2012-08-14T14:00:29-05:00 2011-09-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2010-10-01 020397338 Valley Regional Healthcare Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Steven L Monette 6035427771 2012-08-14 1 Barbara J McGuan CPA 2077752387 2012-08-13 2010 2016-02-24 21:20:13Z Claire Bowen 243 Elm Street Claremont NH 03743 5857283 0 X www.vrh.org X 1986 NH Parent organization to Valley Regional Hospital, Inc. 21 19 119 12 0 0 412185 402572 5461483 4855393 59332 107141 43666 70736 5976666 5435842 4394 0 0 0 4785147 4405200 0 0 0 1178472 954599 5968013 5359799 8653 76043 2909491 2821141 949332 868147 1960159 1952994 Valley Regional Healthcare, Inc. is organized to coordinate and support the activities of health care organizations, including Valley Regional Hospital, Inc. 0 0 4572564 4855393 Valley Regional Healthcare is the parent organization for Valley Regional Hospital. In this role, Valley Regional Healthcare provides integrated management and support services for the Hospital. Valley Regional Healthcare also operates Connecticut Valley Home Care, a home health care agency. 4572564 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 12 0 1 119 1 0 0 0 0 0 0 0 0 0 0 X 21 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 1 1 1 0 NH X Steven Monette 6035427771 243 Elm Street Claremont NH 03743 Volker Bradley MD 1.00 X 0 0 0 Albert Leahy Jr 1.00 X 0 0 0 Debra Livingston 1.00 X 0 0 0 Nancy Merrill 1.00 X 0 0 0 Michael O'Connell 1.00 X 0 0 0 Michael L Prozzo Jr 1.00 X 0 0 0 Alison Raymond 1.00 X 0 0 0 Lisa Richmond 1.00 X 0 0 0 Bernard Rosen MD 1.00 X 0 0 0 Michael Satzow 1.00 X 0 0 0 Evelyn Schlosser 1.00 X 0 0 0 Carol Vivian 1.00 X X 0 0 0 Jim Wimberg 1.00 X 0 0 0 Claire Bowen 40.00 X X 292065 0 10030 Robert Porter 1.00 X X 0 0 0 Randolph Knight MD 40.00 X X 0 241120 24915 Robert Cricco MD 1.00 X 0 0 0 Allen Damren 1.00 X 0 0 0 Michael Fuerst 1.00 X 0 0 0 Oliver Herfort MD 1.00 X 0 0 0 Sherwood Moody 1.00 X 0 0 0 Carol Boerner MD 40.00 X X 0 0 0 Charlene Lovett 1.00 X 0 0 0 Steven Monette 40.00 X 144947 0 889 Margaret Burns 40.00 X 154098 0 4209 Gregg Burdett 40.00 X 139760 0 19195 730870 241120 59238 4 0 1 0 0 363503 39069 402572 Patient Service Revenu 621610 2535559 2535559 Management Services 621610 2136699 2136699 Miscellaneous Revenue 900099 183135 183135 4855393 42395 42395 17244 51151 -33907 -33907 -33907 435036 370290 64746 64746 64746 Other Revenue 900099 104643 104643 104643 5435842 4855393 0 177877 447930 66668 381262 2983743 2983743 15504 15504 726300 658610 67690 231723 207934 23789 1118 1118 17500 17500 12069 12069 278488 75547 202941 65866 65866 174680 163152 11528 124105 112357 11748 111306 109016 2290 549 549 39792 39665 127 54255 54255 Provision for Bad Debts 38966 38966 0 Miscellaneous 29279 28361 918 Purchased Services 6626 6626 0 5359799 4572564 787235 0 50 50 121984 206239 356725 289128 13074 14412 464697 214525 267755 250172 1400767 1459973 749136 601167 2909491 2821141 428143 377653 54904 101833 466285 388661 949332 868147 X 1960159 1913902 39092 1960159 1952994 2909491 2821141 X 76043 -83208 X X 0 1 1 X 0 X X X 0 0 0 Valley Regional Hospital Inc 020222118 3 1 1 1 5359799 1 5359799 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 464697 214525 250172 250172 Due from Affiliates 311984 Cash Surrender Value of Life Insurance 289183 601167 Due to Affiliates 292282 Reserve for Self-Funded Insurance 96379 388661 5435842 5359799 76043 -83208 -83208 -7165 5391716 -83208 51151 -32057 5423773 12069 12069 5435842 5398881 51151 51151 5347730 12069 12069 5359799 Part XII, Line 2d - Other Adjustments: Rental Expenses 51,151. Part XIII, Line 2d - Other Adjustments: Rental Expenses 51,151. X X X X 0 0 0 0 0 1 1 0 0 Claire Bowen 253252 0 27520 0 11293 0 2132 0 7898 0 302095 0 0 0 Randolph Knight MD 0 223768 0 2670 0 14682 0 1972 0 22943 0 266035 0 0 Margaret Burns 143028 0 6561 0 4509 0 1476 0 2733 0 158307 0 0 0 Gregg Burdett 128622 0 7297 0 3841 0 0 0 19195 0 158955 0 0 0 Part I, Line 6 Claire Bowen (CEO) received a bonus that is derived by a number of different factors. There is a fixed dollar amount that is set as a potential bonus. The board sets objectives for the CEO to achieve with a weighted percentage on each objective that will factor into the bonus amount. These weighted amounts equal 100% of the potential bonus. For Margaret Burns, Gregg Burdett, and Steven Monette (Senior VPs), 15% of their salary is eligible for a bonus. They too have a weighted percent on objectives to meet during the year in determining the bonus amount they will receive. For fiscal year 10-11, one of the objectives for the senior management was meeting the budgeted operating return. This counted as 35% of their potential bonus amount. Form 990, Part VI, Section A, line 6 The Corporation has an assembly of Overseers. Form 990, Part VI, Section A, line 7a The Overseers elect directors to the Board. Form 990, Part VI, Section A, line 7b The power to alter, amend or repeal the bylaws or to adopt new bylaws shall be vested in the Assembly of Overseers. 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. At this time, Olney & Associates CEO Survey is used to determine an appropriate rate of pay. Other determining factors include overall hospital performance and completion of individual CEO goals and objectives. 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 losses on investments: -83,208. Oversight of Audit Form 990, Part XI, Line 2c The audit process has not changed from the prior year. Valley Regional Hospital Inc 243 Elm Street Claremont NH 03743 020222118 Critical Access Hospital NH 501(c)(3) 3 Valley Regional Health Care Inc 0 0 1 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0