Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 10-01-2022 , and ending 09-30-2023
BCheck if applicable:
CName of organization
Exeter Health Resources Inc
Self-Insurance Trust
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
5 Alumni Drive
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Exeter, NH03833
D Employer identification number

20-0753662
E Telephone number

G Gross receipts $ 2,021,962
F Name and address of principal officer:
Debra Cresta
5 Alumni Drive
Exeter,NH03833
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 2003
M State of legal domicile: NH
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: A self-insurance trust holding funds to cover losses of supported organizations.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 0
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -55,020 -23,354
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) -55,020 -23,354
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
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) 19,992 13,523
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 3,004,679 850,291
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 3,024,671 863,814
19 Revenue less expenses. Subtract line 18 from line 12....... -3,079,691 -887,168
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 3,785,731 2,895,588
21 Total liabilities (Part X, line 26)............. 14,314,316 14,314,316
22 Net assets or fund balances. Subtract line 21 from line 20..... -10,528,585 -11,418,728
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: A self-insurance trust holding funds to cover losses of supported organizations.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 863,814 including grants of $ 0 ) (Revenue $ 0 )
Provision of funding for professional, general, and other liability losses for organizations controlled, directly or indirectly, by Exeter Health Resources, Inc.Based on the actuarial review of Exeter Health Resources, Inc.'s medical professional and general liability exposure, it was determined that additional funding of the self-insured trust was not needed during the fiscal year ending 9/30/2023.(Continued on Schedule O)In addition to Exeter Health Resources, Inc. Self-Insurance Trust's program service accomplishments described above, and as noted further below, the Beth Israel Lahey Health (BILH) network engaged in significant activities focused on expanding access to care and services, including underserved patient populations in order to reduce health inequities. There was also a strong focus on continuing to provide high quality care at a lower cost, when appropriate. BILH continues to focus on the behavioral health care needs of its communities as well. BILH Network Accomplishments and Activities - Fiscal Year Ended September 30, 2023Throughout the period covered by this filing, Beth Israel Lahey Health ("BILH") and its affiliates focused on expanding access and services, including to underserved patient populations in order to reduce health inequities. In addition, there was a strong focus on continuing to provide high quality care at a lower cost, when appropriate, as demonstrated by BILH's efforts to leverage community settings, keep care within the BILH Performance Network ("BILHPN"), and allow patients to receive care in their homes. The following highlights specific efforts during the period covered by this filing:Access & Expansion to Pharmacy Services - BILH Pharmacy has continued to expand its contractual relationships, allowing more patients to utilize its pharmacy for their prescriptions. In FY 2023, BILH Pharmacy successfully negotiated access to the Point32Health specialty pharmacy network as well as the WellSense Medicaid Accountable Care Organization ("ACO") plan. Examples of BILH Pharmacy's other efforts to expand patient access to medications include: - Enhanced medication authorization and access services to help patients obtain necessary insurance authorizations and find co-pay assistance, - Expanded the medication refill center to assist patients and providers in expediting medication renewals and ensuring prescribed medication and dosage are still appropriate, - Extended patient co-pay assistance programs to the Joslin Adult Diabetes clinic and Northeast Hospital Corporation patients, and - Expanded clinical pharmacy services in ambulatory clinics to help manage and optimize patients' complex medication therapies. - BILH Pharmacy also expanded its clinical pharmacy presence in clinics to reduce the health equity gap in the use of highly impactful medications to treat patients with diabetes and atherosclerotic cardiovascular diseases by improving their blood pressure and hemoglobin A1C. Interventions centered around prescribing evidence-based medications, educating patients about their conditions, and ensuring access to medication. Initial results have demonstrated an increase in the use of GLP-1 agonists and SGLT-2 inhibitors by 32% in Black and Hispanic populations, an average reduction in hemoglobin A1c of 0.8, and a decrease of systolic and diastolic blood pressures of 7mmHg and 2mmHg respectively.Improvement in Lab Services - BILH optimized the transportation routes of collected laboratory specimens to testing laboratories, ensuring high standards for turnaround times and maximum efficiency. This is foundational to the system's ability to consolidate testing, expand access to in-network laboratory services which in turn generally reduces cost, and support the provision of high-quality care and the clinician and patient experience. - Focus remained strong in developing physician practice delivery models and re-opening patient service centers. These efforts enhance community providers' ability to use BILH labs and increase patient access to BILH labs.Leveraging In-Network Care - BILH operates a Transfer Center that facilitates patient access to the appropriate placement of patient transfers. With the creation of the Transfer Center, BILH has been able to retain patients who might otherwise have gone outside of the system. By expanding its focus to community hospitals, BILH has enhanced its ability to place patients, including at locations potentially closer to the patients' homes. - BILHPN operates a centralized referral management program that focuses on patients seeking out-of-network specialty care and redirecting them to in-network specialty care, when clinically appropriate. Throughout FY 2023, BILHPN redirected well over one thousand patient visits. In most cases, care retained within BILH resulted in enhanced care coordination at a lower cost of care.Enabling Patients to Receive Care at Home - BILH launched its Hospital at Home program in FY 2023, starting with Lahey Clinic Hospital d/b/a Lahey Hospital & Medical Center. This has allowed eligible patients to be offered care in the setting most comfortable for them - their homes - while also customizing care plans and improving patients' mobility even while they are acutely ill. - In FY 2023, BILHPN put programs in place to manage length of stay at skilled nursing facilities ("SNFs"), reduce readmissions, and discharge medically appropriate patients directly to their homes with homecare services instead of to a SNF, provided patients are medically stable to return home after an acute care stay and will likely have better outcomes and lower cost of care.Behavioral Health - In FY 2023, BILH Behavioral Services launched its Community Behavioral Health Center ("CBHC") in Lawrence, Massachusetts, consolidating outpatient, mobile crisis intervention, and adult community crisis stabilization services. The establishment of the CBHC is a part of the Commonwealth's Executive Office of Health and Human Services Roadmap for Behavioral Health Reform. - In addition, as part of the Roadmap for Behavioral Health Reform, BILH launched an Emergency Services Redesign that shifts emergency evaluations out of the Emergency Department ("ED"). BILH Behavioral Services also expanded its ED integration efforts to a total of six EDs, including Addison Gilbert Hospital, Anna Jaques Hospital, Beverly Hospital, Lahey Medical Center-Peabody, Beth Israel Deaconess Hospital-Milton, and Winchester Hospital.Health Equity - BILH and Lawyers for Civil Rights launched a medical-legal partnership to provide free legal support to low-income patients, beginning at Beth Israel Deaconess Medical Center. The collaboration will expand BILH's ability to address health equity and expand access to health care for patients living in under-resourced communities. - BILHPN focused on reducing health equity disparities in diabetes and hypertension management by stratifying health outcomes by race, ethnicity and language; sharing performance data with primary care groups; and implementing clinical initiatives such as off-hour clinics, home blood pressure monitor distribution, continuous glucose monitoring, and outreach to patients with higher needs.Ongoing Intiatives:Enhanced Access for MassHealth Patients - To mitigate barriers in access to care and increase the number of MassHealth patients that BILH serves, the system committed to universal network-wide provider participation in MassHealth. All BILH hospitals and providers employed by BILH or on whose behalf BILH jointly contracts participate in and/or have applied to participate in some form of MassHealth. In FY 2022, BILH signed a new MassHealth ACO contract with BMC HealthNet Plan / WellSense Health Plan that went into effect in April 2023. As part of this contract, BILHPN extended participation to all eligible primary care providers ("PCPs") who were not otherwise participating in a MassHealth ACO. Prior to that time, while all eligible BILHPN PCPs were participants in a form of MassHealth, some PCPs were not previously participating in a MassHealth ACO. - BILH has developed, refined and implemented a multicultural marketing, advertising, and outreach plan with the purpose of expanding access for underserved populations, including MassHealth patients, in targeted BILH service areas.
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 expensesMediumBullet863,814
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II.........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment
List of Attached Documents:
// Content
.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
List of Attached Documents:
// Content
....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment
List of Attached Documents:
// Content
..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment
List of Attached Documents:
// Content
..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment
List of Attached Documents:
// Content
.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment
List of Attached Documents:
// Content
.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment
List of Attached Documents:
// Content
............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment
List of Attached Documents:
// Content
......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J.......................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
List of Attached Documents:
// Content
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
List of Attached Documents:
// Content
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
26
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
0
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
 
