ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
Tax period: 2014-10-01 to 2015-09-30
Filed: 2016-05-27
IRS object ID: 201621489349300607
Schema version: 2014v6.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-05-27T10:23:42-05:00	ReturnTs
Tax Period End	2015-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	010494526	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BAKER NEWMAN & NOYES LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	650 ELM STREET SUITE 302	AddressLine1Txt
City	MANCHESTER	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03101	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	020222791	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	ALIC	BusinessNameControlTxt
Phone	6034483121	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Susan E Mooney MD MS	PersonNm
Person Title	President & CEO	PersonTitleTxt
Phone	6034483121	PhoneNum
Signature	2016-05-20	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Nicholas E Porto	PreparerPersonNm
PTIN	P01310283	PTIN
Phone	8002447444	PhoneNum

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-08-17 19:52:53Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	Susan E Mooney MD MS	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$64,735,430	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.alicepeckday.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1943	FormationYr
Legal Domicile State	NH	LegalDomicileStateCd
Activity Or Mission	Critical Access Hospital	ActivityOrMissionDesc
Voting Members Governing Body	19	VotingMembersGoverningBodyCnt
Voting Members Independent	15	VotingMembersIndependentCnt
Total Employee	584	TotalEmployeeCnt
Total Volunteers	50	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$677,336	PYContributionsGrantsAmt
CY Contributions Grants	$618,614	CYContributionsGrantsAmt
PY Program Service Revenue	$56,525,205	PYProgramServiceRevenueAmt
CY Program Service Revenue	$63,447,169	CYProgramServiceRevenueAmt
PY Investment Income	$311,898	PYInvestmentIncomeAmt
CY Investment Income	$198,040	CYInvestmentIncomeAmt
PY Other Revenue	$3,185	PYOtherRevenueAmt
CY Other Revenue	$19	CYOtherRevenueAmt
PY Total Revenue	$57,517,624	PYTotalRevenueAmt
CY Total Revenue	$64,263,842	CYTotalRevenueAmt
PY Grants And Similar Paid	$30,150	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$35,150	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$33,037,574	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$36,019,107	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$234,530	CYTotalFundraisingExpenseAmt
PY Other Expenses	$23,833,252	PYOtherExpensesAmt
CY Other Expenses	$26,816,337	CYOtherExpensesAmt
PY Total Expenses	$56,900,976	PYTotalExpensesAmt
CY Total Expenses	$62,870,594	CYTotalExpensesAmt
PY Revenues Less Expenses	$616,648	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$1,393,248	CYRevenuesLessExpensesAmt
Total Assets BOY	$43,993,395	TotalAssetsBOYAmt
Total Assets EOY	$47,766,765	TotalAssetsEOYAmt
Total Liabilities BOY	$25,711,242	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$28,468,893	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$18,282,153	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$19,297,872	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	The mission of Alice Peck Day Health Systems is to provide personalized, highest quality, patient-focused healthcare services which are responsive to community needs, promote wellness, and continually improve the quality of healthcare in the community.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$59,318,666	ExpenseAmt
Grant	$35,150	GrantAmt
Revenue	$63,447,169	RevenueAmt
Desc	Alice Peck Day Memorial Hospital is a community-based critical access hospital operating in Lebanon, NH. The Hospital began as a small cottage hospital in 1932. From its humble beginnings, Alice Peck Day has continually demonstrated its commitment to provide patient-focused health care services which improve the quality of life within its community and promote wellness for all. Alice Peck Day Memorial Hospital is a charitable health care organization which is dedicated to serving its community. This commitment includes granting credit to patients, substantially all of whom are local residents. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than the established rates. Collections are not pursued for amounts determined to qualify as charity care. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the established costs of the services and supplies provided, and equivalent service statistics. For the year ended September 30, 2015, charity care at a cost of $304,650 was provided to eligible patients. Estimated costs incurred in excess of payment for inpatient and outpatient services for Medicaid patients in the year ended September 30, 2015 were $2,801,098. In addition to the charity care services described above, the Hospital provided a number of other services for which little or no payment was received. These included: community flu clinics, bi-weekly blood pressure checks at a local elderly housing complex, the Upper Valley Smiles Dental Program (free oral health education, screenings, and preventive treatment offered to low-income children in ten local elementary schools), assistance with enrollment into prescription assistance and state health insurance programs, health professional education, emergency pharmacy vouchers for uninsured patients, and many other initiatives which contributed to and supported our community. As a local hospital, Alice Peck Day works closely with community organizations to address community needs. Organizations that were beneficiaries of hospital staff time, meeting space, and/or materials include: Alcoholics Anonymous, Childbirth Education and Postpartum Massage, Geisel School of Medicine at Dartmouth, Georgetown University, Good Neighbor Health Clinic, Grafton County Senior Center, Grafton County Senior Citizens' Council, Hanover Area Chamber of Commerce, Hartford Chamber of Commerce, Hartford School District, Lebanon Area Chamber of Commerce, Lebanon Kiwanis Bike Safety Rodeo, Lebanon School District, Mascoma School District, Mascoma Valley Health Initiative, Richards School in Newport, River Valley Community College, Upper Valley Public Health Council, Upper Valley Turning Point, Weight Watchers, and Yale University. In certain instances, assistance was provided to the community for which no value can be placed. This assistance included leadership in identifying community needs, staff commitment to volunteer for community organizations, advocacy and support for the socially and physically disadvantaged, and support for local public safety organizations. Alice Peck Day considers caring for our community a special responsibility that we are honored to fulfill. Through our many programs, dedicated staff and unwavering commitment to quality care, Alice Peck Day works to exceed these expectations and make a real difference in our community.	Desc
Total Program Service Expenses	$59,318,666	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	67	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	584	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	19	GoverningBodyVotingMembersCnt
Independent Voting Member	15	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NH	StatesWhereCopyOfReturnIsFldCd
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Todd Roberts	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6034483121	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (34 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Terri C Dudley
Trustee Emeritus (non-voting)	0.00	Yes (X)	$0	$0	$0
Closey F Dickey
Trustee Emeritus (non-voting)	0.00	Yes (X)	$0	$0	$0
Robert J Bauman
Trustee	1.00	Yes (X)	$0	$0	$0	1.00
Martha P Candon
Trustee	2.00	Yes (X)	$0	$0	$0	1.00
Curt A Jacques II
Trustee (part year, out)	1.00	Yes (X)	$0	$0	$0	1.00
Richard S Jennings
Trustee	1.00	Yes (X)	$0	$0	$0	2.00
Edward T Kerrigan
Trustee	3.00	Yes (X)	$0	$0	$0	4.00
Michael F Long
Trustee	1.00	Yes (X)	$0	$0	$0	2.00
Anne D MacEwan
Trustee	1.00	Yes (X)	$0	$0	$0	1.00
Miriam M Maguire
Trustee (part year, out)	0.50	Yes (X)	$0	$0	$0	1.50
Mark E Melendy
Trustee	1.00	Yes (X)	$0	$0	$0	3.00
Shelly L Moses
Trustee (part year, out)	1.00	Yes (X)	$0	$0	$0	1.00
Hildegard Z Ojibway
Trustee	1.00	Yes (X)	$0	$0	$0	1.00
Brett C Peltzer
Trustee	1.00	Yes (X)	$0	$0	$0	2.00
Wendell M Smith
Trustee	1.00	Yes (X)	$0	$0	$0	1.00
Michael J Cryans
Trustee (part year, out)	1.00	Yes (X)	$0	$0	$0	1.00
Michael R Harris PhD
Trustee (part year, out)	1.00	Yes (X)	$0	$0	$0	1.00
Judson T Pierson
Chair	3.00	Yes (X)	$0	$0	$0	2.00	Yes (X)
Rev Dr Guy JD Collins
Vice Chair	2.00	Yes (X)	$0	$0	$0	2.00	Yes (X)
Bruce N Johnstone
Treasurer	3.00	Yes (X)	$0	$0	$0	4.00	Yes (X)
Karen G Kayen
Secretary	1.00	Yes (X)	$0	$0	$0	1.00	Yes (X)
Susan E Mooney MD MS
President & CEO	50.00	Yes (X)	$394,272	$20,751	$72,521	11.00	Yes (X)
Daniel F Jones MD
Med. Staff President (part year, out)	3.00	Yes (X)	$12,750	$0	$0	1.00	Yes (X)
Kathryn M Vargo MD
Med. Staff President (part year, in)	3.00	Yes (X)	$257,276	$0	$54,494	1.00	Yes (X)
Claudia C Gibson
President, Auxiliary	2.00	Yes (X)	$0	$0	$0		Yes (X)
Beverley Rankin RN BSN
VP Patient Care, CNO	60.00	Yes (X)	$166,551	$0	$53,867		Yes (X)
Randall D Lea MD MPH
VP & Chief Medical Officer	28.00	Yes (X)	$206,938	$0	$36,163	1.00	Yes (X)
Evalie M Crosby CPA FHFMA
VP of Finance & CFO	40.00		$152,795	$38,199	$35,395	20.00	Yes (X)
J Todd Miller MS
VP & COO	40.00		$166,642	$41,661	$45,675	20.00	Yes (X)
John P Houde MD
Physician	40.00		$523,272	$0	$53,065			Yes (X)
Adnan Khan MD
Physician	40.00		$419,200	$0	$35,417			Yes (X)
Diane C Riley MD CAQSH
Physician	40.00		$444,315	$0	$39,500			Yes (X)
Leonard M Rudolf MD
Physician	40.00		$473,882	$0	$50,744			Yes (X)
Paul Sansone MD
Physician	40.00		$447,288	$0	$46,554			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,665,181	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$100,611	TotReportableCompRltdOrgAmt
Total Other Compensation	$523,395	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	43	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Upper Valley Neurology
106 Hanover Street	Lebanon	NH	03766	Professional Services	$2,989,131
Navin Haffty & Associates LLC
1900 W Park Drive	Westborough	MA	01581	Temp Employee Services	$312,245
Laboratory Corporation of America Holdin
230 Lafayette Road	Portsmouth	NH	03801	Temp Employee Services	$143,243

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	3	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$14,000	FederatedCampaignsAmt
All Other Contributions	$604,614	AllOtherContributionsAmt
Noncash Contributions	$17,572	NoncashContributionsAmt
Total Contributions	$618,614	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient services	621400	$63,211,381	$63,211,381
Other operating	621400	$144,054	$144,054
Nutritional services	722210	$91,734	$91,734

Field	Value	IRS element (for citing)
Total Program Service Revenue	$63,447,169	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$200,393	TotalRevenueColumnAmt
Exclusion	$200,393	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$23,902	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$23,883	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$19	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19	TotalRevenueColumnAmt
Exclusion	$19	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$445,352	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$380,855	SecuritiesAmt
Other	$66,850	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$64,497	SecuritiesAmt
Other	-$66,850	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$2,353	TotalRevenueColumnAmt
Exclusion	-$2,353	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$64,263,842	TotalRevenueColumnAmt
Related Or Exempt Func Income	$63,447,169	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$198,059	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$35,150	TotalAmt
Program Services	$35,150	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,636,028	TotalAmt
Program Services	$867,242	ProgramServicesAmt
Management And General	$768,786	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$28,382,857	TotalAmt
Program Services	$27,354,592	ProgramServicesAmt
Management And General	$907,268	ManagementAndGeneralAmt
Fundraising	$120,997	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$639,867	TotalAmt
Program Services	$637,054	ProgramServicesAmt
Fundraising	$2,813	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,451,158	TotalAmt
Program Services	$3,414,766	ProgramServicesAmt
Management And General	$21,080	ManagementAndGeneralAmt
Fundraising	$15,312	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,909,197	TotalAmt
Program Services	$1,838,882	ProgramServicesAmt
Management And General	$62,398	ManagementAndGeneralAmt
Fundraising	$7,917	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$76,062	TotalAmt
Management And General	$76,062	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$41,864	TotalAmt
Management And General	$41,864	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$6,994,947	TotalAmt
Program Services	$6,671,999	ProgramServicesAmt
Management And General	$286,839	ManagementAndGeneralAmt
Fundraising	$36,109	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$38,278	TotalAmt
Management And General	$38,278	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,120,764	TotalAmt
Program Services	$782,869	ProgramServicesAmt
Management And General	$326,562	ManagementAndGeneralAmt
Fundraising	$11,333	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$161,929	TotalAmt
Program Services	$159,431	ProgramServicesAmt
Management And General	$2,174	ManagementAndGeneralAmt
Fundraising	$324	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,251,111	TotalAmt
Program Services	$1,161,863	ProgramServicesAmt
Management And General	$77,951	ManagementAndGeneralAmt
Fundraising	$11,297	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$201,724	TotalAmt
Program Services	$184,815	ProgramServicesAmt
Management And General	$15,637	ManagementAndGeneralAmt
Fundraising	$1,272	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$478,093	TotalAmt
Management And General	$478,093	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,930,895	TotalAmt
Program Services	$1,758,997	ProgramServicesAmt
Management And General	$154,750	ManagementAndGeneralAmt
Fundraising	$17,148	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$670,799	TotalAmt
Program Services	$660,267	ProgramServicesAmt
Management And General	$9,481	ManagementAndGeneralAmt
Fundraising	$1,051	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical supplies/equipm	$8,681,911	$8,672,281	$8,759	$871
Medicaid Enhancement ta	$2,383,887	$2,383,887
Provison for bad debt	$1,504,718	$1,504,718
Equipment rental/mainte	$717,934	$701,950	$15,943	$41

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$561,421	TotalAmt
Program Services	$527,903	ProgramServicesAmt
Management And General	$25,473	ManagementAndGeneralAmt
Fundraising	$8,045	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$62,870,594	TotalAmt
Program Services	$59,318,666	ProgramServicesAmt
Management And General	$3,317,398	ManagementAndGeneralAmt
Fundraising	$234,530	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$61,240	BOYAmt
EOY	$68,440	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$8,381,042	BOYAmt
EOY	$8,434,054	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$946,893	BOYAmt
EOY	$537,081	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$9,770,473	BOYAmt
EOY	$10,563,099	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,138,741	BOYAmt
EOY	$1,162,166	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$423,922	BOYAmt
EOY	$434,276	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$45,605,917	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$28,447,077	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$16,920,677	BOYAmt
EOY	$17,158,840	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$4,611,444	BOYAmt
EOY	$4,334,795	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$8,500	BOYAmt
EOY	$8,500	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$110,795	BOYAmt
EOY	$104,978	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,619,668	BOYAmt
EOY	$4,960,536	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$43,993,395	BOYAmt
EOY	$47,766,765	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$9,188,735	BOYAmt
EOY	$11,322,921	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$15,474,272	BOYAmt
EOY	$16,016,656	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$363,339	BOYAmt
EOY	$682,735	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$684,896	BOYAmt
EOY	$446,581	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$25,711,242	BOYAmt
EOY	$28,468,893	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$17,548,810	BOYAmt
EOY	$18,890,082	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$702,460	BOYAmt
EOY	$377,522	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$30,883	BOYAmt
EOY	$30,268	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$18,282,153	BOYAmt
EOY	$19,297,872	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$43,993,395	BOYAmt
EOY	$47,766,765	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$1,393,248	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$477,977	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$100,448	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (1)	GrantsOtherOrganizationsInd
Grants Other Organizations	$9,796	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$9,375	OtherActivitiesAmt
Total Lobbying Expenditures	$19,171	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	The Organization pays dues to the New Hampshire Hospital Association and the American Hospital Association, a portion of which are attributable to lobbying activities. Also, APD belongs to the 10 Mile CAH Coalition which engaged Strategic Health Resources (SHR) for purposes of furthering lobbying efforts with regards to attempts to eliminate CAH status. The CEO and CFO participated in regular weekly telephone calls with this group in attempts to keep the issue of rural healthcare in front of the various legislative delegations and the key role that CAHs play in rural healthcare. The CEO and CFO also participated in phone conference calls with SHR and other members of the Coalition for strategic planning purposes.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,883	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$615	InvestmentEarningsOrLossesAmt
End Year Balance	$30,268	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,452	BeginningYearBalanceAmt
Investment Earnings Or Losses	$431	InvestmentEarningsOrLossesAmt
End Year Balance	$30,883	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$27,686	BeginningYearBalanceAmt
Investment Earnings Or Losses	$2,766	InvestmentEarningsOrLossesAmt
End Year Balance	$30,452	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$25,840	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,846	InvestmentEarningsOrLossesAmt
End Year Balance	$27,686	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$28,065	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$2,225	InvestmentEarningsOrLossesAmt
End Year Balance	$25,840	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$927,577	OtherCostOrOtherBasisAmt
Book Value	$927,577	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$20,151,891	OtherCostOrOtherBasisAmt
Depreciation	$10,057,826	DepreciationAmt
Book Value	$10,094,065	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$238,112	OtherCostOrOtherBasisAmt
Depreciation	$223,726	DepreciationAmt
Book Value	$14,386	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$22,502,869	OtherCostOrOtherBasisAmt
Depreciation	$17,265,322	DepreciationAmt
Book Value	$5,237,547	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,785,468	OtherCostOrOtherBasisAmt
Depreciation	$900,203	DepreciationAmt
Book Value	$885,265	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$17,158,840	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
Due from Affiliates	$1,844,505
Estimated Third Party Payor Settlements	$3,011,431
Other Assets	$104,600

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$4,960,536	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
Current Portion of Deferred Annuities	$17,645
Liability Payable	$393,200
Longterm Deferred Annuity	$35,736

Field	Value	IRS element (for citing)
Total Liability	$446,581	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$63,910,196	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	-$477,977	NetUnrealizedGainsInvstAmt
Other Revenue	$124,331	OtherRevenueAmt
Revenue Not Reported	-$353,646	RevenueNotReportedAmt
Revenue Subtotal	$64,263,842	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$64,263,842	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$62,894,477	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$23,883	OtherExpensesIncludedAmt
Expenses Not Reported	$23,883	ExpensesNotReportedAmt
Expenses Subtotal	$62,870,594	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$62,870,594	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part V, Line 4:	The Organization uses the income from its endowment funds for use in operations.
