefits, employment, self-employment/business income, child support, pensions, annuities/retirement income, rental income and interest income. Assets: To be eligible as a household of 1, combined asset limits could not exceed $5,000 and to be eligible as a household greater than 1, combined asset limits could not exceed $10,000. Assets considered were checking/savings bank accounts, certificates of Deposits (CDs), money markets, stocks/bonds/mutual funds, trusts, additional properties, gambling winnings, capital gains, inheritances, and retirement account(s) currently being contributed to.
Part I, Line 6a:	N/A
Part I, Line 7:	The Hospital uses the ratio of cost to charge methodology to calculate the cost of the community benefits it provides. The ratio of cost to charge methodology was also used to reduce charity care charges down to costs and calculate the Medicaid shortfall.In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital refined our approach to calculating the RCC used to adjust charges to cost for reporting on Financial Assistance, Medicaid and Medicare allowable costs. The Hospital includes the net impact of the New Hampshire Medicaid Enhancement Tax (MET) and Disproportionate Share Funding (DSH) in calculating the Ratio of Patient Care to Cost (RCC) to determine the percentage allocation to use in determining the financial assistance at cost and Medicaid net community benefit expense. Additionally, the Hospital includes the net MET/DSH impact as an expense in Part I, Line 7b in arriving total Medicaid-related costs. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure.
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 11,142,070.
Part II, Community Building Activities:	See Form 990, Part III, Line 4a.
Part III, Line 2:	In 2015, charges billed by the Hospital of $11,142,070 were to provide care to patients, for which the Hospital received no payments for services rendered. In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital is now reporting bad debt expense on a charge basis rather than on the cost basis.
Part III, Line 3:	In 2015, the Hospital engaged with an independent national consulting firm to review the Schedule H reporting, and as a result the Hospital refined our approach to calculating the estimated amount of the Hospital's bad debt expense attributable to patients eligible under the organization's financial assistance policy. The Hospital utilizes the percentage of applications that are denied under the Financial Assistance Policy due to incomplete applications as a reasonable basis for calculating the percentage of bad debt that may be considered as eligible under the Financial Assistance Policy. This amount is reported at cost, and is not reported as a community benefit within Part 1, Line 7.
Part III, Line 4:	See Page 8 and 15 of the attached audited financial statements.
Part III, Line 8:	In 2015, the Hospital provided care costing $99,954,721 to Medicare patients, for which it was reimbursed $69,942,010, representing a loss on Medicare services of $30,012,711. This amount represents the amount by which the Hospital was underpaid (relative to cost) by the federal government for care provided to Medicare patients, who are 65 and older, regardless of income or disability. The Hospital includes the net New Hampshire Medicaid Enhancement Tax (MET)/Disproportionate Share Funding (DSH) impact as an expense within Part III, Section B. In prior years, the State of New Hampshire used collected MET dollars to service the general fund of the State. However, recently the State has used these dollars as a direct funding usage for medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact should be considered a healthcare-related expenditure.
Part III, Line 9b:	Hospitals in New Hampshire work hard to make high-quality health care available, affordable, and accessible to all, regardless of ability to pay. Wentworth-Douglass Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community obtaining the health care services that he or she may need. If payment of health care expenses creates a financial hardship for patients, our staff provides assistance to complete the financial application process. The Hospital follows the written policy and consistently applies the policy to all patients and treats all patients equally, regardless of ability to pay.As part of this financial application process, the Hospital will assess patients' eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and Maine Medicaid. If it is determined that patients may be eligible for one of these programs, the Hospital assists patients through the application process. Patients are required to supply the financial or medical documentation that is necessary to secure such insurance coverage.The Hospital understands that health care costs can come up unexpectedly. Whether patients are insured or uninsured, and whether or not patients qualify for financial assistance, we understand that patients may have difficulty paying healthcare costs in full at the time of service or in a lump sum. Our billing team works with patients to set up interest-free payment plans to help ease the financial burden of health care costs.
Part VI, Line 2:	WDH assesses the health care needs of the communities it serves in many ways. The first of which includes the formal Community Health Needs Assessment process which is led by Hospital's Community Benefit Task Force. The 2013 CHNA process included an extensive data analysis and community focus groups. The focus group finding were then evaluated in collaboration with the county level Adult Behavioral Health Risk Factor Surveillance data to identify the top 5 community health needs. WDH, in collaboration with the New Hampshire Foundation for Healthy Communities, partnered (in Fall 2015) with RKM Research and Communications, Inc. to conduct a community needs telephonic survey. The purpose of this survey was to assist WDH in identifying the health care needs of the communities it serves. The findings from this survey will be included in the 2016 Community Health Needs Assessment (CHNA) and reported in the Primary Data section of the report. In addition, WDH also assesses community need on an ongoing basis through both formal and informal channels. On a monthly basis, WDH receives input and feedback on community need from the WDH Patient and Family Advisory Board and the Hospital and Health System Board of Directors. Community need is also assessed on an annual basis as part of WDH's Strategic Planning process which includes a comprehensive assessment of health outcomes and health factors for the communities we serve, and in the Health System's provider need assessment which includes an analysis of provider supply and demand to ensure adequate and appropriate resources are available to meet the need of our community.
