2017-11-07T16:18:27-06:00 2016-12-31 BDO USA LLP TWO INTERNATIONAL PLACE BOSTON MA 02110 990 2016-01-01 020497927 Wentworth-Douglass Physician Corporation % PETER E WALCEK WENT 6037425252 789 Central Avenue Dover NH 038202526 PETER E WALCEK CFO/VP of Finance 6037425252 2017-11-15 true Brian Vigneault P00540650 6174220700 162.249.80.3 04123920173115000002 2017-11-07 P 6CCC3C025DBC962C57DC39F77614343EB29704E0 BBC3B4FE2B4BE7D467FE8DB8FE274F6332A7211F 2016 2018-03-14 21:41:22Z Wentworth Health Partners PETER E WALCEK 789 Central Avenue Dover NH 038202526 37192306 false X https://www.wdhospital.com/whp X 1998 NH Improve the health of the community by providing high quality healthcare. 12 4 513 0 13 0 0 35681675 37083385 0 0 76499 73453 35758174 37156838 0 0 0 0 45729496 49335626 0 0 1 18679279 18647010 64408775 67982636 -28650601 -30825798 5845627 7150143 7505847 8041432 -1660220 -891289 X Improve the health of the community by providing high quality health care that exceeds expectations through an integrated network of highly qualified professionals. false false 62465003 37156825 Wentworth-Douglass Physician Corporation (WDPC) was formed in response to a community needs assessment that identified a lack of primary care and specialty services in the community. The formation of the Physician Corporation and recruitment of primary care and specialty physicians closed the gap by improving access to medical services in Dover, NH and surrounding areas. (See Schedule O for a list of facilities operated by WDPC.) WDPC provides financial aid and information and resources to assist patients with their healthcare bills. Medical care is provided at no charge for eligible patients at 250% of the federal poverty level (300% of the FPL for Dental Services). (Continued on Schedule O). 62465003 true false false false false false false false false false true false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 513 true false false false false false false false false false false X 12 4 false false false false true true true true true false false true true true true true true true true false NH X PETER E WALCEK 6037402804 789 CENTRAL AVENUE Dover NH 038202526 X Ellen Caille FACHE Director/Exec VP, WD 5.0 50.0 X 0 403334 87458 Paul R Cass DO Director/Physician 5.0 50.0 X 0 465716 94298 Mary Ann Gagnon APRN Director/Physician 50.0 0.0 X 137000 0 24117 Matthew Goldberg DO Director/Physician 50.0 0.0 X 257224 0 21597 Hugh MacDonald MD Director/Physician 50.0 0.0 X 280790 0 37876 Gary Usher MD Director/Physician 50.0 0.0 X 343283 0 20862 Roger Hamel Chairman 1.0 6.0 X X 0 0 0 Carol Bailey Vice Chairman 1.0 4.0 X X 0 0 0 Michael Steinberg Treasurer 1.0 4.0 X X 0 0 0 John Salmon Secretary 1.0 4.0 X X 0 0 0 Gregory J Walker President/CEO, WDH 2.0 53.0 X X 0 820180 149567 Peter E Walcek CFO/VP Finance, WDH 2.0 53.0 X X 0 451233 90080 Barbara F Civiello MD Physician 50.0 0.0 X 550271 0 34593 Paul T Berry MD Physician 50.0 0.0 X 590742 0 31943 Lazaro A Diaz MD Physician 50.0 0.0 X 548808 0 39153 Gregory Imbrie MD Physician 50.0 0.0 X 511888 0 32888 Henry Sonneborn MD Physician 50.0 0.0 X 487352 0 26743 3707358 2140463 691175 113 false true false 0 0 Patient Service Revenue 621110 36245053 36245053 Other Related Function Income 621990 693422 693409 13 Meaningful Use 621110 144910 144910 37083385 0 0 0 108921 35468 73453 0 73453 73453 0 0 0 0 0 0 0 0 0 0 0 37156838 37156825 13 0 0 0 0 1493667 1493667 0 39753046 37304670 2448376 358668 332555 26113 4439559 4159834 279725 3290686 3084031 206655 0 350 350 20004 20004 0 0 0 8297948 6845797 1452151 13336 13336 2125295 1836603 288692 0 0 3510275 2755566 754709 0 0 321701 294180 27521 0 0 753598 753598 893710 893710 Provision for Bad Debt 1269136 1269136 Dental Community Benefit 511897 511897 Pharmacy Expense 589536 589536 Transcription 340224 340223 1 67982636 62465003 5517632 1 19239 25843 0 0 0 0 3664523 3355213 0 0 0 0 0 0 0 0 0 0 14197921 10428834 2158168 3769087 0 0 0 0 0 0 0 0 3697 0 5845627 7150143 7505847 8041432 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7505847 8041432 X -1660220 -891289 0 0 0 0 -1660220 -891289 5845627 7150143 X -30825798 31594729 X X false true X true false X 3171055 2798283 372772 3386219 1648983 1737236 7640647 5981568 1659079 3769087 0 0 X 36680408 35467 35467 36644941 511897 511897 37156838 67470739 67470739 511897 511897 67982636 Part X, Line 2: WDHS, the Hospital, WDPC and the Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes pursuant to Section 501(a) of the Code. Management evaluated these not-for-profit corporations have maintained their tax-exempt status, do not have any significant unrelated business income and have taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 2d Occupancy allocated to building rentals - 35,467 Part XI, Line 4b Dental Community Benefit (net of allocated overhead) - $511,897 Part XII, Line 4b Dental Community Benefit (net of allocated overhead) - $511,897 false true false false false false false true false Ellen Caille FACHE Director/Exec VP, WD 287652 56877 58805 59070 28388 490792 Paul R Cass DO Director/Physician 392649 71675 1392 73503 20795 560014 Mary Ann Gagnon APRN Director/Physician 125949 10753 298 5324 18793 161117 Matthew Goldberg DO Director/Physician 240694 15213 1317 11370 10227 278821 Hugh MacDonald MD Director/Physician 215714 63776 1300 9325 28551 318666 Gary Usher MD Director/Physician 249343 92553 1387 7148 13714 364145 Gregory J Walker President/CEO, WDH 480654 146112 193414 126354 23213 969747 Peter E Walcek CFO/VP Finance, WDH 325475 63486 62272 68787 21293 541313 Barbara F Civiello MD Physician 408446 122433 19392 13250 21343 584864 Paul T Berry MD Physician 293606 278464 18672 10600 21343 622685 Lazaro A Diaz MD Physician 460649 68767 19392 8052 31101 587961 Gregory Imbrie MD Physician 335992 174504 1392 32888 544776 Henry Sonneborn MD Physician 370371 98309 18672 7950 18793 514095 Part I, Line 3: The President/CEO of Wentworth-Douglass Physician Corp (WDPC) is an employee of Wentworth-Douglass Hospital (WDH), a related organization, and WDPC does not maintain any procedures to establish his compensation. However, the Hospital uses its executive committee, an independent national compensation consultant, compensation surveys, and requires final approval by its independent Board Members to determine executive compensation for all vice-presidents and above. Part I, Line 4b: Gregory J. Walker (President/CEO) - 2016 total contributions to the 457(f) plan = 113,104. This supplemental retirement plan contribution is intended to fund benefits accruing and payable at retirement for multiple years of service that began in calendar year 1997. In 2016, the Hospital funded a supplemental executive retirement plan which provides benefits to other qualifying executives. The contributions are intended to provide a forfeitable supplemental retirement benefit and are being provided in consideration for many years of service to the Hospital. The respective contributions for the 2016 plan year, for those individuals identified in Schedule J - Part II, are as follows: Peter E. Walcek = $52,887, Ellen Caille - $46,941, and Paul R. Cass = $60,253. The following individuals identified in Schedule J - Part II vested in their 2011 457(f) contributions during 2016: Peter E. Walcek = $41,483 and Ellen L. Caille = $38,813. The 2011 amounts are required to be reported on Schedule J, in Column F and as part of the taxable W-2 compensation reported in Column B (iii) of this Form 990. WDH sponsors a split-dollar life insurance employee benefit program for certain officers and key employees. Split dollar life insurance is an arrangement in which the employee is the owner of the life insurance policy and the premiums are paid by the employer. Pursuant to WDH's split-dollar agreement, and the collateral assignment therein, the employer's share of the policy premiums paid is recovered either upon termination of the policy or at the death of the participant. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance. Total premiums paid during the year ending 12/31/16 were $21,144 for Peter E. Walcek. The taxable value of the life insurance policy has been included in each individuals' W-2. The policies are intended to provide an additional retirement benefit for these indiviuals' multiple years of service. Part I, Line 7: At-risk compensation for Wentworth-Douglass executives, which is subject to review and paid annually. Wentworth-Douglass has an incentive-based compensation model that uses relative value units (RVUs) as a measure for determining physician compensation within the Medical Group Management Association published salary ranges. The model included a base salary plus incentive compensation that has both productivity and performance components inclusive of patient satisfaction and quality. Both budgeted performance and actual performance are measured. Form 990, Part III, Line 2, New Program Services: See narrative for Form 990, Part III, Line 4a below. Form 990, Part III, Line 4a, Program Service Accomplishments: In 2016, WDPC provided $284,888 of financial aid (stated at cost). Medicaid Costs Exceeding Reimbursement totalled $2,946,849 for WDPC in 2016. Wentworth-Douglass Hospital (The Hospital) subsidizes WDPC primary care practices that operate at a loss. The subsidized losses of these primary care practices do not include the financial aid provided to patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $5,336,183 in 2016. The Hospital subsidizes certain WDPC specialty care practices that operate at a loss. The subsidized losses of these specialty care practices do not include the financial aid provided to the patients (stated at cost) or the Medicaid cost exceeding reimbursement associated with these practices, and totaled $9,017,881 in 2016. WDPC supports numerous community based programs, including the COmmunity Dental Center and Behavioral Health Services. In 2015, WDPC acquired Great Bay Mental Health as part of the continued initiative to expand the services offered for behavioral health. WDPC provided $953,100 of behavioral health care services to patients in 2016. The Wentworth-Douglass Community Dental Center is open to low-income, uninsured adults and children living in the Hospital's primary service area (Dover, Durham, Madbury, Lee, Barrington, Somersworth, Rollinsford, NH and Berwick and So. Berwick, ME) or patients of the physician practices who have a family income at or below 300% of the federal poverty level, based on the number of members in the household. Minimum payments are charged on a discounted fee schedule based on household income. In 2016, the Dental Center provided $561,255 of community-based clinic services. Form 990, Part III, Line 4a: WDPC's Facilities: Wentworth-Douglass Physician Corporation does not file a separate annual community benefit report. Rather, Wentworth-Douglass Hospital (WDH) includes WDPC data with its community benefit report that is filed anually with the State of New Hampshire. WDHS owns 100% of WDPC, and oversees all of WDPC's primary care and specialty practices, outpatient physician clinics and its dental clinic. WDPC practices, or practices with WDPC physicians embedded as of December 31, 2016 are listed below with locations details as follows: Adult & Children's Medicine, 10 Members Way, Suite 201, Dover, NH Barrington Health Center, 8 Century Pines Drive, Suite 2, Barrington, NH Bellamy Health Center, 15 Old Rollinsford Road, Suite 201, Dover, NH Center for Medical Genetics, 15 Old Rollinsford Road, Suite 201, Dover, NH Coastal Neurology Services, 158 E. NH Route 108, Suite 5, Dover, NH Dover Family Practice, 10 Members Way, Suite 203, Dover, NH Dover Internal and Geriatric Medicine, 10 Members Way, Suite 301, Dover, NH Durham Health Center, 36 Madbury Road, Durham, NH Endocrinology and Diabetes, 10 Members Way, Suite 400, Dover, NH Great Bay Family Practice, 60 Exeter Road, Suite 300, Newmarket, NH Great Bay Mental Health, 15 Old Rollinsford Road, Suite 302, Dover, NH Hilltop Family Practice, Somersworth Plaza, 85 Main St, Somersworth, NH Integrative Therapy, 15 Old Rollinsford Road, Suite 204, Dover, NH Lee Family Practice, 65 Calef HIghway, Suite 200, Lee, NH Manchester Urology Association at Dover, 10 Members Way, Suite 402, DOver, NH Marshwood Family Care, 19 Levesque Drive, Suite 2, Eliot, ME OB/GYN & Infertility Associates, 15 Old Rollinsford Road, Suite 102, Dover, NH Outpatient Diabetes Services, 10 Members Way, Suite 400, Dover, NH Supportive & Palliative Care, 789 Central Avenue, Level 2, Dover, NH Plastic Surgery Specialists, 10 Members Way, Suite 303, DOver, NH Primary Care of Dover, 10 Members Way, Suite 300, Dover, NH Prompt Care, 10 Members Way, Suite 203, Dover, NH Seacoast Arthritis & Osteoporosis Center, 10 Members Way, Suite 403, Dover, NH Seacoast Cancer Center, 789 Central Avenue, Dover, NH Seacoast General Surgery, 750 Central Avenue, Suite N, Dover, NH Seacoast Pulmonary (Intensivists), 10 Members Way, Suite 401, Dover, NH South Berwick Family Practice, 31 Colcord Street, South Berwick, ME Strafford Medical Associates, 10 Members Way, Suite 302, DOver, NH Summit Infectious Disease, 789 Central Avenue, Dover, NH The Hospital Medicine Team (formerly Hospitalists), 789 Central Avenue, Level 2, Dover, NH WHP Behavioral Health Services, 10 Members Way, Suite 404, Dover, NH WHP Cardiovascular Group, 19 Old Rollinsford Road, Dover, NH WHP Thoracic Surgery Specialists, 789 Central Avenue, Level 1, Dover, NH WHP COmmunity Dental Center, 668 Central Avenue, Dover, NH Wound Healing Institute and Hyperbaric Oxygen Center, 789 Central Avenue, Dover, NH Head & Neck Specialty Group of NH, 361 High Street, Somerworth, NH Surgical Optimization Center, 789 Central Avenue, Dover, NH WD Center for Orthopedics & Joint Replacement, 789 Central Avenue, Level 2, Dover, NH Primary Care at Pease, 73 Corporate Drive, Portsmouth, NH Prompt Care at Pease, 73 Corporate Drive, Portsmouth, NH Seacoast Arthritis at Pease, 73 Corporate Drive, Portsmouth, NH Seacoast Pulmonary at Pease, 73 Corporate Drive, Portsmouth, NH Vascular Surgery at Pease, 73 Corporate Drive, Portsmouth, NH Chest Clinic, 789 Central Avenue, Level 1, DOver, NH Radiology and PFT at Pease, 73 Corporate Drive, Portsmouth, NH Form 990, Part VI, Section A, Line 6: Wentworth-Douglass Health System (WDHS), a New Hampshire nonprofit corporation, was formed in 2012 as the result of the corporate restructuring of Wentworth-Douglass Hospital (WDH) into an integrated health system. WDHS serves as the parent company of WDH and its affiliates Wentworth-Douglass Hospital and Health Foundation (WDHHF) and Wentworth-Douglass Physician Corporation (WDPC), all of which are New Hampshire nonprofit corporations that have been recognized as being 501(c)(3) organizations. These corporations share a common mission with WDH. WDHS is intended to act as a supporting organization of WDH, serving in the rold of the "parent company" of the Hospital and the affiliates. WDHS is the sole member of WDPC. Effective Janary 1, 2017, Massachusetts General Hospital (MGH) became the sole corporate member and parent organization of WDH. Contemporaneously, WDH became the sole corporate member and parent organization of WDHHF, WDPC, and the Wentworth-Douglass COmmunity Health Corporation (WDCHC). As part of the transaction, WDHS was spun off with the purpose of monitoring the integration of the Hospital into MGH. Form 990, Part VI, Section A, Line 7a: WDHS will appoint the Board members for WDPC. Effective January 1, 2017, with MGH becoming the sole corporate member and parent organization of WDH, WDH will now appoint Board members for WDPC. Form 990, Part VI, Section A, Line 7b: WDHS has the power to appoint and remove directors of WDPC, and all actions pertaining to the property, business, and affairs of WDPC, including WDPC's annual budget, are subject to the approval of WDHS. Effective January 1, 2017, with MGH becoming the sole corproate member and parent organization of WDH, and WDH becoming the sole corporate member of WDPC, WDHS no longer holds these powers. WDHS purpose is to monitor the integration of the hospital into MGH. Form 990, Section B, Line 11: A draft of the Form 990 is initially reviewed in detail by key WDH finance employees. Thereafter, the final draft is presented to the full board prior to filing with the IRS. Each member of the Board and Finance Committee is provided with a draft of the FOrm 990 in advance of each meeting. Form 990, Part VI, Section B, Line 12c: A copy of WDPC's Conflict of Interest Policy is distributed annually to all officers, trustees, medical staff officers and committee members, and the management team. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with State of New Hampshire RSA 7:19-a, in the local newspaper, and submitted to the New Hampshire Attorney General. Form 990, Part VI, Section B, Line 15: CEO's Compensation: The compensation and benefits of WDH's CEO are reviewed, adjusted and voted on by all independent members of the board annually. See WDH's separate Form 990 for further details. Compensation of Key Employees: The CEO reviews the salaries of key employees annually and recommends compensation based on performance, salary ranges and market competitive data. Compensation data is provided by an independent national consulting firm every other year. The CEO presents salary range data for key employees to the board annually for approval. Using the Board approved salary range data, the CEO recommends salary increases for vice presidents to the WDH Board for approval and the vice presidents recommended salary increases for Directors and other management positions to the CEO, for approval. All compensation for vice presidents and above requires final approval by the WDH independent Board Members. Form 990, Part VI, Section C, Line 19: Audited financial statements are filed annually with the New Hampshire Attorney General's Charitable Trust Unit. The Director of Charitable Trusts is also informed of any pecuniary benefit transactions that have occurred between the Foundation and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-a. II(d). Current copies of the Bylaws, Conflict of Interest Policy, and Form 990 are on file with the Charitable Trust Unit. The Organization also makes these documents available upon request. Form 990, Part VII, Section A: Reportable Compensation from Related Organizations: The 2016 compensation reported for Ellen L. Caille, Dr. Paul R. Cass, Gregory J. Walker and Peter E. Walcek was paid by Wentworth-Douglass Hospital for their services as full-time executives. Gregory J. Walker and Peter E. Walcek each worked an average of 55 hours per week, as did Ellen Caille and Dr. Cass. Of the respective hours worked by Ellen Caille and Dr. Cass, an average of 5 hours per week was dedicated to Wentwowrth-Douglass Physician Corporation. Form 990, Part XI, Line 9, Change in Net Assets: Other Changes in Net Assets: Transfer from WDH $31,559,262 Rental Expense reported by WDH $35,467 Form 990, Part XII, Line 2c: Audit Review Process: WDH's Finance Committee oversees the audit process for Wentworth-Douglass Health System and all related organizations. The audit process of the financial statements did not change from the prior year. Independent accountants performed the audit on both 2015 and 2016. FORM 990 PART IX LINE 11G DESCRIPTION:TEMP HELP/MNHRS TOTAL FEES:98083 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:8061430 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:122616 FORM 990 PART IX LINE 11G DESCRIPTION:MISC FEES TOTAL FEES:15819 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 020260334 Health Care NH 501(c)(3) Line 3 WDHS false Wentworth-Douglass Hospital & Healt 789 Central Avenue Dover NH 03820 510491062 Fund Raising NH 501(c)(3) Line 11b WDHS false Wentworth-Douglass Health System 789 Central Avenue Dover NH 03820 461635259 Support NH 501(c)(3) Line 11b,II NA false Wentworth Surgery Center LLC PO Box 71 Somersworth NH 03878 900975592 Surgery Ce NH Wentworth-Douglass Community Health 789 Central Avenue Dover NH 03820 020399963 Health Fitness NH WDH C-Corp 0 0 0.00000 false false false false false false false false false false false true false true true true true false false true Part II, Identification of Related Tax-Exempt Organizations: Name of Related Organization: Wentworth-Douglass Health System : Primary activity - Supoort and further charitable activities of hospital and related entities.