Part X, Line 2:	The System consists of not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, all of which are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income, and had taken no uncertain tax positions that require adjustment to the consolidated financial statements. With few exceptions, the System is no longer subject to income tax examinations by the U.S. federal or state tax authorities for years before 2012.
Part XI, Line 2d - Other Adjustments:	Rental Expenses 23,883. Impact of Interest Rate Swap 100,448.
Part XII, Line 2d - Other Adjustments:	Rental Expenses 23,883.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	275.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	275.000000000000	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$282,494	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$282,494	NetCommunityBenefitExpnsAmt
Total Expense	0.00460	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,074,961	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,037,673	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,037,288	NetCommunityBenefitExpnsAmt
Total Expense	0.06580	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,357,455	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,037,673	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,319,782	NetCommunityBenefitExpnsAmt
Total Expense	0.07040	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$170,224	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$170,224	NetCommunityBenefitExpnsAmt
Total Expense	0.00280	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$33,977	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$33,977	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,251,323	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,387,596	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,863,727	NetCommunityBenefitExpnsAmt
Total Expense	0.09560	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$85,191	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$85,191	NetCommunityBenefitExpnsAmt
Total Expense	0.00140	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,540,715	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,387,596	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,153,119	NetCommunityBenefitExpnsAmt
Total Expense	0.10040	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,898,170	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,425,269	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,472,901	NetCommunityBenefitExpnsAmt
Total Expense	0.17080	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,426	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,426	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$38,151	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$38,151	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,951	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,951	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,522	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,522	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,388	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,388	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$57,438	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$57,438	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$947,258	BadDebtExpenseAmt
Bad Debt Expense Attributable	$100,000	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$18,067,921	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$17,831,098	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$236,823	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.alicepeckday.org	WebsiteAddressTxt
State License	00016	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	Physician Clinics	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	12	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	see Part V, Section C	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	12	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	see Part V, Section C	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	275.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	275.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	see Part V, Section C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	see Part V, Section C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	see Part V, Section C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Alice Peck Day Memorial Hospital	Part V, Section B, Line 5: The 2013 Upper Valley Community Needs Assessment Report was the product of an almost year-long process coordinated by Alice Peck Day Memorial Hospital, Mount Ascutney Hospital and Health Care, Dartmouth-Hitchcock Medical Center, and Granite United Way.Between November 2012 and October 2013, information on health, education and economic needs of the Upper Valley region were gathered through secondary data gathering, two forums with informed stateholders, a stakeholders' survey, and six focus group discussions. The CAN process was guided by a Steering Committee composed of individuals (including the Community Health Director at Alice Peck Day Memorial Hospital) with expertise in the areas of health, education and economic well being.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 6a: Alice Peck Day Memorial HospitalMount Ascutney Hospital and Health CareDartmouth-Hitchcock Medical Center
Alice Peck Day Memorial Hospital	Part V, Section B, Line 11: Through primary and secondary data analysis, as well as qualitative research that was inclusive of a wide spectrum of health and human services professionals and community residents, twelve key community needs were identified:1. Lack of quality jobs/income2. Transportation access and cost3. Housing cost4. Tobacco/alcohol/drug use5. Oral health6. Mental health7. Obesity/poor nutrition/lack of physical activity8. All health/oral health /insurance access9. Child care10. Asthma11. Isolation/less time for "community and12. Quality of/limited educationClearly, many of those community needs (1, 2, 3, 9, 11, and 12) do not fall within the primary purview of the health care delivery system. While we acknowledge the growing evidence pointing to the interplay between economic and educational status and health, APD as a small, community-based rural hospital is not positioned to directly address those significant areas of concern (an exception to this is need 2, transportation access and cost: APD made a substantial cash donation to the Grafton County Senior Citizens Council, earmarked for the elderly/disabled bus service.) As described in other sections of this report, Alice Peck Day Memorial Hospital focuses its community health resources in two major areas: oral health (need 5) and health access (need 8.)In November of 2015, after the fiscal year covered by this Schedule H filing, the Hospital completed a new Community Health Needs Assessment (CHNA), this report will be described in greater detail in the Hospital's 2015 Form 990, Schedule H.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 13h: Alice Peck Day Memorial Hospital offers financial assistance to patients demonstrating need. In making the need determination, APD participates with and honors the founding principles and guidelines of the New Hampshire Health Access Network (NHHAN). Accordingly, decisions regarding the granting of financial assistance will be based primarily on a patient and his or her household income and assets. There will be minimal consideration of expenses except when they identify areas for further investigation or incomplete or inaccurate information. The value of a patient's principal residence is not considered in qualifying a patient for in-house assistance. APD requires exhaustion of other payment methodologies, including but not limited to, Worker's Compensation, Veterans Benefits, Medicaid, liability (auto accidents), victims of crime, and COBRA. When applicable, proof of determination may be required prior to consideration for financial assistance.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 16i: Please see Part V, Line 3 for a description of the financial assistance program and the efforts made to publicize and promote the program.
