ANDROSCOGGIN VALLEY HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ANDROSCOGGIN VALLEY HOSPITAL INC (EIN 02-0280367)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-06-27
- IRS object ID
- 201901789349300335
- Schema version
- 2017v2.3
- 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 C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-06-27T10:04:44-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | 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 | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020280367 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Androscoggin Valley Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ANDR | BusinessNameControlTxt |
| Phone | 6037522200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Peterson | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6037522200 | PhoneNum |
| Signature | 2019-06-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2019-06-24 | 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 | 2019-06-24 | IPDt |
| IP Tm | 15:23:11 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C86B3C3384E7B30FA9F9EB149CE7FBCC333204C6 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Michael Peterson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $72,851,789 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.avhnh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 428 | TotalEmployeeCnt |
| Total Volunteers | 78 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $72,524 | PYContributionsGrantsAmt |
| CY Contributions Grants | $71,471 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $57,308,823 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $61,357,711 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,158,870 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,759,387 | CYInvestmentIncomeAmt |
| PY Other Revenue | $59,576 | PYOtherRevenueAmt |
| CY Other Revenue | $64,992 | CYOtherRevenueAmt |
| PY Total Revenue | $58,599,793 | PYTotalRevenueAmt |
| CY Total Revenue | $63,253,561 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $442,382 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,234,023 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $28,137,182 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $31,131,790 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,448,252 | PYOtherExpensesAmt |
| CY Other Expenses | $25,887,975 | CYOtherExpensesAmt |
| PY Total Expenses | $55,027,816 | PYTotalExpensesAmt |
| CY Total Expenses | $58,253,788 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,571,977 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,999,773 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $57,708,258 | TotalAssetsBOYAmt |
| Total Assets EOY | $62,638,972 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $36,712,922 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,660,818 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,995,336 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,978,154 | NetAssetsOrFundBalancesEOYAmt |
| Mission | A non-profit critical access hospital which provides inpatient, outpatient, emergency care, ambulatory care, and specialty care to residents of Berlin, New Hampshire and the surrounding communities. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $42,924,263 | ExpenseAmt |
| Revenue | $52,877,908 | RevenueAmt |
| Desc | Androscoggin Valley Hospital is a critical access hospital. The Hospital provides a broad range of inpatient and outpatient services to meet the health needs of the upper Androscoggin Valley and surrounding communities. With a commitment to the highest quality surgical care - AVH is leading the way to a healthier future for our health care community. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $87,226 | ExpenseAmt |
| Revenue | $284,260 | RevenueAmt |
| Desc | Educational programs offered by AVH include childbirth classes, babysitting course, wellness fairs, lecture series, CPR and first aid courses, nutritional counseling, and a variety of support groups. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,634,352 | ExpenseAmt |
| Grant | $1,234,023 | GrantAmt |
| Revenue | $8,195,543 | RevenueAmt |
| Desc | Other community benefits provided by the Hospital include the provision of care to the underinsured, primarily through participation in the NH Health Assistance Network and North Country Cares; the promotion of good health for children through participation in the healthy kids program; and the sponsorship of numerous clinics and programs supporting good health in the community. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $49,645,841 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 119 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 428 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | Lynn Moore | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6033265640 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Rd | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Donna Goodrich | |||||||||
| Chair | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jay Poulin | |||||||||
| Vice-Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Reverend Dr Alta Chase | |||||||||
| Secretary | 10.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Max Makaitis | |||||||||
| Treasurer | 1.00 | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Louise Belanger | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Javier Cardenas MD | |||||||||
| Director | 42.00 | 0.50 | Yes (X) | $384,164 | $0 | $24,567 | |||
