UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION (EIN 02-0276210)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-12
- IRS object ID
- 202002259349301530
- Schema version
- 2018v3.1
- 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 I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-12T11:49:53-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | 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 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020276210 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UPPE | BusinessNameControlTxt |
| Phone | 6032374971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 181 Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Celeste Pitts | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6032374971 | PhoneNum |
| Signature | 2020-03-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne CPA | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2020-03-17 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.49.157.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-03-17 | IPDt |
| IP Tm | 08:54:01 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E262D3C9A45A77A46A0A2832CF74466488750570 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | FD764483AA263AFE8AB46477EA327BFBBE809DCF | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-09-23 17:36:50Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | Scott Colby | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 181 Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,218,913 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ucvh.org | WebsiteAddressTxt |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To provide high quality and efficient health care services | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 149 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $455,556 | PYContributionsGrantsAmt |
| CY Contributions Grants | $86,257 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,409,225 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,947,010 | CYProgramServiceRevenueAmt |
| PY Investment Income | $760,903 | PYInvestmentIncomeAmt |
| CY Investment Income | $896,312 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $18,625,684 | PYTotalRevenueAmt |
| CY Total Revenue | $18,929,579 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $139,331 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $448,089 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,209,906 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,959,813 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,130,688 | PYOtherExpensesAmt |
| CY Other Expenses | $8,328,071 | CYOtherExpensesAmt |
| PY Total Expenses | $17,479,925 | PYTotalExpensesAmt |
| CY Total Expenses | $18,735,973 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,145,759 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $193,606 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,801,477 | TotalAssetsBOYAmt |
| Total Assets EOY | $32,221,458 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,469,202 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,546,565 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,332,275 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,674,893 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Upper Connecticut Valley Hospital strives to improve the well-being of the rural communities it serves by promoting health and assuring access to quality care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,398,052 | ExpenseAmt |
| Grant | $448,089 | GrantAmt |
| Revenue | $17,947,010 | RevenueAmt |
| Desc | Upper Connecticut Valley Hospital provided hospital care and inpatient and outpatient services on a region-wide basis. The net charity care provided by the Hospital for the year-ended September 30, 2019 was $223,000. | Desc |
| Total Program Service Expenses | $15,398,052 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | 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 | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 149 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Celeste Pitts | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6032374971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 181 Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Greg E Placy | ||||||||
| Chairman | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Odette Crawford | ||||||||
| Vice Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Palmer Lewis | ||||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| E Harlan Connary | ||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Lynn Brewer | ||||||||
| Director, Pharmacist | 2.00 | 0.00 | Yes (X) | $3,016 | $0 | $0 | ||
| Avis Brosseau | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kevin Kelley | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Edward Laverty PA-C | ||||||||
| Chief Medical Officer | 62.00 | 0.00 | Yes (X) | $277,523 | $0 | $42,951 | ||
| Ann Morgan Wade | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Eric Stohl | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| James Wells | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Scott Colby | ||||||||
| President | 38.00 | 2.00 | Yes (X) | Yes (X) | $256,708 | $0 | $42,399 | |
| Robert Soucy DO | ||||||||
| Past Medical Staff President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Celeste Pitts | ||||||||
| Chief Financial Officer | 16.00 | 24.00 | Yes (X) | $70,387 | $105,581 | $20,558 | ||
| Albert Arnold | ||||||||
| ER Physician | 46.00 | 0.00 | $213,660 | $0 | $10,589 | Yes (X) | ||
| Alexis Cochran | ||||||||
| Physician | 17.50 | 0.00 | $118,170 | $0 | $0 | Yes (X) | ||
| Thomas Cochran | ||||||||
| ER Physician | 37.00 | 0.00 | $291,076 | $0 | $34,856 | Yes (X) | ||
| Robert Gooch | ||||||||
| Pharmacist | 40.00 | 0.00 | $168,034 | $0 | $31,008 | Yes (X) | ||
| Todd Hope | ||||||||
| Physician | 25.00 | 0.00 | $237,820 | $0 | $11,041 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,636,394 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $105,581 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $193,402 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Androscoggin Valley Hospital | |||||
| 59 Page Hill Road | Berlin | NH | 035703542 | Locum Staff | $1,003,135 |
| AHSA LLC | |||||
| PO Box 1928 | Edmond | OK | 730831928 | Staffing Agency | $674,326 |
