2023-08-15T15:28:22-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Matthew Streeter System CFO 6037884911 2023-08-15 1 Matthew Streeter 999009999 Joseph R Byrne P01289281 2077752387 2023-08-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Michael D Lee 173 Middle Street Lancaster NH 03584 86234167 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 15 11 356 46 -33305 0 7397277 3695217 60333534 71393106 1478928 575248 41316 509792 69251055 76173363 163825 219365 0 0 35166324 40147695 0 0 0 28189215 32895908 63519364 73262968 5731691 2910395 93203469 76551082 40368933 26275393 52834536 50275689 Weeks Medical Center's compassionate staff is committed to providing high quality and efficient health care services to ensure the well-being of our patients, families and communities. 0 0 59034006 219365 71393106 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 59034006 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 58 0 1 356 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 11 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 Keith Young Chair 1.00 1.00 X X 0 0 0 Dennis Couture Vice Chair 1.00 0.00 X X 0 0 0 Ruby Berryman Treasurer 1.00 0.00 X X 0 0 0 Charlie Cotton Secretary 1.00 0.00 X X 0 0 0 Denise Brisson Director 1.00 0.00 X 0 0 0 Scott Burns Director 1.00 0.00 X 0 0 0 Sarah Desrochers Director 1.00 2.00 X 0 0 0 Zeanny Egea Director 1.00 0.00 X 0 0 0 William Everleth Director 1.00 39.00 X 0 1845 0 Stanley Holz Director 1.00 0.00 X 0 0 0 Sharon Kopp Director 1.00 0.00 X 0 0 0 Frances LaDuke Director 1.00 0.00 X 0 0 0 Edward Samson III Director 1.00 0.00 X 0 0 0 Amber Schmidt Medical Staff President 40.00 0.00 X X 275269 0 41771 Mark Morgan MD CMO 40.00 0.00 X 535246 0 50365 Donald Crane Past Director 1.00 1.00 X 0 0 0 William Kemp Schanlaber Past Medical Staff President 40.00 0.00 X X 292762 0 47396 Michael D Lee President/CEO 40.00 1.00 X 385111 0 21103 Thomas Mee System CEO 1.00 45.00 X 0 677301 39588 Matthew Streeter System CFO 1.00 45.00 X 0 167302 26546 Prouskeh B Ebrahimpour Physician 40.00 0.00 X 600772 0 30138 Christopher Laurent NP Nurse Practicioner 40.00 0.00 X 470954 0 32943 Maude Oetking Physician 40.00 0.00 X 443368 0 27370 John Ford MD Physician 40.00 0.00 X 426799 0 12223 Elisabeth Moore Physician 40.00 1.00 X 408575 0 50674 Celeste Pitts Former CFO 24.00 16.00 X 116567 77712 38926 3955423 924160 419043 62 1 1 0 North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 Management Services 4117671 Fastaff LLC PO Box 911452 Denver CO 802911452 Staffing Agency 1138202 Medical Solutions LLC PO Box 670529 Dallas TX 752670529 Med Services 796694 American Healthcare Staffing Assoc PO Box 850737 Minneapolis MN 554850737 Staffing 703395 Laboratory Corportation of America PO Box 12140 Burlington NC 272162140 Lab Med Services 447844 52 3387570 307647 3695217 Patient Service 621400 107359648 107359648 Miscellaneous 621400 2488650 2306613 182037 Pharmacy Revenue 621400 1520172 1553477 -33305 Contractual/Char. Adj. 621400 -39975364 -39975364 71393106 570188 570188 488200 0 488200 488200 488200 10065864 10060804 5060 5060 5060 Gain on Affiliate Activity 621990 21592 21592 21592 76173363 71244374 -33305 1267077 X 219365 219365 1649023 1649023 31144096 25245511 5898585 463706 374091 89615 5078218 4037586 1040632 1812652 1402326 410326 52953 52953 76000 76000 24065 24065 7526865 6402178 1124687 5307 5307 403567 106265 297302 59995 59995 1614523 1574951 39572 197470 190042 7428 66341 54934 11407 308592 308592 3676561 3676561 940806 438221 502585 Patient Care Supplies 11677093 11677093 MET Taxes 2475701 2475701 Intercompany Allocation 2349740 2349740 Other Expenses 1440329 850589 589740 73262968 59034006 14228962 0 X 11495297 1392559 12368399 8342845 8197617 9492049 9534913 9534913 1172969 1407868 1297110 1480157 64457568 40928970 20411477 23528598 28444762 21372093 280925 0 93203469 76551082 4791681 4014808 671604 336358 5725226 5223590 3667728 3513796 25512694 13186841 40368933 26275393 X 51395830 49057380 1438706 1218309 52834536 50275689 93203469 76551082 X 2910395 -3431760 -2037482 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8874 8874 0 Part II-B, Line 1: Weeks Medical Center is a member of the New Hampshire Hospital Association, and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of WMC and other member organizations in furtherance of their exempt purposes. WMC does not directly perform any lobbying activities. 1118195 -87938 1030257 1012784 105411 1118195 1038704 -25920 1012784 1040597 -1893 1038704 1054173 -13576 1040597 0.00000 0.88510 0.11490 0 0 532630 532630 14791023 10928262 3862761 42413296 29254271 13159025 6720619 746437 5974182 23528598 Estimated Third-Party Payor Settlements 12472634 Deferred HHS Stimulus Revenue 63115 Due to Related Parties 651092 13186841 Part V, Line 4: Weeks Medical Center Endowment Funds were gifted with the intent to help defray the costs of indigent care for adults and children, and general upkeep and operations of the hospital. 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 494267 494267 0.00670 11198474 7996516 3201958 0.04370 11692741 7996516 3696225 0.05040 20045975 11018790 9027185 0.12320 219365 219365 0.00300 20265340 11018790 9246550 0.12620 31958081 19015306 12942775 0.17660 1 1308348 19991996 19904059 87937 X 1 1 1 1 Weeks Medical Center 173 Middle Street Lancaster NH 03584 www.weeksmedical.org 00015 X X X X Weeks Medical Center 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X https://weeksmedical.org/community-health-needs-assessment/ X 1 21 1 https://weeksmedical.org/community-health-needs-assessment/ 1 0 1 X 300.000000000000 300.000000000000 X X 1 1 X X X X 1 X https://weeksmedical.org/patients-visitors/financial-information X https://weeksmedical.org/patients-visitors/financial-information X https://weeksmedical.org/patients-visitors/financial-information X X X X X X 1 X 0 X X X X 1 X 0 0 Weeks Medical Center Part V, Section B, Line 5: An electronic survey was sent to a select group of local experts that included information from well-respected secondary sources on the current state of health care in the community. Individuals and agencies involved in Public Health and State & Local Health were included as were individuals from priority populations, chronic disease groups and other community members. Weeks Medical Center Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Upper Connecticut Valley Hospital, and Androscoggin Valley Hospital. Weeks Medical Center Part V, Section B, Line 6b: The Hospital's CHNA was conducted along with Coos County Family Health, and North Country Home Health & Hospice Agency. The first is a local FQHC. Weeks Medical Center Part V, Section B, Line 11: Please see attached CHNA and Implementation Strategy. Weeks Medical Center Part V, Section B, Line 16j: Brochures and financial counselor information are available in lobbies and handed out to patients. Also, contact information for financial counselors is provided on bills and letters that go out. 4 1 - Lancaster Physicians Offices 170 Middle Street Lancaster NH 03584 Physician Office for primary care 2 - Whitefield Physicians Offices 8 Clover Lane Whitefield NH 03598 Physician Office for primary care 3 - Groveton Physicians Offices 12 Church Street Groveton NH 03582 Physician Office for primary care 4 - North Stratford Physician Offices 43 Main Street North Stratford NH 03590 Physician Office for primary care Part I, Line 7: Cost to charge ratio Part III, Line 4: Please see pages 9-13 of the attached audited financial statements. Part III, Line 8: The entire shortfall is treated as community benefit. Cost to charge ratio from the Medicare cost report was used. Part III, Line 9b: All patients of Weeks Medical Center who have no insurance are notified of the Weeks Health Access Financial Assistance policy and encouraged to make an appointment with one of our Financial Counselors or Social Workers. This information is given out, along with financial assistance applications, at the time of appointment and is also available on our web-site and is reiterated with our monthly statements sent to the patient. It is impossible for our organization to determine if a patient is eligible for financial assistance until an application is filed - we do not access credit reports but rely on the patient supplying us with the necessary financial information. At that time of application, if a patient is determined to be eligible, they are provided with financial assistance. Part VI, Line 2: Every 3 years, Weeks Medical Center 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: The staff is trained to discuss the Hospital's charity care policy with patients, the policy is available throughout the Hospital in the brochure and it is available on the Hospital's website. WMC also employs a full-time financial counselor and other case management staff to assist patients with the financial assistance process. Part VI, Line 4: Weeks Medical Center's general geographic catchment area consists of nine towns, which supply almost 90% of its patients. Towns include Lancaster, Groveton, Dalton, Whitefield, North Stratford, Jefferson and Stark, in New Hampshire; and Lunenburg, Guildhall and Gilman, in Vermont. Together, these towns have a population of approximately 13,000 and cover approximately 375 square miles in both Vermont and New Hampshire. In 2021, Weeks opened a new Physician Office in Littleton, NH. The town has a population of approximately 4,500. Weeks Medical Center is defined by the geographic communities that surround its facilities and by the individuals and groups who benefit from the health and wellness services provided by its various health related institutions. The definition was developed by the Board of Trustees, its Committees, administrative and professional staff in the practical application of the services provided by the institutions and the identified needs of the communities served. Part VI, Line 5: WMC plays an integral role in the Emergency Preparedness plans of our community. In addition to being available in an emergency from a clinical standpoint, we are a large part of the community wide planning team, taking the lead in the planning of training & drills and bringing the various components together, based on State-wide standards. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 033017300 020275078 501(c)(3) 179365 0 Substance Abuse prevention, treatment & recovery. The Bowler-Bartlett Foundation 7 North State Street Concord NH 03301 237425858 501(c)(3) 40000 0 Mobile Medical Unit 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. 0 1 0 0 0 0 0 1 0 Thomas Mee System CEO 0 538642 0 126000 0 12659 0 5597 0 33991 0 716889 0 0 Prouskeh B Ebrahimpour Physician 587732 0 12500 0 540 0 0 0 30138 0 630910 0 0 0 Mark Morgan MD CMO 532206 0 2500 0 540 0 5250 0 45115 0 585611 0 0 0 Christopher Laurent NP Nurse Practicioner 463882 0 2500 0 4572 0 8700 0 24243 0 503897 0 0 0 Maude Oetking Physician 438492 0 2500 0 2376 0 8700 0 18670 0 470738 0 0 0 Elisabeth Moore Physician 377915 0 30300 0 360 0 8420 0 42254 0 459249 0 0 0 John Ford MD Physician 423071 0 2900 0 828 0 7978 0 4245 0 439022 0 0 0 Michael D Lee President/CEO 284708 0 84000 0 16403 0 3300 0 17803 0 406214 0 0 0 William Kemp Schanlaber Past Medical Staff President 288314 0 2900 0 1548 0 8451 0 38945 0 340158 0 0 0 Amber Schmidt Medical Staff President 272245 0 2700 0 324 0 2845 0 38926 0 317040 0 0 0 Celeste Pitts Former CFO 107895 71930 1500 1000 7172 4782 2804 1870 20551 13701 139922 93283 0 0 Matthew Streeter System CFO 0 157136 0 10000 0 166 0 0 0 26546 0 193848 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 - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee Part I, Line 4b Thomas Mee, System CEO, participated in a 457(f) plan administered by North Country Healthcare, a related organization. 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. A Business Finance Authority of the State of NH 521304598 2010-09-01 10000000 Refinance existing debt and finance the Hospital's contruction project 0 0 0 A 4702500 10000000 112960 3044490 6842550 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 1 A 0 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/02/2022 Form 990, Part VI, Section A, line 6 Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Weeks Medical Center. 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 Purchased Services: Program service expenses 1,406,346. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,406,346. Contract Labor: Program service expenses 4,995,832. Management and general expenses 1,124,687. Fundraising expenses 0. Total expenses 6,120,519. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Weeks Medical Center 173 Middle Street Lancaster, NH 03584 EIN: 02-0222242 Weeks Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Intercompany equity transfer -2,037,482. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I N/A 0 Upper Connecticut Valley Hospital Corliss Lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 0 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 0 North Country Home Health & Hospice Agency Inc 536 Cottage St Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 North Country Healthcare Inc 0 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Organization NH 501(c)(3) Line 12a, I Weeks Medical Center 1 Northcare Inc 59 Page Hill Road Berlin NH 03570 521596952 Supporting Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 0 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 0 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 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 Lancaster Patient Care Center K 179000 Checks Issued