CHECK LIST FOR COMPLIANCE WITH COMMUNITY BENEFIT LAW (RSA by zbs19295

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									                          Office of the Attorney General
                               Charitable Trusts Unit
                     33 Capitol Street, Concord, NH 03301-6397
                                    603-271-3591
                         www.state.nh.us/nhdoj/CHARITABLE/char.html

             COMMUNITY BENEFITS PLAN – REPORTING FORM
                       Pursuant to RSA 7:32-c – l

                    FOR FISCAL YEAR BEGINNING July 1, 2000
                      COVERING July 1, 2000 – June 30, 2001

Organization Name: Elliot Health System
Street Address:    1 Elliot Way
City:              Manchester
State:             New Hampshire
Zip Code:          03103

Federal Tax Identification Number: 02-0509911          State Registration Number: 2429

Elliot Health System (EHS) is an integrated healthcare delivery network. The Visiting
Nurse Association of Manchester & Southern New Hampshire, Inc. (VNA) is a subsidiary
of EHS and is an integrated home care delivery network.

       Organization Name: Visiting Nurse Association of Manchester & Southern New
                          Hampshire, Inc.
       Street Address:    1850 Elm Street
       City:              Manchester
       State:             New Hampshire
       Zip Code:          03104

       Federal Tax ID Number: 02-0395296             State Registration Number: 2924
       Administrator: Debra Grabowski, RN            Board Chair: Jacqueline Killgore

       In accordance with RSA 7:32-c – l, this report is being submitted as a
       collaborative effort on behalf of the following subsidiaries of EHS and VNA.

       Subsidiary             Federal Tax State Registration          Board Chair
                              ID Number Number

       Elliot Hospital        02-0232673             6272             James Conway, MD

       Women’s Aid Home 02-0222249                   2964             Sheila Evjy
       dba Pearl Manor




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        VNA Home Health        02-0222241             2927           Jacqueline Killgore
        & Hospice, Inc.

        VNA Community          02-0396549             2926           Jacqueline Killgore
        Services, Inc.

     The following information and attachments must be included in the
community benefits plan filed with the Director of Charitable Trusts:

I.      a. General Background Information:

        Name & Address of CEO: Douglas Dean, President and CEO
                               Elliot Health System
                               1 Elliot Way
                               Manchester, NH 03103

        Board Chair:                  James F. Conway, Jr., MD
                                      Manchester Urology Associates
                                      4 Elliot Way, #200
                                      Manchester, NH 03103

     See above for the names of Board Chairs of EHS subsidiaries. The Boards of Elliot
     Hospital and Visiting Nurse Association of Manchester & Southern New Hampshire,
     Inc. report to the Elliot Health System Board. Pearl Manor reports to the Continuing
     Care Board. The Boards of Continuing Care, VNA Home Health & Hospice, Inc. and
     the VNA Community Services, Inc. report to the Visiting Nurse Association of
     Manchester & Southern New Hampshire, Inc. Board.

     b. Organizational Structure:

        Please find attached Organizational Structure (Appendix A).

        Please attach:

        ·    A copy of the Articles of Incorporation, constitution and by-laws or
             other instruments of creation.

        Please find attached By-laws of the Elliot Health System subsidiaries
        (Appendix B).

        ·    A list of the names and address of officers and directors of organization.

        Please find attached the names and addresses of officers and directors of the Elliot
        Health System organizations (Appendix C).




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       ·   A brief description of governance and administrative structure of health
           care charity’s trust, its parent and subsidiaries, if any.

   The Elliot Health System currently consists of the parent organization (EHS, Inc.) and
   nine direct subsidiaries (for profit and not-for-profit). These subsidiaries present
   distinct missions, strategic intents, markets, philosophies and leadership.

       Governance Principles:

       Ø Each EHS entity will require the appropriate governance and management
         talent to address its specific mission and provide the best possible services.
       Ø There is significant expertise available in the community to be tapped for the
         various subsidiary boards of directors.
       Ø Management may serve on some specific boards, as appropriate, but boards
         will not be management-driven.
       Ø Each EHS Board member will also serve on at least one subsidiary board of
         directors.
       Ø The medical staff will have significant representation on the Elliot Health
         System and Elliot Hospital Boards, and on the boards of directors of EHS
         subsidiaries in which they have a direct interest and / or accountability for
         medical outcomes.
       Ø Boards will be given maximum flexibility within broad guidelines, but must
         meet a basic set of responsibilities.
       Ø No “rubber stamp” boards will be established. Each board will be a working
         board with significant accountability for successful outcomes.
       Ø The EHS will not have to approve every Board action of the subsidiaries. Only
         certain specified reporting and approvals will be required.

Major Governance Responsibilities:

       Elliot Health System:

       Ø Establish an overall system strategic plan – especially a vision for the system;
         communicate plans effectively to key stakeholders.
       Ø Election and removal of individuals who will act as the Chair and President of
         EHS.
       Ø Approval and removal of EHS and subsidiary board members.
       Ø Approve the operating and capital budgets of the EHS and its subsidiaries.
       Ø Establish subsidiaries and approve acquisitions of other subsidiaries.
       Ø Approve strategic plan of each subsidiary.
       Ø Approve dissolution, liquidation, merger, consolidation, lease or transfer of
         substantial assets of the organization and subsidiaries.




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Elliot Hospital:

Ø Assure the quality of care provided by the hospital.
Ø Propose the mission, budget and hospital strategic plan for final approval by
  the EHS.
Ø Approve all medical staff appointments.

Pearl Manor:

Ø   Propose the mission and budget for final approval by the EHS.
Ø   Assure the quality of care / services provided within the organization.
Ø   Approve strategic plan.
Ø   Assure the organization is fulfilling its charitable mission.

Visiting Nurse Association of Manchester & Southern New Hampshire, Inc.:

Ø Plan and make policy decisions.
Ø Assure fiscal viability of the programs.
Ø Recommend annual operating and capital budgets.
Ø Assure the quality of care / services provided within the organization.
Ø Plan, approve and monitor the achievement of goals and objectives of the
  strategic plan.
Ø Assure the agency is fulfilling its charitable mission.
Ø Develop Strategic Plan for all subsidiaries of VNA.

VNA Home Health and Hospice, Inc.:

Ø Plan and make policy decisions.
Ø Assure fiscal viability of the programs.
Ø Recommend annual operating and capital budgets.
Ø Assure the quality of care / services provided within the organization.
Ø Plan, approve and monitor the achievement of goals and objectives of the
  strategic plan.
Ø Assure the agency is fulfilling its charitable mission.

VNA Community Services, Inc.:

Ø Plan and make policy decisions.
Ø Assure fiscal viability of the programs.
Ø Recommend annual operating and capital budgets.
Ø Assure the quality of care / services provided within the organization.
Ø Plan, approve and monitor the achievement of goals and objectives of the
  strategic plan.
Ø Assure the agency is filling its charitable mission.


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II.    Community Benefits Contact Person:

       ·   Name and Title:             Joan A. Stevens, M.Ed.
                                       Executive Director, Community Health
                                       Elliot Health System
       ·   Address:                    317 Lincoln Street
                                       Manchester, NH 03103
       ·   Telephone Number:           (603) 663-8407

III.   Mission Statement: Statutory reference: RSA 7:32-e I

       The health care charitable trust must provide its most recent mission
statement and the date it was adopted. The mission statement must describe the
purpose of the health care charitable trust and delineate how the mission statement
related to the community benefits reported. The mission statement must be
reaffirmed on an annual basis.

       Please attach a copy of your mission statement.

The Elliot Health System, through its subsidiary provider and development organizations,
offers cost-effective strategies and solutions for meeting the region’s health care
challenges.

Please find attached Mission statements for the following EHS subsidiaries. (Appendix
D). Dates of approval at meetings of the respective Boards are indicated.

                                                       Date of Approval by Board

       Elliot Hospital:                                        March 20, 2001
       Pearl Manor:                                            January 10, 2001
       VNA of Manchester & Southern, NH, Inc.:                 May 8, 2001
       VNA Home Health & Hospice:                              May 8, 2001
       VNA Community Services:                                 May 8, 2001

The above EHS Mission Statement is related to all Community Benefits reported under
Sections VIII, IX, and X of this Plan. Elliot Health System would not undertake activities
that are not directly related to its Mission. All activities reported are solutions for meeting
the region’s health care challenges as identified in the Community Needs Assessment
(Section VII).

Between July 1, 2000 and June 30, 2001, particular focus was given to the following
areas:




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Ambulatory Services / Primary Care:

Developed and enhanced Elliot Health System’s ambulatory services including:
Rehabilitation, Ambulatory Surgery, Wound Care and Hyperbaric Medicine, Sleep
Center, Pain Management, and Urology Services. Will be providing fixed magnetic
resonance imaging (MRI) at the Elliot Hospital campus. This will greatly improve patient
access to MRI services at the Elliot Hospital campus. Elliot One-Day Surgery Center is a
freestanding multi-specialty ambulatory surgery center. It is located on the campus of
Elliot Hospital at 445 Cypress Street and has State approval to relocate to the second
floor of the Hospital in the “L” building. Elliot One-Day will have four Operating Rooms
and one Minor Procedure Room and, if volume warrants, could expand by two additional
operating rooms during the first three years of operation in its new location to meet
increasing patient needs. There are individual patient rooms for pre-operative admission
and second phase recovery, which offer privacy and comfort. The phase one recovery
space will have dedicated pediatric beds. The facility performed over 3,300 procedures in
FY01.

The Elliot Health System expanded its network of primary care physicians by twelve in
FY01, increasing our primary care capacity. The Elliot is committed to improving
primary care access for our community and will continue to expand our network to
improve access to care. An access to care service standard quality improvement project is
in the assessment phase.

Critical Care Services:

Reestablished Elliot Hospital’s cardiac catheterization program and enhanced the medical
cardiology unit.

Visiting Nurse / Geriatric Services:

Expanded inpatient and outpatient Geriatric Psychiatry services, and bereavement
services in response to community needs. Developed plans for the expansion of Elliot
Health System’s Adult Day Care program to address market demand and current space
constraints. Plans are underway to construct a geriatric center in Manchester to meet the
health care needs of our aging population while addressing body, mind, and spirit.

Oncology Services:

Initiated collaborative discussions with Concord Hospital and Exeter Hospital to
regionalize Radiation Therapy Services. The Elliot will share its expertise and resources
to facilitate the development of new Radiation Therapy sites to increase patient access
and meet market needs. A personal treatment planner for patients to record their
progression through the treatment of their cancer quality improvement project is currently
in the assessment stage.



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Consumer Education:

The Health Sciences Library is expanding its resources in support of consumer education
at Elliot Health System. Initiatives during the past year included offering Internet
orientation to consumers as part of the hospital’s Women’s and Children’s Health Service
as well as the implementation of a talking book service (in conjunction with the State
Library). The librarian has provided training on consumer WEB sites (in conjunction with
the NH Area Health Education Center) and the library’s Intranet page provides a number
of links to consumer health WEB sites. A library presence on the Elliot WEB is planned
which should expand our support in this area. In addition, a consumer book collection has
been ordered for the library.

Integrative Medicine:

Integrative medicine modalities are offered to in-patients, outpatients and hospice
patients, and in area workplaces and in the community. The provision of Complementary
and Alternative modalities within the Elliot Health System will enhance the
organization’s ability to offer a more complete continuum of care. Program offerings will
be available in an outpatient setting that will promote wholeness and healing through the
exploration of various complementary healing practices in a safe and compassionate
environment. Offering Reiki, Acupuncture, Massages, and Hypnotherapy will expand
outpatient quality care. Other services will be expanded including Integrative Medicine’s
educational programs and classes, as well as patient assessments.

Colleges and High Schools:

Elliot Health System promotes health careers through education, internships, counseling
and public presentations, which communicate the challenges, rewards, and diversity of
being a health care professional. EHS responds to phone and written inquiries from
individuals in the community seeking information about health careers and/or pursuing
second careers in the health care industry. Classroom presentations are coordinated to
discuss a variety of health careers, including educational preparation and educational
pathways to become a health care professional. On August 14, 2001 EH sponsored its
own Career Fair where 18 high school students had an opportunity to speak with 15
different health care professionals and learn more about that particular career. Staffs from
a variety of disciplines also actively participate in middle and high school career fairs. EH
supports an active Medical Explorer Program that introduces high school students to the
hospital environment and health careers. Consideration is currently being given to
developing a mini medical school for pre-adolescents as a career exploration opportunity.
The Discover Nursing Program, introduced in June 2001, was developed in response to
the current nursing shortage. The program is designed to introduce specific target groups
in the greater Manchester area to the many opportunities available to them through a




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nursing career. All these experiences assist to attract students who demonstrate potential
academic abilities that will lead to a successful career in the health care industry.

