2024-08-02T07:54:38-05:00 2023-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-10-01 020223321 Cottage Hospital COTT 6037479000 90 Swiftwater Road Woodsville NH 03785 Ann Duffy CFO 6037479000 2024-07-31 1 1 Joseph R Byrne P01289281 2077752387 2024-07-31 2022 2024-08-08 14:25:15Z Holly McCormack 90 Swiftwater Road Woodsville NH 03785 43707191 0 X www.cottagehospital.org X 1903 NH Medical care and related services 11 9 395 20 0 0 1865171 319158 35658657 40509265 646037 617099 -3147 33087 38166718 41478609 4950 2000 0 0 21419338 23485598 0 0 0 19066778 18684335 40491066 42171933 -2324348 -693324 38805493 37311075 20796180 19483868 18009313 17827207 To strengthen the health of our community by providing accessible, compassionate, quality healthcare. To be the healthcare organization of choice for our service area. 0 0 27933595 2000 35393203 Cottage Hospital provided health care to approximately 609 inpatients and 27,317 outpatients during the fiscal year. 2732908 2913515 The Ray of Hope Geriatric Behavioral Health unit provides quality care for those struggling with a behavioral health issue. This inpatient program is for geriatric patients 65 years and older with persistent or late onset behavioral health illnesses or concerns. Specialized care focuses on assessment, treatment, rehabilitation, prevention, family/community support and education surrounding behavioral health. 2199920 2202548 The Rowe Health Center provides internal medicine, behavioral health, general surgery, podiatry, gastroenterology cardiology and endocrinology services. We are proud to offer a team-based approach to provide all of our patients with accessible, convenient, high quality care. With extended hours and same day acute appointments available, meeting the needs of our patients is our priority. 32866423 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 86 0 1 395 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Ann Duffy 6037479000 90 Swiftwater Road Woodsville NH 03785 Kevin Lawrence Chairperson 1.00 X X 0 0 0 William Darcy Vice Chair 1.00 X X 0 0 0 Prentis Pratt Secretary 1.00 X X 0 0 0 Andrew Barter Trustee 1.00 X 0 0 0 Mark Harris Trustee 1.00 X 0 0 0 Thomas Page Trustee 1.00 X 0 0 0 William Taxter Trustee 1.00 X 0 0 0 Clare Vallee Trustee 1.00 X 0 0 0 Rebecca Zampieri Trustee 1.00 X 0 0 0 Holly McCormack CEO 40.00 X X 219349 0 53134 Mark D Gleicher Past Chairperson 1.00 X X 0 0 0 David Robinson Past Vice Chair 1.00 X X 0 0 0 Lili Cargill Past Medical Staff President 40.00 X 124571 0 0 Delphine Sullivan CMO/Medical Staff President 40.00 X 243384 0 6319 Ann Duffy CFO 40.00 X 179666 0 32276 Christopher Findley Chief of ED 40.00 X 436280 0 45661 Robert Brown Past ED Physician 40.00 X 369563 0 38519 Christopher Danielson Physician RHC 40.00 X 337433 0 42893 Suneer Chander ED Physician 40.00 X 314801 0 48051 Christopher Scianna ED Physician 40.00 X 267495 0 622 2492542 0 267475 40 0 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03766 Contracted Providers 907165 Tru-Staff Travel Nurses LLC PO Box 63-8231 Cincinnati OH 45263 Contracted Staff 561341 Mission Search Corporation 2203 N Lois Ave Suite 1100 Tampa FL 33607 Recruiting Services 539725 Athena Health Inc 311 Arsenal Street Watertown MA 02472 EMR Services 531591 StaffDocs 7776 S Pointe Pkwy W Suite 270 Phoenix AZ 85044 Contracted Staff 474136 29 8887 93846 216425 5100 319158 Patient Service Revenue 622110 75611684 75611684 DSH Payments 622110 3933463 3933463 Other Operating Revenue 622110 477587 174400 303187 Contractual/Char. Adj. 622110 -39513469 -39513469 40509265 309027 309027 2988 0 2988 2988 2988 2435582 88180 2120998 94692 314584 -6512 308072 308072 0 8887 5392 -5392 -5392 42991 7500 35491 35491 41478609 40206078 0 953373 X 2000 2000 858699 374274 484425 18604721 14500051 4104670 301959 237147 64812 2421976 1748328 673648 1298243 979264 318979 37447 37447 129485 129485 7574 7574 9014733 7236425 1778308 89816 52671 37145 1133406 1034372 99034 19924 5064 14860 230838 211682 19156 1935594 1506557 429037 470833 301152 169681 Supplies 3638435 2916676 721759 Medicaid Enhancement Ta 1271062 1271062 Miscellaneous Expenses 378845 259145 119700 Education and Recruitme 326343 230553 95790 42171933 32866423 9305510 0 X 1083515 842166 10103728 9620476 4857795 4646817 619753 618659 297298 237795 35866434 23814602 12895239 12051832 8049153 8110366 188930 205547 0 606622 710082 370795 38805493 37311075 3244182 3385977 250227 2710 4812318 4616519 2519039 2347739 9970414 9130923 20796180 19483868 X 16596329 16334999 1412984 1492208 18009313 17827207 38805493 37311075 X -693324 494601 16617 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7991 7991 0 Part II-B, Line 1: Cottage Hospital is a member of the New Hampshire Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Cottage Hospital and other member organizations in furtherance of their exempt purposes. Cottage Hospital does not directly perform any lobbying activities. 