ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
Tax period: 2020-07-01 to 2021-06-30
Filed: 2022-05-12
IRS object ID: 202231329349301843
Schema version: 2020v4.0
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	2022-05-12T13:02:51-05:00	ReturnTs
Tax Period End	2021-06-30	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	2020-07-01	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	2022-05-12	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	KIM SCIFRES	PreparerPersonNm
PTIN	P01316095	PTIN
Phone	5023263996	PhoneNum

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	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	$84,355,521	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	18	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	671	TotalEmployeeCnt
Total Volunteers	72	TotalVolunteersCnt
Total Gross UBI	-$5,318	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$617,929	PYContributionsGrantsAmt
CY Contributions Grants	$837,236	CYContributionsGrantsAmt
PY Program Service Revenue	$65,607,874	PYProgramServiceRevenueAmt
CY Program Service Revenue	$83,066,859	CYProgramServiceRevenueAmt
PY Investment Income	$95,641	PYInvestmentIncomeAmt
CY Investment Income	$54,742	CYInvestmentIncomeAmt
PY Other Revenue	$6,760,160	PYOtherRevenueAmt
CY Other Revenue	$396,684	CYOtherRevenueAmt
PY Total Revenue	$73,081,604	PYTotalRevenueAmt
CY Total Revenue	$84,355,521	CYTotalRevenueAmt
PY Grants And Similar Paid	$109,193	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$282,974	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$43,787,912	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$47,708,967	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$206,842	CYTotalFundraisingExpenseAmt
PY Other Expenses	$27,435,157	PYOtherExpensesAmt
CY Other Expenses	$29,192,857	CYOtherExpensesAmt
PY Total Expenses	$71,332,262	PYTotalExpensesAmt
CY Total Expenses	$77,184,798	CYTotalExpensesAmt
PY Revenues Less Expenses	$1,749,342	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$7,170,723	CYRevenuesLessExpensesAmt
Total Assets BOY	$106,122,575	TotalAssetsBOYAmt
Total Assets EOY	$121,000,117	TotalAssetsEOYAmt
Total Liabilities BOY	$75,713,869	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$80,902,041	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$30,408,706	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$40,098,076	NetAssetsOrFundBalancesEOYAmt
Mission	To improve the health and wellbeing of our community	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$71,898,854	ExpenseAmt
Grant	$282,974	GrantAmt
Revenue	$83,285,518	RevenueAmt
Desc	Alice Peck Day Memorial Hospital is a community-based critical access hospital operating in Lebanon, NH. The Hospital began as a small cottage hospital in 1932. From its humble beginnings, Alice Peck Day has continually demonstrated its commitment to provide patient-focused health care services which improve the quality of life within its community and promote wellness for all. Alice Peck Day Memorial Hospital is a charitable health care organization which is dedicated to serving its community. This commitment includes granting credit to patients, substantially all of whom are local residents. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than the established rates. Collections are not pursued for amounts determined to qualify as charity care. The Hospital maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy, the established costs of the services and supplies provided, and equivalent service statistics. For the fiscal year ended June 30, 2021, charity care at a cost of $505,912 was provided to eligible patients. Estimated costs incurred in excess of payment for inpatient and outpatient services for Medicaid patients in fiscal year ended June 30, 2021 were $2,360,578. In addition to the charity care services described above, the Hospital provided a number of other services for which little or no payment was received. These included: the Upper Valley Smiles dental program of free oral health education, screenings, and preventive treatment offered to low-income children in ten local elementary schools; Elder Friends, a program matching volunteers one-on-one with isolated, home-bound seniors; Lebanon Lunch Friends, which provides free lunches to eligible local children who no longer have access to free or reduced-price meals at school during the summer; the Tobacco 21 initiative, which involved forming a community coalition to consider supporting a City of Lebanon ordinance that restricts tobacco and e-cigarette sales to individuals 21 years and older; the creation of a public access trail from one of the Hospital parking lots to the Mascoma River Greenway, and Community Care News, a web-based initiative focused on providing helpful tips to improve health and wellbeing during the pandemic. As a local hospital, Alice Peck Day works closely with community organizations to address community needs. Organizations that were beneficiaries of hospital staff time, meeting space, cash and/or materials included: Alcoholics Anonymous, American Red Cross, Good Neighbor Health Clinic, Headrest, Lebanon Chamber of Commerce, Lebanon Department of Recreation, Ottauquechee School, Upper Valley Business Alliance, Upper Valley Medtech Collaborative, and Upper Valley Public Health Council. In certain instances, assistance was provided to the community for which no value can be placed. Alice Peck Day Memorial Hospital considers caring for our community a special responsibility that we are honored to fulfill.	Desc
Total Program Service Expenses	$71,898,854	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
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
IRP Document	109	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	671	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	18	GoverningBodyVotingMembersCnt
Independent Voting Member	10	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 (31 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
Brett C Peltzer
Trustee, Treasurer (Until 12/20)	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
Clayton R Adams
Trustee, Treasurer (As of 1/21)	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, Secty (As of 1/21)	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
Michael F Long
Trustee, Secretary (Until 12/20)	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
SUSAN MOONEY MD MS FACOG
TRUSTEE/PRESIDENT/CEO APD	38.0	2.0	Yes (X)	Yes (X)	$393,822	$0	$28,906
Brenan Riehl
Trustee	0.5	0	Yes (X)		$0	$0	$0
Charles J Wheelan
Trustee	0.5	0	Yes (X)		$0	$0	$0
Cybele M Merrick
Trustee (As Of 1/21)	0.5	0	Yes (X)		$0	$0	$0
GEORGE T BLIKE MD
Trustee	0.5	31.0	Yes (X)		$0	$400,007	$50,140
John L Scherding
Trustee	0.5	2.0	Yes (X)		$0	$0	$0
JOHN P HOUDE MD
TRUSTEE (Until 12/20)	40.0	0	Yes (X)		$540,550	$0	$28,931
Kyle Fisher
Trustee	0.5	0.5	Yes (X)		$0	$0	$0
Marva Williams-Lowe
Trustee (As of 1/21) / Sr. Director	0.5	40.0	Yes (X)		$0	$201,249	$56,003
Mary M Oseid MHCDS
Trustee	0.5	41.0	Yes (X)		$0	$353,987	$60,511
Patrick F Jordan III MBA
Trustee	0.5	56.5	Yes (X)		$0	$756,581	$59,599
Phillip Collins MD
Ex-Officio/Pres Med Staff	40.0	0	Yes (X)		$216,873	$0	$33,450
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	$433,389	$62,317
Tina E Naimie CPA
Trustee	1.0	41.0	Yes (X)		$0	$300,108	$24,224
TODD ROBERTS
VP Finance	38.0	2.0		Yes (X)	$160,076	$0	$27,068
DALE C VIDAL MD MS
Executive Director MSC	40.0	0			$534,594	$0	$28,259	Yes (X)
JEAN TEN HAKEN MSN RN CENP
CNO/COO	40.0	0			$238,526	$0	$10,926	Yes (X)
BRIAN LOMBARDO MD
PHYSICIAN	40.0	0			$243,706	$0	$27,973		Yes (X)
DEBORAH GLAZER MD
PHYSICIAN	40.0	0			$259,918	$0	$11,637		Yes (X)
DIANE RILEY MD CAQSH
Ortho Surgeon Hand Specialist	40.0	0			$459,414	$0	$22,760		Yes (X)
ERIN MCNEELY MD
PHYSICIAN	40.0	0			$109,005	$0	$14,211		Yes (X)
IVAN TOMEK MD
General Orthopedic Surgeon	40.0	0			$584,836	$0	$25,805		Yes (X)
Brenda L Blair
Former VP & COO	0.0	0.0			$0	$258,395	$47,755			Yes (X)
Kathryn M Vargo MD
Former Officer	30.0	0			$127,300	$0	$27,314			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,868,620	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,703,716	TotReportableCompRltdOrgAmt
Total Other Compensation	$647,789	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	Address Line2ContractorAddress/USAddress/AddressLine2Txt
Upper Valley Neurology
106 Hanover Street	Lebanon	NH	03766	Physician Services	$3,261,842
Conifer Revenue Cycle Solutions LLC
PO Box 655025	Dallas	TX	75265	Revenue Management Services	$3,074,283
AMERICAN HEALTHCARE SERVICES ASSN
PO Box 670529	Dallas	TX	75267	Staffing Services	$1,946,293
ENGELBERTH CONSTRUCTION
150 Water Tower Circle	Colchester	VT	05446	Construction Contracting	$1,889,083
AVANT HEALTHCARE PROFESSIONALS LLC
1211 Semoran Blvd	asselberry	FL	32707	Healthcare Staffing	$1,348,525	Suite 227

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	16	CntrctRcvdGreaterThan100KCnt
Government Grants	$393,080	GovernmentGrantsAmt
All Other Contributions	$444,156	AllOtherContributionsAmt
Total Contributions	$837,236	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient Services	622110	$82,257,275	$82,257,275
Nutritional Services	722210	$117,619	$117,619
PHARMACY SALES	446100	$691,965	$691,965

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	$83,066,859	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$46,812	TotalRevenueColumnAmt
Unrelated Business Revenue	-$5,318	UnrelatedBusinessRevenueAmt
Exclusion	$52,130	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$178,025	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$178,025	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$178,025	TotalRevenueColumnAmt
Exclusion	$178,025	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$7,930	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$7,930	SecuritiesAmt
Other	$0	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$7,930	TotalRevenueColumnAmt
Exclusion	$7,930	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PURCHASE REBATES AND DISCOUNTS	900099	$124,170	$124,170
MISCELLANEOUS	900099	$94,489	$94,489

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	$218,659	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$84,355,521	TotalRevenueColumnAmt
Related Or Exempt Func Income	$83,285,518	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$5,318	UnrelatedBusinessRevenueAmt
Exclusion	$238,085	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$282,974	TotalAmt
Program Services	$282,974	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,452,621	TotalAmt
Program Services	$1,085,531	ProgramServicesAmt
Management And General	$1,344,004	ManagementAndGeneralAmt
Fundraising	$23,086	FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$87,888	TotalAmt
Program Services	$87,888	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$38,430,425	TotalAmt
Program Services	$36,508,905	ProgramServicesAmt
Management And General	$1,806,229	ManagementAndGeneralAmt
Fundraising	$115,291	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$623,641	TotalAmt
Program Services	$592,459	ProgramServicesAmt
Management And General	$29,311	ManagementAndGeneralAmt
Fundraising	$1,871	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$4,384,119	TotalAmt
Program Services	$4,164,913	ProgramServicesAmt
Management And General	$206,054	ManagementAndGeneralAmt
Fundraising	$13,152	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,730,273	TotalAmt
Program Services	$1,643,759	ProgramServicesAmt
Management And General	$81,323	ManagementAndGeneralAmt
Fundraising	$5,191	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$10,227	TotalAmt
Management And General	$10,227	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$5,836,005	TotalAmt
Program Services	$5,544,205	ProgramServicesAmt
Management And General	$274,292	ManagementAndGeneralAmt
Fundraising	$17,508	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$53,356	TotalAmt
Management And General	$53,356	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,037,526	TotalAmt
Program Services	$192,980	ProgramServicesAmt
Management And General	$841,433	ManagementAndGeneralAmt
Fundraising	$3,113	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$544,398	TotalAmt
Program Services	$517,178	ProgramServicesAmt
Management And General	$25,587	ManagementAndGeneralAmt
Fundraising	$1,633	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,757,700	TotalAmt
Program Services	$1,669,815	ProgramServicesAmt
Management And General	$82,612	ManagementAndGeneralAmt
Fundraising	$5,273	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$37,756	TotalAmt
Program Services	$35,868	ProgramServicesAmt
Management And General	$1,775	ManagementAndGeneralAmt
Fundraising	$113	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$875,011	TotalAmt
Program Services	$831,260	ProgramServicesAmt
Management And General	$41,126	ManagementAndGeneralAmt
Fundraising	$2,625	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,366,663	TotalAmt
Program Services	$3,198,330	ProgramServicesAmt
Management And General	$158,233	ManagementAndGeneralAmt
Fundraising	$10,100	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$338,169	TotalAmt
Program Services	$321,260	ProgramServicesAmt
Management And General	$15,894	ManagementAndGeneralAmt
Fundraising	$1,015	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Drugs/medical supplies	$9,971,080	$9,971,080
New Hampshire MET	$3,074,616	$3,074,616
Repairs/maintenance	$1,633,171	$1,551,512	$76,759	$4,900
STAFF DUES , LICENSES AND EDUCATION	$241,211	$229,151	$11,337	$723

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$415,968	TotalAmt
Program Services	$395,170	ProgramServicesAmt
Management And General	$19,550	ManagementAndGeneralAmt
Fundraising	$1,248	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$77,184,798	TotalAmt
Program Services	$71,898,854	ProgramServicesAmt
Management And General	$5,079,102	ManagementAndGeneralAmt
Fundraising	$206,842	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$15,725,480	BOYAmt
EOY	$27,581,575	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$10,425,917	BOYAmt
EOY	$14,679,299	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$120,009	BOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$8,642,305	BOYAmt
EOY	$7,216,851	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	$10,749,298	BOYAmt
EOY	$10,269,754	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$444,769	BOYAmt
EOY	$443,112	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$441,331	BOYAmt
EOY	$401,629	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$60,033,236	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$37,409,882	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$38,378,887	BOYAmt
EOY	$22,623,354	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$13,069,164	BOYAmt
EOY	$15,717,379	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,216,933	BOYAmt
EOY	$5,131,433	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,908,482	BOYAmt
EOY	$16,935,731	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$106,122,575	BOYAmt
EOY	$121,000,117	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$6,815,774	BOYAmt
EOY	$12,181,097	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$11,854,938	BOYAmt
EOY	$76,941	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$25,160,000	BOYAmt
EOY	$24,425,000	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	$11,660	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$31,871,497	BOYAmt
EOY	$44,219,003	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$75,713,869	BOYAmt
EOY	$80,902,041	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	$29,463,607	BOYAmt
EOY	$38,969,853	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$945,099	BOYAmt
EOY	$1,128,223	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$30,408,706	BOYAmt
EOY	$40,098,076	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$106,122,575	BOYAmt
EOY	$121,000,117	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$7,170,723	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$2,518,647	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	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	false	FederalGrantAuditRequiredInd

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	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$12,373	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$5,000	OtherActivitiesAmt
Total Lobbying Expenditures	$17,373	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 is a member of various organizations related to its exempt mission, including the American Hospital Association and the New Hampshire Hospital Association. The portion of dues to these organizations associated with lobbying costs is reported in Part II-B as Other Activities. The hospital also belongs to the 10 Mile Critical Access Hospital (CAH) coalition which engaged strategic health resources (SHR) for purposes of furthering lobbying efforts with regards to attempt to eliminate CAH status. The CEO participates in periodic telephone calls with this group in attempts to keep the issue of rural healthcare and the key role that CAHs play in rural healthcare in front of the various legislative delegations.	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	$219,295	BeginningYearBalanceAmt
Other Expenditures	$122,295	OtherExpendituresAmt
End Year Balance	$97,000	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$33,539	BeginningYearBalanceAmt
Contributions	$185,756	ContributionsAmt
End Year Balance	$219,295	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$31,051	BeginningYearBalanceAmt
Contributions	$2,488	ContributionsAmt
End Year Balance	$33,539	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	$20,842,759	OtherCostOrOtherBasisAmt
Depreciation	$12,328,408	DepreciationAmt
Book Value	$8,514,351	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	$32,565,682	OtherCostOrOtherBasisAmt
Depreciation	$23,805,552	DepreciationAmt
Book Value	$8,760,130	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,812,020	OtherCostOrOtherBasisAmt
Depreciation	$1,063,147	DepreciationAmt
Book Value	$748,873	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$22,623,354	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	INVESTMENT IN POOLED FUNDS	Desc
Book Value	$15,717,379	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$15,717,379	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
DUE FROM AFFILIATES	$729,752
RIGHT OF USE ASSETS	$16,104,030
BOND ISSUANCE COSTS	$101,949

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$16,935,731	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
Medical liabilities and payables	$27,005,925
Estimated third-party payor settlements
Accrued constructions costs for building under development
Due to affiliates	$783,757
RIGHT OF USE LIABILITIES	$16,429,321

Field	Value	IRS element (for citing)
Total Liability	$44,219,003	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	$503,927	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$503,927	NetCommunityBenefitExpnsAmt
Total Expense	0.0068	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,149,686	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,816,974	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,332,712	NetCommunityBenefitExpnsAmt
Total Expense	0.0314	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
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	$10,653,613	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,816,974	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,836,639	NetCommunityBenefitExpnsAmt
Total Expense	0.0382	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$79,228	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$79,228	NetCommunityBenefitExpnsAmt
Total Expense	0.0011	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$8,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$8,000	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,676,817	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,602,835	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,073,982	NetCommunityBenefitExpnsAmt
Total Expense	0.0145	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)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$308,241	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$308,241	NetCommunityBenefitExpnsAmt
Total Expense	0.0042	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$4,072,286	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,602,835	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,469,451	NetCommunityBenefitExpnsAmt
Total Expense	0.0198	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$14,725,899	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,419,809	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,306,090	NetCommunityBenefitExpnsAmt
Total Expense	0.0580	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,434	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,434	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,947	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,947	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	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)
Total Community Benefit Expns	$780	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$780	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,626	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$9,626	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	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	$21,787	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$21,787	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Reimbursed By Medicare	$35,505,419	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$21,663,919	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$13,841,500	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	18	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/sites/default/files/2021-11/FY19_DH_APD_VNH_Community_Health_Needs_Asse	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	https://www.doj.nh.gov/charitable-trusts/documents/050-dhh-community-needs.pdf	OtherWebsiteURLTxt
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/sites/default/files/2021-11/FY19_DH_APD_VNH_Community_Health_Needs_Asse	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	www.alicepeckday.org/pa	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	www.alicepeckday.org/patients/financial_services	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	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 (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - Alice Peck Day Memorial Hospital. With a shared Hospital Service Area, Alice Peck Day Memorial Hospital collaborated with Dartmouth-Hitchcock in conducting the fiscal year 2019 Community Health Needs Assessment. Technical expertise was provided by the New Hampshire Community Health Institute, the NH affiliate of JSI, a nation-wide public health management consulting and research organization. Methods employed in the assessment included surveys of community residents made available online and paper surveys placed in numerous locations throughout the region (completed by 2,100 individuals), a direct email survey of key stakeholders and community leaders representing multiple community sectors; a set of community discussion groups; compilation of results from assessment activities focused specifically on behavioral health needs and gaps; and a review of available 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 health-related 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 data gathered in the FY2019 CHNA is part of a continual process for considering progress and emerging community needs informed by dialogue with community members, leaders, and experience.
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 TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT. APDMH ALSO PARTNERED WITH NEIGHBORING HOSPITALS AND ORGANIZATIONS INCLUDING DARTMOUTH HITCHCOCK MEDICAL CENTER, NEW LONDON HOSPITAL,VALLEY REGIONAL HOSPITAL, MOUNT ASCUTNEY HOSPITAL AND VISITING NURSE & HOSPICE OF VT and NH.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - Alice Peck Day Memorial Hospital. Technical assistance for the Hospital's 2018 CHNA was provided by the New Hampshire Community Health Institute
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - ALICE PECK DAY MEMORIAL HOSITAL. Alice Peck Day Memorial Hospital's (APDMH) Community Health Implementation Plan, approved by the governing board in November of 2019, is a three-year document that provides a detailed set of strategies for addressing our region's top health needs. Based on the most recent Community Health Needs Assessment (CHNA), affordable health care and health insurance were the top needs identified. 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. We also provide in-kind donation of space to the Good Neighbor Health Clinic, the Upper Valley's free medical clinic. Additional top health needs include: mental health, substance misuse and addiction, child abuse or neglect, cost of prescription drugs, availability of primary care services, domestic violence, and senior health care services. We work in partnership with local and state organizations and agencies to address these concerns. We offer mental health services through our Behavioral Health Specialist; participate in the region's Integrated Delivery Network to enhance behavioral health capacity, and created an Emergency Department Rapid Referral Program through partnership with West Central Behavioral Health. In the Clinic, we provide Medication Assisted Treatment to patients with substance use disorders, and in the community we led an advocacy initiative aimed at increasing the minimum age to 21 for tobacco sales in Lebanon, NH. We participate in a regional initiative called "Strong Families, Strong Starts" to help strengthen child development and address childhood trauma. We provide vouchers for emergency prescription assistance and one-on-one help applying for prescription assistance programs offered through drug companies. In our clinics, we screen for child abuse and domestic violence and refer patients for treatment. Lastly, we offer our Senior Care Team's home-based primary care program for the elderly in the local community; provide the Elder Friends program, which matches those referred by the Senior Care team with a volunteer for companionship; and host an educational/networking forum focused on the elderly called Elder Forum. These initiatives and ongoing efforts continue to address several of the most pressing community needs as identified in our community needs assessment.
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 (20 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 7 SUBSIDIZED HEALTH SERVICE COSTS	APDMH has several hospital clinical services and hospital-owned physician practices. Per instructions for IRS Form 990, Schedule H, Worksheet 6, organizations may include any applicable physician practice that the Hospital subsidizes (i.e., operates at a loss) in the completing of Schedule H. Therefore, the Hospital has included the following hospital clinical services and hospital-owned physician practices that operate at a loss (i.e., are subsidized by the Hospital) and the associated costs of these practices: a. Women's Care b. Occupational Health c. Sleep Lab The above-listed hospital clinical services and hospital-owned physician practices have a community benefit (i.e. aggregate loss or subsidy from the Hospital) of approximately $1.07 million. In addition, the community benefit does not take into account bad debts, charity care, or contractual adjustments. Thus, this community benefit of approximately $1.07 million is a conservative figure that reconciles to the community benefit information reported on IRS Form 990, Schedule H, Part I, Line 7g, Column e.
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. In partnership with the Upper Valley Trails Alliance, APD paved an access trail to the Mascoma River Greenway across from the Homestead Building to increase accessibility and allow wheelchair use. 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 8 EXTENT ANY SHORTFALL FROM LINE 7	Form 990, Schedule H instructions and guidance contain a template (Worksheet 2) that may be used to determine the overall cost to charge ratio that could be applied throughout Schedule H in order to convert charges to cost. Where applicable, the Hospital has utilized Worksheet 2 for various calculations. The only areas where Worksheet 2 was not utilized for Part III, Line 8 was Schedule H, Worksheet B, Line 2 & 6, Medicare Allowable Costs and Payments Related to Subsidized Health Services. The Hospital utilized the Medicare cost report for estimated cost and payment for these services. The Hospital believes that its hospital clinical services, hospital-owned physician practices, emergency room and inpatient psychiatric units listed above should all be considered community benefits. These services, facilities, and programs provide a benefit to community members, and are both offered and subsidized by the Hospital. Medicare shortfall is reported to the State of New Hampshire in the Community Benefits Report, under Section 4, Unreimbursed Costs, Government-Sponsored Health Care. In prior years, the State of New Hampshire used MET dollars to service the general fund of the State. However, recently the State has used these dollars to directly fund medical and other related budgetary goals. As a result of this change in the State's appropriation of these funds, the net MET/DSH impact is considered a healthcare-related expenditure by the Hospital.
Schedule H, Part V, Section B, Line 16 WEBPAGE LOCATION 16a-c	Financial Assistance Policy, Financial Assistance Policy Application, and Plain Language Summary can be found at: https://www.alicepeckday.org/patients/financial_services
Schedule H, Part III, Line 3 FAP ELIGIBLE PATIENT BAD DEBT CALCULATION METHODOLOGY	THE HOSPITAL IS UNABLE TO ESTIMATE ACCURATELY THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALTHOUGH A PORTION OF BAD DEBT EXPENSE MAY BE RELATED TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE, A REPORTABLE FIGURE CANNOT BE REASONABLY ESTIMATED.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	2921100
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	BAD DEBT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	FOR FINANCIAL STATEMENT PURPOSES, THE HOSPITAL HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	APDMH FILES A CONSOLIDATED AUDITED FINANCIAL STATEMENT WITH DARTMOUTH-HITCHCOCK HEALTH AND ITS SUBSIDIARIES. APDMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR FINANCIAL ASSISTANCE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE MHMH DOES NOT ANTICIPATE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. APDMH GRANTS CREDIT WITHOUT COLLATERAL TO PATIENTS. MOST ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY ARRANGEMENTS. FOR FINANCIAL STATEMENT PURPOSES, DARTMOUTH HITCHCOCK HEALTH HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Our 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 ourpatients 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: www.alicepeckday.org/pa;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Alice Peck Day Memorial Hospital: Line 16b URL: 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: 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 2016 American Community Survey, the population of the APDMH Service Area is slightly older on average than the New Hampshire and Vermont populations. 17.5% of the service area is over age 65, compared with 15.8% in New Hampshire and 17% in Vermont. Income and poverty: 11.5% of children in the hospital service area live at or below 100% FPL, with 25.7% living below 200% FPL. Education: A higher proportion of the hospital service area (94.4%) have earned at least a high school diploma or equivalent compared to New Hampshire (92.6%) and Vermont (91.9%) overall. Language: The percent of the hospital service area, ages 5 or higher, who report speaking English "less than very well" is 0.8%, compared with a statewide rate of 1.5% in New Hampshire and 0.7% in Vermont.
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. This program was temporarily paused at the start of the pandemic due to UVAC and CCBA closures, but the program has resumed under each facilities' revised operating procedures. 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 is 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. During Fiscal Year 2021, the Upper Valley Smiles program was temporarily suspended. The risk of coronavirus transmission prevented us from being able to safely access the schools and provide services during the COVID 19 pandemic.
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 2021 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 (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Valuation Method UsedValuationMethodUsedDesc	Purpose Of GrantPurposeOfGrantTxt
FOUNDATION FOR HEALTHY COMMUNITIES
125 AIRPORT ROAD	CONCORD	NH	03301	020275078	501(C)(3)	$153,885	BOOK	SUBSTANCE ABUSE SUPPORT
NH HOSPITAL ASSOCIATION
125 AIRPORT DRIVE	CONCORD	NH	03301	026012527	501(C)(6)	$121,289	BOOK	SUBSTANCE ABUSE SUPPORT
HARTFORD COMMUNITY COALITION
PO BOX 4343	WHITE RIVER JUNCTION	VT	05001	824272638	501(C)(3)	$7,000	BOOK	SUMMER MEALS PROGRAM

Field	Value	IRS element (for citing)
Total501c3 Org	2	Total501c3OrgCnt
Total Other Org	1	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	Yes (true)	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	$256,954	$0	$0	$0	$1,441	$0	$19,513	$0	$28,242	$0	$306,150	$0	$0
SUSAN MOONEY MD MS FACOG
TRUSTEE/PRESIDENT/CEO APD	$336,548	$0	$0	$0	$57,274	$0	$0	$0	$28,906	$0	$422,728	$0	$0	$0
GEORGE T BLIKE MD
Trustee	$0	$344,982	$0	$0	$0	$55,025	$0	$27,315	$0	$22,825	$0	$450,147	$0	$0
Patrick F Jordan III MBA
Trustee	$0	$707,368	$0	$0	$0	$49,213	$0	$21,615	$0	$37,984	$0	$816,180	$0	$0
Tina E Naimie CPA
Trustee	$0	$291,637	$0	$0	$0	$8,471	$0	$21,615	$0	$2,609	$0	$324,332	$0	$0
Mary M Oseid MHCDS
Trustee	$0	$327,113	$0	$0	$0	$26,874	$0	$27,315	$0	$33,196	$0	$414,498	$0	$0
SCOTT W RODI MD
Trustee	$0	$414,984	$0	$0	$0	$18,405	$0	$27,315	$0	$35,002	$0	$495,706	$0	$0
JOHN P HOUDE MD
TRUSTEE (Until 12/20)	$539,776	$0	$0	$0	$774	$0	$0	$0	$28,931	$0	$569,481	$0	$0	$0
Marva Williams-Lowe
Trustee (As of 1/21) / Sr. Director	$0	$200,841	$0	$408	$0	$0	$0	$18,471	$0	$37,532	$0	$257,252	$0	$0
Phillip Collins MD
Ex-Officio/Pres Med Staff	$213,423	$0	$3,450	$0	$0	$0	$0	$0	$33,450	$0	$250,323	$0	$0	$0
Kathryn M Vargo MD
Former Officer	$102,870	$0	$0	$0	$24,430	$0	$0	$0	$27,314	$0	$154,614	$0	$0	$0
TODD ROBERTS
VP Finance	$160,076	$0	$0	$0	$0	$0	$0	$0	$27,068	$0	$187,144	$0	$0	$0
DALE C VIDAL MD MS
Executive Director MSC	$506,430	$0	$0	$0	$28,164	$0	$0	$0	$28,259	$0	$562,853	$0	$0	$0
JEAN TEN HAKEN MSN RN CENP
CNO/COO	$237,752	$0	$0	$0	$774	$0	$0	$0	$10,926	$0	$249,452	$0	$0	$0
IVAN TOMEK MD
General Orthopedic Surgeon	$547,422	$0	$17,500	$0	$19,914	$0	$0	$0	$25,805	$0	$610,641	$0	$0	$0
DIANE RILEY MD CAQSH
Ortho Surgeon Hand Specialist	$458,640	$0	$0	$0	$774	$0	$0	$0	$22,760	$0	$482,174	$0	$0	$0
DEBORAH GLAZER MD
PHYSICIAN	$200,468	$0	$0	$0	$59,450	$0	$0	$0	$11,637	$0	$271,555	$0	$0	$0
BRIAN LOMBARDO MD
PHYSICIAN	$204,926	$0	$0	$0	$38,780	$0	$0	$0	$27,973	$0	$271,679	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 4a Severance or change-of-control payment	KATHRN VARGO RECEIVED $14,180 SEVERANCE IN CALENDAR 2020.IT IS INCLUDED IN THE AMOUNT REPORTED IN SCHEDULE J PART II COLUMN B(iii).
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 $61,914.
Schedule J, Part I, Line 7 Non-fixed payments	Dr. Philip Collins, President of Medical Staff received a bonus of $3,450. Each year, the senior leadership team at Alice Peck Day Memorial Hospital considers compensation for salaried providers who are not eligible for incentive-based compensation. In 2021, the team decided to award a lump sum award representing 2% of Dr. Collins annual pay in lieu of a 2% increase to his base pay in alignment with the 2% raise that staff received.
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 J, Part II Form 990 Part VII Section A, Former Officer Compensation	Kathryn Vargo, APD Staff Physician served as Medical Staff President in fiscal 2019 and was reported as an officer on the fiscal 2019 Form 990. Vargo stepped down as Medical Staff President and continued to serve APD as Staff Physician in fiscal 2021. Because Vargo was reported as an officer on the filing organization's 2019 Forms 990, and in accordance with IRS Instructions for Form 990, Vargo's 2020 calendar year compensation has been reported on this year's 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	$1,440,000	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	0.0	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.0	PrivateBusConcerningUBIPct
Total Private Business Use	0.0	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 (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part V, Line 1a NUMBER OF EMPLOYEES	FOR ADMINISTRATIVE PURPOSES, ALICE PECK DAY MEMORIAL HOSPITAL MANAGES ALICE PECK DAY LIFE CENTER, INC.'S PAYROLL PROCESSING AND REPORTING. INCLUDED IN THE NUMBER OF EMPLOYEES REPORTED ARE 148 APD LIFECARE EMPLOYEES.
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.
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.
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 VII, Section A, Line 1a, Column (D) CHIEF EXECUTIVE	Dr. Susan E. Mooney is a practicing physician in addition to being the chief executive officer. The majority of her time is spent in executive matters while a minor amount of time spent as a physician.
Form 990, Part VIII, Line 2f Other Program Service Revenue	- Total Revenue: , Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;

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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	HITCHCOCK HEALTH CONNECT	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	ONE MEDICAL CENTER DRIVE	AddressLine1Txt
City	LEBANON	CityNm
State Abbreviation	NH	StateAbbreviationCd
ZIP	03756	ZIPCd

Field	Value	IRS element (for citing)
EIN	800908979	EIN
Primary Activities	TELEHEALTH	PrimaryActivitiesTxt
Legal Domicile State	DE	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Entity Type	C Corporation	EntityTypeTxt
Share Of Total Income	$0	ShareOfTotalIncomeAmt
Share Of EOY Assets	$0	ShareOfEOYAssetsAmt
Controlled Organization	false	ControlledOrganizationInd

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	false	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
ALICE PECK DAY LIFECARE CENTER
A	$36,956	FMV
ALICE PECK DAY LIFECARE CENTER
D	$278,630	FMV
ALICE PECK DAY LIFECARE CENTER
Q	$5,255,199	FMV