ANDROSCOGGIN VALLEY HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ANDROSCOGGIN VALLEY HOSPITAL INC (EIN 02-0280367)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-15
- IRS object ID
- 202332279349303878
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-15T15:05:38-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2211 Congress St | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020280367 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Androscoggin Valley Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ANDR | BusinessNameControlTxt |
| Phone | 6037522200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Matthew Streeter | PersonNm |
| Person Title | System CFO | PersonTitleTxt |
| Phone | 6037522200 | PhoneNum |
| Signature | 2023-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Matthew | PersonFirstNm |
| Person Last | Streeter | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2023-08-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Michael Peterson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $83,231,308 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.avhnh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 443 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,128,809 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,584,058 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $65,847,300 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $74,261,440 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,832,387 | PYInvestmentIncomeAmt |
| CY Investment Income | $684,763 | CYInvestmentIncomeAmt |
| PY Other Revenue | $119,123 | PYOtherRevenueAmt |
| CY Other Revenue | $85,890 | CYOtherRevenueAmt |
| PY Total Revenue | $76,927,619 | PYTotalRevenueAmt |
| CY Total Revenue | $77,616,151 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $588,388 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $692,569 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $36,379,964 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $40,204,428 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,886,900 | PYOtherExpensesAmt |
| CY Other Expenses | $34,227,643 | CYOtherExpensesAmt |
| PY Total Expenses | $66,855,252 | PYTotalExpensesAmt |
| CY Total Expenses | $75,124,640 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $10,072,367 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,491,511 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $96,834,885 | TotalAssetsBOYAmt |
| Total Assets EOY | $74,030,462 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $56,712,041 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,838,892 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,122,844 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $36,191,570 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Delivering the best healthcare experience for every patient, every day. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $55,670,105 | ExpenseAmt |
| Grant | $692,569 | GrantAmt |
| Revenue | $65,565,425 | RevenueAmt |
| Desc | Androscoggin Valley Hospital is a critical access hospital. The Hospital provides a broad range of inpatient and outpatient services to meet the health needs of the upper Androscoggin Valley and surrounding communities. With a commitment to the highest quality surgical care - AVH is leading the way to a healthier future for our health care community. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $258,784 | ExpenseAmt |
| Revenue | $334,176 | RevenueAmt |
| Desc | Educational programs offered by AVH include childbirth classes, babysitting course, wellness fairs, lecture series, CPR and first aid courses, nutritional counseling, and a variety of support groups. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,189,144 | ExpenseAmt |
| Revenue | $8,361,839 | RevenueAmt |
| Desc | Other community benefits provided by the Hospital include the provision of care to the underinsured; the promotion of good health for children through participation in the healthy kids program; and the sponsorship of numerous clinics and programs supporting good health in the community. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $63,118,033 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 120 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 443 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Matthew Streeter CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033265610 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 Clover Lane | AddressLine1Txt |
| City | Whitefield | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03598 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Brianne Teaboldt | ||||||||||
| Medical Staff President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Donna Goodrich | ||||||||||
| Chair | 1.00 | 1.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Jay Poulin | ||||||||||
| Vice-Chair | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Thomas McCue | ||||||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Martha Laflamme | ||||||||||
| Secretary | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Lynn Beede | ||||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Javier Cardenas | ||||||||||
| Director | 40.00 | 0.00 | Yes (X) | $446,241 | $0 | $54,911 | ||||
| Alta Chase | ||||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jessica Foster-Hebert | ||||||||||
| Director | 1.00 | 39.00 | Yes (X) | $0 | $108,222 | $15,925 | ||||
| Julie King | ||||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Daniel Van Buren | ||||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Sarah Verney Frechette | ||||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Tyler White | ||||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| David Backler | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joseph Dupuis | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Tim Godin | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Eric Johnson | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Joan Merrill | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Jerry Rittenhouse MD | ||||||||||
