ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-06-26
- IRS object ID
- 201531779349300538
- Schema version
- 2013v4.0
- 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 | 2015-06-26T14:24:13-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET SUITE 302 | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Evalie M Crosby CPA FHFMA | PersonNm |
| Person Title | VP Finance & CFO | PersonTitleTxt |
| Phone | 6034483121 | PhoneNum |
| Signature | 2015-06-04 | 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 | 2013 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | 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 | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $58,455,928 | 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 | 23 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 20 | VotingMembersIndependentCnt |
| Total Employee | 702 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $483,872 | PYContributionsGrantsAmt |
| CY Contributions Grants | $677,336 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $54,164,603 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $56,525,205 | CYProgramServiceRevenueAmt |
| PY Investment Income | $150,290 | PYInvestmentIncomeAmt |
| CY Investment Income | $311,898 | CYInvestmentIncomeAmt |
| PY Other Revenue | $13,075 | PYOtherRevenueAmt |
| CY Other Revenue | $3,185 | CYOtherRevenueAmt |
| PY Total Revenue | $54,811,840 | PYTotalRevenueAmt |
| CY Total Revenue | $57,517,624 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $40,150 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $30,150 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $31,282,308 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,037,574 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $11,502 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $342,689 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,769,142 | PYOtherExpensesAmt |
| CY Other Expenses | $23,833,252 | CYOtherExpensesAmt |
| PY Total Expenses | $54,103,102 | PYTotalExpensesAmt |
| CY Total Expenses | $56,900,976 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $708,738 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $616,648 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,973,140 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,993,395 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $26,451,784 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $25,711,242 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,521,356 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,282,153 | 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 | $53,251,313 | ExpenseAmt |
| Grant | $30,150 | GrantAmt |
| Revenue | $56,525,205 | 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, 2014, charity care at a cost of $852,441 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, 2014 were $3,037,169. 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. Services included community health, health professional education, community building activities, and community benefit programs. Services ranged from community flu clinics, Upper Valley Smiles Dental Program, student and professional education, emergency pharmacy vouchers, and many other programs 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 included: Alcoholics Anonymous, AARP, Arthritis Foundation, Childbirth Education and Postpartum Massage, Frontier University, Geisel School of Medicine at Dartmouth, Georgetown University, Good Neighbor Health Clinic, Grafton County Senior Center, Grafton County Senior Citizens' Council, Hanover Chamber of Commerce, Lebanon Area Chamber of Commerce, Lebanon Kiwanis Bike Safety Rodeo, Lebanon School District, Mascoma Valley Health Initiative, River Valley Community College, United Valley Interfaith Project, Upper Valley Public Health Council, Upper Valley Turning Point, Upper Valley Smiles Dental Program, Vanderbilt University, 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 | $53,251,313 | 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 | 0 | 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 | 66 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 702 | 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 | 23 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 20 | 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 | Evalie M Crosby CPA FHFMA | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Terri C Dudley | |||||||||
| Trustee Emeritus (non-voting) | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Closey F Dickey | |||||||||
| Trustee Emeritus (non-voting) | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert J Bauman | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Marty P Candon | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Curt A Jacques II | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Richard S Jennings | |||||||||
| Trustee | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Edward T Kerrigan | |||||||||
| Trustee | 3.00 | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael F Long | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $1,080 | $0 | $0 | |||
| Anne D MacEwan | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Miriam M Maguire | |||||||||
| Trustee | 0.50 | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| Mark E Melendy | |||||||||
| Trustee | 1.00 | 2.50 | Yes (X) | $0 | $0 | $0 | |||
| Shelly L Moses | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Hildegard Z Ojibway | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Brett C Peltzer | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Wendell M Smith | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael J Cryans | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael R Harris PhD | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Judson T Pierson | |||||||||
| Chair | 5.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Rev Dr Guy JD Collins | |||||||||
| Vice Chair | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Bruce N Johnstone | |||||||||
| Treasurer | 2.00 | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Karen G Kayen | |||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Susan E Mooney MD MS | |||||||||
| President & CEO | 50.00 | 11.00 | Yes (X) | $294,771 | $15,514 | $52,486 | Yes (X) | ||
| Daniel F Jones MD | |||||||||
| Med. Staff President (part year incoming) | 3.00 | 1.00 | Yes (X) | $12,000 | $0 | $0 | Yes (X) | ||
| Deborah A Glazer MD | |||||||||
| Med. Staff President (part year outgoing) | 12.00 | 1.00 | Yes (X) | $76,167 | $0 | $0 | 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) | $154,537 | $0 | $51,516 | Yes (X) | |||
| Evalie M Crosby CPA FHFMA | |||||||||
| VP of Finance & CFO | 40.00 | 20.00 | $156,088 | $17,343 | $35,395 | Yes (X) | |||
| J Todd Miller MS | |||||||||
| VP & COO | 40.00 | 20.00 | $159,335 | $11,261 | $47,727 | Yes (X) | |||
| Randall D Lea MD MPH | |||||||||
| VP & Chief Medical Officer | 28.00 | 1.00 | $190,265 | $0 | $31,580 | Yes (X) | |||
| John P Houde MD | |||||||||
| Physician | 40.00 | $404,112 | $0 | $36,612 | Yes (X) | ||||
| Adnan Khan MD | |||||||||
| Physician | 40.00 | $338,870 | $0 | $36,797 | Yes (X) | ||||
| Diane C Riley MD CAQSH | |||||||||
| Physician | 40.00 | $416,907 | $0 | $36,132 | Yes (X) | ||||
| Leonard M Rudolf MD | |||||||||
| Physician | 40.00 | $471,334 | $0 | $46,469 | Yes (X) | ||||
| Douglas A Cedeno MD | |||||||||
| Physician | 40.00 | $278,715 | $0 | $23,991 | Yes (X) | ||||
| Harry G Dorman III FACHE | |||||||||
| Former President & CEO APDHS | 0.00 | 0.00 | $0 | $159,084 | $12,710 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,954,181 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $203,202 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $411,415 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 39 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Upper Valley Neurology | |||||
| 106 Hanover Street | Lebanon | NH | 03766 | Professional Services | $2,327,725 |
| ARC Mechanical Contractors | |||||
| 229 Pot Street | Bradford | VT | 05033 | Mechanical Contracting | $107,930 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $677,336 | AllOtherContributionsAmt |
| Noncash Contributions | $6,573 | NoncashContributionsAmt |
| Total Contributions | $677,336 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient services | 621400 | $56,232,491 | $56,232,491 |
| Other operating | 621400 | $205,686 | $205,686 |
| Nutritional services | 722210 | $87,028 | $87,028 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $56,525,205 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $122,999 | TotalRevenueColumnAmt |
| Exclusion | $122,999 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,068 | 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 | $3,185 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,185 | TotalRevenueColumnAmt |
| Exclusion | $3,185 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,101,020 | SecuritiesAmt |
| Other | $2,300 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $914,421 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $186,599 | SecuritiesAmt |
| Other | $2,300 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $188,899 | TotalRevenueColumnAmt |
| Exclusion | $188,899 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,517,624 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,525,205 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $315,083 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,150 | TotalAmt |
| Program Services | $30,150 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,253,921 | TotalAmt |
| Program Services | $585,960 | ProgramServicesAmt |
| Management And General | $667,961 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,282,086 | TotalAmt |
| Program Services | $25,193,953 | ProgramServicesAmt |
| Management And General | $857,126 | ManagementAndGeneralAmt |
| Fundraising | $231,007 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,475 | TotalAmt |
| Program Services | $552,015 | ProgramServicesAmt |
| Management And General | $21,470 | ManagementAndGeneralAmt |
| Fundraising | $4,990 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,165,381 | TotalAmt |
| Program Services | $3,061,877 | ProgramServicesAmt |
| Management And General | $75,285 | ManagementAndGeneralAmt |
| Fundraising | $28,219 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,757,711 | TotalAmt |
| Program Services | $1,648,908 | ProgramServicesAmt |
| Management And General | $94,038 | ManagementAndGeneralAmt |
| Fundraising | $14,765 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,487 | TotalAmt |
| Program Services | $145 | ProgramServicesAmt |
| Management And General | $56,342 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,382 | TotalAmt |
| Management And General | $52,382 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,250,067 | TotalAmt |
| Program Services | $5,903,788 | ProgramServicesAmt |
| Management And General | $312,532 | ManagementAndGeneralAmt |
| Fundraising | $33,747 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,106 | TotalAmt |
| Management And General | $13,106 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,081,090 | TotalAmt |
| Program Services | $733,837 | ProgramServicesAmt |
| Management And General | $337,622 | ManagementAndGeneralAmt |
| Fundraising | $9,631 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,277 | TotalAmt |
| Program Services | $131,781 | ProgramServicesAmt |
| Management And General | $13,375 | ManagementAndGeneralAmt |
| Fundraising | $1,121 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,225,565 | TotalAmt |
| Program Services | $1,139,065 | ProgramServicesAmt |
| Management And General | $75,356 | ManagementAndGeneralAmt |
| Fundraising | $11,144 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,293 | TotalAmt |
| Program Services | $195,559 | ProgramServicesAmt |
| Management And General | $5,813 | ManagementAndGeneralAmt |
| Fundraising | $921 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $491,069 | TotalAmt |
| Management And General | $491,069 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,975,320 | TotalAmt |
| Program Services | $1,815,517 | ProgramServicesAmt |
| Management And General | $159,803 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $471,502 | TotalAmt |
| Program Services | $464,569 | ProgramServicesAmt |
| Management And General | $6,240 | ManagementAndGeneralAmt |
| Fundraising | $693 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medical supplies/equipm | $6,493,782 | $6,482,589 | $7,170 | $4,023 |
| Medicaid Enhancement ta | $2,183,103 | $2,183,103 | ||
| Provison for bad debt | $2,000,783 | $2,000,783 | ||
| Equipment rental/mainte | $592,210 | $580,565 | $11,482 | $163 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,216 | TotalAmt |
| Program Services | $547,149 | ProgramServicesAmt |
| Management And General | $48,802 | ManagementAndGeneralAmt |
| Fundraising | $2,265 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,900,976 | TotalAmt |
| Program Services | $53,251,313 | ProgramServicesAmt |
| Management And General | $3,306,974 | ManagementAndGeneralAmt |
| Fundraising | $342,689 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $382,532 | BOYAmt |
| EOY | $61,240 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,210,783 | BOYAmt |
| EOY | $8,381,042 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,347,100 | BOYAmt |
| EOY | $946,893 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,282,884 | BOYAmt |
| EOY | $9,770,473 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,129,039 | BOYAmt |
| EOY | $1,138,741 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $440,197 | BOYAmt |
| EOY | $423,922 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $43,698,228 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,777,551 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,401,428 | BOYAmt |
| EOY | $16,920,677 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,047,095 | BOYAmt |
| EOY | $4,611,444 | 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 | $116,963 | BOYAmt |
| EOY | $110,795 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,606,619 | BOYAmt |
| EOY | $1,619,668 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,973,140 | BOYAmt |
| EOY | $43,993,395 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,372,064 | BOYAmt |
| EOY | $9,188,735 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,830,040 | BOYAmt |
| EOY | $15,474,272 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $837,113 | BOYAmt |
| EOY | $363,339 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,412,567 | BOYAmt |
| EOY | $684,896 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,451,784 | BOYAmt |
| EOY | $25,711,242 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,878,683 | BOYAmt |
| EOY | $17,548,810 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $612,221 | BOYAmt |
| EOY | $702,460 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,452 | BOYAmt |
| EOY | $30,883 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,521,356 | BOYAmt |
| EOY | $18,282,153 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,973,140 | BOYAmt |
| EOY | $43,993,395 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $616,648 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $57,473 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $86,676 | 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 | $8,712 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,750 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $12,462 | 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 | $30,452 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $431 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $30,883 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $26,827 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,238 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $28,065 | 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 | $19,808,639 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,250,271 | DepreciationAmt |
| Book Value | $10,558,368 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $250,651 | OtherCostOrOtherBasisAmt |
| Depreciation | $222,807 | DepreciationAmt |
| Book Value | $27,844 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,656,566 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,430,675 | DepreciationAmt |
| Book Value | $4,225,891 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,054,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $873,798 | DepreciationAmt |
| Book Value | $1,180,997 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,920,677 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Current Portion of Deferred Annuities | $17,645 |
| Interest Rate Swap | $100,448 |
| Liability Payable | $288,600 |
| Longterm Deferred Annuity | $39,911 |
| Estimated Third Party Settlements | $238,292 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $684,896 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 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 2011. |
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 | $808,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $808,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01470 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,261,531 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,700,401 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $561,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,070,389 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,700,401 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,369,988 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $157,844 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $157,844 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $125,125 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $125,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,447,090 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,274,854 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,172,236 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13060 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,594 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $66,594 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,796,653 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,274,854 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,521,799 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13700 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,867,042 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,975,255 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,891,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16190 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $891 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $891 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,458 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,458 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,669 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,669 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,276,733 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $100,000 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,863,804 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $15,741,787 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $122,017 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 03766 | ZIPCode |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.alicepeckday.org/news/annual_reports | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 275.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 275.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 3: 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 4: Alice Peck Day Memorial HospitalMount Ascutney Hospital and Health CareDartmouth-Hitchcock Medical Center |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 7: 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.) |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 12i: 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 14g: 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 20d: 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. |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 17A | Lebanon | NH | 03766 | General Surgeon Clinic |
| 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 (15 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 9.89% 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 $ 2,000,783. |
| 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, 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 at Part III, Line 4. |
| Part III, Line 3: | See narrative at 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 FY14, 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 allowanced based on its assessment of individual accounts and historical adjustments. Accounts deemed uncollectible are written off through a charge against the established allowance. |
| 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. |
| 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 2014 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 FY14, 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, provided childbirth education classes, offered a dedicated office space for a local public health collaborative, provided space for a satellite free clinic, and worked toward the expansion of local public transportation to ensure all those in need of medical care could receive it. 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 6 different schools, over 1,600 students received oral health education, with nearly 400 of those children receiving screenings from a dental team. Additionally, over 1,200 preventative sealants were given to 239 low-income, uninsured children. Referrals for follow-up restorative treatment were given to 97 of the 239 children. With grant support, APD continued its Women, Infants and Children (WIC) Oral Health Initiative in Lebanon and Enfield New Hampshire, and in Hartford, Vermont. Under the WIC initiative, a total of 104 low-income children aged 0-10 received oral health education, a dental screening, and preventative care. Individuals were provided with assistance in applying for NH/VT Medicaid to ensure increased access to medical care for this needy population. As a result, a significant number of people were successfully enrolled and received ongoing care. To promote health professional education, APD provided clinical undergraduate training to students from Bay Path College, Geisel School of Medicine at Dartmouth, George Washington University, Lebanon College, New England Institute of Technology, River Valley Community College, the University of Vermont 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | 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 |
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 | 0 | 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 | $277,513 | $14,606 | $0 | $0 | $17,258 | $908 | $4,845 | $255 | $45,017 | $2,369 | $344,633 | $18,138 | $0 | $0 |
| Beverley Rankin RN BSN | ||||||||||||||
| VP Patient Care, CNO | $141,260 | $0 | $0 | $0 | $13,277 | $0 | $3,299 | $0 | $48,217 | $0 | $206,053 | $0 | $0 | $0 |
| Evalie M Crosby CPA FHFMA | ||||||||||||||
| VP of Finance & CFO | $139,918 | $15,546 | $0 | $0 | $16,170 | $1,797 | $3,228 | $358 | $28,629 | $3,180 | $187,945 | $20,881 | $0 | $0 |
| J Todd Miller MS | ||||||||||||||
| VP & COO | $137,715 | $9,881 | $0 | $0 | $21,620 | $1,380 | $3,303 | $211 | $41,560 | $2,653 | $204,198 | $14,125 | $0 | $0 |
| Randall D Lea MD MPH | ||||||||||||||
| VP & Chief Medical Officer | $182,423 | $0 | $0 | $0 | $7,842 | $0 | $927 | $0 | $30,653 | $0 | $221,845 | $0 | $0 | $0 |
| John P Houde MD | ||||||||||||||
| Physician | $383,811 | $0 | $0 | $0 | $20,301 | $0 | $0 | $0 | $36,612 | $0 | $440,724 | $0 | $0 | $0 |
| Adnan Khan MD | ||||||||||||||
| Physician | $321,370 | $0 | $0 | $0 | $17,500 | $0 | $3,587 | $0 | $33,210 | $0 | $375,667 | $0 | $0 | $0 |
| Diane C Riley MD CAQSH | ||||||||||||||
| Physician | $400,043 | $0 | $0 | $0 | $16,864 | $0 | $5,100 | $0 | $31,032 | $0 | $453,039 | $0 | $0 | $0 |
| Leonard M Rudolf MD | ||||||||||||||
| Physician | $452,148 | $0 | $0 | $0 | $19,186 | $0 | $5,100 | $0 | $41,369 | $0 | $517,803 | $0 | $0 | $0 |
| Douglas A Cedeno MD | ||||||||||||||
| Physician | $255,715 | $0 | $0 | $0 | $23,000 | $0 | $4,810 | $0 | $19,181 | $0 | $302,706 | $0 | $0 | $0 |
| Harry G Dorman III FACHE | ||||||||||||||
| Former President & CEO APDHS | $0 | $130,653 | $0 | $0 | $0 | $28,431 | $0 | $2,873 | $0 | $9,837 | $0 | $171,794 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 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. |
| 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 ($595,455) 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 | BusinessNameLine1 |
| 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 |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 5.000000000000 | TermOfHedgePct |
| Superintegrated Hedge | 0 | SuperintegratedHedgeInd |
| Hedge Terminated | 0 | 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 review of the filing prior to a vote of acceptance by the full board of trustees. 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 Financial 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 VII: | Harry G. Dorman, III officially retired in May of 2013, prior to the start of the Organization's current fiscal year. His compensation and benefit information reported on Form 990, Part VII represents calendar year 2013 amounts paid to him for his services while an officer of the Organization and related organizations. In accordance with IRS instructions, he is listed as a "former" officer as he had reportable W-2 compensation in excess of $100,000 during the calendar year end covered by this return but did not serve in the capacity as an officer of the Organization during the fiscal year. All compensation received by Mr. Dorman reported in Form 990, Part VII was negotiated and paid at arm's length. |
| Form 990, Part XI, line 9: | Impact of Interest Rate Swaps 86,676. |
| 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 9/30/13 and 9/30/14. |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 03766 | ZIPCode |
| 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 |
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