UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION (EIN 02-0276210)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-02-09
- IRS object ID
- 201600409349301355
- Schema version
- 2014v6.0
- 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 H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-02-09T12:05:48-06:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 020476956 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TYLER SIMMS & ST SAUVEUR CPA PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19 MORGAN DRIVE | AddressLine1Txt |
| City | LEBANON | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | 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 | JAMES TIBBETTS | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 6032374971 | PhoneNum |
| Signature | 2016-02-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES N GODFREY CPA | PreparerPersonNm |
| PTIN | P00913422 | PTIN |
| Phone | 6036530044 | PhoneNum |
| Preparation | 2016-02-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG PLACY | 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 | $18,075,887 | 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 HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 152 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $97,385 | PYContributionsGrantsAmt |
| CY Contributions Grants | $160,264 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,055,633 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,616,811 | CYProgramServiceRevenueAmt |
| PY Investment Income | $630,220 | PYInvestmentIncomeAmt |
| CY Investment Income | $358,185 | CYInvestmentIncomeAmt |
| PY Other Revenue | $42,991 | PYOtherRevenueAmt |
| CY Other Revenue | $44,750 | CYOtherRevenueAmt |
| PY Total Revenue | $15,826,229 | PYTotalRevenueAmt |
| CY Total Revenue | $16,180,010 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $50,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $12,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,943,323 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,181,244 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $978 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,652,023 | PYOtherExpensesAmt |
| CY Other Expenses | $7,442,599 | CYOtherExpensesAmt |
| PY Total Expenses | $14,645,346 | PYTotalExpensesAmt |
| CY Total Expenses | $15,636,343 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,180,883 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $543,667 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,230,154 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,313,655 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,232,373 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,151,482 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,997,781 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,162,173 | NetAssetsOrFundBalancesEOYAmt |
| 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 | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,881,498 | ExpenseAmt |
| Grant | $12,500 | GrantAmt |
| Revenue | $15,616,811 | RevenueAmt |
| Desc | UPPER CONNECTICUT VALLEY HOSPITAL PROVIDED HOSPITAL CARE AND INPATIENT AND OUTPATIENT SERVICES ON A REGION-WIDE BASIS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THE NET CHARITY CARE PROVIDED BY THE HOSPITAL FOR THE YEAR-ENDED SEPTEMBER 30, 2015 WAS $435,543. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $12,881,498 | 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 | Yes (1) | 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 | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 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 | 0 | 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 | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 152 | 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 |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6032374971 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | UCVH CORLISS LANE | AddressLine1Txt |
| City | COLEBROOK | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| E HARLAN CONNARY | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BRUCE BEAN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ODETTE CRAWFORD | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES TIBBETTS | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GREG PLACY | ||||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PALMER LEWIS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PETER MORAN MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ERIC STOHL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SALLY WENTZELL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EDWARD LAVERTY PA-C | ||||||||
| CHIEF OF STAFF | 56.00 | Yes (X) | $199,666 | $0 | $32,333 | |||
| FREDERICK D BROCK | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PETER L GOSLINE | ||||||||
| CHIEF ADMINISTRATIVE OFFICER | 24.00 | Yes (X) | Yes (X) | $0 | $94,500 | $0 | ||
| ROBERT ROSE MD | ||||||||
