2023-08-04T06:02:13-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 020397338 Valley Regional Healthcare Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Jean Shaw CFO 6035427771 2023-08-02 1 Jean Shaw 999009999 Joseph R Byrne P01289281 2077752387 2023-08-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Jocelyn Caple 243 Elm Street Claremont NH 03743 2832961 0 X www.vrh.org X 1986 NH Parent organization to Valley Regional Hospital, Inc. 15 12 4 15 0 0 0 0 2112863 2320073 157402 269244 0 0 2270265 2589317 0 0 0 0 461705 823596 0 0 0 2519606 2150193 2981311 2973789 -711046 -384472 13445921 12176010 18685235 18419640 -5239314 -6243630 Valley Regional Healthcare, Inc. is organized to coordinate and support the activities of health care organizations, including Valley Regional Hospital, Inc. 0 0 1862872 2320073 Valley Regional Healthcare is the parent organization for Valley Regional Hospital. In this role, Valley Regional Healthcare provides integrated management and support services for the Hospital. 1862872 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 11 0 1 4 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X Jean Shaw 6035427771 243 Elm Street Claremont NH 03743 Jocelyn Caple MD Interim President & CEO 1.60 38.40 X X 390600 0 0 Juliann Barrett DO Trustee 0.10 39.90 X 0 246853 3462 Gailyn Thomas MD Trustee 0.10 19.90 X 0 193228 0 Jean Shaw CFO 2.80 37.20 X 177779 0 38577 Patricia Putnam Chair 0.10 0.90 X X 0 0 0 Terri Decker Vice Chair 0.10 0.90 X X 0 0 0 Lisa Richmond Treasurer 0.10 0.90 X X 0 0 0 Bryan Huot Secretary 0.10 0.90 X X 0 0 0 James Borchert Trustee 0.10 0.90 X 0 0 0 Scott Bouranis Trustee 0.10 0.90 X 0 0 0 Cynthia L Burr Trustee 0.10 0.90 X 0 0 0 Eric Crainich Trustee 0.10 0.90 X 0 0 0 Katherine Lajoie Trustee 0.10 0.90 X 0 0 0 Alex Scott Trustee 0.10 0.90 X 0 0 0 Samuel Shields Trustee 0.10 0.90 X 0 0 0 Tom Sullivan Trustee 0.10 0.90 X 0 0 0 John Tomlinson Past Trustee 0.10 0.90 X 0 0 0 568379 440081 42039 2 0 1 1 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 CEO Contract Services 449097 1 Management Services 621610 1278874 1278874 Rental Income 531120 955706 955706 Miscellaneous Revenue 621610 85493 85493 2320073 84632 84632 389326 38930 206041 37603 183285 1327 184612 184612 2589317 2320073 0 269244 606956 540046 66910 122278 108798 13480 3018 2685 333 71690 63787 7903 19654 17487 2167 46876 46876 50833 50833 25910 25910 153509 136586 16923 126114 126114 13291 11826 1465 18244 16233 2011 1562 1390 172 76 68 8 587996 587996 1045174 929955 115219 42384 42384 Dues and Subscriptions 26192 23305 2887 Miscellaneous 12032 10706 1326 2973789 1862872 1110917 0 X 157181 301190 999998 1124342 84065 6659 661 22622 21133 43194198 35872118 8395225 7322080 3735014 3362777 12950 12950 38866 24218 13445921 12176010 163858 190939 117027 117058 17938844 17607572 465506 504071 18685235 18419640 X -5239390 -6243706 76 76 -5239314 -6243630 13445921 12176010 -384472 -619844 0 X 0 1 X 1 1 1 X X 1 Valley Regional Hospital Inc 020222118 3 1 1862872 0 1 1862872 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15822111 11767041 4055070 119313 118924 389 26219321 23102882 3116439 1033453 883271 150182 7322080 Due to Affiliates 491694 Reserve for Self-Funded Insurance 12377 504071 X X X 0 0 0 0 0 0 0 1 0 Jocelyn Caple MD Interim President & CEO 390600 0 0 0 0 0 0 0 0 0 390600 0 0 0 Juliann Barrett DO Trustee 0 236158 0 10500 0 195 0 2485 0 977 0 250315 0 0 Gailyn Thomas MD Trustee 0 193228 0 0 0 0 0 0 0 0 0 193228 0 0 Jean Shaw CFO 164565 0 10225 0 2989 0 1769 0 36808 0 216356 0 0 0 Part I, Line 7 Employees received bonuses in 2021 for employee retention due to the ongoing pandemic. Form 990, Part VII, line 5: Jocelyn F. Caple, Interim President & CEO, is paid by Mary Hitchcock Memorial Hospital, an unrelated organization via a professional services agreement. During calendar year 2021, Valley Regional Healthcare paid Mary Hitchcock Memorial Hospital $390,600 for services rendered to Valley Regional Healthcare. The actual compensation paid to Ms. Caple by Mary Hitchcock Memorial Hospital is not known to the Organization. As such, pursuant to the Form 990 instructions, the Organization is reporting the amount paid for services rendered as compensation to Ms. Caple, and is reporting this amount on Form 990, Part VII, Column D. Form 990, Part VI, Section A, line 6 The Corporation has an assembly of Overseers. Form 990, Part VI, Section A, line 7a The Overseers elect directors to the Board. Additionally, the CEO of Dartmouth Hitchcock Medical Center has the right to appoint one representative to the Board of Directors. Form 990, Part VI, Section A, line 7b The power to alter, amend or repeal the bylaws or to adopt new bylaws shall be vested in the Assembly of Overseers. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the CFO and a full copy is shared and reviewed with the CEO and the Finance Committee members. The Finance Committee members are given an opportunity for comment prior to filing. The review is conducted by the CFO. Form 990, Part VI, Section B, line 12c The Risk & Compliance Office requires annual review of the conflict of interest policy. All Officers, Directors, Trustees, and Key Employees must sign an acknowledgment of the policy and disclose any interests that could give rise to conflicts. The signed forms are held in the following locations: Officers and Trustees - Executive Assistant office Directors and Key Employees - In the Elsevier Human Resources system Contracted Services - within or alongside any contract in the corresponding administration or materials area Form 990, Part VI, Section B, line 15 The executive committee of the board of trustees convenes two to four times annually to review the compensation of the CEO. The amount of compensation shall be reviewed by the D-H independent compensation consultant for purposes of determining compliance with the rebuttable presumption, if necessary. The CEO compensation is tied to the strategic planning goals of the Organization. Regional compensation of like-sized organizations is used for comparison purposes. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Valley Regional Healthcare, Inc. 243 Elm Street Claremont, NH 03743 EIN: 02-0397338 Valley Regional Healthcare, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Valley Regional Hospital Inc 243 Elm Street Claremont NH 03743 020222118 Critical Access Hospital NH 501(c)(3) Line 3 Valley Regional Healthcare Inc 1 Charitable Remainder Trusts (3) Charitable Trust NH Valley Regional Hospital Inc 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 Valley Regional Hospital Inc L 1278874 Amounts Received Valley Regional Hospital Inc A 928872 Amounts Received