2022-08-11T09:57:26-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Matthew Streeter CFO 6037884911 2022-08-08 1 Matthew Streeter 999009999 Joseph R Byrne P01289281 2077752387 2022-08-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Michael D Lee 173 Middle Street Lancaster NH 03584 76485065 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 15 13 427 49 0 0 5603209 7397277 54896042 60333534 1170854 1478928 19760 41316 61689865 69251055 59570 163825 0 0 34703761 35166324 0 0 11912 21579710 28189215 56343041 63519364 5346824 5731691 92603523 93203469 47425639 40368933 45177884 52834536 Weeks Medical Center's compassionate staff is committed to providing high quality and efficient health care services to ensure the well-being of our patients, families and communities. 0 0 51671874 163825 60145310 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 51671874 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 63 0 1 427 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 1 0 1 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 Sarah Desrochers Chairperson 1.00 2.00 X X 0 0 0 Keith Young Vice Chair 1.00 0.00 X X 0 0 0 Dennis Couture Treasurer 1.00 0.00 X X 0 0 0 Ruby Berryman Secretary 1.00 0.00 X X 0 0 0 Denise Brisson Trustee 2.00 0.00 X 4118 0 124 Scott Burns Trustee 1.00 0.00 X 0 0 0 Charlie Cotton Trustee 1.00 0.00 X 0 0 0 Donald Crane Trustee 1.00 1.00 X 0 0 0 Zeanny Egea Trustee 1.00 0.00 X 0 0 0 William Everleth Trustee 1.00 0.00 X 0 0 0 Stanley Holz Trustee 1.00 0.00 X 0 0 0 Sharon Kopp Trustee 1.00 0.00 X 0 0 0 Frances LaDuke Trustee 1.00 0.00 X 0 0 0 William Kemp Schanlaber Medical Staff President 40.00 0.00 X X 287211 0 50521 Mark Morgan MD CMO 37.00 0.00 X X 517744 0 48055 Lars Nielson Past CMO 40.00 0.00 X X 99681 0 16783 Michael D Lee President/CEO 39.00 1.00 X 317741 0 23874 Celeste Pitts CFO 24.00 17.00 X 109924 73283 16360 Paul Kamins MD Physician 33.00 0.00 X 397388 0 44068 Christopher Laurent NP Nurse Practicioner 40.00 0.00 X 469489 0 26533 Maude Oetking Physician 40.00 0.00 X 434191 0 23634 John Ford MD Physician 40.00 0.00 X 396885 0 11578 Elisabeth Moore Physician 35.00 6.00 X 315981 86049 38941 3350353 159332 300471 57 0 1 0 Daniel Herbert Inc 12 Pleasant Street Colebrook NH 03576 Construction Services 615059 AHSA LLC PO Box 670529 Dallas TX 753972633 Temporary Staffing Agency 579282 New England Security 452 Madison Ave Berlin NH 03570 Security Services 348040 Joseph R C Kiernan 199 Bossie Road Randolph VT 05060 Surgical Services 235542 Beattie Enterprises 99 Bridge Street Lancaster NH 03584 Grounds Maintenance 177318 52 5818611 1578666 7397277 Patient Service 621400 100718924 100718924 Miscellaneous 621400 3535183 3346959 188224 Contractual/Char. Adj. 621400 -43920573 -43920573 60333534 1251917 1251917 7458021 3000 7233220 790 224801 2210 227011 227011 Gain on Affiliate Activity 900099 41316 41316 41316 69251055 60145310 0 1708468 163825 163825 1485594 1485594 27744231 23847336 3896895 423521 369832 53689 3861855 3266682 595173 1651123 1353989 297134 2673699 655119 2018580 17270 17270 39367 39367 59154 59154 4366668 4145354 221314 211981 200069 11912 336581 95438 241143 1719581 1719581 1603389 1566626 36763 90912 87397 3515 65178 51642 13536 314856 314856 2930996 2930996 883263 453161 430102 Patient Care Supplies 9326797 9326797 MET Taxes 1980305 1980305 Miscellaneous 1569218 1062519 506699 63519364 51671874 11835578 11912 X 170878 11495297 31976147 12368399 5952775 8197617 9534913 9534913 957205 1172969 1379327 1297110 57663886 37252409 20510643 20411477 22121635 28444762 0 280925 92603523 93203469 3594440 4791681 966934 671604 6240726 5725226 3808500 3667728 32815039 25512694 47425639 40368933 X 43001821 51395830 2176063 1438706 45177884 52834536 92603523 93203469 5731691 1924961 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8488 8488 0 Part II-B, Line 1: Weeks Medical Center is a member of the New Hampshire Hospital Association, and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of WMC and other member organizations in furtherance of their exempt purposes. WMC does not directly perform any lobbying activities. 1012784 105411 1118195 1038704 -25920 1012784 1040597 -1893 1038704 1054173 -13576 1040597 1039727 14446 1054173 0.00000 0.81550 0.18450 0 0 532630 532630 14563258 10501438 4061820 40569419 26098842 14470577 1998579 652129 1346450 20411477 Estimated Third-Party Payor Settlements 17092180 Medicare Accelerated Payments 7351100 Deferred HHS Stimulus Revenue 1069414 25512694 Part V, Line 4: Weeks Medical Center Endowment Funds were gifted with the intent to help defray the costs of indigent care for adults and children, and general upkeep and operations of the hospital. 