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        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Laura Gillespie AB MS</PersonNm>
        <TitleTxt>Trustee/ex-officio</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Michelle Perkins</PersonNm>
        <TitleTxt>Trustee (as of 1/1/25)</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Patrick F Jordan III MBA</PersonNm>
        <TitleTxt>Trustee (through 6/21/25)</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>43.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>1132708</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>79260</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Scott W Rodi MD MPH</PersonNm>
        <TitleTxt>Trustee</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.0</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>618436</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>78029</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Maryann R Caron</PersonNm>
        <TitleTxt>Executive Director MSC (as of 1/1/24)</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>223037</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16563</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Tamera K Sanders</PersonNm>
        <TitleTxt>CFO (as of 6/23/25)</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.5</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Todd Roberts</PersonNm>
        <TitleTxt>VP Finance (through 4/28/25)</TitleTxt>
        <AverageHoursPerWeekRt>38.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>2.0</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>242180</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>15534</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jean Ten Haken MSN RN CENP</PersonNm>
        <TitleTxt>CNO/COO</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.5</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>274745</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17422</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Paula Seaman</PersonNm>
        <TitleTxt>Chief Nursing Officer (as of 7/1/24)</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>162817</ReportableCompFromOrgAmt>
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        <OtherCompensationAmt>56772</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Annika Brown</PersonNm>
        <TitleTxt>Medical Director - Primary Care</TitleTxt>
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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>33871</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Diane Riley MD CAQSH</PersonNm>
        <TitleTxt>Ortho Surgeon Hand Specialist</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>470293</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>55077</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ivan Tomek MD</PersonNm>
        <TitleTxt>General Orthopedic Surgeon</TitleTxt>
        <AverageHoursPerWeekRt>40.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>John S Houde MD</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <OtherCompensationAmt>57192</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Sari Galanes</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <OtherCompensationAmt>48520</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Brenda L Blair</PersonNm>
        <TitleTxt>Former VP &amp; COO</TitleTxt>
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        <FormerOfcrDirectorTrusteeInd>X</FormerOfcrDirectorTrusteeInd>
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        <ReportableCompFromRltdOrgAmt>362426</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>61220</OtherCompensationAmt>
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      <TotalReportableCompFromOrgAmt>4175710</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>3118400</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>814450</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>109</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>true</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>CONIFER REVENUE CYCLE SOLUTIONS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>14201 Dallas Pkwy</AddressLine1Txt>
            <CityNm>DALLAS</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75254</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Healthcare Staffing</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AMERICAN HEALTHCARE SERVICES ASSN</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 945</AddressLine1Txt>
            <CityNm>TRAVERSE CITY</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>49685</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HEALTHCARE STAFFING</ServicesDesc>
        <CompensationAmt>2860584</CompensationAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UVNN</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>106 HANOVER ST</AddressLine1Txt>
            <CityNm>LEBANON</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SERVICES</ServicesDesc>
        <CompensationAmt>2190329</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ENGELBERTH CONSTRUCTION</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>150 WATER TOWER CIRCLE</AddressLine1Txt>
            <CityNm>COLCHESTER</CityNm>
            <StateAbbreviationCd>VT</StateAbbreviationCd>
            <ZIPCd>05446</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONSTRUCTION CONTRACTORS</ServicesDesc>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MARY HITCHCOCK MEMORIAL HOSPITAL</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>ONE MEDICAL CENTER DR</AddressLine1Txt>
            <CityNm>LEBANON</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03756</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HEALTHCARE STAFFING</ServicesDesc>
        <CompensationAmt>1240550</CompensationAmt>
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      <CntrctRcvdGreaterThan100KCnt>18</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>761866</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>359941</AllOtherContributionsAmt>
      <NoncashContributionsAmt>35700</NoncashContributionsAmt>
      <TotalContributionsAmt>1121807</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Patient Services</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>103743366</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>103743366</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Nutritional Services</Desc>
        <BusinessCd>722210</BusinessCd>
        <TotalRevenueColumnAmt>201783</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>201783</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PHARMACY SALES</Desc>
        <BusinessCd>446100</BusinessCd>
        <TotalRevenueColumnAmt>3166268</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3166268</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICAID DSH PAYMENT</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>6571575</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>6571575</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>113682992</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>1152974</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>85446</UnrelatedBusinessRevenueAmt>
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      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>97619</RealAmt>
