2013-08-14T14:45:51-05:00 2012-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2011-10-01 020223332 Huggins Hospital HUGG 6035697500 PO Box 912 Wolfeboro NH 03894 Jeremy Roberge 6035697500 2013-08-14 1 Barbara J McGuan CPA P00219457 2077752387 2013-08-14 2011 2016-02-25 16:41:14Z Michael Connelly PO Box 912 Wolfeboro NH 03894 78234509 0 X www.hugginshospital.org X 1907 NH Critical Access Hospital 17 13 595 250 0 0 1369621 1000616 57156419 51475090 557662 1566768 149235 149312 59232937 54191786 0 0 0 0 27289323 29247467 0 0 36982 34906882 24889279 62196205 54136746 -2963268 55040 100110442 104651750 38518622 42002816 61591820 62648934 X It is the mission of Huggins Hospital to provide quality health care services and to promote well being in the communities we serve. 0 0 46741671 50751645 Huggins Hospital is a 25 bed critical access hospital that provides acute care and primary health care from emergency services to family medical practice care, along with essential wellness and prevention services to the residents of the Eastern Lakes Region of NH (lower Carroll County and North/Northeastern Belknap County). A significant portion of the hospital's service area is uninsured, underinsured and/or dependent on Medicaid/Medicare benefits. Carroll County has one of the largest elderly populations in the state, and also has a significant number of rural, low-income families.Physician Practices. The hospital is committed to providing primary care services throughout our service area. Huggins Hospital has 133 credentialed providers. 21 provide primary care including pediatrics, and 53 are specialists covering general surgery, anesthesiology, orthopedics, emergency medicine, and hospitalists. 46741671 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 91 0 1 595 1 0 0 0 0 0 0 0 0 0 0 X 17 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Jeremy Roberge 6035697510 PO Box 912 Wolfeboro NH 03894 Stephen Wainwright 1.00 X X 0 0 0 Cecile M Chase 1.00 X X 0 0 0 William M Marsh MD 1.00 X X 0 0 0 Timothy Sullivan 1.00 X X 0 0 0 David Booth 1.00 X 0 0 0 Gerard Bozuwa MD 1.00 X 0 0 0 Judith Cole APRN 60.00 X 62583 0 18943 James Cubeddu PA 40.00 X 107973 0 9021 Gregory A Eldridge 1.00 X 0 0 0 Brad Hayes 1.00 X 0 0 0 James Rines 1.00 X 0 0 0 George Walker 1.00 X 0 0 0 Kathy Barnard 1.00 X 0 0 0 J Pierre Lamy 1.00 X 0 0 0 Reuben Wentworth 1.00 X 0 0 0 Vlasta Zdrnja MD 1.00 X 0 0 0 Michael Connelly 40.00 X X 100800 0 0 Timothy Pinard 40.00 X 196655 0 22551 John J Daigneault CPA CVA 1.00 X X 0 0 0 Leslie MacLeod 40.00 X 114194 0 0 Jeremy Roberge 40.00 X 0 0 0 George Costello 30.00 X 329761 0 22551 Thomas Barton 30.00 X 305369 0 27366 Dennis Badman 40.00 X 292756 0 22551 William Barton 40.00 X 277427 0 0 Eric Lewis 40.00 X 246152 0 22988 David W Tower FACHE 40.00 X 434317 0 10000 2467987 0 155971 31 1 1 1 Central NH ER Associates 6 Pickett Fence Road Meredith NH 03253 ER Physicians 1478573 Bauen Corp PO Box 16211 Meredith NH 03253 Construction 432520 Francis J Tranfa PO Box 306 Melvin Village NH 03850 Anesthesiologist 240000 Dan Balser 24 Brice Drive Brookfield NH 03872 CRNA Services 220753 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Hospitalist 201587 14 1000616 353249 1000616 Patient Service Fees 621990 87673740 87673740 Medicaid Tax Revenue 621990 4082346 4082346 Miscellaneous 621990 1753021 1029576 723445 Provision for Bad Debt 621990 -6146912 -6146912 Contractual/Char. Adj. 621990 -35887105 -35887105 51475090 397475 397475 119230 0 119230 119230 119230 25185763 12880 24021504 7846 1164259 5034 1169293 1169293 43455 13373 30082 30082 54191786 50751645 0 2439525 632720 417726 214994 22079563 19379972 2686107 13484 1300791 1133493 166524 774 3682073 3293753 388042 278 1552320 1345383 205906 1031 120940 120940 111900 111900 3816 3816 6404983 5002276 1390614 12093 99003 97867 905 231 688486 416543 263486 8457 117542 60595 56947 3855636 3668415 187177 44 1498096 1498096 4926276 4080931 845345 626075 626075 Medical Supplies 4082338 4082338 0 0 Medicaid Provider Tax 2169324 2169324 Miscellaneous 184864 94959 89315 590 54136746 46741671 7358093 36982 1239618 3146538 8801780 11459987 728796 339213 7011612 6376157 595582 637547 91415755 31421038 63748345 59994717 14682022 18842696 908800 581895 561961 2720792 2384134 100110442 104651750 9487194 8681763 25000000 24890000 868570 715599 3162858 7715454 38518622 42002816 X 51204545 49826839 6903187 9330188 3484088 3491907 61591820 62648934 100110442 104651750 X 55040 1002074 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11297 11297 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Organization pays dues to various associations, a portion of which are attributable to lobbying expenses. 