No
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
 
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
 
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
NH
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletAllison J Casassa CFOTreasurer5 Alumni Drive   Exeter,NH03833 (603) 580-6751
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) TD Bank
 
Trustee
 1.00
.................
  		  X         13,523 0 0
































Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 13,523 0 0
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet  
Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet  
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 57,726     57,726
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss)     6c
d Net rental income or (loss).......MediumBullet        
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   1,964,236 7a
b Less: cost or other basis and sales expenses   2,045,316 7b
c Gain or (loss)   -81,080 7c
d Net gain or (loss).........MediumBullet -81,080     -81,080
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See instructions.....MediumBullet -23,354 0 0 -23,354
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....    
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 13,523 13,523    
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........        
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)        
12 Advertising and promotion ....        
13 Office expenses .......        
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..        
23 Insurance ...        
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 Admin Exp/Claims Paid 850,291 850,291    
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 863,814 863,814 0 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1  
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net .............   4  
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............   8  
9 Prepaid expenses and deferred charges ......   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation 10b     10c  
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 3,785,731 12 2,895,588
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 33)... 3,785,731 16 2,895,588
Liabilities 17 Accounts payable and accrued expenses .....   17  
18 Grants payable ...   18  
19 Deferred revenue ......... 8,385,375 19 7,970,319
20 Tax-exempt bond liabilities .........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
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 5,928,941 25 6,343,997
26 Total liabilities. Add lines 17 through 25.. 14,314,316 26 14,314,316
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... -10,528,585 27 -11,418,728
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... -10,528,585 32 -11,418,728
33 Total liabilities and net assets/fund balances ........ 3,785,731 33 2,895,588
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
-23,354
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
863,814
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-887,168
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
-10,528,585
5
Net unrealized gains (losses) on investments ...............
5
-2,975
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
-11,418,728
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
Name of the organization
Exeter Health Resources Inc
Self-Insurance Trust
Employer identification number

20-0753662
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................3
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
(A) Exeter Hospital Inc
  		222674014 3 Yes   0 0
(B) Rockingham VNA & Hospice
  		020274905 10 Yes   0 0
(C) Core Physicians LLC
  		870807914 10 Yes   0 0
Total
3
 0 0
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
33 1/3% support test—2022. 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
b
33 1/3% support test—2021. 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—2022. 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
b
10%-facts-and-circumstances test—2021. 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
18
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) 2022

Schedule A (Form 990) 2022
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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) right arrow (a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) 2022 (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 on 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.)..            
14
First 5 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
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
33 1/3% support tests-2022. 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
b
33 1/3% support tests—2021. 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
20
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) 2022

Schedule A (Form 990) 2022
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
Yes
 
2
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).
2
 
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
No
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
No
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
No
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
No
7
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) .
7
 
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
No
9a
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.
9a
 
No
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
No
c
Did a disqualified person (as defined on 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.
9c
 
No
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
 
No
b
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) 2022

Schedule A (Form 990) 2022
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
No
b
A family member of a person described on 11a above?
11b
 
No
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
No
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
No
2
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.
2
 
No
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 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  
7
Schedule A (Form 990) 2022

Schedule A (Form 990) 2022
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2022 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2022 		(iii)
Distributable
Amount for 2022
1 Distributable amount for 2022 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2022:
a From 2017.......  
b From 2018.......  
c From 2019.......  
d From 2020.......  
e From 2021.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2022 distributable amount  
i Carryover from 2017 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2022 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2022 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2022, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2022. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2023. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2018.....  
b Excess from 2019.....  
c Excess from 2020.....  
d Excess from 2021.....  
e Excess from 2022.....  
Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022
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
Part IV, Section B, Line 1: The Grantor and controlling entity of Exeter Health Resources Self-Insurance Trust, Inc. is Exeter Health Resources, Inc., a 509(a)(3) supporting organization. All three of Exeter Health Resources Self-Insurance Trust, Inc.'s supported organizations are also supported and controlled by Exeter Health Resources, Inc. As the sole member of all four entities, Exeter Health Resources, Inc. has the power to appoint or elect the majority of Trustees for Exeter Health Resources Self-Insurance Trust, Inc. and all of its supported organizations. As Grantor of Exeter Health Resources Self-Insurance Trust, Exeter Health Resources, Inc. has the power to retain and remove the Trust's institutional Trustee. By virtue of this relationship, the Trust is effectively controlled by its supporting organizations.
Schedule A (Form 990) 2022


Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Exeter Health Resources Inc
Self-Insurance Trust
Employer identification number

20-0753662
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
If the organization elected, as permitted under FASB 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.
b
If the organization elected, as permitted under FASB 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 $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....      
b Buildings ....        
c Leasehold improvements        
d Equipment ....        
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 0
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other 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) Other Investments		 2,895,588 C
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 2,895,588
Part VIII
Investments - Program 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.)Small Bullet  
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.)...........Small Bullet  
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  
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 6,343,997
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) 2021

Schedule D (Form 990) 2021
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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
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  
3 Subtract line 2e from line 1.................. 3  
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  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
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  
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  
3 Subtract line 2e from line 1................... 3  
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  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
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 X, Line 2: Resources, the Hospital, RVNA&H, and Core are not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Med Real is a not-for-profit organization as described in Section 501(c)(25) of the Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the tax positions of these entities and has concluded that they 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 the consolidated financial statements.
Schedule D (Form 990) 2021


Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990)

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Exeter Health Resources Inc
Self-Insurance Trust
Employer identification number