Part VI, Line 3:	WDH and WDPC take an active role in assisting patients who may be interested and qualify for financial assistance, whether it is state, federal or our own charity care benefits. Our Family Resource/Community Benefits Department has several processes in place to ensure patients are aware of the financial assistance available to them.Patients can learn more about these programs by visiting our website, reading our Foundation newsletters, or contacting our Financial Assistance Office. From the time of registration through our billing process, patients have available the opportunity to obtain an application for financial assistance as well as our financial assistance policy. All self pay patients at the time of registration are provided with our charity care cover letter and application, with information about the charity care program and details on how to contact our Financial Assistance Representative(s). Our representatives also see many patients while they are here for services. Social Work Services and Community Benefits team up to assist and make sure our patients are receiving the opportunities to get any and all assistance available to them. We send five billing statements to our patients with the financial assistance guidelines and contact information if patients feel they may meet these guidelines and need assistance with their bill(s).
Part VI, Line 4:	Wentworth-Douglass Hospital serves the Seacoast area of New Hampshire and Southern Maine - Strafford County, Rockingham County and York County, Maine. Our community includes a small but growing Indonesian population, welcomed by local church groups. The community also includes low-income, uninsured adults and children supported by the Hospital's Community Assistance Plan programs.
Part VI, Line 5:	In 2015, the Hospital had 6 trained Certified Application Counselors (CACs). Representatives at the main hospital and offsite locations were available to assist. The Hospital also published and marketed this information to the community so that they could be made aware of the Hospital's available trained professionals. The Hospital assists enrollees from start to finish with the process. All of the Hospital's CACs spend a great deal of time providing education to the Hospital's many patients. Hundreds of patients looking for help in understanding the ACA, ACA terminology, and the differences between plans offered to them were provided assistance in person or via telephone.
Part VI, Line 6:	The affiliates of Wentworth-Douglass Hospital include Wentworth-Douglass Physician Corporation, Wentworth-Douglass Community Health Corporation, the Wentworth-Douglass Hospital and Health Foundation, and Wentworth-Douglass Health System. Our affiliates serve to further our mission of helping our patients and their families attain their highest level of health. The Wentworth-Douglass Physician Corporation was formed in response to a community needs assessment that identified a lack of primary care services in the community. The formation of the Physician Corporation and recruitment of primary care physicians closed the gap by improving access to primary care medical services in our community. Today, WDPC also provides a vast array of specialty physician services to the community.Wentworth-Douglass Physician Corporation (WDPC), d/b/a Wentworth Health Partners, which files its own Form 990 (see Schedule R for more details), is owned 100% by WDHS. The Hospital oversees all of WDPC's primary care practices, specialty practices, behavioral health services and its dental clinic. WDPC supports numerous community based programs, including the Community Dental Center and Behavioral Health Services. In 2015, WDPC acquired Great Bay Mental Health as part of the continued initiative to expand the services offered for behavioral health. WDPC provided $406,004 of behavioral health care services to patients.The Wentworth-Douglass Community Dental Center is open to low-income, uninsured adults and children living in the Hospital's primary service area (Dover, Durham, Madbury, Lee, Barrington, Somersworth, Rollinsford, NH and Berwick and So. Berwick, ME) or patients of the physician practices who have a family income at or below 300% of the federal poverty level, based on the number of members in the household. Minimum payments are charged on a discounted fee schedule based on household income. In 2015, the Dental Center provided $647,682 of community-based clinic services.WDPC provides financial aid information and resources to assist patients with their healthcare bills. Medical care is provided at no charge for eligible patients at 250% of the federal poverty level. In 2015, WDPC provided $422,134 of financial aid (stated at cost).Medicaid Costs Exceeding Reimbursement totaled $2,526,203 for WDPC in 2015.The Hospital subsidizes WDPC primary care practices that operate at a loss. The subsidized losses of these primary care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $5,171,668 in 2015. The Hospital subsidizes certain WDPC specialty care practices that operate at a loss. The subsidized losses of these specialty care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $3,334,725 in 2015. Wentworth-Douglass Community Health Corporation (The Works), a for-profit taxable subsidiary of WDHS, serves to promote community health and wellness, while remaining family focused. The Works offers specially designed and supervised fitness programs, aimed to help manage diabetes, lower risk of heart disease, and improve quality of life. In addition, the Hospital collaborates with The Works to offer group exercise programs to our patients, including Cancer Center patients, who are provided a free three month membership and invited to participate in a program that combines rehabilitation and group exercise. The Works also donates memberships as well as the use of its facilities and staff time to benefit various community organizations in support of health care initiatives.The Wentworth-Douglass Hospital and Health Foundation serves to cultivate, secure and steward philanthropic gifts that will support the capital, programmatic and endowment needs of Wentworth-Douglass Hospital.Wentworth-Douglass Health System was established to support and further the charitable activities of Wentworth-Douglass Hospital and Wentworth-Douglass Physician Corporation. It provides planning, oversight and coordination of the charitable activities related to the promotion of health of these entities.
Part VI, Line 7, Reports Filed With States	NH

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Wentworth-Douglass Hospital

Employer identification number
02-0260334

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) City of Dover Fire and Rescue 262 Sixth Street Dover,NH03820		Government	138,160	QA/AI program ECG Monitor and Defibrillation Equipment
(2) City of Dover Police 46 Chestnut Street Dover,NH03820		Government	125,000	Youth to Youth Program and Dover Coalition for Youth
(3) Dartmouth Hitchcock Memorial Hospital One Medical Center Drive Lebanon,NH03756	02-0222140	501(c)(3)	32,340	Child Advocacy Program
(4) Strafford Health Alliance 200 Route 108 Suite 3 Somersworth,NH03878	02-0389434	501(c)(3)	132,096	CFA-Athletic Training DHS
(5) Southern New Hampshire Service PO Box 5040 Manchester,NH03108	02-0268285	501(c)(3)	15,000	Community Detox and Stabilization Services
(6) Goodwin Community Health 311 Route 108 Somersworth,NH03878	02-0304203	501(c)(3)	100,000	Primary Care Services
(7) Amy's Treat PO Box 03821 Dover,NH03821	26-2350766	501(c)(3)	15,000	Seacoast Cancer Center
(8) AIDS Response - Seacoast 7 Junkins Avenue Portsmouth,NH03801	22-2884488	501(c)(3)	7,500	Support Program

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Part I, Line 2:	During the tax year 2015, WDH only made contributions to governmental entities or other 501(c)(3) public charities, additional monitoring is not deemed necessary.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Anne Kalter MDTrustee	(i) (ii)	0 ------------- 143,846	0 ------------- 86,341	92,707 ------------- 18,433	0 ------------- 0	0 ------------- 29,275	92,707 ------------- 277,895	0 ------------- 0
2John Novello MDTrustee	(i) (ii)	0 ------------- 290,691	0 ------------- 18,534	0 ------------- 1,392	0 ------------- 9,800	0 ------------- 19,692	0 ------------- 340,109	0 ------------- 0
3Gregory J WalkerPresident/CEO	(i) (ii)	464,287 ------------- 0	145,630 ------------- 0	197,288 ------------- 0	125,844 ------------- 0	28,616 ------------- 0	961,665 ------------- 0	0 ------------- 0
4Peter E WalcekCFO/VP Finance	(i) (ii)	310,787 ------------- 0	60,795 ------------- 0	66,897 ------------- 0	66,753 ------------- 0	29,329 ------------- 0	534,561 ------------- 0	40,500 ------------- 0
5Paul R Cass DOVP Medical Affairs/CMO	(i) (ii)	367,330 ------------- 0	69,263 ------------- 0	16,434 ------------- 0	71,186 ------------- 0	19,614 ------------- 0	543,827 ------------- 0	0 ------------- 0
6Ellen L Caille FACHEExecutive Vice President	(i) (ii)	273,673 ------------- 0	53,960 ------------- 0	63,506 ------------- 0	55,735 ------------- 0	28,666 ------------- 0	475,540 ------------- 0	37,500 ------------- 0
7Malcolm D Rosenson MDChief Quality & Safety Off	(i) (ii)	298,777 ------------- 0	29,081 ------------- 0	1,392 ------------- 0	13,699 ------------- 0	25,174 ------------- 0	368,123 ------------- 0	0 ------------- 0
8Sheila M WoolleyCNO/VP Patient Care	(i) (ii)	253,000 ------------- 0	33,297 ------------- 0	48,589 ------------- 0	36,943 ------------- 0	20,162 ------------- 0	391,991 ------------- 0	21,320 ------------- 0
9Daniel N DunnCOO/Sr. VP Operations	(i) (ii)	246,453 ------------- 0	20,928 ------------- 0	27,003 ------------- 0	15,035 ------------- 0	19,112 ------------- 0	328,531 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 1a	Certain retirement and fringe benefits for Gregory J. Walker (President/CEO) have been grossed-up utilizing the applicable marginal federal tax rate as the most efficient and cost effective means to fulfill the target benefit goal at retirement.
Part I, Line 4b	Gregory J. Walker (President/CEO) - 2015 total contributions to the 457(f) plan = $113,104. This supplemental retirement plan contribution is intended to fund benefits accruing and payable at retirement for multiple years of service that began in calendar year 1997. In 2015, the Hospital funded a supplemental executive retirement plan which provides benefits to other qualifying executives. The contributions are intended to provide a forfeitable supplemental retirement benefit and are being provided in consideration for many years of service to the Hospital. The respective contributions for the 2015 plan year, for those individuals identified in Schedule J - Part II, are as follows: Peter E. Walcek = $50,853, Paul R. Cass, DO = $57,936, Ellen L. Caille = $45,135, and Sheila Woolley = $24,702. The following individuals vested in their 2010 457(f) contributions during 2015: Peter E. Walcek = $40,500, Ellen L. Caille = $37,500, and Sheila Woolley = $21,320. The 2010 amounts are required to be reported on Schedule J, in Column F and as part of the taxable W-2 compensation reported in Column B(iii) of this Form 990. WDH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by the employer. Pursuant to WDH's split-dollar agreement, and the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance. Total premiums paid during the year ending 12/31/15 were $21,144 for Peter E. Walcek, $58,352 for Daniel N. Dunn, and $38,168 for Sheila M. Wooley. The taxable value of the life insurance policy has been included in each individuals' W-2. The policies are intended to provide an additional retirement benefit for these individuals' multiple years of service.
Part I, Line 7	At-risk compensation, which is subject to review and paid annually. It is based on several predefined metrics, including patient satisfaction, quality, and financial targets.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Wentworth-Douglass Hospital

Employer identification number
02-0260334

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NHHEFA Authority Revenue BondsWDH Issue Series 2011A	02-0279866	644614var	04-06-2011	87,920,000	Refinancing bonds & construction of new inpatient wing		X		X		X
B	NHHEFA Authority Revenue BondsWDH Issue Series 2011B	02-0279866	644614M63	04-06-2011	18,390,000	Refinancing bonds		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	87,825,276		18,390,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	12,476,983		16,673,374
7 Issuance costs from proceeds ...............	976,169		184,826
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	44,372,124		1,531,800
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2012		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........		X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X
b Exception to rebate? ........		X		X
c No rebate due? .........	X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X	X
b Name of provider ..........			Piper Jaffray - See Part VI for more
c Term of hedge .........
d Was the hedge superintegrated? ......				X
e Was the hedge terminated? ........				X

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Date Rebate Computation Performed	Issuer Name: NHHEFA Authority Revenue Bonds/WDH Issue, Series 2011A Date the Rebate Computation was Performed: 01/01/2013 Issuer Name: NHHEFA Authority Revenue Bonds/WDH Issue, Series 2011B Date the Rebate Computation was Performed: 01/01/2013
Part IV, Line 4c	The $18,390,000 bond listed on line B of Part I is split into approximately two equal hedges, one with a term of 11.8 years (ending on 1/1/2023) and the other 19.8 years (ending on 1/1/2031).
Bond Refinance:	On March 28, 2016, the System refinanced its existing Series 2011B revenue bonds through the issuance of Series 2016A revenue bonds totaling $16,000,000. Additionally, Series 2016B revenue bonds totaling $6,000,000 were issued to reimburse for certain capital expenditures and replenish cash used to payoff the WDCHC note payable described above, which comes due in May 2016. The Series 2016A revenue bonds were directly placed with a financial institution and do not require a secured letter of credit. The Series 2016A and 2016B revenue bonds mature on January 1, 2031 and January 1, 2026, respectively, and carry a weighted average interest rate of 3.1374%.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) Peter E Walcek	CFO/VP Finance	Supplemental Retirement Benefits - Split Dollar Life Insurance		X	102,663	102,663		No	Yes		Yes
(2) Daniel N Dunn	COO/SR. VP Operations	Supplemental Retirement Benefits - Split Dollar Life Insurance		X	403,260	403,260		No	Yes		Yes
(3) Sheila M Wooley	CNO/VP Patient Care	Supplemental Retirement Benefits - Split Dollar Life Insurance		X	225,474	225,474		No	Yes		Yes







Total ............... $						731,397

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Gregory J Walker Peter E Walcek	President/CEO, CFO/VP Finance, & CNO/VP Patient Care	891,429	Joint VentureGregory J. Walker, President/CEO, Peter E. Walcek, CFO/VP Finance, and Sheila M. Woolley, CNO/VP Patient Care of the Hospital serve on the board of managers of Wentworth Home Care & Hospice, LLC. The Hospital has a 50% ownership interest in Wentworth Home Care and Hospice, LLC. The Hospital accounts for its investment in joint ventures under the equity method. The 2015 income recorded for the Hospital's share of revenues equaled $891,429 from which is received a cash distribution of $787,500.In accordance with IRS instructions, this business relationship has been disclosed in Schedule L, Part IV, however, Mr. Walker, Mr. Walcek, and Ms. Woolley received no direct or indirect monetary benefit as a result of this joint venture and all transactions were negotiated at arms-length.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

Schedule L, Part II:

Amounts stated on Schedule L, Part II represent the net present value expected on the total premiums paid through 12/31/15 that is anticipated to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for the disqualified persons listed on Form 990, Part VII and as further reported on Schedule J. Total cumulative premiums paid through December 31, 2015 for disqualified persons are $102,663 for Peter E. Walcek, $403,260 for Daniel N. Dunn, and $225,474 for Sheila M. Wooley. Total premiums paid during the year ending 12/31/15 were $21,144 for Peter E. Walcek, $58,352 for Daniel N. Dunn, and $38,168 for Sheila M. Wooley.Pursuant to updated IRS instructions, the net present value of these split dollar premiums has been reported in Schedule L, Part II this year. Accordingly, the net present value premium amounts described above have been reported on Form 990, Part X, Line 5 in the End of Year column.

