2022-02-08T13:15:14-06:00 2021-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2020-10-01 020223321 Cottage Hospital COTT 6037479000 90 Swiftwater Road Woodsville NH 03785 Ann Duffy CFO 6037479000 2022-02-07 1 Ann Duffy 999009999 Barbara J McGuan CPA P00219457 2077752387 2022-02-07 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Holly McCormack 90 Swiftwater Road Woodsville NH 03785 42574065 0 X www.cottagehospital.org X 1903 NH Medical care and related services 12 10 406 12 0 0 1723633 8094831 34202932 33426720 178617 325501 39976 79718 36145158 41926770 7472 1665 0 0 19907823 21859212 0 0 0 15388437 16722650 35303732 38583527 841426 3343243 41461746 42210200 23742582 20107680 17719164 22102520 To strengthen the health of our community by providing accessible, compassionate, quality healthcare. To be the healthcare organization of choice for our service area. 0 0 24955126 1665 28192801 Cottage Hospital provided health care to approximately 652 inpatients and 32,284 outpatients during the fiscal year. 1973663 2810019 The Ray of Hope Geriatric Behavoiral Health unit provdes quality care for those strugging with a behavorial health issue. This inpatient program is for geriatric patients 65 years and older with persistent or late onset behavorial health illnesses or concerns. Specialized care focuses on assessment, treatment, rehabilitation, prevention, family/community support and education surrounding behavioral health. 2561640 2423900 The Rowe Health Center provides internal medicine, behavioral health, general surgery, podiatry, gastroenterology and endocrinology services. We are proud to offer a team-based approach to provide all of our patients with accessible, convenient, high quality care. With extended hours and same day acute appointments available, meeting the needs of our patients is our priority. 29490429 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 10 0 1 406 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Ann Duffy 6037479000 90 Swiftwater Road Woodsville NH 03785 Christopher Findley Chief of ED 40.00 X 472687 0 37185 Christopher Danielson Physician RHC 40.00 X 339337 0 32878 Maria Ryan Past CEO 40.00 X X 311352 0 29521 Terry Larsen MD Past Medical Staff Secretary 40.00 X 269470 0 21475 Marlene Sarkis Physician RHC 40.00 X 242867 0 29890 Eric McDougall Hospitalist 40.00 X 249373 0 9130 Kathryn Walsh CRNA Past Medical Staff President 40.00 X 227755 0 25006 Kevin Seale CRNA 40.00 X 213998 0 31288 Delphine Sullivan MD Medical Staff Secretary 40.00 X 224561 0 5763 Ann Duffy CFO 40.00 X 177743 0 25133 Holly McCormack CEO 40.00 X X 146724 0 30715 Mark Gleicher Chairperson 1.00 X X 0 0 0 David Robinson Vice Chair 1.00 X X 0 0 0 Teresa Puffer Secretary 1.00 X X 0 0 0 Mark Harris Trustee 1.00 X 0 0 0 Kevin Lawrence Trustee 1.00 X 0 0 0 Ashley Luurtsema Trustee 1.00 X 0 0 0 Tom Page Trustee 1.00 X 0 0 0 Prentis Pratt Trustee 1.00 X 0 0 0 Aaron Solnit MD Medical Staff President 1.00 X 0 0 0 William Taxter Trustee 1.00 X 0 0 0 William Daley Past Vice Chair 1.00 X X 0 0 0 Mark Johnson Past Trustee 1.00 X 0 0 0 2875867 0 277984 37 0 1 0 Dartmouth Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 Medical Services 909256 Athena Health Inc 311 Arsenal Street Watertown MA 02472 EMR Service Contract 481992 Alliance Healthcare PO Box 96485 Chicago IL 606936485 MRI & Nuclear Medicine Services 436554 EM Staff 36 Coventry Road Concord NH 03301 Staffing Services 397729 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Staffing Services 360652 18 7927780 167051 14374 8094831 Patient Service Revenue 622110 69892627 69892627 DSH Payments 622110 3091815 3091815 Other Operating Revenue 622110 813273 254077 559196 Provision For Bad Debt 622110 -1517962 -1517962 Contractual/Char. Adj. 622110 -38853033 -38853033 33426720 157926 157926 4605 0 4605 4605 4605 779786 20397 600420 32188 179366 -11791 167575 167575 20123 8687 11436 11436 69677 6000 63677 63677 41926770 32867524 0 964415 X 1165 1165 500 500 1087454 543705 543749 17263654 13279586 3984068 255382 184364 71018 2001042 1398876 602166 1251680 865255 386425 52944 52944 137050 137050 9657 9657 7500679 6460850 1039829 144046 77009 67037 1174628 476100 698528 9329 1489 7840 252586 248303 4283 1654566 1083790 570776 344605 38061 306544 Supplies 3090864 2740566 350298 Medicaid Enhancement Ta 1358326 1358326 Miscellaneous Expenses 586391 410042 176349 Education and Recruitme 406979 322442 84537 38583527 29490429 9093098 0 X 1466930 997594 12752367 12618800 4370201 4025394 536348 533733 257216 262243 34153656 20938229 12904129 13215427 7964204 9143082 214872 252259 995479 1161668 41461746 42210200 3258495 3827444 4273248 100000 5177192 5003311 2639800 2546309 8393847 8630616 23742582 20107680 X 16166526 20458060 1552638 1644460 17719164 22102520 41461746 42210200 X 3343243 1002726 37387 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 8157 8157 0 Part II-B, Line 1: Cottage Hospital is a member of the New Hampshire Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Cottage Hospital and other member organizations in furtherance of their exempt purposes. Cottage Hospital does not directly perform any lobbying activities. 1338240 102058 30755 1409543 1441360 -63571 39549 1338240 1445662 31310 35612 1441360 1449641 34311 38290 1445662 1262506 157122 67594 37581 1449641 0.00000 0.98799 0.01201 1 0 531787 531787 18994308 10729854 8264454 13045911 9602230 3443681 1581650 606145 975505 13215427 Deferred Compensation 1144868 Due to Third-Party Payors 7485748 8630616 42971913 1002726 52074 1054800 41917113 9657 9657 41926770 38588557 14687 14687 38573870 9657 9657 38583527 Part V, Line 4: The intended use of the Hospital's endowment fund is to support the hospital in its efforts to provide quality healthcare to residents of the communities it serves and others who may use the hospital. Part XI, Line 2d - Other Adjustments: Gaming Expenses 6,000. Change in Funds Held in Trust by Others 37,387. Fundraising Expenses 8,687. Part XII, Line 2d - Other Adjustments: Gaming Expenses 6,000. Fundraising Expenses 8,687. 5k 20123 20123 219 8468 20123 20123 219 8468 8687 11436 69677 6000 0 69677 6000 6000 63677 NH 1 0 1 0 0.00000 1.00000 Ann Duffy CFO 90 Swiftwater Road Woodsville NH 03785 1 63677 6000 Manchester Poker Room & Casino 1279 S Willow Street Manchester NH 03103 0 Schedule G, Part III, Line 15a: The Organization had an agreement where Manchester Poker Room & Casino would provide Cottage Hospital a percentage of revenue from Manchester Poker Room & Casino's games of chance proceeds. Cottage Hospital never paid Manchester Poker Room & Casino directly and was not directly involved in administrating any of the games of chance. Cottage Hospital was charged $600 a day for the ten day event which was taken directly out of the proceeds earned by Manchester Poker Room & Casino which then donated the remaining $63,677 of proceeds to Cottage Hospital. 1 1 1 X 1 X 1 1 1 0 1 1 297747 183819 113928 0.00300 4734618 4519352 215266 0.00560 5032365 4703171 329194 0.00860 164645 164645 0.00430 359173 359173 0.00930 523818 523818 0.01360 5556183 4703171 853012 0.02220 43612 43612 0.00110 11392 11392 0.00030 152323 152323 0.00390 3650 3650 0.00010 210977 210977 0.00540 631885 16117917 16432570 -314653 X 1 1 1 1 Cottage Hospital 90 Switfwater Road Woodsville NH 03785 www.cottagehospital.org 01770 X X X X Cottage Hospital 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X cottagehospital.org/community-benefits X 1 19 1 cottagehospital.org/community-benefits 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X www.cottagehospital.org/patient-info/financial-assistance X www.cottagehospital.org/patient-info/financial-assistance X www.cottagehospital.org/patient-info/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Cottage Hospital Part V, Section B, Line 5: Key leaders and focus groups within the community. For example, politicians, business health partners, staff and administration. Cottage Hospital Part V, Section B, Line 11: The Hospital's most recent CHNA showed the following areas as the greatest need, a description of what we have done to address the need is included:1) Increasing access to transportation to medical appointments and other health services - Cottage has some influence with three transportation services being available in the Area, Stagecoach, HMSC Bus, and RCT (VT)2) Increasing awareness around Hospital services and programs Cottage utilizes social media and community outreach initiatives to communicate the services that Cottage offers to the community.3) Increasing access to drug and other substance abuse treatment services Cottage providers identify patients with substance abuse issues and refer a facility with appropriate resources.4) Increasing access to counseling services for mental health for children5) Increasing awareness of emergency care and trauma services. Cottage utilizes social media and community outreach initiates to communicate the emergency and trauma care services provided.6) Increasing access to dentistry services7) Increasing access to counseling services for mental health for adults.8) Cottage offers outpatient treatment as well as short-term inpatient services for adults struggling with behavioral issues via an IP geriatric psych unit.9) Enhancing drug and other substance abuse education and prevention -10) Cottage works with a local substance misuse prevention program referring patients as appropriate.11) Improving access to financial assistance for healthcare services and prescription drugs. - Cottage provides a financial counselor and patient care counselor to assist patients with understanding financial options available to them.12) Increasing access to specialty care for chronic conditions like diabetes and heart disease - Cottage provides services via a diabetic counselor, endocrinologist and offers a diabetic prevention program.13) Increasing access to primary care services - Cottage offers primary care services, and will utilize community outreach efforts to assist patients in a continuum of care.14) Increasing access to long-term care or dementia care for seniors - Cottage offers a short stay geriatric psych unit for patients that need short-term assistance. Those that require long-term care will be referred to an external long-term care facility.15) Increasing access to care coordination or support services to help people better manage their own health via patient outreach initiatives.16) Increasing access to emergency care and trauma services Cottage utilizes social media and community outreach initiatives to educate the community on available services. Cottage Hospital Part V, Section B, Line 13b: Catastrophic relief guidelines: the Hospital recognizes that on occasion a patient may experience a serious illness or injury. A catastrophic relief program is available to patients that may need substantial financial assistance for an extended episode of care. The policy provides relief to uninsured (or grossly uninsured)individuals whose financial responsibility to the Hospital exceeds $30,000 for any single episode of care. Patients whose family income exceeds 300% of the FPL and whose financial responsibility to the hospital exceeds $30,000 for any single episode of care may be eligible for this program on a case-by-case basis. 1 1 - Rowe Health Center 103 Swiftwater Road Woodsville NH 03785 Rural Health Clinic Part I, Line 7: Part 1, Lines 7a-c; The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990, Schedule H, Worksheet 2, ratio of patient care cost-to-charges.Part 1, Lines 7e & f; The Hospital's costs are determined based on an evaluation of a labor plus estimated overhead absorption rate applied on an hourly basis.Part 1, Lines 7g & 7i; Represent actual costs derived from the Hospital's accounting system. Part II, Community Building Activities: Our community building activities are determined and aligned through our Community Health Needs Assessment. This assessment is evaluated every three years. Key leaders of the community, as well as peers within different demographic segments, are interviewed by a third party. Programs typically target preventative care, areas of health not being met within our community, and education in specialty medicine available within our service market. We strategically collaborate with other organizations to build a stronger message. Part III, Line 2: Part III, line 2-3; The Hospital uses a cost-to-charge ratio. The cost-to-charge ratio was derived from the Form 990 Schedule H worksheet 2, ratio of patient care cost-to-charges. The CCR was then applied to bad debt expense at charge value in order to arrive at the estimated expense reported. Part III, Line 4: Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectible of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payors sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payors sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with service provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary.For receivables associated with self-pay patients, including both patients without insurance and patients with deductible and nonpayment balances due for which third-party coverage exists for only part of the bill, the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Part III, Line 8: As Cottage Hospital operates at a loss from Medicare, the shortfall could be treated as community benefit as there are no other funds available to subsidize the loss. Medicare allowable costs have been determined using a cost-to-charge ratio determined in accordance with worksheet 2, ratio of patient care cost-to-charges, of the Form 990 Schedule H instructions. Part III, Line 9b: If the patient has been on charity care in the past but it has now expired, the patient would have to re-apply. Part VI, Line 2: Cottage Hospital just recently conducted its Community Health Needs Assessment (completed in December 2019). The Affordable Care Act of 2010 requires not-for-profit hospital to conduct a CHNA every three years. In addition, the state of New Hampshire requires one to be done every five years. Key healthcare and public service stakeholders representing a breadth of community perspectives participated in the research as key leaders and sources of information. The stakeholder research was supplemented by an in-depth review of demographic and epidemiological data in order to identify underlying health trends in the service area. The assessment included listing the prioritized community needs, the definition of the community served, a description of the methodology to identify needs in the community, a description of the approach used to prioritize community needs and a list of healthcare resources. The information gathered was then used as part of the Hospital's strategic planning process. The CHNA is available on the Hospital's website. Part VI, Line 3: If at the time of registration or admission, a patient indicates that he or she has no other medical payer available, i.e., no insurance, Medicaid, or Medicare, the Hospital asks if the patient would like an application for Medicaid and/or for the Hospital's charity care program. The Hospital then documents on the patient's account whether or not the patient took either of the applications, or if the applications were turned down.If the patient is admitted and unable to respond to the question of payers available at the time of admission, case management notifies the patient financial counselor. After checking with nursing to see if the patient is alert and able to discuss the payer issue, the patient financial counselor will visit the patient's bedside. Part VI, Line 4: The Hospital's geographic area includes its primary market: New Hampshire - Bath, Benton, Haverhill, Lisbon, Monroe, Piermont, and in Vermont - Barnet, Bradford, Corinth, Groton, Newbury, Ryegate, Wells River and Woodville. The secondary market includes, but is not limited to: in New Hampshire - Landaff, Littleton, Orford, Rumney, Warren and Wentworth and in Vermont - Fairlee, Groton, McIndoe Falls, Peacham, Thetford, and Topsham. Demographically, the hospital services the general population. Part VI, Line 7, Reports Filed With States NH X X X X X 0 0 0 0 0 0 0 1 0 Christopher Findley Chief of ED 440254 0 2000 0 30433 0 9071 0 28114 0 509872 0 0 0 Christopher Danielson Physician RHC 337337 0 2000 0 0 0 8426 0 24452 0 372215 0 0 0 Maria Ryan Past CEO 272940 0 28429 0 9983 0 11131 0 18390 0 340873 0 0 0 Terry Larsen MD Past Medical Staff Secretary 218808 0 2000 0 48662 0 8933 0 12542 0 290945 0 0 0 Marlene Sarkis Physician RHC 240867 0 2000 0 0 0 0 0 29890 0 272757 0 0 0 Eric McDougall Hospitalist 247373 0 2000 0 0 0 7103 0 2027 0 258503 0 0 0 Kathryn Walsh CRNA Past Medical Staff President 223174 0 2000 0 2581 0 6888 0 18118 0 252761 0 0 0 Kevin Seale CRNA 210898 0 2000 0 1100 0 6575 0 24713 0 245286 0 0 0 Delphine Sullivan MD Medical Staff Secretary 222561 0 2000 0 0 0 5283 0 480 0 230324 0 0 0 Ann Duffy CFO 176743 0 1000 0 0 0 7254 0 17879 0 202876 0 0 0 Holly McCormack CEO 136115 0 1000 0 9609 0 4352 0 26363 0 177439 0 0 0 Part I, Line 7 Maria Ryan, CEO, received a bonus of $28,429 in 2020. The bonus is determined based on the Board of Director's review of the CEO's performance and compensation agreement. Christopher Danielson, Christopher Findley, Terry Larsen, Eric McDougal, Marlene Sarkis, Kevin Seale, Delphine Sullivan and Kathryn Walsh received a $2,000 Covid-19 bonus to aid with retention. Ann Duffy and Holly McCormack received a $1,000 Covid-19 bonus to aid with retention. A Business Finance Authority of the State of NH NoneAvail 2011-05-31 7745000 Refinance Mortgage and Terminate Hedge 0 0 0 A 2741689 7745000 156490 7588510 2011 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Form 990, Part VI, Section B, line 11b Cottage Hospital gathers the information, and our CPA firm completes the Form 990. The Form 990 is then reviewed by the CFO and Director of Finance, before it is sent to the Board of Directors for their review. Once all of this has been completed, the CFO signs the Form 990, and it is sent to the IRS. Form 990, Part VI, Section B, line 12c The members of the Board of Trustees are required to file an annual Conflict of Interest Statement. Form 990, Part VI, Section B, line 15 The following were used to determine compensation of the CEO: comparison data and a compensation survey. The CEO's compensation is approved by the Executive Committee and the Board of Trustees. The compensation of officers and key employees, other than the CEO, is set by management using available industry data and benchmarks. Compensation of these employees is indirectly approved when the Board approves the annual operating budget. Form 990, Part VI, Section C, line 18 The Organization makes its Form 1023 and Form 990 available upon request and through a third party website. Form 990, Part VI, Section C, line 19 By using the Annual Report and website. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,229,897. Management and general expenses 987,461. Fundraising expenses 0. Total expenses 5,217,358. Other Professional Fees: Program service expenses 2,216,519. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,216,519. Consulting Fees: Program service expenses 14,434. Management and general expenses 52,368. Fundraising expenses 0. Total expenses 66,802. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Cottage Hospital 90 Swiftwater Road Woodsville, NH 03785 EIN: 02-0223321 Cottage Hospital is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Change in Funds Held in Trust by Others 37,387.