2016-02-08T15:07:35-06:00 2015-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Scott W Howe CEO 6037884911 2016-02-08 1 Barbara J McGuan CPA P00219457 2077752387 2016-02-05 2014 2016-08-17 19:52:53Z Scott W Howe 173 Middle Street Lancaster NH 03584 46055690 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 17 14 420 126 0 0 428108 385581 41036524 42167196 758353 617295 -692 0 42222293 43170072 0 0 0 0 23632210 23936076 0 0 0 17850511 18173623 41482721 42109699 739572 1060373 46394836 49416785 18904305 21504316 27490531 27912469 Weeks Medical Center's compassionate staff is committed to providing high quality and efficient health care services to ensure the well-being of our patients, families and communities. 0 0 35783305 42167196 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 35783305 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 42 0 1 420 1 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Scott W Howe 6037884911 173 Middle Street Lancaster NH 03584 David Atkinson President 1.00 X X 0 0 0 Scott Burns Trustee 1.00 X 0 0 0 George Cook Trustee 1.00 X 0 0 0 Dennis Couture Trustee 1.00 X 0 0 0 Donald Crane Treasurer 1.00 X X 0 0 0 Sarah Desrochers Secretary 1.00 X X 0 0 0 William Everleth Trustee 1.00 X 0 0 0 Charlie Fitch Trustee 1.00 X 0 0 0 Stanley Holz Vice President 1.00 X X 0 0 0 Patrick Kelly Trustee 1.00 X 0 0 0 Patsy Pilgrim Trustee 1.00 X 0 0 0 Lisa Tetreault Member at Large 1.00 X 0 0 0 Keith Young Trustee 1.00 X 0 0 0 Scott Howe CEO 40.00 X X 235121 0 29903 Lars Nielson CMO 40.00 X X 323034 0 37213 Mederic LeBlanc Medical Staff President 40.00 X 132969 0 0 Dana Muzzey Trustee 1.00 X 0 0 0 Celeste Pitts CFO 40.00 X 140237 0 15334 Paul Kamins MD Physician 40.00 X 466737 0 34829 Mark Morgan MD Physician 36.00 X 434699 0 34247 David Pelkowski Physician 40.00 X 418801 0 37517 Christopher Laurent Nurse Practitioner 40.00 X 398752 0 18843 Maude Keeshin Physician 40.00 X 369539 0 38639 2919889 0 246525 34 0 1 1 Kingdom Emergency 815 North Kirby Road Lyndonville VT 35851 ER Physician Coverage 1143652 Daniel Hebert 12 Pleasant Street Colebrook NH 03576 Contractor 847323 Dartmouth-Hitchcock Clinic One Med Ctr Dr Lebanon NH 03756 Professional Services 524707 New Hampshire Imaging Services One Pillsbury Street Suite 200 Concord NH 03301 Medical Services 207883 MedPartners Locum Tenens PO Box 4729 Winter Park FL 327934729 Contract Physicians 174640 10 195430 190151 385581 Patient Service 621400 76087370 76087370 Miscellaneous 621400 2186925 2186925 Meaningful Use 621400 891764 891764 Provision for Bad Debts 621400 -1846607 -1846607 Contractual/Char. Adj. 621400 -35152256 -35152256 42167196 417615 417615 3078798 6500 2850873 34745 227925 -28245 199680 199680 43170072 42167196 0 617295 X 913811 913811 18739682 16078042 2661640 445248 401886 43362 2630234 2329094 301140 1207101 1043901 163200 402643 47832 354811 27077 27077 65136 65136 47828 47828 4508406 4408333 100073 83421 83421 293793 70928 222865 752449 752449 849786 831890 17896 72747 58913 13834 26944 20175 6769 415407 415407 2435619 2435619 375772 170730 205042 Patient Care Supplies 5047086 5047086 MET Taxes 1394257 1394257 Miscellaneous 1375252 1029212 346040 42109699 35783305 6326394 0 X 1250 1350 9272583 13003565 4958113 5256390 805445 560616 747048 767631 663358 699017 41438198 26471761 15353690 14966437 14511263 14077801 -30938 -21945 113024 105923 46394836 49416785 3158914 3725527 819076 801241 8741500 8402500 6184815 8575048 18904305 21504316 X 25872017 26512276 628215 488279 990299 911914 27490531 27912469 46394836 49416785 X 1060373 -553853 -84582 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9114 9114 0 Part II-B, Line 1: Weeks Medical Center 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 WMC and other member organizations in furtherance of their exempt purposes. WMC does not directly perform any lobbying activities. 1174268 -62816 76100 1035352 1144520 2285 27463 1174268 1131612 12908 1144520 1031277 46100 29235 -25000 1131612 1662763 5000 -67822 568664 1031277 0.00000 0.88080 0.11920 0 0 532463 532463 13310575 7949545 5361030 25956177 18354134 7602043 1638983 168082 1470901 14966437 Capital Leases 7815 Interest Rate Swap 384848 Estimated Third-Party Payor Settlements 8182385 8575048 42483809 -553853 57858 -495995 42979804 47828 142440 190268 43170072 42061871 0 42061871 47828 47828 42109699 Part V, Line 4: Weeks Medical Center Endowment Funds were gifted with the intent to help defray the costs of indigent care for adults and children, hospice services and general upkeep and operations of the hospital. Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swap 57,858. Part XI, Line 4b - Other Adjustments: Transfer of Assets to Northern New Hampshire Healthcare Collaborative, Inc. 142,440. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 524803 64726 460077 0.01090 6172207 3858573 2313634 0.05490 1056167 475022 581145 0.01380 7753177 4398321 3354856 0.07960 609224 37565 571659 0.01360 329430 32338 297092 0.00710 3227941 3104526 123415 0.00290 4166595 3174429 992166 0.02360 11919772 7572750 4347022 0.10320 4 131 96366 448 95918 0.00230 68926 68926 0.00160 1 47 19361 10 19351 0.00050 5 178 184653 458 184195 0.00440 1 864776 19786198 19986059 -199861 X 1 1 1 1 Weeks Medical Center Hospital 173 Middle Street Lancaster NH 03584 X X X X Weeks Medical Center 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X www.weeksmedical.org X 1 12 1 www.weeksmedical.org 0 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X http://www.weeksmedical.org X http://www.weeksmedical.org X X X 1 X 0 X X X X X 1 X 0 0 Weeks Medical Center Part V, Section B, Line 5: Input from the community was gathered using two methods including interviews and a public survey. Interviews of 36 individuals were conducted throughout the Weeks Medical Center primary service area. The individuals included elected state legislators, town managers, police chiefs, long term care facilities, dental providers, public health network, FQHC, clergy, business and residents. The group interviewed included 24 individuals that used Weeks Medical Center for medical care and 6 individuals that did not use Weeks Medical Center. The survey was circulated in a number of methods including email to the school district employees, Weeks Medical Center employees and paper copies available in all of our offices for the public. The surveys were completed by 224 individuals from across our communities. Weeks Medical Center Part V, Section B, Line 11: Significant Needs Identified and Being Addressed:1. Uninsured - A high percentage of the population in the Weeks Medical Center Primary Service Area is without health insurance and needed access to appropriate health care services.Weeks Medical Center provides free health services to patients without health insurance through our Weeks Health Access Plan. This plan is available to any resident of Weeks Medical Center Primary Service Area that is not eligible for Insurance or Medicaid with an income and assets (excluding value of primary residence) less than the 300% of the Federal Poverty Guidelines. Weeks Medical Center will continue to offer the Weeks Health Access Plan and any individual presenting for medical services without insurance will be informed, they are eligible to apply for coverage under the Weeks Health Access Plan. This will be done by registration, case management and billing staff. Weeks Medical Center offers help with deductibles and co-pays through our Weeks Health Access Plan. Since our last CHNA was completed, the Accountable Care Act has gone into effect, creating many options for those previously without insurance to obtain coverage, either through expanded Medicaid or the Insurance Exchanges. Because of this significant change, WMC has modified its Financial Assistance Plan to focus more on patient balances after insurance, which can be quite large. Our income guidelines for our FAP have always been 300% of the FPL and below - the same income guidelines where expanded Medicaid and Insurance Exchanges are most beneficial. This program is available to any resident of our Primary Service Area and some secondary service areas, as specified in our policy.In 2012, Weeks Medical Center provided $3,006,108 of free care to individuals that were uninsured and unable to pay for services. The measure of ensuring access to care for residents of the Primary Care Service Area is maintaining or exceeding the amount of free care provided in 2012 or the drop in the number of uninsured to less than 18.6% on the NH Regional Health Profile for Coos County.2. Obesity - A large percentage of the population in the Weeks Medical Center Primary Service Area are obese. This is a result of the poor socioeconomics in the area that leads to poor nutritional habits. The obesity also results in the poor health status as indicated by the rate of high blood pressure and diabetes in the Area.Weeks Medical Center employees a full time registered dietician. The dietician is available to work with inpatients, outpatients and provides consult for patients in the physician offices. A partnership between NH Extension Services and Weeks Medical Center has