Exeter Health Resources 2021 Annual Report

ANNUAL REPORT 2021

Exceptional Care During Extraordinary Times

The Operating Affiliates of Exeter Health Resources

Table of Contents

2 Operating Affi l iates 3 Letter from the President/CEO 4 Cl inical Affi l iations 5-7 Awards & Excel lence 8-12 Healthcare Heroes 13-18 Nursing Annual Report 19-22 Community Benefits 23-28 Financials 29-36 Our Community Gives Back 37-60 Donors 61 Trustees/Officers

Core Physicians is a community- based, multi-specialty group practice that provides comprehensive primary, specialty and pediatric dental care throughout the greater Seacoast region. Over 160 providers in 15 locations pursue excellent patient satisfaction and quality outcomes through the provision of exceptional clinical care.

Rockingham Visiting Nurse Association & Hospice is a community-based, home health and hospice agency providing individuals and families with the highest quality home care, hospice and community outreach programs within Rockingham and Strafford Counties.

Exeter Hospital is a 100-bed, community-based hospital serving New Hampshire’s Seacoast region. The hospital’s scope of care includes comprehensive medical and surgical healthcare services including, but not limited to: breast health, maternal/ child and reproductive medicine, cardiovascular, gastroenterology, sleep medicine, occupational and employee health, oncology, orthopedics, general surgery and emergency care services. Exeter Hospital is accredited by DNV Healthcare, Inc., and is a Magnet ® -recognized hospital. Magnet designation from the American Nurses Credentialing Center is the most prestigious distinction a healthcare organization can receive for nursing excellence and high quality patient care.

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ANNUAL REPORT 2021

Letter from the President/CEO

“Never… was so much owed by so many to so few.” – Winston Churchill, August 1940

The damaging and disruptive path of COVID-19 continued throughout 2021 affecting virtually every segment of society and placing a special burden on healthcare systems and those who work within them. However, the courage, compassion and tireless efforts of the nearly three thousand clinicians and staff employed by Exeter Health Resources and its affiliates – Exeter Hospital, Core Physicians and Rockingham VNA & Hospice ensured that those in need of care received it. There was little, if any, reprieve for the staff who continued to show up day after day, month after month, enduring a second year of pandemic related stress as our healthcare system continued to adapt and respond to COVID. If it were not for our staff, the greater Seacoast community’s perseverance through another year of COVID would have been more difficult than it was. I cannot express deep enough gratitude to our staff for caring for all of us. Throughout 2021, we balanced the needs of providing extraordinary care demanded by the public health crisis of COVID with the demands of our mission to care for an entire community that had ongoing and important health needs outside of COVID. The story of that balancing act is presented in the following pages; it is a story that underlies the commitment we have as a healthcare system – to always be there for you.

Sincerely,

Kevin J. Callahan, President, CEO

3

Clinical Affiliations

Exeter Hospital and Core Physicians have formed clinical relationships with several leading medical organizations that enable us to provide advanced care close to home.

Dartmouth-Hitchcock Medical Center partners with Core Vascular Surgery to provide expanded vascular services to patients in our Exeter office.

Leading Massachusetts General Hospital Cancer Center radiation and medical oncologists and nurse practitioners provide care to patients at Exeter Hospital’s Falzone Center for Cancer Care , along with multidisciplinary clinics, genetic counseling, clinical trials and nurse navigators. Mass General also provides telemedicine stroke services to Exeter Hospital physicians to assist with the care of stroke patients at Exeter Hospital.

Exeter Hospital has two affiliations with Brigham and Women’s Hospital. The Center for Reproductive Care provides comprehensive infertility care, reproductive endocrinology care and advanced reproductive surgery. Maternal Fetal Medicine provides expert care for women who have complications identified prior to or during pregnancy.

Exeter Hospital’s clinical collaboration with MassGeneral for Children brings pediatric hospitalists from MassGeneral for Children onsite 24/7 at Exeter Hospital to assess and treat pediatric patients in the Emergency Department, Family Center and inpatient pediatric unit.

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Excellence. Every Patient. Every Time.

ASGE Recognition – The American Society for Gastrointestinal Endoscopy (ASGE) has recognized Exeter Hospital for its dedication to promoting quality and safety in endoscopy care. This recognition is conferred on only 10% of hospitals in the country.

Magnet ® – Exeter Hospital has held Magnet recognition since 2013, conferred by the American Nurses Credentialing Center’s Magnet Recognition Program. This credential is the highest national honor for professional nursing practice and places Exeter Hospital in the top 8% of hospitals nationwide.

American Heart Association’s Silver Plus Get With The Guidelines ® -Stroke Quality Achievement Award – Exeter Hospital has received the American Heart Association’s Silver Plus Get With The Guidelines-Stroke Quality Achievement Award for their commitment to ensuring stroke patients receive the most appropriate, up-to-date treatment according to nationally recognized, research-based guidelines. Additionally, Exeter Hospital received the Association’s Target: Type 2 Diabetes Honor Roll award.

NCQA – Core Physicians and all of their local practices have received the NCQA Patient-Centered Medical Home (PCMH) recognition for using evidence-based, patient-centered processes that focus on highly coordinated care and long-term, participative relationships.