      </GrossRentsGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>97619</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>97619</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <ExclusionAmt>97619</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>0</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </GainOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>MISCELLANEOUS</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>904841</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>904841</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>PURCHASE REBATES AND DISCOUNTS</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>333597</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>333597</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>1238438</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>117293830</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>114921430</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>85446</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1165147</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>23468</TotalAmt>
        <ProgramServicesAmt>23468</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1966634</TotalAmt>
        <ProgramServicesAmt>453808</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1510609</ManagementAndGeneralAmt>
        <FundraisingAmt>2217</FundraisingAmt>
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        <TotalAmt>51499241</TotalAmt>
        <ProgramServicesAmt>49211046</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2156989</ManagementAndGeneralAmt>
        <FundraisingAmt>131206</FundraisingAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>2249209</TotalAmt>
        <ProgramServicesAmt>2149273</ProgramServicesAmt>
        <ManagementAndGeneralAmt>94206</ManagementAndGeneralAmt>
        <FundraisingAmt>5730</FundraisingAmt>
      </PensionPlanContributionsGrp>
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        <TotalAmt>6173423</TotalAmt>
        <ProgramServicesAmt>5899128</ProgramServicesAmt>
        <ManagementAndGeneralAmt>258567</ManagementAndGeneralAmt>
        <FundraisingAmt>15728</FundraisingAmt>
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      <PayrollTaxesGrp>
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        <ProgramServicesAmt>2716794</ProgramServicesAmt>
        <ManagementAndGeneralAmt>119081</ManagementAndGeneralAmt>
        <FundraisingAmt>7243</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>5642</TotalAmt>
        <ProgramServicesAmt>5642</ProgramServicesAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>11475</TotalAmt>
        <ProgramServicesAmt>11475</ProgramServicesAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>7849760</TotalAmt>
        <ProgramServicesAmt>2619899</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5229861</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>20033</TotalAmt>
        <ProgramServicesAmt>20033</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>188666</TotalAmt>
        <ProgramServicesAmt>129907</ProgramServicesAmt>
        <ManagementAndGeneralAmt>58759</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>24279</ProgramServicesAmt>
        <ManagementAndGeneralAmt>82753</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
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        <ProgramServicesAmt>443</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2058676</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>98857</TotalAmt>
        <ProgramServicesAmt>81312</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17545</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>13987</TotalAmt>
        <ProgramServicesAmt>12768</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1219</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>812663</TotalAmt>
        <ProgramServicesAmt>320037</ProgramServicesAmt>
        <ManagementAndGeneralAmt>492626</ManagementAndGeneralAmt>
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      <DepreciationDepletionGrp>
        <TotalAmt>3636117</TotalAmt>
        <ProgramServicesAmt>3131166</ProgramServicesAmt>
        <ManagementAndGeneralAmt>504951</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>1131266</TotalAmt>
        <ProgramServicesAmt>1038806</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92460</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Drugs/medical supplies</Desc>
        <TotalAmt>15220157</TotalAmt>
        <ProgramServicesAmt>15220157</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Medicaid Enhancement Tax</Desc>
        <TotalAmt>4368931</TotalAmt>
        <ProgramServicesAmt>4368931</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Repairs/maintenance</Desc>
        <TotalAmt>2613621</TotalAmt>
        <ProgramServicesAmt>2227217</ProgramServicesAmt>
        <ManagementAndGeneralAmt>386404</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>ACADEMIC, TEACHING, &amp; MISC SUPPORT</Desc>
        <TotalAmt>368333</TotalAmt>
        <ProgramServicesAmt>116105</ProgramServicesAmt>
        <ManagementAndGeneralAmt>252228</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>459901</TotalAmt>
        <ProgramServicesAmt>66480</ProgramServicesAmt>
        <ManagementAndGeneralAmt>393421</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>103720653</TotalAmt>
        <ProgramServicesAmt>89848174</ProgramServicesAmt>
        <ManagementAndGeneralAmt>13710355</ManagementAndGeneralAmt>
        <FundraisingAmt>162124</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>47496758</BOYAmt>
        <EOYAmt>10778906</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>6658732</BOYAmt>
        <EOYAmt>115551</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
        <BOYAmt>9307270</BOYAmt>
        <EOYAmt>9723654</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
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        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>https://www.alicepeckday.org/patients/billing-financial-assistance</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>https://www.alicepeckday.org/patients/billing-financial-assistance</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>https://www.alicepeckday.org/patients/billing-financial-assistance</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <FAPTranslatedInd>X</FAPTranslatedInd>
        <OtherPublicityInd>X</OtherPublicityInd>
        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>false</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 3E</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 5 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Alice Peck Day Memorial Hospital. During the period October 2023 through December 2024, an assessment of Community Health Needs was completed by Dartmouth Hitchcock Medical Center, Alice Peck Day Memorial Hospital, and Visiting Nurse and Hospice for Vermont and New Hampshire in partnership with Mt. Ascutney Hospital and Health Center, New London Hospital, Cheshire Medical Center, and Valley Regional Hospital with technical support from the New Hampshire Community Health Institute/JSI. The aims of the assessment are to: Better understand the health-related issues and concerns impacting the well-being of area residents; Inform community health improvement plans, partnerships and initiatives; and Guide community benefit activities of Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital and partner organizations. For the purpose of the assessment, the geographic area of interest was 19 municipalities of the Upper Valley region of New Hampshire and Vermont comprising the primary