2011-05-11T11:45:48-05:00 2010-09-30 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2009-10-01 020222152 Littleton Regional Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Robert Fotter 6034449000 2011-05-06 1 Rachel Williamson CPA 6036697337 2011-05-06 2009 2016-02-24 21:20:13Z Robert Fotter 600 St Johnsbury Road Littleton NH 03561 79572604 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 12 510 175 39811 -75130 47145 79016 103055165 67664227 -1148041 892531 1455652 0 103409921 68635774 0 0 30691549 36980445 0 0 70756693 29775137 101448242 66755582 1961679 1880192 76434421 79806884 43258709 45277178 33175712 34529706 To provide quality, compassionate and accessible healthcare in a manner that brings value to all.To offer a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventive diagnostic, theraputic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.To provide these services without regard to race, religion, age, sex, income, creed, national origin, or disability.To maintain a sufficient number and mix of medical staff who are competent, dedicated and commmunity based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.To create a healthy, satisfying work environment for phsycians, nurses and other employees, with a commitment to support the continuing educational needs of its professional staff, including the physicians, nurses and allied health personnel. 0 0 53829543 67664227 Littleton Regional Hospital provides health care services on an in/outpatient basis to the general public, including charity care, community education, and various other health programs and services. 53829543 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 1 0 0 0 0 0 0 0 1 0 0 0 1 107 0 510 1 0 0 0 0 0 0 0 0 0 16 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 NH X Robert Fotter CFO 6034449000 600 St Johnsbury Rd Littleton NH 03561 William Bedor 1.00 X X 0 0 0 Milton Bratz 1.00 X 0 0 0 Anna Rioux 1.00 X 0 0 0 Mell Brooks 1.00 X X 0 0 0 Edward Duffy MD 40.00 X 252202 0 51362 Susan Presby 1.00 X 0 0 0 Wayne Rioux 1.00 X 0 0 0 John Starr 1.00 X X 0 0 0 Margaret Starr 1.00 X 0 0 0 Stevan Trooboff 1.00 X 0 0 0 Charles Wolcott MD 1.00 X 0 0 0 Guilbert Vickery 1.00 X X 0 0 0 Deane Rankin MD 1.00 X 0 0 0 George Brodeur 1.00 X 95474 0 0 Andrew Forrest 40.00 X 335025 0 60752 Robert Thibault 1.00 X 0 0 0 Warren West 40.00 X 276246 0 54788 Robert Fotter 40.00 X 182984 0 17775 Linda Gilmore 40.00 X 195620 0 41175 David Lovejoy 40.00 X 437631 0 46545 Michael Kindred 40.00 X 380485 0 23832 Harlan Herr 40.00 X 345584 0 38267 Nicholas Marks 40.00 X 308514 0 66140 Lon Howard 40.00 X 296617 0 52266 3106382 0 452902 41 0 1 0 Vista Staffing Solutions Inc File 50834 Los Angeles CA 90074 Provide Locum Tenens 594784 Sheehan Phinney Bass & Green 1000 Elm Street PO Box 3701 Manchester NH 03101 Legal Services 472728 On Assignment Inc File 54318 Los Angeles CA 90074 Provide Temporary Clinical Staff 439404 Healthcare Provider Advocates PO Box 2117 Amherst MA 01004 Provide temporary staff in billing depar 403860 Quorum Health Resources Inc 105 Continental Place Brentwood NH 37027 Consulting Services 384226 15 69802 9214 79016 Patient Service Revenu 900099 66161926 66161926 Miscellaneous 900099 589639 589639 Cafeteria 900099 391194 391194 Other Income 900099 191434 191434 Contract Lab 621500 191294 151483 39811 138740 138740 67664227 500731 500731 11328430 200 10903558 33272 424872 -33072 391800 391800 68635774 67624416 39811 892531 1467930 1467930 24597725 21908131 2689594 903676 807718 95958 5290796 4635718 655078 4720318 4002095 718223 654428 654428 66071 66071 145918 145918 197185 197185 9122130 8915417 206713 1629854 545814 1084040 108698 74906 33792 79819 79819 604050 604050 3408555 3408555 394507 394507 Contract Wages 3050946 2474102 576844 Provision for Bad Debt 2765447 2765447 Purchased Services 1679768 1353932 325836 Equipment Rental & Main 1596954 885275 711679 Collection Fees 752143 13127 739016 3518664 1435256 2083408 66755582 53829543 12926039 0 2430 3000 8414364 8253747 8848542 9313655 136 -1884 1153540 1167509 978237 1638939 66460034 25368210 31518684 41091824 16447085 17497603 9071403 842491 76434421 79806884 6620297 7227912 836940 779119 30000000 29725000 5801472 7545147 43258709 45277178 X 32394316 33708016 159220 168060 622176 653630 33175712 34529706 76434421 79806884 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11555 11555 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Littleton Regional Hospital is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Littleton Regional Hospital and other member organizations in furtherance of their exempt purposes. Littleton Regional Hospital does not directly perform any lobbying activities. 728305 49089 10145 767249 739898 9683 -21200 75 728306 0.88070 0.11930 0 0 786809 786809 30673489 13054819 17618670 6823 6823 0 18691172 11976038 6715134 16301741 330530 15971211 41091824 Bonds 7906054 F Stocks 9591549 F 17497603 Reserve for Self-Funded Health Insurance 1147000 Due to Third Party Payers 2573832 Deferred Compensation 558624 Interest Rate Swap 3265691 7545147 68635774 66755582 1880192 526590 -1052788 -526198 1353994 67923735 526590 526590 67397145 145918 1092711 1238629 68635774 66569741 0 66569741 145918 39923 185841 66755582 Part XI, Line 8 - Other Adjustments: Loss on Interest Rate Swap: -1052788. Part XII, Line 4b - Other Adjustments: Foundation Subsidy: 39923. Unrealized Gain on Interest Rate Swap: 1052788. Part XIII, Line 4b - Other Adjustments: Foundation Subsidy: 39923. 1 1 X 1 X 1 X 1 1 1 0 1 1 1275631 1275631 0.01990 3981925 2910410 1071515 0.01670 5257556 2910410 2347146 0.03660 259532 55740 203792 0.00320 16743 16743 0.00030 208875 208875 0.00330 95217 95217 0.00150 580367 55740 524627 0.00830 5837923 2966150 2871773 0.04490 19479 19479 0.00030 48634 48634 0.00080 8008 8008 0.00010 76121 76121 0.00120 1 2765447 0 18526032 18526032 X 1 1 Littleton Regional Hospital

