2017-11-10T10:31:30-06:00 2016-12-31 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-01-01 462459559 Northern New Hampshire Healthcare Collaborative Inc NORT 6034445317 59 Page Hill Road Berlin NH 03570 Russell Keene Vice President 6034445317 2017-11-09 1 Joseph R Byrne CPA P01289281 2077752387 2017-11-09 69.49.157.66 2017-11-09 13:32:35 ES P 195DD2390B87809A4F2C1BC02D65E16960466FA1 53CA451596873B86A1E24CFE6767DCEC9A681D0F 2016 2017-02-10 21:41:12Z Northwoods Home Health & Hospice Michael Counter 536 Cottage Street Littleton NH 03561 4959280 0 X northcountryhomehealth-hospice.org X 2013 NH To provide home health, hospice, and homemaking services to patients in Coos County, New Hampshire. 9 9 73 30 0 0 164780 126855 3848474 3717244 2993 4582 19182 1089041 4035429 4937722 0 0 0 0 3111716 2766908 0 0 0 1194170 1586243 4305886 4353151 -270457 584571 1058881 907061 1373195 635566 -314314 271495 X Northern New Hampshire Healthcare Collaborative, Inc. will ensure access to quality care within the communities in which our patients live, provide local and high quality care with positive outcomes to our patients in Coos County while controlling the cost of care through innovative programs and the use of shared resources. 0 0 2358232 2656049 Northwoods Home Health (NHH) is committed to providing quality, personalized in-home care to anyone in need of everyday assistance after an acute illness or injury, or living with a chronic illness. NHH provides an array of in-home medical and personal care services throughout Coos County including: Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Social Worker, Patient Care Coordination, Home Health Aides, as well as Homemaker services. NHH recorded a total of 28,343 visits during 2016. 582560 1061195 Northwoods Hospice provides services throughout Coos County to assist patients to enhance their quality of life and achieve personal goals in the months and weeks near the end of life by providing comfort and support as well as the highest level of skilled medical and personal care for the patient and their family.The staff help develop a comprehensive personal care plan that involves the patient, the family, physicians, nurses, counselors, and aides; providing care in the patient's home, nursing homes, assisted living residences, as well as hospitals. Patient care services available include: Hospice Care Coordinator, Skilled Nursing, management of necessary medical equipment and medications, Physical Therapy, Occupational Therapy, Speech Therapy, Social Worker, Home Health Aides, as well as Homemaker services. Volunteers are available for companionship, reading, recreation, as well as assistance with household activities. 2940792 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 1 73 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Claudette Audette 6034445317 59 Page Hill Road Berlin NH 03570 Scott Howe Past President/Chairman/Secretary 2.00 X X 0 0 0 Michael Peterson Director, President 2.00 X X 0 0 0 Russell Keene Director, Vice President 2.00 X X 0 0 0 Patrick Kelly Director, Secretary 2.00 X X 0 0 0 Michael Lee Director, Treasurer 2.00 X X 0 0 0 Eric Stohl Director 1.00 X 0 0 0 Bruce Bean Director 1.00 X 0 0 0 Jim Tibbetts Director 1.00 X 0 0 0 Sarah Desrochers Director 1.00 X 0 0 0 William Jackson Director 1.00 X 0 0 0 David Atkinson Past Director 1.00 X 0 0 0 Donald Noyes Past Director 1.00 X 0 0 0 Gail Tattan-Giampaolo Past Executive Director 40.00 X 106198 0 8601 Michael Counter President 16.00 X 0 0 0 Claudette Audette Finance Director 40.00 X 101667 0 23357 Lorene Zammuto Interim Executive Director 40.00 X 161294 0 0 Jim Berube Physical Therapist 40.00 X 180674 0 14374 549833 0 46332 3 0 1 1 Leaders for Today 981 Worcester St Suite 1C Wellesley MA 02482 Professional Services 155551 American Healthcare Services Association PO Box 945 Traverse City MI 49685 Professional Services 151652 Weeks Medical Center 173 Middle Street Lancaster NH 03584 Professional Services 103060 3 10502 75381 40972 126855 Resident Service Revenue 621400 4479163 4479163 Miscellaneous Revenue 900099 15674 15674 Contractual/Char. Adj. 621400 -777593 -777593 3717244 4582 4582 24385 10502 21558 2827 2827 Forgiveness of Debt 900000 1086214 1086214 1086214 4937722 3717244 0 1093623 X 401117 151851 249266 1871653 1366671 504982 40159 28766 11393 292451 212789 79662 161528 109121 52407 2913 1968 945 28873 19505 9368 725179 489897 235282 1360 919 441 53196 35937 17259 108542 73326 35216 85747 57927 27820 206669 139616 67053 3429 2316 1113 19819 19819 52203 35266 16937 Medical Supplies 211445 142843 68602 Miscellaneous Expenses 61440 35077 26363 Dues and Subscriptions 24754 16723 8031 Bad Debt Expense 674 455 219 4353151 2940792 1412359 0 X 216 150 92803 180369 639292 439274 40940 6663 59457 49547 29729 9910 255901 270695 1058881 907061 205181 322008 163228 166522 1004786 147036 1373195 635566 X -570215 800 104801 119595 151100 151100 -314314 271495 1058881 907061 584571 1238 0 X 0 1 X 1 0 X 98697 164780 126855 390332 3816014 3867656 3720071 11403741 3914711 4032436 3846926 11794073 0 0 0 11794073 19 3533 2993 4582 11127 19 3533 2993 4582 11127 1086214 1086214 19 3918244 4035429 4937722 12891414 X Schedule A, Part III, Line 12, Explanation of Other Income: Forgiveness of Debt - 2016 Amount: $ 1,086,214. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2011 2011 0 Part II-B, Line 1: The organization pays dues to associations of which a portion is attributable to lobbying activities. 179112 4998 184110 120466 50000 8646 179112 107399 13067 120466 0.00000 0.82070 0.17930 1 0 59457 49547 9910 9910 Assets Whose Use is Limited 270695 270695 Due to AVH 21601 Due to UCVH 1973 Due to Weeks Medical Center 123462 147036 4938960 1238 1238 4937722 0 4937722 4353151 0 4353151 0 4353151 Hospice Ball 34887 10502 24385 50 2000 14146 2000 3362 34887 10502 24385 50 2000 14146 2000 3362 21558 2827 1 0 0 0 0 0 0 1 0 Lorene Zammuto Interim Executive Director 161294 0 0 0 0 0 0 0 0 0 161294 0 0 0 Jim Berube Physical Therapist 180674 0 0 0 0 0 3735 0 10639 0 195048 0 0 0 Part I, Line 4a During 2016, Gail Tattan-Giampaolo, Past Executive Director of the Organization, received a severance payment in the amount of $48,390. Part I, Line 7 Claudette Audette, Finance Director, received a $2,500 bonus during 2016. The bonus payment was based on individual performance and was not contingent on the revenues or net earnings of the Organization. Form 990, Part VII, line 5: Lorene Zammuto, Interim Executive Director, was compensated by Leaders for Today, an unrelated organization, for services rendered to the Organization. Amounts paid to Leaders for Today by the Organization for services rendered by Ms. Zammuto totaled $161,294 during 2016. Ms. Zammuto's actual compensation from Leaders for Today is not known to the Organization. Per IRS instructions, the Organization has reported the amounts paid to Leaders for Today for services rendered by Ms. Zammuto ($161,294) on Form 990, Part VII & Schedule J, Part II. Form 990, Part VI, Section A, line 6 The Corporation may have any number of members, provided, however, that each member shall be a nonprofit organization that is exempt from taxation under section 501(c)(3) of the Internal Revenue Code, and that is licensed to provide hospital services by the State of New Hampshire pursuant to RSA Chapter 151. Form 990, Part VI, Section A, line 7a Each Member shall appoint three Directors of the Corporation. At least one of the Directors appointed by each Member shall be a Director or Trustee of that Member. Form 990, Part VI, Section A, line 7b The Members shall have the sole authority with respect to the following matters, and the Board of Directors may not take any action on behalf of this Corporation with respect to such matters except as expressly authorized by a unanimous vote of the Members: 1. Amending the Articles or Bylaws of the Corporation; 2. Filing any petition for voluntary dissolution or voluntary bankruptcy of the Corporation; 3. Affiliation, consolidation, or merger with, or acquisition of, any other organization; 4. Adoption of annual operating and capital budgets, or substantial changes thereto; 5. Unbudgeted debt instruments, notes, guarantees, mortgages, or pledges in excess of such limits as the Members shall specify from time to time; 6. Authorization or material amendment of contracts for the sale, lease, exchange, or other disposition or acquisition or divesture of substantial assets of the Corporation in excess of such amounts as the Members shall specify from time to time; 7. Selection of any outside auditor or legal counsel; 8. Permitting the withdrawl of a Member; or 9. Admitting a new Member. Form 990, Part VI, Section B, line 11b The Form 990 will be reviewed and approved by the Finance Director, the President of the Agency as well as the President, the Vice President, and the Treasurer of the Board prior to filing. The Form 990 will be forwarded to the governing body for review prior to filing. Form 990, Part VI, Section B, line 12c NNHHC requires officers, directors, and key employees to review the Conflict of Interest Policy and to complete a Conflict of Interest Disclosure Statement which asks them to disclose any interests that could give rise to a conflict. The Policy is periodically reviewed. Form 990, Part VI, Section B, line 15 NNHHC determines compensation of its Management team through an annual comparable data source: New Hampshire Hospital Association - Wage Survey Reports & Management Personnel Salary Report. Any salary increases must be approved by the governing body. 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 IX, line 11g Skilled Nursing Contract Services: Program service expenses 124,351. Management and general expenses 59,722. Fundraising expenses 0. Total expenses 184,073. Administration Purchased Services: Program service expenses 260,492. Management and general expenses 125,105. Fundraising expenses 0. Total expenses 385,597. Other Contract Services: Program service expenses 45,844. Management and general expenses 22,018. Fundraising expenses 0. Total expenses 67,862. Hospice Care Services: Program service expenses 59,210. Management and general expenses 28,437. Fundraising expenses 0. Total expenses 87,647. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Northern New Hampshire Healthcare Collaborative, Inc. 59 Page Hill Road Berlin, NH 03570 EIN 46-2459559 Northern New Hampshire Healthcare Collaborative, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).