20-0753662
Return Reference Explanation
Form 990, Part III, line 3 The Exeter Health Resources, Inc. Self-Insurance Trust (the "Trust") is a not-for-profit trust which holds funds to cover losses of supported organizations. The Trust is controlled through Exeter Health Resources, Inc. (Resources), a not-for-profit corporation which functions as the Parent Company to the Trust. Resources and Beth Israel Lahey Health signed a definitive agreement that established the terms under which Resources joined the Beth Israel Lahey Health system. Together, the organizations seek to enhance and expand local access to high-quality care in New Hampshire. This transaction was finalized and became effective July 1, 2023.
Form 990, Part III, Line 4a (continued): Investments in Underserved Communities - BILH hospitals have created and maintain strong connections to a network of affiliated hospitals and health centers that provide community-based care to historically underserved populations. In the regions that they serve, the Safety Net Affiliates ("SNAs") and Community Care Alliance ("CCA") Community Health Centers ("CHCs") are the cornerstone of BILH's delivery system regarding community-based care for MassHealth and historically underserved patients. - CCA CHCs include Bowdoin Street Health Center, Charles River Community Health, The Dimock Center, Fenway Health, and South Cove Community Health Center. - SNAs include Cambridge Health Alliance and Signature Healthcare Brockton Hospital. - BILH continues to invest in the CCA CHCs and SNAs, enabling them to expand their capabilities and care for more historically underserved patients. In FY 2022, BILH invested over $8 million in its CHCs and SNAs, in addition to engaging in regional planning and collaborative program development. These investments represent only a portion of a much larger community benefits investment portfolio that is described in greater detail in this and other BILH network tax filings. - BILH continues to explore additional opportunities with CHCs in Essex and Middlesex Counties. For example, BILH has established a telehealth pilot program between physicians at Addison Gilbert and Beverly Hospitals and patients at North Shore Community Health Center. BILH Behavioral Health Services The Beth Israel Lahey Health Network (BILH) is committed to the behavioral health needs of the patients and communities serviced. Below are some of activities that BILH Behavioral Services (BILHBS) has provided to the patients and communities served by BILH and its affiliated entities. BILHBS (which includes the activities of BILH's tax-exempt affiliate Northeast Behavioral Health Corp) is the largest network of mental health and substance use disorder services in eastern Massachusetts. BILHBS' network of behavioral health care includes services for children and adults ranging from inpatient treatment to community-based programs. Services include: - Inpatient psychiatric and detoxification treatment; - Emergency psychiatric and mobile emergency services teams; - Outpatient mental health and addiction treatment; - Individual/couple/family therapy; - Medication assisted treatment programs; and - School-based and home-based counseling for youth and their families. BILHBS serves approximately 35,000 unduplicated individuals annually, offering a full continuum of care for children and adults. Services range from inpatient to home and community-based services. BILHBS operates over 250 beds in 9 facilities for clients requiring acute psychiatric care, detoxification and residential step-down services. During the period covered by this filing, community-based services included mobile emergency services teams in three catchment areas and home-based counseling for adults, youth and their families. BILHBS also provided services in 63 middle and high schools, as well as 9 police departments. Since its creation in March 2019, BILH has continued to invest significantly in improving access to behavioral health care through a system-wide approach to care delivery. As one of several ongoing initiatives, BILH has made a multi-year commitment to provide behavioral health support to its employed primary care practices using an evidence-based approach known as the IMPACT model. More than 75% of BILH employed primary care practices participated in this Collaborative Care Program implementation. BILHBS has a Centralized Bed Finding team that is responsible for conducting bed searches for patients seen through the Emergency Services Program and who are awaiting an inpatient psychiatric placement. This team directly increases the availability of clinicians to continue to see patients in the Emergency Department (ED) and the community who are experiencing a behavioral health and/or co-occurring substance use disorder crisis while other team members search for available inpatient placements. This initiative supports decreased response time to responding to new patients in crisis and reduces ED boarding time for patients who can be safely managed in the community. During the period covered by this filing, and in the area of addiction services, BILHBS serves approximately 17,000 individuals annually, providing over 380,000 units of service, in a vast array of settings based on their needs. BILH BS' ambulatory division serves nearly 4,300 patients every year, delivering more than 108,000 units of services in various settings. More than 43,000 were delivered by telehealth Ambulatory programs and services offered under the children's behavioral health initiative (CBHI) including a broad range of counseling and therapy as well as more intensive treatment modalities. All therapy programs are supported by medication clinics if that is determined to be an appropriate adjunct to treatment. In FY23, NBHC delivered 99,419 units of ambulatory services, supported by 8,432 psychopharmacology visits. BILH BS' emergency psychiatric and mobile response teams in Lawrence, Salem and Lowell are available around the clock, providing psychiatric assessments and supportive services in various settings. NBHC provides these services in conjunction with a large number of area hospitals, including facilities outside of the BILH umbrella. Mobile crisis clinicians also respond to schools, homes and outpatient clinics, and NBHC also provides walk-in services at the three team locations. In addition to emergency evaluation, team members provide ongoing crisis counseling until the patient is stable and relationships are established with longer-term care providers. The Lawrence and Salem locations also house 8-bed community crisis stabilization units, which offer short-term (3-5 day) crisis beds in lieu of hospitalization for MassHealth, Medicare, and uninsured clients. During the fiscal period covered by this filing, emergency service programs had 13,502 encounters, 1,895 of which were done remotely, and the CCS programs recorded 2,546 bed days.