1023418 77628 26726 1074320 1140349 -92523 24408 1023418 1108109 62995 30755 1140349 1219178 -71520 39549 1108109 1227714 27076 35612 1219178 0.00000 0.97441 0.02559 1 0 531787 531787 19666214 12242684 7423530 14077680 10847860 3229820 1590753 724058 866695 12051832 Deferred Compensation 356195 Due to Third-Party Payors 8155308 Lease Liabilities 619420 9130923 42011767 494601 16622 29509 540732 41471035 7574 7574 41478609 42193873 16622 12892 29514 42164359 7574 7574 42171933 Part V, Line 4: The intended use of the Hospital's endowment fund is to support the hospital in its efforts to provide quality healthcare to residents of the communities it serves and others who may use the hospital. Part XI, Line 2d - Other Adjustments: Change in Funds Held in Trust by Others 16,617. Fundraising Expenses 5,392. Gaming Expenses 7,500. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 5,392. Gaming Expenses 7,500. 42991 7500 0 42991 7500 7500 35491 NH 1 0 1 0 0.00000 1.00000 Ann Duffy CFO 90 Swiftwater Road Woodsville NH 03785 1 42991 7500 Manchester Poker Room & Casino 1279 S Willow Street Manchester NH 03103 0 Schedule G, Part III, Line 15a: The Hospital entered into an agreement whereby Manchester Poker Room & Casino would provide Cottage Hospital a percentage of revenues from Manchester Poker Room & Casino's games of chance proceeds. Cottage Hospital never paid Manchester Poker Room & Casino directly and was not directly involved in administrating any of the games of chance. Cottage Hospital was charged $750 a day for the ten day event which was taken directly out of the proceeds earned by Manchester Poker Room and Casino which then donated the remaining $35,491 of proceeds to Cottage Hospital. 1 1 1 X 1 X 1 1 1 0 1 1 238600 150116 88484 0.00210 6311303 5454029 857274 0.02030 6549903 5604145 945758 0.02240 884849 884849 0.02100 628244 628244 0.01490 59260 59260 0.00140 1572353 1572353 0.03730 8122256 5604145 2518111 0.05970 1200 1200 0.00000 55663 55663 0.00130 123600 123600 0.00290 247959 247959 0.00590 4000 4000 0.00010 60106 60106 0.00140 492528 492528 0.01160 0 15102359 15454376 -352017 X 1 1 1 1 Cottage Hospital 90 Switfwater Road Woodsville NH 03785 www.cottagehospital.org 01770 X X X X Cottage Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X cottagehospital.org/community-benefits X 1 22 1 cottagehospital.org/community-benefits 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X www.cottagehospital.org/financial-assistance X www.cottagehospital.org/financial-assistance X www.cottagehospital.org/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Cottage Hospital Part V, Section B, Line 5: Key leaders and focus groups within the community. For example, politicians, business health partners, staff and administration. Cottage Hospital Part V, Section B, Line 6a: The Northern New Hampshire Region Facilities ("NNHR or the "Facilities") performed a Community Health Needs Assessment (CHNA) in partnership with QHR Health ("QHR") to determine the health needs of the local community and developed an accompanying implementation plan to address the identified health needs of the community.The Northern New Hampshire Region Facilities include:- Littleton Regional Healthcare, Littleton, NH ("LRH")- Cottage Hospital, Haverhill, NH ("CH")- Mid State Health Center ("MSHC")- Ammonoosuc Community Health Services, Littleton, NH ("ACHS") Cottage Hospital Part V, Section B, Line 6b: Please see narrative response to line 6a above. Cottage Hospital Part V, Section B, Line 11: The Hospital's most recent CHNA showed the following areas as the greatest need, a description of what we have done to address the need is included:1) Increasing access to transportation to medical appointments and other health services - Cottage has some influence with three transportation services being available in the Area, Stagecoach, HMSC Bus, and RCT (VT).2) Increasing awareness around Hospital services and programs - Cottage utilizes social media, newspaper advertising and community outreach initiatives to communicate the services that Cottage offers to the community.3) Increasing access to drug and other substance abuse treatment services Cottage providers identify patients with substance abuse issues and refer a facility with appropriate resources.4) Increasing access to counseling services for mental health for children5) Increasing awareness of emergency care and trauma services - Cottage utilizes social media and community outreach initiatives to communicate the emergency and trauma care services provided.6) Increasing access to dentistry services7) Increasing access to counseling services for mental health for adults.8) Cottage offers outpatient treatment as well as short-term inpatient services for older adults struggling with behavioral issues via an IP geriatric psych unit.9) Enhancing drug and other substance abuse education and prevention10) Cottage works with a local substance misuse prevention program referring patients as appropriate.11) Improving access to financial assistance for healthcare services and prescription drugs - Cottage provides a financial counselor and patient care counselor to assist patients with understanding financial options available to them.12) Increasing access to specialty care for chronic conditions like diabetes and heart disease - Cottage provides services via a diabetic counselor, endocrinologist and offers a diabetic prevention program.13) Increasing access to primary care services - Cottage offers primary care services, and will utilize community outreach efforts to assist patients in a continuum of care.14) Increasing access to long-term care or dementia care for seniors - Cottage offers a short stay geriatric psych unit for patients that need short-term assistance. Those that require long-term care will be referred to an external long-term care facility.15) Increasing access to care coordination or support services to help people better manage their own health via patient outreach initiatives. Cottage Hospital Part V, Section B, Line 13b: Catastrophic relief guidelines: The Hospital recognizes that on occasion a patient may experience a serious illness or injury. A catastrophic relief program is available to patients that may need substantial financial assistance for an extended episode of care. The policy provides relief to uninsured (or grossly uninsured) individuals whose financial responsibility to the Hospital exceeds $30,000 for any single episode of care. Patients whose family income exceeds 300% of the FPL and whose financial responsibility to the hospital exceeds $30,000 for any single episode of care may be eligible for this program on a case-by-case basis. 1 1 - Rowe Health Center 103 Swiftwater Road Woodsville NH 03785 Rural Health Clinic Part I, Line 7: Part 1, Lines 7a-c: The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990, Schedule H, Worksheet 2, ratio of patient care cost-to-charges.Part 1, Lines 7e & f: The Hospital's costs are determined based on an evaluation of a labor plus estimated overhead absorption rate applied on an hourly basis.Part 1, Lines 7g & 7i: Represent actual costs derived from the Hospital's accounting system. Part II, Community Building Activities: Our community building activities are determined and aligned through our Community Health Needs Assessment. This assessment is evaluated every three years. Key leaders of the community, as well as peers within different demographic segments, are interviewed by a third party. Programs typically target preventative care, areas of health not being met within our community, and education in specialty medicine available within our service market. We strategically collaborate with other organizations to build a stronger message. Part III, Line 2: Part III, line 2-3: The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, ratio of patient care cost-to-charges. The CCR was then applied to bad debt expense at charge value in order to arrive at the estimated expense reported. Part III, Line 4: Please refer to pages 9-13 and pages 16-17 of the attached audited financial statements. Part III, Line 8: As Cottage Hospital operates at a loss from Medicare, the shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. Medicare allowable costs have been determined using a cost-to-charge ratio determined in accordance with worksheet 2, ratio of patient care cost-to-charges, of the Form 990 Schedule H instructions. Part III, Line 9b: If the patient has been on charity care in the past but it has now expired, the patient would have to re-apply. Part VI, Line 2: The Affordable Care Act of 2010 requires not-for-profit hospital to conduct a CHNA every three years. In addition, the state of New Hampshire requires one to be done every five years. Key healthcare and public service stakeholders representing a breadth of community perspectives participated in the research as key leaders and sources of information. The stakeholder research was supplemented by an in-depth review of demographic and epidemiological data in order to identify underlying health trends in the service area. The assessment included listing the prioritized community needs, the definition of the community served, a description of the methodology to identify needs in the community, a description of the approach used to prioritize community needs and a list of healthcare resources. The information gathered was then used as part of the Hospital's strategic planning process. The CHNA is available on the Hospital's website. Part VI, Line 3: If at the time of registration or admission, a patient indicates that he or she has no other medical payer available, i.e., no insurance, Medicaid, or Medicare, the Hospital asks if the patient would like an application for Medicaid and/or for the Hospital's charity care program. The Hospital then documents on the patient's account whether or not the patient took either of the applications, or if the applications were turned down. If the patient is admitted and unable to respond to the question of payers available at the time of admission, case management notifies the patient financial counselor. After checking with nursing to see if the patient is alert and able to discuss the payer issue, the patient financial counselor will visit the patient's bedside. Part VI, Line 4: The Hospital's geographic area includes its primary market: New Hampshire - Bath, Benton, Haverhill, Woodsville, Lisbon, Monroe, Piermont, and in Vermont - Barnet, Bradford, Corinth, Groton, Newbury, Ryegate and Wells River. The secondary market includes, but is not limited to: in New Hampshire - Landaff, Littleton, Orford, Rumney, Warren and Wentworth and in Vermont - Fairlee, Groton, McIndoe Falls, Peacham, Thetford, and Topsham. Demographically, the hospital services the general population. Part VI, Line 7, Reports Filed With States NH X X X X X 0 0 0 0 0 0 0 1 0 Christopher Findley Chief of ED 436280 0 0 0 0 0 9060 0 36601 0 481941 0 0 0 Robert Brown Past ED Physician 369563 0 0 0 0 0 2418 0 36101 0 408082 0 0 0 Christopher Danielson Physician RHC 337083 0 350 0 0 0 8592 0 34301 0 380326 0 0 0 Suneer Chander ED Physician 314801 0 0 0 0 0 9150 0 38901 0 362852 0 0 0 Holly McCormack CEO 219349 0 0 0 0 0 6855 0 46279 0 272483 0 0 0 Christopher Scianna ED Physician 267495 0 0 0 0 0 0 0 622 0 268117 0 0 0 Delphine Sullivan CMO/Medical Staff President 243384 0 0 0 0 0 5697 0 622 0 249703 0 0 0 Ann Duffy CFO 179666 0 0 0 0 0 7435 0 24841 0 211942 0 0 0 Part I, Line 7 In calendar year 2022, Christopher Danielson, Physician RHC, received a $350 retention bonus. A Business Finance Authority of the State of NH NoneAvail 2011-05-31 7745000 Refinance Mortgage and Terminate Hedge 0 0 0 A 3128481 7745000 156490 7588510 2011 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Form 990, Part VI, Section B, line 11b Cottage Hospital gathers the information, and our CPA firm completes the Form 990. The Form 990 is then reviewed by the CFO and Controller, before it is sent to the Board of Directors for their review. Once all of this has been completed, the CFO signs the Form 990, and it is sent to the IRS. Form 990, Part VI, Section B, line 12c The members of the Board of Trustees are required to file an annual Conflict of Interest Statement. Form 990, Part VI, Section B, line 15 The following were used to determine compensation of the CEO: comparison data and a compensation survey. The CEO's compensation is approved by the Executive Committee and the Board of Trustees. The compensation of officers and key employees, other than the CEO, is set by management using available industry data and benchmarks. Compensation of these employees is indirectly approved when the Board approves the annual operating budget. Form 990, Part VI, Section C, line 18 The Organization makes its Form 1023 and Form 990 available upon request and through a third party website. Form 990, Part VI, Section C, line 19 By using the Annual Report and website. Form 990, Part IX, line 11g Purchased Services: Program service expenses 1,134,321. Management and general expenses 486,138. Fundraising expenses 0. Total expenses 1,620,459. Other Professional Fees: Program service expenses 1,771,825. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,771,825. Consulting Fees: Program service expenses 16,606. Management and general expenses 149,453. Fundraising expenses 0. Total expenses 166,059. Collection Fees: Program service expenses 0. Management and general expenses 124,876. Fundraising expenses 0. Total expenses 124,876. Contract Labor: Program service expenses 3,635,112. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,635,112. Service Contracts: Program service expenses 678,561. Management and general expenses 1,017,841. Fundraising expenses 0. Total expenses 1,696,402. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Cottage Hospital 90 Swiftwater Road Woodsville, NH 03785 EIN: 02-0223321 Cottage Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Funds Held in Trust by Others 16,617.