2022-08-11T09:59:50-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 020300637 North Country Home Health & Hospice Agency Inc NORT 6034445317 536 Cottage Street Littleton NH 03561 Matthew Streeter CFO 6034445317 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 Tiffany Haynes-Hicks 536 Cottage Street Littleton NH 03561 9103577 0 X northcountryhomehealth-hospice.org X 1971 NH To provide quality home health and hospice care, utilizing a holistic approach, while working in collaboration with all community resources, to meet the comprehensive needs of the clients and their families, in a cost effective manner. 13 11 105 12 0 0 1216713 760620 7651151 8299303 8544 9114 33246 33891 8909654 9102928 0 0 0 0 5169813 5700811 0 0 0 2932919 3160918 8102732 8861729 806922 241199 5144820 5198676 2704501 2452979 2440319 2745697 To provide quality home health and hospice care, utilizing a holistic approach, while working in collaboration with all community resources, to meet the comprehensive needs of the clients and their families, in a cost effective manner. 0 0 6788265 8299303 Home care: provides home health, hospice, and health promotion services to residents of upper Grafton and Coos Counties of New Hampshire. 6788265 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 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 0 0 0 1 27 0 1 105 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 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 Roxie Severance Chair 1.00 1.00 X X 0 0 0 Chrissy Smith Vice Chair 1.00 0.00 X X 0 0 0 Mell Brooks Secretary 1.00 0.00 X X 0 0 0 Patrick Kelly Treasurer 1.00 0.00 X X 0 0 0 Darrell Bodnar Trustee 1.00 40.00 X 0 169843 29141 JJ Bujeaud Trustee 1.00 0.00 X 0 0 0 Greg Eastman Trustee 1.00 0.00 X 0 0 0 Kimberly Force Trustee 1.00 0.00 X 0 0 0 Ann Hebert Trustee 1.00 0.00 X 0 0 0 Holly McCormack Trustee 1.00 0.00 X 0 0 0 Brian O'Hearn Trustee 1.00 40.50 X 0 192644 28250 John Starr Trustee 1.00 0.00 X 0 0 0 Chad Sterns Trustee 1.00 0.00 X 0 0 0 Nicholas Delaney Past Trustee 1.00 1.00 X 0 0 0 Michael Counter Past President/CEO 40.00 0.00 X 203816 0 10026 Tiffany Haynes-Hicks President/CEO 40.00 0.00 X 127361 0 33481 Matthew Streeter CFO 1.00 39.00 X 0 0 0 Catherine Cullen Past Quality Coordinator 40.00 0.00 X 137427 0 494 Kevin Botelho APRN 32.00 0.00 X 131129 0 23722 Alicia Travers Occupational Therapist 40.00 0.00 X 107812 0 1483 707545 362487 126597 5 0 1 0 Medical Solutions LLC PO Box 310737 Des Moines IA 50331 Rehab & Clinical Staff 306052 Enclara Health LLC PO Box 745791 Atlanta GA 303745791 Pharmaceutical Service 190490 MAS Medical Staffing 156 Harvey Road Londonderry NH 03053 Rehab Staff 190033 Berry Dunn McNeil & Parker 1000 Elm St 4th Floor Manchester NH 03101 Accounting, Auditing & Compliance servic 174670 Littleton Physical Therapy 76 Morrison Hill Drive Littleton NH 03561 Rehab Staff 167235 5 20000 695986 44634 760620 Home Health Care 621610 8299303 8299303 8299303 9114 9114 31690 0 31690 31690 31690 2850 649 2201 2201 9102928 8299303 0 43005 X 374684 374684 4164668 3557383 607285 41928 38911 3017 780133 646013 134120 339398 268566 70832 24780 24780 36352 36352 3754 3754 1233040 633044 599996 46836 37061 9775 130782 103489 27293 152748 120869 31879 45133 35714 9419 246253 243719 2534 186730 147759 38971 28854 22756 6098 199850 160959 38891 35495 28087 7408 Program supplies 503529 503529 Miscellaneous 286782 240406 46376 8861729 6788265 2073464 0 X 1200251 725330 541295 401574 13150 1555563 2311291 31763 28359 2550790 1188395 1502785 1362395 237254 291915 62759 77812 5144820 5198676 876971 1254104 5840 5840 873921 759569 947769 433466 2704501 2452979 X 2151360 2405810 288959 339887 2440319 2745697 5144820 5198676 X 241199 49125 15053 X 0 1 X 1 0 X 420711 970356 434101 1216713 760620 3802501 2332377 5189207 7832461 7651151 8299303 31304499 2753088 6159563 8266562 8867864 9059923 35107000 0 0 0 35107000 4947 3782 6123 7958 40804 63614 4947 3782 6123 7958 40804 63614 30506 33246 2201 65953 2758035 6163345 8303191 8909068 9102928 35236567 0.99630 0.99650 0.00180 0.00120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 265950 56620 2959 319611 250092 18327 2469 265950 245018 7476 2402 250092 240272 6249 1503 245018 71984 156200 12888 800 240272 0.18000 0.82000 0.00000 0 0 168203 168203 1136921 777065 359856 1245666 411330 834336 1362395 Due to Related Parties 433466 433466 X 9164001 49125 15702 64827 9099174 3754 3754 9102928 8858623 649 649 8857974 3754 3754 8861728 Part V, Line 4: All income of the endowment assets earned is to be used for the general operations of the Agency. Part X, Line 2: The Agency is a public charity under Section 501(c)(3) of the Internal Revenue Code (IRC). As a public charity, the Agency is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Agency's tax positions and concluded that the Agency has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: Change in fair value of perpetual trust 15,053. Fundraising Expenses 649. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 649. 1 0 0 0 0 0 0 1 0 Brian O'Hearn Trustee 0 172219 0 1020 0 19405 0 0 0 28250 0 220894 0 0 Michael Counter Past President/CEO 153094 0 45000 0 5722 0 4501 0 5525 0 213842 0 0 0 Darrell Bodnar Trustee 0 167945 0 0 0 1898 0 5147 0 23994 0 198984 0 0 Tiffany Haynes-Hicks President/CEO 119878 0 7270 0 213 0 2744 0 30737 0 160842 0 0 0 Kevin Botelho APRN 128824 0 800 0 1505 0 4013 0 19709 0 154851 0 0 0 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: o Compensation committee o Independent compensation consultant o Form 990 of other organizations o Written employment contract o Compensation survey or study o Approval by the board or compensation committee Part I, Line 4a Catherine Cullen, Past Quality Coordinator, received severance of $13,462. Part I, Line 7 Michael Counter's amount of $45,000 was based on achievement of his performance goals and agency performance. It was approved by NCHHH Board of Directors. Bonuses for Tiffany Haynes and Alicia Travers were combination of recruitment (sign on) and productivity. Bonus for Kevin Botelho was based on productivity. Form 990, Part VI, Section A, line 4 During FY21, the Organization amended its bylaws and the following significant changes were made: 1. The President of the Organization 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 Organization's President on the Committee. Form 990, Part VI, Section A, line 6 North Country Healthcare, Inc. is the sole member. 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 Affiliate. Each Affiliate 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 Affiliate 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 Affiliate Boards are nominated exclusively by the Affiliates. However, the election of any such director must be approved by both the Affiliate 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 Affiliate, merger decisions and hiring/termination of Affiliate 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 Affiliates has been changed to a President/CEO position. As with Board members, each Affiliate President/CEO must be nominated at the Affiliate level and then approved by both the Affiliate Board and the NCH Board. This position reports to both the applicable Affiliate Board and the Chief Executive Officer of NCH. The Chief Financial Officer of each of the Affiliates 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 is reviewed by the CFO and shared with entire Board prior to filing. Form 990, Part VI, Section B, line 12c Annual review - Board of Directors & Agency Management. 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 governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Form 990, Part IX, line 11g Other: Program service expenses 633,044. Management and general expenses 599,996. Fundraising expenses 0. Total expenses 1,233,040. Form 990, Part X, Line 10: Land, Buildings, and Equipment: Section 1.263(a)-3(n) Election: North Country Home Health & Hospice Agency, Inc. 536 Cottage Street Littleton, NH 03561 EIN: 02-0300637 North Country Home Health & Hospice Agency is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in interest of beneficial trust 15,053. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I N/A 0 Androscoggin Valley Hospital 59 Page Hill Road Berlin NH 03570 020280367 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 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 Weeks Medical Center 173 Middle Street Lancaster NH 03584 020222242 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare 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 Northcare Inc 59 Page Hill Road Berlin NH 03570 521596952 Supporting Services 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 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Services NH 501(c)(3) Line 12a, I Weeks Medical Center 0 0 0 1 0 1 0 0 0 0 1 1 0 1 0 1 0 0 0 0