2020-08-12T11:51:28-05:00 2019-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2018-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Celeste Pitts CFO 6037884911 2020-03-17 1 Joseph R Byrne CPA P01289281 2077752387 2020-03-17 69.49.157.66 2020-03-17 07:50:03 ED P E262D3C9A45A77A46A0A2832CF74466488750570 FD764483AA263AFE8AB46477EA327BFBBE809DCF 2018 2020-09-23 17:36:50Z Michael D Lee 173 Middle Street Lancaster NH 03584 60878089 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 15 12 397 96 0 0 691238 1473497 50161379 53645175 2508065 1153273 0 0 53360682 56271945 192301 197215 0 0 28236283 33202557 36000 49500 74609 19563201 19376785 48027785 52826057 5332897 3445888 64012900 71761599 27663203 32037358 36349697 39724241 Weeks Medical Center's compassionate staff is committed to providing high quality and efficient health care services to ensure the well-being of our patients, families and communities. 0 0 43496367 197215 53645175 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 43496367 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 87 0 1 397 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Celeste Pitts 6037884911 173 Middle Street Lancaster NH 03584 Donald Crane Board Chair 2.00 1.00 X X 0 0 0 Sarah Desrochers Vice Chair 2.00 0.00 X X 0 0 0 Dennis Couture Secretary 2.00 0.00 X X 0 0 0 Keith Young Treasurer 2.00 0.00 X X 0 0 0 Ruby Berryman Trustee 1.00 0.00 X 0 0 0 Denise Brisson Trustee 1.00 0.00 X 3117 0 94 Scott Burns Trustee 1.00 0.00 X 0 0 0 Charlie Cotton Trustee 1.00 0.00 X 0 0 0 William Everleth Trustee 1.00 0.00 X 0 0 0 Stanley Holz Trustee 1.00 0.00 X 0 0 0 Patrick Kelly Trustee 1.00 1.00 X 0 0 0 Sharon Kopp Trustee 1.00 1.00 X 0 0 0 Michael D Lee President 40.00 0.00 X X 218603 0 35992 Mark Morgan MD Medical Staff President 40.00 0.00 X 468684 0 34798 Lars Nielson CMO 39.00 1.00 X X 326420 0 29428 Lisa Tetreault Past Trustee 1.00 0.00 X 0 0 0 Celeste Pitts CFO 24.00 16.00 X 105581 70387 20558 John Ford MD Physician 40.00 0.00 X 380583 0 9541 Jeffrey Johnson MD Physician 40.00 0.00 X 340450 0 31463 Paul Kamins MD Physician 40.00 0.00 X 457723 0 49055 Christopher Laurent NP Nurse Practicioner 40.00 0.00 X 401619 0 10631 Maude Oetking Physician 40.00 0.00 X 411747 0 25526 3114527 70387 247086 49 0 1 0 Dartmouth-Hitchcock Clinic One Med Ctr Dr Lebanon NH 03766 Professional Services 928459 AHSA PO Box 1928 Edmond OK 73083 Contract Labor/Nurse Svcs. 668416 Stone River Architects 124 Bedford Center Rd Unit E Bedford NH 03110 Professional Services 484925 Cybernorth 15 Cottage Road Unit 2433 South Portland ME 04116 Professional Services 309638 Healogics Wound Care & Hyperbaric Servic 28525 Network Place Chicago IL 60673 Professional Services 304363 43 333221 1140276 52087 1473497 Patient Service 621400 89385160 89385160 Miscellaneous 621400 4733220 4539023 194197 Meaningful Use 621400 51763 51763 Provision for Bad Debts 621400 -1829918 -1829918 Contractual/Char. Adj. 621400 -38695050 -38695050 53645175 794769 794769 4964648 4601669 4475 362979 -4475 358504 358504 56271945 53450978 0 1347470 197215 197215 1313662 1313662 26012416 22483518 3528898 429570 372965 56605 3910137 3292003 618134 1536772 1262714 274058 530907 51031 479876 20077 20077 76380 76380 49500 49500 51975 51975 1094437 1046156 48281 158279 133170 25109 285449 56160 229289 1124348 1124348 1054048 1033450 20598 202141 194115 8026 117536 102833 14703 469435 469435 1832426 1806905 25521 495239 270752 224487 Patient Care Supplies 7283865 7283865 Miscellaneous 2741604 1601441 1140163 MET Taxes 1838639 1838639 52826057 43496367 9255081 74609 X 247300 249297 22645218 17401824 4889862 7105069 0 9534913 994752 913694 1135232 1281739 47097633 32284786 14841984 14812847 19108552 19687190 150000 775026 64012900 71761599 3961758 4256499 611178 1109460 7120880 6673981 3925950 15969387 16071468 27663203 32037358 X 34824702 37638501 613081 1173826 911914 911914 36349697 39724241 64012900 71761599 X 3445888 428985 -500329 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14214 14214 0 Part II-B, Line 1: Weeks Medical Center is a member of the New Hampshire Hospital Association, and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of WMC and other member organizations in furtherance of their exempt purposes. WMC does not directly perform any lobbying activities. 