2023-08-11T13:51:50-05:00 2022-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2021-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Steven Shaffer CFO 6034449000 2023-08-10 1 Steven Shaffer 999009999 Joseph R Byrne P01289281 2077752387 2023-08-10 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 122855173 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 17 14 652 60 0 0 9690587 2721351 97406827 106344174 859871 1672313 118585 250912 108075870 110988750 356867 287377 0 0 54558651 56338958 0 0 0 44499243 52126381 99414761 108752716 8661109 2236034 135716999 115297202 69222216 56932469 66494783 58364733 X To provide quality, compassionate, and accessible healthcare in a manner that brings value to all. 0 0 82241094 287377 106344174 Littleton Hospital Association provides health care services on an in/outpatient basis to the general public, including charity care, community education, and various other health programs and services. Littleton Hospital Association offers a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventative diagnostic, therapeutic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.Littleton Hospital Association provides these services without regard to race, religion, age, sex, income, creed, national origin, or disability.Littleton Hospital Association maintains a sufficient number and mix of medical staff who are competent, dedicated and community based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.Littleton Hospital Association creates a healthy, satisfying work environment for physicians, nurses and other employees, with a commitment to support the continuing educational needs of its professional staff, including the physicians, nurses and allied health personnel. 82241094 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 144 0 1 652 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 17 14 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X Steven Shaffer 6034449000 600 St Johnsbury Road Littleton NH 03561 Jeff Woodward Chair 1.00 X X 0 0 0 Erin Hennessey Vice Chair 1.00 X X 0 0 0 Dr Patrick Fitzpatrick Treasurer/Physician 40.00 X X 788154 0 41045 Ashley Garrison Secretary 1.00 X X 0 0 0 Fred Chisolm Trustee 1.00 X 0 0 0 Kathryn Fleury Trustee 1.00 X 0 0 0 Dr Stephen Goldberg Trustee/Physician 40.00 X 345059 0 43389 Richard Jesseman Trustee 1.00 X 0 0 0 Elizabeth Kunz Trustee 1.00 X 0 0 0 Robert MacLeod Trustee 1.00 X 0 0 0 Dr Richard McKenzie Ex Officio/Physician 40.00 X 262312 0 40362 Laurie Morgan Trustee & LRH Auxiliary 1.00 X 0 0 0 Stephen Noyes Trustee 1.00 X 0 0 0 Charyl Reardon Trustee 1.00 X 0 0 0 Paul Smith Trustee 1.00 X 0 0 0 Thomas Tremblay Trustee 1.00 X 0 0 0 Roger Gingue Trustee 1.00 X 0 0 0 Steven Shaffer CFO 40.00 X 20000 0 0 Robert Nutter President & CEO 40.00 X 578354 0 485462 Steven Ciampa Past Interim CFO 40.00 X 160884 0 3193 Dr Eric Emig Physician 40.00 X 694866 0 50347 Dr Jeffrey Kauffman Physician 40.00 X 598813 0 42116 Dr Jean Langevin Physician 40.00 X 647058 0 23176 Dr Eric Mullins Physician 40.00 X 719496 0 48390 Dr Anthony Salerni Physician 40.00 X 609458 0 14100 Leslie Walker Former VP of Finance 40.00 X 154244 0 33907 5578698 0 825487 88 1 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 3063165 Midland General Contractors Inc 716 Windsor Rd Loves Park IL 61111 General Contractor 1356246 Secured Network Services 775 Industrial Park Rd Littleton NH 03561 Professional Services Agreement 1187430 General Linen Services 75 Centre Rd Somersworth NH 03878 Laundry Service 439917 Change Healthcare Solutions PO Box 98347 Chicago IL 60693 A/R Collections 322688 15 56953 2156334 508064 2721351 Patient Service Revenue 621110 227061805 227061805 Other Revenue 621110 4093147 3536775 556372 Contract Lab 621500 41837 26959 14878 Contractual Allowances 621110 -124852615 -124837737 -14878 106344174 986356 986356 270990 0 270990 270990 270990 12528092 11842135 685957 685957 685957 4210 56953 24288 -20078 -20078 110988750 105787802 0 2479597 X 287377 287377 2768213 1520320 1247893 43895192 36985883 6909309 1254518 1130017 124501 5649563 4840115 809448 2771472 2363560 407912 183028 134668 48360 117643 117643 12067258 4819887 7247371 269770 259792 9978 2312626 1090679 1221947 1567409 603623 963786 4714959 2011554 2703405 93693 50406 43287 13630 13630 778440 778440 3936561 699016 3237545 1798364 1710806 87558 Medical Supplies 18511666 18511666 Medicaid Enhancement Ta 4198782 4198782 Miscellaneous Expense 1209078 670472 538606 Recruiting Expense 353474 352471 1003 108752716 82241094 26511622 0 X 426974 144066 12844874 5938950 40271 8829 15274075 13456183 2089391 2008161 2089333 2029717 107942082 74538660 32991327 33403422 61972539 49103963 0 591877 7988215 8612034 135716999 115297202 16346332 16427556 1025055 1337204 20961664 20046223 955500 518742 29933665 18602744 69222216 56932469 X 63208775 55514259 3286008 2850474 66494783 58364733 135716999 115297202 X 2236034 -11844569 1478485 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 14685 14685 0 Part II-B, Line 1: Littleton Hospital Association is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Littleton Hospital Association and other member organizations in furtherance of their exempt purposes. Littleton Hospital Association does not directly perform any lobbying activities. 2757824 116439 -487433 2386830 2432225 29896 403922 108219 2757824 2374660 1058 129189 72682 2432225 2365387 1539 56233 48499 2374660 2286360 3245 128304 52522 2365387 0.00000 0.84918 0.15082 0 0 1981468 1981468 43250351 28571945 14678406 1303110 380933 922177 55381860 43625178 11756682 6025293 1960604 4064689 33403422 Other Receivables 8612034 8612034 Estimated Third-Party Payor Settlements 9843071 Deferred Compensation 4446454 Interest Rate Swap 685796 Medicare Accelerated Payments 3149501 Reserve for Self-Funded Health Insurance 477922 18602744 100243254 -11844569 1502773 -10341796 110585050 117643 286057 403700 110988750 108373304 24288 24288 108349016 117643 286057 403700 108752716 Part V, Line 4: All endowed funds are used based on the donors' wishes. The principal of the funds remains, and only the interest earned can be distributed. Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swap 1,478,485. Fundraising Expenses 24,288. Part XI, Line 4b - Other Adjustments: Community Benefit Expense 161,057. Non-Operating Loss 125,000. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 24,288. Part XII, Line 4b - Other Adjustments: Community Benefit Expense 161,057. Non-Operating Loss 125,000. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 5259505 0 0 0 0 0 0 5259505 0 5259505 0 0 1 0 1 0 Part III Accounting Method: Golf Tournament 61163 56953 4210 4981 8193 8514 2600 61163 56953 4210 4981 8193 8514 2600 24288 -20078 1 1 X 1 X 1 X 1 1 0 1 1 607440 0 607440 0.00560 18965253 11329414 7635839 0.07020 19572693 11329414 8243279 0.07580 173160 173160 0.00160 85653 85653 0.00080 26872486 15857352 11015134 0.10130 287377 287377 0.00260 27418676 15857352 11561324 0.10630 46991369 27186766 19804603 0.18210 1 0 24345783 24345783 X 1 1 1 1 Littleton Regional Hospital 600 St Johnsbury Road Littleton NH 03561 www.littletonhealthcare.org 02790 X X X X Littleton Regional Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X https://littletonhealthcare.org/about-lrh/ X 1 19 1 https://littletonhealthcare.org/about-lrh/ 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X X X X X 1 X 0 X X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: In 2019, the Northern New Hampshire Region (Littleton Regional Healthcare, Ammonoosuc Community Health Services and Coos County Family Health Services) performed a Community Health NeedsAssessment to determine the health needs of the Greater Northern New Hampshire Region.Data was gathered from multiple well-respected secondary sources to build an accurate picture of the community and its health needs. A survey of a select group of local Experts was performed to review the prior CHNA and provide feedback, and to ascertain whether the previously identified needs are still a priority. Additionally, the group review the data gathered from the secondary sources and determined the Significant Health Needs for the community. Littleton Regional Hospital Part V, Section B, Line 6b: LRH's (the Hospital) CHNA was conducted along with Ammonoosuc Community Health Services and Coos County Family Health Services. Littleton Regional Hospital Part V, Section B, Line 11: The Hospital is addressing the significant needs identified in its most recent CHNA as follows:- Drug/Substance Abuse: The Doorway at LRH is part of a statewide initiative to address the growing opioid crisis. Littleton Regional Healthcare serves as a HUB for Northern New Hampshire. Fire, police and first responders carry Narcan with them to administer during calls. LRH offers a women's health conference annually that attracts close to 400 women. The Conference offers education on drug and substance misuse.- Mental Health: Two contract providers were available and seeing patients at LRH to address mental health issues. LRH offers community education on topics related to mental health issues to raise awareness that mental health issues can happen to anyone or any family and should be treated with the same care as diabetes, cardiac issues, etc.- Obesity/Overweight: LRH's Registered Dietician shares health related information about healthy eating habits including healthy diets and recipes through North Country Nutrition & Wellness a Blog for visitors to the LRH website. LRH offers entry level fitness classes on campus including yoga, and Bone Builders. LRH's 43.6 acres makes walking on the campus a favorite for everyone to walk and run. This encourages staying fit and addresses the obesity/overweight community health need.- Accessibility (Transportation/Disability, Access to Care, etc.) LRH provided transportation to and from appointments and procedures at LRH through our Care-A-Van service. LRH invested more than $110,000 to cover the cost of this service to assist individuals who cannot drive or cannot afford a vehicle so that they can get to and from Littleton Regional Healthcare.- Alcohol Abuse: Due to Covid-19, LRH did not allow Alcohol Anonymous to host. LRH hosts Alcohol Anonymous weekly meetings at no cost to AA. Again, the Doorway at LRH offers drug/substance abuse treatment in the region we serve.- Affordability: In FY 2022, LRH provided $618,000 in charity care for individuals who are unable to pay for healthcare services. Our patient financial services staff works with patients who do not have insurance but want to be covered to help them make a selection that works for them. We work with patients to help them pay their healthcare bills on a monthly basis, at a level that works for their financial capabilities.- Dental: LRH does not address this need directly, but we do refer patients to Ammonoosuc Community Health Services who offers high-quality, affordable dental care that is open to everyone regardless of ability to pay. They accept Medicaid and most major insurances and work with uninsured through a sliding fee scale payment option. Part I, Line 7: The Hospital determines its cost of charity care based on an overall financial statement cost to charge ratio applied against gross charity care charges. Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to physician practices. Part III, Line 4: Please refer to pages 8-11 of the attached audited financial statements. Part III, Line 8: Any shortfall is treated as a community benefit. The Organization uses a cost to charge ratio from the Medicare cost report to determine the amount of Medicare allowable costs. Part III, Line 9b: Patients who are known to qualify for financial assistance are given a financial assistance application to fill out and return to our Financial Counselor. Upon receipt of the financial assistance application, the application is processed and the amount of financial assistance that will be granted to the patient is determined.Once the percentage of financial assistance is approved, we adjust the account balance accordingly. If a balance is left over after the financial assistance is adjusted, the patient will receive their monthly statements for the remaining balance.If the patient defaults on paying the remaining balance, their account will be sent to a third party collection agency no sooner than 120 days from date of their first statements issued. At this time we would turn the account over to the third party collection agency for further collection efforts. Part VI, Line 2: LRH takes a comprehensive approach to assess community health needs. We perform several independent data analyses based on secondary source data, augment this with local survey data and resolve any data inconsistency or discrepancies from the combined opinions formed from local experts. We rely on secondary source data and most secondary sources use the county as the smallest unit of analysis. Since the service area comprises parts of Grafton County, we asked local residents to note if they perceived the problems, or needs, identified by secondary sources to exist in their portion of the county. Part VI, Line 3: Any applicant will receive a prompt decision on eligibility and amount of charity care offered. Notices of the Charity Care Policy are posted in the lobbies, waiting rooms and other public areas. Notices are also given to recipients who are served in their homes. Part VI, Line 4: The Hospital defines its primary service area as Grafton County. Grafton County, New Hampshire's estimated population is 92,201 with a growth rate of -0.03% in the past year according to the most recent United States census data. Grafton County, New Hampshire is the 5th largest county in New Hampshire. According to the United States Census, the Population estimates base in 2021 is 92,201 in Grafton County, New Hampshire. Persons under 5 years of age will make up 1.3% of the population. Persons under 18 years of age will make up 17% of the population. Persons 65 years of age and over will make up 20.5% and all females will make up 50.2% of the overall population. Median household income was $73,755. Per capita income in past 12 months (in 2021 dollars) 2017-2021 is $42,336. 9.4% of the population is considered at poverty level. For years 2017-2021 the percentage for individuals with a disability, under age 65 years is 9.9%. For people without health insurance, under the age of 65 years, the percentage is 8.4%. Part VI, Line 5: Littleton Regional Healthcare is involved in several community building activities that promote the health and wellbeing of the communities it serves. We collaborate with a number of local agencies including the North Country Health Consortium, Littleton Area Senior Center, Ammonoosuc Community Health Services and others. These agencies share common goals that address access to healthcare, health improvement, health education and affordable healthcare services. LRH encourages senior management and mid-level management to be actively involved in the communities we serve. We work with area schools to address the health of our young students and we work with local safety providers to promote safety and help prevent injury. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 273194 0 Support Medicaid Expansion and Drug & Alcohol Commission. Ammonoosuc Community Health Center 25 Mt Eustis Road Littleton NH 03561 510137745 501(c)(3) 7819 0 Up to Date clinical database 2 0 Part I, Line 2: Amounts were paid to organizations were required by the State of NH in order to support Medicaid expansion, as well as other nonprofit organizations. Therefore, additional monitoring of funds was not deemed to be necessary. X X X X 0 1 0 0 0 0 0 1 0 Robert Nutter President & CEO 548804 0 10000 0 19550 0 444868 0 40594 0 1063816 0 0 0 Dr Patrick Fitzpatrick Treasurer/Physician 387411 0 381205 0 19538 0 5111 0 35934 0 829199 0 0 0 Dr Eric Mullins Physician 688724 0 30722 0 50 0 4488 0 43902 0 767886 0 0 0 Dr Eric Emig Physician 541216 0 153600 0 50 0 3000 0 47347 0 745213 0 0 0 Dr Jean Langevin Physician 609008 0 18500 0 19550 0 8700 0 14476 0 670234 0 0 0 Dr Jeffrey Kauffman Physician 598763 0 0 0 50 0 6300 0 35816 0 640929 0 0 0 Dr Anthony Salerni Physician 584408 0 25000 0 50 0 0 0 14100 0 623558 0 0 0 Dr Stephen Goldberg Trustee/Physician 281009 0 45800 0 18250 0 7922 0 35467 0 388448 0 0 0 Dr Richard McKenzie Ex Officio/Physician 212222 0 50040 0 50 0 7978 0 32384 0 302674 0 0 0 Leslie Walker Former VP of Finance 153194 0 1000 0 50 0 4813 0 29094 0 188151 0 0 0 Steven Ciampa Past Interim CFO 145884 0 15000 0 0 0 0 0 3193 0 164077 0 0 0 Part I, Line 4b Robert Nutter, President and CEO, participated in the Hospital's 457(f) plan. Littleton Regional Healthcare contributed $438,257 to Mr. Nutter's plan during calendar year 2021. Part I, Line 7 Dr. Patrick Fitzpatrick, Dr. Stephen Goldberg, Robert Nutter, Dr. Richard McKenzie, Steven Ciampa, Leslie Walker and Highest Compensated Employees: Dr. Jean Langevin, Dr. Anthony Salerni, Dr. Eric Mullins and Dr. Eric Emig all received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties outlined in their respective contracts. The Board approved bonuses based on performance of the organization for fiscal year 2022. A New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 5331100 Refunded series 2007 Bond 0 0 0 B New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 20753200 Refunded series 2007 Bond 0 0 0 A 1318040 5331100 41800 5289300 2015 1 0 1 1 B 4507487 20753200 162500 20590700 2015 1 0 1 1 A 0 1 0 0 0 0 1 B 0 1 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 1 Deutsche Bank AG 20.000000000000 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2022 Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2022 Schedule K, Part III, Line 2, Lease Arrangements: The debt-financed property is leased to 3 physician practices which operated primarily for purposes related to the hospitals performance of its exempt purpose. Therefore, these leases are not considered to be private business use (Dartmouth Hitchcock (Derm and Cardio), Shippee Family Eyecare, Littleton Internal Med, White Mtn Family Health). Form 990, Part VI, Section A, line 2 Roger Gingue, Board Trustee and Dr. Patrick Fitzpatrick, Treasurer, have a family relationship. Form 990, Part VI, Section B, line 11b The return was reviewed by the entire Board of Trustees prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, and Auxilians complete a Conflict of Interest Statement each year, and any potential conflicts are reported to the Board of Trustees and to other places as required by law. In addition, employees who don't normally make decisions for the facility are expected to report forward any conflicts they may have, should they ever be in a position to influence decision making. Form 990, Part VI, Section B, line 15 Key employees complete self-evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations and market data. The CFO salary is approved by the President. The President/CEO's salary is approved by the Board. Form 990, Part VI, Section C, line 19 The hospital's governing documents and financial statements are made available upon request. The hospital's conflict of interest policy is not made available to the public. Form 990, Part IX, line 11g Contract Labor: Program service expenses 1,557,064. Management and general expenses 6,327,143. Fundraising expenses 0. Total expenses 7,884,207. Consulting: Program service expenses 654,804. Management and general expenses 4,261. Fundraising expenses 0. Total expenses 659,065. Purchased Services: Program service expenses 2,608,019. Management and general expenses 915,967. Fundraising expenses 0. Total expenses 3,523,986. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Littleton Hospital Association 600 St. Johnsury Road Littleton, NH 03561 EIN 02-0222152 Littleton Hospital Association is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain/Loss on Interest Rate Swap 1,478,485.