2022-08-09T09:13:19-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 020280367 Androscoggin Valley Hospital Inc ANDR 6037522200 59 Page Hill Road Berlin NH 03570 Matthew Streeter CFO 6037522200 2022-08-09 1 Matthew Streeter 999009999 Barbara J McGuan CPA P00219457 2077752387 2022-08-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Michael Peterson 59 Page Hill Road Berlin NH 03570 84411360 0 X www.avhnh.org X 1971 NH Critical Access Hospital 14 13 434 70 0 0 4239469 9128809 58612648 65847300 1400470 1832387 79789 119123 64332376 76927619 627042 588388 0 0 33669496 36379964 0 0 0 27731591 29886900 62028129 66855252 2304247 10072367 91964367 96834885 64503885 56712041 27460482 40122844 Delivering the best healthcare experience for every patient, every day. 0 0 50750588 58160713 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. 235915 296436 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. 6553846 588388 7417484 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. 57540349 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 129 0 1 434 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Matthew Streeter CFO 6033265610 8 Clover Lane Whitefield NH 03598 Donna Goodrich Chair 2.00 1.50 X X 0 0 0 Jay Poulin Vice-Chair 1.00 0.50 X X 0 0 0 Thomas McCue Treasurer 1.00 1.00 X 0 0 0 Martha Laflamme Secretary 10.00 1.00 X X 0 0 0 Sarah Baillargeon Director 1.00 0.00 X 0 0 0 Javier Cardenas MD Director 40.00 0.00 X 459715 0 31982 Alta Chase Director 1.00 1.00 X 0 0 0 Sarah Verney Frechette Director 1.00 0.00 X 0 0 0 Tim Godin Director 1.00 0.00 X 0 0 0 Eric Johnson Director 1.00 0.00 X 0 0 0 Joan Merrill Director 1.00 0.00 X 0 0 0 Jerry Rittenhouse MD Director 1.00 0.00 X 531667 0 0 Daniel Van Buren MD Director 1.00 0.00 X 0 0 0 Tyler White Director 1.00 0.00 X 0 0 0 Max Makaitis Past Treasurer 1.00 1.00 X X 0 0 0 Louise Belanger Past Director 1.00 0.00 X 0 0 0 Randall Labnon Past Director 1.00 0.00 X 0 0 0 Michael Peterson President 40.00 1.50 X 309879 0 31422 Richard Werkowski Interim CFO 31.00 1.00 X 62000 0 0 Brian O'Hearn Chief Nursing Officer 40.00 1.50 X 192644 0 38826 Keith Shute MD Chief Medical Officer 40.00 0.50 X 430588 0 29598 Matthew Streeter CFO 18.00 22.00 X 0 0 0 Mahlon Bradley Physician 40.00 0.00 X 647497 0 7840 Krzysztof Plociennik Physician 40.00 0.00 X 560588 0 30037 Richard Kardell Physician 39.00 1.00 X 376669 0 28697 Norman Kossayda Physician 34.00 0.00 X 374246 0 29372 Elisabeth Moore Physician 5.00 36.00 X 86049 315981 38941 Lucien St Onge Former CFO 0.00 0.00 X 163994 0 7643 4195536 315981 274358 51 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Physician Contract Labor 727017 Weeks Medical Center 173 Middle Street Lancaster NH 03584 Contract Labor 714149 Bhannu Health Care Systems 444 Grafton Street Berlin NH 03570 Hospitalists Contract Labor 632765 New Hampshire Imaging Services Inc One Pillsbury St Ste 200 Concord NH 03301 MRI Purchased Services 552708 Granite State GI Consultants 6 Tsienneto Road Suite 301 Derry NH 03035 Gastro Contract Labor 543246 21 8935542 193267 9128809 Patient Revenue 621400 100139667 100139667 Miscellaneous Revenue 621400 1440437 1161709 278728 Contractual/Char. Adj. 621400 -35732804 -35732804 65847300 454299 454299 91647 0 91647 91647 91647 8846208 137 7468257 0 1377951 137 1378088 1378088 42960 15484 27476 27476 76927619 65568572 0 2230238 X 588388 588388 2118321 1899269 219052 27195148 23440597 3754551 818262 705293 112969 4431425 3819624 611801 1816808 1565981 250827 126823 126823 58015 58015 97721 97721 12546662 10159669 2386993 218376 156058 62318 2156561 1541147 615414 206722 147730 58992 972345 694869 277476 3300 2358 942 11234 8028 3206 206677 206677 2889204 2568516 320688 958542 685005 273537 Medical Supplies 6544077 6544077 Medicaid Enhancement Ta 2690323 2690323 Other Expenses 175642 92064 83578 Gift Shop Expenses 24676 24676 66855252 57540349 9314903 0 X 4458 4243 34260072 30535132 4584675 7037374 870092 944479 1085809 696872 59232734 39355248 19449700 19877486 22025803 26116089 9683758 11623210 91964367 96834885 7749558 6536633 6204644 5344700 57975 8492 50491708 44822216 64503885 56712041 X 27460482 40122844 27460482 40122844 91964367 96834885 10072367 1528528 1061467 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8951 8951 0 Part II-B, Line 1: The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. 198192 198192 25353619 21978277 3375342 359449 359449 0 30394300 15684954 14709346 2927174 1332568 1594606 19877486 Due from Affiliates 619986 Other Receivables 2351592 Deferred Compensation 8636249 Investment in Affiliate 15383 11623210 Deferred Compensation 8636249 Estimated Third Party Payor Settlements 26569650 Medicare Accelerated Payments 9616317 44822216 Golf Tournament 42960 42960 700 4247 6449 1800 2288 42960 42960 700 4247 6449 1800 2288 15484 27476 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 201721 201721 0.00300 201721 201721 0.00300 564757 465537 99220 0.00150 159747 159747 0.00240 13348478 8888580 4459898 0.06670 588388 588388 0.00880 14661370 9354117 5307253 0.07940 14863091 9354117 5508974 0.08240 0 456031 24406719 24355663 51056 X 1 0 1 1 Androscoggin Valley Hospital Inc 59 Page Hill Road Berlin NH 03570 www.avhnh.org 00050 X X X X Androscoggin Valley Hospital 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X www.avhnh.org X 1 18 1 www.avhnh.org 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X www.avhnh.org/about-us/financial-services X www.avhnh.org/about-us/financial-services X www.avhnh.org/about-us/financial-services X X X X X X 1 X 0 X X X 1 X 0 0 Androscoggin Valley Hospital Part V, Section B, Line 5: Key informant surveys were completed by 151 participants in the Androscoggin Valley during the summer of 2019. The participants that completed these surveys include the healthcare officials from communities across Coos and Northern Grafton Counties. Surveys were distributed via email and respondents were from the service area of North Country Healthcare partners and FQHCs.Forty respondents identified themselves as having public health expertise; forty-one indicated they are affiliated with or work for departments/agencies with relevant information/data regarding community serviced by the hospitals; Forty-two identified as being in priority populations; Twenty-three identified as being a representative/member of a chronic disease group/organization; Ninety-nine identified as representing the broad interest of the communities. Androscoggin Valley Hospital Part V, Section B, Line 6a: Androscoggin Valley Hospital, Weeks Medical Center, Upper Connecticut Valley Hospital, Ammonoosuc Community Health Services, and North Country Home Health & Hospice Agency conducted a community survey to fulfill requirements of the Patient Protection and Affordable Care Act (PPACA) that requires not-for-profit hospitals to conduct a community health needs assessment not less frequently than every three years and adopt an implementation strategy to meet the community health needs identified through the assessment. Surveys were distributed via email primarily to service areas of NCH Partners and FQHCs. Androscoggin Valley Hospital Part V, Section B, Line 6b: The Hospital's CHNA was conducted along with Ammonoosuc Community Health Services, Coos County Family Health, and North Country Home Health & Hospice Agency. The first two are local FQHC's. Androscoggin Valley Hospital Part V, Section B, Line 11: The health needs identified by the Community Needs Assessment have been integrated into the design of the Community Health Needs Implementation Strategy. After reviewing current community collaborations, partnerships and internal resources, parties have identified their strengths and weaknesses for the most serious health issues. By stewarding existing resources, strengthening partnerships and creating innovative programs both on the hospital campuses and within the community, involved organizations hopes to make a positive impact on these needs. In addition, the survey identified strategies that would improve the health of the community. AVH has made and continues to devote resources in this direction as we realize that these are key to the health of our community. Please see Implementation Strategy online (www.avhnh.org) for more details. Although AVH recognizes the importance of all needs identified by the community, such as cancer care, dental disease, sexually transmitted disease (STD), HIV/AIDS and suicide, AVH will not directly design strategies for these issues in the implementation plan. These issues did not rank high in the needs assessment and can be addressed by other agencies in our community. However, AVH does employ numerous specialists who can diagnose, treat and/or refer cancer patients appropriately for additional oncology services. Resources are available in the community through Coos County Family Health Services to address STD and HIV/AIDS. AVH highly encourages COVID-19 and flu vaccines for its employees and patients and has an Infection Control Professional on staff to address issues. AVH will continue to keep current on these issues and provide referrals to those in need through its ED and specialty practice as well as through frequent community educational classes and newsletters/electronic media. Affordable health care continues to be addressed on a national and state level. AVH has programs available to facilitate financial counseling, enrollment into Medicaid, application to community (charity) care funds and payment plans. 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. 8 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 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: Patient accounts receivable are carried at the amount management expects to collect from outstanding balances. Patient receivables are periodically evaluated for collectibility based on credit history and current financial condition. Provisions for losses on receivables are determined on the basis of loss experience, known and inherent risks, estimated value of collateral and current economic conditions. The Hospital uses the allowance method to account for uncollectible accounts receivable. In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identified trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and the payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Actual write-offs after management has used reasonable collection efforts are charged against allowance for doubtful accounts. During FY 2021, the Hospital decreased its estimate of the allowance for doubtful accounts from $3,281,467 to $2,248,767. The decrease in the allowance reflected the normalization of accounts receivable as in FY 2019 a reallocation of accounts due to an EMR implementation occurred and the Self-Pay accounts receivable increased by 56%. During FY 2021 and FY 2020, write-offs were $469,529 and $953,194, respectively. The costing methodology used in determining the amounts reported above was a ratio of cost to charge. 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 1 Coos County Family Health Services 133 Pleasant Street Berlin NH 03570 020350051 501(c)(3) 422500 To support otherwise uncompensated costs attributable to the Provision of the combined Coos County Family Health Services practice (CCFHS). These costs are incurred in providing comprehensive, community-based preventive and primary health and dental care, behavioral health services, related enabling services, outreach, health education, and promotion, and appropriate services and programs that promote CCFHS to, and availability of, continuous care for the residents of the Coos County service area. Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 155888 Governor's Commission on Alcohol & Other drugs to support substance abuse prevention, treatment, and recovery efforts. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 501(c)(3) 10000 Bowler-Bartlett Foundation - Mobile Medical Unit. 3 0 Part I, Line 2: 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. The NCH Hospitals elected to participate in an initiative with the Bowler-Bartlett Foundation to purchase a mobile medical until that would be available for use throughout New Hampshire. 0 0 0 0 0 0 0 1 0 Mahlon Bradley Physician 600851 0 25270 0 21376 0 0 0 7840 0 655337 0 0 0 Krzysztof Plociennik Physician 546480 0 12560 0 1548 0 0 0 30037 0 590625 0 0 0 Jerry Rittenhouse MD Director 531667 0 0 0 0 0 0 0 0 0 531667 0 0 0 Javier Cardenas MD Director 427643 0 11860 0 20212 0 0 0 31982 0 491697 0 0 0 Keith Shute MD Chief Medical Officer 393403 0 2650 0 34535 0 0 0 29598 0 460186 0 0 0 Elisabeth Moore Physician 79882 307411 0 8333 6167 237 2599 6067 8722 21553 97370 343601 0 0 Richard Kardell Physician 342966 0 16582 0 17121 0 0 0 28697 0 405366 0 0 0 Norman Kossayda Physician 352243 0 110 0 21893 0 0 0 29372 0 403618 0 0 0 Michael Peterson President 287538 0 110 0 22231 0 0 0 31422 0 341301 0 0 0 Brian O'Hearn Chief Nursing Officer 172219 0 1020 0 19405 0 7725 0 31101 0 231470 0 0 0 Lucien St Onge Former CFO 126523 0 379 0 37092 0 0 0 7643 0 171637 0 0 0 Part I, Line 7 Administrative bonuses are done during the executive's evaluations. Each CEO uses the evaluation and decides upon the appropriate percentage based on their contract. Provider bonuses are done annually per their contract. RVU bonuses are calculated using standard RVU values by CPT codes gathered through the billing process. If the provider meets the threshold set in their contract a bonus is calculated. Good Citizenship Bonus is determined by contract and is paid if a physician meets the criteria set in that contract . Schedule J, Part I Line 3 North Country Healthcare, a related organization, uses the following methods to establish compensation for the top management official of the filing organization: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study - Approval by the board or compensation committee A 2012 New Hampshire Health and Education Facilities Authority Revenue Bonds 020279866 2012-03-29 14500000 Refinancing existing bonds, terminate interest rate swap contract 0 0 0 A 9155300 14500000 125386 14374614 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 1 A 0 Form 990, Part VI, Section A, line 4 During FY21, the Hospital amended its bylaws and the following significant changes were made: 1. The President of the Hospital is no longer able to call a special meeting of the Board. 2. Regarding a quorum - language was amended to reflect the following: "After a quorum has been established at a meeting of the Corporation Board, the subsequent withdrawal of directors from the meeting so as to reduce the number of directors present to fewer than the number required for a quorum shall not affect the validity of any action taken by the Corporation Board at the meeting or any adjournment thereof to the extent a quorum was present at the time such action was taken." 3. Regarding Committees of the Board - language was amended to reflect that other committees of the Board shall be established only in conjunction with the System Parent. 4. Regarding the Executive Committee - language was amended to include the Hospital President on the Committee. 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 In accordance with the Affiliation Agreement with North Country Healthcare, each Hospital's charter and bylaws were amended to effect the establishment of NCH as the sole member and to create a shared governance structure between the Board of Directors of NCH and the Boards of each Hospital. Each Hospital continues to maintain its own Board of Directors (Corporation Board) that is distinct from the NCH Board of Directors. However, the Bylaws of NCH and each Hospital identify certain "Major matters" (divided into organizational and operational matters) that require initiation and/or authorization by a majority of the NCH Board. Members of the Hospital Boards are nominated exclusively by the Hospitals. However, the election of any such director must be approved by both the Hospital Board and the NCH Board. Some examples of other organizational "Major matters" requiring the initiation and/or approval of the NCH Board include amendments to by-laws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major matters" requiring the initiation and/or approval of the NCH Board include approval of annual capital and operating budgets, adoption of compensation and benefit programs, approval of information technology systems, financial systems and auditors, plus approval of any major changes to clinical services offered. The Chief Executive Officer position at each of the Hospitals has been changed to a President position. As with Board members, each Hospital President must be nominated at the Hospital level and then approved by both the Hospital Board and the NCH Board. This position reports to both the applicable Hospital Board and the Chief Executive Officer of NCH. The Chief Financial Officer of NCH also serves as the Chief Financial Officer of each of the affiliates appointed by resolution by the NCH Board and each Affiliate board. The Chief Financial Officer reports to the NCH Chief Executive. Form 990, Part VI, Section A, line 7b See narrative provided for Form 990, Part VI, Line 7a. Form 990, Part VI, Section B, line 11b The current year Form 990 was provided to the Organization's Full Board of Trustees prior to submission. Form 990, Part VI, Section B, line 12c The Vice President, Compliance and Risk Management along with the Controller review on an on-going basis all transactions that could potentially violate our conflict of interest policy. In addition, all Board members and key employees sign a Conflict of Interest Statement each year. The first item on every Board Agenda is "Call to Order, Declaration of Potential Conflicts of Interest." Form 990, Part VI, Section B, line 15 The North Country Healthcare Compensation Committee of the Board of Directors reviews and approves the compensation plans for all affiliate presidents and system executives. The committee utilizes Pearl Meyer, an independent consultant, to provide market data, competitive trends, and strategic advice on executive compensation. Compensation for all other employees, including other officers or key employees, is determined by HR utilizing comparable market data and compensation programs approved by the board of directors in accordance with the corporate bylaws. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents or conflict of interest policy available for public inspection. The Organization does make its financial statements available for public inspection upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,996,957. Management and general expenses 2,207,699. Fundraising expenses 0. Total expenses 7,204,656. Contract Labor: Program service expenses 5,162,712. Management and general expenses 179,294. Fundraising expenses 0. Total expenses 5,342,006. 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 Reconciliation of Net Assets, Line 8 Prior Period Adjustm In 2021, the Hospital adopted Financial Accounting Standards Board (FASB) Accounting Standards Update (ASU) No. 2014-09, Revenue from Contracts with Customers (Topic 606), and related guidance, which supersedes accounting standards that previously existed under GAAP and provides a single revenue model to address revenue recognition to be applied by all companies. Under the new standard, companies recognize revenue when a customer obtains control of promised goods or services in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods and services. ASU No. 2014-09 also requires companies to disclose additional information, including the nature, amount, timing, and uncertainty of revenue and cash flows arising from contracts with customers. The Hospital adopted this ASU for the year ended September 30, 2021 and elected the modified retrospective method; therefore, the consolidated financial statements and related notes have been presented accordingly. Under the modified retrospective method, the cumulative effect of applying the standard was recognized at the date of initial application and resulted in an increase in net net assets without donor restrictions of $1,061,467, recording a increase in beginning patient accounts receivable in the same amount. The effect of adopting Topic 606 changed the timing of when the Hospital recognizes uncollectible patient accounts receivable in full upon the recognition of patient service revenue. Previously, these uncollectible patient accounts receivable were recognized through an estimation process that occurred over a period of months. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I N/A 0 Weeks Medical Center 173 Middle Street Lancaster NH 03584 020222242 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 0 Upper Connecticut Valley Hospital Corliss lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 North Country Healthcare Inc 0 North Country Home Health & Hospice Agency Inc 536 Cottage Street Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 North Country Healthcare Inc 0 Northcare Inc 59 Page Hill Road Berlin NH 03570 521596952 Supporting Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Androscoggin Valley Hospital Foundation 59 Page Hill Road Berlin NH 03570 223035216 Management and Financial Support NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Great Northwoods Community Foundation 59 Page Hill Road Berlin NH 03570 020452547 Healthcare Services NH 501(c)(3) Line 12b, II Androscoggin Valley Hospital Inc 1 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Organization NH 501(c)(3) Line 12a, I Weeks Medical Center 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 Northcare Inc D 518580 FMV