service area of Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital. The total resident population of the primary service area is estimated to be 72,736 people. Methods employed in the assessment included: surveys of community residents made available through social media, email distribution, website links and through paper surveys and collection boxes widely distributed in multiple locations and channels across the region; a direct email survey of community leaders and service providers representing multiple community sectors; a set of eleven community discussion groups convened across the region; and assembly of available population demographics and health status indicators including drivers of health characteristics of the hospital service area communities. Community engagement and information gathering sought to focus assessment activities on vulnerable and disproportionately served populations in the region including populations that could experience limited access to health-related services or resources due to income, age, disability, or social or physical isolation. The quantitative and qualitative information gathered through the different sources and methods was then synthesized to understand different perspectives, identify common themes and inform priorities for improvement. Between February and September 2024, the Community Health Needs Assessment committee fielded two surveys; one with targeted distribution to community leaders and service providers, and one broadly disseminated to residents across the region. The survey instruments were designed to have some questions in common to facilitate comparisons and contrasts in the analysis. The community leader survey was distributed via a unique email link to 350 individuals in positions of leadership in agencies, municipalities, business, civic and volunteer organizations serving the combined service areas of the partner organizations ranging from the Greater Windsor and Claremont area, to the New London and Newport area, and to the Upper Valley communities of New Hampshire and Vermont around Lebanon and White River Junction. The survey distribution list was developed by the planning committee. With the understanding that some organizational leaders may be more familiar with some areas of the wider region than others, the survey instrument asked respondents to identify "the areas you primarily serve or are most familiar with". Nearly all community leader survey respondents indicated the ability to afford housing has gotten worse and a majority of community leader respondents also indicated that affordability of child care and health care services have gotten worse. The community resident survey was distributed electronically through email and social media communication channels, on the Dartmouth Hitchcock Medical Center and Alice Peck Day Memorial Hospital websites, promoted through posters and fliers with links and QR codes posted around the region, and by paper copies made available at a variety of distribution points throughout the region including libraries, clinics, and community meeting spaces. The survey was available in both English and Spanish language. A total of 1,739 community members completed the Community Resident Survey, representing all 19 towns of the primary hospital service area as well as a number of bordering communities. Assessments of community health needs are conducted every three years by Dartmouth Health and partner organizations. Over the course of these assessment cycles, a relatively consistent pattern has been observed with regard to the priority issues and concerns identified for health improvement by the community. Among these priorities have been: cost of health care services including health insurance and prescription drugs; access to behavioral health services including mental health care and substance use treatment; availability of health care services including primary care and medical sub-specialties; senior services and concerns of aging; availability and affordability of dental services; and affordability and availability of basic needs including housing, healthy food and child care. In consideration of this observed consistency over time, the 2025 Community Health Needs Assessment asked respondents to the Community Resident and Community Leader surveys to reflect on a set of statements describing the main priorities and themes identified in the recent past by indicating if there has been improvement or not in those areas. In general, more community residents reported needs getting worse compared to those reporting needs getting better over the last few years in each of the topic areas. A majority of survey respondents indicated that affordability of health care, child care, and housing have gotten worse. Nearly all community leader survey respondents indicated the ability to afford housing has gotten worse and a majority of community leader respondents also indicated that affordability of child care and health care services have gotten worse. Community leaders were somewhat more likely to report that the ability to get substance use treatment has improved, and also ability for older adults to age in place, while community residents were somewhat more likely to indicate that access to sub-specialty medical services has improved.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6a Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Alice Peck Day Memorial Hospital. An assessment of Community Health Needs was completed by Dartmouth Hitchcock Medical Center, Alice Peck Day Memorial Hospital, and Dartmouth Health Home Care in partnership with Mt. Ascutney Hospital and Health Center, New London Hospital, Cheshire Medical Center, and Valley Regional Hospital.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 6b Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Alice Peck Day Memorial Hospital. Technical assistance for the Hospital's 2025 CHNA was provided by the New Hampshire Community Health Institute/JSI.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 11 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - ALICE PECK DAY MEMORIAL HOSPITAL. Alice Peck Day Memorial Hospital's (APDMH) Fiscal Year 2025 Community Health Improvement Plan (CHIP), approved by the Board of Trustees June 2025, is a three-year document that provides a detailed set of strategies for addressing our region's top health and social needs. The 2025 Community Health Needs Assessment (CHNA) addressed the following seven identified priority health needs and issues: 1. Availability of primary care and medical subspecialty services 2. Availability and affordability of dental care services for adults 3. Availability of mental health services 4. Services for older adults including opportunities for social interaction and supports for aging in place 5. Cost of health care services including medications, affordability of health insurance 6. Health and human service workforce shortages and challenges navigating the health care system 7. Social drivers of health and well-being such as affordable access to transportation, housing, healthy foods and affordable child care In alignment with the Community Health Improvement Plan (CHIP), we are addressing access to primary and specialty care through expanded community-based services and coordinated care models. In FY26, an urgent care center was established to increase access to low-cost, non-emergency care and reduce emergency and primary care utilization. We will strengthen collaboration with community nurse