2023-08-03T10:09:58-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 020223321 Cottage Hospital COTT 6037479000 90 Swiftwater Road Woodsville NH 03785 Ann Duffy CFO 6037479000 2023-08-01 1 Ann Duffy 999009999 Joseph R Byrne P01289281 2077752387 2023-08-01 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Holly McCormack 90 Swiftwater Road Woodsville NH 03785 38722093 0 X www.cottagehospital.org X 1903 NH Medical care and related services 12 9 395 11 0 0 8094831 1865171 33426720 35658657 325501 646037 79718 -3147 41926770 38166718 1665 4950 0 0 21859212 21419338 0 0 0 16722650 19066778 38583527 40491066 3343243 -2324348 42210200 38805493 20107680 20796180 22102520 18009313 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 27702597 4950 30228412 Cottage Hospital provided health care to approximately 627 inpatients and 30,634 outpatients during the fiscal year. 1956757 2952062 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. 1886198 2478183 The Rowe Health Center provides internal medicine, behavioral health, general surgery, podiatry, gastroenterology 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. 31545552 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 0 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 29 0 1 395 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 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 Holly McCormack CEO 40.00 X X 200385 0 36183 Mark D Gleicher Chairperson 1.00 X X 0 0 0 David Robinson Vice Chair 1.00 X X 0 0 0 Prentis Pratt Secretary 1.00 X X 0 0 0 Lili Cargill APRN Medical Staff President 40.00 X 64621 0 0 William Darcy Trustee 1.00 X 0 0 0 Mark Harris Trustee 1.00 X 0 0 0 Kevin Lawrence 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 Aaron Solnit MD Past Medical Staff President 1.00 X 0 0 0 Ashley Luurtsema Past Trustee 1.00 X 0 0 0 Delphine Sullivan Medical Staff President 22.50 X 229042 0 6004 Ann Duffy CFO 40.00 X 175452 0 28062 Christopher Findley Chief of ED 40.00 X 457658 0 39051 Christopher Danielson Physician RHC 28.00 X 330117 0 35726 Kathryn Walsh CRNA 40.00 X 216880 0 5180 Marlene Sarkis Physician RHC 40.00 X 233738 0 39035 Eric McDougall Hospitalist 28.00 X 244449 0 9591 Maria Ryan Former CEO 0.00 X 289535 0 19129 2441877 0 217961 37 1 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Contracted Providers 1168320 EM Staff 36 Coventry Road Concord NH 03301 Contracted Staff 728465 Athena Health Inc 311 Arsenal Street Watertown MA 02472 EMR Software 487920 Alliance Healthcare Services PO Box 735714 Dallas TX 75373 MRI & Nuclear Medicine Services 466681 Medical Solutions P O Box 850737 Minneapolis MN 55485 Contracted Staff 284728 12 12323 1609208 243640 1865171 Patient Service Revenue 622110 70262157 70262157 DSH Payments 622110 3528145 3528145 Other Operating Revenue 622110 465353 193248 272105 Contractual/Char. Adj. 622110 -38596998 -38596998 35658657 210789 210789 4011 0 4011 4011 4011 926470 56800 535369 12653 391101 44147 435248 435248 195 12323 7353 -7158 -7158 38166718 35386552 0 914995 X 3950 3950 1000 1000 739750 299668 440082 17047621 13221980 3825641 280328 200814 79514 2145694 1486407 659287 1205945 909656 296289 31320 31320 110305 110305 6947 6947 9859047 8396538 1462509 88945 59176 29769 1319159 528876 790283 10692 2308 8384 215304 207519 7785 1761271 1312470 448801 378735 148344 230391 Supplies 3222771 2910800 311971 Medicaid Enhancement Ta 1237300 1237300 Education and Recruitme 455263 361377 93886 Miscellaneous Expenses 369719 257369 112350 40491066 31545552 8945514 0 X 997594 1083515 12618800 10103728 4025394 4857795 533733 619753 262243 297298 35026282 22131043 13215427 12895239 9143082 8049153 252259 188930 1161668 710082 42210200 38805493 3827444 3244182 100000 250227 5003311 4812318 2546309 2519039 8630616 9970414 20107680 20796180 X 20458060 16596329 1644460 1412984 22102520 18009313 42210200 38805493 X -2324348 -1705530 -63329 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2220 2220 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. 1409543 -150608 24438 1234497 1338240 102058 30755 1409543 1441360 -63571 39549 1338240 1445662 31310 35612 1441360 1449641 34311 38290 1445662 0.00000 0.98206 0.01794 1 0 531787 531787 19359159 11493886 7865273 13327100 9973381 3353719 1808236 663776 1144460 12895239 Deferred Compensation 693282 Due to Third-Party Payors 9277132 9970414 36398265 -1705530 -55976 -1761506 38159771 6947 6947 38166718 40491472 7353 7353 40484119 6947 6947 40491066 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 -63,329. Fundraising Expenses 7,353. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 7,353. 1 1 1 X 1 X 1 1 1 0 1 1 327771 228303 99468 0.00250 5967298 5405630 561668 0.01390 6295069 5633933 661136 0.01640 225514 0 225514 0.00560 637688 0 637688 0.01570 3500 0 3500 0.00010 866702 866702 0.02140 7161771 5633933 1527838 0.03780 57700 57700 0.00140 50500 50500 0.00120 22490 22490 0.00060 150210 150210 0.00370 3000 3000 0.00010 283900 283900 0.00700 0 16407853 16548510 -140657 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 19 1 0 0 1 X cottagehospital.org/community-benefits X 1 19 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/patient-info/financial-assistance X www.cottagehospital.org/patient-info/financial-assistance X www.cottagehospital.org/patient-info/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 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 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 initiates 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 adults struggling with behavioral issues via an IP geriatric psych unit.9) Enhancing drug and other substance abuse education and prevention -10) 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.16) Increasing access to emergency care and trauma services Cottage utilizes social media and community outreach initiatives to educate the community on available services. Cottage Hospital Part V, Section B, Line 13b: Catastrophic Relief Guidelines: Cottage 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 underinsured) whose financial responsibility to Cottage Hospital exceeds $30,000 for any single episode of care. Patients whose family income exceeds 275% of the Federal Poverty Limits and whose financial responsibility to Cottage 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 8-11 and pages 14-15 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, Lisbon, Monroe, Piermont, and in Vermont - Barnet, Bradford, Corinth, Groton, Newbury, Ryegate, Wells River and Woodville. 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 1 0 0 0 0 0 0 1 0 Christopher Findley Chief of ED 457038 0 620 0 0 0 8475 0 30576 0 496709 0 0 0 Christopher Danielson Physician RHC 329497 0 620 0 0 0 7320 0 28406 0 365843 0 0 0 Maria Ryan Former CEO 71438 0 28429 0 189668 0 2795 0 16334 0 308664 0 0 0 Marlene Sarkis Physician RHC 233118 0 620 0 0 0 7879 0 31156 0 272773 0 0 0 Eric McDougall Hospitalist 244029 0 420 0 0 0 7282 0 2309 0 254040 0 0 0 Holly McCormack CEO 199765 0 620 0 0 0 5956 0 30227 0 236568 0 0 0 Delphine Sullivan Medical Staff President 228821 0 221 0 0 0 5241 0 763 0 235046 0 0 0 Kathryn Walsh CRNA 216260 0 620 0 0 0 0 0 5180 0 222060 0 0 0 Ann Duffy CFO 174832 0 620 0 0 0 7200 0 20862 0 203514 0 0 0 Part I, Line 4a Maria Ryan, Former CEO, received severance pay of $189,667 in 2021. Part I, Line 7 Maria Ryan, Former CEO, received a bonus of $28,429 in 2021. The bonus is determined based on the Board of Director's review of the CEO's performance and compensation agreement. Delphine Sullivan, Lili Cargill, Holly McCormack, Ann Duffy, Christopher Findley, Christopher Danielson, Marlene Sarkis, and Eric McDougal received bonuses for retention purposes. A Business Finance Authority of the State of NH NoneAvail 2011-05-31 7745000 Refinance Mortgage and Terminate Hedge 0 0 0 A 2932682 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 Director of Finance, 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 1,085,299. Management and general expenses 397,685. Fundraising expenses 0. Total expenses 1,482,984. Other Professional Fees: Program service expenses 1,701,891. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,701,891. Consulting Fees: Program service expenses 11,475. Management and general expenses 57,573. Fundraising expenses 0. Total expenses 69,048. Collection Fees: Program service expenses 0. Management and general expenses 88,638. Fundraising expenses 0. Total expenses 88,638. Contract Labor: Program service expenses 4,958,819. Management and general expenses 122,060. Fundraising expenses 0. Total expenses 5,080,879. Service Contracts: Program service expenses 639,054. Management and general expenses 796,553. Fundraising expenses 0. Total expenses 1,435,607. 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 -63,329.