2021-08-16T08:23:16-05:00 2020-09-30 010523282 Berry Dunn McNeil & Parker LLC PO BOX 1100 Portland ME 041041100 990 2019-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Steven Ciampa Interim CFO 6034449000 2021-08-11 1 Joseph R Byrne P01289281 2077752387 2021-08-11 2019 2022-09-23 18:48:47Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 125558306 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 11 632 150 624 -6939 144867 5899404 95138108 91759728 976814 2526247 167885 177580 96427674 100362959 279956 119444 0 0 52914768 52081294 0 0 0 46391867 49735543 99586591 101936281 -3158917 -1573322 101138670 118195564 48768190 67543076 52370480 50652488 X To provide quality, compassionate and accessible healthcare in a manner that brings value to all.To offer a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventive diagnostic, theraputic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.To provide these services without regard to race, religion, age, sex, income, creed, national origin, or disability.To maintain a sufficient number and mix of medical staff who are competent, dedicated and commmunity based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.To create a healthy, satisfying work environment for phsycians, 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. 0 0 84138539 119444 91759728 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. 84138539 1 1 0 1 0 0 0 0 0 1 1 0 0 0 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 1 140 0 1 632 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Leslie Walker 6034449000 600 St Johnsbury Road Littleton NH 03561 Roger Gingue Chairman 1.00 X X 0 0 0 Jeff Woodward Vice Chair 1.00 X X 0 0 0 Erin Hennessey Treasurer 1.00 X X 0 0 0 Dr Patrick Fitzpatrick Secretary/Chief of Staff 40.00 X X 770485 0 44448 Fred Chisolm Trustee 1.00 X 0 0 0 Kathryn Fleury Trustee 1.00 X 0 0 0 Ashley Garrison Trustee 1.00 X 0 0 0 Dr Stephen Goldberg Trustee/Physician 40.00 X 373201 0 47854 Richard Jesseman Trustee 1.00 X 0 0 0 Elizabeth Kunz Trustee 1.00 X 0 0 0 Dr Dougald MacArthur Trustee/Physician 40.00 X 706000 0 0 Laurie Morgan Trustee & LRH Auxiliary 1.00 X 0 0 0 Dr Deane Rankin Trustee/Physician 40.00 X 374219 0 46241 Dr Alice Rocke Medical Staff President 40.00 X 462641 0 49158 Paul Smith Trustee 1.00 X 0 0 0 Thomas Tremblay Trustee 1.00 X 0 0 0 Ed Shanshala II Past Trustee 1.00 X 0 0 0 Robin Hallquist Past Medical Staff President 1.00 X 5000 0 0 Robert Nutter President & CEO 40.00 X 577638 0 46415 Leslie Walker VP of Finance 40.00 X 178651 0 42075 Jeffrey Herbert Past CFO 40.00 X 27165 0 283 Steven Ciampa Interim CFO 40.00 X 0 0 0 Dr Eric Mullins Physician 40.00 X 718426 0 39325 Dr Harlan Herr Physician 40.00 X 659780 0 18271 Dr Jeffrey Kauffman Physician 40.00 X 563364 0 41539 Dr Anthony Salerni Surgeon 30.00 X 626178 0 0 Dr Edward L Duffy Physician/Medical Director 40.00 X 524016 0 41310 Warren West Former CEO 0.00 X 378947 0 0 6945711 0 416919 89 1 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 3064443 Secured Network Services 775 Industrial Park Road Littleton NH 03561 Professional Services Agreement 1497066 American Healthcare Staffing Assoc LLC PO Box 1928 Edmond OK 73083 Locums 1215649 Medical Solutions LLC PO Box 310737 Des Moines IA 50331 Locums 683417 Trumbull-Nelson Construction 19 Plaza Heights West Lebanon NH 03784 General Contractor 516853 20 30000 5758827 110577 5899404 Patient Service Revenue 622100 179198437 179198437 Other Revenue 622100 4493011 3920970 572041 Contract Lab 621500 62834 62210 624 Provision for Bad Debts 622100 -5779593 -5779593 Contractual Allowances 622100 -86214961 -86214961 91759728 611584 611584 177580 0 177580 177580 177580 27079010 31000 25110126 85221 1968884 -54221 1914663 1914663 0 30000 0 0 100362959 91187063 624 3275868 119444 119444 3751475 2879248 872227 39071830 33084556 5987274 959114 811831 147283 5736408 4862969 873439 2562467 2154687 