| Past Director | 40.00 | 0.00 | Yes (X) | $600,971 | $0 | $0 | ||||
| Sarah Baillargeon | ||||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas Mee | ||||||||||
| System CEO | 1.00 | 45.00 | $0 | $677,301 | $39,588 | Yes (X) | ||||
| Matthew Streeter | ||||||||||
| System CFO | 1.00 | 45.00 | $0 | $167,302 | $26,546 | Yes (X) | ||||
| Michael Peterson | ||||||||||
| President | 40.00 | 2.00 | $413,676 | $0 | $46,019 | Yes (X) | ||||
| Keith Shute MD | ||||||||||
| Chief Medical Officer | 39.50 | 0.50 | $506,394 | $0 | $50,256 | Yes (X) | ||||
| Mahlon Bradley | ||||||||||
| Orthopedic Surgeon | 40.00 | 0.00 | $620,388 | $0 | $56,738 | Yes (X) | ||||
| Glenn M Hall | ||||||||||
| General Surgeon | 40.00 | 0.00 | $537,671 | $0 | $30,970 | Yes (X) | ||||
| Krzysztof Plociennik | ||||||||||
| MD Provider | 40.00 | 0.00 | $500,368 | $0 | $62,917 | Yes (X) | ||||
| Arthur A Ruediger | ||||||||||
| ED Physician | 40.00 | 0.00 | $397,652 | $0 | $57,217 | Yes (X) | ||||
| Stephen G Kraunz | ||||||||||
| Physician | 40.00 | 0.00 | $395,795 | $0 | $34,858 | Yes (X) | ||||
| Richard Werkowski | ||||||||||
| Former Interim CFO | 0.00 | 0.00 | $120,750 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,539,906 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $952,825 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $475,945 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 70 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| North Country Healthcare Inc | |||||
| 8 Clover Land | Whitefield | NH | 03598 | Management Services | $2,885,314 |
| Weeks Medical Center | |||||
| 173 Middle Street | Lancaster | NH | 03584 | Contract Labor/Purchased Services | $854,202 |
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Physician Contract Labor | $832,647 |
| Navin Haffty & Associates | |||||
| PO Box 88597 | Milwaukee | WI | 532888597 | Contract Labor/Purchased Services | $809,357 |
| Granite State GI Consultants | |||||
| 6 Tsienneto Road Suite 301 | Derry | NH | 03035 | GI Contract Labor | $723,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $43,678 | FundraisingAmt |
| Government Grants | $2,016,716 | GovernmentGrantsAmt |
| All Other Contributions | $523,664 | AllOtherContributionsAmt |
| Total Contributions | $2,584,058 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Revenue | 621400 | $99,159,035 | $99,159,035 | |
| Miscellaneous Revenue | 621400 | $2,112,739 | $1,785,996 | $326,743 |
| Contractual/Char. Adj. | 621400 | -$27,010,334 | -$27,010,334 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $74,261,440 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $484,153 | TotalRevenueColumnAmt |
| Exclusion | $484,153 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $104,591 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $104,591 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,591 | TotalRevenueColumnAmt |
| Exclusion | $104,591 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,797,066 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,575,193 | SecuritiesAmt |
| Other | $21,263 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $221,873 | SecuritiesAmt |
| Other | -$21,263 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $200,610 | TotalRevenueColumnAmt |
| Exclusion | $200,610 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $43,678 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $18,701 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,701 | TotalRevenueColumnAmt |
| Exclusion | -$18,701 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,616,151 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73,934,697 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,097,396 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $692,569 | TotalAmt |
| Program Services | $692,569 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,118,287 | TotalAmt |
| Program Services | $1,764,367 | ProgramServicesAmt |
| Management And General | $353,920 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,259,219 | TotalAmt |
| Program Services | $23,647,710 | ProgramServicesAmt |
| Management And General | $6,611,509 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $728,408 | TotalAmt |
| Program Services | $569,517 | ProgramServicesAmt |
| Management And General | $158,891 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,211,559 | TotalAmt |
| Program Services | $3,512,741 | ProgramServicesAmt |
| Management And General | $1,698,818 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,886,955 | TotalAmt |
| Program Services | $1,473,463 | ProgramServicesAmt |
| Management And General | $413,492 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,799 | TotalAmt |
| Management And General | $162,799 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,421 | TotalAmt |
| Management And General | $129,421 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,943 | TotalAmt |
| Management And General | $96,943 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,999,237 | TotalAmt |
| Program Services | $11,269,818 | ProgramServicesAmt |
| Management And General | $1,729,419 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,925 | TotalAmt |
| Management And General | $83,925 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,234,619 | TotalAmt |
| Program Services | $936,621 | ProgramServicesAmt |
| Management And General | $297,998 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,373,834 | TotalAmt |
| Program Services | $1,359,364 | ProgramServicesAmt |
| Management And General | $14,470 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,280 | TotalAmt |
| Program Services | $51,342 | ProgramServicesAmt |
| Management And General | $13,938 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,129 | TotalAmt |
| Program Services | $29,564 | ProgramServicesAmt |
| Management And General | $9,565 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,646 | TotalAmt |
| Program Services | $115,646 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,314,529 | TotalAmt |
| Program Services | $3,314,529 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,103,165 | TotalAmt |
| Program Services | $1,103,165 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient Care Supplies | $7,703,230 | $7,703,230 | |
| MET Tax | $3,157,218 | $3,157,218 | |
| Intercompany Allocation | $2,513,852 | $2,341,944 | $171,908 |
| Other Expenses | $134,816 | $75,225 | $59,591 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,124,640 | TotalAmt |
| Program Services | $63,118,033 | ProgramServicesAmt |
| Management And General | $12,006,607 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,243 | BOYAmt |
| EOY | $4,193 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,535,132 | BOYAmt |
| EOY | $11,969,545 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,037,374 | BOYAmt |
| EOY | $5,942,551 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $944,479 | BOYAmt |
| EOY | $1,005,558 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $696,872 | BOYAmt |
| EOY | $409,563 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $63,834,539 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,554,208 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,877,486 | BOYAmt |
| EOY | $22,280,331 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,116,089 | BOYAmt |
| EOY | $22,146,687 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,623,210 | BOYAmt |
| EOY | $10,272,034 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,834,885 | BOYAmt |
| EOY | $74,030,462 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,536,633 | BOYAmt |
| EOY | $5,443,251 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,344,700 | BOYAmt |
| EOY | $4,317,205 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,492 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,822,216 | BOYAmt |
| EOY | $28,078,436 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,712,041 | BOYAmt |
| EOY | $37,838,892 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,122,844 | BOYAmt |
| EOY | $36,191,570 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,122,844 | BOYAmt |
| EOY | $36,191,570 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,834,885 | BOYAmt |
| EOY | $74,030,462 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,491,511 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,516,741 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,906,044 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $9,494 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $9,494 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $198,192 | OtherCostOrOtherBasisAmt |
| Book Value | $198,192 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,632,384 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,049,718 | DepreciationAmt |
| Book Value | $2,582,666 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $359,449 | OtherCostOrOtherBasisAmt |
| Depreciation | $359,449 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,011,706 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,688,264 | DepreciationAmt |
| Book Value | $15,323,442 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,632,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,456,777 | DepreciationAmt |
| Book Value | $4,176,031 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $22,280,331 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Affiliates | $637,306 |
| Other Receivables | $2,134,631 |
| Deferred Compensation | $7,483,913 |
| Investment in Affiliate | $16,184 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $10,272,034 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $7,483,913 |
| Estimated Third Party Payor Settlements | $19,867,021 |
| Due to Related Parties | $727,502 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $28,078,436 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $72,279,390 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$4,516,740 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$4,516,740 | RevenueNotReportedAmt |
| Revenue Subtotal | $76,796,130 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $96,943 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $723,078 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $820,021 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $77,616,151 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $74,304,619 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $74,304,619 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $96,943 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $723,078 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $820,021 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $75,124,640 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 4b - Other Adjustments: | Gift Shop Expenses 22,678. Auxiliary Expenses 7,831. Contribution Expense 692,569. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary Expenses 7,831. Gift Shop Expenses 22,678. Contribution Expense 692,569. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $43,678 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $43,678 | CharitableContriEvent1Amt |
| Cash Prizes Event1 | $700 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $6,300 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $7,400 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,000 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,301 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $43,678 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $43,678 | CharitableContributionsTotAmt |
| Cash Prizes Total Events | $700 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $6,300 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $7,400 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,000 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,301 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $18,701 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$18,701 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $320,545 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $320,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,871,352 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,414,002 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,457,350 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04600 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,191,897 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,414,002 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,777,895 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $78,840 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $610 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $78,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $82,174 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $82,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,301,668 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,459,006 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $842,662 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $692,569 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $692,569 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00920 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,155,251 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,459,616 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,695,635 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,347,148 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,873,618 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,473,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07280 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,521,416 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $23,265,876 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $23,176,945 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $88,931 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Androscoggin Valley Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.avhnh.org | WebsiteAddressTxt |
| State License | 00050 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Androscoggin Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://avhnh.org/community-health-needs-assessment/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://avhnh.org/community-health-needs-assessment/ | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://avhnh.org/patients-visitors/financial-information/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://avhnh.org/patients-visitors/financial-information/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://avhnh.org/patients-visitors/financial-information/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Androscoggin Valley Hospital | 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. |
| Androscoggin Valley Hospital | Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Weeks Medical Center and Upper Connecticut Valley Hospital. |
| Androscoggin Valley Hospital | 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. |
| Androscoggin Valley Hospital | Part V, Section B, Line 11: Please see attached CHNA and Implementation Strategy. |
| Schedule H, Part V, Section B, Line 22: | All patients are charged the same amount for services and procedures performed, regardless of whether they were insured or uninsured. The net amount due to the hospital is based upon contractual adjustments for insured patients and administrative adjustments for uninsured patients, which may include free care, charity care, and discounted care. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AVH Surgical Associates | ||||
| 7 Page Hill Road | Berlin | NH | 03570 | Physician Practice Office |
| 2 - Androscoggin Valley Hospital | ||||
| 133 Pleasant Street | Berlin | NH | 03570 | Outreach Clinic/Lab Services |
| 3 - Androscoggin Valley Hospital | ||||
| 2 Broadway Avenue | Gorham | NH | 03581 | Outreach Clinic/Lab Services |
| 4 - Androscoggin Valley Hospital | ||||
| 181 Corliss Lane | Colebrook | NH | 03576 | Outreach Clinic/OB, Neuro, Cardio, GS, AUD, ENT, Pulm, Sleep, URO, and Pain |
| 5 - Androscoggin Valley Hospital | ||||
| 173 Middle Street | Lancaster | NH | 03584 | Outreach Clinic/Sleep, ENT, Audiology, OB, Pulmonology, and Urology |
| 6 - NCH Outreach Clinic | ||||
| 167 Main Street | Gorham | NH | 03581 | Outreach Clinic/PT/Rehab |
| 7 - NCH Outreach Clinic | ||||
| 1976 White Mountain Highway | North Conway | NH | 03860 | Outreach Clinic/ENT, Pain, and Sleep |
| 8 - Saco River Medical Group | ||||
| 15 US Route 302 | Glen | NH | 03838 | Sleep and Cardiology |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. |
| Part I, Line 7g: | All costs reported on Part I, Line 7g are attributable to a physician clinic. |
| Part III, Line 4: | Please see pages 8-12 of the attached audited financial statements. |
| Part III, Line 8: | The Organization used a cost report as the costing methodology to determine the amount of allowable Medicare costs. |
| Part VI, Line 2: | Every 3 years, Androscoggin Valley Hospital participates in a community needs assessment with three other members of the community's health care system. Using information from that assessment allows the Hospital to provide healthcare services to the North Country community on an ongoing basis. |
| Part VI, Line 3: | Androscoggin Valley Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to patients getting the healthcare services they need. If payment of healthcare expenses could create a financial hardship, Hospital staff will work with patients to apply for financial assistance. Information regarding financial assistance policies is available at the Hospital's entrances and patient registration and on the Hospital's website. As part of the financial counseling application process, the Hospital will assess eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and assist in the application process. |
| Part VI, Line 4: | The geographic area served by Androscoggin Valley Hospital is the Berlin service area. The Berlin service area is composed of the city of Berlin, and the towns of Gorham, Shelburne, Milan, Randolph, Dummer, Errol and Stark. These communities are within the boundaries of Coos County, which is bordered by the State of Maine to the east, the State of Vermont to the west and Quebec, Canada to the north. The city of Berlin defines much of the region as the largest community in the County with a population of 10,025. The total population of the Berlin service area is 16,121. The changing economic landscape and the closing of paper and pulp mills over the last decade in the Coos County have significantly impacted the area's unemployment rate and population compared to those experienced by the overall state of New Hampshire. |
| Part VI, Line 5: | Androscoggin Valley Hospital is the leading provider of healthcare to thousands of families in the small-town communities of New Hampshire's North Country. As a Critical Access Hospital, AVH offers 24/7 emergency care, in-house treatment of most medical issues, and an arrangement for treatment of all other problems with the nearest tertiary-care facility.Over the past decade, AVH has invested significantly in expanding and improving our facilities and services, and enhancing our team of dedicated, highly trained doctors, nurses and other staff. The result is a hospital that more effectively contributes to the health of our communities than ever before. Our new location in North Conway, NH offers comfortable and private treatment rooms for pain procedures as well as some elective treatments. Recent renovations have taken place to update the Obstetrics and Gynecology space offering an improved patient experience through open reception and more natural flow for patients as well as closer proximity to the inpatient women's services area. At the end of the day, our top priority is to ensure the highest level of quality healthcare to those that we are so fortunate to serve.In an effort to continue to provide a high quality of healthcare for all patients in the North Country, the hospitals of Coos & Grafton County came together to explore collaboration. We, the boards and senior management of Androscoggin Valley Hospital, Upper Connecticut Valley Hospital, and Weeks Medical Center realize that significant national, state and local economic pressures are jeopardizing local access, quality and sustainability. We have therefore formed North Country Healthcare (NCHC) with the stated objective of working collaboratively to better serve the healthcare needs of North Country patients. This collaborative effort will work to:1. Ensure access to quality care within the communities in which our patients live2. Provide local and high quality care with positive outcomes to our patients in the North Country 3. 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Coos County Family Health Services | ||||||||
| 133 Pleasant Street | Berlin | NH | 03570 | 020350051 | 501(c)(3) | $475,000 | $0 | Community Benefit Grant |
| Foundation for Healthy Communities | ||||||||
| 125 Airport Road | Concord | NH | 03301 | 020275078 | 501(c)(3) | $205,345 | $0 | Governor's Commission on Alcohol & Other drugs to support substance abuse prevention, treatment, and recovery efforts. |
| Great Northwoods Community Foundation | ||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020452547 | 501(c)(3) | $10,000 | $0 | General Support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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. The Hospital has entered into an agreement with Coos County Family Health Services (CCFHS) whereby the Hospital will provide funding in the form of a community benefit grant. The terms of the agreement require that the Hospital provide CCFHS with the agreed-upon community benefit grant on July 1 of the grant year. The amount of the community benefit grant to be awarded is determined on an annual basis in accordance with the terms of the agreement. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thomas Mee | ||||||||||||||
| System CEO | $0 | $538,642 | $0 | $126,000 | $0 | $12,659 | $0 | $5,597 | $0 | $33,991 | $0 | $716,889 | $0 | $0 |
| Mahlon Bradley | ||||||||||||||
| Orthopedic Surgeon | $578,635 | $0 | $39,377 | $0 | $2,376 | $0 | $19,000 | $0 | $37,738 | $0 | $677,126 | $0 | $0 | $0 |
| Jerry Rittenhouse MD | ||||||||||||||
| Past Director | $600,971 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $600,971 | $0 | $0 | $0 |
| Glenn M Hall | ||||||||||||||
| General Surgeon | $439,855 | $0 | $97,493 | $0 | $323 | $0 | $15,600 | $0 | $15,370 | $0 | $568,641 | $0 | $0 | $0 |
| Krzysztof Plociennik | ||||||||||||||
| MD Provider | $482,805 | $0 | $15,283 | $0 | $2,280 | $0 | $19,500 | $0 | $43,417 | $0 | $563,285 | $0 | $0 | $0 |
| Keith Shute MD | ||||||||||||||
| Chief Medical Officer | $426,052 | $0 | $59,500 | $0 | $20,842 | $0 | $17,200 | $0 | $33,056 | $0 | $556,650 | $0 | $0 | $0 |
| Javier Cardenas | ||||||||||||||
| Director | $432,559 | $0 | $11,306 | $0 | $2,376 | $0 | $14,865 | $0 | $40,046 | $0 | $501,152 | $0 | $0 | $0 |
| Michael Peterson | ||||||||||||||
| President | $315,540 | $0 | $88,652 | $0 | $9,484 | $0 | $19,500 | $0 | $26,519 | $0 | $459,695 | $0 | $0 | $0 |
| Arthur A Ruediger | ||||||||||||||
| ED Physician | $382,893 | $0 | $13,931 | $0 | $828 | $0 | $15,594 | $0 | $41,623 | $0 | $454,869 | $0 | $0 | $0 |
| Stephen G Kraunz | ||||||||||||||
| Physician | $392,458 | $0 | $2,797 | $0 | $540 | $0 | $14,102 | $0 | $20,756 | $0 | $430,653 | $0 | $0 | $0 |
| Matthew Streeter | ||||||||||||||
| System CFO | $0 | $157,136 | $0 | $10,000 | $0 | $166 | $0 | $0 | $0 | $26,546 | $0 | $193,848 | $0 | $0 |
| Richard Werkowski | ||||||||||||||
| Former Interim CFO | $120,750 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $120,750 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 organization - 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. |
| Form 990, Part VII, line 5: | Jerry Rittenhouse, Past Director, was compensated by a third party, Mystic Valley Urology, LLC for services rendered to the Organization. Mystic Valley Urology received $600,971 from the filing Organization for services rendered. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 2012 New Hampshire Health and Education Facilities Authority Revenue Bonds | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| Bond Issued | 2012-03-29 | BondIssuedDt |
| Issue Price | $14,500,000 | IssuePriceAmt |
| Purpose | Refinancing existing bonds, terminate interest rate swap contract | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $10,182,795 | RetiredAmt |
| Total Proceeds | $14,500,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $125,386 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $14,374,614 | OtherSpentProceedsAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mystic Valley Urology LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Entity controlled more than 35% by Jerry Rittenhouse, Past Director | RelationshipDescriptionTxt |
| Transaction | $600,971 | TransactionAmt |
| Transaction | Independent Contractor Agreement for Medical Services Rendered | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Androscoggin Valley Hospital. |
| Form 990, Part VI, Section A, line 7a | Each member of the Corporation Board shall be nominated by action of an Affiliate Board, or by the Corporation Board, as the case may be, in accordance with the nomination powers indicated in the Corporation's Bylaws. |
| Form 990, Part VI, Section A, line 7b | The Corporation Bylaws include Major Matters which include specific duties and responsibilities which are shared by the Corporation Board and the Affiliate Boards. These Major Matters are further distinguished between Major Organizational Matters and Major Operational Matters. In both cases, the Bylaws contain the provisions for the approval of these matters including whether they are approved by a majority vote or super majority vote of all boards. In all cases, the Major Matters require approval by the Corporation Board and the Affiliate Boards. |
| Form 990, Part VI, Section B, line 11b | A copy of the Form 990 will be shared electronically with the entire NCH Board and Finance committee before filing, with adequate time for questions to be asked. |
| Form 990, Part VI, Section B, line 12c | Conflict of Interest Process: - Conflict of Interest Disclosure completed via BoardPaq (electronic means) - Results compiled into Conflict Matrix which is reviewed and approved by the Board - Conflicts that meet the Pecuniary Benefit criteria are identified, shared with the Board and approved - Disclosure notices are placed in local papers - The NH Division of Charitable Trusts is notified of the Pecuniary Benefit and copies of the public notices are attached |
| Form 990, Part VI, Section B, line 15 | The Compensation Committee is a subcommittee of the Finance Committee of the Corporation Board. This Committee oversees the executive compensation policy and practices of the organization including the CEO, the Affiliate Presidents, and the CEO Cabinet which includes key executive positions for the organization. The Compensation Committee engages with an outside consultant to determine compensation benchmarks and best practices which guide the compensation processes for these executive positions. The comparison benchmark data and guidance are reviewed by the Committee and recommendations are made to the Corporation Board and Affiliate Boards. This is done on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The Organization has implemented all policies and the governing documents and financial statements are available to the public upon request. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 3,349,573. Management and general expenses 431,030. Fundraising expenses 0. Total expenses 3,780,603. Contract Labor: Program service expenses 7,920,245. Management and general expenses 1,298,389. Fundraising expenses 0. Total expenses 9,218,634. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Androscoggin Valley Hospital 59 Page Hill Road Berlin, NH 03570 EIN 02-0280367 Androscoggin Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Transfer to Affiliate -1,906,044. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | North Country Healthcare Inc | |
| Upper Connecticut Valley Hospital | |||||||||||
| Corliss lane | Colebrook | NH | 03576 | 020276210 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | North Country Healthcare Inc | |
| North Country Home Health & Hospice Agency Inc | |||||||||||
| 536 Cottage Street | Littleton | NH | 03561 | 020300637 | Home Health Agency | NH | 501(c)(3) | Line 10 | 0 | North Country Healthcare Inc | |
| Northcare Inc | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 521596952 | Supporting Services | NH | 501(c)(3) | Line 12b, II | Yes (1) | Androscoggin Valley Hospital Inc | |
| Androscoggin Valley Hospital Foundation | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 223035216 | Management and Financial Support | NH | 501(c)(3) | Line 12b, II | Yes (1) | Androscoggin Valley Hospital Inc | |
| Great Northwoods Community Foundation | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020452547 | Healthcare Services | NH | 501(c)(3) | Line 12b, II | Yes (1) | Androscoggin Valley Hospital Inc | |
| Lancaster Patient Care Center | |||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 832130386 | Supporting Organization | NH | 501(c)(3) | Line 12a, I | 0 | Weeks Medical Center | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Northcare Inc | ||
| D | $518,580 | FMV |
| Androscoggin Valley Hospital Foundation | ||
| M | $130,971 | FMV |