Report of the Director of Charitable Trusts: https://indepthnh.org/wp-content/uploads/2025/01/CTU-Report-Final-Incl.-Exhibits-1.pdf
By PAULA TRACY, InDepthNH.org
MANCHESTER – The state’s largest city will continue to have two operating hospitals after the Attorney General’s Office announced approval of a merger acquisition for Manchester’s Catholic Medical Center with the for-profit HCA Healthcare, Inc., on Monday.
This will be HCA’s fourth hospital in New Hampshire, including ones in Portsmouth, Derry and Rochester and its 187th in the United States and United Kingdom.
The $110 million deal comes at a time when the non-profit hospital was on the “brink of bankruptcy” and had laid off 142 this past year and has debt totaling more than $160 million, according to the report of the Director of Charitable Trusts. It projected a $41.5 million in losses for Fiscal Year 2024.
Once the deal is finalized CMC will no longer be a nonprofit.
The statutory review, conducted separately by both the Attorney General’s Charitable Trusts Unit and the AG’s Consumer Protection and Antitrust Bureau, was undertaken to ensure that the transaction aligns with the public interest and complies with applicable laws that exist to preserve competition in the healthcare market.
“This settlement represents a thoughtful approach that both addresses the insurmountable financial challenges CMC is facing and ensures that the healthcare needs of New Hampshire residents continue to be met. Through this transaction, HCA’s financial stability and commitment to preserving essential services will secure a future for CMC and its patients,” said Attorney General John Formella.
The 85-page document comes after a public hearing was held several weeks ago.
Some attending the hearing worried that absent an agreement with HCA, the hospital would close.
Under the terms of the proposed transaction, HCA is required to enter a “Catholic Identity Commitment Agreement” with the Catholic Bishop of Manchester and the newly formed Foundation.
The CICA requires HCA to operate CMC in compliance with the Ethical and Religious Directives for Catholic Healthcare Services. In addition to receiving approval from the Bishop on Dec. 6, 2024, CMC received confirmation of approval of the Holy See in Rome. The Holy See’s review included assessment about how the sale ensures continued adherence with the ERDs and compliance with Canon Law.
Elliot Hospital in Manchester, which is a separate entity and not religiously affiliated, will also continue to provide medical services to the Queen City and its surroundings communities.
Formella said HCA, with its strong financial standing, has agreed to acquire nearly all of CMC’s assets, including its 330-bed acute-care hospital and other healthcare services.
For the state’s mental health crisis, where there are not enough beds to adequately address needs on any given night, and people wait in emergency rooms for placement, the deal states HCA will add 10 designated receiving facility beds at its New Hampshire hospitals within two years of the transaction’s closing.
This expansion will be part of HCA’s $200 million capital investment commitment to strengthen healthcare infrastructure in the state.
HCA has also committed to contributing a total of $2 million over the next three years to local community health initiatives as part of the deal including dental and homeless healthcare.
Critical healthcare services, including pregnancy care and emergency behavioral health services, will be protected, subject to certain contingencies, for at least 10 years following the acquisition.
The Attorney General’s office said HCA must make good faith efforts to ensure that no contingencies are triggered.
The agreement provides for payment of $7.5 million over ten years to the Healthcare Consumer Protection Trust Fund. These funds will be used to support community health programs in the Manchester community and other initiatives to benefit New Hampshire healthcare consumers.
To ensure that these commitments are upheld, the Attorney General’s Office will ensure compliance with the terms of the agreement for 10 years and will have authority to enforce all conditions of the CTU Report through court action if necessary.
HCA will provide an annual public report.
HCA Healthcare comprises 186 hospitals and approximately 2,400 sites of care in 20 states and the United Kingdom.
In 2023, according to its website, it spent $4.7 billion on capital investment in land, buildings and equipment and provided charity care, uninsured discounts and other uncompensated care at an estimated cost of $3.7 billion in 2023.
“At HCA Healthcare, we are excited about the future of medicine. We believe we are uniquely positioned to play a leading role in the transformation of care,” it read.
CMC was founded in 1974.
Officials at the hospital said CMC will expand and grow its high-quality healthcare services in New Hampshire and join HCA which is serving patients at Portsmouth Regional Hospital, Frisbie Memorial Hospital and Parkland Medical Center.
The $110 million transaction is expected to close in the coming weeks.
“After an extensive, multi-year effort to secure the future of CMC, we are excited to partner with HCA Healthcare, a proven leader in delivering high-quality healthcare in New Hampshire for over 40 years,” stated Alex Walker, President & CEO of CMC. “This partnership guarantees the preservation of Catholic healthcare while enhancing our ability to serve the community. We are grateful to the New Hampshire Attorney General’s Office for their thorough review, to the Diocese of Manchester for their invaluable guidance and to our Board of Trustees for their vision and leadership throughout this process. With HCA Healthcare, CMC’s legacy of excellence will not only endure but flourish — expanding access to care, enhancing services, and remaining deeply rooted in our Catholic mission.”
In addition, as part of the agreement, HCA Healthcare has pledged to maintain the Catholic identity of CMC and a $200-million capital commitment that will modernize infrastructure that will allow for the continuation and expansion of key clinical services, including the New England Heart & Vascular Institute, emergency department, trauma services, oncology, behavioral health, women’s services and more.
“Over the past 15 months, countless individuals have worked tirelessly to secure a strong and sustainable future for CMC and the communities we serve,” said Tim Riley, Chair of CMC’s Board of Trustees. “This partnership with HCA Healthcare represents a defining moment for Manchester and all of New Hampshire. It ensures access to high-quality care close to home, preserves our Catholic mission and positions CMC to grow and adapt to the evolving needs of our patients. We are confident this decision will strengthen healthcare throughout the region for years to come.”
A statement from the Most Reverend Peter A. Libasci, D.D., Bishop of Manchester said: “I am most grateful to God for the selfless work that has been done to ensure the longevity of Catholic healthcare in New Hampshire. In particular, I offer my sincere thanks to the leadership and Board of Trustees of Catholic Medical Center and to the leaders of HCA Healthcare for their dedication to this vital mission. No less do I extend my sincere gratitude to Attorney General John Formella and his staff for their careful consideration of this partnership, and to all who attended and thoughtfully participated in the public listening session and public hearing. We may look forward now to a strong, vigorous, Catholic hospital on Manchester’s West Side and Catholic healthcare throughout the State of New Hampshire. My prayers and witness as Bishop of the Diocese of Manchester will continue, as will those of my successors.”