The EH Nursing Center for Practice & Education has partnered with the UNH Nursing
program to offer on-site courses for RNs wishing to obtain a BSN. The Center has also
partnered with Health Career Training Associates to provide on-site CNA programs
beginning in October 2001.

The EH recognizes its responsibility for providing clinical nursing experiences for
certificate, undergraduate and graduate programs. Many departments within the EHS,
including VNA Child Care and Parent-Baby (ad)Venture, provide learning opportunities
and clinical experiences to nursing students from several in-state, as well as out-of-state,
nursing programs.

EH consistently supports the Internship Program for a variety of learners. Currently, EH
sponsors an administrative resident intern from Xavier University in FY01 and 02.

Collaboration with Other Organizations:

Elliot Health System collaborates regularly with Dartmouth-Hitchcock, Child Health
Services, NH Oncology, Manchester Community Health Center, Easter Seals, Manchester
Mental Health Center, and Manchester Health Department, among others. EHS,
Dartmouth-Hitchcock and Child Health Services collaborated on a grant application to
the Endowment for Health.

Elliot Hospital, as the City’s largest hospital collaborated with both private and public
organizations: Child Health Services and Manchester Community Health Center, and the
Manchester Health Department and the Manchester School Department on a grant
application to an outside source to integrate patient medical records electronically. This
initiative will help increase access to health care information, improve communication
and coordination among providers of health care and facilitates easy access to medical
records. As a result of this integrated medical record system, it will improve access and
availability of quality health care information for Manchester’s under served individuals
and families because those people often use the federal designated health clinic for care,
such as Manchester Community Health Center.

Women’s Services:

The development of a strategic plan for women’s services is in progress. The goal is to
develop a comprehensive women’s services program which may include, but not be
limited to, enhanced birthing options, perinatology and breast health services. A Code A
(fire) process improvement project is in the planning stage.




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Children’s Services:

The development of a strategic plan for children’s services is in progress. The goal is to
develop a comprehensive children’s services program that may include, but not be limited
to, increased neonatology, and pediatric sub-specialties. An asthma in-patient guidelines
quality improvement project is currently in the implementation stage and will be
expanded to the outpatient and home health patient populations.

Behavioral Services:

Behavioral health has developed a three-year strategic plan that has been approved by the
Elliot Health System Board. The focus of phase one, which is currently underway, is to
expand outpatient services. EHS purchased Manchester Counseling, a nine-practitioner
practice that serves adults and children. Another outpatient office for children and
adolescents will be opened in July, 2001. This office will have four practitioners with
expertise in child and adolescent psychiatry: a psychiatrist, two neuropsychologists, and a
nurse practitioner. These two practices will augment the adult practice of the Elliot
Psychiatric Group and the geriatric outpatient practice. All of these practices will serve as
a resource for primary physicians, schools and other community agencies. An intake
department is being developed that will enable the Elliot to provide around the clock
referrals and assistance with behavioral health questions. A System-wide aggression
management quality improvement project is currently being implemented. This project
involves debriefing after an event has occurred, and recording the key points for analysis
of trends, education, training and equipment, and on-scene management and call
response. Other efforts include facilitating communication with the Greater Manchester
Mental Health Center relative to continuum of patient care, the new role of Manchester
Counseling, Occupational / Behavioral Health Therapy Project and any new behavioral
health concerns or issues that surface.

Alternative Revenue Sources:

The Mary & John Elliot Charitable Foundation has been created to enhance and
coordinate the fundraising efforts of the Elliot Health System. As the responsible steward
of charitable giving, the Foundation will be the catalyst for collaborative relationships
between the EHS’s healthcare delivery system and the community. The Foundation’s
mission is to support the immediate and ongoing resource needs of the Elliot Health
System. During the past several months, the structure of the Foundation has been
designed. Currently the following programs are being developed; a grants program,
recognition program, corporate partnership program, annual fund, major gift program,
and a planned giving program.




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Community Needs Assessment and Quality Management:

The community needs assessment process is outlined in Section VII. The Quality
Management process is outlined in Section IV. Other quality management projects
include:

Critical Care Services:

A congestive heart failure treatment guideline quality improvement project is in the
implementation phase.

Emergency Services:

An Emergency Department wait times and thru-put lab turnaround quality improvement
projects are currently in the implementation stage.

Environmental Services:

A medical red bag waste reduction quality improvement project is in the implementation
stage and a sharps safety quality improvement project is in the implementation stage. The
medical waste incinerator will be permanently shut down in July, 2001. Medical waste
will be autoclaved, shredded and landfilled.

Medical Services:

A pre-typed / pre-printed orders quality improvement project is currently in the
implementation stage.

Surgical Services:

Surgical Day Care – A pre-op assessment, pain management – epidural, and operating
room start times / turnover quality improvement projects are in the implementation
stages.

Other projects:

A medication error reduction quality improvement project is currently being undertaken:

       Ø System wide error mode analysis has been implemented
       Ø Dispensing automation system has been implemented


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       Ø Administration bedside scanning technique is in the planning stage
       Ø Order entry system is in the assessment stage
       Ø System wide core indicator has been implemented

A concurrent quality review quality improvement project is in the implementation and
evaluation stage.
An employee performance evaluation quality improvement project is complete and
ongoing.

An employee health and safety quality improvement project is in the implementation
stage.

A falls prevention quality improvement project is in the implementation stage. Action
steps include: significantly raise fall prevention awareness through a variety of activities
across EHS, implement consistent Fall Risk Assessment and guidelines to assist in care
planning, improve data presentation and ability to use data, develop and implement a
consistent Post-Fall Analysis, and engage the patient and their family in an active role in
fall prevention.

An outcomes improvement and variation reduction quality improvement project is in the
implementation stage.

A System-wide Partners in Pride patient, employee and physician satisfaction quality
improvement project is in the implementation stage.

IV.    a. Program Information

       Does your health care charitable trust have a strategic plan that addresses
       community benefits?

               Yes     X               No     ___

       If yes, please attach a copy of the plan or section(s) of the plan pertaining to
       community benefits.

The following includes the sections of the plan pertaining to community benefits:

Elliot Health System Vision:

The Elliot Health System sets the standard for health services delivery and community
health / wellness in Southern New Hampshire.

Community Health Vision:




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The communities of Manchester and Southern New Hampshire will be well served with
quality health services and services that affect health status. There will be sufficient
access to services for everyone in need and the overall health of the community will be
continuously and significantly improving.




Excerpts from Critical Success Factors for moving toward the Vision:

       Ø Collaborate with other providers when such an approach clearly enhances
         Elliot Health System’s capabilities and shows good stewardship of community
         resources.
       Ø Make a measurable contribution to a healthy community.
       Ø Provide quality service – do not compromise at being the best at what we
         choose to do.
       Ø Show value and benefit – earn the support and trust of the community we
         serve.
       Ø Enlarge our definition of community and expand our mission to incorporate
         new approaches.

Excerpts from Guiding Principles / Beliefs. We:

       Ø Value diversity, and place a high level of importance on responding to the
         diverse needs and wants of all people in the communities we serve.
       Ø Serve in the best interest of the broader community by being the best we can
         be and being effective stewards of community resources.
       Ø Offer services with concern and respect for the dignity of every person.
       Ø Recognize that resources must be used prudently and effectively.

Excerpts from Goals:

       Ø Elliot Health System will offer a continuum of services that address the whole
         person in a manner that individuals value.
       Ø Elliot Health System will be a catalyst to expedite delivery of innovative and
         leading edge health care services.

      b. Program Narrative:

      Please provide the following information in a concise statement:

      ·    Who has responsibility for community benefits programs and activities?

The Boards of Directors have the responsibility for the community benefits programs and
activities. Responsibility for documentation of community benefits is assigned to the



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Director of Community Health. Projects, programs, and services are delegated through
the existing management structure utilizing vice presidents, service line heads, directors,
managers, supervisors and staff.

      ·    Who is responsible for their implementation?

The management structure referred to above is responsible for the implementation of the
community benefits programs and activities.

      ·    If more than one individual is responsible for implementation, (1) please
           provide a list of the names and the project(s) to which each individual has
           been assigned or (2) provide the number of individuals assigned to each
           project.

       Ø   Ambulatory Services: Keith Lammers, MD and Allyson Baker, RRT, RN
       Ø   Emergency Services: Margaret Burns, RN and Mike Sochat, MD
       Ø   Critical Care Services: Laurie King, RN and Peter Corrigan, MD
       Ø   Surgical Services: Pat Overy, RN and Larry Hoepp, MD
       Ø   Medical Services: Pat Overy, RN and Peter Cheung, MD
       Ø   Oncology Services: Lise Mendham, RN and Tom Sheldon, MD
       Ø   Behavioral Services: Susan Kimper, RN and Paul Brown, MD
       Ø   Women’s Services: Margaret Burns, RN and Marc Leclair, MD
       Ø   Children’s Services: Liz Castrogiovanni, RN and Martin Schwartzberg, MD
       Ø   Environmental Support Services: Mike Dupuis, RPh and Sandie Demars
       Ø   Visiting Nurse / Geriatric Services: Rachel Chaddock, RN and Karen Bryant,
           MD

      ·    How was the health care charitable trust(s) board involved in developing
           the community benefits programs & activities?

The Board of Directors is involved in the development of the community benefit
programs and activities through the strategic planning process. The Strategic Planning
Committee oversees the development of the plan and budget. Elliot Health System’s
Board of Directors has final approval of the plans, budgets and the funding of individual
programs and services for all EHS subsidiaries.

V.     Definition of Community & Population Served:

       Statutory reference: RSA 7:32-d II

       The community may be defined in terms of geographic boundaries, special
populations, community groups, demographic characteristics, health status, health
resources, healthcare utilization data, etc. A description of the methodology used in
identifying and determining the community / population served by the organization




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must be attached. How does your organization define its community? How was this
definition developed? Please be specific.

The Elliot Health System offers Manchester and Southern New Hampshire communities
the best possible and most appropriate patient service regardless of race, religion, color,
national origin, gender, age, disability, marital status, sexual preference, or ability to pay.

The Elliot Health System community includes those towns which depend upon us for
access to the majority of their health care services and which the Elliot considers the
substantial patient base. As part of the southern New Hampshire community, we are
dedicated to serving the many needs of the region’s families and advancing the standard
of medical care in the communities we serve. Elliot Health System considers its own
employees as part of its community, as well, and is committed to taking care of its
caregivers.

As part of its charitable mission, the Elliot Health System is committed to providing
excellent care with quality health services and services that positively affect health status.
There will be sufficient access to services for everyone in need; many programs are aimed
at lower income residents or those who cannot afford health insurance. Further, as
wellness and illness prevention are both critical to maintaining a healthy lifestyle, we
offer health education and screening programs for little or no cost. At the Elliot, we are
dedicated to continuously and significantly improving the health and well being of our
community by providing compassionate, caring and accessible health care.




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       Elliot Health System Total Service Area Population


           Town                 2000        2005       Projected Projected
                               TOTAL       TOTAL       # Change % Change
                                POP         POP        2000-2005 2000-2005



Primary Service Area
Allenstown town                   4,926       5,188          262       5%
Auburn town                       4,750       5,131          381       8%
Bedford town                     17,359      19,452        2,093      12%
Candia town                       5,029       5,702          673      13%
Deerfield town                    3,327       3,503          176       5%
Dunbarton town                    2,179       2,400          221      10%
Goffstown town                   16,236      17,225          989       6%
Hooksett town                     9,885      10,604          719       7%
Manchester city                 103,866     107,675        3,809       4%
New Boston town                   3,978       4,342          364       9%
                subtotal PSA    171,535     181,222        9,687       6%

Secondary Service Area
Amherst town                     10,725      11,562          837       8%
Bow town                          6,944       7,677          733      11%
Chester town                      3,433       3,800          367      11%
Derry town                       32,457      34,477        2,020       6%
Londonderry town                 23,232      25,168        1,936       8%
Merrimack town                   24,819      26,343        1,524       6%
Raymond town                      9,938      10,678          740       7%
Weare town                        7,325       7,894          569       8%
               subtotal SSA     118,873     127,599        8,726       7%

Total Service Area              290,408     308,821       18,413       6%

New Hampshire Total            1,210,807   1,274,730      63,923       5%



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Source: Claritas, INC. 2000 Population Estimates & 2005 Projections




                                New Hampshire Service Area
Allenstown        03275           Dunbarton        03045              Mont Vernon   03057

Amherst           03031           Epsom            03234              Nashua        03060-03063

Atkinson          03811           Fremont          03044              New Boston    03070

Auburn            03032           Goffstown        03045              Pelham        03076

Bedford           03110           Hampstead        03841              Pembroke      03275

Bow               03304           Hooksett         03106              Raymond       03077

Candia            03034           Kingston         03848              Salem         03079

Chester           03036           Litchfield       03052              Sandown       03873

Concord           03301-03303     Londonderry      03053              Suncook       03275

Danville          03819           Manchester       03101-03109        Weare         03281

Deerfield         03037           Merrimack        03054              Windham       03087

Derry             03038           Milford          03055

VI.     Community Needs Assessment Information: Statutory reference: RSA 7:32-f

           Following the development of the initial Community Needs Assessment, the
           assessment must be updated every three years. The charitable trust must
           consult with members of the public, community organizations, service
           providers, and local government officials in the trust’s service area in order
           to identify and prioritize the community needs which the health care
           charitable trust can address directly, or in collaboration with others. The
           report shall also include the means used to solicit the views of the community
           served by the trust, identification of community groups, members of the


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       public, and local government officials consulted on the development of the
       plan, and an evaluation of the plans effectiveness. The Assessment may
       include, but not be limited to, a description of community demographics,
       community health indicators, income level of the affected population, specific
       primary, acute, or chronic health care needs, assessment of the health care
       charitable trust’s capability of responding to identified needs, and the
       availability of other service providers, both public and private. The
       Assessment must include a description of the methodology utilized in
       evaluating and identifying community needs.

       ·    Please describe how community input was solicited & used in developing
            the community benefits plan.


In addition to the Community Needs Assessments described below, community input was
solicited and used from three additional sources. The first was a Community Survey,
which was conducted by the Marketing Department. For the second, the FY00
Community Benefits Report and FY01 Community Benefits Plan was mailed to those
who were interviewed and / or involved in the focus groups as part of the Community
Needs Assessment to solicit their input. For the third, 148,000 living in EHS’s service
area were surveyed in the Your Wellness Matters newsletter. 138 respondents indicated
they were most interested in topics such as Alternative Medicine, Diabetes, Chronic Pain
and Women’s and Men’s Health. Information, programs and services will be offered in
coming months based on these responses.

Press Ganey Summary:

As part of the Elliot Health System’s (EHS) commitment to patient satisfaction, several
areas within EHS have implemented various survey tools developed in conjunction with
Press Ganey Associates, Inc., “the nation’s leading health care satisfaction measurement
firm”. The surveys provide information that is essential to the assessment and
enhancement of the health care experience. Those areas using Press Ganey include
Inpatient, Emergency Room, Ambulatory Surgery, Primary Care Group Practices, Home
Health, and Home Medical Equipment. The results are compiled by Press Ganey in
detailed quarterly reports that are sent to the appropriate respective areas. Additionally,
the EHS Strategic Planning Department conducts an overall analysis to develop a
comprehensive system overview. Since EHS is committed to improving patient
satisfaction, the number of survey tools used within the health system will continue to
grow to capture the experiences of all EHS patients. The Press Ganey reports enable
these areas to monitor all aspects of a patient’s care and focus on areas needing
improvement. Measuring patient satisfaction is essential to gaining important feedback
from patients and ensuring that a high level of quality care and services are available to
the community.

Physician Survey Summary:



                                                                                          17
The physician survey is conducted on an annual basis and is an important tool used to
evaluate clinical, ancillary and other EHS services. More than 100 physicians are selected
to participate in the interview process based on their utilization of EHS services.
Members of the Executive Management Team and EHS Board of Directors interview
each physician individually to go over the questions on the survey. Questions included on
this survey relate to utilization of inpatient and outpatient services, overall perceptions of
the hospital, satisfaction with nursing and patient care on each hospital unit, ancillary
services, and specialty areas needing improvement. Additionally, several questions relate
to the medical staff’s relationship with administration and their level of involvement in
EHS’s strategic direction. The results are carefully analyzed to identify issues raised by
the medical staff and develop improvements to improve the quality of services and best
meet the health care needs of the community.

Women’s Health Focus Groups Summary:

In the early development stages of certain business plans, focus groups may be held as a
method of obtaining important feedback from the community and/or EHS patients. The
focus groups enable the Elliot to listen to members of the community to better understand
their health care needs and expectations of health care services. The comments and
recommendations are taken into consideration as the business plans are developed.
Recently, EHS conducted several focus groups for Women’s and Children’s services that
included:

Ø Three groups of women who recently had babies to discuss hospital child birth
  centers.
Ø A group of patients and parents of patients of the Elliot Hospital Pediatric Unit.
Ø A group of mothers whose babies were in the Elliot Hospital Neonatal Intensive Care
  Unit (NICU).

The results of the focus groups help to define the direction of the business plan, including
improving aesthetics and service offerings. Focus groups also support the development
of process improvement efforts, such as increased communication and improved
efficiencies of admitting/discharge processes and patient flow. Focus groups provide the
Elliot an excellent opportunity to involve the community in operational improvements

In the summer of 2000, Catholic Medical Center, Dartmouth-Hitchcock Clinic and Elliot
Health System engaged Laurie Storey-Manseau, a marketing, public relations and
communications consulting firm located in Hopkinton, New Hampshire, to update
information on community needs in the Greater Manchester area. Plans are underway to
conduct a more comprehensive Community Needs Assessment in FY02 with the Healthy
Manchester Leadership Council.

The study was conducted over a two-month period, and was comprised of two
components – a series of interviews with selected community representatives and focus
groups of various community groups.



                                                                                            18
Community representatives participating in the individual interviews included: the Mayor
of Manchester, the CEO of Moore Center Services, the Executive Director of New
Horizons for New Hampshire, Inc. Homeless Shelter, a Founding Director of the
Manchester Community Health Center and Minority Health Coalition, the School Nurse
from Goffstown High School, the Commissioner of the Manchester Welfare Department,
the Executive Director of the NH Minority Health Coalition, the Family Services
Educator from the Salvation Army, the Student Assistance Program Coordinator from
Memorial High School, the Rabbi from Temple Adath Yeshurun, and the Teen
Coordinator from the Salvation Army.

Eleven individuals were interviewed face-to-face about their perceptions on community
needs. Individuals were selected from a lengthy list provided by Catholic Medical Center,
Dartmouth-Hitchcock Clinic and Elliot Health System. In most instances, interviews were
held in the places of business of those interviewed, and they lasted approximately one
hour. Attempts were made to arrange interviews with three other community leaders, but
meetings could not be scheduled.

Discussions with the consultant were informal and participants seemed very comfortable
in sharing their thoughts, insights and recommendations. Many participants seemed
surprised with the idea that the study sponsors could contribute to community needs in
any way other than those defined as health-care issues. Some were equally excited about
thinking in terms of these organizations’ involvement in finding solutions to housing
shortages, education issues, and providing leadership for the community.

Those interviewed for the study were asked to use the list of community needs identified
in 1997 by the Compass Project as a basis for updating community needs. First, they were
asked to add to or eliminate from the list based on their knowledge and beliefs about
current community needs. They were also given the option of accepting the list as it was,
without changes. Next, they were asked to prioritize these needs through a multi-voting
exercise. In this exercise they were each hypothetically given $10 to allocate to the needs.
They were allowed to allocate only in full-dollar increments. They could allocate any
amount, up to $10, to needs they believed were important. The results of their allocations
can be found in Appendix 2 of the Manchester Community Needs Qualitative Analysis
Report (Appendix E).

In addition to interviews, focus groups of community groups, along with polling of social
service workers and public health leaders in the community comprised the remainder of
the qualitative study. Around one hundred individuals participated. The focus groups
were held with Parents of the VNA Child Care Center and Parent-Baby (ad)Venture,
Seniors participating in Prime Time, Representative of the N.H. Minority Health
Coalition, and the Greater Manchester Social Service Association. Participants were
anxious to share their opinions and pleased that the three organizations were willing to
listen. Participants shared their thoughts and ideas freely, during two hours of discussion.




                                                                                          19
The seven most important needs identified in the Qualitative Assessment in rank order by
the individual interviewees voting were: access to health, mental health and dental
services (20 votes), Education (17 votes), children and youth services (16 votes),
affordable housing (10 votes), elderly and disabled services (8 votes), issues of diversity,
culture and language (6 votes) and public transportation (1 vote).

Excerpts from the focus group priorities that relate to community benefit activities for
consideration by Elliot Health System include: affordable housing, affordable daycare and
after-school programs, expanded space for Parent-Baby (ad)Venture, transportation, cost
of medication, cost of health care, more interpreters and sensitivity to diversity.

The Manchester Community Needs Qualitative Analysis Report includes a summary of
comments and findings, along with recommendations based on feedback from the various
individuals and groups participating in this study. In summary, participants in the
qualitative analysis, which updated the community needs assessment conducted in the
summer and early fall of 2000, concluded that the most pressing community needs
Manchester faces today are:

       Ø   Access to and Affordability of Health, Mental Health and Dental Services
       Ø   Education
       Ø   Affordable and Accessible Housing
       Ø   Children and Youth Services
       Ø   Elderly and Disabled Services
       Ø   Issues of Diversity, Culture and Language
       Ø   Public Transportation
       Ø   Safety

The Qualitative Needs Assessment was used for the development of the Plan for FY02 by
the EHS Board of Directors, Community Health Steering Committee and other
appropriate department heads for their use in determining their community benefits
offerings for FY02. Until the more comprehensive community Needs Assessment with
Healthy Manchester Leadership Council is completed (this effort is described later in this
section), the Qualitative Needs Assessment and the NH Hospital Association’s
Quantitative Needs Assessment will be used in all Elliot Health System efforts toward
meeting the community’s health care needs.

       ·    Once the needs of the community were identified please describe the
            process utilized to prioritize the projects chosen.

In the interviews with individuals, questions probed each individual’s perception of
community needs today in greater Manchester. The first half-hour of each interview was
dedicated to a free-flow of ideas and thoughts surrounding issues and needs in
Manchester. The second half hour of the interviews was structured as a review of the
1997 Compass Project community needs assessment led by the United Way, with the
opportunity for each individual to add to or eliminate from the needs defined in the 1997


                                                                                          20
assessments and then a prioritization of the new list through a multi-voting process,
which is described on page 9. Finally, individuals were asked to make recommendations
as to where the three study sponsors could have a meaningful impact today on
Manchester’s community needs.

In the focus groups, each session began with a free-flow brainstorming among
participants as to what greater Manchester’s community needs might be. The second part
of the focus groups focused on prioritizing the list created by participants and then
discussing what activities or actions needed to take place to address the top priorities.
Finally, participants were asked to individually name one community need that was
important to them and make a recommendation of how the city’s health-care providers
could address the need.

The following Community Benefits were undertaken after prioritization during EHS’
strategic planning process:

Access to and Affordability of Health, Mental Health and Dental Services:

EHS is in the process of adding physician practices in Manchester, Bedford, Goffstown
and Salem and continues to contribute funds to the Manchester Community Health Center
and Child Health Services. Home Health services are provided in support of chronically
ill children and adults. Charity Care policies and procedures are being revised to include
the physician practices of EPN. The VNA Board of Trustees and the VNA Foundation
have taken lead steps in initiating on-site dental hygiene services for the children at the
VNA Child Care & Family Resource Center.

Education:

EHS provides health education programs and services at the Jewett Street School and will
add Hillside Junior High in FY02. EHS will sponsor Safety Saturday with Manchester
and State organizations participating at no cost to the community. Having employees
serve as tutors and mentors to young people is under consideration. EHS provides
speakers and hospital tours for groups who make requests. Through the Visiting Nurse
Association, the EHS will continue to provide bereavement services in the schools as
needed. Internships are provided for college students, such as the placement of St.
Anselm College students at VNA Child Care and Parent-Baby (ad)Venture. The VNA
Child Care & Family Resource Center and VNA Parent-Baby (ad)Venture are working in
partnership with St. Anselm College to provide intern and volunteer opportunities for
students interested in child development careers.

Affordable and Accessible Housing:

Elliot Health System assists patients and clients in accessing appropriate housing through
referrals and case management. The MeetingHouse at Riverfront provides 25 units of




                                                                                        21
assisted living housing which the Visiting Nurse Association staffs. A new day
rehabilitation program for those with neurological damage was started in FY01.

Elliot Health System assists patients and clients in accessing appropriate housing through
referrals and case management. Pearl Manor offers a special combination of housing,
supportive services, personalized assistance and healthcare designed to respond to the
individual needs of those who need help with activities of daily living. Supportive
services are available 24 hours a day to meet scheduled and unscheduled needs, in a way
that promotes maximum dignity and independence for each resident. Subsidized care is
available for those who qualify.

Children and Youth Services:

Through the Visiting Nurse Association Parent-Baby (ad)Venture program, Elliot Health
System provides parenting education, violence prevention, identification of at-risk new
parents and intervention and support for teen parents which assists them in learning skills
and behaviors that foster strong families and healthy children. Child care is provided at
VNA Child care for low-income parents and on the Elliot Hospital campus for EHS
employees. Sliding scale rates will continue to be provided and raising income eligibility
levels is under consideration. Elliot Parenting provides support groups and educational
sessions from the infant to the teenager years on may different topics. The EHS is
providing more infant car seats. Parents are taught by a certified car seat technician.
Proceeds from every infant car seat sold at retail goes back to purchase additional infant
car seats for needy families. Prenatal education for teens from 15-17 will be provided at
no cost in FY02. Prenatal education to Spanish speaking families is also planned for
FY02.

Elliot Health System will continue to support Child Health Services and the Manchester
Community Health Center with cash and in-kind donations to assist them in their
provision of health care services to the under and uninsured patients.

Elderly and Disabled Services:

EHS will strive to improve the comfort and accessibility of its facilities to meet the needs
of senior citizens.

Through Pearl Manor and Elliot Adult Day Care, services are being provided for the
elderly. In addition to day care, these clients also receive physical therapy. Hospice
services including education are available. Plans are underway to open a Geriatric Center
in Manchester in the second half of FY02.

Pearl Manor offers assisted living apartments and Elliot Day Programs offer day services
for the elderly who benefit from a medical / social day program. The Elliot Day Program
at the Arbors was opened March, 2001, and will expand availability of senior day services
in the Bedford / Merrimack / Amherst area to help address market needs and utilize


                                                                                          22
additional space. The established Elliot Adult Day Program will continue to offer medical
/ social day programming for an average of 24 clients per day.

A VNA Community Health Nurse provides clinics for foot care, ear wax removal, and
influenza and pneumonia vaccination, and screenings for osteoporosis, cholesterol, blood
sugar, and blood pressure are provided in senior citizen housing and where they gather.

Community education and outreach for caregivers and seniors will be offered in Fall
2001.



Issues of Diversity, Culture and Language:

Interpretation services are available through the Language Line and will continue to be
improved as more attention is given to this growing need. There will be a focus this
current year on cultural diversity and patient care implications. Efforts are underway to
celebrate diversity by placing displays in visible locations in the hospital at appropriate
times of the year. EHS continues to collaborate with the New Hampshire Minority Health
Coalition, Dartmouth Hitchcock and Catholic Medical Center of issues of diversity,
culture and language.

Public Transportation:

EHS will add free patient transport buses and routes to help EHS patients access health
care. Adult Day Program, VNA Child Care and Parent-Baby (ad)Venture will continue to
provide transportation to and from these programs. A partnership with Caregivers is being
explored to provide transportation for senior citizens to EHS’s Geriatric Center in
Manchester when it opens.

Safety:

EHS provides First Aid classes, Safety Saturday programs for children, EMS Institute,
Heimlich Hugs and other safety education in the schools, and falls prevention for both in-
and outpatient and the community. VNA Childcare has instituted a security system at the
door, a screening process for anyone allowed into the building, and an abduction policy.
VNA Childcare also has a nurse on site to assist with those who are at high risk
medically.

EHS’ Community Health Steering Committee has identified charity care, outreach and
education (mental health, dental health, violence prevention, firearms, smoke detectors,
bike helmet safety, eating disorders, health education: stress management, smoking,
nutrition and fitness), cost of medication, geriatric center, child care and parenting, and
aligning the System efforts in meeting the community’s needs and wants as its foci.




                                                                                              23
       ·   Please attach a copy of the most recent community Needs Assessment.

In addition to the Qualitative Needs Assessment reported in the aforementioned
Appendix E, the Quantitative Needs Assessment conducted by the New Hampshire
Hospital Association is attached as Appendix F. The quantitative needs assessment
revealed:

       Ø The leading causes of morbidity and mortality were heart disease and cancer
         in the Greater Manchester area. The prevalence of the two diseases was higher
         in Manchester (5.7/1000 deaths due to cardiovascular disease) than in the rest
         of the State (3.8/1000).
       Ø Inaccessibility of health care was 18%.
       Ø There was a higher prevalence of injuries in the elderly in the surrounding
         communities. In Manchester the rate mimicked the rest of the State.
       Ø The prevalence of low birth weight was higher in Manchester (56/1000 versus
         52/1000 in NH and 41/1000 in the towns surrounding Manchester).
       Ø There was a higher rate of hospital admissions in Manchester (84/1000) than
         in the rest of the State (79/1000). The rate was 67/1000 in the towns
         surrounding Manchester.
       Ø 3.4% adults receive Medicaid and food stamps versus 2.1% in NH and 1.7%
         in the towns surrounding Manchester.
       Ø 15.8% children receive Medicaid and food stamps in Manchester versus 9.1%
         in NH and 3.4% in the towns surrounding Manchester.
       Ø 24% of 25 year olds have no high school diploma in Manchester versus 12%
         in the towns surrounding Manchester.
       Ø There are 321/1000 births to 15-44 year olds in Manchester versus 275/1000
         in NH and 267/1000 in the towns surrounding Manchester.
       Ø There were 22/1000 births to 15-17 year olds in Manchester versus 15/1000 in
         NH and 8/1000 in the towns surrounding Manchester.
       Ø 33% of the births in Manchester were to unmarried women versus 22.4% in
         NH and 2.2% in the towns surrounding Manchester.
       Ø There were 181/1000 births to mothers with no high school education in
         Manchester versus 110/1000 in NH and 52/1000 in the towns surrounding
         Manchester.
       Ø 22.2% of pregnant women smoke in Manchester versus 17.6% in NH and
         9.4% in the towns surrounding Manchester.

The summary of the quantitative needs assessment indicated the following for the City of
Manchester:

Current Health:

The City of Manchester has higher death rates than the state from heart disease and cancer
(higher, but not as much so, are deaths from diabetes and the incidence of lung cancer).
4% of workers are disabled. 10.6% of people in Manchester and Surrounds were without


                                                                                       24
insurance during the past 12 months which is statistically equivalent to the state average
of 11%.

Use of Health Care:

The City has a slightly higher rate of hospitalizations per person, and higher rates of
hospitalization due to injury.




Risks to Future Health:

In spite of low unemployment, there are high rates of poverty as measured by enrollment
in Medicaid / food stamp programs. The likelihood for continuing high poverty rates is
reflected in high rates of teen births, single motherhood, Medicaid births, and maternal
tobacco use. The high school completion rate also appears to be low.

And finally, Elliot Health System in developing its Plan considered the following
excerpts from the Recommendations to Address Community needs:

       Housing:

       Get rid of bureaucracy. Write letters to Mayor and Governor.

       Transportation:

       Provide more buses and more frequent stops.

       Day Care / After School Care:

       Provide speakers – teenage pregnancy, drugs – orientation, Offer sliding-scale
       rates. Provide sick care. Advertise available services.

       Safety:

       Teach in the schools. Address domestic violence. Address elder abuse. Address
       the need for respite care. Attend community meetings.

       More Interpreters:

       Contact community leaders in each cultural group. Provide flyers when there is a
       need for publicity.


                                                                                          25
        The responses to the following two questions will be used in assessing the
overall cost of implementing this law.

       ·   Did the organization hire an outside firm to prepare the Needs
           Assessment?

           Yes X              No ____

Yes, Elliot Health System, along with Catholic Medical Center and Dartmouth-Hitchcock
Clinic hired an outside firm to prepare the Needs Assessment.



       ·    If the answer is yes, what was the cost of the Needs Assessment?

The cost to EHS of using an outside firm to prepare the needs assessment in FY01 was
$ 4,362.75 .

       ·    If the answer is no and the plan was completed internally, how many
            personnel hours were required to prepare the Needs Assessment?

In addition to the above, fifty (50) personnel hours were required by EHS staff to prepare
the Needs Assessment, approximately 1500 EHS personnel hours were required to
prepare the Community Benefits Plan, and production and distribution costs totalled
approximately $5,000. Therefore, the total cost borne by Elliot Health System for
complying with RSA 7:32 c-l is approximately $ 55,443 annually.

VII. Collaboration – Statutory reference: RSA 7:32-f and 7:32-l.

     If the community needs assessment was prepared in collaboration with other
health care charitable trusts, please attach a list of names, addresses, and telephone
numbers of collaborative organizations and relationship if any, between these
organizations. One health care charitable trust should be selected as the contact for
the collaborative.

Elliot Health System collaborated on the Community Needs Assessment and on segments
of the Plan with Catholic Medical Center and Dartmouth-Hitchcock Clinic. The names,
addresses and phone numbers of those on the Needs Assessment Steering Committee
included:

               Sr. Margaret Ahern, RSM               Paul Mertzic
               Catholic Medical Center               Catholic Medical Center
               195 McGregor Street 3rd fl            195 McGregor Street 3rd fl
               Manchester, NH 03102                  Manchester, NH 03102


                                                                                        26
               Phone: 663-8701                       Phone: 663-8709

               Debra Grabowski, VP                   Joan A. Stevens, M.Ed.
               Elliot Health System                  Elliot Health System
               1850 Elm Street                       321 Lincoln Street
               Manchester, NH 03104                  Manchester, NH 03103
               Phone: 662-4000                       Phone: 663-8407

               Gina Balkus                           Anna Noetzel
               Dartmouth-Hitchcock Clinic            Manchester Health Department
               100 Hitchcock Way                     795 Elm Street, Suite 302
               Manchester, NH 03104-4125             Manchester, NH 03101
               Phone: 629-1286                       Phone: 624-6466


               Gail Garceau, President               Frederick Rusczek, MPH
               United Way of Greater Manchester      Public Health Director
               1001 Elm Street, Suite 105            Manchester Health Department
               Manchester, NH 03101-1829             795 Elm Street, Suite 302
               Phone: 625-6939                       Manchester, NH 03101
                                                     Phone: 628-6466

               Rich DiPentima, RN, MPH               Greg Townsend, Executive Director
               Deputy Public Health Director         of Performance Improvement
               Manchester Health Department          Elliot Hospital
               795 Elm Street, Suite 302             1 Elliot Way
               Manchester, NH 03101                  Manchester, NH 03103
               Phone: 624-6466 X339                  Phone: 663-2969

               Also in attendance at several meetings were:

               Jazmin Miranda-Smith                  Bobbie Bagley
               NH Minority Health Coalition          NH Minority Health Coalition
               PO Box 3992                           PO Box 3992
               Manchester, NH 03105                  Manchester, NH 03105
               Phone: 627-7703                       Phone: 627-7703

All of the individuals named above represent their organizations on the Healthy
Manchester Leadership Council, which is staffed by the Manchester Health Department
and meets monthly in Manchester. Debra Grabowski and Joan Stevens represent Elliot
Health System and its subsidiaries.

Catholic Medical Center, Dartmouth-Hitchcock and Elliot Health System are currently
participating in interpretation and health disparity efforts lead by the New Hampshire
Minority Health Coalition. Elliot Health System is in the process of revising its charitable


                                                                                          27
care policy and application process which may accommodate a reciprocal arrangement
between local healthcare providers.

The Healthy Manchester Leadership Council is currently planning to undertake a major
Needs Assessment, which will address six indicators of health and well being:

       Ø   Natural Environment Issues
       Ø   Health Issues
       Ø   Economic Issues
       Ø   Public Safety Issues
       Ø   Education Issues
       Ø   Social Environment Issues

           Please Note: One copy of the community needs assessment should be filed
       for the collaborative. Participating charitable trusts should make reference
       to this collaborative assessment in preparing their community benefit plans.
           What was the beginning date of the fiscal year used for this
       collaboration?

The beginning date of the fiscal year used for this collaboration was July 1, 2000.

VIII. Community Benefit Plan: Statutory reference: RSA 7:32-e

       The document filed must include a listing of community benefits or benefits
       activities planned by the health care charitable trust. Health care charitable
       trusts working in collaboration with other organizations are required to
       provide individual information pursuant to RSA 7:32-l. For each community
       benefit activity, the following information must be included:

       ·    A description of the benefit or benefit activity and how the activity will
            further the mission of the organization and the objectives of the
            community needs assessment.

       ·    The need to be addressed to the target/affected population for the
            benefit.

       ·    The goal(s) to be accomplished.

       ·    Objectives to be achieved within the target dates and the methodology
            utilized to measure outcomes.

       · If the plan was prepared in collaboration with other health care
           charitable trusts, please complete Section VII.




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Section VII was filled out as required, since the Needs Assessment and the Plan were
conducted in collaboration with other healthcare charitable trusts. The collaborators on
the Needs Assessment are listed in Section VII and the collaborators on the Plan, Elliot
Health System’s subsidiaries, are listed on page 1.

A partial listing of the Community Benefits planned for the ensuing year (FY02) follows.
The project costs indicate the projected benefit (expenses minus revenues).

1. A. Benefit Activity: Additional clinicians offering more appointments in more
   locations
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. By adding clinicians,
           including specialists such as gastroenterologists, in area locations, residents
           will be able to access healthcare more readily.
       2) Objectives of Community Needs Assessment: Access to and affordability of
           health, mental health and dental services
   B. Need to be addressed: Access to healthcare.
       1) Target Population: Those in need of health care in EHS’ service area
   C. Goal: Those in need of health care in EHS’ service area will be able to access
       services
   D. Measurement Objectives: Physician practices will be added in Merrimack, New
       Boston, Raymond, Manchester and in two locations in Hooksett
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: number of new patients and number of appointments
   E. Project Cost: $ 2,515,040

2. A. Benefit Activity: Increased transportation services
      1) Mission of Organization: The Elliot Health System, through its subsidiary
         provider and development organizations, offers cost-effective strategies and
         solutions for meeting the region’s health care challenges. More EHS buses,
         routes and stops will better accommodate clients need for transportation
      2) Objectives of Community Needs Assessment: Public transportation
   B. Need to be addressed: More EHS buses, routes and stops
      1) Target Population: Those in need of transportation in Elliot Hospital’s Primary
         Service Area
   C. Goal: Patients in need of transportation will be able to access it
   D. Measurement Objectives: Add routes and pick-ups
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Press Ganey patient satisfaction surveys
   E. Project Cost: $ 303,000

3. A. Benefit Activity: Continue to have patients rights available in multiple languages:
   English, French, Spanish, Polish, Russian, Greek, Bosnian, and Vietnamese.




                                                                                           29
        1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Materials posted in
            languages will better meet the needs of those for whom English is a second
            language
        2) Objectives of Community Needs Assessment: Issues of Diversity, Culture and
            Language
   B.   Need to be addressed: Language barriers.
        1) Target Population: Minorities in EHS’ service area
   C.   Goal: Two prevalent minority populations will be able to read patients rights
        policy.
   D.   Measurement Objectives: Signs will be prominently posted in common areas.
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Walk through monthly to observe posting of patients
            rights policy in three languages.
   E.   Project Cost: $ 1,000



4. A. Benefit Activity: Health education programming in the schools
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Programs in schools
           will give children information with which to make healthy choices
       2) Objectives of Community Needs Assessment: Health Education
   B. Need to be addressed: School health education
       1) Target Population: Children in the school system in EHS’ service area
   C. Goal: Continue Jewett Street School partnership and add Hillside Junior High
       partnership at the eighth grade level
   D. Measurement Objectives: Evidence of health education programming by EHS
       employees at Jewett Street School and at Hillside at every grade level
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Program evaluations completed by teachers will
           reflect favorable on the program
   E. Project Cost: $ 20,000

5. A. Benefit Activity: Identify at-risk infants and parents, teach parenting skills and
      provide intervention and support to young parents and their at-risk infants through
      Parent-Baby (ad)Venture. Seek new space that will better accommodate the current
      needs and that will allow program expansion in the future.
        1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Good parenting will
            lead to children growing up safe and healthy in body, mind and spirit
        2) Objectives of Community Needs Assessment: Children and Youth Services


                                                                                         30
   B. Need to be addressed: Identification of high risk infants, parenting skills and
       intervention and support
       1) Target Population: Young parents and at-risk infants
   C. Goal: All parents enrolled in the Parent-Baby (ad)Venture program will learn
       good parenting skills and have a support network
   D. Measurement Objectives: Increase in knowledge of good parenting skills, high
       satisfaction of intervention and support services received, and increase in the
       number of program participants
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Questionnaires and follow-up with parents to see
           how much they learned, level of satisfaction and number of participants on
           program registration lists
   E. Project Cost: $ 110,000

6. A. Benefit Activity: Work with minority groups through the NH Minority Health
   Coalition and its REACH project (which focuses on African Americans, Hispanics
   and Asian Americans with hypertension and diabetes) to learn about and better
   understand their cultures and to reduce health disparities.
      1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Minorities have
           language and culture barriers that differ from the traditional white Anglo-
           Saxon population that can be met through staff education to these differences.
      2) Objectives of Community Needs Assessment: Issues of Diversity, Culture and
           Language
   B. Need to be addressed: Cultural competence
      1) Target Population: EHS employees and minorities in Elliot Health System’s
           service area
   C. Goal: Employees of EHS will be better able to communicate effectively to meet
      the health needs of minorities
   D. Measurement Objectives: All EHS employees will document competency in the
      area of cultural and ethnic diversity
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Annual documentation of competency through
           performance reviews and attendance at Required Education Day.
   E. Project Cost: $ 8,000 including $500 in screening services

7. A. Benefit Activity: Safety Education at Jewett Street School’s Fun Fair
      1) Mission of Organization: The Elliot Health System, through its subsidiary
         provider and development organizations, offers cost-effective strategies and
         solutions for meeting the region’s health care challenges. By providing safety
         education the health risk of injury can be mitigated
      2) Objectives of Community Needs Assessment: Safety
   B. Need to be addressed: Unintentional injury
      1) Target Population: School age children in EHS service area


                                                                                         31
   C. Goal: School age children will practice safety precautions
   D. Measurement Objectives: 100 children and parents will attend and participate in
      the Fun Fair
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Attendance level. Observation of safe practices and
          reduction of unintentional injury
   E. Project Cost: $ 100

8. A. Benefit Activity: TraumaRoo presentations
      1) Mission of Organization: The Elliot Health System, through its subsidiary
         provider and development organizations, offers cost-effective strategies and
         solutions for meeting the region’s health care challenges. By meeting the
         TraumaRoo, children, parents, and caregivers will be more aware of potential
         sources of trauma and how to prevent injuries from happening.
      2) Objectives of Community Needs Assessment: Safety
   B. Need to be addressed: Safety
      1) Target Population: Young people in EHS’ service area
   C. Goal: Reduce unintentional injuries
   D. Measurement Objectives: 250 kids will enjoy the presentation and learn how to
      prevent at least one cause of unintentional injury
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Track prevalence of ED visits due to trauma Project
   E. Cost: $ 500

9. A. Benefit: Hospital tours
      1) Mission of Organization: The Elliot Health System, through its subsidiary
         provider and development organizations, offers cost-effective strategies and
         solutions for meeting the region’s health care challenges. By having children
         visit the hospital they will better understand several services they are
         introduced to
      2) Objectives of Community Needs Assessment: Day care and after school care
   B. Need to be addressed: Health education
      1) Target Population: Children in schools and organizations in EHS service area
   C. Goal: Children will better understand hospital services
   D. Measurement Objectives: Elliot Hospital will promote several tour dates each
      month to the community
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Process evaluation only (number of tours and
         number of participants)
   E. Project Cost: $ 5,000

10. A. Benefit: Charitable Care
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and




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           solutions for meeting the region’s health care challenges. Charitable care is a
           solution to enable those most in need to access health care services.
        2) Objectives of Community Needs Assessment: Access to and availability and
           affordability of health care
   B.   Need to be addressed: Access to healthcare
        1) Target Population: The underserved
   C.   Goal: To insure that patients are aware of EHS charitable care policies and how to
        access them.
   D.   Measurement Objectives: There will be a documented increase in the amount of
        charity care provided.
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Financials
   E.   Project Cost: $ 3,974,614

11. A. Benefit: Interpretation Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and
          solutions for meeting the region’s health care challenges. Patients and health
          care providers need to be able to communicate in order to be able to
          render/receive quality health care.
       2) Objectives of Community Needs Assessment: Issues of Diversity, Culture and
          Language
    B. Need to be addressed: Interpretation services to overcome language barriers.
       1) Target Population: Those for whom English is not a primary language
    C. Goal: To eliminate the language barrier
    D. Measurement Objectives: Language interpretation will not appear as a patient
       complaint
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Improvements in Press Ganey survey results
    E. Project Cost: $45,000

12. A. Benefit: Support of Child Health Services and Manchester Community Health
    Center
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Child Health
           Services and the Manchester Community Health Center provide health care to
           those in great need.
       2) Objectives of Community Needs Assessment: Access to Healthcare
    B. Need to be addressed: Access to healthcare
       1) Target Population: The underserved
    C. Goal: Under-served will have access to healthcare
    D. Measurement Objectives: Number of patients seen by Child Health Services and
       Manchester Community Health Center
       1) Target Dates: July 1, 2001 – June 30, 2002


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      2) Outcomes Methodology: Annual reports from the above
   E. Project Cost: $ 490,000 + $50,000 Social Worker for Child Health Services

13. A. Benefit: General Voluntary Action: holiday baskets, turkey distribution, clothing
    collection and the like
        1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Food, clothing, and
            shelter are basic needs that impact the health of the neediest in EHS’s service
            area.
        2) Objectives of Community Needs Assessment: All needs identified
    B. Need to be addressed: The need for available, safe and affordable housing was
        identified. Those without housing or with inadequate housing also need food and
        clothing.
        1) Target Population: The underserved
    C. Goal: To reach the underserved with services that meet basic needs
    D. Measurement Objectives: Documenting services provided
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Documentation of services provided
    E. Project Cost: A dollar amount was non-quantifiable since the food and clothing
        were donations.

14. A. Benefit: Support Groups such as: Breast Cancer, Living Beyond Breast Cancer,
    Chronic Pain, Living with Cancer, Living with Breast Cancer, Parkinson’s, Prostate
    Cancer, S.H.A.R.E.
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. People with chronic
           diseases have psychosocial needs, which can be met through support groups.
       2) Objectives of Community Needs Assessment: Access to medical care and
           health education.
    B. Need to be addressed: helping individuals and their families to live with their
       disease
       1) Target Population: Those with disease and disability
    C. Goal: Those with disease and disability will be better prepared to live with their
       disease / disability
    D. Measurement Objectives: Number of participants
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: 90% or better will be satisfied with the service
    E. Project Cost: $ 36,000

15. A. Benefit: Child Care on a Sliding Fee Scale Based on Income
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and
          solutions for meeting the region’s health care challenges. The need for child


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           care with so many parents working is one of the region’s challenges that is
           broadly related to health care.
        2) Objectives of Community Needs Assessment: Access to child care
   B.   Need to be addressed: Affordable child care
        1) Target Population: Low income working parents and their children
   C.   Goal: Working parents will have access to affordable day care for their children
   D.   Measurement Objectives: Number of families using VNA Child Care
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Track the number of families receiving discounted
           services
   E.   Project Cost: $456,548

16. A. Benefit: Adult Day Program Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Senior citizens with
           health care issues need a nurturing place to spend the day when working
           relatives aren’t available.
       2) Objectives of Community Needs Assessment: Senior services
    B. Need to be addressed: Adult day care
       1) Target Population: Senior citizens in need of day care in EHS Service area
    C. Goal: Families will have a safe, secure, stimulating environment for senior
       citizens in need of day care
    D. Measurement Objectives: A total of 24 senior citizens will be cared for between 8
       a.m. and 4 p.m. at Elliot Adult Day Program, 2 Elliot Way, Manchester, NH, and
       during FY02 six clients building to 20 clients will be served and the Elliot Adult
       Day Program at the Arbors between the hours of 9 a.m. and5 p.m. This almost
       doubles the number served in 2001.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Primary caretakers and clients will be surveyed
           yearly to determine satisfaction and areas for improvement.
    E. Project Cost: Arbors: $ 17,341

17. A. Benefit: Senior Citizen Housing and Care
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Senior citizens who
           need specialized care
       2) Objectives of Community Needs Assessment: Housing and senior services
    B. Need to be addressed: Housing and care for senior citizens
       1) Target Population: Senior citizens in need of care in EHS Service area
    C. Goal: Seniors citizens in need of care will be housed and cared for according to
       subsidy criteria.
    D. Measurement Objectives: Senior citizens in need of long term care will be cared
       for without regard to ability to pay.


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      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Track the number cared for and the cost underwritten
         by EHS according to subsidy criteria.
   E. Project Cost: $ 279,563

18. A. Benefit: Bereavement Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Situations
           necessitating bereavement services constitute emotional health issues.
       2) Objectives of Community Needs Assessment: School health education
    B. Need to be addressed: Students with a death in the family or in the community.
       1) Target Population: Schools in EHS Service area
    C. Goal: Those in need of counseling services will have access to them.
    D. Measurement Objectives: Process grief and develop a network of support.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Schools will ask counselors back as needed.
    E. Project Cost: $ 29,952

19. A. Benefit: Volunteer Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. The VNA is able to
           increase the volume and the quality of care and services being provided to
           patients and their families as well as to give additional support and care to the
           children at the VNA Child Care & Family Resource Center.
       2) Objectives of Community Needs Assessment: Access to health care.
    B. Need to be addressed: Increase and enhance volunteer opportunities by providing
       for increased quality of life for both recipient of service and the volunteers.
       1) Target Population: All
    C. Goal: To improve the quality of life for those suffering from a terminal illness as
       well as to reach out to help more children learn successful coping skills, decrease
       their anger and thereby improve their overall health and well-being.
    D. Measurement Objectives: Increase the volunteer hours being provided through the
       VNA.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: The volunteers will be requested to continue on like
           projects.
    E. Project Cost: Cost is difficult to project since volunteers are not paid. They are
       trained and supervised and get some perks. There is staff time involved.
       The value and benefit to this community of providing volunteers to the patients
       and children served through the programs of the VNA continues to grow on an
       annual basis. Over the past seven years, the total of volunteer hours has grown
       from 2,457 to 10,056. In the year 2000 the benefit to this community was




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       translated to $143,800. The total cost of providing this critical community benefit
       is less than 4% of the benefit.

20. A. Benefit: Hospice Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Hospice exists to
           provide support for individuals and families when there is a life threatening
           illness.
       2) Objectives of Community Needs Assessment: Quality health care services.
    B. Need to be addressed: Increase the knowledge in providing comfort and
        managing pain and other symptoms to caregivers which will ultimately positively
        affect the quality of care to patients and their families.
       1) Target Population: Family members and caregivers.
    C. Goal: To improve the quality of end of life care by ensuring family and
        caregivers are comfortable in managing pain and symptom control.
    D. Measurement Objectives: To share the knowledge and expertise of the hospice
        staff in enhancing comfort and managing pain and other symptoms.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Assess family and caregiver satisfaction survey
           scores.
    E. Project Cost: $29,952 The cost of family and caregiver training is combined with
        the overall cost of nursing, social service and therapists visits.



21. A. Benefit: Car Seat Program
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Accident prevention
           will reduce some of the need for health care.
       2) Objectives of Community Needs Assessment: Safety
    B. Need to be addressed: Educate families of the importance of car seat safety.
        Provide car seats for low-income families at a small cost to the family.
       1) Target Population: All
    C. Goal: Provide two car seat checks during the year of 2001 to quantify use.
    D. Measurement Objectives: 100% of infants leaving Elliot Hospital will be placed
        in car seats throughout infancy.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: The number of families that are given car seats will
            be called by phone. The number of people reached by phone and the number
            still using the car seat will be tracked.
    E. Project Cost: $3,500.00.

22. A. Benefit: Boot Camp Reunion


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        1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Promotes good
            parenting.
        2) Objectives of Community Needs Assessment: Parenting skills.
   B.    Need to be addressed:
        1) Target Population: New fathers.
   C.    Goal: New Dads will reinforce their parenting skills through interaction with
         their peers.
   D.    Measurement Objectives: 10% of the total number of veterans will attend.
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Client satisfaction survey: the percent of the number
            surveyed who give a positive response.
   E.    Project Cost: $800.00

23. A. Benefit: NICU Reunion
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Neonates need
           highly specialized health care.
       2) Objectives of Community Needs Assessment: Health education.
    B. Need to be addressed: Access to health care and psychological support.
       1) Target Population: Families of NICU graduates.
    C. Goal: 25% of graduates will attend.
    D. Measurement Objectives: Graduates of the NICU will attend to share knowledge
        and experiences.
       1) Target Dates: June 2002
       2) Outcomes Methodology: The number reporting a positive response on client
            satisfaction surveys.
    E. Project Cost: $12,000.00.

24. A. Benefit: Safety Saturday
       1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Accident prevention
            will reduce the need for health care. Children, especially boys, need to be
            made aware of safety issues to prevent injury, even death.
       2) Objectives of Community Needs Assessment: Safety
    B. Need to be addressed: To educate families about safety
       1) Target Population: Parents and children in EHS service area.
    C. Goal: Families will be able to give three safety tips.
    D. Measurement Objectives: 25% of the families surveyed will be able to give three
        safety tips.
       1) Target Dates: Fall 2002
       2) Outcomes Methodology: Families will be surveyed.


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   E. Project Cost: $2,500.00.

25. A. Benefit: Lactation Warm Line / Outpatients
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Thriving infants
           will reduce the need for health care.
       2) Objectives of Community Needs Assessment: Parenting education.
    B. Need to be addressed: Questions about breast-feeding.
       1) Target Population: All
    C. Goal: To answer questions about breast-feeding within 24 hours.
    D. Measurement Objectives: Families use the line to have breast-feeding questions
        answered.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: 99% of the time questions will be answered within
           24 hours.
    E. Project Cost: $4,200

26. A. Benefit: Childbirth Classes
       1) Mission of Organization: The Elliot Health System, through its subsidiary
            provider and development organizations, offers cost-effective strategies and
            solutions for meeting the region’s health care challenges. Births with positive
            outcomes will reduce the need for health care.
       2) Objectives of Community Needs Assessment: Parenting education.
    B. Need to be addressed: Education about childbirth.
       1) Target Population: All
    C. Goal: Families will gain knowledge of preparation of labor, being a parent, being
        a grandparent and care and safety of the newborn.
    D. Measurement Objectives: 95% of the attendees will be able to give three tips they
        will use in labor or being a new parent/grandparent.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Quiz and Client Satisfaction Surveys will be
            administered.
    E. Project Cost: $12,000

27. A. Benefit: Parenting Classes
        1) Mission of Organization: The Elliot Health System, through its subsidiary
             provider and development organizations, offers cost-effective strategies and
             solutions for meeting the region’s health care challenges. Parenting education
             will reduce the need for health care.
       2) Objectives of Community Needs Assessment: Parenting education.
    B. Need to be addressed: Dealing with children of all ages.
        1) Target Population: All
    C. Goal: To give families factual information in dealing with children of all ages,
         through support groups or seminars.


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   D. Measurement Objectives: 95% of attendees will be able to give three tips in
       dealing with today’s children.
      1) Target Dates: July 1, 2001 – June 30, 2002
      2) Outcomes Methodology: Survey.
   E. Project Cost: $5,400

28. A. Benefit: Closing medical waste incinerator
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Medical waste is
           expensive and potentially hazardous if not properly handled
       2) Objectives of Community Needs Assessment: Safety
    B. Need to be addressed: Environmental Health
        1) Target Population: All
    C. Goal: Medical waste will be handled in an environmental responsible manner
    D. Measurement Objectives: The medical waste incinerator will be closed by 7/13/01
        1) Target Dates: July 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Record of medical waste incinerator closed and
            medical waste being autoclaved, shredded and landfilled
    E. Project Cost: $35,000

29. A. Benefit: Increased non-profit availability of home health, hospice, home medical
    equipment and infusion therapy services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. VNA Home Health &
           Hospice Services will develop a plan to expand its service area, as needed, to
           meet the needs of the EHS primary care network and beyond
       2) Objectives of Community Needs Assessment: Access to and affordability of
           home health, hospice, home medical equipment, and infusion services
    B. Need to be addressed: Access and affordability
        1) Target Population: Those in need of home health care in EHS service area
    C. Goal: Those in need of home health care will be able to access services
    D. Measurement Objectives: Services will be expanded in FY02 to reach New
        Hampshire patients referred to the VNA through the Elliot Physician Network
        1) Target Dates: October 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Number of new patients served in expanded service
            area
    E. Project Cost: $3,900

30. A. Benefit: Expansion of VNA Child Care programs and service delivery
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and
          solutions for meeting the region’s health care challenges. The child care center




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            will add a dental hygienist program to provide on-site oral hygiene prevention,
            education, and treatments.
        2) Objectives of Community Needs Assessment: Access to and affordability of
            dental care
   B.   Need to be addressed: Access and affordability
        1) Target Population: The children and families served at the VNA Child Care
   C.   Goal: To provide an oral hygiene program that will meet an unmet community
        need and will instill the importance of dental care with families and children in
        the critical and formative years
   D.   Measurement Objectives: Services will be introduced in FY02 to reach the low
        income, high risk children of the VNA Child Care
        1) Target Dates: October 1, 2001 – June 30, 2002
        2) Outcomes Methodology: Number of children screened and served. Number
            referred for dental services, associated real costs, and cost savings
   E.   Project Cost: $25,000. The VNA is currently applying for grant funding to enable
        this program to be brought to the community

31. A. Benefit: Expansion of VNA workforce through the establishment and training of
    Personal Care Service Providers
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. VNA Personal
           Services will develop and implement a plan to recruit, train, and utilize
           Personal Care Service Providers to perform tasks that can be provided more
           cost effectively without compromising clinical care
       2) Objectives of Community Needs Assessment: Access to and affordability of
           personal care services
    B. Need to be addressed: Access and affordability
       1) Target Population: Seniors, children and disabled individuals wishing to
           remain in the comfort of their own home for as long as safely possible
    C. Goal: To provide expanded availability of staff who can assist individuals with
       their personal care needs and help them to improve and / or maintain their
       independence in the comfort of their home.
    D. Measurement Objectives: PCSP services will be introduced in FY02 to assist
       seniors and disabled individuals who are able to self direct their care in this
       community
       1) Target Dates: November 1, 2001 – June 30, 2002
       2) Outcomes Methodology: Number of new patients and visits provided annually
    E. Project Cost: $10,000

32. A. Benefit Activity: Automation of the VNA medical record.
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and
          solutions for meeting the region’s health care challenges. VNA Home Health
          & Hospice Services will implement an automated and linked medical record


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            system that will improve patient care, customer satisfaction, and operational
            efficiencies.
        2) Objectives of Community Needs Assessment: Improved access of quality
            health care.
   B.   Need to be addressed: Access and affordability.
         1) Target population: Home Health patients in current and expanded
             geographical locations.
   C.   Goal: To facilitate improved clinical and financial outcomes through improved
        access and accuracy of data. To expand service provision through recruitment of
        staff in outlying geographical towns who will be able to enter and retrieve patient
        information without coming to the VNA office. To improve patient and employee
        satisfaction by reducing manual paperwork and increasing communication among
        providers resulting in better patient outcomes.
   D.   Measurement Objectives: An automated Medical Record system will be chosen,
        purchased, and implemented in FY 02.
        1) Target Dates: November 1, 2001 – July 30, 2002
        2) Outcomes Methodology: Successful implementation and reduced denials of
            claims from Medicare and other payors.
   E.   Project Cost: The gross estimated cost for full implementation is close to
        $1,000,000. Once staff are trained, however, and the system is fully integrated we
        expect to see several efficiencies as rewriting and rekeying will be eliminated.
        Grants are currently being written to improve our ability to launch this new
        program and to fulfill our mission.

33. A. Benefit Activity: Workforce Recruitment and Retention
       1) Mission of Organization: The Elliot Health System, through its subsidiary
       provider and development organizations, offers cost-effective strategies and
       solutions for meeting the region’s health care challenges. The VNA will develop
       a planned approach for workforce recruitment and retention to address the
       workforce shortage.
       2) Objectives of Community Needs Assessment: Access and affordability of
       quality health care.
    B. Need to be addressed: Access and affordability.
       1) Target population: Home Health patients in current and expanded geographical
       locations.
    C. Goal: To have staff available to meet the growing senior and disabled population.
    D. Measurement Objectives: Decrease turnover of staff and length of time vacant
       positions are open. Use flexibility in strategies that promote staff satisfaction and
       quality of life.
       1) Target Dates: July 1, 2001 – July 30, 2002
       2) Outcomes Methodology: Reduction in staff turnover and improved hiring
           policies and practices to attract and retain the best and brightest staff.
    E. Project Cost: $ 101,650

34. A. Benefit: Breast and Cervical Cancer Program


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        1) Mission: The Elliot Health System, through its subsidiary provider and
            development organizations, offers cost-effective strategies and solutions for
            meeting the region’s health care challenges. To respond to the diverse needs
            of all people in the communities we serve by offering grant funded breast and
            cervical cancer screening at no cost to women who fit the financial and age
            criteria defined by the CDC (funding source).
        2) Objective: Cancer prevention and early detection by screening and education.
   B.   Access to health care for women who are under served.
        1) Target population: Women who live at 250% or below the poverty line and are
            age 50 or older (with some exceptions).
   C.   Goal: To provide early diagnosis and improve prognosis for women in this
        category and provide education about the importance and methods of early
        detection and prevention.
   D.   Measurement objectives: Plan to screen 125 women in 12 months at a cost of $17,
        524.00
   E.   Program cost: $17,524 funded, approximately $2,500.00 in kind service.

35. A. Benefit: Breast Cancer Support Groups
       1) Mission: The Elliot Health System, through its subsidiary provider and
           development organizations, offers cost-effective strategies and solutions for
           meeting the region’s health care challenges. To demonstrate concern for
           individuals who have been diagnosed with Breast Cancer by addressing and
           meeting their need for information and support.
       2) Objective: To provide support and information to individuals who have been
           diagnosed with cancer.
    B. Access to health information and support.
       1) Target population: 1) Women with newly diagnosed breast cancer 2) Women
           who are long term survivors of Breast Cancer.
    C. Goal: To meet the informational and emotional needs of women diagnosed with
       breast cancer.
    D. Measurement objectives: as determined by program evaluation filled out by each
       member and other feedback.
    E. Program Cost: Salary and snacks for two ongoing support groups approximately
       $4000.00

36. A. Benefit: Cancer Symposium
       1) Mission: The Elliot Health System, through its subsidiary provider and
          development organizations, offers cost-effective strategies and solutions for
          meeting the region’s health care challenges. To offer a scientific and medical
          educational opportunity to the health care community in our region.
       2) Objective: To provide a full day educational opportunity for physicians and
          other health care providers on the subject of Cancer and Genetics as Applied
          to Breast and Colon Cancer.
    B. Need to be addressed: Physicians and other health care providers.
       1) Target population: Medical professionals.


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   C. Goal: Provide a scientific educational opportunity for physicians in the
      community on a subject that is new and developing quickly as an area of expertise
      in cancer care so they may address the needs of their patients appropriately and
      knowledgeably.
   D. Measurement objectives: Evaluation tool. Expect to have 350 registered attendees.
   E. Program Cost: Approximately $15,000.00 – paid for by registration fees and
      vendor sponsorship.

37. A. Benefit: Cancer Survivor Day
       1) Mission: The Elliot Health System, through its subsidiary provider and
           development organizations, offers cost-effective strategies and solutions for
           meeting the region’s health care challenges. To provide cancer survivors and
           their loved ones with a fun uplifting event that commemorates their cancer
           experience.
       2) Objective: To provide a “gift” of a fun event to the cancer survivors in the
           Elliot Health System Community.
    B. Need to be addressed: Cancer survivors and the loved ones they choose to include.
       1) Target population: Cancer survivors.
    C. Goal: To provide recognition to these individuals and bring them joy.
    D. Measurement objectives: Number of attendees – more than 350 survivors. Letters
       of appreciation. Positive media representation.
    E. Program Cost: Approximately $16,500.

    The staff in Oncology Services plan to continue to be flexible in regard to accepting
opportunities to go into the community to provide education and support. We expect to
provide one or two other programs this fiscal year that have not been defined. We support
programs initiated by other organizations such as the American Cancer Society that are
not listed here. Other departments in the Elliot Health System provide some Oncology
related programs that have not been listed here. Examples of this are the Prostate Cancer
Screening program and the Prostate Cancer Support Group that the Urology Department
provides and the Living with Cancer Support Group that the Social Work Department
provides.

38. A. Benefit: Bereavement Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Situations
           necessitating bereavement services constitute emotional health issues.
       2) Objectives of Community Needs Assessment: A widows and widowers
           Bereavement Group
    B. Need to be addressed: Grieving widows and widowers
       1) Target Population: Widows and widowers in the EHS service area
    C. Goal: Those in need of counseling services will have access to them.
    D. Measurement Objectives: Process grief and develop a network of support.
       1) Target Dates: July 1, 2001 – June 30, 2002


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      2) Outcomes Methodology: Monthly support groups will be provided for widows
         and widowers.
   E. Project Cost: $ 1,048

39. A. Benefit: Bereavement Services
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Situations
           necessitating bereavement services constitute emotional health issues.
       2) Objectives of Community Needs Assessment: A music and literature library to
           help those individuals deal with loss and grief
    B. Need to be addressed: Those individuals in the community dealing with loss and
       grief.
       1) Target Population: Schools in EHS Service area
    C. Goal: Those in need of educational literature and music will have access to them
       through a literature and music library.
    D. Measurement Objectives: Process grief and develop a network of support.
       1) Target Dates: July 1, 2001 – June 30, 2002
       2) Outcomes Methodology: A library for books and music related to dealing with
           grief will be provided for the community.
    E. Project Cost: $ 5,000

40. A. Benefit: Mind / Body Medicine Open House
       1) Mission of Organization: The Elliot Health System, through its subsidiary
           provider and development organizations, offers cost-effective strategies and
           solutions for meeting the region’s health care challenges. Educating the
           community about preventative measures for stress reduction and how one can
           incorporates “Complementary and Alternative Modalities” (CAM) therapies in
           the home and / or combined with conventional medicine will reduce the need
           for health care and create a greater sense of well being that supports healing.
       2) Objectives of Community Needs Assessment: Outreach / education
    B. Need to be addressed: Dealing with children of all ages.
       1) Target Population: All
    C. Goal: To provide the community access to information, education and therapies
       based on CAM for mind / body medicine, as well as a chance to experience first
       hand various therapeutic modalities.
    D. Measurement Objectives:
       1) Target Date: May 9, 2002
       2) Outcomes Methodology: Survey
    E. Project Cost: $1,200

41. A. Benefit: Healthy Heart Fair
       1) Mission of Organization: The Elliot Health System, through its subsidiary
          provider and development organizations, offers cost-effective strategies and
          solutions for meeting the region’s health care challenges.


                                                                                         45
           2) Objectives of Community Needs Assessment: Increase community awareness
               and provide information to assist with healthcare self-advocacy.
      B.   Need to be addressed: Access to and availability of health care and education
           1) Target Population: All
      C.   Goal: To give families factual information regarding heart health, diagnostics and
           treatment.
      D.   Measurement Objectives: Have a minimum or 75 people come through the fair
           having blood pressure or cholesterol checks
           1) Target Dates: February, 2002
           2) Outcomes Methodology: The number of people counseled / referred to their
               PCP because of elevated cholesterol of BP findings.
      E.   Project Cost: $3,703

The report of the activities the trust has undertaken is reported in Section IX.

IX.        Inventory & Valuation of all Community Benefits:

           Statutory reference: RSA 7:32-d III and 7:32-e IV and V

        Describe in detail the cost of the community benefits planned by the health
care charitable trust and the methodology for estimating the cost. The plan shall
include an estimate of the cost of each activity expected to be undertaken or
supported in the ensuing year and a report on the unreimbursed cost of each
activity undertaken in the preceding year. For each quantifiable benefit undertaken,
the trust should provide an economic valuation which identifies the unreimbursed
cost to the trust and the method for calculating the cost. Nonquantifiable benefits
should be identified separately and described in narrative form.

The estimated cost of each activity expected to be undertaken in the ensuing year is
reported in Section VIII. EHS reached more than 1,000,000 people and expended more
than $7,000,000 in community benefits. For each quantifiable benefit undertaken in the
previous year (Appendix G), we have identified the unreimbursed cost to the EHS of
providing the benefit. The costs of contributed services were determined in accordance
with the rates, costs, units of service and other statistical measures used for general
accounting purposes by Elliot Health System. The non-quantifiable benefits undertaken in
the previous year are described in narrative form (Appendix H). For the purposes of this
Report, the preceding year is 7/1/00 – 6/30/01, and the ensuing year is 7/1/01 – 6/30/02.

X.         Annual Assessment of Community Benefit Activities:

           Statutory reference: RSA 7:32-e IV

       The plan shall include a report on Community Benefit Activities under taken
by the trust in the preceding year and information describing the results or
outcomes of the trust’s Community Benefits Activities. The report shall also include


                                                                                           46
a means used to solicit the views of the community served by the trust, identification
of community groups, members of the public, and local government officials
consulted on the development of the plan, and an evaluation of the plans
effectiveness.

Outcomes for major community benefit activities undertaken in the preceding year are
contained in the All Activity Report in Appendix G. In FY01 Elliot Health System
reached 951,621 with Community Education and Outreach programs for a total financial
benefit to the community of $2,334,734. The number of people reached may include an
individual more than once if they attended more than one program or service. Several
major outcomes are as follows:

Community Education and Outreach:

Nearly one million people (this number has not been adjusted to account for individuals
who receive more than one service) received community education and outreach services
for a benefit of $2,334,734.

The breast and cervical cancer screening program for uninsured and underinsured reached
64 people for a benefit of $11,142. 298. These clients became more aware of breast
cancer through health education lectures. 1,603 minority, uninsured and underinsured
acquired child care skills in parenting education programs. $813,423 was spent in the
provision of quality child care addressing development, social, and medical needs and
preventing child abuse and neglect and services for 160 latchkey children.

Community education, offered in the classroom and via the media, were provided on such
topics as stress, balance, drug / herb family education, safety, grief, education in long-
term care facilities, cancer, senior health, CPR, Helmet Hugs, genealogy and health, Safe
Sitter, lifesaving techniques, smoking prevention, awareness of dangers, exercise,
women’s health, professional education on continuing care, nutrition, physical activity,
home visits, healthy pregnancy, birth, maternal bonding, safety, literacy, reducing
pregnancy, jobs, child care education and education in the schools. Nearly 1,000 were
reached in the Hospital Goes to School program. 135 were reached with the Legs for Life
peripheral vascular disease education. And 1,085 from area workplaces received
education promoting healthy lifestyle for employees.

       Ø 20 American Red Cross instructors were certified to teach workplace safety.
       Ø 15 participants understood and appreciated the relationship of exercise to
         nutrition and weight loss.
       Ø The public received appropriate information on nutrition, including increased
         awareness of maintaining health during the holidays by fighting holiday
         weight gain, cancer awareness, stress management through meditation,
         breathing and muscle exercises, and creative imagery, and other health topics
         via the media and printed materials.




                                                                                        47
       Ø Dialysis patients and those with kidney stones have a better understanding of
         the medical management of their conditions.
       Ø 195 participants learned how to recognize stress, how it affects the body and
         tips for achieving balance, and ways to cope resulting in better stress
         management.
       Ø 1,000 middle school students became fully aware of the dangers of tobacco
         use.
       Ø 20 community members had a better understanding of sleep problems.
       Ø 198 parents had increased knowledge of car seats and home safety.
       Ø 30 elderly had increased awareness of fall prevention.
       Ø 1,050 teens demonstrated competence in lifesaving techniques through
         babysitting education.
       Ø 848 people learned about choices regarding healthy lifestyle habits to reduce
         cancer risks.
       Ø 196 people had a greater understanding of current nutrition issues.
       Ø 25 children can state the importance of three mandatory immunizations.
       Ø 35 students were able to make informed choices on future health careers.
       Ø 135 people had increased awareness of PVD (peripheral vascular disease).
       Ø 400 kids understood and became interested in the voting system.
       Ø 150 children at KidsCafe were provided a healthy meal and physical activity
         to promote health.
       Ø 960 people had increased awareness and decreased anxiety regarding
         hospitalization.
       Ø 200 home visits promoted healthy pregnancy and birth outcomes, bonding,
         immunizations, safety, improved literacy, decreased subsequent pregnancy,
         increased job training, continuing education, child care and early education.
       Ø 1,301 third graders can perform the Heimlich maneuver.
       Ø 57 people were competent in performing CPR.
       Ø 50 employees were tested for grip / pinch, strength, ergonomics, and
         osteoporosis.
       Ø 518 seniors demonstrated increased knowledge on selected health issues such
         as medication use and urinary incontinence.
       Ø Participants in safety fairs had increased awareness regarding helmet and bike
         safety, drunk driving and seasonal first aid.
       Ø 15 seniors improved driving skills through AARP's eight hour 55 / Alive
         Defensive driving course.
       Ø 120 former patients of Geropsych Unit and Folkways were afforded the
         opportunity to interact in a healthy manner around the holiday season to
         celebrate their recovery.
       Ø 18 caregivers were better educated on financial and legal issues of aging.

Screenings, Clinics and Immunizations:

       Ø 3,985 people were reached for a total benefit of $27,390.




                                                                                     48
       Ø 1,101 people were reached for a community benefit of $11,149. Participants
         received services that included: cholesterol and blood pressure screenings and
         assistance in obtaining services that allowed older individuals to remain
         independent by living in their apartments longer. Women were screened for
         osteoporosis and were made aware of risk factors and risk factor
         improvement. 75 men were screened for PSA.
       Ø 36 people gained increased awareness regarding damage caused by the sun
         and the risk of melanoma. 86 school children received immunizations to keep
         them healthy.
       Ø 2,884 were reached in earwax removal, foot care, and influenza clinics for a
         benefit of $20,143. Clients had their external ear canal cleared of matter that
         might have reduced normal hearing and individuals at risk of circulatory and
         foot problems were identified and referred to physicians. 329 potential cases
         of influenza were averted through immunization.

Support Groups:

      Ø 4,857 were reached for a total of $231,785. 50 participants gained support,
          confidence, knowledge in coping, adjusting, and dealing with breast cancer.
          43 families were better able to understand and express their grief and gain
          support from being with other families experiencing grief through
          bereavement counseling. 26 people benefited from the epilepsy support group
          through learning more about their disease and how to cope. Eight parents of
          NICU babies were provided with information and education increasing their
          understanding and confidence in providing nutritional care for neonates. 90
          moms with chronically ill children made connections, learned about resources
          and received support. The Parent-Baby (ad)Venture program helped decrease
          the incidence of child abuse in its client population and clients received
          information to assist them in parenting successfully. 12 families in parent
          support groups were supported, learned about resources to help reduce stress.
          129 participants in pulmonary rehab gained a better understanding of their
          disease.
Counseling:

       Ø 1,489 clients were reached with counseling services for a benefit of $18,351.
         This included such services as one-on-one bereavement counseling for 126
         people who have lost a child or other loved one primarily due to suicide.
         Others with financial, personal and emotional issues were educated and linked
         to appropriate community services.

Patient Education:

       Ø 41,750 people were reached with patient education, such as lymphedema
         awareness education and health information via Nurse On Call, for an




                                                                                      49
            aggregate benefit of $470,960. 56 patients learned to lead more productive
            lives by knowing their options regarding portable oxygen systems.

Other:

         Ø 9,338 people were reached for a total benefit of $876,538. 131 blood donors
           resulted in 106 units collected. Patient transport transported 8,217 patients to
           and from Elliot Hospital and its entities. The Patient Transport department
           added several new shuttle buses to handle the growing volumes of Folkways
           and the new Abilitations Day rehab program on Lincoln Street.
         Ø 54 residents of Pearl Manor received subsidized care as well as room and
           board.
         Ø 185 uninsured and underinsured patients receive prescriptions on discharge
           free of charge. 102 patients remained hospitalized while awaiting discharge
           placement.

Other Health Professionals:

         Ø 851 health professionals gained increased skills and knowledge at a cost of
           $64,845. Ten physical therapy students gained competence in providing
           physical therapy to clients through internships. 48 medical professionals were
           updated on current and new treatment for breast cancer and hospice in-service.
           Four residents and nurse practitioners were trained in office settings, 59 CNAs
           were trained in home care and eight nutrition majors participated in dietetic
           internships.

Cash Donations:

         Ø 7,900 people were positively impacted by the Elliot Health System’s donation
           of $458,984. $450,000 was donated to the Manchester Community Health
           Center and Child Health Services to provide health care services to the under
           or uninsured.


In Kind Donations:

         Ø $7,984 was raised in support of United Way efforts in the community. 2,347
           people benefited from donations totaling $11,936 for such items as first aid
           kits which were donated to four youth athletic associations, and food and
           supplies to four not-for-profit organizations for community events and
           fundraisers as well as to third world countries. 1,073 people who needed food
           received donations of canned goods through a collection. Other patients were
           given enough food to meet their nutritional needs for the first few days after
           discharge.




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Safety:

          Ø A Medication error reduction quality improvement project is in progress.
            Outcomes at this point include:

          Ø   Implementation of a system wide error mode analysis process
          Ø   Implementation of a dispensing automation system
          Ø   Planning the administration of bedside scanning technique
          Ø   Assessment of the order entry system
          Ø   Implementation of a system wide core indicator plan

          Ø A falls prevention quality improvement project is in the implementation stage.
            Action steps include: significantly raise fall prevention awareness through a
            variety of activities across EHS, implement consistent Fall Risk Assessment
            and guidelines to assist in care planning, improve data presentation and ability
            to use data, develop and implement a consistent Post-Fall Analysis, and
            engage the patient and their family in an active role in fall prevention.

Access to Care:

          Ø The Elliot Health System expanded its network of primary care physicians by
            twelve in FY01, increasing our ability to provide health care in this setting by
            close to forty percent.

          Ø The Folkways partial hospitalization program provided an educational seminar
            series for the drivers of frail elders and elders with psychiatric conditions.
            These three one-hour sessions for 5-6 drivers focused on geropsychiatry,
            practical guidelines for safely working with frail elders, and safe transfers and
            assisting patients with ambulation. Improvement in performance was noted.

        Outcomes methodologies for activities planned for FY02 have been reported in
Section VIII.

          Please be sure the assessment section is included in the plan.

THE COMPLETED COMMUNITY BENEFITS PLAN MUST BE FILED WITH
THE ATTORNEY GENERAL WITHIN 90 DAYS OF THE BEGINNING OF THE
FISCAL YEAR. FAILURE TO FILE THE PLAN MAY RESULT IN THE
IMPOSITION OF CIVIL PENALTIES OF $1,000 PLUS ATTORNEYS FEES AND
COSTS (RSA 7:32-g III) EXTENSIONS MAY BE REQUESTED BY FILING THE
APPLICATION FOR EXTENSION OF TIME TO FILE COMMUNITY
BENEFITS PLAN FORM WITH THE ATTORNEY GENERAL.

NOTE: A copy of RSA 7:32-c-l will be included with the form mailed to health care
charitable trusts.



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Notes: (will be deleted from final report)

Appendixes:
      A Organizational Structure (Section I) – 1 from Str Pl book
      B Bylaws (Section I)                   –3
            EHS for EH
            VNA of M & SH Inc.: VNA HHH, & VNA CS
            Continuing Care for Pearl Manor
      C Boards of Directors (Section I)      –3
             Same as B above
      D Mission Statements (Section III)     –3


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               Same as B above
        E Qualitative Needs Assessment (Section VI)
        F Quantitative Needs Assessment (Section VI)
        G Quantifiable Report from Preceding Year (Section IX)
               All Activities
               List of Occurrences
               Executive Summary
               Summary of Quantifiable Benefits
        H Non-quantifiable Report from Previous Year (Section IX)


Relevant Statutory References (for easy referral):

III Mission 7:32-e I: The trust shall adopt a mission statement which shall be included in
its plan and which shall be reaffirmed by the trust on an annual basis.

V Community and Population Served 7:32-d II: “Community” means the service area or
patient population for which a health care charitable trust provides services.

VI Community Needs Assessment 7:32-f. Every health care charitable trust shall, either
alone or in conjunction with other health care charitable trusts in its community, conduct
a community needs assessment to assist in determining the activities to be included in its
community benefits plan. The Needs Assessment process shall include consultation with
members of the public, community organizations, service providers, and local
government officials in the trust’s service area, in the identification and prioritization of
community needs that the health care charitable trust can address directly, or in
collaboration with others. The community needs assessment shall be updated at least
every 3 years.

VII Collaboration 7:32-l (see below) and 7:32 f (see VI above)

7:32-l. Combined Needs Assessments, Planning, Reporting. Health care charitable trusts
may satisfy the requirements of RSA 7:32-e (Plan) (attached below) , RSA 7:32-f (Needs
Assessment) (see VI above), and RSA 7:32-g (Notice to AG, public, & Administrative
Fine) (see below), individually or in a combination with other health care charitable
trusts, provided that information required to be reported under RSA 7:32-e, V(a) and (b)
(attached below) shall be specifically reported for each health care charitable trust
participating in a combined plan or report.

Publicity: 7:3-g. I. Every health care charitable trust shall submit its community benefits
plan to the director of charitable trusts on an annual basis no later than 90 days after the
start of the trust’s fiscal year. The trust and the director of charitable trusts shall make its
Community Benefit Plan available to the public and where practicable, shall place the
report on an Internet site or web page. Every health care charitable trust shall at least
annually provide notice to the public of the availability and process for obtaining a copy


                                                                                               53
of its Community Benefit Plan and shall prominently display such notice in its lobby,
waiting rooms or other area of public access.

III.    An extension of time for filing the community benefits plan may be granted by the
        director.
IV.     The director may impose an administrative fine upon a charitable organization
        that violates any provision of RSA 7:32-g, I, in an amount not to exceed $1,000
        plus attorneys fees and costs for each such violation.

VIII Plan 7:32-e (attached below)

IX Inventory and Valuation 7:32-d III (attached below) and 7:32-e IV and V (attached
below) Community input: 7:32-e. IV. The report shall include the means used to solicit
the views of the community served by the trust, identification of community groups,
members of the public, and local government officials consulted on development of plan.

Gross receipts 7:32-e. V. (b) Each charitable trust shall include in its report the ratio of its
gross receipts from operations to its net operating costs, as shown in its final statement of
accounts for the preceding fiscal year.

X Assessment 7:32-e IV (attached below)

Community/Publicity:

        7:32-e. IV. The report shall include the means used to solicit the views of the
community served by the trust, identification of community groups, members of the
public, and local government officials consulted on development of plan.

       7:32-e. VI. The process for the development of the plan shall include an
opportunity for members of the public to provide input into development of plan and
comment on the proposed plan.

        7:32-f. The Needs Assessment process shall include consultation with members of
the public, community organizations, service provides and local government officials in
the identification and prioritization of community needs.

        7:32-g. I. The trust shall make its Community Benefit Plan available to the public
and where practicable, shall place the report on an Internet site or web page. Every health
care charitable trust shall at least annually provide notice to the public of the availability
and process for obtaining a copy of its Community Benefit Plan and shall prominently
display such notice in its lobby, waiting rooms or other area of public access.



Other to be decided/done:


                                                                                              54
Report preparation:
       ½ way between glossy report & brochure – Tara Hershberger (like Dover / DH’s)

       Blue: Cover sheet (tag board), TOC, Appendix TOC and sub-pages, and back
       cover (tag board)

       # full copies & # copies bound & copies with and without appendixes: Lobby,
       Library, Joan, Deb, Beth, Doug, Pat Hayward, Rick Elwell, Jennifer Comer,
       Boards-EHS, VNA, EPN, Continuing Care, Carolyn, Subsidiaries – Barbara
       LeBouf, Dottie, Keith, Rachel=18, Citizens Action, Health Department, Chamber,
       NHHA, offer: 11 individual interviewees, 4 focus groups = 37.

Offer to present final report to Boards.

Put CBR in Inside Report and YWM and on website.

Timeline
         July: X (from last year’s plan and quality teams outcomes and finalize draft – ask
Finance for financials and new salary, room figures
         August: Management reviews draft: Beth, Deb, Rick Elwell, Pat Hayward,
Marketing, Greg Townsend
         September: Make final changes and submit to AG by 9/30, present to new
managers
         October: I and Executive Summary with Marketing, put report on Internet and
notice to public re: availability of and process for obtaining report in lobby, waiting room
and other area of public access.
         November: II
         December: III , Mission statements are reaffirmed by all reporting subsidiaries
         January: IV Input changes in strategic initiatives, etc., determine when and how to
solicit community view of the development of the plan and comment on the proposed
plan
         February: V
         March: VI, Community input, Needs assessments
         April: VII
         May: VIII, Meet with main people: Myrta, Lisa Gray, Barbara LeBouf, Dottie,
Chan Newton, Kelley Winn, Chris Brown, Al Roldan
         June: IX Steering Committee meets e-mail draft report in advance
         July – June: Activity, Occurrence and Leadership Journals are submitted by
departments and input into report on WW CH T- drive. Check A, O, LJ monthly and
tweek verbiage, placement (A-N) and outcomes.




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