2025-08-15T12:50:55-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 020276210 UPPER CONNECTICUT VALLEY HOSPITAL UPPE 6032374971 181 CORLISS LANE COLEBROOK NH 03576 MATTHEW STREETER SYSTEM CFO 6032374971 2025-08-15 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-15 2023 2025-03-06 01:10:19Z GREGORY COOK 181 CORLISS LANE COLEBROOK NH 03576 36287204 0 X WWW.UCVH.ORG X 1969 NH UPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE. 10 8 148 8 0 0 477868 550418 35980776 33980603 740186 1218109 108477 538074 37307307 36287204 249399 474080 0 0 12087222 13355358 0 0 0 19042315 19910180 31378936 33739618 5928371 2547586 41887833 41869573 6581227 2588858 35306606 39280715 UPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE. 0 0 25715313 474080 33980603 UPPER CONNECTICUT VALLEY HOSPITAL PROVIDED HOSPITAL CARE AND INPATIENT AND OUTPATIENT SERVICES ON A REGION-WIDE BASIS. THE NET CHARITY CARE PROVIDED BY THE HOSPITAL FOR THE YEAR-ENDED SEPTEMBER 30, 2024 WAS $765,908. 25715313 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 54 0 148 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 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 EDWARD LAVERTY PA-C CHIEF MEDICAL OFFICER 40.00 X 280929 0 18053 ROBERT DAWSON PRESIDENT OF MEDICAL STAFF 1.00 39.00 X 0 13251 0 DAVID THATCHER CHAIR 1.00 X X 0 0 0 LYNN BREWER CHAIR (THRU 12/23) 39.00 1.00 X X 0 0 0 GAIL FISHER VICE CHAIR 1.00 X X 0 0 0 MORGAN WADE VICE CHAIR (THRU 1/24) 1.00 X X 0 0 0 ROD DE GREEF TREASURER 1.00 X X 0 0 0 JAMES WELLS TREASURER (THRU 3/24) 1.00 X X 0 0 0 MAGGIE FITZGERALD SECRETARY 1.00 X 0 0 0 ERIC STOHL SECRETARY (THRU 1/24) 1.00 1.00 X X 0 0 0 JEANNINE BURNS DIRECTOR (THRU 6/23) 1.00 X 0 0 0 FR CRAIG CHENEY DIRECTOR (THRU 7/24) 1.00 X 0 0 0 E HARLAN CONNARY DIRECTOR 1.00 X 0 0 0 SHARON ELLINGWOOD WHITE DIRECTOR (THRU 9/24) 1.00 X 0 0 0 RICHARD LAPOINT DIRECTOR 1.00 X 0 0 0 LAURA MILLS DIRECTOR 1.00 X 0 0 0 PETER WEINER DIRECTOR 1.00 X 0 0 0 THOMAS MEE SYSTEM CEO 1.00 45.00 X 0 706230 18318 SCOTT COLBY PRESIDENT/CEO (THRU 12/23) 40.00 X 361012 0 23991 MATTHEW STREETER SYSTEM CFO 1.00 45.00 X 0 357595 20804 LINDSAY LEA CNO 40.00 X 182568 0 8597 GREGORY COOK PRESIDENT/CEO (BEG 11/23) 40.00 X 29092 0 569 THOMAS COCHRAN ED PHYSICIAN 40.00 X 459590 0 17859 TAMSIN DURAND GENERAL SURGEON 40.00 X 393971 0 18698 DARIN BROWN ED PHYSICIAN 40.00 X 376272 0 23319 JULIE BOLTON RN 40.00 X 167017 0 6283 JUDY GRIMES EMPLOYEE 40.00 X 139813 0 13351 2390264 1077076 169842 36 0 1 0 MEDICAL SOLUTIONS LLC 1010 N 102ND ST OMAHA NE 68114 CONTRACT LABOR 1785277 NEW HAMPSHIRE IMAGING SERVICES INC 1 PILLSBURY ST SUITE 200 CONCORD NH 03301 MRI PURCHASED SERVICES AND CONTRACT LABO 218465 DARTMOUTH HITCHCOCK MEDICAL CENTER 1 MEDICAL CENTER DR LEBANON NH 03766 PURCHASED SERVICES AND CONTRACT LABOR 139409 WEEKS MEDICAL CENTER 173 MIDDLE ST LANCASTER NH 03584 MISC CONTRACT LABOR 111430 4 499311 51107 550418 PATIENT SERVICE REVENUE 621400 33402479 33402479 CONTRACTED SERVICE REVENUE 621400 563050 563050 PHARMACY REVENUE 456110 13995 13995 1079 1079 33980603 228223 228223 104023 0 104023 104023 104023 989886 0 989886 989886 989886 CAFETERIA REVENUE 722514 103415 103415 330636 