2025-08-15T12:41:28-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 020222242 WEEKS MEDICAL CENTER WEEK 6037884911 173 MIDDLE STREET LANCASTER NH 03584 MATTHEW STREETER SYSTEM CFO 6037884911 2025-08-15 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-14 2023 2025-03-06 01:10:19Z MICHAEL D LEE 173 MIDDLE STREET LANCASTER NH 03584 95630825 0 X WWW.WEEKSMEDICAL.ORG X 1948 NH TO PROVIDE HIGH QUALITY AND EFFICIENT HEALTH CARE SERVICES. 9 7 377 34 0 0 785141 1275232 84639662 91119561 248804 1928395 1237822 1307637 86911429 95630825 318227 224260 0 0 34175015 38030886 0 0 0 53611021 54988505 88104263 93243651 -1192834 2387174 71649472 69767089 22721834 18013250 48927638 51753839 WEEKS MEDICAL CENTER'S COMPASSIONATE STAFF IS COMMITTED TO PROVIDING HIGH QUALITY AND EFFICIENT HEALTH CARE SERVICES TO ENSURE THE WELL-BEING OF OUR PATIENTS, FAMILIES AND COMMUNITIES. 0 0 74549396 224260 91119561 HEALTH CARE SERVICES TO INDIVIDUALS IN THE SURROUNDING REGION ON AN INPATIENT & OUTPATIENT BASIS, WHICH INCLUDES HOSPITAL SERVICES AS WELL AS PHYSICIAN OFFICE SERVICES. 74549396 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 96 0 377 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 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 8 CLOVER LANE WHITEFIELD NH 03598 MARK MORGAN MD CMO 40.00 X 612823 0 27666 AMBER SCHMIDT MEDICAL STAFF PRESIDENT 40.00 X X 287809 0 14315 RUBY BERRYMAN ACTING CHAIR/VICE CHAIR 1.00 X X 0 0 0 DENNIS COUTURE VICE CHAIR (THRU 09/24) 1.00 X X 0 0 0 CHARLIE COTTON TREASURER 1.00 X X 0 0 0 DENISE BRISSON DIRECTOR (THRU 04/24) 1.00 X 0 0 0 SCOTT BURNS DIRECTOR 1.00 X 0 0 0 TIMOTHY CONNOLLY DIRECTOR 1.00 X 0 0 0 SARAH DESROCHERS DIRECTOR 1.00 2.00 X 0 0 0 WILLIAM EVERLETH DIRECTOR (THRU 09/24) 1.00 39.00 X 0 123223 3954 MICHAEL FOSTER DIRECTOR (THRU 04/24) 1.00 X 0 0 0 STANLEY HOLZ DIRECTOR (THRU 04/24) 1.00 X 0 0 0 SHARON KOPP DIRECTOR (THRU 08/24) 1.00 X 0 0 0 FRANCES LADUKE DIRECTOR 1.00 X 0 0 0 EDWARD SAMSON III DIRECTOR 1.00 X 0 0 0 THOMAS MEE SYSTEM CEO 1.00 45.00 X 0 706230 18318 MICHAEL D LEE PRESIDENT/CEO 40.00 1.00 X 383255 0 9940 MATTHEW STREETER SYSTEM CFO 1.00 45.00 X 0 357595 20804 PROUSKEH EBRAHIMPOUR PHYSICIAN 40.00 X 587507 0 11617 JOHN FORD PHYSICIAN 40.00 X 554404 0 17440 ELISABETH MOORE ED PHYSICIAN 40.00 X 530237 0 28825 MATTHEW JONES PHYSICIAN 40.00 X 437489 0 27810 RYAN BRASS PHYSICIAN 40.00 X 421766 0 23663 3815290 1187048 204352 92 0 1 0 AMERICAN HEALTHCARE STAFFING ASSOC PO BOX 850737 MINNEAPOLIS MN 554850737 CONTRACT LABOR 1574378 MEDICAL SOLUTIONS LLC PO BOX 670529 DALLAS TX 752670529 CONTRACT LABOR 1371429 FASTAFF PO BOX 911452 DENVER CO 802911452 CONTRACT LABOR 901685 MAXIM HEALTHCARE STAFFING 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 638389 MAXOR 320 S POLKM SUITE 200 AMARILLO TX 79101 PHARMACY OTHER PURCHASED SERVICES 533046 13 1182097 93135 1275232 PATIENT SERVICE REVENUE 621400 86539536 86539536 PHARMACY REVENUE 456110 3329396 3329396 1250629 1250629 91119561 1786103 1786103 528868 0 528868 528868 528868 142292 0 142292 142292 142292 CAFETERIA REVENUE 722514 281843 281843 496926 496926 778769 95630825 91119561 0 3236032 X 224260 224260 763889 431239 332650 27698309 26242050 1456259 502068 459577 42491 6829652 6239739 589913 2236968 2041408 195560 239973 239973 10194 10194 9394443 9343271 51172 312762 102243 210519 217741 82228 135513 66746 64369 2377 1156871 1120566 36305 194866 190818 4048 102700 90384 12316 414598 211730 202868 4091125 2675741 1415384 1262929 777557 485372 MEDICAL SUPPLIES 12683004 12677466 5538 INTERCOMPANY ALLOCATION 10863076 1409285 9453791 BAD DEBT EXPENSE 7502164 7502164 HOSPITAL ASSESSMENT 2952352 2952352 3522961 2663301 859660 93243651 74549396 18694255 0 168398 2596443 10636374 9146220 946771 666847 8735189 14560063 9534913 9534913 1759746 1941491 1145301 1718503 71341953 48721318 23217180 22620635 13021535 6981974 2484065 0 71649472 69767089 8732601 5944706 32561 23427 4840504 4320041 3321280 3059553 5794888 4665523 22721834 18013250 X 47512984 50155918 1414654 1597921 48927638 51753839 71649472 69767089 2387174 439027 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10194 10194 0 PART II-B, LINE 1: WEEKS MEDICAL CENTER 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 WMC AND OTHER MEMBER ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES. WMC DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. 1130418 155395 1285813 1030257 100161 1130418 1118195 -87938 1030257 1012784 105411 1118195 1038704 -25920 1012784 0.00000 0.70920 0.29080 0 0 1447031 1447031 21272510 13251607 8020903 47765773 35469711 12296062 856639 856639 22620635 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 4102656 DUE TO RELATED PARTIES 562867 4665523 PART V, LINE 4: WEEKS MEDICAL CENTER ENDOWMENT FUNDS WERE GIFTED WITH THE INTENT TO HELP DEFRAY THE COSTS OF INDIGENT CARE FOR ADULTS AND CHILDREN, AND GENERAL UPKEEP AND OPERATIONS OF THE HOSPITAL. THE INCOME GENERATED BY THE ENDOWMENT FUNDS ARE TO BE USED FOR HOSPITAL OPERATIONS AND SCHOLARSHIPS FOR MEDICAL EDUCATION FOR EMPLOYEES OF THE HOSPITAL. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 1121882 1121882 0.01200 11146012 7460089 3685923 0.03950 12267894 7460089 4807805 0.05150 25069521 20314298 4755223 0.05100 25069521 20314298 4755223 0.05100 37337415 27774387 9563028 0.10250 1 3692459 0 17262730 17100099 162631 X 1 1 1 1 WEEKS MEDICAL CENTER 173 MIDDLE STREET LANCASTER NH 03584 WWW.WEEKSMEDICAL.ORG 00015 X X X X WEEKS MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X X 1 21 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 300.000000000000 300.000000000000 X X 1 1 X X X X 1 X HTTPS://WEEKSMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION X HTTPS://WEEKSMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION X HTTPS://WEEKSMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL-INFORMATION X X X X X X 1 X 0 X X X X 1 X 0 0 WEEKS MEDICAL CENTER PART V, SECTION B, LINE 5: AN ELECTRONIC SURVEY WAS SENT TO A SELECT GROUP OF LOCAL EXPERTS THAT INCLUDED INFORMATION FROM WELL-RESPECTED SECONDARY SOURCES ON THE CURRENT STATE OF HEALTH CARE IN THE COMMUNITY. INDIVIDUALS AND AGENCIES INVOLVED IN PUBLIC HEALTH AND STATE & LOCAL HEALTH WERE INCLUDED AS WERE INDIVIDUALS FROM PRIORITY POPULATIONS, CHRONIC DISEASE GROUPS AND OTHER COMMUNITY MEMBERS. WEEKS MEDICAL CENTER PART V, SECTION B, LINE 6A: THE HOSPITAL'S CHNA WAS CONDUCTED ALONG WITH UPPER CONNECTICUT VALLEY HOSPITAL AND ANDROSCOGGIN VALLEY HOSPITAL. WEEKS MEDICAL CENTER PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS CONDUCTED ALONG WITH COOS COUNTY FAMILY HEALTH AND NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY. THE FIRST IS A LOCAL FQHC. WEEKS MEDICAL CENTER PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://WEEKSMEDICAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ WEEKS MEDICAL CENTER PART V, SECTION B, LINE 11: WEEKS MEDICAL CENTER TOOK THE FOLLOWING STEPS DURING FY 2024 TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENT CHNA, COMPLETED IN TAX YEAR 2021:- ADDITIONAL PROVIDERS ADDED TO EXISTING WMC BEHAVIORAL HEALTH PRACTICE- CONTINUANCE OF FINANCIAL ASSISTANCE- PA-C ADDED TO BERLIN AND COLEBROOK MARKET TO REPLACE PREVIOUS PA-C. (CHRONIS DISEASE MANAGEMENT HEART DISEASE)- WE HAVE CONDUCTED VIRTUAL LECTURES ON VARIOUS HEALTH-RELATED TOPICS, BASED ON PROVIDER AVAILABILITY. NOT NECESSARILY CHRONIC DISEASE EDUCATION. WE HAVE HAD A PRESENCE (AND WILL LATER THIS MONTH AND NEXT) AT LANCASTER FAIR TO CONDUCT BLOOD PRESSURE SCREENINGS, PROVIDE INFORMATION. COMMUNITY WELLNESS FAIR WAS SCHEDULED EARLIER THIS SUMMER, BUT POSTPONED DUE TO EXTREME HEAT.- UNDER ACCESS TO HEALTHCARE- WE ADDED A NEW POSITION: CLINICAL LIAISON, WHO IS A NURSE, SHE ROUNDS AT EACH HOSPITAL DAILY TO FACILITATE DISCHARGES TO HOME HEALTH, PALLIATIVE CARE AND HOSPICE.- UNDER CHRONIC DISEASE MANAGEMENT: WEEKS HIRED A PALLIATIVE APRN IN MARCH. PALLIATIVE CARE CAN HELP OUR COMMUNITY GREATLY BY ASSISTING PATIENTS WHO HAVE CHRONIC ILLNESSES ACHIEVE SYMPTOM CONTROL, COMPLETE ADVANCED DIRECTIVES AND STAY OUT OF THE HOSPITAL- ALZHEIMER'S AND DEMENTIA- NCHHHA STARTED AN ALZHEIMER'S AND DEMENTIA SUPPORT GROUP FOR CAREGIVERS WEEKS MEDICAL CENTER PART V, SECTION B, LINE 16J: BROCHURES AND FINANCIAL COUNSELOR INFORMATION ARE AVAILABLE IN LOBBIES AND HANDED OUT TO PATIENTS. ALSO, CONTACT INFORMATION FOR FINANCIAL COUNSELORS IS PROVIDED ON BILLS AND LETTERS THAT GO OUT. 4 1 - LANCASTER PHYSICIANS OFFICES 170 MIDDLE ST LANCASTER NH 03584 PHYSICIAN OFFICE FOR PRIMARY CARE 2 - WHITEFIELD PHYSICIANS OFFICES 8 CLOVER LANE WHITEFIELD NH 03598 PHYSICIAN OFFICE FOR PRIMARY CARE 3 - NORTH STRATFORD PHYSICIANS OFFICES 43 MAIN ST NORTH STRATFORD NH 03590 PHYSICIAN OFFICE FOR PRIMARY CARE 4 - GROVETON PHYSICIANS OFFICES 12 CHURCH ST GROVETON NH 03582 PHYSICIAN OFFICE FOR PRIMARY CARE PART I, LINE 7: THE HOSPITAL USES A COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FORM 990 SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES PART I, LINES 7E-I. THE HOSPITAL DETERMINES COST BY COMBINING DIRECT EXPENSES IDENTIFIED BY ITS ACCOUNTING SYSTEM WITH AN ESTIMATED OVERHEAD ALLOCATION. PART I, LINE 7G: THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE EMERGENCY DEPARTMENT AND FIVE RURAL HEALTH CLINICS. PART III, LINE 2: THE HOSPITAL USES A COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO WAS DERIVED FROM THE FORM 990 SCHEDULE H WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE CCR WAS THEN APPLIED TO BAD DEBT EXPENSE AT CHARGE VALUE IN ORDER TO ARRIVE AT THE ESTIMATED EXPENSE REPORTED. PART III, LINE 4: PLEASE SEE PAGES 9-13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: ALL PATIENTS OF WEEKS MEDICAL CENTER WHO HAVE NO INSURANCE ARE NOTIFIED OF THE WEEKS HEALTH ACCESS FINANCIAL ASSISTANCE POLICY AND ENCOURAGED TO MAKE AN APPOINTMENT WITH ONE OF OUR FINANCIAL COUNSELORS OR SOCIAL WORKERS. THIS INFORMATION IS GIVEN OUT, ALONG WITH FINANCIAL ASSISTANCE APPLICATIONS, AT THE TIME OF APPOINTMENT AND IS ALSO AVAILABLE ON OUR WEBSITE AND IS REITERATED WITH OUR MONTHLY STATEMENTS SENT TO THE PATIENT. IT IS IMPOSSIBLE FOR OUR ORGANIZATION TO DETERMINE IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNTIL AN APPLICATION IS FILED - WE DO NOT ACCESS CREDIT REPORTS BUT RELY ON THE PATIENT SUPPLYING US WITH THE NECESSARY FINANCIAL INFORMATION. AT THAT TIME OF APPLICATION, IF A PATIENT IS DETERMINED TO BE ELIGIBLE, THEY ARE PROVIDED WITH FINANCIAL ASSISTANCE. PART VI, LINE 2: EVERY 3 YEARS, WEEKS MEDICAL CENTER PARTICIPATES IN A COMMUNITY NEEDS ASSESSMENT WITH THREE OTHER MEMBERS OF THE COMMUNITY'S HEALTH CARE SYSTEM. USING INFORMATION FROM THAT ASSESSMENT ALLOWS THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO THE NORTH COUNTRY COMMUNITY ON AN ONGOING BASIS. PART VI, LINE 3: THE STAFF IS TRAINED TO DISCUSS THE HOSPITAL'S CHARITY CARE POLICY WITH PATIENTS, THE POLICY IS AVAILABLE THROUGHOUT THE HOSPITAL IN THE BROCHURE AND IT IS AVAILABLE ON THE HOSPITAL'S WEBSITE. WMC ALSO EMPLOYS A FULL-TIME FINANCIAL COUNSELOR AND OTHER CASE MANAGEMENT STAFF TO ASSIST PATIENTS WITH THE FINANCIAL ASSISTANCE PROCESS. PART VI, LINE 4: WEEKS MEDICAL CENTER'S GENERAL GEOGRAPHIC CATCHMENT AREA CONSISTS OF NINE TOWNS, WHICH SUPPLY ALMOST 90% OF ITS PATIENTS. TOWNS INCLUDE LANCASTER, GROVETON, DALTON, WHITEFIELD, NORTH STRATFORD, JEFFERSON AND STARK, IN NEW HAMPSHIRE; AND LUNENBURG, GUILDHALL AND GILMAN, IN VERMONT. TOGETHER, THESE TOWNS HAVE A POPULATION OF APPROXIMATELY 13,000 AND COVER APPROXIMATELY 375 SQUARE MILES IN BOTH VERMONT AND NEW HAMPSHIRE. IN 2021, WEEKS OPENED A NEW PHYSICIAN OFFICE IN LITTLETON, NH. THE TOWN HAS A POPULATION OF APPROXIMATELY 4,500. WEEKS MEDICAL CENTER IS DEFINED BY THE GEOGRAPHIC COMMUNITIES THAT SURROUND ITS FACILITIES AND BY THE INDIVIDUALS AND GROUPS WHO BENEFIT FROM THE HEALTH AND WELLNESS SERVICES PROVIDED BY ITS VARIOUS HEALTH RELATED INSTITUTIONS. THE DEFINITION WAS DEVELOPED BY THE BOARD OF TRUSTEES, ITS COMMITTEES, ADMINISTRATIVE AND PROFESSIONAL STAFF IN THE PRACTICAL APPLICATION OF THE SERVICES PROVIDED BY THE INSTITUTIONS AND THE IDENTIFIED NEEDS OF THE COMMUNITIES SERVED. PART VI, LINE 5: WMC PLAYS AN INTEGRAL ROLE IN THE EMERGENCY PREPAREDNESS PLANS OF OUR COMMUNITY. IN ADDITION TO BEING AVAILABLE IN AN EMERGENCY FROM A CLINICAL STANDPOINT, WE ARE A LARGE PART OF THE COMMUNITY WIDE PLANNING TEAM, TAKING THE LEAD IN THE PLANNING OF TRAINING & DRILLS AND BRINGING THE VARIOUS COMPONENTS TOGETHER, BASED ON STATE-WIDE STANDARDS. ADDITIONALLY, WMC PROVIDED 18 FREE BLOOD PRESSURE SCREENINGS TO THE LOCAL COMMUNITY WITH EACH SESSION LAST FOR AT LEAST 3 HOURS. WMC ALSO SUPPORTED 5 FAMILIES IN NEED DURING THE HOLIDAYS THROUGH PROVIDING $1,175 IN DONATIONS TO THE LOCAL GROCERY PLAZA. WMC PROVIDED A VARIETY OF DONATIONS AND VOLUNTEER EFFORTS FOR DIRECT AID FOR VETERANS & FIRST RESPONDERS, "CLEANING UP THE STREETS", AND OVER $2500 IN SCHOLARSHIPS TO NEW GRADUATES SEEKING CAREERS IN THE HEALTHCARE. WMC IN COORDINATION WITH IS AFFILIATION THROUGH NORTH COUNTRY HEALTHCARE SUPPORTED BLOOD PRESSURE SCREENINGS, FREE COVID TEST KITS, AND NARCAN KITS TO NEARLY 1,300 INDIVIDUALS IN THE LOCAL COMMUNITY. PART VI, LINE 6: WEEKS MEDICAL CENTERS TOP PRIORITY IS TO ENSURE THE HIGHEST LEVEL OF QUALITY HEALTHCARE TO THOSE THAT WE ARE SO FORTUNATE TO SERVE. IN AN EFFORT TO CONTINUE TO PROVIDE A HIGH QUALITY OF HEALTHCARE FOR ALL PATIENTS IN THE NORTH COUNTRY, THE HOSPITALS OF COOS & GRAFTON COUNTY CAME TOGETHER TO EXPLORE COLLABORATION. WE, THE BOARDS AND SENIOR MANAGEMENT OF ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER REALIZE THAT SIGNIFICANT NATIONAL, STATE AND LOCAL ECONOMIC PRESSURES ARE JEOPARDIZING LOCAL ACCESS, QUALITY AND SUSTAINABILITY. WE HAVE THEREFORE FORMED NORTH COUNTRY HEALTHCARE (NCH) WITH THE STATED OBJECTIVE OF WORKING COLLABORATIVELY TO BETTER SERVE THE HEALTHCARE NEEDS OF NORTH COUNTRY PATIENTS. THIS COLLABORATIVE EFFORT WILL WORK TO:1. ENSURE ACCESS TO QUALITY CARE WITHIN THE COMMUNITIES IN WHICH OUR PATIENTS LIVE2. PROVIDE LOCAL AND HIGH QUALITY CARE WITH POSITIVE OUTCOMES TO OUR PATIENTS IN THE NORTH COUNTRY3. CONTROL THE COST OF CARE THROUGH INNOVATIVE PROGRAMS AND THE USE OF SHARED RESOURCESNATIONAL HEALTHCARE REFORM DEMANDS LOWER COSTS AND HIGHER QUALITY FROM ALL HOSPITALS, REQUIRING COLLABORATION IN PATIENT CARE ACROSS ALL PROVIDERS: FROM PRIMARY CARE TO SPECIALIST, FROM AMBULANCE TO HOSPITAL, FROM HOSPITAL TO REHABILITATION TO HOME CARE, FROM LOCAL HOSPITAL TO TERTIARY (SPECIALTY HOSPITAL) CARE. THEREFORE, ANDROSCOGGIN VALLEY HOSPITAL, UPPER CONNECTICUT VALLEY HOSPITAL, AND WEEKS MEDICAL CENTER HAVE FORMED THIS JOINT VENTURE TO IDENTIFY AND IMPLEMENT SUSTAINABLE OPPORTUNITIES FOR OUR FUTURE. THE NCHC AND ITS MEMBER HOSPITALS ARE PREPARED TO MANAGE COSTS AND COORDINATE CARE IN A WAY THAT IS FINANCIALLY SUSTAINABLE, WHILE