VALLEY REGIONAL HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- VALLEY REGIONAL HOSPITAL INC (EIN 02-0222118)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-04
- IRS object ID
- 202342169349300304
- 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 H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-04T06:02:13-05:00 | 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 | 020222118 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Regional Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VALL | BusinessNameControlTxt |
| Phone | 6035427771 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jean Shaw | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6035427771 | PhoneNum |
| Signature | 2023-08-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jean | PersonFirstNm |
| Person Last | Shaw | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2023-08-02 | 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 | Jocelyn Caple | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $66,526,601 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.vrh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1893 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 419 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,731,711 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,693,251 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,313,683 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $55,397,090 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,117,978 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,891,469 | CYInvestmentIncomeAmt |
| PY Other Revenue | $21,626 | PYOtherRevenueAmt |
| CY Other Revenue | $90,130 | CYOtherRevenueAmt |
| PY Total Revenue | $53,184,998 | PYTotalRevenueAmt |
| CY Total Revenue | $62,071,940 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,072,061 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,352,401 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,392,340 | PYOtherExpensesAmt |
| CY Other Expenses | $27,978,256 | CYOtherExpensesAmt |
| PY Total Expenses | $47,464,401 | PYTotalExpensesAmt |
| CY Total Expenses | $54,330,657 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,720,597 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,741,283 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $72,743,139 | TotalAssetsBOYAmt |
| Total Assets EOY | $66,016,739 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,615,624 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,687,768 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $41,127,515 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $42,328,971 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of Valley Regional Hospital, Inc. is to improve community health, patient experience, and value. Our vision is to partner with the community to optimize health by ensuring access to high value health care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $45,333,531 | ExpenseAmt |
| Revenue | $55,397,090 | RevenueAmt |
| Desc | Valley Regional Hospital is a provider of health services with facilities in the Claremont, NH area. The Hospital grants credit to patients, substantially all of whom are local residents.The Hospital also provides care to patients who meet certain criteria under its Financial Assistance policy without charge or at amounts less than its established rates. The Hospital does not pursue collection of amounts determined to qualify as financially-assisted care.The Hospital maintains records to identify and monitor the level of financially-assisted care it provides. For the year ending September 30, 2022 charges forgone for services and supplies furnished under the charity care policy were approximately $778,000. The estimated cost of those services and supplies was approximately $477,000.In addition, the Hospital provides a number of other services to benefit certain poor and elderly patients. Medicaid and state programs do not cover the full cost of the Hospital incurred cost of providingmedical care to patients. The hospital provides services to residents throughout the region. Those services include health evaluations, screenings, and flu vaccine administration at community events and in the workplace. Health education, wellness, chronic disease management, fitness, and ergonomic programs are also widely offered. For these services, and many other community services, the hospital receives little or no payment.Other community benefits can't be quantified or assigned a value. For example, the hospital provides committee and board participants and expertise to address community needs; to support community health initiatives; to advocate for and support individuals who are socially, economically and physically challenged; and to collaborate with the local public safety organizations. | Desc |
| Total Program Service Expenses | $45,333,531 | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | 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 | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 419 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| 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 | Jean Shaw | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6035427771 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Jeffrey A Hanissian | |||||||||
| Physician | 36.00 | 0.00 | Yes (X) | $367,400 | $0 | $39,189 | |||
| Jocelyn Caple MD | |||||||||
| Interim President & CEO | 38.40 | 1.60 | $0 | $390,600 | $0 | Yes (X) | Yes (X) | ||
| Joel P Herrington | |||||||||
| Physician | 28.00 | 0.00 | Yes (X) | $360,308 | $0 | $29,694 | |||
| Charles M Sawyer | |||||||||
| Physician | 24.00 | 0.00 | Yes (X) | $362,918 | $0 | $17,499 | |||
| Joshua R Rudner | |||||||||
| Physician | 40.00 | 0.00 | Yes (X) | $321,342 | $0 | $15,238 | |||
| Ivar L Frithsen | |||||||||
| Physician | 35.00 | 0.00 | Yes (X) | $299,510 | $0 | $16,176 | |||
| Juliann Barrett DO | |||||||||
| Trustee | 39.90 | 0.10 | $246,853 | $0 | $3,462 | Yes (X) | |||
| Beverley A Rankin | |||||||||
| CNO | 40.00 | 0.00 | $185,771 | $0 | $33,547 | Yes (X) | |||
| Jean Shaw | |||||||||
| CFO | 37.20 | 2.80 | $0 | $177,779 | $38,577 | Yes (X) | |||
| Gailyn Thomas MD | |||||||||
| Trustee | 19.90 | 0.10 | $193,228 | $0 | $0 | Yes (X) | |||
| Brenda L Slossberg | |||||||||
| Nurse Practitioner | 34.00 | 0.00 | $177,041 | $0 | $13,010 | Yes (X) | |||
| Patricia Putnam | |||||||||
| Chair | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Terri Decker | |||||||||
| Vice Chair | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Lisa Richmond | |||||||||
| Treasurer | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Bryan Huot | |||||||||
| Secretary | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| James Borchert | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Scott Bouranis | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Cynthia L Burr | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Eric Crainich | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Katherine Lajoie | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Alex Scott | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Samuel Shields | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Tom Sullivan | |||||||||
| Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| John Tomlinson | |||||||||
| Past Trustee | 0.90 | 0.10 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,514,371 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $568,379 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $206,392 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 31 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| Dartmouth Hitchcock Clinic | |||||
| One Medical Center Drive | Lebanon | NH | 037560000 | Medical Services | $2,393,085 |
| American Healthcare Services Association | |||||
| PO Box 670529 | Dallas | TX | 752670529 | Contracted Staffing | $1,005,836 |
| Essex Orthopaedics & Optima Sports Medic | |||||
| 16 Pelham Road Suite 1 | Salem | NH | 030790000 | Medical Services | $576,408 |
| Triage LLC | |||||
| PO Box 773328 | Chicago | IL | 606773328 | Contracted Staffing | $458,000 |
| Amnesia Anesthesia | |||||
| PO Box 1362 | Claremont | NH | 03743 | Medical Services | $426,917 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,359,909 | GovernmentGrantsAmt |
| All Other Contributions | $333,342 | AllOtherContributionsAmt |
| Total Contributions | $2,693,251 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Service Revenue | 622110 | $82,501,918 | $82,501,918 | |
| Medicaid DSH Revenue | 622110 | $3,099,689 | $3,099,689 | |
| Other Revenue | 622110 | $1,095,054 | $966,941 | $128,113 |
| Charity/Contractual Adjustment | 622110 | -$31,299,571 | -$31,299,571 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $55,397,090 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $735,947 | TotalRevenueColumnAmt |
| Exclusion | $735,947 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $90,130 | 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 | $90,130 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $90,130 | TotalRevenueColumnAmt |
| Exclusion | $90,130 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,508,333 | SecuritiesAmt |
| Other | $101,850 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,402,270 | SecuritiesAmt |
| Other | $52,391 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,106,063 | SecuritiesAmt |
| Other | $49,459 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,155,522 | TotalRevenueColumnAmt |
| Exclusion | $3,155,522 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,071,940 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,268,977 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,109,712 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $852,912 | TotalAmt |
| Program Services | $852,912 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,303,516 | TotalAmt |
| Program Services | $17,976,761 | ProgramServicesAmt |
| Management And General | $2,326,755 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,743 | TotalAmt |
| Program Services | $220,650 | ProgramServicesAmt |
| Management And General | $28,093 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,505,035 | TotalAmt |
| Program Services | $3,113,808 | ProgramServicesAmt |
| Management And General | $391,227 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,442,195 | TotalAmt |
| Program Services | $1,283,211 | ProgramServicesAmt |
| Management And General | $158,984 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,837 | TotalAmt |
| Program Services | $10,794 | ProgramServicesAmt |
| Management And General | $74,043 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,507 | TotalAmt |
| Program Services | $35,996 | ProgramServicesAmt |
| Management And General | $30,511 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,084 | TotalAmt |
| Management And General | $157,084 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,413,399 | TotalAmt |
| Program Services | $9,537,058 | ProgramServicesAmt |
| Management And General | $2,876,341 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $946,785 | TotalAmt |
| Program Services | $781,657 | ProgramServicesAmt |
| Management And General | $165,128 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $814,260 | TotalAmt |
| Program Services | $685,030 | ProgramServicesAmt |
| Management And General | $129,230 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,954,843 | TotalAmt |
| Program Services | $1,665,963 | ProgramServicesAmt |
| Management And General | $1,288,880 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,820 | TotalAmt |
| Program Services | $5,874 | ProgramServicesAmt |
| Management And General | $1,946 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,321 | TotalAmt |
| Program Services | $40,980 | ProgramServicesAmt |
| Management And General | $11,341 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $659,294 | TotalAmt |
| Program Services | $540,819 | ProgramServicesAmt |
| Management And General | $118,475 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $877,791 | TotalAmt |
| Program Services | $1,772 | ProgramServicesAmt |
| Management And General | $876,019 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $5,546,574 | $5,219,923 | $326,651 |
| Medicaid Enhancement Ta | $2,477,994 | $2,477,994 | |
| Miscellaneous | $767,786 | $740,258 | $27,528 |
| Dues & Subscriptions | $150,961 | $142,071 | $8,890 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,330,657 | TotalAmt |
| Program Services | $45,333,531 | ProgramServicesAmt |
| Management And General | $8,997,126 | 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 | $251,157 | BOYAmt |
| EOY | $485,322 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,178,166 | BOYAmt |
| EOY | $20,288,504 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,048,637 | BOYAmt |
| EOY | $3,758,691 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,025,989 | BOYAmt |
| EOY | $1,013,838 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,677 | BOYAmt |
| EOY | $388,122 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,182,815 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,609,816 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,485,400 | BOYAmt |
| EOY | $4,572,999 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,726,422 | BOYAmt |
| EOY | $27,835,459 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,117,482 | BOYAmt |
| EOY | $4,461,628 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,533,209 | BOYAmt |
| EOY | $3,212,176 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,743,139 | BOYAmt |
| EOY | $66,016,739 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,834,796 | BOYAmt |
| EOY | $6,793,531 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,060 | BOYAmt |
| EOY | $123,518 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,629,768 | BOYAmt |
| EOY | $16,770,719 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,615,624 | BOYAmt |
| EOY | $23,687,768 | 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 | $33,673,186 | BOYAmt |
| EOY | $35,835,853 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,454,329 | BOYAmt |
| EOY | $6,493,118 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,127,515 | BOYAmt |
| EOY | $42,328,971 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,743,139 | BOYAmt |
| EOY | $66,016,739 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,741,283 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$5,883,973 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$655,854 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $12,932 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,932 | 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 local associations, a portion of which are attributable to lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,279,159 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$891,253 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $73,535 | OtherExpendituresAmt |
| End Year Balance | $6,314,371 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,058,402 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,287,893 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $67,136 | OtherExpendituresAmt |
| End Year Balance | $7,279,159 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,895,100 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $163,302 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $6,058,402 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,990,786 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$94,455 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,231 | AdministrativeExpensesAmt |
| End Year Balance | $5,895,100 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,712,343 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $279,662 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,219 | AdministrativeExpensesAmt |
| End Year Balance | $5,990,786 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.74679 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.25321 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $250,667 | OtherCostOrOtherBasisAmt |
| Book Value | $250,667 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,043,309 | OtherCostOrOtherBasisAmt |
| Depreciation | $652,037 | DepreciationAmt |
| Book Value | $391,272 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,237,721 | OtherCostOrOtherBasisAmt |
| Depreciation | $297,129 | DepreciationAmt |
| Book Value | $1,940,592 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,563,450 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,652,158 | DepreciationAmt |
| Book Value | $1,911,292 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $87,668 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,492 | DepreciationAmt |
| Book Value | $79,176 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,572,999 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial Interest in Perpetual Trusts | Desc |
| Book Value | $4,461,628 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,461,628 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due To Affiliates | $19,513 |
| Estimated Third-Party Payor Settlements | $15,936,257 |
| Reserve for Self-Funded Insurance | $814,949 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $16,770,719 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | The Organization uses its endowment funds in support of health care services, purchases of equipment, health education, and indigent care. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 275.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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 | $2,954,877 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,346,744 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $608,133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,607,340 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,037,671 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,569,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,562,217 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,384,415 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,177,802 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07690 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $375,102 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,765 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $354,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,764 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $55,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,052 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,052 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $435,918 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,765 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $415,153 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,998,135 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,405,180 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,592,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08450 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,051 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,051 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,249 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,249 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $786 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $786 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $239 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $239 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,478 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,478 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,339 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,941 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,941 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,083 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $74,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $19,162,101 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,162,101 | CostOfCareReimbursedByMedcrAmt |
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 | Yes (1) | 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 | Valley Regional Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.vrh.org | WebsiteAddressTxt |
| State License | 00007 | 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 | Valley Regional Hospital Inc | 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 | 20 | 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 | www.vrh.org/about-vrh/public-reports | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.vrh.org/about-vrh/public-reports | StrategyWebsiteURLTxt |
| 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 275.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://vrh.org/patient-billing/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://vrh.org/patient-billing/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://vrh.org/patient-billing/ | 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 Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Valley Regional Hospital, Inc. | Part V, Section B, Line 5: During the period February through July 2021, Valley Regional Hospital conducted a Community Health Needs Assessment of its service area, in partnership with New London Hospital, Alice Peck Day Memorial Hospital, Dartmouth-Hitchcock, Mt. Ascutney Hospital and Health Center, Visiting Nurse and Hospice of VT & NH, Lake Sunapee Region VNA & Hospice, and the NH Community Health Institute.Information gathering utilized in the assessment included the following:1. Surveys received from 569 community residents from all 15 towns, made available on-line and paper surveys placed in numerous locations throughout the region;2. Series of 10 community discussion groups;3. Summary information associated with over 2,000 primary care patient assessments, collected from 2019-2021, identifying gaps in social determinants of health, which could impact medical health outcomes. 4. Direct email survey with 207 responding stakeholders and community leaders representing multiple community sectors, including:- Derek Ferland, Sullivan County Manager- Nancy Merrill, Claremont City Planner- Elyse Crossman, ED, Claremont Chamber of Commerce- Sally Bouchard, ED, Sullivan County Oral Health Collaborative- Ted Purdy, Sullivan County Healthcare- Deborah Mozden, ED, Turning Points Network- Mark Brislin, Claremont Community Center- Mark Mills, CEO, Pathways of the River Valley- Ed Morris, Claremont City Manager- Charlene Lovett, Claremont City Mayor- Courtney Porter, Claremont School District- Brendan Minnihan, Superintendent SAU #43- Ella Casey, ED, Newport Chamber of Commerce- Jim Culhane, CEO, Lake Sunapee Visiting Nurse & Hospice- Sue Ellen Griffin, CEO, West Central Behavioral Health- Stephanie Slayton, ED, TLC Family Center- PJ Lovely, Newport Recreation Department- Taralyn Belaski, Sullivan County Public Health Network- Denise Liveston, President, Claremont Senior Center- Dale Girard, President, Golden Cross Ambulance Service |
| Valley Regional Hospital, Inc. | Part V, Section B, Line 6a: Due to significant overlap in service area, Valley Regional Hospital partnered with the following hospitals to identify both regional and community-specific needs for the community health needs assessment: - New London Hospital - Alice Peck Day Memorial Hospital, - Dartmouth-Hitchcock Medical Center, - Mt. Ascutney Hospital and Health CenterThere is significant overlap in service area among these organizations; the CHNA identified both regional and community-specific needs. |
| Valley Regional Hospital, Inc. | Part V, Section B, Line 6b: Due to significant overlap in service area, Valley Regional Hospital partnered with the following organizations to identify both regional and community-specific needs for the community health needs assessment: - Visiting Nurse and Hospice for VT and NH- Lake Sunapee VNA & Hospice- New Hampshire Community Health InstituteThere is significant overlap in service area among these organizations; the CHNA identified both regional and community-specific needs. |
| Valley Regional Hospital, Inc. | Part V, Section B, Line 7d: The CHNA was widely distributed in traditional ways (hard copy mailings, website, social media links, paper copy handouts at community meetings, etc.) as well as distributed through COVID-19 vaccination clinics and primary care practices. |
| Valley Regional Hospital, Inc. | Part V, Section B, Line 11: CHNA Implementation StrategyThe diverse community issues identified through the assessment process far exceed the ability of a single entity to solve the issues; however, Valley Regional is committed to being an active partner in determining ways to address all of the identified issues, in collaboration with many other local nonprofit groups and community leaders.1. Availability of Mental Health Services:a. VRH will seek private and public funding sources to launch a hospital-wide integrative model of mental & medical health care, within its primary care, emergency and in-patient departments.b. VRH will enhance their primary care staff with providers who specialize in the care of patients with mental health challenges.c. VRH will hire additional emergency department staff to provide mental health triage assessment, medication reconciliation, and assistance with Social Determinants of Health factors.d. VRH will utilize collaborations with local mental health programs and providers to assist with the referral process and provide on-site care when appropriate.e. Patients facing mental health challenges seen in the primary care setting will benefit from an onsite social worker and community health navigator to assist with areas of life that may be contributing to a decline in health.f. VRH staff will complete training opportunities to enhance compassionate treatment and care for patients entering VRH service areas.2. Cost of Health Care Services, Affordability of Health Insurance: a. VRH will increase its team of primary care providers to address the availability of appointments for community members. b. Patients will be made aware of new providers and health savings options in a timely manner. c. Patients will be presented with health care options, community supports and financial assistance options by the Community Health Navigator, Social Workers & Case Managers in the primary care practices, and Emergency and Med/Surg Departments.d. Indigent patients will be provided with information about VRH's Medication Assistance Program, providing discounted or free medications from pharmaceutical companies. 3. Alcohol and Drug Use Prevention, Treatment and Recovery:a. VRH will seek private and public funding sources to launch a hospital-wide integrative model of mental & medical health care, with a component addressing SUD, within its primary care, emergency and in-patient departments.b. VRH staff will complete training opportunities to enhance compassionate treatment and care for patients entering VRH service areas.c. Patients facing mental health challenges seen in the primary care setting will benefit from an onsite social worker and community health navigator to assist with factors of life that may be contributing to a decline in health.d. VRH will hire additional primary care staff, who specialize in the care of patients with SUD and mental health challenges. e. VRH will hire additional emergency department staff to provide mental health triage assessment, medication reconciliation, and assistance with Social Determinants of Health factors. f. VRH will utilize collaborations with local mental health programs and providers to assist with the referral process and provide on-site care when appropriate.4. Socio-economic conditions affecting health and well-being, such as housing affordability, access to healthy foods and affordable, dependable childcare:a. Address factors in a patient's life that could contribute to a decline in healthy living at the time of their medical appointments. b. Patients will be referred to community organizations and resources, as well as given assistance in completing necessary applications by the Community Health Navigator & Social Workers.c. Provide up-to-date information to the key patient providers of community resources.d. Provide primary care patients a resource for fruit and veggie purchases when indicating a positive food insecurity on the patient assessment form.5. Availability and Affordability of Dental Care:a. Continue VRH's longstanding collaboration with Sullivan County Oral Health Collaborative, which operates the community's only nonprofit dental center. b. Providers will have up-to-date information of local oral health services and referrals options to provide patients. c. Patients experiencing immediate dental needs will be triaged within primary care, urgent care and the emergency department, as care and complexity demands, with referrals made to local dental resources.6. Prevent Child Abuse and Neglect: a. Patients will be asked and surveyed for abuse and violence in the home as part of routine screenings. Appropriate referrals will occur to BEAS, CDYF and TPN. b. Local organizations will provide referral resources that can be accessed in private bathrooms and within patient care rooms.c. Local organizations will benefit from collaboration and partnership with VRH in their missions to support survivors of violence and neglect.d. VRH staff will participate in "trauma-informed" training opportunities across all departments providing healthcare services to patients. |
| Valley Regional Hospital, Inc. | Part V, Section B, Line 20e: Applications are offered to all self-pay patients along with education regarding Medicaid. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Kane Oncology Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Oncology Center | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | It is the policy of Valley Regional Hospital to provide financial assistance to those patients who are unable to pay for all or part of the cost of their care that is not covered by other sources of funding. Valley Regional Hospital's Financial Assistance Program is a program that assists uninsured and under-insured patients who meet specific income, geographical and Valley Regional Hospital guidelines.The Hospital will cover up to 100% of the cost of care for patients depending on the patient's level of income and family size. The Hospital also is a participating provider with the NH Health Access Network. |
| Part I, Line 7: | The Organization used an overall cost to charge ratio for lines 7a and 7b. Amounts listed on lines 7e, 7f and 7i were derived from internal financial/cost accounting systems. |
| Part II, Community Building Activities: | Valley Regional Healthcare believes the skills and knowledge of its employees are the most critical assets to building a strong and healthy community. VRH employees participate on a wide variety of local boards serving or participating in health and wellness missions, including dental health, domestic violence, higher education, school boards, chambers of commerce, public transportation, elder health, and substance abuse. Employees also participate on state level boards and within elected government, working to improve policy and practice on a broad spectrum.Local businesses rely upon collaborations with VRH to provide education and expertise in community building activities such as through public and private health fairs. VRH takes advantage of public chamber activities to provide tables of health information and free screening activities. VRH also provides financial support for non-profit organizations with complementary missions, in the form of event sponsorships. |
| Part III, Line 4: | Please refer to pages 9-13 and pages 16-17 of the attached audited financial statements. |
| Part III, Line 8: | Medicare costs approximate Medicare revenue. The Organization does not anticipate a Medicare shortfall or that any such shortfall should be considered as community benefit. |
| Part III, Line 9b: | Patients who are known to qualify for financial assistance file a financial assistance determination application with the Hospital. If the application is approved, the patient's account shall be written off, in accordance to the level of adjustment the applicant was qualified to receive. The patient write-off guidelines are as follows:1. The determination is valid for 6 months from the date of signature for all applications except those individuals who demonstrate that they are on a fixed income (i.e. Social Security, retirment, disability), in which case approval is for 1 year from the date of signature.2. Patient qualifies according to the established Financial Assistance income guidelines3. Account notes must indicate what payor that the balance is due to (appropriate payor write-off codes to be utilized). |
| Part VI, Line 2: | The purpose of the assessment was to identify community health concerns, priorities and opportunities for community health and health care delivery systems improvement. In collaboration with The Community Health Institute/JSI and our partner hospitals, key healthcare, public service and community member stakeholders were engaged to collect and analyze qualitative and quantitative data.The CHNA provides a clear blueprint for community outreach and collaboration opportunities, and also creates a timely benchmark against which to measure progress.The purpose of the research design was as follows:1. To clearly define the VRH service area2. To define measurement methodologies which can identify community needs3. To create a prioritized list of community resources4. To develop a catalogue of available healthcare resourcesThe following health issues were identified by survey respondents:1. Availability of Mental Health Services 2. Cost of Health Care Services, Affordability of Health Insurance 3. Alcohol and Drug Use Prevention, Treatment and Recovery:4. Socio-economic conditions affecting health and well-being, such as housing affordability, access to healthy foods and affordable, dependable childcare 5. Availability and Affordability of Dental Care 6. Prevent Child Abuse and Neglect |
| Part VI, Line 3: | The Community Engagement department has created and posted signage throughout the hospital and clinics, and has posted information on the hospital's website. |
| Part VI, Line 4: | Valley Regional serves a rural region which includes the 15 towns of Sullivan County and portions of eastern Vermont, with a total resident population of 43,104. Spanning 552 square miles, the County is the 2nd least populated in NH. 16.6% of Sullivan County children live below 100% of the Federal Poverty level, with four communities with child poverty estimates over 20%: Croydon (24%), Claremont (26%), Cornish (27%) and Langdon (42%). Just over 6% of residents have no access to a vehicle within their home environment. Community members of all ages have at least one form of disability, with 5.1% under the age of 18; 10.6% between age 18 and 64; and, 30.4% over the age of 65. |
| Part VI, Line 5: | Valley Regional Healthcare recognizes its importance to the community - economically, as one of the largest local employers, and philosophically, as a large entity entrusted with community wellness. VRH leadership instills in employees the sense of responsibility to be involved in support of the community, on behalf of the hospital.VRH employees participate and lend expertise as board members of other non-profits, including those focused on dental health, community revitalization, higher education and school boards, elder issues, public transportation, domestic violence, substance misuse and abuse, and health and wellness initiatives. Employees also participate on state and Federal boards and committees as well as Chambers of Commerce and United Way, working to improve policy and practice in healthcare delivery.Business collaborations are a priority, particularly with large employers such as Claremont Parks and Recreation, Whelen Engineering, River Valley Technical Center, Claremont Savings Bank, National Field Representatives, Sturm Ruger, Red River and The City of Claremont. Our common goals include health education, health screenings, worker safety and employment opportunities. |
| Part VI, Line 6: | Valley Regional Hospital is not affiliated with another healthcare system, but it collaborates voluntarily with other hospitals. Sharing resources, both material and human, participating in community groups, providing sponsorships to other non-profits whose missions are aligned, contributing to disaster and international relief efforts, partnering with the American Red Cross for blood drives - all these things represent community benefits. Our physicians and other providers offer free wellness programming at locations throughout the communities we serve - at senior centers, schools, recreation venues.Valley Regional Hospital has entered into a letter of intent for affiliation with Dartmouth-Hitchcock Medical Center. |
| Part VI, Line 7, Reports Filed With States | NH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jeffrey A Hanissian | ||||||||||||||
| Physician | $346,268 | $0 | $10,500 | $0 | $10,632 | $0 | $2,850 | $0 | $36,339 | $0 | $406,589 | $0 | $0 | $0 |
| Jocelyn Caple MD | ||||||||||||||
| Interim President & CEO | $0 | $390,600 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $390,600 | $0 | $0 |
| Joel P Herrington | ||||||||||||||
| Physician | $340,007 | $0 | $10,500 | $0 | $9,801 | $0 | $2,850 | $0 | $26,844 | $0 | $390,002 | $0 | $0 | $0 |
| Charles M Sawyer | ||||||||||||||
| Physician | $360,936 | $0 | $500 | $0 | $1,482 | $0 | $2,850 | $0 | $14,649 | $0 | $380,417 | $0 | $0 | $0 |
| Joshua R Rudner | ||||||||||||||
| Physician | $310,617 | $0 | $10,500 | $0 | $225 | $0 | $2,850 | $0 | $12,388 | $0 | $336,580 | $0 | $0 | $0 |
| Ivar L Frithsen | ||||||||||||||
| Physician | $255,244 | $0 | $18,000 | $0 | $26,266 | $0 | $2,850 | $0 | $13,326 | $0 | $315,686 | $0 | $0 | $0 |
| Juliann Barrett DO | ||||||||||||||
| Trustee | $236,158 | $0 | $10,500 | $0 | $195 | $0 | $2,485 | $0 | $977 | $0 | $250,315 | $0 | $0 | $0 |
| Beverley A Rankin | ||||||||||||||
| CNO | $178,337 | $0 | $6,345 | $0 | $1,089 | $0 | $1,927 | $0 | $31,620 | $0 | $219,318 | $0 | $0 | $0 |
| Jean Shaw | ||||||||||||||
| CFO | $0 | $164,565 | $0 | $10,225 | $0 | $2,989 | $0 | $1,769 | $0 | $36,808 | $0 | $216,356 | $0 | $0 |
| Gailyn Thomas MD | ||||||||||||||
| Trustee | $193,228 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $193,228 | $0 | $0 | $0 |
| Brenda L Slossberg | ||||||||||||||
| Nurse Practitioner | $153,002 | $0 | $20,500 | $0 | $3,539 | $0 | $1,684 | $0 | $11,326 | $0 | $190,051 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Valley Regional Healthcare, Inc., a related organization, establishes the compensation for the Organization's CEO. Valley Regional Healthcare, Inc. uses a variety of resources to establish compensation as follows: 1. Written employment contract 2. Compensation survey/study 3. Approval by the board/compensation committee |
| Part I, Line 7 | Individuals listed with Incentive Bonus amounts are physicians who under their employment agreements/contracts have a provision for Incentive Bonuses based on Quality, Patient Satisfaction and Relative Value Units (RVUs) of services exceeding a target amount. Employees also received bonuses in 2021 for employee retention due to the ongoing pandemic. |
| Form 990, Part VII, line 5: | Jocelyn F. Caple, Interim President & CEO, is paid by Mary Hitchcock Memorial Hospital, an unrelated organization via a professional services agreement. During calendar year 2021, Valley Regional Healthcare paid Mary Hitchcock Memorial Hospital $390,600 for services rendered to Valley Regional Healthcare. The actual compensation paid to Ms. Caple by Mary Hitchcock Memorial Hospital is not known to the Organization. As such, pursuant to the Form 990 instructions, the Organization is reporting the amount paid for services rendered as compensation to Ms. Caple, and is reporting this amount on Form 990, Part VII, Column E. Gailyn Thomas, Trustee, is a contracted physician paid through Mary Hitchcock Memorial Hospital, an unrelated organization, for services rendered to Valley Regional Hospital. During calendar year 2021, Valley Regional Hospital paid Mary Hitchcock Memorial Hospital $193,228 for services rendered to Valley Regional Hospital. The actual compensation paid to Dr. Thomas by Mary Hitchcock Memorial Hospital is not known to the Hospital. As such, pursuant to the Form 990 instructions, the Hospital is reporting the amount paid for services rendered as compensation to Dr. Thomas, and is reporting this amount on Form 990, Part VII, Column D. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is Valley Regional Healthcare, Inc. |
| Form 990, Part VI, Section A, line 7a | The Organization's directors are nominated and elected by the Organization's member at the annual meeting of the Corporation. |
| Form 990, Part VI, Section A, line 7b | The following actions and undertakings involving the business of the Organization are subject to the ratification by the member: adoption of operating budget; adoption of capital budgets; adoption of strategic plans; initiation of significant fund-raising activities; implementation of institutional affiliations, mergers, consolidations or other reorganizations; material modification of service and business offerings; material acquisitions or dispositions of assets; changes in certified public accountants, fiscal year or material accounting practices; incurrence of material indebtedness; material changes in insurance programs and arrangements; material changes in employee benefits plans; adoption of quality improvements plans; election of directors; selection of the president/CEO; amendment of the Organization's bylaws; and amendment of the articles of association. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is reviewed by the CFO and a full copy is shared and reviewed with the CEO and the Finance Committee members. The Finance Committee members are given an opportunity for comment prior to filing. The review is conducted by the CFO. |
| Form 990, Part VI, Section B, line 12c | The Risk & Compliance Office requires annual review of the conflict of interest policy. All Officers, Directors, Trustees, and Key Employees must sign an acknowledgment of the policy and disclose any interests that could give rise to conflicts. The signed forms are held in the following locations: Officers and Trustees - Executive Assistant office Directors and Key Employees - In the Elsevier Human Resources system Contracted Services - within or alongside any contract in the corresponding administration or materials area |
| Form 990, Part VI, Section B, line 15 | The executive committee of the board of trustees convenes two to four times annually to review the compensation of the CEO. Regional compensation of like-sized organizations are used. The amount of compensation shall be reviewed by the D-H independent compensation consultant for purposes of determining compliance with the rebuttable presumption, if necessary. The CEO compensation is tied to the strategic planning goals of the Organization. |
| Form 990, Part VI, Section C, line 19 | The Organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 1,354,883. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,354,883. Purchased Services: Program service expenses 6,661,384. Management and general expenses 2,341,726. Fundraising expenses 0. Total expenses 9,003,110. Other Professional Fees: Program service expenses 1,520,791. Management and general expenses 534,615. Fundraising expenses 0. Total expenses 2,055,406. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Valley Regional Hospital, Inc. 243 Elm Street Claremont, NH 03743 EIN: 02-0222118 Valley Regional Hospital, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Net Loss of Beneficial Interest In Perpetual Trust -655,854. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Valley Regional Healthcare Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 243 Elm Street | AddressLine1Txt |
| City | Claremont | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03743 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020397338 | EIN |
| Primary Activities | Healthcare supporting organization | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12b, II | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|
| Charitable Remainder Trusts (3) | |||
| Charitable Trust | NH | Valley Regional Hospital Inc | Yes (1) |
| (no name) | |||
| 0 | |||
| (no name) | |||
| 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |