2016-05-16T12:58:35-05:00 2015-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2014-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Andrew J Majka CFO 6034449000 2016-05-10 1 Barbara J McGuan CPA P00219457 2077752387 2016-05-10 2014 2016-08-17 19:52:53Z Littleton Regional Healthcare Warren West 600 St Johnsbury Road Littleton NH 03561 95380770 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 12 546 249 707 -459 51695 30872 84873335 87169612 294248 586877 0 218632 85219278 88005993 201406 235168 0 0 46449522 47819749 0 0 0 36625030 38957121 83275958 87012038 1943320 993955 96738504 95939117 48296165 49197745 48442339 46741372 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 65963009 235168 87169612 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. 65963009 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 113 0 1 546 1 0 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Leslie Walker Controller 6034449000 600 St Johnsbury Rd Littleton NH 03561 Stevan Trooboff Chairman 1.00 1.00 X X 0 0 0 William Bedor Vice-Chairman/Treasurer 1.00 1.00 X X 0 0 0 James Hamblin Secretary 1.00 X X 0 0 0 John Starr Trustee 1.00 1.00 X 0 0 0 Dr Andrew Forrest Trustee/Physician 40.00 X 316505 0 30125 Dr John Sauter Trustee Emeritus 40.00 1.00 X 269085 0 1697 Laurie Morgan Auxiliary President 1.00 X 0 0 0 Dr Deane Rankin Trustee/Physician 40.00 X 364572 0 47609 Roger Gingue Trustee 1.00 X 0 0 0 Dr Imelyn Fernandez Trustee 1.00 X 0 0 0 Gail Tomlinson Trustee 1.00 X 0 0 0 Kim Butler Trustee 1.00 X 0 0 0 Jeff Woodward Trustee 1.00 X 0 0 0 Erin Hennessey Trustee 1.00 X 0 0 0 Dr Dougald MacArthur Chief of Staff 40.00 X 706000 0 0 James Nohl Trustee 1.00 X 0 0 0 Milton Bratz Past Trustee 1.00 X 0 0 0 Mell Brooks Past Secretary 1.00 X X 0 0 0 Wayne Rioux Past Trustee 1.00 X 0 0 0 Warren West CEO 40.00 1.00 X 371630 0 26329 Nick Braccino CFO 40.00 1.00 X 194869 0 28746 Linda Gilmore CAO/CNO 40.00 X 194312 0 58409 Dr Patrick Fitzpatrick Physician 40.00 X 719543 0 52341 Dr Eric Mullins Physician 40.00 X 593752 0 40652 Dr Harlan Herr Physician 40.00 X 535006 0 24711 Dr Michael Kindred Physician 40.00 X 515623 0 36735 Dr Jeffrey Kauffman Physician 40.00 X 512434 0 48398 5293331 0 395752 62 0 1 1 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 4596834 Hutter Construction 810 Turnpike Road New Ipswich NH 03071 General Contractor 645330 Balanced Healthcare Receivables LLC 164 Burke St Nashua NH 03060 Collection Services 427674 Griffin York & Krause 121 River Front Drive Manchester NH 03102 Advertising Consultant 341319 Rath Young & Pignatelli PC 1 Capital Plaza Suite 2 Concord NH 03302 Legal Services 320652 12 18881 11991 30872 Patient Service Revenue 900099 155508226 155508226 Other Revenue 900099 4037086 3390607 646479 Contract Lab 621500 102654 101947 707 Provision for Bad Debts 900099 -3468041 -3468041 Contractual Allowances 900099 -69010313 -69010313 87169612 452918 452918 218632 0 218632 218632 218632 7508736 7364107 10670 144629 -10670 133959 133959 88005993 86522426 707 1451988 235168 235168 2609888 1735592 874296 36502168 31837808 4664360 1317778 1150598 167180 5227106 4568549 658557 2162809 1861322 301487 480783 480783 236766 236766 85133 85133 5070100 2858516 2211584 607453 16394 591059 4016374 3065193 951181 1667750 322108 1345642 4235374 2555976 1679398 218062 132394 85668 92753 92753 751083 751083 5635407 4574486 1060921 1314539 540935 773604 Medical Supplies 8819040 8819040 Medicaid Enhancement Ta 3664189 3664189 Miscellaneous Expenses 1649050 833543 815507 Recruiting Expenses 413265 11551 401714 87012038 65963009 21049029 0 X 233688 204935 8902413 8559600 8663835 8931966 1703212 1140682 1644380 1624404 1818371 2508440 88408345 48132951 43506672 40275394 29886739 32332837 121302 102963 257892 257896 96738504 95939117 6171435 7131593 1454265 678830 27270000 26585000 3730750 3050242 9669715 11752080 48296165 49197745 X 47488526 45841613 185197 179563 768616 720196 48442339 46741372 96738504 95939117 X 993955 -2204517 -490405 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14848 14848 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. 