ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
Tax period: 2012-10-01 to 2013-09-30
Filed: 2014-05-08
IRS object ID: 201411289349300971
Schema version: 2012v2.1
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)
Timestamp	2014-05-08T10:27:02-05:00	Timestamp
Tax Period End Date	2013-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	010494526	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BAKER NEWMAN & NOYES LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

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	ReturnType
Tax Period Begin Date	2012-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	020222791	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	ALIC	NameControl
Phone	6034483121	Phone

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

Officer Officer

Field	Value	IRS element (for citing)
Name	Evalie M Crosby CPA FHFMA	Name
Title	VP Finance & CFO	Title
Phone	6034483121	Phone
Date Signed	2014-04-30	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Nicholas E Porto	Name
PTIN	P01310283	PTIN
Phone	8002447444	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Susan E Mooney MD MS	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

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	55778622	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.alicepeckday.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1943	YearFormation
State Legal Domicile	NH	StateLegalDomicile
Activity Or Mission Description	Critical Access Hospital	ActivityOrMissionDescription
Nbr Voting Members Governing Body	20	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	17	NbrIndependentVotingMembers
Total Nbr Employees	692	TotalNbrEmployees
Total Nbr Volunteers	50	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	2648403	ContributionsGrantsPriorYear
Contributions Grants Current Year	483872	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	51719846	ProgramServiceRevenuePriorYear
Program Service Revenue CY	54164603	ProgramServiceRevenueCY
Investment Income Prior Year	284746	InvestmentIncomePriorYear
Investment Income Current Year	150290	InvestmentIncomeCurrentYear
Other Revenue Prior Year	39312	OtherRevenuePriorYear
Other Revenue Current Year	13075	OtherRevenueCurrentYear
Total Revenue Prior Year	54692307	TotalRevenuePriorYear
Total Revenue Current Year	54811840	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	40000	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	40150	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	30812469	SalariesEtcPriorYear
Salaries Etc Current Year	31282308	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	256600	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	11502	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	368956	TotalFundrsngExpCurrentYear
Other Expense Prior Year	21328367	OtherExpensePriorYear
Other Expenses Current Year	22769142	OtherExpensesCurrentYear
Total Expenses Prior Year	52437436	TotalExpensesPriorYear
Total Expenses Current Year	54103102	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	2254871	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	708738	RevenuesLessExpensesCY
Total Assets BOY	39832951	TotalAssetsBOY
Total Assets EOY	43973140	TotalAssetsEOY
Total Liabilities BOY	23447694	TotalLiabilitiesBOY
Total Liabilities EOY	26451784	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	16385257	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	17521356	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	The mission of Alice Peck Day Health Systems is to provide personalized, high quality, patient-focused healthcare services which are responsive to community needs, promote wellness, and continually improve the quality of healthcare in the community.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	50028636	Expense
Grants	40150	Grants
Revenue	54164603	Revenue
Description	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, 2013, charity care at a cost of $867,713 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, 2013 were $2,083,515. 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 services, 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 include Alcoholics Anonymous, AARP, Arthritis Foundation, Awake Support Group, Childbirth Education and Postpartum Massage, Colby Sawyer College, Community Health Department, Geisel School of Medicine at Dartmouth, Good Neighbor Health Clinic, Grafton County Senior Center, Grafton County Senior Citizens' Council, Lebanon Area Chamber of Commerce, Lebanon College, Lebanon School Bike Rodeo, Lebanon School District, NE Institute of Technology, Over-Eaters Anonymous, River Valley Community College, Savvy Seniors Exercise Program, Upper Valley Interfaith Project, Upper Valley Turning Point, Upper Valley Smiles Dental Program, Vermont Technical College, 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.	Description
Total Program Service Expense	50028636	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Info In Schedule O Part V	X	InfoInScheduleOPartV
Number Forms Transmitted With1096	51	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	692	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	20	NbrVotingGoverningBodyMembers
Number Independent Voting Members	17	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	NH	StatesWhereCopyOfReturnIsFiled
Own Website	X	OwnWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Evalie M Crosby CPA FHFMA	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6034483121	TelephoneNumber