1040597 -1893 1038704 1054173 -13576 1040597 1039727 14446 1054173 1035352 4375 1039727 1174268 -62816 76100 1035352 0.00000 0.87790 0.12210 0 0 532630 532630 14329703 9651448 4678255 29252863 22172592 7080271 2982437 460746 2521691 14812847 Estimated Third-Party Payor Settlements 16071468 16071468 Part V, Line 4: Weeks Medical Center Endowment Funds were gifted with the intent to help defray the costs of indigent care for adults and children, and general upkeep and operations of the hospital. X X X X X 1 Robert Pettegrew Associates 117 Middle Road Hancock NH 03449 Fundraiser 0 550256 49500 500756 550256 49500 500756 NH 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 801002 26225 774777 0.01470 7944576 7041999 902577 0.01710 1742818 1229854 512964 0.00970 10488396 8298078 2190318 0.04150 940648 940648 0.01780 319036 319036 0.00600 197215 197215 0.00370 1456899 1456899 0.02750 11945295 8298078 3647217 0.06900 187701 187701 0.00360 4981 4981 0.00010 7369 7369 0.00010 200051 200051 0.00380 1 976092 24155785 24399782 -243997 X 1 1 1 1 Weeks Medical Center 173 Middle Street Lancaster NH 03584 www.weeksmedical.org 00015 X X X X Weeks Medical Center 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X https://weeksmedical.org/about/community-benefit-report/ X 1 18 1 https://weeksmedical.org/about/community-benefit-report/ 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X http://www.weeksmedical.org X http://www.weeksmedical.org X http://www.weeksmedical.org X X X X X X 1 X 0 X X X X 1 X 0 0 Weeks Medical Center 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. Weeks Medical Center Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Upper Connecticut Valley Hospital, Littleton Regional Hospital, and Androscoggin Valley Hospital. Weeks Medical Center 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. Weeks Medical Center Part V, Section B, Line 11: Significant Needs Identified and Being Addressed:1. Drug/Substance Abuse - This was identified in the last CHNA. Weeks started a Medication Assisted Therapy (MAT) pilot program in 2017 at our Lancaster location and expanded to more clinics in 2018. Presently we have two MAT clinics and provide staffing for Androscoggin Valley Hospital and Littleton Regional Hospital Substance Abuse HUBS. Early in 2020, WMC is planning on opening a clinic in Colebrook and transitioning the Littleton Doorway to a stand-alone clinic in January 2020. Lastly, WMC is working on developing funding to work on a mobile van outreach clinic.2. Mental Health - Weeks has significantly grown our program from 3 Mental Health providers to 8, increasing access in mental health and substance abuse disorder. In addition, we added support staff case management (4) and recovery coaches (4) and multiple people are in queues for recovery coach training. The support staff works with community health workers employed by North Country Health Consortium (NCHC), our local public health agency. Presently, we are partnering with NCHC to develop a 24 hour call center health for mental and health and substance use.3. Obesity/Overweight - Recruited a new dietitian to continue our IBT (Intensive Behavioral Therapy weight management program), we are completing Body Mass Index screening through Rural Health Clinic (RHC) Primary Practices and refer to counseling and other available services. North Country Healthcare (NCH) is exploring a partnership for a Bariatric Program. Weeks has an ongoing employee wellness program that it will continue for employee and spouses. 4. Accessibility (Transportation, Disability, Access to Care, etc.)- Weekend Acute Care Clinics began in 2018 that have open access and scheduling for present patients. Additionally our 4 RHCs have open access scheduling with same day appointments and evening hours. All of these will continue and be expanded. Case Management facilitates transportation for patients that need support. Lastly, WMC has 7 providers that do home visits. All sites are handicap accessible and case management works with community support to ensure the delivery of care.5. Alcohol Abuse - This is part of our substance use disorder program. WMC has a formal outpatient detox program as well as support for the inpatient program. We have two master level LADC (Licensed Alcohol and Drug Counselor) and one LADC with two in process of being developed. We Provide space for Alcoholics Anonymous and are a referral source for them as well. Weeks Medical Center Part V, Section B, Line 16j: Brochures and financial counselor information are available in lobbies and handed out to patients. Also, contact information for financial counselors is provided on bills and letters that go out. 4 1 - Lancaster Physicians Offices 170 Middle Street Lancaster