2013-08-14T13:33:35-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 020222118 Valley Regional Hospital Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Steven L Monette 6035427771 2013-08-13 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-13 2011 2016-02-25 16:41:14Z Claire Bowen 243 Elm Street Claremont NH 03743 51140198 0 X www.vrh.org X 1893 NH Critical Access Hospital 21 17 437 22 0 0 112735 66688 46099943 47218549 1364767 1156282 -59678 -61814 47517767 48379705 3914 0 0 0 24533738 22374069 0 0 0 23295921 24224667 47833573 46598736 -315806 1780969 58108658 65242601 39097439 42381512 19011219 22861089 X The mission of Valley Regional Healthcare, Inc. is to enhance the health of the community we serve. Our vision is to be a model rural community healthcare organization: the provider preferred for its excellence by area residents and physicians; the healthcare employer of choice, and an active participant in community efforts to improve the quality of life in our region. 0 0 40759534 47218549 Valley Regional Hospital is a provider of health services with facilities in the Claremont, NH area. The Hospital grants credit to patients, substantially all of whom are local residents. The Hospital also provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The Hospital does not pursue collection of amounts determined to qualify as charity care. The Hospital maintains records to identify and monitor the level of charity care it provides. For the year ending September 30, 2012 charges forgone for services and supplies furnished under the charity care policy were approximately $1,637,375. The estimated cost of those services and supplies was approximately $1,194,000.In addition, the Hospital provides a number of other services to benefit certain poor and elderly patients. Medicaid and state programs do not cover the full cost of the Hospital incurred cost of providing medical care to patients. During the year ending September 30, 2012, the Hospital incurred costs in excess of payments of approximately $5,540,000.The Hospital provides services to the community at large for which it receives little or no payment. Services include health evaluation and screening programs at community and/or work site, flu shot, and health educational and fitness programs.The Hospital also provided other community benefits on which no value could be placed, such as leadership in identifying community needs, staff commitment to volunteer community health organizations, advocacy and support for the socially and physically disadvantaged, and support for the local public safety organization. 40759534 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 1 1 0 0 0 0 0 0 1 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 0 1 42 0 1 437 1 0 0 0 0 0 0 0 0 0 0 X 21 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 1 1 1 0 NH X Steven Monette 6035427771 243 Elm Street Claremont NH 03743 Claire Bowen 40.00 X X 0 274279 14139 Robert Porter 1.00 X 0 0 0 Volker Bradley MD 1.00 X 0 0 0 Albert Leahy Jr 1.00 X 0 0 0 Michael L Prozzo Jr 1.00 X 0 0 0 Alison Raymond 1.00 X 0 0 0 Lisa Richmond 1.00 X 0 0 0 Bernard Rosen MD 1.00 X 0 0 0 Carol Vivian 1.00 X X 0 0 0 Jim Wimberg 1.00 X 0 0 0 Michael O'Connell 1.00 X 0 0 0 Michael Satzow 1.00 X 0 0 0 Robert Cricco MD 1.00 X 282213 0 22394 Michael Fuerst 1.00 X X 0 0 0 Oliver Herfort MD 1.00 X 195328 0 27484 Sherwood Moody 1.00 X 0 0 0 James Borchert 1.00 X 0 0 0 Charlene Lovett 1.00 X 0 0 0 Valerie Mahar 1.00 X 0 0 0 Patricia Putnam 1.00 X 0 0 0 Charles Sawyer MD 1.00 X 288427 0 14670 Steven Monette 40.00 X 0 152126 1686 Douglass Weiss 40.00 X 472683 0 18356 John Houde 40.00 X 372997 0 30377 Michael Ritondo 40.00 X 282307 0 29390 Carl Tetirick 40.00 X 280212 0 29348 Randolph Knight 40.00 X 243439 0 28160 2417606 426405 216004 22 0 1 0 Healthcare Management Systems 2739 Momentum Place Chicago IL 606895327 IT System & Service 1244068 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Contract Labor 690108 American Health Centers Inc 498 Essex Street Bangor ME 04401 MRI Service 254360 AHSA LLC PO Box 945 Traverse City MI 496850000 Contract Labor 241353 Dartmouth Hitchcock Clinic One Medical Ctr Drive Lebanon NH 03756 Contract Labor 209227 9 25535 15728 25425 66688 Patient Service Revenu 621400 63842262 63842262 Other Revenue 900099 1026119 889937 136182 Meaningful Use Revenue 900099 845288 845288 Charity/Contractual Ad 621400 -18495120 -18495120 47218549 647093 647093 32900 94714 -61814 -61814 -61814 3162301 2649411 3701 512890 -3701 509189 509189 12667 25535 12667 0 48379705 47082367 0 1230650 830516 830516 16764972 14857606 1907366 191184 169282 21902 3402001 3025942 376059 1185396 1056425 128971 8061 8061 51392 51392 154247 154247 5622843 5011077 611766 260619 232264 28355 184948 164826 20122 2406811 2144950 261861 16619 14811 1808 1175921 1175921 2563270 2284386 278884 352003 352003 Provision for Bad Debts 5005557 5005557 Medical Supplies 3720878 3316046 404832 Medicaid Enhancement Ta 2189994 2189994 Dues & Subscriptions 154690 137860 16830 356814 317992 38822 46598736 40759534 5839202 0 2295 2370 9144137 10999572 2828013 3366262 689774 676353 211334 351028 47125585 24559558 24376676 22566027 15515536 18749178 3095842 3560046 384360 210204 1860691 4761561 58108658 65242601 4454309 6365793 14898 14336 26260000 25785000 8368232 10216383 39097439 42381512 X 14714685 18019290 946798 1027859 3349736 3813940 19011219 22861089 58108658 65242601 X 1780969 2068901 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11109 11109 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 4044562 72 640539 4685173 4115180 355 -58567 12406 4044562 3968278 71 157717 10886 4115180 4259270 331 -277479 13844 3968278 0.00000 0.81400 0.18600 0 0 250667 250667 16408656 7316249 9092407 148235 113579 34656 29083725 16643177 12440548 1234302 486553 747749 22566027 Beneficial Interest in Perpetual Trust 3560046 F 3560046 Due From Affiliates 285920 Other Receivables 4368006 Deferred Compensation 107635 4761561 Due To Affiliates 319885 Estimated Third Party Settlements 4911283 Interest Rate Swap 4130318 Reserve for Self-Funded Insurance 747262 Deferred Compensation 107635 10216383 48379705 46598736 1780969 2068901 2068901 3849870 50401740 2068901 107381 2176282 48225458 154247 154247 48379705 46551870 107381 107381 46444489 154247 154247 46598736 Description of Intended Use of Endowment Funds: Part V, Line 4: The Organization uses its endowment funds in support of health care services, purchases of equipment, health education, and indigent care. Part XII, Line 2d - Other Adjustments: Rental Expenses 94,714. Fundraising Expenses 12,667. Part XIII, Line 2d - Other Adjustments: Rental Expenses 94,714. Fundraising Expenses 12,667. Golf Tournament 38202 25535 12667 882 2079 6120 1835 1751 38202 25535 12667 882 2079 6120 1835 1751 12667 0 1 1 X 1 X 1 X 275.000000000000 1 1 0 1 1 3164214 2069899 1094315 0.02630 4843612 2332814 2510798 0.06040 8007826 4402713 3605113 0.08670 208584 53896 154688 0.00370 69723 7200 62523 0.00150 271266 271266 0.00650 10038 10038 0.00020 559611 61096 498515 0.01190 8567437 4463809 4103628 0.09860 3 1863 1863 0.00000 3 2610 2610 0.00010 5 4499 4499 0.00010 4 2520 2520 0.00010 15 11492 11492 0.00030 1 2978306 0 13380679 13380679 X 1 1 1 1 Valley Regional Hospital Inc

243 Elm Street Claremont NH 03743

X X X X Valley Regional Hospital Inc 1 1 X X X X X X X X X 11 1 1 1 X X X X X 1 1 1 200.000000000000 1 275.000000000000 1 X X X X 1 1 X X X 1 X 1 X X X X 1 X 0 0 1 Kane Oncology Center

243 Elm Street Claremont NH 03743

Oncology Center Part I, Line 3c: It is the policy of Valley Regional Hospital to provide financial assistance to those patients who are unable to pay for all or part of the cost of their care that is not covered by other sources of funding. Valley Regional Hospital's Financial Assistance Program is a program that assists uninsured and under-insured patients who meet specific income, geographical and Valley Regional Hospital guidelines.The Hospital will cover up to 100% of the cost of care for patients depending on the patient's level of income and family size. The Hospital also is a participating provider with the NH Health Access Network. Part I, Line 7: The Organization used an overall cost to charge ratio for lines 7a and 7b. Amounts listed on lines 7e, 7f and 7i were derived from internal financial/cost accounting systems. Part I, L7 Col(f): Amount of bad debt expense included on Form 990, Part IX, line 25 but subtracted for purposes of calculating the percentage in column 7f: $5,005,557. Part II: Valley Regional Healthcare believes the skills and knowledge of its employees are the most critical assets to building a strong and healthy community. VRH employees participate on a wide variety of local boards serving or participating in health and wellness missions, including dental health, domestic violence, higher education, school boards, chambers of commerce, United Way, public transportation, elder health, and substance abuse. Employees also participate on state level boards and within elected government, working to improve policy and practice on a broad spectrum. Local businesses rely upon collaborations with VRH to provide education and expertise in community building activities such as through public and private health fairs. VRH takes advantage of public chamber activities, such as the Chili and Apple Festivals, Winter Carnivals, and Spring Home Show to provide tables of health information and free screening activities. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.The Organization used a cost-to-charge ratio as its methodology for reporting bad debt expense at cost. Part III, Line 8: Medicare costs approximate Medicare revenue. The Organization does not anticipate a Medicare shortfall or that any such shortfall should be considered as community benefit. Part III, Line 9b: Patients who are known to qualify for financial assistance file a financial assistance determination application with the Hospital. If the application is approved, the patient's account shall be written off. The patient write-off guidelines are as follows:1. The determination is valid for 6 months from the date of signature for all applications except those individuals who demonstrate that they are on a fixed income (i.e. Social Security, retirment, disability), in which case approval is for 1 year from the date of signature.2. Patient qualifies according to the established Financial Assistance income guidelines3. Account notes must indicate what payor that the balance is due to (appropriate payor write-off codes to be utilized).4. If the balance is other than co-insurance and/or deductible, the balance is written off to charity care. Valley Regional Hospital, Inc. Part V, Section B, Line 17e: Applications are given to all self-pay patients. Part VI, Line 2: In May 2012, Valley Regional Hospital (VRH) partnered with New London Hospital to finalize a joint community needs assessment. While each health care facility possesses community needs assessments, which are unique to their service area, it was advantageous to pool their resources due to the overlap of service territory in eastern Sullivan County. VRH worked with Crescendo Consulting Group, LLC, (CCG) to bring together key healthcare and public service stakeholders, collect quantitative and qualitative data, and reach out to the community in order to elicit feedback directly from them and their service providers. The quantitative and qualitative findings included in the assessment are based on the most currently available data from community resources, the State of New Hampshire, and other regional sources.While this document fulfills federal and State reporting requirements, more importantly, it serves as a guidepost for community outreach efforts and as a benchmark with which to compare future progress.The purpose of the research design was to:-Clearly define the community served by VRH-Define a data-based and qualitative methodology to identify needs in the community-Develop a prioritized list of community resources-Develop a list of healthcare resources in the service area In order to generate the information, CCG and VRH incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health - community opinion leaders (a diverse set of service providers), hospital service providers, and healthcare consumers. In addition, statistical data was integrated with other community data to provide a detailed profile of needs and resources. Crescendo conducted several focus groups with service providers and stakeholders, including patients from various service lines. The following ranked needs were identified following the assessment process: 1. Availability of affordable healthcare, prescriptions, and related services2. Drug and alcohol abuse early detection and treatment3. Managing the expected growth in senior health services4. Wellness initiatives and the individual's ability to maintain a healthy lifestyle 5. Obesity / Nutrition / Exercise education and services6. Addictions awareness and education7. Behavioral Health early detection and intervention8. Transportation to/from healthcare service providers9. Dental health services 10. Chronic disease screenings - broad spectrum (hypertension, cancer, heart disease, stroke)11. Elder Care Services and Dementia Spectrum Issues Part VI, Line 3: The Community Engagement Department has created and posted signs in all public areas of the hospital, as well as on the hospital's website. Part VI, Line 4: Valley Regional Healthcare serves a rural region surrounding Claremont and Newport, NH. Sullivan County has a population of over 43,000 people, living in 15 towns over 537 square miles. VRH also serves portions of eastern VT. Through the 2012 VRH needs assessment and 2009 Sullivan County Human Services Coordination Plan, the following demographics describe the area: -Much of the growth in Sullivan County is now occurring in the rural communities, not in the more urban centers, such as Newport or Claremont.-The median age in Sullivan County is nearly 44 years of age (43.7) while the state average is 40 years. -Similarly, the median annual household income in Sullivan County is about $13,000 less than the state average. In Claremont, household income is more than $21,000 (roughly 33%) below the New Hampshire median income - $41,721 compared to $63,277.-One in six Sullivan County residents is over 64 years of age. In some of communities, the percentage of seniors is over 20% and expected to rise to nearly 25% over the next decade. In addition, Sullivan County has the fourth highest rate of elderly in poverty.