Address US AddressUS

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	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
Marty P Candon
Trustee	1.00	1.00	X	0	0	0
Michael J Cryans
Trustee	1.00	1.00	X	0	0	0
Closey F Dickey
Trustee Emeritus (non-voting)	0.00	0.00	X	0	0	0
Terri C Dudley
Trustee Emeritus (non-voting)	0.00	0.00	X	0	0	0
Curt A Jacques II
Trustee	1.00	1.00	X	0	0	0
Richard S Jennings
Trustee	1.00	2.00	X	0	0	0
Bruce N Johnstone
Trustee	2.00	4.00	X	0	0	0
Edward T Kerrigan
Trustee	2.00	4.00	X	0	0	0
Miriam M Maguire
Trustee	0.50	1.50	X	0	0	0
Mark E Melendy
Trustee	1.00	2.50	X	0	0	0
Shelly L Moses
Trustee	1.00	1.00	X	0	0	0
Hildegard Z Ojibway
Trustee	1.00	1.00	X	0	0	0
Brett C Peltzer
Trustee	1.00	1.00	X	0	0	0
Wendall M Smith
Trustee	1.00	1.00	X	0	0	0
Michael R Harris PhD
Chair	1.00	1.00	X	0	0	0	X
Rev Dr Guy J D Collins
Vice Chair	1.00	2.00	X	0	0	0	X
Judson T Pierson
Treasurer	2.00	4.00	X	0	0	0	X
Karen G Kayen
Secretary	2.00	1.00	X	0	0	0	X
Harry G Dorman III FACHE
President & CEO (part year outgoing)	43.00	17.00	X	148298	181253	32248	X
Susan E Mooney MD MS
President & CEO (part year incoming)	50.00	11.00	X	257562	13556	45062	X
Deborah A Glazer MD
Med. Staff President (part year outgoing)	12.00	1.00	X	59347	0	0	X
Randall D Lea MD MPH
VP & Chief Med Officer (part year incoming)	2.00	1.00	X	23857	0	4658	X
Claudia C Gibson
President, Auxiliary	5.00		X	0	0	0	X
Beverley Rankin RN BSN
VP Patient Care, CNO	60.00	0.00	X	149526	0	42029	X
Evalie M Crosby CPA FHFMA
VP of Finance & CFO	40.00	20.00		130463	32615	37326	X
J Todd Miller MS
VP & COO	40.00	20.00		157792	0	41306	X
Brenda L Blair
VP Human Resources & Organizational Learning	60.00			117393	0	27389	X
Andrew Best MD
Physician	40.00			315461	0	33117		X
Diane C Riley MD
Physician	40.00			408801	0	35149		X
Leonard M Rudolf MD
Physician	40.00			463539	0	29921		X
Douglas Cedeno MD
Physician	40.00			286465	0	22024		X
David R Kroner MD
Physician	40.00			288406	0	32614		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2806910	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	227424	TotalReportableCompFrmRltdOrgs
Total Other Compensation	382843	TotalOtherCompensation
Number Individuals GT100 K	41	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Upper Valley Neurology
106 Hanover Street	Lebanon	NH	03766	Professional Services	1927991
Engelberth Construction
428 Main Street	Keene	NH	03431	Construction Services	605525
Carpenter & Costin
289 North Main Street	Rutland	VT	05701	Landscaping Services	147139

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
All Other Contributions	483872	AllOtherContributions
Total Contributions	483872	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient services	621400	53729634	53729634
Other operating	621400	343728	343728
Nutritional services	722210	91241	91241

Field	Value	IRS element (for citing)
Total Program Service Revenue	54164603	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	97095	TotalRevenueColumn
Exclusion	$97,095	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	36958	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	23883	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	13075	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	13075	TotalRevenueColumn
Exclusion	$13,075	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	988215	Securities
Other	7879	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	942899	Securities
Other	0	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	45316	Securities
Other	7879	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	53195	TotalRevenueColumn
Exclusion	$53,195	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	54811840	TotalRevenueColumn
Related Or Exempt Function Income	54164603	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$163,365	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	40150	Total
Program Services	40150	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	659091	Total
Program Services	61564	ProgramServices
Management And General	597527	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	25964607	Total
Program Services	24673868	ProgramServices
Management And General	1054380	ManagementAndGeneral
Fundraising	236359	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	402759	Total
Program Services	374806	ProgramServices
Management And General	24248	ManagementAndGeneral
Fundraising	3705	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	2501297	Total
Program Services	2380140	ProgramServices
Management And General	97569	ManagementAndGeneral
Fundraising	23588	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1754554	Total
Program Services	1632788	ProgramServices
Management And General	105624	ManagementAndGeneral
Fundraising	16142	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	26109	Total
Program Services	3740	ProgramServices
Management And General	22369	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	47125	Total
Management And General	47125	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	11920	Total
Management And General	11920	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	11502	Total
Fundraising	11502	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	5400274	Total
Program Services	5041985	ProgramServices
Management And General	322292	ManagementAndGeneral
Fundraising	35997	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	42405	Total
Program Services	10587	ProgramServices
Management And General	31697	ManagementAndGeneral
Fundraising	121	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1245305	Total
Program Services	882409	ProgramServices
Management And General	347320	ManagementAndGeneral
Fundraising	15576	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	83622	Total
Program Services	78320	ProgramServices
Management And General	4407	ManagementAndGeneral
Fundraising	895	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1084965	Total
Program Services	919583	ProgramServices
Management And General	160810	ManagementAndGeneral
Fundraising	4572	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	196149	Total
Program Services	174557	ProgramServices
Management And General	19183	ManagementAndGeneral
Fundraising	2409	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	481043	Total
Management And General	481043	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1955564	Total
Program Services	1655517	ProgramServices
Management And General	291813	ManagementAndGeneral
Fundraising	8234	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	983557	Total
Program Services	971306	ProgramServices
Management And General	11915	ManagementAndGeneral
Fundraising	336	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
Medical supplies/equipm	5620283	5612130	7950	203
Medicaid Enhancement ta	2433571	2433571
Provison for bad debt	2085471	2085471
Equipment rental/mainte	481802	470973	10747	82

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	589977	Total
Program Services	525171	ProgramServices
Management And General	55571	ManagementAndGeneral
Fundraising	9235	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	54103102	Total
Program Services	50028636	ProgramServices
Management And General	3705510	ManagementAndGeneral
Fundraising	368956	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	49669	BOY
EOY	382532	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2737368	BOY
EOY	4210783	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	1833739	BOY
EOY	1347100	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	7528117	BOY
EOY	8282884	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1238856	BOY
EOY	1129039	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	387557	BOY
EOY	440197	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	43240471	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	24839043	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	19099897	BOY
EOY	18401428	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	3395054	BOY
EOY	4047095	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	8500	BOY
EOY	8500	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	122544	BOY
EOY	116963	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	3431650	BOY
EOY	5606619	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	39832951	BOY
EOY	43973140	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	7799569	BOY
EOY	8372064	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	14807522	BOY
EOY	14830040	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	837113	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	840603	BOY
EOY	2412567	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	23447694	BOY
EOY	26451784	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	15898995	BOY
EOY	16878683	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	458576	BOY
EOY	612221	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	27686	BOY
EOY	30452	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	16385257	BOY
EOY	17521356	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	39832951	BOY
EOY	43973140	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	708738	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	336654	ReconciliationUnrealizedInvest
Reconcilation Other Changes	90707	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	1	GrantsOtherOrganizations
Grants Other Organizations	$7,279	GrantsOtherOrganizationsAmount
Direct Contact Legislators	1	DirectContactLegislators
Direct Contact Legislators	$495	DirectContactLegislatorsAmount
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$4,196	OtherActivitiesAmount
Total Lobbying Expenditures IIB	11970	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1:	ReturnReference
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 joined the 10 Mile CAH Coalition which engaged in strategic health resources (SHA) in lobbying efforts with regards to efforts in trying to eliminate CAH status. The CEO and CFO participated in a gathering in Washington DC that included visits to and discussions with all 4 members of the New Hampshire Legislative delegation. This was a two day event in February 2013. APD signed letters produced by SHA and sent them to members of Congress regarding the protection of the critical access hospital program. The CEO and CFO participated in phone conference calls with SHA and other members of the Coalition for strategic planning purposes.	Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	27686	BeginningOfYearBalance
Investment Earnings Or Losses	2766	InvestmentEarningsOrLosses
End Of Year Balance	30452	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	25840	BeginningOfYearBalance
Investment Earnings Or Losses	1846	InvestmentEarningsOrLosses
End Of Year Balance	27686	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	28065	BeginningOfYearBalance
Investment Earnings Or Losses	-2225	InvestmentEarningsOrLosses
End Of Year Balance	25840	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	26827	BeginningOfYearBalance
Investment Earnings Or Losses	1238	InvestmentEarningsOrLosses
End Of Year Balance	28065	EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	26456	BeginningOfYearBalance
Investment Earnings Or Losses	371	InvestmentEarningsOrLosses
End Of Year Balance	26827	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.00000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	1.00000	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.00000	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	927577	OtherCostOrOtherBasis
Book Value	927577	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	19758231	OtherCostOrOtherBasis
Depreciation	8441352	Depreciation
Book Value	11316879	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	250651	OtherCostOrOtherBasis
Depreciation	209757	Depreciation
Book Value	40894	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	20111647	OtherCostOrOtherBasis
Depreciation	15339583	Depreciation
Book Value	4772064	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2192365	OtherCostOrOtherBasis
Depreciation	848351	Depreciation
Book Value	1344014	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	18401428	TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescription	Book ValueBookValue
Estimated Third-Party Payor Settlements	1831736
Due from Affiliates	2012350
Liability Insurance Receivable	1762533

Field	Value	IRS element (for citing)
Total Book Value Other Assets	5606619	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescription	AmountAmount
Current portion of deferred annuities	$17,645
Interest rate swap	$187,124
Liability payable	$2,157,533
Longterm deferred annuity	$50,265

Field	Value	IRS element (for citing)
Total Of Amounts	2412567	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of Intended Use of Endowment Funds:	Part V, Line 4:	The Organization uses the income from its endowment funds for use in operations.
Description of Uncertain Tax Positions Under FIN 48:	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 Sections 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 2010.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	275.000000000000	FreeOtherPercentage

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

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	275.000000000000	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	867713	TotalCommunityBenefitExpense
Net Community Benefit Expense	867713	NetCommunityBenefitExpense
Percent Of Total Expense	0.01670	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4165481	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2081966	DirectOffsettingRevenue
Net Community Benefit Expense	2083515	NetCommunityBenefitExpense
Percent Of Total Expense	0.04010	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5033194	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2081966	DirectOffsettingRevenue
Net Community Benefit Expense	2951228	NetCommunityBenefitExpense
Percent Of Total Expense	0.05680	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	141559	TotalCommunityBenefitExpense
Net Community Benefit Expense	141559	NetCommunityBenefitExpense
Percent Of Total Expense	0.00270	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	190934	TotalCommunityBenefitExpense
Net Community Benefit Expense	190934	NetCommunityBenefitExpense
Percent Of Total Expense	0.00370	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	13214767	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5689151	DirectOffsettingRevenue
Net Community Benefit Expense	7525616	NetCommunityBenefitExpense
Percent Of Total Expense	0.14470	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Total Community Benefit Expense	0	TotalCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	70523	TotalCommunityBenefitExpense
Net Community Benefit Expense	70523	NetCommunityBenefitExpense
Percent Of Total Expense	0.00140	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	13617783	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5689151	DirectOffsettingRevenue
Net Community Benefit Expense	7928632	NetCommunityBenefitExpense
Percent Of Total Expense	0.15250	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	18650977	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7771117	DirectOffsettingRevenue
Net Community Benefit Expense	10879860	NetCommunityBenefitExpense
Percent Of Total Expense	0.20930	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	1939	TotalCommunityBuildingExpense
Net Community Building Expense	1939	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	12549	TotalCommunityBuildingExpense
Net Community Building Expense	12549	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Total Community Building Expense	3736	TotalCommunityBuildingExpense
Net Community Building Expense	3736	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	3725	TotalCommunityBuildingExpense
Net Community Building Expense	3725	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	1650	TotalCommunityBuildingExpense
Net Community Building Expense	1650	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	23599	TotalCommunityBuildingExpense
Net Community Building Expense	23599	NetCommunityBuildingExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$1,376,250	BadDebtExpenseAmount
Amount Attributable To	100000	AmountAttributableTo
Amount Reimbursed By Medicare	14850900	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	13849369	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	1001531	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Memorial Hospital	BusinessNameLine1

Address Address

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	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours
Other	Physician Clinics	Other

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

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)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	1	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	1	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	0	AllNeedsAddressed
Organization Incur Excise Tax	0	OrganizationIncurExciseTax
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	275.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	275.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Other Factors	X	OtherFactors
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Permit Report To Credit Agency	X	PermitReportToCreditAgency
Permit Lawsuit	X	PermitLawsuit
Collection Activities	1	CollectionActivities
Lawsuit	X	Lawsuit
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	8	NumberOfOtherFacilities

Other Facilities OtherFacilities (8 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
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

Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
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 6.19% of total expenditures on Form 990, Part IX, Column A, Line 25, excluding bad debt expense.
Part I, L7 Col(f): Bad debt expense reported on Form 990, Part IX, Line 25 was excluded from total expenses for the calculation of net community benefit expenses as a percent of total expense.
Part II: Alice Peck Day Memorial Hospital participates in various community building activities to promote and advocate for the health needs of the community. Significant activities include participation in the Upper Valley Interfaith Project, which promotes adequate public transportation in the region, including availability of transportation for hospital and clinic visits for area residents. APD's social services department works with patients who seek assistance with living wills and advance medical directives. APD personnel are actively involved in disaster and emergency preparedness planning and training activities. These activities are designed to promote the health and safety of the community in the event of widespread or large natural or other disaster, or in the event of widespread viral outbreaks, such as influenza. Finally, APD personnel are active participants in the New Hampshire Hospital Association (NHHA). NHHA advocates for the care and protection of NH hospital patients, including making quality health care available, affordable, and accessible to all, regardless of ability to pay.
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 FY 13, 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 allowances 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 attempt to 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 if they choose to pursue these benefits. 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 V, Section B, Line 3: The 2012 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 2011 and October 2012, 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 educationMany 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 12h: 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 exceeded 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. In addition to these eligible patients, a 10% prompt pay discount is offered.	Alice Peck Day Memorial Hospital
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 2013 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 is comprised of 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 FY13, 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.
NH	Reports Filed With States	Part VI, Line 7

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
Good Neighbor Health Clinic
70 North Main Street	White River Junction	VT	05001	030346949	501(c)(3)	18333	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)	18333	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)
Total Nbr Of501 C3 And Govt Grants	2	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: 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.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Harry G Dorman III FACHE
President & CEO (part year outgoing)	130523	159528	0	0	17775	21725	3684	4502	10828	13234	162810	198989	0	0
Susan E Mooney MD MS
President & CEO (part year incoming)	241428	12707	0	0	16134	849	7541	397	35268	1856	300371	15809	0	0
Beverley Rankin RN BSN
VP Patient Care, CNO	136525	0	0	0	13001	0	4836	0	37193	0	191555	0	0	0
Evalie M Crosby CPA FHFMA
VP of Finance & CFO	116864	29216	0	0	13599	3399	4118	1029	25743	6436	160324	40080	0	0
J Todd Miller MS
VP & COO	135302	0	0	0	22490	0	4988	0	36318	0	199098	0	0	0
Andrew Best MD
Physician	315461	0	0	0	0	0	7156	0	25961	0	348578	0	0	0
Diane C Riley MD
Physician	401177	0	0	0	7624	0	9427	0	25722	0	443950	0	0	0
Leonard M Rudolf MD
Physician	455192	0	0	0	8347	0	10000	0	19921	0	493460	0	0	0
Douglas Cedeno MD
Physician	263965	0	0	0	22500	0	7983	0	14041	0	308489	0	0	0
David R Kroner MD
Physician	267907	0	0	0	20499	0	8375	0	24239	0	321020	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Part I, Line 3	The compensation of the Organization's CEO/President is determined through a related party, APD Health Systems, Corp, the sole corporate member of the Organization. APD Health Systems used its Compensation Committee, an independent compensation consultant, a compensation survey/study, and approval by its Board's Compensation Committee to establish the CEO/President's compensation and benefits.
Part III	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 ($459,052) are included in salaries and benefits expense.	Supplemental Information

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

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)
Issuer EIN	521304598	IssuerEIN
Date Issued	2010-11-30	DateIssued
Issue Price	12282000	IssuePrice
Description Of Purpose	Current Refund Existing Bond	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	12282000	TotalProceeds
Refunding Escrow	12237068	RefundingEscrow
Issuance Costs From Proceeds	44932	IssuanceCostsFromProceeds
Year Of Subst Completion	2010	YearOfSubstCompletion
Current Refunding	1	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	1	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test	0	BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs	1	NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiled
Rebate Not Due Yet	0	RebateNotDueYet
Exception To Rebate	0	ExceptionToRebate
No Rebate Due	1	NoRebateDue
Variable Rate Issue	1	VariableRateIssue
Hedge Identified In Books And Recds	1	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	TD Banknorth NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Term Of Hedge	5.000000000000	TermOfHedge
Superintegrated Hedge	0	SuperintegratedHedge
Hedge Terminated	0	HedgeTerminated
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Written Proc To Monitor Reqs	1	WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Proc To Undertk Corrective Action	1	ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI

Field	Value	IRS element (for citing)
Identifier	Schedule K Part IV, Arbitrage, Line 2c	Identifier
Return Reference	Date Rebate Computation Performed	ReturnReference
Explanation	Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 01/03/2011	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
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 all members of the finance and governance committees of the Board of Trustees in advance of the filing deadline to enable a detailed and conscientious review by all members of both committees. 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	The Alice Peck Day Health System has a multifaceted 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 do arise, the Organization complies with the State of 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. 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.
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 President & CEO. She worked an average of 61 hours per week, of which an average of 59 hours per week were spent on executive matters and 2 in her role as a physician.
Form 990, Part XI, line 9:	Impact of interest rate swaps 90,707.	Changes in Net Assets or Fund Balances:
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 9/30/12 and 9/30/13.	Oversight of Audit Process:
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

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg	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

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	Alice Peck Day Health Management Corp	BusinessNameLine1

Address US AddressUS

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 Activity	Inactive	PrimaryActivity
Legal Domicile State	NH	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	APD Health Systems	BusinessNameLine1

Field	Value	IRS element (for citing)
Type Of Entity	C	TypeOfEntity
Controlled Org	0	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg