2011-05-11T12:11:47-05:00 2010-09-30 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2009-10-01 020222791 ALICE PECK DAY MEMORIAL HOSPITAL ALIC 6034483121 125 MASCOMA STREET LEBANON NH 037662647 EVALIE M CROSBY 6034483121 2011-05-02 1 8002447444 2009 2016-02-24 21:20:13Z HARRY G DORMAN III 125 MASCOMA STREET LEBANON NH 037662647 44954543 0 X www.alicepeckday.org X 1943 NH CRITICAL ACCESS HOSPITAL 21 18 480 94 0 0 622434 1029971 48776296 42411307 -246880 137115 50200 48297 49202050 43626690 0 0 21593020 23580477 0 248739 27577277 17285987 49170297 40866464 31753 2760226 26231660 28392505 15916794 15278155 10314866 13114350 THE MISSION OF ALICE PECK DAY MEMORIAL HOSPITAL IS TO PROVIDE PATIENT-FOCUSED HEALTH CARE SERVICES THAT ARE RESPONSIVE TO COMMUNITY NEEDS, TO PROMOTE WELLNESS, AND TO CONTINUALLY IMPROVE THE QUALITY OF HEALTH CARE SERVICES IN THE COMMUNITY. 0 0 37540598 42325574 Alice Peck Day Memorial Hospital is a community-based 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 forgone for services and supplies furnished under its charity care policy, the established costs of the services and supplies and equivalent service statistics. For the year ended September 30, 2010: charges forgone based on established rates were $1,198,647 with charity care AT COST OF $734,688. Estimated costs incurred in excess of payment for inpatient and outpatient services for Medicare and Medicaid patients in the year ended September 30, 2010 were $3.3 million.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 included countless other programs that contributed to and supported our community. As a local community hospital, Alice Peck Day works closely with community organizations to address community needs. Organizations that were beneficiaries of the Hospital's staff, time, and/or materials include Alcoholics Anonymous, AARP, American Legion, American Red Cross, Awake Support Group, Bonnie Clac, Brookside Nursing home, Childbirth Education and Postpartum Massage, Community Health Department, Dartmouth Medical School, Elmira College, Frontier School of Midwifery, Good Beginnings of Sullivan County, Good Neighbor Health Center, Grafton County Senior Center, Grafton County Senior Citizens Council, Lebanon Area Chamber of Commerce, Lebanon College, Lebanon Housing Authority, Lebanon School Bike Rodeo, Lebanon School District Nature Program, Over Eaters Anonymous, River Valley Community College, Rogers House, Savvy Seniors Exercise Program, Storrs Hill, United Valley Interfaith Project, Upper Valley Smiles Dental Program, Vermont Institute of Natural Sciences, West Central and West Central Behavioral Health. 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 its 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. 37540598 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 68 0 480 1 0 0 0 0 0 0 0 21 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X X ELIZABETH LOUDERMILK 6034483121 125 MASCOMA STREET LEBANON NH 037662647 MICHAEL R HARRIS 1.00 X X 0 0 0 REV DR GUY JD COLLINS 1.00 X 0 0 0 JUDSON T PIERSON 2.00 X X 0 0 0 KAREN G KAYEN 1.00 X 0 0 0 BARBARA CALLAHAN CRNA 1.00 X 0 0 0 JAMES R CALLAN PART YEAR 2.00 X 0 0 0 MICHAEL J CRYANS 0.50 X 0 0 0 HARRY G DORMAN III 60.00 X X X 293463 0 25377 TERRI C DUDLEY 0.50 X 0 0 0 CLAUDIA C GIBSON 0.50 X 0 0 0 RICHARD S JENNINGS PART YEAR 1.00 X 0 0 0 BRUCE N JOHNSTONE PART YEAR 1.00 X 0 0 0 WILLIAM N JOSLER 1.00 X 0 0 0 JENNIFER H JUDKINS PART YEAR 0.50 X 0 0 0 JOHN A KELLY MD 0.50 X 0 0 0 EDWARD T KERRIGAN 2.00 X X 0 0 0 SARA L KOBYLENSKI 1.00 X 0 0 0 MIRIAM M MAGUIRE 0.50 X 0 0 0 ANN E MARCHEWKA PART YEAR 60.00 X 135849 0 13066 MARK E MELENDY PART YEAR 0.50 X 0 0 0 J TODD MILLER 0.50 X 0 0 0 SUSAN E MOONEY MD 60.00 X X 237215 0 31258 PATRICK J MORHUN MD 0.50 X 0 0 0 MICHAEL PWH PAINE FRCS 2.00 X 0 0 0 EVALIE M CROSBY 60.00 X 112321 0 17032 DOUGLAS CEDENO MD 40.00 X 222102 0 20012 CHRISTOPHER MAZUR MD 40.00 X 204532 0 29767 DAVID KRONER MD 40.00 X 330652 0 25336 SUZANNE SHIPMAN MD 40.00 X 216620 0 30857 KATHRYN VARGO MD 40.00 X 239165 0 31540 1991919 0 224245 14 0 1 0 AMN HEALTHCARE INC 26 CONNELL STREET QUINCY MA 02169 TEMP STAFFING 413833 SAGENT HEALTHSTAFF VA PO BOX 55553 BOSTON MA 02205 TEMP STAFFING 320445 TECHNICAL NEEDS NORTH INC 85 MECHANIC STREET LEBANON NH 03766 TEMP STAFFING 303325 LEADERS FOR TODAY LLC 38 RESNICK ROAD PLYMOUTH MA 02360 TEMP STAFFING 203325 VALLEY REGIONAL