2019-06-27T10:04:44-05:00 2018-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2017-10-01 020280367 Androscoggin Valley Hospital Inc ANDR 6037522200 59 Page Hill Road Berlin NH 03570 Michael Peterson President 6037522200 2019-06-24 1 Barbara J McGuan CPA P00219457 2077752387 2019-06-24 69.49.157.66 2019-06-24 15:23:11 ED P C86B3C3384E7B30FA9F9EB149CE7FBCC333204C6 BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED 2017 2019-02-21 02:37:17Z Michael Peterson 59 Page Hill Road Berlin NH 03570 72851789 0 X www.avhnh.org X 1971 NH Critical Access Hospital 14 12 428 78 0 0 72524 71471 57308823 61357711 1158870 1759387 59576 64992 58599793 63253561 442382 1234023 0 0 28137182 31131790 0 0 0 26448252 25887975 55027816 58253788 3571977 4999773 57708258 62638972 36712922 37660818 20995336 24978154 A non-profit critical access hospital which provides inpatient, outpatient, emergency care, ambulatory care, and specialty care to residents of Berlin, New Hampshire and the surrounding communities. 0 0 42924263 52877908 Androscoggin Valley Hospital is a critical access hospital. The Hospital provides a broad range of inpatient and outpatient services to meet the health needs of the upper Androscoggin Valley and surrounding communities. With a commitment to the highest quality surgical care - AVH is leading the way to a healthier future for our health care community. 87226 284260 Educational programs offered by AVH include childbirth classes, babysitting course, wellness fairs, lecture series, CPR and first aid courses, nutritional counseling, and a variety of support groups. 6634352 1234023 8195543 Other community benefits provided by the Hospital include the provision of care to the underinsured, primarily through participation in the NH Health Assistance Network and North Country Cares; the promotion of good health for children through participation in the healthy kids program; and the sponsorship of numerous clinics and programs supporting good health in the community. 49645841 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 119 0 1 428 1 0 0 0 0 0 1 1 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Lynn Moore 6033265640 59 Page Hill Rd Berlin NH 03570 Donna Goodrich Chair 2.00 1.00 X X 0 0 0 Jay Poulin Vice-Chair 1.00 1.00 X X 0 0 0 Reverend Dr Alta Chase Secretary 10.00 1.00 X X 0 0 0 Max Makaitis Treasurer 1.00 1.50 X X 0 0 0 Louise Belanger Director 1.00 0.50 X 0 0 0 Javier Cardenas MD Director 42.00 0.50 X 384164 0 24567 Arthur Couture Director 1.00 0.50 X 0 0 0 John Guertin Director 1.00 0.50 X 0 0 0 Eric Johnson Director 1.00 0.50 X 0 0 0 Randall Labnon Director 1.00 0.50 X 0 0 0 Martha Laflamme Director 1.00 0.50 X 0 0 0 Thomas McCue Director 1.00 0.50 X 0 0 0 Daniel Van Buren MD Director 1.00 0.50 X 0 0 0 Michael Peterson President 40.00 2.00 X X 302336 0 30152 Joseph DellaValla MD Past Medical Staff President 40.00 0.50 X 284431 0 30152 Kelly Guilmette Past Director 1.00 0.50 X 0 0 0 William Jackson Past Director 1.00 0.50 X 0 0 0 Peter Morency Past Director 1.00 0.50 X 0 0 0 J Rodger Wood MD Past Director 1.00 1.00 X 0 0 0 Krzystof Z Plociennik MD Past Medical Staff President 40.00 0.50 X 464586 0 32167 Brian O'Hearn Chief Nursing Officer 40.00 0.00 X 201491 0 30152 Keith Shute MD Sr. VP/Chief Medical Officer 40.00 0.00 X 404422 0 27161 Lucien St Onge VP of Finance 40.00 2.00 X 98065 0 4987 Kenneth Danielson MD Physician 40.00 0.00 X 349270 0 0 Christopher Fitzmorris MD Physician 40.00 0.00 X 522043 0 24567 Richard Kardell MD Physician 40.00 0.00 X 339516 0 29672 Peggy Simon MD Physician 40.00 0.00 X 411822 0 19679 Norman Kossayda Physician 40.00 0.00 X 314403 0 301 Russell Keene Former President & CEO 0.00 40.00 X 0 538975 18931 Richard Werkowski Former Interim CFO 0.00 0.00 X 142064 0 0 4218613 538975 272488 37 1 1 0 Northwood Anesthesia Services PO Box 322 Berlin NH 03570 Anesthesia Services 1030800 CompHealth PO Box 972651 Dallas TX 753972651 ASA Neuro Contract Labor 642821 Dartmouth Hitchcook Medical Center One Medical Center Drive Lebanon NH 037660001 Contract Labor 601625 Weatherby Locums Inc PO Box 97633 Dallas TX 753972633 OB/GYN, Gen Surg, Hospitalist Contract L 540483 Mystic Valley Urology 93 Wesson Rd Lancaster NH 03584 Urgology Services 500083 13 31353 40118 71471 Patient Revenue 621400 90935394 90935394 Miscellaneous Revenue 621400 2887318 2543624 343694 Provision for Bad Debts 621400 -1722160 -1722160 Contractual/Char. Adj. 621400 -30742841 -30742841 61357711 504024 504024 64992 0 64992 64992 64992 10836593 9567909 13321 1268684 -13321 1255363 1255363 16998 31353 16998 0 63253561 61014017 0 2168073 X 1234023 1234023 2318833 1924631 394202 22342119 18543959 3798160 668313 554700 113613 4111379 3412445 698934 1691146 