2024-08-14T16:00:45-05:00 2023-09-30 991856619 GRANT THORNTON ADVISORS LLC 53 STATE STREET SUITE 1600 BOSTON MA 02109 990 2022-10-01 814023607 NORTHERN BERKSHIRE MEDICAL PC NORT 4134584452 375 MAIN ST WILLIAMSTOWN MA 01267 ROBERT LABA CFO 4134584452 2024-08-14 1 1 ERIN COUTURE P01390592 6177237900 2022 2024-08-08 14:25:15Z NORTHERN BERKSHIRE ORTHOPEDICS PC CARL DOBSON 375 MAIN ST WILLIAMSTOWN MA 01267 813444 0 X WWW.ORTHONA.COM/ X 2016 MA NORTHERN BERKSHIRE MEDICAL PC OPERATES AN ORTHOPEDIC OFFICE IN WILLIAMSTOWN, MA. 1 0 5 0 0 0 0 0 797068 813444 0 0 0 0 797068 813444 0 0 0 0 275209 271873 0 0 0 969073 943804 1244282 1215677 -447214 -402233 620552 491201 1428303 1092158 -807751 -600957 NORTHERN BERKSHIRE MEDICAL PC OPERATES AN ORTHOPEDIC OFFICE IN WILLIAMSTOWN, MA. 0 0 1056028 813444 OUR BOARD-CERTIFIED ORTHOPEDIC SURGEONS AND SPORTS MEDICINE DOCTORS PROVIDE THE MOST EFFECTIVE TREATMENTS FOR LONG-LASTING HEALING AND PAIN RELIEF. THEY TREAT ALL GENERAL ORTHOPEDIC CONDITIONS AND INJURIES AND PROVIDE EXPERT FRACTURE CARE, ARTHRITIS TREATMENT, JOINT REPLACEMENTS, AND SPORTS MEDICINE, INCLUDING ARTHROSCOPIC SURGERY. OUR COMPREHENSIVE APPROACH TO MANAGING PATIENT CARE MAKES IT POSSIBLE FOR PATIENTS TO GET A PROMPT DIAGNOSIS AND TREATMENT PLAN. X-RAYS AND MINOR PROCEDURES SUCH AS CARPAL TUNNEL SURGERY, TRIGGER FINGER RELEASE, NEEDLE APONEUROTOMY FOR THE TREATMENT OF DUPUYTREN'S CONTRACTURE, AND ORTHOVISC INJECTIONS ARE ALL AVAILABLE ON SITE. 1056028 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 5 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MA X ROBERT LABA 8024475011 100 HOSPITAL DRIVE BENNINGTON VT 05201 CARL DOBSON PRESIDENT 1.00 1.00 X X 0 456524 55245 STEPHEN D MAJETICH CFO/TREASURER 1.00 45.00 X 0 787033 148798 0 1243557 204043 0 0 1 0 0 NET PATIENT SERVICE REVENUE 621110 813444 813444 813444 813444 813444 0 0 X 217575 180587 36988 6966 5782 1184 31566 26200 5366 15766 13086 2680 853 853 681836 617854 63982 41390 31043 10347 87870 72932 14938 145 145 37875 32194 5681 17485 17485 MEDICAL SUPPLIES & DRUG 75925 75925 LICENSES, DUES, SUBS. 425 425 1215677 1056028 159649 0 69428 56794 79792 50043 0 0 713510 490263 261122 223247 0 0 0 0 210210 161117 620552 491201 35222 12562 0 0 1393081 1079596 1428303 1092158 X -807750 -600957 -807751 -600957 620552 491201 X -402233 609027 X 0 1 X 0 0 X 0 25493 90080 0 0 115573 847539 525797 610913 797068 813444 3594761 847539 551290 700993 797068 813444 3710334 0 0 0 3710334 53 10 48 0 0 111 53 10 48 111 847592 551300 701041 797068 813444 3710445 1.00000 0.00000 X 373740 175654 198086 326845 306208 20637 12925 8401 4524 223247 OPERATING LEASE OBLIGATION 157117 OTHER ASSETS 4000 161117 DUE TO AFFILIATE 916020 CONTRACT LIABILITIES 111501 CURRENT OPERATING LEASE OBLIGATION 47566 ESTIMATED SELF-INSURANCE COSTS 4509 1079596 X 813444 0 813444 0 813444 1215677 0 1215677 0 1215677 PART X, LINE 2: UNCERTAIN TAX POSITIONS: SVHC, SVMC, TWIN RIVERS, NBM, THE FOUNDATION, MAHC, SVHCNY, SVHCHF, SVHCF, AND SVHC REALITY, INC. HAVE BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THE CORPORATION IS SUBJECT TO TAX ON INCOME UNRELATED TO ITS EXEMPT PURPOSE UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE CODE. EACH ORGANIZATION HAS PROCESSES PRESENTLY IN PLACE TO ENSURE THE MAINTENANCE OF ITS TAX-EXEMPT STATUS; TO IDENTIFY AND REPORT UNRELATED INCOME; TO DETERMINE ITS FILING AND TAX OBLIGATIONS IN JURISDICTIONS FOR WHICH IT HAS NEXUS; AND TO IDENTIFY AND EVALUATE OTHER MATTERS THAT MAY BE CONSIDERED TAX POSITIONS. SVHCE IS A FOR PROFIT ENTITY AND ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH INCOME TAX ACCOUNTING GUIDANCE. THE CORPORATION FOLLOWS GUIDANCE THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, INCLUDING ISSUES RELATING TO FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT. THIS GUIDANCE PROVIDES THAT THE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION CAN ONLY BE RECOGNIZED IN THE FINANCIAL STATEMENTS IF THE POSITION IS "MORE-LIKELY-THAN-NOT" TO BE SUSTAINED IF THE POSITION WERE TO BE CHALLENGED BY A TAXING AUTHORITY. THE ASSESSMENT OF THE TAX POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. THE CORPORATION HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS AT SEPTEMBER 30, 2023 (SUCCESSOR). 0 1 0 0 0 0 0 0 0 STEPHEN D MAJETICH CFO/TREASURER 0 397656 0 77500 0 311877 0 120012 0 28786 0 935831 0 261827 CARL DOBSON PRESIDENT 0 391024 0 65500 0 0 0 34188 0 21057 0 511769 0 0 PART I, LINE 3 TOP MANAGEMENT OFFICIAL COMPENSATION DETERMINATION: SOUTHWESTERN VERMONT MEDICAL CENTER, A RELATED ORGANIZATION, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD. PART I, LINE 4B SUPPLEMENTAL NONQUALIFED RETIREMENT PLAN: CERTAIN LISTED INDIVIDUALS PARTICIPATED IN A NON-QUALIFIED DEFERRED COMPENSATION ARRANGEMENT IN CALENDAR YEAR 2022. UNDER THE TERMS OF THE PLAN PLAN, THE INDIVIDUAL BECOMES VESTED IF THEY REMAINED EMPLOYED THROUGH A TARGETED DATE OF THE PLAN. AMOUNTS VESTED IN THE PLAN DURING THE REPORTING PERIOD ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). AMOUNTS SUBJECT TO VESTED REQUIREMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AND INCLUDED BELOW. $112,012 STEPHEN D. MAJETICH. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS, STOCKHOLDERS, OR OTHER PERSONS: NORTHERN BERKSHIRE MEDICAL PC IS ORGANIZED AS A STOCK CORPORATION. THE CORPORATION HAS ONE AUTHORIZED SHAREHOLDER. THE SOLE SHAREHOLDER/DIRECTOR IS AUTHORIZED TO TAKE SUCH ACTIONS AND EXECUTE SUCH DOCUMENTS AS THEY DEEM NECESSARY AND APPROPRIATE TO CARRY OUT THE PURPOSE OF THE ORGANIZATION. THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED AND CONDUCTED BY A SOLE DIRECTOR, SUBJECT TO THE AUTHORITY AND DIRECTION OF THE SVMC BOARD. THE SOLE HOLDER OF THE ISSUED AND OUTSTANDING SHARES OF THE CORPORATION SHALL BE THAT INDIVIDUAL WHO IS (I) LICENSED TO PRACTICE OF MEDICINE IN THE COMMONWEALTH OF MASSACHUSETTS; (II) DESIGNATED BY SOUTHWESTERN VERMONT MEDICAL CENTER OR ITS SUCCESSOR ("SVMC") TO BE A SHAREHOLDER OF THE CORPORATION; (III) IS THE CHIEF MEDICAL OFFICER OR AN EMPLOYEE OF SVMC OR AN AFFILIATED ENTITY OR IS DEPLOYED TO SVMC OR AN AFFILIATED ENTITY UNDER A PROFESSIONAL SERVICES AGREEMENT WITH SVMC OR AN AFFILIATED ENTITY; AND (IV) SUBSCRIBES TO AND COMPLIES WITH THE STOCK TRANSFER AND INDEMNIFICATION AGREEMENT WITH SVMC OR ITS SUCCESSOR (HEREINAFTER REFERRED TO AS THE ELIGIBLE SHAREHOLDER). NO SUCH INDIVIDUAL MAY BE AN OFFICER, SHAREHOLDER, DIRECTOR OR EMPLOYEE OF ANY OTHER CORPORATION ENGAGED IN THE PRACTICE OF MEDICINE WITHOUT THE WRITTEN PRIOR APPROVAL OF THE PRESIDENT OF SVMC OR ITS SUCCESSOR. THE SHAREHOLDER SHALL NOT ISSUE OR AUTHORIZE THE ISSUANCE OF ANY ADDITIONAL SHARES OR AMEND THE CERTIFICATE OF INCORPORATION OR BYLAWS IN A MANNER ADVERSE TO THE PURPOSES SET FORTH IN THIS AGREEMENT, THE CERTIFICATE OF INCORPORATION, THE BYLAWS OR WITHOUT THE PRIOR WRITTEN CONSENT OF THE CORPORATION AND SVMC. ALL BY-LAWS OF THE CORPORATION SHALL BE SUBJECT TO ALTERATION OR REPEAL, AND NEW BY-LAWS MAY BE ADOPTED EITHER BY THE VOTE OF A MAJORITY OF THE OUTSTANDING SHARES OF THE CORPORATION ENTITLED TO VOTE IN RESPECT THEREOF, OR BY THE VOTE OF THE BOARD OF DIRECTORS, PROVIDED THAT IN EACH CASE NOTICE OF THE PROPOSED ALTERATION OR REPEAL OR OF THE PROPOSED NEW BY-LAWS BE INCLUDED IN THE NOTICE OF THE MEETING AT WHICH SUCH ALTERATION, REPEAL OR ADOPTION IS ACTED UPON, AND PROVIDED FURTHER THAT ANY SUCH ACTION BY THE BOARD OF DIRECTORS MAY BE CHANGED BY THE SHAREHOLDERS, EXCEPT THAT NO SUCH CHANGE SHALL AFFECT THE VALIDITY OF ANY ACTIONS THERETOFORE TAKEN PURSUANT TO THE BY-LAWS AS ALTERED, REPEALED OR ADOPTED BY THE BOARD OF DIRECTORS, AND PROVIDED STILL FURTHER THAN ANY AMENDMENT OF ARTICLE XI SHALL REQUIRE THE WRITTEN PRIOR APPROVAL OF THE PRESIDENT OF SOUTHWESTERN VERMONT MEDICAL CENTER OR ITS SUCCESSOR. IN NOVEMBER 2022, THE BOARD OF TRUSTEES OF THE CORPORATION APPROVED AN AFFILIATION AND INTEGRATION AGREEMENT (THE AGREEMENT) WITH DARTMOUTH-HITCHCOCK HEALTH ('D-HH'). UNDER THE TERMS OF THE AGREEMENT, THE CORPORATION AND DHH WILL INTEGRATE THEIR GOVERNANCE STRUCTURES, COORDINATE THEIR FINANCIAL ACTIVITIES, AND CONSOLIDATE ADMINISTRATIVE FUNCTIONS OVER TIME TO THE EXTENT THAT EFFICIENCIES CAN BE ACHIEVED. THE AGREEMENT BECAME EFFECTIVE JULY 1, 2023, WHICH HAD D-HH AS THE SOLE CORPORATE MEMBER OF SVHC. FORM 990, PART VI, SECTION A, LINE 7A PLEASE SEE FORM 990, SECTION A, LINE 6 RESPONSE ABOVE. FORM 990, PART VI, SECTION A, LINE 7B PLEASE SEE FORM 990, SECTION A, LINE 6 RESPONSE ABOVE. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING WITH THE IRS, THE DRAFT 990 IS REVIEWED BY THE SOLE DIRECTOR OF NORTHERN BERKSHIRE MEDICAL PC AS WELL AS THE FINANCE COMMITTEE AND FULL BOARD OF DIRECTORS OF SOUTHWESTERN VERMONT HEALTH CARE CORP, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: TRUSTEES, SENIOR OFFICERS, AND SENIOR MEDICAL STAFF MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST AND POTENTIAL CONFLICTS OF INTEREST TO THE CORPORATE COMPLIANCE OFFICER ANNUALLY. IF THE CORPORATE COMPLIANCE DETERMINES THAT A POTENTIAL CONFLICT OF INTEREST EXISTS, THE MATTER IS REFERRED TO THE AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND MAY BE REFERRED TO THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW: THE ORGANIZATION'S OFFICER COMPENSATION IS PAID BY SOUTHWESTERN VERMONT MEDICAL CENTER (SVMC). THE PROCESS SVMC USES TO DETERMINE COMPENSATION IS AS FOLLOWS: THE BOARD ENGAGES AN OUTSIDE CONSULTING FIRM TO REVIEW COMPARABLE SALARY DATA AND USES NATIONAL PROFESSIONAL ORGANIZATION SURVEY DATA IN THE DETERMINATION OF SALARY AND BENEFITS. PROCESS BEGINS WITH A REQUEST TO SVMC'S COMPENSATION CONSULTANT