2018-05-03T12:50:37-05:00 2017-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2016-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Leslie Walker VP of Finance 6034449000 2018-05-02 1 Barbara J McGuan CPA P00219457 2077752387 2018-05-02 69.49.157.66 2018-05-02 15:32:13 ED P C9B17F91A2F9740444165E3537F2E031898F407F C9B17F91A2F9740444165E3537F2E031898F407F 2016 2021-01-29 14:40:06Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 86153195 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 14 8 572 226 0 0 367741 203320 87274990 85164572 9836 428551 203874 177088 87856441 85973531 98329 43994 0 0 49421138 48989327 0 0 0 38190407 36106254 87709874 85139575 146567 833956 98584999 102102426 49112149 47152717 49472850 54949709 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 63466687 43994 85164572 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. 63466687 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 128 0 1 572 1 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Leslie Walker VP of Finance 6034449000 600 St Johnsbury Rd Littleton NH 03561 William Bedor Chairman 1.00 1.00 X X 0 0 0 Roger Gingue Vice Chair 1.00 1.00 X X 0 0 0 Jeff Woodward Treasurer 1.00 X X 0 0 0 Erin Hennessey Secretary 1.00 X X 0 0 0 John Starr Past Vice Chair 1.00 1.00 X X 0 0 0 Dr Andrew Forrest Past Trustee/Physician 40.00 X 0 0 0 Dr John Sauter Trustee Emeritus 40.00 1.00 X 396397 0 13250 Laurie Morgan Auxiliary Representative 1.00 X 0 0 0 Dr Deane Rankin Trustee/Physician 40.00 X 375728 0 53087 Dr Nicholas Marks Trustee/Physician 40.00 X 477989 0 52812 Elizabeth Kunz Trustee 1.00 X 0 0 0 Ed Shanshala II Trustee 1.00 X 0 0 0 Ned Brewer Trustee 1.00 X 0 0 0 Dr Imelyn Fernandez Past Trustee 1.00 X 0 0 0 Gail Tomlinson Past Trustee 1.00 X 0 0 0 James Nohl Past Trustee 1.00 X 0 0 0 Dr Patrick Fitzpatrick Chief of Staff 40.00 X 634831 0 54809 Dr Stephen Goldberg Trustee/Physician 40.00 X 348387 0 60617 Robert Nutter President 40.00 X X 0 0 0 Warren West NCH CEO 1.00 40.00 X 0 399494 45221 Russell Keene NCH President/CFO 1.00 40.00 X 0 538367 32663 Nick Braccino Past Interim President 40.00 1.00 X 188034 0 14452 Andrew Majka Past CFO 40.00 1.00 X 256315 0 0 Leslie Walker VP of Finance 40.00 X 109370 0 45503 Linda Gilmore CAO/CNO 40.00 X 192774 0 48928 Dr Eric Mullins Physician 40.00 X 786849 0 49708 Dr Harlan Herr Physician 40.00 X 606671 0 30231 Dr Jeffrey Kauffman Physician 40.00 X 574240 0 53803 Dr Leon Kogan Physician 40.00 X 495650 0 15583 Dr Jennifer Lucas Physician 40.00 X 447430 0 42803 5890665 937861 613470 61 0 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 2985530 Trumbull-Nelson Construction PO Box 1000 Hanover NH 03755 General Contractor 2224365 Envision Pharmaceutical Svc Inc 2181 E Aurora Road Suite 201 Twinsburg OH 44087 Pharmacy Services 811772 Comphealth PO Box 972651 Dallas TX 75397 Locum 796244 McKesson Technologies Inc PO Box 98347 Chicago IL 606938347 IT Support 675541 9 57979 145341 203320 Patient Service Revenue 900099 162403391 162403391 Other Revenue 900099 3722722 3695051 27671 Contract Lab 621500 125112 125112 0 Provision for Bad Debts 900099 -4447206 -4447206 Contractual Allowances 900099 -76639447 -76639447 85164572 532517 532517 199749 0 199749 199749 199749 52200 52654 103512 -454 -103512 -103966 -103966 837 57979 23498 -22661 -22661 85973531 85136901 0 633310 43994 43994 3323281 2467906 855375 38266221 32548055 5718166 567647 489756 77891 4706669 4012946 693723 2125509 1792369 333140 139038 139038 89154 89154 88107 88107 5802770 1702978 4099792 441300 27335 413965 1114387 260689 853698 181567 1971 179596 3941678 2351442 1590236 87867 50206 37661 67443 67443 916367 916367 4848783 3924947 923836 453958 66632 387326 Medical Supplies 12223414 12223414 Medicaid Enhancement Ta 3510562 3510562 Miscellaneous Expenses 1791166 517843 1273323 Recruiting Expenses 408693 394 408299 85139575 63466687 21672888 0 X 81785 975078 7871995 6342252 58784 39250 8877739 8606746 94403 74231 1580635 1821601 1612448 1447215 93995591 55428034 41531454 38567557 35727434 42898947 1148322 1329549 98584999 102102426 7109172 6079767 580859 863987 25180505 24395530 3348960 2005714 12892653 13807719 49112149 47152717 X 47191321 52340287 459376 614117 1822153 1995305 49472850 54949709 98584999 102102426 X 833956 3544037 1098866 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13220 13220 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. 2068307 950 221332 4229 2286360 886217 1150768 31397 75 2068307 939547 5464 -57271 1523 886217 870609 5517 63496 75 939547 794094 81883 5368 870609 0.00000 0.87270 0.12730 0 0 786809 786809 42230466 23933550 18296916 46860461 30324533 16535928 4117855 1169951 2947904 38567557 Reserve for Self-Funded Health Insurance 395941 Due to Third Party Payors 8359268 Deferred Compensation 2626634 Interest Rate Swap 2382162 Due to Related Party 43714 13807719 90030899 3544037 601438 4145475 85885424 88107 88107 85973531 84554040 0 84554040 88107 497428 585535 85139575 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/Loss on Interest Rate Swap 1,098,866. Community Benefit Expense -520,926. Fundraising Expenses 23,498. Part XII, Line 4b - Other Adjustments: Community Benefit Expense 520,926. Fundraising Expenses -23,498. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 Investments 10427265 0 0 0 0 0 0 10427265 0 10427265 0 0 1 0 1 0 Dr. Moose Golf Tournament 58816 57979 837 100 15990 1525 5883 58816 57979 837 100 15990 1525 5883 23498 -22661 1 1 X 1 X 1 X 1 1 0 1 1 3971357 3441996 529361 0.00620 14482459 12235496 2246963 0.02640 18453816 15677492 2776324 0.03260 358356 358356 0.00420 121879 121879 0.00140 20424666 15333071 5091595 0.05980 7490 7490 0.00010 20912391 15333071 5579320 0.06550 39366207 31010563 8355644 0.09810 26691 26691 0.00030 72106 72106 0.00080 3708 3708 0.00000 102505 102505 0.00110 1 2105571 25861535 25861535 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 16 1 1 0 1 X http://www.littletonhealthcare.org/pdf/LRH_CHNA_Implementation_a_2017.pdf X 1 16 1 http://www.littletonhealthcare.org/pdf/LRH_CHNA_Implementation_a_2017.pdf 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X 1 X http://www.littletonhospital.org/pdf/LRH_Financial_Assistance_Policy__2018. X http://littletonhealthcare.org/pdf/LRH_Financial_Assistance_Application.pdf X http://www.littletonhospital.org/pdf/LRH_Financial_Assistance_Policy2018.pd X X X X X 1 X 0 X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: In 2016, input from the community was solicited through a survey, which was available both electronically (through Survey Money) and via paper copy. Paper copies were distributed to various community locations. Electronic surveys were available via the Littleton and North Country Healthcare websites and through the Littleton Facebook page, plus other community partner websites. 252 surveys were completed. In addition, 49 Community leaders were also surveyed electronically. This group represented area business & economic development leaders, community board members of health & human service organizations, municipal government and human service providers. Littleton Regional Hospital Part V, Section B, Line 6a: The Hospital's CHNA was conducted along with Upper Connecticut Valley Hospital, Weeks Medical Center, and Androscoggin Valley Hospital. Littleton Regional Hospital Part V, Section B, Line 11: The Hospital is addressing the significant needs identified in its most recently conducted CHNA as follows:1. Substance Misuse, Alcohol Abuse & Mental Health Problems: Naloxone (Narcan) treatment for overdoses is an available option. Fire, police and first responders now carry Narcan with them to administer during calls. LRH employs a full time behavior health provider. Alcohol Anonymous is given space at LRH to host their weekly meetings. LRH offers a women's health conference each year that attracts close to 400 women. The conference offers education on mental health issues and substance misuse, and alcohol abuse. 2. Obesity/Overweight: North Country Healthcare affiliated hospitals employ full time registered dieticians and diabetes educators who are available to provide consults through the primary care offices. LRH offers fitness classes for community members - we currently host Bone Builders and Yoga. We offer Weight Watchers at no cost for the space. LRH developed a Healthy Eating & Fitness Blog that community members can visit to learn about ways to eat healthy and stay active. 3. Smoking and Tobacco Use: Ongoing smoking cessation classes available to the public. In addition, Littleton is a smoke/tobacco free campus. LRH includes Weeks Medical Center who offers a smoking cessation class to participate in wellness fairs, women's health conference, and any other community events.Significant Needs not being addressed and why:The needs identified that Littleton is not able to address center around the County's lack of jobs. Low Income/Poverty and Unemployment/Lack of Jobs were two such items. Cost of healthy foods was also mentioned. These are not within the scope of our mission; however we will continue to work with local resources in our role as a responsible corporate citizen to improve our economy where we can. There are currently several economic development groups in the area and some new businesses are considering moving in.Other needs we are currently unable to meet revolve around lack of dental insurance, cost of prescription drugs, and access to health insurance. While Littleton cannot fix these issues, we have made a huge effort over these past 3 years to ensure as many of our patients as possible take advantage of Medicaid Expansion or the Insurance Exchanges. This has resulted in a significant drop in our uninsured population. Littleton continues to offer free care for eligible patients through our LRH Cares program. 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 as well as the paramedic program. Part II, Community Building Activities: Littleton Regional Healthcare is involved in many community building activities that promote the health and wellbeing of the communities it serves. We work closely with a number of local healthcare agencies including; North Country Health Consortium, North Country Home Health & Hospice, Ammonosuc Community Health Services, and Littleton Area Senior Center, to name a few, whose mission is similar to LRH. Each of these agencies addresses common concerns including access to healthcare, health improvement, and health education. LRH encourages its staff to serve oncommunity collaboration boards, and health advocacy agencies to promote the services and programs provided by LRH and surrounding agencies. We also work with local safety providers to promote safety and prevent injuries. LRH is actively involved in working with area schools to promote health and wellness among our youth. 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 amd 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's defines its primary service area as Grafton County, New Hampshire. The 2012 population for Grafton County is estimated to be 90,847, and is expected to grow at a rate faster than the national rate of growth, projecting a 2017 population of 95,080. This population growth is at a faster rate than for New Hampshire as a whole.According to the population estimates utilized by Truven, provided by the Neilson Company, the 2012 median age for the County is 39.9 years, younger than the New Hampshire median age (40.4 years) but older then the national median age (36.8 years). The 2012 Median Household Income for the area is $52,729, which is lower than the New Hampshire median income of $59,470 but higher than the national median income of $49,599. Median Household Wealth and Median Home Values likewise are below State and above national values. Grafton's unemployment rate as of August 2012 was 4.4%, which is lower than the statewide rate of 5.7%, and considerably better than the national civilian unemployment rate of 8.1%.The portion of the population in the County over 65 is 15.9%, above the New Hampshire average of 13.5%. The portion of the population of women of childbearing age is 19.9%, somewhat higher than the New Hampshire average of 19.5%. In the County this population is anticipated to increase 1%, whereas for New Hampshire as a whole, the female population age 15 to 44 is anticipated to decline as a rate of just over 2%. Part VI, Line 7, Reports Filed With States NH X X X X 0 0 0 0 0 0 0 1 1 1 Dr John Sauter Trustee Emeritus 308512 0 81834 0 6051 0 13250 0 0 0 409647 0 0 0 Dr Deane Rankin Trustee/Physician 369677 0 0 0 6051 0 13250 0 39837 0 428815 0 0 0 Dr Nicholas Marks Trustee/Physician 310337 0 163908 0 3744 0 13250 0 39562 0 530801 0 0 0 Dr Patrick Fitzpatrick Chief of Staff 433657 0 173355 0 27819 0 13250 0 41559 0 689640 0 0 0 Dr Stephen Goldberg Trustee/Physician 264336 0 27000 0 57051 0 13250 0 47367 0 409004 0 0 0 Warren West NCH CEO 0 393494 0 0 0 6000 0 13250 0 31971 0 444715 0 0 Russell Keene NCH President/CFO 0 538367 0 0 0 0 0 17080 0 15583 0 571030 0 0 Nick Braccino Past Interim President 182284 0 0 0 5750 0 9404 0 5048 0 202486 0 0 0 Andrew Majka Past CFO 231264 0 25000 0 51 0 0 0 0 0 256315 0 0 0 Leslie Walker VP of Finance 109319 0 0 0 51 0 5949 0 39554 0 154873 0 0 0 Linda Gilmore CAO/CNO 192723 0 0 0 51 0 10099 0 38829 0 241702 0 0 0 Dr Eric Mullins Physician 637552 0 149246 0 51 0 13250 0 36458 0 836557 0 0 0 Dr Harlan Herr Physician 532730 0 73890 0 51 0 13250 0 16981 0 636902 0 0 0 Dr Jeffrey Kauffman Physician 553240 0 20949 0 51 0 13250 0 40553 0 628043 0 0 0 Dr Leon Kogan Physician 475599 0 0 0 20051 0 13250 0 2333 0 511233 0 0 0 Dr Jennifer Lucas Physician 447430 0 0 0 0 0 6700 0 36103 0 490233 0 0 0 Part I, Line 7 Dr. Stephen Goldberg, Dr. Nicholas Marks, Dr. Harlan Herr, Dr. Eric Mullins and Dr. Jeffrey Kauffman, Highest Compensated Employees; Dr. Patrick Fitzpatrick, Chief of Staff and Dr. John Sauter all received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties outlined in their respective contracts. Part I, Line 8 Andrew Majka's bonus was a sign-on bonus paid in accordance with his initial employment agreement. 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 346607 5331100 41800 5289300 2015 1 0 1 1 B 1155628 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 6 North Country Healthcare (NCH) became the Sole Member of Littleton Hospital Association. Form 990, Part VI, Section A, line 7a North Country Healthcare, Inc. ("NCH") has worked with members of Littleton Hospital Association ("LHA") to create a shared governance structure between the Board of Directors of NCH and the Board of Trustees at LHA. LHA continues to maintain its own Board of Directors (Corporation Board) that is distinct from the NCH Board of Directors. However, the Bylaws of NCH and LHA identify certain "Major matters" (divided into organizational and operational matters) that require initiation and/or authorization by a majority of the NCH Board. Members of the LHA Board are nominated exclusively by the LHA. However, the election of any such director must be approved by both the LHA Board and the NCH Board. Some examples of other organizational "Major matters" requiring the initiation and/or approval of the NCH Board include amendments to by-laws, election of officers, dissolution of a Hospital, merger decisions and hiring/termination of Hospital Presidents. Examples of operational "Major matters" requiring the initiation and/or approval of the NCH Board include approval of annual capital and operating budgets, adoption of compensation and benefit programs, approval of information technology systems, financial systems and auditors, plus approval of any major changes to clinical services offered. Form 990, Part VI, Section A, line 7b The Chief Executive Officer position at LHA has been changed to a President position. As with Board members, the Hospital President must be nominated at the Hospital level and then approved by both the Hospital Board and the NCH Board. The President of LHA reports to both the applicable Hospital Board and the Chief Executive Officer of NCH. The Chief Financial Officer position at LHA has been changed to the Vice President of Finance position. The Vice President of Finance at LHA will remain an appointed position by the President, this individual will also report to the President/Chief Financial Officer of NCH. Form 990, Part VI, Section B, line 11b The return was reviewed by the entire Board of Directors prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, Department directors 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, front-line 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. Quality Services queries these groups on an annual basis, and tracks down people until all statements are complete. Form 990, Part VI, Section B, line 15 Key employees complete self-evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations. The VP of Finance salary is approved by the President. The President'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 1,098,866. North Country Healthcare Inc 8 Clover Lane Whitefield NH 03598 812225283 Healthcare Management NH 501(c)(3) Line 12a, I 0 Androscoggin Valley Hospital 59 Page Hill Road Berlin NH 03570 020280367 Critical Access Hospital NH 501(c)(3) Line 3 0 Upper Connecticut Valley Hospital Corliss Lane Colebrook NH 03576 020276210 Critical Access Hospital NH 501(c)(3) Line 3 0 Weeks Medical Center 173 Middle Street Lancaster NH 03584 020222242 Critical Access Hospital NH 501(c)(3) Line 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0