-Heart disease, cancer, and stroke are the leading causes of death in VRH's service area. Specifically, death rates for two of these diseases are higher in the Sullivan County than for the overall State of New Hampshire.-Sullivan County has an overall higher rate of households without vehicle ownership. While this rate points to the obvious implication and dependence upon alternate means of transportation, it is also critical to note the secondary effect upon the volunteer pool to provide potential rides to health care providers within the region. Part VI, Line 5: While VRH is committed to supporting its local community, it also recognizes the potential for far reaching impact on an international level. VRH continually partners with neighboring health care providers to extend support in national and international disaster relief efforts, be that through donations of medical supplies or skilled healthcare providers sharing their medical knowledge in foreign lands. VRH is also an active partner with the American Red Cross to insure adequate blood supplies for local and national recipients. VRH is not part of any affiliated health care system. Its collaborations are on a voluntary basis to improve the health of all New Englanders. VRH is part of the New England Alliance for Health (NEAH), a group of community hospitals, behavioral health centers, and home health agencies that came together in a shared commitment to improve the quality, efficiency, and availability of health care in New Hampshire, Vermont and western Massachusetts. And VRH is an active member of the New Hampshire Hospital Associations. X X X X 0 0 0 0 0 1 1 0 0 Claire Bowen 0 260128 0 5000 0 9151 0 5175 0 8964 0 288418 0 0 Robert Cricco MD 273924 0 0 0 8289 0 597 0 21797 0 304607 0 0 0 Oliver Herfort MD 167298 0 3014 0 25016 0 3929 0 23555 0 222812 0 0 0 Charles Sawyer MD 281037 0 0 0 7390 0 5595 0 9075 0 303097 0 0 0 Steven Monette 0 151809 0 0 0 317 0 0 0 1686 0 153812 0 0 Douglass Weiss 471918 0 0 0 765 0 8419 0 9937 0 491039 0 0 0 John Houde 371755 0 0 0 1242 0 6580 0 23797 0 403374 0 0 0 Michael Ritondo 272135 0 0 0 10172 0 5593 0 23797 0 311697 0 0 0 Carl Tetirick 271922 0 0 0 8290 0 5551 0 23797 0 309560 0 0 0 Randolph Knight 223613 0 0 0 19826 0 4901 0 23259 0 271599 0 0 0 Part I, Line 6 No specific goals were established by the Board for the CEO. For the CEO and Senior VPs, any increase in pay rate would be the same as an approved rate increase hospital-wide. State of New Hampshire Business Finance Authority 521304598 64468KBJ4 2008-06-02 26260000 Financing for Buildings and Structures 0 0 0 475000 26260000 325806 25934194 2010 0 1 1 1 0 0 0 0 1 0 1 1 Morgan Stanley & RBS Citizens 20.000000000000 0 0 0 0 0 Form 990, Part VI, Section A, line 6 The sole member of the Organization is Valley Regional Healthcare, Inc. Form 990, Part VI, Section A, line 7a The Organization's directors are nominated and elected by the Organization's member at the annual meeting of the Corporation. Form 990, Part VI, Section A, line 7b The following actions and undertakings involving the business of the Organization are subject to the ratification by the member: adoption of operating budget; adoption of capital budgets; adoption of strategic plans; initiation of significant fund-raising activities; implementation of institutional affiliations, mergers, consolidations or other reorganizations; material modification of service and business offerings; material acquisitions or dispositions of assets; changes in certified public accountants, fiscal year or material accounting practices; incurrence of material indebtedness; material changes in insurance programs and arrangements; material changes in employee benefits plans; adoption of quality improvements plans; election of directors; selection of the president/CEO; amendment of the Organization's bylaws; and amendment of the articles of association. Form 990, Part VI, Section B, line 11 The Organization's CFO reviews the draft Form 990 prior to its filing. The CFO then goes over the document with the board's finance committee. Form 990, Part VI, Section B, line 15 The executive committee of the board of trustees convenes on an annual basis to review the compensation of the CEO. At this time, several resources are used to determine an appropriate rate of pay. The sources of data include, but are not limited to, Olney & Associates CEO Survey, Hay Companies Executive Compensation Survey, and the New Hampshire Hospital Association compensation survey. Other determining factors include overall hospital performance and completion of individual CEO goals and objectives. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 2,068,901. Valley Regional Healthcare Inc 243 Elm Street Claremont NH 03743 020397338 Healthcare supporting organization NH 501(c)(3) Line 11b, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0