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 1 1034205 249882 784323 0.01230 1 9832959 8946390 886569 0.01400 1 2628892 1115334 1513558 0.02380 3 13496056 10311606 3184450 0.05010 12 1285228 57232 1227996 0.01930 2 293358 293358 0.00460 2 5610825 3795180 1815645 0.02860 3 225423 225423 0.00350 19 7414834 3852412 3562422 0.05600 22 20910890 14164018 6746872 0.10610 10285 10285 0.00020 10285 10285 0.00020 1 1219167 31412343 31867362 -455019 X 1 1 1 1 Weeks Medical Center 173 Middle Street Lancaster NH 03584 www.weeksmedical.org 00015 X X X X Weeks Medical Center 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X https://weeksmedical.org/community-health-needs-assessment/ X 1 18 1 https://weeksmedical.org/community-health-needs-assessment/ 0 1 X 300.000000000000 300.000000000000 X X 1 1 X X X X 1 X https://weeksmedical.org/patients-visitors/financial-information X https://weeksmedical.org/patients-visitors/financial-information X https://weeksmedical.org/patients-visitors/financial-information X X X X X X 1 X 0 X X X X 1 X 0 0 Weeks Medical Center Part V, Section B, Line 5: An electronic survey was sent to a select group of local experts that included information from well-respected secondary sources on the current state of health care in the community. Individuals and agencies involved in Public Health and State & Local Health were included as were individuals from priority populations, chronic disease groups and other community members. Weeks Medical Center Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Upper Connecticut Valley Hospital, Littleton Regional Hospital, and Androscoggin Valley Hospital. Weeks Medical Center Part V, Section B, Line 6b: The Hospital's CHNA was conducted along with Ammonoosuc Community Health Services, Coos County Family Health, and North Country Home Health & Hospice Agency. The first two are local FQHC's. Weeks Medical Center Part V, Section B, Line 11: Significant Needs Identified and Being Addressed:1. Drug/Substance Abuse - This was identified in the last CHNA. Weeks started a Medication Assisted Therapy (MAT) pilot program in 2017 at our Lancaster location and expanded to more clinics in 2018. Presently we have three MAT clinics and provide staffing for Androscoggin Valley Hospital's HUB. In 2021, WMC opened a clinic in Colebrook.2. Mental Health - Weeks has significantly grown our program from 3 Mental Health providers to 8, increasing access in mental health and substance abuse disorder. In addition, we added support staff case management and recovery coaches. The support staff works with community health workers employed by North Country Health Consortium (NCHC), our local public health agency. Presently, we are partnering with NCHC to develop a 24 hour call center health for mental and health and substance use.3. Obesity/Overweight - Recruited a new dietitian to continue our IBT (Intensive Behavioral Therapy weight management program), we are completing Body Mass Index screening through Rural Health Clinic (RHC) Primary Practices and refer to counseling and other available services. North Country Healthcare (NCH) is exploring a partnership for a Bariatric Program. 4. Accessibility (Transportation, Disability, Access to Care, etc.)- Weekend Acute Care Clinics began in 2018 that have open access and scheduling for present patients. Unfortunately, COVID-19 required us to temporarily suspend these services. Additionally our 4 RHCs have open access scheduling with same day appointments and evening hours and the Hospital expanded telehealth visits during the year due to COVID-19. Case Management facilitates transportation for patients that need support. Lastly, WMC has 7 providers that do home visits. All sites are handicap accessible and case management works with community support to ensure the delivery of care.5. Alcohol Abuse - This is part of our substance use disorder program. WMC has a formal outpatient detox program as well as support for the inpatient program. We have several master level LADCs (Licensed Alcohol and Drug Counselors). We Provide space for Alcoholics Anonymous and are a referral source for them as well, though this was curtailed during the COVID-19 pandemic. Weeks Medical Center Part V, Section B, Line 16j: Brochures and financial counselor information are available in lobbies and handed out to patients. Also, contact information for financial counselors is provided on bills and letters that go out. 4 1 - Lancaster Physicians Offices 170 Middle Street Lancaster NH 03584 Physician Office for primary care 2 - Whitefield Physicians Offices 8 Clover Lane Whitefield NH 03598 Physician Office for primary care 3 - Groveton Physicians Offices 12 Church Street Groveton NH 03582 Physician Office for primary care 4 - North Stratford Physician Offices 43 Main Street North Stratford NH 03590 Physician Office for primary care Part I, Line 7: Cost to charge ratio Part III, Line 4: Please see pages 8-12 and 16-17 of the attached audited financial statements. Part III, Line 8: The entire shortfall is treated as community benefit. Cost to charge ratio from the Medicare cost report was used. Part III, Line 9b: All patients of Weeks Medical Center who have no insurance are notified of the Weeks Health Access Financial Assistance policy and encouraged to make an appointment with one of our Financial Counselors or Social Workers. This information is given out, along with financial assistance applications, at the time of appointment and is also available on our web-site and is reiterated with our monthly statements sent to the patient. It is impossible for our organization to determine if a patient is eligible for financial assistance until an application is filed - we do not access credit reports but rely on the patient supplying us with the necessary financial information. At that time of application, if a patient is determined to be eligible, they are provided with financial assistance. Part VI, Line 2: In 2019, North Country Health Care engaged Quorum Health Resources to facilitate on our behalf the preparation of a Community Health Needs Assessment (CHNA) for the four affiliated hospitals, our Home Health Division and two community health centers. The CHNA was completed in September, 2019. An implementation plan was developed by Senior Leadership at the individual affiliates, and was then combined to develop the NCH Implementation plan. This plan was approved by the Weeks Board of Directors at the December, 2019 meeting. The CHNA and Implementation Plan are available on the Weeks website. Part VI, Line 3: The staff is trained to discuss the Hospital's charity care policy with patients, the policy is available throughout the Hospital in the brochure and it is available on the Hospital's website. WMC also employs a full-time financial counselor and other case management staff to assist patients with the financial assistance process. Part VI, Line 4: Weeks Medical Center's general geographic catchment area consists of nine towns, which supply almost 90% of its patients. Towns include Lancaster, Groveton, Dalton, Whitefield, North Stratford, Jefferson and Stark, in New Hampshire; and Lunenburg, Guildhall and Gilman, in Vermont. Together, these towns have a population of approximately 13,000 and cover approximately 375 square miles in both Vermont and New Hampshire. In 2021, Weeks opened a new Physician Office in Littleton, NH. The town has a population of approximately 4,500. Weeks Medical Center is defined by the geographic communities that surround its facilities and by the individuals and groups who benefit from the health and wellness services provided by its various health related institutions. The definition was developed by the Board of Trustees, its Committees, administrative and professional staff in the practical application of the services provided by the institutions and the identified needs of the communities served. Part VI, Line 5: WMC plays an integral role in the Emergency Preparedness plans of our community. In addition to being available in an emergency from a clinical standpoint, we are a large part of the community wide planning team, taking the lead in the planning of training & drills and bringing the various components together, based on State-wide standards. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 033017300 020275078 501(c)(3) 153825 Substance abuse prevention, treatment, and recovery at State level. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 501(c)(3) 10000 Contribution for Mobile Medical Unit 2 0 Part I, Line 2: The Hospital was mandated by the State of NH to contribute funds to the Alcohol and Drug Prevention Treatment Fund in order to continue the Medicaid Expansion Program. These funds go towards various programs surrounding recovery, treatment and prevention for substance misuse in New Hampshire. Additionally, each of the Hospitals affiliated with North Country Healthcare elected to participate in an initiative with the Bowler-Bartlett Foundation to purchase a mobile medical unit to be made available for use throughout New Hampshire. 0 0 0 0 0 0 0 1 0 Mark Morgan MD CMO 516227 0 0 0 1517 0 5365 0 42690 0 565799 0 0 0 Christopher Laurent NP Nurse Practicioner 456280 0 8637 0 4572 0 8550 0 17983 0 496022 0 0 0 Maude Oetking Physician 431815 0 0 0 2376 0 8550 0 15084 0 457825 0 0 0 Paul Kamins MD Physician 393519 0 0 0 3869 0 7583 0 36485 0 441456 0 0 0 Elisabeth Moore Physician 307411 79882 8333 0 237 6167 6067 2599 21553 8722 343601 97370 0 0 John Ford MD Physician 395068 0 1000 0 817 0 7844 0 3734 0 408463 0 0 0 Michael D Lee President/CEO 273875 0 33750 0 10116 0 7715 0 16159 0 341615 0 0 0 William Kemp Schanlaber Medical Staff President 285691 0 0 0 1520 0 8508 0 42013 0 337732 0 0 0 Celeste Pitts CFO 106015 70677 0 0 3909 2606 2825 1883 6991 4661 119740 79827 0 0 Part I, Line 7 The President/CEO (Michael Lee) has an annual bonus clause in his contract. The amount is discretionary and determined by the Board of Directors, based on overall performance of the Organization for that year. The other individuals received a purely discretionary bonus per the President based on recognition of additional responsibilities and special projects performed. Schedule J, Part I, Line 3: North Country Healthcare, a related organization, uses the following methods to establish compensation for the top management official of the filing organization: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee A Business Finance Authority of the State of NH 521304598 2010-09-01 10000000 Refinance existing debt and finance the Hospital's contruction project 0 0 0 A 4274774 10000000 112960 3044490 6842550 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 1 A 0 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/10/2021 Form 990, Part VI, Section A, line 4 During FY21, the Hospital amended its bylaws and the following significant changes were made: 1. The President of the Hospital is no longer able to call a special meeting of the Board. 2. Regarding a quorum - language was amended to reflect the following: "After a quorum has been established at a meeting of the Corporation Board, the subsequent withdrawal of directors from the meeting so as to reduce the number of directors present to fewer than the number required for a quorum shall not affect the validity of any action taken by the Corporation Board at the meeting or any adjournment thereof to the extent a quorum was present at the time such action was taken." 3. Regarding Committees of the Board - language was amended to reflect that other committees of the Board shall be established only in conjunction with the System Parent. 4. Regarding the Executive Committee - language was amended to include the Hospital President on the Committee. Form 990, Part VI, Section A, line 6 Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Weeks Medical Center. Form 990, Part VI, Section A, line 7a In accordance with the Affiliation Agreement with North Country Healthcare (NCH), each Hospital's charter and bylaws were amended to effect the establishment of NCH as the sole member and to create a shared governance structure between the Board of Directors of NCH and the Boards of each Hospital. Each Hospital continues to maintain its own Board of Directors (Corporation Board) that is distinct from the NCH Board of Directors. However, the Bylaws of NCH and each Hospital identify certain "Major matters" (divided into organizational and operational matters) that require initiation and/or authorization by a majority of the NCH Board. Members of the Hospital Boards are nominated exclusively by the Hospitals. However, the election of any such director must be approved by both the Hospital Board and the NCH Board. Some examples of other organizational "Major matters" requiring the initiation and/or approval of the NCH Board include amendments to by-laws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major matters" requiring the initiation and/or approval of the NCH Board include approval of annual capital and operating budgets, adoption of compensation and benefit programs, approval of information technology systems, financial systems and auditors, plus approval of any major changes to clinical services offered. The President position at each of the Hospitals has been changed to a President/CEO position. As with Board members, each Hospital President/CEO must be nominated at the Hospital level and then approved by both the Hospital Board and the NCH Board. This position reports to both the applicable Hospital Board and the Chief Executive Officer of NCH. The Chief Financial Officer of each of the Hospitals will remain an appointed position by the President. Form 990, Part VI, Section A, line 7b See narrative provided for Form 990, Part VI, line 7a. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by CFO & President/CEO of the Hospital. After their review is complete, the Form is shared electronically with the entire Board and Finance Committee prior to filing. Form 990, Part VI, Section B, line 12c Annual conflict of interest forms are signed by all employees, officers, and Board members. Board members with a conflict are excused from voting on any items that relate to the other organization, etc. that is the conflict. The Organization also provides annual 990 questionnaires with several potential conflict situations discussed and distributed to the full Board every year at the time of the audit. Annual questionnaire was distributed electronically this year by the NCH Corporate Compliance staff and forwarded to BerryDunn. Any conflict discovered by the CPA's would be addressed by Hospital Management. Members with a conflict are excused from voting on any items that relate to the conflict identified. Form 990, Part VI, Section B, line 15 The President/CEO's compensation is determined by the Executive Committee of the Board (serving as the compensation committee), a written employment contract, a state compensation survey and approval of the full Board and Executive Committee. Other officers have their compensation determined through a state compensation survey, along with approval of the President. 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: Weeks Medical Center 173 Middle Street Lancaster, NH 03584 EIN: 02-0222242 Weeks Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I N/A 0 Upper Connecticut Valley Hospital Corliss Lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 0 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 0 North Country Home Health & Hospice Agency Inc 536 Cottage St Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 North Country Healthcare Inc 0 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Organization NH 501(c)(3) Line 12a, I Weeks Medical Center 1 Northcare Inc 59 Page Hill Road Berlin NH 03570 521596952 Supporting Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 0 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 0 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 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0 Lancaster Patient Care Center K 179000 Checks Issued