2026-08-10T14:16:18-05:00 2025-09-30 010494526 Baker Newman & Noyes 280 Fore Street Suite 500 Portland ME 04101 990 2024-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Robert F Nutter President & CEO 6034449000 2026-08-07 1 0 Connor Smart P02285543 2078792100 2026-08-07 2024 2025-03-06 01:10:19Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 170170125 0 X https://littletonhealthcare.org/ X 1906 NH To provide health care services in Northern New Hampshire. 15 11 717 69 0 0 1429132 1220883 112525590 141098187 2604691 3466817 296641 188514 116856054 145974401 135086 0 0 0 60799031 68205201 0 0 0 69824853 75020736 130758970 143225937 -13902916 2748464 102964897 98323846 69020654 61550430 33944243 36773416 X To provide quality, compassionate, and accessible healthcare in a manner that brings value to all. 0 0 96981396 0 141098187 Littleton Hospital Association 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. Littleton Hospital Association offers a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventative diagnostic, therapeutic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services. Littleton Hospital Association provides these services without regard to race, religion, age, sex, income, creed, national origin, or disability. Littleton Hospital Association maintains a sufficient number and mix of medical staff who are competent, dedicated and community based, supporting them with the technologically up to date equipment and facility needed to provide these services competitively. Littleton Hospital Association creates a healthy, satisfying work environment for physicians, 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. 96981396 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 96 0 1 717 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X Jennifer Griffey Interim CFO 6034449000 600 St Johnsbury Road Littleton NH 03561 Dr Eric Emig Trustee/Med Staff Pres (start 12/24) 40.00 X 818418 0 52373 Dr Patrick Fitzpatrick Trustee/Physician 40.00 X 525669 0 45185 Dr Jennifer Lucas Trustee/Med. Staff Pres. (end 12/24) 40.00 X 447776 0 38462 Dr Richard McKenzie Trustee/Physician/Vice Chair 40.00 X X 313459 0 26583 Dr Stephen Goldberg Trustee/Physician 40.00 X 340125 0 28456 Audrey Goudie Trustee 1.00 X 0 0 0 Susan Ide Trustee 1.00 X 0 0 0 Richard Jesseman Trustee 1.00 X 0 0 0 Nathan Karol Trustee (start 12/2024) 1.00 X 0 0 0 Robert MacLeod Trustee (end 12/2024) 1.00 X 0 0 0 Claire Mei Trustee/LRH Aux. Rep. (start 2/25) 1.00 X 0 0 0 Laurie Morgan Trustee/LRH Auxiliary Rep. 1.00 X 0 0 0 Stephen Noyes Trustee 1.00 X 0 0 0 Charyl Reardon Trustee 1.00 X 0 0 0 Paul Smith Trustee 1.00 X 0 0 0 Jeff Woodward Chair(end 12/24); Treas.(start 1/25) 1.00 X X 0 0 0 Ashley Garrison V.C. (end 12/24); Chair (start 1/25) 1.00 X X 0 0 0 Fred Chisolm Treasurer (end 12/2024) 1.00 X X 0 0 0 Thomas Tremblay Secretary (end 12/2024) 1.00 X X 0 0 0 Robert Nutter President & CEO 40.00 X 900313 0 53143 Dr Edward Duffy CMO (end 5/25) 40.00 X 610423 0 65931 Koren Superchi COO/CNO 40.00 X 396362 0 42663 Chris Frauenhofer CFO 40.00 X 170048 0 14700 Dr Jeffrey Kauffman Physician 40.00 X 772851 0 66319 Dr Jean Langevin Physician 40.00 X 637770 0 54486 Dr Anthony Salerni Physician 40.00 X 697420 0 52607 Dr Jonathan Lamphier Physician 40.00 X 610580 0 47600 Dr Daniel Underbakke Physician 40.00 X 552560 0 43419 Steven Shaffer Former CFO 40.00 X 334046 0 37859 8127820 0 669786 106 1 1 0 The Alpine Clinic PLLC 1095 Profile Road Franconia NH 03580 Orthopedic services 2608239 Maxim Healthcare Staffing Services Inc 7223 Lee DeForest Drive Columbia MD 21046 Staffing services 1637757 AHSA LLC 3051 Willowood Road Edmond OK 73034 Speech pathology services 1279761 Red River Managed Services LLC 14111 Park Meadow Drive Chantilly VA 20151 IT services 1085319 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Staffing services 697781 25 46316 447210 727357 11216 1220883 Patient services 621110 122888044 122888044 Disproportionate share revenue 621110 12048368 12048368 Pharmacies 456110 4278856 4278856 Auxiliary health services 621110 1001891 1001891 Cafeteria/dining services 722514 881028 881028 141098187 799742 799742 196101 0 196101 196101 196101 26823709 24156634 2667075 2667075 2667075 28158 46316 35905 -7747 -7747 3345 3185 160 160 145974401 141098187 0 3655331 4890090 3379380 1510710 52186365 36064281 16122084 1084941 749767 335174 6439282 4449976 1989306 3604523 2490967 1113556 408505 408505 255303 255303 3658 3658 83075 83075 25353170 16367288 8985882 547392 4706 542686 4583912 2808987 1774925 4111642 704019 3407623 3701300 2078751 1622549 492779 449253 43526 1823764 620794 1202970 1006762 502576 504186 4551886 1534462 3017424 2461344 187248 2274096 Provision for bad debts 10353162 10353162 Pharmaceuticals 6237574 5934061 303513 NH Medicaid tax 4290914 4290914 Medical/lab supplies 3154013 3144813 9200 1600581 865991 734590 143225937 96981396 46244541 0 246342 165480 917107 1458107 16193141 17973650 2301887 2533309 1603224 1326285 117317731 86701268 32446297 30616463 34409829 28070887 4911382 4234625 3321154 3073341 6614534 8871699 102964897 98323846 32192442 29613695 18344725 17462830 2083685 1529388 16399802 12944517 69020654 61550430 X 29912854 32367408 4031389 4406008 33944243 36773416 102964897 98323846 X 2748464 -97503 178212 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3658 0 0 0 3658 0 Part II-B, Line 1: The Hospital maintains a membership with the American Hospital Association ("AHA"). A portion of the dues remitted to the AHA may be made available for the AHA to use towards lobbying expenditures on behalf of its members' programs and missions. During the period covered by this Form 990, the Hospital paid AHA total membership dues and fees of $10,162. 