2021-08-12T08:43:52-05:00 2020-09-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2019-10-01 020274905 Rockingham Visiting Nurse Association and Hospice ROCK 6035806695 5 Alumni Drive Exeter NH 03833 Kevin J O'Leary Treasurer 6035806695 2021-08-03 1 Timothy R Hepburn P00182393 8002447444 2021-08-03 2019 2022-09-23 18:48:47Z Kevin J Callahan 5 Alumni Drive Exeter NH 03833 20090270 0 X www.exeterhospital.com/Rockingham-VNA-Hospice X 1996 NH The mission of Rockingham VNA & Hospice, a home health agency, is to assist in improving the health of the community. This mission is principally accomplished through the provision of health services and information to the community. Rockingham VNA & Hospice works to accomplish this mission by promoting well being and independence by providing patient-centered health care services in the comfort of the home and within the communities served. 7 0 216 59 0 0 105659 1421448 19199432 18660712 8509 8110 0 -6961 19313600 20083309 0 0 0 0 15028421 16007402 0 0 0 5130765 4565949 20159186 20573351 -845586 -490042 4995432 4894203 2911555 3282798 2083877 1611405 X The mission of Rockingham VNA & Hospice, a home health agency, is to assist in improving the health of the community. This mission is principally accomplished through the provision of health services and information to the community. Rockingham VNA & Hospice works to accomplish this mission by promoting well being and independence by providing patient-centered health care services in the comfort of the home and within the communities served. 0 0 18064335 0 18660712 Rockingham VNA & Hospice's Home Care Program provides comprehensive skilled services to the adult population. The goal of these services is to improve the health and independence of the patients we serve. Our services include Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Social Work services, Home Health Aide, Dietician, IV Specialist, Wound/Ostomy Specialist, Certified Diabetes Educator, Lymphedema Specialist and a Palliative Care Program. Rockingham VNA and Hospice provided 68,701 visits to 3,417 Home Care patients during fiscal year 2020, and also incurred $542 in costs to provide charity care to patients throughout the communities served. Rockingham VNA & Hospice's Hospice Program provides a comprehensive, medically directed, team oriented program of care. The essential components include care of the patient and family as one unit, pain and symptom management, 24 hour on-call availability, medical and nursing care, Home Health Aide, Social Work services, Bereavement and Spiritual care, Volunteers, Rehab services, and coordination of medications, medical supplies, and durable medical equipment. Rockingham VNA & Hospice provided 21,239 visits to 383 patients who received 34,005 days of patient care during fiscal year 2020. Rockingham VNA & Hospice's Community Outreach Program is dedicated to assisting in improving the health of the communities served through offering a variety of wellness clinics and educational opportunities. Community programs include Community Foot Clinics, Diabetes Support Groups, and Health Education Programs. In fiscal year 2020, RVNA & Hospice supported its mission by providing $252,322 in community outreach, benefits and financial support to the community which excludes $538,892 in uncovered Medicaid expenses. 18064335 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 216 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Kevin J O'Leary 6035806695 5 Alumni Drive Exeter NH 03833 X Kevin J O'Leary Treasurer/Trustee, Ex-Officio 1.00 44.00 X X 0 1665025 28511 Kevin J Callahan Chairman/Trustee, Ex-Officio 1.00 44.00 X X 0 1192824 28511 Neil Meehan DO Trustee 1.00 40.00 X 0 630893 43614 Susan Burns-Tisdale Secretary/Trustee (end 3/20) 1.00 40.30 X X 0 478286 37586 Eliot DeSilva MD Trustee (end 3/20) 1.00 40.00 X 0 331463 34750 Donna McKinney Secretary/Trustee (as of 4/20) 1.00 40.00 X X 0 322853 36514 Darren Guy DO Trustee (as of 4/20) 1.00 40.00 X 0 231539 41057 Jennifer Costain Trustee 1.00 40.00 X 0 208876 32728 Karen Michel President/Trustee 40.00 0.00 X X 191753 0 13294 Mary Arnault Finance Director 40.00 0.00 X 127945 0 22523 Sherry Ovens Burleigh Clinical Manager 40.00 0.00 X 144134 0 3128 Frank Orifici Physical Therapist 40.00 0.00 X 105088 0 28847 Bridgette Martel Clinical Director (end 8/19) 40.00 0.00 X 109010 0 18617 Diane Levasseur Clinical Manager 40.00 0.00 X 111270 0 11356 789200 5061759 381036 8 0 1 0 Exeter Hospital Inc 5 Alumni Drive Exeter NH 03833 Support Services 546121 Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 Administrative Management Fees 535617 Core Physicians LLC 5 Alumni Drive Exeter NH 03833 Physician Services 321038 Berry Dunn McNeil & Parker LLC 1000 Elm Street 4th FLoor Manchester NH 03101 Coding and Audit Services 265668 McBee Associates Inc 14 Penn Plaza Suite 2110 New York NY 10122 Outside Services 215235 8 28161 1292726 100561 1421448 Net Patient Services 621610 18660712 18660712 18660712 8110 8110 0 28161 6961 -6961 -6961 20083309 18660712 0 1149 205047 205047 12611969 11446317 1165652 155487 142460 13027 2133019 1915312 217707 901880 806266 95614 37689 37689 1666001 1065587 600414 2212 1381 831 330005 289712 40293 19027 16704 2323 128260 112600 15660 381955 362787 19168 98372 88289 10083 36066 31663 4403 Medical Supplies 924748 924748 Other Supplies 672344 591239 81105 Medical Fees 273739 273739 Bad Debt Recovery -4469 -4469 20573351 18064335 2509016 0 1761795 1529418 2309215 2509211 62256 71636 3097456 2797730 398098 299726 464068 484212 4995432 4894203 1932109 2584736 666584 380102 312862 317960 2911555 3282798 X 1586001 1118737 497876 492668 2083877 1611405 4995432 4894203 -490042 17570 0 X X 0 1 X 1 0 X 141336 48126 67135 105659 1421448 1783704 16380834 16975309 18523565 19199432 18660712 89739852 16522170 17023435 18590700 19305091 20082160 91523556 949158 949158 0 949158 949158 90574398 6858 7870 7447 8509 8110 38794 6858 7870 7447 8509 8110 38794 16529028 17031305 18598147 19313600 20090270 91562350 0.98920 0.99950 0.00040 0.00050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2634 2634 0 Part II-B, Line 1: A portion of Home Care Association of New Hampshire and NHPCO dues are considered lobbying expenses. For the fiscal year ending September 30, 2020, the amounts deemed lobbying were $2,537 and $97, respectively. 497876 6455 17570 29234 492667 446562 37790 21625 8101 497876 415065 6017 31126 5646 446562 382083 8461 29234 4713 415065 369670 12413 382083 0.02240 0.97760 1 0 660442 419323 241119 300695 300695 0 2136319 2077712 58607 299726 Beneficial Interest in Trusts 484212 484212 Due to Affiliates 317960 317960 X 20107840 17570 6961 24531 20083309 0 20083309 20580312 6961 6961 20573351 0 20573351 Part V, Line 4: Endowment funds are held by the Town of Derry, New Hampshire. The income earned from the funds is used to fund the organization's operations. The quasi-endowments are funds which have been donated to the organization for a purpose specified by the donor. These funds are held until used for the purpose intended by the donor. Part X, Line 2: The Association is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Association is exempt from state and federal income taxes on income earned in accordance with its tax-exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Association's tax positions and concluded that the Association has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. Part XI, Line 2d - Other Adjustments: Fundraising Event Expenses 6,961. Part XII, Line 2d - Other Adjustments: Fundraising Event Expenses 6,961. Home is Where the Heart Is 28161 28161 1077 300 5584 28161 28161 1077 300 5584 6961 -6961 Schedule G, Part II, Fundraising Events: Part II(a), Home is Where the Heart is In accordance with IRS instructions for the reporting of income on Schedule G, event revenue deemed to be charitable contributions has been reported on line 2, thus reducing the total gross event income on line 3. This presentation gives the appearance on Schedule G of a loss from the event. However, when the charitable contributions are considered and added back, this event had a profit of $21,200. X 1 1 0 0 0 0 0 1 0 Kevin J O'Leary Treasurer/Trustee, Ex-Officio 0 438060 0 192640 0 1034325 0 8400 0 20111 0 1693536 0 748000 Kevin J Callahan Chairman/Trustee, Ex-Officio 0 675611 0 435000 0 82213 0 8400 0 20111 0 1221335 0 0 Neil Meehan DO Trustee 0 410858 0 205052 0 14983 0 16800 0 26814 0 674507 0 0 Susan Burns-Tisdale Secretary/Trustee (end 3/20) 0 297398 0 158615 0 22273 0 16800 0 20786 0 515872 0 0 Eliot DeSilva MD Trustee (end 3/20) 0 302237 0 28851 0 375 0 8400 0 26350 0 366213 0 0 Donna McKinney Secretary/Trustee (as of 4/20) 0 258867 0 51510 0 12476 0 16800 0 19714 0 359367 0 0 Darren Guy DO Trustee (as of 4/20) 0 209455 0 21699 0 385 0 14345 0 26712 0 272596 0 0 Jennifer Costain Trustee 0 189323 0 14660 0 4893 0 12901 0 19827 0 241604 0 0 Karen Michel President/Trustee 166498 0 24233 0 1022 0 3867 0 9427 0 205047 0 0 0 Mary Arnault Finance Director 122239 0 5283 0 423 0 2630 0 19893 0 150468 0 0 0 Part I, Lines 4a-b Bridgette Martel received severance payments totaling $30,000 during calendar year 2019. The organization's parent (Exeter Health Resources, Inc.) maintains a split dollar supplemental retirement plan for two executives (listed below with amounts) selected by the Exeter Health Resources, Inc. Board of Trustees. The plan is closed to future participants. The Plan provides for annual payments of premiums for life insurance policies insuring the listed individuals. Those life insurance premiums are collaterally assigned to the corporation and any excess accumulated value in the policies (net of accumulated premium payments which are returned to the organization upon the executive attaining the age of 70 or at the death of the participant) is available to be paid to the participant once vested at age 62 and upon retirement from the organization. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance provided. Life insurance premium payments during tax year: Kevin J. Callahan $313,421 Kevin J. O'Leary $136,191 Excess Accumulated Value: Kevin J. Callahan $3,506,002 Kevin J. O'Leary $1,448,487 Certain of the listed employees participate in a nonqualified deferred compensation plan as described in Internal Revenue Code Section 457(f) sponsored by Exeter Health Resources, Inc. In the calendar year ended December 31, 2019, the contribution to the plan for the vested benefit of Kevin J. O'Leary was $68,000. The contribution is intended to provide a forfeitable supplemental retirement benefit. Participants in the 457(f) plan do not vest until age 62 when it is payable to the participant. During the calendar year ended December 31, 2019, Kevin O'Leary reached the age of 62 and received $1,002,727 payment from the 457(f) plan, which includes $748,000 of contributions reported on Form 990, Part VII-A and Schedule J, Part II, Column (C) in prior years. Part I, Line 7 Karen Michel, Sherry Ovens Burleigh, Mary Arnault, Bridgette Martel and Diane Levasseur are also provided incentive bonus payments under a plan aligned with the strategic interests of RVNA. These incentive awards are approved by operating management and Human Resources. Form 990, Part VI, Section A, line 6 Exeter Health Resources, Inc., a charitable organization acting through its Board of Trustees, is the sole member of the organization. Form 990, Part VI, Section A, line 7a Exeter Health Resources, Inc. as sole member elects five (5) persons to the Board of Trustees of Rockingham VNA & Hospice, which also includes two (2) of its officers who serve as ex-officio Trustees (with vote). Form 990, Part VI, Section A, line 7b As sole member, Exeter Health Resources, Inc. has certain reserved rights as reflected in the bylaws of the organization. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an outside tax accountant with information provided by the organization. The Form 990 is reviewed by the organization's Treasurer and then presented to the Board of Trustees before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The Board of Trustees has adopted a Conflict of Interest Policy that requires the disclosure of conflicts of interest either when the interest becomes a matter of possible action by the Board or during an annual disclosure process. Trustees, officers, and key employees, as well as all members of senior management, are part of the annual disclosure process, which is initiated by the issuance of a memorandum and accompanying questionnaire by the President of the Member (i.e., Exeter Health Resources, Inc.). All disclosures are reviewed. Any trustee with a conflict of interest is required to abstain from voting and is not included in a quorum determination on the matter and any officer, key employee, or member of senior management with a conflict does not take part in making and is not present for any decision regarding the matter. The policy is monitored and enforced by both the President and the full Board. A separate organizational policy requires all employees to disclose any conflict of interest in writing upon hire. Thereafter, on an annual basis, all employees and contracted staff must make a full and complete disclosure in writing of any conflict of interest, conflict of commitment, and/or personal interest. Employees are otherwise required to make any further written disclosure at the time such conflict arises. This policy is monitored and enforced by the Department of Human Resources, as well as the agency's Executive Director and Compliance Officer. Any conflict of interest is managed under this policy by disclosure, recusal, or divestiture of the interest. Form 990, Part VI, Section B, line 15 The organization's parent (Exeter Health Resources, Inc.) has a formal process for determining total compensation for the Chairman of Rockingham Visiting Nurse Association and Hospice (RVNA&H) and other listed officers that is intended to provide reasonable compensation for achieving the organization's mission, to recognize individual and team performance and to comply with the organization's obligations as a tax-exempt charitable organization. The Executive Committee of the Exeter Health Resources, Inc.'s Board of Trustees conducts an annual review of the compensation of the Chairman of RVNA&H and other listed officers. In doing so, the committee retains a qualified independent compensation consultant to conduct competitive market analysis of the market ranges of base, incentive, and total cash compensation, and to provide advice concerning the reasonableness of the compensation of the Chairman and other listed officers. The Committee utilizes that analysis and other appropriate information in connection with its annual review and makes recommendations to the full Board of Exeter Health Resources, Inc. for adjustment of the Chairman's compensation and the compensation for other listed officers. Information which the Committee may consider can include but is not limited to the performance of an individual and/or that individual's contributions to a team, the performance of the organization in whole and in part, the elements of total compensation and salary history, the organization's compensation targets and comparability data, including the data prepared by the independent consultant and reviewed with the Committee. The Committee incorporates a performance appraisal process in the Chairman's and the other listed officers' compensation review. The Chairman and other listed officers are not present when the committee discusses their respective compensation. In addition, the Committee determines if the threshold requirements for incentive awards are met, consisting of the organization's performance results for quality, operating system excellence and financial performance. The results of the committee's deliberations are presented to the Exeter Health Resources, Inc. Board and include recommendations concerning salary range adjustments and incentive awards and the basis for the committee's decisions/recommendations. The deliberations of the Exeter Health Resources, Inc. Board are conducted in executive session with the independent members of the Board but do include the Chairman only for that period of time in which the Exeter Health Resources, Inc. Board has questions concerning the performance of any listed officer other than the Chairman. The Exeter Health Resources, Inc. Board reviews the Chairman's performance and determines if the adjustments and awards recommended by the committee for the Chairman are in the organization's best interest and for the benefit of the organization and the parent organization. For the other listed officer positions, adjustments and incentive awards are approved upon recommendation of the Chairman by the Executive Committee within the Exeter Health Resources, Inc. Board approved parameters and ratified by the Exeter Health Resources, Inc. Board of Trustees. For the Executive Director of Rockingham Visiting Nurse Association and Hospice, compensation is determined by consulting with the organization's parent Human Resources department. Comparison compensation surveys and external benchmarks are used in the process. Form 990, Part VI, Section C, line 19 The documents are available upon request. Part VII, Section A, Line 1: Kevin J. Callahan, Kevin J. O'Leary and Susan Burns-Tisdale, who serve as officers of Rockingham Visiting Nurse Association and Hospice, are compensated by a related organization, Exeter Health Resources, Inc. Their compensation is based on their roles as CEO, CFO and Senior Vice President of Clinical Operations, respectively, of the consolidated Exeter Health Resources, Inc. system. Donna McKinney who also serves as an officer is compensated by Exeter Hospital, Inc., a related organization, for her role as Vice President. Form 990, Part XII, Line 2c: The audit process has not changed since the prior year. Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 020222126 Management and Supporting Organization; Holding Company NH 501(c)(3) Line 12a, I N/A 0 Exeter Hospital Inc 5 Alumni Drive Exeter NH 03833 222674014 Hospital NH 501(c)(3) Line 3 Exeter Health Resources Inc 0 Core Physicians LLC 5 Alumni Drive Exeter NH 03833 870807914 Physician Practices NH 501(c)(3) Line 10 Exeter Health Resources Inc 0 Matrix Health Inc 5 Alumni Drive Exeter NH 03833 020473737 Manage Resources NH 501(c)(3) Line 12b, II Exeter Health Resources Inc 0 Exeter Med Real Inc 5 Alumni Drive Exeter NH 03833 020418718 Real Estate Holding NH 501(c)(25) Exeter Health Resources Inc 0 Exeter Health Resources Inc Self-Insurance Trust 5 Alumni Drive Exeter NH 03833 200753662 Self Insurance Trust NH 501(c)(3) Line 12a, I Exeter Health Resources Inc 0 Core Health Services of MA 5 Alumni Drive Exeter NH 03833 201598042 Inactive Physician Practice MA N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0