600 St Johnsbury Road Littleton NH 03561

X X X X Littleton Rehabilitative Services

551 Meadow Street Littleton NH 03561

Rehabilitation Clinic Littleton Orthopaedics

81 Bethlehem Road Littleton NH 03561

Outpatient Physician Clinic Summit Medical Group

220 Cottage Street Littleton NH 03561

Outpatient Physician Clinic Part I, Line 7: The Hospital determines its cost of charity care based on an overall financial statement cost to charge ratio applied against gross charity care charges. Part I, Line 7f: The Hospital has recorded $2,765,447 of Bad Debt Expense included on Form 990, Part IX, Line 25 which has been subtracted for purposes of calculating the percentage in this column. Part III, Line 4: Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable. The valuation of charity care does not include any bad debt receivables or revenue. Part V: The Hospital operates one rehabiliation center and two outpaitent physician clinics that are not required to be licensed as a health care facility under state law. Part VI, Line 2: The Littleton Regional Hospital Community is defined as all people living in the communities listed in Part XI, Line 4. These communities were chosen by their geographic proximity to the Hospital and to the services and programs provided. Part VI, Line 3: Any applicant will receive a prompt decision on eligibility and amount of charity care offered. Notices of the Charity Care Policy are posted in the lobbies, waiting rooms and other public areas. Notices are also given to recipients who are served in their homes. Part VI, Line 4: The Hospital's primary service area includes Littleton, Bethlehem, Lisbon, Franconia and Sugar Hill. The secondary service area includes Whitefield, Lancaster, Goveton, Monroe, North Woodstock, Lincoln, Woodsville and Bath (all in NH), and St. Johnsbury, Lunenberg, Lyndonville, Concord, Gilman (all in VT). The area spans across a good majority of Northern New Hampshire and the Northeast Kingdom of Vermont. NH X X X X 0 0 0 0 0 0 0 0 0 Edward Duffy MD 251926 0 276 0 0 0 12250 0 39112 0 303564 0 0 0 Andrew Forrest 294760 0 34015 0 6250 0 12250 0 48502 0 395777 0 0 0 Warren West 257146 0 8100 0 11000 0 12250 0 42538 0 331034 0 0 0 Robert Fotter 174665 0 5125 0 3194 0 2257 0 15518 0 200759 0 0 0 Linda Gilmore 190588 0 5032 0 0 0 9989 0 31186 0 236795 0 0 0 David Lovejoy 424631 0 10000 0 3000 0 0 0 46545 0 484176 0 0 0 Michael Kindred 304013 0 68872 0 7600 0 2505 0 21327 0 404317 0 0 0 Harlan Herr 345584 0 0 0 0 0 0 0 38267 0 383851 0 0 0 Nicholas Marks 302264 0 0 0 6250 0 12250 0 53890 0 374654 0 0 0 Lon Howard 288117 0 0 0 8500 0 0 0 52266 0 348883 0 0 0 Business Finance Authority of the State of New Hampshire 521304598 64468kbg0 2007-11-15 30000000 Refunded series 1998A and 1998B Bonds 0 0 30000000 17757778 274108 11968114 2007 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 George Brodeur Trustee 95474 George Brodeur is the Clerk of the Works for Littleton Regional Hospital's building project. He became a member of the Board of Trustees in September 2010 and was paid as an independent contractor for his services. 0 Form 990, Part VI, Section A, line 6 All persons making an annual contribution to Littleton Regional Hospital or Littleton Regional Hospital Charitable Foundation, who are at least eighteen (18) years of age, or any legal adult resident of any town raising an annual appropriation to the Littleton Regional Hospital shall thereupon, and without further election or action by the Association, automatically become a member of the Association. Failure to contribute to the Hospital or Foundation in the following fiscal year shall automatically terminate the membership. Form 990, Part VI, Section A, line 7a Each member of the Association shall be qualified to originate and take part in the discussion of any subject that may properly come before any meeting of the Association, to vote on such subject, and to hold any office in the Association to which he or she may be elected or appointed. Form 990, Part VI, Section B, line 11 The return was reviewed by the entire Board of Directors prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, Department directors and Auxilians complete a Conflict of Interest Statement each year, and any potential conflicts are reported to the Board of Trustees and to other places as required by law. In addition, front-line employees who don't normally make decisions for the facility are expected to report forward any conflicts they may have, should they ever be in a position to influence decision making. Quality Services queries these groups on an annual basis, and tracks down people until all statements are complete. Form 990, Part VI, Section B, line 15 Key employees complete self-evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations. The CFO's salary is approved by the CEO. The CEO's salary is approved by the Board. Form 990, Part VI, Section C, line 19 The hospital's governing documents and financial statements are made available upon request. The hospital's conflict of interest policy is not made available to the public. Part XI, Line 2c The organization did not change the oversight or selection process during the tax year. Littleton Regional Hospital Charitable Foundation 600 St Johnsbury Road Littleton NH 03561 043750643 Charitable Foundation NH 501(c)(3) Line 7 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0