2024-05-13T12:47:39+00:00 2023-06-30 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402413902 990 2022-07-01 020222791 Alice Peck Day Memorial Hospital ALIC 6034483121 10 Alice Peck Day Drive Lebanon NH 03766 Susan E Mooney President & CEO 2024-05-13 true Todd Roberts 999009999 Kim Scifres P01316095 5023263996 2022 2023-04-26 12:10:37Z Susan E Mooney MD MS 10 Alice Peck Day Drive Lebanon NH 03766 105043692 false X www.alicepeckday.org X 1943 NH To improve the health and wellbeing of our community. 17 9 707 39 11764 598 1990642 2845272 101009627 100955821 52573 408974 538201 833625 103591043 105043692 7545 26883 0 0 53568608 57954276 0 0 433200 36541890 37578770 90118043 95559929 13473000 9483763 122096031 126644590 66776810 60454188 55319221 66190402 To improve the health and wellbeing of our community. false false 83848352 26883 101613204 Alice Peck Day Memorial Hospital (APD) is a community-based critical access hospital operating in Lebanon, NH. It is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code (Code) and is exempt from federal income taxes on related income, pursuant to Section 501(a) of the Code. APD operates as an integral component of (and is fully owned by) Dartmouth-Hitchcock Health (D-HH), a New Hampshire not-for-profit corporation organized to support medical organizations like APD. 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, sleep health, and emergency services.In 2023, Alice Peck Day Memorial Hospital was listed as the #3 hospital in New Hampshire by Newsweek; received top marks from Becker's Hospital Review as one of the best hospitals for nurse communication, physician communication, and staff responsiveness; and was named by U.S. News & World Report to its 2023-2024 Best Hospitals as a High Performing hospital for Hip Replacement. 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 FY23, of which 19 were primary care, 3 were in pediatrics, and 19 were providers in other specialties. During FY23, APD had a total of 965 patient discharges consisting of 6,174 patient days. We also had 11,373 emergency department visits in FY23, open 24 hours a day, 7 days a week.. 83848352 true true false true false false false false true true true false true true false false true false false false false false false false false true true true false true true false false false false false false false false false false true false false false false true true true false false true 77 0 true 707 true true true false false false false false false false false false false false X 17 9 false false false false true true true true true false false true true true true true true true true false NH X Todd Roberts 6034483121 10 Alice Peck Day Drive Lebanon NH 03766 Charles J Wheelan PhD MPA Trustee / Vice Chair (as of 1/1/23) 0.5 0 X X 0 0 0 Clayton R Adams MBA Trustee / Treasurer 2.0 0 X X 0 0 0 Greg W Lange MS Trustee / Chair (through 12/31/22) 2.0 0 X X 0 0 0 Jennifer Sage Schiffman MPH Trustee / Secretary 0.5 0 X X 0 0 0 Laura Greer MD Trustee/Medical Staff President/ExOfficio (as of 1/1/23) 40.0 0 X X 223252 0 10758 Marisa D Devlin Trustee/Vice Chair (through 12/31/22)/Chair (as of 1/1/23) 2.0 0 X X 0 0 0 SUSAN MOONEY MD MS FACOG TRUSTEE/PRESIDENT/CEO APDMH 38.0 2.0 X X 431970 0 45382 Anna Adachi-Mejia PhD Trustee (as of 1/1/23) 0.5 0 X 0 0 0 Chelsea Paige Trustee (as of 1/1/23) 0.5 0 X 0 0 0 Cybele M Merrick MA MS Trustee 0.5 0 X 0 0 0 David F Duncan Trustee 0.5 40.5 X 0 309143 45557 Ellesse-Roselee Akr Trustee (as of 1/1/23, resigned 3/30/23) 0 X 0 0 0 GEORGE T BLIKE MD MHCDS Trustee 0.5 21.0 X 0 154960 11234 Gerard Duprat JR MD FRCP Trustee 0.5 0 X 0 0 0 Jenny H Barba MBA MHSA Trustee 0.5 0 X 0 0 0 Kyle Fisher MBA Trustee (through 8/31/22) 0.5 0.5 X 0 0 0 Patrick F Jordan III MBA Trustee 0.5 42.5 X 0 829011 69885 Phillip Collins MD Ex-Officio (Through 12/31/22)/President Med Staff 40.0 0 X 212226 0 39853 Sara L Kobylenski MSW Trustee 0.5 2.0 X 0 0 0 SCOTT W RODI MD MPH Trustee 0.5 40.0 X 0 509984 74529 Sloane Mayor AIA Trustee 0.5 0.5 X 0 0 0 Tina E Naimie CPA MSA MHCDS Trustee 1.0 41.0 X 0 313173 31562 MICHAEL T LYNCH MD MBA Chief Medical Officer 40.0 0 X 360478 0 10516 TODD ROBERTS VP Finance 38.0 2.0 X 188301 0 44384 DALE C VIDAL MD MS Executive Director MSC 40.0 0 X 526166 0 51166 JEAN TEN HAKEN MSN RN CENP CNO/COO 40.0 0.5 X 246927 0 23268 BRIAN LOMBARDO MD PHYSICIAN 40.0 0 X 261086 0 41090 DIANE RILEY MD CAQSH Ortho Surgeon Hand Specialist 40.0 0 X 450013 0 42694 IVAN TOMEK MD General Orthopedic Surgeon 40.0 0 X 573288 0 46905 JOHN P HOUDE MD Physician 40.0 0 X 529429 0 51804 Peter Loescher Physician 40.0 0 X 265152 0 50712 