2025-08-12T09:06:33-05:00 2024-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2023-10-01 020222118 Valley Regional Hospital Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Celeste Pitts Interim CFO 6035427771 2025-08-11 1 1 Melissa Magoon CPA P01712842 2077752387 2025-08-11 2023 2025-03-06 01:10:19Z Matthew Foster MD MMM 243 Elm Street Claremont NH 03743 72804236 0 X www.vrh.org X 1893 NH Critical Access Hospital 20 13 447 20 0 0 481992 382904 63971940 68289077 964141 1472715 13727 -2488 65431800 70142208 0 0 0 0 28728130 30201269 0 0 0 33322142 34238267 62050272 64439536 3381528 5702672 72533242 76525625 24129421 17178105 48403821 59347520 X 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. 0 0 54510507 68289077 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, 2024, charges forgone for services and supplies furnished under the charity care policy were approximately $803,000. The estimated cost of those services and supplies was approximately $538,000.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. 54510507 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 64 0 1 447 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 13 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X Celeste Pitts 6035427771 243 Elm Street Claremont NH 03743 John Tansey Chair 0.90 0.10 X X 0 0 0 Patricia Putnam Vice Chair 0.90 0.10 X X 0 0 0 Alan Keiller Treasurer 0.90 0.10 X X 0 0 0 Terri Decker Secretary 0.90 0.10 X X 0 0 0 Juliann Barrett DO CMO 39.90 0.10 X 314490 0 6896 Pamela Brown Trustee 0.90 0.00 X 0 0 0 Eric Crainich Trustee 0.90 0.00 X 0 0 0 Michael Fuerst Trustee 0.90 0.00 X 0 0 0 John Gilman Trustee 0.90 0.00 X 0 0 0 Matthew Houde Trustee 0.90 39.10 X 0 285002 60242 Deanna Howard Trustee 0.90 0.00 X 0 0 0 Bryan Huot Trustee 0.90 0.00 X 0 0 0 Patrick Jordan Trustee 0.90 39.10 X 0 979872 71266 William Palmer MD Trustee 0.90 39.10 X 0 139980 415 Lisa Richmond Trustee 0.90 0.00 X 0 0 0 Samuel Shields Jr Trustee 0.90 39.10 X 0 358191 27595 Tom Sullivan Trustee 0.90 0.00 X 0 0 0 Steven Surgenor Trustee 0.90 39.10 X 0 496952 72787 Carol Vivian Trustee 0.90 0.00 X 0 0 0 James Borchert Past Trustee 0.90 0.00 X 0 0 0 Scott Bouranis Past Trustee 0.90 0.00 X 0 0 0 Vincent Fusca III Past Trustee 0.90 0.00 X 0 0 0 Katherine Lajoie Past Trustee 0.90 0.00 X 0 0 0 Alex Scott Past Trustee 0.90 0.00 X 3707 0 0 Jocelyn Caple MD Interim President & CEO 39.00 1.00 X X 0 301934 58356 Celeste Pitts Interim CFO 39.00 1.00 X 0 37200 0 Joshua Rudner Past ER Physician/CMO 40.00 0.00 X 335822 0 16239 Jeffrey A Hanissian Past Physician 40.00 0.00 X 406429 0 45478 Whitney F Hilton Orthopedist 40.00 0.00 X 348013 0 30151 Charles M Sawyer Past Physician 40.00 0.00 X 338802 0 20834 Joel P Herrington Past Physician 40.00 0.00 X 328232 0 33299 Fernanda Magalhaes De Melo Manara M Physician 40.00 0.00 X 292831 0 36691 Jean Shaw Former CFO 0.00 0.00 X 0 173716 29246 2368326 2772847 509495 56 1 1 1 American Healthcare Services Association PO Box 670529 Dallas TX 752670529 Contracted Staffing 3766301 HMS Holdings LLC PO Box 660 Exeter NH 03833 Contracted Staffing 1811728 Dartmouth Hitchcock One Medical Center Drive Lebanon NH 03756 Medical Services 1723931 EM Staff PO Box 540 Exeter NH 038330540 Contracted Staffing 1026517 Jackson & Coker Locumtenens LLC PO Box 277638 Atlanta GA 303847638 Contracted Staffing 446146 12 382904 382904 Patient Service Revenue 621400 96108318 96108318 Medicaid DSH Revenue 621400 4319097 4319097 Other Revenue 621400 995839 824013 171826 Charity/Contractual Adjustment 621400 -33134177 -33134177 68289077 1463216 1463216 11776 14264 -2488 -2488 -2488 2655948 1315 2634138 13626 21810 -12311 9499 9499 70142208 68117251 0 1642053 X 677154 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13602 13602 0 Part II-B, Line 1: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 7171456 1553432 8724888 6314371 941032 83947 7171456 7279159 -891253 73535 6314371 6058402 1287893 67136 7279159 5895100 163302 6058402 0.00000 0.74546 0.25454 0 0 250667 250667 581904 334196 247708 3733490 775399 2958091 5724389 2808458 2915931 4568838 10611 4558227 10930624 Beneficial Interest in Perpetual Trusts 6250147 F 6250147 Due To Affiliates 3036 Estimated Third-Party Payor Settlements 6988058 Reserve for Self-Funded Insurance 886736 Lease Liabilities 1834289 9712119 Part V, Line 4: The Organization uses its endowment funds in support of health care services, purchases of equipment, health education, and indigent care. 1 1 X 1 X 1 X 275.000000000000 1 1 1 0 1 1 697 474313 474313 0.00740 697 474313 474313 0.00740 2463 834965 834965 0.01300 20 235244 235244 0.00370 11390 11390 0.00020 2483 1081599 1081599 0.01690 3180 1555912 1555912 0.02430 475 475 0.00000 69321 69321 0.00110 1055 1055 0.00000 212 212 0.00000 5066 5066 0.00010 8705 8705 0.00010 21621 21621 0.00030 106455 106455 0.00160 1 0 0 22033663 28268140 -6234477 X 1 1 1 1 Valley Regional Hospital Inc 243 Elm Street Claremont NH 03743 www.vrh.org 00007 X X X X Valley Regional Hospital Inc 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X https://vrh.org/public-reports/ X X 1 23 1 https://vrh.org/public-reports/ 0 1 X 200.000000000000 275.000000000000 X X X X 1 1 X X X 1 X https://vrh.org/patients-visitors/patient-billing/financial-assistance/ X https://vrh.org/patients-visitors/patient-billing/financial-assistance/ X https://vrh.org/patients-visitors/patient-billing/financial-assistance/ X X X X X 1 X 0 X 1 X 0 0 Valley Regional Hospital, Inc. Part V, Section B, Line 5: During the period February through July 2024, 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 Health, Mt. Ascutney Hospital and Health Center, Cheshire Medical Center and Visiting Nurse and Hospice for Vermont.Information gathering utilized in the assessment included the following:1. Surveys received from 479 community residents from all 15 towns, made available on-line and paper surveys placed in numerous locations throughout the region;2. Series of 4 community discussion groups;3. Summary information associated with over 2,000 primary care patient assessments, collected from 2021-2023, identifying gaps in social determinants of health, which could impact medical health outcomes. 4. Direct email survey with 206 responding stakeholders and community leaders representing multiple community sectors, including, but not limited to, Human Services, Mental Health, Public Health, State & Local Government, Advocates for racial & social justice and members of the business community. 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 Center - Cheshire Medical 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 VermontThere 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 via hard copy mailings, website, social media links, paper copy handouts at community meetings, as well as distributed through our 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. Please refer to the CHIP-2025 on our website for further details.1. Availability of primary care and medical sub-specialty servicesa. VRH will increase its team of primary care providers to address the availability of appointments for community membersb. Patients will be made aware of new providers and health savings options in a timely mannerc. Establish sub-specialty services to bridge gaps in care2. Availability of Mental Health Servicesa. VRH will enhance their primary care staff with providers who specialize in the care of patients with mental health challenges.b. VRH will utilize collaborations with local mental health programs and providers to assist with the referral process and provide on-site care when appropriate.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 areas of life that may be contributing to a decline in health.d. VRH staff will complete training opportunities to enhance compassionate treatment and care for patients entering VRH service areas.e. Investigate the integration of an Emergency Department Social Worker who will provide brief mental health counseling to assess emergency needsf. VRH will collaborate with DH Outpatient substance use disorder clinic to establish a site and services on the VRH campus3. Cost of Health Care Services, including medications, affordability of health insurancea. VRH will review and adjust its Financial Assistance guidelines to provide greater opportunity for patients to access healthcare servicesb. 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.c. Indigent patients will be provided with information about VRH's Medication Assistance Program, providing discounted or free medications from pharmaceutical companies. 4. Services for older adults including opportunities for social interactions and support for aging in placea. Support older adults with education and completion of Advance Directivesb. Support older adults aging in place and establish a payor source for long term care when they can no longer remain at homec. Support older adults with obtaining necessary durable medical equipment to support their decisions to age in placed. Provide an opportunity for socialization and health education for aging in place seniorse. Obtain current information about community organizations, new programs and services, as well as key contacts to provide assistance to patients 65 and older, especially those choosing to age in place5. Availability and affordability of dental servicesa. Providers will have up-to-date information of services and referrals options to provide patientsb. Address acute conditions with treatment and referralsc. Support Sullivan Oral Health Collaborative with senior team member board participationd. Provide credible sources of financial assistance for community members on a fixed income, with urgent dental needs6. Health and human service workforce shortages and challenges navigating the health care systema. Decrease onboarding wait time of new healthcare workers moving into the community and starting work at VRHb. Increase the opportunities for high school students to investigate health care careersc. Provide opportunities for clinical rotation skill building for students attending area colleges and trade schools7. Social drivers of health and well-being such as affordable access to housing, healthy foods and affordable childcarea. Enhance the collaboration and communication between in-patient and primary care for patients positive for screens for Social Determinants of Healthb. Patients will be referred to community organizations and resources, as well as given assistance in completing necessary applications by the Community Health team & Inpatient Case Managementc. Provide up-to-date information to the key patient providers of community resourcesd. Provide primary care patients a resource for fruit and veggie purchases when indicating a positive food insecurity on the patient assessment forme. Provide skill building opportunities to learn healthy meal preparation on limited budgets for patients and families with identified food insecurity challengesf. Obtain current information about community organizations, new programs and services, as well as key contacts to provide assistance to individuals and families in need Valley Regional Hospital, Inc. Part V, Section B, Line 20e: Applications are offered to all self-pay patients along with education regarding Medicaid. 1 1 - Kane Oncology Center 243 Elm Street Claremont NH 03743 Oncology Center 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 page 17 of the attached audited financial statements. Part III, Line 8: Medicare costs approximate Medicare revenue. Any shortfalls should be considered community benefits. 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, retirement, disability), in which case approval is for 1 year from the date of signature.2. Patient qualifies according to the established Financial Assistance income guidelines.3. 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 primary care and medical sub-specialty services2. Availability of Mental Health Services 3. Cost of Health Care Services, Including Medications, Affordability of Health Insurance 4. Services for older adults including opportunities for social interaction and supports for aging in place5. Availability and Affordability of Dental Care Services6. Health and human service workforce shortages and challenges navigating the health care system 7. Social drivers of health and well-being, such as housing affordability, access to healthy foods and affordable childcare 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 43,356. Spanning 552 square miles, the County is the 2nd least populated in NH. 11.7% of all people and 13% of the children in the VRH service area live below 100% of the Federal Poverty level. 8.5% of our seniors live below the FPL. Housing costs in the VRH service area are higher than the rest of New Hampshire when compared to being greater than 30% of household income. Community members of all ages have at least one form of disability, with 4% under the age of 18; 13.5% between age 18 and 64; and 26.1% 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: Effective 7/31/24, Valley Regional Hospital became a member of the Dartmouth-Hitchock Health system. This affiliation has allowed the sharing of resources, both material and human and is a significant opportunity for a broader availability of services and educational opportunities for our staff. This trickles down to the community we serve. In addition, Valley participates in community groups, providing sponsorships to other non-profits whose missions are aligned, contributing to disaster and international relief efforts and partnering with the American Red Cross for blood drives. Our physicians and other providers offer free wellness programming at locations throughout the communities we serve - at senior centers, schools, recreation venues. Part VI, Line 7, Reports Filed With States NH 0 0 0 0 0 0 0 1 0 Patrick Jordan Trustee 0 777017 0 140000 0 62855 0 31590 0 39676 0 1051138 0 0 Steven Surgenor Trustee 0 473066 0 0 0 23886 0 31590 0 41197 0 569739 0 0 Jeffrey A Hanissian Past Physician 376614 0 20000 0 9815 0 5386 0 40092 0 451907 0 0 0 Samuel Shields Jr Trustee 0 313919 0 37800 0 6472 0 24990 0 2605 0 385786 0 0 Whitney F Hilton Orthopedist 347797 0 0 0 216 0 7419 0 22732 0 378164 0 0 0 Joel P Herrington Past Physician 311202 0 10000 0 7030 0 4881 0 28418 0 361531 0 0 0 Jocelyn Caple MD Interim President & CEO 0 285889 0 0 0 16045 0 18810 0 39546 0 360290 0 0 Charles M Sawyer Past Physician 320367 0 10000 0 8435 0 6665 0 14169 0 359636 0 0 0 Joshua Rudner Past ER Physician/CMO 315640 0 20000 0 182 0 2576 0 13663 0 352061 0 0 0 Matthew Houde Trustee 0 248195 0 26000 0 10807 0 21590 0 38652 0 345244 0 0 Fernanda Magalhaes De Melo Manara M Physician 259791 0 30000 0 3040 0 0 0 36691 0 329522 0 0 0 Juliann Barrett DO CMO 275834 0 15506 0 23150 0 6009 0 887 0 321386 0 0 0 Jean Shaw Former CFO 0 173400 0 0 0 316 0 3126 0 26120 0 202962 0 0 Celeste Pitts Interim CFO 0 37200 0 0 0 0 0 0 0 0 0 37200 0 0 Part I, Line 3 The CEO's compensation amount is determined by a related organization, which uses a compensation committee, an independent consultant, and a compensation committee to estiblish the CEO's compensation. 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 Form 990, Part VII, line 5: Jocelyn F. Caple, Interim President & CEO, is paid by Mary Hitchcock Memorial Hospital, which was an unrelated organization until 7/31/2024, via a professional services agreement. During calendar year 2023, Valley Regional Healthcare paid Mary Hitchcock Memorial Hospital $396,945 for services rendered to Valley Regional Healthcare. Effective 7/31/2024, Dartmouth Hitchcock Health became the sole member of Valley Regional Healthcare and MHMH became a related organization to Valley Regional Hospital. Pursuant to the instructions Ms. Caple's 2023 calendar year wages and benefits as paid by MHMH are reported as related organization compensation on Part VII and Schedule J. Celeste Pitts, Interim CFO, is paid by Helms & Co., an unrelated organization via a professional agreement. During calendar year 2023, Valley Regional Healthcare paid Helms & Co. $37,200 for services rendered to Valley Regional Healthcare. The actual compensation paid to Ms. Pitts by Helms & Co. 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. Pitts, and is reporting this amount on Form 990, Part VII, Column E. Form 990, Part VI, Section A, line 3 Celeste Pitts serves as the Interim Chief Financial Officer and is compensated by Helms & Co., an independent management company engaged by the organization. Ms. Pitts performs certain financial and management functions under the supervision of the board of directors. Form 990, Part VI, Section A, line 4 Effective 7/31/24 Dartmouth-Hitchcock Health (DHH) became the sole member of Valley Regional Health Care, who is the sole member of the organization. DHH now has the right to appoint up to one third of the Hospital Board, and has reserve powers that include approval of Board of Trustee (BOT) actions. The DHH CEO or designee is now a member of the BOT Executive committee. The CEO of the organization now reports to the BOT and the DHH CEO or designee. Form 990, Part VI, Section A, line 6 The sole member of the Organization is Valley Regional Healthcare, Inc. Effective 7/31/2024 the sole member of Valley Regional Healthcare, Inc. is Dartmouth-Hitchcock Health. Form 990, Part VI, Section A, line 7a The Organization's trustees are nominated and elected by the Organization's member at the annual meeting of the Corporation. Effective 7/31/2024, the Member's member, Dartmouth-Hitchcock Health, has the right to appoint up to one-third of the directors of the board. 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. The member, acting solely at the direction, or upon approval of Dartmouth-Hitchcock Health will have the right to initiate the following actions: Removal of Trustees, hiring, evaluating, compensating and termination of the CEO, participation in system programs and initiatives and strategies, changes in clinical services, reallocation of Dartmouth-Hitchcock Health system resources and allocation of the corporations share of system expenses. 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 4,091,471. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,091,471. Purchased Services: Program service expenses 7,702,133. Management and general expenses 2,702,070. Fundraising expenses 0. Total expenses 10,404,203. Other Professional Fees: Program service expenses 0. Management and general expenses 591,006. Fundraising expenses 0. Total expenses 591,006. 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 Gain of Beneficial Interest In Perpetual Trust 1,102,496. Business Combination - Fair Value Adjustment -343,539. Form 990, Part XI, Line 9: Other Changes in Net Assets The business combination was accounted for using the acquisition method of accounting. DHH has chosen to push-down the fair value adjustment of $2,901,000 related to the identifiable assets and liabilities, which consisted of land, buildings, and equipment of the Organization. The $343,539 represents the adjustment portion for Valley Regional Hospital, Inc. Valley Regional Healthcare Inc 243 Elm Street Claremont NH 03743 020397338 Healthcare supporting organization NH 501(c)(3) Line 12b, II Dartmouth-Hitchcock Health 0 Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 020222791 Hospital NH 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Organization NH 501(c)(3) Line 7 N/A 0 Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Physician Services NH 501(c)(3) Line 10 Dartmouth-Hitchcock Health 0 Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 The New London Hospital Association Inc 273 County Road New London NH 03257 020222171 Hospital NH 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 Windsor Hospital Corporation 289 Country Road Windsor VT 05089 030183721 Hospital VT 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 Cheshire Medical Center 580 Court Street Keene NH 03431 020354549 Hospital NH 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 Visiting Nurse Association and Hospice of VT & NH Inc 88 Prospect Street White River Junction VT 05001 036006494 Healthcare VT 501(c)(3) Line 10 Dartmouth-Hitchcock Health 0 Southwestern Vermont Health Care Corporation 100 Hospital Drive Bennington VT 05201 030179435 Hospital VT 501(c)(3) Line 3 Dartmouth-Hitchcock Health 0 Charitable Remainder Trusts (3) Charitable Trust NH Valley Regional Hospital Inc 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0