ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-15
- IRS object ID
- 201921359349300312
- Schema version
- 2017v2.3
- 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 L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-15T07:17:22-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET SUITE 302 | AddressLine1Txt |
| City | MANCHESTER | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | 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 MD MS | PersonNm |
| Person Title | President & CEO | PersonTitleTxt |
| Phone | 6034483121 | PhoneNum |
| Signature | 2019-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 8002447444 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.105.168.164 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-05-13 | IPDt |
| IP Tm | 10:26:38 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 98DE52733C2B26E898897C723B4DD0B631253A03 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 86AD5A998A217BD7885303F5109AB5202568ED7D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Susan E Mooney MD MS | PrincipalOfficerNm |
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 | $71,825,729 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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 | Critical Access Hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 571 | TotalEmployeeCnt |
| Total Volunteers | 70 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $729 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $360,135 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,105,059 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $48,706,952 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $70,526,144 | CYProgramServiceRevenueAmt |
| PY Investment Income | $22,398 | PYInvestmentIncomeAmt |
| CY Investment Income | -$58,871 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $29,303 | CYOtherRevenueAmt |
| PY Total Revenue | $49,089,485 | PYTotalRevenueAmt |
| CY Total Revenue | $71,601,635 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $40,590 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $41,972 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $26,352,582 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,709,910 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $182,275 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,343,930 | PYOtherExpensesAmt |
| CY Other Expenses | $32,554,938 | CYOtherExpensesAmt |
| PY Total Expenses | $48,737,102 | PYTotalExpensesAmt |
| CY Total Expenses | $69,306,820 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $352,383 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,294,815 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $53,279,410 | TotalAssetsBOYAmt |
| Total Assets EOY | $60,180,132 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,015,801 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,514,635 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,263,609 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $21,665,497 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of Alice Peck Day Health Systems is to provide personalized, highest quality, patient-focused healthcare services which are responsive to community needs, promote wellness, and continually improve the quality of healthcare in the community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $65,027,551 | ExpenseAmt |
| Grant | $41,972 | GrantAmt |
| Revenue | $70,526,144 | 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, 2018, charity care at a cost of $571,229 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, 2018 were $1,771,848. 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; nursing support for community flu clinics; Canaan Elementary School morning activity program; Elder Friends, a program matching volunteers one-on-one with isolated, home-bound seniors; assistance with enrollment into prescription assistance and state health insurance programs and scholarships for health professions workforce training.As a local hospital, Alice Peck Day worked 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 Heart Association GO RED campaign, American Red Cross, Child and Family Services, Daniel Webster Council, Good Neighbor Health Clinic, Grafton County Senior Citizens' Council, Headrest, Lebanon Lunch Friends (free summer lunch program for low-income children), Lebanon Chamber of Commerce, Lebanon School District, Mascoma Savings Bank, Mascoma School District, Richards School in Newport, Turning Point, Upper Valley Music Center, and the Upper Valley Public Health Council. In certain instances, assistance was provided to the community for which no value can be placed. This assistance included leadership in identifying community needs, staff commitment to volunteer for community organizations, advocacy and support for the socially and physically disadvantaged, and support for local public safety organizations. Alice Peck Day considers caring for our community a special responsibility that we are honored to fulfill. Through our many programs, dedicated staff and unwavering commitment to quality care, Alice Peck Day works to exceed these expectations and make a real difference in our community. | Desc |
| Total Program Service Expenses | $65,027,551 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 99 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 571 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Robert J Bauman | ||||||||
| Trustee (end 12/17) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| George T Blike | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $479,654 | $354,998 | ||
| Claudia C Gibson | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Anne D MacEwan | ||||||||
| Trustee | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark E Melendy | ||||||||
| Trustee | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Edward J Merrens | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $672,063 | $66,216 | ||
| Tina E Naimie | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $252,623 | $21,009 | ||
| Mary M Oseid | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $259,439 | $362,997 | ||
| Jennifer Sage Schiffman | ||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Roderic O Young | ||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $273,470 | $24,181 | ||
| Michael F Long | ||||||||
| Chair (end 12/17); Vice Chair (beg 1/18) | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Rev Dr Guy J D Collins | ||||||||
| Vice Chair (end 12/17) | 2.00 | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Brett C Peltzer | ||||||||
| Treasurer | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Bruce N Johnstone | ||||||||
| Treasurer (end 4/18) | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Brenan Riehl | ||||||||
| Secretary | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Martha P Candon | ||||||||
| Secretary (end 12/17) | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Susan E Mooney MD MS | ||||||||
| President & CEO | 53.00 | 8.00 | Yes (X) | $381,858 | $57,059 | $61,242 | Yes (X) | |
| Kathryn M Vargo MD | ||||||||
| Medical Staff President | 30.00 | 1.00 | Yes (X) | $223,173 | $0 | $38,167 | Yes (X) | |
| Randall D Lea MD MPH | ||||||||
| VP & Chief Medical Officer | 28.00 | 1.00 | Yes (X) | $219,643 | $0 | $35,398 | Yes (X) | |
| Greg W Lange | ||||||||
| Chair (beg 1/18) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Barbra Brown RN | ||||||||
| Interim CNO (begin 10/17) | 60.00 | 0.00 | $48,748 | $0 | $0 | Yes (X) | ||
