2024-08-15T15:00:32-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 223035216 ANDROSCOGGIN VALLEY HOSPITAL FOUNDATION ANDR 6037522200 59 PAGE HILL ROAD BERLIN NH 03570 MATTHEW STREETER SYSTEM CFO 6037522200 2024-08-15 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-08-13 2022 2024-08-08 14:25:15Z MICHAEL PETERSON 59 PAGE HILL ROAD BERLIN NH 03570 139991 0 X N/A X 1987 NH TO PROVIDE ASSET MANAGEMENT AND FINANCIAL SUPPORT TO ANDROSCOGGIN VALLEY HOSPITAL. 5 3 0 3 0 0 0 69802 0 0 167210 -1207 0 0 167210 68595 112636 65974 0 0 0 0 0 0 0 18335 13631 130971 79605 36239 -11010 2723873 3111132 118726 123284 2605147 2987848 TO SUPPORT THE CHARITABLE MISSION OF ANDROSCOGGIN VALLEY HOSPITAL, PRIMARILY THROUGH FUNDRAISING AND INVESTMENT MANAGEMENT. 0 0 74360 65974 0 PROVIDE ASSET MANAGEMENT AND FINANCIAL SUPPORT TO ANDROSCOGGIN VALLEY HOSPITAL. 74360 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X MATTHEW STREETER 6033265610 59 PAGE HILL ROAD BERLIN NH 03570 MICHAEL PETERSON PRESIDENT 1.00 41.00 X X 0 406469 6555 BRIAN O'HEARN DIRECTOR 0.50 40.50 X 0 232123 37755 MARK KELLEY CHAIR 0.50 1.00 X X 0 0 0 PAMELA LAFLAMME VICE CHAIR 0.50 1.00 X X 0 0 0 THOMAS MCCUE TREASURER 0.50 1.50 X 0 0 0 THOMAS MEE SYSTEM CEO 0.50 45.50 X 0 681354 28979 MATTHEW STREETER SYSTEM CFO 0.50 45.50 X 0 300812 10917 0 1620758 84206 0 0 1 0 0 69802 69802 70189 70189 71396 -71396 -71396 -71396 68595 0 0 -1207 42500 42500 23474 23474 5245 5245 PROGRAM EXPENSES 8386 8386 79605 74360 5245 0 1395 16762 2722478 3094370 2723873 3111132 118726 123284 118726 123284 X 2561385 2944086 43762 43762 2605147 2987848 2723873 3111132 -11010 393711 0 X X 0 1 X 1 0 X X 1 ANDROSCOGGIN VALLEY HOSPITAL INC 020280367 3 1 74359 0 1 74359 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 AVHF FND DUE TO AVH 123284 123284 1 GREAT NORTHWOODS COMMUNITY FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 020452547 501C(3) 40000 0 SUPPORT LOCAL COMMUNITY HEALTH & WELLNESS FUNDS 1 0 GAYNOR SCHOLARSHIP 4 9000 EDUCATIONAL ASSISTANCE 6 14474 PART I, LINE 2: MISCELLANEOUS GRANTS ARE PROVIDED PER MANAGEMENT DISCRETION AND THE CRITERIA IS BASED ON AN ORGANIZATIONS BYLAWS AND/OR THEIR MISSION/PROJECTS. EXAMPLE: GREAT NORTHWOODS COMMUNITY FOUNDATION BYLAWS CONSIST OF HOW THEY WILL BE ASSISTING OUR COMMUNITY WHICH IS THE BASIS OF THE DECISION TO SUPPORT THAT ORGANIZATION. 0 1 0 0 0 0 0 0 0 THOMAS MEE SYSTEM CEO 0 537600 0 131095 0 12659 0 1891 0 27088 0 710333 0 0 MICHAEL PETERSON PRESIDENT 0 305165 0 77489 0 23815 0 0 0 6555 0 413024 0 0 MATTHEW STREETER SYSTEM CFO 0 276715 0 23655 0 442 0 2631 0 8286 0 311729 0 0 BRIAN O'HEARN DIRECTOR 0 189788 0 31318 0 11017 0 0 0 37755 0 269878 0 0 PART I, LINE 3 NORTH COUNTRY HEALTHCARE, A RELATED ORGANIZATION, USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THOMAS MEE, SYSTEM CEO, PARTICIPATED IN A 457(F) PLAN ADMINISTERED BY NORTH COUNTRY HEALTHCARE, A RELATED ORGANIZATION. THERE WERE NO CONTRIBUTIONS OR DISTRIBUTIONS IN 2022. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS ANDROSCOGGIN VALLEY HOSPITAL, A NEW HAMPSHIRE NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER SHALL BE ENTITLED TO VOTE IN THE ELECTION OF DIRECTORS AND TO CAST ONE VOTE FOR EACH DIRECTOR TO BE ELECTED. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER SHALL ALSO BE ENTITLED TO ONE VOTE ON ALL OTHER MATTERS TO BE VOTED ON. THE MEMBER'S VOTE SHALL BE CAST BY THE PRESIDENT OF ANDROSCOGGIN VALLEY HOSPITAL, INC., SUBJECT TO SUCH DIRECTIVES AS MAY BE ISSUED BY THE BOARD OF THAT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE CURRENT YEAR FORM 990 WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE VICE PRESIDENT OF COMPLIANCE AND RISK MANAGEMENT REVIEWS ON AN ON-GOING BASIS ALL TRANSACTIONS THAT COULD POTENTIALLY VIOLATE OUR CONFLICT OF INTEREST POLICY. IN ADDITION, ALL BOARD MEMBERS AND OFFICERS OF THE CORPORATION ANNUALLY SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT AS WELL AS A CONFLICT OF INTEREST ACKNOWLEDGMENT STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT IS COMPENSATED BY ANDROSCOGGIN VALLEY HOSPITAL, A RELATED ENTITY. NORTH COUNTRY HEALTHCARE HIRED AN OUTSIDE HEALTHCARE CONSULTING AND MANAGEMENT COMPANY TO ASSIST WITH THE COMPENSATION REVIEW FOR THE SYSTEM PRESIDENTS. THE ORGANIZATION REVIEWED A NUMBER OF COMPARABLE POSITIONS WITHIN THE NEW HAMPSHIRE LANDSCAPE AND UTILIZED THOSE SAME BENCHMARKS IN DETERMINING THE ADEQUACY AND APPROPRIATENESS OF THE COMPENSATION STRUCTURE FOR THE HOSPITAL'S PRESIDENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THERE HAS NOT BEEN CHANGES MADE FROM PRIOR YEAR. ANDROSCOGGIN VALLEY HOSPITAL INC 59 PAGE HILL ROAD BERLIN NH 03570 020280367 CRITICAL ACCESS HOSPITAL NH 501(C)(3) LINE 3 NORTH COUNTRY HEALTHCARE INC 1 WEEKS MEDICAL CENTER 173 MIDDLE STREET LANCASTER NH 03584 020222242 CRITICAL ACCESS HOSPITAL NH 501(C)(3) LINE 3 NORTH COUNTRY HEALTHCARE INC 1 UPPER CONNECTICUT VALLEY HOSPITAL 181 CORLISS LANE COLEBROOK NH 03576 020276210 CRITICAL ACCESS HOSPITAL NH 501(C)(3) LINE 3 NORTH COUNTRY HEALTHCARE INC 1 NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY INC 536 COTTAGE STREET LITTLETON NH 03561 020300637 HOME HEALTH AGENCY NH 501(C)(3) LINE 10 NORTH COUNTRY HEALTHCARE INC 1 NORTHCARE INC 59 PAGE HILL ROAD BERLIN NH 03570 521596952 SUPPORTING SERVICES NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL INC 1 NORTH COUNTRY HEALTHCARE INC 8 CLOVER LANE WHITEFIELD NH 03598 812225283 HEALTHCARE MANAGEMENT NH 501(C)(3) LINE 12A, I N/A 0 GREAT NORTHWOODS COMMUNITY FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 020452547 HEALTHCARE SERVICES NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL INC 1 LANCASTER PATIENT CARE CENTER 173 MIDDLE STREET LANCASTER NH 03584 832130386 SUPPORTING ORGANIZATION NH 501(C)(3) LINE 12A, I WEEKS MEDICAL CENTER 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0