NH 03584 Physician Office for primary care 2 - Whitefield Physicians Offices 8 Clover Lane Whitefield NH 03598 Physician Office for primary care 3 - Groveton Physicians Offices 12 Church Street Groveton NH 03582 Physician Office for primary care 4 - North Stratford Physician Offices 43 Main Street North Stratford NH 03590 Physician Office for primary care Part I, Line 7: Cost to charge ratio Part III, Line 4: 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 are charged against the allowance for doubtful accounts. Part III, Line 8: The entire shortfall is treated as community benefit. Cost to charge ratio from the Medicare cost report was used. Part III, Line 9b: All patients of Weeks Medical Center who have no insurance are notified of the Weeks Health Access Financial Assistance policy and encouraged to make an appointment with one of our Financial Counselors or Social Workers. This information is given out, along with financial assistance applications, at the time of appointment and is also available on our web-site and is reiterated with our monthly statements sent to the patient. It is impossible for our organization to determine if a patient is eligible for financial assistance until an application is filed - we do not access credit reports but rely on the patient supplying us with the necessary financial information. At that time of application, if a patient is determined to be eligible, they are provided with financial assistance. 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 Weeks Boardof Directors at the December, 2019 meeting. The CHNA and Implementation Plan are available on the Weeks website. Part VI, Line 3: The staff is trained to discuss the Hospital's charity care policy with patients, the policy is available throughout the Hospital in the brochure and it is available on the Hospital's website. WMC also employs a full-time financial counselor and other case management staff to assist patients with the financial assistance process. Part VI, Line 4: Weeks Medical Center's general geographic catchment area consists of nine towns, which supply almost 90% of its patients. Towns include Lancaster, Groveton, Dalton, Whitefield, North Stratford, Jefferson and Stark, in New Hampshire; and Lunenburg, Guildhall and Gilman, in Vermont. Together, these towns have a population of approximately 13,000 and cover approximately 375 square miles in both Vermont and New Hampshire.Weeks Medical Center is defined by the geographic communities that surround its facilities and by the individuals and groups who benefit from the health and wellness services provided by its various health related institutions. The definition was developed by the Board of Trustees, its Committees, administrative and professional staff in the practical application of the services provided by the institutions and the identified needs of the communities served. Part VI, Line 5: WMC plays an integral role in the Emergency Preparedness plans of our community. In addition to being available in an emergency from a clinical standpoint, we are a large part of the community wide planning team, taking the lead in the planning of training & drills and bringing the various components together, based on State-wide standards. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 033017300 020275078 501(c)(3) 197215 Alcohol and Drug Prevention Treatment Fund 1 0 Part I, Line 2: 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. X X X X 0 0 0 0 0 0 0 1 0 Michael D Lee President 175103 0 19500 0 24000 0 6286 0 29706 0 254595 0 0 0 Mark Morgan MD Medical Staff President 431325 0 400 0 36959 0 5328 0 29470 0 503482 0 0 0 Lars Nielson CMO 298920 0 3000 0 24500 0 8250 0 21178 0 355848 0 0 0 Celeste Pitts CFO 87316 58210 3565 2377 14700 9800 2631 1754 9704 6469 117916 78610 0 0 John Ford MD Physician 359083 0 3000 0 18500 0 7587 0 1954 0 390124 0 0 0 Jeffrey Johnson MD Physician 276719 0 39231 0 24500 0 4803 0 26660 0 371913 0 0 0 Paul Kamins MD Physician 433223 0 0 0 24500 0 7311 0 41744 0 506778 0 0 0 Christopher Laurent NP Nurse Practicioner 375396 0 3600 0 22623 0 7584 0 3047 0 412250 0 0 0 Maude Oetking Physician 381247 0 0 0 30500 0 8250 0 17276 0 437273 0 0 0 Part I, Line 7 The President (Michael Lee) 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. A Business Finance Authority of the State of NH 521304598 2010-09-01 10000000 Refinance existing debt and finance the Hospital's contruction project 0 0 0 A 3326019 10000000 112960 3044490 6842550 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 09/01/2015 X 2 52087 FMV 0 0 0 Form 990, Part VI, Section A, line 6 Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Weeks Medical Center. Form 990, Part VI, Section A, line 7a In accordance with the Affiliation Agreement with North Country Healthcare (NCH), each Hospital's charter and bylaws were amended to effect the establishment of NCH as the sole member and to create a shared governance structure between the Board of Directors of NCH and the Boards of each Hospital. Each Hospital continues to maintain its own Board of Directors (Corporation Board) that is distinct from the NCH Board of Directors. However, the Bylaws of NCH and each Hospital identify certain "Major matters" (divided into organizational and operational matters) that require initiation and/or authorization by a majority of the NCH Board. Members of the Hospital Boards are nominated exclusively by the Hospitals. However, the election of any such director must be approved by both the Hospital Board and the NCH Board. Some examples of other organizational "Major matters" requiring the initiation and/or approval of the NCH Board include amendments to by-laws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major matters" requiring the initiation and/or approval of the NCH Board include approval of annual capital and operating budgets, adoption of compensation and benefit programs, approval of information technology systems, financial systems and auditors, plus approval of any major changes to clinical services offered. The Chief Executive Officer position at each of the Hospitals has been changed to a President position. As with Board members, each Hospital President must be nominated at the Hospital level and then approved by both the Hospital Board and the NCH Board. This position reports to both the applicable Hospital Board and the Chief Executive Officer of NCH. The Chief Financial Officer of each of the Hospitals will remain an appointed position by the President. Form 990, Part VI, Section A, line 7b See narrative provided for Form 990, Part VI, line 7a. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by CFO & President of the Hospital. After their review is complete, the Form is shared electronically with the Board Finance Committee prior to filing. Form 990, Part VI, Section B, line 12c Annual conflict of interest forms are signed by all employees, officers, and Board members. Board members with a conflict are excused from voting on any items that relate to the other organization, etc. that is the conflict. The Organization also provides annual 990 questionnaires with several potential conflict situations discussed and distributed to the full Board every year at the time of the audit. Annual questionnaire was distributed electronically this year and managed by BerryDunn. Responses are sent directly to the audit firm. Any conflict discovered by the CPA's would be addressed by Hospital Management. Members with a conflict are excused from voting on any items that relate to the conflict identified. Form 990, Part VI, Section B, line 15 The President's compensation is determined by the Executive Committee of the Board (serving as the compensation committee), a written employment contract, a state compensation survey and approval of the full Board and Executive Committee. Other officers have their compensation determined through a state compensation survey, along with approval of the President. 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 X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Weeks Medical Center 173 Middle Street Lancaster, NH 03584 EIN: 02-0222242 Weeks Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Net Asset Transfer to Lancaster Patient Care Center -500,329. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I 0 Upper Connecticut Valley Hospital Corliss Lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 0 Littleton Hospital Association 600 St Johnsbury Road Littleton NH 03561 020222152 Critical Access Hospital NH 501(c)(3) Line 3 0 Androscoggin Valley Hospital Inc 59 Page Hill Road Berlin NH 03570 020280367 Critical Access Hospital NH 501(c)(3) Line 3 0 North Country Home Health & Hospice Agency Inc 536 Cottage St Littleton NH 03561 020300637 Home Health Agency NH 501(c)(3) Line 10 0 Lancaster Patient Care Center 173 Middle Street Lancaster NH 03584 832130386 Supporting Organization NH 501(c)(3) Line 12a, I Weeks Medical Center 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 Lancaster Patient Care Center R 500329 FMV