ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-09
- IRS object ID
- 202301299349300830
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-09T13:00:15+00:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9600 Brownsboro Road Suite 400 | AddressLine1Txt |
| City | Louisville | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 402413902 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222791 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alice Peck Day Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ALIC | BusinessNameControlTxt |
| Phone | 6034483121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Susan E Mooney | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Signature | 2023-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Susan E | PersonFirstNm |
| Person Last | Mooney | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rachel Spurlock | PreparerPersonNm |
| PTIN | P00520729 | PTIN |
| Phone | 5023263996 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Susan E Mooney MD MS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $103,591,043 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.alicepeckday.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1943 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To improve the health and wellbeing of our community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 712 | TotalEmployeeCnt |
| Total Volunteers | 74 | TotalVolunteersCnt |
| Total Gross UBI | $13,688 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $825 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $837,236 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,990,642 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $83,066,859 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $101,009,627 | CYProgramServiceRevenueAmt |
| PY Investment Income | $54,742 | PYInvestmentIncomeAmt |
| CY Investment Income | $52,573 | CYInvestmentIncomeAmt |
| PY Other Revenue | $396,684 | PYOtherRevenueAmt |
| CY Other Revenue | $538,201 | CYOtherRevenueAmt |
| PY Total Revenue | $84,355,521 | PYTotalRevenueAmt |
| CY Total Revenue | $103,591,043 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $282,974 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,545 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $47,708,967 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $53,568,608 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $137,400 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,192,857 | PYOtherExpensesAmt |
| CY Other Expenses | $36,541,890 | CYOtherExpensesAmt |
| PY Total Expenses | $77,184,798 | PYTotalExpensesAmt |
| CY Total Expenses | $90,118,043 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,170,723 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $13,473,000 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $121,000,117 | TotalAssetsBOYAmt |
| Total Assets EOY | $122,096,031 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $80,902,041 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $66,776,810 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,098,076 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $55,319,221 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To improve the health and wellbeing of our community | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $78,563,893 | ExpenseAmt |
| Grant | $7,545 | GrantAmt |
| Revenue | $101,346,221 | RevenueAmt |
| Desc | 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 FY22, APD was recognized as the "Healthcare Business of the Year" by the Upper Valley Business Alliance and was one of three critical access hospitals recognized nationwide for excellence in revenue cycle by the Healthcare Finance Management Association. 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 36 providers in FY22, of which 17 were primary care, 3 were in pediatrics, and 16 were providers in other specialties. During FY22, APD had a total of 840 patient discharges consisting of 4,427 patient days. We also had 8,758 emergency department visits in FY22, open 24 hours a day, 7 days a week. | Desc |
| Total Program Service Expenses | $78,563,893 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 83 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 712 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Todd Roberts | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6034483121 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Clayton R Adams | ||||||||||
| Trustee, Treasurer | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Greg W Lange | ||||||||||
| Trustee, Chair | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Jennifer Sage Schiffman | ||||||||||
| Trustee, Secretary | 0.5 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Marisa D Devlin | ||||||||||
| Trustee, Vice Chair | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| SUSAN MOONEY MD MS FACOG | ||||||||||
| TRUSTEE/PRESIDENT/CEO APDMH | 38.0 | 2.0 | Yes (X) | Yes (X) | $435,379 | $0 | $51,538 | |||
| Brenan Riehl | ||||||||||
| Trustee (Through 12/31/21) | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Charles J Wheelan | ||||||||||
| Trustee | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Cybele M Merrick | ||||||||||
| Trustee | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| David F Duncan | ||||||||||
| Trustee (As of 1/1/22) | 0.5 | 40.0 | Yes (X) | $0 | $297,369 | $22,803 | ||||
| GEORGE T BLIKE MD | ||||||||||
| Trustee | 0.5 | 21.0 | Yes (X) | $0 | $245,035 | $20,819 | ||||
| Gerard Duprat JR MD | ||||||||||
| Trustee (As of 1/1/22) | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Jenny H Barba | ||||||||||
| Trustee (As of 1/1/22) | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| John L Scherding | ||||||||||
| Trustee (Through 12/31/21) | 0.5 | 2.0 | Yes (X) | $0 | $0 | $0 | ||||
| Kyle Fisher | ||||||||||
| Trustee | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| Marva Williams-Lowe | ||||||||||
| Trustee | 0.5 | 40.0 | Yes (X) | $0 | $198,524 | $38,562 | ||||
| Mary M Oseid MHCDS | ||||||||||
| Trustee (Through 5/31/22)/SVP-Regional Strategy | 0.5 | 40.5 | Yes (X) | $0 | $348,821 | $63,103 | ||||
| Michael F Long | ||||||||||
| Trustee (Through 12/31/21) | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| Patrick F Jordan III MBA | ||||||||||
| Trustee | 0.5 | 42.5 | Yes (X) | $0 | $809,680 | $62,619 | ||||
| Phillip Collins MD | ||||||||||
| Ex-Officio/Pres Med Staff | 40.0 | 0 | Yes (X) | $224,530 | $0 | $40,258 | ||||
| Sara L Kobylenski | ||||||||||
| Trustee | 0.5 | 2.0 | Yes (X) | $0 | $0 | $0 | ||||
| SCOTT W RODI MD | ||||||||||
| Trustee | 0.5 | 40.0 | Yes (X) | $0 | $457,762 | $65,206 | ||||
| Sloane Mayor | ||||||||||
| Trustee (As of 1/1/22) | 0.5 | 0.5 | Yes (X) | $0 | $0 | $0 | ||||
| Tina E Naimie CPA | ||||||||||
| Trustee | 1.0 | 41.0 | Yes (X) | $0 | $286,886 | $32,458 | ||||
| TODD ROBERTS | ||||||||||
| VP Finance | 38.0 | 2.0 | Yes (X) | $173,268 | $0 | $43,380 | ||||
| DALE C VIDAL MD MS | ||||||||||
| Executive Director MSC | 40.0 | 0 | $524,633 | $0 | $51,036 | Yes (X) | ||||
| JEAN TEN HAKEN MSN RN CENP | ||||||||||
| CNO/COO | 40.0 | 0.5 | $239,976 | $0 | $23,274 | Yes (X) | ||||
| BRIAN LOMBARDO MD | ||||||||||
| PHYSICIAN | 40.0 | 0 | $242,405 | $0 | $41,982 | Yes (X) | ||||
| DIANE RILEY MD CAQSH | ||||||||||
| Ortho Surgeon Hand Specialist | 40.0 | 0 | $489,638 | $0 | $42,597 | Yes (X) | ||||
| IVAN TOMEK MD | ||||||||||
| General Orthopedic Surgeon | 40.0 | 0 | $573,302 | $0 | $47,334 | Yes (X) | ||||
| Peter Loescher | ||||||||||
| Physician | 40.0 | 0 | $265,626 | $0 | $21,276 | Yes (X) | ||||
| Sari Galanes | ||||||||||
| Physician | 40.0 | 0 | $236,240 | $0 | $31,769 | Yes (X) | ||||
| Brenda L Blair | ||||||||||
| Former VP & COO | 0.0 | 40.0 | $0 | $299,921 | $51,450 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,404,997 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,943,998 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $751,464 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 57 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MARY HITCHCOCK MEMORIAL HOSPITAL | |||||
| One Medical Center Drive | Lebanon | NH | 03756 | HEALTHCARE SERVICES | $7,034,908 |
| Upper Valley Neurology | |||||
| 106 Hanover Street | Lebanon | NH | 03766 | Physician Services | $3,308,500 |
| Conifer Revenue Cycle Solutions LLC | |||||
| PO Box 655025 | Dallas | TX | 75265 | Revenue Management Services | $3,049,134 |
| ENGELBERTH CONSTRUCTION | |||||
| 150 Water Tower Circle | Colchester | VT | 05446 | Construction Contracting | $2,641,775 |
| DARTMOUTH-HITCHCOCK CLINIC | |||||
| ONE MEDICAL CENTER DRIVE | LEBANON | NH | 03756 | HEALTHCARE SERVICES | $1,984,205 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Fundraising | $0 | FundraisingAmt |
| Related Organizations | $65,617 | RelatedOrganizationsAmt |
| Government Grants | $1,589,229 | GovernmentGrantsAmt |
| All Other Contributions | $335,796 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $1,990,642 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Services | 622110 | $99,609,507 | $99,609,507 |
| Nutritional Services | 722210 | $107,854 | $107,854 |
| PHARMACY SALES | 446100 | $1,292,266 | $1,292,266 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $101,009,627 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,038 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $13,688 | UnrelatedBusinessRevenueAmt |
| Exclusion | $33,350 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $201,607 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $201,607 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $201,607 | TotalRevenueColumnAmt |
| Exclusion | $201,607 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,535 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,535 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,535 | TotalRevenueColumnAmt |
| Exclusion | $5,535 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PURCHASE REBATES AND DISCOUNTS | 622110 | $169,617 | $169,617 |
| MISCELLANEOUS | 622110 | $166,977 | $166,977 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $336,594 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $103,591,043 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $101,346,221 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $13,688 | UnrelatedBusinessRevenueAmt |
| Exclusion | $240,492 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,545 | TotalAmt |
| Program Services | $7,545 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,933,608 | TotalAmt |
| Program Services | $474,155 | ProgramServicesAmt |
| Management And General | $1,433,312 | ManagementAndGeneralAmt |
| Fundraising | $26,141 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,646,418 | TotalAmt |
| Program Services | $39,852,995 | ProgramServicesAmt |
| Management And General | $1,703,033 | ManagementAndGeneralAmt |
| Fundraising | $90,390 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,455,578 | TotalAmt |
| Program Services | $1,395,239 | ProgramServicesAmt |
| Management And General | $57,298 | ManagementAndGeneralAmt |
| Fundraising | $3,041 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,480,144 | TotalAmt |
| Program Services | $6,211,520 | ProgramServicesAmt |
| Management And General | $255,085 | ManagementAndGeneralAmt |
| Fundraising | $13,539 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,052,860 | TotalAmt |
| Program Services | $1,967,762 | ProgramServicesAmt |
| Management And General | $80,809 | ManagementAndGeneralAmt |
| Fundraising | $4,289 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,580 | TotalAmt |
| Program Services | $2,580 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,475 | TotalAmt |
| Program Services | $11,475 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,473,900 | TotalAmt |
| Program Services | $3,210,709 | ProgramServicesAmt |
| Management And General | $3,263,191 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,144 | TotalAmt |
| Program Services | $36,144 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $307,408 | TotalAmt |
| Program Services | $307,408 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,475 | TotalAmt |
| Program Services | $32,216 | ProgramServicesAmt |
| Management And General | $251,259 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,975,667 | TotalAmt |
| Program Services | $1,115,912 | ProgramServicesAmt |
| Management And General | $859,755 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,624 | TotalAmt |
| Program Services | $31,785 | ProgramServicesAmt |
| Management And General | $42,839 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $876,180 | TotalAmt |
| Program Services | $401,863 | ProgramServicesAmt |
| Management And General | $474,317 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,518,462 | TotalAmt |
| Program Services | $2,974,953 | ProgramServicesAmt |
| Management And General | $543,509 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $725,053 | TotalAmt |
| Program Services | $706,288 | ProgramServicesAmt |
| Management And General | $18,765 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Drugs/medical supplies | $13,433,716 | $13,433,716 | |
| Medicaid Enhancement Tax | $3,980,288 | $3,980,288 | |
| Repairs/maintenance | $2,044,121 | $1,825,313 | $218,808 |
| STAFF DUES, LICENSES AND EDUCATION | $117,354 | $60,077 | $57,277 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,681,443 | TotalAmt |
| Program Services | $523,950 | ProgramServicesAmt |
| Management And General | $2,157,493 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,118,043 | TotalAmt |
| Program Services | $78,563,893 | ProgramServicesAmt |
| Management And General | $11,416,750 | ManagementAndGeneralAmt |
| Fundraising | $137,400 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,581,575 | BOYAmt |
| EOY | $23,774,817 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,679,299 | BOYAmt |
| EOY | $15,148,336 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,216,851 | BOYAmt |
| EOY | $10,584,815 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,269,754 | BOYAmt |
| EOY | $10,062,109 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $443,112 | BOYAmt |
| EOY | $483,860 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $401,629 | BOYAmt |
| EOY | $296,108 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $64,593,631 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $39,836,346 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,623,354 | BOYAmt |
| EOY | $24,757,285 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,717,379 | BOYAmt |
| EOY | $14,900,028 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,131,433 | BOYAmt |
| EOY | $5,131,433 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,935,731 | BOYAmt |
| EOY | $16,957,240 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,000,117 | BOYAmt |
| EOY | $122,096,031 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,181,097 | BOYAmt |
| EOY | $9,477,976 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,941 | BOYAmt |
| EOY | $76,941 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,425,000 | BOYAmt |
| EOY | $23,950,003 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,219,003 | BOYAmt |
| EOY | $33,271,890 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,902,041 | BOYAmt |
| EOY | $66,776,810 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,969,853 | BOYAmt |
| EOY | $54,590,374 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,128,223 | BOYAmt |
| EOY | $728,847 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,098,076 | BOYAmt |
| EOY | $55,319,221 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,000,117 | BOYAmt |
| EOY | $122,096,031 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $13,473,000 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$822,835 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,570,980 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $13,987 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $13,987 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $97,000 | BeginningYearBalanceAmt |
| End Year Balance | $97,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $97,000 | BeginningYearBalanceAmt |
| End Year Balance | $97,000 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $97,000 | BeginningYearBalanceAmt |
| End Year Balance | $97,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $219,295 | BeginningYearBalanceAmt |
| Other Expenditures | $122,295 | OtherExpendituresAmt |
| End Year Balance | $97,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $33,539 | BeginningYearBalanceAmt |
| Contributions | $185,756 | ContributionsAmt |
| End Year Balance | $219,295 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.0 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.0 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,600,000 | OtherCostOrOtherBasisAmt |
| Book Value | $4,600,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,372,518 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,025,817 | DepreciationAmt |
| Book Value | $11,346,701 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $212,775 | OtherCostOrOtherBasisAmt |
| Depreciation | $212,775 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,341,774 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,446,949 | DepreciationAmt |
| Book Value | $7,894,825 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,066,564 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,150,805 | DepreciationAmt |
| Book Value | $915,759 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,757,285 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN POOLED FUNDS | Desc |
| Book Value | $14,900,028 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $14,900,028 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | $1,975,259 |
| RIGHT OF USE ASSETS | $14,891,644 |
| BOND ISSUANCE COSTS | $90,337 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $16,957,240 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Medical liabilities and payables | $17,487,423 |
| Due to affiliates | $433,446 |
| RIGHT OF USE LIABILITIES | $15,351,021 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $33,271,890 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part V, Line 4 Intended uses of endowment funds | FormAndLineReferenceDesc |
| Explanation | The Organization uses the income from its endowment funds in support of its operations. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 225 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $822,818 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $822,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0091 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,230,979 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,824,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $406,143 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0045 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $11,053,797 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,824,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,228,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0136 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $105,042 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $105,042 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0012 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,686 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $60,686 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0007 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $173,728 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $173,728 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0019 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $11,227,525 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,824,836 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,402,689 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0156 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,566 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,566 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $780 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $7,346 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $41,645,445 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $26,045,760 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $15,599,685 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alice Peck Day Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Alice Peck Day Drive | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.alicepeckday.org | WebsiteAddressTxt |
| State License | 00016 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Physician Clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alice Peck Day Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.alicepeckday.org/about/community-and-annual-reports | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.alicepeckday.org/about/community-and-annual-reports | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 225.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.alicepeckday.org/patients/financial-services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.alicepeckday.org/patients/financial-services | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.alicepeckday.org/patients/financial-services | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 ages 12 through adult are screened for depression during 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 and Medicaid enrollment assistance. Prescription and pharmacy assistance is also offer 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 APDMH cafe to patients who express need for food supports. The Kitchen also collaborates with LISTEN Community Services and donates access prepared food to their food pantry. 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 childcare. 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 including weekly team meetings. APDMH is also exploring a potential partnership to create a residential treatment center for women in recovery and their children on our campus. 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 these efforts to support the economy, APDMH staff are 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation for Healthy Communities | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 Airport Road | AddressLine1Txt |
| City | Concord | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 020275078 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $6,545 | CashGrantAmt |
| Valuation Method Used | Book | ValuationMethodUsedDesc |
| Purpose Of Grant | Program Support | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Brenda L Blair | ||||||||||||||
| Former VP & COO | $0 | $285,341 | $0 | $100 | $0 | $14,480 | $0 | $21,860 | $0 | $29,590 | $0 | $351,371 | $0 | $0 |
| SUSAN MOONEY MD MS FACOG | ||||||||||||||
| TRUSTEE/PRESIDENT/CEO APDMH | $322,727 | $0 | $91,040 | $0 | $21,612 | $0 | $5,800 | $0 | $45,738 | $0 | $486,917 | $0 | $0 | $0 |
| GEORGE T BLIKE MD | ||||||||||||||
| Trustee | $0 | $222,135 | $0 | $0 | $0 | $22,900 | $0 | $20,819 | $0 | $0 | $0 | $265,854 | $0 | $0 |
| Patrick F Jordan III MBA | ||||||||||||||
| Trustee | $0 | $693,656 | $0 | $70,100 | $0 | $45,924 | $0 | $21,860 | $0 | $40,759 | $0 | $872,299 | $0 | $0 |
| Tina E Naimie CPA | ||||||||||||||
| Trustee | $0 | $282,026 | $0 | $100 | $0 | $4,760 | $0 | $27,200 | $0 | $5,258 | $0 | $319,344 | $0 | $0 |
| Mary M Oseid MHCDS | ||||||||||||||
| Trustee (Through 5/31/22)/SVP-Regional Strategy | $0 | $318,940 | $0 | $100 | $0 | $29,781 | $0 | $27,660 | $0 | $35,443 | $0 | $411,924 | $0 | $0 |
| SCOTT W RODI MD | ||||||||||||||
| Trustee | $0 | $420,655 | $0 | $400 | $0 | $36,707 | $0 | $27,660 | $0 | $37,546 | $0 | $522,968 | $0 | $0 |
| Marva Williams-Lowe | ||||||||||||||
| Trustee | $0 | $196,750 | $0 | $0 | $0 | $1,774 | $0 | $17,930 | $0 | $20,632 | $0 | $237,086 | $0 | $0 |
| Phillip Collins MD | ||||||||||||||
| Ex-Officio/Pres Med Staff | $204,788 | $0 | $4,233 | $0 | $15,509 | $0 | $4,559 | $0 | $35,699 | $0 | $264,788 | $0 | $0 | $0 |
| David F Duncan | ||||||||||||||
| Trustee (As of 1/1/22) | $0 | $291,879 | $0 | $100 | $0 | $5,390 | $0 | $17,400 | $0 | $5,403 | $0 | $320,172 | $0 | $0 |
| TODD ROBERTS | ||||||||||||||
| VP Finance | $155,435 | $0 | $11,160 | $0 | $6,673 | $0 | $3,827 | $0 | $39,553 | $0 | $216,648 | $0 | $0 | $0 |
| DALE C VIDAL MD MS | ||||||||||||||
| Executive Director MSC | $485,209 | $0 | $11,260 | $0 | $28,164 | $0 | $5,800 | $0 | $45,236 | $0 | $575,669 | $0 | $0 | $0 |
| JEAN TEN HAKEN MSN RN CENP | ||||||||||||||
| CNO/COO | $227,942 | $0 | $11,260 | $0 | $774 | $0 | $4,925 | $0 | $18,349 | $0 | $263,250 | $0 | $0 | $0 |
| IVAN TOMEK MD | ||||||||||||||
| General Orthopedic Surgeon | $524,710 | $0 | $28,678 | $0 | $19,914 | $0 | $5,800 | $0 | $41,534 | $0 | $620,636 | $0 | $0 | $0 |
| DIANE RILEY MD CAQSH | ||||||||||||||
| Ortho Surgeon Hand Specialist | $440,139 | $0 | $9,069 | $0 | $40,430 | $0 | $5,800 | $0 | $36,797 | $0 | $532,235 | $0 | $0 | $0 |
| BRIAN LOMBARDO MD | ||||||||||||||
| PHYSICIAN | $196,331 | $0 | $25,386 | $0 | $20,688 | $0 | $5,112 | $0 | $36,870 | $0 | $284,387 | $0 | $0 | $0 |
| Peter Loescher | ||||||||||||||
| Physician | $239,852 | $0 | $5,500 | $0 | $20,274 | $0 | $5,610 | $0 | $15,666 | $0 | $286,902 | $0 | $0 | $0 |
| Sari Galanes | ||||||||||||||
| Physician | $185,118 | $0 | $49,813 | $0 | $1,309 | $0 | $4,900 | $0 | $26,869 | $0 | $268,009 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | Dartmouth Hitchcock Clinic (DHC) and Mary Hitchcock Memorial Hospital (MHMH) sponsor a split dollar life plan for certain long-term employees. The original objectives for offering these plans were to better enable DHC and MHMH to attract and retain quality executive personnel, improve the physicians' post-retirement life insurance benefits, and to replace an increasingly costly retiree life insurance program. The plan was frozen to new participants in 1998. The number of participants and dollar value continues to dwindle as individuals retire/leave the organization. THE FOLLOWING INDIVIDUALS HAVE A SPLIT DOLLAR LIFE PLAN ARRANGEMENT:MARY OSEID $42,307. |
| Schedule J, Part I, Line 7 Non-fixed payments | Bonuses provided for 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 2021. 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. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NH Health and Education Facilities Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 020279866 | BondIssuerEIN |
| CUSIP | 000000000 | CUSIPNum |
| Bond Issued | 2018-08-15 | BondIssuedDt |
| Issue Price | $25,865,000 | IssuePriceAmt |
| Purpose | Refund bond issued 11/30/2010 | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,915,000 | RetiredAmt |
| Total Proceeds | $25,865,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $289,249 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $25,575,751 | OtherSpentProceedsAmt |
| Substantial Completion | 2018 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (true) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (true) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.0002 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.0 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.0002 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 FY22. |
| 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 FY22. |
| 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 - 2570980; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Alice Peck Day Lifecare Center Inc | ||
| Q | $3,026,157 | Book |
| Alice Peck Day Lifecare Center Inc | ||
| O | $2,777,655 | Book |
| Alice Peck Day Lifecare Center Inc | ||
| R | $5,436,433 | Book |
| Alice Peck Day Lifecare Center inc | ||
| A | $321,019 | Book |