2013-02-06T09:39:05-06:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2011-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Scott W Howe 6037884911 2013-01-30 1 Rachel Williamson CPA P00186614 6036697337 2013-01-30 2011 2016-02-25 16:41:14Z Scott W Howe 173 Middle Street Lancaster NH 03584 44903371 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 16 13 393 179 0 0 716053 898368 39525843 40378848 409449 415370 9160 8486 40660505 41701072 0 0 0 0 24278907 24888158 0 0 18875 16127651 16844240 40406558 41732398 253947 -31326 39514153 42181204 15032083 16499537 24482070 25681667 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 34016915 40378848 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. 34016915 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 0 0 0 0 0 0 0 1 0 0 0 0 1 40 0 1 393 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 Ernest F Angelicola 1.00 X 0 0 0 David Atkinson 1.00 X X 0 0 0 Scott Burns 1.00 X X 0 0 0 George Cook 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 John Howell MD 1.00 X 0 0 0 Peter Johnson 1.00 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 Rebecca More 1.00 X 0 0 0 Marie Thompson 1.00 X 0 0 0 Sharon Atkinson 1.00 X 0 0 0 Scott Howe 40.00 X X 214792 0 27056 Lars Nielson 40.00 X X 300041 0 32111 Wendy Muello MD 40.00 X 164924 0 31095 John Ford MD 40.00 X 344641 0 26245 Celeste Pitts 40.00 X 105384 0 12402 Paul Kamins MD 40.00 X 418904 0 32394 Mark Morgan MD 36.00 X 385590 0 30729 David Pelkowski 41.00 X 366580 0 29695 Walter Voigt MD 40.00 X 338422 0 32395 Maude Keeshin 40.00 X 329742 0 32395 2969020 0 286517 32 0 1 0 Kingdom Emergency 815 North Kirby Road Lyndonville VT 35851 Emergency Room Physician Coverage 1531433 American Health Centers Inc 10 Commerce Park North Unit 10 Bedford NH 03110 Mobile Scans 549876 Daniel Hebert Inc 12 Pleasant St Colebrook NH 03576 Labor on Building Project 237100 Virtual Radiologic Corp 25983 Network Place Chicago IL 60673 Radiology Interpretation Services 235946 GreenPages Technology Solutions PO Box 843435 Boston MA 02284 Computer Networking Services 196932 6 711478 186890 898368 Net Patient Service 621400 41352770 41352770 Miscellaneous 621400 600639 600639 Pharmacy 621400 298618 298618 Cafeteria 621400 136581 136581 Provision for bad debt 621400 -2009760 -2009760 40378848 413774 413774 3180018 7800 3174676 11546 5342 -3746 1596 1596 24563 16077 8486 8486 41701072 40378848 0 423856 1258691 1258691 19224598 16985277 2239321 463824 411626 52198 2664409 2303528 360881 1276636 1064204 212432 457786 84264 373522 59958 59958 60402 60402 38341 38341 3979840 3709295 270545 122849 85 103889 18875 366746 111338 255408 499972 499972 967205 910078 57127 184922 162571 22351 38345 29813 8532 475184 475184 2377920 2377920 292002 124699 167303 Patient Care Supplies 4444697 4444697 MET Taxes 1306776 1306776 Miscellaneous 1171295 822336 348959 41732398 34016915 7696608 18875 30 30 4679790 3630327 5650300 6116902 810445 783723 171047 235949 37864541 20394804 16532564 17469737 11241694 12774887 428283 1169649 39514153 42181204 3917239 4480437 430379 1708894 9700000 9400000 984465 910206 15032083 16499537 X 22995706 24131764 569450 561889 916914 988014 24482070 25681667 39514153 42181204 X -31326 1230923 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11288 11288 0 Explanation of Lobbying Activities: 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. 1031277 46100 29235 -25000 1131612 1662763 5000 -67822 568664 1031277 1591035 118038 46310 1662763 1517579 123226 49770 1591035 0.87310 0.12690 0 0 462709 462709 13082495 6865164 6217331 23407139 13202462 10204677 912198 327178 585020 17469737 Capital Leases 47148 Interest Rate Swap 863058 910206 41701072 41732398 -31326 1271943 -41020 1230923 1199597 42909731 1271943 16077 1288020 41621711 38341 41020 79361 41701072 41710134 16077 16077 41694057 38341 38341 41732398 Part XI, Line 8 - Other Adjustments: Unrealized Loss on Interest Rate Swap -41,020. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 16,077. Part XII, Line 4b - Other Adjustments: Unrealized Loss on Interest Rate Swap 41,020. Part XIII, Line 2d - Other Adjustments: Fundraising Expenses 16,077. Hospice Ball 24563 24563 16077 24563 24563 16077 16077 8486 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 2668891 727317 1941574 0.04650 5037188 4379600 657588 0.01580 1959012 1347852 611160 0.01460 9665091 6454769 3210322 0.07690 911264 62769 848495 0.02030 660624 5955 654669 0.01570 4206189 3739885 466304 0.01120 5778077 3808609 1969468 0.04720 15443168 10263378 5179790 0.12410 40781 40781 0.00100 46818 46818 0.00110 16527 16527 0.00040 3686 3686 0.00010 107812 107812 0.00260 0 20972132 20972132 X 1 1 1 1 Weeks Medical Center Hospital

173 Middle Street Lancaster NH 03584

X X X X Weeks Medical Center 1 1 1 300.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X 1 X X X 1 X X X X X X 1 X 0 1 6 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 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 8: The entire shortfall is treated as community benefit. Cost to charge ratio from the Medicare cost report was used. Weeks Medical Center Part V, Section B, Line 13g: 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 21: Patients with a non-contracted insurance may have their insurance billed to gross charges - no discount. This is rare and usually only applies to some worker's compensation companies. Part VI, Line 2: In the summer of 2007, 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 have become part of the overall 2009-2013 Strategic Plan. 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.With the recent merger of WMC - Home Health and Hospice with the Upper Connecticut Valley Hospital - Home Health, the service area for homecare services have expanded to include Clarksville, Colebrook, Columbia, Errol, Pittsburg, and Stewartstown. The expanded territory includes an additional 804 square miles and 5,542 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 201557 0 0 0 13235 0 6710 0 20346 0 241848 0 0 0 Lars Nielson 278041 0 0 0 22000 0 7350 0 24761 0 332152 0 0 0 Wendy Muello MD 142918 0 0 0 22006 0 5284 0 25811 0 196019 0 0 0 John Ford MD 328141 0 0 0 16500 0 7350 0 18895 0 370886 0 0 0 Paul Kamins MD 396904 0 0 0 22000 0 7350 0 25044 0 451298 0 0 0 Mark Morgan MD 369090 0 0 0 16500 0 7350 0 23379 0 416319 0 0 0 David Pelkowski 366580 0 0 0 0 0 4900 0 24795 0 396275 0 0 0 Walter Voigt MD 331446 0 0 0 6976 0 7350 0 25045 0 370817 0 0 0 Maude Keeshin 307742 0 0 0 22000 0 7350 0 25045 0 362137 0 0 0 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 600000 10000000 112960 9887040 2011 1 0 1 1 0 0 0 0 1 0 1 0 0 0 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 survery and approval of the full Board and Compensation Committee. Other officers have their compensation determined through a state compensation survery, 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,271,943. Unrealized Loss on Interest Rate Swap -41,020. Total to Form 990, Part XI, Line 5: 1,230,923. Form 990, Part XII, Line 2c The organization has not changed its selection or oversight process during the tax year. Form 990, Part X, Line 11 The Balance Sheet reflects the GAAP value of the following partnership investments: New England Pharmacy Collaborative, LLC which had a September 30, 2011 year end and an ending capital account of $658. Northern NH Healthcare Collaborative LLC 59 Paige Hill Road Berlin NH 035703542 455617105 Health Care Collaborative NH Related 0 1 0.33333 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0