2022-08-10T14:07:31-05:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2020-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Steven Shaffer CFO 6034449000 2022-08-10 1 Steven Shaffer 999009999 Joseph R Byrne P01289281 2077752387 2022-08-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 121122555 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 13 634 65 16407 0 5899404 9690587 91759728 97406827 2526247 859871 177580 118585 100362959 108075870 119444 356867 0 0 52081294 54558651 0 0 0 49735543 44499243 101936281 99414761 -1573322 8661109 118195564 135716999 67543076 69222216 50652488 66494783 X To provide quality, compassionate and accessible healthcare in a manner that brings value to all.To offer a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventive diagnostic, theraputic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.To provide these services without regard to race, religion, age, sex, income, creed, national origin, or disability.To maintain a sufficient number and mix of medical staff who are competent, dedicated and commmunity based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.To create a healthy, satisfying work environment for phsycians, nurses and other employees, with a commitment to support the continuing educational needs of its professional staff, including the physicians, nurses and allied health personnel. 0 0 83914234 356867 97406827 Littleton Hospital Association provides health care services on an in/outpatient basis to the general public, including charity care, community education, and various other health programs and services. 83914234 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 143 0 1 634 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Steven Shaffer 6034449000 600 St Johnsbury Road Littleton NH 03561 Jeff Woodward Chair 1.00 X X 0 0 0 Erin Hennessey Vice Chair 1.00 X X 0 0 0 Dr Patrick Fitzpatrick Treasurer 40.00 X X 717046 0 42368 Ashley Garrison Secretary 1.00 X X 0 0 0 Fred Chisolm Trustee 1.00 X 0 0 0 Kathryn Fleury Trustee 1.00 X 0 0 0 Roger Gingue Trustee 1.00 X 0 0 0 Dr Stephen Goldberg Trustee/Physician 40.00 X 333765 0 43017 Richard Jesseman Trustee 1.00 X 0 0 0 Elizabeth Kunz Trustee 1.00 X 0 0 0 Richard McKenzie Ex Officio 40.00 X 278611 0 41101 Laurie Morgan Trustee & LRH Auxiliary 1.00 X 0 0 0 Stephen Noyes Trustee 1.00 X 0 0 0 Charyl Reardon Trustee 1.00 X 0 0 0 Paul Smith Trustee 1.00 X 0 0 0 Thomas Tremblay Trustee 1.00 X 0 0 0 Dr Alice Rocke Past Medical Staff President 40.00 X 437542 0 48128 Dr Deane Rankin Past Trustee/Physician 40.00 X 367036 0 54587 Robert Nutter President & CEO 40.00 X 516552 0 50983 Leslie Walker Dir. Fin. Planning/Dec. Support 40.00 X 146057 0 34834 Steven Ciampa Past Interim CFO 40.00 X 132354 0 17753 Steven Shaffer Interim CFO 40.00 X 0 0 0 Dr Eric Emig Physician 40.00 X 554851 0 32249 Dr Jeffrey Kauffman Physician 40.00 X 588390 0 42982 Dr Jean Langevin Physician 40.00 X 565545 0 19821 Dr Eric Mullins Physician 40.00 X 645961 0 48518 Dr Anthony Salerni Physician 30.00 X 625051 0 0 Dr Dougald MacArthur Physician/Former Trustee 40.00 X 706000 0 0 6614761 0 476341 89 1 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 3010199 Secured Network Services 775 Industrial Park Road Littleton NH 03561 Professional Services Agreement 1296155 Resolution Consulting INc 1573 Mallory Lane Suite 200 Brentwood TN 37027 A/R Collections 763092 Hayes Locums LLC PO Box 88122 Chicago IL 60680 Locum 725477 Active Healthcare Receivables LLC 164 Burke Street Nashua NH 03060 A/R Collections 691316 18 56355 9488745 145487 9690587 Patient Service Revenue 622100 197974895 197974895 Other Revenue 622100 4838428 4276152 562276 Contract Lab 621500 43799 27392 16407 Contractual Allowances 622100 -105450295 -105450295 97406827 596047 596047 140765 0 140765 140765 140765 13288329 13019178 5327 269151 -5327 263824 263824 0 56355 22180 -22180 -22180 108075870 96828144 16407 1540732 356867 356867 3261736 2363202 898534 42519656 36004362 6515294 786672 666947 119725 5394931 4570411 824520 2595656 2178153 417503 157039 157039 72441 72441 79132 79132 3735073 3276549 458524 245067 165232 79835 4687710 3160609 1527101 2575088 1736209 838879 4812838 3244974 1567864 68863 46430 22433 8277 5581 2696 791364 791364 4222573 3467443 755130 1692792 1141336 551456 Medical Supplies 15575872 15575872 Medicaid Enhancement Ta 3863116 3863116 Miscellaneous Expense 1795514 1221040 574474 Recruiting Expense 116484 78537 37947 99414761 83914234 15500527 0 X 242472 426974 20601282 12844874 7050 40271 12780011 15274075 2066069 2089391 2314253 2089333 103657362 70666035 35062827 32991327 42269104 61972539 2852496 7988215 118195564 135716999 11695785 16346332 862868 1025055 21919698 20961664 1373039 955500 31691686 29933665 67543076 69222216 X 47852166 63208775 2800322 3286008 50652488 66494783 118195564 135716999 X 8661109 6695470 485716 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12732 12732 0 Part II-B, Line 1: Littleton Hospital Association is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Littleton Hospital Association and other member organizations in furtherance of their exempt purposes. Littleton Hospital Association does not directly perform any lobbying activities. 2432225 29896 403922 108219 2757824 2374660 1058 129189 72682 2432225 2365387 1539 56233 48499 2374660 2286360 3245 128304 52522 2365387 2068307 950 221332 4229 2286360 0.00000 0.73500 0.26500 0 0 1749183 1749183 42189184 27506923 14682261 54993399 41090759 13902640 4725596 2068353 2657243 32991327 Other Receivables 7988215 7988215 Estimated Third-Party Payor Settlements 14408520 Deferred Compensation 4777382 Interest Rate Swap 2164280 Medicare Accelerated Payments 8583483 29933665 114859991 6695470 507896 7203366 107656625 79132 340113 419245 108075870 99017696 22180 22180 98995516 79132 340113 419245 99414761 Part V, Line 4: All endowed funds are used based on the donors' wishes. The principal of the funds remains, and only the interest earned can be distributed. Part XI, Line 2d - Other Adjustments: Unrealized Loss on Interest Rate Swap 485,716. Fundraising Expenses 22,180. Part XI, Line 4b - Other Adjustments: Community Benefit Expense 340,113. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 22,180. Part XII, Line 4b - Other Adjustments: Community Benefit Expense 340,113. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments.LIST 74 _ 32325bd - 07/15/21 10:08 AM Worksheet Schedule F - Activities Per RegionFSFN 1 5780847 0 0 0 0 0 0 5780847 0 5780847 0 0 1 0 1 0 Part III Accounting Method: Golf Tournament 56355 56355 2930 13539 945 4766 56355 56355 2930 13539 945 4766 22180 -22180 1 1 X 1 X 1 X 1 1 0 1 1 560670 560670 0.00560 15473215 10106421 5366794 0.05400 16033885 10106421 5927464 0.05960 506540 506540 0.00510 66840 66840 0.00070 26292950 17573822 8719128 0.08770 356867 356867 0.00360 27223197 17573822 9649375 0.09710 43257082 27680243 15576839 0.15670 1 0 23377902 23377902 X 1 1 1 1 Littleton Regional Hospital 600 St Johnsbury Road Littleton NH 03561 www.littletonhealthcare.org 02790 X X X X Littleton Regional Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X https://littletonhealthcare.org/about-lrh/ X 1 19 1 https://littletonhealthcare.org/about-lrh/ 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X X X X X 1 X 0 X X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: In 2019, the Northern New Hampshire Region (Littleton Regional Healthcare, Ammonoosuc Community Health Services and Coos County Family Health Services) performed a Community Health NeedsAssessment to determine the health needs of the Greater Northern New Hampshire Region.Data was gathered from multiple well-respected secondary sources to build an accurate picture of the community and its health needs. A survey of a select group of local Experts was performed to review the prior CHNA and provide feedback, and to ascertain whether the previously identified needs are still a priority. Additionally, the group review the data gathered from the secondary sources and determined the Significant Health Needs for the community. Littleton Regional Hospital Part V, Section B, Line 6b: LRH's (the Hospital) CHNA was conducted along with Ammonoosuc Community Health Services and Coos County Family Health Services. Littleton Regional Hospital Part V, Section B, Line 11: The Hospital is addressing the significant needs identified in its most recent CHNA as follows:- Drug/Substance Abuse: The Doorway at LRH is part of a statewide initiative to address the growing opioid crisis. Littleton Regional Healthcare serves as a HUB for Northern New Hampshire. Fire, police and first responders carry Narcan with them to administer during calls. LRH offers a women's health conference annually that attracts close to 400 women. The Conference offers education on drug and substance misuse.- Mental Health: Two contract providers were available and seeing patients at LRH to address mental health issues. LRH offers community education on topics related to mental health issues to raise awareness that mental health issues can happen to anyone or any family and should be treated with the same care as diabetes, cardiac issues, etc.- Obesity/Overweight: LRH's Registered Dietician shares health related information about healthy eating habits including healthy diets and recipes through North Country Nutrition & Wellness a Blog for visitors to the LRH website. LRH offers entry level fitness classes on campus including yoga, and Bone Builders. LRH's 43.6 acres makes walking on the campus a favorite for everyone to walk and run. This encourages staying fit and addresses the obesity/overweight community health need.- Accessibility (Transportation/Disability, Access to Care, etc.) LRH provided transportation to and from appointments and procedures at LRH through our Care-A-Van service. LRH invested more than $110,000 to cover the cost of this service to assist individuals who cannot drive or cannot afford a vehicle so that they can get to and from Littleton Regional Healthcare.- Alcohol Abuse: Due to Covid-19, LRH did not allow Alcohol Anonymous to host. LRH hosts Alcohol Anonymous weekly meetings at no cost to AA. Again, the Doorway at LRH offers drug/substance abuse treatment in the region we serve.- Affordability: In 2020, LRH provided $609,000 in charity care for individuals who are unable to pay for healthcare services. Our patient financial services staff works with patients who do not have insurance but want to be covered to help them make a selection that works for them. We work with patients to help them pay their healthcare bills on a monthly basis, at a level that works for their financial capabilities.- Dental: LRH does not address this need directly, but we do refer patients to Ammonoosuc Community Health Services who offers high-quality, affordable dental care that is open to everyone regardless of ability to pay. They accept Medicaid and most major insurances and work with uninsured through a sliding fee scale payment option. Part I, Line 7: The Hospital determines its cost of charity care based on an overall financial statement cost to charge ratio applied against gross charity care charges. Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to physician practices. Part III, Line 4: Please refer to pages 8-12 of the attached audited financial statements. Part III, Line 8: Any shortfall is treated as a community benefit. The Organization uses a cost to charge ratio from the Medicare cost report to determine the amount of Medicare allowable costs. Part III, Line 9b: Patients who are known to qualify for financial assistance are given a financial assistance application to fill out and return to our Financial Counselor. Upon receipt of the financial assistance application, the application is processed and the amount of financial assistance that will be granted to the patient is determined.Once the percentage of financial assistance is approved, we adjust the account balance accordingly. If a balance is left over after the financial assistance is adjusted, the patient will receive their monthly statements for the remaining balance.If the patient defaults on paying the remaining balance, their account will be sent to a third party collection agency no sooner than 120 days from date of their first statements issued. At this time we would turn the account over to the third party collection agency for further collection efforts. Part VI, Line 2: LRH takes a comprehensive approach to assess community health needs. We perform several independent data analyses based on secondary source data, augment this with local survey data and resolve any data inconsistency or discrepancies from the combined opinions formed from local experts. We rely on secondary source data and most secondary sources use the county as the smallest unit of analysis. Since the service area comprises parts of Grafton County, we asked local residents to note if they perceived the problems, or needs, identified by secondary sources to exist in their portion of the county. Part VI, Line 3: Any applicant will receive a prompt decision on eligibility and amount of charity care offered. Notices of the Charity Care Policy are posted in the lobbies, waiting rooms and other public areas. Notices are also given to recipients who are served in their homes. Part VI, Line 4: The Hospital defines its primary service area as Grafton County, Grafton County, New Hampshire's estimated population is 89,947 with a growth rate of -0.04% in the past year according to the most recent United States census data. Grafton County, New Hampshire is the 5th largest county inNew Hampshire. According to the United States Census, the Population estimates base July 1, 2018 is 89,786 in Grafton County, New Hampshire. Persons under 5 years of age will make up 4.1 of the population. Persons under 18 years of age will make up 16.2% of the population. Persons 65 years of age and over will make up 20.7% and all females will make up 50.6 of the overall population. Median household income (in 2018 dollars), 2014 - 2018 was $63,153. Per capita income in past 12 months {in 2018 dollars) 2014-2018 is $36,619. 9.0% of the population is considered at poverty level. Individuals with a disability, under age 65 years, percent 2014- 2018 is 9.9%. People without health insurance, under the age of 65 years is 8.4. Part VI, Line 5: Littleton Regional Healthcare is involved in several community building activities that promote the health and wellbeing of the communities it serves. We collaborate with a number of local agencies including the North Country Health Consortium, Littleton Area Senior Center, Ammonoosuc Community Health Services and others. These agencies share common goals that address access to healthcare, health improvement, health education and affordable healthcare services. LRH encourages senior management and mid-level management to be actively involved in the communities we serve. We work with area schools to address the health of our young students and we work with local safety providers to promote safety and help prevent injury. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 237655 Support Medicaid Expansion and Drug & Alcohol Commission. Ammonoosuc Community Health Center 25 Mt Eustis Road Littleton NH 03561 510137745 501(c)(3) 7151 Up to Date clinical database New Hampshire Medical Society 7 North State Street Concord NH 03301 020223176 501(c)(6) 50000 Mobile Van Project Mid-State Health Center 101 Boulder Point Dr Suite 1 Plymouth NH 03264 020487172 501(c)(3) 50000 Childcare Facility 3 1 Part I, Line 2: Amounts were paid to organizations were required by the State of NH in order to support Medicaid expansion, as well as other nonprofit organizations. Therefore, additional monitoring of funds was not deemed to be necessary. X X X X 0 1 0 0 0 0 0 1 0 Dr Patrick Fitzpatrick Treasurer 395769 0 307165 0 14112 0 5721 0 36647 0 759414 0 0 0 Dr Dougald MacArthur Physician/Former Trustee 706000 0 0 0 0 0 0 0 0 0 706000 0 0 0 Dr Eric Mullins Physician 645371 0 0 0 590 0 4029 0 44489 0 694479 0 0 0 Dr Jeffrey Kauffman Physician 583912 0 0 0 4478 0 5950 0 37032 0 631372 0 0 0 Dr Anthony Salerni Physician 600001 0 25000 0 50 0 0 0 0 0 625051 0 0 0 Dr Eric Emig Physician 540767 0 12486 0 1598 0 0 0 32249 0 587100 0 0 0 Dr Jean Langevin Physician 538705 0 6462 0 20378 0 8185 0 11636 0 585366 0 0 0 Robert Nutter President & CEO 486795 0 9379 0 20378 0 8869 0 42114 0 567535 0 0 0 Dr Alice Rocke Past Medical Staff President 367116 0 48500 0 21926 0 1150 0 46978 0 485670 0 0 0 Dr Deane Rankin Past Trustee/Physician 361598 0 0 0 5438 0 8125 0 46462 0 421623 0 0 0 Dr Stephen Goldberg Trustee/Physician 258607 0 56970 0 18188 0 4337 0 38680 0 376782 0 0 0 Richard McKenzie Ex Officio 206320 0 55169 0 17122 0 8094 0 33007 0 319712 0 0 0 Leslie Walker Dir. Fin. Planning/Dec. Support 145179 0 0 0 878 0 4502 0 30332 0 180891 0 0 0 Steven Ciampa Past Interim CFO 132354 0 0 0 0 0 0 0 17753 0 150107 0 0 0 Part I, Line 4b Robert Nutter, President and CEO participated in the Hospital's 457(f) plan. No amounts were paid during the year to Mr. Nutter, nor were any amounts contributed to the plan during calendar year 2020. Part I, Line 7 Dr. Patrick Fitzpatrick, Dr. Stephen Goldberg, Dr. Alice Rocke, Robert Nutter, Richard McKenzie and Highest Compensated Employees: Dr. Jean Langevin, Dr. Anthony Salerni, and Dr. Eric Emig all received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties outlined in their respective contracts. The Board approved bonuses based on performance of the organization for fiscal year 2021. A New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 5331100 Refunded series 2007 Bond 0 0 0 B New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 20753200 Refunded series 2007 Bond 0 0 0 A 1114281 5331100 41800 5289300 2015 1 0 1 1 B 3784942 20753200 162500 20590700 2015 1 0 1 1 A 0 1 0 0 0 0 1 B 0 1 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 1 Deutsche Bank AG 20.000000000000 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2020 Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2020 Schedule K, Part III, Line 2, Lease Arrangements: The debt-financed property is leased to 3 physician practices which operated primarily for purposes related to the hospitals performance of its exempt purpose. Therefore, these leases are not considered to be private business use (Dartmouth Hitchcock(Derm and Cardio), Shippee/Eye Associates, Littleton Internal Med, White Mtn Family Health). Form 990, Part VI, Section A, line 2 Roger Gingue, Board Trustee and Dr. Patrick Fitzpatrick, Treasurer, have a family relationship. Form 990, Part VI, Section B, line 11b The return was reviewed by the entire Board of Trustees prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, and Auxilians complete a Conflict of Interest Statement each year, and any potential conflicts are reported to the Board of Trustees and to other places as required by law. In addition, employees who don't normally make decisions for the facility are expected to report forward any conflicts they may have, should they ever be in a position to influence decision making. Form 990, Part VI, Section B, line 15 Key employees complete self-evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations and market data. The CFO salary is approved by the President. The President/CEO's salary is approved by the Board. Form 990, Part VI, Section C, line 19 The hospital's governing documents and financial statements are made available upon request. The hospital's conflict of interest policy is not made available to the public. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Littleton Hospital Association 600 St. Johnsury Road Littleton, NH 03561 EIN 02-0222152 Littleton Hospital Association is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain/Loss on Interest Rate Swap 485,716.