Governor and Executive Council Agenda item PDF - 2026-03-25 - agenda 29

Meeting Date

2026-03-25

Attachment Kind Label

Agenda item PDF

Attachment Relation

primary_meeting_attachment

Agenda Numbers

29

Agency Names

Office Of Professional Licensure And Certification

Parent Meeting Title

Governor and Executive Council meeting - 2026-03-25

NEW HAMPSHIRE

#PLC STATE OF NEW HAMPSHIRE MAR 2 5 2026

o?7Office of Professi<Mial

Ltccnsure and Certification

Deanna Jurius OFFICE OF PROFESSIONAL LICENSURE AND CERTIFICATION

Executive Director

OFFICE OF THE EXECUTIVE DIRECTORHeather A. Kelley

Director

7 EAGLE SQUARE, CONCORD, NH 03301-4980

Telephone: 603-271-2152

TDD Access: Relay NH 1-800-735-2964

www.oplc.nh.gov

February 23, 2026

Her Excellency, Governor Kelly A. Ayotte

and the Honorable Council

State House

Concord, New Hampshire 03301

REOUESTED ACTION

Authorize the Office of Professional Licensure and Certification (OPLC) to enter into a Sole

Source contract with New Hampshire Professionals Health Program (VC# 175105), Concord, New

Hampshire in the amount of $ 1,616,340.00 to administer the professionals' health program (PHP), with the

option to renew for up to an additional two-year period, effective upon Governor and Executive Council

approval for the period May 1, 2026 through June 30,2028. 100% Agency Funds.

Funds are anticipated to be available in Fiscal Year (FY) 2026, FY 2027, and FY 2028 upon the

availability of continued appropriation of funds in the future operating budget, with the authority to adjust

encumbrances between fiscal years within the price limitation through the Budget Office, if needed and

justified:

01-21-21-2110I0-240400000 Division of Administration FY2026 FY2027 FY2028

531-500372 - Impaired Programs (Boards) $119,260.00 $736,463.00 $760,617.00

EXPLANATION

This contract is Sole Source because New Hampshire Professionals Health Program is the only

vendor able to provide the statutorily obligated services; outlined below, in accordance with current

administrative regulations.

OPLC is statutorily obligated to administer the PHP for various health professions in accordance

with RSAs 310:5, 318:29-a, 326-B:36-a, and 329:13-b. The program is funded by a fee charged to

licensees at the time of initial licensure, renewal of licensure, and reinstatement of licensure for

thirteen licensing bodies: the Board of Medicine, Board of Dental Examiners, Pharmacy Board, Board of

Nursing, Board of Veterinary Medicine, Board of Psychologists, Board of Chiropractic Examiners, Board

of Mental Health Practice, Midwifery Council, Board of Registration in Optometry, Board of Podiatry,

Board of Licensed Dietitians, and Board of Licensing for Alcohol and Other Drug Use Professionals.

These licensing boards may require licensees whose ability to practice safely is impaired, or

could reasonably be expected to become impaired, by a mental or physical illness, including by substance

abuse or disruptive behavior, to participate in a PHP as a condition of continued licensure. The PHP

administrator develops, administers, and monitors treatment plan contracts with licensees. The PHP

administrator monitors the licensee's recovery process and assists them with intervention, diagnosis, and

treatment as an alternative to board discipline. The PHP administrator identifies treatment resources for

licensees which may include body fluid monitoring, participation in support groups, individual therapy

sessions, regular check-ins with sponsors, and other related programs.

Her Excellency, Governor Kelly A. Ayotte

and the Honorable Council

In addition to those licensees referred by their licensing board, the PHP offers a

voluntary enrollment pathway for healthcare professionals who recognize the need to self-report and seek

assistance while avoiding the perceived implications or penalties of board involvement. If a licensee

violates the terms of the monitoring treatment plans, whether board-referred or self-reported, the PHP

administrator will report the licensee to the respective licensing board for possible disciplinary action.

In consideration of the current contract's expiration on May 1, 2026, OPLC requests approval of

this Sole Source contract to continue the uninterrupted delivery of the PHP for the licensees of the above

identified boards and prevent a lapse in services for those licensees who are currently enrolled in

monitoring agreements.

In the event that Agency funds become no longer available. General Funds will not be requested

to support this program.

Based on the foregoing, 1 respectfully request and recommend approval of the Sole Source

contract with New Hampshire Professionals Health Program.

Respectfully submitted,

Deanna E. Jurius

Executive Director

FORM NUMBER P-37 (version 2/23/2023)

Subject' Heeltbcare ProfesdoHilMoaltorlag Pregram

Notice: This agreement and all of its attachments shall become public i^ion submission to Governor and

Executive Council for approval Any infonnaticai that is private, confidential or projxietaty must

be clearly identified to the agency and agreed to in writing prior to rigning the contract

AGREEMENT

The State of New Hampshire and (he Contractor hweby mutually agree as follows:

GENERAL PROVISIONS

1.1 State Agency Name

Office of Professional Licensure and Certification

1.2 State Agency Address

7 Eagle Square

Concord, NH 03301

13 Contractor Name

New Hampshire Professionals Health Program

1.4 Contractor Address

125 Airport Road, Concord, NH 03301.1,5 Contractor Phone Number

(603)223-0990

1.6 Account Unit and Pass

24040000-531

1.7 Completion Date

June 30,2028

1.8 Price Limitation

$1,616,340.00

1.9 Contracting OfBcer for State Agency

Steven H. Buigess, Contnicts Admiuislramr

1.10 State Agency Telephone Number

(603)271-9369

1.11 Contractor Signature 1.12 Name and Title of Ctxitractor Signatory

WtecsUclcxA Oitrcc-teva.

1.13 State Agency Signature

2/23/2026

1.14 Name and Title of State Agency Signatory

Deanna E. Jurhis, Executive Director

1.15 Approval by the N.H. Department ofAdministration, Division of Personnel /J/ <q>pUcable)

By: Director, On:

1.16 Approval by the Attorney General ^orm, Substance and Execution) (ffapplicable)

By.^-6, On: 316-120^

1.17 Approval by the Governor and Executive Council (tfc^Ucable)

G&C Item number: G&C Meeting Date:

2. SERVICES TO BE PERFORMED, The State of New

Hampshire, acting through the agency identified in block 1.1

("State"), engages contractor identified in block 1.3 ("Contractor")

to perform, and the Contractor shall perform, the work or sale of

goods, or both, identified and more particularly described in the

attached EXHIBIT B which is incorporated herein by reference

("Services").

3. EFFECTIVE DATE/COMPLETION OF SERVICES.

3.1 Notwithstanding any provision of this Agreement to the

contrary, and subject to the approval of the Governor and Executive

Council of die State of New Hampshire, if applicable, this

Agreement, and all obligations of the parties hereunder, shall

become effective on the date the Governor and Executive Council

approve this Agreement, unless no such approval is required, in

which case the Agreement shall become effective on the date the

Agreement is signed by the State Agency as shown in block 1.13

("Effective Date").

3.2 If the Contractor commences the Services prior to the ESective

Date, all Services performed by the Contractor prior to the

Effective Date shall be performed at the sole risk of the Contractor,

and in the event that this Agreement does not become effective, the

State shall have no liability to die Contractor, including without

limitation, any obligation to pay the Contractor for any costs

incurred or Services performed.

3.3 Contractor must complete all Services by the Completion Date

specified in block 1.7.

4. CONDITIONAL NATURE OF AGREEMENT.

Notwithstanding any provision of this Agreement to the contrary,

all obligations of the State hereunder, including, without limitation,

the continuance of payments hereunder, are contingent upon die

availability and continued appropriation of funds. In no event shall

the State be liable for any payments hereunder in excess of such

available appropriated funds. In the event of a reduction or

termination of appropriated fuuds by any state or federal legislative

or exeeutive action that reduces, eliminates or otherwise modifies

the appropriation or availability of funding for this Agreement and

the Scope for Services provided in EXHIBIT B, in whole or in part,

the State shall have the right to withhold payment until such funds

become available, if ever, and shall have the right to reduce or

terminate the Services under this Agreement immediately upon

giving the Contractor notice of such reduction or termination. The

State shall not be required to transfer fimds fi:om any other account

or source to the Account identified in block 1.6 in the event fimds

in that Account are reduced or unavailable.

5. CONTRACT PRICE/PRICE LIMITATION/ PAYMENT.

5.1 The contract price, method of payment, and terms of payment

are identified and more particularly described in EXHIBIT C which

is incorporated herein by reference.

5.2 Notwitbtanding any provision in this Agreement to the

contrary, and notwidistanding unexpected circumstances, in no

event shall the total of all payments authorized, or actually made

hereunder, exceed the Price Limitation set forth in block 1.8. The

payment by the State of the contract price shall be die only and the

complete reimbursement to the Contractor for all expenses, of

whatever nature incurred by the Contractor in the performance

hereof, and shall be the only and the complete compensation to the

Contractor for the Services.

5.3 The State reserves the right to oflfeet firom any amounts

otherwise payable to the Contractor under this Agreement those

liquidated amoimts required or permitted by N.H. RSA 80:7

through RSA 80:7-c or any other provision of law.

5.4 The State's liability under this Agreement shall be limited to

monetary damages not to exceed the total fees paid. The Contractor

agrees that it has an adequate remedy at law for any breach of this

Agreement by the State and hereby waives any right to specific

performance or other equitable remedies against the State.

6. COMPLIANCE BY CONTRACTOR WITH LAWS AND

REGULATIONS/EQUAL EMPLOYMENT

OPPORTUNITY.

6.1 In connection with the performance of the Services, the

Contractor shall comply with aU applicable statutes, laws,

regulations, and orders of federal, state, county or municipal

authorities which impose any obligation or duty upon the

Contractor, including, but not limited to, civil rights and equal

employment opportunity laws and the Governor's order on Respect

and Civility in the Workplace, Executive order 2020-01. In

addition, if this Agreement is funded in any part by monies of the

United States, the Contractor shall comply with all federal

executive orders, rules, regulations and statutes, and with any roles,

regulations and guidelines as the State or the United States issue to

implement these regulations. The Contractor shall also comply

with all applicable intellectual property laws.

6.2 During the term of this Agreement, the Contractor shall not

discriminate against employees or applicants for employment

because of age, sex, sexual orientation, race, color, marital status,

physical or mental disability, religious creed, national origin,

gender identity, or gender expression, and will take affirmative

action to prevent such discrimination, unless exempt by state or

federal law. The Contractor shall ensure any subcontractors comply

with these nondiscrimination requirements.

6.3 No payments or transfers of value by Contractor or its

representatives in connection with this Agreement have or shall be

made whieh have the purpose or effect of public or commercial

bribery, or acceptance of or acquiescence in extortion, kickbacks,

or other unlawful or improper means of obtaining business.

6.4. The Contractor agrees to permit the State or United States

access to any of the Contractor's books, records and accounts for

the purpose of ascertaining compliance with this Agreement and all

roles, regulations and orders pertaining to the covenants, terms and

conditions of this Agreement.

7. PERSONNEL.

7.1 The Contractor shall at its own expense provide all personnel

necessary to perform the Services. The Contractor warrants that all

personnel engaged in the Services shall be qualified to perform the

Services, and shall be properly licensed and otherwise authorized

to do so under all applicable laws.

7.2 The Contracting Officer specified in block 1.9, or any

successor, shall be the State's point of contact pertaining to this

Agreement.

New Hampshire Professionals Health Program

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8. EVENT OF DEFAULT/REMEDIES.

8.1 Any one or more of the following acts or omissions of the

Conttactor shall constitute an event of default hereunder ("Event of

Default"):

8.1.1 failure to perform the Services satisfactorily or on schedule;

8.1.2 failure to submit any report required hereunder; and/or

8.1.3 failure to perform any other covenant, term or condition of

this Agreement.

8.2 Upon the occurrence of any Event of Default, the State may

take any one, or more, or all, of the following actions;

8.2.1 give the Contractor a written notice specifying the Event of

Default and requiring it to be remedied within, in the absence of a

greater or lesser specification of time, thirty (30) calendar days

flom (he date of the notice; and if the Event of Default is not timely

cured, terminate this Agreement, effective two (2) calendar days

after giving the Contractor notice of termination;

8.2.2 give the Contractor a written notice specifying the Event of

Default and suspending all payments to be made under this

Agreement and ordering that the portion of the contract price which

would otherwise accrue to the Contractor during the period from

the date of such notice until such time as the State determines that

the Contractor has cured the Event of Default shall never be paid

to the Contractor;

8.2.3 give the Contractor a written notice specifying the Event of

Default and set off against any other obligations tihe State may owe

to the Contractor any damages the State suffers by reason of any

Event of Default; and/or

8.2.4 give the Contractor a written notice specifying die Event of

Default, treat the Agreement as breached, terminate the Agreement

and pursue any of its remedies at law or in equity, or both.

9. TERMINATION.

9.1 Notwithstanding paragraph 8, the State may, at its sole

discretion, terminate the Agreement for any reason, in whole or in

part, by thirty (30) calendar days written notice to the Contractor

that the State is exercising its option to terminate the Agreement.

9.2 In the event of an early termination of this Agreement for any

reason other than the completion of the Services, the Contractor

shall, at the State's discretion, deliver to the Contracting Officer,

not later than fifteen (15) calendar days after the date of

termination, a report ("Termination Report") describing in detail

all Services performed, and the contract price earned, to and

including the date of termination. In ad^tion, at the State's

discretion, the Contractor shall, within fifteen (15) calendar days

of notice of early termination, develop and submit to the State a

transition plan for Services under the Agreement.

10. PROPERTY OWNERSfflP/DISCLOSURE.

10.1 As used in this Agreement, the word "Property" shall mean

all data, information and things developed or obtained during the

performance of or acquired or developed by reason of, this

Agreement, including, but not limited to, all studies, reports, files,

formulae, surveys, m^s, charts, sound recordings, video

recordings, pictorial reproductions, drawings, analyses, graphic

representations, computer programs, computer printouts, notes,

letters, memoranda, papers, and documents, all whether finished or

unfinished.

10.2 All data and any Property which has been received from the

State, or purchased with fimds provided for that purpose under this

Agreement, shall be the property of the State, and sMl be returned

to die State upon demand or upon termination of this Agreement

for any reason.

10.3 Disclosure of data, information and other records shall be

governed by N.H. RSA chapter 91-A and/or other applicable law.

Disclosure requires prior written approval of the State.

11. CONTRACTOR'S RELATION TO THE STATE. In flie

performance of this Agreement the Contractor is in all respects an

independent contractor, and is neither an agent nor an employee of

the State. Neither the Contractor nor any of its officers, employees,

agents or members shall have authority to bind the State or receive

any benefits, workers' compensation or other emoluments

provided by the State to its employees.

12. ASSIGNMENT/DELEGATION/SUBCONTRACTS.

12.1 Contractor shall provide the State written notice at least fifteen

(15) calendar days before any proposed assignment, delegation, or

other transfer of any interest in this Agreement. No such

assignment, delegation, or other transfer shall be effective without

the written consent of the State.

12.2 For purposes of paragraph 12, a Change of Control shall

constitute assignment. "Change of Control" means (a) merger,

consolidation, or a transaction or series of related transactions in

which a third party, together with its affiliates, becomes the direct

or indirect owner of fifty percent (50%) or more of the voting

shares or similar equity interests, or combined voting power of the

Contractor, or (b) the sale of all or substantially all of the assets of

the Contractor.

12.3 None of the Services shall be subcontracted by the Contractor

without priw written notice and consent of the State.

12.4 The State is entitled to copies of all subcontracts and

assignment agreements and shall not be bound by any provisions

contained in a subcontract or an assignm^t agreement to which it

is not a party.

13. INDEMNIFICATION. The Contractor shall indemnify,

defend, and hold harmless the State, its officers, and employees

from and against all actions, claims, damages, demands,

judgments, fines, liabilities, losses, and other expenses, including,

without limitation, reasonable attorneys' fees, arising out of or

relating to this Agreement directly or indirectly arising from death,

personal injury, property damage, intellectual property

infringement, or other claims asserted against the State, its officers,

or employees caused by the acts or omissions of negligence,

reckless or wiUfiil misconduct, or fraud by the Contractor, its

employees, agents, or subcontractors. The State shall not be liable

for any costs incurred by the Contractor arising under this

paragraph 13. Notwithstanding the foregoing, nothing herein

contained shall be deemed to constitute a waiver of the State's

sovereign immunity, which inmaunity is hereby reserved to the

State. This covenant in paragraph 13 shall smvive the termination

of tiiis Agreement.

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14. INSURANCE.

14.1 The Contractor shall, at its sole expense, obtain and

continuously maintain in force, and shall require any subcontractor

or assignee to obtain and maintain in force, the following insurance:

14.1.1 commercial general liability insurance against all claims of

bodily injury, deadi or property damage, in amounts of not less than

$1,000,000 per occurrence and $2,000,000 aggregate or excess;

and

14.1.2 ^cial cause of loss coverage form covering all Property

subject to subparagraph 10.2 herein, in an amount not less than

80% of the whole replacement value of the Property.

14J2 The policies described in subparagraph 14.1 herein shall be on

policy forms and endorsements approved for use in the State of

New Hampshire by the N.H. Department of Insurance, and issued

by insurers licensed in the State of New Hampshire.

14.3 The Contractor shall furnish to the Contracting Officer

identified in block 1.9, or any successor, a certificate(s) of

insurance for all insurance required under this Agreement At the

request ofthe Contracting Officer, or any successor, the Contractor

shdl provide certificate(s) of insurance for all renewal{s) of

insurance required under this Agreement. The certificate{s) of

insurance and any renewals thereof shall be attached and are

incorporated herein by reterencc.

15. WORKERS' COMPENSATION.

15.1 By signing this agreement the Contractor agrees, certifies and

warrants that the Contractor is in compliance with or exempt firom,

die requirements of N.H. RSA chapter 281-A ("Workers'

Compensation ").

15.2 To the extent the Contractor is subject to the requirements of

NJl. RSA chapter 281-A, Contractor shall maintain, and require

any subcontractor or assignee to secure and maintain, payment of

Workers' Compensation in coimection with activities which the

person proposes to undertake pursuant to fliis Agreement. The

Contractor shall furnish the Contracting Officer identified in block

1.9, or any successor, proof of Workers' Compensation in the

manner described in N.H. RSA chapter 281-A and any applicable

renewal(s) thereof, which shall be attached and are incorporated

herein by reference. The State shall not be responsible for payment

of any Workers' Compensation premiums or for any other claim or

benefit for Contractor, or any subcontractor or employee of

Contractor, which might arise under applicable State of New

Hampshire Workers' Compensation laws in cormection with the

performance of the Services under this Agreement

16. WAIVER OF BREACH. A State's failure to enforce its rights

with respect to any single or continuing breach of this Agreement

gtiall not act as a waiver of the right of the State to later enforce any

such rights or to enforce any other or any subsequent breach.

17. NOTICE. Any notice by a party hereto to the other party shall

be deemed to have been duly delivered or given at the time of

mailing by certified mail, postage prepaid, in a United States Post

Office addressed to the parties at the addresses given in blocks 1.2

and 1.4, herein.

18. AMENDMENT. This Agreement may be amended, waived or

discharged only by an instrument in writing signed by the parties

hereto and only after approval of such amendment, waiver or

discharge by the Govemor and Executive Council of the State of

New Hampshire imless no such approval is required under the

circumstances pursuant to State law, rule or policy.

19. CHOICE OF LAW AND FORUM.

19.1 This Agreement shall be governed, interpreted and construed

in accordance with the laws of the State of New Hampshire except

where the Federal supremacy clause requires otherwise. The

wording used in this Agreement is the wording chosen by the

parties to express their mutual intent, and no rule of construction

shall be applied against or in fevor of any party.

19.2 Any actions arising out of this Agreement, including the

breach or alleged breach thereof, may not be submitted to binding

arbitration, but must, instead, be brought and maintained in the

Merrimack Cotmty Superior Court of New Hampshire which shall

have exclusive jurisdiction thereof.

20. CONFLICTING TERMS. In the event of a conflict between

the terms of this P-37 form (as modified in EXHIBIT A) and any

other portion of this Agreement including any attachments thereto,

the tenns of the P-37 (as modified in EXHIBIT A) shall control.

21. THIRD PARTIES. This Agreement is being entered into for

the sole benefit of the parties hereto, and nothing herein, express or

implied, is intended to or will confer any legal or equitable right,

benefit, or remedy of any nature upon any other person.

22. HEADINGS. The headings throughout the Agreement are for

reference purposes only, and the words contained therein shall in

no way be held to explain, modify, amphfy or aid in the

interpretation, construction or meaning of the provisions of this

Agreement

23. SPECIAL PROVISIONS. Additional or modifying

provisions set forth in the attached EXHIBIT A are incorporated

herein by reference.

24. FURTHER ASSURANCES. The Contractor, along with its

agents and affiliates, shall, at its own cost and expense, execute any

documents and take such further actions as may be

reasonably required to cany out the provisions of this Agreement

and give effect to the transactions contemplated herdry.

25. SEVERABILITY. In the event any of the provisions of this

Agreement are held by a court of competent jiuisdiction to be

contrary to any state or federal law, the remaining provisions of this

Agreement will remain in full force and effect.

26. ENTIRE AGREEMENT. This Agreement, which may be

executed in a number of counterparts, each of which shall be

deemed an original, constitutes the entire agreement and

understanding between the parties, and supersedes all prior

agreements and understandings with respect to the subject matter

hereof.

1

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New Hampshire Professionals HeaUii Program

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New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

EXHfRTT A - SPECIAL PROVISIONS

1. Revisions to Form P-37. General Provisions

1.1. Paragraph 3, Effective Date: Completion of Project, is amended by adding subparagraph 3.4 as

follows:

3.4 The parties may extend the Agreement for up to two (2) additional years from the

Completion Date, contingent upon satisfactory delivery of services, available funding,

agreement of the parties, and approval of the Governor and Executive Council.

2. Special Provisions:

2.1. Contractors Obligations: The Contractor covenants and agrees that all funds received by the

Contractor under the Contract shall be used only as payment to the Contractor for services

provided in Exhibit B, Performance Measures and Scope of Services and, in furtherance of the

aforesaid covenants, the Contractor hereby covenants and agrees as follows:

2.1.1. Compliance with Federal and State Laws: Once the Contractor is permitted to determine

an individual's eligibility for monitoring, the eligibility determination shall be made in

accordance with applicable federal and state laws, regulations, orders, guidelines, policies

and procedxues.

2.1.2. Documentation: The Contractor shall maintain a data file on each recipient of services

hereunder, which file shall include all information necessary to support an eligibility

determination and such other information as the Boards request.

2.1.3. Maintenance of Records: In addition to the eligibility records specified above, the

Contractor covenants and agrees to maintain the following records during the Contract

Period:

2.1.3.1. Fiscal Records: books, records, documents and other data evidencing and

reflecting all costs and other expenses incurred by the Contractor in the

performance of the Contract, and all income received or collected by the

Contractor during the Contract Period, said records to be maintained in

accordance with accounting procedures and practices which.sufficiently

and properly reflect all such costs and expenses, and which are acceptable

to the OPLC, and to include, without limitation, all ledgers, books,

records, and original evidence of costs such as purchase requisitions and

orders, vouchers, requisitions for materials, inventories, valuations of in-

kind contributions, labor time cards, payrolls, and other records requested

or required by the State.

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EXHIBIT A - SPECIAL PROVISIONS

2.1.3.2. Statistical Records: Statistical, enrollment, attendance or visit records for

each recipient of services during the Contract Period, which records shall

include all records of application and eligibility (including all forms

required to determine eligibility for each such recipient), records

regarding provision of services and all invoices submitted to the OPLC to

obtain payment for such services.

2.1.3.3. Participant Records: Where appropriate and as prescribed by State and

Federal regulations, the Contractor shall retain a participant file on each

recipient of services.

2.1.4. Confidentiality of Records: All information, reports, and records maintained hereunder or

collected in connection with the performance of the services and the Contract, shall be

confidential and shall not be disclosed by the Contractor, provided however, that pursuant

to State laws and regulations regarding the use and disclosure of such information,

disclosure may be made to the professional's licensing board requiring such information

in connection with their ofbcial duties and for purposes directly connected to the

administration of the services and the Contract; and provided further, that the use or

disclosure by any party of any information concerning a Healthcare Professional for any

purpose not directly connected with the administration of the boards or the Contractor's

responsibilities with respect to purchased services hereunder is prohibited except on

written consent of the Healthcare Professional, his or her attorney, or guardian. The

detailed reports of services conducted pursuant to this section shall be confidential and not

subject to RSA 91-A. Notwithstanding anything to the contrary contained herein the

covenants and conditions contained in this paragraph shall survive the applicable effective

date/completion of services of the Contract.

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New Hampshire Office of Professional Licensure and Certification

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FXHTBTT R - SCOPE OF SERVICE

1. Statement of Work

1.1. The purpose of this Agreement is to specify the framework and terms, conditions, safeguards,

and procedures under which New Hampshire Professionals Health Program ("the Contractor")

agrees to provide a comprehensive Professionals' Health Program which monitors and treats any

impairment from alcohol or substance abuse/dependence, mental or physical illness, behavioral

issues, and/or bumout and/or behavior and physical conditions to the OfSce of Professional

Licensure and Certification ("Agency") and applicable boards in accordance with Revised

Statute Annotated (RSA) 310:5, EH.

1.2. The Contractor shall maintain records that provide the information needed to compile an

evaluative report and provide quarterly evaluative reports to the agency's executive director and

the director of operations for review and distribution to the boards.

1.3. The Contractor shall ensure that there are staff at its New Hampshire location who have a

working knowledge of insurance and self-pay treatment options locally, regionally, and

nationally, for the types of treatment likely to be required in its agreements.

1.4. The Contractor shall have in place a policy and procedure for periodic systematic evaluation of

the services it offers that requires review of, and modifications to, as necessary:

1.4.1. Its program agreements as a whole.

1.4.2. Individual components of program agreements, including but not limited to the treatment

programs to which participants are referred.

1.4.3. The non-therapeutic goals and objectives of facilitated meetings and the extent to which

they are being met.

1.4.4. Participation in and attendee reviews of any continuing education courses offered.

1.4.5. What services are being requested by licensees.

1.4.6. Any other services or resources made available to participants and potential participants.

1.5. The Contractor shall have a conflict of interest policy for officers, directors, committee

members, executive staff, and volunteers acting on behalf of the provider to ensure that those in

positions of responsibility or influence have no personal or outside financial, business, or

professional interests or responsibilities that conflict with their duties to the provider that could

create a bias or predisposition on an issue that may compromise the interests of the provider or

unduly influence the treatment or monitoring of a participant.

1.6. The Contractor shall require, to the maximum extent possible, that participants:

1.6.1. Make full disclosure of all relevant facts to the program director;

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New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

F YTTTBTT R - SCOPE OF SERVICE

1.6.2. Provide the program director with continuing, unrestricted access to any of the

participant's medical or other records that are relevant to the condition or conduct being

addressed by the program agreement, exclusive of records pertaining to the participant's

clients or patients that contain protected health information.

1.7. The contractor shall not include in any advertising, informational website or brochure, or

program agreement any language or representations to any person that explicitly or implicitly

indicates that:

1.7.1. The contractor's program director is an agent of the applicable board or is performing

functions of the applicable board.

1.7.2. Participation in the approved program will protect the participant against disciplinary

action being taken by the applicable board.

1.7.3. The applicable board is financially or otherwise responsible for any aspect of the

participant's involvement in the program.

1.8, The contractor shall keep a list of Known to the Board (KTB) participants, and Not Known to

the Board (NKTB) participants.

1.8.1. KTB participants are licensees the applicable board has ordered or agreed to a licensee's

participation in a program agreement as an alternative to discipline or a condition of

discipline.

1.8.2. NKTB participants are licensees seeking guidance on, or assistance with, treatment for

an impairment or potential impairment from the Contractor without the knowledge of the

applicable board or any other regulatory authority. The term includes full participation in

a program agreement without the knowledge of the applicable board.

1.8.3. The Contractor shall assign a unique identified (UID) to each NKTB participant so that

the Contractor may track participant numbers accurately and report these numbers to the

Agency. The UID shall not be the participant's social security number, license number, or

other identifiable number that is known to the Agency.

2. Program Ameements Standards

2.1. The Contractor shall develop a program agreement for each participant based on the

participant's specific conditions and circumstances that contain specific and objectively

determinable requirements to be met by the participant that are designed to ensure safe practice

and public safety.

2.2. Each program agreement and any amendments or modifications thereto shall be in writing and

signed by the participant and the Contractor's program director.

New Hampshire Profeesionate Health Program Contractor Initials

7-/2,0-/2.SS-2026-ADMIN-SUPP-02 D®*® *■

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

FXHTBIT B - SCOPE OF SERVICE

2.3. Each program agreement shall:

2.3.1. Require the Contractor's program director to keep detailed records of the participant's

involvement in all aspects of the program agreement.

2.3.1.1. ForKTB participants. Require the Contractor's program director to inform the

applicable board within two (2) working days of receiving verification of a

participant's non-compliance with any of the requirements contained in the

participant's program agreement.

2.3.2. For NKTB participants, clearly inform the participant that the Contractor shall report

noncomphance by the participant with the terms of a program agreement to the applicable

board only if the Contractor determines there is clear and convincing evidence that not

reporting the participant would jeopardize the health and safety of the public.

2.3.3. Authorize and require the Contractor's program director to maintain the confidentiality of

records concerning the participant's involvement in the program agreement except to the

extent the records are released by the participant, provided that in cases where the

participant's noncompliance with one or more terms of the program agreement has been

reported to the applicable board, only the confirmation of noncompliance documentation

shall be released to the applicable board if requested by the applicable board.

2.3.4. Require the Contractor's program director to:

2.3.4.1. Provide, except for NKTB participants, information regarding the participant's

compliance with the program agreement to the applicable board if requested for

purposes of a pending or potential disciplinary proceeding.

2.3.4.2. Notify the board administrator assigned to the board, director of enforcement, and

director of licensing and board administration.

2.3.4.3. Cooperate, except as relating to NKTB participants, with the applicable board in

any disciplinary action undertaken by the applicable board that relates to the

condition or conduct addressed by Ihe participant's program agreement.

2.3.5. If the program agreement for a specific participant addresses a treatable or modifiable

(T/M) condition of the participant, include a detailed T/M plan that contains the elements

listed in paragraph 3 below. !

3. Necessary Elements for T/M Plan: |

3.1. For all participants with a treatable or modifiable condition, the Contractor shall create and f

include a T/M plan in the program agreement. The T/M plan shall contain the following: jI

3.1.1. Identification of the assessment made, and the condition diagnosed. j

i

New Hampshire Professionals Health Program Contractor initials |

SS-2026-ADMIN.SUPP-02 2-ia |

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

FXHIRIT R - SrOPE OF SERVICE

3.1.2. A clear statement of tiie treatment required, including the frequency of treatment and the

licensing requirements for each treatment provider.

3.1.3. A clear statement of the details of any practice limitations that the participant has agreed

to observe, independent of any license restrictions imposed by the applicable board, as

well as:

3.1.3.1. The circumstances under which the limitations will be removed.

3.1.3.2. The circumstances, such as a relapse, that will extend the limitations and the

program agreement.

3.1.4. For KTB participants, a requirement for the program director to report relapse or other

noncompUance with the program agreement to the applicable board by notifying the

Board Administrator assigned to the Board, Director of Enforcement, and Director of

Licensing and Board Administration.

3.1.5. Details of any required physical monitoring, such as testing for drugs or alcohol, included

in the plan, the participant's obligations thereunder, and the consequences of positive test

results or refusing to engage in testing.

3.1.6. A clear statement of any continuing education requirements and, if applicable, the specific

topics to be covered.

3.1.7. A requirement for the participant to abstain from psychoactive substances that are not

prescribed by the participant's health care provider and pre^proved by the program

director.

3.1.8. A requirement for the participant to participate in a monthly facilitated meeting with the

approved program and other participants with emphasis on work stress mitigation and

recovery topics.

3.1.9. A requirement for the participant to submit a monthly self-assessment report.

3.1.10. Identification of a community-based support group requirement based on diagnosis.

3.1.11. Language that:

3.1.11.1. Speeifically describes any applicable employment requirements or limitations

relative to hours, duties, and work settings.

3.1.11.2. Identifies the workplace monitor(s) and requires the monitor(s) to submit 30-day |

and quarterly reports to the program director. |

3.1.11.3. Requires fiill collaboration and discussion between the program director and [treatment providers and workplace monitors at all times. i

3.1.11.4. Provides avenues for grievance if a participant disagrees with the terms or I

implementation of the program agreement. \

New Hampshire Professionals Health Program Contractor InltiBle/^'^'^^tl— j

SS-202e-ADMIN.SUPP-02 Page10of16 Date ^/^'^(Z U> [

New Hampshire Office of Professionat Licensure and Certification

Healthcare Professional Monitoring Program

FXHTRIT B - SCOPE OF SERVICE

3.2. Anotificatioa that any healthcare professionals seeking enrollment in the monitoring services,

that if the healthcare professionals holds a multi-state compact license under a multi-state

compact agreement, the healthcare professionals may be disqualified from a multi-state license

due to enrollment in the monitoring program.

4. Personnel-Related Criteria

4.1. The Contractor's program director shall:

4.1.1. Be a licensee in a profession regulated by any of the following New Hampshire boards:

4.1.1.1. Board of licensing for alcohol and other dmg use professionals;

4.1.1.2. Board of medicine;

4.1.1.3. Board of nursing;

4.1.1.4. Board of mental health practice; or

4.1.1.5. Board of psychology.

4.1.2. Carry professional liability coverage for the types of work to be done,

4.1.3. Fully disclose in writing any disciplinary action, including reprimand or restriction, taken

against them by any licensing, certifying, or credentialing agency or professional society

in any jurisdiction.

4.1.4. Have experience working with professionals in one or more of the professions to be

served by the Contractor regarding drug and alcohol issues, behavioral health impairment,

physical impairment, random testing, use and expertise with biologic specimen and

toxicology testing, and intervention, interviewing, and monitoring.

4.1.5. Adhere to applicable professional standards and ethical obligations at all times; and

4.1.6. Be accessible to participants at all reasonable times, wherein "reasonable" shall be

determined in relation to the participant's reason(s) for being subject to a program

agreement.

4.2. The Contractor shall have in place policies and practices that, at a minimum:

4.2.1. Do not allow the Contractor's program director or any treatment provider to be assigned

to a participant's case if there is any question of that individual's objectivity,

dependability, or commitment

4.2.2. Require program directors to verify that any treatment provider who is included in a T/M

plan meets the same standards as those established for program directors in 4.2.1.

New Hampshire Professionals Health Program Contractor Initials,^!^^^^^^

SS-2026-ADMiN-SUPP-02 Date

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

F.XHreiT B - SCOPE OF SERVICE

4.2.3. Disqualify an individual from serving as a program director or treatment provider for a

particular program agreement if any discipline was for conduct similar in nature to the

issues being monitored, if the discipline occurred within 5 years of the date the individual

would provide services to the participant under the treatment and monitoring program.

5. Establish a NKTB Path

5.1. The Contractor shall develop an NKTB path for individuals who wish to obtain guidance on, or

assistance with, treatment for an impairment or potential impairment without the knowledge of

the applicable board.

5.2. The Contractor shall ensure no records or reports relative to an NKTB participant's involvement

in a program agreement are provided to the applicable board by the Contractor or anyone

associated with the Contractor, except as provided in the program agreement pursuant to N.H.

Admin. R. Pic 503.06(c)(3) and in 5.3. below.

5.3. The Contractor shall ensure all applicable board are notified of an NKTB participant's

noncompliance with the terms of a program agreement only if the approved program determines

there is clear and convincing evidence that not notifying the board would jeopardize the health

and safety of the public.

6. General Requirements

6.1. At least once a year, the Contractor shall provide two (2) hours of continuing education

programs in New Hampshire to all eligible healthcare professionals concerning substance abuse

and wellness, at no cost to licensees.

6.2. On an annual basis, the Contractor shall make available information to eligible healthcare

professionals notifying them of the availability of the program, the dangers of substance abuse,

occupational stressors, and behavioral, mental and/or physical health issues that may impact

their ability to function at work.

6.3. The Contractor is responsible for all recordkeeping for healthcare professionals enrolled in the

program, as well as all other communications necessary to keep the Agency informed of the

referred healthcare professionals and the program.

6.4. The Contractor shall meet with the Executive Director, Director of Operations, Director of

Enforcement, and the Director of Licensing and Board Administration, on a quarterly basis, or

as requested, to discuss and assess progress towards performance measures, clinical quality and,

if necessary, administrative function.

New Hampshire Professionals Health Program Contractor lnltlal^^^l^^!!^!r~"

SS-2026-ADMIN-SUPP^)2 Data

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

EXHTBTT B - SCOPE OF SERVICE

6.5. The Contractor shall notify the Agency in writing, within 30 days of hire, when a new Medical

Director or Assistant Director is hired to work in the program. If the new hire is a licensed

physician in NH or any other state, notification from the licensee's state shall be obtained stating

that the professional's license is current and in good standing. If the health professional is not

licensed in NH, an application shall be completed and the license approved by the Agency prior

to the start of employment The Agency shall be provided with a resume from the newly hired

individual.

7. Performance Measures

7.1. The Contractor shall provide a quality improvement (QI) report with relapse statistics and

performance measures. This QI report shall be developed and submitted on a quarterly basis.

7.2. The Contractor shall provide the following:

7.2.1. The number of professionals receiving services, known and not known to the board.

7.2.1.1. Report shall be broken down by overall program and then by board.

7.2.1.2. The report shall identify treatment program type (e.g., mental or physical illness,

behavioral issues, etc.).

7.2.1.3. Total professionals' eligible number to determine percentage of licensees receiving

services shall be the number of licensees id^tified in the agency's annual report.

7.2.2. Number of newly enrolled professionals from the last reporting period.

7.2.2.1. The report shall identify, number of board referred professionals and self-referred

professionals.

7.2.22. Report shall be broken down by board.

7.2.2.3. Total professionals' eligible number to determine percentage of licensees enrolled

shall be the number of licensees identified in the agency's annual report.

7.2.3. Number of relapses and monitoring contract violations.

7.2.3.1. Report shall identify relapsed into addictive behavior versus other contract violations.

7.2.3.2. Report shall include total number of violations for the month and year to date.

7.2.3.3. Report shall identify the percentage of licensees with violations year to date, for the

overall program and by board.

7.2.3.4. Report shall identify the percentage of licensees with violations for the month, for the

overall program and by the board.

7.2.4. Number of missed monitoring activities by enrolled professionals.

7.2.4.1. Report shall be broken down by board referred and self-referred licensees, by board.

New Hampshire Professionals Health Program Contractor Initials^i^l^^^!!'^SS-2026-ADMIN-SUPP-02 Date

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

EXHIBIT B - SCOPE OF SERVICE

7.2.4.2. Report shall identify the percentage of missed monitoring activities with violations

year to date, for the overall program and by board.

7.2.4.3. Report shall identify the percentage of missed monitoring activities with violations for

the month, for the overall program and by the board.

7.2.5. Number of professionals that successfully completed the program.

7.2.5.1. Report shall be broken out by overall program and then by those referred by the board

and those that self-reported.

7.2.5.2. Report shall provide monthly, quarterly, and year to date success rate by overall

program and by board.

7.2.6. Number of closures (discharges/unsuccessful completions)

7.2.6.1. Report shall be broken out by overall program and then by those referred by the board

and those that self-reported.

7.2.6.2. Report shall provide monthly, quarterly, and year to date number of closures by overall

program and by board.

8. Reporting

8.1.1. The Contractor shall provide monthly reports to the Agency's Director of Operations,

separating participants by participating professions, containing the metrics listed in the

Performance Measures above, and any other mutually agreeable metrics,

8.1.2. The Contractor shall provide quarterly reports to the Agency's Executive Director and

Director of Operations, which will then be distributed to the applicable boards.

8.1.3. The Contractor shall submit a work plan/summary of activity reporting form on a

quarterly basis that accurately details activities, educational presentations, clinical

outcomes, and continuous quality improvement plans that monitor and evaluate the

Agency's progress towards achieved strategic goals.

New Hampshire Professionals Health Program

SS-2026-ADMIN-SUPP-02

Contractor Initials

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

F.XHIRTT r - MKTHOD OF PAYMENT

1. Contract Price

Professionals'

Health

Program

State Fiscal Year 2026 State Fiscal Year 2027 State Fiscal Year 2028

$119,260.00 $736,463.00 $760,617.00

1.1. The Agency shall pay the Contractor an amount up to and not to exceed the P-37, Block 1.8, [

Price Limitation for the services provided by the Contractor pursuant to Exhibit B, Scope of i

Services. •

1.2. This Agreement is fimded with 100% Agency Funds.

1.3. The Contractor agrees to provide the services in EXHIBIT B, Scope of Service in compliance

with funding requirements. Failure to meet the scope of services may jeopardize the

Contractor's funding.

2. Pricing Structure

2.1. Payment shall be made as described in the table below:

3. Invoicing

3.1. The Contractor shall submit an invoice in a form satisfactory to the State by the twentieth (20th)

working day of each month, which identifies and requests reimbursement for authorized

expenses incurred in the prior month. The Contractor shall:

3.1.1. Ensure each invoice is completed, dated, and returned to the Agency in order to initiate

payment.

3.1.2. Keep detailed records of activities related to contract services.

3.2. The State shall make payment to the Contractor within thirty (30) days of receipt of each

invoice, subsequent to approval of the submitted invoice and if sufficient funds are available.

3.3. The fmal invoice is due to the State no later than forty (40) days after the contract Form P-37,

Block 1.7 Completion Date.

3.4. In lieu of hard copies, all invoices may be electronically signed and emailed to

finance@oplc.nh.gov; hard copy invoices may be mailed to:

Director of Operations

Office of Prof^sional Licensure and Certification

7 Eagle Square

Concord, NH 03301

New Hampshire Professionals Health Program Contractor Inltials^/^'"^'^^

SS-2026-ADMIN-SUPP-02 Page15of16 Date

New Hampshire Office of Professional Licensure and Certification

Healthcare Professional Monitoring Program

F.yHTRIT C - METHOD OF PAYMENT

3.5. Payments may be withheld pending receipt of required reports or documentation as identified in

EXHIBIT B, Scope of Services and this EXHIBIT C.

New Hampshire Professionals Health Program

SS-2026-ADMIN-SUPP-02

Contractor Initialsnitials

Date

state of New Hampshire

Department of State

CERTIFICATE

I, David M. Scanlan, Secretary of State of the State of New Hampshire, do hereby certify that NEW HAMPSHIRE

PROFESSIONALS HEALTH PROGRAM is a New Hampshire Nonprofit Corporation registered to transact business in New

Hampshire on May 07, 2007.1 further certify that all fees and documents required by the Secretary of State's office have been

received and is in good standing as far as this office is concerned.

Business ID: 577394

Certificate Number: 0007201720

DA.

fe)

IN TESTIMONY WHEREOF,

I hereto set my hand and cause to be affixed

the Seal of the State of New Hampshire,

this 19th day of June A.D. 2025.

David M. Scanlan

Secretary of State

CERTIFICATE OF AUTHORITY

I, Pamela DiNapoli. PhD RN CNL hereby certify that:

1. I am a duly elected officer of New Hampshire Professionals Health Program (NHPHP)

2. The following is a true copy of an electronic vote taken by the NHPHP Board of

Directors, duly called and held on 2/18/2026, at which a quorum of the Directors

were

present and voting.

VOTED: That Mollv Rossignol. DO FASAM Medical Director is duly authorized on behalf of

NHPHP to enter into contracts or agreements with the State of New Hampshire and any of its

agencies or departments and further is authorized to execute any and all documents, agreements

and other instruments, and any amendments, revisions, or modifications thereto, which may in

his/her judgment be desirable or necessary to effect the purpose of this vote.

3. I hereby certify that said vote has not been amended or repealed and remains in full force

and effect as of the date of the contract/contract amendment to which this certificate is

attached. This authority remains valid for sixty (60) days from the date of this Certificate

of Authority. I further certify that it is understood that the State of New Hampshire will

rely on this certificate as evidence that the person(s) listed above currently occupy the

position(s) indicated and that they have full authority to bind the corporation. To the

extent that there are any limits on the authority of any listed individual to bind the

corporation in contracts with the State of New Hampshire, all such limitations are

expressly stated herein.

Dated:^®'^ Signature of Elected Officer:

Name: ParngK DiNamll! PhD RN

Title: President of NHPHP BOD

ACCORD CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES

BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on

this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Eaton & Berube Insurance Agency, Inc.

11 Concord St

Nashua NH 03064

SSme'^'^^ Debbie Rioux

F..1. 603-882-2766 wc. No): 603-886^230

AnnRFss- driouxOeatonberube.com

INSURER(S) AFFORDING COVERAGE NAIC#

INSURER A: Liberty Mutual Insurance Company 23043

INSURED NHPROFE-02

New Hampshire Professionals Health Program

125 Airport Road

Concord NH 03301

INSURER B: Travelers Casualty Insurance Company of America 19046

INSURER c: Sequoia Insurance Company

INSURER D:

INSURERE:

INSURER F:

COVERAGES CERTIFICATE NUMBER: 1243084965 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OE INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD

INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,

EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR

LTR TYPE OF INSURANCE

ADDL SUBR

INSD WVD POLICY NUMBER

POLICY EPF POLICY EXP

(MM/DD/yYYYI IMM/DDfYYYY) LIMITS

A X COMMERCIAL GENERAL LIABIUTY

CLAIMS-MADE OCCUR

BZS57426320 7/16/2025 7/15/2026 EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENl AGGREGATE LIMIT APPLIES PER:

I I LOOPOLICY □ PRO

JECT

GENERAL AGGREGATE

OTHER:

PRODUCTS - COMP/OP AGG

$1,000,000

$1,000,000

$15,000

$1,000,000

$2,000,000

$2,000,000

AUTOMOBILE LIABILITY

ANY AUTO

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

EACH OCCURRENCE

AGGREGATE

DED RETENTIONS

WORKERS COMPENSATION

AND EMPLOYERS'LIABILITY y/N

ANYPROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBEREXCLUDED?

(Mandatory in NH)

If yes, describe under

DESCRIPTION OF OPERATIONS below

H

QWS1481518 9/14/2025 9/14/2026 PER OTH-

STATUTE ER

E.L EACH ACCIDENT $1,000,000

E.L. DISEASE - EA EMPLOYEE $1,000,000

E.L. DISEASE - POLICY LIMIT $1,000,000

Directors & Officers

Liability

107147719 9/14/2025 9/14/2026 Limit

Retention

Continuity Date

$1,000,000

$5,000

09/14/2010

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)

New Hampshire Office of Professional Licensure and

Certification

7 Eagle Square

Concord NH 03301

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

/XCORD

MOLLROS-01

CERTIFICATE OF LIABILITY INSURANCE

DRIOUX

DATE (MM/DD/YYYY)

12/15/2025

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES

BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy{les) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on

this certificate does not confer riahts to the certificate holder In lieu of such endorsement(s).

PRODUCER

Eaton 8> Berube Insurance Agency, LLC.

11 Concord Street

Nashua, NH 03064

contact Deborah Rioux

PHONE FAX

(A/C, No, Ext): (A/C, No):

Appp^s- drioux@)eatonberube.com

INSURER(S) AFFORDING COVERAGE NAIC#

INSURER A Covervs

INSURED INSURER B

INSURER C

INSURER D

INSURER E

INSURER F

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD

INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUFiANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,

EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS

INSR

JJH. TYPE OF INSURANCE

ADDL

INSD

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE | | OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY LOG

OTHER:

AUTOMOBILE LIABIUTY

ANY AUTO

OWNED

AUTOS ONLY

AUT^ ONLY

UMBRELLA UAB

EXCESS UAB

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

OCCUR

CLAIMS-MADE

DED RETENTIONS

WORKERS COMPENSATION

AND EMPLOYERS' LIABIUTY Y/N

ANY PROPRIETOR/PARTNER/EXECUTIVE

" FICER/MEMBER EXCLUDED?

andatory In NH) '

es, describe under

SCRIPTION OF OPERATIONS below

Professional

Liability

SUBR

WVD POLICY NUMBER

002NH000037026

002NH000037026

POLICY EPF

IMM/DD/YYYYI

8/9/2025

8/9/2025

POLICY EXP

(MM/DD/YYYYl

8/9/2026

8/9/2026

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES ^Ea occurrence^

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

^Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY Di

(Per accident)

lAMAGE

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

E.L EACH ACCIDENT

E.L DISEASE ♦ EA EMPLOYEE

E.L DISEASE-POLICY LIMIT

Per Claim

Aggregate

1,000,000

3,000,000

DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remailfs Schedule, may be attached if more space Is required)

Occurrence

CERTIFICATE HOLDER CANCELLATION

State of NH Office of Professional LIcensure & Certification

7 Eagle Square, Suite 200

Concord, NH 03301

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

DEANNA E. JURIUS

Executive Director

State of New Hampshire

OFFICE OF PROFESSIONAL LICENSURE AND CERTIFICATION

Division of Licensing and Board Administration

7 Eagle Square, Concord, N.H. 03301-2412

Telephone 603-271-2152 ERICA E. LAMY

Director

December 15, 2025

This Letter is to certify that the licensure/certification/registration for the individual listed below

is a true and accurate report directly from the New Hampshire Office of Professional Licensure and

Certification database. This Letter of Verification further certifies that the undersigned is under the

guidance of the keeper of the records and duly certifies this information is accurate and complete as of

the date listed above. In order to expedite the processing of license verifications, this form letter has

been created and is used for all verifications requested from the New Hampshire Office of Professional

Licensure and Certification.

cLicense/Permit Holder Name

Profession

License Type

License/Certificate/Registration Number

IssueDate eilSUTe

Expiration Date

License/Certificate/Registration Status

Obtained By:

MOLLY E ROSSIGNOL

Medicine

Physician

Assional

'oottificationJune 30, 2026

Active

Conversion

OFfi

f American Board of Family Medicine, Inc.

Quality Health Care, Public Trust... Setting the Standards in Family Medicine

December 13, 2025

To Whom It May Concern:

This letter verifies Molly Rossignol, D.O. (NPI: 1780687145) is currently certified with the American

Board of Family Medicine (ABFM).

Family Medicine Certification

Current Status: ^ Meeting Requirements

Certification History:

Jul 09, 1999-Jul 26, 2006

Jul 27, 2006-Nov 13,2016

Nov 14, 2016 - * Certification Number: 1071591485

*Certification is continuous as long as Family Medicine Certification Requirements are maintained.

Clinical Status:

Clinical Status: Clinically Active

Clinical Status History:

Jun 28, 2018 - Clinically Active

Initial display of clinical status began June 2018 and history is only shown for certified periods.

Beginning in 2011 certification by the American Board of Family Medicine is maintained through

successful completion of the Family Medicine Certification process. The Family Medicine Certification

process is a continuous process that requires being in compliance with Guidelines for Professionalism

Licensure and Personal Conduct including maintaining a currently valid, full, and unrestricted license to

practice medicine in the United States or Canada, completing certification activities in a timely fashion,

and being current in meeting the Family Medicine Certification Examination requirement. Failure to

maintain any of these requirements will result in the loss of certification status with the ABFM. Based

upon the continuous nature of Family Medicine Certification, no end date for certification is presented

above.

Certification in Family Medicine was for a period of seven years. From 1970 through 2002, certification

was renewed by completion of requirements for Recertification. Each physician (Diplomate) fulfilled

these requirements by maintaining a medical license to practice medicine in the United States or Canada,

earning 300 hours of continuing medical education (CME), completing a computerized office record

review, and performing successfully on the recertification examination.

In 2003 family physicians who performed successfully on the Certification and Recertification

examinations began a gradual transition from Recertification to MC-FP. MC-FP was designed to

transition all Diplomates into the program by 2010, enrolling all physicians who certified or recertified as

they successfully passed the examination.

1648 McGrathiana Pkwy. Suite 550 • Lexington, KY 40511-1247 • Ph: 877-223-7437 • Fax: 859-335-7516 • theabfm.org

A Member Board of the American Board of Medical Specialties

OFR

uv^

American Board of Family Medicine, Inc.

Quality Health Care, Public Trust... Setting the Standards in Family Medicine

The ABFM website serves as primary source verification. Details of the Family Medicine Certification

process are available online at www.theabfm.org.

Sincerely,

Salena C. Nelson

Verifications Coordinator and Professionalism Coordinator

1648 McGrathiana Pkwy, Suite 550 • Lexington, KY 40511-1247 • Ph: 877-223-7437 • Fax; 859-335-7516 • theabfm.org

A Member Board of the American Board of Medical Specialties

NONPROFIT COVER SHEET

A. Entity Name: New Hampshire Professionals Health Program

B. Entity's Contact Information:

Person responsible for Accuracy and Completeness of information provided:

Name: Molly^Rossignol Title: Executive Medical Director NHPHP

Signature:;; MGllV Kossignoi

tture:

Additional Contact:

Name / Phone / Email: Sweezy/603-223-0990/psweezy@nhphp.org

C. List Board of Directors and Affiliations

Name (Identify any additional rolefs) in

Parentheses)

E.g., John Doe (President)

Pamela DINapoii, PhD RN

John Gallagher, MD

Briana Matuszko, JD

Jennifer Pitts

Tom Schell, DMD

Robert O'Donnel, LICSW

Affiliations

NH Nursing Association

retired

Nixon Peabody, LLP

Longwood Advisors

Private dentistry practice

DHMC Neurology Dept

D. List Key Personnel (Resumes should be attached for each key personnel listed)

Name Role Annual Salary Amount Paid From

This Contract

Molly Rossignol

Pam Sweezy

Kathleen Russo

Andrew Seefeld

Mary Behnke

Executive/Med Director

Program Manager

Clinical Case Manager

Assoc Medical Director

Nurse Advocate

250000

70000

70000

50000

28000

250000

70000

70000

50000

28000

Version 4.012/15/25

DISCLOSURE OF LEGAL ACTIVITIES INVOLVING THE STATE OF NEW

HAMPSHIRE OR ANOTHER GOVERNMENT ENTITY

E. Check one of the following:

1^1 The entity is not currently or has not been party to any legal proceeding involving the

State of New Hampshire (or any agency or subdivision thereof) or any other state/federal

government entity before any adjudicative body in any jurisdiction OR

I I The entity is or has been party to one or more legal proceedings as set forth above.

Identify the jurisdiction, court or other adjudicative body, case number, and briefly

describe the nature of the proceeding (Attached extra sheet if necessary).

CHARITABLE TRUSTS UNIT COMPLIANCE CERTIFICATION

F. Check one of the following (and attach applicable document):

1^1 is registered and in good standing with the New Hampshire Department of Justice

Charitable Trusts Unit (** see note below) or has submitted a complete application for

registration to the Charitable Trusts Unit and is awaiting a registration determination OR

I [ is not required to register with the Charitable Trusts Unit because it is neither tax-exempt

under section 501(c)(3) of the Internal Revenue Code nor engages in charitable

solicitations in the State of New Hampshire OR

n is exempt from registration with the Charitable Trusts Unit because it is a federal or stategovernment, agency, or subdivision or is a religious organization, an integrated auxiliary

of a religious organization, or is a convention or association of churches.

** Note: If registered with DOJ, attach screen shot from the Registered Charities List found at:

https://mm.nh.gov/files/uploads/doi/remote-docs/registered-charities.pdf

Version 4.0 12/15/25

FINANCIAL DISCLOSURES

G. Check one the following (and attach applicable financial documentation):

□ The organization hired an outside firm to audit its financial statements or to prepareGAAP-compliant financial statements for its most recently completed fiscal year. If so,

please ensure that the financial statements and audit results are attached. OR

1^1 The above does not apply, but the organization filed an IRS Form 990 or Form 990-EZ

for its most recently completed fiscal year. Please attach that IRS Form 990 or Form 990-

EZ to the submission. (Form 990 Schedule B is not required) OR

I I If neither of the above apply, complete the Income Statement and Balance Sheet below

with the following basic financial information from the organization's most recently

completed fi scal year:

1. INCOME STATEMENT

Revenue Expenses

Grants Compensation of

officers, directors,

Donations and key personnel

Program Other salaries &

Services wages

Revenue

Payroll taxes &

Interest & employee benefits

Dividends

Occupancy, rent.

All other utilities, and

Revenue insurance

Total Revenue Printing,

publications, postage,

office supplies, and IT

All other expenses

Total Expenses

Version 4.0 12/15/25

FINANCIAL DISCLOSURES rconU

2. BALANCE SHEET

Assets Liabilities

Cash & Equivalents Accounts Payable

Investments Loans Payable

Real Estate (less any

depreciation) All other liabilities

Other Property &

Equipment (less any

depreciation)

Total Liabilities

Fledges, grants,

accounts receivable

All other assets

Total Assets

Version 4.012/15/25

Caution: Forms printed from within Adobe Acrobat products may not meet IRS or state taxing agency

specifications. When using Acrobat, select the "Actual Size" in the Adobe "Print" dialog.

CLIENT'S COPY

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

WIPFLI

10000 Innovation Drive Wipfli Advisory LLC

Suite 250 A14 431 9300

Miiwaukee, Wl 53226 wipfli.com

October 27, 2025

New Hampshire Professionals

Health Program

125 Airport Road

Concord, NH 03301

Dear Dr. Rossignol,

Enclosed is the 2024 exempt organization return, as follows...

2024 Form 990

The enclosed Form 3115 should be signed by the appropriate filer.

Please review the return for completeness and accuracy.

We prepared the return from information you furnished us without verification. Upon examination of the

return by tax authorities, requests may be made for underlying data. We therefore recommend that you

preserve all records which you may be called upon to produce in connection with such possible

examinations.

We sincerely appreciate the opportunity to serve you. Please contact us if you have any questions

concerning the tax return.

Sincerely,

Sheila McNeil

Certified Public Accountant

"Wipfli" is the brand name under which Wipfli LLP and Wipfli Advisory LLC and its respective subsidiary entities provide professional services.

Wipfli LLP and Wipfli Advisory LLC (and its respective subsidiary entities) practice in an alternative practice structure in accordance with the

AiCPA Code of Professional Conduct and applicable law, regulations, and professional standards. Wipfli LLP is a licensed independent CPA

firm that provides attest services to its clients, and Wipfli Advisory LLC provides tax and business consulting services to its clients. Wipfli

Advisory LLC and its subsidiary entities are not licensed CPA firms.

***** THIS IS NOT A FILEABLE COPY *****

8879-TE

Department of the Treasury

Internal Revenue Service

IRS E-file Signature Authorization

for a Tax Exempt Entity

For calendar year 2024. or fiscal year beginning JUL 1, 2024. and ending JUN 30, 20 2 5

Do not send to the IRS. Keep for your records.

Go to vvww.irs.gov/Form8879TE for the latest information.

OMB No. 1645-0047

2024

Name of filer NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

EIN or SSN

20-8986771

Name and title of officer or person subject to tax DR. MOLLY ROSSIGNOL

MEDICAL DIRECTOR

j Part I I Type of Return and Return Information

Cfieck ttie box for ttie return for wfiicfi you are using tfiis Form 8879-TE and enter tfie applicable amount, if any, from ttie return. Form 8038-CP and

Form 5330 filers may enter dollars and cents. For all otfier forms, enter wfiole dollars only. If you cfieck ttie box on line 1a, 2a, 3a, 4a, 5a, 6a, 7a, 8a, 9a,

or 10a below, and the amount on that line for the return being filed with this form was blank, then leave line lb, 2b, 3b, 4b, 5b, 6b, 7b, 8b, 9b, or 10b,

whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more

than one line in Part 1.

la Form 990 check here b Total revenue, if any (Form 990, Part VIII, column (A), line 12) lb

2a Form 990-EZ check here u b Total revenue, if any (Form 990-EZ, line 9) 2b

3a Form 1120-POL check here u b Total tax (Form 1120-POL, line 22) 3b

4a Form 990-PF check here u b Tax based on Investment Income (Form 990-PF, Part V, line 5) 4b

5a Form 8868 check here 1 1 b Balance due (Form 8868, iine 3c) 5b

6a Form 990-T check here n b Total tax (Form 990-T, Part III, line 4) 8b

7a Form 4720 check here □ b Total tax (Form 4720, Part III, line 1) 7b

8a Form 5227 check here u b FMV of assets at end of tax year (Form 5227, Item D) 8b

9a Form 5330 check here 1 1 b Tax due (Form 5330, Part II, line 19) 9b

10a Form 8038-CP check here n b Amount of credit payment reauested (Form 8038-CP, Part III, line 22) 10b

Part II Declaration and Signature Authorization of Officer or Person Subject to Tax

836,715.

Under penalties of perjury, I declare that I X I I am an officer of the above entity or I I I am a person subject to tax with respect to (name

of entity), (EIN) and that I have examined a copy of the

2024 electronic return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are tme, correct, and

complete. I further declare that the amount in Part I above is the amount shown on the copy of the electronic return. I consent to allow my

intermediate service provider, transmitter, or electronic return originator (ERO) to send the return to the IRS and to receive from the IRS (a) an

acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date

of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit)

entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the

financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no

later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic

payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected a

personal identification number (PIN) as my signature for the electronic return and, if applicable, the consent to electronic funds withdrawal.

PIN; check one box only

fXI I authorize WIPFLI ADVISORY LLC to enter my PIN 13328

ERO firm name Enter five numbers, but

do not enter all zeros

as my signature on the tax year 2024 electronically filed return. If I have indicated within this return that a copy of the retum is being filed

with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN

on the return's disclosure consent screen.

1 I As an officer or person subject to tax with respect to the entity, I wiil enter my PIN as my signature on the tax year 2024 electronically filed

retum. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the

IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen.

Signature of officer or person subject to tax

P

**** THIS IS NOT A FILEABLE COPY **** Date

art III Certification and Authentication

02267554403

ERG'S EFIN/P1N. Enter your six-digit electronic filing identification

number (EFIN) followed by your five-digit self-selected PIN.

Do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature on the 2024 electronically filed retum indicated above. I confirm that I am

submitting this retum in accordance with the requirements of Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for

Business Returns.

Date 10/27/25ERD's signature SHEILA MCNEIL

ERO Must Retain This Form - See Instructions

Do Not Submit This Form to the IRS Unless Requested To Do So

For Privacy Act and Paperwork Reduction Act Notice, see instructions,

LHA 402521 12-26-24

15081027 147695 134597 202

Form 8879-TE (2024)

4.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Form 990

Department of the Treasury

Internal Revenue Service

Return of Organization Exempt From income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

Do not enter social security numbers on this form as it may be made public.

Go to www.irs.gov/Form990 for instructions and the latest information.

0MB No. 1545-0047

2024Open to Public

Inspection

A For the 2024 calendar year, or tax year beginning JUL 1, 2024 and ending JUN 30, 2025

B Check if

applicable:

□ Addresschange

□ Namechange

□ Initialreturn

□ Finalreturn/

termin

ated

□ Amendedreturn

□ Application

pending

C Name of organization

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Doing business as

D Employer identification number

20-8986771

Number and street (or P.O. box if mail is not delivered to street address)

125 AIRPORT ROAD

Room/suite E Telephone number

603-223-0990

City or town, state or province, country, and ZIP or foreign postal code

CONCORD, NH 03301

Q Gross receipts $ 836,715.

F Name and address of principal officer: DR.

SAME AS C ABOVE

MOLLY ROSSIGNOL

Tax-exempt status: I X I 501(ct(3t T I 501(c) ((insert no.) I I 4947(a)f1) or I 1527

H(a) Is this a group return

tor subordinates? I I Yes I X I No

H(b) Are all subordinates included? □y es I I No

If "No," attach a list. See instructions

WWW.NHPHP.ORG

K Form of oroanization' 1 X 1 Corporation | | Trust I I Association I I Other L Year of formation: 2007 M State of legal domicile: NH

Pati 1 Summary

Check this box I I if the organization discontinued its operations or disposed of more than 25% of its net assets.

1 Briefly describe the organization's mission or most significant activities: THE MISSION OF THE NEW HAMPSHIRE

PROFESSIONALS HEALTH PROGRAM (NHPHP) IS TO SERVE CONTRACTED

2

3

4

5

6

Number of voting members of the governing body (Part VI, line la)

Number of independent voting members of the governing body (Part VI, line 1 b)

Total number of individuals employed in calendar year 2024 (Part V, line 2a)

Total number of volunteers (estimate if necessary)

7 a Total unrelated business revenue from Part VIII, column (C), line 12

b Net unrelated business taxable income from Form 990-T. Part I, line 11

7a

7b

0.

0.

8 Contributions and grants (Part VIII, line 1 h)

9 Program service revenue (Part VIII, line 2g)

10 Investment income (Part VIII, column (A), lines 3, 4, and 7d)

11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and lie)

12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12)

Prior Year Current Year

823,360 817,996.

0.

16,982. 18,719.

0 0.

840.342, 836,715.

13 Grants and similar amounts paid (Part IX, column (A), lines 1-3)

14 Benefits paid to or for members (Part IX, column (A), line 4)

15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)

16a Professional fundraising fees (Part IX, column (A), line lie)

b Total fundraising expenses (Part IX, column (D), line 25) 0.

17 Other expenses (Part IX, column (A), lines 1 la-lid, 11 f-24e)

18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)

19 Revenue less expenses. Subtract line 18 from line 12

0. 9,064.

0. 0.

732,513. 652,947.

0. 0.

92,958. 72,143.

825,471. 734,154.

14,871. 102,561.

og Beginning of Current Year End of Year

20 Total assets (Part X, line 16)

21 Total liabilities (Part X, line 26)

22 Net assets or fund balances. Subtract line 21 from line 20

574,420. 750,194.

2,363. 8,921.

572,057. 741,273.

Part II Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is

true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign

Here

Signature of officer

DR. MOLLY ROSSIGNOL, MEDICAL DIRECTOR

Date

Type or print name and title

Preparer's name Preparer's signature Date Check 1 1if

self-emplove(3

PTIN

Paid SHEILA MCNEIL SHEILA MCNEIL 10/27/25 P01282590

Preparer

Use Only

Firm's name WIPFLI ADVISORY LLC Firm's EIN 39-3647910

Firm's address 43 CONSTITUTION DRIVE, SUITE 100

BEDFORD, NH 03110 Phone no. 603.627.3838

Mav the IRS discuss this return with the preparer shown above? See instructions I X I Yes I I No

LHA For Paperwork Reduction Act Notice, see the separate instructions. 432001 12-10-24 Form 990 (2024)

SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION

Form 990 (2024)

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Paqe2

art 111 Statement of Program Service Accomplishments

Check if Schedule 0 contains a response or note to any line in this Part III I X I

Briefly describe the organization's mission;

THE MISSION OF THE NEW HAMPSHIRE PROFESSIONALS HEALTH PROGRAM (NHPHP)

IS TO SERVE CONTRACTED PROFESSIONAL HEALTHCARE BOARDS IN THE

EVALUATION AND DETERMINATION OF TREATMENT RECOMMENDATIONS AND

MONITORING FOR INDIVIDUAL HEALTHCARE PROFESSIONALS WHO HAVE OR MAY

Did the organization undertake any significant program services during the year which were not listed on the

prior Form 990 or 990-EZ? I X I Yes I I No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? I I Yes I X I No

If "Yes," describe these changes on Schedule O.

Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.

Section 501 (c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and

revenue, if any, for each program service reported.

4a (code:) (Expenses 3 444,132. including grants of $ 9,064.) (r avenue $ 0-)

THE ORGANIZATION ASSISTED HEALTH CARE PROFESSIONALS WHO WERE AT RISK OR

AFFECTED BY SUBSTANCE USE DISORDERS, BEHAVIORAL/MENTAL HEALTH

CONDITIONS, OR OTHER ISSUES IMPACTING THEIR HEALTH AND WELL-BEING. THE

PROGRAM INVOLVED ASSESSMENT FOLLOWED WHEN APPROPRIATE BY CONTRACTED

TREATMENT AND MONITORING. SERVICES WERE AVAILABLE TO ALL LICENSED

MEDICAL PROFESSIONALS AND RESIDENTS OF THE FOLLOWING PROFESSIONS WHO

PRACTICE IN NH OR SEEK LICENSURE IN NH REGARDLESS OF THEIR LOCATION:

CHIROPRACTORS, DENTISTS, DIETICIANS, LICENSED ALCOHOL AND DRUG

COUNSELORS, MENTAL HEALTH PRACTITIONERS, MIDWIVES, NURSE LICENSEES,

OPTOMETRISTS, PHARMACISTS, PHYSICIANS, PHYSICIAN ASSISTANTS,

PODIATRISTS, PSYCHOLOGISTS AND VETERINARIANS.

4b (Code:) (Expenses $ _ Including grants of $) (Revenue $ ^

4C (Code;) (Expenses $ including grants of $) (R«'

4d Other program services (Describe on Schedule O.)

(Expenses $ including grants of $ (Revenue $

4e Total program service expenses 444,132.

Form 990 (2024)

432002 12-10-24

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Form 990 (2024)

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Paqe3

art iV Checklist of Required Schedules

1 Is the organization described in section 501 (c)(3) or 4947(a)(1) (other than a private foundation)?

If "Yes," complete Schedule A

2 is the organization required to complete Schedule B, Schedule of Contributors'^ See instructions

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for

public office? If "Yes," complete Schedule C, Part I

4 Section 501(cK3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect

during the tax year? if "Yes," complete Schedule C, Part II

5 is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or

similar amounts as defined in Rev. Proc. 98-19? if "Yes," complete Schedule 0, Part III

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to

provide advice on the distribution or investment of amounts in such funds or accounts? if "Yes," complete Schedule D, Part I

7 Did the organization receive or hold a conservation easement, including easements to preserve open space,

the environment, historic land areas, or historic structures? if "Yes," complete Schedule D, Part II

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? if "Yes," complete

Schedule D, Part III

9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for

amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?

If "Yes," complete Schedule D, Part IV

10 Did the organization, directly or through a related organization, hold assets in donor-restricted endowments

or in quasi-endowments? if "Yes," complete Schedule D, Part V

11 If the organization's answer to any of the following questions is 'Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X,

as applicable.

a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? if "Yes," complete Schedule D,

Part VI

b Did the organization report an amount for investments - other securities in Part X, line 12, that is 5% or more of its total

assets reported in Part X, line 16? if "Yes," complete Schedule D, Part VII

c Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total

assets reported in Part X, line 16? if "Yes," complete Schedule D, Part VIII

d Did the organization report an amount for other assets in Part X, line 15, that is 5% or more of its total assets reported in

Part X, line 16? if "Yes," complete Schedule D, Part IX

e Did the organization report an amount for other liabilities in Part X, line 25? if "Yes," complete Schedule D, Part X

f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? if "Yes," complete Schedule D, Part X

12a Did the organization obtain separate, independent audited financial statements for the tax year? if "Yes," complete

Schedule D, Parts XI and XII

b Was the organization included in consolidated, independent audited financial statements for the tax year?

If" Yes," and If the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII Is optional

Is the organization a school described in section 170(b)(1)(A)(ii)? if "Yes," complete Schedule E

Did the organization maintain an office, employees, or agents outside of the United States?

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,

investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000

or more? if "Yes," complete Schedule F, Parts I and IV

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any

foreign organization? if "Yes." complete Schedule F, Parts II and IV

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to

or for foreign individuals? if "Yes," complete Schedule F, Parts III and IV

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,

column (A), lines 6 and 11 e? if "Yes," complete Schedule G. Part I. See instructions

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines

1 c and 8a? if "Yes," complete Schedule G, Part II

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? if "Yes,"

complete Schedule G. Part III

Did the organization operate one or more hospital facilities? if "Yes," complete Schedule H

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this retum?

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or

domestic government on Part IX, column (A), line 1 ? /f "Yes." complete Schedule I. Parts I and II

13

14a

b

15

16

17

18

19

20a

b

21

Yes No

1 X

2 X

3 X

4 X

5 X

6 X

7 X

8 X

9 X

10 X

11a X

lib X

11c X

lid X

lie X

11f X

12a X

12b X

13 X

14a X

14b X

15 X

16 X

17 X

18 X

19 X

20a X

20b

21 X

432003 12-10-24

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Form 990 (2024)

3

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Form 990 (2024) HEALTH PROGRAM

[ Part IVI Checklist of Required Schedules (continued) ~

20-8986771 Paqe4

22

23

26

27

28

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on

Part IX, column (A), line 2? if "Yes," complete Schedule I, Parts I and III

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization's current

and former officers, directors, trustees, key employees, and highest compensated employees? if "Ves," complete

Scheduled

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the

last day of the year, that was issued after December 31, 2002? if "Yes," answer lines 24b through 24d and complete

Schedule K. If "No." go to line 25a

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

any tax-exempt bonds?

d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?

25a Section 501(cM3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit

transaction with a disqualified person during the year? if "Yes," complete Schedule L, Part I

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and

that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? if "Yes," complete

Schedule L, Part I

Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current

or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35%

controlled entity or family member of any of these persons? if "Yes," complete Schedule L, Part II

Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee,

creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled

entity (including an employee thereof) or family member of any of these persons? if "Yes," complete Schedule L, Part III

Was the organization a party to a business transaction with one of the following parties? (See the Schedule L, Part IV,

instructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? if

"Yes," complete Schedule L, Part IV

b A family member of any individual described in line 28a? if "Yes," complete Schedule L, Part IV

c A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? if

"Yes," complete Schedule L, Part IV

Did the organization receive more than $25,000 in noncash contributions? if "Yes," complete Schedule M

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation

contributions? if "Yes," complete Schedule M

Did the organization liquidate, terminate, or dissolve and cease operations? if "Yes," complete Schedule N, Part I

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? if "Ves," complete

Schedule N, Part II

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301.7701-2 and 301.7701-3? if "Yes," complete Schedule R, Part I

Was the organization related to any tax-exempt or taxable entity? if "Yes," complete Schedule R, Part II, III, or IV, and

Part V, line 1

35a Did the organization have a controlled entity within the meaning of section 512(b)(13)?

b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity

within the meaning of section 512(b)(13)? if "Yes," complete Schedule R. Part V, line 2

Section 501(cM3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?

If "Yes," complete Schedule R, Part V, line 2

Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is treated as a partnership for federal income tax purposes? if "Yes," complete Schedule R, Part W

Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines lib and 19?

Note: All Form 990 filers are required to complete Schedule O

[Part yi Statements Regarding Other IRS Filings and Tax Compliance

29

30

31

32

33

34

36

37

38

22

23

24a

24b

24c

24d

25a

25b

26

27

28a

28b

28c

29

30

31

32

33

34

35a

35b

36

37

38

Yes No

X

X

X

X

X

X

Yes No

1 a Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable 1a 8 s

1

b Enter the number of Forms W-2G included on line la. Enter -0- if not applicable 1b 0 1c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

(gambling) winnings to prize winners? 1c X

432004 12-10-24 Form 990 (2024)

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Form 990 (2024)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 PaqeS

Part V Statements Regarding Other IRS Filings and Tax Compliance (continued)

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,

filed for the calendar year ending with or within the year covered by this return 2a

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

3a Did the organization have unrelated business gross income of $1,000 or more during the year?

b If "Yes," has it filed a Form 990-T for this year? if "/Vo" to line 3b, provide an explanation on Schedule O

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a

financial account in a foreign country (such as a bank account, securities account, or other financial account)?

b If "Yes," enter the name of the foreign country

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

0 If "Yes" to line 5a or 5b, did the organization file Form 8886-T?

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit

any contributions that were not tax deductible as charitable contributions?

b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts

were not tax deductible?

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?

b If "Yes," did the organization notify the donor of the value of the goods or services provided?

c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required

to file Form 8282?

If "Yes," indicate the number of Forms 8282 filed during the year I 7d Id

e

f

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

9 If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?.

h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the

sponsoring organization have excess business holdings at any time during the year?

9 Sponsoring organizations maintaining donor advised funds.

a Did the sponsoring organization make any taxable distributions under section 4966?

b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?

10 Section 501(c)(7) organizations. Enter;

a Initiation fees and capital contributions included on Part VIII, line 12 10a

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 10b

11 Section 501(cK12) organizations. Enter:

a Gross income from members or shareholders 11a

b Gross income from other sources. (Do not net amounts due or paid to other sources against

amounts due or received from them.) lib

12a Section 4947(aM1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041 ?

b If "Yes," enter the amount of tax-exempt interest received or accrued during the year I 12b I

13 Section 501(cH29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state?

Note: See the instructions for additional information the organization must report on Schedule O.

b Enter the amount of reserves the organization is required to maintain by the states in which the

organization is licensed to issue qualified health plans 13b

c Enter the amount of reserves on hand 13c

14a Did the organization receive any payments for indoor tanning services during the tax year?

b If "Yes," has it filed a Form 720 to report these payments? if "No," provide an explanation on Schedule O

15 Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment(s) during the year?

If "Yes," see the instructions and file Form 4720, Schedule N.

16 Is the organization an educational institution subject to the section 4968 excise tax on net investment income?

If "Yes," complete Form 4720, Schedule O.

17 Section 501(cK21) organizations. Did the trust, or any disqualified or other person engage in any activities

that would result in the imposition of an excise tax under section 4951, 4952 or 4953?

If "Yes," complete Form 6069.

2b

3a

3b

4a

5a

5b

5c

6a

6b

7a

7b

7c

7e

7f

la.

7h

9a

9b

12a

13a

14a

14b

15

16

17

Yes No

X

X

X

X

X

432005 12-10-24

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Form 990 (2024)

5

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 990 (2024)

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Paae6

art VI Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response

to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI I X I

Section A. Governing Body and Management

Yes No

la Enter the number of voting members of the governing body at the end of the tax year la 8

If there are material differences in voting rights among members of the governing body, or If the governing

body delegated broad authority to an executive committee or similar committee, explain on Schedule 0.

b Enter the number of voting members included on line 1 a, above, who are independent lb 8 1

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other f"

officer, director, trustee, or key employee? 2 X

3 Did the organization delegate control over management duties customarily performed by or under the direct supervision

of officers, directors, trustees, or key employees to a management company or other person? 3 X

4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 4 X

5 Did the organization become aware during the year of a significant diversion of the organization's assets? 5 X

6 Did the organization have members or stockholders? 6 X

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or

more members of the goveming body? 7a X

b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or

persons other than the goveming body? 7b X

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

a The goveming body? 8a X

b Each committee with authority to act on behalf of the governing body? 8b X

9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the

organization's mailing address? if "Yes." provide the names and addresses on Schedule O 9 X

Section B. Policies (This Section B requests Information about policies not required bv the Internal Revenue Code.)

13

14

15

10a Did the organization have locai chapters, branches, or affiliates?

b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,

and branches to ensure their operations are consistent with the organization's exempt purposes?

11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

b Describe on Schedule O the process, if any, used by the organization to review this Form 990.

12a Did the organization have a written conflict of interest policy? if "No," go to line 13

b Were officers, directors, or trustees, and key employees required to disclose annually Interests that could give rise to conflicts?

c Did the organization regularly and consistently monitor and enforce compliance with the policy? if "/es," describe

on Schedule O how this was done

Did the organization have a written whistleblower policy?

Did the organization have a written document retention and destruction policy?

Did the process for determining compensation of the following persons include a review and approval by independent

persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization's CEO, Executive Director, or top management official

b Other officers or key employees of the organization

If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.

16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a

taxable entity during the year?

b If "Yes,' did the organization follow a written policy or procedure requiring the organization to evaluate its participation

in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's

exempt status with respect to such arrangements?

10a

10b

11a

12a

12b

12c

13

14

15a

15b

16a

16b

Yes

X

X

No

X

Section C. Disclosure

17

18

List the states with which a copy of this Form 990 is required to be filed NH

Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable). 990, and 990-T (section 501(c)(3)s only) available

for public inspection. Indicate how you made these available. Check all that apply.

I I Own website I X I Another's website I X I Upon request I I Other (explain on Schedule O)

Describe on Schedule O whether (and if so, how) the organization made its goveming documents, conflict of interest policy, and financial

statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records

ULTRAPRECISE BOOKKEEPING - 315-920-7930

5001 ALEXIS DRIVE, LIVERPOOL, NY 13090

432006 12-10-24

19

20

Form 990 (202

6

4)

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Form 990 (2024)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Page?

Part VH] Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated

Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line in this Part VII I I

Section A. Officers, Directors. Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.

• List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.

Enter -0- in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization's current key employees, if any. See the instructions for definition of "key employee."

• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-IVIISC, and/or box 1 of Form 1099-NEC) of more than

$100,000 from the organization and any related organizations.

• List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of

reportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization,

more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.

(A)

Name and title

(B)

Average

hours per

week

(list any

hours for

related

organizations

below

line)

(C)

Position

(do not check more than one

box, unless person is both an

officer and a director/trustee)

(D)

Reportable

compensation

from

the

organization

(W-2/1099-MISC/

1099-NEC)

(E)

Reportable

compensation

from related

organizations

(W-2/1099-MISC/

1099-NEG)

(F)

Estimated

amount of

other

compensation

from the

organization

and related

organizations

liKiividual trustee rodirotcerInstitutiona ltrustee

o

Key employeeHi tsehgdetasnepmocemployeeE

(1) MOLLY ROSSIGNOL

MEDICAL DIRECTOR

40.00

X 275,085. 0. 44,397.

(2) PAMELA DINAPOLI

PRESIDENT

0.30

X X 0. 0. 0.

(3) ROBERT GREENE

TREASURER

0.30

X X 0. 0. 0.

(4) SARAH PROCTOR

SECRETARY

0.30

X X 0. 0. 0.

(5) JOHN GALLAGHER

DIRECTOR

0.30

X 0. 0. 0.

(6) SKIP JENKYN

DIRECTOR

0.30

X 0. 0. 0.

(7) BRIANA MATUSZKO

DIRECTOR

0.30

X 0. 0. 0.

(8) JENNIFER PITTS

DIRECTOR

0.30

X 0. 0. 0.

(9) TOM SCHELL

DIRECTOR

0.30

X 0. 0. 0.

432007 12-10-24 Form 990 (2024)

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 990 (2024)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 PageS

(A)

Name and title

(B)

Average

hours per

week

(list any

hours for

related

organizations

below

line)

(C)

Position

(do not check more than one

box, unless person is both an

officer and a director/trustee)

(D)

Reportable

compensation

from

the

organization

(W-2/1099-MISC/

1099-NEC)

(E)

Reportable

compensation

from related

organizations

(W-2/1099-MISC/

1099-NEC)

(F)

Estimated

amount of

other

compensation

from the

organization

and related

organizations

Individual trustee rodirectorInstitutional trusteeOfficer

Key employeeHi tsettgdetasnepmocemployeeFormer

lb Subtotal 275,085. 0. 44,397.

c Total from continuation sheets to Part VII

d Total (add lines 1b and 1c)

Section A 0. 0. 0.

275,085. 0. 44,397.

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable

Yes No

3 Did the organization list any former officer, director, trustee, key employee, or highest compensated employee on

line 1 a? if" Yes," complete Schedule J for such individual 3 "x '

4 For any individual listed on line la, is the sum of reportable compensation and other compensation from the organization

and related organizations greater than $150,000? if "Yes " complete Schedule J for such Individual 4 X:■ ■ ■■

5 Did any person listed on line la receive or accrue compensation from any unrelated organization or individual for services

rendered to the organization? if "Yes." cnmnlete Schedule J for such oerson

i-., /

5

1X

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from

(A)

Name and business address NONE

(B)

Description of services

(C)

Compensation

2 Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 of compensation from the organization 0

Form 990 (2024)

432008 12-10-24

8

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Form 990 (2024)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Page9

Part VIII Statement of Revenue

V) (/I

II

® iu<

b:=

F3

■=d

O c

U B

g>

o

■>

« c

ESn 01

orOC

o

Check if Schedule O contains a response or note to any line in this Part VIII

(A)

1 a

b

c

d

e

f

g

h

Federated campaigns

Membership dues

Fundraising events

Related organizations

Government grants (contributions)

All other contributions, gifts, grants, and

similar amounts not included above

Noncash confributions included in lines la-If

Total. Add lines 1a-1t

1a

lb

1c

Id

1e

If

la

806,856.

11,140.

2 a

b

c

d

All other program service revenue

Total. Add lines 2a-2t

Business Code

4

5

6 a

c

d

7 a

Investment income (including dividends, interest, and

other similar amounts)

Income from investment ot tax-exempt bond proceeds

Royalties

d

8 a

b

0

9 a

b

c

10 a

b

c

Gross rents

Less: rental expenses

Rental income or (loss)

Net rental income or (loss)

Gross amount from sales ot

assets other than inventory

Less: cost or other basis

and sales expenses

Gain or (loss)

Net gain or (loss)

6a

6b

6c

(i) Real (ii) Personal

7a

7b

7c

(i) Securities (ii) Other

Gross income from fundraising events (not

including $ ot

contributions reported on line 1c). See

Part IV, line 18 8a

Less: direct expenses 18b

Net income or (loss) from fundraising events

Gross income from gaming activities. See

Part IV, line 19 9a

Less: direct expenses

Net income or (loss) from gaming activities

Gross sales ot inventory, less returns

and allowances 10a

Less: cost ot goods sold [lOb

Net income or (loss) from sales ot inventory

Total revenue

817,996,

18,719.

(B)

Related or exempt

function revenue

(C)

Unrelated

business revenue

m.

(D)

Revenue excluded

from tax under

sections 512 - 514

18,719.

v>

3

ii0) S

Sa

11 a

All other revenue

Total. Add lines 1 la-lid

Business Code

12 Total revenue. See instructions 836,715. 0. 0. 18,719.

432009 12-10-24

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Form 990 (2024)

9

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 990 (2024)

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 PaaelO

art IXI Statement of Functional Expenses

Section 501 (c)(3) and 501(c)(4) orpanizations must complete all columns. All other organizations must complete column (A).

Do not include amounts reported on lines 6b,

7b, 8b, 9b, and 10b of Part Vill.

(A)

Total expenses

(B)

Program service

expenses

(C)

Management and

general expenses

Fundraisingexpenses

1 Grants and other assistance to domestic organizations

and domestic governments. See Part IV, line 21

2 Grants and other assistance to domestic

individuals. See Part IV, line 22 9,064. 9,064.

3 Grants and other assistance to foreign

organizations, foreign governments, and foreign

individuals. See Part IV, lines 15 and 16

■ p

1

4 Benefits paid to or for members k

5 Compensation of current officers, directors,

trustees, and key employees 329,830. 230,881. 98,949.

6 Compensation not included above to disqualified

persons (as defined under section 4958(f)(1)) and

persons described in section 4958(c)(3)(B)

7 Other salaries and wages 255,380. 151,751. 103,629.

8 Pension plan accruals and contributions (include

section 401(k) and 403(b) employer contributions)

9 Other employee benefits

12,544. 8,154. 4,390.

20,502. 13,327. 7,175.

10 Payroll taxes 34,691. 22,551. 12,140.

11 Fees for services (nonemployees):

a Management

b Legal

0 Accounting 7,000. 7,000.

d Lobbying

e Professional fundraising services. See Part IV, line 17

f Investment management fees

- ■

g Other. (If line 11g amount exceeds 10% of line 25,

column (A), amount, list line 11g expenses on Sch 0.)

12 Advertising and promotion

11,717. 8,273. 3,444.

2,169. 2,169.

