2017-02-10T14:14:18-06:00 2016-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2015-10-01 020222242 Weeks Medical Center WEEK 6037884911 173 Middle Street Lancaster NH 03584 Michael D Lee President 6037884911 2017-02-10 1 Barbara J McGuan CPA P00219457 2077752387 2017-02-10 2015 2021-01-29 14:40:06Z Michael D Lee 173 Middle Street Lancaster NH 03584 45768394 0 X www.weeksmedical.org X 1948 NH To provide high quality and efficient health care services 17 14 367 101 0 0 385581 525979 42167196 42797847 617295 650616 0 0 43170072 43974442 0 0 0 0 23936076 25694683 0 0 0 18173623 17937478 42109699 43632161 1060373 342281 49310862 54277536 21398393 25027947 27912469 29249589 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 36656559 42797847 Health care services to individuals in the surrounding region on an Inpatient & Outpatient basis, which includes Hospital Services as well as Physician Office services. 36656559 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 49 0 1 367 1 0 0 0 0 0 0 0 0 0 0 X 17 14 0 0 1 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 Michael D Lee President 40.00 0.00 X X 0 0 0 Stanley Holz Chair 1.00 0.00 X X 0 0 0 Donald Crane Vice Chair 1.00 0.00 X X 0 0 0 Sarah Desrochers Treasurer 1.00 0.00 X X 0 0 0 Keith Young Secretary 1.00 0.00 X X 0 0 0 David Atkinson Trustee 1.00 0.00 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 George Cook Trustee 1.00 0.00 X 0 0 0 Dennis Couture Member at Large 1.00 0.00 X 0 0 0 William Everleth Trustee 1.00 0.00 X 0 0 0 Scott Howe Past CEO 40.00 0.00 X X 231753 0 19186 Patrick Kelly Trustee 1.00 0.00 X 0 0 0 Mark Morgan MD Medical Staff President 36.00 0.00 X 425832 0 20350 Dana Muzzey Trustee 1.00 0.00 X 0 0 0 Lars Nielson CMO 40.00 0.00 X X 311458 0 23112 Cindy Normandeau Trustee 1.00 0.00 X 0 0 0 Lisa Tetreault Trustee 1.00 0.00 X 0 0 0 Patsy Pilgrim Past Trustee 1.00 0.00 X 0 0 0 Charlie Fitch Past Trustee 1.00 0.00 X 0 0 0 Celeste Pitts CFO 24.00 16.00 X 82685 55123 10750 John Ford Physician 40.00 0.00 X 331109 0 9837 Paul Kamins MD Physician 40.00 0.00 X 456828 0 21373 Maude Keeshin Physician 40.00 0.00 X 374830 0 24347 David Pelkowski Physician 40.00 0.00 X 406537 0 24456 Walter Voigt Physician 40.00 0.00 X 375192 0 23203 2996224 55123 176614 8 0 1 0 Daniel Hebert 12 Pleasant Street Colebrook NH 03576 Contractor 1827764 Kingdom Emergency 815 North Kirby Road Lyndonville VT 05851 ER Physician Services 1256833 Dartmouth-Hitchcock Clinic One Med Ctr Dr Lebanon NH 03766 Professional Services 748677 AHSA PO Box 945 Traverse City MI 49685 Contract Labor/Nurse Svcs. 369187 Healogics Wound Care & Hyperbaric Servic 3087 Momentum Place Chicago IL 60689 Wound Care Services 332822 30 266029 259950 525979 Patient Service 621400 75964133 75964133 Miscellaneous 621400 2396517 2230738 165779 Meaningful Use 621400 478091 478091 Provision for Bad Debts 621400 -2181659 -2181659 Contractual/Char. Adj. 621400 -33859235 -33859235 42797847 447005 447005 1997563 1779187 14765 218376 -14765 203611 203611 43974442 42632068 0 816395 1180248 1180248 20143066 17627794 2515272 453079 398581 54498 2599831 2194838 404993 1318459 1093723 224736 448774 78072 370702 61664 61664 79444 79444 47762 47762 3711095 3500467 210628 84638 84638 287054 75710 211344 781838 781838 839736 819368 20368 98524 73245 25279 30608 27933 2675 315190 315190 2201512 2201512 491824 260617 231207 Patient Care Supplies 5341998 5341998 Miscellaneous 1611133 1142827 468306 MET Taxes 1504684 1504684 43632161 36656559 6975602 0 X 1350 1350 13003565 15419385 5256390 4365221 560616 767631 766680 699017 597844 43598063 28312585 14966437 15285478 14077801 14608317 -21945 -26739 0 3260000 49310862 54277536 3725527 6732096 801241 741627 8296577 7913678 8575048 9640546 21398393 25027947 X 26512276 27861256 488279 476419 911914 911914 27912469 29249589 49310862 54277536 X 342281 947691 47148 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8785 8785 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. 1035352 4375 1039727 1174268 -62816 76100 1035352 1144520 2285 27463 1174268 1131612 12908 1144520 1031277 46100 29235 -25000 1131612 0.00000 0.87710 0.12290 0 0 532463 532463 14043395 8378413 5664982 27024880 19744493 7280387 1997325 189679 1807646 15285478 Other Receivables 3260000 3260000 Estimated Third-Party Payor Settlements 9640546 9640546 44921519 947691 47148 994839 43926680 47762 47762 43974442 43584399 0 43584399 47762 47762 43632161 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, hospice services and general upkeep and operations of the hospital. Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swap 47,148. 1 1 1 X 300.000000000000 1 X 1 1 0 1 1 624486 43068 581418 0.01330 5572729 3158458 2414271 0.05530 1243744 457204 786540 0.01800 7440959 3658730 3782229 0.08660 1228769 34041 1194728 0.02740 133218 21822 111396 0.00260 4260006 3896890 363116 0.00830 5621993 3952753 1669240 0.03830 13062952 7611483 5451469 0.12490 4 147 654101 448 653653 0.01500 69937 69937 0.00160 1 47 19852 19852 0.00050 5 194 743890 448 743442 0.01710 1 874407 21081540 21294485 -212945 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 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X X 1 X http://www.weeksmedical.org X http://www.weeksmedical.org X http://www.weeksmedical.org X X X X X X 1 X 0 X X X X 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. Policy being developed for sharing Narcan kits with 3rd party friends and families. Weeks employs several Behavioral Health Providers, including a Licensed Alcohol and Drug Counselor (LADC) through the Primary Care offices. 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: 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 is currently being trialed. 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 16i: 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 I, Line 7g: Chronic Disease Management, 24/7 ER & Behaviorial Health Services Part III, Line 4: Bad debt expense is described under Patient Accounts Receivable beginning on page 7 and is also discussed on pages 11 & 12 of the Organization's attached financial statements. 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 X X X X 0 0 0 0 0 0 0 0 0 Scott Howe Past CEO 231753 0 0 0 0 0 7229 0 11957 0 250939 0 0 0 Mark Morgan MD Medical Staff President 425832 0 0 0 0 0 7950 0 12400 0 446182 0 0 0 Lars Nielson CMO 311458 0 0 0 0 0 7950 0 15162 0 334570 0 0 0 John Ford Physician 331109 0 0 0 0 0 7950 0 1887 0 340946 0 0 0 Paul Kamins MD Physician 456828 0 0 0 0 0 7950 0 13423 0 478201 0 0 0 Maude Keeshin Physician 374830 0 0 0 0 0 7950 0 16397 0 399177 0 0 0 David Pelkowski Physician 406537 0 0 0 0 0 7950 0 16506 0 430993 0 0 0 Walter Voigt Physician 375192 0 0 0 0 0 7950 0 15253 0 398395 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 2086322 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 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 Weeks Medical Center. 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 electronically with the Board Finance Committee prior to filing. Form 990, Part VI, Section B, line 12c The organization requires the Board Members to review and sign a Conflict of Interest Policy annually. 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 CEO's compensation is determined by the Compensation Committee of the Board, a written employment contract, a state compensation survey and approval of the full Board and Compensation Committee. Other officers have their compensation determined through a state compensation survey, along with approval of the CEO. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Weeks Medical Center 173 Middle Street Lancaster, NH 03584 EIN: 02-0222242 Weeks Medical Center is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 47,148. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 11a, 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0