330636 434051 36287204 33980603 0 1756183 X 474080 474080 867473 431239 436234 9333631 8561136 772495 224576 210220 14356 2239952 2030085 209867 689726 622583 67143 332741 1425 331316 5612 5612 4744151 4391455 352696 117439 27400 90039 100294 10712 89582 15030 15030 390544 378525 12019 206212 204739 1473 11509 7554 3955 2869 2412 457 2035291 1711275 324016 625177 625177 INTERCOMPANY ALLOCATION 3952731 168406 3784325 BAD DEBT EXPENSE 2648601 2648601 MEDICAL SUPPLIES 2277405 2277181 224 ENHANCEMENT TAX 1382584 1382584 1061990 931108 130882 33739618 25715313 8024305 0 835 1106 2119340 4871847 3322628 3918352 269311 304170 455200 387063 34749014 17362610 17338955 17386404 17113896 14009863 1267668 990768 41887833 41869573 4592707 1554883 71927 52615 292329 270130 1624264 711230 6581227 2588858 X 34985711 38876953 320895 403762 35306606 39280715 41887833 41869573 2547586 1426523 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 5612 5612 0 PART II-B, LINE 1: THE HOSPITAL 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 THE HOSPITAL AND OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. 290705 40423 331128 259755 30950 290705 299038 -39283 259755 263236 35802 299038 240915 24066 1745 263236 0.00000 0.52270 0.47730 0 0 69700 69700 18208392 5392804 12815588 15538474 11969806 3568668 932448 932448 17386404 DUE TO RELATED PARTIES 711230 711230 34932589 1426523 -2648601 -1222078 36154667 132537 132537 36287204 31041347 0 31041347 2698271 2698271 33739618 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENTS ARE USED FOR STAFF EDUCATION, NURSING PROJECTS AND INDIGENT CARE. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 180184 180184 0.00530 4167790 1638836 2528954 0.07500 4347974 1638836 2709138 0.08030 6404769 5208873 1195896 0.03540 6404769 5208873 1195896 0.03540 10752743 6847709 3905034 0.11570 1 1514187 0 8952561 9003212 -50651 X 1 1 1 1 UPPER CONNECTICUT VALLEY HOSPITAL 181 CORLISS LANE COLEBROOK NH 03576 WWW.UCVH.ORG 00592 X X X X UPPER CONNECTICUT VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 21 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 300.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X X X X X 1 X 0 X X X X 1 X 0 0 UPPER CONNECTICUT VALLEY HOSPITAL 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. UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL'S CHNA WAS CONDUCTED ALONG WITH WEEKS MEDICAL CENTER AND ANDROSCOGGIN VALLEY HOSPITAL. UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS CONDUCTED ALONG WITH COOS COUNTY FAMILY HEALTH AND NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY. THE FIRST IS A LOCAL FQHC. UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 7D: LINE 7A: HTTPS://WWW.UCVH.ORG/COMMUNITY-BENEFITS-REPORT/LINE 10A: HTTPS://WWW.UCVH.ORG/COMMUNITY-BENEFITS-REPORT/ UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 11: UPPER CONNECTICUT VALLEY HOSPITAL TOOK THE FOLLOWING STEPS DURING FY 2024 TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENT CHNA, COMPLETED IN TAX YEAR 2021:- ADDITIONAL PROVIDERS ADDED TO EXISTING WMC BEHAVIORAL HEALTH PRACTICE- CONTINUANCE OF FINANCIAL ASSISTANCE- PA-C ADDED TO BERLIN AND COLEBROOK MARKET TO REPLACE PREVIOUS PA-C. (CHRONIS DISEASE MANAGEMENT HEART DISEASE)- WE HAVE CONDUCTED VIRTUAL LECTURES ON VARIOUS HEALTH-RELATED TOPICS, BASED ON PROVIDER AVAILABILITY. NOT NECESSARILY CHRONIC DISEASE EDUCATION. WE HAVE HAD A PRESENCE (AND WILL LATER THIS MONTH AND NEXT) AT LANCASTER FAIR TO CONDUCT BLOOD PRESSURE SCREENINGS, PROVIDE INFORMATION. COMMUNITY WELLNESS FAIR WAS SCHEDULED EARLIER THIS SUMMER, BUT POSTPONED DUE TO EXTREME HEAT.- UNDER ACCESS TO HEALTHCARE- WE ADDED A NEW POSITION: CLINICAL LIAISON, WHO IS A NURSE, SHE ROUNDS AT EACH HOSPITAL DAILY TO FACILITATE DISCHARGES TO HOME HEALTH, PALLIATIVE CARE AND HOSPICE.- UNDER CHRONIC DISEASE MANAGEMENT: WEEKS HIRED A PALLIATIVE APRN IN MARCH. PALLIATIVE CARE CAN HELP OUR COMMUNITY GREATLY BY ASSISTING PATIENTS WHO HAVE CHRONIC ILLNESSES ACHIEVE SYMPTOM CONTROL, COMPLETE ADVANCED DIRECTIVES AND STAY OUT OF THE HOSPITAL- ALZHEIMER'S AND DEMENTIA- NCHHHA STARTED AN ALZHEIMER'S AND DEMENTIA SUPPORT GROUP FOR CAREGIVERS PART I, LINE 7: THE HOSPITAL USES A COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FORM 990 SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES PART I, LINES 7E-I. THE HOSPITAL DETERMINES COST BY COMBINING DIRECT EXPENSES IDENTIFIED BY ITS ACCOUNTING SYSTEM WITH AN ESTIMATED OVERHEAD ALLOCATION. PART I, LINE 7G: THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE EMERGENCY SERVICES UNIT, OBSERVATION BEDS AND SPECIALTY CLINICS. PART II, COMMUNITY BUILDING ACTIVITIES: THE COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY UCVH CONSIST OF SUPPORTING LOCAL GOVERNMENT AND OTHER HEALTH CARE PROVIDERS, COORDINATION OF DISASTER DRILLS, EMERGENCY PREPAREDNESS, AND SUPPORT OF OTHER LOCAL ORGANIZATIONS WITHIN THE COMMUNITY. IN ADDITION, IN AN EFFORT TO PROVIDE THE NECESSARY HEALTH CARE SERVICES FOR THE POPULATION WITHIN A REASONABLE DRIVING DISTANCE, UCVH HAS ENTERED INTO A COLLABORATION WITH THE OTHER TWO COOS COUNTY HOSPITALS TO PROVIDE NECESSARY PRIMARY CARE, BEHAVIORAL HEALTH, AND SPECIALTY SERVICES FOR THE UCVH SERVICE AREA. PART III, LINE 2: THE HOSPITAL USES A COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FORM 990 SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE CCR WAS THEN APPLIED TO BAD DEBT EXPENSE AT CHARGE VALUE IN ORDER TO ARRIVE AT THE ESTIMATED EXPENSE REPORTED. PART III, LINE 8: THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: IF KNOWN TO QUALIFY FOR CHARITY OR FINANCIAL ASSISTANCE, PATIENTS ARE GIVEN THE ASSISTANCE NEEDED. PART VI, LINE 2: EVERY 3 YEARS, UPPER CONNECTICUT VALLEY HOSPITAL PARTICIPATES IN A COMMUNITY NEEDS ASSESSMENT WITH THREE OTHER MEMBERS OF THE COMMUNITY'S HEALTH CARE SYSTEM. USING INFORMATION FROM THAT ASSESSMENT ALLOWS THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO THE NORTH COUNTRY COMMUNITY ON AN ONGOING BASIS. PART VI, LINE 3: UCVH HAS A PATIENT FINANCIAL COUNSELOR WHO IS RESPONSIBLE FOR WORKING WITH PATIENTS AND ANY WHO MAY BE BILLED FOR THEIR CARE TO DETERMINE THEIR ELIGIBILITY, ON A CASE BY CASE BASIS. FOR ANY GOVERNMENT PROGRAMS, SUCH AS MEDICAID OR THE UCVH FINANCIAL ASSISTANCE PROGRAM ALL STAFF AT UCVH, PARTICULARLY REGISTRATION STAFF WHO WILL BE THE FIRST ONES TO NOTICE