| PHYSICIAN, CHIEF MEDICAL OFFICER | 44.00 | Yes (X) | Yes (X) | $352,371 | $0 | $0 | ||
| CELESTE PITTS | ||||||||
| CHIEF FINANCIAL OFFICER | 16.00 | Yes (X) | $140,237 | $0 | $15,334 | |||
| KIMBERLEE DALEY | ||||||||
| PATIENT EXPERIENCE OFFICER | 40.00 | Yes (X) | $122,140 | $0 | $14,243 | |||
| THOMAS COCHRAN | ||||||||
| PHYSICIAN | 16.00 | $182,991 | $0 | $0 | Yes (X) | |||
| JOHN EPPOLIOTO | ||||||||
| PHYSICIAN | 63.00 | $365,590 | $0 | $22,258 | Yes (X) | |||
| CHARANJIT VEDI | ||||||||
| PHYSICIAN | 34.00 | $323,604 | $0 | $25,062 | Yes (X) | |||
| JOSEPH KIERNAN | ||||||||
| PHYSICIAN | 31.00 | $263,220 | $0 | $5,963 | Yes (X) | |||
| ROBERT GOOCH | ||||||||
| PHARMACIST | 41.00 | $173,576 | $0 | $7,164 | Yes (X) | |||
| NICOLE PAIER-MULLEN | ||||||||
| PHYSICIAN, CHIEF MEDICAL OFFICER | 32.00 | $270,183 | $0 | $21,303 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,393,578 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $94,500 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $143,660 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 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 | REHAB SERVICES | $956,852 |
| NORTHERN NH HEALTHCARE MANAGEMENT LLC | |||||
| 59 PAGE HILL ROAD | BERLIN | NH | 03570 | MANAGEMENT SERVICES | $345,171 |
| DARTMOUTH HITCHCOCK CLINIC | |||||
| 1 MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | PATHOLOGIST & RADIOLOGIST STAFFING | $195,251 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $63,995 | GovernmentGrantsAmt |
| All Other Contributions | $96,269 | AllOtherContributionsAmt |
| Total Contributions | $160,264 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | $29,443,704 | $29,443,704 |
| MISCELLANOUS REVENUE | 624100 | $216,266 | $216,266 |
| SCHOOL NURSING | 624100 | $211,290 | $211,290 |
| MEANINGFUL USE REVENUE | 621400 | $193,316 | $193,316 |
| MEDICAL RECORD TRANSMI | 624100 | -$75 | -$75 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,447,690 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$14,447,690 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,616,811 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $192,420 | TotalRevenueColumnAmt |
| Exclusion | $192,420 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,061,642 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,795,131 | SecuritiesAmt |
| Other | $100,746 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $266,511 | SecuritiesAmt |
| Other | -$100,746 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $165,765 | TotalRevenueColumnAmt |
| Exclusion | $165,765 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $44,750 | TotalRevenueColumnAmt |
| Exclusion | $44,750 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $44,750 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,180,010 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,616,811 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $402,935 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,500 | TotalAmt |
| Program Services | $12,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581,926 | TotalAmt |
| Program Services | $388,426 | ProgramServicesAmt |
| Management And General | $193,500 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,069,807 | TotalAmt |
| Program Services | $5,125,848 | ProgramServicesAmt |
| Management And General | $943,959 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,144 | TotalAmt |
| Program Services | $50,447 | ProgramServicesAmt |
| Management And General | $8,697 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,070,720 | TotalAmt |
| Program Services | $907,625 | ProgramServicesAmt |
| Management And General | $163,095 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,647 | TotalAmt |
| Program Services | $340,883 | ProgramServicesAmt |
| Management And General | $58,764 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,671 | TotalAmt |
| Management And General | $151,671 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,193 | TotalAmt |
| Management And General | $46,193 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,948 | TotalAmt |
| Management And General | $52,948 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,672 | TotalAmt |
| Program Services | $18,894 | ProgramServicesAmt |
| Management And General | $2,778 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,536,215 | TotalAmt |
| Program Services | $1,487,641 | ProgramServicesAmt |
| Management And General | $48,574 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,819 | TotalAmt |
| Program Services | $195,420 | ProgramServicesAmt |
| Management And General | $81,399 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $548,312 | TotalAmt |
| Program Services | $426,845 | ProgramServicesAmt |
| Management And General | $121,467 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,103 | TotalAmt |
| Program Services | $86,572 | ProgramServicesAmt |
