Rockingham Visiting Nurse Association and Hospice

“For the period covered by this filing, beth israel lahey health, inc. (bilh) served as direct or indirect sole member of: beth israel deaconess medical center, inc. (bidmc), mount auburn hospital (mah), new england baptist hospital (nebh), beth israel deaconess hospital milton, inc. (milton), beth israel deaconess hospital needham, inc. (needham), beth israel deaconess hospital plymouth, inc. (plymouth), lahey clinic foundation (lcf) , lahey clinic (lci), lahey clinic hospital d/b/a lahey hospital and medical center (lhmc), winchester hospital (winchester), northeast hospital corporation (northeast), anna jaques hospital (ajh), beth israel lahey health pharmacy, joslin diabetes center, exeter health resources, inc. (ehri) and exeter hospital. Each of these affiliates may have, in turn, served as member of additional entities within the bilh network of affiliates. In addition, harvard medical faculty physicians at beth israel deaconess medical center, inc. (hmfp) is the dedicated physician practice of bidmc and an entity integrally related to helping bidmc and other affiliates in the bilh network accomplish their charitable purposes. For this same period hmfp served as the sole member of affiliated physicians of harvard medical faculty physicians at beth israel deaconess medical center (aphmfp) as well as the direct or indirect member of several additional entities. Two or more of the persons listed in this form 990 part vii have a business relationship with each other by virtue of sitting on one or more boards of directors/trustees or by serving in an employment relationship with one or more entities within the network of the affiliated organizations noted above. Additional detail is provided in the explanatory notes to this form 990 schedule j.”

“Exeter health resources, inc. (ehri) is the sole member of rockingham visiting nurse association and hospice (rvna or corporation). In addition, beth israel lahey health, inc. (bilh or system member) is the sole member of ehri.”

“The board of trustees (the "board") shall consist of from five (5) to seven (7) persons, including the executive director of the corporation ex-officio (with vote), and the treasurer of the member ex-officio (with vote), and from three (3) to five (5) persons elected by the member (elected trustees). Any vacancy in the elected trustees may be filled by the member.”

“Exeter health resources, inc. (ehri) is the sole member of rockingham visiting nurse association and hospice (rvna or corporation). In addition, as noted throughout this filing, beth israel lahey health, inc. (bilh or system member) is the sole member of ehri. Except for those powers reserved to the member by law, the articles of agreement or the by-laws, the affairs of the corporation shall be managed by the board, which shall have and may exercise all the powers of the corporation in accordance with its legal responsibilities. Notwithstanding any provision of the by-laws to the contrary, the board shall have no authority, except upon the prior express approval of the member, to: (a) amend the articles of agreement or by-laws of the corporation; (b) merge consolidate or dissolve the corporation; (c) sell, transfer, distribute, lease or encumber all or substantially all of the assets of the corporation; or (d) donate, loan or invest any assets of the corporation in excess of $10,000.00 subject to the provisions of the rvna articles of agreement and the bylaws and the authorities of beth israel lahey health (bilh or system member) as described in the ehri articles of agreement and the bylaws and chapter 292 of the new hampshire revised statues (act), the sole member shall have the right to amend the articles of agreement and the by-laws (governance action), as follows: to the extent that new hampshire law requires the board of trustees to make a recommendation or adopt a resolution on a governance action, then the recommendation or resolution shall be taken by the board of trustees in accordance with the by-laws. In the normal course, either the governance action will be recommended by the board of trustees of its own accord, or the sole member of the corporation will request that the board of trustees consider and make a recommendation to the sole member of the corporation regarding such governance action. If the board of trustees recommends a governance action, then the sole member of the corporation may approve, disapprove, defer or suggest reconsideration or amendment of the governance action as recommended by the board of trustees. If the sole member of the corporation requests that the board of trustees reconsider or amend a governance action, then the board of trustees shall take the requested action within such reasonable time as may be specified by the sole member of the corporation for such action. Unless otherwise provided in the articles of agreement, these by-laws may be amended by action of the sole member of the corporation.”

“As noted in various disclosures throughout this filing, beth israel lahey health, inc. (bilh) is the direct or indirect sole member of rockingham visiting nurse association and hospice. This form 990 is prepared by the bilh tax department in conjunction with deloitte tax, llp (deloitte). As part of this process, the bilh tax department works with other disciplines and functions within bilh and rockingham visiting nurse association and hospice to ensure that all financial and non-financial disclosures are complete and accurate. Examples of such departments include but are not limited to: finance and accounting, human resources and payroll, treasury, compliance, legal, community benefits, financial assistance and reimbursement, governance, development, graduate medical education, government relations, research and/or research finance. Rockingham visiting nurse association and hospice's form 990 is reviewed internally by the bilh assistant vice president, taxation and externally by deloitte. Rockingham visiting nurse association and hospice's form 990, along with the forms 990 of all entities in the bilh network, are discussed with the bilh audit and compliance committee. Deloitte signs the final returns. A copy of the complete return is then provided to each member of rockingham visiting nurse association and hospice's board of trustees prior to submission to the internal revenue service.”

“As noted throughout this filing, rockingham visiting nurse association and hospice is a member of the beth israel lahey health (bilh) system of affiliates. All entities in the bilh network adhere to the bilh conflict of interest policy and maintain a written, comprehensive conflict of interest policy at the entity level. Pursuant to these policies, bilh entities' officers, trustees and key employees as well as certain other individuals are required to complete the annual conflict of interest and tax questionnaire (coi-tq). The coi-tq is designed to require disclosure of any business and family relationships and affiliations maintained by officers, trustees, or key employees and their family members and which may result in a real or perceived conflict of interest. The bilh office of integrity and compliance, in conjunction with the bilh tax department, administers the coi-tq process annually. Bilh integrity and compliance collects and reviews all disclosures. Disclosures for bilh executives and key employees are assigned appropriate follow-up action in accordance with the bilh policy. A summary of positive responses for each bilh affiliate is provided to the compliance officer for that entity for review final determination of any potential or actual conflict. Any activity that requires action under the conflict of interest policies is subject to ongoing review by rockingham visiting nurse association and hospice as well as the bilh integrity and compliance office. Pursuant to the bilh conflict of interest policy, certain activities which could create conflicts of interest are prohibited while other types of relationships are permitted, subject to compliance with a management plan to require disclosure and recusal, including appropriate documentation in the minutes. In addition, as noted above, the annual coi-tq process outlined above is jointly issued by the bilh tax department, to ensure that the questionnaire is distributed to all current and former members of the rockingham visiting nurse association and hospice board of trustees as well as former officers and key employees. The coi-tq process is designed to gather the information necessary for rockingham visiting nurse association and hospice to completely and accurately complete form 990 schedule l, transactions with interested persons and form 990, part vi, question 2, family and business relationships between officers, directors/trustees and key employees.”

“As required by this form 990 and as reported in the form 990 schedule j, although this filing covers the fiscal period october 1, 2023 to september 30, 2024, compensation reported in this filing is calendar year 2023 compensation. In addition, as reported in the prior year form 990, effective july 1, 2023, beth israel lahey health (bilh) became the sole member of exeter health resources, inc. (ehri) and ehri is the member of rockingham visiting nurse association & hospice (rvna. The president of ehri also serves as the chair and trustee (ex-officio) of rvna. The ehri president effective july 1, 2023 as well as other rvna officers, trustees and key employees whose positions commenced on or after july 1, 2023 and who are employed by bilh or a bilh affiliate other than ehri or rvna, was set by the bilh compensation committee and/or board. Compensation for the ehri and rvna chair who commenced in that role effective july 1, 2023 was also set by the bilh compensation committee as was the compensation of the rvna president who commenced in that role april 20, 2024. Compensation of other rvna officers, trustees and key employees was set prior to bilh becoming the sole member of ehri and was set by the ehri compensation committee and board. Both compensation committees engaged in processes intended to ensure that all officers, directors/trustees and key employees received reasonable compensation packages. Additional detail is below. Bilh compensation committee process: rvna's chair who is also the president of ehri is employed through beth israel lahey health (bilh), which as noted throughout this filing became the sole member of ehri on july 1, 2023. Ehri is the sole member of rvna. In this capacity, the bilh compensation committee sets compensation for the chair of rvna who started in the role effective july 1, 2023. The bilh compensation committee also set the compensation for other individuals who assumed roles as rvna officers, trustees and/or key employees after july 1, 2023. The compensation setting process for the rvna chair who also served as the ehri president through june 30, 2023 as well as officers, trustees and key employees whose positions commenced before july 1, 2023 is described below. The bilh compensation committee establishes the policies and the compensation structure, including benefits, for the beth israel lahey health network of affiliates including the bilh chief executive officer as well as other members of senior management at bilh and its affiliates. The compensation committee is responsible for assuring that the total compensation provided to these individuals is fair and reasonable using current and credible market practice information and is responsible for ensuring compliance with applicable legal and regulatory guidelines. The bilh compensation committee is composed of independent members of its board of trustees in setting compensation, the compensation committee relies upon published compensation surveys and studies produced by independent compensation consulting firms that regularly assess executive compensation and benefits of substantially similar organizations. The compensation committee meets to review the compensation structure of the individuals described above and at that time reviews the compensation survey details prepared by the independent compensation consulting firm. For some categories of positions, the compensation committee will review the compensation structure and targets as a group, rather than by individual. Compensation for the bilh ceo and other senior executives is reviewed on an individual basis. The compensation committee then votes to approve the compensation arrangements of all individuals described above except for the bilh ceo. The compensation package for the bilh ceo as voted by the compensation committee is submitted to the full bilh board of trustees for approval. All deliberations for both the compensation committee and the board of trustees are contemporaneously d”