Brenda L Blair Former VP & COO 0.0 40.0 X 0 343522 58603 4268288 2459793 749902 70 true true false MARY HITCHCOCK MEMORIAL HOSPITAL ONE MEDICAL CENTER DR LEBANON NH 03756 HEALTHCARE STAFFING 6389360 AMERICAN HEALTHCARE SERVICES ASSN PO BOX 945 TRAVERSE CITY MI 49685 HEALTHCARE STAFFING 3671120 ENGELBERTH CONSTRUCTION 150 WATER TOWER CIRCLE COLCHESTER VT 05446 CONSTRUCTION CONTRACTORS 3558519 CONIFER REVENUE CYCLE SOLUTIONS LLC 14201 Dallas Pkwy DALLAS TX 75254 Healthcare Staffing 3331764 UVNN 106 HANOVER ST LEBANON NH 03766 SERVICES 3218829 14 342367 2502905 16083 2845272 Patient Services 622110 98694305 98694305 Nutritional Services 722210 178965 178965 PHARMACY SALES 446100 2082551 2082551 0 0 0 0 100955821 408974 11764 397210 176242 176242 0 176242 176242 0 0 PURCHASE REBATES AND DISCOUNTS 622110 219607 219607 MISCELLANEOUS 622110 437776 437776 0 0 0 0 657383 105043692 101613204 11764 573452 26883 26883 2806567 1350831 1430315 25421 46689754 44332636 2009315 347803 1435076 1366110 58790 10176 4740318 4512511 194193 33614 2282561 2172867 93508 16186 9182 9182 11475 11475 6551827 2609824 3942003 0 62423 62188 235 225916 126789 99127 249822 860 248962 2405272 2282527 122745 104941 70878 34063 805097 344879 460218 3372417 2805573 566844 591441 462279 129162 Drugs/medical supplies 14636319 14636319 Medicaid Enhancement Tax 4426365 4426365 Repairs/maintenance 2143207 1770068 373139 STAFF DUES, LICENSES AND EDUCATION 236558 43187 193371 1746508 424121 1322387 0 95559929 83848352 11278377 433200 23774817 34977939 15148336 5772155 10584815 10892710 0 0 0 0 10062109 9254233 483860 432490 296108 477128 69984441 42260382 24757285 27724059 14900028 15720716 0 5131433 5131433 16957240 16261727 122096031 126644590 9477976 7463873 76941 23950003 22860000 0 0 33271890 30130315 66776810 60454188 X 54590374 63708222 728847 2482180 55319221 66190402 122096031 126644590 X 9483763 684596 702822 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10601 10601 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Alice Peck Day Memorial Hospital pays dues to various organizations related to its exempt mission. The amount reported under other activities refers to the amount of lobbying activities identified in dues payments to outside organizations. 97000 97000 97000 97000 97000 97000 97000 97000 219295 122295 97000 0.0 1.0 0.0 false true true 4600000 4600000 28722532 13682702 15039830 212775 212775 0 34331483 27104462 7227021 2117651 1260443 857208 27724059 INVESTMENT IN POOLED FUNDS 15720716 F 15720716 DUE FROM AFFILIATES 1215368 RIGHT OF USE ASSETS 14967246 BOND ISSUANCE COSTS 79113 16261727 Medical liabilities and payables 12587573 Due to affiliates 1998439 RIGHT OF USE LIABILITIES 15544303 30130315 Schedule D, Part V, Line 4 Intended uses of endowment funds The Organization uses the income from its endowment funds in support of its operations. true true X true X 225 true X true true false true true 906528 906528 0.0095 14805603 9779964 5025639 0.0526 0 0.0 0 0 15712131 9779964 5932167 0.0621 94707 94707 0.0010 0 0.0 0 0.0 0 0.0 56600 56600 0.0006 0 0 151307 0 151307 0.0016 0 0 15863438 9779964 6083474 0.0637 0 0.0 6829 6829 0.0001 0 0.0 0 0.0 0 0.0 0 0.0 34042 34042 0.0004 0 0.0 0 0.0 0 0 40871 0 40871 0.0004 true 0 0 26218331 27624162 -1405831 X true true 1 1 Alice Peck Day Memorial Hospital 10 Alice Peck Day Drive Lebanon NH 03766 www.alicepeckday.org 00016 X X X X Physician Clinics Alice Peck Day Memorial Hospital 1 false false true X X X X X X X X X 22 true true true true X https://www.alicepeckday.org/about/community-and-annual-reports X true 22 true https://www.alicepeckday.org/about/community-and-annual-reports false true X 225.0 300.0 X X X X X X true true X X X true X https://www.alicepeckday.org/patients/financial-services X https://www.alicepeckday.org/patients/financial-services X https://www.alicepeckday.org/patients/financial-services X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Alice Peck Day Memorial Hospital. During the period February 2021 through October 2021 an assessment of Community Health Needs was completed by Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital and Visiting Nurse and Hospice for VT and NH in partnership with Mt. Ascutney Hospital and Health Center, New London Hospital, Valley Regional Healthcare, Lake Sunapee Region VNA & Hospice and the New Hampshire Community Health Institute. The purpose of the assessment was 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 * Satisfy state and federal Community Health Needs Assessment requirements for Community Benefit reporting. For the purpose of the assessment, the geographic area of interest was 19 municipalities comprising the primary service area of Mary Hitchcock Memorial Hospital and Alice Peck Day Memorial Hospital with a total resident population of 69,612 people. Methods employed in the assessment included surveys of community residents made available through email, distribution at COVID-19 vaccination clinics, social media and website links through multiple channels throughout the region; a direct email survey of community leaders representing multiple community sectors; a set of eleven community discussion groups convened virtually across the region (including one with members of the community ages 65+ receiving services from the Lake Sunapee Visiting Nurse); and a review of available population demographics and health status indicators including summary social determinant of health characteristics. 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 health-related services or resources due to income, age, disability, and social or physical isolation. The community health needs assessment also acknowledged the significant impact of the COVID-19 pandemic, which was an over-arching concern affecting both the community health needs assessment process and the content of community input. Enhanced efforts were made to understand the needs of these populations through targeted surveys and virtual community conversations, multiple regional free COVID vaccination clinics, homeless programs, and other community settings serving economically-vulnerable residents. Findings of this assessment have been shared with public health officials in NH and VT, as well as with the Public Health Council of the Upper Valley. Surveys were made available through primary care clinics, free care clinics, annual town meetings/elections, and numerous other community locations. Visiting nurses and others provided pre-paid mailers and surveys to homebound residents. Residents completing surveys included members of African-American, Hispanic, Native American, and Asian populations. Surveys were distributed through regional health clinics, the region's shelter for homeless populations; the region's low-income housing trust; senior centers; substance use disorder treatment programs, delivered directly to resident homes, and other locations where populations most affected by health disparities congregate. Community partners provided assistance disseminating the survey, including the Public Health Council of the Upper Valley, whose membership includes community mental health services, substance use services, mental health peer leaders, WIC providers, senior services advocates, services working with people with physical and developmental disabilities, community nursing, visiting nurses, and other core human services. In addition to assisting in survey dissemination, these providers advocated for underserved and vulnerable populations in our region as a part of the CHNA process. During this CHNA process, we made resident surveys widely available to community residents through public list serves, direct e-mail invitations to patients of our primary care clinics, survey links on town web sites and e-news, employee e-news in major employers, and through other systems that provided widespread access to our surveys. We partnered closely with organizations serving populations affected by poverty, lack of insurance, homelessness, behavioral health conditions, and serious and chronic illnesses in order to survey these members of populations in our community and hosted multiple discussion groups with people affected by poverty and chronic illness. More than half of respondents to the community survey indicated that they were currently experiencing increased stress or anxiety because of the COVID-19 pandemic. We worked with the Good Neighbor Health Clinic and Mascoma Community Health Center to disseminate surveys to patients who are uninsured and low-income. Surveys were disseminated at the Upper Valley Haven (shelter); Listen Community Services (basic need support, food shelf, and community dinners); to parents of children in Dartmouth-Hitchcock and Alice Peck Day's Pediatrics Clinics; via Women, Infants, and Children's clinics; through Grafton County Senior Citizens Council (home-delivered meals and congregate meals); through Visiting Nurse and Hospice of VT and NH (home-visiting programs for families with young children and for seniors with complex health needs); and through other community organizations serving people affected by poverty and poor health. Specific efforts to contact and receive input from members of income-vulnerable populations, include working with the Good Neighbor Health Clinic and Mascoma Community Health Center to disseminate surveys to patients who are uninsured and low-income. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Alice Peck Day Memorial Hospital. ALICE PECK DAY MEMORIAL HOSPITAL PARTNERED WITH MARY HITCHCOCK MEMORIAL HOSPITAL (AKA DARTMOUTH-HITCHCOCK) TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT ALONG WITH THE FOLLOWING NEIGHBORING HOSPITALS: NEW LONDON HOSPITAL, VALLEY REGIONAL HEALTHCARE, AND MOUNT ASCUTNEY HOSPITAL AND HEALTH CENTER. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Alice Peck Day Memorial Hospital. Technical assistance for the Hospital's 2022 CHNA was provided by the New Hampshire Community Health Institute/JSI. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ALICE PECK DAY MEMORIAL HOSPITAL. Alice Peck Day Memorial Hospital's (APDMH) Community Health Implementation Plan (CHNA), approved by the governing board in November of 2022, is a three-year document that provides a detailed set of strategies for addressing our region's top health needs. Based on this most recent CHNA, the top health needs were 1) the availability of mental health services, 2) the cost of health care services and the affordability of health insurance, 3) improved resources and environment for healthy eating, nutrition, and food affordability. The hospital has taken steps to expand access to mental health services. In Primary Care, all patients age 12 through adult are screened for depression and anxiety during annual wellness visits. Patients who screen positive for depression or anxiety are referred to a Behavioral Health Specialist for follow-up or a referral is made for on-going counseling support. The department has expanded its Behavioral Health team to address patient need. The Emergency Department also offers streamlined access to behavioral health care through a partnership with West Central Behavioral Health, to ensure that patients are more immediately to mental health support. APDMH offers affordable care to our under- and uninsured patients through our Financial Assistance programs, in addition to offering Marketplace Health Insurance counseling during Open Enrollment, New Hampshire (NH) Medicaid enrollment assistance and NH Health Access Network financial assistance. Prescription and pharmacy assistance is also offered to uninsured or underinsured patients. Regarding healthy eating and food affordability, APDMH partners with the Hartford Community Coalition to provide a free summer lunch program for children who live in low-income housing sites in Lebanon and offers food bags of non-perishable food and Meal Cards for a free, hot meal at the APD cafe to patients who express need for food supports. The Kitchen also collaborates with LISTEN Community Services and the Upper Valley Senior Center in Lebanon and donates access prepared food to their food pantry. The Kitchen also works to continuously improve the menu with healthier food choices. Additional top health needs include: alcohol and drug use, prevention, treatment and recovery; affordability and availability of dental care services; and socio-economic conditions affecting health and well-being such as housing affordability, livable wages, and affordable, dependable child care. To address these issues, APDMH partners with additional organizations in the community and focuses on improving clinical services for our patients. We partner with Headrest, a local organization that provides treatment and support to people affected by substance use disorder, to provide collaborative Primary Care and substance use treatment. For over a decade, APDMH has offered Upper Valley Smiles, a free pediatric oral health program, to elementary schools in Vermont and New Hampshire. APDMH also helped to start the Upper Valley Business Alliance, which aims to grow the economy of the Upper Valley through advocacy and education, and will help create better paying jobs. APDMH was also involved in the launching of the Med-Tech Alliance as part of the Upper Valley Business Alliance. In addition to this efforts to support the economy, APDMH staff have gotten involved in local initiatives to address the shortage in affordable and dependable childcare in the Upper Valley. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Alice Peck Day Mememorial 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. Schedule H, Part V, Section B, Line 16 Facility , 1 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. 7 Neurosurgery Services at APD (NSAPD) 106 Hanover Street Lebanon NH 03766 Neurosurgery Physician Clinic RAM Center for Community Care 5 Alice Peck Day Drive Lebanon NH 03766 Primary Care Physician Clinic APD Orthopaedic Clinic 9 Alice Peck Day Drive Lebanon NH 03766 Orthopaedic Physician Clinic Women's Care Center 9 Alice Peck Day Drive Lebanon NH 03766 OB/GYN Physician Clinic General Surgery Clinic 9 Alice Peck Day Drive Lebanon NH 03766 General Surgery Clinic Pain Management Clinic 9 Alice Peck Day Drive Lebanon NH 03766 Pain Management Clinic Occupational Health Services 9 Alice Peck Day Drive Lebanon NH 03766 Occupational Health Physician Clinic Schedule H, Part I, Line 3c OTHER FACTORS USED IN DETERMINING ELIGIBILITY OTHER THAN FPG 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. Schedule H, Part I, Line 7g Subsidized Health Services THERE WERE NO AMOUNTS REPORTED ON LINE 7G. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance 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. Schedule H, Part II Community Building Activities 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. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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. Schedule H, Part III, Line 3 Bad Debt Expense Methodology 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. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote 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. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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. Schedule H, Part V, Section B, Line 16a FAP website - Alice Peck Day Memorial Hospital: Line 16a URL: https://www.alicepeckday.org/patients/financial-services; Schedule H, Part V, Section B, Line 16b FAP Application website - Alice Peck Day Memorial Hospital: Line 16b URL: https://www.alicepeckday.org/patients/financial-services; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Alice Peck Day Memorial Hospital: Line 16c URL: https://www.alicepeckday.org/patients/financial-services; Schedule H, Part VI, Line 2 Needs assessment 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. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 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. Schedule H, Part VI, Line 4 Community information 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 2019 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%. Schedule H, Part VI, Line 5 Promotion of community health APDMH promotes physical activity, addresses food insecurity, and provides dental care in order to promote the health of the community. APDMH continues to offer its FitScripts program to patients. The FitScripts program aims to get patients exercising more and leading healthier lifestyles. FitScripts allows our primary care providers to write referrals for their patients age 16 or older, who are living with one or more chronic conditions, and for whom the cost of a gym membership has been a barrier. 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 subsided 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. Schedule H, Part VI, Line 6 Affiliated health care system 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 2022 MHMH HAD 396 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 Schedule H, Part VI, Line 7 State filing of community benefit report NH true Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 6787 Book Program Support Hartford Community Coalition PO Box 4343 White River Junction VT 05001 824272638 501(c)3 19700 Book Program Support 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. APD provides support for selected community organizations that address needs identified in the Community Health Needs Assessment and are part of APD's Community Health Improvement plan. The annual amount to be contributed by APD to organizations is approved annually through the annual budget process. APD receives and reviews each year the organization's published annual reports and also maintains informal contacts throughout the year to monitor the organization's operations and services. X X X X false false false false false false false true false Brenda L Blair Former VP & COO 0 327318 0 0 0 16204 0 29250 0 29353 0 402125 0 0 SUSAN MOONEY MD MS FACOG TRUSTEE/PRESIDENT/CEO APDMH 334143 0 75101 0 22726 0 6100 0 39282 0 477352 0 0 0 Laura Greer MD Trustee/Medical Staff President/ExOfficio (as of 1/1/23) 132362 0 90890 0 0 0 4541 0 6217 0 234010 0 0 0 GEORGE T BLIKE MD MHCDS Trustee 0 154960 0 0 0 0 0 11234 0 0 0 166194 0 0 Patrick F Jordan III MBA Trustee 0 777526 0 0 0 51485 0 29250 0 40635 0 898896 0 0 Tina E Naimie CPA MSA MHCDS Trustee 0 294710 0 0 0 18463 0 29250 0 2312 0 344735 0 0 SCOTT W RODI MD MPH Trustee 0 469447 0 300 0 40237 0 29250 0 45279 0 584513 0 0 Phillip Collins MD Ex-Officio (Through 12/31/22)/President Med Staff 204511 0 4233 0 3482 0 4318 0 35535 0 252079 0 0 0 David F Duncan Trustee 0 304108 0 0 0 5035 0 18300 0 27257 0 354700 0 0 TODD ROBERTS VP Finance 168186 0 13153 0 6962 0 4022 0 40362 0 232685 0 0 0 MICHAEL T LYNCH MD MBA Chief Medical Officer 321695 0 13153 0 25630 0 6100 0 4416 0 370994 0 0 0 DALE C VIDAL MD MS Executive Director MSC 483735 0 13153 0 29278 0 6100 0 45066 0 577332 0 0 0 JEAN TEN HAKEN MSN RN CENP CNO/COO 233000 0 13153 0 774 0 5068 0 18200 0 270195 0 0 0 IVAN TOMEK MD General Orthopedic Surgeon 523336 0 28678 0 21274 0 6100 0 40805 0 620193 0 0 0 DIANE RILEY MD CAQSH Ortho Surgeon Hand Specialist 439756 0 9069 0 1188 0 6100 0 36594 0 492707 0 0 0 BRIAN LOMBARDO MD PHYSICIAN 196043 0 43355 0 21688 0 5471 0 35619 0 302176 0 0 0 Peter Loescher Physician 238378 0 5500 0 21274 0 5610 0 45102 0 315864 0 0 0 JOHN P HOUDE MD Physician 517567 0 10674 0 1188 0 6100 0 45704 0 581233 0 0 0 Schedule J, Part I, Line 7 Non-fixed payments Certain Alice Peck Day Memorial Hospital employees listed on Schedule J were paid a bonus in lieu of a 2% cost of living raise for calendar 2022. Instead, management awarded a 2% bonus calculated on base pay. Schedule J, Part II Form 990, Part VII Section A Former Officer Compensation Brenda Blair, Mary Hitchcock Memorial Hospital's VP Total Rewards, and former APD Memorial Hospital's VP and Chief Medical Officer transitioned from APDMH to MHMH in May 2019. Because Blair was reported as an Officer on APD's 990 in fiscal year 2019, and in accordance with IRS instructions, Blair's earnings from MHMH are reported on Form 990 Part VII, and Schedule J, Part II. A NH Health and Education Facilities Authority 020279866 000000000 2018-08-15 25865000 Refund bond issued 11/30/2010 false false false A 3005000 25865000 289249 25575751 2018 true false true true A false true true true false 0.0002 0.0 0.0002 false false true A false true false false true false false false true A true X 1 16083 Market value 1 false false false Schedule M, Part I Explanations of reporting method for number of contributions Securities - Publicly traded - THE ORGANIZATION REPORTS THE NUMBER OF INDIVIDUAL ITEMS RECEIVED DURING THE FISCAL YEAR. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Executive Committee of the Board consists of all board officers, all of whom are members of the board. 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. Form 990, Part VI, Line 6 Classes of members or stockholders The Membership of the corporation shall consist of Dartmouth-Hitchcock health (D-HH) as the sole member. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body 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. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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. Form 990, Part VI, Line 11b Review of form 990 by governing body 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. Form 990, Part VI, Line 12c Conflict of interest policy 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. Form 990, Part VI, Line 15a Process to establish compensation of top management official 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 FY23. Form 990, Part VI, Line 15b Process to establish compensation of other employees 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 FY23. Form 990, Part VI, Line 19 Required documents available to the public The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Net Assets Transferred - 702822; Alice Peck Day Lifecare Center Inc 10 Alice Peck Day Drive Lebanon NH 03766 020479094 Independent & Assisted Living NH 501(c)(3) 10 APD Memorial Hospital true Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 264812335 Parent Organization NH 501(c)(3) 7 NA false Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Physician Services NH 501(c)(3) 10 D-HH false Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)(3) 3 D-HH false The New London Hospital Association Inc 273 County Road New London NH 03257 020222171 Hospital NH 501(c)(3) 3 D-HH false Windsor Hospital Corporation 289 Country Road Windsor VT 05089 030183721 Hospital VT 501(c)(3) 3 D-HH false Cheshire Medical Center 580 Court Street Keene NH 03431 020354549 Hospital NH 501(c)(3) 3 D-HH false true false true true false false false false false true false true true false true true true true true Alice Peck Day Lifecare Centers Inc Q 1106310 Book Alice Peck Day Lifecare Centers Inc O 3528368 Book Alice Peck Day Lifecare Centers Inc R 6977174 Book Alice Peck Day Lifecare Centers Inc A 303126 Book