2015-08-14T08:59:27-05:00 2014-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-10-01 020222118 Valley Regional Hospital Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Jean Shaw CFO 6035427771 2015-08-14 1 Joseph R Byrne CPA P01289281 2077752387 2015-08-14 2013 2016-03-07 17:11:31Z Peter Wright 243 Elm Street Claremont NH 03743 43837720 0 X www.vrh.org X 1893 NH Critical Access Hospital 23 19 423 20 0 0 119868 201019 37993767 37721546 1128730 2053504 -24544 -26770 39217821 39949299 0 0 0 0 21464801 21304708 0 0 0 17954875 19004578 39419676 40309286 -201855 -359987 63610293 64279099 37958484 37958812 25651809 26320287 X The mission of Valley Regional Healthcare, Inc. is to foster optimal and sustainable population health. Our vision is to provide compassionate, affordable, evidence-based, high quality care in partnership with the community. 0 0 33210459 37721546 Valley Regional Hospital is a provider of health services with facilities in the Claremont, NH area. The Hospital grants credit to patients, substantially all of whom are local residents. The Hospital also provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The Hospital does not pursue collection of amounts determined to qualify as charity care. The Hospital maintains records to identify and monitor the level of charity care it provides. For the year ending September 30, 2014 charges forgone for services and supplies furnished under the charity care policy were approximately $2,316,000. The estimated cost of those services and supplies was approximately $1,600,000.In addition, the Hospital provides a number of other services to benefit certain poor and elderly patients. Medicaid and state programs do not cover the full cost of the Hospital incurred cost of providing medical care to patients. The Hospital provides services to the community at large for which it receives little or no payment. Services include health evaluation and screening programs at community and/or work site, flu shot, and health educational and fitness programs.The Hospital also provided other community benefits on which no value could be placed, such as leadership in identifying community needs, staff commitment to volunteer community health organizations, advocacy and support for the socially and physically disadvantaged, and support for the local public safety organization. 33210459 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 43 0 1 423 1 0 0 0 0 0 0 0 0 0 0 X 23 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 1 1 1 0 NH X Jean Shaw 6035427771 243 Elm Street Claremont NH 03743 Peter Wright President & CEO 38.40 1.60 X X 0 197623 20784 Robert Porter Trustee 0.90 0.10 X 0 0 0 Michael L Prozzo Jr Trustee 0.90 0.10 X 0 0 0 Alison Raymond Trustee 0.90 0.10 X 0 0 0 Lisa Richmond Trustee 0.90 0.10 X 0 0 0 Bernard Rosen MD Trustee 0.90 0.10 X 0 0 0 Carol Vivian Trustee 0.90 0.10 X 0 0 0 Jim Wimberg Trustee 0.90 0.10 X 0 0 0 Michael O'Connell Treasurer 0.90 0.10 X X 0 0 0 Michael Satzow Trustee 0.90 0.10 X 0 0 0 Robert Cricco MD Trustee 39.90 0.10 X 280746 0 33725 Michael Fuerst Chair 0.90 0.10 X X 0 0 0 Oliver Herfort MD Trustee 39.90 0.10 X 250239 0 32596 Sherwood Moody Trustee 0.90 0.10 X 0 0 0 James Borchert Trustee 0.90 0.10 X 0 0 0 Charlene Lovett Vice Chair 0.90 0.10 X X 0 0 0 Patricia Putnam Trustee 0.90 0.10 X 0 0 0 Charles Sawyer MD Trustee 39.90 0.10 X 445830 0 18457 Allan Berggren MD Secretary 0.90 0.10 X X 0 0 0 John Tomlinson Trustee 0.90 0.10 X 0 0 0 Deanna Howard Trustee 0.90 0.10 X 0 0 0 Allen Damren Trustee 0.90 0.10 X 0 0 0 Valerie Mahar Trustee 0.90 0.10 X 0 0 0 Steven Monette VP of Finance 37.20 2.80 X 0 169408 734 Michael E Ritondo Physician 40.00 0.00 X 279723 0 33195 Alan C Rogers Physician 24.00 0.00 X 243025 0 17006 Clifford B Langweiler Physician 36.00 0.00 X 346240 0 22180 Ernest J Hanowell Physician 40.00 0.00 X 284254 0 1180 Robert L Bassett Physician 32.00 0.00 X 249153 0 11846 Claire Bowen Former President & CEO 0.00 0.00 X 0 131448 8512 2379210 498479 200215 19 1 1 1 CompHealth PO Box 972651 Dallas TX 753972651 Locum Tenens 447378 MedHost 2739 Momentum Place Chicago IL 606895327 IT System & Service 416530 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Locum Tenens 370027 American Health Centers Inc 100 Griffin Road Portsmouth NH 038010000 MRI Services 305237 Healthcare Management Systems 2739 Momentum Place Chicago IL 606895327 IT System & Service 264025 14 31370 14400 155249 201019 Patient Service Revenue 621400 58319763 58319763 Other Revenue 900099 1125601 990062 135539 Meaningful Use Revenue 900099 367406 367406 Provision for Bad Debts 621400 -4233183 -4233183 Charity/Contractual Adjustment 621400 -17858041 -17858041 37721546 642121 642121 129460 156230 -26770 -26770 -26770 5108877 20375 3704094 13775 1404783 6600 1411383 1411383 14322 31370 14322 0 39949299 37586007 0 2162273 X 1061591 1061591 15505373 12978654 2526719 161176 133862 27314 3480311 2936388 543923 1096257 928201 168056 25647 25647 48865 48865 183659 183659 5840047 5175001 665046 383757 324927 58830 707511 599049 108462 2106785 1783815 322970 19587 16584 3003 1145221 1145221 2388089 2021995 366094 322328 322328 Medical Supplies 3475601 2942791 532810 Medicaid Enhancement Ta 2032100 2032100 Miscellaneous 210925 178591 32334 Dues & Subscriptions 114456 96910 17546 40309286 33210459 7098827 0 42905 474190 11503367 11151864 3481609 3170444 742511 634981 412852 394330 45656536 26728662 20521290 18927874 20955632 23051682 3687952 3976203 196048 181893 2066127 2315638 63610293 64279099 3897866 3834040 20228 80774 25290000 24775000 8750390 9268998 37958484 37958812 X 20567775 20765173 1142188 1325017 3941846 4230097 25651809 26320287 63610293 64279099 -359987 1028465 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11425 11425 0 Part II-B, Line 1: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 4934551 63 416864 1001 5350477 4685173 67 250258 947 4934551 4044562 72 640539 4685173 4115180 355 -58567 12406 4044562 3968278 71 157717 10886 4115180 0.00000 0.79060 0.20940 0 0 250667 250667 16430267 8535886 7894381 148235 121192 27043 27504913 17447549 10057364 1322454 624035 698419 18927874 Beneficial Interest in Perpetual Trust 3976203 F 3976203 Due To Affiliates 40522 Estimated Third-Party Payor Settlements 6232956 Interest Rate Swaps 2388577 Reserve for Self-Funded Insurance 581417 Deferred Compensation 25526 9268998 40958709 1028465 170552 1199017 39759692 183659 5948 189607 39949299 40290231 170552 170552 40119679 183659 5948 189607 40309286 Part V, Line 4: The Organization uses its endowment funds in support of health care services, purchases of equipment, health education, and indigent care. Part XI, Line 2d - Other Adjustments: Rental Expenses 156,230. Fundraising Expenses 14,322. Part XI, Line 4b - Other Adjustments: Other Nonoperating Expenses Included in Revenue 5,948. Part XII, Line 2d - Other Adjustments: Rental Expenses 156,230. Fundraising Expenses 14,322. Part XII, Line 4b - Other Adjustments: Other Nonoperating Expenses Included in Revenue 5,948. Golf Tournament 45692 31370 14322 882 2211 6300 1835 3094 45692 31370 14322 882 2211 6300 1835 3094 14322 0 1 1 X 1 X 1 X 275.000000000000 1 1 0 1 1 3486292 1883122 1603170 0.03980 4920604 2594809 2325795 0.05770 8406896 4477931 3928965 0.09750 265111 53840 211271 0.00520 49135 49135 0.00120 278223 278223 0.00690 9123 9123 0.00020 601592 53840 547752 0.01350 9008488 4531771 4476717 0.11100 3000 3000 0.00010 8000 8000 0.00020 1500 1500 0.00000 2000 2000 0.00000 14500 14500 0.00030 1 2657592 11615071 11615071 X 1 1 1 1 Valley Regional Hospital Inc 243 Elm Street Claremont NH 03743 X X X X Valley Regional Hospital Inc 1 1 X X X X X X X X X 11 1 1 1 X www.vrh.org X X X X 1 0 1 1 200.000000000000 1 275.000000000000 1 X X X X 1 1 X X X 1 0 X X X 1 X 0 0 Valley Regional Hospital, Inc. Part V, Section B, Line 3: Crescendo Consulting Group and VRH incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health - community opinion leaders (a diverse set of service providers), hospital service providers, and healthcare consumers. In addition, statistical data was integrated with other community data to provide a detailed profile of needs and resources.To formally launch the needs assessment, a leadership group was convened of community leaders with a diverse breadth of community health vision, knowledge and power to impact the well being of the greater Sullivan County area. This group provided critical feedback on quantitative data, refined the list of community needs, helped to build the list of available community health resources, and assisted with the prioritization of community needs identified in this report.The Leadership Group included the following members:1. Community Dental Care of Claremont, Sue Schroeter, Director2. Connecticut Valley Home Care, Dianne Lemay, Interim Director3. Greater Claremont Chamber of Commerce, Kelly Murphy, Interim Executive Director4. Greater Sullivan County Public Health Region, Jessica McAuliff, Regional Coordinator5. River Valley Community College, Steven Budd, President6. School Administrative Unit #6, Allen Damren, Assistant Superintendent7. Southwestern Community Services, Gail Merrill, Program Director8. Sullivan County, Greg Chanis, County Administrator9. Sullivan County Healthcare, Ted Purdy, Administrator10. Turning Points Network, Deborah Mozden, Executive Director11. Valley Regional Hospital, Associates in Medicine for Pediatrics, Shirley Tan, MD, Physician12. Valley Regional Hospital, Tracy Pike, RN, Emergency Nurse Manager13. West Central Behavioral Health, Pat Kinne, Older Adult Service Manager Valley Regional Hospital, Inc. Part V, Section B, Line 4: In May 2012, Valley Regional Hospital (VRH) partnered with New London Hospital to finalize a joint community needs assessment. While each health care facility possesses community needs assessments, which are unique to their service area, it was advantageous to pool their resources due to the overlap of service territory in eastern Sullivan County. Valley Regional Hospital, Inc. Part V, Section B, Line 18e: Applications are offered to all self-pay patients along with education regarding NHHP and expanded Medicaid. 1 Kane Oncology Center 243 Elm Street Claremont NH 03743 Oncology Center Part I, Line 3c: It is the policy of Valley Regional Hospital to provide financial assistance to those patients who are unable to pay for all or part of the cost of their care that is not covered by other sources of funding. Valley Regional Hospital's Financial Assistance Program is a program that assists uninsured and under-insured patients who meet specific income, geographical and Valley Regional Hospital guidelines.The Hospital will cover up to 100% of the cost of care for patients depending on the patient's level of income and family size. The Hospital also is a participating provider with the NH Health Access Network. Part I, Line 7: The Organization used an overall cost to charge ratio for lines 7a and 7b. Amounts listed on lines 7e, 7f and 7i were derived from internal financial/cost accounting systems. Part II, Community Building Activities: Valley Regional Healthcare believes the skills and knowledge of its employees are the most critical assets to building a strong and healthy community. VRH employees participate on a wide variety of local boards serving or participating in health and wellness missions, including dental health, domestic violence, higher education, school boards, chambers of commerce, United Way, public transportation, elder health, and substance abuse. Employees also participate on state level boards and within elected government, working to improve policy and practice on a broad spectrum. Local businesses rely upon collaborations with VRH to provide education and expertise in community building activities such as through public and private health fairs. VRH takes advantage of public chamber activities, such as the Chili and Apple Festivals, Winter Carnivals, and Spring Home Show to provide tables of health information and free screening activities. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a provision for bad debts in the period of service based on past experience, which indicates that many patients are unable or unwilling to pay amounts for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or eligible) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged against the allowance for doubtful accounts.During 2014, the Hospital decreased its estimate from $3,489,423 to $3,041,148 in the allowance for doubtful accounts relating to self-pay patients and during 2013 the Hospital decreased its estimate from $3,738,130 to $3,489,423 in the allowance for doubtful accounts relating to self-pay patients. During 2014, self-pay write-offs decreased from $4,825,886 to $4,597,314 and during 2013 self-pay write-offs increased from $4,366,205 to $4,825,886. Such increases in write-offs resulted from trends experienced in the collection of amounts from self-pay patients.The Organization used a cost-to-charge ratio as its methodology for reporting bad debt expense at cost. Part III, Line 8: Medicare costs approximate Medicare revenue. The Organization does not anticipate a Medicare shortfall or that any such shortfall should be considered as community benefit. Part III, Line 9b: Patients who are known to qualify for financial assistance file a financial assistance determination application with the Hospital. If the application is approved, the patient's account shall be written off. The patient write-off guidelines are as follows:1. The determination is valid for 6 months from the date of signature for all applications except those individuals who demonstrate that they are on a fixed income (i.e. Social Security, retirment, disability), in which case approval is for 1 year from the date of signature.2. Patient qualifies according to the established Financial Assistance income guidelines3. Account notes must indicate what payor that the balance is due to (appropriate payor write-off codes to be utilized). Part VI, Line 2: VRH worked with Crescendo Consulting Group, LLC, (CCG) to bring together key healthcare and public service stakeholders, collect quantitative and qualitative data, and reach out to the community in order to elicit feedback directly from them and their service providers. The quantitative and qualitative findings included in the assessment are based on the most currently available data from community resources, the State of New Hampshire, and other regional sources.While this document fulfills federal and State reporting requirements, more importantly, it serves as a guidepost for community outreach efforts and as a benchmark with which to compare future progress.The purpose of the research design was to:-Clearly define the community served by VRH-Define a data-based and qualitative methodology to identify needs in the community-Develop a prioritized list of community resources-Develop a list of healthcare resources in the service area In order to generate the information, CCG and VRH incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health - community opinion leaders (a diverse set of service providers), hospital service providers, and healthcare consumers. In addition, statistical data was integrated with other community data to provide a detailed profile of needs and resources. Crescendo conducted several focus groups with service providers and stakeholders, including patients from various service lines. The following ranked needs were identified following the assessment process: 1. Availability of affordable healthcare, prescriptions, and related services2. Drug and alcohol abuse early detection and treatment3. Managing the expected growth in senior health services4. Wellness initiatives and the individual's ability to maintain a healthy lifestyle 5. Obesity / Nutrition / Exercise education and services6. Addictions awareness and education7. Behavioral Health early detection and intervention8. Transportation to/from healthcare service providers9. Dental health services 10. Chronic disease screenings - broad spectrum (hypertension, cancer, heart disease, stroke)11. Elder Care Services and Dementia Spectrum Issues Part VI, Line 3: The Community Engagement Department has created and posted signs in all public areas of the Hospital, as well as on the Hospital's website. Part VI, Line 4: Valley Regional Healthcare serves a rural region surrounding Claremont and Newport, NH. Sullivan County has a population of over 43,000 people, living in 15 towns over 537 square miles. VRH also serves portions of eastern VT. Through the 2012 VRH needs assessment and 2009 Sullivan County Human Services Coordination Plan, the following demographics describe the area: -Much of the growth in Sullivan County is now occurring in the rural communities, not in the more urban centers, such as Newport or Claremont.-The median age in Sullivan County is nearly 44 years of age (43.7) while the state average is 40 years. -Similarly, the median annual household income in Sullivan County is about $13,000 less than the state average. In Claremont, household income is more than $21,000 (roughly 33%) below the New Hampshire median income - $41,721 compared to $63,277.-One in six Sullivan County residents is over 64 years of age. In some of communities, the percentage of seniors is over 20% and expected to rise to nearly 25% over the next decade. In addition, Sullivan County has the fourth highest rate of elderly in poverty.-Heart disease, cancer, and stroke are the leading causes of death in VRH's service area. Specifically, death rates for two of these diseases are higher in the Sullivan County than for the overall State of New Hampshire.-Sullivan County has an overall higher rate of households without vehicle ownership. While this rate points to the obvious implication and dependence upon alternate means of transportation, it is also critical to note the secondary effect upon the volunteer pool to provide potential rides to health care providers within the region. Part VI, Line 5: While VRH is committed to supporting its local community, it also recognizes the potential for far reaching impact on an international level. VRH continually partners with neighboring health care providers to extend support in national and international disaster relief efforts, be that through donations of medical supplies or skilled healthcare providers sharing their medical knowledge in foreign lands. VRH is also an active partner with the American Red Cross to insure adequate blood supplies for local and national recipients. VRH is not part of any affiliated health care system. Its collaborations are on a voluntary basis to improve the health of all New Englanders. VRH is part of the New England Alliance for Health (NEAH), a group of community hospitals, behavioral health centers, and home health agencies that came together in a shared commitment to improve the quality, efficiency, and availability of health care in New Hampshire, Vermont and western Massachusetts. And VRH is an active member of the New Hampshire Hospital Associations. Part VI, Line 7, Reports Filed With States NH 0 0 0 0 0 1 1 1 0 Peter Wright President & CEO 0 197492 0 0 0 131 0 8704 0 12080 0 218407 0 0 Robert Cricco MD Trustee 270844 0 0 0 9902 0 5798 0 27927 0 314471 0 0 0 Oliver Herfort MD Trustee 210808 0 4757 0 34674 0 5178 0 27418 0 282835 0 0 0 Charles Sawyer MD Trustee 435138 0 0 0 10692 0 6018 0 12439 0 464287 0 0 0 Steven Monette VP of Finance 0 168814 0 0 0 594 0 0 0 734 0 170142 0 0 Michael E Ritondo Physician 271340 0 0 0 8383 0 5768 0 27427 0 312918 0 0 0 Alan C Rogers Physician 239425 0 0 0 3600 0 4439 0 12567 0 260031 0 0 0 Clifford B Langweiler Physician 340290 0 0 0 5950 0 0 0 22180 0 368420 0 0 0 Ernest J Hanowell Physician 214063 0 0 0 70191 0 0 0 1180 0 285434 0 0 0 Robert L Bassett Physician 237435 0 10000 0 1718 0 0 0 11846 0 260999 0 0 0 Claire Bowen Former President & CEO 0 131065 0 0 0 383 0 1904 0 6608 0 139960 0 0 Part I, Line 3 Valley Regional Healthcare, Inc., a related organization, establishes the compensation for the Organization's CEO & CFO. Valley Regional Healthcare, Inc. uses a variety of resources to establish compensation as follows: 1. Form 990 of other organizations 2. Written employment contract 3. Compensation survey/study 4. Approval by the board/compensation committee Part I, Line 6 No specific goals were established by the Board for the CEO. For the CEO and Senior VPs, any increase in pay rate would be the same as an approved rate increase hospital-wide. Part I, Line 7 Individuals listed with Incentive Bonus amounts are physicians who under their employment agreements/contracts have a provision for Incentive Bonus based on their Relative Value Units (RVU) of services exceeding a target amount. Form 990, Part VII, line 5: Peter Wright, CEO is paid by Dartmouth-Hitchcock Medical Center, an unrelated organization. A breakdown of Mr. Wright's 2013 compensation is as follows: Salary: $197,623 Benefits: $20,784 A State of New Hampshire Business Finance Authority 521304598 64468KBJ4 2008-06-02 26260000 Financing for Buildings and Structures 0 0 0 A 1485000 26260000 325806 25934194 2010 0 1 1 1 A 0 0 0 0 0 0 1 A 0 0 1 1 1 1 Morgan Stanley & RBS Citizens 20.000000000000 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: State of New Hampshire Business Finance Authority Date the Rebate Computation was Performed: 06/27/2014 Form 990, Part VI, Section A, line 6 The sole member of the Organization is Valley Regional Healthcare, Inc. Form 990, Part VI, Section A, line 7a The Organization's directors are nominated and elected by the Organization's member at the annual meeting of the Corporation. Form 990, Part VI, Section A, line 7b The following actions and undertakings involving the business of the Organization are subject to the ratification by the member: adoption of operating budget; adoption of capital budgets; adoption of strategic plans; initiation of significant fund-raising activities; implementation of institutional affiliations, mergers, consolidations or other reorganizations; material modification of service and business offerings; material acquisitions or dispositions of assets; changes in certified public accountants, fiscal year or material accounting practices; incurrence of material indebtedness; material changes in insurance programs and arrangements; material changes in employee benefits plans; adoption of quality improvements plans; election of directors; selection of the president/CEO; amendment of the Organization's bylaws; and amendment of the articles of association. Form 990, Part VI, Section B, line 11 The Organization's CFO reviews the draft Form 990 prior to its filing. The CFO then goes over the document with the board's finance committee. Form 990, Part VI, Section B, line 15 The executive committee of the board of trustees convenes on an annual basis to review the compensation of the CEO. The amount of compensation shall be reviewed by the D-H independent compensation consultant for purposes of determining compliance with the rebuttable presumption, if necessary. The CEO compensation is tied to the strategic planning goals of the Organization. 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 Physician Fees: Program service expenses 1,501,847. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,501,847. Purchased Services: Program service expenses 3,406,151. Management and general expenses 616,703. Fundraising expenses 0. Total expenses 4,022,854. Other Professional Fees: Program service expenses 267,003. Management and general expenses 48,343. Fundraising expenses 0. Total expenses 315,346. Valley Regional Healthcare Inc 243 Elm Street Claremont NH 03743 020397338 Healthcare supporting organization NH 501(c)(3) Line 11b, II N/A 0 George H Stowell Trust 295 Windsor Rd Claremont NH 03743 Charitable Trust NH T 46366 1780078 1.00000 0 Clarence H Martin Trust 243 Elm St Claremont NH 03743 Charitable Trust NH T 2156858 0.66670 0 McGuire Endowment 243 Elm St Claremont NH 03743 Charitable Trust NH T 39267 1.00000 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0