“As noted throughout this filing, rockingham visiting nurse association and hospice is a member of the beth israel lahey health (bilh) network of affiliates with bilh serving as rockingham visiting nurse association and hospice's sole member, or if not as direct sole member, indirectly as the member in its capacity as parent of the beth israel lahey health network. Rockingham visiting nurse association and hospice's governing documents, conflict of interest policy and financial statements are available to the general public upon request at the following location: beth israel lahey health tax department schrafft's city center, 4th floor, 529 main street charlestown, ma 02129”

“Rockingham vna & hospice (rvna), a home health agency and its mission is to provide skilled nursing and palliative care services in the comfort of a patient's home. Care is provided within the communities served by its affiliates, exeter health resources, inc. (ehri), exeter hospital and core physicians, llc. In addition, rvna works conjunction with other continuing care and health at home affiliates in the beth israel lahey health network in furtherance of its purposes. Bilh is an integrated health care system committed to expanding access to extraordinary patient care across eastern massachusetts and southern new hampshire advancing the science and practice of medicine through groundbreaking research and education. The bilh system is comprised of academic and teaching hospitals, a premier orthopedics hospital, primary care and specialty care providers, ambulatory surgery centers, urgent care centers, community hospitals, homecare services, outpatient behavioral health centers, addiction treatment programs. Bilh's community of clinicians, caregivers and staff includes approximately 4,700 physicians and 39,000 employees. During the fiscal period covered by this filing, beth israel lahey health (bilh) served as the sole member of beth israel deaconess medical center, inc. (bidmc), mount auburn hospital (mah), new england baptist hospital (nebh), beth israel deaconess hospital - milton, inc. (milton), beth israel deaconess hospital - needham, inc. (needham), beth israel deaconess hospital - plymouth, inc. (plymouth), lahey health shared services (lhss), lahey clinic foundation (lcf), winchester hospital (winchester), northeast hospital corporation (nhc) which includes beverly, addison gilbert and bayridge hospitals, northeast behavioral corporation (nbhc), anna jaques hospital (ajh), the beth israel lahey health performance network (bilhpn), the joslin diabetes center, exeter health resources, inc (ehri) and the beth israel lahey health pharmacy. The lahey clinic foundation in turn served as the sole member of lahey clinic inc, and lahey clinic hospital d/b/a lahey hospital and medical center (lhmc), ehri in turn served as the sole member of exeter hospital and lhss in turn served as the sole member of beth israel lahey health primary care. See form 990 schedule r for additional information.”

“Rockingham vna & hospice's hospice program provides a comprehensive, medically directed, team oriented program of care. The essential components include care of the patient and family as one unit, pain and symptom management, 24 hour on-call availability, medical and nursing care, home health aide, social work services, bereavement and spiritual care, volunteers, rehab services, and coordination of medications, medical supplies, and durable medical equipment. Rockingham vna & hospice provided 17,643 visits to 559 patients who received 29,215 days of patient care during fiscal year 2024. Rockingham vna & hospice's community outreach program is dedicated to assisting in improving the health of the communities served through offering a variety of wellness clinics and educational opportunities. Community programs include community foot clinics, diabetes support groups, and health education programs. In fiscal year 2024, rvna & hospice supported its mission by providing $127,911 in community outreach, benefits and financial support to the community which excluding $460,194 in uncovered medicaid expenses.”

“Rockingham vna & hospice's (rvna) home care program has provided comprehensive skilled services to the adult population. The goal of these services is to improve the health and independence of the patients. Services include skilled nursing, physical therapy, occupational therapy, speech therapy, social work services, home health aide, dietician, iv specialist, wound/ostomy specialist, certified diabetes educator, lymphedema specialist and a palliative care program. In a typical fiscal year, rvna provides on average 40,000 visits to 2,800 home care patients. Rvna provides a comprehensive, medically directed, team-oriented program of care. The essential components include care of the patient and family as one unit, pain and symptom management, 24 hour on-call availability, medical and nursing care, home health aide, social work services, bereavement and spiritual care, volunteers, rehab services, and coordination of medications, medical supplies, and durable medical equipment. In a typical fiscal year, rvna provides on average 21,300 visits to 425 patients who receive 28,000 days of patient care. Rvna's community outreach program is dedicated to assisting in improving the health of the communities served through offering a variety of wellness clinics and educational opportunities. Community programs include community foot clinics, diabetes support groups, and health education programs. In addition, as noted above, rvna is a member of the beth israel lahey health network of affiliates and operates in conjunction with other continuing care and health at home affiliates in the beth israel lahey health network. In addition to the accomplishments noted above for rockingham visiting nurse association and hospice (rvna), and as noted throughout this form 990, rockingham visiting nurse association and hospice (rvna) is a member of the beth israel lahey health (bilh) network of affiliates. The bilh core values and principals are listed here as well as network-wide accomplishments during the fiscal period covered by this filing. The bilh network is delivering on the promise to bilh patients and communities to expand access and provide extraordinary care, while also advancing medicine through discovery and education. The bilh purpose statement articulates the impact that each bilh affiliate strives to make in the communities served. These shared values guide each entity's daily efforts and keep each affiliate aligned in the pursuit of the bilh purpose, showing how "we care" for patients, each other and the communities served. Purpose statement: bilh creates healthier communities one person at a time through seamless care and ground-breaking science, driven by excellence, innovation and equity. Bilh we care values: wellbeing. We provide a health-focused workplace and support a healthy work-life balance. Empathy. We do our best to understand others' feelings, needs and perspectives. Collaboration. We work together to achieve extraordinary results. Accountability. We hold ourselves and each other to behaviors necessary to achieve our collective goals. Respect. We value diversity and treat all members of our community with dignity and inclusiveness. Equity. Everyone has the opportunity to attain their full potential in our workplace and through the care we provide. Bilh is accomplishing this mission by providing support to its affiliates which include: 1. A physician enterprise that encompasses the system's network of employed primary care and specialty physicians located throughout our region; 2. A hospital and ambulatory services group that includes world-class academic medical centers and teaching hospitals with affiliations with harvard medical school, um and tufts university school of medicine; leading community hospitals; a renowned orthopedics hospital; and comprehensive ambulatory centers; 3. A population health enterprise that embraces a model of care to improve the health of all those served by bilh; the population health domain incl”

“During this period more than 31,000 inpatient surgeries were performed and approximately 14,000 newborns were delivered and there were approximately 52,000 pain clinic visits. Bilh hospitals also had more than 75,000 urgent care visits during this period. Non-hospital physician care: during the period covered by this filing, the bilh physicians provided care to patients outside of the hospitals and in physician office or other clinical settings. Below are a sample of the non-hospital physician services provided to bilh patients. During the fiscal year covered by this filing, more than 470 primary care and family practice providers had approximately 843,000 patient visits and providers across the full spectrum of specialties had more than 624,000 patient visits. In addition, joslin diabetes center had more than 27,000 patient visits related to diabetes care and there were more than 53,000 urgent care visits to non-hospital urgent care locations. Community benefits, uncompensated care, costs to provide care to medicaid and medicare patients fiscal year ended september 30, 2024 during the fiscal year covered by this filing bilh hospitals provided more than $52 million in net cost of charity care, including care for emergent services provided to non-paying patients and including payments to the health safety net trust. In addition to the charity care reported above, each of the bilh hospitals also provides care to patients who participate in other programs designed to support low-income families, including particularly the medicaid program, which is jointly funded by federal and state governments. The massachusetts health reform law provided an initiative for expansion of medicaid coverage to greater populations and for enrollment of uninsured patients in other insurance programs. Payments from medicaid and other programs that ensure low-income populations do not cover the cost of services provided. During the fiscal period covered by this filing, the cost of providing care to medicaid patients across bilh exceeded payments received for providing that care resulting in a combined shortfall exceeding $35.5 million related to treating medicaid patients. Medicare is the federally sponsored health insurance program for elderly or disabled patients. Payments from medicare do not cover the cost of services provided. All bilh hospitals provide care to patients who participate in the medicare program. During the fiscal period covered by this filing, the cost of providing care to medicare patients across bilh exceeded payments received for providing that care, resulting in a combined shortfall exceeding $161 million related to treating medicare patients. In addition to the costs noted above, during the fiscal year covered by this filing bilh hospitals provided combined community benefits, community health improvement services, cash and in-kind contributions to community health centers and other groups as well as costs incurred related to subsidies for primary and specialty care access, behavioral health care and other care provided at a loss totaling over $150 million. For additional information on these activities as well as each hospital's most recent community health needs assessment and implementation strategy, please see form 990 schedule h for each of the bilh hospitals. Education and research fiscal year ended september 30, 2024 research activities across bilh serve patient care both at bilh and beyond as part of the advancement of science. Beth israel deaconess medical center, inc. (bidmc or medical center) is a tertiary care academic medical center providing leading edge patient care, is a world class research institution and is devoted to teaching and training the medical professionals of tomorrow, embracing technological and clinical practice innovation and to that end, part of the medical center's mission is to be a world-class research institution where outstanding scientists work to develop new knowledge for the betterment of”

“Expanded the virtualist program, enhancing access to acute and overflow care; and introduced a self-scheduling tool for new patients seeking to establish care with a primary care provider. Education and awareness efforts to promote access to care in fy 2024, bilh worked to improve access for masshealth patients in eastern massachusetts through various communications initiatives. A key effort was launching a monthly newsletter, available in seven languages, to engage patients and share health information. New england baptist hospital ("nebh") hosted information sessions to educate underserved populations about its services. Nebh also performed outreach to community housing facilities, participated in boston mayor wu's hispanic heritage month luncheon, and partnered with neighborhood associations and main street boards.”

“The boston, ma office of kpmg issued an unqualified opinion on the consolidated audited financial statements of the beth israel lahey health, inc. And affiliates for fiscal period ended september 30, 2024. These statements were prepared in accordance with generally accepted accounting principles (gaap) and included the accounts of the beth israel lahey health, inc. (bilh), and the entities for which beth israel lahey health, inc. (bilh) served as sole member during the fiscal period covered by this filing, (anna jaques hospital (ajh), beth israel deaconess medical center, inc. (bidmc), mount auburn hospital (mah), new england baptist hospital (nebh), beth israel deaconess hospital - milton, inc. (milton), beth israel deaconess hospital - needham, inc. (needham), beth israel deaconess hospital - plymouth, inc. (plymouth), lahey health shared services (lhss), lahey clinic foundation (lcf), winchester hospital (winchester), northeast hospital corporation (nhc) which includes beverly, addison gilbert and bayridge hospitals, northeast behavioral corporation (nbhc), the beth israel lahey health performance network (bilhpn), the joslin diabetes center, exeter health resources, inc. (ehri) and the beth israel lahey health pharmacy. The lahey clinic foundation in turn served as the sole member of lahey clinic inc, and lahey clinic hospital d/b/a lahey hospital and medical center (lhmc). Ehri in turn served as the sole member of exeter hospital and other affiliates of ehri. Each of these bilh affiliates may in turn serve as member of additional entities within the network of affiliates, and whose accounts are included in the bilh audited financial statements. In addition, the bilh financial statements also include the accounts of harvard medical faculty physicians at beth israel deaconess medical center, inc. (hmfp), the dedicated physician practice of beth israel deaconess medical center and an entity integrally related to helping bidmc and other affiliates in the bilh network accomplish their charitable purposes. The accounts of the entities for which hmfp serves as member are also included in the hmfp and bilh audited financial statements. The audit and compliance committee of bilh's board of trustees assumes responsibility for oversight of the consolidated audit for the network as a whole.”

“Rockingham visiting nurse association and hospice did not receive any contributions of intellectual property and as such, was not required to file form 8899.”

“Rockingham visiting nurse association and hospice did not receive any contributions of cars, boats, airplanes or other vehicles and as such, was not required to file form 1098-c.”

“Physician fees: program service expenses 543,328. Management and general expenses 135,832. Fundraising expenses 0. Total expenses 679,160. Other fees: program service expenses 894,318. Management and general expenses 223,580. Fundraising expenses 0. Total expenses 1,117,898.”

“Use of grant funds not booked against expenses 3,121. Change in net investments 103,060.”

“As noted throughout this form 990, rockingham visiting nurse association and hospice is a member of the beth israel lahey health network of affiliates. Beth israel lahey health (bilh) serves as the direct or indirect member of rockingham visiting nurse association and hospice and rockingham visiting nurse association and hospice is included in the consolidated audited financial statements of beth israel lahey health. The audit and compliance committee of bilh's board of trustees assumes responsibility for oversight of the consolidated audit for the network as a whole.”