UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- UPPER CONNECTICUT VALLEY HOSPITAL ASSOCIATION (EIN 02-0276210)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-03-12
- IRS object ID
- 201240729349300704
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2012-03-12T08:19:47-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TYLER SIMMS & STSAUVEUR CPAS PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19 MORGAN DRIVE | AddressLine1 |
| City | LEBANON | City |
| State | NH | State |
| ZIP Code | 03766 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020276210 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER CONNECTICUT VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | UPPE | NameControl |
| Phone | 6032374971 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CORLISS LANE | AddressLine1 |
| City | COLEBROOK | City |
| State | NH | State |
| ZIP Code | 03576 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES TIBBETTS | Name |
| Title | TREASURER | Title |
| Phone | 6032374971 | Phone |
| Date Signed | 2012-03-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | W JAY SIMMS | Name |
| Phone | 6036530044 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WINSTON YOUNG | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CORLISS LANE | AddressLine1 |
| City | COLEBROOK | City |
| State | NH | State |
| ZIP Code | 03576 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 15218602 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.DARTMOUTH-HITCHCOCK.ORG/UCVH | WebSite |
| Type Of Organization Association | X | TypeOfOrganizationAssociation |
| Year Formation | 1969 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 178 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 289409 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 94567 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15311159 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14309260 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -90458 | InvestmentIncomePriorYear |
| Investment Income Current Year | 388046 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 381051 | OtherRevenuePriorYear |
| Other Revenue Current Year | 408329 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 15891161 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15200202 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 75000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7462102 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7449464 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 12177 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8119979 | OtherExpensePriorYear |
| Other Expenses Current Year | 8109993 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15582081 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15634457 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 309080 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -434255 | RevenuesLessExpensesCY |
| Total Assets BOY | 15323454 | TotalAssetsBOY |
| Total Assets EOY | 16103171 | TotalAssetsEOY |
| Total Liabilities BOY | 4077709 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4352765 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11245745 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11750406 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12733592 | Expense |
| Revenue | 14684941 | Revenue |
| Description | UPPER CONNECTICUT VALLEY HOSPTIAL PROVIDED HOSPITAL CARE AND INPATIENT AND OUTPATIENT SERVICES ON A REGION-WIDE BASIS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | THE NET CHARITY CARE PROVIDED BY THE HOSPITAL FOR THE YEAR-ENDED SEPTEMBER 30, 2011 WAS $789,632. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 12733592 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 40 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 178 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6032374971 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | UCVH CORLISS LANE | AddressLine1 |
| City | COLEBROOK | City |
| State | NH | State |
| ZIP Code | 03576 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| E HARLAN CONNARY | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| NEIL P COUTURE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SHIRLEY POWELL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARGARET CLEARY | |||||||
| EX-OFFICIO/INTERIM CEO | 1.00 | X | X | 0 | 0 | 0 | |
| GREG E PLACY | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES TIBBETTS | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| WINSTON YOUNG | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| THE REV CRAIG CHENEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| PALMER LEWIS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRUCE BEAN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ODETTE CRAWFORD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ED LAVERTY PA-C | |||||||
| CHIEF OF STAFF: EX OFFICIO MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LOUISE MCCLEERY | |||||||
| CEO (THROUGH 3/31/11) | 40.00 | X | X | 128635 | 0 | 11881 | |
| ROBERT SOUCY | |||||||
| EMERGENCY DEPT. PHYSICIAN | 43.00 | 194643 | 0 | 22828 | X | ||
| WILLIAM SPINA | |||||||
| SURGEON | 40.00 | 175557 | 0 | 26230 | X | ||
| GERALD WESTOVER | |||||||
| PHYSICIAN | 54.00 | 201199 | 0 | 14905 | X | ||
| EDWARD LAVERTY | |||||||
| MID LEVEL PROVIDER | 51.00 | 162253 | 0 | 21249 | X | ||
| FERIAL LADAK | |||||||
| EMERGENCY DEPT. PHYSICIAN | 46.00 | 238133 | 0 | 16681 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1100420 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 113774 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ANDROSCOGGIN VALLEY HOSPITAL | |||||
| 59 PAGE HILL ROAD | BERLIN | NH | 03570 | PT AND OT STAFF/SERVICE | 481483 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | SERVICE CONTRACTS | 337892 |
| LIQUID AGENTS HEALTHCARE LLC | |||||
| 6900 DALLAS PARKWAY | PLANO | TX | 75024 | HEALTHCARE STAFFING FIRM | 201431 |
| LEADERS FOR TODAY | |||||
| 50 RESNIK ROAD | PLYMOUTH | MA | 02360 | HEALTHCARE STAFFING FIRM | 129800 |
| VIRTUAL RADIOLOGIC CORPORATION | |||||
| PO BOX 4246 | CAROL STREAM | IL | 60197 | RADIOLOGY SERVICES | 106603 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 67691 | GovernmentGrants |
| All Other Contributions | 26876 | AllOtherContributions |
| Total Contributions | 94567 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 14309260 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14309260 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14309260 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40864 | TotalRevenueColumn |
| Exclusion | $40,864 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 365582 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 18400 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 365582 | Securities |
| Other | -18400 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 347182 | TotalRevenueColumn |
| Exclusion | $347,182 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| OTHER INCOME | 900099 | 190702 | 190702 | |
| SCHOOL NURSE PROGRAM | 900099 | 169804 | 169804 | |
| CAFETERIA | 900099 | 32648 | $32,648 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15175 | TotalRevenueColumn |
| Related Or Exempt Function Income | 15175 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 408329 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15200202 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14684941 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $420,694 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75000 | Total |
| Program Services | 75000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90727 | Total |
| Management And General | 90727 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5886819 | Total |
| Program Services | 5228431 | ProgramServices |
| Management And General | 658388 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71489 | Total |
| Program Services | 63917 | ProgramServices |
| Management And General | 7572 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1007257 | Total |
| Program Services | 886180 | ProgramServices |
| Management And General | 121077 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393172 | Total |
| Program Services | 344264 | ProgramServices |
| Management And General | 48908 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256798 | Total |
| Management And General | 256798 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63444 | Total |
| Management And General | 63444 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64000 | Total |
| Management And General | 64000 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1351699 | Total |
| Program Services | 1245458 | ProgramServices |
| Management And General | 106241 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289273 | Total |
| Program Services | 289273 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87109 | Total |
| Program Services | 58900 | ProgramServices |
| Management And General | 28209 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16305 | Total |
| Management And General | 16305 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 716683 | Total |
| Program Services | 716683 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96716 | Total |
| Management And General | 96716 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| PURCHASED SERVICES | 1571278 | 1176401 | 394877 | |
| PROVISION FOR BAD DEBT | 1249259 | 1249259 | ||
| MEDICAID ENHANCEMENT TA | 637827 | 637827 | ||
| PHYSICIAN FEES | 600925 | 511675 | 89250 | |
| MISCELLANEOUS | 416054 | 388207 | 15670 | 12177 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 692623 | Total |
| Program Services | 499944 | ProgramServices |
| Management And General | 192679 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15634457 | Total |
| Program Services | 12733592 | ProgramServices |
| Management And General | 2888688 | ManagementAndGeneral |
| Fundraising | 12177 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294199 | BOY |
| EOY | 565903 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1053141 | BOY |
| EOY | 1713405 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1746800 | BOY |
| EOY | 1517504 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 274613 | BOY |
| EOY | 279493 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 226949 | BOY |
| EOY | 204376 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11210058 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6687366 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4718358 | BOY |
| EOY | 4522692 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6068555 | BOY |
| EOY | 5916947 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 579110 | BOY |
| EOY | 808417 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 361729 | BOY |
| EOY | 574434 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15323454 | BOY |
| EOY | 16103171 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 741642 | BOY |
| EOY | 1303529 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85173 | BOY |
| EOY | 24790 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1863899 | BOY |
| EOY | 1767718 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1386995 | BOY |
| EOY | 1256728 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4077709 | BOY |
| EOY | 4352765 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9872249 | BOY |
| EOY | 10595930 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1304311 | BOY |
| EOY | 1085291 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69185 | BOY |
| EOY | 69185 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11245745 | BOY |
| EOY | 11750406 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15323454 | BOY |
| EOY | 16103171 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -434255 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 938916 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,832 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3832 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | UPPER CONNECTICUT VALLEY HOSPITAL IS A MEMBER OF THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS AVAILABLE FOR LOBBYING EXPENDITURES ON BEHALF OF UCVH AND OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. UPPER CONNECTICUT VALLEY HOSPITAL DOES NOT DIRECLTY PERFORM ANY LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 125114 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 2130 | InvestmentEarningsOrLosses |
| End Of Year Balance | 127244 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 112258 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 12856 | InvestmentEarningsOrLosses |
| End Of Year Balance | 125114 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 111704 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 554 | InvestmentEarningsOrLosses |
| End Of Year Balance | 112258 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.54370 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.45620 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9700 | OtherCostOrOtherBasis |
| Book Value | 9700 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4284323 | OtherCostOrOtherBasis |
| Depreciation | 1978224 | Depreciation |
| Book Value | 2306099 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 351255 | OtherCostOrOtherBasis |
| Depreciation | 194726 | Depreciation |
| Book Value | 156529 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6539748 | OtherCostOrOtherBasis |
| Depreciation | 4514416 | Depreciation |
| Book Value | 2025332 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25032 | OtherCostOrOtherBasis |
| Book Value | 25032 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4522692 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH AND CASH EQUIVALENTS | 149403 | F |
| SHORT TERM INVESTMENTS | 659014 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 808417 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY PAYERS | $1,225,246 |
| CAPITAL LEASE | $31,482 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1256728 | TotalOfAmounts |
| Total Revenue | 15200202 | TotalRevenue |
| Total Expenses | 15634457 | TotalExpenses |
| Excess Or Deficit For Year | -434255 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -310343 | NetUnrealizedGLOnInvestments |
| Other | $1,249,259 | OtherAmount |
| Total Adjustments | 938916 | TotalAdjustments |
| Excess Or Deficit Per FS | 504661 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 14774311 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -310343 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -310343 | RevenueNotRptdF990 |
| Revenue Subtotal | 15084654 | RevenueSubtotal |
| Other Revenues Not Included | 115548 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 115548 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 15200202 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 14373021 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 14373021 | ExpensesSubtotal |
| Other Expenses Not Included | 1261436 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1261436 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 15634457 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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 8 - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 12,177. NET ASSETS RELEASED FOR CAPITAL EXPENDITURS 103,371. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 12,177. PROVISION FOR BAD DEBTS 1,249,259. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 789227 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 340283 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 448944 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03120 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1907633 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1520143 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 387490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02690 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2696860 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1860426 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 836434 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05810 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10895 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10895 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 462105 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 462105 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03210 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12450 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12450 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 485450 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 485450 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03380 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3182310 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1860426 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1321884 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09190 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 640 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 640 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 670 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 670 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1310 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1310 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $695,984 | BadDebtExpenseAmount |
