UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization
UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION (EIN 02-0276210)
Tax period
2024-10-01 to 2025-09-30
Filed
2026-08-17
IRS object ID
202622299349302782
Schema version
2024v5.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2026-08-17T13:57:44-05:00ReturnTs
Tax Period End2025-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN393647910PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI ADVISORY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11502 LONDON ROAD SUITE 220AddressLine1Txt
CityDULUTHCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55812ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2024-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN020276210EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UPPER CONNECTICUT VALLEY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlUPPEBusinessNameControlTxt
Phone6032374971PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1181 CORLISS LANEAddressLine1Txt
CityCOLEBROOKCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03576ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMATTHEW STREETERPersonNm
Person TitleSYSTEM CFOPersonTitleTxt
Phone6032374971PhoneNum
Signature2026-08-16SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL J PETERSON CPAPreparerPersonNm
PTINP01833529PTIN
Phone2187224705PhoneNum
Preparation2026-08-13PreparationDt
FieldValueIRS element (for citing)
Tax2024TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGREGORY COOKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1181 CORLISS LANEAddressLine1Txt
CityCOLEBROOKCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03576ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$39,061,437GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.UCVH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1969FormationYr
Legal Domicile StateNHLegalDomicileStateCd
Activity Or MissionUPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee142TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$550,418PYContributionsGrantsAmt
CY Contributions Grants$1,078,111CYContributionsGrantsAmt
PY Program Service Revenue$33,980,603PYProgramServiceRevenueAmt
CY Program Service Revenue$32,427,544CYProgramServiceRevenueAmt
PY Investment Income$1,218,109PYInvestmentIncomeAmt
CY Investment Income-$1,039,903CYInvestmentIncomeAmt
PY Other Revenue$538,074PYOtherRevenueAmt
CY Other Revenue$451,405CYOtherRevenueAmt
PY Total Revenue$36,287,204PYTotalRevenueAmt
CY Total Revenue$32,917,157CYTotalRevenueAmt
PY Grants And Similar Paid$474,080PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$166,889CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,355,358PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,349,607CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$19,910,180PYOtherExpensesAmt
CY Other Expenses$18,559,396CYOtherExpensesAmt
PY Total Expenses$33,739,618PYTotalExpensesAmt
CY Total Expenses$32,075,892CYTotalExpensesAmt
PY Revenues Less Expenses$2,547,586PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$841,265CYRevenuesLessExpensesAmt
Total Assets BOY$41,869,573TotalAssetsBOYAmt
Total Assets EOY$45,864,585TotalAssetsEOYAmt
Total Liabilities BOY$2,588,858TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,171,931TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$39,280,715NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$42,692,654NetAssetsOrFundBalancesEOYAmt
MissionUPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$22,984,469ExpenseAmt
Grant$166,889GrantAmt
Revenue$32,427,544RevenueAmt
DescUPPER CONNECTICUT VALLEY HOSPITAL PROVIDED HOSPITAL CARE AND INPATIENT AND OUTPATIENT SERVICES ON A REGION-WIDE BASIS. FOR MORE INFORMATION REGARDING THE HOSPITAL'S OVERALL COMMUNITY BENEFIT IMPACT, SEE SCHEDULE H.Desc
Total Program Service Expenses$22,984,469TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document79IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee142EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMATTHEW STREETERPersonNm
Phone6033265610PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18 CLOVER LANEAddressLine1Txt
CityWHITEFIELDCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03598ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
DAVID THATCHER
CHAIR1.00Yes (X)Yes (X)$0$0$0
GAIL FISHER
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
MAGGIE FITZGERALD
SECRETARY (TERM 09/25)1.00Yes (X)Yes (X)$0$0$0
ROD DE GREEF
TREASURER1.00Yes (X)Yes (X)$0$0$0
THOMAS COCHRAN
DIRECTOR1.00Yes (X)$559,876$0$45,599
E HARLAN CONNARY
DIRECTOR1.00Yes (X)$0$0$0
ROBERT DAWSON
PRESIDENT OF MEDICAL STAFF1.00Yes (X)$0$0$0
RICHARD LAPOINT
DIRECTOR1.00Yes (X)$0$0$0
LAURA MILLS
DIRECTOR (TERM 05/25)1.00Yes (X)$0$0$0
MARCIA PARKHURST
DIRECTOR1.00Yes (X)$0$0$0
PETER WEINER
DIRECTOR1.00Yes (X)$0$0$0
SHARON ELLINGWOOD-WHITE
DIRECTOR1.00Yes (X)$0$0$0
THOMAS MEE
SYSTEM CEO1.00Yes (X)$0$868,962$45,09645.00
MATTHEW STREETER
SYSTEM CFO/INTERIM CEO WMC1.00Yes (X)$0$433,138$41,99245.00
DARRELL BODNAR
CIO1.00Yes (X)$0$339,048$5,524
GREGORY COOK
PRESIDENT/CEO40.00Yes (X)$252,130$0$26,132
TAMSIN DURAND
GENERAL SURGEON40.00$452,289$0$59,649Yes (X)
ELISABETH MOORE
ED PHYSICIAN40.00$433,855$0$56,593Yes (X)
DARIN BROWN
ED PHYSICIAN40.00$353,180$0$41,626Yes (X)
JUDY GRIMES
RN40.00$204,728$0$60,408Yes (X)
JULIE BOLTON
RN40.00$177,643$0$23,146Yes (X)
LINDSAY LEA
CNO (FORMER - JUL '24)0.00$223,728$0$24,4060.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,657,429TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,641,148TotReportableCompRltdOrgAmt
Total Other Compensation$430,171TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K39IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MEDICAL SOLUTIONS LLC
1010 N 102ND STOMAHANE68114CONTRACT LABOR$529,512
NEW HAMPSHIRE IMAGING SERVICES INC
1 PILLSBURY ST SUITE 200CONCORDNH03301MRI PURCHASED SERVICES AND CONTRACT LABO$301,525
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$1,075,306GovernmentGrantsAmt
All Other Contributions$2,805AllOtherContributionsAmt
Total Contributions$1,078,111TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621400$31,716,097$31,716,097
SHARED STAFF REVENUE621400$628,451$628,451
340B PHARMACY REVENUE456110$19,182$19,182

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$63,814TotalRevenueColumnAmt
Related Or Exempt Func Income$63,814RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$32,427,544TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,453,090TotalRevenueColumnAmt
Exclusion$1,453,090ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$103,930RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$103,930RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$103,930TotalRevenueColumnAmt
Exclusion$103,930ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$3,634,837SecuritiesAmt
Other$16,450OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$6,144,280SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$2,509,443SecuritiesAmt
Other$16,450OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,492,993TotalRevenueColumnAmt
Exclusion-$2,492,993ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCAFETERIA REVENUEDesc
Business722514BusinessCd
Total Revenue Column$102,877TotalRevenueColumnAmt
Exclusion$102,877ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$244,598TotalRevenueColumnAmt
Exclusion$244,598ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$347,475OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,917,157TotalRevenueColumnAmt
Related Or Exempt Func Income$32,427,544RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$588,498ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$166,889TotalAmt
Program Services$166,889ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$347,689TotalAmt
Management And General$347,689ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,535,329TotalAmt
Program Services$9,061,448ProgramServicesAmt
Management And General$473,881ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$203,244TotalAmt
Program Services$183,825ProgramServicesAmt
Management And General$19,419ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,569,657TotalAmt
Program Services$2,343,861ProgramServicesAmt
Management And General$225,796ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$693,688TotalAmt
Program Services$627,410ProgramServicesAmt
Management And General$66,278ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$40,468TotalAmt
Management And General$40,468ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$6,267TotalAmt
Management And General$6,267ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,227,856TotalAmt
Program Services$3,650,836ProgramServicesAmt
Management And General$577,020ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$6,426TotalAmt
Program Services$1,985ProgramServicesAmt
Management And General$4,441ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$58,504TotalAmt
Program Services$16,732ProgramServicesAmt
Management And General$41,772ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$215,220TotalAmt
Management And General$215,220ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$575,333TotalAmt
Program Services$64,815ProgramServicesAmt
Management And General$510,518ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$38,478TotalAmt
Program Services$34,299ProgramServicesAmt
Management And General$4,179ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$20,307TotalAmt
Program Services$17,834ProgramServicesAmt
Management And General$2,473ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,634TotalAmt
Program Services$2,215ProgramServicesAmt
Management And General$419ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,965,510TotalAmt
Program Services$1,652,603ProgramServicesAmt
Management And General$312,907ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$665,618TotalAmt
Management And General$665,618ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
INTERCOMPANY ALLOCATION$4,795,886$1,122,666$3,673,220
MEDICAL SUPPLIES$2,042,081$2,026,540$15,541
ENHANCEMENT TAX$1,833,220$1,833,220
BAD DEBT EXPENSE$1,024,540$1,024,540

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,041,048TotalAmt
Program Services$985,971ProgramServicesAmt
Management And General$55,077ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$32,075,892TotalAmt
Program Services$22,984,469ProgramServicesAmt
Management And General$9,091,423ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,106BOYAmt
EOY$1,106EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,871,847BOYAmt
EOY$6,129,228EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,918,352BOYAmt
EOY$3,531,819EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$304,170BOYAmt
EOY$330,528EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$387,063BOYAmt
EOY$346,083EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$35,498,516LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$19,173,819LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,386,404BOYAmt
EOY$16,324,697EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$14,009,863BOYAmt
EOY$16,655,586EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$990,768BOYAmt
EOY$2,545,538EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$41,869,573BOYAmt
EOY$45,864,585EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,554,883BOYAmt
EOY$1,088,214EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$52,615BOYAmt
EOY$18,244EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$270,130BOYAmt
EOY$247,698EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$711,230BOYAmt
EOY$1,817,775EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,588,858BOYAmt
EOY$3,171,931EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$38,876,953BOYAmt
EOY$42,260,191EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$403,762BOYAmt
EOY$432,463EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$39,280,715BOYAmt
EOY$42,692,654EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$41,869,573BOYAmt
EOY$45,864,585EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$841,265ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,570,674NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$6,267OtherActivitiesAmt
Total Lobbying Expenditures$6,267TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE 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.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$331,128BeginningYearBalanceAmt
Investment Earnings Or Losses$30,324InvestmentEarningsOrLossesAmt
End Year Balance$361,452EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$290,705BeginningYearBalanceAmt
Investment Earnings Or Losses$40,423InvestmentEarningsOrLossesAmt
End Year Balance$331,128EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$259,755BeginningYearBalanceAmt
Investment Earnings Or Losses$30,950InvestmentEarningsOrLossesAmt
End Year Balance$290,705EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$299,038BeginningYearBalanceAmt
Investment Earnings Or Losses-$39,283InvestmentEarningsOrLossesAmt
End Year Balance$259,755EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$263,236BeginningYearBalanceAmt
Investment Earnings Or Losses$35,802InvestmentEarningsOrLossesAmt
End Year Balance$299,038EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.47880PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.52120TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$69,700OtherCostOrOtherBasisAmt
Book Value$69,700BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,205,528OtherCostOrOtherBasisAmt
Depreciation$6,209,389DepreciationAmt
Book Value$12,996,139BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,193,187OtherCostOrOtherBasisAmt
Depreciation$12,964,430DepreciationAmt
Book Value$3,228,757BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,101OtherCostOrOtherBasisAmt
Book Value$30,101BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$16,324,697TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescAMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMSDesc
Book Value$2,545,538BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$2,545,538TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO RELATED PARTIESDesc
Amt$1,817,775Amt
FieldValueIRS element (for citing)
Total Liability$1,817,775TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$34,434,590TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$2,570,674NetUnrealizedGainsInvstAmt
Other Revenue-$1,024,540OtherRevenueAmt
Revenue Not Reported$1,546,134RevenueNotReportedAmt
Revenue Subtotal$32,888,456RevenueSubtotalAmt
Other Revenues Not Included$28,701OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$28,701RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$32,917,157TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$31,051,352TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$31,051,352ExpensesSubtotalAmt
Other Expenses Not Included$1,024,540OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,024,540ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$32,075,892TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:THE ORGANIZATION'S ENDOWMENTS ARE USED FOR STAFF EDUCATION, NURSING PROJECTS AND INDIGENT CARE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE -1,024,540.
PART XI, LINE 4B - OTHER ADJUSTMENTS:NET ASSETS RELEASED FROM RESTRICTIONS -2,878. INVESTMENT INCOME 30,324. CONTRIBUTIONS TO RESTRICTED NET ASSETS 1,255.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE 1,024,540.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other300.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$249,155TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$249,155NetCommunityBenefitExpnsAmt
Total Expense0.00780TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,666,730TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,560,708DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,106,022NetCommunityBenefitExpnsAmt
Total Expense0.09680TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,915,885TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,560,708DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,355,177NetCommunityBenefitExpnsAmt
Total Expense0.10460TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,740,299TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,190,591DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,549,708NetCommunityBenefitExpnsAmt
Total Expense0.07950TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,740,299TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,190,591DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,549,708NetCommunityBenefitExpnsAmt
Total Expense0.07950TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,656,184TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,751,299DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,904,885NetCommunityBenefitExpnsAmt
Total Expense0.18410TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$640,268BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,106,909ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,166,624CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$59,715MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UPPER CONNECTICUT VALLEY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1181 CORLISS LANEAddressLine1Txt
CityCOLEBROOKCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03576ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.UCVH.ORGWebsiteAddressTxt
State License00592StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1UPPER CONNECTICUT VALLEY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted24CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SUPPLEMENTAL INFORMATIONOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt24ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE SUPPLEMENTAL INFORMATIONStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care300.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
UPPER CONNECTICUT VALLEY HOSPITALPART 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.
UPPER CONNECTICUT VALLEY HOSPITALPART 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.
UPPER CONNECTICUT VALLEY HOSPITALPART 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.
UPPER CONNECTICUT VALLEY HOSPITALPART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://WWW.UCVH.ORG/2025-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
UPPER CONNECTICUT VALLEY HOSPITALPART 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.

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7: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 PART I, LINES 7E-I. THE HOSPITAL DETERMINES COST BY COMBINING DIRECT EXPENSES IDENTIFIED BY ITS ACCOUNTING SYSTEM WITH AN ESTIMATED OVERHEAD ALLOCATION.
PART I, LINE 7G:THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE EMERGENCY SERVICES UNIT, OBSERVATION BEDS AND SPECIALTY CLINICS.
PART II, COMMUNITY BUILDING ACTIVITIES:THE COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY UCVH CONSIST OF SUPPORTING LOCAL GOVERNMENT AND OTHER HEALTH CARE PROVIDERS, COORDINATION OF DISASTER DRILLS, EMERGENCY PREPAREDNESS, AND SUPPORT OF OTHER LOCAL ORGANIZATIONS WITHIN THE COMMUNITY. IN ADDITION, IN AN EFFORT TO PROVIDE THE NECESSARY HEALTH CARE SERVICES FOR THE POPULATION WITHIN A REASONABLE DRIVING DISTANCE, UCVH HAS ENTERED INTO A COLLABORATION WITH THE OTHER TWO COOS COUNTY HOSPITALS TO PROVIDE NECESSARY PRIMARY CARE, BEHAVIORAL HEALTH, AND SPECIALTY SERVICES FOR THE UCVH SERVICE AREA.
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 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, UPPER CONNECTICUT 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:UCVH HAS A PATIENT FINANCIAL COUNSELOR WHO IS RESPONSIBLE FOR WORKING WITH PATIENTS AND ANY WHO MAY BE BILLED FOR THEIR CARE TO DETERMINE THEIR ELIGIBILITY, ON A CASE BY CASE BASIS. FOR ANY GOVERNMENT PROGRAMS, SUCH AS MEDICAID OR THE UCVH FINANCIAL ASSISTANCE PROGRAM ALL STAFF AT UCVH, PARTICULARLY REGISTRATION STAFF WHO WILL BE THE FIRST ONES TO NOTICE IF A PATIENT DOES NOT HAVE INSURANCE, ARE TRAINED TO REFER THE PATIENT TO THE FINANCIAL COUNSELOR. IN ADDITION, BROCHURES ARE AVAILABLE, AS IS CONTACT INFORMATION ON THE WEBSITE.
PART VI, LINE 4:UCVH IS THE SMALLEST CRITICAL ACCESS HOSPITAL IN NEW HAMPSHIRE THAT SERVES THE LARGEST GEOGRAPHIC SERVICE AREA (OVER 850 SQUARE MILES) INCLUDING COMMUNITIES IN THE STATES OF NEW HAMPSHIRE, VERMONT, AND MAINE. ACCORDING TO THE NEW HAMPSHIRE STATE HEALTH PROFILE, OUR RESIDENTS ARE THE MOST FRAGILE OF ALL CITIZENS IN NEW HAMPSHIRE AS IT RELATES TO HEALTH OUTCOMES AND ECONOMIC CONDITIONS. UCVH IS DEPENDENT ON PUBLIC FUNDING AND DISPROPORTIONATE SHARE FUNDING TO SUBSIDIZE THE CARE PROVIDED TO THE PATIENTS WE SERVE.
PART VI, LINE 5:UCVH PERFORMS BLOOD DRIVES FOR THE LOCAL COMMUNITY, IN WHICH IT VOLUNTEERS ITS TIME ASSOCIATED WITH THESE EFFORTS. ADDITIONALLY, UCVH SUPPORTS A LOCAL "PRESCRIPTION FOOD PROGRAM" THAT PROVIDES FREE MONTHLY FOOD BOXES AND NUTRITION EDUCATION TO INDIVIDUALS IN NEED. THIS PROGRAM CONSISTS OF APPROXIMATELY 310 HOURS OF VOLUNTEERS AND EMPLOYEES TO SUPPORT, IN ADDITION TO SERVING OVER 175 INDIVIDUALS IN THE LOCAL COMMUNITY. UCVH PROVIDES DONATIONS IN EXCESS OF $50,000 ANNUALLY TO SUPPORT LOCAL TRANSPORTATION TO INDIVIDUALS IN NEED TO ASSIST IN ENSURING ACCESS TO MEDICAL, DENTAL, BEHAVIORAL HEALTH CARE, AND TO THE PHARMACY TO GET THEIR PRESCRIPTIONS. OVER 1,650 INDIVIDUALS BENEFIT FROM THIS PROGRAM IN THE GREATER COLEBROOK AREA. UCVH IN COORDINATION WITH IS AFFILIATION THROUGH NORTH COUNTRY HEALTHCARE SUPPORTED BLOOD PRESSURE SCREENINGS, FREE COVID TEST KITS, AND NARCAN KITS TO NEARLY 1,300 INDIVIDUALS IN THE LOCAL COMMUNITY.
PART VI, LINE 6:UPPER CONNECTICUT VALLEY HOSPITALS 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 (NCH) 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 7, REPORTS FILED WITH STATESNH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtPurpose Of GrantPurposeOfGrantTxt
FOUNDATION FOR HEALTHY COMMUNITIES
125 AIRPORT RDCONCORDNH033017300020275078501(C)(3)$108,041$0SUBSTANCE USE DISORDER TREATMENT PROJECT
TRI-COUNTY CAP
30 EXCHANGE STBERLINNH03570020267404501(C)(3)$50,000$0NON-EMERGENCY MEDICAL TRANSPORTATION GRANT
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL WAS MANDATED BY THE STATE OF NH TO CONTRIBUTE FUNDS TO THE ALCOHOL AND DRUG PREVENTION TREATMENT FUND IN ORDER TO CONTINUE THE MEDICAID EXPANSION PROGRAM. THESE FUNDS GO TOWARDS VARIOUS PROGRAMS SURROUNDING RECOVERY, TREATMENT AND PREVENTION FOR SUBSTANCE MISUSE IN NEW HAMPSHIRE. ADDITIONALLY, EACH OF THE HOSPITALS AFFILIATED WITH NORTH COUNTRY HEALTHCARE ELECTED TO PARTICIPATE IN AN INITIATIVE WITH THE BOWLER-BARTLETT FOUNDATION TO PURCHASE A MOBILE MEDICAL UNIT TO BE MADE AVAILABLE FOR USE THROUGHOUT NEW HAMPSHIRE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
THOMAS MEE
SYSTEM CEO$0$634,794$0$219,715$0$14,453$0$6,032$0$39,064$0$914,058$0$0
THOMAS COCHRAN
DIRECTOR$559,465$0$51$0$360$0$11,245$0$34,354$0$605,475$0$0$0
TAMSIN DURAND
GENERAL SURGEON$431,698$0$20,051$0$540$0$10,695$0$48,954$0$511,938$0$0$0
ELISABETH MOORE
ED PHYSICIAN$433,418$0$105$0$332$0$0$0$56,593$0$490,448$0$0$0
MATTHEW STREETER
SYSTEM CFO/INTERIM CEO WMC$0$347,286$0$84,876$0$976$0$10,166$0$31,826$0$475,130$0$0
DARIN BROWN
ED PHYSICIAN$351,581$0$51$0$1,548$0$10,648$0$30,978$0$394,806$0$0$0
DARRELL BODNAR
CIO$0$290,363$0$47,741$0$944$0$0$0$5,524$0$344,572$0$0
GREGORY COOK
PRESIDENT/CEO$251,251$0$51$0$828$0$0$0$26,132$0$278,262$0$0$0
JUDY GRIMES
RN$176,579$0$27,913$0$236$0$0$0$60,408$0$265,136$0$0$0
LINDSAY LEA
CNO (FORMER - JUL '24)$130,499$0$30,015$0$63,214$0$6,180$0$18,226$0$248,134$0$0$0
JULIE BOLTON
RN$160,891$0$13,175$0$3,577$0$385$0$22,761$0$200,789$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3NORTH 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-BLINDSAY LEA, FORMER OFFICER, RECEIVED $40,536 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.
PART I, LINE 7PART OF THE COMPENSATION PROGRAM OVERSEEN BY THE COMPENSATION COMMITTEE AND APPROVED BY THE CORPORATION BOARD AND AFFILIATE BOARDS INCLUDES VARIABLE INCENTIVE COMPENSATION FOR EXECUTIVES. THIS VARIABLE COMPENSATION IS A WITHHOLD OF TOTAL COMPENSATION AND EARNED BACK BY EXECUTIVES BASED ON STRATEGIC GOAL PERFORMANCE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6AS THE PARENT ORGANIZATION, NORTH COUNTRY HEALTHCARE (NCH) IS THE SOLE MEMBER OF UPPER CONNECTICUT VALLEY HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7AEACH 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 7BTHE 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 11BA 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 12CCONFLICT 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 15THE 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 19THE ORGANIZATION HAS IMPLEMENTED ALL POLICIES AND THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GCONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,406,476. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,406,476. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,244,360. MANAGEMENT AND GENERAL EXPENSES 577,020. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,821,380.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
ANDROSCOGGIN VALLEY HOSPITAL INC
59 PAGE HILL ROADBERLINNH03570020280367CRITICAL ACCESS HOSPITALNH501(C)(3)LINE 3NORTH COUNTRY HEALTHCARE INCYes (1)
NORTH COUNTRY HEALTHCARE INC
8 CLOVER LANEWHITEFIELDNH03598812225283HEALTHCARE MANAGEMENTNH501(C)(3)LINE 12A, I0N/A
WEEKS MEDICAL CENTER
173 MIDDLE STREETLANCASTERNH03584020222242CRITICAL ACCESS HOSPITALNH501(C)(3)LINE 3NORTH COUNTRY HEALTHCARE INCYes (1)
NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY INC
536 COTTAGE STREETLITTLETONNH03561020300637HOME HEALTH AGENCYNH501(C)(3)LINE 10NORTH COUNTRY HEALTHCARE INCYes (1)
NORTHCARE INC
59 PAGE HILL ROADBERLINNH03570521596952SUPPORTING SERVICESNH501(C)(3)LINE 12B, IIANDROSCOGGIN VALLEY HOSPITAL INCYes (1)
ANDROSCOGGIN VALLEY HOSPITAL FOUNDATION
59 PAGE HILL ROADBERLINNH03570223035216MANAGEMENT AND FINANCIAL SUPPORTNH501(C)(3)LINE 12B, IIANDROSCOGGIN VALLEY HOSPITAL INCYes (1)
GREAT NORTHWOODS COMMUNITY FOUNDATION
59 PAGE HILL ROADBERLINNH03570020452547HEALTHCARE SERVICESNH501(C)(3)LINE 12B, IIANDROSCOGGIN VALLEY HOSPITAL INCYes (1)
LANCASTER PATIENT CARE CENTER
173 MIDDLE STREETLANCASTERNH03584832130386SUPPORTING ORGANIZATIONNH501(C)(3)LINE 12A, IWEEKS MEDICAL CENTERYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
ANDROSCOGGIN VALLEY HOSPITAL INC
P$285,049COST
ANDROSCOGGIN VALLEY HOSPITAL INC
L$316,820COST
NORTH COUNTRY HEALTHCARE INC
P$71,920COST
NORTH COUNTRY HEALTHCARE INC
L$105,742COST
WEEKS MEDICAL CENTER
P$194,085COST
WEEKS MEDICAL CENTER
L$199,022COST

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