COTTAGE HOSPITAL: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- COTTAGE HOSPITAL (EIN 02-0223321)
- Tax period
- 2024-10-01 to 2025-09-30
- Filed
- 2026-03-12
- IRS object ID
- 202620719349300622
- Schema version
- 2024v5.5
- 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 D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-03-12T10:23:07-05:00 | ReturnTs |
| Tax Period End | 2025-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2211 Congress St | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04102 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020223321 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cottage Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COTT | BusinessNameControlTxt |
| Phone | 6037479000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ann Duffy | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6037479000 | PhoneNum |
| Signature | 2026-03-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Joseph R Byrne | PreparerPersonNm |
| PTIN | P01289281 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2026-03-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Holly McCormack | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $49,098,328 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.cottagehospital.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1903 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Medical care and related services | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 380 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $232,700 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,247,820 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $41,822,710 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,113,481 | CYProgramServiceRevenueAmt |
| PY Investment Income | $572,315 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,283,705 | CYInvestmentIncomeAmt |
| PY Other Revenue | $45,346 | PYOtherRevenueAmt |
| CY Other Revenue | $66,827 | CYOtherRevenueAmt |
| PY Total Revenue | $42,673,071 | PYTotalRevenueAmt |
| CY Total Revenue | $45,711,833 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,298,103 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $24,609,278 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,518,165 | PYOtherExpensesAmt |
| CY Other Expenses | $19,424,924 | CYOtherExpensesAmt |
| PY Total Expenses | $43,817,268 | PYTotalExpensesAmt |
| CY Total Expenses | $44,034,202 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,144,197 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,677,631 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,828,101 | TotalAssetsBOYAmt |
| Total Assets EOY | $36,071,557 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,839,103 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,882,200 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,988,998 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,189,357 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To strengthen the health of our community by providing accessible, quality care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,151,703 | ExpenseAmt |
| Revenue | $34,275,854 | RevenueAmt |
| Desc | Cottage Hospital provided health care to approximately 572 inpatients and 44,976 outpatients during the fiscal year. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,777,830 | ExpenseAmt |
| Revenue | $2,637,689 | RevenueAmt |
| Desc | The Ray of Hope Geriatric Behavioral Health unit provides quality care for those struggling with a behavioral health issue. This inpatient program is for geriatric patients 65 years and older with persistent or late onset behavioral health illnesses or concerns. Specialized care focuses on assessment, treatment, rehabilitation, prevention, family/community support and education surrounding behavioral health. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,241,058 | ExpenseAmt |
| Revenue | $2,199,938 | RevenueAmt |
| Desc | The Rowe Health Center provides internal medicine, behavioral health, podiatry, cardiology, gastroenterology and endocrinology services. We are proud to offer a team-based approach to provide all of our patients with accessible, convenient, high quality care. With same day acute appointments available, meeting the needs of our patients is our priority. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $35,170,591 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 68 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 380 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ann Duffy | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6037479000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| Clare Vallee | ||||||||
| Chairperson | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Andrew Barter | ||||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| William Taxter | ||||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Maryanne Aldrich | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Derek Curtis | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Jesse Dimick | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Randy Foster | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Ian Kirit | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Rebecca Zampieri | ||||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Mark Harris | ||||||||
| Past Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Holly McCormack | ||||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $253,823 | $0 | $43,978 | ||
| E Colin McDougal | ||||||||
| Med Staff President | 40.00 | Yes (X) | $245,204 | $0 | $10,040 | |||
| James Wilton | ||||||||
| Med Staff Secretary | 40.00 | Yes (X) | $215,779 | $0 | $33,670 | |||
| Delphine Sullivan | ||||||||
| CMO | 40.00 | Yes (X) | $269,493 | $0 | $9,163 | |||
| Ann Duffy | ||||||||
| CFO | 40.00 | Yes (X) | $195,007 | $0 | $25,047 | |||
| Natalie Kennett | ||||||||
| CNO | 40.00 | Yes (X) | $134,252 | $0 | $6,496 | |||
| Nathan Potter | ||||||||
| Physician ED | 40.00 | $448,037 | $0 | $29,995 | Yes (X) | |||
| Jeffrey Hanissian | ||||||||
| Chief Of ED | 40.00 | $417,906 | $0 | $42,490 | Yes (X) | |||
