UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION (EIN 02-0276210)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-02-15
- IRS object ID
- 201730469349300338
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-15T08:53:14-06:00 | ReturnTs |
| Tax Period End | 2016-09-30 | 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 | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020276210 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UPPE | BusinessNameControlTxt |
| Phone | 6032374971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Scott Colby | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6032374971 | PhoneNum |
| Signature | 2017-02-10 | 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 | 2017-02-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Scott Colby | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,014,132 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ucvh.org | WebsiteAddressTxt |
| Type Of Organization Assoc | Yes (X) | TypeOfOrganizationAssocInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To provide high quality and efficient health care services | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 147 | TotalEmployeeCnt |
| Total Volunteers | 32 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $160,264 | PYContributionsGrantsAmt |
| CY Contributions Grants | $548,486 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,616,811 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,707,982 | CYProgramServiceRevenueAmt |
| PY Investment Income | $358,185 | PYInvestmentIncomeAmt |
| CY Investment Income | $397,493 | CYInvestmentIncomeAmt |
| PY Other Revenue | $44,750 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $16,180,010 | PYTotalRevenueAmt |
| CY Total Revenue | $16,653,961 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $12,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,181,244 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,869,615 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $32,933 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $37,255 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,442,599 | PYOtherExpensesAmt |
| CY Other Expenses | $8,106,798 | CYOtherExpensesAmt |
| PY Total Expenses | $15,636,343 | PYTotalExpensesAmt |
| CY Total Expenses | $16,009,346 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $543,667 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $644,615 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,313,655 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,768,458 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,151,482 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,446,861 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,162,173 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,321,597 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Upper Connecticut Valley Hospital strives to improve the well-being of the rural communities it serves by promoting health and assuring access to quality care. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,950,965 | ExpenseAmt |
| Revenue | $15,707,982 | RevenueAmt |
| Desc | Upper Connecticut Valley Hospital provided hospital care and impatient and outpatient services on a region-wide basis. The net charity care provided by the Hospital for the year-ended September 30, 2016 was $487,621. | Desc |
| Total Program Service Expenses | $12,950,965 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 147 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Celeste Pitts | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6032374971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Greg E Placy | ||||||||
| Chairman | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Odette Crawford | ||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Tibbetts | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| E Harlan Connary | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Bruce Bean | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Frederick D Brock | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Palmer Lewis | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Peter Moran MD | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Eric Stohl | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Robert Rose MD | ||||||||
| Physician, Chief Medical Officer | 62.00 | 0.00 | Yes (X) | Yes (X) | $443,642 | $0 | $4,350 | |
| James Wells | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Avis Brosseau | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sally S Wentzell | ||||||||
| Past Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Edward Laverty PA-C | ||||||||
| Past Chief of Staff | 59.00 | 0.00 | Yes (X) | $198,550 | $0 | $12,496 | ||
| Scott Colby | ||||||||
| President | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Peter L Gosline | ||||||||
| Past Chief Administrative Officer | 24.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Celeste Pitts | ||||||||
| Chief Financial Officer | 16.00 | 24.00 | Yes (X) | $55,123 | $82,685 | $10,750 | ||
| Kimberlee Daley | ||||||||
| Patient Experience Officer | 42.00 | 0.00 | Yes (X) | $114,550 | $0 | $8,190 | ||
| Thomas Cochran | ||||||||
| ER Medical Director | 32.00 | 0.00 | $225,649 | $0 | $4,815 | Yes (X) | ||
| Robert Gooch | ||||||||
| Director of Pharmacy | 42.00 | 0.00 | $156,413 | $0 | $7,174 | Yes (X) | ||
| Joseph Kiernan | ||||||||
| General Surgeon | 32.00 | 0.00 | $271,615 | $0 | $9,090 | Yes (X) | ||
| Thomas Marallo | ||||||||
| Director of Lab | 49.00 | 0.00 | $115,161 | $0 | $7,968 | Yes (X) | ||
| Charanjit Veeramalla | ||||||||
| Hospitalist | 34.00 | 0.00 | $377,634 | $0 | $18,351 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,958,337 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $82,685 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $83,184 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Androscoggin Valley Hospital | |||||
| 59 Page Hill Road | Berlin | NH | 03570 | Lab, Rehab & Office Staff Svcs. | $1,059,602 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | Billing Services/Software Support | $718,559 |
| Northern NH Healthcare Management LLC | |||||
| 59 Page Hill Road | Berlin | NH | 03570 | Management Services | $345,171 |
| Vista Staffing Solutions | |||||
| 275 East 200 South | Salt Lake City | UT | 84111 | Locum Physician Staffing | $153,206 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $25,400 | GovernmentGrantsAmt |
| All Other Contributions | $523,086 | AllOtherContributionsAmt |
| Total Contributions | $548,486 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Service Revenue | 621400 | $29,609,774 | $29,609,774 | |
| Miscellanous Revenue | 624100 | $307,398 | $264,715 | $42,683 |
| Meaningful Use Revenue | 621400 | $146,237 | $146,237 | |
| Provision for Bad debts | 621400 | -$846,974 | -$846,974 | |
| Contractual/Char. Adj. | 621400 | -$13,508,453 | -$13,508,453 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,707,982 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $240,245 | TotalRevenueColumnAmt |
| Exclusion | $240,245 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,517,419 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,355,054 | SecuritiesAmt |
| Other | $5,117 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $162,365 | SecuritiesAmt |
| Other | -$5,117 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $157,248 | TotalRevenueColumnAmt |
| Exclusion | $157,248 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,653,961 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,665,299 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $440,176 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $841,201 | TotalAmt |
| Program Services | $659,038 | ProgramServicesAmt |
| Management And General | $182,163 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,343,730 | TotalAmt |
| Program Services | $4,735,330 | ProgramServicesAmt |
| Management And General | $608,400 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,329 | TotalAmt |
| Program Services | $52,865 | ProgramServicesAmt |
| Management And General | $4,464 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,241,285 | TotalAmt |
| Program Services | $1,090,385 | ProgramServicesAmt |
| Management And General | $150,900 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,070 | TotalAmt |
| Program Services | $337,270 | ProgramServicesAmt |
| Management And General | $48,800 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,035 | TotalAmt |
| Management And General | $338,035 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,414 | TotalAmt |
| Management And General | $59,414 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,800 | TotalAmt |
| Management And General | $53,800 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,933 | TotalAmt |
| Fundraising | $32,933 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,975 | TotalAmt |
| Management And General | $78,975 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,830,503 | TotalAmt |
| Program Services | $2,168,013 | ProgramServicesAmt |
| Management And General | $662,490 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,933 | TotalAmt |
| Management And General | $6,933 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,332 | TotalAmt |
| Management And General | $98,332 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $284,253 | TotalAmt |
| Management And General | $284,253 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,973 | TotalAmt |
| Program Services | $269,973 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,732 | TotalAmt |
| Program Services | $60,669 | ProgramServicesAmt |
| Management And General | $54,063 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,153 | TotalAmt |
| Program Services | $1,153 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $690,972 | TotalAmt |
| Program Services | $690,972 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,846 | TotalAmt |
| Management And General | $159,846 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies Expense | $1,658,754 | $1,625,398 | $33,356 | |
| Medicaid Enhancement Ta | $747,004 | $747,004 | ||
| Miscellanous | $714,119 | $512,895 | $196,902 | $4,322 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,009,346 | TotalAmt |
| Program Services | $12,950,965 | ProgramServicesAmt |
| Management And General | $3,021,126 | ManagementAndGeneralAmt |
| Fundraising | $37,255 | 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 | $189,100 | BOYAmt |
| EOY | $131,461 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,790,585 | BOYAmt |
| EOY | $6,808,927 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $439,500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,546,607 | BOYAmt |
| EOY | $1,872,163 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,832 | BOYAmt |
| EOY | $291,351 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $268,316 | BOYAmt |
| EOY | $125,873 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,462,589 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,085,893 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,233,781 | BOYAmt |
| EOY | $4,376,696 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,834,794 | BOYAmt |
| EOY | $10,185,655 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $473,161 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,680,479 | BOYAmt |
| EOY | $536,832 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,313,655 | BOYAmt |
| EOY | $24,768,458 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,485,739 | BOYAmt |
| EOY | $1,929,583 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $356,417 | BOYAmt |
