2023-08-15T15:11:49-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 812225283 North Country Healthcare Inc NORT 6033892205 8 Clover Lane Whitefield NH 03598 Matthew Streeter System CFO 6033892205 2023-08-15 1 Matthew Streeter 999009999 Barbara J McGuan CPA P00219457 2077752387 2023-08-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Thomas Mee 8 Clover Lane Whitefield NH 03598 16592242 0 X www.northcountryhealth.org X 2016 NH Healthcare Management 14 11 58 15 0 0 30000 0 7049958 16312123 27792 41567 0 0 7107750 16353690 50000 25000 0 0 1762650 8398296 0 0 0 5267308 8711250 7079958 17134546 27792 -780856 3297109 7583910 3076950 2946035 220159 4637875 X The mission of NCH is to improve lives by assuring consistently excellent, integrated healthcare. 0 1 15672484 25000 16312123 The main focus of NCH is management oversight and development of common administrative and clinical processes and practices between its healthcare affiliates. It is the intent to develop synergies and shared services to increase efficiency, lower cost and increase quality and patient satisfaction for the entire region. 15672484 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 25 0 1 58 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Matthew Streeter 6033265610 8 Clover Lane Whitefield NH 03598 Donald Crane Chair 1.00 1.00 X X 0 0 0 Donna Goodrich Vice Chair 1.00 1.50 X X 0 0 0 Greg Placy Treasurer 1.00 0.00 X X 0 0 0 Roxie Severance Secretary 1.00 1.00 X X 0 0 0 Lynn Brewer Director 1.00 39.00 X 0 5481 0 JJ Bujeaud Director 1.00 1.00 X 0 0 0 Corinne Cascadden Director 1.00 0.00 X 0 0 0 Alta Chase Director 1.00 1.00 X 0 0 0 James Hamblin Director 1.00 0.00 X 0 0 0 Richard Kardell DO Director 1.00 39.00 X 0 368266 55765 Mark Kelley Director 1.00 0.50 X 0 0 0 Elisabeth Moore MD Director 1.00 40.00 X 0 408575 50674 Mark Russell Director 1.00 0.00 X 0 0 0 Keith Young Director 1.00 1.00 X 0 0 0 Odette Crawford Past Director 1.00 1.00 X 0 0 0 Nicholas Delaney NP Past Director 1.00 0.00 X 0 0 0 Sarah Descrochers Past Director 1.00 2.00 X 0 0 0 Eric Stohl Past Director 1.00 1.00 X 0 0 0 Thomas Mee System CEO 40.00 6.00 X 677301 0 39588 Matthew Streeter System CFO 40.00 6.00 X 167302 0 26546 Darrell Bodnar CIO 40.00 1.00 X 254388 0 32958 Kate E Pina Chief Human Resources Officer 40.00 0.00 X 147989 0 32378 Jesse M Raimer System Director Materials Management 40.00 0.00 X 107205 0 40142 Maryanne A St Jean Executive Administrative Assistant 40.00 0.00 X 102500 0 0 1456685 782322 278051 6 0 1 0 Sean Tracey Associates 401 State St Suite 3 Portsmouth NH 03801 Marketing Services 669164 Coos North Country Radiology PLLC 1 Hardy Road 1204 Bedford NH 03110 Radiology Services 469651 BerryDunn 2211 Congress Street Portland ME 04102 Accounting Services 335961 Medical Information Technology PO Box 74569 Chicago IL 60696 IT Services 249021 Quorum Health Resources LLC 1573 Mallory Lane Suite 200 Brentwood TN 37027 GPO Services 135714 5 Management Fees 900099 16312123 16312123 16312123 11676 11676 268443 238552 29891 29891 29891 16353690 16312123 0 41567 X 25000 25000 910737 910737 6122112 5543918 578194 103322 94282 9040 879483 801467 78016 382642 350885 31757 314319 286046 28273 590848 590848 2903932 2607952 295980 1021231 929370 91861 28121 25591 2530 2890379 2630386 259993 28776 26188 2588 71706 65256 6450 21749 19793 1956 21840 20027 1813 24432 22234 2198 Minor Equipment 464932 423111 41821 Recruitment Expense 177310 161361 15949 Other Expenses 88444 80489 7955 Education Center 63231 57543 5688 17134546 15672484 1462062 0 503328 1256465 27860 24838 750554 2047778 238510 1240360 1148914 21840 49374 1127074 1333733 1101527 393750 785868 3297109 7583910 559773 2160167 2123427 0 393750 785868 3076950 2946035 X 220159 4637875 220159 4637875 3297109 7583910 X -780856 -276795 640468 4834899 X 1 X 1 X 1 0 X X X 4 Androscoggin Valley Hospital Inc 020280367 3 1 7261304 0 Weeks Medical Center 020222242 3 1 6749543 0 Upper Connecticut Valley Hospital 020276210 3 1 2698784 0 North Country Home Health & Hospice Agency Inc 020300637 10 1 207961 0 4 16917592 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Part IV, Section B, Line 1: Androscoggin Valley Hospital, Inc., Weeks Medical Center, and Upper Connecticut Valley Hospital are all listed in the Organization's governing documents. Effective January 2017, the Organization became the sole member of North Country Home Health & Hospice Agency, Inc. Three directors are appointed from AVH, two directors are appointed from WMC, one director is appointed from UCVH, and two directors are appointed from NCHHHA. 822408 13707 808701 110639 8133 102506 215867 215867 1127074 Deferred Compensation 785868 785868 Deferred Compensation 785868 785868 16051895 -276795 -276795 16328690 25000 25000 16353690 17109546 0 17109546 25000 25000 17134546 Part XI, Line 4b - Other Adjustments: Other Nonoperating Expense 25,000. Part XII, Line 4b - Other Adjustments: Other Nonoperating Expense 25,000. 1 Granite United Way 22 Concord Street Floor 2 Manchester NH 03101 026006033 501(c)(3) 25000 0 NH Ukraine Relief Fund 1 0 Part I, Line 2: Additional grant monitoring is not deemed necessary for funding provided to confirmed public charities. X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 Thomas Mee System CEO 538642 0 126000 0 12659 0 5597 0 33991 0 716889 0 0 0 Elisabeth Moore MD Director 0 377915 0 30300 0 360 0 8420 0 42254 0 459249 0 0 Richard Kardell DO Director 0 345440 0 20450 0 2376 0 14390 0 41375 0 424031 0 0 Darrell Bodnar CIO 194186 0 52020 0 8182 0 7736 0 25222 0 287346 0 0 0 Matthew Streeter System CFO 157136 0 10000 0 166 0 0 0 26546 0 193848 0 0 0 Kate E Pina Chief Human Resources Officer 147327 0 0 0 662 0 1837 0 30541 0 180367 0 0 0 Part I, Line 1a Thomas Mee, System CEO, receives a housing allowance from the Organization as part of his compensation package. The housing is reported as taxable wages to Mr. Mee, who began his employment during calendar year 2019. Part I, Lines 4a-b Maryanne St. Jean, Executive Administrative Assistant, received a change in control payment of $102,500 during the calendar year 2021. Thomas Mee, System CEO, participated in a 457(f) plan. Part I, Line 7 Part of the compensation program overseen by the Compensation Committee and approved by the Corporation Board and Affiliate Boards includes variable incentive compensation for executives. This variable compensation is a withhold of total compensation and earned back by executives based on strategic goal performance. Form 990, Part III, line 3 During the year ended September 30, 2022 the shared services provided by NCH were expanded to include human resources, information technology, and marketing. Form 990, Part VI, Section A, line 7a Each member of the Corporation Board shall be nominated by action of an Affiliate Board, or by the Corporation Board, as the case may be, in accordance with the nomination powers indicated in the Corporation's Bylaws. Form 990, Part VI, Section A, line 7b The Corporation Bylaws include Major Matters which include specific duties and responsibilities which are shared by the Corporation Board and the Affiliate Boards. These Major Matters are further distinguished between Major Organizational Matters and Major Operational Matters. In both cases, the Bylaws contain the provisions for the approval of these matters including whether they are approved by a majority vote or super majority vote of all boards. In all cases, the Major Matters require approval by the Corporation Board and the Affiliate Boards. Form 990, Part VI, Section B, line 11b A copy of the Form 990 will be shared electronically with the entire NCH Board and Finance committee before filing, with adequate time for questions to be asked. Form 990, Part VI, Section B, line 12c Conflict of Interest Process: - Conflict of Interest Disclosure completed via BoardPaq (electronic means) - Results compiled into Conflict Matrix which is reviewed and approved by the Board - Conflicts that meet the Pecuniary Benefit criteria are identified, shared with the Board and approved. - Disclosure notices are placed in local papers. - The NH Division of Charitable Trusts is notified of the Pecuniary Benefit and copies of the public notices are attached. Form 990, Part VI, Section B, line 15 The Compensation Committee is a subcommittee of the Finance Committee of the Corporation Board. This Committee oversees the executive compensation policy and practices of the organization including the CEO, the Affiliate Presidents, and the CEO Cabinet which includes key executive positions for the organization. The Compensation Committee engages with an outside consultant to determine compensation benchmarks and best practices which guide the compensation processes for these executive positions. The comparison benchmark data and guidance are reviewed by the Committee and recommendations are made to the Corporation Board and Affiliate Boards, as applicable. Form 990, Part VI, Section C, line 19 The Organization has implemented all policies and the governing documents and financial statements are available to the public upon request. Form 990, Part IX, line 11g Consulting: Program service expenses 112,797. Management and general expenses 69,550. Fundraising expenses 0. Total expenses 182,347. Contract Labor: Program service expenses 2,422,558. Management and general expenses 219,254. Fundraising expenses 0. Total expenses 2,641,812. Other Professional Services: Program service expenses 72,597. Management and general expenses 7,176. Fundraising expenses 0. Total expenses 79,773. Form 990, Part XI, line 9: Equity Transfers from Affiliates 4,834,899. Form 990, Part XI, Line 8: The Organization's financial statements for the year ended September 30, 2021 were restated to properly reflect the recognition of income related to the settlement from the litigation with Littleton Regional Heathcare previously reported as deferred revenues of $1,080,427. Additionally, amounts previously included in due from affiliates of $439,959 were recognized as an equity transfer to the Organization. The impact of the restatement was a net increase to beginning net assets of $640,468. Androscoggin Valley Hospital Inc 59 Page Hill Road Berlin NH 03570 020280367 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 1 Weeks Medical Center 173 Middle Street Lancaster NH 03584 020222242 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 1 Upper Connecticut Valley Hospital Corliss lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 1 North Country Home Health & Hospice Agency Inc 536 Cottage Street Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 North Country Healthcare Inc 1 Northcare Inc 59 Page Hill Road Berlin NH 03570 521596952 Supporting Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Androscoggin Valley Hospital Foundation 59 Page Hill Road Berlin NH 03570 223035216 Management and Financial Support NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Great Northwoods Community Foundation 59 Page Hill Road Berlin NH 03570 020452547 Healthcare Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Organization NH 501(c)(3) Line 12a, I Weeks Medical Center 1 0 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 Androscoggin Valley Hospital L 7053091 FMV North Country Home Health & Hospice Agency L 164184 FMV Upper Connecticut Valley Hospital L 2626932 FMV Weeks Medical Center L 6467899 FMV Weeks Medical Center M 328016 FMV North Country Home Health & Hospice Agency S 185409 FMV Upper Connecticut Valley Hospital S 705964 FMV Weeks Medical Center S 2037482 FMV Androscoggin Valley Hospital S 1906044 FMV