2026-08-17T13:42:05-05:00 2025-09-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 220 DULUTH MN 55812 990 2024-10-01 020280367 ANDROSCOGGIN VALLEY HOSPITAL INC ANDR 6037522200 59 PAGE HILL ROAD BERLIN NH 03570 MATTHEW STREETER SYSTEM CFO 6037522200 2026-08-17 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-08-13 2024 2025-03-06 01:10:19Z MICHAEL PETERSON 59 PAGE HILL ROAD BERLIN NH 03570 98045966 0 X WWW.AVHNH.ORG X 1971 NH DELIVERING THE BEST HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY DAY. 12 10 370 47 0 0 173677 48752 93056193 93689834 -843133 2257339 1643550 2036537 94030287 98032462 5000 5000 0 0 37588771 39930129 0 0 0 52766959 53349269 90360730 93284398 3669557 4748064 64738399 66179909 14118679 11556519 50619720 54623390 DELIVERING THE HIGHEST QUALITY HEALTHCARE AND EXPERIENCE FOR EVERY PATIENT, EVERY DAY. 0 0 70959360 5000 93689834 ANDROSCOGGIN VALLEY HOSPITAL IS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES A BROAD RANGE OF INPATIENT AND OUTPATIENT SERVICES TO MEET THE HEALTH NEEDS OF THE UPPER ANDROSCOGGIN VALLEY AND SURROUNDING COMMUNITIES. WITH A COMMITMENT TO THE HIGHEST QUALITY SURGICAL CARE - AVH IS LEADING THE WAY TO A HEALTHIER FUTURE FOR OUR HEALTH CARE COMMUNITY. 0 0 0 EDUCATIONAL PROGRAMS OFFERED BY AVH INCLUDE CHILDBIRTH CLASSES, BABYSITTING COURSE, WELLNESS FAIRS, LECTURE SERIES, CPR AND FIRST AID COURSES, NUTRITIONAL COUNSELING, AND A VARIETY OF SUPPORT GROUPS. 0 0 0 OTHER COMMUNITY BENEFITS PROVIDED BY THE HOSPITAL INCLUDE THE PROVISION OF CARE TO THE UNDERINSURED; THE PROMOTION OF GOOD HEALTH FOR CHILDREN THROUGH PARTICIPATION IN THE HEALTHY KIDS PROGRAM; AND THE SPONSORSHIP OF NUMEROUS CLINICS AND PROGRAMS SUPPORTING GOOD HEALTH IN THE COMMUNITY. 70959360 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 141 0 370 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X MATTHEW STREETER 6033265610 8 CLOVER LANE WHITEFIELD NH 03598 DAVID BACKLER CHAIR 1.00 X X 0 0 0 MARTHA LAFLAMME VICE CHAIR 1.00 0.50 X X 0 0 0 JAY POULIN SECRETARY 1.00 0.50 X X 0 0 0 JAVIER CARDENAS DIRECTOR/HOSPITALIST 40.00 X 515237 0 61090 JESSICA LOCKE DIRECTOR/NCHHHA DIR. CLIN 1.00 40.00 X 0 172722 38086 CHRISTY LANGLOIS DIRECTOR 1.00 X 0 0 0 SUSAN LESSARD DIRECTOR/APRN 30.00 X 99383 0 42910 RICHARD LUNA DIRECTOR 1.00 X 0 0 0 THOMAS MCCUE DIRECTOR 1.00 1.50 X 0 0 0 JESSIE PERKINS DIRECTOR 1.00 X 0 0 0 DANIEL VAN BUREN DIRECTOR 1.00 X 0 0 0 TYLER WHITE DIRECTOR 1.00 X 0 0 0 THOMAS MEE SYSTEM CEO 1.00 45.00 X 0 868962 45096 MICHAEL PETERSON PRESIDENT 40.00 2.00 X 417698 0 40186 MATTHEW STREETER SYSTEM CFO/INTERIM CEO WMC 1.00 45.00 X 0 433138 41992 KEITH SHUTE MD CHIEF MEDICAL OFFICER 39.50 0.50 X 543471 0 57504 KRZYSZTOF PLOCIENNIK GENERAL SURGEON 40.00 X 664913 0 61986 GEOFFREY STARR NEUROLOGIST 40.00 X 593053 0 59515 MAHLON BRADLEY MD PROVIDER 40.00 X 586067 0 56259 RICHARD KARDELL ORTHOPEDIC SURGEON 40.00 X 543403 0 56200 STEPHEN KRAUNZ ED PHYSICIAN 40.00 X 485240 0 55228 BRIAN O'HEARN CNO (FORMER) 40.00 X 290104 0 35882 4738569 1474822 651934 88 1 1 0 DARTMOUTH HITCHCOCK PO BOX 411754 BOSTON MA 02441 CONTRACT LABOR 770010 NEW HAMPSHIRE IMAGING SERVICESINC 1 PILLSBURY ST SUITE 200 CONCORD NH 03301 MRI PURCHASED SERVICES 642879 SIGNAL 88 FRANCHISE GROUP INC PO BOX 8246 OMAHA NE 68108 SECURITY 298459 WEEKS MEDICAL CENTER 173 MIDDLE ST LANCASTER NH 03584 PURCHASED SERVICES 226797 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 PURCHASED SERVICES 202567 6 41666 7086 48752 NET PATIENT REVENUE 621400 91916259 91916259 340(B) PHARMACY REVENUE 456110 1201238 1201238 SHARED STAFF REVENUE 621400 569833 569833 2504 2504 93689834 527258 527258 264688 0 264688 264688 264688 1694631 35450 0 0 1694631 35450 1730081 1730081 0 41666 13504 -13504 -13504 CAFETERIA REVENUE 722514 437008 437008 1348345 1348345 1785353 98032462 93689834 0 4293876 X 5000 5000 475195 475195 29859670 28946819 912851 790219 778965 11254 6732072 6362777 369295 2072973 2043449 29524 150901 150901 12661 12661 44869 3938 40931 12869546 12000871 868675 161939 108298 53641 71214 60314 10900 1414293 264706 1149587 123019 98839 24180 54361 47091 7270 36665 31151 5514 3553667 3019214 534453 1551085 1551085 INTERCOMPANY ALLOCATION 12738082 1226259 11511823 MEDICAL SUPPLIES 8612853 8607487 5366 MCD TAX 4895671 4895671 BAD DEBT EXPENSE 4871528 4871528 2186915 931569 1255346 93284398 70959360 22325038 0 2820 2820 10878313 11780060 13071667 13915856 1736783 1732280 472939 432802 71877443 51807593 22095578 20069850 15991693 17419586 488606 826655 64738399 66179909 6210495 4544917 2394738 1363361 5513446 5648241 14118679 11556519 X 50619720 54623390 50619720 54623390 64738399 66179909 4748064 -744395 0 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 12661 12661 0 PART II-B, LINE 1: THE HOSPITAL 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 THE HOSPITAL AND OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. 198192 198192 33894866 24002424 9892442 359449 359449 0 35936456 27445720 8490736 1488480 1488480 20069850 DEFERRED COMPENSATION 4593664 DUE TO RELATED PARTIES 1054577 5648241 92389112 -744396 13504 -730892 93120004 40931 4871528 4912459 98032463 88385443 13504 13504 88371939 40931 4871528 4912459 93284398 PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 13,504. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,871,528. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 13,504. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,871,528. GOLF TOURNAMENT 41666 41666 700 4162 6620 1233 789 41666 41666 700 4162 6620 1233 789 13504 -13504 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 855142 855142 0.00920 9084864 9045964 38900 0.00040 9940006 9045964 894042 0.00960 17361146 9179396 8181750 0.08770 17361146 9179396 8181750 0.08770 27301152 18225360 9075792 0.09730 0 2432762 0 23150164 23270626 -120462 X 1 0 1 1 ANDROSCOGGIN VALLEY HOSPITAL INC 59 PAGE HILL ROAD BERLIN NH 03570 WWW.AVHNH.ORG 00050 X X X X ANDROSCOGGIN VALLEY HOSPITAL INC 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X X 1 24 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X HTTPS://AVHNH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://AVHNH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://AVHNH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X X X X X X 1 X 0 X X X X 1 X 0 0 ANDROSCOGGIN VALLEY HOSPITAL, INC. PART V, SECTION B, LINE 5: THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH A COMMUNITY-WIDE SURVEY CONDUCTED IN JANUARY 2025 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. A TOTAL OF 1,174 SURVEY RESPONSES WERE RECEIVED. SURVEY PARTICIPANTS INCLUDED COMMUNITY RESIDENTS, HEALTHCARE PROFESSIONALS, PUBLIC HEALTH OFFICIALS, GOVERNMENT EMPLOYEES AND REPRESENTATIVES, REPRESENTATIVES OF CHRONIC DISEASE AND ADVOCACY ORGANIZATIONS, AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, RACIAL AND ETHNIC MINORITY, RURAL, AND OTHER PRIORITY POPULATIONS. THE SURVEY SOLICITED INPUT REGARDING SIGNIFICANT HEALTH NEEDS, BARRIERS TO CARE, PRIORITY POPULATIONS, HEALTHCARE SERVICE GAPS, SOCIAL DETERMINANTS OF HEALTH, AND FEEDBACK ON ACTIONS TAKEN IN RESPONSE TO THE PRIOR CHNA. THE HOSPITAL ALSO CONSIDERED SECONDARY PUBLIC HEALTH AND POPULATION HEALTH DATA FROM SOURCES INCLUDING COUNTY HEALTH RANKINGS, THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS), THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA), AND THE NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES (NHDHHS) IN EVALUATING COMMUNITY HEALTH NEEDS AND ESTABLISHING PRIORITIES. ANDROSCOGGIN VALLEY HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED COLLABORATIVELY WITH OTHER HOSPITAL FACILITIES IN THE NORTH COUNTRY REGION, INCLUDING ANDROSCOGGIN VALLEY HOSPITAL (BERLIN, NH), UPPER CONNECTICUT VALLEY HOSPITAL (COLEBROOK, NH), AND WEEKS MEDICAL CENTER (LANCASTER, NH). THE ASSESSMENT WAS PERFORMED ON A REGIONAL BASIS TO EVALUATE THE HEALTH NEEDS OF RESIDENTS ACROSS THE SHARED SERVICE AREA. ANDROSCOGGIN VALLEY HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH NORTH COUNTRY HEALTHCARE, NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, COS COUNTY FAMILY HEALTH SERVICES, AND OVATION HEALTHCARE, WHICH PROVIDED ASSESSMENT SUPPORT AND FACILITATION SERVICES. COMMUNITY INPUT WAS ALSO OBTAINED FROM PUBLIC HEALTH OFFICIALS, GOVERNMENT REPRESENTATIVES, HEALTHCARE PROFESSIONALS, COMMUNITY RESIDENTS, REPRESENTATIVES OF CHRONIC DISEASE ORGANIZATIONS, AND MEMBERS OF MEDICALLY UNDERSERVED AND OTHER PRIORITY POPULATIONS. ANDROSCOGGIN VALLEY HOSPITAL, INC. PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7D:HTTPS://AVHNH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2025/ ANDROSCOGGIN VALLEY HOSPITAL, INC. PART V, SECTION B, LINE 11: THE CHNA IDENTIFIED THREE SIGNIFICANT HEALTH NEEDS SELECTED FOR INCLUSION IN THE IMPLEMENTATION STRATEGY:1. IMPROVE BEHAVIORAL HEALTH OUTCOMES (INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDERS);2. INCREASE ACCESS TO LOCAL HEALTHCARE SERVICES (INCLUDING PRIMARY CARE, SPECIALTY CARE, AND CARE COORDINATION); AND3. REDUCE BARRIERS TO CARE (INCLUDING HEALTHCARE AFFORDABILITY AND ACCESS TO FINANCIAL AND COMMUNITY SUPPORT RESOURCES).THESE PRIORITIES WERE DETERMINED THROUGH ANALYSIS OF COMMUNITY SURVEY RESPONSES, HEALTH OUTCOME DATA, COMMUNITY HEALTH INDICATORS, HEALTH EQUITY CONSIDERATIONS, AVAILABILITY OF RESOURCES, AND THE FEASIBILITY OF IMPLEMENTING EFFECTIVE INTERVENTIONS. COMMUNITY CONCERNS SUPPORTING THESE PRIORITIES INCLUDED HIGH RATES OF MENTAL HEALTH AND SUBSTANCE USE CHALLENGES, SHORTAGES OF HEALTHCARE PROVIDERS AND SPECIALTY SERVICES, HEALTHCARE AFFORDABILITY CONCERNS, TRANSPORTATION BARRIERS, AND OTHER ACCESS-TO-CARE CHALLENGES AFFECTING RURAL AND UNDERSERVED POPULATIONS. 4 1 - AVH SURGICAL ASSOCIATES 7 PAGE HILL RD BERLIN NH 03570 PHYSICIAN PRACTICE OFFICE 2 - ANDROSCOGGIN VALLEY HOSPITAL 133 PLEASANT ST BERLIN NH 03570 OUTREACH CLINIC/LAB SERVICES 3 - ANDROSCOGGIN VALLEY HOSPITAL 2 BROADWAY AVE GORHAM NH 03581 OUTREACH CLINIC/LAB SERVICES 4 - SACO RIVER MEDICAL GROUP 15 US ROUTE 302 GLEN NH 03838 SLEEP AND CARDIOLOGY PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. A COST-TO-CHARGE RATIO WAS USED. THE RATIO WAS DERIVED FROM WORKSHEET 2. PART I, LINE 7G: THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE EMERGENCY SERVICES UNIT, OBSERVATION BEDS, DIABETES, ENT, OBGYN, AUDIOLOGY, ORTHOPEDIC, OPTHALMOLOGY, GENERAL SURGERY, NEUROLOGY, GASTRO, UROLOGY, SLEEP AND PULMONOLOG SERVICES. PART III, LINE 2: THE HOSPITAL USES A COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FORM 990 SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE CCR WAS THEN APPLIED TO BAD DEBT EXPENSE AT CHARGE VALUE IN ORDER TO ARRIVE AT THE ESTIMATED EXPENSE REPORTED. PART III, LINE 4: PLEASE SEE PAGES 9-13 OF ATTACHED AUDITED FINANCIAL STATEMENTS PART III, LINE 8: THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: IF KNOWN TO QUALIFY FOR CHARITY OR FINANCIAL ASSISTANCE, PATIENTS ARE GIVEN THE ASSISTANCE NEEDED. PART VI, LINE 2: EVERY 3 YEARS, ANDROSCOGGIN VALLEY HOSPITAL PARTICIPATES IN A COMMUNITY NEEDS ASSESSMENT WITH THREE OTHER MEMBERS OF THE COMMUNITY'S HEALTH CARE SYSTEM. USING INFORMATION FROM THAT ASSESSMENT ALLOWS THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO THE NORTH COUNTRY COMMUNITY ON AN ONGOING BASIS. PART VI, LINE 3: ANDROSCOGGIN VALLEY HOSPITAL OFFERS MANY FINANCIAL ASSISTANCE AND REFERRAL PROGRAMS TO ENSURE THAT COST WILL NOT BE A BARRIER TO PATIENTS GETTING THE HEALTHCARE SERVICES THEY NEED. IF PAYMENT OF HEALTHCARE EXPENSES COULD CREATE A FINANCIAL HARDSHIP, HOSPITAL STAFF WILL WORK WITH PATIENTS TO APPLY FOR FINANCIAL ASSISTANCE. INFORMATION REGARDING FINANCIAL ASSISTANCE POLICIES IS AVAILABLE AT THE HOSPITAL'S ENTRANCES AND PATIENT REGISTRATION AND ON THE HOSPITAL'S WEBSITE. AS PART OF THE FINANCIAL COUNSELING APPLICATION PROCESS, THE HOSPITAL WILL ASSESS ELIGIBILITY FOR HEALTH INSURANCE COVERAGE THROUGH FEDERAL OR STATE PROGRAMS SUCH AS NEW HAMPSHIRE MEDICAID AND ASSIST IN THE APPLICATION PROCESS. PART VI, LINE 4: THE GEOGRAPHIC AREA SERVED BY ANDROSCOGGIN VALLEY HOSPITAL IS THE BERLIN SERVICE AREA. THE BERLIN SERVICE AREA IS COMPOSED OF THE CITY OF BERLIN, ANDROSCOGGIN VALLEY HOSPITAL, INC. 02-0280367 AND THE TOWNS OF GORHAM, SHELBURNE, MILAN, RANDOLPH, DUMMER, ERROL AND STARK. THESE COMMUNITIES ARE WITHIN THE BOUNDARIES OF COOS COUNTY, WHICH IS BORDERED BY THE STATE OF MAINE TO THE EAST, THE STATE OF VERMONT TO THE WEST AND QUEBEC, CANADA TO THE NORTH. THE CITY OF BERLIN DEFINES MUCH OF THE REGION AS THE LARGEST COMMUNITY IN THE COUNTY WITH A POPULATION OF 10,025. THE TOTAL POPULATION OF THE BERLIN SERVICE AREA IS 16,121. THE CHANGING ECONOMIC LANDSCAPE AND THE CLOSING OF PAPER AND PULP MILLS OVER THE LAST DECADE IN THE COOS COUNTY HAVE SIGNIFICANTLY IMPACTED THE AREA'S UNEMPLOYMENT RATE AND POPULATION COMPARED TO THOSE EXPERIENCED BY THE OVERALL STATE OF NEW HAMPSHIRE. PART VI, LINE 5: ANDROSCOGGIN VALLEY HOSPITAL IS THE LEADING PROVIDER OF HEALTHCARE TO THOUSANDS OF FAMILIES IN THE SMALL-TOWN COMMUNITIES OF NEW HAMPSHIRE'S NORTH COUNTRY. AS A CRITICAL ACCESS HOSPITAL, AVH OFFERS 24/7 EMERGENCY CARE, IN-HOUSE TREATMENT OF MOST MEDICAL ISSUES, AND AN ARRANGEMENT FOR TREATMENT OF ALL OTHER PROBLEMS WITH THE NEAREST TERTIARY-CARE FACILITY. OVER THE PAST DECADE, AVH HAS INVESTED SIGNIFICANTLY IN EXPANDING AND IMPROVING OUR FACILITIES AND SERVICES, AND ENHANCING OUR TEAM OF DEDICATED, HIGHLY TRAINED DOCTORS, NURSES AND OTHER STAFF. THE RESULT IS A HOSPITAL THAT MORE EFFECTIVELY CONTRIBUTES TO THE HEALTH OF OUR COMMUNITIES THAN EVER BEFORE. OUR NEW LOCATION IN NORTH CONWAY, NH OFFERS COMFORTABLE AND PRIVATE TREATMENT ROOMS FOR PAIN PROCEDURES AS WELL AS SOME ELECTIVE TREATMENTS. RECENT RENOVATIONS HAVE TAKEN PLACE TO UPDATE THE OBSTETRICS AND GYNECOLOGY SPACE OFFERING AN IMPROVED PATIENT EXPERIENCE THROUGH OPEN RECEPTION AND MORE NATURAL FLOW FOR PATIENTS AS WELL AS CLOSER PROXIMITY TO THE INPATIENT WOMEN'S SERVICES AREA. AT THE END OF THE DAY, OUR TOP PRIORITY IS TO ENSURE THE HIGHEST LEVEL OF QUALITY HEALTHCARE TO THOSE THAT WE ARE SO FORTUNATE TO SERVE. IN AN EFFORT TO CONTINUE TO PROVIDE A HIGH QUALITY OF HEALTHCARE FOR ALL PATIENTS IN THE NORTH COUNTRY, THE HOSPITALS OF COOS & GRAFTON COUNTY CAME TOGETHER TO EXPLORE COLLABORATION. WE, THE BOARDS AND SENIOR MANAGEMENT OF ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER REALIZE THAT SIGNIFICANT NATIONAL, STATE AND LOCAL ECONOMIC PRESSURES ARE JEOPARDIZING LOCAL ACCESS, QUALITY AND SUSTAINABILITY. WE HAVE THEREFORE FORMED NORTH COUNTRY HEALTHCARE (NCHC) WITH THE STATED OBJECTIVE OF WORKING COLLABORATIVELY TO BETTER SERVE THE HEALTHCARE NEEDS OF NORTH COUNTRY PATIENTS. THIS COLLABORATIVE EFFORT WILL WORK TO:1. ENSURE ACCESS TO QUALITY CARE WITHIN THE COMMUNITIES IN WHICH OUR PATIENTS LIVE2. PROVIDE LOCAL AND HIGH QUALITY CARE WITH POSITIVE OUTCOMES TO OUR PATIENTS IN THE NORTH COUNTRY3. CONTROL THE COST OF CARE THROUGH INNOVATIVE PROGRAMS AND THE USE OF SHARED RESOURCESNATIONAL HEALTHCARE REFORM DEMANDS LOWER COSTS AND HIGHER QUALITY FROM ALL HOSPITALS, REQUIRING COLLABORATION IN PATIENT CARE ACROSS ALL PROVIDERS: FROM PRIMARY CARE TO SPECIALIST, FROM AMBULANCE TO HOSPITAL, FROM HOSPITAL TO REHABILITATION TO HOME CARE, FROM LOCAL HOSPITAL TO TERTIARY (SPECIALTY HOSPITAL) CARE. THEREFORE, ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER HAVE FORMED THIS JOINT VENTURE TO IDENTIFY AND IMPLEMENT SUSTAINABLE OPPORTUNITIES FOR OUR FUTURE. THE NCHC AND ITS MEMBER HOSPITALS ARE PREPARED TO MANAGE COSTS AND COORDINATE CARE IN A WAY THAT IS FINANCIALLY SUSTAINABLE, WHILE CONTINUING TO PROVIDE LOCAL ACCESS TO QUALITY CARE THROUGHOUT THE COUNTY AND BEYOND. THE HOSPITALS OF THE NORTH COUNTRY MUST WORK TOGETHER AS CRITICAL PARTS OF OUR ECONOMY AND COMMUNITY. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH OTHER ENTITIES UNDER THE NORTH COUNTRY HEALTHCARE WHICH OVERSEES THREE CRITICAL ACCESS HOSPITALS AND ONE HOME HEALTH AND HOSPICE AGENCY IN NORTHERN NEW HAMPSHIRE. PART VI, LINE 7, REPORTS FILED WITH STATES NH 1 GREAT NORTHWOODS COMMUNITY FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 020452547 501(C)(3) 5000 0 GENERAL SUPPORT 1 0 1 1 0 0 0 0 0 0 0 THOMAS MEE SYSTEM CEO 0 634794 0 219715 0 14453 0 6032 0 39064 0 914058 0 0 KRZYSZTOF PLOCIENNIK GENERAL SURGEON 647537 0 15000 0 2376 0 14676 0 47310 0 726899 0 0 0 GEOFFREY STARR NEUROLOGIST 327810 0 263695 0 1548 0 12426 0 47089 0 652568 0 0 0 MAHLON BRADLEY MD PROVIDER 551944 0 29551 0 4572 0 15250 0 41009 0 642326 0 0 0 KEITH SHUTE MD CHIEF MEDICAL OFFICER 475308 0 51556 0 16607 0 14542 0 42962 0 600975 0 0 0 RICHARD KARDELL ORTHOPEDIC SURGEON 499830 0 39001 0 4572 0 13672 0 42528 0 599603 0 0 0 JAVIER CARDENAS DIRECTOR/HOSPITALIST 493610 0 19251 0 2376 0 8455 0 52635 0 576327 0 0 0 STEPHEN KRAUNZ ED PHYSICIAN 484649 0 51 0 540 0 6913 0 48315 0 540468 0 0 0 MATTHEW STREETER SYSTEM CFO/INTERIM CEO WMC 0 347286 0 84876 0 976 0 10166 0 31826 0 475130 0 0 MICHAEL PETERSON PRESIDENT 342954 0 73113 0 1631 0 0 0 40186 0 457884 0 0 0 BRIAN O'HEARN CNO (FORMER) 147889 0 27032 0 115183 0 4807 0 31075 0 325986 0 0 0 JESSICA LOCKE DIRECTOR/NCHHHA DIR. CLIN 0 139614 0 32809 0 299 0 4587 0 33499 0 210808 0 0 PART I, LINE 3 NORTH COUNTRY HEALTHCARE, A RELATED ORGANIZATION, USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION: - COMPENSATION COMMITTEE - FORM 990 OF OTHER ORGANIZATIONS - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B BRIAN O'HEARN RECEIVED $92,803 IN SEVERANCE PAYMENTS IN 2024. THOMAS MEE, SYSTEM CEO, PARTICIPATED IN A 457(F) PLAN ADMINISTERED BY NORTH COUNTRY HEALTHCARE, A RELATED ORGANIZATION. THERE WERE NO CONTRIBUTIONS OR DISTRIBUTIONS IN 2024. A 2012 NEW HAMPSHIRE HEALTH AND EDUCATION FACILITIES AUTHORITY REVENUE BONDS 020279866 2012-03-29 14500000 REFINANCING EXISTING BONDS, TERMINATE INTEREST RATE SWAP CONTRACT 0 0 0 A 13136636 14500000 125386 14374614 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 A 0 MYSTIC VALLEY UROLOGY LLC ENTITY CONTROLLED MORE THAN 35% BY JERRY RITTENHOUSE, FORMER DIRECTOR 639477 INDEPENDENT 0 PART IV, COLUMN B SUPPLEMENTAL INFORMATION: JERRY RITTENHOUSE WAS A DIRECTOR THROUGH 12/2021 FORM 990, PART VI, SECTION A, LINE 6 NORTH COUNTRY HEALTHCARE (NCH) IS THE SOLE MEMBER OF ANDROSCOGGIN VALLEY HOSPITAL FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE CORPORATION BOARD SHALL BE NOMINATED BY ACTION OF AN AFFILIATE BOARD, OR BY THE CORPORATION BOARD, AS THE CASE MAY BE, IN ACCORDANCE WITH THE NOMINATION POWERS INDICATED IN THE CORPORATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATION BYLAWS INCLUDE MAJOR MATTERS WHICH INCLUDE SPECIFIC DUTIES AND RESPONSIBILITIES WHICH ARE SHARED BY THE CORPORATION BOARD AND THE AFFILIATE BOARDS. THESE MAJOR MATTERS ARE FURTHER DISTINGUISHED BETWEEN MAJOR ORGANIZATIONAL MATTERS AND MAJOR OPERATIONAL MATTERS. IN BOTH CASES, THE BYLAWS CONTAIN THE PROVISIONS FOR THE APPROVAL OF THESE MATTERS INCLUDING WHETHER THEY ARE APPROVED BY A MAJORITY VOTE OR SUPER MAJORITY VOTE OF ALL BOARDS. IN ALL CASES, THE MAJOR MATTERS REQUIRE APPROVAL BY THE CORPORATION BOARD AND THE AFFILIATE BOARDS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WILL BE SHARED ELECTRONICALLY WITH THE ENTIRE NCH BOARD AND FINANCE COMMITTEE BEFORE FILING, WITH ADEQUATE TIME FOR QUESTIONS TO BE ASKED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST PROCESS: - CONFLICT OF INTEREST DISCLOSURE COMPLETED VIA BOARDPAQ (ELECTRONIC MEANS) - RESULTS COMPILED INTO CONFLICT MATRIX WHICH IS REVIEWED AND APPROVED BY THE BOARD - CONFLICTS THAT MEET THE PECUNIARY BENEFIT CRITERIA ARE IDENTIFIED, SHARED WITH THE BOARD AND APPROVED - DISCLOSURE NOTICES ARE PLACED IN LOCAL PAPERS - THE NH DIVISION OF CHARITABLE TRUSTS IS NOTIFIED OF THE PECUNIARY BENEFIT AND COPIES OF THE PUBLIC NOTICES ARE ATTACHED FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE IS A SUBCOMMITTEE OF THE FINANCE COMMITTEE OF THE CORPORATION BOARD. THIS COMMITTEE OVERSEES THE EXECUTIVE COMPENSATION POLICY AND PRACTICES OF THE ORGANIZATION INCLUDING THE CEO, THE AFFILIATE PRESIDENTS, AND THE CEO CABINET WHICH INCLUDES KEY EXECUTIVE POSITIONS FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE ENGAGES WITH AN OUTSIDE CONSULTANT TO DETERMINE COMPENSATION BENCHMARKS AND BEST PRACTICES WHICH GUIDE THE COMPENSATION PROCESSES FOR THESE EXECUTIVE POSITIONS. THE COMPARISON BENCHMARK DATA AND GUIDANCE ARE REVIEWED BY THE COMMITTEE AND RECOMMENDATIONS ARE MADE TO THE CORPORATION BOARD AND AFFILIATE BOARDS. THIS IS DONE ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS IMPLEMENTED ALL POLICIES AND THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 9,574,396. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,574,396. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 2,426,475. MANAGEMENT AND GENERAL EXPENSES 868,675. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,295,150. 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