| Christopher Danielson | ||||||||
| Physician RHC | 40.00 | $370,008 | $0 | $51,786 | Yes (X) | |||
| Russell Sarver | ||||||||
| Physician-Urology | 40.00 | $353,027 | $0 | $19,238 | Yes (X) | |||
| Peter B Schroer | ||||||||
| Physician RHC | 40.00 | $337,381 | $0 | $38,576 | Yes (X) | |||
| Lili Cargill | ||||||||
| Former Med Staff President | 40.00 | $159,586 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,399,503 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $310,479 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 35 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Bread Loaf Corporation | |||||
| 1293 Route 7 South | Middlebury | VT | 05753 | Building Contractor | $2,203,948 |
| Management Health System | |||||
| 1580 Sawgrass Corporate Pkwy Suite | Sunrise | FL | 33323 | Contracted Staff | $821,126 |
| Dartmouth Hitchcock Clinic | |||||
| One Medical Center Drive | Lebanon | NH | 03766 | Contracted Providers | $647,341 |
| Cerner Corp CO Oracle | |||||
| PO Box 203448 | Dallas | TX | 75320 | EMR Services | $513,995 |
| EM Staff | |||||
| 36 Coventry Rd | Concord | NH | 03301 | Contracted Staff | $469,529 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 27 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $700 | FundraisingAmt |
| Government Grants | $4,137,138 | GovernmentGrantsAmt |
| All Other Contributions | $109,982 | AllOtherContributionsAmt |
| Total Contributions | $4,247,820 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Patient Service Revenue | 622110 | $83,342,292 | $83,342,292 | |
| Other Operating Revenue | 622110 | $1,006,433 | $830,175 | $176,258 |
| Contractual/Charity Care Adj. | 622110 | -$45,235,244 | -$45,235,244 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,113,481 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,179,848 | TotalRevenueColumnAmt |
| Exclusion | $1,179,848 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,393 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,393 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,393 | TotalRevenueColumnAmt |
| Exclusion | $1,393 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,464,619 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,347,148 | SecuritiesAmt |
| Other | $13,614 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,117,471 | SecuritiesAmt |
| Other | -$13,614 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,103,857 | TotalRevenueColumnAmt |
| Exclusion | $1,103,857 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $44,894 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $700 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $25,733 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,161 | TotalRevenueColumnAmt |
| Exclusion | $19,161 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $46,273 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,273 | TotalRevenueColumnAmt |
| Exclusion | $46,273 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,711,833 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,937,223 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,526,790 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,441,952 | TotalAmt |
| Program Services | $783,349 | ProgramServicesAmt |
| Management And General | $658,603 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,025,393 | TotalAmt |
| Program Services | $15,137,192 | ProgramServicesAmt |
| Management And General | $3,888,201 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $306,996 | TotalAmt |
| Program Services | $241,156 | ProgramServicesAmt |
| Management And General | $65,840 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,454,704 | TotalAmt |
| Program Services | $1,697,120 | ProgramServicesAmt |
| Management And General | $757,584 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,380,233 | TotalAmt |
| Program Services | $1,059,006 | ProgramServicesAmt |
| Management And General | $321,227 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,047 | TotalAmt |
| Management And General | $24,047 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,814 | TotalAmt |
| Management And General | $93,814 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,948 | TotalAmt |
| Management And General | $3,948 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,112,516 | TotalAmt |
| Program Services | $7,825,301 | ProgramServicesAmt |
| Management And General | $1,287,215 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,473 | TotalAmt |
| Program Services | $88,575 | ProgramServicesAmt |
| Management And General | $51,898 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $757,720 | TotalAmt |
| Program Services | $366,587 | ProgramServicesAmt |
| Management And General | $391,133 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,032,241 | TotalAmt |
| Program Services | $224,005 | ProgramServicesAmt |
| Management And General | $808,236 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,746 | TotalAmt |
| Program Services | $9,129 | ProgramServicesAmt |
| Management And General | $10,617 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,984 | TotalAmt |
| Program Services | $229,668 | ProgramServicesAmt |
| Management And General | $3,316 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,997,211 | TotalAmt |
| Program Services | $1,672,150 | ProgramServicesAmt |
| Management And General | $325,061 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $666,155 | TotalAmt |
| Program Services | $545,919 | ProgramServicesAmt |
| Management And General | $120,236 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Supplies | $3,643,274 | $3,643,274 | |
| Medicaid Enhancement Ta | $1,423,953 | $1,423,953 | |
| Education and Recruitme | $223,513 | $170,878 | $52,635 |
| Miscellaneous Expenses | $53,329 | $53,329 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,034,202 | TotalAmt |
| Program Services | $35,170,591 | ProgramServicesAmt |
| Management And General | $8,863,611 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300 | BOYAmt |
| EOY | $300 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,886,565 | BOYAmt |
| EOY | $3,875,468 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,273,963 | BOYAmt |
| EOY | $6,690,237 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $727,023 | BOYAmt |
| EOY | $688,126 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $420,055 | BOYAmt |
| EOY | $446,863 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $31,898,492 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,374,088 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,271,174 | BOYAmt |
| EOY | $12,524,404 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,279,808 | BOYAmt |
| EOY | $9,845,327 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,593 | BOYAmt |
| EOY | $260,298 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,226,867 | BOYAmt |
| EOY | $1,162,136 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,753 | BOYAmt |
| EOY | $578,398 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,828,101 | BOYAmt |
| EOY | $36,071,557 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,905,096 | BOYAmt |
| EOY | $5,370,996 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,710 | BOYAmt |
| EOY | $2,710 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,416,101 | BOYAmt |
| EOY | $4,210,367 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,239,805 | BOYAmt |
| EOY | $2,131,273 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,275,391 | BOYAmt |
| EOY | $5,166,854 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,839,103 | BOYAmt |
| EOY | $16,882,200 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,283,220 | BOYAmt |
| EOY | $17,401,693 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,705,778 | BOYAmt |
| EOY | $1,787,664 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,988,998 | BOYAmt |
| EOY | $19,189,357 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,828,101 | BOYAmt |
| EOY | $36,071,557 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,677,631 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$493,977 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $16,705 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,215,094 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $85,618 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $34,459 | OtherExpendituresAmt |
| End Year Balance | $1,266,253 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,074,320 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $172,258 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $31,484 | OtherExpendituresAmt |
| End Year Balance | $1,215,094 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,023,418 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $77,628 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $26,726 | OtherExpendituresAmt |
| End Year Balance | $1,074,320 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,140,349 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$92,523 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $24,408 | OtherExpendituresAmt |
| End Year Balance | $1,023,418 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,108,109 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $62,995 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $30,755 | OtherExpendituresAmt |
| End Year Balance | $1,140,349 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.97550 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.02450 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $531,787 | OtherCostOrOtherBasisAmt |
| Book Value | $531,787 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,128,654 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,997,212 | DepreciationAmt |
| Book Value | $6,131,442 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,998,241 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,855,190 | DepreciationAmt |
| Book Value | $2,143,051 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,239,810 | OtherCostOrOtherBasisAmt |
| Depreciation | $521,686 | DepreciationAmt |
| Book Value | $3,718,124 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,524,404 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Deferred Compensation | $563,798 |
| Due to Third-Party Payors | $3,408,454 |
| Lease Liabilities | $1,194,602 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,166,854 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $45,256,346 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$493,977 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $42,438 | OtherRevenueAmt |
| Revenue Not Reported | -$451,539 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,707,885 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $3,948 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $3,948 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $45,711,833 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $44,055,987 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $25,733 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $25,733 | ExpensesNotReportedAmt |
| Expenses Subtotal | $44,030,254 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $3,948 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $3,948 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $44,034,202 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The intended use of the Hospital's endowment fund is to support the hospital in its efforts to provide quality healthcare to residents of the communities it serves and others who may use the hospital. |
| Part XI, Line 2d - Other Adjustments: | Change in Funds Held in Trust by Others 16,705. Fundraising Expenses 25,733. |
| Part XII, Line 2d - Other Adjustments: | Fundraising Expenses 25,733. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Gala | Event1Nm |
| Gross Receipts Event1 | $40,291 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $700 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $39,591 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $15,518 | RentFacilityCostsEvent1Amt |
| Entertainment Event1 | $2,000 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $4,503 | OtherDirectExpensesEvent1Amt |
| Event2 | 5k | Event2Nm |
| Gross Receipts Event2 | $5,303 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $5,303 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $3,712 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $45,594 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $700 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $44,894 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $15,518 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $2,000 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $8,215 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $25,733 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $19,161 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $46,273 | GrossRevenueOtherGamingAmt |
| Volunteer Labor Other Gaming | 0 | VolunteerLaborOtherGamingInd |
| Gross Revenue Total Gaming | $46,273 | GrossRevenueTotalGamingAmt |
| Net Gaming Income Summary | $46,273 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | NH | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | Yes (1) | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Own Facility | 0.00000 | GamingOwnFacilityPct |
| Gaming Other Facility | 1.00000 | GamingOtherFacilityPct |
| Individual With Books | Ann Duffy CFO | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | Yes (1) | CntrctWith3rdPrtyForGameRevInd |
| Gaming Revenue Received By Org | $46,273 | GamingRevenueReceivedByOrgAmt |
| Gaming Revenue Rtn By3 Prty | $0 | GamingRevenueRtnBy3PrtyAmt |
Third Party Business Name ThirdPartyBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lebanon Poker Room and Casino LLC | BusinessNameLine1Txt |
Third Party US Address ThirdPartyUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 45 Hanover St | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule G, Part III, Line 15a: | FormAndLineReferenceDesc |
| Explanation | The Organization had an agreement whereby the Revo Casino and Social House in Lebanon, NH would provide Cottage Hospital a percentage of revenues from Revo Casino and Social House games of chance proceeds. Cottage Hospital never paid Revo Casino and Social House directly and was not directly involved in administrating any of the games of chance. Cottage Hospital held the license for 10 days and Revo Casino and Social House then donated proceeds of $46,273 to Cottage Hospital. While gaming activities are the primary commercial business activity for Lebanon Poker Room and Casino LLC, Cottage Hospital's involvement was entirely passive and only for a short period of time, and thus not considered to be an activity regularly carried on by the Organization. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $302,915 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $170,968 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $131,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,774,508 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,829,617 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $944,891 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02150 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,077,423 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,000,585 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,076,838 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02450 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,082,766 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,082,766 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02460 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $680,020 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $680,020 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01540 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,762,786 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,762,786 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04000 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,840,209 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,000,585 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,839,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06450 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,011 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,011 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,810 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,810 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $246,674 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $246,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $300,295 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $300,295 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $14,572,448 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,944,521 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$372,073 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cottage Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.cottagehospital.org | WebsiteAddressTxt |
| State License | 01770 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cottage Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | cottagehospital.org/community-benefits | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | cottagehospital.org/community-benefits | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.cottagehospital.org/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.cottagehospital.org/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.cottagehospital.org/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Cottage Hospital | Part V, Section B, Line 5: Key leaders and focus groups within the community. For example, politicians, business health partners, staff and administration. |
| Cottage Hospital | Part V, Section B, Line 6a: The Northern New Hampshire Region Facilities ("NNHR or the "Facilities") performed a Community Health Needs Assessment (CHNA) in partnership with QHR Health ("QHR") to determine the health needs of the local community and developed an accompanying implementation plan to address the identified health needs of the community.The Northern New Hampshire Region Facilities include:- Littleton Regional Healthcare, Littleton, NH ("LRH")- Cottage Hospital, Haverhill, NH ("CH")- Mid State Health Center ("MSHC")- Ammonoosuc Community Health Services, Littleton, NH ("ACHS") |
| Cottage Hospital | Part V, Section B, Line 6b: Please see narrative response to line 6a above. |
| Cottage Hospital | Part V, Section B, Line 11: The Hospital's most recent CHNA showed the following areas as the greatest need, a description of what we have done to address the need is included:1) Increasing access to transportation to medical appointments and other health services - Cottage has some influence with three transportation services being available in the Area, Stagecoach, HMSC Bus, and RCT (VT).2) Increasing awareness around Hospital services and programs - Cottage utilizes social media, newspaper advertising and community outreach initiatives to communicate the services that Cottage offers to the community.3) Increasing access to drug and other substance abuse treatment services Cottage providers identify patients with substance abuse issues and refer a facility with appropriate resources.4) Increasing access to counseling services for mental health for children5) Increasing awareness of emergency care and trauma services - Cottage utilizes social media and community outreach initiatives to communicate the emergency and trauma care services provided.6) Increasing access to dentistry services7) Increasing access to counseling services for mental health for adults.8) Cottage offers outpatient treatment as well as short-term inpatient services for older adults struggling with behavioral issues via an IP geriatric psych unit.9) Enhancing drug and other substance abuse education and prevention10) Cottage works with a local substance misuse prevention program referring patients as appropriate.11) Improving access to financial assistance for healthcare services and prescription drugs - Cottage provides a financial counselor and patient care counselor to assist patients with understanding financial options available to them.12) Increasing access to specialty care for chronic conditions like diabetes and heart disease - Cottage provides services via a diabetic counselor, endocrinologist and offers a diabetic prevention program.13) Increasing access to primary care services - Cottage offers primary care services, and will utilize community outreach efforts to assist patients in a continuum of care.14) Increasing access to long-term care or dementia care for seniors - Cottage offers a short stay geriatric psych unit for patients that need short-term assistance. Those that require long-term care will be referred to an external long-term care facility.15) Increasing access to care coordination or support services to help people better manage their own health via patient outreach initiatives. |
| Cottage Hospital | Part V, Section B, Line 13b: Catastrophic relief guidelines: The Hospital recognizes that on occasion a patient may experience a serious illness or injury. A catastrophic relief program is available to patients that may need substantial financial assistance for an extended episode of care. The policy provides relief to uninsured (or grossly uninsured) individuals whose financial responsibility to the Hospital exceeds $30,000 for any single episode of care. Patients whose family income exceeds 300% of the FPL and whose financial responsibility to the hospital exceeds $30,000 for any single episode of care may be eligible for this program on a case-by-case basis. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Rowe Health Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 103 Swiftwater Road | AddressLine1Txt |
| City | Woodsville | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03785 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Rural Health Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Part 1, Lines 7a-c: The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990, Schedule H, Worksheet 2, ratio of patient care cost-to-charges.Part 1, Lines 7e & f: The Hospital's costs are determined based on an evaluation of a labor plus estimated overhead absorption rate applied on an hourly basis.Part 1, Lines 7g & 7i: Represent actual costs derived from the Hospital's accounting system. |
| Part II, Community Building Activities: | Our community building activities are determined and aligned through our Community Health Needs Assessment. This assessment is evaluated every three years. Key leaders of the community, as well as peers within different demographic segments, are interviewed by a third party. Programs typically target preventative care, areas of health not being met within our community, and education in specialty medicine available within our service market. We strategically collaborate with other organizations to build a stronger message. |
| Part III, Line 2: | Part III, line 2-3: The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, ratio of patient care cost-to-charges. The CCR was then applied to bad debt expense at charge value in order to arrive at the estimated expense reported. |
| Part III, Line 4: | Please refer to pages 8-12 and pages 15-16 of the attached audited financial statements. |
| Part III, Line 8: | As Cottage Hospital operates at a loss from Medicare, the shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. Medicare allowable costs have been determined using a cost-to-charge ratio determined in accordance with worksheet 2, ratio of patient care cost-to-charges, of the Form 990 Schedule H instructions. |
| Part III, Line 9b: | If the patient has been on charity care in the past but it has now expired, the patient would have to re-apply. |
| Part VI, Line 2: | The Affordable Care Act of 2010 requires not-for-profit hospital to conduct a CHNA every three years. In addition, the state of New Hampshire requires one to be done every five years. Key healthcare and public service stakeholders representing a breadth of community perspectives participated in the research as key leaders and sources of information. The stakeholder research was supplemented by an in-depth review of demographic and epidemiological data in order to identify underlying health trends in the service area. The assessment included listing the prioritized community needs, the definition of the community served, a description of the methodology to identify needs in the community, a description of the approach used to prioritize community needs and a list of healthcare resources. The information gathered was then used as part of the Hospital's strategic planning process. The CHNA is available on the Hospital's website. |
| Part VI, Line 3: | If at the time of registration or admission, a patient indicates that he or she has no other medical payer available, i.e., no insurance, Medicaid, or Medicare, the Hospital asks if the patient would like an application for Medicaid and/or for the Hospital's charity care program. The Hospital then documents on the patient's account whether or not the patient took either of the applications, or if the applications were turned down. If the patient is admitted and unable to respond to the question of payers available at the time of admission, case management notifies the patient financial counselor. After checking with nursing to see if the patient is alert and able to discuss the payer issue, the patient financial counselor will visit the patient's bedside. |
| Part VI, Line 4: | The Hospital's geographic area includes its primary market: New Hampshire - Bath, Benton, Haverhill, Woodsville, Lisbon, Monroe, Piermont, and in Vermont - Barnet, Bradford, Corinth, Groton, Newbury, Ryegate and Wells River. The secondary market includes, but is not limited to: in New Hampshire - Landaff, Littleton, Orford, Rumney, Warren and Wentworth and in Vermont - Fairlee, Groton, McIndoe Falls, Peacham, Thetford, and Topsham. Demographically, the hospital services the general population. |
| Part VI, Line 7, Reports Filed With States | NH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Nathan Potter | ||||||||||||||
| Physician ED | $448,037 | $0 | $0 | $0 | $0 | $0 | $588 | $0 | $29,407 | $0 | $478,032 | $0 | $0 | $0 |
| Jeffrey Hanissian | ||||||||||||||
| Chief Of ED | $417,906 | $0 | $0 | $0 | $0 | $0 | $13,800 | $0 | $28,690 | $0 | $460,396 | $0 | $0 | $0 |
| Christopher Danielson | ||||||||||||||
| Physician RHC | $370,008 | $0 | $0 | $0 | $0 | $0 | $10,350 | $0 | $41,436 | $0 | $421,794 | $0 | $0 | $0 |
| Peter B Schroer | ||||||||||||||
| Physician RHC | $337,381 | $0 | $0 | $0 | $0 | $0 | $9,927 | $0 | $28,649 | $0 | $375,957 | $0 | $0 | $0 |
| Russell Sarver | ||||||||||||||
| Physician-Urology | $353,027 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,238 | $0 | $372,265 | $0 | $0 | $0 |
| Holly McCormack | ||||||||||||||
| CEO | $253,823 | $0 | $0 | $0 | $0 | $0 | $10,542 | $0 | $33,436 | $0 | $297,801 | $0 | $0 | $0 |
| Delphine Sullivan | ||||||||||||||
| CMO | $269,493 | $0 | $0 | $0 | $0 | $0 | $8,084 | $0 | $1,079 | $0 | $278,656 | $0 | $0 | $0 |
| E Colin McDougal | ||||||||||||||
| Med Staff President | $245,204 | $0 | $0 | $0 | $0 | $0 | $7,367 | $0 | $2,673 | $0 | $255,244 | $0 | $0 | $0 |
| James Wilton | ||||||||||||||
| Med Staff Secretary | $215,779 | $0 | $0 | $0 | $0 | $0 | $5,711 | $0 | $27,959 | $0 | $249,449 | $0 | $0 | $0 |
| Ann Duffy | ||||||||||||||
| CFO | $195,007 | $0 | $0 | $0 | $0 | $0 | $7,964 | $0 | $17,083 | $0 | $220,054 | $0 | $0 | $0 |
| Lili Cargill | ||||||||||||||
| Former Med Staff President | $159,586 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $159,586 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Business Finance Authority of the State of NH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CUSIP | NoneAvail | CUSIPNum |
| Bond Issued | 2011-05-31 | BondIssuedDt |
| Issue Price | $7,745,000 | IssuePriceAmt |
| Purpose | Refinance Mortgage and Terminate Hedge | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,534,633 | RetiredAmt |
| Total Proceeds | $7,745,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $156,490 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $7,588,510 | OtherSpentProceedsAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | Cottage Hospital gathers the information, and our CPA firm completes the Form 990. The Form 990 is then reviewed by the CFO and Controller, before it is sent to the Board of Directors for their review. Once all of this has been completed, the CFO signs the Form 990, and it is sent to the IRS. |
| Form 990, Part VI, Section B, line 12c | The members of the Board of Trustees are required to file an annual Conflict of Interest Statement. |
| Form 990, Part VI, Section B, line 15 | The following were used to determine compensation of the CEO: comparison data and a compensation survey. The CEO's compensation is approved by the Executive Committee and the Board of Trustees. The compensation of officers and key employees, other than the CEO, is set by management using available industry data and benchmarks. Compensation of these employees is indirectly approved when the Board approves the annual operating budget. |
| Form 990, Part VI, Section C, line 18 | The Organization makes its Form 1023 and Form 990 available upon request and through a third party website. |
| Form 990, Part VI, Section C, line 19 | By using the Annual Report and website. |
| Form 990, Part IX, line 11g | Consulting Fees: Program service expenses 27,786. Management and general expenses 43,762. Fundraising expenses 0. Total expenses 71,548. Collection Fees: Program service expenses 0. Management and general expenses 96,805. Fundraising expenses 0. Total expenses 96,805. Contract Labor: Program service expenses 4,661,307. Management and general expenses 21,280. Fundraising expenses 0. Total expenses 4,682,587. Service Contracts: Program service expenses 482,053. Management and general expenses 565,601. Fundraising expenses 0. Total expenses 1,047,654. Professional Fees: Program service expenses 1,440,789. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,440,789. Purchased Services: Program service expenses 1,213,366. Management and general expenses 559,767. Fundraising expenses 0. Total expenses 1,773,133. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Cottage Hospital 90 Swiftwater Road Woodsville, NH 03785 EIN: 02-0223321 Cottage Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Change in Funds Held in Trust by Others 16,705. |