2026-08-17T13:57:44-05:00 2025-09-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 220 DULUTH MN 55812 990 2024-10-01 020276210 UPPER CONNECTICUT VALLEY HOSPITAL UPPE 6032374971 181 CORLISS LANE COLEBROOK NH 03576 MATTHEW STREETER SYSTEM CFO 6032374971 2026-08-16 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-08-13 2024 2025-03-06 01:10:19Z GREGORY COOK 181 CORLISS LANE COLEBROOK NH 03576 39061437 0 X WWW.UCVH.ORG X 1969 NH UPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE. 10 9 142 7 0 0 550418 1078111 33980603 32427544 1218109 -1039903 538074 451405 36287204 32917157 474080 166889 0 0 13355358 13349607 0 0 0 19910180 18559396 33739618 32075892 2547586 841265 41869573 45864585 2588858 3171931 39280715 42692654 UPPER CONNECTICUT VALLEY HOSPITAL STRIVES TO IMPROVE THE WELL-BEING OF THE RURAL COMMUNITIES IT SERVES BY PROMOTING HEALTH AND ASSURING ACCESS TO QUALITY CARE. 0 0 22984469 166889 32427544 UPPER 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. 22984469 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 79 0 142 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 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 THATCHER CHAIR 1.00 X X 0 0 0 GAIL FISHER VICE CHAIR 1.00 X X 0 0 0 MAGGIE FITZGERALD SECRETARY (TERM 09/25) 1.00 X X 0 0 0 ROD DE GREEF TREASURER 1.00 X X 0 0 0 THOMAS COCHRAN DIRECTOR 1.00 X 559876 0 45599 E HARLAN CONNARY DIRECTOR 1.00 X 0 0 0 ROBERT DAWSON PRESIDENT OF MEDICAL STAFF 1.00 X 0 0 0 RICHARD LAPOINT DIRECTOR 1.00 X 0 0 0 LAURA MILLS DIRECTOR (TERM 05/25) 1.00 X 0 0 0 MARCIA PARKHURST DIRECTOR 1.00 X 0 0 0 PETER WEINER DIRECTOR 1.00 X 0 0 0 SHARON ELLINGWOOD-WHITE DIRECTOR 1.00 X 0 0 0 THOMAS MEE SYSTEM CEO 1.00 45.00 X 0 868962 45096 MATTHEW STREETER SYSTEM CFO/INTERIM CEO WMC 1.00 45.00 X 0 433138 41992 DARRELL BODNAR CIO 1.00 X 0 339048 5524 GREGORY COOK PRESIDENT/CEO 40.00 X 252130 0 26132 TAMSIN DURAND GENERAL SURGEON 40.00 X 452289 0 59649 ELISABETH MOORE ED PHYSICIAN 40.00 X 433855 0 56593 DARIN BROWN ED PHYSICIAN 40.00 X 353180 0 41626 JUDY GRIMES RN 40.00 X 204728 0 60408 JULIE BOLTON RN 40.00 X 177643 0 23146 LINDSAY LEA CNO (FORMER - JUL '24) 0.00 0.00 X 223728 0 24406 2657429 1641148 430171 39 1 1 0 MEDICAL SOLUTIONS LLC 1010 N 102ND ST OMAHA NE 68114 CONTRACT LABOR 529512 NEW HAMPSHIRE IMAGING SERVICES INC 1 PILLSBURY ST SUITE 200 CONCORD NH 03301 MRI PURCHASED SERVICES AND CONTRACT LABO 301525 2 1075306 2805 1078111 PATIENT SERVICE REVENUE 621400 31716097 31716097 SHARED STAFF REVENUE 621400 628451 628451 340B PHARMACY REVENUE 456110 19182 19182 63814 63814 32427544 1453090 1453090 103930 0 103930 103930 103930 3634837 16450 6144280 0 -2509443 16450 -2492993 -2492993 CAFETERIA REVENUE 722514 102877 102877 244598 244598 347475 32917157 32427544 0 -588498 X 166889 166889 347689 347689 9535329 9061448 473881 203244 183825 19419 2569657 2343861 225796 693688 627410 66278 40468 40468 6267 6267 4227856 3650836 577020 6426 1985 4441 58504 16732 41772 215220 215220 575333 64815 510518 38478 34299 4179 20307 17834 2473 2634 2215 419 1965510 1652603 312907 665618 665618 INTERCOMPANY ALLOCATION 4795886 1122666 3673220 MEDICAL SUPPLIES 2042081 2026540 15541 ENHANCEMENT TAX 1833220 1833220 BAD DEBT EXPENSE 1024540 1024540 1041048 985971 55077 32075892 22984469 9091423 0 1106 1106 4871847 6129228 3918352 3531819 304170 330528 387063 346083 35498516 19173819 17386404 16324697 14009863 16655586 990768 2545538 41869573 45864585 1554883 1088214 52615 18244 270130 247698 711230 1817775 2588858 3171931 X 38876953 42260191 403762 432463 39280715 42692654 41869573 45864585 841265 2570674 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6267 6267 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. 331128 30324 361452 290705 40423 331128 259755 30950 290705 299038 -39283 259755 263236 35802 299038 0.00000 0.47880 0.52120 0 0 69700 69700 19205528 6209389 12996139 16193187 12964430 3228757 30101 30101 16324697 AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 2545538 2545538 DUE TO RELATED PARTIES 1817775 1817775 34434590 2570674 -1024540 1546134 32888456 28701 28701 32917157 31051352 0 31051352 1024540 1024540 32075892 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. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 249155 249155 0.00780 4666730 1560708 3106022 0.09680 4915885 1560708 3355177 0.10460 6740299 4190591 2549708 0.07950 6740299 4190591 2549708 0.07950 11656184 5751299 5904885 0.18410 1 640268 0 10106909 10166624 -59715 X 1 1 1 1 UPPER CONNECTICUT VALLEY HOSPITAL 181 CORLISS LANE COLEBROOK NH 03576 WWW.UCVH.ORG 00592 X X X X UPPER CONNECTICUT VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 24 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 300.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X HTTPS://WWW.UCVH.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION/ X X X X X 1 X 0 X X X X 1 X 0 0 UPPER CONNECTICUT VALLEY HOSPITAL 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. UPPER CONNECTICUT VALLEY HOSPITAL 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. UPPER CONNECTICUT VALLEY HOSPITAL 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. UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://WWW.UCVH.ORG/2025-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ UPPER CONNECTICUT VALLEY HOSPITAL 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. 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 STATES NH 1 FOUNDATION FOR HEALTHY COMMUNITIES 125 AIRPORT RD CONCORD NH 033017300 020275078 501(C)(3) 108041 0 SUBSTANCE USE DISORDER TREATMENT PROJECT TRI-COUNTY CAP 30 EXCHANGE ST BERLIN NH 03570 020267404 501(C)(3) 50000 0 NON-EMERGENCY MEDICAL TRANSPORTATION GRANT 2 0 PART I, LINE 2: THE 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. 1 1 0 0 0 0 0 1 0 THOMAS MEE SYSTEM CEO 0 634794 0 219715 0 14453 0 6032 0 39064 0 914058 0 0 THOMAS COCHRAN DIRECTOR 559465 0 51 0 360 0 11245 0 34354 0 605475 0 0 0 TAMSIN DURAND GENERAL SURGEON 431698 0 20051 0 540 0 10695 0 48954 0 511938 0 0 0 ELISABETH MOORE ED PHYSICIAN 433418 0 105 0 332 0 0 0 56593 0 490448 0 0 0 MATTHEW STREETER SYSTEM CFO/INTERIM CEO WMC 0 347286 0 84876 0 976 0 10166 0 31826 0 475130 0 0 DARIN BROWN ED PHYSICIAN 351581 0 51 0 1548 0 10648 0 30978 0 394806 0 0 0 DARRELL BODNAR CIO 0 290363 0 47741 0 944 0 0 0 5524 0 344572 0 0 GREGORY COOK PRESIDENT/CEO 251251 0 51 0 828 0 0 0 26132 0 278262 0 0 0 JUDY GRIMES RN 176579 0 27913 0 236 0 0 0 60408 0 265136 0 0 0 LINDSAY LEA CNO (FORMER - JUL '24) 130499 0 30015 0 63214 0 6180 0 18226 0 248134 0 0 0 JULIE BOLTON RN 160891 0 13175 0 3577 0 385 0 22761 0 200789 0 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 LINDSAY 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 7 PART 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. FORM 990, PART VI, SECTION A, LINE 6 AS THE PARENT ORGANIZATION, NORTH COUNTRY HEALTHCARE (NCH) IS THE SOLE MEMBER OF UPPER CONNECTICUT 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 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. ANDROSCOGGIN VALLEY HOSPITAL INC 59 PAGE HILL ROAD BERLIN NH 03570 020280367 CRITICAL ACCESS HOSPITAL NH 501(C)(3) LINE 3 NORTH COUNTRY HEALTHCARE INC 1 NORTH COUNTRY HEALTHCARE INC 8 CLOVER LANE WHITEFIELD NH 03598 812225283 HEALTHCARE MANAGEMENT NH 501(C)(3) LINE 12A, I N/A 0 WEEKS MEDICAL CENTER 173 MIDDLE STREET LANCASTER NH 03584 020222242 CRITICAL ACCESS HOSPITAL NH 501(C)(3) LINE 3 NORTH COUNTRY HEALTHCARE INC 1 NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY INC 536 COTTAGE STREET LITTLETON NH 03561 020300637 HOME HEALTH AGENCY NH 501(C)(3) LINE 10 NORTH COUNTRY HEALTHCARE INC 1 NORTHCARE INC 59 PAGE HILL ROAD BERLIN NH 03570 521596952 SUPPORTING SERVICES NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL INC 1 ANDROSCOGGIN VALLEY HOSPITAL FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 223035216 MANAGEMENT AND FINANCIAL SUPPORT NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL INC 1 GREAT NORTHWOODS COMMUNITY FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 020452547 HEALTHCARE SERVICES NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL INC 1 LANCASTER PATIENT CARE CENTER 173 MIDDLE STREET LANCASTER NH 03584 832130386 SUPPORTING ORGANIZATION NH 501(C)(3) LINE 12A, I WEEKS MEDICAL CENTER 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 ANDROSCOGGIN VALLEY HOSPITAL INC P 285049 COST ANDROSCOGGIN VALLEY HOSPITAL INC L 316820 COST NORTH COUNTRY HEALTHCARE INC P 71920 COST NORTH COUNTRY HEALTHCARE INC L 105742 COST WEEKS MEDICAL CENTER P 194085 COST WEEKS MEDICAL CENTER L 199022 COST