| Arthur Couture | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| John Guertin | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Eric Johnson | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Randall Labnon | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Martha Laflamme | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Thomas McCue | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Daniel Van Buren MD | |||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Michael Peterson | |||||||||
| President | 40.00 | 2.00 | Yes (X) | Yes (X) | $302,336 | $0 | $30,152 | ||
| Joseph DellaValla MD | |||||||||
| Past Medical Staff President | 40.00 | 0.50 | Yes (X) | $284,431 | $0 | $30,152 | |||
| Kelly Guilmette | |||||||||
| Past Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| William Jackson | |||||||||
| Past Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Peter Morency | |||||||||
| Past Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| J Rodger Wood MD | |||||||||
| Past Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Krzystof Z Plociennik MD | |||||||||
| Past Medical Staff President | 40.00 | 0.50 | Yes (X) | $464,586 | $0 | $32,167 | |||
| Brian O'Hearn | |||||||||
| Chief Nursing Officer | 40.00 | 0.00 | Yes (X) | $201,491 | $0 | $30,152 | |||
| Keith Shute MD | |||||||||
| Sr. VP/Chief Medical Officer | 40.00 | 0.00 | Yes (X) | $404,422 | $0 | $27,161 | |||
| Lucien St Onge | |||||||||
| VP of Finance | 40.00 | 2.00 | Yes (X) | $98,065 | $0 | $4,987 | |||
| Kenneth Danielson MD | |||||||||
| Physician | 40.00 | 0.00 | $349,270 | $0 | $0 | Yes (X) | |||
| Christopher Fitzmorris MD | |||||||||
| Physician | 40.00 | 0.00 | $522,043 | $0 | $24,567 | Yes (X) | |||
| Richard Kardell MD | |||||||||
| Physician | 40.00 | 0.00 | $339,516 | $0 | $29,672 | Yes (X) | |||
| Peggy Simon MD | |||||||||
| Physician | 40.00 | 0.00 | $411,822 | $0 | $19,679 | Yes (X) | |||
| Norman Kossayda | |||||||||
| Physician | 40.00 | 0.00 | $314,403 | $0 | $301 | Yes (X) | |||
| Russell Keene | |||||||||
| Former President & CEO | 0.00 | 40.00 | $0 | $538,975 | $18,931 | Yes (X) | |||
| Richard Werkowski | |||||||||
| Former Interim CFO | 0.00 | 0.00 | $142,064 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,218,613 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $538,975 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $272,488 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 37 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| Northwood Anesthesia Services | |||||
| PO Box 322 | Berlin | NH | 03570 | Anesthesia Services | $1,030,800 |
| CompHealth | |||||
| PO Box 972651 | Dallas | TX | 753972651 | ASA Neuro Contract Labor | $642,821 |
| Dartmouth Hitchcook Medical Center | |||||
| One Medical Center Drive | Lebanon | NH | 037660001 | Contract Labor | $601,625 |
| Weatherby Locums Inc | |||||
| PO Box 97633 | Dallas | TX | 753972633 | OB/GYN, Gen Surg, Hospitalist Contract L | $540,483 |
| Mystic Valley Urology | |||||
| 93 Wesson Rd | Lancaster | NH | 03584 | Urgology Services | $500,083 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $31,353 | FundraisingAmt |
| All Other Contributions | $40,118 | AllOtherContributionsAmt |
| Total Contributions | $71,471 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Revenue | 621400 | $90,935,394 | $90,935,394 | |
| Miscellaneous Revenue | 621400 | $2,887,318 | $2,543,624 | $343,694 |
| Provision for Bad Debts | 621400 | -$1,722,160 | -$1,722,160 | |
| Contractual/Char. Adj. | 621400 | -$30,742,841 | -$30,742,841 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $61,357,711 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $504,024 | TotalRevenueColumnAmt |
| Exclusion | $504,024 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $64,992 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $64,992 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,992 | TotalRevenueColumnAmt |
| Exclusion | $64,992 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,836,593 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,567,909 | SecuritiesAmt |
| Other | $13,321 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,268,684 | SecuritiesAmt |
| Other | -$13,321 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,255,363 | TotalRevenueColumnAmt |
| Exclusion | $1,255,363 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $16,998 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $31,353 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $16,998 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,253,561 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $61,014,017 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,168,073 | 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 | $1,234,023 | TotalAmt |
| Program Services | $1,234,023 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,318,833 | TotalAmt |
| Program Services | $1,924,631 | ProgramServicesAmt |
| Management And General | $394,202 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,342,119 | TotalAmt |
| Program Services | $18,543,959 | ProgramServicesAmt |
| Management And General | $3,798,160 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $668,313 | TotalAmt |
| Program Services | $554,700 | ProgramServicesAmt |
| Management And General | $113,613 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,111,379 | TotalAmt |
| Program Services | $3,412,445 | ProgramServicesAmt |
| Management And General | $698,934 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,691,146 | TotalAmt |
| Program Services | $1,403,651 | ProgramServicesAmt |
| Management And General | $287,495 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,614 | TotalAmt |
| Management And General | $213,614 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,667 | TotalAmt |
| Management And General | $58,667 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,900 | TotalAmt |
| Management And General | $82,900 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,308,570 | TotalAmt |
| Program Services | $8,556,113 | ProgramServicesAmt |
| Management And General | $1,752,457 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,861 | TotalAmt |
| Program Services | $249,715 | ProgramServicesAmt |
| Management And General | $51,146 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,292,871 | TotalAmt |
| Program Services | $1,903,083 | ProgramServicesAmt |
| Management And General | $389,788 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $797,754 | TotalAmt |
| Program Services | $662,136 | ProgramServicesAmt |
| Management And General | $135,618 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,994 | TotalAmt |
| Program Services | $84,655 | ProgramServicesAmt |
| Management And General | $17,339 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,352 | TotalAmt |
| Program Services | $24,362 | ProgramServicesAmt |
| Management And General | $4,990 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,795 | TotalAmt |
| Program Services | $328,510 | ProgramServicesAmt |
| Management And General | $67,285 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,397,405 | TotalAmt |
| Program Services | $1,989,846 | ProgramServicesAmt |
| Management And General | $407,559 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $562,663 | TotalAmt |
| Program Services | $467,010 | ProgramServicesAmt |
| Management And General | $95,653 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $5,612,479 | $5,612,479 | |
| Provider Tax | $2,645,534 | $2,645,534 | |
| Other Expenses | $45,308 | $6,781 | $38,527 |
| Gift Shop Expenses | $42,208 | $42,208 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,253,788 | TotalAmt |
| Program Services | $49,645,841 | ProgramServicesAmt |
| Management And General | $8,607,947 | 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 | $3,764 | BOYAmt |
| EOY | $3,765 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,048,662 | BOYAmt |
| EOY | $13,296,975 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,179,690 | BOYAmt |
| EOY | $5,054,706 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $578,254 | BOYAmt |
| EOY | $724,365 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,137,295 | BOYAmt |
| EOY | $665,082 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,763,222 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $34,091,011 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,132,369 | BOYAmt |
| EOY | $14,672,211 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,644,408 | BOYAmt |
| EOY | $19,486,030 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,983,816 | BOYAmt |
| EOY | $8,735,838 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,708,258 | BOYAmt |
| EOY | $62,638,972 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,563,924 | BOYAmt |
| EOY | $6,109,373 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,985,353 | BOYAmt |
| EOY | $7,985,290 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,233,525 | BOYAmt |
| EOY | $149,807 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,930,120 | BOYAmt |
| EOY | $23,416,348 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,712,922 | BOYAmt |
| EOY | $37,660,818 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,995,336 | BOYAmt |
| EOY | $24,978,154 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,995,336 | BOYAmt |
| EOY | $24,978,154 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,708,258 | BOYAmt |
| EOY | $62,638,972 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,999,773 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,016,955 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $8,584 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,584 | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $77,592 | OtherCostOrOtherBasisAmt |
| Book Value | $77,592 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,018,464 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,895,861 | DepreciationAmt |
| Book Value | $3,122,603 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $359,449 | OtherCostOrOtherBasisAmt |
| Depreciation | $359,449 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,444,340 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,659,386 | DepreciationAmt |
| Book Value | $9,784,954 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,863,377 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,176,315 | DepreciationAmt |
| Book Value | $1,687,062 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,672,211 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Affiliates | $1,478,149 |
| Other Receivables | $1,878,262 |
| Deferred Compensation | $5,379,427 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,735,838 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $5,379,427 |
| Estimated Third Party Payor Settlements | $18,036,921 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,416,348 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $48,351 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $31,353 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $16,998 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,000 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $4,488 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $7,907 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $1,754 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $1,849 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $48,351 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $31,353 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $16,998 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,000 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $4,488 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $7,907 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $1,754 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,849 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $16,998 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $0 | NetIncomeSummaryAmt |
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 | 0 | ExpensesExceedBudgetInd |
| 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 | $655,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $649,134 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $655,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $649,134 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $137,515 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,410 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $129,105 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,648 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,648 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,820,692 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,173,173 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,647,519 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09690 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,010,900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,010,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01740 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,013,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,181,583 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,832,172 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11730 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,669,304 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,830,717 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,838,587 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $827,482 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $24,152,873 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $24,565,343 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$412,470 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | 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 | Androscoggin Valley Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 59 Page Hill Road | AddressLine1Txt |
| City | Berlin | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03570 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.avhnh.org | WebsiteAddressTxt |
| State License | 00050 | 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 | Androscoggin 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.avhnh.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.avhnh.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 |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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.avhnh.org/about-us/financial-services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.avhnh.org/about-us/financial-services | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.avhnh.org/about-us/financial-services | 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 Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Androscoggin Valley Hospital | Part V, Section B, Line 5: Key informant surveys were completed by 213 participants in the Androscoggin Valley during the fall of 2015. The participants that completed these surveys include the Berlin City Council, Town Government officials of Shelburne, Gorham, and Randolph, along with officials and superintendents of two School Administration Units (SAU). In addition, CEOs, staff, and Board members of local health and human services agencies, the community health center, the local hospital, mental health center, community action agency and family resource center completed a key informant survey.Surveys were distributed throughout the community and respondents were primarily from the Androscoggin Valley Health Care Service Area.Fifty-six percent of respondents were from Berlin, 18% from Gorham, 11% from Milan, 3% from Randolph, 1% from Shelburne, and less than 1% from Dummer and Errol. Close to 9% of respondents were from other towns including Lancaster, Bethlehem, Littleton, Groveton, Whitefield, Franconia, Piermont, North Conway, Stark, Jefferson, Gilead, Maine and Fryeburg, Maine.Fourteen percent of respondents have advanced degrees and 22% are college graduates. Almost 50% have had some college education or are community college graduates. Thirteen percent graduated from high school, and less than 1% did not complete high school.Fifty-eight percent of respondents are between the ages of 45 and 65, with another 8% over 65. Twenty-five percent are between 30 and 44, and 9% between 18 and 29. Eighty-three percent of the respondents are female, 17% are male.Fifty-one percent of the respondents reported having an annual household income over $60,000, 18% were in the $40,000 to $59,000 range, 20% were in the $20,000 to $39,999 range, 7% were in the $12,000 to $19,999 range, and 4% of the respondents reported income less than $12,000. |
| Androscoggin Valley Hospital | Part V, Section B, Line 6a: Androscoggin Valley Hospital, Androscoggin Valley Home Care Services, Coos County Family Health Services, Family Resource Center, Granite United Way Northern Region, National Alliance on Mental Illness NH, Northern Human Services, North Country Health Consortium, Tri-County Community Action Program, and White Mountains Community College conducted a community survey in the Fall of 2015 to fulfill requirements of the Patient Protection and Affordable Care Act (PPACA) that requires not-for-profit hospitals to conduct a community health needs assessment not less frequently than every three years and adopt an implementation strategy to meet the community health needs identified through the assessment. Surveys were distributed throughout the community and respondents were primarily from the Androscoggin Valley Health Care Service Area. |
| Androscoggin Valley Hospital | Part V, Section B, Line 11: The health needs identified by the Community Needs Assessment have been integrated into the design of the AVH Strategic Plan. After reviewing current community collaborations, partnerships and internal resources, AVH identified its strengths and weaknesses for the most serious health issues. By stewarding existing resources, strengthening partnerships and creating innovative programs both on the hospital campus and within the community, AVH hopes to make a positive impact on these needs. In addition, the survey identified strategies that would improve the health of the community. AVH has made and continues to devote resources in this direction as we realize that these are key to the health of our community. Please see Implementation Strategy online (www.avhnh.org) for more details. Although AVH recognizes the importance of all needs identified by the community, such as cancer care, dental disease, sexually transmitted disease (STD), HIV/AIDS and suicide, AVH will not directly design strategies for these issues in the implementation plan. These issues did not rank high in the needs assessment and can be addressed by other agencies in our community. However, AVH does employ numerous specialists who can diagnose, treat and/or refer cancer patients appropriately for additional oncology services. Resources are available in the community through Coos County Family Health Services to address STD and HIV/AIDS. AVH highly encourages flu vaccines for its employees and patients and has an Infection Control Professional on staff to address issues. AVH will continue to keep current on these issues and provide referrals to those in need through its ED and specialty practice as well as through frequent community educational classes and newsletters/electronic media. Affordable health care continues to be addressed on a national and state level. AVH has programs available to facilitate financial counseling, enrollment into Medicaid, application to community (charity) care funds and payment plans. |
| Schedule H, Part V, Section B, Line 22: | All patients are charged the same amount for services and procedures performed, regardless of whether they were insured or uninsured. The net amount due to the hospital is based upon contractual adjustments for insured patients and administrative adjustments for uninsured patients, which may include free care, charity care, and discounted care. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AVH Surgical Associates | ||||
| 7 Page Hill Road | Berlin | NH | 03570 | Physician Practice Office |
| 2 - Androscoggin Valley Hospital | ||||
| 133 Pleasant Street | Berlin | NH | 03570 | Outreach Clinic/Lab Services |
| 3 - Androscoggin Valley Hospital | ||||
| 2 Broadway Avenue | Gorham | NH | 03581 | Outreach Clinic/Lab Services |
| 4 - Androscoggin Valley Hospital | ||||
| 181 Corliss Lane | Colebrook | NH | 03576 | Outreach Clinic/OB, Neurology, Orthopedic Rehab Services |
| 5 - Androscoggin Valley Hospital | ||||
| 130 Main Street | Gorham | NH | 03581 | Outreach Clinic/Rehab Services |
| 6 - Androscoggin Valley Hospital | ||||
| 173 Middle Street | Lancaster | NH | 03584 | Outreach Clinic/Sleep & ENT Services |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | A cost accounting system was used to calculate the amounts reported in the table. The cost accounting system addresses all patient segments. A cost-to-charge ratio was used. The ratio was derived from Worksheet 2. |
| Part I, Line 7g: | All costs reported on Part I, Line 7g are attributable to a physician clinic. |
| Part III, Line 4: | Patient accounts receivable are carried at the amount management expects to collect from outstanding balances.Patient receivables are periodically evaluated for collectibility based on credit history and current financial condition. Provisions for losses on receivables are determined on the basis of loss experience, known and inherent risks, estimated value of collateral and current economic conditions. The Hospital uses the allowance method to account for uncollectible accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identified trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. Data in each major payor source are regularly reviewed to evaluate the adequacy of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, an allowance for doubtful accounts and a corresponding provision for bad debts are established at varying levels based on the age of the receivables and the payor source. For receivables relating to self-pay patients, a provision for bad debts is made in the period services are rendered based on experience indicating the inability or unwillingness of patients to pay amounts for which they are financially responsible. Actual write-offs after management has used reasonable collection efforts are charged against allowance for doubtful accounts.During FY 2018, the Hospital decreased its estimate of the allowance for doubtful accounts from $4,636,756 to $3,059,647. The decrease in the allowance reflected an overall decrease in accounts receivable. During FY 2018 and FY 2017, write-offs were $1,005,186 and $1,070,078, respectively.The costing methodology used in determining the amounts reported above was a ratio of cost to charge. |
| Part III, Line 8: | The Organization used a cost report as the costing methodology to determine the amount of allowable Medicare costs. |
| Part VI, Line 2: | Every 3 years, Androscoggin Valley Hospital participates in a community needs assessment with four other members of the community's health care system. Using information from that assessment allows the Hospital to provide healthcare services to the North Country community on an ongoing basis. |
| Part VI, Line 3: | Androscoggin Valley Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to patients getting the healthcare services they need. If payment of healthcare expenses could create a financial hardship, Hospital staff will work with patients to apply for financial assistance. Information regarding financial assistance policies is available at the Hospital's entrances and patient registration and on the Hospital's website. As part of the financial counseling application process, the Hospital will assess eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid and assist in the application process. |
| Part VI, Line 4: | The geographic area served by Androscoggin Valley Hospital is the Berlin service area. The Berlin service area is composed of the city of Berlin, and the towns of Gorham, Shelburne, Milan, Randolph, Dummer, Errol and Stark. These communities are within the boundaries of Coos County, which is bordered by the State of Maine to the east, the State of Vermont to the west and Quebec, Canada to the north. The city of Berlin defines much of the region as the largest community in the County with a population of 10,225. The total population of the Berlin service area is 16,243. The changing economic landscape and the closing of paper and pulp mills over the last decade in the Coos County have significantly impacted the area's unemployment rate and population compared to those experienced by the overall state of New Hampshire. |
| Part VI, Line 5: | Androscoggin Valley Hospital is the leading provider of healthcare to thousands of families in the small-town communities of New Hampshire's North Country. As a Critical Access Hospital, AVH offers 24/7 emergency care, in-house treatment of most medical issues, and an arrangement for treatment of all other problems with the nearest tertiary-care facility.Over the past decade, AVH has invested significantly in expanding and improving our facilities and services, and enhancing our team of dedicated, highly trained doctors, nurses and other staff. The result is a hospital that more effectively contributes to the health of our communities than ever before. Our new 2-North area, features numerous exam rooms, office space and two comfortable reception areas, which is home to expanded and enhanced space for innovative cardiac care, sleep medicine, pulmonary care, and ear, nose & throat services. At the end of the day, our top priority is to ensure the highest level of quality healthcare to those that we are so fortunate to serve.In an effort to continue to provide a high quality of healthcare for all patients in the North Country, the hospitals of Coos & Grafton County came together to explore collaboration. We, the boards and senior management of Androscoggin Valley Hospital, Upper Connecticut Valley Hospital, Weeks Medical Center and Littleton Regional Hospital realize that significant national, state and local economic pressures are jeopardizing local access, quality and sustainability. We have therefore formed North Country Healthcare (NHC) with the stated objective of working collaboratively to better serve the healthcare needs of North Country patients. This collaborative effort will work to:1. Ensure access to quality care within the communities in which our patients live2. Provide local and high quality care with positive outcomes to our patients in the North Country 3. Control the cost of care through innovative programs and the use of shared resourcesNational healthcare reform demands lower costs and higher quality from all hospitals, requiring collaboration in patient care across all providers: from primary care to specialist, from ambulance to hospital, from hospital to rehabilitation to home care, from local hospital to tertiary (specialty hospital) care. Therefore, Androscoggin Valley Hospital, Upper Connecticut Valley Hospital, Weeks Medical Center, and Littleton Regional Hospital have formed this joint venture to identify and implement sustainable opportunities for our future. The NHC and its member hospitals are prepared to manage costs and coordinate care in a way that is financially sustainable, while continuing to provide local access to quality care throughout the county and beyond. The hospitals of the North Country must work together as critical parts of our economy and community. |
| Part VI, Line 7, Reports Filed With States | NH |
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 |
|---|---|---|---|---|---|---|---|
| Coos County Family Health Services | |||||||
| 133 Pleasant Street | Berlin | NH | 03570 | 020350051 | 501(c)(3) | $1,010,900 | To support otherwise uncompensated costs attributable to the Provision of the combined Coos County Family Health Services practice (CCFHS). These costs are incurred in providing comprehensive, community-based preventive and primary health and dental care, behavioral health services, related enabling services, outreach, health education, and promotion, and appropriate services and programs that promote CCFHS to, and availability of, continuous care for the residents of the Coos County service area. |
| Foundation for Healthy Communities | |||||||
| 125 Airport Road | Concord | NH | 03301 | 020275078 | 501(c)(3) | $223,123 | Funding Medicaid Expansion |
| 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 has entered into an agreement with Coos County Family Health Services (CCFHS) whereby the Hospital will provide funding in the form of a community benefit grant. The terms of the agreement require that the Hospital provide CCFHS with the agreed-upon community benefit grant on July 1 of the grant year. The amount of the community benefit grant to be awarded is determined on an annual basis in accordance with the terms of the agreement. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 | Yes (1) | 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 (13 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Javier Cardenas MD | ||||||||||||||
| Director | $372,380 | $0 | $0 | $0 | $11,784 | $0 | $0 | $0 | $24,567 | $0 | $408,731 | $0 | $0 | $0 |
| Michael Peterson | ||||||||||||||
| President | $278,086 | $0 | $0 | $0 | $24,250 | $0 | $0 | $0 | $30,152 | $0 | $332,488 | $0 | $0 | $0 |
| Joseph DellaValla MD | ||||||||||||||
| Past Medical Staff President | $273,227 | $0 | $0 | $0 | $11,204 | $0 | $0 | $0 | $30,152 | $0 | $314,583 | $0 | $0 | $0 |
| Krzystof Z Plociennik MD | ||||||||||||||
| Past Medical Staff President | $451,186 | $0 | $0 | $0 | $13,400 | $0 | $0 | $0 | $32,167 | $0 | $496,753 | $0 | $0 | $0 |
| Brian O'Hearn | ||||||||||||||
| Chief Nursing Officer | $193,516 | $0 | $0 | $0 | $7,975 | $0 | $0 | $0 | $30,152 | $0 | $231,643 | $0 | $0 | $0 |
| Keith Shute MD | ||||||||||||||
| Sr. VP/Chief Medical Officer | $386,971 | $0 | $3,879 | $0 | $13,572 | $0 | $0 | $0 | $27,161 | $0 | $431,583 | $0 | $0 | $0 |
| Kenneth Danielson MD | ||||||||||||||
| Physician | $349,270 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $349,270 | $0 | $0 | $0 |
| Christopher Fitzmorris MD | ||||||||||||||
| Physician | $504,043 | $0 | $0 | $0 | $18,000 | $0 | $0 | $0 | $24,567 | $0 | $546,610 | $0 | $0 | $0 |
| Richard Kardell MD | ||||||||||||||
| Physician | $325,862 | $0 | $0 | $0 | $13,654 | $0 | $0 | $0 | $29,672 | $0 | $369,188 | $0 | $0 | $0 |
| Peggy Simon MD | ||||||||||||||
| Physician | $395,807 | $0 | $0 | $0 | $16,015 | $0 | $0 | $0 | $19,679 | $0 | $431,501 | $0 | $0 | $0 |
| Norman Kossayda | ||||||||||||||
| Physician | $303,963 | $0 | $0 | $0 | $10,440 | $0 | $0 | $0 | $301 | $0 | $314,704 | $0 | $0 | $0 |
| Russell Keene | ||||||||||||||
| Former President & CEO | $0 | $329,119 | $0 | $0 | $0 | $209,856 | $0 | $0 | $0 | $18,931 | $0 | $557,906 | $0 | $29,750 |
| Richard Werkowski | ||||||||||||||
| Former Interim CFO | $142,064 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $142,064 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | Russell Keene participated in a supplemental nonqualified retirement plan. Amounts related to this plan, reported on Page 2 of Schedule J, include $181,064 in column B(iii). |
| Part I, Line 7 | During 2017, Dr. Keith Shute received a bonus in the amount of $3,879. The bonus payment was based on performance based criteria and was paid to Dr. Shute based on meeting expectations and goals within the criteria. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 2012 New Hampshire Health and Education Facilities Authority Revenue Bonds | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| Bond Issued | 2012-03-29 | BondIssuedDt |
| Issue Price | $14,500,000 | IssuePriceAmt |
| Purpose | Refinancing existing bonds, terminate interest rate swap contract | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $6,514,710 | RetiredAmt |
| Total Proceeds | $14,500,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $125,386 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $14,374,614 | OtherSpentProceedsAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwood Anesthesia Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Entity owned more than 35% by J. Rodger Wood, Past Board Member | RelationshipDescriptionTxt |
| Transaction | $1,030,800 | TransactionAmt |
| Transaction | Independent Contractor Arrangement | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Androscoggin Valley Hospital. |
| Form 990, Part VI, Section A, line 7a | In accordance with the Affiliation Agreement with North Country Healthcare, each Hospital's charter and bylaws were amended to effect the establishment of NCH as the sole member and to create a shared governance structure between the Board of Directors of NCH and the Boards of each Hospital. Each Hospital continues to maintain its own Board of Directors (Corporation Board) that is distinct from the NCH Board of Directors. However, the Bylaws of NCH and each Hospital identify certain "Major matters" (divided into organizational and operational matters) that require initiation and/or authorization by a majority of the NCH Board. Members of the Hospital Boards are nominated exclusively by the Hospitals. However, the election of any such director must be approved by both the Hospital Board and the NCH Board. Some examples of other organizational "Major matters" requiring the initiation and/or approval of the NCH Board include amendments to by-laws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major matters" requiring the initiation and/or approval of the NCH Board include approval of annual capital and operating budgets, adoption of compensation and benefit programs, approval of information technology systems, financial systems and auditors, plus approval of any major changes to clinical services offered. The Chief Executive Officer position at each of the Hospitals has been changed to a President position. As with Board members, each Hospital President must be nominated at the Hospital level and then approved by both the Hospital Board and the NCH Board. This position reports to both the applicable Hospital Board and the Chief Executive Officer of NCH. The Chief Financial Officer of each of the Hospitals will remain an appointed position by the President, but this individual will also report to the President/Chief Financial Officer of NCH. |
| Form 990, Part VI, Section A, line 7b | See narrative provided for Form 990, Part VI, Line 7a. |
| Form 990, Part VI, Section B, line 11b | The current year Form 990 was provided to the Organization's Board of Directors or Finance Committee prior to submission. |
| Form 990, Part VI, Section B, line 12c | The Senior Director of Administrative and Revenue Cycle Services along with the Controller review on an on-going basis all transactions that could potentially violate our conflict of interest policy. In addition, all Board members and key employees sign a Conflict of Interest Statement each year. The first item on every Board Agenda is "Call to Order, Declaration of Potential Conflicts of Interest and Confidentiality Reminder." |
| Form 990, Part VI, Section B, line 15 | AVH retained AON Hewett to provide information relative to CEO compensation. AON Hewett's business is to provide independent advice to management and Board of Directors concerning compensation and benefit programs for, among others, executive managers. In the study that they performed for Androscoggin Valley Hospital, they provided an opinion which is intended to be an expert opinion that can be relied upon by the Compensation Committee of NorthCare and the Board of Directors for up to one year. In addition, AVH also relies on compensation survey information obtained from a regional firm for information relative to all of its Senior Managers so that all compensation at the senior level has been viewed in a reliable and comparable manner that would meet the spirit implied with the IRS intermediate sanction regulations. |
| Form 990, Part VI, Section C, line 19 | The Organization does not make its governing documents or conflict of interest policy available for public inspection. The Organization does make its financial statements available for public inspection upon request. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 4,635,151. Management and general expenses 949,368. Fundraising expenses 0. Total expenses 5,584,519. Contract Labor: Program service expenses 3,920,962. Management and general expenses 803,089. Fundraising expenses 0. Total expenses 4,724,051. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Androscoggin Valley Hospital 59 Page Hill Road Berlin, NH 03570 EIN 02-0280367 Androscoggin Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Northcare Inc | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 521596952 | Supporting Services | NH | 501(c)(3) | Line 12b, II | Androscoggin Valley Hospital Inc | Yes (1) | |
| Androscoggin Valley Hospital Foundation | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 223035216 | Management and Financial Support | NH | 501(c)(3) | Line 12b, II | Androscoggin Valley Hospital Inc | Yes (1) | |
| Mountain Health Services Inc | |||||||||||
| 59 Page Hill Road | Berlin | NE | 03570 | 020452547 | Healthcare Services | NH | 501(c)(3) | Line 12b, II | Androscoggin Valley Hospital Inc | Yes (1) | |
| North Country Healthcare Inc | |||||||||||
| 8 Clover Lane | Whitefield | NH | 03598 | 812225283 | Management and Support | NH | 501(c)(3) | Line 12a, I | 0 | N/A | |
| Weeks Medical Center | |||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 020222242 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | N/A | |
| Upper Connecticut Valley Hospital | |||||||||||
| Corliss Lane | Colebrook | NH | 03576 | 020276210 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | N/A | |
| Littleton Hospital Association | |||||||||||
| 600 St Johnsbury Road | Littleton | NH | 03561 | 020222152 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 | N/A | |
| North Country Home Health & Hospice Agency Inc | |||||||||||
| 536 Cottage Street | Littleton | NH | 03561 | 020300637 | Home Health Agency | NH | 501(c)(3) | Line 10 | 0 | N/A | |
| 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 | Yes (1) | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Northcare Inc | ||
| D | $518,580 | FMV |
| Androscoggin Valley Hospital Foundation | ||
| D | $72,614 | FMV |