2011-08-08T15:28:03-05:00 2010-09-30 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2009-10-01 020222118 Valley Regional Hospital Inc VALL 6035427771 243 Elm Street Claremont NH 03743 Steven L Monette 6035427771 2011-08-05 1 Barbara J McGuan CPA 2077752387 2011-08-05 2009 2016-02-24 21:20:13Z Claire Bowen 243 Elm Street Claremont NH 03743 59671145 0 X www.vrh.org X 1893 NH Critical Access Hospital 21 19 467 17 0 0 354344 463666 41558107 45473332 -392731 817891 -91658 -68899 41428062 46685990 269053 30291 0 23110364 23839331 0 0 18429413 22650910 41808830 46520532 -380768 165458 55735677 56224360 33654702 35293155 22080975 20931205 The mission of Valley Regional is to serve and respond to the ongoing healthcare needs of the residents in the greater Claremont, New Hampshire area. 0 0 38794495 30291 45473332 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, 2010 charges forgone for services and supplies furnished under the charity care policy were approximately $2,223,861. The estimated cost of those services and supplies was approximately $1,575,000.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, 2010, the Hospital incurred costs in excess of payments of approximately $7,290,000.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. 38794495 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 42 0 467 1 0 0 0 0 0 0 0 0 0 21 19 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 293209 16488 David McCrillis 1.00 X X 0 0 0 Robert Porter 1.00 X X 0 0 0 Clay Hawkins 1.00 X 0 0 0 Volker Bradley MD 1.00 X 0 0 0 Albert Leahy Jr 1.00 X 0 0 0 Debra Livingston 1.00 X 0 0 0 Nancy Merrill 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 Ellen Joyce MD 1.00 X 0 0 0 Randolph Knight MD 40.00 X X 273470 0 33783 Michael O'Connell 1.00 X 0 0 0 Michael Satzow 1.00 X 0 0 0 Evelyn Schlosser 1.00 X 0 0 0 Robert Cricco MD 1.00 X 0 0 0 Allen Damren 1.00 X 0 0 0 Michael Fuerst 1.00 X 0 0 0 Oliver Herfort MD 1.00 X 0 0 0 Sherwood Moody 1.00 X 0 0 0 Steven Monette 40.00 X 0 143108 889 John Houde MD 40.00 X 404168 0 24480 Carl Tetirick 40.00 X 274777 0 24987 Charles Sawyer 40.00 X 264560 0 6591 Catherine Schneider 40.00 X 259474 0 9904 Michael Ritondo 40.00 X 245249 0 29384 1721698 436317 146506 18 0 1 0 Harvey Construction 10 Harvey Road Bedford NH 03110 Construction Services 569028 American Health Centers Inc 498 Essex Street Bangor ME 04401 MRI Services 299977 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Contract Labor 268268 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Contract Labor 252200 Mary Hitchcock Hospital One Medical Center Drive Lebanon NH 03756 Mobile Echo Services 208805 12 22408 4394 315810 121054 2023 463666 Patient Service Revenu 621400 65937877 65937877 Other Revenue 900099 853680 853680 Lab Outreach Revenue 621400 435112 435112 Cafeteria Revenue 900099 168198 168198 Charity/Contractual Ad 621400 -21921535 -21921535 45473332 606038 606038 26527 95426 -68899 -68899 -68899 13083636 5000 12658643 218140 424993 -213140 211853 211853 12946 22408 12946 0 46685990 45305134 0 917190 30291 30291 307253 307253 18329497 16981048 1348449 120417 111098 9319 3846479 3565806 280673 1235685 1146116 89569 72972 72972 40000 40000 135180 135180 6087800 3253560 2834240 4506697 4265852 240845 1520990 455199 1065791 19271 15913 3358 868245 868245 2010177 1808284 201893 342177 342177 Provision for Bad Debts 4445304 4445304 Medicaid Enhancement Ta 2165360 2165360 Dues & Subscriptions 185278 97038 88240 Licenses & Taxes 109260 106417 2843 Miscellaneous 97436 1848 95588 44763 38108 6655 46520532 38794495 7726037 0 2350 2350 8360330 5305310 4071141 3819111 643089 715137 226118 244562 46021536 20912967 19528309 25108569 18820009 15491938 3084387 3172437 341277 383515 658667 1981431 55735677 56224360 4856145 4470073 13056 10914 26260000 26260000 2525501 4552168 33654702 35293155 X 17776744 16526254 965950 978620 3338281 3426331 22080975 20931205 55735677 56224360 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12238 12238 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: The Organization pays dues to local associations, a portion of which are attributable to lobbying activities. 3968278 71 157717 10886 4115180 4259270 331 -277479 13844 3968278 0.00000 0.83260 0.16740 0 0 250667 250667 16290205 5938525 10351680 148235 104865 43370 27981177 14541405 13439772 1351252 328172 1023080 25108569 Beneficial Interest in Perpetual Trust 3172437 F 3172437 Due To Affiliates 455282 Estimated Third Party Settlements 720990 Interest Rate Swap 2703288 Reserve for Self-Funded Insurance 610416 Deferred Compensation 62192 4552168 46685990 46520532 165458 -1315228 -1315228 -1149770 45343954 -1315228 108372 -1206856 46550810 135180 135180 46685990 46493724 108372 108372 46385352 135180 135180 46520532 Part V, Line 4: Description of Intended Use of Endowment Funds: 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: 95426. Fundraising Expenses: 12946. Part XIII, Line 2d - Other Adjustments: Rental Expenses: 95426. Fundraising Expenses: 12946. Golf Tournament 35354 22408 12946 12946 35354 22408 12946 12946 12946 0 1 1 0 0 1 1 1 0 1 1 3455420 2004383 1451037 0.03450 5024299 2482324 2541975 0.06040 8479719 4486707 3993012 0.09490 261704 62304 199400 0.00470 17974 17974 0.00040 30291 30291 0.00070 309969 62304 247665 0.00580 8789688 4549011 4240677 0.10070 5 4849 4849 0.00010 1 320 320 0.00000 7 9984 9984 0.00020 5 5756 5756 0.00010 18 20909 20909 0.00040 1 2530711 0 13926187 13926187 X 1 1 Valley Regional Hospital Inc

243 Elm Street Claremont NH 03743

X X X X Kane Oncology Center

243 Elm Street Claremont NH 03743

Oncology Center River Valley Associates

241 Elm Street Claremont NH 03743

Counseling & Psychotherapy Services Vital Signs Fitness Center

4 Dunning Street Claremont NH 03743

Fitness 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, Line 7f: Amount of bad debt expense included on Form 990, Part IX, line 25 but subtracted for purposes of calculating the percentage in column 7f: $4,445,304. 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. Part VI, Line 2: VRH is a partner in the Bi-State Coalition for Community Health Improvement. This group, which also includes United Ways of the Upper Valley and Sullivan County, West Central Behavioral Health, Alice Peck Day Hospital, Dartmouth-Hitchcock Medical Center, Mascoma Health, and New London Hospital, has completed a community needs assessment that encompasses 11 specific indicators. For each of the indicators, primary and secondary data was collected to report both quantitative and qualitative information. The Bi-State Coalition utilized focus groups, health and human services data, community leaders, random phone surveys and data collected from Grafton and Sullivan County social services agencies. A list of community resources and assets are also provided for each indicator. VRH chose to focus on responses elicited from the service providers as well as consumers who took part in the needs assessment. Health and Human Service providers identified education/prevention/wellness, availability of dental care, and availability or primary care as the highest three needs. Consumers identified chronic disease screenings, availability of primary care, and health education as their priorities. Part VI, Line 3: All self pay patients are offered a financial assistance application upon registration. Notification of process is outlined on the reverse side of patient statements, including requirements for applying and phone number for a patient representative for assistance. This information is also available on the Valley Regional Hospital 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 Sullivan County Human Services Coordination Plan, the following demographics describe the area: 1. 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. 2. Sixteen percent (16%) of Sullivan County citizens over age 65 versus 11.9% of NH citizens.3. Over nineteen percent (19.3%) of Sullivan County residents have one or more disabilities versus 16.9 percent of New Hampshire residents, with Newport, Claremont and Charlestown representing the highest geographic concentration of disabled community members. 4. For the last 17 years Sullivan County per capita income has been consistently less than the state and national per capita rate. Over eight percent (8.5%) of Sullivan County residents live below the federal poverty level, and several communities exceed the Sullivan County rate: 8.8% in Goshen; 15.6% in Acworth; 10% in Claremont, and 14.4% in Newport.5. 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: Valley Regional Healthcare believes the skills and knowledge of its employees are the most critical asset 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, health initiatives of the local Rotary, 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 VI, Line 6: 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 health care 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. 1 Community Dental Care 1 Tremont Street Claremont NH 037432654 680662886 15000 Operational assistance 1 X X X X 0 0 0 0 0 1 1 0 0 Claire Bowen 0 244781 0 40000 0 8428 0 9286 0 7202 0 309697 0 0 Randolph Knight MD 229608 0 0 0 43862 0 8140 0 25643 0 307253 0 0 0 John Houde MD 392950 0 10588 0 630 0 3837 0 20643 0 428648 0 0 0 Carl Tetirick 272955 0 0 0 1822 0 4344 0 20643 0 299764 0 0 0 Charles Sawyer 246238 0 500 0 17822 0 5058 0 1533 0 271151 0 0 0 Catherine Schneider 259096 0 0 0 378 0 3208 0 6696 0 269378 0 0 0 Michael Ritondo 237948 0 0 0 7301 0 8741 0 20643 0 274633 0 0 0 Part I, Line 6 Part I, Line 6: Claire Bowen (CEO) received a bonus that is derived by a number of different factors. There is a fixed dollar amount that is set as a potential bonus. The board sets objectives for the CEO to achieve with a weighted percentage on each objective that will factor into the bonus amount. These weighted amounts equal 100% of the potential bonus. For Steve Monette (CFO), 15% of his salary is eligible for a bonus. He, too, has a weighted percent on objectives to meet during the year in determining the bonus amount he will receive. For fiscal year 09-10, one of the objectives for the senior management was meeting the budgeted operating return. This counted as 35% of their potential bonus amount. State of New Hampshire Business Finance Authority 521304598 64468KBJ4 2008-06-02 26260000 Financing for Buildings and Structures 0 0 26260000 325806 25934194 0 0 0 1 0 0 0 0 0 1 0 1 1 1 MBIA 2.000000000000 1 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. Form 990, Part XI, Line 2c: Oversight of Audit The audit process has not changed from the prior year. Form 990, Part I, Lines 8-18: Prior year numbers have been restated to present revenue net of contractual and charity care adjustments. Valley Regional Healthcare Inc 243 Elm Street Claremont NH 03743 020397338 Healthcare supporting organization NH 501(c)(3) Line 11b, II N/A 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 Valley Regional Healthcare Inc A 13308 Valley Regional Healthcare Inc L 2413487