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Return Reference	Explanation
Form 990, Part III:	In April 2016, the Boards of WDHS and Massachusetts General Hospital (MGH) voted to have the Hospital become a subsidiary of MGH. Under a letter of intent signed by both organizations, MGH will become the parent organization of the Hospital. The Hospital will become the parent organization of WDPC, WDCHC and the Foundation. At the time of this filing, the definitive agreements were signed and approved by the Boards of WDHS and MGH. The transaction is subject to confirmatory due diligence, and notice to and (where required) approval by state and federal agencies.
Form 990, Part VI, Section A, line 4	The following significant changes were made to Wentworth-Douglass Hospital's bylaws on April 6, 0215: -The article regarding management of the corporation was revised to read that the Board of Trustees must obtain the approval of the Member's Board of Directors before action on certain matters of governance can be considered final. Previously, the filing organization was required to obtain approval of the member organization, but it was not specified that approval must come from the member's Board of Directors. -The following sentence was added to the bylaws as it relates to the Board of Trustees and the organization's management: Nothing herein shall limit the Wentworth-Douglass Health System Board of Directors, as Member, from unilaterally taking any of the actions identified above which impact the Corporation."
Form 990, Part VI, Section A, line 6	Wentworth-Douglass Health System (WDHS), a New Hampshire nonprofit corporation, was formed in 2012 as the result of the corporate restructuring of Wentworth-Douglass Hospital (WDH) into an integrated health system. WDHS serves as the parent company of WDH and its affiliates Wentworth-Douglass Hospital and Health Foundation and Wentworth-Douglass Physician Corporation, all of which are New Hampshire nonprofit corporations that have been recognized as being 501(c)(3) organizations. These corporations share a common mission with WDH. WDHS is intended to act as a supporting organization of WDH, serving in the role of the "parent company" of the Hospital and the affiliates. WDHS is the sole member of WDH.
Form 990, Part VI, Section A, line 7a	WDHS will appoint the Board members for WDH.
Form 990, Part VI, Section A, line 7b	Wentworth-Douglass Health System has the power to appoint and remove directors of WDH, and all actions pertaining to the property, business, and affairs of WDH, including WDH's annual budget, are subject to the approval of WDHS.
Form 990, Part VI, Section B, line 11	A draft of the Form 990 is initially reviewed in detail by the Finance Committee and key Finance employees. Thereafter, the final draft is presented to the full Board prior to filing with the IRS. Each member of the Board and Finance Committee is provided with a complete draft of the Form 990 in advance of each meeting.
Form 990, Part VI, Section B, line 12c	A copy of the Hospital's conflict of interest policy is distributed annually to all officers, trustees, medical staff officers and committee members, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with State of New Hampshire RSA 7:19-A in the local newspaper and submitted to the New Hampshire Attorney General.
Form 990, Part VI, Section B, line 15	CEO's Compensation: The CEO's compensation and benefits are reviewed, adjusted, and voted on by all independent members of the Board annually. Every other year, a national independent consulting firm is engaged by the Board to provide comparative market compensation data for executive and management positions at the Hospital. The Board uses the data provided to compare Wentworth-Douglass's CEO compensation with that of other hospital executives nationally and in the Northeast region to determine the CEO's total compensation. On alternate years, when the consulting firm is not engaged, the Board uses salary ranges established the prior year and market economic data to validate that the CEO's salary is competitive and make market adjustments. Additional factors taken into account to determine the CEO's salary are based on several predefined metrics, including patient satisfaction, quality, and financial targets. The CEO is excused from Board discussion and voting on issues surrounding his compensation and benefits. Compensation of Key Employees: The CEO reviews the salaries of key employees annually and recommends compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. The CEO presents salary range data for key employees to the Board annually for approval. Using the Board approved salary range data. The CEO recommends salary increases for vice presidents to the Board for approval and the vice presidents recommend salary increases for Directors and other management positions to the CEO for approval. All compensation for vice presidents and above requires final approval by the independent Board Members.
Form 990, Part VI, Section C, line 19	Wentworth-Douglass Hospital files audited financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between the Foundation and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-a, II(d). Current copies of the Bylaws, Conflict Of Interest Policy, and Form 990 are on file with the Charitable Trust Unit. The Organization also makes these documents available upon request.
Form 990, Part VI, Section A, Line 1a and Line 1b:	Governing Body and Management: Steven C. Webb is a trustee of the Hospital and an executive at TD Bank. The Hospital maintains operating and payroll accounts with TD Bank. Transactions in 2015 were in excess of $10,000. An exact figure cannot be stated due to daily account activity and balance changes. Both accounts were active prior to Mr. Webb joining the Board and all transactions with TD Bank are at a fair market rate. For 2015, Mr. Webb has been classified as an independent board member.
Form 990, Part VII, Section A, Column D:	Reportable Compensation from the Organization: The 2015 compensation reported for Dr. Anne Kalter and Dr. John Novello was paid by a related organization (Wentworth-Douglass Phsycian Corporation) for their full-time services as members of the medical staff. Neither individual is compensated for their services as a trustee of WDH. Dr. Anne Kalter is also a 50% owner of Gynecologic Paradox (formerly Gynecology & Infertility Associates). During 2015, Wentworth-Douglass Hospital made payments to Gynecologic Paradox of $92,707 for consulting services, call services, and rent. These amounts have been reported to her on a 1099 and included in Schedule J, Part II, Column B(iii) and further disclosed on the Hospital's Schedule L, Part IV. Additionally, Dr. Dirksmeier, Dr. Lally, and Dr. Flavin each received a contribution during 2015 to WDH's Call Pay Plan which is available to independent physician contractors who provide on call services to the Hospital. These amounts have been reported in Part VII, Column (F). In 2015, Dr. Lally and Dr. Flavin received distributions from their Call Pay Plan which was reported to them on a 1099-MISC. These distributions have been added to Column D of Part VII of Form 990 and Column B(iii) on Schedule J, Part II. As outlined above, these distributions have been reported in Part VII, Column (F) of prior 990s when they were contributed to each individual's plan.
Part IX, Line 24d:	The New Hampshire Medicaid Enhancement Tax (MET) is a tax on net patient service revenue paid by hospitals to the State of New Hampshire (the tax rate for State fiscal year 2016 was 5.45% and was 5.5% for State fiscal year 2015). Hospitals have been paying the MET since 1991, but in previous years, after the State had received matching federal funds, it provided the hospitals uncompensated care payments towards the cost of care of patients without insurance and those covered by Medicaid. The net effect was that most of the MET was returned to the hospitals. Accordingly, in 2010 Wentworth-Douglass Hospital paid $11,257,754 in MET and received $10,520,601 in uncompensated care payments from the State. However, beginning in 2011, the State reduced and/or eliminated payments to the hospitals for uncompensated care. For 2015, Wentworth-Douglass Hospital paid $14,751,461 in MET (see Part IX, line 24d) and recorded $4,815,728 of disproportionate share uncompensated care.
Form 990, Part XI, line 9:	Net Loss on Investments in Joint Ventures & Related Organizations -28,537,061. Accrued Earnings in Joint Ventures Owned by Affiliates 507,005.
Form 990, Part XII, Line 2c:	Audit Review Process: The Finance Committee oversees the audit process for Wentworth-Douglass Hospital and all related organizations. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit in both 2014 and 2015.
Form 990, Part IX, Column D:	Fundraising expenses: Wentworth-Douglass Hospital and Health Foundation (a related organization) performs all fundraising activities on behalf of Wentworth-Douglass Hospital. All fundraising expenses are reported on the Foundation's separate Form 990.
Form 990, Part X, Line 5:	Amounts separately stated on Form 990, Part X, Line 5 represent the net present value expected on the total cumulative premiums paid through 12/31/15 that is expected to be received by the Hospital with respect to supplemental retirement benefits related to split dollar life insurance policies for various disqualified persons listed on Form 990, Part VII and as reported on Schedule L and J.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wentworth-Douglass Hospital

Employer identification number

02-0260334

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) 73 Corporate Drive at Pease LLC 95 Market Street Manchester,NH03101	Acquisition, Ownership, & Development of Real Property	NH	0	5,086,416	Wentworth-Douglass Hospital

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Wentworth-Douglass Physician Corporation 789 Central Avenue Dover,NH03820 02-0497927	Health care	NH	501(c)(3)	Line 3	Wentworth-Douglass Health System		No
(2)Wentworth-Douglass Hospital & Health Foundation 789 Central Avenue Dover,NH03820 51-0491062	Philanthropic fund raising & stewardship	NH	501(c)(3)	Line 11b, II	Wentworth-Douglass Health System		No
(3)Wentworth-Douglass Health System 789 Central Avenue Dover,NH03820 46-1635259	Support and further charitable activities of Hospital and related entities	NH	501(c)(3)	Line 11b, II	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Wentworth Surgery Center LLC PO Box 71 Somersworth,NH03878 90-0975592	Surgery Center	NH	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Wentworth-Douglass Community Health Corporation 789 Central Avenue Dover,NH03820 02-0399963	Health fitness center	NH	N/A	C				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Wentworth-Douglass Community Health Corporation	L	158,706	Actual per books
(2) Wentworth-Douglass Community Health Corporation	O	75,568	Actual per books
(3) Wentworth-Douglass Community Health Corporation	Q	37,618	Actual per books
(4) Wentworth-Douglass Community Health Corporation	A	22,731	Actual per books

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

Schedule R, Part III:

The Hospital system invested in Granite Healthcare Asset Holding Company, LLC, a joint venture with several hospital facilities. The Hospital's investment in this entity does not otherwise meet the disclosure requirements for Schedule R, Part III.

Schedule R, Part II:

Although not listed in Schedule R, Part II, Wentworth-Douglass Hospital owns 100 shares (50% of shares issued and outstanding) of non par value corporate stock in Strafford Health Alliance, a 501(c)(3) public charity. Strafford Health Alliance provides physical therapy, occupational therapy, and breast imaging services to residents of southeastern New Hampshire. Due to a lack of a control relationship by Wentworth-Douglass Hospital, Strafford Health Alliance has not been listed as a related organization in Schedule R, Part II in accordance with IRS instructions.

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Help individuals and their families attain their highest level of health.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,046
6	Total number of volunteers (estimate if necessary) .............	6	182
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	271,286
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	650,214	185,995
9	Program service revenue (Part VIII, line 2g) .........	278,986,224	295,574,889
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,600,927	3,201,407
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,174,294	3,991,739
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	288,411,659	302,954,030
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	422,784	601,106
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	117,782,152	122,756,613
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	131,218,575	131,817,023
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	249,423,511	255,174,742
19	Revenue less expenses. Subtract line 18 from line 12.......	38,988,148	47,779,288
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	444,140,997	458,061,852
21	Total liabilities (Part X, line 26).............	190,257,126	191,124,100
22	Net assets or fund balances. Subtract line 21 from line 20.....	253,883,871	266,937,752

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 222,734,850 including grants of $ 601,106 ) (Revenue $ 297,602,071 )
	Wentworth-Douglass Hospital (WDH or the Hospital) is an acute care hospital located in Dover, New Hampshire. WDH is a not-for-profit organization, as described in Section 501(c)(3) of the Internal Revenue Code. Wentworth-Douglass Hospital is the largest acute care hospital in the Seacoast region of New Hampshire and Southern Maine, specializing in Trauma and Emergency Services, Surgery, Cancer Care, Birthing, Orthopedic Services, Cardiovascular Services, Sleep Disorders, Rehabilitation, Pain Management, Wound Healing, Wellness, and Prevention Programs plus extensive diagnostic services. A healthcare leader in the Seacoast since 1906, Wentworth-Douglass Hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. (continued on Schedule O)At Wentworth-Douglass Hospital (WDH), we are committed to serving our community and addressing the needs of all our patients. Our community benefit programs are available to local residents with income at or below 250% of Federal Poverty Level guidelines, one of the most generous programs in the State of NH. WDH files an annual Community Benefits Report with the State of NH which outlines the community and charitable benefits provided. Numerous programs were developed to assist people in the area we serve, including Financial Aid, Behavioral Health Services, Family Resource Counselor Program, Financial Assistance Services, Physician Referral Services, Care-Van transportation services, and Wentworth-Douglass Community Dental Center. The Hospital provided $15,976,700 (as measured by gross charges) of community assistance programs in 2015. In total, the Hospital and WDPC together provided $16,792,000 (as measured by gross charges) of community assistance programs in 2015.The Hospital's core programs include our Cancer Center, Emergency Department, and Surgical Services. In addition, WDH offers other key services in the areas of Women's and Children's Services and Cardiology Services.1. The Seacoast Cancer Center at Wentworth-Douglass Hospital offers the most comprehensive cancer treatment services covering the Seacoast region of New Hampshire and Southern Maine. Founded over 30 years ago as a single room adjacent to the Emergency Department, the Cancer Center's services now include extensive, state of the art medical and radiation oncology diagnostic services with multiple treatment options. A multidisciplinary Chest Clinic, located in the Seacoast Cancer Center, saw its first patients in October 2008. The medical team focuses on timely access to services for patients with lung nodules and lung cancer. 2. The Emergency Department at Wentworth-Douglass Hospital has one of the highest volume of visits in the State of New Hampshire. Close linkages to local emergency services personnel and Fire & Rescue Departments continue to extend the skill and capabilities of the Department. Through internal and external education efforts, the Emergency Department focused on improving patient care for specific types of heart attack (STEMI) and stroke. The Department's efforts in the Fall of 2008, through a clinical collaboration with Massachusetts General Hospital, created the Stroke Initiative to form a center of excellence for stroke care. In October 2009 the American Heart/Stroke Association awarded WDH the Bronze Award for achieving its high standard, quality guidelines for six consecutive months. In 2011, the Hospital received a Gold Plus Award from The Joint Commission for 24 consecutive months of achievement at the Stroke Center.To accommodate increasing patients the Department also added additional space for six treatment rooms and opened a Walk-In Express Care Centers in both Dover and Lee, NH to support the growing population areas in the towns surrounding Dover and Lee.The Hospital's generous Charity Care Program offers emergency, walk-in and other hospital services at no charge for qualifying patients at 250% of the Federal Poverty Level. 3. Surgical Services at WDH include a wide array of services and technological advances frequently associated with larger medical centers. A renovation to enlarge operating rooms created digital ORs and space for new equipment such as the da Vinci Robotic Surgical System. Now in its eighth year, the robotic program began with OB/GYN surgeons, and now includes Thoracic, General Surgery and Urology. Another clinical collaboration with MGH at WDH brings a GYN/Oncology surgeon to WDH to perform "medical center" surgery in the community setting, eliminating the time and the frustration of travel to and parking at metropolitan cities.A range of minimally invasive procedures including Robotic Surgery, Single Incision Laparoscopic Surgery (SILS) used by general surgeons and Video Assisted Thoracic Surgery (VATS) procedures used by the thoracic surgeon offer patients the benefits of complex surgery with less blood loss, less infection and faster recovery.The Joint Replacement Program introduced in 2006 offers a unique approach to joint replacement surgery with pre-op group education and post-op group rehab. Surgeons, anesthesiologists, nursing, rehab and nutrition staff worked collaboratively to create this new approach to joint replacement care. In 2009, the Hospital created the Northern New England Spine Center, a partnership of specialists to coordinate and expedite the care of patients with neck and back pain. The Spine Center members include a spine surgeon, physiatry specialists, pain specialists, WDH rehab, behavioral health specialists and a WDH Spine Coordinator. The virtual center holds bimonthly multidisciplinary conferences to coordinate the care and treatment of Spine Center patients.Other Services:In addition to the services listed above, Wentworth-Douglass Hospital offers traditional services with non-traditional components. One example is The Birth Center. Currently The Birth Center is the fastest growing birthing service in the Seacoast area with over 1,000 births per year. In an effort to support a small but growing and young Indonesian population, The Birth Center translated all forms and information for new mothers into Indonesian. Local church groups welcomed Indonesian families into their communities.Cardiology Services recently replaced the cath lab with new equipment and the Department added Non-Invasive Cardiovascular Services at a new, offsite medical office building in Dover, extending the options now available for patients. A second cardiovascular interventional lab was opened late in 2010 to accommodate growing patient volume and urgent cases.All the Community Assistance (Benefit) Services support low income, uninsured individuals and families in the Hospital's service area with Charity Care (Financial Assistance), the Wentworth-Douglass Community Dental Center, and the Care-Van free patient transport service.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses222,734,850

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Paul R Cass DO........................................................................ VP Medical Affairs/CMO	50.00 .......................5.00	X	453,027	0	90,800
(19) Ellen L Caille FACHE........................................................................ Executive Vice President	50.00 .......................5.00	X	391,139	0	84,401
(20) Malcolm D Rosenson MD........................................................................ Chief Quality & Safety Off	50.00 .......................0.00	X	329,250	0	38,873
(21) Sheila M Woolley........................................................................ CNO/VP Patient Care	50.00 .......................0.00	X	334,886	0	57,105
(22) Daniel N Dunn........................................................................ COO/Sr. VP Operations	50.00 .......................0.00	X	294,384	0	34,147

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,166,699	559,237	643,655

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	46,392
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	139,603

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		185,995

		Business Code
2a	Patient service revenue	621400	286,209,621	286,209,621
b	Disproportionate Share Funding	621400	4,815,728	4,815,728
c	Miscellaneous Revenue	621400	2,247,806	2,089,100	158,706
d	Cafeteria	722320	1,300,801	1,259,318	41,483
e	Child care service	624410	1,000,933	1,000,933
f	All other program service revenue.
g Total.Add lines 2a–2f.....			295,574,889

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			3,258,317		71,097	3,187,220
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		2,139,844
b	Less: rental expenses		375,476
c	Rental income or (loss)		1,764,368
d	Net rental income or (loss)......			1,764,368			1,764,368
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		15,639,248
b	Less: cost or other basis and sales expenses		15,696,158
c	Gain or (loss)		-56,910
d	Net gain or (loss).....			-56,910			-56,910
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Granite Shield		621990	1,230,397	1,230,397
b	Meaningful Use		621400	667,928	667,928
c	Transcription		621400	329,046	329,046
d	All other revenue ....
e	Total. Add lines 11a–11d ......			2,227,371
12	Total revenue. See Instructions......			302,954,030	297,602,071	271,286	4,894,678

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	601,106	601,106
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,643,575	147,349	1,496,226
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	92,605,496	78,765,313	13,840,183
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,160,598	2,686,508	474,090
9	Other employee benefits .......	16,590,273	14,101,732	2,488,541
10	Payroll taxes ...........	8,756,671	7,443,170	1,313,501
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,281,544		1,281,544
c	Accounting ...........	83,709		83,709
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	156,062		156,062
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	14,049,072	13,354,765	694,307
12	Advertising and promotion ....	1,712,685	1,712,685
13	Office expenses .......	4,139,097	3,518,237	620,860
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	3,794,559	2,978,729	815,830
17	Travel ............	179,136	134,352	44,784
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	268,703	201,527	67,176
20	Interest ...........	7,095,700	6,740,915	354,785
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	16,209,746	13,778,284	2,431,462
23	Insurance ...	2,391,588	2,272,009	119,579
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies/Equipm	23,048,851	19,591,523	3,457,328
b	Pharmacy	18,905,361	18,905,361
c	NH MET	14,751,461	14,751,461
d	Provision for bad debt	11,142,070	11,142,070
e	All other expenses	12,607,679	9,907,754	2,699,925
25	Total functional expenses. Add lines 1 through 24e	255,174,742	222,734,850	32,439,892	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			92,262	1	84,377
2	Savings and temporary cash investments .........			42,956,190	2	40,667,833
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			29,261,132	4	31,561,120
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				653,033	5	731,397
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			3,075,305	8	3,612,673
9	Prepaid expenses and deferred charges ......			10,904,429	9	11,453,491
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	369,895,915
b	Less: accumulated depreciation	10b	224,855,398	147,219,167	10c	145,040,517
11	Investments—publicly traded securities .			133,603,063	11	136,797,516
12	Investments—other securities. See Part IV, line 11 .....			53,841,862	12	49,573,127
13	Investments—program-related. See Part IV, line 11 ..			15,319,714	13	19,258,742
14	Intangible assets ...............			1,203,936	14	1,156,022
15	Other assets. See Part IV, line 11 ...........			6,010,904	15	18,125,037
16	Total assets. Add lines 1 through 15 (must equal line 34)...			444,140,997	16	458,061,852

17	Accounts payable and accrued expenses .....	53,553,742	17	53,623,283
18	Grants payable ...		18
19	Deferred revenue .........	2,894,739	19	4,098,670
20	Tax-exempt bond liabilities .........	107,114,820	20	104,391,195
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	10,752,974	23	10,555,094
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	15,940,851	25	18,455,858
26	Total liabilities. Add lines 17 through 25..	190,257,126	26	191,124,100

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	250,640,058	27	262,706,459
28	Temporarily restricted net assets ...........	1,629,369	28	1,980,760
29	Permanently restricted net assets	1,614,444	29	2,250,533
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	253,883,871	33	266,937,752
34	Total liabilities and net assets/fund balances ........	444,140,997	34	458,061,852

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No