Frequently Asked Questions

“Our pledge throughout this process is to provide our employees, patients, providers and the public with as much up-to-the minute information as possible, so they can provide valued feedback and learn why we are so excited about coming together and the future of healthcare in New Hampshire.”

  • Douglas Dean, President and CEO Elliot Health System
  • Michael Rose, President and CEO, Southern New Hampshire Health System



The Basics


What are Elliot Health System and Southern New Hampshire Health announcing with the Letter of Intent?

The Letter of Intent between Elliot Health System (Elliot) and Southern New Hampshire Health (SNHH) is our announcement of a commitment to explore joining together to form a new regional healthcare system for New Hampshire.  The Letter of Intent sets forth our vision to create a non-profit organization that would build an integrated governance system, within which both SNHH and Elliot would each retain their respective names, identities, current corporate structures, licenses, medical staffs, employed physician networks, and local governance through community Boards of Trustees.  By entering into this Letter of Intent, we have agreed to work together on an exclusive basis to review all aspects of the proposed combination and developing a Definitive Agreement that would be subject to the approval of both Boards of Trustees and various government agencies, including the New Hampshire Department of Justice.


Why are Elliot and SNHH talking about combining?

The purpose of this proposed combination is to strengthen and expand our charitable missions to provide the very best healthcare possible to the communities we serve in a rapidly changing health care environment.  Our approach anticipates a solution to address the increasingly complex health care challenges faced by hospitals in New Hampshire and around the country, such as:

  • our aging population who require easy and affordable access to quality care;
  • consumer preferences around how care is delivered;
  • addressing emerging challenges relating to behavioral and mental health, and the opioid crisis;
  • the way healthcare is paid for; and
  • technological advancements, such as a shared and comprehensive electronic medical record systems to help improve patient care.


Faced with these many challenges, we would be far better positioned to serve our communities working together to provide the best health care possible for tomorrow and for generations to come.


Our vision is to develop a highly-coordinated, community-based regional health care network to increase local access to affordable care while improving the quality of healthcare in southern New Hampshire. We are excited to work together to find a New Hampshire solution for the people and to serve the healthcare needs of our state.


What factors did you consider when deciding to announce exclusive discussions about combining?

Beginning with our shared values and visions, the leadership at Elliot and SNHH carefully considered a number of factors, including:

  • The compatible missions of both Elliot and SNHH;
  • The ability of both organizations to improve access to quality care while keeping it affordable for patients;
  • Integration sufficient to enable collaboration of care and sharing of best practices;
  • The opportunity to implement and optimize state-of-the-art health care information technology;
  • The ability to collaboratively develop and maintain medical and surgical services;
  • Improving local access to specialty services throughout southern New Hampshire;
  • Greater access to financial capital to support the charitable and community-focused missions of both organizations;
  • Recognition of the rapidly changing landscape for community-based hospitals, and creating long-term organizational sustainability


Why can’t SNHH and Elliot continue to grow independently like they have been?

The challenging and dynamic pressures of the economics of healthcare are compounded by our rapidly aging patient population. With the second highest per capita rate of baby boomers in the nation, New Hampshire’s capacity must evolve and expand to be able to provide timely access to the spectrum of clinical specialties and sub-specialties in a convenient and cost-effective manner for these and all of our patients. This is why a regional care system makes sense -- it would allow us to collaborate in clinical care, expertise and technologies and grow over time to meet our communities’ needs in ways that assure access, high quality care and value.


Why Elliot and SNHH?

Elliot and SNHH are natural partners, as we are closely aligned in our missions, values and vision.  Although we serve different markets and communities, the fact that we are only sixteen miles apart would help our collaboration in areas like population health and expanded sub-specialty care capabilities.



The Next Steps in the Process

How does the process work?

The Letter of Intent that SNHH and Elliot have entered into is a non-binding commitment to work together, on an exclusive basis, to conduct careful due diligence and to negotiate a final binding combination agreement (definitive agreement) that would formally join the parties together in an integrated regional healthcare system for New Hampshire.


With our announcement of the Letter of Intent we are also beginning a process of inviting questions and obtaining input from the public regarding our proposed combination.


Both of the SNHH and Elliot Boards of Trustees must approve any final agreement.  If we reach a final agreement, the proposed combination would be subject to approval by various government authorities, including the New Hampshire Department of Justice, Office of the Attorney General.  This regulatory process would also include public meetings in both communities.


How long will this process take?

The management teams of SNHH and Elliot anticipate that we can complete negotiations of a final binding agreement by this fall of 2017.  The process of moving from a final binding definitive agreement to the combination transaction involves numerous variables, including review by regulators.  The State regulatory process typically takes 120 days following notice that the parties have reached final agreement. It is our hope that the entire transaction, including obtaining all governmental approvals, would be completed by sometime during the first quarter of 2018.


How will information be shared?

With our announcement of the Letter of Intent, we have begun a series of discussions with our valued employees, patients, providers and the public, to provide information and answer questions. Throughout this process, we will continue to engage in conversations with our employees and community stakeholders, whose input and ideas we value greatly, and which will be incorporated into our considerations. Our website will continue to be updated as discussions proceed, and will include schedules and information on meetings and open forums for the public to share comments and questions.


How do I comment?

Our goal is to make it easy to provide us with your comments and questions.  All documents, releases and other updates will be posted on this website for public review.  We will also be posting dates and locations of community forums as we schedule them, so you have ample notice to attend, listen and ask questions.  You can also visit the “Your Voice” section of this website to enter your questions or comments.



Organizational Structure and Governance

Is this a merger?

SNHH and Elliot, including our respective hospitals, employees, medical staffs and physician groups, would continue to exist as distinct entities and would retain their existing identities.  The proposed combination would involve the establishment of a new, non-profit organization which would facilitate the establishment of a regional healthcare system that would operate under an integrated governance structure.


Would each organization continue to be governed locally?

Both SNHH and Elliot would continue to be governed by with our respective local Boards.  The new regional organization would have its own Board of Trustees that would engage with the local Boards under an integrated governance system to coordinate the delivery of health care services across all communities served by Elliot and SNHH.


Would the names ‘Elliot’ and ‘Southern New Hampshire Health’ change?

No.  Both Elliot and SNHH would retain their names. For our employees, this would also be true as it relates to signage and employee badges.   Once formed, the new regional system and its name would be added to public signage and employee badges to indicate that Elliot and SNHH are operating as participants in the new regional system.


What happens to Southern New Hampshire Medical Center and Elliot Hospital?

Both medical centers would continue to be known as Southern New Hampshire Medical Center and Elliot Hospital respectively, and would continue to each maintain their own medical staffs dedicated to the communities they faithfully serve.  Each would continue to pursue their respective missions and to serve their communities. The proposed combination is intended to enhance the ability of each organization to provide more affordable and accessible care to our region and to create and benefit together from technologies that support our patients and providers in improving the health and well-being of the greater Nashua and Manchester communities.


Who would lead this regional healthcare system?

The Letter of Intent contemplates establishing a new non-profit regional healthcare organization that would have its own Board of Trustees.  This regional Board would have 11 members.  Upon completion of the transactions, the Board would be comprised of 5 members nominated by SNHH and 5 members nominated by Elliot.  The remaining member would be the CEO of the regional system.  At this time, no potential members of this Board have been identified.


Who would lead SNHH and Elliot?

SNHH and Elliot would continue to maintain their own Boards and management teams.  These local teams would work with the management at the regional system organization to coordinate activities across the communities served by the system.


How would the proposed combination impact the charitable assets of both Elliot and SNHH?

The proposed combination does not involve any transfer of assets from Elliot or SNHH, including any charitable and endowment assets.  These assets would continue to be held by their current organizations, and would continue to support the charitable missions of each entity, and to benefit their respective communities without disruption



Financial and Economic Considerations

How would this new regional system improve value?

Forming a regional healthcare delivery system would allow SNHH and Elliot to combine in planning and coordinating healthcare services for nearly half a million residents in southern New Hampshire.  By using population health data and enhanced technologies, our providers would be able to collaborate and coordinate in delivering high quality care, proven by outcomes, locally and easily accessible to area residents. These are the drivers of health care costs – value is our ability to meet our patients’ and communities’ needs when and where they live, using the most efficient, effective and advanced tools, resources and relationships at our disposal.


How would the regional healthcare system achieve efficiencies?

Our intention is that the proposed combination would allow the regional system to expand and introduce special clinical programs that allow providers to manage the care of their patients locally, with the confidence that high quality care is both accessible and affordable.  To have providers and patients rely on clinical subspecialists located outside of our area is burdensome and costly.  With the increased scope of services and demand from our combined populations, we can bring clinical expertise into our communities in areas where alone we would not be otherwise able to. By sharing technologies and the costs associated with optimum care management and delivery, we can afford enhancements and innovation we couldn’t fund on our own. This includes development of a shared, innovative electronic medical record platform that benefits providers and patients alike.


How would the regional healthcare system enhance medical staff development potential?

By establishing a regional healthcare system, SNHH and Elliot would have the potential to serve more than half a million residents in southern New Hampshire. We are positioning ourselves to be state a leader and the organization of choice for employees and providers, by together developing an innovative IT infrastructure, a strong population health-driven model of care delivery that is responsive to our communities, and our enhanced ability to offer patients access to high quality care across a greater spectrum of services in demand, all as easily and affordably as possible.


Would this combination result in layoffs or jobs lost?

It is neither the goal nor the intention of this process to reduce the number of employees at either organization, particularly as our intention is to expand our scope of care and expertise in response to the evolving needs of our communities.   As we adapt our delivery models and supporting infrastructure, our expectation is that new needs for workforce would emerge.  While we can’t state with 100% certainty that the combination would not see a decline in the number of employees down the road, our goal would be to expand and grow in response to the growing and diversifying needs of our communities for care that can be delivered locally.


Are there services where you see enhanced collaboration in the short term and if so, which?

The signing of the Letter of Intent only begins the process of careful due diligence.  While some limited discussions of possible collaborations may occur during the months prior to completing the combination, substantive steps toward collaboration must wait until the regional system is actually established.



What Does this Mean for our Employees, Patients and Providers?

How would this new regional system affect patients’ experience at SNHH and Elliot?

Our patients would continue to work with their clinical care teams and providers to access the services offered within each organization.  Our proposed system would enhance their experience to the extent we are able to collaborate on bringing expanded clinical care expertise and sub-specialties to our region based on defined population health needs and opportunities to deliver care locally. Our expectation is that patients would also benefit from our ability to deliver technology advancements that allow them to more easily engage with their providers, such as telehealth and new and emerging platforms to integrate mobile health monitoring and management devices in our patients’ hands.


Looking to the future, this combination would allow us to provide even greater access and care that meet the needs of our patients.  Our shared commitment is to ensure that patients experience no confusion or challenges in receiving the healthcare they need, where and when they need it.  Patients who have come to rely on the trusted services of either SNHH or Elliot would continue to be cared for in the compassionate manner they have come to expect.


How would this new regional system affect our physicians and the medical staff members of our respective hospitals?

Foundation Medical Partners , Southern New Hampshire Medical Center (SNHMC) and Elliot Health System providers would remain employed by their respective organizations and relationships with all physicians in good standing and currently serving on the medical staffs  of the respective hospitals would continue as before.


How would this new regional system affect Foundation Medical Partners providers? SNHMC Providers? Elliot Health providers?

Foundation Medical Partners and Elliot Health System providers would continue to provide patient care within their respective multi-disciplinary groups.  SNHMC providers would continue to provide hospital-based care as they have been.  As our regional system would be established, provider leaders at both organizations would be able to work together to  develop and implement collaborative plans to enhance our collective scope of care and identify opportunities to improve our ability to meet the needs of our patients locally.


Would this new regional system change how staff are employed currently?

Elliot employees would remain Elliot employees.  SNHH staff, including Foundation and Medical Center providers and staff, would remain SNHH employees.  Staff at both organizations (including nurses and physicians), in good standing, would remain employed at competitive wages and benefits.