IF A PATIENT DOES NOT HAVE INSURANCE, ARE TRAINED TO REFER THE PATIENT TO THE FINANCIAL COUNSELOR. IN ADDITION, BROCHURES ARE AVAILABLE, AS IS CONTACT INFORMATION ON THE WEBSITE. PART VI, LINE 4: UCVH IS THE SMALLEST CRITICAL ACCESS HOSPITAL IN NEW HAMPSHIRE THAT SERVES THE LARGEST GEOGRAPHIC SERVICE AREA (OVER 850 SQUARE MILES) INCLUDING COMMUNITIES IN THE STATES OF NEW HAMPSHIRE, VERMONT, AND MAINE. ACCORDING TO THE NEW HAMPSHIRE STATE HEALTH PROFILE, OUR RESIDENTS ARE THE MOST FRAGILE OF ALL CITIZENS IN NEW HAMPSHIRE AS IT RELATES TO HEALTH OUTCOMES AND ECONOMIC CONDITIONS. UCVH IS DEPENDENT ON PUBLIC FUNDING AND DISPROPORTIONATE SHARE FUNDING TO SUBSIDIZE THE CARE PROVIDED TO THE PATIENTS WE SERVE. PART VI, LINE 5: UCVH PERFORMS BLOOD DRIVES FOR THE LOCAL COMMUNITY, IN WHICH IT VOLUNTEERS ITS TIME ASSOCIATED WITH THESE EFFORTS. ADDITIONALLY, UCVH SUPPORTS A LOCAL "PRESCRIPTION FOOD PROGRAM" THAT PROVIDES FREE MONTHLY FOOD BOXES AND NUTRITION EDUCATION TO INDIVIDUALS IN NEED. THIS PROGRAM CONSISTS OF APPROXIMATELY 310 HOURS OF VOLUNTEERS AND EMPLOYEES TO SUPPORT, IN ADDITION TO SERVING OVER 175 INDIVIDUALS IN THE LOCAL COMMUNITY. UCVH PROVIDES DONATIONS IN EXCESS OF $50,000 ANNUALLY TO SUPPORT LOCAL TRANSPORTATION TO INDIVIDUALS IN NEED TO ASSIST IN ENSURING ACCESS TO MEDICAL, DENTAL, BEHAVIORAL HEALTH CARE, AND TO THE PHARMACY TO GET THEIR PRESCRIPTIONS. OVER 1,650 INDIVIDUALS BENEFIT FROM THIS PROGRAM IN THE GREATER COLEBROOK AREA. UCVH IN COORDINATION WITH IS AFFILIATION THROUGH NORTH COUNTRY HEALTHCARE SUPPORTED BLOOD PRESSURE SCREENINGS, FREE COVID TEST KITS, AND NARCAN KITS TO NEARLY 1,300 INDIVIDUALS IN THE LOCAL COMMUNITY. PART VI, LINE 6: UPPER CONNECTICUT VALLEY HOSPITALS TOP PRIORITY IS TO ENSURE THE HIGHEST LEVEL OF QUALITY HEALTHCARE TO THOSE THAT WE ARE SO FORTUNATE TO SERVE. IN AN EFFORT TO CONTINUE TO PROVIDE A HIGH QUALITY OF HEALTHCARE FOR ALL PATIENTS IN THE NORTH COUNTRY, THE HOSPITALS OF COOS & GRAFTON COUNTY CAME TOGETHER TO EXPLORE COLLABORATION. WE, THE BOARDS AND SENIOR MANAGEMENT OF ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER REALIZE THAT SIGNIFICANT NATIONAL, STATE AND LOCAL ECONOMIC PRESSURES ARE JEOPARDIZING LOCAL ACCESS, QUALITY AND SUSTAINABILITY. WE HAVE THEREFORE FORMED NORTH COUNTRY HEALTHCARE (NCH) WITH THE STATED OBJECTIVE OF WORKING COLLABORATIVELY TO BETTER SERVE THE HEALTHCARE NEEDS OF NORTH COUNTRY PATIENTS. THIS COLLABORATIVE EFFORT WILL WORK TO:1. ENSURE ACCESS TO QUALITY CARE WITHIN THE COMMUNITIES IN WHICH OUR PATIENTS LIVE2. PROVIDE LOCAL AND HIGH QUALITY CARE WITH POSITIVE OUTCOMES TO OUR PATIENTS IN THE NORTH COUNTRY3. CONTROL THE COST OF CARE THROUGH INNOVATIVE PROGRAMS AND THE USE OF SHARED RESOURCESNATIONAL HEALTHCARE REFORM DEMANDS LOWER COSTS AND HIGHER QUALITY FROM ALL HOSPITALS, REQUIRING COLLABORATION IN PATIENT CARE ACROSS ALL PROVIDERS: FROM PRIMARY CARE TO SPECIALIST, FROM AMBULANCE TO HOSPITAL, FROM HOSPITAL TO REHABILITATION TO HOME CARE, FROM LOCAL HOSPITAL TO TERTIARY (SPECIALTY HOSPITAL) CARE. THEREFORE, ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER HAVE FORMED THIS JOINT VENTURE TO IDENTIFY AND IMPLEMENT SUSTAINABLE OPPORTUNITIES FOR