Form 990, Part IV, Lines 12a and 12b: In addition, as noted throughout this filing, as of July 1, 2023, Beth Israel Lahey Health became the sole Member of Exeter Health Resources, Inc. (EHRI). The Boston, MA office of KPMG issued an unqualified opinion on the consolidated audited financial statements of the Beth Israel Lahey Health, Inc. And affiliates for fiscal period ended September 30, 2023. These statements were prepared in accordance with generally accepted accounting principles (GAAP) and included the accounts of the Beth Israel Lahey Health, Inc. (BILH), and the entities for which Beth Israel Lahey Health, Inc. (BILH) served as sole member during the fiscal period covered by this filing, (Anna Jaques Hospital (AJH), Beth Israel Deaconess Medical Center, Inc. (BIDMC), Mount Auburn Hospital (MAH), New England Baptist Hospital (NEBH), Beth Israel Deaconess Hospital -- Milton, Inc. (Milton), Beth Israel Deaconess Hospital -- Needham, Inc. (Needham), Beth Israel Deaconess Hospital -- Plymouth, Inc. (Plymouth), Lahey Health Shared Services (LHSS), Lahey Clinic Foundation (LCF), Winchester Hospital (Winchester), Northeast Hospital Corporation (NHC) which includes Beverly, Addison Gilbert and Bayridge Hospitals, Northeast Behavioral Corporation (NBHC), the Beth Israel Lahey Health Performance Network (BILHPN), the Joslin Diabetes Center and the Beth Israel Lahey Health Pharmacy. The Lahey Clinic Foundation in turn served as the sole Member of Lahey Clinic Inc, and Lahey Clinic Hospital d/b/a Lahey Hospital and Medical Center (LHMC).) Each of these affiliates may in turn serve as member of additional entities within the network of affiliates, and whose accounts are included in the BILH audited financial statements. In addition, the BILH financial statements also include the accounts of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc. (HMFP), the dedicated physician practice of Beth Israel Deaconess Medical Center and an entity integrally related to helping BIDMC and other affiliates in the BILH network accomplish their charitable purposes. The accounts of the entities for which HMFP serves as Member are also included in the HMFP and BILH audited financial statements. As of July 1, 2023, Beth Israel Lahey Health became the sole Member of Exeter Health Resources, Inc. (EHRI) which in turns serves as the sole Member of Exeter Hospital and other affiliates of EHRI. The BILH audited financial statements also include the accounts of these entities for the last three months of the fiscal period covered by this filing. The Audit and Compliance Committee of BILH's Board of Trustees assumes responsibility for oversight of the consolidated audit for the network as a whole.
Form 990, Part VI, Section A, line 7a Exeter Health Resources, Inc. is the grantor of the trust. The grantor, by resolution of its board of directors may remove the trustee at any time and appoint a successor.
Form 990, Part VI, Section A, line 7b As grantor, Exeter Health Resources, Inc. sets the funding policy and methods of the trust. The trustee invests in such property and for such duration as the trustee determines to be consistent with the policies set forth by the grantor.
Form 990, Part VI, Section B, line 11b As noted in various disclosures throughout this filing, Exeter Health Resources, Inc. (EHRI) is the grantor of the Exeter Health Resources, Inc. Self-Insurance Trust (the "Trust"). In addition, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) is the sole Member of EHRI. This Form 990 is prepared by the EHRI finance team in conjunction with the BILH tax department and Baker Newman Noyes (BNN). As part of this process, the EHRI finance and BILH tax teams work with other disciplines and functions within BILH and EHRI to ensure that all financial and non-financial disclosures are complete and accurate. Examples of such departments include but are not limited to: Finance and Accounting, Human Resources and Payroll, Treasury, Compliance, Legal, Community Benefits, Financial Assistance and Reimbursement, Governance, Development, Graduate Medical Education, Government Relations, Research and/or Research Finance. The Trust's Form 990 is reviewed internally by the EHRI Vice President of Accounting, the EHRI Chief Financial Officer, the BILH Assistant Vice President, Taxation and externally by BNN. The Trust's Form 990, along with the Forms 990 of all entities in the BILH network, are discussed with the BILH Audit and Compliance Committee. BNN signs the final returns. A copy of the complete return is then provided to management of BILH and EHRI, the Trust's grantor, prior to submission to the Internal Revenue Service.
Form 990, Part VI, Section C, line 19 As noted throughout this filing, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) became the sole Member of Exeter Health Resources, Inc (EHRI) and the indirect Member of Exeter Health Resources, Inc. Self-Insurance Trust (the "Trust"). The Trust's governing documents, Conflict of Interest Policy and Financial Statements are available to the general public upon request at the following location: Exeter Health Resources and Affiliates 5 Alumni Drive Exeter, NH 03833 And Beth Israel Lahey Health Tax Department Schrafft's City Center, 4th Floor, 529 Main Street Charlestown, MA 02129
Form 990, Part VI, Section B, Lines 13 and 14: As noted throughout this filing, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) became the sole Member of Exeter Health Resources, Inc (EHRI) and the indirect Member of Exeter Health Resources, Inc. Self-Insurance Trust (the "Trust"). Although the Trust has not formally adopted a written whistleblower policy or document retention and destruction policy, because of the close connection and affiliation between the Trust and BILH, the Trust follows the formal written policy which was adopted by the BILH Board.
Form 990, Part XII, Line 2c: The Organization is part of the consolidated operations of Exeter Health Resources, Inc. The Exeter Health Resources, Inc. ("Resources") Executive Committee is responsible for the oversight of the audit and the selection of an independent accountant. Furthermore, pursuant to an affiliation agreement between Resources and Beth Israel Lahey Health, key members of the various Beth Israel executive teams and audit and finance committees may also provide review and oversight over the Resources audit procedures. During the year ending September 30, 2023, Resources and Beth Israel Lahey Health have signed a definitive agreement that establishes the terms under which Resources joins the Beth Israel Lahey Health system. For financial reporting of the Organization, the affiliation was accounted for as an acquisition and "push down" accounting was required to be applied, with the result that acquisition accounting adjustments have been reflected in the Organization's financial statements. The application of "push down" accounting resulted in a new basis of accounting for property, plant and equipment based on the assets' fair value at the date of affiliation. Accordingly, the Organization's audited financial statements refer to the Trust in the period prior to the affiliation as "Predecessor and in the period subsequent to the affiliation as "Successor." The 2023 Predecessor period represents the nine-month period ending June 30, 2023 prior to push-down accounting adjustments, and the 2023 Successor period represents the three-month period ending September 30, 2023 subsequent to push-down accounting adjustments. As of July 1, 2023, Beth Israel Lahey Health (BILH) became the sole Member of Exeter Health Resources, Inc. (EHRI) which in turns serves as the grantor of the Exeter Health Resources Self-Insurance Trust and other affiliates of EHRI. The BILH audited financial statements also include the accounts of these entities for the last three months of the fiscal period covered by this filing. The Boston office of KPMG performs an annual audit and signs a consolidated financial statement audit of Beth Israel Lahey Health (BILH) and its affiliates. The Audit and Compliance Committee of BILH's Board of Trustees assumes responsibility for oversight of the consolidated audit for the network as a whole.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Exeter Health Resources Inc
Self-Insurance Trust
Employer identification number

