2016-08-03T12:50:20-05:00 2015-09-30 010494526 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2014-10-01 020274905 Rockingham Visiting Nurse Association and Hospice ROCK 6035806695 5 Alumni Drive Exeter NH 03833 Kevin J O'Leary Treasurer 6035806695 2016-07-25 1 Timothy R Hepburn P00182393 8002447444 2016-07-25 2014 2016-12-15 16:53:06Z Kevin J Callahan 5 Alumni Drive Exeter NH 03833 15140328 0 X N/A X 1996 NH The mission of Rockingham VNA & Hospice, a home health agency, is to assist in improving the health of the community. This mission is principally accomplished through the provision of health services and information to the community. Rockingham VNA & Hospice works to accomplish this mission by promoting well being and independence by providing patient-centered health care services in the comfort of the home and within the communities served. 7 0 175 60 0 0 54252 59326 14227824 15072334 7789 8668 0 0 14289865 15140328 0 0 0 0 10218738 10565043 0 0 0 3481425 3841223 13700163 14406266 589702 734062 4367472 5014935 2255813 2165399 2111659 2849536 X The mission of Rockingham VNA & Hospice, a home health agency, is to assist in improving the health of the community. This mission is principally accomplished through the provision of health services and information to the community. Rockingham VNA & Hospice works to accomplish this mission by promoting well being and independence by providing patient-centered health care services in the comfort of the home and within the communities served. 0 0 12916619 0 15072334 Rockingham VNA & Hospice's Home Care Program provides comprehensive skilled services to the adult population. The goal of these services is to improve the health and independence of the patients we serve. Our services include Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Social Work services, Home Health Aide, Dietician, IV Specialist, Wound/Ostomy Specialist, Certified Diabetes Educator, Lymphedema Specialist and an Advanced Illness Program. Rockingham VNA and Hospice provided 73,287 visits to 3,407 Home Care patients during FY 2015, and also incurred $26,611 in costs to provide charity care to patients throughout the communities served. 0 0 0 Rockingham VNA & Hospice's Hospice Program provides a comprehensive, medically directed, team oriented program of care. The essential components include care of the patient and family as one unit, pain and symptom management, 24 hour on-call availability, medical and nursing care, Home Health Aide, Social Work services, Bereavement and Spiritual care, Volunteers, Rehab services, and coordination of medications, medical supplies, and durable medical equipment. Rockingham VNA & Hospice provided 15,306 visits to 493 patients who received 21,912 days of patient care during FY 2015. 0 0 0 Rockingham VNA & Hospice's Community Outreach Program is dedicated to assisting in improving the health of the communities served through offering a variety of wellness clinics and educational opportunities. Community programs include Community Foot Clinics, Diabetes Support Groups, and Health Education Programs. In FY2015, RVNA & H supported its mission by supporting $486,410 in community outreach, benefits and financial support to the community. 12916619 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 25 0 1 175 1 0 0 0 0 0 0 0 0 0 0 X 7 0 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Kevin J O'Leary 6035806695 5 Alumni Drive Exeter NH 03833 Susan Burns-Tisdale Trustee 1.00 40.30 X 0 361927 47246 Jennifer Costain beg April 2015 Trustee 1.00 40.00 X 0 51506 7104 Eliot DeSilvaMD beg April 2015 Trustee 1.00 40.00 X 0 282252 38232 Kevin J Callahan Chairman/Trustee 1.00 44.00 X X 0 802610 197039 Kevin J O'Leary Treasurer/Trustee 1.00 44.00 X X 0 438225 101770 Mary Palmer Secretary/Trustee 1.00 40.00 X X 0 209112 22499 Karen Michel President/Trustee 40.00 0.00 X X 148371 0 29840 Lois Ferguson Hospice Director 40.00 0.00 X 125614 0 16181 Sherry Ovens Burleigh Clinical Manager 40.00 0.00 X 115768 0 5592 Linda Taylor Clinical Services Director 40.00 0.00 X 108441 0 25791 Charlene Girard Occupational Therapist 40.00 0.00 X 100560 0 13138 598754 2145632 504432 5 0 1 0 Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 Administrative Management Fees 325693 Exeter Hospital Inc 5 Alumni Drive Exeter NH 03833 Support Services 289923 HBO & Company PO Box 98347 Chicago IL 60693 Service Contracts 176400 Creekside Therapy LLC 212 Oak Hill Road Barrington NH 03825 Contracted Therapists 148941 McBee Associates 14 Penn Plaza Suite 2110 New York NY 10122 Outside Services ICD 10 Review 118092 6 59326 59326 Net Patient Services 621610 15072334 15072334 15072334 8668 8668 15140328 15072334 0 8668 178211 166627 11584 8338716 7796699 542017 147921 138306 9615 1288838 1205064 83774 611357 546859 64498 35230 35230 970188 394160 576028 4652 4652 318071 284515 33556 122628 109691 12937 67924 60758 7166 410063 366801 43262 53317 47692 5625 41830 37417 4413 Medical Supplies 689219 689219 Other Supplies 524073 468783 55290 Bad Debt Expense 334731 334731 Medical Fees 269297 269297 14406266 12916619 1489647 0 957101 1988918 2669583 2133512 38557 56195 2677683 2211043 336377 466640 365854 369670 4367472 5014935 1289370 1353870 641073 684644 325370 126885 2255813 2165399 X 1745805 2479866 365854 369670 2111659 2849536 4367472 5014935 734062 3815 0 X X 0 1 X 1 0 X 39719 49287 54479 54252 59326 257063 12069957 12614400 12927688 14227824 15072334 66912203 12109676 12663687 12982167 14282076 15131660 67169266 0 0 0 67169266 12176 6309 8369 7789 8668 43311 12176 6309 8369 7789 8668 43311 12121852 12669996 12990536 14289865 15140328 67212577 0.99940 0.99930 0.00060 0.00070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3433 3433 0 Part II-B, Line 1: A portion of Home Care Association of New Hampshire and NHPCO membership dues are considered lobbying expenses. During 2015, the amounts available for lobbying were $3,246 and $187, respectively. 365854 3816 369670 334271 31583 365854 318300 15971 334271 316344 1956 318300 306804 9540 316344 0.00000 1.00000 0.00000 1 0 639661 222925 416736 300695 295619 5076 1737327 1692499 44828 466640 Beneficial Interest in Trusts 369670 369670 Due to Affiliates 126885 126885 X 15140328 0 15140328 0 15140328 14406266 0 14406266 0 14406266 Part V, Line 4: Endowment funds are held by the Town of Derry, New Hampshire. The income earned from the funds are used to fund the organization's operations. Part X, Line 2: The Association is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Association is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Association's tax position and concluded that the Association has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. X 0 1 X 0 1 0 0 0 0 0 1 0 Susan Burns-Tisdale Trustee 0 285508 0 63683 0 12736 0 15600 0 31646 0 409173 0 0 Eliot DeSilvaMD beg April 2015 Trustee 0 232563 0 34367 0 15322 0 7800 0 30432 0 320484 0 0 Kevin J Callahan Chairman/Trustee 0 586029 0 150000 0 66581 0 167800 0 29239 0 999649 0 0 Kevin J O'Leary Treasurer/Trustee 0 343993 0 75017 0 19215 0 81487 0 20283 0 539995 0 0 Mary Palmer Secretary/Trustee 0 170975 0 34228 0 3909 0 12503 0 9996 0 231611 0 0 Karen Michel President/Trustee 132078 0 10803 0 5490 0 3186 0 26654 0 178211 0 0 0 Part I, Line 1a Tax indemnification and gross up payments were provided to Kevin Callahan, Kevin O'Leary, Susan Burns-Tisdale and Mary Palmer (for acquisition of supplemental long term disability insurance). The benefit was treated as taxable income. Part I, Line 1b There was no existing policy concerning tax indemnification and gross up payments. However, in the instance of such action related to the acquisition of long term disability insurance described above, the tax indemnification and gross up payments were approved by the Exeter Health Resources, Inc. Board of Trustees Executive Committee comprised of disinterested persons. Part I, Line 4b The organization's parent (Exeter Health Resources, Inc.) maintains a split dollar supplemental retirement plan for two executives (listed below with amounts) selected by the Exeter Health Resources, Inc. Board of Trustees. The plan is closed to future participants. The Plan provides for annual payments of premiums for life insurance policies insuring the listed individuals. Those life insurance premiums are collaterally assigned to the corporation and any excess accumulated value in the policies (net of accumulated premium payments which are returned to the organization upon the executive attaining the age of 70) is available to be paid to the participant once vested at age 62 and upon retirement from the organization. Note that the split-dollar arrangement is part of an employee benefit program and economically not a direct extension of credit. Furthermore, the reportable compensation of the respective employees includes the annual value of the life insurance provided. Life insurance premium payments during tax year: Kevin Callahan $ 343,870 Kevin O'Leary $ 148,100 Excess Accumulated Value: Kevin Callahan $ 2,059,399 Kevin O'Leary $ 821,634 Certain of the listed employees participate in a nonqualified deferred compensation plan as described in Internal Revenue Code Section 457(f) sponsored by Exeter Health Resources, Inc. In the calendar year ended December 31, 2014, the contribution to the plan for the non-vested benefit of Kevin Callahan was $160,000 and the contribution to the plan for the non-vested benefit of Kevin O'Leary was $68,000. The contributions are intended to provide a forfeitable supplemental retirement benefit. Participants in the 457(f) plan do not vest until age 62 when it is payable to the participant. Part I, Line 7 Karen Michel is also provided incentive bonus payments under a plan aligned with the strategic interests of RVNA. These incentive awards are approved by operating management and Human Resources. Form 990, Part VI, Section A, line 4 The Bylaws of the Rockingham Visiting Nurse Association and Hospice Bylaws were amended during the fiscal year ending September 30, 2015. Reportable changes are as follows: 1. The following was removed from the Powers and Rights of the Member article: "The Member may take any such action by vote of its Board of Trustees or by or through any person or persons designated by its Board of Trustees to act on its behalf. Any such action may also be taken without a meeting by written communication of a duly authorized representative of the Member acting within the limits of said representative's authority. Any such action by the Member or its duly authorized representative shall be filed with the Secretary of the Corporation." 2. The Number and Composition of the Board was changed from "five (5) persons, including the President of the Member ex-officio, the Treasurer of the Member ex-officio, and three (3) persons elected by the Member" to "from five (5) to seven (7) persons, including the Executive Director of the Corporation ex-officio (with vote), and the Treasurer of the Member ex-officio (with vote), and from three (3) to five (5) persons elected by the Member." Additionally, a clause stating that elected Board members "shall not include employees of the Corporation unless otherwise permitted by law" was added to the article. 3. The sentence "An ex-officio Trustee shall automatically cease to hold office as of the date he/she ceases to hold his/her position as officer of the Member." was added to the article regarding election and tenure of Trustees. 4. The Powers and Responsibilities of the Board Members article was updated to note the exception of powers reserved to the Member by law. 5. The sentence "Each Trustee shall be entitled to one vote and shall be counted in determining the existence of a quorum." was removed from the article regarding Quorum and Voting. 6. An Assistant Treasurer was added to the officer positions enumerated in the bylaws. Additionally, a clause was removed from the same article that read, "no employee of the Corporation may hold the position of Chairman of the Board." 7. The article regarding Election and Tenure of officers was updated to remove the stipulation that officers are nominated by the Member and the tenure of officers was changed to end at the first meeting following the Annual Meeting instead of at the Annual Meeting. 8. The article describing the Treasurer position was changed from, "Treasurer: The Treasurer shall be the Chief Financial Officer of the Corporation. Subject to the control of the Board, he/she shall be in charge of the Corporation's financial affairs, funds, securities and valuable papers and shall keep full and accurate records thereof. He/she shall have such other duties and powers as designated by the Board or President. He/she shall also be in charge of the Corporation's books of account and accounting records and of its account procedures." to "Treasurer/Assistant Treasurer: The Treasurer, who shall be the Treasurer of the Member, shall oversee the Corporation's financial affairs, funds, securities and valuable papers and shall cause full and accurate records to be kept thereof. The Treasurer shall cause the accounts of the Corporation to be audited at least annually by a certified public accountant. The Assistant Treasurer shall oversee the Corporation's books of account and accounting records and its accounting procedures, shall assist the Treasurer as requested, and shall have such other duties and powers as designated by the Board or the President." 9. The stipulation requiring the Secretary to be a resident of New Hampshire was removed. 10. The article regarding amendments to the bylaws was updated to clarify the Member has exclusive rights to amend the bylaws. Form 990, Part VI, Section A, line 6 Exeter Health Resources, Inc., a charitable organization acting through its Board of Trustees, is the sole member of the organization. Form 990, Part VI, Section A, line 7a Exeter Health Resources, Inc. as sole member, elects the majority of the Board of Trustees of Rockingham VNA & Hospice, in addition to one of its officers who serve as ex-officio Trustee. Form 990, Part VI, Section A, line 7b As sole member, Exeter Health Resources, Inc. has certain reserved rights as reflected in the bylaws of the organization. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by an outside tax accountant with information provided by the organization. The Form 990 is reviewed by the organization's Treasurer and then presented to the Board of Trustees before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The Board of Trustees has adopted a Conflict of Interest Policy that requires the disclosure of conflicts of interest either when the interest becomes a matter of possible action by the Board or during an annual disclosure process. Trustees, officers, and key employees, as well as all members of senior management, are part of the annual disclosure process, which is initiated by the issuance of a memorandum and accompanying questionnaire by the President of the Member (i.e., Exeter Health Resources, Inc.). All disclosures are reviewed. Any trustee with a conflict of interest is required to abstain from voting and is not included in a quorum determination on the matter and any officer, key employee, or member of senior management with a conflict does not take part in making and is not present for any decision regarding the matter. The policy is monitored and enforced by both the President and the full Board. A separate organizational policy requires all employees to disclose any conflict of interest in writing upon hire. Thereafter, on an annual basis, all employees and contracted staff must make a full and complete disclosure in writing of any conflict of interest, conflict of commitment, and/or Personal Interest. Employees are otherwise required to make any further written disclosure at the time such conflict arises. This policy is monitored and enforced by the Department of Human Resources, as well as the agency's Executive Director and Compliance Officer. Any conflict of interest is managed under this policy by disclosure, recusal, or divestiture of the interest. Form 990, Part VI, Section B, line 15 The organization's parent (Exeter Health Resources, Inc.) has a formal process for determining total compensation for the Chairman of Rockingham Visiting Nurse Association and Hospice (RVNA&H) and other listed officers that is intended to provide reasonable compensation for achieving the organization's mission, to recognize individual and team performance and to comply with the organization's obligations as a tax-exempt charitable organization. The Executive Committee of the Exeter Health Resources, Inc.'s Board of Trustees conducts an annual review of the compensation of the Chairman of RVNA&H and other listed officers. In doing so, the committee retains a qualified independent compensation consultant to conduct competitive market analysis of the market ranges of base, incentive, and total cash compensation, and to provide advice concerning the reasonableness of the compensation of the Chairman and other listed officers. The Committee utilizes that analysis and other appropriate information in connection with its annual review and makes recommendations to the full Board of Exeter Health Resources, Inc. for adjustment of the Chairman's compensation and the compensation for other listed officers. Information which the Committee may consider can include but is not limited to the performance of an individual and/or that individual's contributions to a team, the performance of the organization in whole and in part, the elements of total compensation and salary history, the organization's compensation targets and comparability data, including the data prepared by the independent consultant and reviewed with the Committee. The Committee incorporates a performance appraisal process in the Chairman's and the other listed officers' compensation review. The Chairman and other listed officers are not present when the committee discusses their respective compensation. In addition, the Committee determines if the threshold requirements for incentive awards are met, consisting of the organization's performance results for quality, operating system excellence and financial performance. The results of the committee's deliberations are presented to the Exeter Health Resources, Inc. Board and include recommendations concerning salary range adjustments and incentive awards and the basis for the committee's decisions/recommendations. The deliberations of the Exeter Health Resources, Inc. Board are conducted in executive session with the independent members of the Board but do include the Chairman only for that period of time in which the Exeter Health Resources, Inc. Board has questions concerning the performance of any listed officer other than the Chairman. The Exeter Health Resources, Inc. Board reviews the Chairman's performance and determines if the adjustments and awards recommended by the committee for the Chairman are in the organization's best interest and for the benefit of the organization and the parent organization. For the other listed officer positions, adjustments and incentive awards are approved upon recommendation of the chairman by the executive committee within the Exeter Health Resources, Inc. board approved parameters and ratified by the Exeter Health Resources, Inc. Board of Trustees. For the Executive Director of Rockingham Visiting Nurse Association and Hospice, compensation is determined by consulting with the organization's parent Human Resources department. Comparison compensation surveys and external benchmarks are used in the process. Form 990, Part VI, Section C, line 19 The documents are available upon request. Form 990, Part XII, Line 2c: The audit process has not changed since the prior year. Exeter Health Resources Inc 5 Alumni Drive Exeter NH 03833 020222126 Management and Supporting Organization; Holding Company NH 501(c)(3) Line 11a, I N/A 0 Exeter Hospital Inc 5 Alumni Drive Exeter NH 03833 222674014 Hospital NH 501(c)(3) Line 3 Exeter Health Resources Inc 0 Core Physicians LLC 5 Alumni Drive Exeter NH 03833 870807914 Physician Practices NH 501(c)(3) Line 9 Exeter Health Resources Inc 0 Matrix Health Inc 5 Alumni Drive Exeter NH 03833 020473737 Manage Resources NH 501(c)(3) Line 11a, I Exeter Health Resources Inc 0 Exeter Med Real Inc 5 Alumni Drive Exeter NH 03833 020418718 Real Estate Holding NH 501(c)(25) Exeter Health Resources Inc 0 Exeter Health Resources Inc Self-Insurance Trust 5 Alumni Drive Exeter NH 03833 200753662 Self Insurance Trust NH 501(c)(3) Line 11b, II Exeter Health Resources Inc 0 Convergent Health Systems Inc 5 Alumni Drive Exeter NH 03833 020469711 Wellness Center NH N/A C 0 Vx Health Services Inc 5 Alumni Drive Exeter NH 03833 020469712 Inactive Fitness Center NH N/A C 0 Exeter Medical Services Inc 5 Alumni Drive Exeter NH 03833 020419850 Inactive Physician Practice NH N/A C 0 Core Health Services of MA 5 Alumni Drive Exeter NH 03833 201598042 Inactive Physician Practice MA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0