CONTINUING TO PROVIDE LOCAL ACCESS TO QUALITY CARE THROUGHOUT THE COUNTY AND BEYOND. THE HOSPITALS OF THE NORTH COUNTRY MUST WORK TOGETHER AS CRITICAL PARTS OF OUR ECONOMY AND COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES NH 1 FOUNDATION FOR HEALTHY COMMUNITIES 125 AIRPORT ROAD CONCORD NH 03301 020275078 501(C)(3) 90791 0 SUBSTANCE ABUSE PREVENTION, TREATMENT & RECOVERY 1 0 PART I, LINE 2: THE HOSPITAL WAS MANDATED BY THE STATE OF NH TO CONTRIBUTE FUNDS TO THE ALCOHOL AND DRUG PREVENTION TREATMENT FUND IN ORDER TO CONTINUE THE MEDICAID EXPANSION PROGRAM. THESE FUNDS GO TOWARDS VARIOUS PROGRAMS SURROUNDING RECOVERY, TREATMENT AND PREVENTION FOR SUBSTANCE MISUSE IN NEW HAMPSHIRE. 0 1 0 0 0 0 0 1 0 THOMAS MEE SYSTEM CEO 0 559584 0 133893 0 12753 0 6394 0 11924 0 724548 0 0 MARK MORGAN MD CMO 563483 0 48750 0 590 0 10817 0 16849 0 640489 0 0 0 PROUSKEH EBRAHIMPOUR PHYSICIAN 490250 0 96667 0 590 0 0 0 11617 0 599124 0 0 0 JOHN FORD PHYSICIAN 404936 0 148589 0 879 0 14168 0 3272 0 571844 0 0 0 ELISABETH MOORE ED PHYSICIAN 409855 0 119972 0 410 0 9701 0 19124 0 559062 0 0 0 MATTHEW JONES PHYSICIAN 266941 0 163750 0 6798 0 8335 0 19475 0 465299 0 0 0 RYAN BRASS PHYSICIAN 350326 0 71067 0 373 0 6279 0 17384 0 445429 0 0 0 MICHAEL D LEE PRESIDENT/CEO 295389 0 76318 0 11548 0 2025 0 7915 0 393195 0 0 0 MATTHEW STREETER SYSTEM CFO 0 290340 0 66580 0 675 0 8934 0 11870 0 378399 0 0 AMBER SCHMIDT MEDICAL STAFF PRESIDENT 286794 0 605 0 410 0 2955 0 11360 0 302124 0 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 - FORM 990 OF OTHER ORGANIZATIONS - INDEPENDENT COMPENSATION CONSULTANT - 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 2023. PART I, LINE 7 PART OF THE COMPENSATION PROGRAM OVERSEEN BY THE COMPENSATION COMMITTEE AND APPROVED BY THE CORPORATION BOARD AND AFFILIATE BOARDS INCLUDES VARIABLE INCENTIVE COMPENSATION FOR EXECUTIVES. THIS VARIABLE COMPENSATION IS A WITHHOLD OF TOTAL COMPENSATION AND EARNED BACK BY EXECUTIVES BASED ON STRATEGIC GOAL PERFORMANCE. A BUSINESS FINANCE AUTHORITY OF THE STATE OF NH 521304598 2010-09-01 10000000 REFINANCE EXISTING DEBT AND FINANCE THE HOSPITAL'S CONTRUCTION PROJECT 0 0 0 A 5835000 10000000 112960 3044490 6842550 2011 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 0 0 0 1 A 0 FORM 990, PART VI, SECTION A, LINE 6 NORTH COUNTRY HEALTHCARE (NCH) BECAME THE SOLE MEMBER OF WEEKS MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE CORPORATION BOARD SHALL BE NOMINATED BY ACTION OF AN AFFILIATE BOARD, OR BY THE CORPORATION BOARD, AS THE CASE MAY BE, IN ACCORDANCE WITH THE NOMINATION POWERS INDICATED IN THE CORPORATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATION BYLAWS INCLUDE MAJOR MATTERS WHICH INCLUDE SPECIFIC DUTIES AND RESPONSIBILITIES WHICH ARE SHARED BY THE CORPORATION BOARD AND THE AFFILIATE BOARDS. THESE MAJOR MATTERS ARE FURTHER DISTINGUISHED BETWEEN MAJOR ORGANIZATIONAL MATTERS AND MAJOR OPERATIONAL MATTERS. IN BOTH CASES, THE BYLAWS CONTAIN THE PROVISIONS FOR THE APPROVAL OF THESE MATTERS INCLUDING WHETHER THEY ARE APPROVED BY A MAJORITY VOTE OR SUPER MAJORITY VOTE OF ALL BOARDS. IN ALL CASES, THE MAJOR MATTERS REQUIRE APPROVAL BY THE CORPORATION BOARD AND THE AFFILIATE BOARDS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED CLOSELY BY THE CFO OF THE SYSTEM AFTER CAREFUL PREPARATION IS PERFORMED IN CONNECTION WITH THE INTERNAL TEAM AND PAID PREPARER. A COPY IS MADE AVAILABLE TO THE BOARD PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST PROCESS: - CONFLICT OF INTEREST DISCLOSURE COMPLETED VIA BOARDPAQ (ELECTRONIC MEANS). - RESULTS COMPILED INTO CONFLICT MATRIX WHICH IS REVIEWED AND APPROVED BY THE BOARD. - CONFLICTS THAT MEET THE PECUNIARY BENEFIT CRITERIA ARE IDENTIFIED, SHARED WITH THE BOARD AND APPROVED. - DISCLOSURE NOTICES ARE PLACED IN LOCAL PAPERS. - THE NH DIVISION OF CHARITABLE TRUSTS IS NOTIFIED OF THE PECUNIARY BENEFIT AND COPIES OF THE PUBLIC NOTICES ARE ATTACHED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE IS A SUBCOMMITTEE OF THE FINANCE COMMITTEE OF THE CORPORATION BOARD. THIS COMMITTEE OVERSEES THE EXECUTIVE COMPENSATION POLICY AND PRACTICES OF THE ORGANIZATION INCLUDING THE CEO, THE AFFILIATE PRESIDENTS, AND THE CEO CABINET WHICH INCLUDES KEY EXECUTIVE POSITIONS FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE ENGAGES WITH AN OUTSIDE CONSULTANT TO DETERMINE COMPENSATION BENCHMARKS AND BEST PRACTICES WHICH GUIDE THE COMPENSATION PROCESSES FOR THESE EXECUTIVE POSITIONS. THE COMPARISON BENCHMARK DATA AND GUIDANCE ARE REVIEWED BY THE COMMITTEE AND RECOMMENDATIONS ARE MADE TO THE CORPORATION BOARD AND AFFILIATE BOARDS. THIS IS DONE ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS IMPLEMENTED ALL POLICIES AND THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,979,563. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,979,563. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,204,108. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,204,108. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 4,159,600. MANAGEMENT AND GENERAL EXPENSES 51,172. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,210,772. LANCASTER PATIENT CARE CENTER 173 MIDDLE STREET LANCASTER NH 03584 832130386 SUPPORTING ORGANIZATION NH 501(C)(3) LINE 12A, I WEEKS MEDICAL CENTER 1 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 ANDROSCOGGIN VALLEY HOSPITAL FOUNDATION 59 PAGE HILL ROAD BERLIN NH 03570 223035216 MANAGEMENT AND FINANCIAL SUPPORT NH 501(C)(3) LINE 12B, II ANDROSCOGGIN VALLEY HOSPITAL 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 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 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 HEALTHCARE INC 8 CLOVER LANE WHITEFIELD NH 03598 812225283 HEALTHCARE MANAGEMENT NH 501(C)(3) LINE 12A, I N/A 0 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 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 LANCASTER PATIENT CARE CENTER K 179000 CASH