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 to: 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 and to affiliates of these entities. Effective July 1, 2023, BILH also became the sole Member of Exeter Health Resources, Inc. (EHRI) and its affiliates', including 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 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.”

“Ms. Margaret Luna held these positions until November 11, 2022: - Vice President, Human Resources - Exeter Hospital, Inc. - Vice President, Human Resources - Exeter Health Resources, Inc. - Vice President, Human Resources - Rockingham Visiting Nurse Association and Hospice. - Vice President, Human Resources - Core Physicians, LLC Ms. Luna's services were retained through Witt Keiffer, Inc., a management company. She started the position prior to the beginning of the fiscal year covered by this filing. She served in the roles stated above through November 11, 2022. Other Reportable Compensation for Ms. Luna includes payments made by Exeter Health Resources, Inc. to Witt Keiffer for these services in the amount of $368,476. As Ms. Luna served the Organization as a Vice President, and was engaged through an independent third-party management company: this Form 990, Part VI, Line 3, has been marked "Yes; Ms. Luna's relationship, role, and compensation has been disclosed here on this Schedule O; and she has been listed on this Form 990, Part VII, and this Form 990, Schedule J, as an officer in accordance with IRS Instructions.”

“Yes. Exeter Health Resources, Inc. (EHRI) is the sole Member of Rockingham Visiting Nurse Association and Hospice (RVNA or Corporation)). In addition, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) became the sole Member of EHRI and RVNA adopted Amended and Restated By-Laws. Additional information is included further below in this filing.”

“Exeter Health Resources, Inc. (EHRI) is the sole Member of Rockingham Visiting Nurse Association and Hospice (RVNA or Corporation). In addition, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH or System Member) became 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, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH or System Member) became 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, Exeter Health Resources, Inc. (EHRI) is the sole Member of Rockingham Visting Nurse Association and Hospice (RVNA). In addition, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) is the sole Member of EHRI. This Form 990 is prepared by the EHRI finance team in conjunction with the BILH tax department and Baker Newman Noyes (BNN). As part of this process, the EHRI finance and BILH tax teams work with other disciplines and functions within BILH and EHRI 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. RVNA's Form 990 is reviewed internally by the EHRI Vice President of Accounting, the EHRI Chief Financial Officer, the BILH Assistant Vice President, Taxation and externally by BNN. RVNA's Form 990, along with the Forms 990 of all entities in the BILH network, are discussed with the BILH Audit and Compliance Committee. BNN signs the final returns. A copy of the complete return is then provided to each member of RVNA's Board of Trustees prior to submission to the Internal Revenue Service.”

“As noted throughout this filing, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) became the sole Member of Exeter Health Resources, Inc (EHRI) and the indirect Member of Rockingham Visting Nurse Association and Hospice (RVNA). 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. The BILH Integrity and Compliance office collects and reviews all disclosures. Disclosures for Executives and Key Employees are assigned appropriate follow-up action in accordance with the COI Policy. A summary of positive responses for each BILH affiliate is provided to the Compliance Officer for that entity for review and 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 RVNA 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 RVNA Board of Trustees as well as former Officers and Key Employees. The COI-TQ process is designed to gather the information necessary for RVNA to completely and accurately respond to 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.”

“The organization's parent (Exeter Health Resources, Inc.) has a formal process for determining total compensation for the Chairman of Rockingham Visiting Nurse Association and Hospice (RVNA&H) and other listed officers that is intended to provide reasonable compensation for achieving the organization's mission, to recognize individual and team performance and to comply with the organization's obligations as a tax-exempt charitable organization. The Executive Committee of the Exeter Health Resources, Inc.'s Board of Trustees conducts an annual review of the compensation of the Chairman of RVNA&H and other listed officers. In doing so, the Committee retains a qualified independent compensation consultant to conduct competitive market analysis of the market ranges of base, incentive, and total cash compensation, and to provide advice concerning the reasonableness of the compensation of the Chairman and other listed officers. The Committee utilizes that analysis and other appropriate information in connection with its annual review and makes recommendations to the full Board of Exeter Health Resources, Inc. for adjustment of the Chairman's compensation and the compensation for other listed officers. Information which the Committee may consider can include but is not limited to the performance of an individual and/or that individual's contributions to a team, the performance of the organization in whole and in part, the elements of total compensation and salary history, the organization's compensation targets and comparability data, including the data prepared by the independent consultant and reviewed with the Committee. The Committee incorporates a performance appraisal process in the Chairman's, other listed officers', and key employees' compensation review. The Chairman and other listed officers are not present when the Committee discusses their respective compensation. In addition, the Committee determines if the threshold requirements for incentive awards are met, consisting of the organization's performance results for quality, operating system excellence and financial performance. The results of the Committee's deliberations are presented to the Exeter Health Resources, Inc. Board and include recommendations concerning salary range adjustments and incentive awards and the basis for the Committee's decisions/ recommendations. The deliberations of the Exeter Health Resources, Inc. Board are conducted in executive session with the independent members of the Board but do include the Chairman only for that period of time in which the Exeter Health Resources, Inc. Board has questions concerning the performance of any listed officer or key employee other than the Chairman. The Exeter Health Resources, Inc. Board reviews the Chairman's performance and determines if the adjustments and awards recommended by the Committee for the Chairman are in the organization's best interest and for the benefit of the organization and the parent organization. For the other listed officer positions, adjustments and incentive awards are approved upon recommendation of the Chairman by the Executive Committee within the Exeter Health Resources, Inc. Board approved parameters and ratified by the Exeter Health Resources, Inc. Board of Trustees. For the Executive Director of Rockingham Visiting Nurse Association and Hospice, compensation is determined by consulting with the organization's parent Human Resources department. Comparison compensation surveys and external benchmarks are used in the process.”

“As noted throughout this filing, effective July 1, 2023, Beth Israel Lahey Health, Inc. (BILH) became the sole Member of Exeter Health Resources, Inc (EHRI) and the indirect Member of Rockingham Visiting Nurse Association and Hospice (RVNA). RVNA's governing documents, Conflict of Interest Policy and Financial Statements are available to the general public upon request at the following location: Exeter Health Resources, Inc. and Affiliates 5 Alumni Drive Exeter, NH 03833 And Beth Israel Lahey Health Tax Department Schrafft's City Center, 4th Floor, 529 Main Street Charlestown, MA 02129”

“In addition, as noted throughout this filing, as of July 1, 2023, Beth Israel Lahey Health (BILH) became the sole Member of Exeter Health Resources, Inc. (EHRI). Accordingly, various persons who serve as directors, trustees, officers, key employees, or highly compensated employees of Rockingham Visting Nurse Association and Hospice may be compensated by a related organization affiliated with EHRI or BILH. Such persons' compensation, if any, is based on their roles held and services performed with and for the applicable related organization. For additional information regarding the compensation and benefits of the individuals listed on this Form 990, Part VII, please refer to the explanatory notes included on this Form 990, Schedule J.”

“Rockingham Visiting Nurse Association and Hospice ("RVNA") is a not-for-profit health service provider which primarily serves residents of New Hampshire. RVNA is controlled through Exeter Health Resources, Inc. (Resources), a not-for-profit corporation which functions as the Parent Company to RVNA. Resources and Beth Israel Lahey Health signed a definitive agreement that established the terms under which Resources joined the Beth Israel Lahey Health system. Together, the organizations seek to enhance and expand local access to high-quality care in New Hampshire. This transaction was finalized and became effective July 1, 2023.”

“Ongoing Intiatives: Enhanced Access for MassHealth Patients - To mitigate barriers in access to care and increase the number of MassHealth patients that BILH serves, the system committed to universal network-wide provider participation in MassHealth. All BILH hospitals and providers employed by BILH or on whose behalf BILH jointly contracts participate in and/or have applied to participate in some form of MassHealth. In FY 2022, BILH signed a new MassHealth ACO contract with BMC HealthNet Plan / WellSense Health Plan that went into effect in April 2023. As part of this contract, BILHPN extended participation to all eligible primary care providers ("PCPs") who were not otherwise participating in a MassHealth ACO. Prior to that time, while all eligible BILHPN PCPs were participants in a form of MassHealth, some PCPs were not previously participating in a MassHealth ACO. - BILH has developed, refined and implemented a multicultural marketing, advertising, and outreach plan with the purpose of expanding access for underserved populations, including MassHealth patients, in targeted BILH service areas. Investments in Underserved Communities - BILH hospitals have created and maintain strong connections to a network of affiliated hospitals and health centers that provide community-based care to historically underserved populations. In the regions that they serve, the Safety Net Affiliates ("SNAs") and Community Care Alliance ("CCA") Community Health Centers ("CHCs") are the cornerstone of BILH's delivery system regarding community-based care for MassHealth and historically underserved patients. - CCA CHCs include Bowdoin Street Health Center, Charles River Community Health, The Dimock Center, Fenway Health, and South Cove Community Health Center. - SNAs include Cambridge Health Alliance and Signature Healthcare Brockton Hospital. - BILH continues to invest in the CCA CHCs and SNAs, enabling them to expand their capabilities and care for more historically underserved patients. In FY 2022, BILH invested over $8 million in its CHCs and SNAs, in addition to engaging in regional planning and collaborative program development. These investments represent only a portion of a much larger community benefits investment portfolio that is described in greater detail in this and other BILH network tax filings. - BILH continues to explore additional opportunities with CHCs in Essex and Middlesex Counties. For example, BILH has established a telehealth pilot program between physicians at Addison Gilbert and Beverly Hospitals and patients at North Shore Community Health Center. BILH Behavioral Health Services The Beth Israel Lahey Health Network (BILH) is committed to the behavioral health needs of the patients and communities serviced. Below are some of activities that BILH Behavioral Services (BILHBS) has provided to the patients and communities served by BILH and its affiliated entities. BILHBS (which includes the activities of BILH's tax-exempt affiliate Northeast Behavioral Health Corp) is the largest network of mental health and substance use disorder services in eastern Massachusetts. BILHBS' network of behavioral health care includes services for children and adults ranging from inpatient treatment to community-based programs. Services include: - Inpatient psychiatric and detoxification treatment; - Emergency psychiatric and mobile emergency services teams; - Outpatient mental health and addiction treatment; - Individual/couple/family therapy; - Medication assisted treatment programs; and - School-based and home-based counseling for youth and their families. BILHBS serves approximately 35,000 unduplicated individuals annually, offering a full continuum of care for children and adults. Services range from inpatient to home and community-based services. BILHBS operates over 250 beds in 9 facilities for clients requiring acute psychiatric care, detoxification and residential step-down services. During the period covered by this filing, community”

“In addition, as noted throughout this filing, as of July 1, 2023, Beth Israel Lahey Health became the sole Member of Exeter Health Resources, Inc. (EHRI). 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, 2023. 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 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).) Each of these 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. As of July 1, 2023, Beth Israel Lahey Health became the sole Member of Exeter Health Resources, Inc. (EHRI) which in turns serves as the sole Member of Exeter Hospital and other affiliates of EHRI. The BILH audited financial statements also include the accounts of these entities for the last three months of the fiscal period covered by this filing. 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.”

“Contracted services: Program service expenses 1,183,006. Management and general expenses 295,752. Fundraising expenses 0. Total expenses 1,478,758. Physician fees: Program service expenses 377,656. Management and general expenses 94,414. Fundraising expenses 0. Total expenses 472,070.”

“Change in beneficial interest in perpetual trusts 32,817. Net transfers from affiliates 3,705,443. Application of push-down accounting 76,325.”

“The Organization is part of the consolidated operations of Exeter Health Resources, Inc. The Exeter Health Resources, Inc. ("Resources") Executive Committee is responsible for the oversight of the audit and the selection of an independent accountant. Furthermore, pursuant to an affiliation agreement between Resources and Beth Israel Lahey Health, key members of the various Beth Israel executive teams and audit and finance committees may also provide review and oversight over the Resources audit procedures. During the year ending September 30, 2023, Resources and Beth Israel Lahey Health signed a definitive agreement that established the terms under which Resources joined the Beth Israel Lahey Health system. For financial reporting of the Organization, the affiliation was accounted for as an acquisition and "push down" accounting was required to be applied, with the result that acquisition accounting adjustments have been reflected in the Organization's financial statements. The application of "push down" accounting resulted in a new basis of accounting for property, plant and equipment based on the assets' fair value at the date of affiliation. Accordingly, the Organization's audited financial statements refer to RVNA in the period prior to the affiliation as "Predecessor and in the period subsequent to the affiliation as "Successor." The 2023 Predecessor period represents the nine-month period ending June 30, 2023 prior to push-down accounting adjustments, and the 2023 Successor period represents the three-month period ending September 30, 2023 subsequent to push-down accounting adjustments. As of July 1, 2023, Beth Israel Lahey Health (BILH) became the sole Member of Exeter Health Resources, Inc. (EHRI) which in turns serves as the sole Member of RVNA and other affiliates of EHRI. The BILH audited financial statements also include the accounts of these entities for the last three months of the fiscal period covered by this filing. The Boston office of KPMG performs an annual audit and signs a consolidated financial statement audit of Beth Israel Lahey Health (BILH) and its affiliates. 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.”