SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
New London Hospital Association Inc
 
Employer identification number

02-0222171
Return Reference Explanation
Form 990, Part VI, Section A, line 3 Mr. Bruce King, CEO, of New London Hospital Association (NLHA) is an employee of Mary Hitchcock Memorial Hospital (MHMH). NLHA purchases Mr. King's services from MHMH.
Form 990, Part VI, Section A, line 6 The sole member of the Corporation is Dartmouth-Hitchcock Health, a New Hampshire non-profit corporation.
Form 990, Part VI, Section A, line 7a The Member of the Corporation has the power to appoint 1/3 of the NLHA Board of the Trustees and must ratify the nomination of 2/3 of the members of the Board of Trustees.
Form 990, Part VI, Section A, line 7b The Member has certain reserved powers which require the Organization to obtain approval of the Member.
Form 990, Part VI, Section B, line 11 NLHA posted a copy of the Form 990 on its trustee intranet site and solicited trustee comments before filing the return. The Schedule B provided did not include the names of the donors.
Form 990, Part VI, Section B, line 12c Each year, as part of the preparation process for the Form 990, a written conflict of interest survey is sent to each Trustee inquiring about situations that could result in conflicts of interest.
Form 990, Part VI, Section B, line 15 The CEO's compensation is determined by the New London Hospital Association (NLHA) Executive Committee and Mary Hitchcock Memorial Hospital, the CEO's employer, after considering compensation for CEOs of various sized hospitals in the region. Compensation levels for all other officers and key employees are reviewed periodically by NLHA's Senior Director of Human Resources and the CEO of NLHA. These reviews include comparisons of compensation levels to independent salary survey data for comparable positions in the region.
Form 990, Part VI, Section C, line 19 NLHA makes this information available to the public upon request. Additionally, Form 990 is filed with the State of New Hampshire and is available to the public through the State. NLHA also maintians public inspection copies of the Form 990 that are available upon request and its Form 990 is also available through GuideStar. NLH files a Community Benefit Report annually with the State of NH. A summary of the Community Benefit Report and summary financial information is available on NLHA's website and in annual reports to donors.
Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: New London Hospital Association, Inc. 273 Country Road New London, NH 03257 EIN 02-0222171 New London Hospital Association, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).
Form 990, Part XI, line 9: Unrealized Loss on Interest Rate Swap -1,115,340. Change in Beneficial Interest in Perpetual Trust -104,236.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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