407780 987675 987675 78056 78056 94778 94778 6595289 5936985 658304 443440 274445 168995 6646243 4113361 2532882 2062869 1276710 786159 4898468 3031663 1866805 148025 91613 56412 38637 23912 14725 861909 861909 4456351 3681299 775052 1258518 778897 479621 Medical Supplies 14945412 14945412 Medicaid Enhancement Ta 3864918 3864918 Miscellaneous Expense 2151430 1218718 932712 Recruiting Expense 203525 125962 77563 101936281 84138539 17797742 0 X 134354 242472 1202745 20601282 6244 0 11060454 12780011 29946 0 2195332 2066069 2287417 2314253 101714210 66651383 38050941 35062827 43719926 42269104 2451311 2859546 101138670 118195564 9200193 11695785 608811 862868 22772521 21919698 1774773 1373039 14411892 31691686 48768190 67543076 X 49733881 47852166 2636599 2800322 52370480 50652488 101138670 118195564 X -1573322 209218 -353888 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10802 10802 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. 2374660 1058 129189 72682 2432225 2365387 1539 56233 48499 2374660 2286360 3245 128304 52522 2365387 2068307 950 221332 4229 2286360 886217 1150768 31397 75 2068307 0.00000 0.82280 0.17720 0 0 764443 764443 42177509 26367604 15809905 54368504 38473725 15894779 4403754 1810054 2593700 35062827 Estimated Third-Party Payor Settlements 13478741 Deferred Compensation 3274482 Interest Rate Swap 2649996 CARES Act Funding 1316793 Medicare Accelerated Payments 10971674 31691686 100007081 209218 -330135 -120917 100127998 94778 140183 234961 100362959 101725073 0 101725073 94778 116430 211208 101936281 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 Loss on Interest Rate Swap -330,135. Part XI, Line 4b - Other Adjustments: Community Benefit Expense 116,430. Disaffiliation Expenses 23,753. Part XII, Line 4b - Other Adjustments: Community Benefit Expense 116,430. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 4892132 0 0 0 0 0 0 4892132 0 4892132 0 0 1 0 1 0 Part III Accounting Method: Virtual Golf Tournament 30000 30000 0 0 0 0 0 0 30000 30000 1 1 X 1 X 1 X 1 1 0 1 1 546445 546445 0.00540 13155271 9248313 3906958 0.03830 13701716 9248313 4453403 0.04370 522346 522346 0.00510 216780 216780 0.00210 26181210 16804297 9376913 0.09200 106913 106913 0.00100 27027249 16804297 10222952 0.10020 40728965 26052610 14676355 0.14390 131337 131337 0.00130 43319 43319 0.00040 155574 155574 0.00150 14891 14891 0.00010 345121 345121 0.00330 1 2942539 26981228 25485256 1495972 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 See Part V, Page 8 X 1 19 1 See Part V, Page 8 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 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 Needs Assessment 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 2020, LRH provided $609,000 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 V, Section B, Line 7a & Line 10a: Hospital facility website: https://littletonhealthcare.org/pdf/LRH_CHNA_11_19.pdf Part V, line 16a, FAP website: https://littletonhealthcare.org/pdf/LRH_Financial_Assistance_Policy2018.pdf?d=7546 Part V, line 16b, FAP application https://littletonhealthcare.org/pdf/LRH_Financial_Assistance_Application.pdf Part V, line 16c, FAQ Plain Language Summary website https://littletonhealthcare.org/pdf/LRH_Financial_Assistance_Policy2018.pdf 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 II, Community Building Activities: 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 III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable.In evaluating the collectibility of accounts receivable, the Hospital analyzes past results and identifies trends for each major payor source of revenue for the purpose of estimating the appropriate amounts of the allowance for doubtful accounts and the provision for bad debts. The adequacy of the allowance for doubtful accounts is regularly reviewed. For receivables associated with services provided to patients who have third-party coverage, an allowance for doubtful accounts and a provision for bad debts are established at varying levels based on the age and payor source of the receivable. For receivables associated with self-pay patients, the Hospital records a provision for bad debts in the period of service based on past experience indicating the inability or unwillingness to pay amounts for which they are financially responsible. 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 89,947 with a growth rate of -0.04% 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 July 1, 2018 is 89,786 in Grafton County, New Hampshire. Persons under 5 years of age will make up 4.1 of the population. Persons under 18 years of age will make up 16.2% of the population. Persons 65 years of age and over will make up 20.7% and all females will make up 50.6 of the overall population. Median household income (in 2018 dollars), 2014 - 2018 was $63,153. Per capita income in past 12 months {in 2018 dollars) 2014-2018 is $36,619. 9.0% of the population is considered at poverty level. Individuals with a disability, under age 65 years, percent 2014- 2018 is 9.9%. People without health insurance, under the age of 65 years is 8.4. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 93854 Support Medicaid Expansion and Drug & Alcohol Commission. Ammonoosuc Community Health Center 25 Mt Eustis Road Littleton NH 03561 510137745 501(c)(3) 7730 Clinical full text database 2 0 Schedule I, Part I, Line 2 Amounts paid to organizations were required by the State of NH in order to support Medicaid expansion. Therefore, additional monitoring of funds was not deemed to be necessary. X X X X 1 0 0 0 0 0 0 1 0 Dr Patrick Fitzpatrick Secretary/Chief of Staff 411889 0 344099 0 14497 0 5697 0 38751 0 814933 0 0 0 Dr Stephen Goldberg Trustee/Physician 259406 0 74810 0 38985 0 8190 0 39664 0 421055 0 0 0 Dr Dougald MacArthur Trustee/Physician 706000 0 0 0 0 0 0 0 0 0 706000 0 0 0 Dr Deane Rankin Trustee/Physician 347804 0 7200 0 19215 0 7826 0 38415 0 420460 0 0 0 Dr Alice Rocke Medical Staff President 402591 0 41000 0 19050 0 8400 0 40758 0 511799 0 0 0 Robert Nutter President & CEO 419788 0 155000 0 2850 0 6183 0 40232 0 624053 0 0 0 Leslie Walker VP of Finance 172773 0 5000 0 878 0 5643 0 36432 0 220726 0 0 0 Dr Eric Mullins Physician 692378 0 25458 0 590 0 5623 0 33702 0 757751 0 0 0 Dr Harlan Herr Physician 537261 0 117549 0 4970 0 2804 0 15467 0 678051 0 0 0 Dr Jeffrey Kauffman Physician 552086 0 0 0 11278 0 6000 0 35539 0 604903 0 0 0 Dr Anthony Salerni Surgeon 577089 0 49039 0 50 0 0 0 0 0 626178 0 0 0 Dr Edward L Duffy Physician/Medical Director 382398 0 120192 0 21426 0 7202 0 34108 0 565326 0 0 0 Warren West Former CEO 0 0 0 0 378947 0 0 0 0 0 378947 0 0 0 Part I, Line 4a Warren West, Former CEO, received a severance payment of $378,947 during calendar year 2019. Part I, Line 7 Dr. Patrick Fitzpatrick, Dr. Stephen Goldberg, Dr. Deane Rankin, Dr. Alice Rocke, and Highest Compensated Employees; Dr. Eric Mullins, and Dr. Harlan Herr all received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties outlined in their respective contracts. Dr. Anthony Salerni received a sign on bonus. The Board approved bonuses based on performance of the organization for fiscal year 2020. The President received 15% of gross salary and the senior team received 10% of salary. 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 915329 5331100 41800 5289300 2015 1 0 1 1 B 3089386 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 1 0 0 0 0 0 1 B 0 0 1 0 1 1 Deutsche Bank AG 20.000000000000 0 0 0 0 1 A 1 B 1 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. Form 990, Part VI, Section A, line 2 Roger Gingue, Board Chair and Dr. Patrick Fitzpatrick, Board Secretary and Chief of Staff, 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 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 -330,135. Disaffiliation expenses -23,753.