ASTRON SOLUTIONS TO PERFORM A MARKET ANALYSIS OF THE POSITION. THIS REPORT IS USED AS THE BASIS FOR STRUCTURING COMPENSATION DURING THE NEXT CONTRACT PERIOD. USING THE RESULTS OF THE MARKET ANALYSIS WITH INPUT FROM OUR CEO, THE COMPENSATION OFFER FOR THE NEXT CONTRACT PERIOD IS DEVELOPED AND INCORPORATED INTO THE CONTRACT. THE COMPENSATION IS THEN DISCUSSED BY THE GOVERNANCE COMMITTEE OF THE BOARD WITH ASTRON SOLUTIONS IN ATTENDANCE. ASTRON SOLUTIONS WILL PROVIDE A WRITTEN LETTER CONFIRMING THEIR AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PSA FEES: PROGRAM SERVICE EXPENSES 617,854. TOTAL EXPENSES 617,854. PURCHASED SERVICES: MANAGEMENT AND GENERAL EXPENSES 63,982. TOTAL EXPENSES 63,982. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATES 609,027. SOUTHWESTERN VERMONT HEALTH CARE CORP 100 HOSPITAL DRIVE BENNINGTON VT 05201 030179435 MANAGEMENT VT 501(C)(3) LINE 3 N/A 0 SOUTHWESTERN VERMONT MEDICAL CENTER 100 HOSPITAL DRIVE BENNINGTON VT 05201 222563241 HOSPITAL VT 501(C)(3) LINE 3 SVHC 0 SOUTHWESTERN VT HEALTH CARE FOUNDATION 100 HOSPITAL DRIVE BENNINGTON VT 05201 453362785 FUNDRAISING VT 501(C)(3) LINE 12A, I SVHC 0 TWIN RIVERS MEDICAL PC 2 SUNRISE DRIVE HOOSICK FALLS NY 12090 473028931 HEALTH CARE NY 501(C)(3) LINE 10 SVMC 0 MOUNT ANTHONY HOUSING CORPORATION 160 HOSPITAL DRIVE BENNINGTON VT 05201 030279740 NURSING HOMES VT 501(C)(3) LINE 10 SVHC 0 HOOSICK FALLS HEALTH CENTER INC 21 DANFORTH STREET HOOSICK FALLS NY 12090 141370000 NURSING HOMES NY 501(C)(3) LINE 3 SVHC 0 HOOSICK FALLS HEALTH CENTER FOUNDATION 21 DANFORTH STREET HOOSICK FALLS NY 12090 223186959 FUNDRAISING NY 501(C)(3) LINE 7 HFHC 0 SVHC REALTY INC 100 HOSPITAL DRIVE BENNINGTON VT 05201 861399877 REAL ESTATE MANAGEMENT VT 501(C)(3) LINE 12A, I SVHC 0 DARTMOUTH-HITCHCOCK HEALTH ONE MEDICAL CENTER DRIVE LEBANON NH 03756 264812335 PARENT ORGANIZATION NH 501(C)(3) LINE 7 N/A 0 VISITING NURSE ASSOCIATION AND HOSPICE OF VERMONT AND NEW HAMPSHIRE INC 88 PROSPECT STREET WHITE RIVER JUNCTION VT 05001 036006494 HOSPICE VT 501(C)(3) LINE 10 D-HH 0 CHESHIRE MEDICAL CENTER 580 COURT STREET KEENE NH 03431 020354549 HOSPITAL NH 501(C)(3) LINE 3 D-HH 0 WINDSOR HOSPITAL CORPORATION 289 COUNTY ROAD WINDSOR VT 05089 030183721 HOSPITAL VT 501(C)(3) LINE 3 D-HH 0 MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DRIVE LEBANON NH 03756 020222140 HOSPITAL NH 501(C)(3) LINE 3 D-HH 0 DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYSICIAN SERVICES NH 501(C)(3) LINE 10 D-HH 0 ALICE PECK DAY MEMORIAL HOSPITAL 10 ALICE PECK DAY DRIVE LEBANON NH 03766 020222791 HOSPITAL NH 501(C)(3) LINE 3 D-HH 0 THE NEW LONDON HOSPITAL ASSOCIATION 273 COUNTY ROAD NEW LONDON NH 03257 020222171 HOSPITAL NH 501(C)(3) LINE 3 D-HH 0 SOUTHWESTERN VT HEALTHCARE ENTERPRISES 100 HOSPITAL DRIVE BENNINGTON VT 05201 030314501 HEALTHCARE VT N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 SCHEDULE R PART II - IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS THE REPORTING ORGANIZATION IS A MEMBER OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM (ALSO KNOWN AS "DARTMOUTH HEALTH"). ADDITIONAL INFORMATION REGARDING RELATED ORGANIZATIONS CAN BE FOUND ON THE FORM 990, SCHEDULE R FOR DARTMOUTH-HITCHCOCK HEALTH.