| Management And General | $42,531 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333 | TotalAmt |
| Management And General | $333 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $617,939 | TotalAmt |
| Program Services | $617,939 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,689 | TotalAmt |
| Management And General | $130,689 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $2,455,161 | $1,823,664 | $631,497 |
| MEDICAID ENHANCEMENT TA | $760,722 | $760,722 | |
| RECRUITMENT | $234,343 | $234,068 | $275 |
| REPAIRS AND MAINTENANCE | $216,228 | $212,725 | $3,503 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,251 | TotalAmt |
| Program Services | $191,279 | ProgramServicesAmt |
| Management And General | $71,994 | ManagementAndGeneralAmt |
| Fundraising | $978 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,636,343 | TotalAmt |
| Program Services | $12,881,498 | ProgramServicesAmt |
| Management And General | $2,753,867 | ManagementAndGeneralAmt |
| Fundraising | $978 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,517 | BOYAmt |
| EOY | $189,100 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,498,816 | BOYAmt |
| EOY | $2,790,585 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,137,100 | BOYAmt |
| EOY | $2,546,607 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,879 | BOYAmt |
| EOY | $296,832 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $210,553 | BOYAmt |
| EOY | $268,316 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,843,231 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,609,450 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,449,915 | BOYAmt |
| EOY | $4,233,781 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,293,695 | BOYAmt |
| EOY | $10,834,794 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $271,581 | BOYAmt |
| EOY | $473,161 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,797,098 | BOYAmt |
| EOY | $1,680,479 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,230,154 | BOYAmt |
| EOY | $23,313,655 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,274,599 | BOYAmt |
| EOY | $2,485,739 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $417,675 | BOYAmt |
| EOY | $356,417 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $977,598 | BOYAmt |
| EOY | $750,405 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,562,501 | BOYAmt |
| EOY | $4,558,921 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,232,373 | BOYAmt |
| EOY | $8,151,482 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,542,320 | BOYAmt |
| EOY | $14,791,324 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $362,391 | BOYAmt |
| EOY | $197,779 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,070 | BOYAmt |
| EOY | $173,070 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,997,781 | BOYAmt |
| EOY | $15,162,173 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,230,154 | BOYAmt |
| EOY | $23,313,655 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $543,667 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$379,274 | 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 | $3,787 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,787 | 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 | UPPER CONNECTICUT VALLEY HOSPITAL IS A MEMBER OF THE NEW HAMPSHIRE HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THIS ORGANIZATION IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF UCVH AND OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. UPPER CONNECTICUT VALLEY HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,616 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,130 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $129,746 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.65680 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.34320 | 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 | $3,982,468 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,296,400 | DepreciationAmt |
| Book Value | $1,686,068 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $237,084 | OtherCostOrOtherBasisAmt |
| Depreciation | $129,376 | DepreciationAmt |
| Book Value | $107,708 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,613,743 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,183,674 | DepreciationAmt |
| Book Value | $2,430,069 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $236 | OtherCostOrOtherBasisAmt |
| Book Value | $236 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,233,781 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $1,469,497 |
| DEPOSITS & OTHER | $97,149 |
| RECEIVABLE FROM NORTHERN NH HEALTHCARE COLLABORATIVE | $109,951 |
| RECEIVABLE FROM NORTHERN NH HEALTHCARE MANAGEMENT | $3,882 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,680,479 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY PAYERS | Desc |
| Amt | $4,558,921 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,558,921 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $15,799,758 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$379,274 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$978 | OtherRevenueAmt |
| Revenue Not Reported | -$380,252 | RevenueNotReportedAmt |
| Revenue Subtotal | $16,180,010 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $16,180,010 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,635,366 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,635,366 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $978 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $978 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,636,344 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INVESTMENTS ARE TO BE HELD IN PERPETUITY. THE INCOME FROM THE INVESTMENTS IS EXPENDABLE TO SUPPORT THE HOSPITAL'S HEALTH CARE SERVICES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES -978. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSE 978. |
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 |
| Percent150 | Yes (X) | Percent150Ind |
| 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 | $461,344 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $115,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $346,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02210 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,367,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,781,536 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $586,013 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03750 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,828,893 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,896,720 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $932,173 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05960 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,680,153 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,567,448 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,112,705 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07120 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,079 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,079 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $864,275 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $319,491 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $544,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03480 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,046 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,046 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,607,553 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,886,939 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,720,614 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,436,446 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,783,659 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,652,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16960 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $54,929 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $54,929 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,181 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,181 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,110 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $505,793 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $16,185 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,349,722 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,434,062 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$84,340 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 NORTHERN NEW HAMPSHIRE HEALTHCARE MANAGEMENT LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | LLC OF 3 COOS COUNTY HOSPITALS | PrimaryActivitiesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 181 CORLISS LANE | AddressLine1Txt |
| City | COLEBROOK | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.UCVH.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | 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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.UCVH.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| 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 (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| UPPER CONNECTICUT VALLEY HOSPITAL | PART V, SECTION B, LINE 5: UPPER CONNECTICUT VALLEY HOSPITAL USED INFORMATION GATHERED FROM A NUMBER OF SOURCES INTERNAL AND EXTERNAL TO COMPLETE ITS CHNA. THESE SOURCES INCLUDE INDIAN STREAM HEALTH CENTER (FQHC) IN COLEBROOK, NH; UNITED STATES CENSUS BUREAU; CENTERS FOR MEDICARE AND MEDICAID SERVICES; STATE OF NEW HAMPSHIRE, DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF PUBLIC HEALTH SERVICES; NATIONAL ADVISORY COUNCIL; NATIONAL RESEARCH CORPORATION; AND THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.INPUT FROM THE COMMUNITY WAS GATHERED USING TWO METHODS INCLUDING AN INTERNET/PAPER SURVEY AND FOCUS GROUP INTERVIEWS IN COLLABORATION WITH INDIAN STREAM HEALTH. |
| UPPER CONNECTICUT VALLEY HOSPITAL | PART V, SECTION B, LINE 11: CHRONIC DISEASE MANAGEMENT: A HIGH PERCENT OF THE POPULATION IN THE UPPER CONNECTICUT VALLEY HOSPITAL SERVICE AREA HAS A HIGHER USE OF HEALTH CARE SERVICES FOR CHRONIC AMBULATORY CARE SENSITIVE CONDITIONS (960.8 VS. 605.4 FOR NH) WHICH INDICATES THAT THERE IS AN OPPORTUNITY TO REDUCE ADMISSIONS THROUGH STRENGTHENED PRIMARY CARE AND PREVENTATIVE SERVICES. THROUGH COLLABORATION BETWEEN UPPER CONNECTICUT VALLEY HOSPITAL AND INDIAN STREAM HEALTH CENTER, THE ORGANIZATIONS WILL FORM A TEAM THAT IS CHARGED WITH DEVELOPMENT OF A ROBUST CARE MANAGEMENT SYSTEM THAT BUILDS STRATEGIES TO IMPROVE TRANSITIONS OF CARE. UCVH WILL CONTINUE TO REVIEW AND IMPLEMENT STRATEGIES AIMED AT IMPROVING AND SUSTAINING CMS CORE MEASURE PERFORMANCE. THESE MEASURES ARE REPORTED TO THE BOARD ON AN ANNUAL BASIS VIA THE QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT (QAPI) PLAN ANNUAL REPORT, WHICH MUST BE APPROVED BY THE BOARD.UCVH COLLABORATES WITH ISHC TO PROVIDE NUTRITION AND DIABETIC EDUCATION SERVICES TO THE PATIENTS OF OUR PRIMARY SERVICE AREA. SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THE ABILITY TO PAY. IN ADDITION, UCVH HAS COMMITTED RESOURCES TO TRAIN AN ADDITIONAL STAFF MEMBER TO BE A CERTIFIED DIABETIC EDUCATOR TO STRENGTHEN DIABETIC EDUCATION IN BOTH THE OUTPATIENT AND INPATIENT SETTINGS.AVAILABILITY OF PHYSICIANS: SURVEY AND FOCUS GROUP PARTICIPANTS INDICATED RECRUITMENT AND RETENTION OF PHYSICIANS IN THE AREA AS THERE SECOND PRIORITY TO ASSURE ACCESS TO QUALITY CARE. RESPONDENTS ALSO WERE NOT CLEAR ABOUT THE AVAILABILITY OF SPECIALTY SERVICES THAT EXIST WITHIN THE COMMUNITY. UCVH IN COLLABORATION WITH ANDROSCOGGIN VALLEY HOSPITAL WILL CONTINUE TO DEVELOP STRATEGIES TO EDUCATE THE COMMUNITY IN REGARD TO AVAILABILITY OF SPECIALTY SERVICES WITHIN THE PRIMARY SERVICE AREA. UCVH WILL CONTINUE TO PARTICIPATE IN OUTREACH ACTIVITIES AT COMMUNITY EVENTS AND OFFER FINANCIAL ASSISTANCE TO PATIENTS WHO REQUIRE SPECIALTY SERVICES AND HAVE AN INABILITY TO PAY.UCVH AND ISHC UNDERTOOK PHYSICIAN AND PROVIDER RECRUITMENT ACTIVITIES COLLABORATIVELY TO RECRUIT MEDICAL PROFESSIONALS INTO THE AREA. UCVH HAS BEEN DESIGNATED AS A NATIONAL HEALTH SERVICES CORP SITE AND WILL CONTINUE CERTIFICATION ACTIVITIES AS REQUIRED. TO DATE, ISHC IS FULLY STAFFED WITH PROVIDERS AND ABLE TO MEET THE NEEDS OF THE COMMUNITIES SERVED.AVAILABILITY OF EMERGENCY CARE: UPPER CONNECTICUT VALLEY HOSPITAL IS LOCATED IN A RURAL ISOLATED MOUNTAINOUS AREA AND HAS THE LARGEST GEOGRAPHIC SERVICE AREA OF ANY HOSPITAL LOCATED IN NEW HAMPSHIRE. THE EMERGENCY DEPARTMENT SERVES AS A SAFETY NET FOR THE MOST DISADVANTAGED AND MEDICALLY UNDERSERVED CITIZENS OF NEW HAMPSHIRE. RESIDENTS AND VISITORS WOULD HAVE TO TRAVEL AT LEAST AN HOUR TO THE NEXT CLOSEST FACILITY FOR ACCESS TO EMERGENCY CARE SERVICES.SURVEY AND FOCUS GROUP PARTICIPANTS IDENTIFIED THE PROVISION OF EMERGENCY CARE AS THEIR THIRD PRIORITY AS A COMMUNITY NEED.UCVH CURRENTLY MAINTAINS AN EMERGENCY DEPARTMENT THAT PROVIDES ACCESS TO EMERGENCY CARE SERVICES WITHOUT REGARD TO THE ABILITY TO PAY FOR SUCH SERVICES. UCVH IS THE MEDICAL RESOURCE HOSPITAL TO LOCAL EMERGENCY MANAGEMENT SERVICES (AMBULANCE SERVICES). EMERGENCY MEDICAL SERVICES IS A SUBSIDIZED SERVICE THAT IS DEPENDENT ON APPROPRIATE FUNDING STREAMS. UCVH WILL CONTINUE TO STRIVE TO DEVELOP STRATEGIES TO IMPROVE AND MAINTAIN FINANCIAL PERFORMANCE THAT SUSTAINS EMERGENCY MEDICAL SERVICES IN THE REGION. TO THIS END, UCVH IS IN THE PROCESS OF AFFILIATING WITH OTHER HOSPITALS IN NORTHERN NH TO DEVELOP OF PLATFORM FOR SHARED SAVINGS AND REGIONAL NON-EMERGENCY SERVICES. THE GOAL OF THE AFFILIATION WILL BE TO MAINTAIN THE NECESSARY LEVELS OF PRIMARY CARE AND EMERGENCY CARE IN EVERY COMMUNITY.THERE WERE NO NEEDS SPECIFIED BY THE PUBLIC THAT UCVH, IN COLLABORATION WITH ISHC, WAS NOT ABLE TO MEET. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| UPPER CONNECTICUT VALLEY HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: | WWW.UCVH.ORG |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | PART I, LINES 7A-C; 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, LET NO WOMAN BE OVERLOOKED |
| PART I, LN 7 COL(F): | PART III, LINE 2-3; 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. THE HOSPITAL ESTIMATED THAT APPROXIMATELY 3.2% OF THIS VALUE CAN BE ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FAP. THIS ESTIMATE WAS SOLELY DERIVED FROM A SURVEY REPORTING THE AVERAGE % REPORTED FOR SIMILAR SIZED HOSPITALS. |
| 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 4: | PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICE PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR ONLY PART OF THE BILL, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL HAS ESTIMATED ITS COST OF BAD DEBT USING COST-TO-CHARGE METHODOLOGY IN ACCORDANCE WITH WORKSHEET 2 OF THE FORM 990 SCHEDULE H INSTRUCTIONS. |
| 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 OR FINANCIAL ASSISTANCE, PATIENTS ARE GIVEN THE ASSISTANCE NEEDED. |
| PART VI, LINE 2: | UCVH, WITH COLLABORATION FROM INDIAN STREAM HEALTH CENTER (A FEDERALLY QUALIFIED HEALTH CENTER), COMPLETED ITS LAST COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS CONDUCTED USING FOCUS GROUPS TO SOLICIT FEEDBACK FROM KEY STAKEHOLDERS, AND TO ANALYZE TRENDS IN REGARD TO POPULATION, HEALTH AND RISK FACTORS FOR THE COOS COUNTY. THE INFORMATION GATHERED IS THEN USED AS PART UCVH'S STRATEGIC PLANNING PROCESS. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ON THE ORGANIZATION'S 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 FINANCIAL 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 ACCESS 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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIAN STREAM HEALTH CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2 CORLISS LN RR2 BOX 25 | AddressLine1Txt |
| City | COLEBROOK | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03576 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 200999212 | RecipientEIN |
| IRC Section | 501(C)3 | IRCSectionDesc |
| Cash Grant | $12,500 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Purpose Of Grant | MEDICAL SERVICESMEDICAL SERVICES | PurposeOfGrantTxt |
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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EDWARD LAVERTY PA-C | ||||||||||||||
| CHIEF OF STAFF | $199,666 | $0 | $0 | $0 | $0 | $0 | $3,403 | $0 | $28,930 | $0 | $231,999 | $0 | $0 | $0 |
| ROBERT ROSE MD | ||||||||||||||
| PHYSICIAN, CHIEF MEDICAL OFFICER | $352,371 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $352,371 | $0 | $0 | $0 |
| CELESTE PITTS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $140,237 | $0 | $0 | $0 | $0 | $0 | $4,336 | $0 | $10,998 | $0 | $155,571 | $0 | $0 | $0 |
| THOMAS COCHRAN | ||||||||||||||
| PHYSICIAN | $182,991 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $182,991 | $0 | $0 | $0 |
| JOHN EPPOLIOTO | ||||||||||||||
| PHYSICIAN | $365,590 | $0 | $0 | $0 | $0 | $0 | $1,021 | $0 | $21,237 | $0 | $387,848 | $0 | $0 | $0 |
| CHARANJIT VEDI | ||||||||||||||
| PHYSICIAN | $323,604 | $0 | $0 | $0 | $0 | $0 | $5,009 | $0 | $20,053 | $0 | $348,666 | $0 | $0 | $0 |
| JOSEPH KIERNAN | ||||||||||||||
| PHYSICIAN | $263,220 | $0 | $0 | $0 | $0 | $0 | $5,104 | $0 | $859 | $0 | $269,183 | $0 | $0 | $0 |
| ROBERT GOOCH | ||||||||||||||
| PHARMACIST | $173,576 | $0 | $0 | $0 | $0 | $0 | $3,365 | $0 | $3,799 | $0 | $180,740 | $0 | $0 | $0 |
| NICOLE PAIER-MULLEN | ||||||||||||||
| PHYSICIAN, CHIEF MEDICAL OFFICER | $270,183 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,303 | $0 | $291,486 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII, SECTION A, LINE 5 | FormAndLineReferenceDesc |
| Explanation | AN UNRELATED ORGANIZATION, WEEKS MEDICAL CENTER EIN: 02-0222242, PROVIDES COMPENSATION TO CELESTE PITTS, INCLUDING REPORTABLE COMPENSATION AS REPORTED PER FORM W-2 BOX 5 OF $140,237 AND NONTAXABLE BENEFITS TOTALING $15,334, AS REPORTED IN FORM 990 PART VII, SECTION A. UPPER CONNECTICUT VALLEY HOSPITAL DOES NOT PROVIDE COMPENSATION DIRECTLY TO CELESTE PITTS FOR HER SERVICES PERFORMED AS THE CHIEF FINANCIAL OFFICER OF THE HOSPITAL. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | NORTHERN NEW HAMPSHIRE HEALTHCARE MANAGEMENT, LLC PROVIDES MANAGEMENT SERVICES TO THE HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW AND APPROVAL BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS, DIRECTORS, AMD KEY EMPLOYEES ARE REQUIRED TO SIGN A 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 ORGANZATION 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 AND ON THE GUIDESTAR WEBSITE |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST |
| FORM 990, PART VII | CELESTE PITTS IS THE CFO FOR UCVH AND FOR WEEKS MEDICAL CENTER, TWO FIFTHS OF HER TIME IS SPENT AT UCVH. SHE RECEIVES A FORM W-2 FROM WEEKS MEDICAL CENTER. WEEKS MEDICAL CENTER IS PAID FOR HER TIME BY NORTHERN NEW HAMPSHIRE HEALTHCARE MANAGEMENT LLC, WHICH IS PAID BY UCVH. AN ALLOCATION OF HER CALENDAR-YEAR WAGES AND BENEFITS ARE INCLUDED ON PART VII. HER FISCAL-YEAR WAGES AND BENEFITS ARE NOT SHOWN SEPARATELY ON PART IX, LINE 5, BUT ARE INCLUDED IN THE PAYMENT TO NORTHERN NEW HAMPSHIRE HEALTHCARE MANAGEMENT LLC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN NEW HAMPSHIRE HEALTHCARE COLLABORATIVE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462459559 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 9 | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN NEW HAMPSHIRE HEALTHCARE MANAGEMENT LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455617105 | EIN |
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.33330 | OwnershipPct |
| 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 | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN NH HEALTHCARE MANAGEMENT LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | M | TransactionTypeTxt |
| Involved | $345,171 | InvolvedAmt |