36%, or approximately $3,658, of the total dues paid to the AHA were used for lobbying purposes. 2075661 50 236937 241913 2070735 2624405 44966 -119893 473817 2075661 2386830 277727 40152 2624405 2757824 116439 -487433 2386830 2432225 29896 403922 108219 2757824 0.00000 1.00000 0.00000 0 0 1981468 1981468 50037778 34619090 15418688 2553615 934245 1619370 61931242 51147933 10783309 813628 813628 30616463 Malpractice insurance recovery reserves 1188397 Employee benefit plan assets 5409107 Estimated third-party payor settlements 2274195 8871699 Operating lease liabilities 2643763 Fair value of interest rate swap 317045 Malpractice and professional coverage liabilities 2574602 Discount stock option plan 5034907 Deferred executive comp 374200 Long-term credit balance adjustments 2000000 12944517 X 135580144 -97503 -38729 -136232 135716376 83075 10174950 10258025 145974401 132750971 -38729 -38729 132789700 83075 10353162 10436237 143225937 Part V, Line 4: The Hospital maintains a perpetually restricted endowment fund, intended to provide support for current and future operations of the Hospital. Specifically, the endowment funds are restricted to be used in furtherance of health care services and related activities. The endowment fund is composed of permanently restricted capital, though accumulated earnings may be expended for the provision of care services. Part X, Line 2: The Hospital is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. Management evaluated the Hospital's tax position and concluded the Hospital has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying financial statements with the exception of the ERC reserve discussed below: The Employee Retention Credit (ERC) was established by the Coronavirus Aid, Relief and Economic Security Act (CARES Act) and was intended to help organizations retain their workforce during the pandemic. ERC provides a per employee credit to eligible businesses based on a percentage of qualified wages and health insurance benefits paid to employees. ERC is a refundable tax credit claimed quarterly as either a reduction in payroll taxes or cash refunds. The One Big Beautiful Bill Act (OBBBA) enacted July 4, 2025, further changed the ERC statute of limitations, primarily by extending the Internal Revenue Service's (IRS) timeframe for audits and collections for certain quarters and retroactively disallowing specific late claims. While management believes the Hospital met the requirements of the ERC program, a reserve has been established totaling approximately $2,700,000 as of September 30, 2025 and 2024, should the IRS determine the Hospital is not eligible to receive the credits and seeks reimbursement. This reserve is included in accounts payable, accrued expenses and other current liabilities in accompanying balance sheets. Part XI, Line 2d - Other Adjustments: Fundraising event revenue and expenses -38,729. Part XI, Line 4b - Other Adjustments: Provision for bad debts 10,353,162. Contribution expense Change in value of interest rate swap -178,212. Part XII, Line 2d - Other Adjustments: Fundraising event revenue and expenses -38,729. Part XII, Line 4b - Other Adjustments: Provision for bad debts 10,353,162. Contribution expense Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 4235000 0 0 0 0 0 0 4235000 0 4235000 0 0 1 0 0 0 Form 990, Schedule F, Part IV: The Organization holds an interest in Drake Capital Offshore Partners, L.P ("Drake"), a Cayman Island-based exempted partnership. For U.S. tax purposes, the Partnership has filed an election to be treated as a corporation. The Organization's interest in Drake is under the ownership thresholds requiring filing of the Form 5471. Accordingly, the Organization is not required to prepare or submit to the IRS a Form 5471 regarding this investment with this tax return. Additionally, the Organization did not make any transfers to Drake during the period covered by this Form 990. Accordingly, the Organization is not required to prepare or submit to the IRS any Forms 926 regarding this investment with this tax return. Golf Tournament 74474 46316 28158 8691 7767 14033 5414 74474 46316 28158 8691 7767 14033 5414 35905 -7747 1 1 1 X 1 X 1 1 0 1 1 600284 600284 0.00450 4510209 219295 4290914 0.03230 5110493 219295 4891198 0.03680 87611 87611 0.00070 496237 496237 0.00370 41707682 17983720 23723962 0.17850 13975 13975 0.00010 42305505 17983720 24321785 0.18300 47415998 18203015 29212983 0.21980 1420 1420 0.00000 75338 75338 0.00060 43193 43193 0.00030 82148 82148 0.00060 1105 1105 0.00000 1967 1967 0.00000 205171 205171 0.00150 4630132 0 18791036 19504080 -713044 X 1 1 1 1 Littleton Regional Hospital 600 St Johnsbury Road Littleton NH 02790 www.littletonhealthcare.org X X X X Littleton Regional Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X See Part V, Section C X See Part V, Section C X 1 22 1 See Part V, Section C 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X 1 X 0 X X X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: In 2022, the Northern New Hampshire Region (composed of Littleton Regional Healthcare, Ammonoosuc Community Health Services, Mid-State Health Center, and Cottage Hospital) performed a Community Health Needs Assessment to determine the health needs of the Greater Northern New Hampshire Region. Data was gathered from multiple well-respected secondary sources to build an accurate picture of the community and its health needs. Through the assessment process, a survey was issued to a select group of local experts to review the most recent prior CHNA, to provide feedback on those past assessments, and to ascertain whether the previously identified needs remained a priority. Additionally, the group of hospitals and care facilities reviewed the data gathered from the secondary sources to determine the overall significant health needs for the community.For complete details of how the NNHR CHNA gathered community input in determining the significant health needs of the region, please see the full assessment and reports, available online at:https://littletonhealthcare.org/about-lrh/ Littleton Regional Hospital Part V, Section B, Line 6a: Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR, or, the "Facilities") Community Health Needs Assessment ("CHNA"). NNHR conducted this CHNA in partnership with QHR Health ("QHR") to determine the health needs of the applicable regional and local communities. NNHR and QHR also developed an accompanying implementation plan to address the health needs identified through the CHNA process. The Northern New Hampshire Region Facilities included the following hospital facilities: - Littleton Regional Healthcare, Littleton, NH ("LRH") - Cottage Hospital, Haverhill, NH ("CH") - Mid-State Health Center ("MSHC") - Ammonoosuc Community Health Services, Littleton, NH ("ACHS") Littleton Regional Hospital Part V, Section B, Line 6b: Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR, or, the "Facilities") Community Health Needs Assessment ("CHNA"). The 2022 NNHR CHNA also involved many different organizations other than hospital facilities, including the following:- QHR Health- Stratasan- Bureau of Labor Statistics- NAMI- New Hampshire Fiscal Policy Institute- CDC- Cetners for Medicare and Madicaid Services- National Cancer Institute- Vermont Department of Health- Mental Health America- Vermont Housing Finance Agency- Vermont Legislative Joint Fiscal Office Littleton Regional Hospital Part V, Section B, Line 11: Littleton Regional Hospital ("LRH") participated in and contributed to the shared 2022 Northern New Hampshire Region Community Health Needs Assessment for its most recent CHNA. This assessment identified ten primary, significant health needs impacting the region served by the Hospital. An implantation plan framework, which organized these needs by key groups, was developed. The framework has allowed LRH to prioritize and address the identified needs as efficiently and effectively as possible.The ten identified health needs, and a summary of how those needs fit within the Hospital's overall implementation plan, are as follows: 1. Mental Health: LRH's emergency department acts as a regional intake center for all patients with emergent behavioral health needs. LRH also contracts with Dartmouth Health's Connect Care to provide telepsychiatry in its emergency department. LRH is continuously enhancing its inpatient units to better accommodate the behavioral health needs of patients whose primary diagnosis is not itself behavioral, but who are nonetheless placed on observation or admitted. LRH continues its efforts to embed behavioral health into its primary care clinic, including recruiting providers dedicated to behavioral health, and incorporates sharing mental health resources in the clinic and to the public on an ongoing basis. 2. Affordability of Healthcare Services: LRH's onsite urgent care clinic provides cost-effective, accessible care as an alternative to the emergency department, or for conditions too urgent to wait for an appointment. LRH also offers financial assistance to qualifying patients, providing over a million dollars each year in Charity Care to those unable to pay for services. LRH's established endowment funds also help support patients needing assistance in specific health areas, such as those receiving cancer treatment. 3. Access to Mental Health and Substance Use Disorder Services: The Doorway at LRH is part of a statewide initiative to address the growing need for substance use disorder ("SUD") services. This clinic serves as a regional hub for patients throughout Northern and Central New Hampshire requiring these services. LRH understands the growing need for behavioral health services and is taking this into consideration as it prepares to embark on a complete emergency department renovation. 4. Affordable Housing: LRH has joined nine other major area employers to address the lack of affordable housing in the area, which is impacting recruitment efforts for all major employers in the community. The group is actively engaged with AHEAD (Affordable Housing Education and Development) to determine the feasibility of constructing workforce housing in the near future on an identified parcel of local land. LRH keeps a running list of housing availability for new hires seeking housing in the area, and also owns a multi-unit property in Littleton which provides on-call housing and longer-term stays options for those providing care services within the community. 5. Livable Wages: LRH is the largest employer in Northern Grafton Country and Coos County, and overhauled its compensation and benefits structure in 2022 to reinforce its position as the market leader. LRH is proud to say it achieves at or above the 75th percentile for all staff wages. 6. Drug/Substance Abuse: The Doorway at LRH serves as a single point of entry for those seeking help for substance abuse. The Doorway provides resources, treatment, and other support and services to assist in long-term recovery, including peer recovery support services, coordination of placement in treatment centers, screening and evaluation, and medication assisted treatment. LRH's emergency department also helps coordinate emergent treatment for substance use disorders for The Doorway. 7. Access to Senior Services: Senior health services was ranked as one of the top health needs in the most recent CHNA, in part due to mobility and accessibility concerns. In response to this identified need, LRH maintains a Mobile Integrated Health Program, which works closely with local EMS providers throughout the region, as well as a mobile health clinic, to address healthcare access issues throughout Grafton and Coos Counties. LRH also collaborates clinically with a regional FQHC to bring specialty care closer to home for residents of Central New Hampshire through a visiting specialist program. These mobile health services help bring care to senior citizens who cannot otherwise travel to health facilities. 8. Cancer: LRH shares resources with the public on services it provides such as skin cancer screenings, breast cancer screening, colonoscopies, cervical cancer screenings, prostate screenings, among others, and how to access these services. LRH also partners with Dartmouth Health's Norris Cotton Cancer Center to staff its onsite Oncology, Hematology, and Infusion Center. Through LRH's involvement in the visiting specialist program, many of these screenings are now available in central New Hampshire office locations. 9. Obesity: LRH employs a full-time Diabetes Educator and a full-time Registered Dietitian who both accept referrals for patients requiring these services. LRH's Diabetes Educator offers a free, virtual support group once a month for patients and nonpatients to attend. LRH encourages patients to see their provider on an annual basis to monitor health conditions, like weight concerns. 10. Alzheimer's and Dementia: LRH shares resources related to Dementia and Alzheimer's and encourages routine care to address any concerns related to these conditions. LRH also employs a Neurologist, and contracts with Dartmouth Health for supplemental tele-neurology support.The complete Implementation Plan can be found within the shared 2022 CHNA, which is available online at:https://littletonhealthcare.org/about-lrh/ Schedule H, Section B, Lines 7 and 10: Littleton Regional Hospital was one of multiple hospital organizations to participate in and contribute to the Northern New Hampshire Region Facilities ("NNHR or the "Facilities") Community Health Needs Assessment (CHNA).The NNHR CHNA and its associated CHNA Implementation Strategy is available online on the Hospital's website at:https://littletonhealthcare.org/about-lrh/A direct link to the 2022 CHNA and its Implementation Strategy is available at:https://littletonhealthcare.org/wp-content/uploads/2023/01/NNHR-2022-CHNA_Littleton.pdfAs a shared, regional CHNA, the 2022 NNHR CHNA can also be found on multiple other organizations' websites, including the following:https://www.cottagehospital.org/uploads/files/NNHR%202022%20CHNA_Cottage.pdfhttps://www.midstatehealth.org/wp-content/uploads/2023/02/NNHR-2022-CHNA_Mid-State.pdfLastly, while released outside the required CHNA reporting period for this Form 990, due to timing differences between this tax return's filing and the publication of the Organization's health assessments, the 2025 Community Health Needs Assessment is also availanle online, at the following address (the 2025 CHNA will be covered in greater detail on future Form 990 tax returns to be filed by the Hospital):https://littletonhealthcare.org/wp-content/uploads/2026/04/Northern-NH-Northeast-VT-2025-CHNA-Final.pdf Schedule H, Part V, Section B, Line 16a & 16b: Information regarding the Hospital's billing and financial assistance policies can be found online at:https://littletonhealthcare.org/patients-and-visitors/my-bill/The Hospital's Financial Assistance Policy is available on the Hospital's website at:https://littletonhealthcare.org/wp-content/uploads/2024/02/Financial-Assistance-Program-Policy-2.20.2024.pdfThe Hospital's Financial Assistance Application is available on the Hospital's website at:https://littletonhealthcare.org/wp-content/uploads/2025/02/FAP-APPLICATION.pdfThe Hospital's Financial Assistance Plain Language and Eligibility Summary is available online at:https://littletonhealthcare.org/wp-content/uploads/2025/02/FAP-PLAIN-LANGUAGE-SUMMARY-2025.pdf Part I, Line 7: Littleton Hospital has several hospital clinical services and hospital-owned physician practices. Per the Instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completion of Schedule H and its costing method calculations. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices: a. Rural Health Clinic b. LRH Franconia Ortho c. LRH Urology Associates d. LRH Littleton Orthopaedics e. LRH Lincoln Urgent Care f. LRH General Surgery g. LRH NC Otolaryngology h. LRH Neurology i. LRH Urgent Care j. LRH NC Women's Health k. LRH NC Orthopedics l. LRH NC Sleep m. LRH Gastroenterology n. NC Spine Center o. Emergency p. Alpine Plymouth q. LRH Alpine PhysiciansThe above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $23.72 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $23.72 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.Form 990, Schedule H instructions and guidance also contains a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H to convert charges to cost figures. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part 1, Line 7, were the following: a. Schedule H, Worksheet 3, Unreimbursed Medicaid and Other Means Tested Government Programs (the supporting schedule for Part I, Lines 7b and 7c); and Worksheet 6, Medicaid Allowable Costs for Subsidized Health Services, as listed in line 1c above (which is part of the line 7g costs): The Hospital did not utilize the Worksheet 2 percentage when calculating the Medicaid allowable cost. Instead, the Hospital utilized the Medicaid worksheets on the filed cost report for these allowable costs. b. Schedule H, Worksheet 4, Community Health Improvement Services and Community Benefit Operations: The hospital provided the following community health improvement services.a- Seasonal Flu Vaccine Clinicb - UpToDate Wellness Clinicc - Littleton Wellness Faird - Child passenger safetye - lactation servicesf - perinatal bereavementg - CPRh - CPR AT CHURCHi - baby's morning outj - childbirth educationk - dedicated staff cost to community benefitsl - website maintenancem - NEWT fairn - NNOo - bridge project back to school drivep - nh highland games medical field coverageq - Loon mountain orientationr- center for new beginningss - Senior Center presentationsBecause Worksheet 4 was used for these services' community benefits, Worksheet 2 was not utilized. c. Schedule H, Worksheet 5, Health Professions Education: The hospital provides nursing and life support saving education to local high school students. Because Worksheet 5 was used for these services' community benefits, Worksheet 2 was not utilized. d. Schedule H, Worksheet 8, Cash and In-Kind Donations to Community Groups: The hospital donates to support various community groups. Because Worksheet 8 was used for these services' community benefits, Worksheet 2 was not utilized. e. Community Building Activities: The Hospital provides community building activities by supporting the following activities within the below-listed entities.- Economic Development:a - MWV Chamberb - Littleton Area Chamber of Commercec - Western White Mountain Chamber of Commerce- Community Support:a - 220 sharps containers from urgent care clinicsb - EMS Omnicell- Environmental Improvements:a. Bio-Chemical Waste Management Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 10,353,162. Part II, Community Building Activities: Littleton Regional Healthcare participates in several community building activities that promote the health and wellbeing of the communities it serves. For example, LRH collaborates with a number of local agencies including the North Country Health Consortium, Littleton Area Senior Center, Ammonoosuc Community Health Services, to name just a few. These agencies share common goals that address access to healthcare, health improvement, health education, and affordable healthcare services.Additionally, LRH encourages senior management and mid-level management to be actively involved in the communities served by the Hospital. For example, LRH works with area schools to address the health of our young students, and also collaborates with local safety providers to promote safety and help prevent injury. As a community asset and center, LRH hosts multiple public engagement and volunteer opportunities. The Hospital's active volunteers provide a sense of communal enterprise, advancing high-quality, compassionate service to the Hospital's visitors, patients, and other community members.The Hospital also promotes public education and personal wellness through its publications of magazines and online blogs. These resources improve the general community's and region's access to resources and overall health literacy.Through these programs and the Hospital's collaboration with these agencies, LRH continues to bolster the strength and health of its community beyond just the services offered through its care facilities. Part III, Line 2: The Hospital utilized Worksheet 2 from the IRS Schedule H instructions/guidance to determine the ratio of patient care cost to charge (44.72% for fiscal year 2025) and multiplied this ratio by the Hospital's total bad debt expense attributable to patients eligible under the financial assistance policy of $10,353,162 to determine the Part II, Line 2 bad debt expense of $4,630,132. Part III, Line 4: See Footnote 2 on page 10 of the attached audited financial statements. Part III, Line 8: Form 990, Schedule H instructions and guidance contains a template (Worksheet 2) that may be used to determine the overall cost-to-charge ratio that could be applied throughout Schedule H in order to convert charges to cost figures. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report estimated cost and payment for these services.The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room, and rural health center, as detailed in these Schedules supplemental narratives, should be considered a community benefit, as community members benefit by having easy access to these services, facilities, and programs which are both offered and subsidized. These facilities and programs are offered and thus subsidized through the Hospital. Part VI, Line 2: Littleton Regional Hospital ("LRH") takes a comprehensive approach to assess community health needs. We perform several independent data analyses based on secondary source data, augment this with local survey data and resolve any data inconsistency or discrepancies from the combined opinions formed from local experts. We rely on secondary source data and most secondary sources use the county as the smallest unit of analysis. Since the service area comprises parts of Grafton County, we asked local residents to note if they perceived the problems, or needs, identified by secondary sources to exist in their portion of the county. 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. The Hospital also provides its financial assistance policies, applications, descriptions of coverage, and billing and financial literacy tools online, through the Hospital's website. Part VI, Line 4: The Hospital defines its primary service area as Grafton County. Grafton County, New Hampshire is the 5th largest county in New Hampshire, with an estimated population of 91,118, and a growth rate of 0.03%, according to the most recent United States census data. Of this population, people under five years of age make up 3.9% of the population, and people under 18 years of age make up 20.4% of the population. This contrasts with persons 65 years of age and over, who make up 21.9% of the population. All females account for 50.2% of the overall population in the County. The most recent census data found median household income to be $82,045, with per capita income through 2018-2022 of $37,847 (adjusted for inflation for 2022 dollars). The income data also found that 11% of the County's population to be considered at poverty level. Individuals with a disability account for 15.5% of the population, and people without health insurance represent 5.3% of the population. Part VI, Line 5: Littleton Regional Hospital's ("LRH") care services and hospital facilities significantly contribute to the health of its community. The list below covers just a few ways that the Hospital engages with its community to promote its overall health and wellbeing:Education: LRH maintains an internal Department of Education, which seeks to provide evidence-based educational opportunities, through the use of simulated learning experiences, that supports clinical staff in meeting the unique needs of a rural community.The Alpine Clinic: the largest orthopaedic practice in Northern New Hampshire with offices in four convenient locations. Our highly skilled orthopaedic surgeons have been providing care to the communities it serves for more than 20 years. With more than 90 years of combined orthopaedic experience, you can be confident that our surgeons provide the best possible care.The Doorway Program: For many people, addiction is a daily reality. The Doorway is here to help - whether it helps you or a loved one - we can connect you to support, services, and care that is right for you. The Doorway at LRH is part of a statewide initiative to address the growing opioid crisis. Littleton Regional Healthcare (LRH) serves as a hub for Northern New Hampshire.Sauter Birthing Suite: Our mission is to provide a high-quality, positive birth experience not only for our mothers but also for the entire family. Our goal is to make families feel welcome while giving the very best medical care in a comfortable, home-like environment.In addition to these specific clinics, LRH provides medical and specialty care across a wide array of practice areas, including: allergy; anesthesiology; behavioral health; cardiopulmonary; cardiology; dermatology; diagnostic imaging; emergency and urgent care; plastics; gastroenterology; general surgery; gynecology/obstetrics; hospice care; infection control; intensive care; laboratory work; maternity care; neurology and neuro surgery; occupational health; oncology; ophthalmology; orthopedics; otolaryngology; pain management; pharmacy access; primary care and family medicine; pulmonology; radiology; sleep medicine; addiction and substance abuse treatment; perioperative; and urology. Part VI, Line 6: Littleton Regional Hospital is not itself part of a formal, affiliated health care system. However, the Hospital does coordinate with many community partners and other hospital entities to collaborate on health assessments and responses, with the purpose of improving the overall wellbeing of the community which the Hospital serves. Additional details regarding these collaborative efforts can be found in the Hospital's shared Northern New Hampshire Region's 2022 Community Health Needs Assessment. Part VI, Line 7, Reports Filed With States NH X X X 1 1 0 0 0 0 0 1 0 Robert Nutter President & CEO 422954 0 263611 0 213748 0 0 0 53143 0 953456 0 181563 0 Dr Eric Emig Trustee/Med Staff Pres (start 12/24) 612160 0 203882 0 2376 0 0 0 52373 0 870791 0 0 0 Dr Jeffrey Kauffman Physician 771303 0 0 0 1548 0 0 0 66319 0 839170 0 0 0 Dr Anthony Salerni Physician 607848 0 85000 0 4572 0 0 0 52607 0 750027 0 0 0 Dr Jean Langevin Physician 613942 0 0 0 23828 0 0 0 54486 0 692256 0 0 0 Dr Edward Duffy CMO (end 5/25) 473016 0 96134 0 41273 0 22822 0 43109 0 676354 0 0 0 Dr Jonathan Lamphier Physician 556008 0 50000 0 4572 0 0 0 47600 0 658180 0 0 0 Dr Daniel Underbakke Physician 509343 0 42857 0 360 0 0 0 43419 0 595979 0 0 0 Dr Patrick Fitzpatrick Trustee/Physician 504589 0 0 0 21080 0 0 0 45185 0 570854 0 0 0 Dr Jennifer Lucas Trustee/Med. Staff Pres. (end 12/24) 423228 0 0 0 24548 0 0 0 38462 0 486238 0 0 0 Koren Superchi COO/CNO 295867 0 75820 0 24675 0 14768 0 27895 0 439025 0 0 0 Steven Shaffer Former CFO 191784 0 42504 0 99758 0 13105 0 24754 0 371905 0 0 0 Dr Stephen Goldberg Trustee/Physician 304499 0 20000 0 15626 0 0 0 28456 0 368581 0 0 0 Dr Richard McKenzie Trustee/Physician/Vice Chair 308887 0 0 0 4572 0 0 0 26583 0 340042 0 0 0 Chris Frauenhofer CFO 168788 0 0 0 1260 0 0 0 14700 0 184748 0 0 0 Part I, Lines 4a-b Schedule J, Line 4a, Severance Payments: During calendar year 2024, Littleon Hospital Association made severance payments to one of its former officers. Steven Shaffer, who served as the Organization's Chief Financial Officer until May 2024, received severance payments of $80,000. These payments were included in Mr. Shafer's 2024 Form W-2, Box 5 wages, and the amounts are included in Mr. Shafer's total Other Compensation as reported on this 2024 Form 990, Schedule J, Page 2, Part II, Line B(iii). Schedule J, Line 4b, Supplemental Non-Qualified Retirement Plans: Littleton Hospital Association maintains a 457(f) non-qualified deferred compensation plan. During the 2024 calendar year, certain directors, trustees, officers, key employees, and/or highest compensated employees received non-taxable employer-paid contributions into the plan. For these individuals, as these deferred compensation plan contributions were not deemed taxable, the payments have been included within the amounts reported on this Form 990, Schedule J, Part II, Column C. Such deferrals were as follows: - Steven Shaffer, $13,105. - Koren Superchi, $14,768. - Edward Duffy, $22,822. Additionally, Robert Nutter, the Organization's CEO, also participated in the Plan during this fiscal year. Mr. Nutter received distributions from his 457(f) plan of $181,563 in calendar year 2024. Such distributions have been reported on this Form 990 and included within the amounts shown on Schedule J, Part II, Column B(iii), as Other Compensation. As these payments represent distributions of amounts previously reported as deferred compensation, the distributions have also been reported on this Schedule J, Part II, Column F. Part I, Line 7 From time to time the Hospital may pay bonuses, incentive compensation, performance awards, or other non-fixed payments to selected employees or officers, based upon the accomplishment of defined goals and metrics. For example, certain bonuses are based on productivity measures using Medical Group Management Association's standards by relative value units ("RVUs"), and by each applicable individual's specialties as outlined in their respective contracts. Such performance measurement tools allow the Hospital to align alternative or non-fixed compensation with patient care outcomes and overall Hospital performance. Other bonuses are paid based on and subject to achieving organizational quality and financial metrics. The goals and measurements for these latter non-fixed payments and achievement awards were developed with input from the Board Executive Committee, and were approved by the Board of Directors. A New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 5331100 Refunded series 2007 Bond 0 0 0 B New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 20753200 Refunded series 2007 Bond 0 0 0 A 1954667 5331100 41800 5289300 2015 1 0 1 1 B 6807476 20753200 162500 20590700 2015 1 0 1 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 1 Deutsche Bank AG 2000.000000000000 0 0 0 0 1 A 1 B 1 Schedule K, Part III, Line 2, Lease arrangements: The Hospital holds lease arrangements which may result in private business use of the bond-financed property. This private business use would be due to agreements wherein the Hospital rents excess medical practice space to physician practices, including the following: Dartmouth Hitchcock's Cardiovascular Medicine satellite offices; Shippee Family Eye Care Littleton; Littleton Internal Medicine; and White Mountain Family Health. Accordingly, of the leased space offered by the Hospital, the majority is provided to other organizations directly tax exempt under Section 501(c)(3) or otherwise affiliated with charitable entities. Additionally, the private practices operate primarily for purposes related to or in direct furtherance of the Hospital's own activities and charitable purpose, including the provision of patient care and health services to the general region in which the Hospital operates. The Hospital actively monitors these lease arrangements to ensure that the tenants' activities conducted directly further the Hospital's mission to provide care to its patients. As a result, it is the Hospital's position that the presence of these practices on or near the Hospital's own campus enhances the Hospital's patients and community's access to care and health resources. Lastly, any space occupied by lease tenants working within or around the Hospital's campus constitutes only a nominal and immaterial footprint of the entire facility. Therefore, while these private practices may operate within or around bond-financed property, the Hospital does not believe that such activities would constitute an inappropriate private benefit or unauthorized use of the bond funds. The Hospital actively monitors any such entities leasing space in the bond-financed property to make sure their activities are substantially related to the Hospital's exempt purpose and would not constitute an unauthorized private benefit or unrelated business activity. Form 990, Part VI, Section B, line 11b The Form 990 is prepared with the assistance of an independent CPA firm, who coordinates with the Organization's finance personnel and officers to ensure the tax return is complete and accurate prior to its finalization. A complete copy of the Form 990 is circulated among the entire Board prior to the tax return's filing with the IRS. Form 990, Part VI, Section B, line 12c The Hospital's Board of Trustees has adopted a policy for identifying conflicts of interest, in compliance with applicable law. Through this policy, the Board commits to conduct itself at all times in an ethical manner. The Board will identify all "pecuniary benefit transactions and comply with the requirements of New Hampshire RSA 7:19-a, as it may be amended from time to time, and any successor statute. No Trustee who also is an employee of the Association may participate in Board determinations regarding his or her compensation, and no Trustee who also is a physician employed by the Association may vote with respect to the establishment of compensation and/or benefits to be paid to the Association's employed physicians generally. To monitor and enforce this policy, all Trustees and Auxilians complete a Conflict-of-Interest Statement each year, and any potential conflicts are reported to the Board of Trustees and to other authoritative bodies as required by law. In addition, 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. Form 990, Part VI, Section B, line 15 The Board of Trustees will select, oversee and annually evaluate the Hospital's President/CEO, who will be a full-time salaried employee of the Hospital. Accordingly, compensation and benefits paid to the Hospital's President and CEO is subject to the review and approval of the Board of Trustees. The Board utilizes its Executive Committee and other resources, such as surveys, market research, and data from comparable organizations, to determine a compensation and benefits package that is reasonable and appropriate for the level of services and skills provided and employed by the President and CEO. Similarly, the Hospital's HR Director prepares compensation reports and packages using similar datapoints for other key employees and officers who are not the President and CEO. The President specifically reviews and approves the compensation and benefits of the CFO. Trustees will serve solely for the purpose of furthering the Hospital's charitable purposes and without compensation, except that reasonable expenses may be reimbursed as approved by the Board. However, Trustees may be employed by the Hospital, and in turn be compensated for their non-Trustee services as the Board may authorize. Form 990, Part VI, Section C, line 19 The Hospital's governing documents and financial statements are made available upon request to the extent required by applicable law. Form 990, Part VI, Section A, Line 16b: Littleton Hospital Association may occasionally partner or collaborate with for-profit businesses or care practices to improve the Hospital's ability to provide services and care to its patients and the broader community. For example, certain private facilities, physician practices, or dental and eye care centers may also operate on the Hospital's campus or lease real estate from the Hospital where it has excess capacity. In the nature of transparency, the Hospital has deemed such arrangements as "joint ventures, and has therefore answered "Yes" on this Form 990, Part VI, Section A, Line 16a. The Hospital does not have a separate, formal joint venture policy. However, all joint venture arrangements and similar business agreements are subject to the review, approval, and oversight of the Hospital's top management and operational officials. The Hospital also reviews all joint venture agreements or similar contracts to ensure the arrangements are in compliance with applicable law, and the Hospital reviews any joint venture or similar activities closely and regularly. Accordingly, while there is no separate joint venture policy, any business arrangements that are similar in nature to a joint venture are thoroughly monitored and regularly reviewed to ensure that such activities are compliant with requisite laws and regulations, and that any such activities also contribute meaningfully to the Hospital's ability to fulfill its charitable purpose. Form 990, Part XI, line 9: Change in value of interest rate swap 178,212. Form 990, Part XII, Line 2c: The audit of the Hospital's financial statements was subject to the oversight of chief management employees, the Hospital's finance committee, and the Chief Financial Officer. The Hospital's Chief Financial Officer and other applicable staff and board members met with the auditors prior to the start, during, and at the end of the audit to review results and to coordinate timely and accurate testing of the Hospital's financial statements. These same review and oversight procedures are consistent with previous years.