OUR FUTURE. THE NCHC AND ITS MEMBER HOSPITALS ARE PREPARED TO MANAGE COSTS AND COORDINATE CARE IN A WAY THAT IS FINANCIALLY SUSTAINABLE, WHILE CONTINUING TO PROVIDE LOCAL ACCESS TO QUALITY CARE THROUGHOUT THE COUNTY AND BEYOND. THE HOSPITALS OF THE NORTH COUNTRY MUST WORK TOGETHER AS CRITICAL PARTS OF OUR ECONOMY AND COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES NH 1 USDA RURAL DEVELOPMENT 26 MAIN ST ST JOHNSBURY VT 05819 720564834 GOV 255313 0 HVAC SYSTEM FOUNDATION FOR HEALTHY COMMUNITIES 125 AIRPORT RD CONCORD NH 033017300 020275078 501(C)(3) 94721 0 SUD NEW HAMPSHIRE CHARITABLE FOUNDATION 37 PLEASANT ST CONCORD NH 03301 026005625 501(C)(3) 89000 0 GENERAL SUPPORT TRI-COUNTY CAP 30 EXCHANGE ST BERLIN NH 03570 020267404 501(C)(3) 35046 0 NEMT GRANT - MOBILITY MANAGER 4 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 1 0 0 0 0 0 1 0 THOMAS MEE SYSTEM CEO 0 559584 0 133893 0 12753 0 6394 0 11924 0 724548 0 0 THOMAS COCHRAN ED PHYSICIAN 459180 0 0 0 410 0 11208 0 6651 0 477449 0 0 0 TAMSIN DURAND GENERAL SURGEON 286133 0 20538 0 87300 0 8719 0 9979 0 412669 0 0 0 DARIN BROWN ED PHYSICIAN 374674 0 0 0 1598 0 10758 0 12561 0 399591 0 0 0 SCOTT COLBY PRESIDENT/CEO (THRU 12/23) 282409 0 58401 0 20202 0 8866 0 15125 0 385003 0 0 0 MATTHEW STREETER SYSTEM CFO 0 290340 0 66580 0 675 0 8934 0 11870 0 378399 0 0 EDWARD LAVERTY PA-C CHIEF MEDICAL OFFICER 255964 0 20185 0 4780 0 7995 0 10058 0 298982 0 0 0 LINDSAY LEA CNO 166218 0 15996 0 354 0 5545 0 3052 0 191165 0 0 0 JULIE BOLTON RN 143187 0 10800 0 13030 0 429 0 5854 0 173300 0 0 0 JUDY GRIMES EMPLOYEE 125745 0 5250 0 8818 0 0 0 13351 0 153164 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: - COMPENSATION COMMITTEE - FORM 990 OF OTHER ORGANIZATIONS - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THOMAS MEE, SYSTEM CEO, PARTICIPATED IN A 457(F) PLAN ADMINISTERED BY NORTH COUNTRY HEALTHCARE, A RELATED ORGANIZATION. THERE WERE NO CONTRIBUTIONS OR DISTRIBUTIONS IN 2023. 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 VI, SECTION A, LINE 6 NORTH COUNTRY HEALTHCARE (NCH) IS THE SOLE MEMBER OF UPPER CONNECTICUT VALLEY HOSPITAL. 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 THE FORM 990 IS REVIEWED CLOSELY BY THE CFO OF THE SYSTEM AFTER CAREFUL PREPARATION IS PERFORMED IN CONNECTION WITH THE INTERNAL TEAM AND PAID PREPARER. A COPY IS MADE AVAILABLE TO THE BOARD PRIOR TO SUBMISSION TO THE IRS. 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. THIS IS DONE ON AN ANNUAL BASIS. 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 CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,301,414. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,301,414. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,090,041. MANAGEMENT AND GENERAL EXPENSES 352,696. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,442,737. 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 NORTH COUNTRY HEALTHCARE INC 8 CLOVER LANE WHITEFIELD NH 03598 812225283 HEALTHCARE MANAGEMENT NH 501(C)(3) LINE 12A, I N/A 0 WEEKS MEDICAL CENTER 173 MIDDLE STREET LANCASTER NH 03584 020222242 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 0 0 1 0 0 0 0 0 1 0 0 1 0 1 1 0 1 0