939547 5464 -57271 1523 886217 870609 5517 63496 75 939547 794094 81883 5368 870609 717945 77221 1072 794094 767249 -48189 1115 717945 0.00000 0.81270 0.18730 0 0 786809 786809 40790323 21273910 19516413 42678171 25967582 16710589 4153042 891459 3261583 40275394 Reserve for Self-Funded Health Insurance 612000 Due to Third Party Payors 6443088 Deferred Compensation 1498548 Interest Rate Swap 3198444 11752080 85030385 -2204517 -490405 -2694922 87725307 85133 195553 280686 88005993 86731352 0 86731352 85133 195553 280686 87012038 Part XI, Line 2d - Other Adjustments: Unrealized Loss on Interest Rate Swap -490,405. Part XI, Line 4b - Other Adjustments: Foundation Subsidy 195,553. Part XII, Line 4b - Other Adjustments: Foundation Subsidy 195,553. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 8511065 0 0 0 0 0 0 8511065 0 8511065 1 0 1 0 1 0 1 1 X 1 X 1 X 1 1 0 1 1 4230102 3114461 1115641 0.01280 13451748 8523787 4927961 0.05660 17681850 11638248 6043602 0.06940 329356 86522 242834 0.00280 58398 58398 0.00070 22277456 17075690 5201766 0.05980 6010 6010 0.00010 22671220 17162212 5509008 0.06340 40353070 28800460 11552610 0.13280 37421 37421 0.00040 60453 60453 0.00070 3600 3600 0.00000 101474 101474 0.00110 1 1771919 21423840 21423840 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 12 1 0 0 1 X www.littletonhealthcare.org X 1 12 1 www.littletonhealthcare.org 0 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X www.littletonhealthcare.org X www.littletonhealthcare.org X www.littletonhealthcare.org X X X X X 1 X 0 X X X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: The Organization deployed a Community Health Needs Assessment survey within the local population for any resident to complete. The Organization received community input from 164 area residents. The terms of gaining input stipulated each respondent would remain anonymous.The internet based survey was promoted through a paid advertisement in a local newspaper and distributed to local civic and health organizations with a request for participation. Preliminary conclusions were presented to a local group of experts, who were asked to validate prior assessments and to establish priority among various identified health and medical issues.Information analysis augmented by local opinions showed how Grafton County relates among its peers in terms of primary and chronic needs, as well as other issues of uninsured persons, low income persons and minority groups; respondents commented on if they believe certain population groups (or people with certain situations) need help to improve their condition and if so, who needs to do what.When the analysis was complete, the Organization put the information and summary conclusions before our local group of experts who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need; new needs could, and did, emerge from this exchange. Consultation with local experts occurred again via an internet based survey (explained below).With the prior steps identifying potential community needs, the local experts participated in a structured communication technique called a Delphi method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. Experts answer questionnaires in a series of rounds. The Organization contemplated and implemented one round as referenced during the above dates. After each round, the Organization provided an anonymous summary of the experts' forecasts from the previous round, as well as the reasons provided for their judgments. The process encourages experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process stops when we identify the most pressing, highest priority community needs.In the Organization's process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving virtually no support and other needs receiving identical point allocations.We dichotomized the rank order into two groups: high priority needs and low priority needs. The determination of the break point, high as opposed to low, was a qualitative interpretation by Quorum Health Resources and the Organization's executive team where a reasonable break point in rank occurred, indicated by the weight amount of points each potential need received and the number of local experts allocating any points to the need. When presented to the Organization's executive team, the dichotomized need rank order identified which needs the hospital considered high responsibility to respond vs. low responsibility to respond. The result provided a matrix of needs and guided the Organization in developing its implementation response. 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. Obesity/Overweight:- Continue to offer nutritional counseling to patients and their families- Continue to provide diabetes education to patients and their families on the importance of maintaining a healthy weight- Increase the number of fitness classes offered at LRH- Allocate resources to offer weekly Weight Watchers classes at LRH.- LRH participates in the NH Heal Program, a statewide project concerned about the rising obesity epidemic and the impace on health and wellenss. HEAL is a healthy eating and active living intervention.2. Healthcare Cost, Quality & Coverage:- LRH provides charity care to those unable to pay for services.- LRH will continue to provide specialty service coverage at area rural hospitals to increase access to specialty coverage beyond the Hospital's service area.- Allocate resources to support charity care for the uninsured and underinsured- Focus on engaging health care users to improve outcomes and reduce health care costs, making healthcare provied by LRH more affordable.- Providing a schedule of educational seminars to patients and interested residents- Providing free health screenings to patients who may not have access to healthcare.3. Cancer:- Increase community outreach for mammography services- Through generous gifts, LRH has funds available for women in need of breast cancer screenings, mammograms and education- Fund raising allowed LRH to purchase 100 copies of the 7th Edition of Breast Cancer Treatment Handbook. These books are given to patients who present with breast cancer.- Host an LRH Goes Pink Event annually to educate women about breast cancer prevention, detection and treatment.- Seek Federal and State grants to utilize funds that may be available for breast and cervical cancer screening- Continue to partner with area agencies who respond to the needs of women who have recently been diagnosed with breast cancer4. Coronary Heart Disease:- Market wellness programs to companies throughout the regions serviced by LRH- Implement a "Healthy Eating Program" for patients, visitors and employees- Implement a Senior Citizen Free Screening for Coronary HealthNeeds Not Being Addressed:Alcohol Abuse, Drug Use in Youths, Mental Health and Suicide, and Smoking - LRH does not intend to develop an implementation plan for these needs for the following reasons:- Lack of expertise of competency (i.e., certain professional credential required and no such individual is in our immediate service area)- Lack of identified interventions to address need- Need is addressed by other organization or facilities Part V, Section B, Line 16 Financial Assistance Policy Website Availability Littleton Regional Hospital Part V, Section B, line 16a website: www.littletonhealthcare.org Littleton Regional Hospital Part V, Section B, line 16b website: www.littletonhealthcare.org Littleton Regional Hospital Part V, Section B, line 16c website: www.littletonhealthcare.org 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 popolation 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 meduian 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 unemployement 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 1 Littleton Regional Healthcare Charitable Foundation 600 St Johnsbury Road Littleton NH 03561 043750643 501(c)(3) 195553 Foregiveness of salary and benefit expense that is paid on behalf of the charitable foundation. Ammonoosuc Community Health Services Inc 25 Mt Eustis Road Littleton NH 03561 510137745 501(c)(3) 15000 Organizational Support 2 0 Part I, Line 2: The Organization tracks the amount of expenses paid on behalf of the Littleton Regional Hospital Charitable Foundation, a related organization, and at the end of the year will forgive the Foundation for the reimbursement of expenses related to salaries and benefits. The Organization only makes grants and other assistance payments to other 501(c)(3) organizations. Therefore, additional monitoring is not deemed necessary. X X X X 0 0 0 0 0 1 0 1 0 Dr Andrew Forrest Trustee/Physician 280455 0 12000 0 24050 0 13000 0 17125 0 346630 0 0 0 Dr John Sauter Trustee Emeritus 263034 0 6000 0 51 0 0 0 1697 0 270782 0 0 0 Dr Deane Rankin Trustee/Physician 341637 0 0 0 22935 0 13000 0 34609 0 412181 0 0 0 Dr Dougald MacArthur Chief of Staff 706000 0 0 0 0 0 0 0 0 0 706000 0 0 0 Warren West CEO 318329 0 47250 0 6051 0 13300 0 13029 0 397959 0 0 0 Nick Braccino CFO 194869 0 0 0 0 0 0 0 28746 0 223615 0 0 0 Linda Gilmore CAO/CNO 194312 0 0 0 0 0 10099 0 48310 0 252721 0 0 0 Dr Patrick Fitzpatrick Physician 336569 0 367558 0 15416 0 13000 0 39341 0 771884 0 0 0 Dr Eric Mullins Physician 557086 0 0 0 36666 0 11812 0 28840 0 634404 0 0 0 Dr Harlan Herr Physician 486667 0 0 0 48339 0 13000 0 11711 0 559717 0 0 0 Dr Michael Kindred Physician 357382 0 111556 0 46685 0 13000 0 23735 0 552358 0 0 0 Dr Jeffrey Kauffman Physician 450001 0 0 0 62433 0 13000 0 35398 0 560832 0 0 0 Part I, Line 6 Warren West, CEO, received a bonus based on certain goals included in his contract, one of which is related to the performance of the Organization. The Board assesses the performance of these goals and determines the bonus to be paid. Part I, Line 7 Dr. Patrick Fitzpatrick and Dr. Michael Kindred, Highest Compensated Employees, received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties. Dr. Andrew Forrest, Trustee, received a bonus during the year, which represented a vice chair stipend for Medical Staff Leadership. Dr. John Sauter received a bonus in accordance with his employment contract. Form 990, Part VII, Section A, Line 5: Dr. Dougald MacArthur, Chief of Medical Staff, by The Alpine Clinic, PLLC, and unrelated organization, for services rendered to the Organization. Compensation received from The Alpine Clinic for calendar year 2014 is as follows: Compensation: $656,000 A Business Finance Authority of the State of New Hampshire 521304598 64468kbg0 2007-11-15 30000000 Refunded series 1998A and 1998B Bonds 0 0 0 A 3415000 30000000 274108 29725892 2012 0 1 1 1 A 0 1 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 Schedule K, Part III, Line 2, Lease Arrangements: The debt-financed property is leased to 3 physician practices which are 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 All persons making an annual contribution to Littleton Hospital Association or Littleton Regional Hospital Charitable Foundation, who are at least eighteen (18) years of age, or any legal adult resident of any town raising an annual appropriation to the Littleton Hospital Association shall thereupon, and without further election or action by the Association, automatically become a member of the Association. Failure to contribute to the Hospital or Foundation in the following fiscal year shall automatically terminate the membership. Form 990, Part VI, Section A, line 7a Each member of the Association shall be qualified to originate and take part in the discussion of any subject that may properly come before any meeting of the Association, to vote on such subject, and to hold any office in the Association to which he or she may be elected or appointed. Form 990, Part VI, Section B, line 11 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 CFO's salary is approved by the CEO. The CEO's salary is approved by the Board. Form 990, Part VI, Section C, line 19 The hospital's governing documents and financial statements are made available upon request. The hospital's conflict of interest policy is not made available to the public. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Littleton Hospital Association 600 St. Johnsury Road Littleton, NH 03561 EIN 02-0222152 Littleton Hospital Association is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Loss on Interest Rate Swap -490,405. Littleton Regional Healthcare Charitable Foundation 600 St Johnsbury Road Littleton NH 03561 043750643 Charitable Foundation NH 501(c)(3) Line 7 Littleton Hospital Association 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 Littleton Regional Hospital Charitable Foundation B 195553 FMV Littleton Regional Hospital Charitable Foundation D 257896 FMV