| EOY | $402,641 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $750,405 | BOYAmt |
| EOY | $521,081 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,558,921 | BOYAmt |
| EOY | $5,593,556 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,151,482 | BOYAmt |
| EOY | $8,446,861 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,791,324 | BOYAmt |
| EOY | $15,583,933 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,779 | BOYAmt |
| EOY | $564,594 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,070 | BOYAmt |
| EOY | $173,070 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,162,173 | BOYAmt |
| EOY | $16,321,597 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,313,655 | BOYAmt |
| EOY | $24,768,458 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $644,615 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $514,809 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,683 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,683 | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $263,522 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $20,177 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,042 | OtherExpendituresAmt |
| End Year Balance | $280,657 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $191,998 | BeginningYearBalanceAmt |
| Contributions | $80,000 | ContributionsAmt |
| Investment Earnings Or Losses | $3,175 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $11,651 | OtherExpendituresAmt |
| End Year Balance | $263,522 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $170,203 | BeginningYearBalanceAmt |
| Contributions | $20,000 | ContributionsAmt |
| Investment Earnings Or Losses | $14,929 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $13,134 | OtherExpendituresAmt |
| End Year Balance | $191,998 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $161,056 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $18,320 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $9,173 | OtherExpendituresAmt |
| End Year Balance | $170,203 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $129,746 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $31,310 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $161,056 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.61670 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.38330 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,700 | OtherCostOrOtherBasisAmt |
| Book Value | $9,700 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,962,786 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,407,522 | DepreciationAmt |
| Book Value | $1,555,264 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,123,284 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,539,838 | DepreciationAmt |
| Book Value | $2,583,446 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $366,819 | OtherCostOrOtherBasisAmt |
| Depreciation | $138,533 | DepreciationAmt |
| Book Value | $228,286 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,376,696 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Third Party Payers | Desc |
| Amt | $5,593,556 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,593,556 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $17,085,473 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $514,809 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $514,809 | RevenueNotReportedAmt |
| Revenue Subtotal | $16,570,664 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $78,975 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $4,322 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $83,297 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $16,653,961 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,926,049 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,926,049 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $78,975 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $4,322 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $83,297 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $16,009,346 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 4b - Other Adjustments: | Fundraising Expenses 4,322. |
| Part XII, Line 4b - Other Adjustments: | Fundraising Expenses 4,322. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robert P Pettegrew | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 117 Middle Road | AddressLine1Txt |
| City | Hancock | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03449 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Feasibility Study and Fundraising | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $457,750 | GrossReceiptsAmt |
| Retained By Contractor | $32,933 | RetainedByContractorAmt |
| Net To Organization | $424,817 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $457,750 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $32,933 | TotalRetainedByContractorsAmt |
| Total Net To Organization | $424,817 | TotalNetToOrganizationAmt |
| Licensed States | NH | LicensedStatesCd |
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 | $565,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $78,295 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $487,621 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03050 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,032,528 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,702,928 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,329,600 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,598,444 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,781,223 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,817,221 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11360 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $447,679 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,027 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $425,652 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02660 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $110,053 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $110,053 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,216,672 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,982,636 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,234,036 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07710 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,774,404 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,004,663 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,769,741 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,372,848 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,785,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,586,962 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.22420 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,903 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,903 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,251 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,251 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,154 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,154 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $500,295 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,066,763 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,148,245 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$81,482 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Corliss Lane | AddressLine1Txt |
| City | Colebrook | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.ucvh.org | WebsiteAddressTxt |
| State License | 000592 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Upper Connecticut Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| 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.ucvh.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.ucvh.org | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.ucvh.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.ucvh.org | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.ucvh.org | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Upper Connecticut Valley Hospital | 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 UCVH and North Country Healthcare websites 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. |
| Upper Connecticut Valley Hospital | Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Weeks Medical Center, Littleton Regional Hospital, and Androscoggin Valley Hospital. |
| Upper Connecticut Valley Hospital | 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. Policy being developed for sharing Narcan kits with 3rd party friends and families. Indian Stream Health Center, the local FQHC, employs several Behavioral Health Providers through their Primary Care offices located on the same campus as the hospital. In addition, there are other Community based services available. Alcohol Anonymous is given space in the hospital for regular weekly meetings. North Country Healthcare is currently in discussion with the State to determine feasibility of creating a more in-depth hospitalization/outpatient type program for the entire region and is collaborating with the NH Region 7 activities that are targeting behavioral health concerns for the entire state.2. Obesity/Overweight: UCVH employs a registered dietician and diabetes educator who is available to provide consults and diabetes prevention classes. 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, UCVH is a smoke/tobacco free campus.Significant Needs not being addressed and why:The needs identified that UCVH 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 UCVH cannot fix these issues, we continue to work with our patients to enroll them with Medicaid Expansion products or the Insurance Exchanges. This has resulted in a significant drop in our uninsured population. UCVH continues to offer free care for eligible patients through our UCV Free Care program. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, Ratio of patient care cost-to-charges Part I, lines 7E-I. The Hospital determines cost by combining direct expenses identified by its accounting system with an estimated overhead allocation. |
| Part I, Line 7g: | Specialty Care Providers & Emergency Department |
| Part II, Community Building Activities: | The community building activities undertaken by UCVH consist of supporting local government and other health care providers, coordination of disaster drills, emergency preparedness, and support of other local organizations within the community. In addition, in an effort to provide the necessary health care services for the population within a reasonable driving distance, UCVH has entered into a collaboration with the other two Coos county hospitals to provide necessary specialty services for the UCVH service area. |
| Part III, Line 2: | The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, Ratio of patient care cost-to-charges. The CCR was then applied to bad debt expense at charge value in order to arrive at the estimated expense reported. |
| Part III, Line 4: | Patient accounts receivable are carried at the amount management expects to collect from outstanding balances.Patient receivables are periodically evaluated for collectability 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 collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each major payer 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 payer 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 payer 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: | Allowable costs come from the filed cost report as UCVH operates at a loss from Medicare. The shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. UCVH uses CCR to determine cost revenue received is net patient revenue. |
| Part III, Line 9b: | If known to qualify for charity of financial assistance, patients are given the assistance needed. |
| 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 and the implementation plan are available on the UCVH website. |
| Part VI, Line 3: | UCVH has a full time patient financial counselor who is responsible for working with patients and any who may be billed for their care to determine their eligibility, on a case by case basis. For any government programs, such as Medicaid or the UCVH fiancial assistance program all staff at UCVH, particularly registration staff who will be the first ones to notice if a patient does not have insurance, are trained to refer the patient to the financial counselor. In addition, brochures are available, as is contact information on the website. |
| Part VI, Line 4: | UCVH is the smallest critical assess hospital in New Hampshire that serves the largest geographic service area (over 850 square miles) including communities in the states of New Hampshire, Vermont, and Maine. According to the New Hampshire state health profile, our residents are the most fragile of all citizens in New Hampshire as it relates to health outcomes and economic conditions. UCVH is dependent of public funding and disproportionate share funding to subsidize the care provided to the patients we serve |
| Part VI, Line 7, Reports Filed With States | NH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert Rose MD | ||||||||||||||
| Physician, Chief Medical Officer | $440,594 | $0 | $0 | $0 | $3,048 | $0 | $0 | $0 | $4,350 | $0 | $447,992 | $0 | $0 | $0 |
| Edward Laverty PA-C | ||||||||||||||
| Past Chief of Staff | $198,332 | $0 | $0 | $0 | $218 | $0 | $3,277 | $0 | $9,219 | $0 | $211,046 | $0 | $0 | $0 |
| Thomas Cochran | ||||||||||||||
| ER Medical Director | $225,559 | $0 | $0 | $0 | $90 | $0 | $0 | $0 | $4,815 | $0 | $230,464 | $0 | $0 | $0 |
| Robert Gooch | ||||||||||||||
| Director of Pharmacy | $155,835 | $0 | $0 | $0 | $578 | $0 | $3,241 | $0 | $3,933 | $0 | $163,587 | $0 | $0 | $0 |
| Joseph Kiernan | ||||||||||||||
| General Surgeon | $270,594 | $0 | $0 | $0 | $1,021 | $0 | $5,396 | $0 | $3,694 | $0 | $280,705 | $0 | $0 | $0 |
| Charanjit Veeramalla | ||||||||||||||
| Hospitalist | $377,394 | $0 | $0 | $0 | $240 | $0 | $5,300 | $0 | $13,051 | $0 | $395,985 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shari Parker | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Board Director Eric Stohl | RelationshipDescriptionTxt |
| Transaction | $70,579 | TransactionAmt |
| Transaction | Employment | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | Mobile MRI services began in March, 2016 through a contract with NH Imaging Services. MRI is on site 1 day/week |
| Form 990, Part VI, Section A, line 3 | Northern New Hampshire Healthcare Management, LLC provides management services to Upper Connecticut Valley Hospital. Northern New Hampshire Healthcare Management, LLC provided a Chief Administrative Officer (Peter Gosline) to UCVH from October 2015 through August 2016. Mr. Gosline was paid $193,500 during calendar year 2015 for services rendered to UCVH by Northern New Hampshire Healthcare Management, LLC. |
| Form 990, Part VI, Section A, line 4 | On June 30, 2015, Weeks Medical Center, Upper Connecticut Valley Hospital Association, Androscoggin Valley Hospital and Littleton Hospital Association, Inc. (collectively, the "Hospitals") entered into an Affiliation Agreement (the "Affiliation Agreement"), pursuant to which the Hospitals agreed to affiliate under a single common parent upon the closing of the agreement. The Affiliation Agreement resulted in the formation of North Country Healthcare, Inc. ("NCH"), a 501(c)(3) charitable organization. Effective April 1, 2016, the closing of the Affiliation Agreement occurred and NCH became the sole member of each of the Hospitals. In accordance with the Affiliation Agreement, 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 6 | Effective April 1, 2016, North Country Healthcare (NCH) became the Sole Member of Upper Connecticut Valley Hospital. |
| Form 990, Part VI, Section A, line 7a | See narrative provided for Form 990, Part VI, line 4. |
| Form 990, Part VI, Section A, line 7b | See narrative provided for Form 990, Part VI, line 4. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by CFO & President of the Hospital. After their review is complete, the Form is shared with the Board Finance Committee prior to filing. |
| Form 990, Part VI, Section B, line 12c | Directors, Officers, Highly Compensated Employees are all required to review and sign the Conflict of Interest Document. |
| Form 990, Part VI, Section B, line 15 | The hospital CAO's compensation and benefit package is reviewed periodically by community board members who govern the non-profit organization as unpaid, independent volunteers. The periodic review includes comparability data, and the deliberation and decision making is substantiated by written minutes. |
| Form 990, Part VI, Section C, line 18 | UVCH makes its 990 available upon request. |
| Form 990, Part VI, Section C, line 19 | Available upon request. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Upper Connecticut Valley Hospital Corliss Lane Colebrook, NH 03576 EIN: 02-0276210 Upper Connecticut Valley Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| North Country Healthcare Inc | |||||||||
| 8 Clover Lane | Whitefield | NH | 03598 | 812225283 | Healthcare Management | NH | 501(c)(3) | Line 11a, I | 0 |
| Androscoggin Valley Hospital Inc | |||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020280367 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | 0 |
| Weeks Medical Center | |||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 020222242 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |