2015-02-04T12:28:02-06:00 2014-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2013-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Scott W Howe CEO 6037884911 2015-02-02 1 Barbara J McGuan CPA P00219457 2077752387 2015-02-02 2013 2016-03-07 17:11:31Z Scott W Howe 173 Middle Street Lancaster NH 03584 44728107 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 16 13 427 202 0 0 571981 428108 41972943 41036524 403777 758353 -663 -692 42948038 42222293 0 0 0 0 26035318 23632210 0 0 20836 17859986 17850511 43895304 41482721 -947266 739572 44154341 46394836 18143880 18904305 26010461 27490531 X 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 1 35238897 41036524 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services, Physician Office services, and Hospice services. Home Health services were offered through 12/31/13. 35238897 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 41 0 1 427 1 0 0 0 0 0 0 0 0 0 0 X 16 13 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 Trustee 1.00 X 0 0 0 Keith Young Trustee 1.00 X 0 0 0 Scott Howe CEO 40.00 X X 224607 0 30800 Lars Nielson CMO 40.00 X X 313705 0 36312 Mederic LeBlanc Medical Staff President 40.00 X 223290 0 0 John Ford MD Past Medical Staff President 40.00 X 345904 0 11171 Celeste Pitts CFO 40.00 X 134033 0 15099 Paul Kamins MD Physician 40.00 X 442341 0 36119 Mark Morgan MD Physician 36.00 X 408950 0 36371 David Pelkowski Physician 40.00 X 401339 0 36879 Christopher Laurent Nurse Practitioner 40.00 X 358963 0 8686 Maude Keeshin Physician 40.00 X 353091 0 30895 3206223 0 242332 39 0 1 1 Kingdom Emergency 815 North Kirby Road Lyndonville VT 35851 Emergency Room Physician Coverage 1607336 AHSA LLC PO Box 945 Traverse City MI 49685 Contract Labor/Travel Nurses 419811 AVH-HH Contract Staffing 59 Page Hill Rd Berlin NH 03570 Home Health Contracted Staffing 389698 Dartmouth-Hitchcock Clinic One Med Ctr Dr Lebanon NH 03756 Professional Services 367334 Daniel Hebert Inc 12 Pleasant St Colebrook NH 03576 Contractor - Building Projects 327834 12 22305 145645 260158 428108 Patient Service 621400 71764889 71764889 Miscellaneous 621400 1766223 1766223 Meaningful Use 621400 1076595 1076595 Provision for Bad Debts 621400 -1934949 -1934949 Contractual/Char. Adj. 621400 -31636234 -31636234 41036524 408248 408248 2831782 1500 2462465 20712 369317 -19212 350105 350105 21945 22305 22637 -692 -692 42222293 41036524 0 757661 X 1334921 1334921 18121739 16065317 2056422 440517 387700 52817 2520864 2146837 374027 1214169 1007396 206773 403918 77202 326716 12889 12889 59935 59935 41438 41438 5475891 4863789 612102 87897 934 66127 20836 342587 72077 270510 38630 38630 814622 778741 35881 106405 96604 9801 32492 30770 1722 446836 446836 2565620 2565620 329186 148650 180536 Patient Care Supplies 4277070 4277070 Miscellaneous 1465835 924094 541741 MET Taxes 1349260 1349260 41482721 35238897 6222988 20836 1250 1250 5592061 9272583 7294702 5763558 785686 747048 500860 663358 40263303 24909613 16025201 15353690 13833471 14511263 985 -30938 120125 113024 44154341 46394836 3455266 3158914 1669231 819076 9080500 8741500 3938883 6184815 18143880 18904305 X 24416246 25872017 606201 628215 988014 990299 26010461 27490531 44154341 46394836 X 739572 600422 140076 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10238 10238 0 Part II-B, Line 1: Weeks Medical Center is a member of the New Hampshire Hospital Association, the American Hospital Association, and the Rural Home Care Network. 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. 1144520 2285 27463 1174268 1131612 12908 1144520 1031277 46100 29235 -25000 1131612 1662763 5000 -67822 568664 1031277 1591035 118038 46310 1662763 0.00000 0.84330 0.15670 0 0 509290 509290 13411357 7627769 5783588 25719381 16933393 8785988 623275 348451 274824 15353690 Capital Leases 19431 Interest Rate Swap 442706 Estimated Third-Party Payor Settlements 5722678 6184815 41806834 600422 162713 763135 41043699 41438 1137156 1178594 42222293 40326764 22637 22637 40304127 41438 1137156 1178594 41482721 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: Fundraising Expenses 22,637. Unrealized Gain on Interest Rate Swap 140,076. Part XI, Line 4b - Other Adjustments: Expenses from Discontinued Operations 1,137,156. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 22,637. Part XII, Line 4b - Other Adjustments: Expenses from Discontinued Operations 1,137,156. Hospice Ball 44250 22305 21945 11619 8826 1500 692 44250 22305 21945 11619 8826 1500 692 22637 -692 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 2211688 390261 1821427 0.04390 4728126 3634352 1093774 0.02640 1156295 766721 389574 0.00940 8096109 4791334 3304775 0.07970 592922 38065 554857 0.01340 473423 1207 472216 0.01140 3536071 2858765 677306 0.01630 4602416 2898037 1704379 0.04110 12698525 7689371 5009154 0.12080 90802 90802 0.00220 105857 105857 0.00260 16675 16675 0.00040 213334 213334 0.00520 1 1072216 18865245 19055803 -190558 X 1 1 1 1 Weeks Medical Center Hospital 173 Middle Street Lancaster NH 03584 X X X X Weeks Medical Center 1 1 X X X X X X X X X 12 1 0 1 X www.weeksmedical.org X X X X X X 1 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X X X 1 X 0 0 Weeks Medical Center Part V, Section B, Line 3: 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 14g: 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 18e: 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. During the past two years, the organization has partnered with North Country Health Consortium to provide Navigators on-site at the various practice locations in order to assist patients and the community with signing up for the Insurance Exchanges. In addition, our Financial Counseling staff have become 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. 7 Lancaster Physicians Offices 170 Middle Street Lancaster NH 03584 Physician Office for primary care Weeks Home Health 278 Main Street Lancaster NH 03584 Home Health & Hospice Services 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 Weeks Home Health 120 Main Street Colebrook NH 03576 Home Health & Hospice Services North Stratford Physician Offices 43 Main Street North Stratford NH 03590 Physician Office for primary care Weeks Home Health 7 Page Hill Road Berlin NH 03570 Home Health & Hospice Services Part I, Line 7: Cost to charge ratio Part I, Line 7g: Chronic Disease Management, Emergency Department, Family Planning Program, Psychiatric Consultations, 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: Last year, 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. 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.Since the mergers of WMC's Home Health and Hospice with Upper Connecticut Valley Hospital's Home Health and Androscoggin Valley Hospital's Home Health, the service area for homecare services has expanded to include all of Coos County and some of Grafton County. The expanded territory covers 1,800 square miles and 41,800 residents.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. We are the ones who staff the 911 emergency line and tone out the ambulance when needed. 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 224607 0 0 0 0 0 7020 0 23780 0 255407 0 0 0 Lars Nielson CMO 313705 0 0 0 0 0 7800 0 28512 0 350017 0 0 0 Mederic LeBlanc Medical Staff President 223290 0 0 0 0 0 0 0 0 0 223290 0 0 0 John Ford MD Past Medical Staff President 345904 0 0 0 0 0 7800 0 3371 0 357075 0 0 0 Paul Kamins MD Physician 442341 0 0 0 0 0 7800 0 28319 0 478460 0 0 0 Mark Morgan MD Physician 408950 0 0 0 0 0 7800 0 28571 0 445321 0 0 0 David Pelkowski Physician 401339 0 0 0 0 0 7946 0 28933 0 438218 0 0 0 Christopher Laurent Nurse Practitioner 358963 0 0 0 0 0 7650 0 1036 0 367649 0 0 0 Maude Keeshin Physician 353091 0 0 0 0 0 7800 0 23095 0 383986 0 0 0 Form 990, Part VII, Section A, Line 5 Mederic LeBlanc received compensation from Kingdom Emergency (an unrelated third party) for services rendered to the Organization in calendar year 2013. His compensation was as follows: Compensation: $223,290 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 1258500 10000000 112960 9887040 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 0 0 0 0 A 0 Cynthia Nielson Spouse of Lars Nielson, CMO and Trustee 21862 Lars Nielson, CMO and Trustee's spouse is employed and compensated as a registered nurse by the organization. 0 Form 990, Part III, line 3 In January 2014, the Hospital's Home Health division formally ceased operations under the Hospital and joined Northern New Hampshire Healthcare Collaborative, Inc. 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 4,863,789. Management and general expenses 612,102. Fundraising expenses 0. Total expenses 5,475,891. Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 140,076.