13 Office expenses 8,123. 8,123.

14 Information technology 7,708. 7,708.

15 Royalties

16 Occupancy 9,919. 9,919.

17 Travel 1,602. 1,602.

18 Payments of travel or entertainment expenses

for any federal, state, or local public officials

19 Conferences, conventions, and meetings 1,919. 1,919.

20 Interest

21 Payments to affiliates

22 Depreciation, depletion, and amortization 462. 462.

23 Insurance 17,828. 17,828.

24 Other expenses. Itemize expenses not covered

above. (List miscellaneous expenses on line 24e. If

line 24e amount exceeds 10% of line 25, column (A),

amount, list line 24e expenses on Schedule 0.)

a CONTINUING EDUCATION

M3,243. 3,243.

b OTHER 322. 322.

c DRUG TESTING 131. 131.

d

e All other expenses

25 Total functional exoenses. Add lines 1 through 24e 734,154. 444,132. 290,022. 0.

26 Joint costs. Complete this line only if the organization

reported in column (B) joint costs from a combined

educational campaign and fundraising solicitation.

Check here | | ir following sop 98-2(ASC958-720)

432010 12-10-24

15081027 147695 134597

10

2024.

Form 990 (2024)

04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 990 (2024)

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Paae11

art X Balance Sheet

Check if Schedule 0 contains a response or note to any line in this Part X

(A)

Beginning of year

(B)

End of year

7

8

9

10a

11

12

13

14

15

16

Cash - non-interest-bearing

Savings and temporary cash investments

Pledges and grants receivable, net

Accounts receivable, net

Loans and other receivables from any current or former officer, director,

trustee, key employee, creator or founder, substantial contributor, or 35%

controlled entity or family member of any of these persons

Loans and other receivables from other disqualified persons (as defined

under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)

Notes and loans receivable, net

Inventories for sale or use

Prepaid expenses and deferred charges

Land, buildings, and equipment: cost or other

basis. Complete Part VI of Schedule D

Less: accumulated depreciation

Investments - publicly traded securities

Investments - other securities. See Part IV, line 11

Investments - program-related. See Part IV, line 11

Intangible assets

Other assets. See Part IV, line 11

10a

10b

2,6

1,7

573,103.

28.

73, 1,317. 10c

11

12

13

14

15

Total assets. Add lines 1 through 15 (must equal line 33) 574,420. 16

676,412.

67,238.

5,689.

855.

750,194.

17

18

19

20

21

22

23

24

25

26

Accounts payable and accrued expenses

Grants payable

Deferred revenue

Tax-exempt bond liabilities

Escrow or custodial account liability. Complete Part IV of Schedule D

Loans and other payables to any current or former officer, director,

trustee, key employee, creator or founder, substantial contributor, or 35%

controlled entity or family member of any of these persons

Secured mortgages and notes payable to unrelated third parties

Unsecured notes and loans payable to unrelated third parties

Other liabilities (including federal income tax, payables to related third

parties, and other liabilities not included on lines 17-24). Complete Part X

of Schedule D

Total liabilities. Add lines 17 through 25

2,363. 17

18

19

20

21

22

23

24

25

2,363. 26

8,921.

8,921.

27

28

29

30

31

32

33

Organizations that follow FASB ASC 958, check here I I

and complete lines 27, 28, 32, and 33.

Net assets without donor restrictions

Net assets with donor restrictions

Organizations that do not follow FASB ASC 958, check here

and complete lines 29 through 33.

Capital stock or trust principal, or current funds

Paid-in or capital surplus, or land, building, or equipment fund

Retained eamings, endowment, accumulated income, or other funds

Total net assets or fund balances

Total liabilities and net assets/fund balances

27

28

m

0. 29

0. 30

572,057. 31

572,057. 32

574,420. 33

0.

0.

741,273.

741,273.

750,194.

Form 990 (2024)

432011 12-10-24

15081027 147695 134597

11

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 990 (2024)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

I Part XII Reconciliation of Net Assets

20-8986771 Paae12

HL

1 Total revenue (must equal Part VIII, column (A), line 12) 1 836,715.

2 Total expenses (must equal Part IX, column (A), line 25) 2 734,154.

3 Revenue less expenses. Subtract line 2 from line 1 3 102,561.

4 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) 4 572,057.

5 Net unrealized gains (losses) on investments... 5

6 Donated sen/ices and use of facilities 6

7 Investment expenses 7

8 Prior period adjustments 8

9 Other changes in net assets or fund balances (explain on Schedule 0) 9 66,655.

10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32,

column (B)) 10 741,273.

1 Part XII Financial Statements and Reporting

□Check if Schedule O contains a response or note to any line in this Part XII

1 Accounting method used to prepare the Form 990: I I Cash I X I Accrual I I Other

2a

3a

If the organization changed its method of accounting from a prior year or checked "Other," explain on Schedule O.

Were the organization's financial statements compiled or reviewed by an independent accountant?

If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a

separate basis, consolidated basis, or both:

I I Separate basis I I Consolidated basis I I Both consolidated and separate basis

Were the organization's financial statements audited by an independent accountant?

If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,

consolidated basis, or both:

I I Separate basis I I Consolidated basis I I Both consolidated and separate basis

If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,

review, or compilation of its financial statements and selection of an independent accountant?

If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the

Uniform Guidance, 2 C.F.R. Part 200, Subpart F?

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit

or audits, explain why on Schedule O and describe any steps taken to undergo such audits

2a

2b

3a

3b

Yes No

Form 990 (2024)

432012 12-10-24

15081027 147695 134597

12

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

SCHEDULE A

(Form 990)

Department of the Treasury

Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ.

Go to www.irs.gov/Form990 for instructions and the latest information.

0MB No. 1545-0047

2024Open to Public

Inspection

Name of the organization NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Part 1 Reason for Public Charity Status. (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

1 I I A church, convention of churches, or association of churches described in section 170(bK1KA)(i).

2 I I A school described in section 170(b)(1MA)(ii). (Attach Schedule E (Form 990).)

3 I I A hospital or a cooperative hospital service organization described in section 170(bH1)(A)(iii).

4 I I A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,

city, and state:

10

11

12

□

□

m

□

□

□

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(AHiv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b){1)(A){v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(bM1KAHvi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in section 170(b)(1)(AKix) operated in conjunction with a land-grant college

or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or

university:

□

□

An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from

activities related to its exempt functions, subject to certain exceptions; and (2) no more than 33 1/3% of its support from gross investment

income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.

See section 509(aX2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(aK4).

/\n organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or

more publicly supported organizations described in section 509(aK1) or section 509(a)(2). See section 509(a)(3). Check the box on

lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

I I Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving

the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting

organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having

control or management of the supporting organization vested in the same persons that control or manage the supported

organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with,

its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s)

that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness

requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III

functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations

□

□

□

□

(i) Name of supported

organization

(ii) EIN (ill) Type of organization

(described on iines 1-10

above (see instructions)!

(iv) Is the organization listed

in your governing document? (v) Amount of monetary

support (see instructions)

(vi) Amount of other

support (see instructions)Yes No

Total

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 432021 01-14-25 Schedule A (Form 990) 2024

Schedule A (Form 990) 2024

P S

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 Page 2

art II upport Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization

fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)

1 Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants.")

(a) 2020 (b) 2021 (c) 2022 (d) 2023 (e) 2024 m Total

517,345. 792,362. 833,576. 823,360. 817,996. 3784639.

2 Tax revenues levied for the organ

ization's benefit and either paid to

or expended on its behalf

3 The value of services or facilities

furnished by a governmental unit to

the organization without charge

4 Total. Add lines 1 through 3 517,345. 792,362. 833,576. 823,360. 817,996. 3784639.

5 The portion of total contributions

by each person (other than a

govemmental unit or publicly

supported organization) included

on line 1 that exceeds 2% of the

amount shown on line 11,

column (f) 16 Public support. Subtract line 5 from line 4. 1 3784639.

Section B. Total Support

(a) 2020 (b) 2021 (c) 2022 (d) 2023 le) 2024 (f) Total

517,345. 792,362. 833,576. 823,360. 817,996. 3784639.

1,033. 16,982. 18,719. 36,734.

3821373.

etc. (see instructions) 12

Calendar year (or fiscal year beginning in)

10

11

12

13

Amounts from line 4

Gross income from interest,

dividends, payments received on

securities loans, rents, royalties,

and income from similar sources

Net income from unrelated business

activities, whether or not the

business is regularly carried on

Other income. Do not include gain

or loss from the sale of capital

assets (Explain in Part Vl.)

Total support Add lines 7 through 10

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3)

organization, check this box and stop here

Section C. Computation of Public Support Percentage

14

15

99.04

99.41

14 Public support percentage for 2024 (line 6, column (f), divided by line 11, column (f))

15 Public support percentage from 2023 Schedule A, Part II, line 14

16a 33 1/3% support test - 2024. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and

stop here. The organization qualifies as a publicly supported organization I X I

b 33 1/3% support test - 2023. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box

and stop here. The organization qualifies as a pubiicly supported organization I I

17a 10% -facts-and-circumstances test - 2024. If the organization did not check a box on line 13,16a, or 16b, and line 14 is 10% or more,

and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain in Part VI how the organization

meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization I I

b 10% -facts-and-circumstances test - 2023. If the organization did not check a box on line 13,16a, 16b, or 17a, and line 15 is 10% or

more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Expiain in Part VI how the

organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization I I

18 Private foundation. If the organization did not check a box on line 13,16a. 16b, 17a, or 17b, check this box and see instructions n

Schedule A (Form 990) 2024

432022 01-14-25

15081027 147695 134597

14

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Schedule A (Form 990) 2024

NEW HAMPSHIRE PROFESSIONALS. HEALTH PROGRAM ^ 20-8986771

Part 111 Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only If you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to

qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Page 3

Calendar year (or fiscal year beginning In)

1 Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants.")

(a) 2020 (b) 2021 (c) 2022 (d) 2023 (e) 2024 (f) Total

2 Gross receipts from admissions,

merchandise sold or services per

formed, or facilities furnished in

any activity that is related to the

organization's tax-exempt purpose

3 Gross receipts from activities that

are not an unrelated trade or bus

iness under section 513

4 Tax revenues levied for the organ

ization's benefit and either paid to

or expended on its behalf

5 The value of services or facilities

furnished by a governmental unit to

the organization without charge

6 Total. Add lines 1 through 5

7a Amounts included on lines 1, 2, and

3 received from disqualified persons

b Amounts included on lines 2 and 3 received

from other than disqualified persons that

exceed the greater of $5,000 or 1% of the

amount on line 13 for the year

c Add lines 7a and 7b

8 Public support. (Sublracl line 7c from line 6.1

Section B. Total Support

Calendar year (or fiscal year beginning in)

9 Amounts from line 6

10a Gross income from interest,

dividends, payments received on

securities loans, rents, royalties,

and income from similar sources

b Unrelated business taxable income

(less section 511 taxes) from businesses

acquired after June 30,1975

c Add lines 10a and 10b

11 Net income from unrelated business

activities not included on line 10b,

whether or not the business is

regularly carried on

12 Other income. Do not include gain

or loss from the sale of capital

assets (Explain in Part VI.)

Total support. (AddHnesS, 10c, 11. and 12.)13

14

(a) 2020 (b) 2021 (c) 2022 (d) 2023 (e) 2024 (f) Total

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization.

check this box and stop here i '

Section C. Computation of Public Support Percentage

15 Public support percentage for 2024 (line 8, column (f), divided by line 13, column (f)) 15 %

16 Public suDDort oercentaoe from 2023 Schedule A. Part III. line 15 16 %

Section D. Computation of investment Income Percentage

17

18

17 Investment income percentage for 2024 (line 10c, column (f), divided by line 13, column (f))

18 Investment income percentage from 2023 Schedule A, Part III, line 17

19a 33 1/3% support tests - 2024. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not

more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization I I

b 33 1/3% support tests - 2023. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1 /3%, and

line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization I I

20 Private foundation. If the organization did not check a box on line 14,19a, or 19b, check this box and see instructions I I

432023 01-14-25

%

Schedule A (Form 990) 2024

15

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Schedule A (Form 990) 2024

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

art IV Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, Part I, complete Sections A

and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete

Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

20-8986771 PaaeA

1 Are all of the organization's supported organizations listed by name in the organization's governing

documents? if "No," describe in Part VI how the supported organizations are designated. If designated by

class or purpose, describe the designation. If historic and continuing reiationship, explain.

2 Did the organization have any supported organization that does not have an IRS determination of status

under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported

organization was described in section 509(a)(1) or (2).

3a Did the organization have a supported organization described in section 501 (c)(4), (5), or (6)? if "Yes," answer

lines 3b and 3c beiow.

b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and

satisfied the public support tests under section 509(a)(2)? /f "Yes," describe in Part VI when and how the

organization made the determination.

c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)

purposes? if "Yes," explain in Part VI what controls the organization put in piace to ensure such use.

4a Was any supported organization not organized in the United States ("foreign supported organization")? if

"Yes," and if you checked box 12a or 12b in Part I, answer iines 4b and 4c below.

b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign

supported organization? if "Ves," describe in Part VI how the organization had such control and discretion

despite being controlled or supervised by or in connection with its supported organizations.

c Did the organization support any foreign supported organization that does not have an IRS determination

under sections 501 (c)(3) and 509(a)(1) or (2)? if "Yes," explain in Part VI what controis the organization used

to ensure that ali support to the foreign supported organization was used exclusively for section 170(c)(2)(B)

purposes.

5a Did the organization add, substitute, or remove any supported organizations during the tax year? if "Yes,"

answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and BIN

numbers of the supported organizations added, substituted, or removed; (li) the reasons for each such action;

(lii) the authority under the organization's organizing document authorizing such action; and (iv) how the action

was accomplished (such as by amendment to the organizing document).

b Type I or Type II only. Was any added or substituted supported organization part of a class already

designated in the organization's organizing document?

c Substitutions only. Was the substitution the result of an event beyond the organization's control?

6 Did the organization provide support (whether in the form of grants or the provision of sen/ices or facilities) to

anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class

benefited by one or more of its supported organizations, or (iii) other supporting organizations that also

support or benefit one or more of the filing organization's supported organizations? if "Ves," provide detail in

Part VI.

7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor

(as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with

regard to a substantial contributor? if "Yes," complete Part I of Schedule L (Form 990).

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7?

If "Yes," complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more

disqualified persons, as defined in section 4946 (other than foundation managers and organizations described

in section 509(a)(1) or (2))? if "Yes," provide detail in Part VI.

b Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which

the supporting organization had an interest? if "Yes," provide detail in Part VI.

c Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit

from, assets in which the supporting organization also had an interest? if "Ves," provide detail in Part VI.

10a Was the organization subject to the excess business holdings rules of section 4943 because of section

4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated

supporting organizations)? if "Yes," answer line 10b beiow.

b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to

determine whether the organization had excess business holdinas.)

8

9a

3a

3b

3c

4a

4b

4c

5a

5b

5c

i

9a

9b

9c

10a

10b

Yes No

■f

432024 01-14-25

15081027 147695 134597

16

2024.04032 NEW HAMPSHIRE

Schedule A (Form 990) 2024

PROFESSIONA 134597 1

NEW HAMPSHIRE PROFESSIONALS

Part IV Supporting Organizations (continued)

Yes No

11 Has the organization accepted a gift or contribution from any of the following persons?

a A person who directly or indirectly controls, either alone or together with persons described on lines lib and

11c below, the governing body of a supported organization?

b A family member of a person described on line 11 a above?

c A 35% controlled entity of a person described on line 1 la or 1 lb above? if "Yes" to line 1 la, 1 lb, or 11c,

provide detail In Part VI.

11a

lib

11c

Section B. Type I Supporting Organizations

Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or

more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers,

directors, or trustees at all times during the tax year? if "No," describe in Part VI how the supported organization(s)

effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported

organization, descnbe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the

supported organizations and what conditions or resthctlons, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported

organization{s) that operated, supervised, or controlled the supporting organization? if "Yes," explain in

Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated,

supervised, or controlled the supporting organization.

Yes No

Section C. Type II Supporting Organizations

1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors

or trustees of each of the organization's supported organization(s)? if "No," describe In Part VI how control

or management of the supporting organization was vested in the same persons that controlled or managed

the supported oraanization/s).

Yes No

Section D. All Type III Supporting Organizations

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the

organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax

year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the

organization's goveming documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported

organization(s) or (ii) serving on the governing body of a supported organization? if "No," explain In Part VI how

the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described on line 2, above, did the organization's supported organizations have a

significant voice in the organization's investment policies and in directing the use of the organization's

income or assets at all times during the tax year? if "Yes," describe In Part VI the role the organization's

supported organizations olaved in this regard.

Yes No

Section E. Type III Functionally Integrated Supporting Organizations

Yes No

1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions),

a I I The organization satisfied the Activities Test. Complete line 2 below.

b I I The organization is the parent of each of its supported organizations. Complete line 3 below.

c I I The organization supported a governmental entity. Describe in Part VI how you supported a governmental

entity (see Instructions).

2 Activities Test. Answer lines 2a and 2b below.

a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of

the supported organlzatlon(s) to which the organization was responsive? If "Yes," then in Part VI identify

those supported organizations and explain how these activities directly furthered their exempt purposes,

how the organization was responsive to those supported organizations, and how the organization determined

that these activities constituted substantially all of Its activities.

b Did the activities described on line 2a, above, constitute activities that, but for the organization's involvement,

one or more of the organization's supported organization(s) would have been engaged in? if "Ves," explain in

Part VI the reasons for the organization's position that Its supported organizatlon(s) would have engaged in

these activities but for the organization's Involvement.

3 Parent of Supported Organizations. Answer lines 3a and 3b below,

a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or

trustees of each of the supported organizations? If "Yes" or "No," provide details in Part VI.

b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each

of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

2a

2b

3a

3b

432025 01-14-25

15081027 147695 134597

17 Schedule A (Form 990) 2024

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Schedule A (Form 990) 2024

P

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM 20-8986771 PaoeS

art V I Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

I I Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20,1970 (explain in Part VI). See instructions.

Section A - Adjusted Net Income (A) Prior Year

(B) Current Year

(optional)

1 Net short-term capital gain 1

2 Recoveries of prior-year distributions 2

3 Other gross income (see instructions) 3

4 Add lines 1 through 3. 4

5 Depreciation and depletion 5

6 Portion of operating expenses paid or incurred for production or

collection of gross income or for management, conservation, or

maintenance of propertv held for production of income (see instructions) 6

7 Other expenses (see instructions) 7

8 Adjusted Net Income (subtract lines 5, 6. and 7 from line 4) 8

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year

(optional)

1 Aggregate fair market value of all non-exempt-use assets (see

instructions for short tax year or assets held for part of year):

a Average monthly value of securities 1a

b Average monthly cash balances 1b

c Fair market value of other non-exempt-use assets 1c

d Total (add lines 1a. 1b, and 1c) 1d

e Discount claimed for blockage or other factors

(exDlain in detail In Part VI):

2 Acquisition indebtedness applicable to non-exempt-use assets 2

3 Subtract line 2 from line Id. 3

4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount,

see instructions). 4

5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5

6 Multiply line 5 by 0.035. 6

7 Recoveries of prior-year distributions 7

8 Minimum Asset Amount (add line 7 to line 6) 8

Section 0 - Distributable Amount Current Year

1 Adjusted net income for prior year (from Section A, line 8, column A) 1

2 Enter 0.85 of line 1. 2

3 Minimum asset amount for prior year (from Section B, line 8, column A) 3

4 Enter greater of line 2 or line 3. 4

5 Income tax imposed in prior year 5

6 Distributable Amount. Subtract line 5 from line 4, unless subject to

emergency temporary reduction (see instructions). 6

7 I I Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see

instructions).

Schedule A (Form 990) 2024

432026 01-14-25

15081027 147695 134597

18

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

NEW HAMPSHIRE PROFESSIONALS

Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions Current Year

1 Amounts paid to supported organizations to accomplish exempt purposes 1

2 Amounts paid to perform activity that directly furthers exempt purposes of supported

organizations, in excess of income from activity 2

3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3

4 Amounts paid to acguire exempt-use assets 4

5 Qualified set-aside amounts (prior IRS approval required ■ nrnvide details in Part VI) 5

6 Other distributions (describe in Part VI). See instructions. 6

7 Total annual distributions. Add lines 1 through 6. 7

8 Distributions to attentive supported organizations to which the organization is responsive

inrnvide details in Part VI). See instructions. 8

9 Distributable amount for 2024 from Section C, line 6 9

10 Line 8 amount divided bv line 9 amount 10

Section E - Distribution Allocations (see instructions)

(i)

Excess Distributions

(ii)

Underdistributions

Pre-2024

(iii)

Distributable

Amount for 2024

1 Distributable amount for 2024 from Section C, line 6

2 Underdistributions, if any, for years prior to 2024 (reason

able cause required - exniain in Part VI). See instructions.

3 Excess distributions carryover, if any, to 2024

a From 2019

b From 2020

c From 2021

d From 2022

e From 2023

f Total of lines 3a through 3e

q Applied to under distributions of prior years

h Applied to 2024 distributable amount

i Carryover from 2019 not applied (see instructions)

1 Remainder. Subtract lines 3g, 3h, and 3i from line 3f.

4 Distributions for 2024 from Section D,

line?: $ ■

a Applied to underdistributions of prior years

b Applied to 2024 distributable amount

c Remainder. Subtract lines 4a and 4b from line 4.

5 Remaining underdistributions for years prior to 2024, if

any. Subtract lines 3g and 4a from line 2, For result greater

than zero, pxniain in Part VI. See instructions. HHH6 Remaining underdistributions for 2024. Subtract lines 3h

and 4b from line 1. For result greater than zero, explain in

Part VI. See instructions.

vv;

7 Excess distributions carryover to 2025. Add lines 3j

and 4c.

8 Breakdown of line 7:

a Excess from 2020

b Excess from 2021

c Excess from 2022

d Excess from 2023

e Excess from 2024

Schedule A (Form 990) 2024

432027 01-14-25

15081027 147695 134597

19

2024.04032 NEW HAMPSHIRE PROFESSlONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Schedule A (Form 990) 2024 HEALTH PROGRAM 20-8986771 Pages

PirFW Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12;

Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11 a, 11 b, and 11 c; Part IV, Section B, lines 1 and 2; Part IV, Section C,

line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V,

Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional Information.

(See Instructions.)

432028 01-14-25 Schedule A (Form 990) 2024

20

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Schedule B

(Form 990)

(Rev. December 2024)

Department of the Treasury

Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to vvww.irs.gov/Form990 for the latest information.

OMBNo. 1545-0047

Name of the organization

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Organization type (check one):

Filers of:

Form 990 or 990-EZ

Form 990-PF

Section:

I X I 501 {c)(3) (enter number) organization

I I 4947(a)(1) nonexempt charitable trust not treated as a private foundation

I I 527 political organization

I I 501 (c)(3) exempt private foundation

I I 4947(a)(1) nonexempt charitable trust treated as a private foundation

I I 501 (c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.

Note: Only a section 501 (c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

I I For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or

property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

I X I For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under

sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990), Part II, line 13,16a, or 16b, and that received from any one

contributor, during the year, total contributions of the greater of (1) $5,000; or (2) 2% of the amount on (i) Form 990, Part Vlll, line 1 h;

or (ii) Form 990-EZ, line 1. Complete Parts I and II.

I I For an organization described in section 501 (c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one

contributor, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific,

literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I (entering

"N/A" in column (b) instead of the contributor name and address), II, and III.

I I For an organization described in section 501 (c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the

year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box

is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.,

purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexcluslvely

religious, charitable, etc., contributions totaling $5,000 or more during the year $

Caution: /^ organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990), but it must

answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify

that it doesn't meet the filing requirements of Schedule B (Form 990).

For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990) (Rev. 12-2024)

LHA 423451 01-09-25

Schedule B (Form 990) (Rev. 12-2024) Page 2

Name of organization

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Part I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

1

NH BOARD OF PROFESSIONAL LICENSURE AND

CERTIFICATION

$ 806,856.

Person 1 X 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

7 EAGLE SQUARE

CONCORD. NH 03301

(a)

No.

(b)

Name, address, and ZIP + 4

(C)

Total contributions

(d)

Type of contribution

$

Person 1 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

$

Person 1 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

$

Person 1 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

$

Person 1 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Total contributions

(d)

Type of contribution

$

Person 1 1

Payroll 1 1

Noncash | |

(Complete Part II for

noncash contributions.)

423452 01-09-25 Schedule B (Form 990) (Rev. 12-2024)

22

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSlONA 134597_1

Schedule B (Form 990) (Rev. 12-2024) Page 3

Name of organization

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Part II Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.

(a)

No.

from

Parti

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

(a)

No.

from

Parti

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

(a)

No.

from

Parti

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

(a)

No.

from

Parti

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

(a)

No.

from

Parti

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

(a)

No.

from

Part 1

(b)

Description of noncash property given

(c)

FMV (or estimate)

(See instructions.)

(d)

Date received

$

423453 01-09-25 Schedule B (Form 990) (Rev. 12-2024)

23

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

Schedule B (Form 990) (Rev. 12-2024) Page 4

Name of organization

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Part III Exclusively religious, charitable, etc., contrib

Employer identification number

20-8986771

utions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year

from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations

completing Part III. enter the total of exclusively religious, charitable, etc., contributions of $1,000 Or leSS for the year. (Enter this info, once.) ^

(a) No.

from

Part 1

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

(a) No.

from

Parti

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

(a) No.

from

Part 1

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

(a) No.

from

Part 1

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee

423454 01-09-25

24

Schedule B (Form 990) (Rev. 12-2024)

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597 1

SCHEDULE D

(Form 990)

(Rev. December 2024)

Department of the Treasury

Internal Revenue Service

Supplemental Financial Statements

Complete If the organization answered "Yes" on Form 990,

Part IV, line 6, 7, 8, 9, 10, 11a, lib, 11c, lid, lie, 11f, 12a, or 12b.

Attach to Form 990.

Go to www.lrs.aov/Form990 for instructions and the latest Information.

OMB No. 1545-0047

Open to Public

Inspection

Name of the organization NEW HAMPSHJRE PROFESSIONALS

HEALTH PROGRAM

Employer Identification number

20-8986771

Part 1 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts, complete if the

organization answered "Yes" on Form 990, Part IV, line 6.

1 Total number at end of year

(a) Donor advised funds (b) Funds and other accounts

2 Aggregate value of contributions to (during year)

3 Aggregate value of grants from (during year)

4 Aggregate value at end of year

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds

are the organization's property, subject to the organization's exclusive legal control? I I Yes

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only

for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring

impermissible private benefit? I I Yes

I I No

No

Part H Conservation Easements, complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

I I Preservation of land for public use (for example, recreation or education) I I Preservation of a historically important land area

I I Protection of natural habitat I I Preservation of a certified historic structure

I I Preservation of open space

day of the tax year.

Total number of conservation easements

Total acreage restricted by conservation easements

Number of conservation easements on a certified historic structure included on line 2a

Number of conservation easements included on line 2c acquired after July 25, 2006, and not

on a historic structure listed in the National Register

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax

year

Number of states where property subject to conservation easement Is located

Held at the End of the Tax Year

2a

2b

2c

2d

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of

violations, and enforcement of the conservation easements it holds? I I Yes I I No

6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year

Amount of expenses Incurred In monitoring, inspecting, handling of violations, and enforcing conservation easements during the year

Does each conservation easement reported on line 2d above satisfy the requirements of section 170(h)(4)(B)(i)

and section 170(h)(4)(B)(ll)?

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement and

balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the

organization's accounting for conservation easements.

I I Yes I I No

Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.

Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

la If the organization elected, as permitted under FASB ASC 958, not to report in Its revenue statement and balance sheet works

of art, historical treasures, or other similar assets held for public exhibition, education, or research In furtherance of public

service, provide In Part XIII the text of the footnote to Its financial statements that describes these items,

b If the organization elected, as permitted under FASB ASC 958, to report In Its revenue statement and balance sheet works of

art, historical treasures, or other similar assets held for public exhibition, education, or research In furtherance of public service,

provide the following amounts relating to these Items.

(1) Revenue Included on Form 990, Part VIII, line 1 $

(ii) Assets Included In Form 990. Part X $

2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide

the following amounts required to be reported under FASB ASC 958 relating to these Items:

a Revenue Included on Form 990, Part VIII, line 1 $

b Assets included in Form 990. Part X $

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

LHA 432051 01-02-25

Schedule D (Form 990) (Rev. 12-2024)

25

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Schedule D (Form 990) (Rev. 12-2024) HEALTH PROGRAM 20-8986771 Paae2

I Part III I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its

collection items (check all that apply).

a I I Public exhibition d I I Loan or exchange program

b I I Scholarly research e I I Other

c I I Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.

5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets

to be sold to raise funds rather than to be maintained as part of the organization's collection? I I Yes riNo

I Part IV

1a

Escrow and Custodial Arrangements complete if the organization answered "Yes" on Form 990, Part IV, line 9, or

reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian, or other intermediary for contributions or other assets not included

on Form 990, Part X? I I Yes I I No

c Beginning balance

Amount

1c

d Additions during the year Id

e Distributions during the year 1e

f Ending balance If

2a

b

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? I I Yes

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII

I I No

Part V Endowment Funds Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back

la Beginning of year balance

b Contributions

c Net investment earnings, gains, and losses

d Grants or scholarships

e Other expenditures for facilities

and programs

f Administrative expenses

9 End of year balance

2 Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

a Board designated or quasi-endowment %

b Permanent endowment %

c Term endowment %

The percentages on lines 2a, 2b, and 2c should equal 100%.

3a Are there endowment funds not in the possession of the organization that are held and administered for the

organization by:

(i) Unrelated organizations?

(ii) Related organizations?

b If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R?

Describe in Part XIII the intended uses of the organization's endowment funds.

Yes No

3a(i)

3a(ii)

3b

Part Vi| Land, Buildings, and Equipment

Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property (a) Cost or other

basis (investment)

(b) Cost or other

basis (other)

(c) Accumulated

depreciation

(d) Book value

1a Land

b Buildings

c Leasehold improvements

d Equipment 2,628. 1,773. 855.

e Other

Total. Add lines la through 1e. fCnIumn M) muxt ftntial Form 990 Part X Una 10c. column (B)) 855.

Schedule D (Form 990) (Rev. 12-2024)

432052 01-02-25

15081027 147695 134597

26

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Schedule D (Form 990) (Rev. 12-2024) HEALTH PROGRAM 20-8986771 Paqe3

Part VU| Investments - Other Securities

Complete if the organization answered "Yes " on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security) (b) Book value (c) Method of valuation: Cost or end-of-year market value

(1) Financial derivatives

(2) Closely held equity interests

(3) Other

(A)

(B)

(C)

(D)

(E)

(R

(G)

(H)

Total. (Col. (b) must equal Form 990, Part X, line 12, col. (B))

Part Vlll Investments - Program Related.

Complete if the organization answered ""Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment (b) Book value (c) Method of valuation: Cost or end-of-year market value

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

Total. (Col. (b) must equal Form 990, Part X, line 13, col. (B))

Part IX Other Assets

Complete if the organization answered "Yes" on Form 990, Part IV, line lid. See Form 990, Part X, line 15.

(a) Description (b) Book value

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

Total. /Cnliimn M mimt pniial Fnrm 990 Part X Una 75. CO/. (B))

Part X Other Liabilities

Complete if the organization answered "Yes" on Form 990, Part IV, line 11 e or 11 f. See Form 990, Part X, line 25.

(a) Description of liability (b) Book value

(1) Federal income taxes

JSL

M.

J6L

JZL

JiL

_§L

Total. (Cakimn (b) must equal Form 990. Part X. line 25. col. (B))

2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization"s financial statements that reports the

organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII I I

Schedule D (Form 990) (Rev. 12-2024)

432053 01-02-25

15081027 147695 134597

27

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Schedule D (Form 990) (Rev. 12-2024) HEALTH PROGRAM 20-8986771 Paqe4

Part XI j Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.

1 Total revenue, gains, and other support per audited financial statements 1

2 Amounts included on line 1 but not on Form 990, Part VIII, line 12;

a Net unrealized gains (losses) on investments 2a

2e

b Donated services and use of facilities 2b

c Recoveries of prior year grants 2c

d Other (Describe in Part XIII.) 2d

e Add lines 2a through 2d

3 Subtract line 2e from line 1 3

4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

4c

b Other (Describe in Part XIII.) 4b

0 Add lines 4a and 4b

5 Total revenue. Add lines 3 and 4c. mu^t pnual Fnrm.9.90 Part 1 Una 1? 1 6

Part XIIJ Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.

1 Total exoenses and losses per audited financial statements 1

2 Amounts included on line 1 but not on Form 990, Part IX, line 25:

a Donated services and use of facilities 2a

2e

b Prior year adjustments 2b

c Other losses 2c

d Other (Describe in Part XIII.) 2d

e Add lines 2a through 2d

3 Subtract line 2e from line 1 3

4 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

4c

b Other (Describe in Part XIII.) 4b

c Add lines 4a and 4b

5 Total exoenses. Add lines 3 and 4c. (T/i/.s muat anual Form.9.90. Part 1. line 18.) 5

Part Xlllj Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines la and 4; Part IV, lines 1 b and 2b; Part V, line 4; Part X, line 2; Part XI,

lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

432054 01-02-25

28

Schedule D (Form 990) (Rev. 12-2024)

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

SCHEDULE 1

(Form 990)

(Rev. December 2024)

Department of the Treasury

Internal Revenue Service

Grants and Other Assistance to Organizations,

Governments, and Individuals In the United States

Complete if the organization answered "Yes" on Form 990, Part IV, line 21 or 22.

Attach to Form 990.

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public E

Inspection

Name of the organization NEW HAMPSHXRE PROFESSXONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Part 1 1 General Information on Grants and Assistance

1 Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and the selection

criteria used to award the grants or assistance?

2 Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

[X] Yes □ No

Part II Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered '"Yes" on Form 990, Part IV, line 21, for any

recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name and address of organization

or government

(b) EIN (c) IRC section

(if applicable)

(d) Amount of

cash grant

(e) Amount of

noncash

assistance

(f) Method of

valuation (book,

FMV, appraisal,

other)

(g) Description of

noncash assistance

(h) Purpose of grant

or assistance

Enter total number of section 501 (c)(3) and govemment organizations listed in the line 1 table

Enter total number of other organizations listed in the line 1 table

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (Rev. 12-2024)

LHA 432101 01-02-25

29

NEW HAMPSHIRE PROFESSIONALS

Schedule I (Form 990) (Rev. 12-2024) HEALTH PROGRAM

EPart III J Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.

Part III can be duplicated if additional space is needed.

20-8986771 Page 2

(a) Type of grant or assistance (b) Number of

recipients

(c) Amount of

cash grant

(d) Amount of non-

cash assistance

(e) Method of valuation

(book, FMV, appraisal, other)

(f) Description of noncash assistance

FINANCIAL ASSISTANCE 20 9,064. 0.

Part IV I Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

PART I, LINE 2:

OUR PROGRAM COVERS THE COST OF ANY REQUIRED TESTING AT THE INITIAL

APPOINTMENT TO DETERMINE NEXT STEPS FOR THE INDIVIDUAL. WE HAVE A

BENEVOLENCE FUND WHICH PROVIDES FINANCIAL ASSISTANCE FOR ONGOING TESTING

FOR A LIMITED AMOUNT OF TIME AND IS AWARDED TO THOSE PARTICIPANTS WHO MEET

FINANCIAL ASSISTANCE CRITERIA AS DETERMINED BY A BENEVOLENCE FUND

COMMITTEE. THIS COMMITTEE REVIEWS THE PARTICIPANTS FINANCIAL DOCUMENTS AND

CURRENT SITUATION IN DETERMINING THE ASSISTANCE PROVIDED.

432102 01-18-25

30

Schedule I (Form 990) (Rev. 12-2024)

SCHEDULEJ

(Form 990)

{Rev. December 2024)

Department of the Treasury

Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest

Compensated Employees

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.

Attach to Form 990.

Go to www.irs.qov/Form990 for instructions and the latest information.

0MB No. 1545-0047

Open to Public

Inspection

Name of the organization NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

Part I Questions Regarding Compensation

6

8

9

Check the appropriate box(es) If the organization provided any of the following to or for a person listed on Form 990,

Part VII, Section A, line la. Complete Part III to provide any relevant Information regarding these Items.

I I First-class or charter travel I I Housing allowance or residence for personal use

I I Travel for companions I I Payments for business use of personal residence

I I Tax Indemnification and gross-up payments I I Heafth or social club dues or Initiation fees

I I Discretionary spending account I I Personal services (such as maid, chauffeur, chef)

If any of the boxes on line 1 a are checked, did the organization follow a written policy regarding payment or

reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain

Did the organization require substantiation prior to reimbursing or allowing expenses Incurred by all directors,

trustees, and officers, Including the CEO/Executlve Director, regarding the Items checked on line la?

Indicate which. If any, of the following the organization used to establish the compensation of the organization's

CEO/Executlve Director. Check all that apply. Do not check any boxes for methods used by a related organization to

establish compensation of the CEO/Executlve Director, but explain In Part III.

I I Compensation committee IZZl Written employment contract

I I Independent compensation consultant I X I Compensation survey or study

I I Form 990 of other organizations I I /Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line la, with respect to the filing

organization or a related organization:

Receive a severance payment or change-of-control payment?

Participate In or receive payment from a supplemental nonqualified retirement plan?

Participate In or receive payment from an equity-based compensation arrangement?

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each Item In Part III.

Only section 501(c)(3), 501(c)(4), and 501(cM29) organizations must complete lines 5-9.

> For persons listed on Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensation

contingent on the revenues of:

a The organization?

b Aoiy related organization?

If "Yes" on line 5a or 5b, describe In Part III.

For persons listed on Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensation

contingent on the net earnings of:

a The organization?

b Any related organization?

If "Yes" on line 6a or 6b, describe In Part III.

' For persons listed on Form 990, Part VII, Section A, line la, did the organization provide any nonflxed payments

not described on lines 5 and 6? If "Yes," describe In Part III

Were any amounts reported on Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the

Initial contract exception described In Regulations section 53.4958-4(a)(3)? If "Yes," describe In Part III

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described In

Regulations section 53.4958-6(c)?

lb

4a

4b

4c

5a

5b

6a

6b

Yes No

X

X_

X

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) (Rev. 12-2024)

LHA 432111 01-15-25

15081027 147695 134597

31

2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

NEW HAMPSHIRE PROFESSIONALS

Schedule J (Form 990) (Rev. 12-2024) HEALTH PROGRAM 20-8986771 Page 2

Part 11 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii).

Do not list any individuals that aren't listed on Form 990, Part Vll.

Note: The sum of columns (B){i)-(iii) for each listed individual must equal the total amount of Form 990, Part Vll, Section A, line la, applicable column (D) and (E) amounts for that individual.

(A) Name and Title

(B) Breakdown of W-2 and/or 1099-MISC and/or 1099-NEC

compensation

(C) Retirement and

other deferred

compensation

(D) Nontaxable

benefits

(E) Total of columns

(B)(i)-(D)

(F) Compensation

in column (B)

reported as deferred

on prior Form 990

(i) Base

compensation

(ii) Bonus &

incentive

compensation

(ill) Other

reportable

compensation

(1) MOLLY ROSSIGNOL

MEDICAL DIRECTOR

(i)

(ii)

275,085. 0. 0. 26,887. 17,510. 319,482. 0.

0. 0. 0. 0. 0. 0. 0.

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(•)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(•)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

Schedule J (Form 990) (Rev. 12-2024)

432112 01-15-25

32

NEW HAMPSHIRE PROFESSIONALS

Schedule J (Form 990) (Rev. 12-2024) HEALTH PROGRAM 20-8986771 Page 3

Part III Supplemental Infortnation

Provide the information, explanation, or descriptions required for Part I, lines la, lb, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

PART I, LINE 7:

SCHEDULE J, PART II, COLUMN (B)(II) REPORTS DISCRETIONARY INCENTIVE AMOUNTS

THAT WERE APPROVED BY THE BOARD BASED UPON PERFORMANCE.

Schedule J (Form 990) (Rev. 12-2024)

432113 01-15-25

33

SCHEDULE 0

(Form 990)

(Rev. December 2024)

Department of the Treasi^y

Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on

Form 9M or 990-EZ or to provide any additional information.

Attach to Form 990 or Form 990-EZ.

Go to vvww.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

Open to Public ^Inspection

Name of the organization NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Employer identification number

20-8986771

FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:

PROFESSIONAL HEALTHCARE BOARDS IN THE EVALUATION AND DETERMINATION OF

TREATMENT RECOMMENDATIONS AND MONITORING FOR INDIVIDUAL HEALTHCARE

PROFESSIONALS WHO HAVE OR MAY HAVE POTENTIALLY IMPAIRING CONDITIONS.

FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:

HAVE POTENTIALLY IMPAIRING CONDITIONS.

FORM 990, PART III, LINE 2, NEW PROGRAM SERVICES:

THE ORGANIZATION IMPLEMENTED A SERIES CALLED EMOTIONAL SOBRIETY, WHICH

IS TARGETED AT ALL PARTICIPANTS, REGARDLESS OF THE REASON FOR REFERRAL.

THIS PROGRAM SUPPORTS ALL HEALTHCARE PROFESSIONALS BY HELPING THEM

EVALUATE HOW THEIR THOUGHTS, EMOTIONS, AND BEHAVIORS ARE RELATED TO

THEIR EXPERIENCES. IN EFFECT AN OPPORTUNITY TO APPLY STRATEGIES TO

MANAGE BEHAVIORS BY GOING 'UPSTREAM'. THIS SERVICE IS A RECURRING GROUP

FACILITATED MEETING AND HAS HAD RESOUNDING POSITIVE FEEDBACK.

FORM 990, PART VI, SECTION B, LINE llB;

ALL OF THE OFFICERS OF THE ORGANIZATION REVIEW THE FORM 990 PRIOR TO

SIGNING AND FILING. THE BOARD IS PROVIDED A COPY PRIOR TO FILING.

FORM 990, PART VI, SECTION B, LINE 15:

THE EXECUTIVE COMMITTEE MEMBERS REVIEW NON-PROFIT COMPARIBILITY DATA TO

DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS.

COMPARIBILITY DATA WAS USED IN DETERMINATION OF COMPENSATION AND THE

EXECUTIVE COMMITTEE MEMBERS AND MEDICAL DIRECTOR REVIEWED THESE FIGURES.

DISCUSSIONS TOOK PLACE AMONG THESE INDIVIDUALS.

FORM 990, PART VI, SECTION C, LINE 19

THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIALS

STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC:

MOLLY ROSSIGNOL - 81 WARREN STREET, CONCORD, NH 03301

PAMELA DINAPOLI - 344 ASH STREET, MANCHESTER, NH 03104

ROBERT GREENE - 21 SPENCER STREET APT 219, LEBANON, NH 03766

SARAH PROCTOR - 1 DESTINY WAY, DEERFIELD, NH 03037

JOHN GALLAGHER - 289 GOOSE POND ROAD, LYME, NH 03768

SKIP JENKYN - 7 FERN LANE, HANOVER, NH 03755

BRIANA MATUSZKO - 11 SETTLEMENT DR UNIT 204, DOVER, NH 03820

JENNIFER PITTS - PO BOX 1485, GRANTHAM, NH 03753

TOM SCHELL - PO BOX 127, MERIDEN, NH 03770

FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS;

CHANGE IN ACCOUNTING METHOD 66,655,

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-E2. Schedule O (Form 990) (Rev. 12-2024)

LHA 432211 01-15-25

34

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

2024 DEPRECIATION AND AMORTIZATION REPORT

FORM 990 PAGE 10 990

Asset

No. Description

Date

Acquired Method Life

Line

No.

Unadjusted

Cost Or Basis

Bus

%

Exci

Section 179

Expense

Reduction In

Basis

Basis Eor

Depreciation

Beginning

Accumulated

Depreciation

Current

Sec 179

Expense

Current Year

Deduction

Ending

Accumulated

Depreciation

FURNITURE & FIXTURES

CELL PHONE

COMPUTERS

COMPUTERS

* 990 PAGE 10 TOTAL

FURNITURE & FIXTURES

* GRAND TOTAL 990 PAGE 10

DEPR.

12/10/21

10/14/22

09/19/23,

SL

SL

SL

3.00

5.00

5.00

1,060.

819.

749,

2,628.

2,628.

Jl..

ML.

i

1,060.

819.

749.

2,628.

2,628.

912.

287.

112.

1,311.

1 3L1.

148.

164.

150.

462.

462.

1,060.

451..262.

1,773.

1,773.

1 mm i

1

wm

n

428111 04-01-24

(D) • Asset disposed

35

* ITC, Salvage, Bonus, Commercial Revitalization Deduction, GO Zone

Form 3115(Rev. December 2022)

Department of the Treasury

Internal Revenue Service

Application for Change in Accounting Method

Go to www.irs.90v/F0rm3ii5 for instructions and the latest information.

OMB No. 1545-2070

Attachment

Sequence No. 315

Name of filer (name of parent corporation if a consolidated group) (see instructions)

NEW HAMPSHIRE PROFESSIONALS

HEALTH PROGRAM

Identification number (see instructions)

20-8986771

Principal business activity code number (see instructions)

541990

Number, street, and room or suite no. If a P.O. box, see the instructions.

125 AIRPORT ROAD

Tax year of change begins (MM/DD/YYYY) 07/01/2024

Tax year of change ends (MM/DD/YYYY) 06/30/2025

City or town, state, and ZIP code

CONCORD, NH 03301

Name of contact person (see instructions)

DR. MOLLY ROSSIGNOL

Name of applicant(s) (if different than filer) and identification number(s) (see instructions) Contact person's telephone number

603-223-0990

Does the filer want to receive a copy of the change in method of accounting letter ruling or other correspondence

related to this Form 3115 by fax or encrypted email attachment? If "Yes," see instructions I I Yes I X I No

If the applicant is a member of a consolidated group, check this box I I

If Form 2848, Power of Attorney and Declaration of Representative, is attached (see instructions for when Form 2848 is required),

check this box n

Check the box to indicate the type of applicant.

I I Individual

I I Corporation

I I Controlled foreign corporation

(Sec. 957)

I I 10/50 corporation (Sec. 904(d)(2)(E))

I I Qualified personal service

corporation (Sec. 448(d)(2))

I X I Exempt organization. Enter Code section:

I ICooperative (Sec. 1381)

I I Partnership

I I S corporation

I I Insurance CO. (Sec. 816(a))

I I Insurance co. (Sec. 831)

I I Other (specify):

501(C)(3)

Check the appropriate box to indicate the type of accounting

method change being requested. See instructions.

I I Depreciation or Amortization

I I Financial Products and/or Financial Activities of

Financial Institutions

[X] Other (specify): CASH TO ACCRUAL

Caution; To be eligible for approval of the requested change in method of accounting, the taxpayer must provide all information that is relevant to the

taxpayer or to the taxpayer's requested change in method of accounting. This includes (1) all relevant information requested on this Form 3115

(including its instructions), and (2) any other relevant information, even if not specifically requested on Form 3115.

The taxpayer must attach all applicable statements requested throughout this form.

I Part i I Information for Automatic Change Request

Enter the applicable designated automatic accounting method change number ("DON") for the requested automatic change.

Enter only one DON, except as provided for in guidance published by the IRS. If the requested change has no DON, check

"Other," and provide both a description of the change and a citation of the IRS guidance providing the automatic change.

See instructions.

(1)DCN: 122 (2) DON: (3) DON: (4) DON:.

(7) DON: (8) DON: (9) DON: (10) DON:,

Other I I

(5) DCN:_

(11)DCN:_

(6) DCN:_

(12) DCN:_

Description:

Do any of the eligibility rules restrict the applicant from filing the requested change using the automatic change

procedures (see instructions)? If "Yes," attach an explanation

Has the filer provided all the information and statements required (a) on this form and (b) by the List of Automatic

Changes under which the applicant is requesting a change? See instructions

Note: Complete Part II and Part IV of this form, and. Schedules A through E, if applicable.

Yes

X

No

If

3

X

[]Part III Information for All Requests" Yes No

During the tax year of change, did or will the applicant (a) cease to engage in the trade or business to which the requested

change relates, or (b) terminate its existence? See instructions.

Is the applicant requesting to change to the principal method in the tax year of change under Regulations section

1.381 (c)(4)-1 (d)(1) or 1.381 (c)(5)-1 (d)(1)?

If "No," go to line 6a.

If "Yes," the applicant cannot file a Form 3115 for this change. See instructions.

Sign

Here

Preparer

(other than

filer/applicant)

Under penalties of perjury, I declare that I have examined this application, including accompanying schedules and statements, and to the best of my knowledge and belief, the

application contains all the relevant facts relating to the application, and it is true, correct, and complete. Declaration of preparer (other than applicant) is based on all information

of which pre(>arer has any knowledge.

NSignature of filer (and spouse, if joint return)

Print/Type preparer's name

SHEILA MCNEIL

ame and title (print or type)

DR. MOLLY ROSSIGN

Preparer's signature

Firm's name WIPFLI ADVISORY LLC

LHA For Privacy Act and Paperwork Reduction Act Notice, see the instructions. Form 3115 (Rev. 12-2022)

423361 04-01-24

15081027 147695 134597 2024.04032 NEW HAMPSHIRE PROFESSIONA 134597_1

Form 3115 (Rev. 12-2022)

P

Page 2

art II Information for All Requests (continued) Yes No

6a

d

7a

8a

10

11a

12

13

Does the applicant (or any present or former consolidated group in which the applicant was a member during the

applicable tax year(s)) have any federal income tax return(s) under examination (see instructions)?

If "No," go to line 7a.

Is the method of accounting the applicant is requesting to change an issue under consideration (with respect to

either the applicant or any present or former consolidated group in which the applicant was a member during the

applicable tax year(s))? See instructions

Enter the name and telephone number of the examining agent and the tax year(s) under examination.

Name Telephone no. Tax year(s)

Has a copy of this Form 3115 been provided to the examining agent identified on line 6c?

Does audit protection apply to the applicant's requested change in method of accounting? See instructions

If "No," attach an explanation.

If "Yes," check the applicable box and attach the required statement.

I X I Not under exam I I 3-month window I I 120 dav: Date examination ended

I I Method not before director I I Negative adjustment I I CAP: Date member joined group

I I Audit protection at end of exam I I Other

Does the applicant (or any present or former consolidated group in which the applicant was a member during the

applicable tax year(s)) have any federal income tax return(s) before Appeals and/or a federal court?

If "No," go to line 9.

Is the method of accounting the applicant is requesting to change an issue under consideration by Appeals and/or

a federal court (for either the applicant or any present or former consolidated group in which the applicant was a

member for the tax year(s) the applicant was a member)? See instructions

If "Yes," attach an explanation.

If "Yes," enter the name of the (check the box) I I Appeals officer and/or I I counsel for the govemment,

telephone number, and the tax year(s) before Appeals and/or a federal court.

Name Telephone no. Tax year(s)

Has a copy of this Form 3115 been provided to the Appeals officer and/or counsel for the govemment identified

on line 8c?

If the applicant answered "Yes" to line 6a and/or 8a with respect to any present or former consolidated group,

attach a statement that provides each parent corporation's (a) name, (b) identification number, (c) address, and

(d) tax year(s) during which the applicant was a member that is under examination, before an Appeals office,

and/or before a federal court.

If for federal income tax purposes, the applicant is either an entity (including a limited liability company) treated as

a partnership or an S corporation, is it requesting a change from a method of accounting that is an issue under

consideration in an examination, before Appeals, or before a federal court, with respect to a federal income tax

return of a partner, member, or shareholder of that entity?

Has the applicant, its predecessor, or a related party requested or made (under either an automatic or

non-automatic change procedure) a change in method of accounting within any of the 5 tax years ending with

the tax year of change?

If "No," go to line 12.

If "Yes," for each trade or business, attach a description of each requested change in method of accounting

(including the tax year of change) and state whether the applicant received consent.

If any application was withdrawn, not perfected, or denied, or if a Consent Agreement granting a change was not

signed and retumed to the IRS, or the change was not made or not made in the requested year of change, attach

an explanation.

Does the applicant, its predecessor, or a related party currently have pending any request (including any

concurrently filed request) for a private letter ruling, change in method of accounting, or technical advice?

If "Yes," for each request attach a statement providing (a) the name(s) of the taxpayer, (b) identification number(s),

(c) the type of request (private letter ruling, change in method of accounting, or technical advice), and (d) the

specific issue(s) in the request(s).