| Amount Attributable To | 22271 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7640191 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7739629 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -99438 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER CONNECTICUT VALLEY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 181 CORLISS LANE | AddressLine1 |
| City | COLEBROOK | City |
| State | NH | State |
| ZIP Code | 03576 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER CONNECTICUT VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (6 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1249259. | ||
| 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 A COMMUNITY BENEFIT AS THERE ARE NO OTHER FUNDS AVAILABLE TO SUBSIDIZE THE LOSS. | ||
| PART VI, LINE 2: UCVH ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH A VARIETY OF METHODOLOGIES. FOR EXAMPLE, UCVH CONDUCTS COMMUNITY HEALTH CARE SCREENINGS AT BUSINESSES AND SCHOOLS FOR "REAL TIME" ASSESSMENTS. THESE SCREENINGS ASSESS HEALTH THROUGH SUCH THINGS AS BLOOD TESTING FOR GLUCOSE AND CHOLESTEROL, BLOOD PRESSURE CHECKS, AND SKIN CANCER AWARENESS EDUCATION. VOUCHERS ARE OFFERED FOR COUNSELING ABOUT THE TEST RESULTS, AND DIRECT FEEDBACK FROM THE PARTICIPANTS ABOUT THEIR HEALTH CARE NEEDS IS RECEIVED ONE-ON-ONE IN A PRIVATE AREA. FEEDBACK FROM THE SCREENINGS IS USED TO PREPARE EDUCATIONAL TOPICS FOR PUBLIC EDUCATION, AND TO HELP PLAN FOR FUTURE SCREENINGS. ANOTHER METHODOLOGY USED BY UCVH IS A COMMUNITY NEEDS ASSESSEMENT USING FOCUS GROUP INTERVIEWS, AN ANAYLSIS OF COOS COUNTY BEHAVIORAL AND RISK FACTOR SURVEILLANCE STATISTICS, AND COMPARISONS OF PREVIOUS COMMUNITY NEEDS ASSESSMENTS. | ||
| PART VI, LINE 3: UCVH IS A CHARITABLE HEALTH CARE ORGANIZATION AND A DESIGNATED CRITICAL ACCESS HOSPITAL. UCVH WILL TREAT PATIENTS WHO COME TO US FOR NON-ELECTIVE, MEDICALLY NECESSARY CARE, REGARDLESS OF THEIR FINANCIAL STATUS. WE OFFER FINANCIAL ASSISTANCE FOR THESE SERVICES - IN THE FORM OF FREE OR DISCOUNTED CARE - TO THOSE PATIENTS WHO ARE UNABLE TO PAY THEIR BILLS.THE PATIENTS OR THEIR FAMILY REPRESENTATIVES MUST COMPLETE AN APPLICATION AND PROVIDE INFORMATION THAT SUPPORTS THEIR FINANCIAL NEED. ALL APPLICATIONS RECEIVED WILL BE PROCESSED UNDER BOTH THE NHHAN GUIDELINES, AS PUBLISHED IN THE NHHAN MANUAL, AND THE UCVH GUIDELINES. PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE NHHAN GUIDELINES WILL RECEIVE A PORTABLE CARD THAT WILL BE HONORED AT OTHER NEW HAMPSHIRE PARTICIPATING MEDICAL FACILITIES. UCVH GUIDELINES ARE ONLY APPLICABLE TO SERVICE RENDERED AT OUR SERVICE LOCATIONS AND ARE NOT PORTABLE. | ||
| PART VI, LINE 4: THE UCVH SERVICE AREA IS COMPRISED OF SIX COMMUNITIES IN NORTHERN NEW HAMPSHIRE (COLEBROOK, STRATFORD, PITTSBURG, STREWARTSTOWN, COLUMBIA, ERROL, AND CLARKSVILLE), AS WELL AS EIGHT OTHER SMALL COMMUNITIES IN VERMONT AND TWO IN MAINE. THE REGIONAL HEALTH PROFILE ASSESSED OUR POPULATION AT APPROXIMATELY 8,500 COVERING 850 SQUARE MILES. THE MAJOR ISSUES OF THE COMMUNITY THAT UCVH SERVES ARE GEOGRAPHIC AND ECONOMIC BARRIERS, AND THE POVERTY-RELATED ISSUES OF SUBSTANCE ABUSE AND TEEN PREGNANCY. | ||
| NH | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|
| 45TH PARALLEL EMS | ||||||||
| 46 RAMSEY ROAD | COLEBROOK | NH | 03576 | 262005001 | 501(C)3 | 25000 | FMV | AMBULANCE SERVICES |
| INDIAN STREAM HEALTH CENTER INC | ||||||||
| 2 CORLISS LN RR2 BOX 14 | COLEBROOK | NH | 03576 | 200999212 | 501(C)3 | 50000 | FMV | MEDICAL SERVICES |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT SOUCY | |||||||||||||
| 194643 | 0 | 0 | 0 | 0 | 0 | 4032 | 0 | 18796 | 0 | 217471 | 0 | 0 | 0 |
| WILLIAM SPINA | |||||||||||||
| 175557 | 0 | 0 | 0 | 0 | 0 | 4800 | 0 | 21430 | 0 | 201787 | 0 | 0 | 0 |
| GERALD WESTOVER | |||||||||||||
| 201199 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 14905 | 0 | 216104 | 0 | 0 | 0 |
| EDWARD LAVERTY | |||||||||||||
| 162253 | 0 | 0 | 0 | 0 | 0 | 2534 | 0 | 18715 | 0 | 183502 | 0 | 0 | 0 |
| FERIAL LADAK | |||||||||||||
| 238133 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16681 | 0 | 254814 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW AND APPROVAL BEFORE IT IS FILED. | |
| OFFICERS, DIRECTORS, AMD KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DOCUMENT. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE HOSPITAL CEO'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 B, LINE 15 | |
| UVCH MAKES ITS FORM 990 AVAILABLE UPON REQUEST AND ON THE GUIDESTAR WEBSITE | FORM 990, PART VI, SECTION C, LINE 18 | |
| AVAILABLE UPON REQUEST | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -310,343. PROVISION FOR BAD DEBTS 1,249,259. TOTAL TO FORM 990, PART XI, LINE 5: 938,916. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| WEEKS MEDICAL CENTER | |||||||||
| 173 MIDDLE STREET | LANCASTER | NH | 03584 | 020222242 | HOSPITAL | NH | 501C(3) | 170(B)(1)(A)III | 0 |
| MARY HITCHCOCK MEMORIAL HOSPITAL | |||||||||
| 1 MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 020222140 | HOSPITAL | NH | 501C(3) | 170(B)(1)(A)III | 0 |
| DARTMOUTH-HITCHCOCK CLINIC | |||||||||
| 1 MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | 222519596 | MEDICAL CLINIC | NH | 501C(3) | 509(A)(2) | 0 |
| ANDROSCOGGIN VALLEY HOSPITAL | |||||||||
| 59 PAGE HILL ROAD | BERLIN | NH | 03570 | 020280367 | HOSPITAL | NH | 501C(3) | 170(B)(1)(A)III | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||
| E | 203423 | CASH PAID |
| MARY HITCHCOCK MEMORIAL HOSPITAL | ||
| L | 16161 | FMV |
| NEW ENGLAND ALLIANCE FOR HEALTH | ||
| L | 145811 | FMV |
| DARTMOUTH-HITCHCOCK CLINIC | ||
| L | 19117 | FMV |
| WEEKS MEDICAL CENTER | ||
| L | 29910 | FMV |
| ANDROSCOGGIN VALLEY HOSPITAL | ||
| L | 465757 | FMV |