Alice Peck Day Memorial Hospital	Part V, Section B, Line 22d: The hospital facility provides uninsured patients with a 15% discount. At the time the discount was established, the discount approximated the average of the three lowest negotiated commercial insurance rates for services at the hospital facility. The average of the three lowest commercial insurance rates was approximately 87.5%; the rate applied to uninsured patients was lower than that rate, at 85%, representing a 15% discount.
Part V, Line 7a:	http://www.alicepeckday.org/assets/2015_APDH_Community_Health_Needs_Assessment.pdf
Part V, Line 10a:	http://www.alicepeckday.org/assets/CommunityHealthImplementationPlan_2014.pdf
Part V, Section B, Line 16	Financial Assistance Policy Website Availability
Alice Peck Day Memorial Hospital Part V, Section B, line 16a website:	see Part V, Section C
Alice Peck Day Memorial Hospital Part V, Section B, line 16b website:	see Part V, Section C
Alice Peck Day Memorial Hospital Part V, Section B, line 16c website:	see Part V, Section C

Field	Value	IRS element (for citing)
Facility	8	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt	Address Line2USAddress/AddressLine2Txt
RAM Center for Community Care
5 Alice Peck Day Drive	Lebanon	NH	03766	Primary Care Physician Clinic
Women's Care Center
141 Mascoma Street	Lebanon	NH	03766	OB/GYN Physician Clinic
APD Orthopaedic Clinic
17 Alice Peck Day Drive	Lebanon	NH	03766	Orthopaedic Physician Clinic
General Surgery Clinic
10 Alice Peck Day Drive 12 Mascoma	Lebanon	NH	03766	General Surgeon Clinic	St
Pain Management Clinic
17 Alice Peck Day Drive B	Lebanon	NH	03766	Pain Management Clinic
APD Hand & Upper Extremity Clinic
205 Billings Farm Road Unit 3A	White River Junction	NH	05001	Hand & Upper Extremity Orthopaedic Physician Clinic
Occuptational Health Services
127 Mascoma Street 2nd Floor	Lebanon	NH	03766	Occupational Health Physician Clinic
Neurosurgery Services at APD (NSAPD)
106 Hanover Street	Lebanon	NH	03766	Neurosurgery Physician Clinic

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	Family income limit for eligibility for discounted care ranges from 200%-275% of FPG.
Part I, Line 7:	The costs of charity care and means-tested programs are calculated using the facility-wide cost to charge ratio as calculated in Worksheet 2. Subsidized health services are calculated using the cost to charge ratios per service area, using a step-down cost allocation methodology consistent with Medicare cost report methodology. The cost of financial assistance and other community benefits at cost are 17.08% of total expenditures on Form 990, Part IX, Column A, Line 25, excluding bad debt expense.
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,504,718.
Part II, Community Building Activities:	Alice Peck Day actively promotes community-based leadership development. Staff members participate in the Lebanon Chamber of Commerce, Leadership Upper Valley, Vital Communities Corporate Council, Foundation for Healthy Communities, the Rural Health Coalition, the Go Red for Women event, and the Advocacy Task Force. As an active member of the community, APD works to be proactive concerning disaster readiness. Staff have participated in onsite training for disaster preparedness as well as off-site training with other regional hospitals. Collaborative efforts include all hazard regional training, emergency response training, and a regional mass casualty response program to help facilitate cooperative efforts if such needs arise.
Part III, Line 2:	See narrative for Schedule H, Part III, Line 4.
Part III, Line 3:	See narrative for Schedule H, Part III, Line 4.
Part III, Line 4:	Bad debt cost is calculated using a cost to charge ratio using a step-down cost allocation methodology consistent with Medicare cost reporting. In FY15, accounts written off to bad debt included gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. We estimated the amount of charity care in bad debt expense based on the number of applications for charity care. We believe the amount is minimal based on our extensive efforts to educate our patients and staff about our various payment plans and charity care to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances, a patient may be eligible for charity care, discounted care, time-payment programs, or a combination of the above. Due to these efforts, we feel that amounts written off to bad debt that could qualify as charity care are minimal. Footnote 1 to the audited consolidated financial statements of Alice Peck Day Health Systems, Corp. includes the following to address bad debt: Accounts receivable are stated at the amount management expects to collect on outstanding balances. Management provides for possible uncollectible amounts through a charge to operations and a credit to the valuation allowance based on its assessment of individual accounts and historical adjustments. Accounts deemed uncollectible are written off through a charge against the established allowance.See also Footnote 1 on Page 9 of the attached audited financial statements.
Part III, Line 8:	Medicare allowable costs for the Medicare Cost Report are reported in accordance with CMS guidelines using the cost to charge ratio methodology.
Part III, Line 9b:	Our bad debts collection policy applies to all patient accounts in a consistent manner. The policy specifically indicates that, after a second statement is sent with no payment received, a patient accounts representative will contact the patient by phone to determine if a financial assistance application or payment plan is appropriate. This is completed to avoid further escalation of past due account(s) if the patient may qualify for full or partial relief under the charity care policy. If the application is successful, then the qualifying balance or balances are classified as charity care and no longer pursued for collections. Once a patient balance is classified as charity care, it is not subject to collection activities. Alice Peck Day is committed to helping our patients obtain quality healthcare, regardless of ability to pay. Our financial assistance programs encourage and enable our patients to make healthcare decisions free of financial barriers. We educate our patients about our programs and provide assistance prior to their receiving services, at registration for services, and during our billing process to ensure that any and all patients in need of assistance are provided with the help they qualify for under APD programs. Brochures and signs are placed in high traffic areas such as the ER and Registration. Our staff is trained to identify patients during registration, provide information, and offer assistance in completing the necessary forms. During our billing process, calls are made to patients with outstanding balances. APD staff work with patients to identify problems they are facing in dealing with outstanding balances. Patients are notified again of the many types of financial assistance available for which they may qualify. Programs are explained and assistance is offered, if needed, in completing the applications. Due to this multi-level approach and staff that is trained to identify clients who may need financial assistance, very few qualifying patients reach the point of bad debt. Our collection policies and procedures, in conjunction with our small size, allow our organization to place great emphasis on helping all patients who may be in need to apply for, and obtain, the appropriate level of financial assistance.