1403651 287495 213614 213614 58667 58667 82900 82900 10308570 8556113 1752457 300861 249715 51146 2292871 1903083 389788 797754 662136 135618 101994 84655 17339 29352 24362 4990 395795 328510 67285 2397405 1989846 407559 562663 467010 95653 Medical Supplies 5612479 5612479 Provider Tax 2645534 2645534 Other Expenses 45308 6781 38527 Gift Shop Expenses 42208 42208 58253788 49645841 8607947 0 X 3764 3765 10048662 13296975 5179690 5054706 578254 724365 1137295 665082 48763222 34091011 14132369 14672211 19644408 19486030 6983816 8735838 57708258 62638972 4563924 6109373 8985353 7985290 4233525 149807 18930120 23416348 36712922 37660818 X 20995336 24978154 20995336 24978154 57708258 62638972 4999773 -1016955 0 X 0 1 X 1 0 X 1 8584 8584 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. 77592 77592 22018464 18895861 3122603 359449 359449 0 23444340 13659386 9784954 2863377 1176315 1687062 14672211 Due from Affiliates 1478149 Other Receivables 1878262 Deferred Compensation 5379427 8735838 Deferred Compensation 5379427 Estimated Third Party Payor Settlements 18036921 23416348 Golf Tournament 48351 31353 16998 1000 4488 7907 1754 1849 48351 31353 16998 1000 4488 7907 1754 1849 16998 0 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 655549 649134 6415 0.00010 655549 649134 6415 0.00010 137515 8410 129105 0.00220 44648 44648 0.00080 11820692 6173173 5647519 0.09690 1010900 1010900 0.01740 13013755 6181583 6832172 0.11730 13669304 6830717 6838587 0.11740 0 827482 0 24152873 24565343 -412470 X 1 0 1 1 Androscoggin Valley Hospital Inc 59 Page Hill Road Berlin NH 03570 www.avhnh.org 00050 X X X X Androscoggin Valley Hospital 1 0 0 1 X X X X X X X X 15 1 1 0 1 X www.avhnh.org X 1 15 1 www.avhnh.org 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.avhnh.org/about-us/financial-services X www.avhnh.org/about-us/financial-services X www.avhnh.org/about-us/financial-services X X X X X X 1 X 0 X X 1 X 0 0 Androscoggin Valley Hospital Part V, Section B, Line 5: Key informant surveys were completed by 213 participants in the Androscoggin Valley during the fall of 2015. The participants that completed these surveys include the Berlin City Council, Town Government officials of Shelburne, Gorham, and Randolph, along with officials and superintendents of two School Administration Units (SAU). In addition, CEOs, staff, and Board members of local health and human services agencies, the community health center, the local hospital, mental health center, community action agency and family resource center completed a key informant survey.Surveys were distributed throughout the community and respondents were primarily from the Androscoggin Valley Health Care Service Area.Fifty-six percent of respondents were from Berlin, 18% from Gorham, 11% from Milan, 3% from Randolph, 1% from Shelburne, and less than 1% from Dummer and Errol. Close to 9% of respondents were from other towns including Lancaster, Bethlehem, Littleton, Groveton, Whitefield, Franconia, Piermont, North Conway, Stark, Jefferson, Gilead, Maine and Fryeburg, Maine.Fourteen percent of respondents have advanced degrees and 22% are college graduates. Almost 50% have had some college education or are community college graduates. Thirteen percent graduated from high school, and less than 1% did not complete high school.Fifty-eight percent of respondents are between the ages of 45 and 65, with another 8% over 65. Twenty-five percent are between 30 and 44, and 9% between 18 and 29. Eighty-three percent of the respondents are female, 17% are male.Fifty-one percent of the respondents reported having an annual household income over $60,000, 18% were in the $40,000 to $59,000 range, 20% were in the $20,000 to $39,999 range, 7% were in the $12,000 to $19,999 range, and 4% of the respondents reported income less than $12,000. Androscoggin Valley Hospital Part V, Section B, Line 6a: Androscoggin Valley Hospital, Androscoggin Valley Home Care Services, Coos County Family Health Services, Family Resource Center, Granite United Way Northern Region, National Alliance on Mental Illness NH, Northern Human Services, North Country Health Consortium, Tri-County Community Action Program, and White Mountains Community College conducted a community survey in the Fall of 2015 to fulfill requirements of the Patient Protection and Affordable Care Act (PPACA) that requires not-for-profit hospitals to conduct a community health needs assessment not less frequently than every three years and adopt an implementation strategy to meet the community health needs identified through the assessment. Surveys were distributed throughout the community and respondents were primarily from the Androscoggin Valley Health Care Service Area. Androscoggin Valley Hospital Part V, Section B, Line 11: The health needs identified by the Community Needs Assessment have been integrated into the design of the AVH Strategic Plan. After reviewing current community collaborations, partnerships and internal resources, AVH identified its strengths and weaknesses for the most serious health issues. By stewarding existing resources, strengthening partnerships and creating innovative programs both on the hospital campus and within the community, AVH hopes to make a positive impact on these needs. In addition, the survey identified strategies that would improve the health of the community. AVH has made and continues to devote resources in this direction as we realize that these are key to the health of our community. Please see Implementation Strategy online (www.avhnh.org) for more details. Although AVH recognizes the importance of all needs identified by the community, such as cancer care, dental disease, sexually transmitted disease (STD), HIV/AIDS and suicide, AVH will not directly design strategies for these issues in the implementation plan. These issues did not rank high in the needs assessment and can be addressed by other agencies in our community. However, AVH does employ numerous specialists who can diagnose, treat and/or refer cancer patients appropriately for additional oncology services. Resources are available in the community through Coos County Family Health Services to address STD and HIV/AIDS. AVH highly encourages flu vaccines for its employees and patients and has an Infection Control Professional on staff to address issues. AVH will continue to keep current on these issues and provide referrals to those in need through its ED and specialty practice as well as through frequent community educational classes and newsletters/electronic media. Affordable health care continues to be addressed on a national and state level. AVH has programs available to facilitate financial counseling, enrollment into Medicaid, application to community (charity) care funds and payment plans. Schedule H, Part V, Section B, Line 22: All patients are charged the same amount for services and procedures performed, regardless of whether they were insured or uninsured. The net amount due to the hospital is based upon contractual adjustments for insured patients and administrative adjustments for uninsured patients, which may include free care, charity care, and discounted care. 6 1 - AVH Surgical Associates 7 Page Hill Road Berlin NH 03570 Physician Practice Office 2 - Androscoggin Valley Hospital 133 Pleasant Street Berlin NH 03570 Outreach Clinic/Lab Services 3 - Androscoggin Valley Hospital 2 Broadway Avenue Gorham NH 03581 Outreach Clinic/Lab Services 4 - Androscoggin Valley Hospital 181 Corliss Lane Colebrook NH 03576 Outreach Clinic/OB, Neurology, Orthopedic Rehab Services 5 - Androscoggin Valley Hospital 130 Main Street Gorham NH 03581 Outreach Clinic/Rehab Services 6 - Androscoggin Valley Hospital 173 Middle Street Lancaster NH 03584 Outreach Clinic/Sleep & ENT Services Part I, Line 7: A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to a physician clinic. Part III, Line 4: Patient accounts receivable are carried at the amount management expects to collect from outstanding balances.Patient receivables are periodically evaluated for collectibility based on credit history and current financial condition. Provisions for losses on receivables are determined on the basis of loss experience, known and inherent risks, estimated value of collateral and current economic conditions. The Hospital uses the allowance method to account for uncollectible accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identified trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and the payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Actual write-offs after management has used reasonable collection efforts are charged against allowance for doubtful accounts.During FY 2018, the Hospital decreased its estimate of the allowance for doubtful accounts from $4,636,756 to $3,059,647. The decrease in the allowance reflected an overall decrease in accounts receivable. During FY 2018 and FY 2017, write-offs were $1,005,186 and $1,070,078, respectively.The costing methodology used in determining the amounts reported above was a ratio of cost to charge. Part III, Line 8: The Organization used a cost report as the costing methodology to determine the amount of allowable Medicare costs. Part VI, Line 2: Every 3 years, Androscoggin Valley Hospital participates in a community needs assessment with four 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: Androscoggin Valley Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to patients getting the healthcare services they need. If payment of healthcare expenses could create a financial hardship, Hospital staff will work with patients to apply for financial assistance. Information regarding financial assistance policies is available at the Hospital's entrances and patient registration and on the Hospital's website. As part of the financial counseling application process, the Hospital will assess eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and assist in the application process. Part VI, Line 4: The geographic area served by Androscoggin Valley Hospital is the Berlin service area. The Berlin service area is composed of the city of Berlin, and the towns of Gorham, Shelburne, Milan, Randolph, Dummer, Errol and Stark. These communities are within the boundaries of Coos County, which is bordered by the State of Maine to the east, the State of Vermont to the west and Quebec, Canada to the north. The city of Berlin defines much of the region as the largest community in the County with a population of 10,225. The total population of the Berlin service area is 16,243. The changing economic landscape and the closing of paper and pulp mills over the last decade in the Coos County have significantly impacted the area's unemployment rate and population compared to those experienced by the overall state of New Hampshire. Part VI, Line 5: Androscoggin Valley Hospital is the leading provider of healthcare to thousands of families in the small-town communities of New Hampshire's North Country. As a Critical Access Hospital, AVH offers 24/7 emergency care, in-house treatment of most medical issues, and an arrangement for treatment of all other problems with the nearest tertiary-care facility.Over the past decade, AVH has invested significantly in expanding and improving our facilities and services, and enhancing our team of dedicated, highly trained doctors, nurses and other staff. The result is a hospital that more effectively contributes to the health of our communities than ever before. Our new 2-North area, features numerous exam rooms, office space and two comfortable reception areas, which is home to expanded and enhanced space for innovative cardiac care, sleep medicine, pulmonary care, and ear, nose & throat services. At the end of the day, our 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, Weeks Medical Center and Littleton Regional Hospital realize that significant national, state and local economic pressures are jeopardizing local access, quality and sustainability. We have therefore formed North Country Healthcare (NHC) 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 Country 3. 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, Weeks Medical Center, and Littleton Regional Hospital have formed this joint venture to identify and implement sustainable opportunities for our future. The NHC 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 Coos County Family Health Services 133 Pleasant Street Berlin NH 03570 020350051 501(c)(3) 1010900 To support otherwise uncompensated costs attributable to the Provision of the combined Coos County Family Health Services practice (CCFHS). These costs are incurred in providing comprehensive, community-based preventive and primary health and dental care, behavioral health services, related enabling services, outreach, health education, and promotion, and appropriate services and programs that promote CCFHS to, and availability of, continuous care for the residents of the Coos County service area. Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 223123 Funding Medicaid Expansion 2 0 Part I, Line 2: The Hospital has entered into an agreement with Coos County Family Health Services (CCFHS) whereby the Hospital will provide funding in the form of a community benefit grant. The terms of the agreement require that the Hospital provide CCFHS with the agreed-upon community benefit grant on July 1 of the grant year. The amount of the community benefit grant to be awarded is determined on an annual basis in accordance with the terms of the agreement. X X X X X X 0 1 0 0 0 0 0 1 0 Javier Cardenas MD Director 372380 0 0 0 11784 0 0 0 24567 0 408731 0 0 0 Michael Peterson President 278086 0 0 0 24250 0 0 0 30152 0 332488 0 0 0 Joseph DellaValla MD Past Medical Staff President 273227 0 0 0 11204 0 0 0 30152 0 314583 0 0 0 Krzystof Z Plociennik MD Past Medical Staff President 451186 0 0 0 13400 0 0 0 32167 0 496753 0 0 0 Brian O'Hearn Chief Nursing Officer 193516 0 0 0 7975 0 0 0 30152 0 231643 0 0 0 Keith Shute MD Sr. VP/Chief Medical Officer 386971 0 3879 0 13572 0 0 0 27161 0 431583 0 0 0 Kenneth Danielson MD Physician 349270 0 0 0 0 0 0 0 0 0 349270 0 0 0 Christopher Fitzmorris MD Physician 504043 0 0 0 18000 0 0 0 24567 0 546610 0 0 0 Richard Kardell MD Physician 325862 0 0 0 13654 0 0 0 29672 0 369188 0 0 0 Peggy Simon MD Physician 395807 0 0 0 16015 0 0 0 19679 0 431501 0 0 0 Norman Kossayda Physician 303963 0 0 0 10440 0 0 0 301 0 314704 0 0 0 Russell Keene Former President & CEO 0 329119 0 0 0 209856 0 0 0 18931 0 557906 0 29750 Richard Werkowski Former Interim CFO 142064 0 0 0 0 0 0 0 0 0 142064 0 0 0 Part I, Line 4b Russell Keene participated in a supplemental nonqualified retirement plan. Amounts related to this plan, reported on Page 2 of Schedule J, include $181,064 in column B(iii). Part I, Line 7 During 2017, Dr. Keith Shute received a bonus in the amount of $3,879. The bonus payment was based on performance based criteria and was paid to Dr. Shute based on meeting expectations and goals within the criteria. A 2012 New Hampshire Health and Education Facilities Authority Revenue Bonds 020279866 2012-03-29 14500000 Refinancing existing bonds, terminate interest rate swap contract 0 0 0 A 6514710 14500000 125386 14374614 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 Northwood Anesthesia Services Entity owned more than 35% by J. Rodger Wood, Past Board Member 1030800 Independent Contractor Arrangement 0 Form 990, Part VI, Section A, line 6 Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Androscoggin Valley Hospital. Form 990, Part VI, Section A, line 7a In accordance with the Affiliation Agreement with North Country Healthcare, 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 Chief Executive Officer position at each of the Hospitals has been changed to a President position. As with Board members, each Hospital President 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, but this individual will also report to the President/Chief Financial Officer of NCH. 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 current year Form 990 was provided to the Organization's Board of Directors or Finance Committee prior to submission. Form 990, Part VI, Section B, line 12c The Senior Director of Administrative and Revenue Cycle Services along with the Controller review on an on-going basis all transactions that could potentially violate our conflict of interest policy. In addition, all Board members and key employees sign a Conflict of Interest Statement each year. The first item on every Board Agenda is "Call to Order, Declaration of Potential Conflicts of Interest and Confidentiality Reminder." Form 990, Part VI, Section B, line 15 AVH retained AON Hewett to provide information relative to CEO compensation. AON Hewett's business is to provide independent advice to management and Board of Directors concerning compensation and benefit programs for, among others, executive managers. In the study that they performed for Androscoggin Valley Hospital, they provided an opinion which is intended to be an expert opinion that can be relied upon by the Compensation Committee of NorthCare and the Board of Directors for up to one year. In addition, AVH also relies on compensation survey information obtained from a regional firm for information relative to all of its Senior Managers so that all compensation at the senior level has been viewed in a reliable and comparable manner that would meet the spirit implied with the IRS intermediate sanction regulations. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents or conflict of interest policy available for public inspection. The Organization does make its financial statements available for public inspection upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,635,151. Management and general expenses 949,368. Fundraising expenses 0. Total expenses 5,584,519. Contract Labor: Program service expenses 3,920,962. Management and general expenses 803,089. Fundraising expenses 0. Total expenses 4,724,051. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Androscoggin Valley Hospital 59 Page Hill Road Berlin, NH 03570 EIN 02-0280367 Androscoggin Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). 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 Mountain Health Services Inc 59 Page Hill Road Berlin NE 03570 020452547 Healthcare Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Management and Support 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 N/A 0 Upper Connecticut Valley Hospital Corliss Lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 N/A 0 Littleton Hospital Association 600 St Johnsbury Road Littleton NH 03561 020222152 Critical Access Hospital NH 501(c)(3) Line 3 N/A 0 North Country Home Health & Hospice Agency Inc 536 Cottage Street Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 Northcare Inc D 518580 FMV Androscoggin Valley Hospital Foundation D 72614 FMV