20-0753662
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










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?
Yes No
(1)Addison Gilbert Society Inc
529 Main St 4th Fl

Charlestown,MA02129
46-4371382 		Professional services & financial support MA 501(c)(3) Line 10 Lahey Health Shared Services Inc
 
Yes
 
(2)Anna Jaques Hospital
25 Highland Ave

Newburyport,MA01950
04-2104338 		Healthcare MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(3)Assoc Phys Harvard Med Fac Phy at BIDMC
375 Longwood Ave

Boston,MA02215
32-0058309 		To provide emergency medical services MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(4)Baim Institute for Clinical Research Inc dba BAIM Institute
930 Commonwealth Ave

Boston,MA02215
04-3521077 		Scientific & Medical Research MA 501(c)(3) Line 7 N/A
 
No
(5)Beth Israel Anaesthesia Foundation Inc
330 Brookline Ave

Boston,MA02215
04-2997215 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(6)Beth Israel Community Foundation Inc
330 Brookline Ave

Boston,MA02215
04-2776678 		Inactive Corporation MA 501(c)(3) Line 7 N/A
 
No
(7)Beth Israel Deaconess Department of Emergency Medicine Foundation Inc
330 Brookline Ave

Boston,MA02215
36-4803234 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(8)Beth Israel Deaconess Department of Medicine Foundation Inc
330 Brookline Ave

Boston,MA02215
04-3079630 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(9)Beth Israel Deaconess Department of Neonatology Foundation Inc
330 Brookline Ave

Boston,MA02215
20-8253452 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(10)Beth Israel Deaconess Department of Neurology Foundation Inc
330 Brookline Ave

Boston,MA02215
04-3030397 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(11)Beth Israel Deaconess Department of Orthopaedic Surgery Foundation Inc
330 Brookline Ave

Boston,MA02215
20-4974585 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(12)Beth Israel Deaconess Department of Radiation Oncology Foundation Inc
330 Brookline Ave

Boston,MA02215
87-3655583 		Support patient care, research and teaching missions of BIDMC, HMFP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(13)Beth Israel Deaconess Department of Surgery Foundation Inc
110 Francis St

Boston,MA02215
02-0671240 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(14)Beth Israel Deaconess Hospital Milton Inc
199 Reedsdale Rd

Milton,MA02186
04-2103604 		Hospital for the treatment, care and relief of sick and suffering persons MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(15)Beth Israel Deaconess Hospital Needham Inc
148 Chestnut St

Needham,MA02492
04-3229679 		Hospital for the treatment, care and relief of sick and suffering persons MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(16)Beth Israel Deaconess Hospital Plymouth Inc
275 Sandwich St

Plymouth,MA02360
22-2667354 		Hospital for the treatment, care and relief of sick and suffering persons MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(17)Beth Israel Deaconess Medical Center Inc
330 Brookline Ave

Boston,MA02215
04-2103881 		The operation of a world class academic medical center in Boston, MA MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(18)Beth Israel Dermatology Foundation Inc
330 Brookline Ave

Boston,MA02215
04-3117601 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(19)Beth Israel Lahey Health Pharmacy Inc
80 Wilson Way

Westwood,MA02090
82-2526816 		To operate a specialty pharmacy and 340B program for BIDMC MA 501(c)(3) Line 10 Beth Israel Deaconess Medical Center
 
Yes
 
(20)Beth Israel Lahey Health Primary Care
529 Main St 4th Fl

Charlestown,MA02129
47-2248298 		Healthcare MA 501(c)(3) Line 10 Lahey Health Shared Services Inc
 
Yes
 
(21)Beth Israel Lahey Health Inc
529 Main St 4th Fl

Charlestown,MA02129
83-2671600 		Management professional & IT support services MA 501(c)(3) Line 12c, III-FI N/A
 
No
(22)BID-Milton Physician Associates Inc
199 Reedsdale Road

Milton,MA02186
22-2566792 		Promote Healthcare MA 501(c)(3) Line 10 Beth Israel Deaconess Hospital - Milton
 
Yes
 
(23)BIDMC and Children's Hospital Medical Care Corp
300 Longwood Ave

Boston,MA02215
04-3200113 		Outpatient ambulatory center - Inactive MA 501(c)(3) Line 12a, I N/A
 
No
(24)BIDMC Obstetrics and Gynecology Foundation Inc
330 Brookline Ave

Boston,MA02215
04-2794855 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(25)BIH Pathology Foundation Inc
330 Brookline Ave

Boston,MA02215
22-2548374 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(26)BIH Radiologic Foundation Inc
330 Brookline Ave

Boston,MA02215
04-2571853 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(27)CAB Health and Recovery Services Inc
199 Rosewood Drive

Danvers,MA01923
04-2400270 		Substance Abuse - Inactive MA 501(c)(3) Line 10 Northeast Behavioral Health Corporation
 
Yes
 
(28)Community Physicians Associates Inc
199 Reedsdale Rd

Milton,MA02186
04-3243146 		Outpatient and Primary Care Services MA 501(c)(3) Line 3 Beth Israel Deaconess Hospital - Milton
 
Yes
 
(29)Continuing Edu Program dba BID Dept of Psych FDN
375 Longwood Ave

Boston,MA02215
04-3242952 		Support patient care, research and teaching missions of BIDMC, HFMP and HMS MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(30)Core Physicians LLC
5 Alumni Drive

Exeter,NH03833
87-0807914 		Physician Practices NH 501(c)(3) Line 10 Exeter Health Resources Inc
 
Yes
 
(31)CPHCH Inc dba BILH at Home - Watertown
C/O NRPN 600 Cummings Ctr

Beverly,MA01915
47-3111453 		Home Care & Hospice - Inactive MA 501(c)(3) Line 12a, I Northeast Senior Health Corporation
 
Yes
 
(32)Exeter Health Resources Inc
5 Alumni Drive

Exeter,NH03833
02-0222126 		Support Community Health & Network Mgmt Svcs NH 501(c)(3) Line 12a, I Beth Israel Lahey Health Inc
 
Yes
 
(33)Exeter Hospital
5 Alumni Drive

Exeter,NH03833
22-2674014 		Hospital for the treatment, care and relief of sick and suffering persons. NH 501(c)(3) Line 3 Exeter Health Resources Inc
 
Yes
 
(34)Exeter Med Real Inc
5 Alumni Drive

Exeter,NH03833
02-0418718 		Real Estate Holding Company NH 501(c)(25)   Exeter Health Resources Inc
 
Yes
 
(35)Harvard Medical Faculty Physicians at BIDMC Inc
375 Longwood Ave

Boston,MA02215
22-2768204 		General and specialized medical services to the patients of BIDMC and others MA 501(c)(3) Line 10 Beth Israel Deaconess Medical Center
 
Yes
 
(36)Health and Education Housing Services Inc
199 Rosewood Drive

Danvers,MA01923
22-3232914 		HUD Housing - Inactive MA 501(c)(3) Line 10 Northeast Behavioral Health Corporation
 
Yes
 
(37)Jordan Physician Associates Inc
275 Sandwich St

Plymouth,MA02360
04-3228556 		Outpatient and Primary Care Services MA 501(c)(3) Line 10 Beth Israel Deaconess Hospital - Plymouth Inc
 
Yes
 
(38)Joslin Clinic Inc
One Joslin Place

Boston,MA02215
22-2984590 		Prevention, treatment, and cure of diabetes MA 501(c)(3) Line 12a, I Joslin Diabetes Center Inc
 
Yes
 
(39)Joslin Diabetes Center Inc
One Joslin Place

Boston,MA02215
04-2203836 		Prevention, treatment, and cure of diabetes MA 501(c)(3) Line 7 Beth Israel Lahey Health Inc
 
Yes
 
(40)Lahey Clinic Canadian Foundation
130 King St West
Toronto,Ontario  
CA
Fundraising org CA     N/A
 
No
(41)Lahey Clinic Foundation Inc
529 Main St 4th Fl

Charlestown,MA02129
04-2323457 		Financial & operational support to LCI and LCH MA 501(c)(3) Line 7 Beth Israel Lahey Health Inc
 
Yes
 
(42)Lahey Clinic Hospital Inc dba Lahey Hospital & Medical Center and LMC
529 Main St 4th Fl

Charlestown,MA02129
04-2704686 		Healthcare MA 501(c)(3) Line 3 Lahey Clinic Foundation Inc
 
Yes
 
(43)Lahey Clinic Inc
529 Main St 4th Fl

Charlestown,MA02129
04-2704683 		Healthcare MA 501(c)(3) Line 10 Lahey Clinic Foundation Inc
 
Yes
 
(44)Lahey Health Shared Services Inc
529 Main St 4th Fl

Charlestown,MA02129
04-3178972 		Admin MA 501(c)(3) Line 10 Beth Israel Lahey Health Inc
 
Yes
 
(45)Longwood Medical Energy Collaborative Inc
375 Longwood Ave

Boston,MA02215
04-3476764 		Coordinate and provide strategic planning opp for HMS MA 501(c)(3) Line 12a, I N/A
 
No
(46)Longwood Medical International Foundation Inc
375 Longwood Ave

Boston,MA02215
04-3208878 		Inactive Corporation MA 501(c)(3) Line 12a, I Harvard Medical Physicians Beth Israel Medical Center
 
Yes
 
(47)Med Care of Boston Mgmt Corp dba BILH Primary Care
464 Hillside Ave

Needham,MA02494
04-2810972 		Outpatient, Primary Care and Specialty Services MA 501(c)(3) Line 10 Beth Israel Lahey Health Primary Care
 
Yes
 
(48)Mount Auburn Hospital
330 Mount Auburn St

Cambridge,MA02138
04-2103606 		Hospital for the treatment, care and relief of sick and suffering persons MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(49)Mount Auburn Professional Services Inc
330 Mount Auburn St

Cambridge,MA02138
04-3026897 		Offering medical care in general and specialized practices MA 501(c)(3) Line 12a, I Mount Auburn Hospital
 
Yes
 
(50)New England Baptist Hospital
125 Parker Hill Ave

Boston,MA02120
04-2103612 		Orthopedic specialty hospital MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(51)New England Baptist Medical Associates Inc
125 Parker Hill Ave

Boston,MA02120
04-3235796 		Outpatient medical services to the various communities serviced by NEBH MA 501(c)(3) Line 3 New England Baptist Hospital
 
Yes
 
(52)Northeast Behavioral Health Corporation dba BILH Behavioral Health Service
199 Rosewood Drive

Danvers,MA01923
04-2777145 		Healthcare MA 501(c)(3) Line 10 Beth Israel Lahey Health Inc
 
Yes
 
(53)Northeast Health Systems Inc
85 Herrick St

Beverly,MA01915
04-3240453 		Financial & operational support MA 501(c)(3) Line 12b, II Lahey Health Shared Services Inc
 
Yes
 
(54)Northeast Hospital Corporation
85 Herrick St

Beverly,MA01915
04-2121317 		Healthcare MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(55)Northeast Medical Practice Inc
85 Herrick St

Beverly,MA01915
04-3201853 		Healthcare MA 501(c)(3) Line 10 Northeast Hospital Corporation
 
Yes
 
(56)Northeast Professional Registry of Nurses Inc dba BILH at Home
800 Cummings Center

Beverly,MA01915
20-1287349 		Healthcare MA 501(c)(3) Line 10 Northeast Senior Health Corporation
 
Yes
 
(57)Northeast Senior Health Corporation
85 Herrick St

Beverly,MA01915
04-2731137 		Healthcare MA 501(c)(3) Line 10 Lahey Health Shared Services Inc
 
Yes
 
(58)Rockingham Visiting Nurse Association and Hospice
5 Alumni Drive

Exeter,NH03833
02-0274905 		Home Care & Hospice NH 501(c)(3) Line 10 Exeter Health Resources Inc
 
Yes
 
(59)Seacoast Affiliated Group Practice Inc
25 Highland Ave

Newburyport,MA01915
04-3485648 		Physician Group MA 501(c)(3) Line 10 Anna Jaques Hospital Inc
 
Yes
 
(60)Seacoast Nursing and Rehabilitation Center Inc
300 Washington St

Gloucester,MA01930
04-1305001 		Healthcare MA 501(c)(3) Line 10 Lahey Health Shared Services Inc
 
Yes
 
(61)The Jordan Health Systems Inc
275 Sandwich St

Plymouth,MA02360
04-2103805 		Promote Healthcare MA 501(c)(3) Line 7 Beth Israel Deaconess Medical Center
 
Yes
 
(62)Winchester Community Accountable Care Organization Inc
41 Highland Ave

Winchester,MA01890
22-3137856 		ACO - Inactive MA 501(c)(3) Line 12a, I Winchester Healthcare Management Inc
 
Yes
 
(63)Winchester Healthcare Management Inc
41 Highland Ave

Winchester,MA01890
22-2701817 		Management MA 501(c)(3) Line 12a, I Lahey Health Shared Services Inc
 
Yes
 
(64)Winchester Hospital
41 Highland Ave

Winchester,MA01890
04-2104434 		Healthcare MA 501(c)(3) Line 3 Beth Israel Lahey Health Inc
 
Yes
 
(65)Winchester Hospital Foundation Inc
41 Highland Ave

Winchester,MA01890
04-3399570 		Professional services & financial support MA 501(c)(3) Line 12a, I Winchester Healthcare Management Inc
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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?



 		(k)
Percentage
ownership
Yes No Yes No












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
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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) Exeter Hospital Inc

 Q 118,904 Actual per books
(2) Exeter Med Real Inc

 Q 3,000 Actual per books
(3) Core Physicians LLC

 Q 1,128,632 Actual per books
(4) Rockingham Visiting Nurse Association and Hospice

 Q 14,812 Actual per books
(5) Exeter Health Resources Inc

 Q 2,500 Actual per books

Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

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