9500670 7819 1570384 152411 10926462 9918249 9152 -307873 118858 9500670 9805179 5125 376905 268960 9918249 9684899 246777 -112132 14365 9805179 0.00000 0.31960 0.68040 0 0 1638475 1638475 54738432 10587875 44150557 28692527 19231060 9461467 6346321 1602103 4744218 59994717 Interest Rate Swap 3296889 Estimated Third-Party Payor Settlements 4418565 7715454 Description of Intended Use of Endowment Funds: Part V, Line 4: The intended use of the endowment fund is to support health care services including indigent care, health education, adult daycare as well as capital improvements and acquisitions. 2012 Golf Tournament 43455 43455 2630 4950 5793 43455 43455 2630 4950 5793 13373 30082 1 1 1 X 125.000000000000 1 X 1 1 0 1 1 4264214 1804456 2459758 0.04540 2481018 2392414 88604 0.00160 6745232 4196870 2548362 0.04700 6745232 4196870 2548362 0.04700 1 3342622 0 17087809 17087809 X 1 1 1 1 Huggins Hospital

PO Box 912 Wolfeboro NH 03894

X X X X Huggins Hospital 1 1 1 125.000000000000 1 200.000000000000 1 X X 1 1 X X X X X 1 0 1 X 0 0 Part I, Line 7: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio. Part II: Community Building Activities: Community-building activities include cash, in-kind donations, and budgeted expenditures by the Trust for the development of programs and partnerships intended to address social and economic determinants of health. Sub-categories in this area include:Physical Improvements/Housing: Community improvement and revitalization projects; housing rehabilitation; public works; contribution to community-based assisted living, senior and low income housing projects, home safety assessment and installation.Economic Development: Small business development, participation in economic development council, chamber of commerce: - Gene Goodwin is a member on the WEDCO Board and its mission is to promote and support businesses and the creation of employment opportunities by providing development assistance and financing. - Gene Goodwin is a member on the Hearth Stone Homes of Wolfeboro Board of Directors which is two low income housing developments that assists people for placement within these two developments. - Mike Connelly, President and CEO of the Hospital sits on the Wolfeboro Area Chamber of Commerce and the Town Economic Development Committee.Support Systems Enhancements: Adopt-a-school efforts, childcare for community residents with qualified need; mentoring programs; youth development initiatives, including categories of caring adults, safe places, emergency preparedness; community disease surveillance and reporting infrastructure, cost of stockpiling, medical, surgical, and pharmaceutical supplies, including barriers, respirators, clothing, IV pumps and poles, IV fluids, suction machines, stretchers, wheelchairs, linens, bandages, and dressings, personal protective equipment; costs associated with training, community partnership, and outreach planning. - We have several employees that are specially trained as part of the Carroll County Emergency Preparedness team for the State of New Hampshire. As being designated as part of that team our employees must attend specialized training and perform drills that stretch across Carroll County. In addition our employee Ms. Janet Williamson is the Chair of our Emergency Preparedness Committee and the Hospital's EMS Interceptor. She is qualified to provide continued education to our local EMS providers which she does several times a year. As part of our Emergency Preparedness team we also provide flu clinics for all of our surrounding EMS providers. - The Hospital has seen an increase in patients having mental health issues and the Hospital is having to hold patients for several days before beds become available. Meetings were established with the State of New Hampshire Hospital, County Jail, and Northern Human Services and local police chiefs to evaluate and assess the process to ensure the agencies are working together to address the lack of mental health services in NH.Environmental Improvements: Efforts to reduce environmental hazards in the air, water and ground including lead detection and remediation; radon detection and remediation; community waste reduction and sharps disposal programs; health care facility waste and mercury reduction.Coalition Building: Organizational representation on community coalitions; collaborative partnerships with community groups to improve community health; community coalition meeting costs, visioning, sessions, task force meetings, etc. and costs for task-force specific project initiatives. - Hospital employees sit on the Carroll County Coalition which provides training and development of teen initiatives to promote healthy life style choices and opportunities for the children in the community to participate in. - Each quarter the Hospital publishes articles on various health topics for all of our service areas. Our physicians contribute wellness information and other classes and programs that are being offered at Huggins.Community Health Improvement Advocacy: Local, state, and/or national advocacy for community members and groups relative to policies and funding to improve community and public health including the social and economic determinants of health. - Mike Connelly sits on the Rural Health Coalition, which is made up of the 13 NH Critical Access Hospitals which specifically addresses issues and concerns relative to critical access hospitals.Workforce Enhancement: Recruitment of physicians and other health professionals for government-designated medically underserved areas; recruitment of underrepresented minorities; job creation and training programs; participation in community workforce boards, workforce partnerships, and welfare-to-work initiatives; partnerships to address the health care workforce shortage; school and community-based programs on health care careers. - The Hospital is actively recruiting for several providers. Due to our Hospital location it is extremely difficult to recruit physicians to a rural area and with many physicians moving towards specialized medicine it is difficult to recruit MD, DO and staff to this area without having specialized care options available to treat critically ill patients, which many graduates are familiar with. Part III, Line 4: Patient accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.The Hospital used a cost-to-charge ratio as its costing methodology for amounts reported in Part III, Section A. Part III, Line 8: The Organization used a cost-to-charge ratio as its costing methodology to determine the amount of Medicare allowable costs. Part III, Line 9b: As a not-for-profit, tax-exempt, and charitable organization, Huggins Hospital serves all in medical need regardless of ability to pay. The Organization is governed by a volunteer Board of Trustees committed to balancing community needs with our available resourses to meet those needs. As a hospital-employed medical staff, all twelve physican practices accept patients regardless of ability to pay. Part VI, Line 2: In 2009 as part of an every three-year process, the Hospital in collaboration with the VNA of Southern Carroll County & Vicinity, Inc completed a Community Needs Assessment for the purpose of assessing the region's most prevalent medical conditions. The assessment was done through interviews and surveys of key community leaders, local and area selectmen, School Administrative Unit #49 teachers and staff including letters and surveys to all families in the district. Heart disease, cancer, stroke, respiratory illness, trauma, and diabetes make up much of the medical care needs of the area we serve. Many of the services we provide are inadequately reimbursed by both government and private insurers. Through the Community Needs Assessment, we have established programs that are designed to meet the needs of special populations such as at-risk youth, the elderly, the impoverished, and those with disabilities, chronic and terminal illnesses. Part VI, Line 3: Huggins Hospital provides a notice to all patients both in the hospital and its physician practices of the financial assistance programs available to them. There is a staff of three financial councilors who work with the uninsured and underinsured to assist in qualifying for Charity Care or a sliding fee schedule depending on the family income. Financial councilors also assist those uninsured in applying for and receiving assistance through the Medicaid program. Part VI, Line 4: The population served by Huggins Hospital consists of those towns that have been designated by the New Hampshire Department of Health and Human Services as being located in the Wolfeboro Hospital Service Area. The primary service area includes: Alton, Brookfield, Effingham, Freedom, Ossipee, Tamworth, Tuftonboro, Wakefield, and Wolfeboro. Secondary service areas are parts of Gilford, Moultonborough, New Durham and Barnstead and are also considered a part of the Huggins Hospital service area. These towns are located in Carroll County, Belknap County, and Strafford County. Our community is rural in nature and is a section of the State that has seasonal population changes. Our year round population base of approximately 33,000 citizens expands in the tourist season to about 90,000 residents. Reports Filed With States Part VI, Line 7 NH X X X 1 1 0 0 0 0 0 0 0 Timothy Pinard 192779 0 3846 0 30 0 0 0 22551 0 219206 0 0 0 George Costello 316613 0 13019 0 129 0 0 0 22551 0 352312 0 0 0 Thomas Barton 291976 0 13264 0 129 0 0 0 27366 0 332735 0 0 0 Dennis Badman 244691 0 47936 0 129 0 0 0 22551 0 315307 0 0 0 William Barton 266526 0 10772 0 129 0 0 0 0 0 277427 0 0 0 Eric Lewis 192435 0 53648 0 69 0 0 0 22988 0 269140 0 0 0 David W Tower FACHE 242166 0 0 0 192151 0 10000 0 0 0 444317 0 0 0 Part I, Lines 4a-b Leslie MacLeod participates in a split-dollar life insurance plan related to his prior employment with the Organization several years ago. The applicable amounts are not readily determinable. David Tower received a severance payment from the organization in the amount of $81,415 during calendar year 2011. Supplemental Information Part III Form 990, Part VII, Section A, Line 5 Michael Connelly received compensation from Leaders for Today (an unrelated third party) for services rendered to the Organization in calendar year 2011. His compensation was as follows: Compensation: $100,800. Business Finance Authority of the State of New Hampshire 521304598 64448KBF2 2007-11-15 10000000 Financing of Construction Project 0 0 0 Business Finance Authority of the State of New Hampshire 521304598 64468KBM7 2009-10-06 15000000 Financing of Construction Project 0 0 0 110000 10000000 187687 9812313 2010 0 0 1 1 15000000 1209938 188500 13490234 2010 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 Paul E DeMasi DO X 161019 57821 1 1 1 57821 Jodi C Balint Family member of James Cubeddu, current trustee 127146 Employment 0 Richard Tower Family member of David Tower, Former President 66019 Employment (compensation & benefits) 0 Jennifer Pinard Family member of Timothy Pinard, current trustee 33872 Employment 0 X 11 353249 Fair Market Value 0 0 1 Third Party Use: Part I, Line 32b: Contributions of securities are sold through an investment broker. All gifts of securities are sold as soon as administratively possible. Form 990, Part VI, Section B, line 11 A designated officer or management official meets with the preparer to discuss a draft of the Form 990 in detail. Once any necessary revisions are made, this draft is then submitted to the Finance & Budget Committee for further review. Afterwards, a copy of the public inspection copy of Form 990 is made available to the full board for their general review and comment prior to filing the return. A designated officer then signs the return after considering board comments. Form 990, Part VI, Section B, line 12c A copy of the conflict of interest policy is given to every officer, board member, and key employee on an annual basis, along with an annual disclosure statement. Each person is asked to complete, date and sign the disclosure statement, listing any known financial interest that the individual, or a member of the individual's family, has in any business entity that transacts business with the Organization. The Chairman of the board then reviews and maintains the disclosure statements for future reference. If a conflict arises, the board member will recuse themselves from participation in the deliberations and decisions relating to that conflict. Form 990, Part VI, Section B, line 15 The Hospital relies on externally available market data to determine the appropriate salary and any incentive compensation for the President as well as other officers and key employees of the organization. Each year, the President provides the Board with a listing of the five highest paid senior staff. Base salary and incentive compensation provided to the President is determined by three members of the Executive Committee of the Board as part of an annual performance review and their recommendation is shared with the full Board for final approval. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request for inspection in the President's office. Contact Addresses for Officers, Directors, Etc Form 990, Part VII David W. Tower, FACHE - 82 Kent Locke Circle, Alton, NH 03809. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 558,639. Pension Liability Adjustment -331,334. Change in Value of Interest Rate Swap -134,031. Beneficial Interest in Charitable Remainder Trust 908,800. Total to Form 990, Part XI, Line 5: 1,002,074. Huggins Senior Housing PO Box 912 Wolfeboro NH 03894 020490445 Elderly Housing NH N/A C 670770 637245 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Huggins Senior Housing D 1090565 Fair Market Value