| Hebert Daniel Inc | |||||
| 12 Pleasant Street | Colebrook | NH | 03576 | General Contractor, Building Renovations | $635,767 |
| Dartmouth-Hitchcock | |||||
| One Medical Center Drive | Lebanon | NH | 03766 | Medical Staff Services | $324,891 |
| Weeks Medical Center | |||||
| PO Box 240 | Whitefield | NH | 03598 | Management & Physician Staff | $310,305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $25,165 | GovernmentGrantsAmt |
| All Other Contributions | $61,092 | AllOtherContributionsAmt |
| Total Contributions | $86,257 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Service Revenue | 621400 | $31,682,779 | $31,682,779 | |
| Miscellanous Revenue | 624100 | $257,720 | $206,732 | $50,988 |
| Meaningful Use Revenue | 621400 | $25,688 | $25,688 | |
| Provision for Bad debts | 621400 | -$822,036 | -$822,036 | |
| Contractual/Char. Adj. | 621400 | -$13,197,141 | -$13,197,141 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,947,010 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $228,761 | TotalRevenueColumnAmt |
| Exclusion | $228,761 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,905,335 | SecuritiesAmt |
| Other | $51,550 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,288,063 | SecuritiesAmt |
| Other | $1,271 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $617,272 | SecuritiesAmt |
| Other | $50,279 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $667,551 | TotalRevenueColumnAmt |
| Exclusion | $667,551 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,929,579 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,896,022 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $947,300 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $448,089 | TotalAmt |
| Program Services | $448,089 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,597 | TotalAmt |
| Program Services | $323,490 | ProgramServicesAmt |
| Management And General | $299,107 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,410,276 | TotalAmt |
| Program Services | $6,566,594 | ProgramServicesAmt |
| Management And General | $843,682 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,077 | TotalAmt |
| Program Services | $133,006 | ProgramServicesAmt |
| Management And General | $19,071 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,313,357 | TotalAmt |
| Program Services | $1,126,759 | ProgramServicesAmt |
| Management And General | $186,598 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $461,506 | TotalAmt |
| Program Services | $388,724 | ProgramServicesAmt |
| Management And General | $72,782 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,610 | TotalAmt |
| Management And General | $78,610 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,240 | TotalAmt |
| Management And General | $45,240 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,000 | TotalAmt |
| Management And General | $60,000 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,990 | TotalAmt |
| Management And General | $102,990 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,063,544 | TotalAmt |
| Program Services | $2,327,732 | ProgramServicesAmt |
| Management And General | $735,812 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,075 | TotalAmt |
| Management And General | $16,075 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,220 | TotalAmt |
| Management And General | $85,220 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,057 | TotalAmt |
| Program Services | $115,614 | ProgramServicesAmt |
| Management And General | $101,443 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,132 | TotalAmt |
| Program Services | $249,132 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,105 | TotalAmt |
| Program Services | $62,777 | ProgramServicesAmt |
| Management And General | $54,328 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,056,539 | TotalAmt |
| Program Services | $1,043,172 | ProgramServicesAmt |
| Management And General | $13,367 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,848 | TotalAmt |
| Management And General | $130,848 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Supplies Expense | $1,727,079 | $1,644,874 | $82,205 |
| Medicaid Enhancement Ta | $905,512 | $905,512 | |
| Miscellanous | $473,120 | $62,577 | $410,543 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,735,973 | TotalAmt |
| Program Services | $15,398,052 | ProgramServicesAmt |
| Management And General | $3,337,921 | 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 | $660,049 | BOYAmt |
| EOY | $2,819,482 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,113,247 | BOYAmt |
| EOY | $2,855,131 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $308,099 | BOYAmt |
| EOY | $4,754 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,917,872 | BOYAmt |
| EOY | $2,436,094 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $342,333 | BOYAmt |
| EOY | $307,581 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,574 | BOYAmt |
| EOY | $245,261 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,467,598 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,847,722 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,494,327 | BOYAmt |
| EOY | $7,619,876 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,371,334 | BOYAmt |
| EOY | $15,606,270 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $326,642 | BOYAmt |
| EOY | $327,009 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,801,477 | BOYAmt |
| EOY | $32,221,458 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,771,499 | BOYAmt |
| EOY | $1,946,113 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,954 | BOYAmt |
| EOY | $10,754 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,550,749 | BOYAmt |
| EOY | $10,589,698 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,469,202 | BOYAmt |
| EOY | $12,546,565 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,806,252 | BOYAmt |
| EOY | $19,431,172 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $352,953 | BOYAmt |
| EOY | $70,651 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,070 | BOYAmt |
| EOY | $173,070 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,332,275 | BOYAmt |
| EOY | $19,674,893 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,801,477 | BOYAmt |
| EOY | $32,221,458 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $193,606 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $149,012 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,471 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,471 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. In addition, North Country Healthcare has contracted with a local firm to lobby on our behalf at the State Level. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $232,266 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $13,836 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,187 | OtherExpendituresAmt |
| End Year Balance | $240,915 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $233,884 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,524 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,142 | OtherExpendituresAmt |
| End Year Balance | $232,266 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $280,657 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $22,414 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $69,187 | OtherExpendituresAmt |
| End Year Balance | $233,884 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $263,522 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $20,177 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,042 | OtherExpendituresAmt |
| End Year Balance | $280,657 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $191,998 | BeginningYearBalanceAmt |
| Contributions | $80,000 | ContributionsAmt |
| Investment Earnings Or Losses | $3,175 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $11,651 | OtherExpendituresAmt |
| End Year Balance | $263,522 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.71840 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.28160 | 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 | $9,700 | OtherCostOrOtherBasisAmt |
| Book Value | $9,700 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,778,077 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,806,829 | DepreciationAmt |
| Book Value | $3,971,248 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,309,621 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,935,728 | DepreciationAmt |
| Book Value | $3,373,893 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $370,200 | OtherCostOrOtherBasisAmt |
| Depreciation | $105,165 | DepreciationAmt |
| Book Value | $265,035 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,619,876 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Third Party Payers | Desc |
| Amt | $10,589,698 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,589,698 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $18,975,601 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $149,012 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $149,012 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,826,589 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $102,990 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $102,990 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,929,579 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,632,983 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,632,983 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $102,990 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $102,990 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,735,973 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 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 | $331,828 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,171 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $314,657 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01680 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,682,536 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,627,480 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,055,056 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05630 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,014,364 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,644,651 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,369,713 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07310 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,110,388 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,517,704 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,592,684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08500 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $233,834 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $233,834 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01250 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $450,066 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $450,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02400 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,794,288 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,517,704 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,276,584 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,808,652 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,162,355 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,646,297 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19460 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,262 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,846 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,846 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,617 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,617 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,794 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,794 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,519 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,519 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $421,073 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,841,852 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,931,164 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$89,312 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 181 Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.ucvh.org | WebsiteAddressTxt |
| State License | 000592 | 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 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | 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.ucvh.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.ucvh.org | 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 | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.ucvh.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.ucvh.org | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.ucvh.org | 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 |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Upper Connecticut Valley Hospital | Part V, Section B, Line 5: An electronic survey was sent to a select group of local experts that included information from well-respected secondary sources on the current state of health care in the community. Individuals and agencies involved in Public Health and State & Local Health were included as were individuals from priority populations, chronic disease groups and other community members. |
| Upper Connecticut Valley Hospital | Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Weeks Medical Center, Littleton Regional Hospital, Androscoggin Valley Hospital. |
| Upper Connecticut 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. |
| Upper Connecticut Valley Hospital | Part V, Section B, Line 11: Significant Needs Identified and Being Addressed:1. Drug/Substance Abuse: This was identified in the last CHNA. UCVH has partnered with both Dartmouth-Hitchcock and Northern Human Services to provide Tele-psych services through the Emergency Department. Education on the use of Narcan is given during complimentary CPR/BLS/First Aid Community trainings. Education regarding Substance Abuse & Alcohol abuse is given through the Emergency Department. Mental Health inpatient accommodations are available for patients awaiting placement in State or Private Institutions. A Pain Management program has been instituted to offer an alternative to opioid use. This program includes a behavioral health counseling component.2. Mental Health: See above response.3. Obesity/Overweight: Nutritionist available for dietary counseling with Inpatients. Medical Nutrition Counseling and Diabetes Self-Management program are available to members of the community. Prescription Food Program developed in 2019. Community health wellness fairs/activities that provide nutrition information to the public, glucose screenings, cholesterol screenings and Bike Blender for healthy smoothies. UCVH works in partnership with the UNH Cooperative Extension, SAU#7, and the Farm School Beacon Project, providing cooking nutrition classes to low income community members, and focusing on the improvement of health of our area school's children and their families.4. Accessibility (Transportation, Disability, Access to Care, etc.): UCVH partners with Weeks Medical Center and Androscoggin Valley Hospital to bring many Specialists to Colebrook for accessibility within our community. Patient would need to drive an hour or more for an office visit otherwise. In addition, Case Management staff work with patients for transportation and UCVH staff offer Rehabilitation services to our local schools and nursing home. Cardiac Rehab is available at the hospital for those who qualify which makes this valuable program more accessible to those who need it most. UCVH is working with Weeks Medical Center to bring substance abuse counseling to the Colebrook area over the next year and is researching further Telemedicine opportunities, such as Rheumatology.5. Alcohol Abuse: See response #1. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, Ratio of patient care cost-to-charges Part I, lines 7E-I. The Hospital determines cost by combining direct expenses identified by its accounting system with an estimated overhead allocation. |
| Part I, Line 7g: | Specialty Care Providers & Emergency Department |
| Part II, Community Building Activities: | The community building activities undertaken by UCVH consist of supporting local government and other health care providers, coordination of disaster drills, emergency preparedness, and support of other local organizations within the community. In addition, in an effort to provide the necessary health care services for the population within a reasonable driving distance, UCVH has entered into a collaboration with the other two Coos county hospitals to provide necessary specialty services for the UCVH service area. |
| Part III, Line 2: | The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, Ratio of patient care cost-to-charges. The CCR was then applied to bad debt expense at charge value in order to arrive at the estimated expense reported. |
| 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 identifies 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 the allowance for doubtful accounts. |
| Part III, Line 8: | Allowable costs come from the filed cost report as UCVH operates at a loss from Medicare. The shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. UCVH uses CCR to determine cost revenue received is net patient revenue. |
| Part III, Line 9b: | If known to qualify for charity or financial assistance, patients are given the assistance needed. |
| Part VI, Line 2: | In 2019, North Country Health Care engaged Quorum Health Resources to facilitate on our behalf the preparation of a Community Health Needs Assessment (CHNA) for the four affiliated hospitals, our Home Health Division and two community health centers. The CHNA was completed in September, 2019. An implementation plan was developed by Senior Leadership at the individual affiliates, and was then combined to develop the NCH Implementation plan. This plan was approved by the UCVH Boardof Directors at the December, 2019 meeting. The CHNA and Implementation Plan are available on the UCVH website. |
| Part VI, Line 3: | UCVH has a patient financial counselor who is responsible for working with patients and any who may be billed for their care to determine their eligibility, on a case by case basis. For any government programs, such as Medicaid or the UCVH financial assistance program all staff at UCVH, particularly registration staff who will be the first ones to notice if a patient does not have insurance, are trained to refer the patient to the financial counselor. In addition, brochures are available, as is contact information on the website. |
| Part VI, Line 4: | UCVH is the smallest critical assess hospital in New Hampshire that serves the largest geographic service area (over 850 square miles) including communities in the states of New Hampshire, Vermont, and Maine. According to the New Hampshire state health profile, our residents are the most fragile of all citizens in New Hampshire as it relates to health outcomes and economic conditions. UCVH is dependent of public funding and disproportionate share funding to subsidize the care provided to the patients we serve |
| Part VI, Line 7, Reports Filed With States | NH |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Foundation for Healthy Communities | |||||||
| 125 Airport Road | Concord | NH | 033017300 | 020275078 | 501(c)(3) | $126,089 | Drug & Alcohol Commission |
| Indian Stream Health Center | |||||||
| 141 Corliss Lane | Colebrook | NH | 03756 | 200999212 | 501(c)(3) | $322,000 | Operational support and purchase of EMR. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Hospital was mandated by the State of NH to contribute funds to the Alcohol and Drug Prevention Treatment Fund in order to continue the Medicaid Expansion Program. These funds go towards various programs surrounding recover, treatment and prevention for substance misuse in New Hampshire. The Hospital and Indian Stream Health Center (ISHC) have entered into an agreement, effective March 1, 2019, whereby the Hospital will provide funding in the form of a one-time community benefit grant to ISHC for the purpose of assisting with recent financial challenges caused by loss of providers, uncompensated and undercompensated care, one-time legal expenses incurred by ISHC, and assist in funding of an updated Electronic Health Record. Where the funds in both cases were contributed to Section 501(c)(3) organizations, additional monitoring of use of funds was not deemed to be necessary. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Edward Laverty PA-C | ||||||||||||||
| Chief Medical Officer | $277,523 | $0 | $0 | $0 | $0 | $0 | $8,202 | $0 | $34,749 | $0 | $320,474 | $0 | $0 | $0 |
| Scott Colby | ||||||||||||||
| President | $225,708 | $0 | $31,000 | $0 | $0 | $0 | $7,368 | $0 | $35,031 | $0 | $299,107 | $0 | $0 | $0 |
| Celeste Pitts | ||||||||||||||
| Chief Financial Officer | $58,210 | $87,316 | $2,377 | $3,565 | $9,800 | $14,700 | $1,754 | $2,631 | $6,469 | $9,704 | $78,610 | $117,916 | $0 | $0 |
| Albert Arnold | ||||||||||||||
| ER Physician | $213,660 | $0 | $0 | $0 | $0 | $0 | $5,346 | $0 | $5,243 | $0 | $224,249 | $0 | $0 | $0 |
| Thomas Cochran | ||||||||||||||
| ER Physician | $291,076 | $0 | $0 | $0 | $0 | $0 | $8,041 | $0 | $26,815 | $0 | $325,932 | $0 | $0 | $0 |
| Robert Gooch | ||||||||||||||
| Pharmacist | $168,034 | $0 | $0 | $0 | $0 | $0 | $5,204 | $0 | $25,804 | $0 | $199,042 | $0 | $0 | $0 |
| Todd Hope | ||||||||||||||
| Physician | $237,820 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,041 | $0 | $248,861 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | The President, Scott Colby, has an annual bonus clause in his contract. The amount is discretionary and determined by the Board of Directors, based on overall performance of the organization for that year. The other individuals received a purely discretionary bonus per the President based on recognition of additional responsibilities and special projects performed. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Shari Parker | |||
| Family member of Board Director Eric Stohl | $124,005 | Employment | 0 |
| Martha Wells | |||
| Family member of Board Director James Wells | $65,449 | Employment | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | As the Parent Organization, North Country Healthcare (NCH) is the Sole Member of Upper Connecticut Valley Hospital. |
| Form 990, Part VI, Section A, line 7a | Members of the Hospital Boards are nominated exclusively by the Hospital, however the election of any such Director must be approved by the Hospital Board and the NCH Board. |
| Form 990, Part VI, Section A, line 7b | 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. Examples of organizational "Major Matters" include amendments to Bylaws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major Matters" 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. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is reviewed by CFO & President of the Hospital. After their review is complete, the Form is shared with the Board Finance Committee prior to filing. |
| Form 990, Part VI, Section B, line 12c | Directors, Officers, Highly Compensated Employees are all required to review and sign the Conflict of Interest Document. Annual conflict of interest documents were distributed electronically this year and managed by BerryDunn. |
| Form 990, Part VI, Section B, line 15 | The hospital President compensation and benefit package is reviewed periodically by community board members who govern the non-profit organization as unpaid, independent volunteers. The periodic review includes comparability data, and the deliberation and decision making is substantiated by written minutes. |
| Form 990, Part VI, Section C, line 18 | UVCH makes its 990 available upon request. |
| Form 990, Part VI, Section C, line 19 | Available upon request. |
| Form 990, Part IX, line 11g | Other Fees: Program service expenses 2,327,732. Management and general expenses 735,812. Fundraising expenses 0. Total expenses 3,063,544. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Upper Connecticut Valley Hospital 181 Corliss Lane Colebrook, NH 03576 EIN: 02-0276210 Upper Connecticut Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| North Country Healthcare Inc | ||||||||||
| 8 Clover Lane | Whitefield | NH | 03598 | 812225283 | Healthcare Management | NH | 501(c)(3) | Line 12a, I | N/A | 0 |
| Androscoggin Valley Hospital Inc | ||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020280367 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 |
| Weeks Medical Center | ||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 020222242 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 |
| Littleton Hospital Association | ||||||||||
| 600 St Johnsbury Road | Littleton | NH | 03561 | 020222152 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 |
| North Country Home Health & Hospice Agency Inc | ||||||||||
| 536 Cottage Street | Littleton | NH | 03561 | 020300637 | Home Health Agency | NH | 501(c)(3) | Line 10 | N/A | 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 | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | 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 |