HOSPITAL 42 ELM STREET CLAREMONT NH 03743 LAB SERVICES 148453 8 1029971 1029971 PATIENT SERVICE REVENU 621400 42123672 42123672 OTHER OPERATING REVENU 621400 201902 201902 NUTRITIONAL REVENUE 900099 85733 85733 42411307 63502 63502 66361 18064 48297 48297 48297 1383402 1294245 15544 89157 -15544 73613 73613 43626690 42325574 0 271145 1062286 405985 656301 18717484 17736652 826177 154655 410200 388705 18106 3389 2071287 1942866 111765 16656 1319220 1215265 93665 10290 18206 3451 14755 81509 81509 3661333 3431725 195251 34357 172028 4552 167432 44 1241714 938628 289815 13271 15840 15060 634 146 877978 680872 190082 7024 156780 137572 16840 2368 107489 83325 23250 914 1286182 1005666 280516 439578 430370 8860 348 MEDICAL SUPPLIES & EQUI 4260353 4258523 1653 177 BAD DEBT EXPENSE 1931752 1931752 MET tax 1910835 1910835 LOSS FROM DISCONTINUED 486074 486074 EQUIP RENTAL & MAINTENA 383982 371874 11897 211 254354 160846 88619 4889 40866464 37540598 3077127 248739 992 1955 5054967 4464824 98655 8764 4494556 6151124 985035 1158009 192181 194503 34551439 23151141 11188524 11400298 2579843 2555238 8500 8500 158399 150291 1470008 2298999 26231660 28392505 6018343 6020355 6492000 9021000 3331000 75451 236800 15916794 15278155 X 8098613 11576659 2189426 1509626 26827 28065 10314866 13114350 26231660 28392505 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 10458 10458 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE ORGANIZATION PAYS DUES TO THE NEW HAMPSHIRE HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, A PORTION OF WHICH ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES 26827 1238 28065 26456 371 26827 1.00000 0 0 927577 927577 13995900 7417805 6578095 179509 173716 5793 17217361 14771771 2445590 2231092 787849 1443243 11400298 DUE FROM AFFILIATES 2103230 OTHER ASSETS 46517 ASSETS WHOSE USE IS LIMITED OR RESTRICTED 149252 2298999 DEFERRED ANNUITY 72130 ESTIMATED THIRD PARTY SETTLEMENTS 164670 236800 43626690 40866464 2760226 52297 -13039 39258 2799484 43684012 52297 5025 57322 43626690 0 43626690 40398454 18064 18064 40380390 486074 486074 40866464 Part X: Description of Uncertain Tax Positions Under FIN 48: Alice Peck Day Health Systems Corp. and subsidiaries (the "System") adopted FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109, effective October 1, 2007. The System has evaluated its tax positions taken in accordance with FIN 48 and has determined that there is no impact on the System's current tax-exempt status, or financial position or results of operations for the years ended September 30, 2010 and 2009. Part XI, Line 8 - Other Adjustments: CHANGE IN INTEREST RATE SWAPS: 29044. CHANGE IN ANNUITY LIABILITY: -42083. Part XII, Line 2d - Other Adjustments: rental expenses: 18064. CHANGE IN INTEREST RATE SWAPS: 29044. CHANGE IN ANNUITY LIABILITY: -42083. Part XIII, Line 2d - Other Adjustments: rental expenses: 18064. Part XIII, Line 4b - Other Adjustments: LOSS FROM DISCONTINUED OPERATIONS: 486074. 1 1 1 X 1 X 212.000000000000 1 1 1 0 1 1 734688 734688 0.01800 5269409 3075642 2193767 0.05370 0 0 6004097 3075642 2928455 0.07170 126776 0 126776 0.00310 226728 0 226728 0.00550 0 0 0 0 117284 117284 0.00290 470788 470788 0.01150 6474885 3075642 3399243 0.08320 0 0 27160 27160 0.00070 6500 6500 0.00020 33660 33660 0.00090 1 1184031 100000 10014895 11143679 -1128784 X 1 1 NONE ALICE PECK DAY MEMORIAL HOSPITAL

125 MASCOMA STREET LEBANON NH 03766

X X X X ALICE PECK DAY EXTENDED CARE FACILITY

125 MASCOMA STREET LEBANON NH 03766

DISCONTINUED IN 2010 Part I, Line 3c: N/A Part I, Line 6a: N/A Part I, Line 7: Charity care and means tested programs use the cost to charge ratio as their methodology. Alice Peck Day Memorial Hospital calculates the ratio in a manner consistent with work worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of costs to charges.Part I, Line 7, column (f): Bad debt expense reported on Form 990 Part IX, Line 25 was excluded from Total Expenses for the calculation of Net Community Benefits as a percent of Total Expenses. Part I, Line 7g: Part I, Line 7f: Part III, Line 4: Bad Debt expense is calculated using a cost to charge ratio using Worksheet B. In FY10, 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 denied due to lack of complete documentation. 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, 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 is minimal. Footnote 1 to the audited consolidated financial statements of Alice Peck Day Health Systems contains the following to address bad debt: ACCOUNTS RECEIVABLE - Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probably uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Accounts deemed uncollectible are written off through a charge against the established allowance. 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 debt collections policy applies to all patient accounts in a consistent manner. The policy specifically indicates that, after a second patient statement is sent with no payment received, a Patient Accounts representative will contact the patient by phone to determine if a Financial Assistance Application or Payment Plan is appropriate. This is done 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 attain quality healthcare, regardless of ability to pay. Our financial assistance programs provide, 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 receiving services, at registration for services and during our billing process to ensure that any and all patients in need of assistance are provided the help the need. Brochures and signs are placed in high traffic areas such as the ER and Registration. Our staff is trained to identify patients during registration that may be in need of financial assistance and provide information and offer help in completing the necessary forms. During our billing process, calls are made to patients with outstanding balances. Our staff works with patient to identify problems they are facing in dealing with outstanding balances. Patients are again notified of the many types of financial assistance available that they may qualify for. 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 that may need financial assistance, very few qualifying patients patients reach the point of bad debt. Our collection policies and procedures in conjuction with our small size, allow our ogranziation to place great emphasis on helping all patients who may be in need apply for, and attain the appropriate level of financial assistance. Part V: In addition to the hospital, there were 8 physician clinics in place at the end of FY 2010. Part VI, Line 2: Due to our rural location and size, a collaborative effort between the United Way, Dartmouth Hitchcock Memorial Hospital and Alice Peck Day Memorial Hospital created the FY 2009 Community Benefits Plan. Priority needs and health concerns for our community were based upon information collected from community needs assesments and community surveys. Identified needs included: availability of oral health, availability of primary care, prescription assistance, transportation, availability of behavioral health and access to alcohol/drug treatment. Alice Peck Day Memorial hospital used this information to help focus their community benefit efforts to meet the priority needs identified in the community benefit plan. Of special note is the Upper Valley Smiles Program which has served a priority need for oral health within our local community. Upper Valley Smiles has touched the lives of many children in our community and provided much needed care for a very vulnerable population. 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 attain the care they need. We reach out to our patients in many different ways to ensure they are aware that help is available and to guide them through the process. Brochures and signage are posted in high traffic areas such as the emergency room, registration, and lobby. Registration staff is trained to identify patients who may be in need of financial assistance. Once identified, the staff notifies the patient that APD has various forms of financial assistance and explains 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 is trained to help identify and offer assistance to anyone who might require financial assistance. Patients with outstanding balances are contacted by our credit coordinator who works with them to clear up balances through the variety of programs that we offer. Depending on the individual situation, patients may qualify for free care, discounted care, payment plans or a combination of the above. Assistance is also provided in applying to federal/state programs for those who qualify. Specially trained staff guides 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 as well as Vermont. APD's service area in NH comprises fifteen 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 Memorial Hospital actively promotes community leadership development. Staff members participate in two local Chambers of Commerce, Leadership Upper Valley, Foundation for Healthy Communities, the Rural Health Coalition and the Advocacy Task Force. As an active member of its community, Alice Peck Day works to be proactive concerning disaster readiness. Staff has participated in onsite training for disaster preparedness as well as offsite training with other regional hospitals. Collaborative efforts include all hazard regional planning, emergency response training and a regional mass casualty response program to help facilitate cooperative efforts if such needs arise. H1N1 planning included both vaccination clinics for staff and the general public, training of staff and stocking supplies that would be required if a pandemic were to 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 the Board of Trustees are not employed by the Hospital, and include local government and business representatives as well as practicing non-employed physicians. Despite its small size, APD is committed to giving back to the community to the greatest extent possible. During FY 2010, cash donations were given to many programs that help provide to 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 over 36 local non-profit organizations with meeting space and refreshments. Although we are a small critical access hospital, Alice Peck Day recognizes that we are all part of the global community and have a responsibility to help others in need. APD supported the Haiti relief effort by providing staff, in-kind contributions and cash assistance to help the country of Haiti recover from the devastation it suffered as a result of the earth quake that hit in January of 2010. Alice Peck Day held community flu clinics, provided emergency prescription drug vouchers, subsidized senior exercise classes and worked towards 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 Program. This program provides an oral health safety net for disadvantaged residents in its service area. In 4 different schools, over 728 students received oral health education. Dental screenings were provided to over 307 children of those children, with 203 receiving dental sealants and 159 of those were referred to dentists for restorative treatment. 36 children requiring urgent care were referred, case managed and paid for by Alice Peck Day. At WIC clinics within the area an additional 124 low income families received health education, 119 received dental screenings and 9 children were referred to local dentists for restorative treatment. Alice Peck Day hosted two free oral health clinics with 16 homeless children receiving a dental cleaning and fluoride applications. Individuals were provided with assistance in applying for NH/VT Medicaid to ensure increased access for 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 Dartmouth Medical School, School of Midwifery, River Valley Community College, Elmira College and Lebanon College. Alice Peck Day annually sponsors district wide professional development for school nurses for in our area and others within the region. These initiatives and ongoing efforts continue to address several of the most pressing community health needs as identified in our community needs assessment. Part VI, Line 7: N/A NH X X X X 0 0 0 0 0 1 0 0 0 HARRY G DORMAN III 235767 0 0 0 57696 0 10729 0 14648 0 318840 0 0 0 SUSAN E MOONEY MD 221353 0 0 0 15862 0 9283 0 21975 0 268473 0 0 0 DOUGLAS CEDENO MD 222102 0 0 0 0 0 7878 0 12134 0 242114 0 0 0 CHRISTOPHER MAZUR MD 204532 0 0 0 0 0 7545 0 22222 0 234299 0 0 0 DAVID KRONER MD 287317 0 43335 0 0 0 11546 0 13790 0 355988 0 0 0 SUZANNE SHIPMAN MD 216620 0 0 0 0 0 8282 0 22575 0 247477 0 0 0 KATHRYN VARGO MD 239165 0 0 0 0 0 9565 0 21975 0 270705 0 0 0 Part I, Line 6 Dr. David Kroner, a physician and one of the top five highest paid employees of the Organization, had an employment contract whereby he received a base salary and an opportunity for a productivity based incentive should net Professional service revenue from his practice exceed a pre-established threshold. STATE OF NEW HAMPSHIRE BUSINESS FINANCE AUTHORITY 521304598 64468KAY2 2007-05-11 6925000 ADVANCE REFUND EXISTING BONDS 0 0 6925000 6563296 111527 14112 236065 2007 0 1 1 1 0 1 1 DEUTSCHE BANK 2.400000000000 0 0 1 Form 990, Part VI, Section A, line 6 Alice Peck Day Health Systems Corp, a charitable coporation, 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. The board of trustees shall include at least a majority of the board of trustees 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. Vacanicies on the board of trustees due to death, resigination, 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. Subject to the approval of the Member, the board of trustees shall selct and employ a president who shall be the chief executive officer of the Hospital. All other officers of the Organization, the Chairman, Vice Chairman, Secretary, and Treasurer of the board, are all to be elected at the discretion of the Organization's board of trustees. Form 990, Part VI, Section A, line 7b The Organization's annual operating budget and all capital budgets shall be subject to the approval by the Member. Any overall strategic plan for the Organization, including the development of off-site facilities, 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 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 as certified public accountants for the Organization the firm which audits 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 Alice Peck Day has a multi-faceted conflict of interest policy. Our board of trustees completes a conflict of interest questionnaire on an annual basis and any new members complete the questionnaire upon joining the board. Additionally, the board has its own board standard of conduct guidelines and statement of financial interest which are reviewed and signed by all board members on an annual basis. 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 to this, our Executive Assistant attends all board meetings to ensure that if any conflicts arise they are handled appropriately. If such conflicts arise, the Organization complies with New Hampshire and federal requirements for disclosure 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 staff upon hire and on an annual basis. The standard of conduct covers conflict of interest and other vital matters to ensure all business activity will be conducted in a manner 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 board of trustees is responsible for determining the compensation of the Chief Executive Officer/President. The HR director 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 performamce of the 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 an analysis of salary data and performance. Individual salary increases are then based on overall performance, within budgeted wage increases for the Orgaization. The compensation committee approves the base compensation and salary increase amount. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. FORM 990, PART VII, SECTION A, COLUMN E REPORTABLE COMPENSATION DR. SUSAN MOONEY IS A PRACTICING PHYSICIAN IN ADDITION TO BEING THE HOSPITAL'S CHIEF MEDICAL OFFICER. SHE WORKED AN AVERAGE OF 60 HOURS PER WEEK, OF WHICH AN AVERAGE OF 40 HOURS PER WEEK WAS SPENT ON EXECUTIVE MATTERS AND 20 IN HER ROLE AS A PHYSICIAN. FORM 990, PART XI, LINE 2C OVERSIGHT OF AUDIT PROCESS THE ORGANIZATION DID NOT CHANGE ITS AUDIT OVERSIGHT PROCESS BUT DID SELECT A NEW INDEPENDENT AUDITOR FOR THE FISCAL YEAR ENDED 9/30/10. FORM 990, PART IV, LINE 34 INACTIVE ENTITIES In addition to the organizations listed in Schedule R, the Organization is related to Alice Peck Day Realty Corp (EIN 02-0485369) and Alice Peck Day Health Management Services, Inc. (EIN 02-0485370) through the direct controlling parent, Alice Peck Day Health Systems Corp. Both entities are inactive and hold no assets. FORM 990, PART VII, SECTION A CHANGE OF ROLE FOR TRUSTEE J. TODD MILLER, WHO HAD PREVIOUSLY SERVED AS A TRUSTEE ON APD MEMORIAL HOSPITAL'S BOARD, WAS HIRED BY THE HOSPITAL AS CHIEF OPERATING OFFICER IN FEBRUARY 2010. HE DID NOT RECEIVE ANY REPORTABLE COMPENSATION FROM ANY OF THE ALICE PECK DAY ENTITIES IN 2009. ALICE PECK DAY HEALTH SYSTEMS CORPORATION 125 MASCOMA STREET LEBANON NH 03766 020479095 PROMOTE HEALTH CARE NH 501(C)(3) Line 11b, II ALICE PECK DAY LIFECARE CENTER INC 125 MASCOMA STREET LEBANON NH 03766 020479094 ASSISTED LIVING FACILITY NH 501(C)(3) Line 9 ALICE PECK DAY HEALTH SYSTEMS CORP 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALICE PECK DAY HEALTH SYSTEMS CORP D 1177139 ALICE PECK DAY LIFECARE CENTER INC D 926091