| Timothy Graham MBA FHFMA CPA | ||||||||
| Interim CFO | 40.00 | 20.00 | $189,950 | $47,488 | $0 | Yes (X) | ||
| J Todd Miller MS | ||||||||
| VP & COO | 32.00 | 29.00 | $71,803 | $63,674 | $41,236 | Yes (X) | ||
| Dale C Vidal MD MS | ||||||||
| Executive Director, Multi-Specialty Clinic | 40.00 | 0.00 | $518,155 | $0 | $44,261 | Yes (X) | ||
| Paul Sansone MD | ||||||||
| Pain Management MD | 40.00 | 0.00 | $440,252 | $0 | $40,705 | Yes (X) | ||
| Leonard M Rudolf MD | ||||||||
| Orthopaedic Surgeon | 40.00 | 0.00 | $503,071 | $0 | $29,361 | Yes (X) | ||
| John P Houde MD | ||||||||
| Orthopaedic Surgeon | 40.00 | 0.00 | $515,354 | $0 | $42,115 | Yes (X) | ||
| Ivan Tomek MD | ||||||||
| Orthopaedic Surgeon | 40.00 | 0.00 | $559,950 | $0 | $57,237 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,671,957 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,105,470 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,219,123 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 37 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Upper Valley Neurology | |||||
| 106 Hanover Street | Lebanon | NH | 03766 | Neurology Physician Practice Services | $3,357,940 |
| EmCare Physician Services Inc | |||||
| 7032 Collection Center Drive | Chicago | IL | 60693 | Emergency Room/ Hospitalist Services | $1,811,932 |
| Conifer Revenue Cycle Solutions LLC | |||||
| PO Box 655025 | Dallas | TX | 75265 | Coding Operations | $686,632 |
| The Chappelle Group LLC | |||||
| 7500 Greenway Center Drive Suite 4 | Greenbelt | MD | 20770 | Revenue Cycle/ Financial Services | $646,361 |
| American Healthcare Services Associates | |||||
| PO Box 945 | Traverse | MI | 49685 | Agency/Temp Employee Services | $462,928 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $77,731 | RelatedOrganizationsAmt |
| All Other Contributions | $1,027,328 | AllOtherContributionsAmt |
| Noncash Contributions | $30,224 | NoncashContributionsAmt |
| Total Contributions | $1,105,059 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient services | 621400 | $67,979,275 | $67,979,275 |
| NH DSH Payment | 962140 | $3,478,463 | $3,478,463 |
| Other operating | 621400 | $670,518 | $670,518 |
| Nutritional services | 722210 | $77,901 | $77,901 |
| Provision for Bad Debt | 621400 | -$1,680,013 | -$1,680,013 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $70,526,144 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $69,065 | TotalRevenueColumnAmt |
| Exclusion | $69,065 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,303 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,303 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,303 | TotalRevenueColumnAmt |
| Exclusion | $29,303 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $96,158 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $224,094 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $96,158 | SecuritiesAmt |
| Other | -$224,094 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$127,936 | TotalRevenueColumnAmt |
| Exclusion | -$127,936 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,601,635 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $70,526,144 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$29,568 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,500 | TotalAmt |
| Program Services | $17,500 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,472 | TotalAmt |
| Program Services | $24,472 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,283,876 | TotalAmt |
| Program Services | $632,260 | ProgramServicesAmt |
| Management And General | $651,616 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,168,267 | TotalAmt |
| Program Services | $26,871,893 | ProgramServicesAmt |
| Management And General | $1,185,721 | ManagementAndGeneralAmt |
| Fundraising | $110,653 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,825 | TotalAmt |
| Program Services | $610,731 | ProgramServicesAmt |
| Management And General | $9,589 | ManagementAndGeneralAmt |
| Fundraising | $2,505 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,703,663 | TotalAmt |
| Program Services | $4,481,097 | ProgramServicesAmt |
| Management And General | $204,238 | ManagementAndGeneralAmt |
| Fundraising | $18,328 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,931,279 | TotalAmt |
| Program Services | $1,824,479 | ProgramServicesAmt |
| Management And General | $99,451 | ManagementAndGeneralAmt |
| Fundraising | $7,349 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,900 | TotalAmt |
| Management And General | $57,900 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,478 | TotalAmt |
| Management And General | $76,478 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,269,171 | TotalAmt |
| Program Services | $12,468,356 | ProgramServicesAmt |
| Management And General | $783,976 | ManagementAndGeneralAmt |
| Fundraising | $16,839 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,790 | TotalAmt |
| Management And General | $85,790 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,132,331 | TotalAmt |
| Program Services | $767,660 | ProgramServicesAmt |
| Management And General | $360,777 | ManagementAndGeneralAmt |
| Fundraising | $3,894 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,593 | TotalAmt |
| Program Services | $112,544 | ProgramServicesAmt |
| Management And General | $4,011 | ManagementAndGeneralAmt |
| Fundraising | $38 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,040,636 | TotalAmt |
| Program Services | $951,922 | ProgramServicesAmt |
| Management And General | $83,261 | ManagementAndGeneralAmt |
| Fundraising | $5,453 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,352 | TotalAmt |
| Program Services | $156,379 | ProgramServicesAmt |
| Management And General | $1,852 | ManagementAndGeneralAmt |
| Fundraising | $121 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $974,764 | TotalAmt |
| Program Services | $891,665 | ProgramServicesAmt |
| Management And General | $77,991 | ManagementAndGeneralAmt |
| Fundraising | $5,108 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,831,419 | TotalAmt |
| Program Services | $1,675,290 | ProgramServicesAmt |
| Management And General | $146,532 | ManagementAndGeneralAmt |
| Fundraising | $9,597 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $951,421 | TotalAmt |
| Program Services | $943,776 | ProgramServicesAmt |
| Management And General | $7,175 | ManagementAndGeneralAmt |
| Fundraising | $470 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medical Supplies/Equipm | $9,290,523 | $9,283,439 | $6,709 | $375 |
| Medicaid Enhancement Ta | $2,175,745 | $2,175,745 | ||
| Equipment Rental/Mainte | $678,351 | $661,023 | $17,133 | $195 |
| MRI Expenses | $425,072 | $425,072 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,392 | TotalAmt |
| Program Services | $52,248 | ProgramServicesAmt |
| Management And General | $236,794 | ManagementAndGeneralAmt |
| Fundraising | $1,350 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,306,820 | TotalAmt |
| Program Services | $65,027,551 | ProgramServicesAmt |
| Management And General | $4,096,994 | ManagementAndGeneralAmt |
| Fundraising | $182,275 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $657,704 | BOYAmt |
| EOY | $1,247,096 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,729,206 | BOYAmt |
| EOY | $4,698,217 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,463 | BOYAmt |
| EOY | $158,696 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,878,043 | BOYAmt |
| EOY | $7,996,791 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,214,330 | BOYAmt |
| EOY | $1,322,780 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,041,417 | BOYAmt |
| EOY | $892,831 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $57,544,969 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,959,673 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,445,990 | BOYAmt |
| EOY | $25,585,296 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,107,061 | BOYAmt |
| EOY | $15,841,735 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,500 | BOYAmt |
| EOY | $8,500 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,333 | BOYAmt |
| EOY | $139,333 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,990,363 | BOYAmt |
| EOY | $2,288,857 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,279,410 | BOYAmt |
| EOY | $60,180,132 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,158,192 | BOYAmt |
| EOY | $8,894,447 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $99,676 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,805,409 | BOYAmt |
| EOY | $15,408,101 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,570 | BOYAmt |
| EOY | $399,825 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,621,630 | BOYAmt |
| EOY | $13,712,586 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,015,801 | BOYAmt |
| EOY | $38,514,635 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,965,454 | BOYAmt |
| EOY | $21,030,940 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $264,615 | BOYAmt |
| EOY | $415,262 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,540 | BOYAmt |
| EOY | $219,295 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,263,609 | BOYAmt |
| EOY | $21,665,497 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,279,410 | BOYAmt |
| EOY | $60,180,132 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,294,815 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $107,073 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $11,200 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,500 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $15,700 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to the New Hampshire Hospital Association and the American Hospital Association, a portion of which are attributable to lobbying activities. Also, APD belongs to the 10 Mile CAH Coalition which engaged Strategic Health Resources (SHR) for purposes of furthering lobbying efforts with regards to attempts 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 | $33,230 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $185,160 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $218,390 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,845 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,385 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $33,230 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,268 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,577 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $31,845 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,883 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$615 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $30,268 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,452 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $431 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $30,883 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $927,577 | OtherCostOrOtherBasisAmt |
| Book Value | $927,577 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,165,601 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,372,850 | DepreciationAmt |
| Book Value | $7,792,751 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $212,775 | OtherCostOrOtherBasisAmt |
| Depreciation | $210,856 | DepreciationAmt |
| Book Value | $1,919 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,069,572 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,375,967 | DepreciationAmt |
| Book Value | $3,693,605 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,169,444 | OtherCostOrOtherBasisAmt |
| Book Value | $13,169,444 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,585,296 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Medical Liability Payable | $513,000 |
| Deferred Annuity | $29,626 |
| Estimated Third-Party Payor Settlements | $2,448,274 |
| Accrued Construction Costs for Building Under Development | $10,721,686 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $13,712,586 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The Organization uses the income from its endowment funds for use in operations. |
| Part X, Line 2: | Dartmouth-Hitchcock Health (D-HH) serves as the sole corporate member of the following entities: Dartmouth-Hitchcock Clinic and Subsidiaries (DHC), Mary Hitchcock Memorial Hospital and Subsidiaries (MHMH), (DHC and MHMH together are referred to as D-H), The New London Hospital Association and Subsidiaries (NLH), Windsor Hospital Corporation (d/b/a MT. Ascutney Hospital and Health Center) and Subsidiaries (MAHHC), Cheshire Medical Center and Subsidiaries (Cheshire), Alice Peck Day Memorial Hospital (APD), and the Visiting Nurse and Hospice of NH and VT and Subsidiaries (VNH). The "Health System" consists of D-HH, its affiliates and their subsidiaries. The Health System currently operates one tertiary, one community and three acute care (critical access) hospitals in New Hampshire (NH) and Vermont (VT). One facility provides inpatient and outpatient rehabilitation medicine and long-term care. The Health System also operates multiple physician practices, a nursing home and a home health and hospice service. The Health System operates a graduate level program for health professions and is the principal teaching affiliate of the Geisel School of Medicine (Geisel), a component of Dartmouth College. D-HH, MHMH, DHC, NLH, Cheshire, and APD are NH not-for-profit corporations exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (IRC). MAHHC and VNH are VT not-for-profit corporations exempt from federal income taxes under Section 501(c)(3) of the IRC. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 275.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $546,099 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $546,099 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00790 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,404,183 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,206,254 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,197,929 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01730 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,950,282 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,206,254 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,744,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $138,188 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $138,188 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,993 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,993 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,022,877 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,265,909 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $756,968 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01090 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,289 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,289 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,240,347 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,265,909 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $974,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,190,629 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,472,163 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,718,466 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03920 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,068 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,068 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,203 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,203 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,271 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,271 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,696,009 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $100,000 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $21,082,029 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $21,999,557 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$917,528 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | see Part V, Section C | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Part V, Section C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | see Part V, Section C | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 275.000000000000 | 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | see Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | see Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | see Part V, Section C | 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 5: With a shared Hospital Service Area, Alice Peck Day Memorial Hospital collaborated with Dartmouth-Hitchcock in conducting the 2016 Community Health Needs Assessment. Technical expertise was provided by Community Health Institute, the NH affiliate of JSI, a nation-wide public health management consulting and research organization. Input from the joint hospital service area, in an effort to hear from community residents and key stakeholders was gathered using a multi-pronged strategy: 1) a community survey was completed by 1,566 individuals. These surveys were available through town listings, at primary care clinics, a homeless shelter, free community dinners, senior housing projects and other community locations. 2) An online key stakeholder survey was completed by 69 community leaders and service providers, representing the following sections: Human Service/Social Service, Education/Youth Services, Municipal/County Government, Mental/Behavioral Health, Home Health Care, Primary Health Care, Medical Subspecialty, Public Safety/Fire, Public Health, Community Members, Dental Health Care, Emergency Medical Service and the Business Sector. 3) In an effort to get input and community-level context on health issues that matter to the community, four discussion groups were convened representing a variety of key community sectors: business leaders, teenage mothers, low income families and the United Valley Interfaith Project. |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 6a: Alice Peck Day Memorial HospitalDartmouth-Hitchcock Medical CenterNew London Hospital Valley Regional Hospital Mt. Ascutney Hospital and Health Center |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 6b: Technical assistance for the Hospital's 2015 CHNA was provided by Community Health Institute. |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 11: Please see attached Implementation Plan. |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 13h: Alice Peck Day Memorial Hospital offers financial assistance to patients demonstrating need. In making the need determination, APD participates with and honors the founding principles and guidelines of the New Hampshire Health Access Network (NHHAN). Accordingly, decisions regarding the granting of financial assistance will be based primarily on a patient and their household income and assets. There will be minimal consideration of expenses except when they identify areas for further investigation or incomplete or inaccurate information. The value of a patient's principal residence is not considered in qualifying a patient for in-house assistance. APD requires exhaustion of other payment methodologies, including but not limited to, worker's compensation, veterans benefits, Medicaid, liability insurance, victims of crime, and COBRA. When applicable, proof of determination may be required prior to consideration for financial assistance. |
| Alice Peck Day Memorial Hospital | Part V, Section B, Line 16j: Please see Part V, Line 3 for a description of the financial assistance program and the efforts made to publicize and promote the program.Alice Peck Day Memorial Hospital prints and distributes its financial assistance application in Spanish when requested. |
| Part V, Line 7a & 7b: | CHNA can be found on the Hospital's website at:https://www.alicepeckday.org/assets/FY2016_APDH_Community_Health_Needs_Assessment.pdf Other websites:www.mtascutneyhospital.org/community-services/community-resources/community-health-needs www.dartmouth-hitchcock.org/documents/pdf/FY16-18%20CHNA.pdf |
| Part V, Line 10a: | Implementation Plan can be found at: https://www.alicepeckday.org/assets/APDCommunityHealthNeedsImplementation2017.pdf |
| 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 |
|---|---|---|---|---|
| 1 - Neurosurgery Services at APD (NSAPD) | ||||
| 106 Hanover Street | Lebanon | NH | 03766 | Neurosurgery Physician Clinic |
| 2 - RAM Center for Community Care | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | Primary Care Physician Clinic |
| 3 - APD Orthopaedic Clinic | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | Orthopaedic Physician Clinic |
| 4 - Women's Care Center | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | OB/GYN Physician Clinic |
| 5 - General Surgery Clinic | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | General Surgeon Clinic |
| 6 - Pain Management Clinic | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | Pain Management Clinic |
| 7 - Occuptational Health Services | ||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | Occupational Health Physician Clinic |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Alice Peck Day provides sliding scale coverage with 100% coverage for those with household income below 200% of the Federal Poverty Limit (FPL) and partial coverage for those with household income between 200% and 275% of FPL. The coverage tiers are maintained on the APD website, and are available from all financial counselors or by mail upon request. |
| Part I, Line 7: | The costs of charity care and means-tested programs are calculated using the facility-wide cost to charge ratio as calculated in Worksheet 2. Subsidized health services are calculated using the cost to charge ratios per service area, using a step-down cost allocation methodology consistent with Medicare cost report methodology. |
| Part II, Community Building Activities: | Alice Peck Day actively promotes community-based leadership development. Staff members participate in the Lebanon Chamber of Commerce, Mascoma Savings Bank Board of Directors, Foundation for Healthy Communities, the Rural Health Coalition, and the Advocacy Task Force. As an active member of the community, APD 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. |
| Part III, Line 2: | Bad debt cost is calculated using a cost to charge ratio using a step-down cost allocation methodology consistent with Medicare cost reporting. In FY18, accounts written off to bad debt included gross charges being written off less any payments received against those charges. Any cash collected on accounts previously written off is included as an offset to bad debt expense as recoveries of bad debt. We estimated the amount of charity care in bad debt expense based on the number of applications for charity care. We believe the amount is minimal based on our extensive efforts to educate our patients and staff about our various payment plans and charity care to ensure that patients who qualify for any of our programs utilize them. Depending on the specific circumstances, a patient may be eligible for charity care, discounted care, time-payment programs, or a combination of the above. Due to these efforts, the amounts written off to bad debt that could qualify as charity care are minimal. Footnote 3 of the audited combined financial statements includes the following to address bad debt: Accounts receivable are reduced by an allowance for estimated uncollectibles. In evaluating the collectibility of accounts receivable, the Health System analyzes past collection history and identifies trends for several categories of self-pay accounts (uninsured, residual balances, pre-collection accounts and charity) to estimate the appropriate allowance percentages in establishing the allowance for bad debt expense. Management performs collection rate look-back analyses on a quarterly basis to evaluate the sufficiency of the allowance for estimated uncollectibles. Throughout the year, after all reasonable collection efforts have been exhausted, the difference between the standard rates and the amounts actually collected, including contractual adjustments and uninsured discounts, will be written off against the allowance for estimated uncollectibles. In addition to the review of the categories of revenue, management monitors the write offs against established allowances as of a point in time to determine the appropriateness of the underlying assumptions used in estimating the allowance for estimated uncollectibles. |
| Part III, Line 3: | See narrative for Schedule H, Part III, Line 2 and Line 4. |
| Part III, Line 4: | See Footnote 3 on Page 14 of the attached audited financial statements. |
| Part III, Line 8: | Medicare allowable costs for the Medicare Cost Report are reported in accordance with CMS guidelines using the cost to charge ratio methodology. |
| Part III, Line 9b: | 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 our patients about our programs and provide assistance prior to their receiving services, at registration for services, and during our billing process to ensure that any and all patients in need of assistance are provided with the help they qualify for under APD 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. APD 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-16c: | Financial Assistance Policy, Financial Assistance Policy Application, and Plain Languange Summary can be found at: www.alicepeckday.org/patients/financial_services/financial_assistance/ |
| Part VI, Line 2: | In addition to completing a comprehensive needs assessment every three years, the organization's Community Health Director serves on the Steering Committee of the Public Health Council of the Upper Valley, one of the State of New Hampshire's 13 regional health networks, which also serves 22 communities in Vermont. The PHC is comprised of community leaders and representatives from multiple community sectors, working together to set regional health priorities, provide guidance to regional public health activities, and ensure coordination of health improvement projects. In 2014, the PHC created the Upper Valley Agenda for Public Health, and the following year, the 2015-2017 Upper Valley Community Health Improvement Plan. This plan will be updated in the summer of 2019 with input from APD's Community Health Director. The Public Health Council provides a "finger on the pulse" of the community, and by serving in a leadership role, Alice Peck Day Memorial Hospital is able to stay abreast of the health care needs of our local service area. |
| Part VI, Line 3: | 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 APD 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. |
| Part VI, Line 4: | 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. APD'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, 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 2013 American Community Survey, the population of the APD Service Area is slightly older on average than the New Hampshire and Vermont populations. 15.6% of the service area is over age 65, compared with 14.2% in New Hampshire and 15.2% in Vermont.Income, poverty and unemployment: 9.7% of children in the hospital service area live at or below 100% FPL, with 27.0% living below 200%FPL. The unemployment rate of 6.8% for the region is equal to the statewide rate for Vermont, and slightly lower than the statewide rate of 7.0% for New Hampshire.Education: A higher proportion of the hospital service area (93.9) have earned at least a high school diploma or equivalent compared to New Hampshire (91.8) and Vermont (91.4) overall.Language: The percent of the hospital service area, ages 5 or higher, who report speaking English "less than very well" is 1.6, compared with a statewide rate of 2.5% in New Hampshire and 1.5% in Vermont. |
| Part VI, Line 5: | In addition to initiatives to deliver affordable care to our under and uninsured patients through our Financial Assistance programs, the organization provides a wide variety of no-cost or low-cost programs and services for the community. We work in partnership with local and state agencies, including but not limited to: the Lebanon, Mascoma, Hartford, Hartland and Newport school districts; the Good Neighbor Health Clinic; Grafton County Senior Citizens Council; NH Division of Health and Human Services; NH Oral Health Coalition; Vermont Oral Health Coalition; the Public Health Council of the Upper Valley; and the Vermont Department of Health. Among the free programs and services APD offers in response to demonstrated community need are: cash support and an in-kind donation of space for the Good Neighbor Health Clinic; vouchers for emergency prescription assistance and one-on-one assistance with applying for prescription assistance programs offered through drug companies; cash support to the Grafton County Senior Citizens Council for transportation; cash donations to human service agencies; and administrative support for "Elder Friends," a companionship program for frail, isolated elders in the community who are matched with a volunteer.APD'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 APD dental team visits each school annually, providing classroom oral health education, dental screenings, fluoride varnish, sealants and (in NH only) decay-stopping fluoride treatments and interim therapeutic restorations, all at little or no cost to parents. During fiscal year 2018, the Upper Valley Smiles program of oral health education, dental screenings, preventive treatment, and referrals to dental offices was offered in ten elementary schools. 2,721 children received classroom oral health education, 700 children had a dental screening, 953 children received preventive care (fluoride varnish, sealants, and in NH schools, temporary fillings and decay-stopping fluoride), and 192 children were referred to a dental office for restorative treatment. |
| Part VI, Line 6: | Alice Peck Day Memorial Hospital is a critical access hospital located in Lebanon, NH. The Hospital is served by a board of trustees consisting of local citizens active in community activities and organizations. The majority of board members are not employed by the hospital, and include local government and business representatives as well as practicing independent physicians. Despite its small size, APD is committed to giving back to the community to the greatest extent possible. During fiscal year 2018, cash donations were given to organizations to help those in need. Local financial contributions helped support free primary care clinics for the uninsured, provided transportation for the elderly and disabled to receive medical care, and provided local nonprofit organizations with meeting space and refreshments. Alice Peck Day also supported: community flu clinics, the West Central Behavioral Health agency, a free summer lunch program for low-income school-age children in Lebanon public housing sites, emergency prescription drug vouchers for uninsured patients, and a pilot "before school" morning activity program for children in the Canaan Elementary School. To promote health professional education, APD provided tuition reimbursement for students in the Surgical Tech Training Program and hosted a Nurse Residency Program. These initiatives and ongoing efforts continue to address several of the most pressing community needs as identified in our community needs assessment.Alice Peck Day Memorial Hospital became affiliated with Dartmouth-Hitchcock Health, Inc. (D-HH), on March 2, 2016. As a result, the sole corporate member of APD is D-HH. This agreement is intended to improve, integrate, and streamline patient care between the Hospital and D-HH, as well as take advantage of other efficiencies that may be achieved through the affiliation. |
| Part VI, Line 7, Reports Filed With States | NH |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| Grafton County Senior Citizens Council | ||||||||
| PO Box 433 | Lebanon | NH | 03766 | 237248316 | 501(c)(3) | $12,000 | $0 | Support for services that enable seniors to age-in-place |
| Good Neighbor Health Clinic | ||||||||
| 70 North Main Street | White River Junction | VT | 05001 | 030346949 | 501(c)(3) | $5,000 | $0 | Support for free medical and dental care for patients in need |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Tuition Assistance | GrantTypeTxt |
| Recipient | 12 | RecipientCnt |
| Cash Grant | $24,472 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | 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. For this reporting period, hospital staff identified the Grafton County Senior Citizens Council and Good Neighbor Health Clinic. The annual amount to be contributed by APD to these organizations is approved annually through the annual budget process. APD receives and reviews each year the organizations' published annual reports and also maintains informal contacts throughout the year to monitor the organizations' operations and services. Additionally, the Hospital provides tuition reimbursement for some health professional employees. The employees must have been employed by the Hospital or a related entity for at least one year and be in good standing. | 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 (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| George T Blike | ||||||||||||||
| Trustee | $0 | $437,202 | $0 | $0 | $0 | $42,452 | $0 | $333,250 | $0 | $21,748 | $0 | $834,652 | $0 | $0 |
| Edward J Merrens | ||||||||||||||
| Trustee | $0 | $637,949 | $0 | $0 | $0 | $34,114 | $0 | $53,885 | $0 | $12,331 | $0 | $738,279 | $0 | $0 |
| Tina E Naimie | ||||||||||||||
| Trustee | $0 | $252,087 | $0 | $0 | $0 | $536 | $0 | $19,147 | $0 | $1,862 | $0 | $273,632 | $0 | $0 |
| Mary M Oseid | ||||||||||||||
| Trustee | $0 | $258,929 | $0 | $0 | $0 | $510 | $0 | $343,760 | $0 | $19,237 | $0 | $622,436 | $0 | $0 |
| Roderic O Young | ||||||||||||||
| Trustee | $0 | $187,436 | $0 | $0 | $0 | $86,034 | $0 | $13,044 | $0 | $11,137 | $0 | $297,651 | $0 | $0 |
| Susan E Mooney MD MS | ||||||||||||||
| President & CEO | $291,196 | $43,512 | $75,002 | $11,207 | $15,660 | $2,340 | $20,358 | $3,042 | $32,923 | $4,919 | $435,139 | $65,020 | $0 | $0 |
| Kathryn M Vargo MD | ||||||||||||||
| Medical Staff President | $212,254 | $0 | $10,919 | $0 | $0 | $0 | $4,162 | $0 | $34,005 | $0 | $261,340 | $0 | $0 | $0 |
| Randall D Lea MD MPH | ||||||||||||||
| VP & Chief Medical Officer | $205,046 | $0 | $14,597 | $0 | $0 | $0 | $4,651 | $0 | $30,747 | $0 | $255,041 | $0 | $0 | $0 |
| Barbra Brown RN | ||||||||||||||
| Interim CNO (begin 10/17) | $45,500 | $0 | $0 | $0 | $3,248 | $0 | $0 | $0 | $0 | $0 | $48,748 | $0 | $0 | $0 |
| Timothy Graham MBA FHFMA CPA | ||||||||||||||
| Interim CFO | $161,500 | $40,375 | $0 | $0 | $28,450 | $7,113 | $0 | $0 | $0 | $0 | $189,950 | $47,488 | $0 | $0 |
| J Todd Miller MS | ||||||||||||||
| VP & COO | $66,787 | $59,226 | $0 | $0 | $5,016 | $4,448 | $6,466 | $5,734 | $15,389 | $13,647 | $93,658 | $83,055 | $0 | $0 |
| Dale C Vidal MD MS | ||||||||||||||
| Executive Director, Multi-Specialty | $505,743 | $0 | $12,412 | $0 | $0 | $0 | $5,400 | $0 | $38,861 | $0 | $562,416 | $0 | $0 | $0 |
| Paul Sansone MD | ||||||||||||||
| Pain Management MD | $440,252 | $0 | $0 | $0 | $0 | $0 | $5,400 | $0 | $35,305 | $0 | $480,957 | $0 | $0 | $0 |
| Leonard M Rudolf MD | ||||||||||||||
| Orthopaedic Surgeon | $503,071 | $0 | $0 | $0 | $0 | $0 | $5,400 | $0 | $23,961 | $0 | $532,432 | $0 | $0 | $0 |
| John P Houde MD | ||||||||||||||
| Orthopaedic Surgeon | $515,354 | $0 | $0 | $0 | $0 | $0 | $5,400 | $0 | $36,715 | $0 | $557,469 | $0 | $0 | $0 |
| Ivan Tomek MD | ||||||||||||||
| Orthopaedic Surgeon | $542,450 | $0 | $0 | $0 | $17,500 | $0 | $22,900 | $0 | $34,337 | $0 | $617,187 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Lines 4a-b | Roderic Young, who served as a Trustee during the year, received $80,324 in severance payments from Dartmouth-Hitchcock Health, a related organization. The following individuals received Dartmouth-Hitchcock Supplemental Retirement Plan Terms and Conditions: Various individuals listed in Form 990, Part VII and Schedule J, Part II are compensated as full-time employees of Dartmouth-Hitchcock Health, or Mary Hitchcock Memorial Hospital, the sole-corporate member of the Organization and a related organization, respectively. The following individuals participated in and received payments from a supplemental nonqualified deferred retirement plan sponsored by Dartmouth-Hitchcock Health. Amounts reported in Schedule J, Part II, Column C as follows: Edward J. Merrens, MD - $33,700 George Blike - $40,874 Roderic Young - $5,293 Gay Landstrom - $29,011 The following individuals had an actuarial change in pension value during the year reported in Schedule J, Part II, Column C: Edward J. Merrens, MD - $25,145 George Blike - $333,250 Mary Oseid - $343,760 All amounts reported in Column C will be included as part of taxable wages in the employees' Form W-2 when paid out. An eligible employee is a participant in the Dartmouth-Hitchcock retirement plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including a qualified defined benefit plan) who would be entitled to additional contributions or benefit accruals under the terms of the plans for the plan year, but are limited by IRC Section 401(a)(17) and/or 415. For eligible employees, the employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC Sections 401(a)(17) and/or 415. Schedule J, Part II, Column B, Parts (i), (ii), and (iii) represent actual amounts paid to employees by Alice Peck Day Memorial Hospital, APD Health Systems Corp, or Dartmouth-Hitchcock Health. These amounts are reported to employees on their annual Form W-2 as compensation. Columns C and D represent items earned, however, not paid directly to the employee as cash payments during the calendar year. Column C includes retirement benefits as well as any changes in pension actuarial value (if applicable) in a calendar year. Column D represents nontaxable benefits such as the cost of healthcare coverage sponsored by the Organization or a related organization. |
| Part I, Line 7 | A portion of compensation to certain employees is at-risk and variable, and payment depends on the quality of job performance. |
| Form 990, Part VII-A, Line 5: | During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC, during the calendar year. The total amount paid to Healthcare RESQ, LLC for his services was $201,875. Mr. Graham was directly compensated an additional $35,563 to cover travel expenses. Healthcare RESQ, LLC is unrelated to Alice Peck Day Memorial Hospital and its affiliates. The amounts allocated as specific to the filing organization are broken out in Form 990, Part VII. Beginning in October 2017, Alice Peck Day Memorial Hospital also had an interim CNO, Barbra Brown, who was compensated through a consulting firm called Leaders for Today. Pursuant to IRS instructions, Ms. Brown's 2017 1099-MISC compensation is reported on Schedule J since she was compensated from an unrelated organization for her work with the hospital. |
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 | Business Finance Authority of the State of NH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 521304598 | BondIssuerEIN |
| Bond Issued | 2010-11-30 | BondIssuedDt |
| Issue Price | $12,282,000 | IssuePriceAmt |
| Purpose | Current Refund Existing Bond | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,622,966 | RetiredAmt |
| Total Proceeds | $12,282,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $44,932 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $12,237,068 | OtherSpentProceedsAmt |
| Substantial Completion | 2010 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | Yes (1) | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TD Banknorth NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 5.000000000000 | TermOfHedgePct |
| Superintegrated Hedge | 0 | SuperintegratedHedgeInd |
| Hedge Terminated | Yes (1) | HedgeTerminatedInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Date Rebate Computation Performed | FormAndLineReferenceDesc |
| Explanation | Issuer Name: Business Finance Authority of the State of NH Date the Rebate Computation was Performed: 01/03/2011 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Timothy Graham MBA FHFMA CPA | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Chief Financial Officer | RelationshipDescriptionTxt |
| Transaction | $201,875 | TransactionAmt |
| Transaction | During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC. Mr. Graham is 100% owner of Healthcare RESQ, LLC. The total amount paid to Healthcare RESQ, LLC for his services during calendar year 2017 was $201,875, and Mr. Graham was directly compensated an additional $35,563 to cover travel expenses. These totals represent payment for services to Alice Peck Day Memorial Hospital, Alice Peck Day Lifecare Center, and Alice Peck Day Health Systems, Inc. All transactions were at arm's length. The amounts allocated as specific to the filing organization are broken out in Form 990, Part VII. The total amount paid to Healthcare RESQ, LLC for Mr. Graham's services to the entire APD system has been reported in Schedule L, Part IV, Column (c). | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 6 | ContributionCnt |
| Noncash Contributions Rpt F990 | $30,224 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Stock Exchange Price | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | Yes (1) | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 32b: | FormAndLineReferenceDesc |
| Explanation | The organization uses a third party broker to sell gifts of stock when received. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a & 2a: | For administrative purposes, Alice Peck Day Memorial Hospital acts as the common paymaster for both Alice Peck Day Health Systems, Corp. and Alice Peck Day Lifecare Center, Inc. |
| Form 990, Part VI, Section A, line 3 | During the fiscal year, Alice Peck Day Memorial Hospital had an interim CFO, Timothy Graham. Mr. Graham was compensated through a consulting firm, Healthcare RESQ, LLC, during the calendar year. The total amount paid to Healthcare RESQ, LLC for his services was $201,875. Mr. Graham was directly compensated an additional $35,563 to cover travel expenses. The amounts allocated as specific to the filing organization are broken out in Form 990, Part VII. The total amounts allocated to each related organization are also codified in Part VII. |
| Form 990, Part VI, Section A, line 6 | The Membership of the Corporation shall consist of Dartmouth-Hitchcock Health (D-HH) as the sole member. |
| Form 990, Part VI, Section A, line 7a | 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, Section A, line 7b | The Member will retain the following reserved powers over APD, which, except as otherwise required below, will be exercised by the D-HH Board of Trustees or the D-HH CEO, as determined by the D-HH Board of Trustees: 1. To initiate and/or to approve or disapprove all material governance, programmatic, and financial decisions of the Board of Trustees, including without limitation the elimination or addition of any material health/health care services or programs; 2. 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; 3. To ratify those trustee candidates nominated by the Board in accordance with Section 2.04 of the Corporation's bylaws (meaning the ability of Member to approve or disapprove, based on a good faith and reasonableness standard, each trustee candidate nominated by the Board of Trustees and upon such approval, the ability to install such approved candidate to the Board); 4. To remove by a vote of two-thirds of the D-HH Board of Trustees any Trustee if the Member determines in its reasonable good faith discretion that such removal is in the best interests of the D-H System which will include APD and taking into consideration the impact on APD and the community it serves, following prior consultation with the Board Chair; 5. To approve of borrowings (debt) and dispositions of material assets by APD; 6. To approve any key strategic relationship(s) between APD and another organization(s) (key strategic relationships defined as the ownership or contractual participation in a network, system, affiliation, joint venture, alliance or similar arrangement with an organization that is not part of the D-H System or which is not addressed in a Member approved APD strategic plan); 7. To initiate and/or to approve all operating and capital budgets as well as all strategic plans of APD; 8. To approve all policies relating to academic and research programs and affiliations; 9. To allocate the non-donor restricted assets and resources of APD and D-H/D-HH as appropriate to serve the overall best interests of the D-H System (which will include APD), taking into consideration the impact on APD and the community it serves; while Member will retain this reserved power, Member will exercise this reserved power only after consulting with and providing reasonable time and opportunity for the Board of Trustees to provide meaningful input and recommendations which shall be considered in good faith. For one (1) year following the effective date of its bylaws any material reallocation of assets or resources will also require an affirmative vote by a majority of the Board of Trustees. 10. Except as limited by the affiliation agreement, to appoint, evaluate the performance of, and terminate the APD President and CEO, subject to prior consultation with the Board of Trustees and a reasonable time and opportunity for the Board to provide meaningful input and recommendations which shall be considered in good faith. 11. To approve any proposed amendment or repeal of the APD articles of agreement or bylaws which proposed amendment or repeal would (i) impact the powers reserved to Member in its bylaws, or (ii) reasonably be expected to have any material strategic, competitive or financial impact on the D-H System. No change in the provisions of APD's bylaws shall be binding on D-H/D-HH or APD unless such change(s) is/are approved by way of amendment to APD's governing documents approved by Member. 12. To approve the dissolution or liquidation of APD, following such approval by the Board. |
| Form 990, Part VI, Section B, line 11b | Management provides a notice that the completed Form 990 is available to the Finance Committee at the May meeting. Management advises the Finance Committee that the completed Form 990 is available on a secure website that requires an assigned user name and password. The Chair of the Finance Committee advises the Financial Committee members to review the Form 990 for content and raise any issues with Board Leadership or Management. The Chair of the Finance Committee advises the Chair of the Board and the full Board that the Form 990 is available for review. That notice is in advance of the filing deadline to enable a detailed and conscientious review by the 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, Section B, line 12c | Alice Peck Day has a multi-faceted conflict of interest policy. Members of the Board of Trustees complete conflict of interest questionnaires on an annual basis and any new members complete the questionnaire upon joining the Board. As part of our ongoing monitoring process, our Executive Assistant reviews all Board questionnaires and disclosures to identify any potential conflicts before they arise. In addition, our Executive Assistant attends all Board meetings to ensure that if any conflicts arise, they are handled appropriately. If such conflicts arise, the Organization complies with the New Hampshire and federal requirements for disclosures of such events. The Organization is committed to conducting its business in a manner that is both ethical and legal. As part of this commitment, a standard of conduct form is required of all employees of the organization. This is reviewed with all employees upon hire and on an annual basis thereafter. The standard of conduct covers conflict of interest and other vital matters to ensure all business activity is conducted in a manner that is consistent with the highest standards of honesty, integrity, and fairness. |
| Form 990, Part VI, Section B, line 15 | 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. 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, Section C, line 19 | 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, Column D: | Dr. Susan E. Mooney is a practicing physician in addition to being the Chief Executive Officer. She worked an average of 61 hours per week, of which a majority of time is spent on executive matters. Approximately 8 hours per month is spent as a physician. |
| Form 990, Part IX, line 11g | Physician Service Fees: Program service expenses 7,354,498. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,354,498. Consulting Service Fees: Program service expenses 3,273,978. Management and general expenses 732,560. Fundraising expenses 13,768. Total expenses 4,020,306. Maintenance Service Agreements: Program service expenses 1,839,880. Management and general expenses 51,416. Fundraising expenses 3,071. Total expenses 1,894,367. |
| Form 990, Part XII, Line 2c: | The finance committee acts as the audit committee and oversees the audit process for the Alice Peck Day entities. Independent accountants performed the audit for the fiscal year ended 6/30/17. For the fiscal year ended 6/30/18 the Hospital was included in the Dartmouth Hitchcock Health System consolidated audited statements. |
| Form 990, Part XII, Line 3a: | Alice Peck Day Memorial Hospital was included in the consolidated audited financial statements of the Dartmouth-Hitchcock Health System. During fiscal year 2018, Mary Hitchcock Memorial Hospital expended federal funding which met the minimum threshold set forth in the single audit act and OMB Circular A-133. Due to the nature of the consolidated financial statements, the audit was performed on the financial information of all organizations, including Alice Peck Day Memorial Hospital. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Alice Peck Day Health Systems Corp | |||||||||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | 020479095 | Promote Health | NH | 501(c)(3) | Line 12b, II | N/A | 0 | |
| Alice Peck Day Lifecare Center Inc | |||||||||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | 020479094 | Independent & Assisted Living | NH | 501(c)(3) | Line 10 | 0 | APD Health Systems | |
| Alice Peck Day Realty Corp | |||||||||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | 020485369 | Inactive | NH | 501(c)(2) | 0 | APD Health Systems | ||
| Dartmouth-Hitchcock Health | |||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 264812335 | Govern Integrated Health System | NH | 501(c)(3) | Line 7 | N/A | 0 | |
| Dartmouth-Hitchcock Clinic | |||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222519596 | Physician Services | NH | 501(c)(3) | Line 10 | 0 | Dartmouth-Hitchcock Health | |
| Mary Hitchcock Memorial Hospital | |||||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222140 | Hospital | NH | 501(c)(3) | Line 3 | 0 | Dartmouth-Hitchcock Health | |
| The New London Hospital Association Inc | |||||||||||
| 273 County Road | New London | NH | 03257 | 020222171 | Hospital | NH | 501(c)(3) | Line 3 | 0 | Dartmouth-Hitchcock Health | |
| Windsor Hospital Corporation | |||||||||||
| 289 Country Road | Windsor | VT | 05089 | 030183721 | Hospital | VT | 501(c)(3) | Line 3 | 0 | Dartmouth-Hitchcock Health | |
| Cheshire Medical Center | |||||||||||
| 580 Court Street | Keene | NH | 03431 | 020354549 | Hospital | NH | 501(c)(3) | Line 3 | 0 | Dartmouth-Hitchcock Health | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OneCare VT ACO LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 Colchester Avenue | AddressLine1Txt |
| City | Burlington | CityNm |
| State Abbreviation | VT | StateAbbreviationCd |
| ZIP | 05401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455399218 | EIN |
| Primary Activities | Shared Saving | PrimaryActivitiesTxt |
| Legal Domicile State | VT | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Alice Peck Day Health Management Corp | |||||||||
| 10 Alice Peck Day Drive | Lebanon | NH | 03766 | 020485370 | Inactive | NH | N/A | C | 0 |
| Hitchcock Health Connect | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 800908979 | Telehealth | DE | N/A | C | 0 |
| Imaginecare Inc | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 813105071 | Software Tech | NH | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |