2014-02-07T08:41:58-06:00 2013-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Scott W Howe 6037884911 2014-01-31 1 Barbara J McGuan CPA P00219457 2077752387 2014-01-31 2012 2015-11-30 17:44:51Z Scott W Howe 173 Middle Street Lancaster NH 03584 46936267 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 15 12 410 160 0 0 898368 571981 40378848 41972943 415370 403777 8486 -663 41701072 42948038 0 0 0 0 24888158 26035318 0 0 16175 16844240 17859986 41732398 43895304 -31326 -947266 42181204 44154341 16499537 18143880 25681667 26010461 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 36204836 41972943 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services, Physician Office services and Home Health & Hospice services. 36204836 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 1 0 0 0 1 39 0 1 410 1 0 0 0 0 0 0 0 0 0 0 X 15 12 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 1.00 X X 0 0 0 Scott Burns 1.00 X 0 0 0 George Cook 1.00 X 0 0 0 Dennis Couture 1.00 X 0 0 0 Donald Crane 1.00 X X 0 0 0 Sarah Desrochers 1.00 X 0 0 0 Charlie Fitch 1.00 X 0 0 0 Stanley Holz 1.00 X X 0 0 0 Patrick Kelly 1.00 X 0 0 0 Patsy Pilgrim 1.00 X 0 0 0 Lisa Tetreault 1.00 X X 0 0 0 Keith Young 1.00 X 0 0 0 Scott Howe 40.00 X X 219346 0 29670 Lars Nielson 40.00 X X 309876 0 34374 John Ford MD 40.00 X 355942 0 21720 Ernest Angelicola 1.00 X 0 0 0 Celeste Pitts 40.00 X 130941 0 14491 Paul Kamins MD 40.00 X 433298 0 34099 Mark Morgan MD 36.00 X 403294 0 34657 David Pelkowski 41.00 X 383446 0 37153 Walter Voigt MD 40.00 X 341062 0 34387 Maude Keeshin 40.00 X 341046 0 34627 2918251 0 275178 35 0 1 0 Daniel Hebert Inc 12 Pleasant St Colebrook NH 03576 Labor on Building Project 1807046 Kingdom Emergency 815 North Kirby Road Lyndonville VT 35851 Emergency Room Physician Coverage 1596257 American Health Center Inc 100 Griffin Road Unit C Portsmouth NH 03801 Mobile MRI/Nuclear Medicine 334427 American Healthcare Services Association PO Box 945 Traverse City MI 49685 Travel/Contract Labor 265929 Virtual Radiologic Corp 25983 Network Place Chicago IL 60673 Teleradiology Services 242489 11 15559 138960 417462 571981 Patient Service 621400 73571456 73571456 Miscellaneous 621400 1584801 1584801 Meaningful Use 621400 1131282 1131282 Provision for bad debts 621400 -2114609 -2114609 Charity Care 621400 -2973234 -2973234 -29226753 -29226753 41972943 398436 398436 3951091 26482 3953704 18528 -2613 7954 5341 5341 15334 15559 15997 -663 -663 42948038 41972943 0 403114 X 1116360 1116360 20391828 18008495 2383333 479673 425038 54635 2716669 2348059 368610 1330788 1119459 211329 472770 92798 379972 31460 31460 60835 60835 40175 40175 4678004 4514613 163391 111693 95518 16175 356030 78877 277153 622726 622726 837675 793555 44120 174904 161979 12925 40362 34688 5674 458132 458132 2536594 2536594 328563 147790 180773 Patient Care Supplies 4643739 4643344 395 MET Taxes 1330368 1330368 Miscellaneous 1135956 841415 294541 43895304 36204836 7674293 16175 30 50 3630327 5593261 6116902 7294702 783723 785686 235949 500860 38711014 22685813 17469737 16025201 12774887 13833471 985 1169649 120125 42181204 44154341 4480437 3455266 1708894 1669231 9400000 9080500 910206 3938883 16499537 18143880 X 24131764 24416246 561889 606201 988014 988014 25681667 26010461 42181204 44154341 X -947266 995784 280276 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10698 10698 0 Explanation of Lobbying Activities: 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. 1131612 12908 1144520 1031277 46100 29235 -25000 1131612 1662763 5000 -67822 568664 1031277 1591035 118038 46310 1662763 1517579 123226 49770 1591035 0.86330 0.13670 0 0 462709 462709 13154848 7327252 5827596 23873184 15019111 8854073 1220273 339450 880823 16025201 Capital Leases 28545 Interest Rate Swap 582782 Estimated third-party payor settlements 3327556 3938883 44199920 995784 296273 1292057 42907863 40175 40175 42948038 43871126 15997 15997 43855129 40175 40175 43895304 Part XI, Line 2d - Other Adjustments: Fundraising Expenses 15,997. Unrealized Gain on Interest Rate Swap 280,276. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 15,997. Hospice Ball 30893 15559 15334 7050 7063 1500 384 30893 15559 15334 7050 7063 1500 384 15997 -663 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 2118066 505695 1612371 0.03670 4742929 3847621 895308 0.02040 1079322 1058599 20723 0.00050 7940317 5411915 2528402 0.05760 689908 45332 644576 0.01470 764708 18943 745765 0.01700 3996215 3597162 399053 0.00910 5450831 3661437 1789394 0.04080 13391148 9073352 4317796 0.09840 95685 95685 0.00220 79311 79311 0.00180 17340 17340 0.00040 192336 192336 0.00440 1 1242413 16415967 19786433 -3370466 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 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 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, Geriatric Psychiatrist, 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. 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. 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 VI, Line 2: This past 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. Reports Filed With States Part VI, Line 7 NH X X X X 0 0 0 0 0 0 0 0 0 Scott Howe 204507 0 0 0 14839 0 6862 0 22808 0 249016 0 0 0 Lars Nielson 287876 0 0 0 22000 0 7350 0 27024 0 344250 0 0 0 John Ford MD 338942 0 0 0 17000 0 7350 0 14370 0 377662 0 0 0 Paul Kamins MD 410798 0 0 0 22500 0 7350 0 26749 0 467397 0 0 0 Mark Morgan MD 386294 0 0 0 17000 0 7350 0 27307 0 437951 0 0 0 David Pelkowski 378839 0 0 0 4607 0 9841 0 27312 0 420599 0 0 0 Walter Voigt MD 334043 0 0 0 7019 0 7350 0 27037 0 375449 0 0 0 Maude Keeshin 318546 0 0 0 22500 0 7350 0 27277 0 375673 0 0 0 A Business Finance Authority of the State of NH 2010-09-01 10000000 Refinance existing debt and finance the Hospital's contruction project 0 0 0 A 919500 10000000 112960 9887040 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 Cynthia Nielson Spouse of Lars Nielson, CMO and Trustee 24670 Lars Nielson, CMO and Trustee's spouse is employed and compensated as a registered nurse by the organization. 0 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. Other Fees Form 990, Part IX, line 11g Other Fees: Program service expenses 4,514,613. Management and general expenses 163,391. Fundraising expenses 0. Total expenses 4,678,004. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 280,276. Northern NH Healthcare Management LLC 59 Paige Hill Road Berlin NH 035703542 455617105 Health Care Collaborative NH Related 0 1 0.33330 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Northern New Hampshire Healthcare Management LLC O 61792 FMV