programs and continue Mobile Integrated Health services to expand care outside the hospital. Community screenings, health fairs, and prevention programming will support early risk identification, improve health literacy, and connect individuals to care. We are advancing value-based and collaborative care models to improve specialty access, chronic disease management, and outcomes. We are expanding oral health access through the Upper Valley Smiles school-based program and regional partnerships, including mobile Medicaid dental services. Preventive care such as fluoride varnish and silver diamine fluoride will be integrated into clinical settings. We will also expand virtual Medicaid dental intake, including MAT patients, to improve access, reduce stigma, and support recovery. These efforts improve prevention, early intervention, and affordability of dental care. To address behavioral health needs, we are expanding integrated screening and treatment for mental health and substance use in primary care, with timely referral and on-site support. Workforce behavioral health supports will continue, with evaluation of trauma-informed programs for high-risk groups. Collaboration with schools and community partners will expand to pediatric and vulnerable population access. We are also increasing access to medication-assisted treatment, naloxone distribution, and prevention programs to support early intervention and improved coordination of care. For older adults, we are strengthening coordination with community partners to support aging in place. Services include home-based primary care, emergency department follow-up, and caregiver support. Volunteer and engagement programs such as Elder Friends will reduce isolation and increase social connection. We will also support aging-focused education and collaboration to improve care models and outcomes. Every patient at APDMH is screened annually for Social Determinants of Health, including substance use (prevention, treatment, and recovery), access to dental care, and socioeconomic factors such as housing, wages, and childcare. Patients with identified needs are referred to social work services. We screen all Primary Care patients ages 0- 18 years of age for food insecurity during annual wellness visit, and all Emergency Room patients 70 years and older. For patients who screen positive for food insecurity and request support offer non-perishable food bags, APD Alice Cafe Meal Cards, Farmers Market vouchers and automated eDH (APD electronic medical record) referral to Women, Infant and Children (WIC) in certain patient populations. Review and continuously improve APD's in-patient and outpatient-Alice Cafe -menu with affordable and healthier food choices. APD will Continue to make Alice Cafe available to community residents. APDMH partners with the Hartford Community Coalition to provide a free summer lunch program for children in low-income housing in Lebanon, NH and Hartford, VT, work with LISTEN Community Services, provide Pop Up Health Clinics (Hosted by DHMC/Community Nurses) and City of Lebanon Seasonal Winter Shelter; Collaborate Upper Valley Haven and Willing Hands in close collaboration with DH system.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 13 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - Alice Peck Day Memorial Hospital. APDMH HAS A SEPARATE UNINSURED DISCOUNT POLICY THAT OUTLINES HOW THE DISCOUNT IS CALCULATED ANNUALLY AND IS APPLIED PRIOR TO BILLING ANY UNINSURED PATIENT. THIS ASSURES A PATIENT IS NOT BILLED AT AN AMOUNT GREATER THAN THE AMOUNT GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS POLICY IS REFERENCED IN THE FINANCIAL ASSISTANCE POLICY.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16 Facility , 1</FormAndLineReferenceDesc>
        <ExplanationTxt>Facility , 1 - ALICE PECK DAY MEMORIAL HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON APDH'S WEBSITE, INCLUDING THE VERBATIM POLICY AND A SHORTER, MORE PATIENT-FRIENDLY PLAIN-LANGUAGE SUMMARY. APDMH PROVIDES THE PLAIN LANGUAGE SUMMARY BROCHURE TO ALL INPATIENTS, EMERGENCY DEPARTMENT INTAKES, UNINSURED, AND SELF-PAY INDIVIDUALS. APDMH CONTINUES TO NOTIFY PATIENTS ON THE BACK OF THE BILLING STATEMENT ABOUT FINANCIAL ASSISTANCE AVAILABLE TO THEM. ADDITIONALLY, APDMH POSTS INFORMATION ABOUT THE POLICY IN PUBLIC AREAS THROUGHOUT THE FACILITIES INCLUDING ADMISSION OFFICES, PUBLIC AREA BOARDS THROUGHOUT THE FACILITIES, THE EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE POLICY BROCHURES IN PATIENT AREAS. APDMH SCREENS 100% OF UNINSURED INPATIENT AND SAME-DAY PATIENTS PRIOR TO ADMISSION. AS PART OF THIS PROCESS, APDMH CHECKS ALL STATE AND FEDERAL PROGRAMS TO SEE IF INDIVIDUALS ARE ELIGIBLE FOR ASSISTANCE. PATIENTS ARE ALSO SCREENED TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE AND THE APPLICATION IS PROVIDED AND/OR COMPLETED AT THIS TIME.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>7</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Neurosurgery Services at APD (NSAPD)</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>106 Hanover Street</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>Neurosurgery Physician Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>RAM Center for Community Care</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>5 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>Primary Care Physician Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>APD Orthopaedic Clinic</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>9 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>Orthopaedic Physician Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Women's Care Center</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>9 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>OB/GYN Physician Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>General Surgery Clinic</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>9 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>General Surgery Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Pain Management Clinic</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>9 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>Pain Management Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>Occupational Health Services</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>9 Alice Peck Day Drive</AddressLine1Txt>
            <CityNm>Lebanon</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03766</ZIPCd>
          </USAddress>
          <FacilityTxt>Occupational Health Physician Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG</FormAndLineReferenceDesc>
        <ExplanationTxt>APDMH USES THE FPG GUIDELINES IN DETERMINING THE INITIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED. IN ADDITION, APDMH ALLOWS FOR CATASTROPHIC ASSISTANCE CONSIDERATION BASED ON A CALCULATION OF 10% OF TWO YEARS INCOME PLUS 10% OF AMOUNT OVER SHELTERED ASSETS. IF THE PROJECTED OR CURRENT SELF-PAY BALANCE IS GREATER THAN THIS CALCULATION, THE SELF-PAY BALANCE IS REDUCED TO THE SUM OF 10% OF TWO YEARS INCOME PLUS 10% OF ASSETS. EACH HOUSEHOLD IS ALLOWED CERTAIN SHELTERED ASSETS WHICH ARE NOT USED WHEN CALCULATING HOUSEHOLD INCOME OR ASSETS SAVINGS IS SHELTERED UP TO 100% OF FPL BASED ON FAMILY SIZE, EQUITY IN PRIMARY RESIDENCE UP TO $200,000 UP TO 55 AND $250,000 FOR AGED 55 AND OLDER, AND A RETIREMENT SHELTER OF UP TO $100,000 IN RETIREMENT ASSETS AS LONG AS IT IS EMPLOYER BASED CONTRIBUTIONS IF WORKING OR IRA IF SELF-EMPLOYED. IF A PATIENT IS RETIRED, PRIOR RETIREMENT ACCOUNTS WOULD BE INCLUDED AS A SHELTERED ASSET.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7g Subsidized Health Services</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE WERE NO AMOUNTS REPORTED ON 7g</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE TO COST-TO-CHARGES FOR LINES 7A AND 7B. LINES 7E, 7F, AND 7I ARE BASED ON ACTUAL COSTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part II Community Building Activities</FormAndLineReferenceDesc>
        <ExplanationTxt>ALICE PECK DAY MEMORIAL HOSPITAL ACTIVELY SUPPORTS RURAL HEALTH, ECONOMIC DEVELOPMENT, TRANSPORTATION, AND OUTDOOR RECREATION. STAFF MEMBERS PROVIDE LEADERSHIP PARTICIPATION IN THE UPPER VALLEY BUSINESS ALLIANCE, THE FOUNDATION FOR HEALTHY COMMUNITIES, THE RURAL HEALTH COALITION, THE ADVOCACY TASK FORCE, AND THE NEAH. APDMH SPONSORS ADVANCE TRANSIT, A NOT-FOR-PROFIT CHARITABLE ORGANIZATION PROVIDING FREE TRANSIT IN VERMONT AND NEW HAMPSHIRE WITH THE GOAL OF REDUCING TRAFFIC CONGESTION. APD ALSO WORKS TO BE PROACTIVE CONCERNING DISASTER READINESS. STAFF HAVE PARTICIPATED IN ONSITE TRAINING FOR DISASTER PREPAREDNESS AS WELL AS OFF-SITE TRAINING WITH OTHER REGIONAL HOSPITALS. COLLABORATIVE EFFORTS INCLUDE ALL HAZARD REGIONAL TRAINING, EMERGENCY RESPONSE TRAINING, AND A REGIONAL MASS CASUALTY RESPONSE PROGRAM TO HELP FACILITATE COOPERATIVE EFFORTS IF SUCH NEEDS ARISE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount</FormAndLineReferenceDesc>
        <ExplanationTxt>AS A RESULT OF ACCOUNTING GUIDANCE (STATEMENT 15 AND ASC 606), BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 3 Bad Debt Expense Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>Bad Debt is not treated as an expense due to accounting guidance (Statement 15 and ASC 606). As a result, an amount attributable to patients eligible under the organization's financial assistance policy is unable to be reasonably estimated.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>APDMH IS INCLUDED IN THE DARTMOUTH-HITCHCOCK HEALTH AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS. AS A RESULT OF the adoption of ASC 606, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDE AS A REDUCTION IN NET PATIENT REVENUE. THEREFORE, THERE IS NO SEPARATE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 8 Community benefit &amp; methodology for determining medicare costs</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COSTING METHODOLOGY WAS COMPLETED ACCORDING TO GUIDANCE PROVIDED BY THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>The bad debts collection policy applies to all patient accounts in a consistent manner. The policy specifically indicates that, after a second statement is sent with no payment received, a patient accounts representative will contact the patient by phone to determine if a financial assistance application or payment plan is appropriate. This is completed to avoid further escalation of past due account(s) if the patient may qualify for full or partial relief under the charity care policy. If the application is successful, then the qualifying balance or balances are classified as charity care and no longer pursued for collections. Once a patient balance is classified as charity care, it is not subject to collection activities. Alice Peck Day is committed to helping our patients obtain quality healthcare, regardless of ability to pay. Our financial assistance programs encourage and enable our patients to make healthcare decisions free of financial barriers. We educate our patients about our programs and provide assistance prior to their receiving services, at registration for services, and during our billing process to ensure that any and all patients in need of assistance are provided with the help they qualify for under APDMH programs. Brochures and signs are placed in high traffic areas such as the ER and registration. Our staff is trained to identify patients during registration, provide information, and offer assistance in completing the necessary forms. During our billing process, calls are made to patients with outstanding balances. APDMH staff work with patients to identify problems they are facing in dealing with outstanding balances. Patients are notified again of the many types of financial assistance available for which they may qualify. Programs are explained and assistance is offered, if needed, in completing the applications. Due to this multi-level approach and staff that is trained to identify clients who may need financial assistance, very few qualifying patients reach the point of bad debt. Our collection policies and procedures, in conjunction with our small size, allow our organization to place great emphasis on helping all patients who may be in need to apply for, and obtain, the appropriate level of financial assistance.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16a FAP website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Alice Peck Day Memorial Hospital: Line 16a URL: https://www.alicepeckday.org/patients/billing-financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16b FAP Application website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Alice Peck Day Memorial Hospital: Line 16b URL: https://www.alicepeckday.org/patients/billing-financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part V, Section B, Line 16c FAP plain language summary website</FormAndLineReferenceDesc>
        <ExplanationTxt>- Alice Peck Day Memorial Hospital: Line 16c URL: https://www.alicepeckday.org/patients/billing-financial-assistance;</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 2 Needs assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>Every three years, APDMH conducts a Community Health Needs Assessment (CHNA). We partner with Dartmouth-Hitchcock Health member organizations and other healthcare institutions to identify top community health needs in our region. The assessment includes a community survey, discussion groups, conversations with key stakeholders, analysis of population demographics, and health status indicators. All information-collection activities and analyses sought to focus assessment activities on vulnerable and disproportionately-served populations in the region including populations that could experience limited access to healthrelated services or resources due to income, age, disability, and social or physical isolation. Enhanced efforts were made to understand the needs of these populations through targeted surveys and community conversations including facilitated surveys and discussions at community suppers, a regional free clinic, homeless programs, and other community settings serving economically-vulnerable residents. The CHNA allows APDMH to strategically allocate resources to best meet community needs and improve community health.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 3 Patient education of eligibility for assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>Alice Peck Day believes that quality health care should be available to all, regardless of ability to pay. Our financial assistance programs and staff are dedicated to helping people obtain the care they need. We reach out to our patients in many different ways to ensure that they are aware that help is available and to help guide them through the process. Brochures and signage are posted in high traffic areas such as the emergency room, registration, and the lobby. Registration staff are trained to identify patients who may be in need of financial assistance. Once identified, staff notify the patient that APDMH has various forms of financial assistance and explain that assistance is available for anyone who might require help or guidance in completing any necessary paperwork. In addition to the above, our billing staff are trained to help identify and offer assistance to anyone who might require financial assistance. Patients with outstanding claims are contacted by our credit coordinator who works with them to clear up balances through the variety of programs we offer. Assistance is also provided in applying for federal/state programs to those who qualify. Specially trained staff guide applicants through the process to ensure forms are filled out correctly, all required documentation is attached, and the applicants understand what they can expect to happen along the way.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 4 Community information</FormAndLineReferenceDesc>
        <ExplanationTxt>Alice Peck Day Memorial Hospital is part of the Lebanon Health Care service area. The Lebanon service area comprises cities and towns in New Hampshire and Vermont. APDMH's service area in NH comprises 15 towns in addition to the city of Lebanon, including Canaan, Cornish, Croydon, Dorchester, Enfield, Grafton, Grantham, Hanover, Lyme, Newport, Orange, Orford, Piermont, Plainfield, and Warren. Vermont towns include East Thetford, Fairlee, Hartford, Hartland, North Hartland, North Thetford, Norwich, Post Mills, Quechee, Sharon, South Strafford, Strafford, Thetford, Thetford Center, Vershire, West Vershire, West Fairlee, West Hartford, White River Junction and Woodstock. Demographics: Age: According to the 2020 United States Census Bureau, the population of the APDMH Service Area is 69,612. It is slightly older on average than the New Hampshire and Vermont populations. 20% of the service area is over the age of 65, compared the statewide percentages of 17.5% in New Hampshire and 18.8% in Vermont. Income and poverty: 7.3% of households in the hospital service area have incomes under the 100% poverty level. There is a significant range of median household income between communities ranging from $52,128 to $137,344. Education: A higher proportion of the hospital service area (94.7%) have earned at least a high school diploma or equivalent compared to New Hampshire (93.1%) and Vermont (92.7%) overall. Language: The percent of the hospital service area, ages 5 or higher, who report speaking English "less than very well" is 0.9%, compared with a statewide rate of 1.4% in New Hampshire and 0.8% in Vermont. Health Insurance coverage: 4.9% of the total service area population does not have health insurance. The statewide percentage for New Hampshire is 5.9% and for Vermont it is 4.0%.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule H, Part VI, Line 5 Promotion of community health</FormAndLineReferenceDesc>
        <ExplanationTxt>APDMH PROVIDES FINANCIAL SUPPORT, ADMINISTRATIVE COORDINATION, AND VOLUNTEER RECRUITMENT SERVICES TO THE LEBANON COMPONENT OF THE TAKE A BITE OUT OF HUNGER PROGRAM, WHICH PROVIDES FREE MEALS DURING THE SUMMER MONTHS TO CHILDREN LIVING IN SUBSIDIZED HOUSING LOCATIONS. APDMH'S COMMUNITY HEALTH DEPARTMENT'S STAFF ARE WELL KNOWN IN THE REGION FOR UPPER VALLEY SMILES, A UNIQUE SCHOOL-BASED ORAL HEALTH PROGRAM FOR LOW-INCOME ELEMENTARY SCHOOL CHILDREN ENROLLED IN TEN SCHOOLS ACROSS THE UPPER VALLEY. THE APDMH DENTAL TEAM VISITS EACH SCHOOL ANNUALLY, PROVIDING CLASSROOM ORAL HEALTH EDUCATION, DENTAL SCREENINGS, FLUORIDE VARNISH, SEALANTS, DECAY-STOPPING FLUORIDE TREATMENTS, AND INTERIM THERAPEUTIC RESTORATIONS, ALL AT NO COST TO PARENTS. THESE COMMUNITY HEALTH PROGRAMS ARE SUPPLEMENTED BY THE IN-KIND CONTRIBUTION OF MEDICAL STAFF TIME, PRIVILEGES, AND EXPERTISE, TO SUPPORT THESE STRATEGIES AND OPPORTUNITIES, WORKING TOGETHER TO IMPROVE THE LIVES OF THOSE IN THE AREA. APDMH partnered with the Carter Community Building Association (CCBA) in Lebanon, New Hampshire, and the Upper Valley Aquatic Center (UVAC) in White River Junction, Vermont, to offer this program. APDMH pays for the gym memberships and other associated costs. There is no cost to our patients. APDMH also provides financial support, administrative coordination, and volunteer recruitment services to the Lebanon component of the Take a Bite Out of Hunger program, which provides free meals during the summer months to children living in subsidized housing locations. APDMH's Community Health Department's staff are well known in the region for Upper Valley Smiles, a unique school-based oral health program for low-income elementary school children enrolled in ten schools across the Upper Valley. The APDMH dental team visits each school annually, providing classroom oral health education, dental screenings, fluoride varnish, sealants, decay-stopping fluoride treatments, and interim therapeutic restorations, all at no cost to parents. These community health programs are supplemented by the in-kind Contribution of medical staff time, privileges, and expertise, to support these strategies and opportunities, working together to improve the lives of those in the area. More than half of the APDMH Board of Trustees are independent of APD and the Dartmouth-Health system and reside within the community service area, supporting the health of the local communities. APDMH EXTENDS PROFESSIONAL STAFF PRIVILEGES TO QUALIFIED AND APPROPRIATE PHYSICIANS WHO ARE EMPLOYEES OF DARTMOUTH HITCHCOCK CLINIC, MARY HITCHCOCK MEMORIAL HOSPITAL, AND DARTMOUTH COLLEGE, WHO ALSO HOLD A FACULTY APPOINTMENT AT GEISEL SCHOOL OF MEDICINE.</ExplanationTxt>
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        <ExplanationTxt>Alice Peck Day Memorial Hospital is a critical access hospital located in Lebanon, NH. APDMH IS a member of the Dartmouth-Hitchcock Health System (D-HH) WHICH INCLUDES MARY HITCHCOCK MEMORIAL HOSPITAL, DARTMOUTH-HITCHCOCK CLINIC, AND OTHER RELATED ORGANIZATIONS WHOSE PRIMARY MISSION IS HEALTH CARE. MARY HITCHCOCK MEMORIAL HOSPITAL (MHMH) IN LEBANON IS NEW HAMPSHIRE'S LARGEST HOSPITAL. IN FISCAL YEAR 2025 MHMH HAD 461 LICENSED INPATIENT BEDS. THE DARTMOUTH-HITCHCOCK CLINIC (DHC) IS A MULTI-SPECIALTY PHYSICIAN PRACTICE WITH A NETWORK OF PROVIDERS ACROSS NEW HAMPSHIRE AND VERMONT. WHILE DHC'S MAIN OFFICES ARE LOCATED IN LEBANON, THE CLINIC ALSO HAS MULTI-SPECIALTY PRACTICES IN MANCHESTER, NASHUA, CONCORD, AND KEENE, NH AREAS AS WELL AS BENNINGTON, VT. IN ADDITION, THE CLINIC PROVIDES PRIMARY CARE IN RURAL COMMUNITIES IN VERMONT AND NORTHERN NEW HAMPSHIRE. THE HOSPITAL AND CLINIC OPERATE JOINTLY THROUGH INTERLOCKING DIRECTORATES, STRATEGIC PLANNING AND MANAGEMENT AND SHARE IDENTICAL MISSIONS. THE MEDICAL SCHOOL, WHICH WORKS CLOSELY WITH THE HOSPITAL AND CLINIC, IS FOCUSED ON MEDICAL EDUCATION AND RESEARCH</ExplanationTxt>
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        <ExplanationTxt>NH</ExplanationTxt>
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        <PersonNm>Jean Ten Haken MSN RN CENP</PersonNm>
        <TitleTxt>CNO/COO</TitleTxt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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        <PersonNm>Paula Seaman</PersonNm>
        <TitleTxt>Chief Nursing Officer (as of 7/1/24)</TitleTxt>
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        <PersonNm>Ivan Tomek MD</PersonNm>
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        <PersonNm>John S Houde MD</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Diane Riley MD CAQSH</PersonNm>
        <TitleTxt>Ortho Surgeon Hand Specialist</TitleTxt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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        <PersonNm>Sari Galanes</PersonNm>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Annika Brown</PersonNm>
        <TitleTxt>Medical Director - Primary Care</TitleTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A NONQUALIFIED RETIREMENT PLAN (WHICH ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B (III)): David Duncan $431 Patrick Jordan $73,201 Christopher Hubble $3,600 Scott Rodi $23,741 Brenda Blair $2,617</ExplanationTxt>
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        <BondIssuedDt>2025-05-28</BondIssuedDt>
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        <ProceduresCorrectiveActionInd>true</ProceduresCorrectiveActionInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part I BOND A</FormAndLineReferenceDesc>
        <ExplanationTxt>The proceeds of this bond issue benefited the following subsidiaries of Dartmouth-Hitchcock Obligated group - Dartmouth-Hitchcock Health (EIN: 26-4812335), Alice Peck Day Memorial Hospital (EIN: 02-0222791), Mary Hitchcock Memorial Hospital (EIN: 02-0222140), Cheshire Medical Center (EIN: 02-0354549), Valley Regional Hospital, Inc. (EIN: 02-0222118), and Dartmouth-Hitchcock Clinic (EIN: 22-2519596). The portion of the issue that has been loaned to each subsidiary is being reported on that subsidiary member's schedule K.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule K, Part II, Line 11 BOND A</FormAndLineReferenceDesc>
        <ExplanationTxt>Part II Bond A Line 11: The Other Spent Proceeds are the refunding proceeds of the issue no longer in escrow.</ExplanationTxt>
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        <NoncashContributionsRptF990Amt>35700</NoncashContributionsRptF990Amt>
        <MethodOfDeterminingRevenuesTxt>Market value</MethodOfDeterminingRevenuesTxt>
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      <Form8283ReceivedCnt>0</Form8283ReceivedCnt>
      <AnyPropertyThatMustBeHeldInd>false</AnyPropertyThatMustBeHeldInd>
      <ReviewProcessUnusualNCGiftsInd>false</ReviewProcessUnusualNCGiftsInd>
      <ThirdPartiesUsedInd>false</ThirdPartiesUsedInd>
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        <FormAndLineReferenceDesc>Schedule M, Part I Explanations of reporting method for number of contributions</FormAndLineReferenceDesc>
        <ExplanationTxt>Securities - Publicly traded - THE ORGANIZATION REPORTS THE NUMBER OF INDIVIDUAL ITEMS RECEIVED DURING THE FISCAL YEAR.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a PROGRAM SERVICE DESCRIPTION (continued)</FormAndLineReferenceDesc>
        <ExplanationTxt>Founded in 1932 and a member of the Dartmouth Health system since 2016, APD's areas of clinical excellence include surgical services, primary care, geriatric care, and emergency services. In FY2025, Alice Peck Day Memorial Hospital (APD) was recognized as an Age-Friendly Health System by an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement. Our hospital was recognized by the American Heart Association for excellence in stroke and heart disease care, and was named by U.S. News &amp; World Report to its 2024-2025 Best Hospitals as a High Performing hospital for Hip Replacement. APD became the first critical access hospital in the U.S. to earn Level 1 Geriatric ED accreditation, and our emergency department received Press Ganey Guardians of Excellence recognition. Our nurse residency program became the first in New Hampshire to receive Practice Transition Accreditation Program national accreditation. APD is a GUIDE participant (Guiding an Improved Dementia Experience), an initiative of the Centers for Medicare and Medicaid Services. APD's mission is to improve the health and well-being of the community. Our vision is to build a healthier community, one connection at a time. Our values include kindness, community, service, and partnership. APD employed 41 providers in FY25, of which 21 were primary care, 2 pediatric, and 18 were providers in other specialties. During FY25, APD had a total of 2,443 patient discharges consisting of 7,159 patient days. We also had 14,715 emergency department visits in FY25. APD is open 24 hours a day and 7 days a week.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 1a Delegate broad authority to a committee</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Committee of the Board consists of all board officers. The committee has the power to transact all regular business of the Corporation during the period between the meetings of the Board, subject to the powers reserved to the Member and any limitations imposed by the Board.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 2 Family/business relationships amongst interested persons</FormAndLineReferenceDesc>
        <ExplanationTxt>SUSAN MOONEY AND CLAYTON ADAMS - Business relationship</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>The Membership of the corporation shall consist of Dartmouth-Hitchcock health (D-HH) as the sole member.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The Member will retain the reserved power to appoint without limitation one-third of the Trustees (which appointees, before final appointment by Member, will be discussed with the Board Chair and other Trustees selected by the Chair for their input). The D-H/D-HH CEO or designee will serve on the Board ex officio, with full voting rights, and will count toward the one-third membership appointed by Member.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>DARTMOUTH-HITCHCOCK HEALTH (D-HH) IS THE SOLE CORPORATE MEMBER OF Alice Peck Day Memorial Hospital. D-HH HAS SPECIFIC AUTHORITY AND RESERVED POWERS, INCLUDING the power to: * Initiate and/or approve or disapprove all material governance, programmatic and financial decisions of the APD board of trustees; * Appoint without limitation one-third of the APD board of trustee members; * Ratify the two-thirds membership of the APD Board of trustees members which APD board of trustees has the right to nominate; * Remove by a vote of two-thirds any APD trustee; * Approve borrowings and dispositions of material assets; * Approve any key strategic relationships between APD and other organization; * Initiate and approve all operating and capital budgets and strategic plans; * Approve all policies relating to academic and research programs and affiliations; * Allocate the non-donor restricted assets and resources of APD and D-HH as appropriate to serve the overall best interest of the D-HH System; * Except as limited by the affiliation agreements, to appoint, evaluate the performance of, and terminate the APD CEO; * Approve any proposed amendment or repeal of the Articles of Agreement or Bylaws; * Approve the dissolution or liquidation of APD, following such approval by the APD Board of Trustees.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>Prior to filing, the completed form 990 is made available to the Finance Committee on a secure website. The Chair of the Finance Committee advises the Finance Committee members to review the Form 990 for content and raise any issues with Board Leadership or Management. The Chair of the Finance Committee then advises the Chair of the Board and the full Board that Form 990 is available for their review to enable a detailed and conscientious review by the full Board. All questions and concerns are addressed by the Chief Executive Officer and are incorporated into the Form 990 as deemed appropriate. Management files the final Form 990 with the Internal Revenue Service as required after the above review is concluded.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>ALICE PECK DAY HOSPITAL IS A MEMBER OF THE Dartmouth Hitchcock Health (D-HH) Compliance Advisory Group which provides oversight for audit and compliance matters related to the D-HH System. D-HH COMPLIANCE AND AUDIT SERVICES REQUIRES ANNUAL DISCLOSURE OF ANY POTENTIAL CONFLICTS OF INTEREST and CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, ANY CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS, IN FACT, FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a Process to establish compensation of top management official</FormAndLineReferenceDesc>
        <ExplanationTxt>The Human Resources Committee of the Alice Peck Day Memorial Hospital Board of Trustees is responsible for determining the compensation of the Chief Executive Officer/President. The Chief Administrative Officer or her designee provides compensation data of comparable organizations with approximately the same size staff and spending in a location of similar size. The committee determines the appropriate compensation and approves an amount that is then communicated to Human Resources for adjustment. Dartmouth-Hitchcock Health reviews the compensation of the CEO/President in addition to the process described above. A review was last completed in FY25.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b Process to establish compensation of other employees</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO/President is responsible for reviewing the performance of senior management staff. The information is brought to the Human Resource Committee of the Board of Trustees along with a recommendation for the salary of each individual. The compensation is determined through a variety of analysis of salary data and performance. Individual salary increases are then based on overall performance, within budgeted increases for the organization. The Human Resources committee approves the base compensation and salary increase amount. A review was last completed in FY25.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9 Other changes in net assets or fund balances</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Assets Transferred or Released from Restriction - -481141; Total - -481141;</ExplanationTxt>
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          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>10 Alice Peck Day Drive</AddressLine1Txt>
          <CityNm>Lebanon</CityNm>
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        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <BusinessNameLine1Txt>Dartmouth-Hitchcock Clinic</BusinessNameLine1Txt>
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        </USAddress>
        <EIN>222519596</EIN>
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        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
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          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <BusinessNameLine1Txt>Mary Hitchcock Memorial Hospital</BusinessNameLine1Txt>
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          <CityNm>Lebanon</CityNm>
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        </USAddress>
        <EIN>020222140</EIN>
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        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
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        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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        <DisregardedEntityName>
          <BusinessNameLine1Txt>The New London Hospital Association Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <AddressLine1Txt>273 County Road</AddressLine1Txt>
          <CityNm>New London</CityNm>
          <StateAbbreviationCd>NH</StateAbbreviationCd>
          <ZIPCd>03257</ZIPCd>
        </USAddress>
        <EIN>020222171</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Windsor Hospital Corporation</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>289 Country Road</AddressLine1Txt>
          <CityNm>Windsor</CityNm>
          <StateAbbreviationCd>VT</StateAbbreviationCd>
          <ZIPCd>05089</ZIPCd>
        </USAddress>
        <EIN>030183721</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VT</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Cheshire Medical Center</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>580 Court Street</AddressLine1Txt>
          <CityNm>Keene</CityNm>
          <StateAbbreviationCd>NH</StateAbbreviationCd>
          <ZIPCd>03431</ZIPCd>
        </USAddress>
        <EIN>020354549</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VALLEY REGIONAL HEALTHCARE INC</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>243 ELM STREET</AddressLine1Txt>
          <CityNm>CLAREMONT</CityNm>
          <StateAbbreviationCd>NH</StateAbbreviationCd>
          <ZIPCd>03743</ZIPCd>
        </USAddress>
        <EIN>020397338</EIN>
        <PrimaryActivitiesTxt>SUPPORTING ORGANIZATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NH</LegalDomicileStateCd>
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        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Dartmouth Health Home Care Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <CityNm>WHITE RIVER JUNCTION</CityNm>
          <StateAbbreviationCd>VT</StateAbbreviationCd>
          <ZIPCd>05001</ZIPCd>
        </USAddress>
        <EIN>036006494</EIN>
        <PrimaryActivitiesTxt>Home Health and Hospice Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>VT</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>D-HH</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>true</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>true</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>true</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>true</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>true</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>true</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>true</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>true</TransferFromOtherOrgInd>
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        <OtherOrganizationName>
          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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        <TransactionTypeTxt>Q</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>Book</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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        <TransactionTypeTxt>O</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>Book</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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      </TransactionsRelatedOrgGrp>
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        <OtherOrganizationName>
          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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        <TransactionTypeTxt>A</TransactionTypeTxt>
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        <MethodOfAmountDeterminationTxt>Book</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Alice Peck Day Lifecare Center Inc</BusinessNameLine1Txt>
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        <InvolvedAmt>366925</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Book</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>