Beacon Award for Excellence TM Exeter Hospital’s Progressive Care Unit (PCU), Family Center and Intensive Care Unit (ICU) have all been recognized with this prestigious award from the American Association of Critical-Care Nurses (AACN), which recognizes caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards.

Top Docs – Twenty-one physicians from Core Physicians’ primary and specialty care practices were recognized among the best physicians in the state in New Hampshire Magazine’s 2021 Top Doctors issue.

5

Excellence. Every Patient. Every Time.

Cardiac Cath Lab Excellence The American College of Cardiology

(ACC) has recognized Exeter Hospital for its demonstrated

expertise and commitment to treating patients who come to a cardiac cath lab for care, including diagnostic catheterizations and percutaneous coronary intervention (PCI) procedures. Exeter Hospital was awarded Cardiac Cath Lab Accreditation with PCI based on rigorous onsite evaluation of the staff’s ability to evaluate, diagnose and treat cath lab patients.

Acute Stroke Ready Exeter Hospital has achieved Acute Stroke Ready (ASR) certification through DNV GL ® Healthcare. To receive this certification, the hospital demonstrated compliance with quality standards of care for the evaluation and initial treatment of stroke patients when rapid action and proper medications can save lives and limit long-term disabling effects. An ASR hospital has the infrastructure and capability to care for acute stroke, including administration of intravenous thrombolytic therapy (also known as tissue plasminogen activator “tPA” or alteplase). Exeter Hospital has been providing telestroke care in partnership with Massachusetts General Hospital since 2007.

Family Center Receives Lactation Award Exeter Hospital’s Family Center

has received the 2021 International Board Certified Lactation Consultant ® (IBCLC) Care Award , which recognizes hospitals/birthing facilities that hire currently certified IBCLC and have a dedicated lactation support program that promotes and supports breastfeeding. Exeter Hospital provides inpatient and outpatient lactation services free of charge, and the lactation program works closely with the Family Center’s home visiting program to support new mothers.

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Citizen of the Year Kristen Johnson, MD of Core

Pediatric & Adolescent Medicine was recognized by the Exeter Area Chamber of Commerce as Citizen of

the Year. In addition to her work as a pediatrician, Dr. Johnson served as the consulting physician to SAU 16 during the initial height of the COVID-19 pandemic. Dr. Johnson also advocated on a state level to pass legislation requiring insurance companies to cover telemedicine, improving patient access to healthcare.

Inpatient Operating Room Receives Award Exeter Hospital’s inpatient Operating Room received the Gold Level Go Clear Award ™ from the Association of periOperative Registered Nurses (AORN). The award recognizes facilities that maintain a “smoke-free” surgical environment. Surgical smoke is a by-product of the use of energy-generating devices such as ultrasound machines and powered surgical instruments.

Even before the pandemic, Dr. Johnson was an active voice for children – she is pictured here with other New Hampshire pediatricians in Washington, D.C., advocating for children.

7

I GOT THE SHOT !

8 ANNUAL REPORT 2021

ANNUAL REPORT 2021

Healthcare Heroes

Healthcare Heroes – Innovative Care in Unprecendented Times

As the COVID-19 pandemic continued throughout the 2021 fiscal year, the providers and staff at Exeter Hospital, Core Physicians and Rockingham VNA & Hospice continued tirelessly to provide care to the community, pivoting to use innovative means when necessary.

Core Physicians offered several COVID-19 and flu vaccination clinics for patients. Core Pediatric & Adolescent Medicine hosted a COVID vaccination clinic for kids when the vaccine became available for those under 17 and vaccinated 900 children in one weekend. COVID testing continued to be offered as a drive through service at the Exeter Hospital parking garage for Core Physicians’ patients for much of the year when demand was high.

At the hospital, flexibility was an important factor in meeting the needs of patients. When COVID-19 inpatient numbers were high, patient care areas were flexed as needed – for example, space was made in the surgical recovery area for COVID patients, and some surgical patients were moved to the Family Center for recovery. Through even the most taxing times, our providers continued to receive compliments from patients about their kindness and attentive care.

The COVID-19 vaccine was made available to all staff in a special clinic set up in the hospital conference rooms by Staff Health. They worked closely with facilities, the lab and other departments to ensure a smooth and effective process.

10 ANNUAL REPORT 2021

Innovation also extended to new technology. A. Neil Clerk, MD of Core Orthopedics became the first surgeon in New Hampshire to use InSpace TM technology to treat severe rotator cuff injuries in the shoulder. The Falzone Center for Cancer Care introduced cooling caps, which help reduce hair loss for patients undergoing chemotherapy by cooling the scalp, thereby reducing the amount of chemotherapy reaching hair follicles.

At the close of the fiscal year, Core Physicians was able to introduce the use of monoclonal antibodies to eligible patients with COVID-19, thanks to a team effort that included Exeter Hospital pharmacy staff, Core Physicians’ clinical education, infectious disease, and primary care teams, the leadership of Core Pediatric & Adolescent Medicine, and the staff at Epping Regional Health Center.

Providers and staff from all three affiliates supported the state’s vaccination clinics at fixed sites such as the football field at Exeter High School, as well as the super clinics that were held at the New Hampshire Motor Speedway in Loudon, sometimes even in frigid temperatures and during their free time on weekends.

Rockingham VNA & Hospice held a Virtual Remembrance service in September for the hospice bereaved. Before COVID, the service was held annually for friends and families to celebrate the lives of loved ones who had passed in the care of Rockingham VNA & Hospice during the past year. This virtual ceremony honored two years of patients as last year’s ceremony was canceled due to the pandemic.

11

Healthcare Heroes – Innovative Care in Unprecendented Times

As a way to thank our healthcare heroes and lift their spirits – as well as those of patients – we introduced Pet Partners ® , certified therapy dogs that came to visit the hospital and some Core Physicians’ practices, bringing smiles to all while patiently accepting endless pats and hugs.

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ANNUAL REPORT 2021

Nursing Annual Report

Nursing Annual Report

Nursing, in collaboration with Exeter Health Resources’ leadership, began preparing for the COVID-19

and Rockingham VNA & Hospice to create a new pool of nurses to staff the additional surge areas. Education was developed and provided to these non-hospital staff re-deployed to Exeter Hospital surge areas in order to continue to deliver safe care to our community. COVID created challenges for everyone. Many can relate to sacrifice, loss and uncertainty. Despite this, nurses at Exeter Hospital, Core Physicians and Rockingham VNA & Hospice showed up and stepped up. These nurses have worked so hard, changed their schedules, changed work locations, worked countless hours of overtime, learned new skills, created new teams, and disrupted their lives to provide safe care to our community. Nurses have worked under the most stressful situations in and out of the hospital, yet they continue to do more, work more and care more.

surge in March of 2020. Core Physicians’ offices condensed

locations, ambulatory services were closed to all but emergencies, many services were put on hold, and staff were re-trained and re-deployed to other care areas. We were prepared, ready and waiting for what we were witnessing in other parts of the country and the world. While the surge hit close to home, New Hampshire did not experience the volume or severity expected. Gradually business returned, as close as possible, to “as usual” while still maintaining a focus on patient safety, and continuing to work around COVID. Beginning in the fall of 2021, New Hampshire experienced the surge they were expecting in 2020. Nursing teams across the hospital reviewed and updated plans previously developed to support

caring for additional patients above our normal capacity. With the added challenge of having staff out sick, and the overwhelming number of patients, there was a significant challenge to keep all areas staffed. In an effort not to disrupt patient appointments and procedures in outpatient services by pulling those nurses, hospital nurses and leadership worked collaboratively with Core Physicians’ medical offices

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Excellence in Practice

Susan Burns-Tisdale Patient Care Excellence Award Susan Burns-Tisdale served as Exeter Health Resources’ Chief Nurse Executive for 12 years prior to passing away from cancer in 2020. A hallmark of Susan’s career was her unwavering focus on patients and her extraordinary commitment to inter-professional team collaboration to better serve patient needs. Her executive leadership practice was founded on innovation and the principles of creating and sustaining High Reliability Organizations and LEAN thinking. Susan was known for her compassionate inclusion of multiple and diverse people and perspectives to improve team and organizational performance. This award is dedicated to her memory, and recipients exemplify Susan’s vision for ideal patient care. Three awards are given each quarter. Here are the inaugural recipients, announced in the last quarter of fiscal year 2021, with excerpts from their nominations.

Audrey Donovan, RN Clinical Leader, 4West

Audrey is so deserving of this award. She looks to better every individual she comes into contact with. She always supports those who look to further their education or career here at Exeter Hospital, which speaks volumes to how much she values her teammates and this organization.

Heather Hynick, RN Intensive Care

Heather rarely receives “kudos”, simply because she is always extraordinary. It can be difficult to determine when she goes above and beyond, because going above and beyond is her norm.

Lucille Marvin, RN Program Manager of the Hospital’s HealthReach Diabetes Center Cille is recognized by providers, nurses and registered dietitians as a highly respected clinical diabetes care and education specialist. If any member of my family had diabetes, I would want Cille to be there to care for them.

To learn about the campaign that supports the Susan Burns-Tisdale Patient Care Excellence Award, see page 33.

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Nursing Excellence

Exeter Hospital was initially awarded Magnet ® designation in 2013, and will be submitting documentation on April 1, 2022 for their third Magnet designation. Magnet is a four year designation awarded by the American Nurses Credentialing Center (ANCC) and is the gold standard for nursing excellence. Magnet is a factor when consumers assess health care organizations. In fact, in its annual showcase of “America’s Best Hospitals”, U.S. News & World Report includes Magnet recognition in its ranking criteria for quality inpatient care. The Magnet model provides a framework for nursing practice, research and measurement of outcomes. Through this framework, the ANCC evaluates hospitals to

Photo taken before COVID-19.

determine if they meet specific criteria for nursing excellence. The assessment is based on a number of elements deemed essential to delivering superior patient care, including quality of nursing leadership, coordination and collaboration across specialties, and processes for measuring and improving the quality and delivery of care.

Nursing leadership at Exeter Hospital is committed to maintaining a structure and processes that support clinical nurses’ active participation in organizational decision-making through Shared Governance, flexible scheduling, and ensuring cross-sectional membership on committees and councils. Clinical nurses and nurse leaders are influential members of committees, task forces and process improvement teams that address clinical practice, the work environment and patient care. Healthcare is a complex, high-hazard industry. Exeter Hospital is committed to providing the highest quality, safest care to our patients. Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system. Vascular Access Nurses, as members of the multidisciplinary High Reliability Work Group, have contributed their expertise of evidence-based practice to standardize process resulting in ZERO central line infections since 2018.

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Innovation The Family Center at Exeter Hospital is thrilled to be participating in a New Hampshire statewide initiative to address maternal mortality, morbidity and health disparities in our community. This effort is being led by New Hampshire Alliance for Innovation on Maternal Health (AIM & ERASE) along with the Council on Patient Safety in Women’s Health, and Northern New England Perinatal Quality Improvement Network (NNEPQIN). Data shows the leading cause of maternal mortality in New Hampshire is currently accidental overdose. The Family Center is working with labor and delivery units across the state as well as community stakeholders to implement patient safety bundles to improve obstetric care for women with Substance Use Disorder (SUD). This care bundle provides the resources and direction needed to implement screening tools, education for patients and staff, training on trauma informed care, and clinical pathways for women with SUD that incorporate care coordination among multiple providers. This group meets monthly and the work will continue through 2022.

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Excellence in Practice

Professional Development Three years ago, the Institute of Medicine released its landmark report The Future of Nursing: Leading Change, Advancing Health, made possible by the support of the Robert Wood Johnson Foundation. The need for nurses in healthcare has increased dramatically as a result of an aging population and the number of people living with chronic disease. The need for care coordination is

greater than ever and rising steadily. A transformation of the nursing profession is underway to remove barriers to practice independently and provide care, increase the number of nurse leaders, and expand the percentage of nurses with a baccalaureate degree or higher to at least 80%. Every two years, the National Council of State Boards of Nursing

(NCSBN) and the National Forum of State Nursing Workforce Centers conduct the only national- level survey focused on the entire U.S. nursing workforce. In 2020, 65.1% of RNs held a BSN or higher. Exeter Hospital is proud to announce that 79% of their RNs hold a BSN or higher, a percentage that has steadily increased since 2018.

Exeter Hospital Registered Nurses (RN) with a BSN or Greater

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

79 %

76 %

66 %

66 %

65 %

2018

2019

2020

2021

2022

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ANNUAL REPORT 2021

United in Community

Our Mission

The mission of Exeter Health Resources and its affiliates is to improve the health of the community. This mission will be principally accomplished without compromising Exeter Health Resources’ sustainability by supporting the provision of health services and information to the community by the affiliated companies of Exeter Health Resources. Throughout the past year Exeter Hospital, Core Physicians and Rockingham VNA & Hospice have continued the pursuit of this mission. The COVID-19 pandemic brought enormous challenges that continued throughout FY 2021. Despite this, the affiliates provided $90,976,911 in charity care and other community benefit programs and services to communities in the areas served.

Community benefit services and programs provided by the affiliates are focused on addressing needs identified in the Community Health Needs Assessment. Access to health care – Mental health services – Social drivers of health Substance use disorder – Support for the needs of seniors Transportation – Youth suicide prevention

For more information on how the affiliates of Exeter Health Resources work together with the community to improve the health of the New Hampshire Seacoast, or to view the 2019 Community Health Needs Assessment, please visit exeterhospital.com/about-us/community-benefits.

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Giving Back to Our Community

Community Health Services

Charity Care

Research

Health Professions Education

Financial & In-Kind Contributions

Subsidized Health Services

Community Building Activities

Govt-Sponsored Healthcare (Medicaid Loss)

Govt-Sponsored Healthcare (Medicaid Loss)

$ 76,439,284 $ 9,660,097 $ 1,955,688 $ 1,034,059

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subsidized Health Services

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health Professions Education

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Community Health Services

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Charity Care

$ $ $ $

656,177 511,581 445,881 274,142

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Research

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Financial & In-Kind Contributions

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Community Building Activities

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total

$ 90,976,911

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Additional information can be found by visiting exeterhospital.com/patients-and-visitors/financial-assistance.

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Exeter Hospital’s Community Call

Early in the pandemic, Exeter Hospital leadership recognized the need to create a new way to stay connected with community partners and to share reliable information directly from the medical staff regarding COVID-19. A bi-weekly call began in June 2020 – which has grown to include over 100 participants from 50+ organizations.

In FY 2021, Neil Meehan, DO, Chief Physician Executive hosted seven calls, balancing the at times difficult news from the field with the newest data, and always encouraging vaccination, mask wearing, and staying home if unwell. The calls also featured valued community partners and guests addressing some of the greatest community needs during the pandemic such as mental health, substance use disorder and violence prevention.

Community Call Guests Included (but not limited to) :

John Burns, MBA, SOS Recovery Center (substance misuse) Peter Clark, Office of U.S. Senator Shaheen Gayle Davis, Senior Helpers (needs of seniors) Corey Garry, Deputy State Director, Office of U.S. Senator Maggie Hassan Carol Gulla, Director of TASC (needs of seniors) Bobby Kelly, MD, MPH, (LGBTQ awareness, inclusion and education) Captain Darick Krause, National Guard (vaccination sites) John Nyhan, President, Hampton Chamber

William McGowan, M.Ed., Principal, Winnacunnet High School Debbie Perou, Rockingham Meals on Wheels (needs of seniors) Candice Porter, MSW, Connor’s Climb Foundation (mental health) David Ryan, Ed.D, Superintendent, SAU-16 Christian Seasholtz, Office of Congressman Chris Pappas (NH-01) Sarah Shanahan, HAVEN (violence prevention) Corey Towne-Kerr, The Chase Home for Children Jennifer Wheeler, President, Exeter Area Chamber of Commerce

“As the leader of a small nonprofit organization, the Community Call has been incredibly valuable during the pandemic. Hearing directly from medical

specialists and being able to ask questions about the changing landscape helped our organization feel more confident as we navigated the many decisions needed to provide home-based services safely for infants and toddlers, their families as well as our staff. Thank you to everyone at Exeter Hospital for providing this resource.” – Peggy Small-Porter, former Executive Director of Richie McFarland Children’s Center (now merged with Waypoint NH)

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ANNUAL REPORT 2021

Financials

Financial Summary

Exeter Health Resources’ financial performance in fiscal year 2021 continued to be impacted by the COVID-19 pandemic. In mid-December, COVID-19 admissions increased significantly and there was a reduction in surgical inpatient as well as outpatient services. This trend continued until the later part of January 2021 when other non COVID-19 volume resumed. Gross patient service revenue generated by the three operating subsidiaries increased $129.2 million from $863.3 million in 2020 to $992.5 million in 2021. This was a direct result of not having to postpone elective procedures and significantly limit normal operations as we did for the six week time period from March 17 to April 30, 2020. Under the Coronavirus Aid Relief and Economic Security Act (CARES Act), the subsidiaries of Exeter Health Resources were the recipients of distributions from the Provider Relief Fund which totaled $10.3 million in 2020 and $19.6 million in 2021. These distributions were used for eligible healthcare-related expenses that were incurred to prevent, prepare for and respond to COVID-19 or lost revenue attributable to the pandemic. While consolidated total revenues and other support increased by $51.7 million or 14.1%, consolidated operating expenses also increased by $15.2 million compared to 2020. The two largest drivers of expense included an increase of $4.2 million in salaries and benefits and $11.4 million for supplies and other expenses, including contract labor, and the associated expenditures related to the infection prevention, screening, and COVID-19 testing. Exeter Health Resources generated a $15.9 million gain from operations in fiscal 2021 which was $36.5 million higher than the operating loss of $20.6 million in 2020. Without the Provider Relief Funds mentioned above, the consolidated loss from operations would have been $3.7 million in 2021 which is $27.2 million less than the $30.9 million loss in 2020. The total non-operating gain was $41.8 million versus a $12.5 million gain in fiscal 2020 as investment returns accounted for over $25.9 million of the total increase. Overall liquidity grew even stronger in fiscal 2021. The organization’s days cash on hand for 2021 was 250 days representing a 30 day increase over 2020. Additionally, total cash, short-term investments, and investments net of donor restrictions increased approximately $41.2 million in 2021 in large part due to the investment portfolio as a result of stock market performance. Exeter Hospital maintained a Baa2 bond rating from Moody’s. The debt to equity ratio improved from 18.1% in 2020 to 11.7% in 2021 as no new debt was incurred in 2021 and unrestricted net assets grew from $235.4 million to $327.5 million. As a system, Exeter Health Resources provided approximately $91.0 million of community benefits in fiscal 2021, which included $14.5 million to subsidize health services, other community service programs, charity care, and the provision of direct cash contributions to other community agencies that support the mission of the organization. The other $76.5 million represents the costs of Medicare and Medicaid services provided to patients that exceeds reimbursement. The organization continued its capital investment commitment by purchasing $11.2 million in property, plant and equipment in 2021 including over $3.0 million towards the Michael and Jeanne Falzone Center for Cancer Care expansion, and the remaining $8 million on new medical equipment, building renovations, infrastructure improvements, and upgrades in information technology.

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Exeter Health Resources, Inc.

2021

2020

2019

2018

2017

Gross revenues and other support

$ 1,033,941,239

$ 895,807,404

$ 884,233,554 $ 798,265,118 $ 730,327,367

Deductions from revenue: Contractual allowances and discounts

605,772,470 10,809,847

518,750,153 11,373,261

497,083,376 12,933,872

436,297,117 9,392,322

394,040,880

Bad debt

8,240,171

Total deductions

616,582,317

530,123,414

510,017,248

445,689,439

402,281,051

Total revenues and other support

417,358,922

365,683,990

374,216,306

352,575,679

328,046,316

Consolidated operating expenses

401,459,252

386,260,374

370,839,501

352,333,580

327,870,755

Income (loss) from operations

15,899,670

(20,576,384)

3,376,805

242,099

175,561

Nonoperating gains (losses): Investment return

40,636,363

14,751,673

4,500,018 4,998,191 (1,263,838) (3,006,625) 1,011,509

9,326,460 120,891 (878,213) 1,073,897

17,182,663

Unsolicited donations and gifts

151,865 (444,360) 964,473 514,097

122,266 (474,052)

85,568

Contributions to community programs

(792,524) 2,403,455

Impact of interest rate swaps

(2,257,679)

Other

314,384

238,130

(27,005)

Total nonoperating gains, net

41,822,438

12,456,592

6,239,255

9,881,165

18,852,157

Excess (deficiency) of revenues and other support and nonoperating gains (losses) over expenses

$ 57,722,108

$ (8,119,792)

$ 9,616,060 $ 10,123,264

$ 19,027,718

* Provider Relief Funds received

$ 19,600,000

$ 10,300,000

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Exeter Health Resources, Inc. & Subsidiaries Consolidated Balance Sheets

September 30, 2021 and 2020

Assets

2021

2020

Current assets: Cash and cash equivalents

$ 47,092,320 4,412,653 40,474,468

$ 46,405,715 4,403,891 35,181,607

Short-term investments Accounts receivable

Inventories

6,834,595 7,416,036

6,042,608 6,386,319

Prepaid expenses and other current assets

Current portion of funds held by trustee under revenue bond and other financing agreements

6,301,340

8,300,985

Total current assets

112,531,412

106,721,125

Investments, limited as to use

243,662,478

197,033,978

Funds held by trustee for professional liability claims

5,115,421

5,282,332

Property, plant and equipment, net

107,994,131

113,191,566

Prepaid pension and other assets

33,645,409

20,152,463

Total assets

$ 502,948,851

$ 442,381,464

26 ANNUAL REPORT 2021

Exeter Health Resources, Inc. & Subsidiaries Consolidated Balance Sheets

September 30, 2021 and 2020

Liabilities and Net Assets

2021

2020

Current liabilities:

Accounts payable

$ 23,094,617 25,060,117 32,991,958

$ 22,832,746 21,585,916

Accrued salaries and payroll taxes

Due to third-party payors

11,120,166 4,331,626

Current portion of long-term debt

4,048,973

Total current liabilities

85,195,665

59,870,454

Accrued pension and other liabilities

18,611,433

78,752,594

Long-term debt, less current portion

34,147,404

38,336,431

Reserve for professional liability claims

6,261,452

4,898,560

Net assets:

Without donor restrictions With donor restrictions

327,504,491 31,228,406

235,388,832 25,134,593

358,732,897

260,523,425

Total liabilities and net assets

$ 502,948,851

$ 442,381,464

27

Exeter Health Resources, Inc. & Subsidiaries Consolidated Statements of Operations

September 30, 2021 and 2020

2021

2020

Net patient service revenues less provision for bad debts

$ 375,964,277 5,313,993 34,427,570 1,653,082 417,358,922 220,781,392 148,982,817 16,382,096 14,754,996

$ 333,196,213

Disproportionate share funding

6,591,068 25,477,768

Other revenues

Net assets released from restrictions used for operations

418,941

Total revenues and other support

365,683,990

Operating expenses:

Salaries and benefits Supplies and other

216,573,109 137,550,148 16,728,695 14,433,658

Depreciation

New Hampshire Medicaid enhancement tax

Interest

557,951

974,764

Total operating expenses

401,459,252

386,260,374

Income (loss) from operations

15,899,670

(20,576,384)

Nonoperating gains (losses): Unrestricted contributions

151,865 929,229

122,266

Investment income and dividends, net Realized gains on investments, net Unrealized gains on investments, net

1,079,030

6,315,876 33,391,258

739,845

12,932,798 (2,257,679)

Impact of interest rate swaps

964,473 (444,360) 352,163 161,934

Contributions to community programs

(474,052) 394,950 (80,566)

Other, net

Net periodic pension gain (cost)

Nonoperating gains, net

41,822,438

12,456,592

Excess (deficiency) of revenues and other support, and nonoperating gains over expenses

57,722,108

(8,119,792)

Net assets released from restriction used for capital purchases

549,980

Transfer of balances between funds

(3,549,208) (4,738,368)

Adjustment to pension liability

33,843,571

Increase (decrease) in net assets without donor restrictions

$ 92,115,659

$ (16,407,368)

28 ANNUAL REPORT 2021

ANNUAL REPORT 2021

Our Community Gives Back

United in Wellness

Exeter Health Resources and its operating affiliates, Exeter Hospital, Core Physicians and Rockingham VNA & Hospice, are United in Wellness . This simple, but important, phrase embodies our health system’s collective efforts to improve the health of the communities we serve, working together with our donors, patients, staff and community partners. As a not-for-profit healthcare system, the operating affiliates of Exeter Health Resources are supported in part by community members, grateful patients and local business leaders, all of whom have been compelled to give back after their experience within our healthcare system. Whether it was because of the compassionate care provided to a loved one or inspired by their own personal experience, these individuals have helped to strengthen our collective efforts to care for the community. With their support and our dedication to being United in Wellness, we are better able to purchase state-of-the-art equipment and technology, implement innovative treatment options and therapies, provide continuing education to clinical staff and assist with financial support for community members in need.

Exeter Health Resources’ Community Advancement Partners (CAPs)

We are stronger thanks to the support

of these devoted local businesses:

30 ANNUAL REPORT 2021

Our Mission

The mission of the operating affiliates of Exeter Health Resources is to

improve the health of the community. One of our greatest rewards is to hear from our patients expressing the quality of care and compassion they experienced while receiving care within our health system.

Through generous donations of time and funding, many local businesses as well as community members have made it their mission to help ensure future patients have the very best treatment available by supporting the advancement of Exeter Hospital, Core Physicians and Rockingham VNA & Hospice. Some of our grateful patient stories follow on these pages.

To learn how you can help, please visit unitedinwellness.org.

31

Exeter Hospital Launches Together We Can Capital Campaign

Exeter Hospital has launched the Together We Can capital campaign, a $4 million initiative that builds upon the best of what we do and creates the highest vision of what Exeter Hospital can be for the New Hampshire Seacoast. This comprehensive campaign will drive our continued leadership, innovative spirit and transformative potential.

32 ANNUAL REPORT 2021

The campaign consists of four comprehensive components:

1

3

Build a New Home for Cancer Care A groundbreaking was held on March 25, 2021 for the expansion and renovation of Exeter Hospital’s Michael and Jeanne Falzone Center for Cancer Care, with a goal of aligning the physical site with the excellent quality of care that the Center has provided for decades. The addition of 7,000 new square feet will bring together medical oncology and radiation oncology into a more cohesive space with a shared reception area. The renovations will increase the number of infusion bays and create larger, more modern and comfortable treatment areas with views to outdoor gardens. Additional space is also being created for the Center’s renowned multidisciplinary clinics for breast, thoracic/lung, gastrointestinal, head and neck, and prostate/genitourinary cancers. The $3 million fundraising goal will contribute to the renovation and expansion, which is expected to be complete in early fall 2022.

Supporting Mental Health Care Demand for mental health and addiction treatment services has increased significantly, even before the onset of the COVID-19 pandemic. We have invested in 24/7 emergency mental health services in Exeter Hospital’s Emergency Department (ED) in partnership with Seacoast Mental Health Center. The $250,000 goal for mental health services will help support resources needed to treat behavioral health needs in the ED in a timely, effective and compassionate way, as well as further partnerships between primary medical care practices and mental healthcare specialists.

4

Recognizing Healthcare Provider Excellence Philanthropists Bill and Mary Schleyer established an annual financial award to be presented to Exeter Hospital employees, monthly and annually, who best exemplify qualities of empathy, integrity, professionalism and teamwork while providing care to patients. The $250,000 fundraising goal will help grow and sustain this award, which has been named the Susan Burns- Tisdale Memorial Patient Service Award* in memory of Susan

2

A Commitment to World-Class Pediatric Care Exeter Hospital has expanded and improved pediatric care, ensuring a pediatric hospitalist is onsite 24/7 to assess and provide care to children in the Emergency Department, newborns in the Family Center, and patients in the inpatient pediatric unit. The $500,000 fundraising goal for pediatric care will help sustain this program, purchase innovative medical technology and update exam room equipment to enhance pediatric care.

Burns-Tisdale, MPH, RN, who served as Senior Vice President for Clinical Operations at Exeter Health Resources and Chief Nursing Officer at Exeter Hospital.

Susan Burns-Tisdale, MPH, RN

* To learn about the first award recipients, see page 15.

33

Michael and Jeanne Falzone were honored for their $1 million gift to the Together We Can capital campaign. They are pictured with Kevin Callahan, President and CEO of Exeter Health Resources (far right) and Davis Farmer, Chair of the Campaign Cabinet.

Million Dollar Gift Received from Grateful Patient

The Center for Cancer Care received the largest and truly transformational gift of the hospital’s first capital campaign in almost four decades from grateful patients Michael and Jeanne Falzone of North Hampton. Their gift, as part of the Together We Can capital campaign, will bring expanded spaces, new services and breakthrough treatments that advance and transform cancer care for the greater Seacoast community. Michael Falzone received cancer treatment at Exeter Hospital. He and his wife Jeanne made their donation with a deep sense of gratitude to the entire staff, especially Michael’s oncologist, Panos Fidias, MD. Due to the impactful and history-making nature of the gift, the Exeter Hospital Board of Trustees voted to rename the Center for Cancer Care the Michael and Jeanne Falzone Center for Cancer Care. “The staff at Exeter Hospital are so caring and responsive – everyone from the front desk to the infusion ward,” said Jeanne Falzone about their experience. Regarding the donation, she went on to say “When I bring Michael to his appointments and treatments, I see people of all ages and walks of life, each of them suffering quietly with cancer – and I want this gift to make their visits to Exeter Hospital more comfortable. We want to create a more spacious,

comfortable, calming and healing environment for the patients and their loved ones while they are going through such a difficult time in their lives. That’s why this gift is so important to us.” Coordination with Massachusetts General Hospital Cancer Center will continue, with onsite Mass General oncologists and nurse practitioners working alongside Exeter Hospital providers to ensure the highest level of cancer care. “The Campaign Cabinet for Exeter Hospital is grateful and inspired by the way our philanthropic community has stepped forward in support of our fundraising efforts on behalf of those in the Seacoast who are affected by cancer,” said Together We Can Campaign Chair Davis Farmer of East Kingston. According to Exeter Health Resources’ President and CEO Kevin Callahan, “Together we can be the benchmark of a new standard of excellence that combines world-class doctors, the finest and most compassionate staff, and a state-of-the-art cancer care facility.” Total project cost of the facility renovation and expansion is $11 million with projected completion of construction by early fall 2022.

For more information about the Together We Can capital campaign or to support the campaign, visit unitedinwellness.org.

34 ANNUAL REPORT 2021

Our Community Gives Back

Newburyport Bank Senior Vice President Jamie Thompson (right) along with other bank employees presented the check to Davis Farmer, Chair of the Together We Can Campaign Cabinet.

Newburyport Bank Supports Pediatric Care At the public launch of the Together We Can (TWC) capital campaign, Newburyport Bank announced a gift of $50,000, the first gift toward the pediatric component of the campaign. This gift will support programs and technology to provide specialized care for pediatric patients and newborns at Exeter Hospital.

Newburyport Bank previously made one of the first gifts to the TWC campaign in 2019 in the amount of $100,000. A courtyard garden at the entrance to the renovated Falzone Center for Cancer Care will bear recognition of this gift.

A Golf Win for Cancer Care Mike Moore’s Together We Can Golf Tournament raised $21,000 for the TWC campaign. Mike’s daughter Samantha was diagnosed with a rare

back, and the 2022 event is planned for June. Samantha said this about her cancer care providers, “They were so loving and caring and concerned. They were there every step of the way.” Now 27 years old, Samantha has had

but very treatable form of cancer when she was in fifth grade – both Mike and Samantha are very thankful to her Core Physicians’ pediatrician Steven Loh, MD for recognizing the initial lump as abnormal, as well as the providers at Exeter Hospital and Massachusetts General Hospital who treated her. Mike started the golf tournament as a way to give

Samantha Moore with Steven Loh, MD.

her final checkup and is cleared. She is now a youth minister and sang “Somewhere Over the Rainbow” at Exeter Hospital’s Cancer Survivors’ Day Celebration held at Stratham Hill Park in June 2021.

35

Paul Bamford Surpasses $100,000 Goal

Paul Bamford held another successful Chris Bamford Memorial Golf Run with Oyster River High School students, raising thousands of dollars that were donated to the Together We Can capital campaign in memory of his son Chris, who passed away from colon cancer in 2016. He has surpassed his total goal of $100,000, and in recognition, the Gastrointestinal Multidisciplinary Clinic will be named in memory of

Chris. Paul was honored with the 2021 United in Wellness Maureen Barrows Community Champion Award for his commitment and dedication to community service, philanthropy and our United in Wellness mission. The award was named in honor of Maureen Barrows, a major hospital donor and founding member of the United in Wellness Leadership Advisory Board.

Virtual Cancer Walk is a Tangible Success

“Honoring Lynda’s memory is so important to me,” said Sue. “A donation from Lynda before she died, plus funds raised through

The community once again stepped up with their virtual participation in this year’s Cancer Walk & Trick or Treat Trot 5K, raising more than $60,000 for the

Lynda Beck (left) with Sue Ratnoff.

memorial donations and now a donation from me will mean that one of the treatment rooms that look out on a garden will be named in memory of Lynda. The absolutely wonderful staff at the Center made her time there manageable and comfortable.”

Together We Can (TWC) capital campaign and The Beyond the Rainbow Fund. One of this year’s teams, “Team Avagadro” in memory of Lynda Beck, was captained by Lynda’s wife Sue Ratnoff.

Paving the Way

with my husband Ed’s name. Ed was extremely proud of my career and the fact that I worked for Exeter Hospital. Whenever he introduced me, it was never simply as his wife. Instead he would say, ‘This is my wife, Mary. She is an oncology pharmacist at Exeter Hospital.’ Sponsoring a paver in his memory is my way of thanking him for always encouraging me to pursue my path.”

Each of the two gardens that will line the new main entrance to the Michael and Jeanne Falzone Center for Cancer Care will offer a limited number of

commemorative paver bricks. In recognition for a donation of $1,500 to the TWC capital campaign, a loved one may be honored or memorialized on a paver. For a $2,500 donation, two pavers with the same or differing messages may be inscribed. Mary Ellis, Pharm.D., operations manager for the Oncology Pharmacy at Exeter Hospital, was one of the first donors through this opportunity. In her own words, “My daughter Katelyn and I sponsored a paver

For more information about commemorative pavers, visit unitedinwellness.org

36 ANNUAL REPORT 2021

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