2019-06-25T07:57:51-05:00 2018-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2017-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Celeste Pitts CFO 6037884911 2019-06-24 1 Barbara J McGuan CPA P00219457 2077752387 2019-06-24 69.49.157.66 2019-06-24 16:03:10 ED P 32BC52385E097AD1B92E63E6016D3C1011811B46 BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED 2017 2019-02-21 02:37:17Z Michael D Lee 173 Middle Street Lancaster NH 03584 57445540 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 15 12 380 101 0 0 513450 691238 45698141 50161379 664713 2508065 0 0 46876304 53360682 212741 192301 0 0 26524711 28236283 0 36000 36000 18640805 19563201 45378257 48027785 1498047 5332897 55770730 64012900 24540087 27663203 31230643 36349697 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 39229875 192301 50161379 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 39229875 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 60 0 1 380 1 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 1.00 1.00 X X 0 0 0 Sarah Desrochers Vice Chair 1.00 0.00 X X 0 0 0 Dennis Couture Secretary 1.00 0.00 X X 0 0 0 Keith Young Treasurer 1.00 0.00 X X 0 0 0 Ruby Berryman Trustee 1.00 0.00 X 0 0 0 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 0.00 X 0 0 0 Lisa Tetreault Trustee 1.00 0.00 X 0 0 0 Mark Morgan MD Medical Staff President 40.00 0.00 X 455992 0 29776 Lars Nielson CMO 40.00 1.00 X X 312657 0 27226 Michael D Lee President 40.00 0.00 X X 200412 0 2637 David Atkinson Past Trustee 1.00 0.00 X 0 0 0 Dana Muzzey Past Trustee 1.00 0.00 X 0 0 0 Cindy Normandeau Past Trustee 1.00 0.00 X 0 0 0 Celeste Pitts CFO 24.00 16.00 X 98517 65678 12580 Paul Kamins MD Physician 40.00 0.00 X 459178 0 29777 Jeffrey Johnson MD Physician 40.00 0.00 X 380014 0 26036 Christopher Laurent NP Physician 40.00 0.00 X 389736 0 9083 Maude Oetking Physician 40.00 0.00 X 399179 0 31084 Walter Voigt Physician 40.00 0.00 X 403062 0 31025 3098747 65678 199224 51 0 1 0 Dartmouth-Hitchcock Clinic One Med Ctr Dr Lebanon NH 03766 Professional Services 848818 AHSA PO Box 945 Traverse City MI 49685 Contract Labor/Nurse Svcs. 582455 Arthur J Gallagher Risk Mgmt Services PO Box 71164 Chicago IL 60694 Professional Services 543322 Healogics Wound Care & Hyperbaric Servic 3087 Momentum Place Chicago IL 60689 Wound Care Services 379756 New Hampshire Imaging Services One Pillsbury Street Suite 200 Concord NH 033013570 Professional Services 247277 35 63222 628016 691238 Patient Service 621400 84681862 84681862 Miscellaneous 621400 3831744 3647880 183864 Meaningful Use 621400 118081 118081 Provision for Bad Debts 621400 -1709154 -1709154 Contractual/Char. Adj. 621400 -36761154 -36761154 50161379 641376 641376 5910547 41000 4068245 16613 1842302 24387 1866689 1866689 53360682 49977515 0 2691929 192301 192301 1205475 1205475 21892224 18783833 3108391 393610 337258 56352 3301806 2736321 565485 1443168 1177314 265854 442625 50516 392109 63002 63002 68940 68940 36000 36000 54723 54723 3829272 3659505 169767 160720 160720 275588 71468 204120 981323 981323 955740 937501 18239 131271 113214 18057 87137 75879 11258 271842 271842 1826546 1826546 527667 268152 259515 Patient Care Supplies 5780294 5780294 Miscellaneous 2376921 1218341 1158580 MET Taxes 1729590 1729590 48027785 39229875 8761910 36000 X 1450 247300 12494140 22645218 4798603 4889862 805045 994752 716190 1135232 45470752 30628768 14223340 14841984 22604044 19108552 -22082 150000 150000 55770730 64012900 3700248 3961758 418835 611178 7530779 7120880 12890225 15969387 24540087 27663203 X 29909916 34824702 408813 613081 911914 911914 31230643 36349697 55770730 64012900 5332897 -213843 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9624 9624 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. 1054173 -13576 1040597 1039727 14446 1054173 1035352 4375 1039727 1174268 -62816 76100 1035352 1144520 2285 27463 1174268 0.00000 0.87630 0.12370 0 0 532630 532630 14196027 9239931 4956096 28350286 21024619 7325667 2391809 364218 2027591 14841984 Estimated Third-Party Payor Settlements 15969387 15969387 53092116 -213843 -213843 53305959 54723 54723 53360682 47973062 0 47973062 54723 54723 48027785 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 167953 36000 131953 167953 36000 131953 NH 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 740398 62016 678382 0.01410 5834619 4175169 1659450 0.03460 1374707 322924 1051783 0.02190 7949724 4560109 3389615 0.07060 724073 60551 663522 0.01380 354328 354328 0.00740 192301 192301 0.00400 1270702 60551 1210151 0.02520 9220426 4620660 4599766 0.09580 3 95 111767 448 111319 0.00230 21292 21292 0.00040 2 232 4817 4817 0.00010 5 327 137876 448 137428 0.00280 1 904237 22437516 22664158 -226642 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 15 1 1 0 1 X www.weeksmedical.org X 1 15 1 www.weeksmedical.org 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 1 X 0 0 Weeks Medical Center Part V, Section B, Line 5: Input from the community was solicited through a survey, which was available both electronically (through Survey Monkey) and via paper copy. Paper copies were distributed to various community locations. Electronic surveys were available via the Weeks and North Country Healthcare websites and through the Weeks Facebook page, plus other community partner websites. 203 Surveys were completed. In addition, 89 Community leaders were also surveyed electronically. This group represented area business & economic development leaders, community board members of health & human service organizations, municipal government and human services providers. 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 11: Significant Needs Identified and Being Addressed:1. Substance Misuse, Alcohol Abuse & Mental health problems: 24/7 Emergency medical care available. Naloxone (Narcan) treatment for overdose is an available option. In Fiscal 2017, Weeks instituted a Medication Assisted Therapy (MAT) program in our Physician Offices that combines Suboxone treatment with intensive behavioral health counseling. The program has grown tremendously in 2018 resulting in our need to bring in additional staff. We recently contracted with Walgreens to allow MAT patients who are in between insurance programs or have a large deductible to fill their Suboxone prescription and no cost to them. Weeks covers that cost. In addition to our in-house programs, Alcohol Anonymous is given space in the hospital for regular weekly meetings. 2. Obesity/Overweight: Weeks employs registered dieticians and a diabetes educator who is available to provide consults through the Primary Care offices. In addition, an Intensive Behavioral Therapy program has been underway for the second year in a row. Meeting space for Weight Watchers and healthy and affordable meal choices for the public/visitors are also available.3. Smoking and Tobacco Use: Ongoing smoking cessation classes available to the public. In addition, Weeks is a smoke/tobacco free campus.Significant Needs not being addressed and why:The needs identified that Weeks is not able to address center around the County's lack of jobs. Low Income/Poverty and Unemployment/Lack of Jobs were two such items. Cost of healthy foods was also mentioned. These are not within the scope of our mission; however we will continue to work with local resources in our role as a responsible corporate citizen to improve our economy where we can. There are currently several economic development groups active in the area and some new businesses are considering moving in.Other needs we are currently unable to meet revolve around lack of dental insurance, cost of prescription drugs, and access to health insurance. While Weeks cannot fix these issues, we have made a huge effort over these past 3 years to ensure as many of our patients as possible take advantage of Medicaid Expansion or the Insurance Exchanges. This has resulted in a significant drop in our uninsured population. Weeks continues to offer free care for eligible patients through our Weeks Health Access program. 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. Weeks Medical Center Part V, Section B, Line 20e: Weeks Medical Center (The Organization) takes multiple steps to collect information which will allow the Organization to determine patient eligibility. The Organization will send two letters offering Weeks Health Access, as well as, the screening and outreach up-front procedures for surgeries and large dollar accounts. All billing letters and statements sent to patients contain a copy of the Financial Assistance Plain Language Summary. Additionally, the Organization will work with the patients to set-up payment plans and assist patients with programs which they may qualify for. Our Financial Counseling staff are Certified Application Counselors and are also eligible to do Medicaid Presumptive Eligibility, which enables them to sign eligible patients up for Medicaid. The Medicaid program expanded due to the Affordable Care Act in August, 2014. The Organization believes these steps to be a reasonable effort.If a payment is not made, the Organization uses an outside agency to monitor payment plans and pursue payment or make payment arrangements. The outside agency will place unpaid accounts on the patients credit file. The Organization will look at unpaid accounts over $10,000 with the collection agency and determine if litigation should be pursued. 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 2016, North Country Healthcare partnered with the North Country Health Consortium based in Littleton, NH to complete a Community health needs assessment (CHNA) for the four affiliated hospitals. Once the CHNA was completed, a strategic planning committee of the four hospitals met to determine which community needs were to be addressed by the hospitals and which specific initiatives would be put into place to meet these needs. The initiatives will become part of the overall 2017-2019 Strategic Plan. The CHNA is 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 03301 020275078 501(c)(3) 186001 Fund Medicaid Expansion New Hampshire Food Bank 700 East Industrial Park Drive Manchester NH 03109 020222163 501(c)(3) 6300 To support Food Pantry operations 2 0 Part I, Line 2: The Hospital was mandated by the State of NH to contribute funds to the Foundation for Healthy Communities in order to support Medicaid expansion. Any other amounts contributed are to other 501(c)(3) organizations and therefore, additional monitoring of funds is not deemed necessary. X X X X 0 0 0 0 0 0 0 0 0 Mark Morgan MD Medical Staff President 437892 0 100 0 18000 0 8099 0 21677 0 485768 0 0 0 Lars Nielson CMO 289489 0 0 0 23168 0 5632 0 21594 0 339883 0 0 0 Michael D Lee President 176622 0 0 0 23790 0 1074 0 1563 0 203049 0 0 0 Celeste Pitts CFO 78724 52483 5393 3595 14400 9600 3000 2000 4548 3032 106065 70710 0 0 Paul Kamins MD Physician 435178 0 0 0 24000 0 8100 0 21677 0 488955 0 0 0 Jeffrey Johnson MD Physician 356014 0 0 0 24000 0 10171 0 15865 0 406050 0 0 0 Christopher Laurent NP Physician 381993 0 0 0 7743 0 8100 0 983 0 398819 0 0 0 Maude Oetking Physician 375079 0 100 0 24000 0 8099 0 22985 0 430263 0 0 0 Walter Voigt Physician 394779 0 0 0 8283 0 8100 0 22925 0 434087 0 0 0 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 2879120 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 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, 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 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. 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). 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 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0