2023-08-15T07:37:14-05:00 2022-12-31 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-01-01 461635259 Wentworth-Douglass Health System WENT 6037425252 789 Central Avenue Dover NH 038202526 Joel Degenaars Vice President of Finance 6037425252 2023-08-14 1 Joel Degenaars 999009999 1 Joseph R Byrne P01289281 2077752387 2023-08-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X Darin Roark 789 Central Avenue Dover NH 038202526 4554561 0 X wdhospital.org X 2012 NH Support and further the charitable activities of Wentworth-Douglass Hospital, Wentworth-Douglass Physician Corporation and Wentworth-Douglass Hospital & Health Foundation by being operated in connection with said organizations. X 15 12 0 12 0 0 0 0 0 0 1462327 -725059 0 0 1462327 -725059 1467690 0 0 0 0 0 0 0 0 39868 45786 1507558 45786 -45231 -770845 5216380 0 11467 0 5204913 0 X Support and further the charitable activities of Wentworth-Douglass Hospital, Wentworth-Douglass Physician Corporation and Wentworth-Douglass Hospital & Health Foundation by being operated in connection with said organizations. 0 1 Effective January 1, 2017, Massachusetts General Hospital (MGH) became the sole corporate member and parent organization of Wentworth-Douglass Hospital (the Hospital). Contemporaneously, the Hospital became the sole corporate member and parent organization of Wentworth-Douglass Hospital and Health Foundation (the Foundation), Wentworth-Douglass Physician Corporation (WDPC), and the Wentworth-Douglass Community Health Corporation (the Works).In conjunction with this transaction, the Wentworth-Douglass Health System (the Health System) amended its bylaws with the mission to support and further the charitable activities of Wentworth-Douglass Hospital, Wentworth-Douglass Physician Corporation and Wentworth-Douglass Hospital & Health Foundation by being operated in connection with said organizations, with the specific purpose of monitoring the integration of the Hospital. 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Michael Steinberg 6037402801 789 Central Avenue Dover NH 03820 X Michael Bolduc Esq Chairman 1.00 3.00 X X 0 0 0 Carol Bailey Vice Chairman 1.00 4.00 X X 0 0 0 Michael Steinberg Treasurer 1.00 0.00 X X 0 0 0 John Salmon Secretary 1.00 5.00 X X 0 0 0 Gerald Daley EDD Trustee 1.00 0.00 X 0 0 0 Peter Dirksmeier MD Trustee 1.00 53.50 X 0 712766 40141 David Flavin MD Trustee 1.00 0.00 X 0 0 0 Neil Garvey Trustee 1.00 2.00 X 0 0 0 Roger Hamel Trustee 1.00 5.00 X 0 0 0 Anne Kalter MD Trustee 1.00 44.00 X 0 101758 12899 John Novello MD Trustee 1.00 52.00 X 0 225093 11751 Donna Rinaldi Trustee 1.00 0.00 X 0 0 0 Theodore Ristaino Trustee 1.00 2.50 X 0 0 0 Ingo Roemer Trustee 1.00 2.00 X 0 0 0 Steven Webb Trustee 1.00 0.00 X 0 0 0 0 1039617 64791 0 0 1 0 0 78232 78232 4476329 5279620 -803291 -803291 -803291 -725059 0 0 -725059 4098 4098 16700 16700 2000 2000 14476 14476 8437 8437 State of New Hampshire 75 75 45786 0 45786 0 46438 0 0 0 0 0 0 0 0 1169 0 0 5168773 0 0 0 0 0 5216380 0 11467 0 11467 0 X 0 0 0 0 5204913 0 5204913 0 5216380 0 X -770845 50007 -4484075 X 0 0 0 X X X 2 Wentworth-Douglass Hospital 020260334 3 1 0 0 Wentworth-Douglass Physician Corporation 020497927 3 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Part IV, Section C, Line 1 While Wentworth-Douglass Health System does share independent board members with the supported organizations Wentworth-Douglass Hospital and Wentworth-Douglass Phyisician Corporation, the shared members do not make up a majority of the directors of Wentworth-Douglass Hospital or Wentworth-Douglass Physician Corporation. 0 0 0 0 0 0 0 0 0 Peter Dirksmeier MD Trustee 0 652366 0 22770 0 37630 0 13725 0 26416 0 752907 0 0 John Novello MD Trustee 0 154173 0 46985 0 23935 0 10302 0 1449 0 236844 0 0 Cash 2022-12-31 46437 Internal Financial Statements 020260334 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 501(c)(3) Investments 2022-12-31 25499 Internal Financial Statements 020260334 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 501(c)(3) Due to Affiliate 2022-12-31 -56083 Internal Financial Statements 020260334 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 501(c)(3) 0 0 0 0 1 1 1 1 0 Form 990, Part III, line 3 Effective 12/31/22, Wentworth-Douglass Health System merged into Wentworth-Douglass Hospital. Form 990, Part VI, Section A, line 3 The organization filed articles of merger effective 12/31/22 and is dissolving as a result of the merger. Form 990, Part VI, Section B, line 11b A draft of the Form 990 is initially reviewed by the key finance employees. The 2022 final draft was presented to the Vice President of Finance and Chief Operating Officer/President for review prior to the IRS filing. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is distributed annually to all officers and trustees. All are required to report any conflicts and sign, date, and return the policy, whether or not a conflict exists, to confirm compliance. Conflicts are disclosed in accordance with state of New Hampshire RSA 7:19-A in the local newspaper and submitted to the New Hampshire Attorney General. Form 990, Part VI, Section B, line 15 All compensation reported on this Form 990 is paid by a related organization. Form 990, Part VI, Section C, line 19 Wentworth-Douglass Health System files financial statements annually with the New Hampshire Attorney General's Charitable Trust Unit and informs the Director of Charitable Trusts of any pecuniary benefit transactions that have occurred between the Health System and a board member or officer. Notices of such transactions of $5,000 or more are also published in the local newspaper in accordance with NH RSA 7:19-A, II(D). Current copies of the bylaws, conflict of interest policy, and the form 990 are on file with the Charitable Trust Unit. The organization also makes these documents available upon request. Form 990, Part VII, Section A Reportable compensation from related organizations: The 2022 Compensation reported for Dr. Anne Kalter, Dr. John Novello, and Dr. Peter Dirksmeier was paid by related organizations for their services as members of the medical staff. None of the individuals listed are compensated for their services as a trustee of Wentworth-Douglas Health System. These amounts have been reported in Part VII Columns (E) and (F). Form 990, Part XI, line 9: Net Asset Transfer to Wentworth-Douglass Hospital Upon Dissolution -4,484,075. Wentworth-Douglass Physician Corporation 789 Central Avenue Dover NH 03820 020497927 Healthcare NH 501(c)(3) Line 3 WDH 0 Wentworth-Douglass Hospital & Health Foundation 789 Central Avenue Dover NH 03820 510491062 Fundraising NH 501(c)(3) Line 12b, II WDH 0 Wentworth-Douglass Hospital 789 Central Avenue Dover NH 03820 020260334 Healthcare NH 501(c)(3) Line 3 MGH 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0