offered healthy cooking classes to families. Weeks Medical Center has a wellness program for staff and their families to promote a health life style. Plus all patients are screened by Weeks Medical Center providers during office visits and provided appropriate information on lifestyle modification, exercise and nutrition.Weeks Medical Center will continue to employ a Registered Dietician to provide consultation to patients. Weeks Medical Center will also continue to partner with NH Extension Service on healthy cooking classes. Weeks Medical Center will continue to have a wellness program for staff and their families. A team will be created to explore and expand the outreach to the community on Nutrition Education as well as identify potential partners to work with collaboratively. Weeks Medical Center will develop a group visit program increase education and support for obese patients. The goal of our efforts will be to reduce the percent of Obese Patients in the Weeks Medical Center Physician Practices. The percentage of obese patients in the Weeks Medical Center Physician Practices currently is 41.8%.3. Teen Birth Rate - There is a high rate of teen births in comparison to the rest of the State of New Hampshire based on the NH Regional Health Profile.Weeks Medical Center operates a Family Planning Clinic that is available to teens throughout the Primary Service Area. The Family Planning Clinic provides individual birth control services to teens at reduced or no cost. Most recently, Weeks Medical Center has expanded its Family Practice services to North Stratford and Whitefield and has two more Providers who will be offering these valuable services.Weeks Medical Center will continue to operate the Family Planning Clinics. A media campaign will be designed and implemented to increase the awareness of these services. Primary Care Providers as appropriate will address birth control with any teens. The Family Planning Staff will outreach to the schools in the Primary Service Area and provide services or education as requested. The goal of our efforts will be to maintain a low number of Teen Births in the Weeks Medical Center Physician Practices. The number of Teen Births in the past year in the Weeks Medical Center Physician Practices was 5. This is a 3% teen birth rate for patients served by Weeks Medical Center.4. Smoking - There is a higher rate of smoking in the Primary Service Area.Weeks Medical Center has offered ongoing smoking cessation classes for the public to assist in reducing tobacco usage. Weeks Medical Center maintains a tobacco free campus. Weeks Medical Center will continue to offer smoking cessation classes on a regular basis plus create a marketing plan to encourage individuals to give up tobacco. Weeks Medical Center will develop a group visit program increase education and support for patients that smoke. The goal of our efforts will be to reduce the percentage of patients that smoke in the Weeks Medical Center Physician Practices. The percent of patients that smoke in the Weeks Medical Center Physician Practices currently is 24%, down from 49% in the previous year.5. Colonoscopies (Cancer Screening) - The residents of the Weeks Medical Center Primary Service Area are less likely to have had a colonoscopy. This is an important screening tool to reduce the incidents of colorectal cancer.The General Surgeons employed by Weeks Medical Center are available to perform colonoscopies on any residents of the Weeks Medical Center Primary Service Area.A media campaign will be designed and implemented to educate the residents of the Primary Service Area of the benefits of a colonoscopy. The Electronic Medical Record now includes a specific flag if a patient is due for a screening flag. Primary Care Providers will encourage patients to get a colonoscopy during the course of their evaluations. The goal of our efforts will be to increase the percent of Patients over 50 that have had a colonoscopy in the last 5 years in the Weeks Medical Center Physician Practices. The percent of patients over 50 that have had a colonoscopy in the past 5 years in the Weeks Medical Center Physician Practices currently is 49%, up from 38% in the previous year.Significant Needs Identified and Not Being Addressed:1. Alcohol/Drug Abuse - Weeks Medical Center does not have any credentialed professionals with expertise in this area and this is not considered in the scope of services offered. However, at the end of September 2015, a full-time Licensed Alcohol and Drug Counselor has been hired to assist our other providers with their patients. Non-Weeks patients may obtain these services through Northern Human Services.2. Increasing Primary Care Providers - This was highlighted as a need by the Community input but in reviewing the current data there appears to be adequate number of primary care providers. We therefore will not recruit additional primary care providers.3. Childbirth Services - Weeks Medical Center closed our Childbirth Services a number of years ago due to low volume. The low volume made it impossible to maintain a qualified staff and ensure quality of the service. The population has not increased and continues to age which would not indicate a need to provide Childbirth Services. Littleton Regional Hospital (21 miles away) and Androscoggin Valley Hospital (31 miles away) both offer these services.4. Mental Health Treatment - This is not in the scope of services provided by Weeks Medical Center. We do have a Psychiatric Nurse Practitioner and a Licensed Clinical Social Worker that are available to assist our other providers with their patients. Non-Weeks patients may obtain these services through Northern Human Services. Weeks Medical Center Part V, Section B, Line 16i: Brochures and financial counselor information are available in lobbies and handed out to patients. Also, contact information for financial counselors is provided on bills and letters that go out. Weeks Medical Center Part V, Section B, Line 20e: Weeks Medical Center (The Organization) takes multiple steps to collect information which will allow the Organization to determine patient eligibility. The Organization will send two letters offering Weeks Health Access, as well as, the screening and outreach up-front procedures for surgeries and large dollar accounts. Additionally, the Organization will work with the patients to set-up payment plans and assist patients with programs which they may qualify for. Our Financial Counseling staff are Certified Application Counselors and are also eligible to do Medicaid Presumptive Eligibility, which enables them to sign eligible patients up for Medicaid. The Medicaid program expanded due to the Affordable Care Act in August, 2014. The Organization believes these steps to be a reasonable effort.If a payment is not made, the Organization uses an outside agency to monitor payment plans and pursue payment or make payment arrangements. The outside agency will place unpaid accounts on the patients credit file. The Organization will look at unpaid accounts over $10,000 with the collection agency and determine if litigation should be pursued. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Weeks Medical Center Part V, Section B, line 16a website: http://www.weeksmedical.org Weeks Medical Center Part V, Section B, line 16b website: http://www.weeksmedical.org 4 Lancaster Physicians Offices 170 Middle Street Lancaster NH 03584 Physician Office for primary care Whitefield Physicians Offices 8 Clover Lane Whitefield NH 03598 Physician Office for primary care Groveton Physicians Offices 12 Church Street Groveton NH 03582 Physician Office for primary care North Stratford Physician Offices 43 Main Street North Stratford NH 03590 Physician Office for primary care Part I, Line 7: Cost to charge ratio Part I, Line 7g: Chronic Disease Management, Emergency Department, Family Planning Program, Behaviorial Health Services, Child Psychology Program Part III, Line 4: Bad debt expense is described under Patient Accounts Receivable beginning on page 6 and in the third paragraph on page 12 of the Organization's attached financial statements. Part III, Line 8: The entire shortfall is treated as community benefit. Cost to charge ratio from the Medicare cost report was used. Part III, Line 9b: All patients of Weeks Medical Center who have no insurance are notified of the Weeks Health Access Financial Assistance policy and encouraged to make an appointment with one of our Financial Counselors or Social Workers. This information is given out, along with financial assistance applications, at the time of appointment and is also available on our web-site and is reiterated with our monthly statements sent to the patient. It is impossible for our organization to determine if a patient is eligible for financial assistance until an application is filed - we do not access credit reports but rely on the patient supplying us with the necessary financial information. At that time of application, if a patient is determined to be eligible, they are provided with free care. Part VI, Line 2: In 2013, the Strategic Planning Committee conducted a community needs assessment. The community needs have been identified and became part of the planning process whereby specific initiatives were defined based on priorities and institutional capacity. The initiatives will become part of the overall 2014-2019 Strategic Plan. The community health needs assessment is available on the Organization's website. Initial planning has commenced for the community health needs assessment due in fiscal year 2016. Part VI, Line 3: The staff is trained to discuss the Hospital's charity care policy with patients, the policy is available throughout the Hospital in the brochure and it is available on the Hospital's website. WMC also employs a full-time financial counselor and other case management staff to assist patients with the financial assistance process. Part VI, Line 4: Weeks Medical Center's general geographic catchment area consists of nine towns, which supply almost 90% of its patients. Towns include Lancaster, Groveton, Dalton, Whitefield, North Stratford, Jefferson and Stark, in New Hampshire; and Lunenburg, Guildhall and Gilman, in Vermont. Together, these towns have a population of approximately 13,000 and cover approximately 375 square miles in both Vermont and New Hampshire.Weeks Medical Center is defined by the geographic communities that surround its facilities and by the individuals and groups who benefit from the health and wellness services provided by its various health related institutions. The definition was developed by the Board of Trustees, its Committees, administrative and professional staff in the practical application of the services provided by the institutions and the identified needs of the communities served. Part VI, Line 5: WMC plays an integral role in the Emergency Preparedness plans of our community. In addition to being available in an emergency from a clinical standpoint, we are a large part of the community wide planning team, taking the lead in the planning of training & drills and bringing the various components together, based on State-wide standards. Part VI, Line 7, Reports Filed With States NH X X X X 0 0 0 0 0 0 0 0 0 Scott Howe CEO 235121 0 0 0 0 0 7332 0 22571 0 265024 0 0 0 Lars Nielson CMO 323034 0 0 0 0 0 7800 0 29413 0 360247 0 0 0 Celeste Pitts CFO 140237 0 0 0 0 0 4336 0 10998 0 155571 0 0 0 Paul Kamins MD Physician 466737 0 0 0 0 0 7800 0 27029 0 501566 0 0 0 Mark Morgan MD Physician 434699 0 0 0 0 0 7800 0 26447 0 468946 0 0 0 David Pelkowski Physician 418801 0 0 0 0 0 7800 0 29717 0 456318 0 0 0 Christopher Laurent Nurse Practitioner 398752 0 0 0 0 0 7800 0 11043 0 417595 0 0 0 Maude Keeshin Physician 369539 0 0 0 0 0 7800 0 30839 0 408178 0 0 0 Form 990, Part VII, Section A, Line 5 Mederic LeBlanc received compensation from Kingdom Emergency Sevices, LLC (an unrelated third party) for services rendered to the Organization in calendar year 2014. His compensation was as follows: Compensation: $132,969 A Business Finance Authority of the State of NH 521304598 2010-09-01 10000000 Refinance existing debt and finance the Hospital's contruction project 0 0 0 A 1597500 10000000 112960 3044490 6842550 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/01/2015 Form 990, Part VI, Section B, line 11 The Finance Committe reviews and approves the Form 990 and provides a copy to each member prior to submission. Form 990, Part VI, Section B, line 12c The organization requires the Board Members to review and sign a Conflict of Interest Policy annually. The organization also provides annual 990 questionnaires with several potential conflict situations discussed and distributed to the full Board every year at the time of the audit. Responses are sent directly to the audit firm. Any conflict discovered by the CPA's would be addressed by Hospital Management. Form 990, Part VI, Section B, line 15 The CEO's compensation is determined by the Compensation Committee of the Board, a written employment contract, a state compensation survey and approval of the full Board and Compensation Committee. Other officers have their compensation determined through a state compensation survey, along with approval of the CEO. 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 Other Fees: Program service expenses 4,408,333. Management and general expenses 100,073. Fundraising expenses 0. Total expenses 4,508,406. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Weeks Medical Center 173 Middle Street Lancaster, NH 03584 EIN: 02-0222242 Weeks Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 57,858. Transfer of Assets to Northern New Hampshire Healthcare Collaborative, Inc. -142,440.