Schedule H, Part V, Section B, Line 16a-16c:	Financial Assistance Policy URL: http://www.alicepeckday.org/assets/Financial_Assistance_Policy_April-26-2016.pdfFinancial Assistance Policy Application URL:http://www.alicepeckday.org/assets/Financial%20Aid%20Cover%20Letter%20Sept-2014.pdf Financial Assistance Plain Languange Summary URL: http://www.alicepeckday.org/assets/FINAL_FAP_brochure_Dec-24-2015.pdf
Part VI, Line 2:	Due to our rural location and size, a collaborative effort between the United Way, Dartmouth Hitchcock Memorial Hospital, Mount Ascutney Hospital, Granite United Way and Alice Peck Day Memorial Hospital created the 2012 Community Needs Assessment that formed the basis for the FY 2015 Community Benefits Plan. Priority needs and health concerns for our community were based upon information collected from community needs assessments and community surveys. Identified population health concerns included tobacco/alcohol/drug use, oral health, mental health, obesity/poor nutrition/lack of physical activity, access to care and asthma. Alice Peck Day used this information to help focus its community benefit efforts to meet the priority needs identified in the Community Benefit Plan. Of special note is the Upper Valley Smiles Program that has served a priority need to oral health within our local community. Upper Valley Smiles has touched the lives of many children ages newborn to eighteen in our community and provided much needed care, particularly for the uninsured.
Part VI, Line 3:	Alice Peck Day believes that quality health care should be available to all, regardless of ability to pay. Our financial assistance programs and staff are dedicated to helping people obtain the care they need. We reach out to our patients in many different ways to ensure that they are aware that help is available and to help guide them through the process. Brochures and signage are posted in high traffic areas such as the Emergency Room, Registration, and the lobby. Registration staff are trained to identify patients who may be in need of financial assistance. Once identified, staff notify the patient that APD has various forms of financial assistance and explain that assistance is available for anyone who might require help or guidance in completing any necessary paperwork. In addition to the above, our billing staff are trained to help identify and offer assistance to anyone who might require financial assistance. Patients with outstanding claims are contacted by our credit coordinator who works with them to clear up balances through the variety of programs we offer. Assistance is also provided in applying for federal/state programs to those who qualify. Specially trained staff guide applicants through the process to ensure forms are filled out correctly, all required documentation is attached, and the applicants understand what they can expect to happen along the way.
Part VI, Line 4:	Alice Peck Day Memorial Hospital is part of the Lebanon Health Care service area. The Lebanon service area comprises cities and towns in New Hampshire and Vermont. APD's service area in NH comprises 15 towns in addition to the city of Lebanon, including Canaan, Cornish, Croydon, Dorchester, Enfield, Grafton, Grantham, Hanover, Lyme, Newport, Orange, Orford, Piermont, Plainfield and Warren. Vermont towns include East Thetford, Fairlee, Hartford, Hartland, North Hartland, North Thetford, Post Mills, Quechee, Sharon, South Strafford, Strafford, Thetford, Thetford Center, Vershire, West Vershire, West Fairlee, West Hartford, White River Junction and Woodstock.
Part VI, Line 5:	Alice Peck Day actively promotes community-based leadership development. Staff members participate in the Lebanon Chamber of Commerce, Leadership Upper Valley, Vital Communities Corporate Council, Foundation for Healthy Communities, the Rural Health Coalition, and the Advocacy Task Force. As an active member of the community, APD works to be proactive concerning disaster readiness. Staff have participated in onsite training for disaster preparedness as well as off-site training with other regional hospitals. Collaborative efforts include all hazard regional training, emergency response training, and a regional mass casualty response program to help facilitate cooperative efforts if such needs arise.
Part VI, Line 6:	Alice Peck Day Memorial Hospital is a critical access hospital located in Lebanon, NH. The hospital is served by a board of trustees consisting of local citizens active in community activities and organizations. The majority of board members are not employed by the hospital, and include local government and business representatives as well as practicing independent physicians. Despite its small size, APD is committed to giving back to the community to the greatest extent possible. During FY15, cash donations were given to organizations to help those in need. Local financial contributions helped support free primary care clinics for the uninsured, provided transportation for the elderly and disabled to receive medical care, and provided local nonprofit organizations with meeting space and refreshments. Alice Peck Day supported community flu clinics, provided emergency prescription drug vouchers, and bicycle safety rodeos for local children. One of APD's most exciting and celebrated programs is the Upper Valley Smiles Dental Program. This program provides an oral health safety net for disadvantaged residents within our service area. In 8 different schools, 2039 elementary school children participated in oral health education presentations, with 553 of those children receiving screenings from a dental team. Additionally, preventative sealants and fluoride varnish were given to 407 low-income, uninsured children. With grant support from Dartmouth Hitchcock Community Health Improvement, APD continued its Women, Infants and Children (WIC) Oral Health Initiative in Lebanon and Enfield New Hampshire, and Hartford, Vermont. Under the WIC initiative, a total of 102 low-income children aged 0-10 received oral health education, a dental screening, and preventative care. To promote health professional education, APD provided clinical undergraduate/graduate training to students from the Geisel School of Medicine at Dartmouth, George Washington University, River Valley Community College, and Yale University. APD annually sponsors district-wide professional development for school nurses in our local area and for others within our region. These initiatives and ongoing efforts continue to address several of the most pressing community needs as identified in our community needs assessment.
Part VI, Line 7, Reports Filed With States	NH

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Good Neighbor Health Clinic
70 North Main Street	White River Junction	VT	05001	030346949	501(c)(3)	$10,000	Operational support for clinic providing free primary care services to patients in the upper valley area of NH and White River Junction area in Vermont. Patients receiving free care are at or below 225% of the Federal Poverty Level.
Grafton County Senior Citizens Council
PO Box 433	Lebanon	NH	03766	237248316	501(c)(3)	$20,000	Operational support for transportation services for area senior citizens. The Council provides lift-assisted buses with priority on medical transport for hospital or clinical appointments.

Field	Value	IRS element (for citing)
Total501c3 Org	2	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	As part of APD's Access Improvement Plan developed in 2003, Hospital staff and Board members identified the Grafton County Senior Citizens Council and the Good Neighbor Health Clinic (which also includes the Red Logan Dental Clinic) as essential to providing access to health care in the Upper Valley NH and White River VT areas. Based on the needed services provided, the Board approved on-going monetary support for these organizations. The annual amount to be contributed by APD to these organizations is approved annually through the annual budget process. APD receives and reviews each year the organizations' published annual reports and also maintains informal contacts throughout the year to monitor the organizations' operations and services.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Susan E Mooney MD MS
President & CEO	$302,407	$15,916	$70,015	$3,685	$21,850	$1,150	$21,565	$1,135	$47,330	$2,491	$463,167	$24,377	$0	$0
Kathryn M Vargo MD
Med. Staff President (part year, in)	$249,401	$0	$7,875	$0	$0	$0	$5,200	$0	$49,294	$0	$311,770	$0	$0	$0
Beverley Rankin RN BSN
VP Patient Care, CNO	$166,551	$0	$0	$0	$0	$0	$3,549	$0	$50,318	$0	$220,418	$0	$0	$0
Randall D Lea MD MPH
VP & Chief Medical Officer	$206,938	$0	$0	$0	$0	$0	$4,263	$0	$31,900	$0	$243,101	$0	$0	$0
Evalie M Crosby CPA FHFMA
VP of Finance & CFO	$134,395	$33,599	$0	$0	$18,400	$4,600	$2,869	$717	$25,448	$6,361	$181,112	$45,277	$0	$0
J Todd Miller MS
VP & COO	$155,842	$38,961	$10,800	$2,700	$0	$0	$10,495	$2,624	$26,573	$5,983	$203,710	$50,268	$0	$0
John P Houde MD
Physician	$500,272	$0	$23,000	$0	$0	$0	$5,200	$0	$47,865	$0	$576,337	$0	$0	$0
Adnan Khan MD
Physician	$401,700	$0	$17,500	$0	$0	$0	$5,200	$0	$30,217	$0	$454,617	$0	$0	$0
Diane C Riley MD CAQSH
Physician	$426,249	$0	$18,066	$0	$0	$0	$5,200	$0	$34,300	$0	$483,815	$0	$0	$0
Leonard M Rudolf MD
Physician	$454,555	$0	$19,327	$0	$0	$0	$5,200	$0	$45,544	$0	$524,626	$0	$0	$0
Paul Sansone MD
Physician	$447,288	$0	$0	$0	$0	$0	$0	$0	$46,554	$0	$493,842	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3	The compensation of the Organization's CEO/President is determined through a related party, APD Health Systems, Corp, the sole corporate member of the Organization. APD Health Systems used its Compensation Committee, an independent compensation consultant, a compensation survey/study, and approval by its Board's Compensation Committee to establish the CEO/President's compensation and benefits.
Part I, Line 7	A portion of compensation to certain employees is at-risk and variable, and payment depends on the quality of job performance.
Schedule J, Part II:	Salary and benefit expense for the CEO/President and CFO are charged to APD Health Systems, Corp. and then allocated to Alice Peck Day Memorial Hospital and Alice Peck Day Lifecare Center, Inc. based on the relative share of services performed for those entities. On the audited consolidated financial statements and 990, these expenses ($601,461) are included in salaries and benefits expense.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	Business Finance Authority of the State of NH	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	521304598	BondIssuerEIN
Bond Issued	2010-11-30	BondIssuedDt
Issue Price	$12,282,000	IssuePriceAmt
Purpose	Current Refund Existing Bond	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$12,282,000	TotalProceedsAmt
Refunding Escrow	$12,237,068	RefundingEscrowAmt
Issuance Costs From Proceeds	$44,932	IssuanceCostsFromProceedsAmt
Substantial Completion	2010	SubstantialCompletionYr
Current Refunding	Yes (1)	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	Yes (1)	NoRebateDueInd
Variable Rate Issue	Yes (1)	VariableRateIssueInd
Hedge Identified In Bks And Rec	Yes (1)	HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

Field	Value	IRS element (for citing)
Business Name Line1	TD Banknorth NA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Term Of Hedge	5.000000000000	TermOfHedgePct
Superintegrated Hedge	0	SuperintegratedHedgeInd
Hedge Terminated	Yes (1)	HedgeTerminatedInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Date Rebate Computation Performed	FormAndLineReferenceDesc
Explanation	Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 01/03/2011	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part V, Line 2a:	For administrative purposes, Alice Peck Day Memorial Hospital acts as the common paymaster for both Alice Peck Day Health Systems, Corp. and Alice Peck Day Lifecare Center, Inc.
Form 990, Part VI, Section A, line 6	Alice Peck Day Health Systems, Corp., a charitable corporation, acting by and through its board of trustees, is the sole member of the organization.
Form 990, Part VI, Section A, line 7a	All Trustees shall be elected by the Board of Trustees of the member at the annual meeting of the Member. A nomination slate for the Trustees shall be submitted by the governance committee of the Member. Any Trustee may be removed at any time, with or without cause, by the Member. Vacancies on the Board of Trustees due to death, resignation, or other cause except removal shall be filled by election by the remaining members of the Board. Vacancies caused by removal shall be filled by election by the Member. Trustees elected to fill vacancies shall hold office until the next annual meeting of the Member, at which time successors shall be elected in the manner provided for in the case of original elections.
Form 990, Part VI, Section A, line 7b	The Organization's annual operating budget and all capital budgets shall be subject to approval by the Member. Any overall strategic plan for the Organization, including the development of off-site facilities or the addition of new programs and affiliations with other institutions, shall be consistent with the strategic plan of the Member as determined by the Member. The borrowing of any sum in excess of $50,000 which has a stated term of greater than one year or which is secured by a mortgage of all or any portion of the Organization's real property or by a security interest in the Organization's assets or revenues shall be subject to approval by the member, provided, however, that the approval by the Member shall not be necessary for any borrowing to purchase or lease equipment or other personal property secured by a purchase money lien or title retention or security agreement, except as incident to the review of the capital budget. Any voluntary dissolution, merger or consolidation of the Organization or the sale or transfer of all or substantially all of the Organization's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. The Board shall select certified public accountants for the Organization which will audit the books and records of the Member. The Board shall select the President who must be confirmed by the Member.
Form 990, Part VI, Section B, line 11	The completed Form 990 is provided to the Chair of the Board and a designated member of the finance committee in advance of the filing deadline to enable a detailed and conscientious review to bring to the rest of the members of the committee to address any questions or changes. The completed Form 990 is also distributed to all members of the full Board for review no later than the final regularly scheduled Board meeting prior to the filing deadline. All questions and concerns are addressed by the Chief Executive Officer and incorporated into the Form 990 as deemed appropriate. After all input from the Board, finance, and governance committees has been appropriately addressed and incorporated into the final Form 990, a vote of acceptance of the final document is required. The vote is recorded in the minutes of the Board of Trustees prior to the filing of the Form 990. Once approved, senior management files the final Form 990 with the Internal Revenue Service as required.
Form 990, Part VI, Section B, line 12c	Alice Peck Day has a multi-faceted conflict of interest policy. Members of the Board of Trustees complete conflict of interest questionnaires on an annual basis and any new members complete the questionnaire upon joining the Board. As part of our ongoing monitoring process, our Executive Assistant reviews all Board questionnaires and disclosures to identify any potential conflicts before they arise. In addition, our Executive Assistant attends all Board meetings to ensure that if any conflicts arise, they are handled appropriately. If such conflicts arise, the Organization complies with the New Hampshire and federal requirements for disclosures of such events. The Organization is committed to conducting its business in a manner that is both ethical and legal. As part of this commitment, a standard of conduct form is required of all employees of the organization. This is reviewed with all employees upon hire and on an annual basis thereafter. The standard of conduct covers conflict of interest and other vital matters to ensure all business activity is conducted in a manner that is consistent with the highest standards of honesty, integrity and fairness.
Form 990, Part VI, Section B, line 15	The Compensation Committee of the Alice Peck Day Health Systems, Corp. Board of Trustees is responsible for determining the compensation of the Chief Executive Officer/President. The Vice President of Human Resources and Organizational Development provides compensation data of comparable organizations with approximately the same size staff and spending in a location of similar size. The committee determines the appropriate compensation and approves an amount that is then communicated to Human Resources for adjustment. The CEO/President is responsible for reviewing the performance of senior management staff. The information is brought to the compensation committee of the Board of Trustees along with a recommendation for the salary of each individual. The compensation is determined through a variety of analysis of salary data and performance. Individual salary increases are then based on overall performance, within budgeted increases for the organization. The compensation committee approves the base compensation and salary increase amount.
Form 990, Part VI, Section C, line 19	The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
Form 990, Part VII, Section A, Column D:	Dr. Susan E. Mooney is a practicing physician in addition to being the Chief Executive Officer. She worked an average of 61 hours per week, of which an average of 51 hours per week were spent on executive matters and 10 in her role as a physician.
Form 990, Part IX, line 11g	Purchased Services: Program service expenses 6,671,999. Management and general expenses 286,839. Fundraising expenses 36,109. Total expenses 6,994,947.
Form 990, Part XI, line 9:	Impact of Interest Rate Swap 100,448.
Form 990, Part XII, Line 2c:	The finance committee acts as the audit committee and oversees the audit process for the Alice Peck Day entities. The audit process for the financial statements did not change from the prior year. Independent accountants performed the audit for the fiscal years ended 9/30/14 and 9/30/15.
Form 990, Part IV, Line 34:	Alice Peck Day Health Systems, Corp. is the direct controlling parent company of Alice Peck Day Lifecare Center, Inc. (02-0479094) and Alice Peck Day Memorial Hospital (02-0222791). Alice Peck Day Health Systems, Corp. is also the direct controlling parent company of Alice Peck Day Realty Corp. (02-0485369) and Alice Peck Day Health Management Corp. (02-0485370). Both entities are inactive and hold no assets.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Alice Peck Day Health Systems Corp
10 Alice Peck Day Drive	Lebanon	NH	03766	020479095	Promote Health	NH	501(c)(3)	Line 11b, II	N/A	0
Alice Peck Day Lifecare Center Inc
10 Alice Peck Day Drive	Lebanon	NH	03766	020479094	Independent & Assisted Living	NH	501(c)(3)	Line 9		0	APD Health Systems
Alice Peck Day Realty Corp
10 Alice Peck Day Drive	Lebanon	NH	03766	020485369	Inactive	NH	501(c)(2)			0	APD Health Systems

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Health Management Corp	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	10 Alice Peck Day Drive	AddressLine1Txt
City	Lebanon	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03766	ZIPCd

Field	Value	IRS element (for citing)
EIN	020485370	EIN
Primary Activities	Inactive	PrimaryActivitiesTxt
Legal Domicile State	NH	LegalDomicileStateCd
Direct Controlling NA	N/A	DirectControllingNACd
Entity Type	C	EntityTypeTxt
Controlled Organization	0	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd