2014-05-14T09:49:32-05:00 2013-09-30 010523282 Berry Dunn McNeil & Parker LLC PO Box 1100 Portland ME 041041100 990 2012-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Nick Braccino 6034449000 2014-04-03 1 Barbara J McGuan CPA P00219457 2077752387 2014-04-03 2012 2015-11-30 17:44:51Z Littleton Regional Healthcare Nick Braccino 600 St Johnsbury Road Littleton NH 03561 105791491 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 13 482 240 18723 -17388 51546 122101 71499864 80091833 402610 1383355 0 0 71954020 81597289 7040 103734 0 0 39264133 42507068 0 0 0 31423152 35218794 70694325 77829596 1259695 3767693 85349412 95068821 46900809 50423017 38448603 44645804 X To provide quality, compassionate and accessible healthcare in a manner that brings value to all.To offer a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventive diagnostic, theraputic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.To provide these services without regard to race, religion, age, sex, income, creed, national origin, or disability.To maintain a sufficient number and mix of medical staff who are competent, dedicated and commmunity based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.To create a healthy, satisfying work environment for phsycians, nurses and other employees, with a commitment to support the continuing educational needs of its professional staff, including the physicians, nurses and allied health personnel. 0 0 62943305 103734 80073110 Littleton Hospital Association provides health care services on an in/outpatient basis to the general public, including charity care, community education, and various other health programs and services. 62943305 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 126 0 1 482 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Leslie Walker Controller 6034449000 600 St Johnsbury Rd Littleton NH 03561 William Bedor 1.00 X X 0 0 0 Milton Bratz 1.00 X 0 0 0 Mell Brooks 1.00 X X 0 0 0 Edward Duffy MD 40.00 1.00 X 331711 0 41241 Wayne Rioux 1.00 1.00 X 0 0 0 John Starr 1.00 1.00 X X 0 0 0 Margaret Starr 1.00 X 0 0 0 Stevan Trooboff 1.00 1.00 X X 0 0 0 Charles Wolcott MD 1.00 X 0 0 0 Guilbert Vickery 1.00 1.00 X 0 0 0 Deane Rankin MD 40.00 X 432925 0 39246 George Brodeur 1.00 X 49599 0 0 Kevin Silva MD 1.00 X 12000 0 0 Roger Gingue 1.00 X 0 0 0 James Hamblin 1.00 X 0 0 0 Dr Stephen Phipps 1.00 X 10000 0 0 Everett Aldrich 1.00 X 0 0 0 Gary Meader 1.00 X 0 0 0 Gail Tomlinson 1.00 X 0 0 0 Kim Butler 1.00 X 0 0 0 Dr David Nelson 1.00 X 0 0 0 Warren West 40.00 1.00 X 299328 0 24517 Robert Fotter 40.00 1.00 X 185520 0 29033 Nick Braccino 40.00 1.00 X 0 0 0 Linda Gilmore 40.00 X 186270 0 35313 Harlan G Herr 40.00 X 505538 0 13347 Richard Caesar 40.00 X 470079 0 30989 Patrick Fitzpatrick 40.00 X 462436 0 39246 Michael Kindred 40.00 X 459791 0 32066 Lon Howard 40.00 X 448830 0 34277 3854027 0 319275 46 0 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Professional Services Agreement 4203864 Daniel Hebert Inc 12 Pleasant St Colebrook NH 03576 General Contractor 2547709 Griffin York & Krause 121 River Front Drive Manchester NH 03102 Advertising Consultant 486311 Quorum Health Resources Inc 105 Continental Place Brentwood TN 37027 Consulting Services 393318 C&A Industries PO Box 3037 Omaha NE 68103 Non-provider staffing 295990 17 114760 7341 122101 Patient Service Revenue 900099 130968028 130968028 Meaningful Use Incentive Revenues 900099 1230736 1230736 Contract Lab 621500 185323 166600 18723 Provision for Bad Debts 900099 -4096468 -4096468 Contractual Allowances 900099 -51780297 -51780297 3584511 3584511 80091833 368059 368059 25185928 23570 24137948 56254 1047980 -32684 1015296 1015296 81597289 80073110 18723 1383355 X 103734 103734 1676703 916722 759981 30045850 26429846 3616004 1030012 913969 116043 4716667 4117764 598903 5037836 4353347 684489 161710 519 161191 79311 6683 72628 127664 127664 8138572 6613201 1525371 706586 25100 681486 10338981 9759841 579140 351508 7804 343704 2158481 1006087 1152394 316999 235195 81804 86529 86529 722882 722882 5772459 5063406 709053 897466 490551 406915 Equipment Expenses 2737325 1766108 971217 Collection Agency 712323 58149 654174 Recruitment Costs 561869 404 561465 Quorum Fees 336828 336828 1011301 351993 659308 77829596 62943305 14886291 0 2945 2750 8794837 8807577 9385246 8619960 227973 2563866 1485073 1580589 1175935 1336949 84836200 38568366 45116903 46267834 18891154 25589388 269346 299908 85349412 95068821 5373287 6654710 593490 2025458 30155983 27925000 4289282 10778049 9528567 46900809 50423017 X 37642591 43762042 145619 165664 660393 718098 38448603 44645804 85349412 95068821 X 3767693 921062 1508446 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13157 13157 0 Explanation of Lobbying Activities: Part II-B, Line 1: Littleton Hospital Association is a member of the NH Hospital Association and the American Hospital Association. A portion of the dues paid to these organizations is available for lobbying expenditures on behalf of Littleton Hospital Association and other member organizations in furtherance of their exempt purposes. Littleton Hospital Association does not directly perform any lobbying activities. 794094 81883 5368 870609 717945 77221 1072 794094 767249 -48189 1115 717945 728305 49089 10145 767249 739898 9683 -21200 75 728306 0.00000 0.82480 0.17520 0 0 786809 786809 40084265 17841960 22242305 37652627 20097414 17555213 6312499 628992 5683507 46267834 Reserve for Self-Funded Health Insurance 751000 Due to Third Party Payors 5130354 Deferred Compensation 1063723 Interest Rate Swap 2583490 9528567 83785156 921062 1508446 2429508 81355648 127664 113977 241641 81597289 77587955 0 77587955 127664 113977 241641 77829596 Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swap 1,508,446. Part XI, Line 4b - Other Adjustments: Foundation Subsidy 103,734. Community Benefit 10,243. Part XII, Line 4b - Other Adjustments: Foundation Subsidy 103,734. Community Benefit 10,243. Central America and the Caribbean 0 0 Investments 5083331 0 0 0 0 0 0 5083331 0 5083331 1 0 1 0 1 0 1 1 X 1 X 1 X 1 1 1 0 1 1 2007331 2007331 0.02580 1639571 1639571 0.02110 3646902 3646902 0.04690 182011 182011 0.00230 38546 38546 0.00050 280201 280201 0.00360 18072 18072 0.00020 518830 518830 0.00660 4165732 4165732 0.05350 29082 29082 0.00040 19225 19225 0.00020 48307 48307 0.00060 1 2355012 20778484 20778484 X 1 1 1 1 Littleton Regional Hospital

600 St Johnsbury Road Littleton NH 03561

X X X X Littleton Regional Hospital 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X X 1 X 0 0 1 Littleton Orthopaedics

81 Bethlehem Road Littleton NH 03561

Outpatient Physician Clinic Part I, Line 7: The Hospital determines its cost of charity care based on an overall financial statement cost to charge ratio applied against gross charity care charges. Part III, Line 4: Management provides for probable uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Balances that are still outstanding, after management has used reasonable collection efforts, are written off through a charge to the valuation allowance and a credit to patient accounts receivable. The valuation of charity care does not include any bad debt receivables or revenue. Part III, Line 8: Any shortfall is treated as a community benefit. The organization uses a cost to charge ratio from the Medicare cost report to determine the amount of Medicare allowable costs. Part III, Line 9b: Patients who are known to qualify for financial assistance are given a financial assistance application to fill out and return to our Financial Counselor. Upon receipt of the financial assistance application, the application is processed and the amount of financial assistance that will be granted to the patient is determined.Once the percentage of financial assistance is approved, we adjust the account balance accordingly. If a balance is left over after the financial assistance is adjusted, the patient will receive their monthly statements for the remaining balance.If the patient defaults on paying the remaining balance , their account will be sent to a third party collection agency no sooner than 120 days from date of their first statements issued. At this time we would turn the account over to the third party collection agency for further collection efforts. Littleton Regional Hospital Part V, Section B, Line 3: The Organization deployed a Community Health Needs Assessment survey within the local population for any resident to complete. The Organization received community input from 164 area residents. The terms of gaining input stipulated each respondent would remain anonymous.The internet based survey was promoted through a paid advertisement in a local newspaper and distributed to local civic and health organizations with a request for participation. Preliminary conclusions were presented to a local group of experts, who were asked to validate prior assessments and to establish priority among various identified health and medical issues.Information analysis augmented by local opinions showed how Grafton County relates among its peers in terms of primary and chronic needs, as well as other issues of uninsured persons, low income persons and minority groups; respondents commented on if they believe certain population groups (or people with certain situations) need help to improve their condition and if so, who needs to do what.When the analysis was complete, the Organization put the information and summary conclusions before our local group of experts who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need; new needs could, and did, emerge from this exchange. Consultation with local experts occurred again via an internet based survey (explained below).With the prior steps identifying potential community needs, the local experts participated in a structured communication technique called a Delphi method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. Experts answer questionnaires in a series of rounds. The Organization contemplated and implemented one round as referenced during the above dates. After each round, the Organization provided an anonymous summary of the experts' forecasts from the previous round, as well as the reasons provided for their judgments. The process encourages experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process stops when we identify the most pressing, highest priority community needs.In the Organization's process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving virtually no support and other needs receiving identical point allocations.We dichotomized the rank order into two groups: high priority needs and low priority needs. The determination of the break point, high as opposed to low, was a qualitative interpretation by Quorum Health Resources and the Organization's executive team where a reasonable break point in rank occurred, indicated by the weight amount of points each potential need received and the number of local experts allocating any points to the need. When presented to the Organization's executive team, the dichotomized need rank order identified which needs the hospital considered high responsibility to respond vs. low responsibility to respond. The result provided a matrix of needs and guided the Organization in developing its implementation response. Littleton Regional Hospital Part V, Section B, Line 7: Alcohol Abuse, Drug Use in Youths, Mental Health and Suicide, and Smoking - LRH does not intend to develop an implementation plan for these needs for the following reasons:*Lack of expertise of competency (i.e., certain professional credential required and no such individual is in our immediate service area)*Lack of identified interventions to address need*Need is addressed by other organization or facility Part VI, Line 2: The Littleton Regional Hospital Community is defined as all people living in the communities listed in Part VI, Line 4. These communities were chosen by their geographic proximity to the Hospital and to the services and programs provided. Part VI, Line 3: Any applicant will receive a prompt decision on eligibility and amount of charity care offered. Notices of the Charity Care Policy are posted in the lobbies, waiting rooms and other public areas. Notices are also given to recipients who are served in their homes. Part VI, Line 4: The Hospital's primary service area includes Littleton, Bethlehem, Lisbon, Franconia, Sugar Hill and Carroll. The secondary service area includes Whitefield, Lancaster, Groveton, Monroe, North Woodstock, Lincoln, Woodsville and Bath (all in NH), and St. Johnsbury, Lunenberg, Lyndonville, Concord, Gilman (all in VT). The area spans across a good majority of Northern New Hampshire and the Northeast Kingdom of Vermont. Reports Filed With States Part VI, Line 7 NH 1 Littleton Regional Hospital Charitable Foundation 600 St Johnsbury Road Littleton NH 03561 043750643 501(c)(3) 103734 Foregiveness of salary and benefit expense that is paid on behalf of the charitable foundation. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Organization tracks the amount of expenses paid on behalf of the Littleton Regional Hospital Charitable Foundation, a related organization, and at the end of the year will forgive the Foundation for the reimbursement of expenses related to salaries and benefits. X X X X 0 0 0 0 0 1 0 1 0 Edward Duffy MD 273211 0 0 0 58500 0 12500 0 28741 0 372952 0 0 0 Deane Rankin MD 350000 0 57909 0 25016 0 12500 0 26746 0 472171 0 0 0 Warren West 278100 0 12676 0 8552 0 12500 0 12017 0 323845 0 0 0 Robert Fotter 175968 0 0 0 9552 0 9467 0 19566 0 214553 0 0 0 Linda Gilmore 180357 0 0 0 5913 0 9627 0 25686 0 221583 0 0 0 Harlan G Herr 465716 0 0 0 39822 0 12500 0 847 0 518885 0 0 0 Richard Caesar 430000 0 0 0 40079 0 4244 0 26745 0 501068 0 0 0 Patrick Fitzpatrick 350000 0 81307 0 31129 0 12500 0 26746 0 501682 0 0 0 Michael Kindred 336000 0 100443 0 23348 0 12500 0 19566 0 491857 0 0 0 Lon Howard 443302 0 0 0 5528 0 12450 0 21827 0 483107 0 0 0 Part I, Line 6 Warren West, CEO, received a bonus based on certain goals included in his contract, one of which is related to the performance of the Organization. The Board assesses the performance of these goals and determines the bonus to be paid. Part I, Line 7 Deane Rankin, Trustee, Patrick Fitzpatrick, Highest Compensated Employee, and Michael Kindred, Highest Compensated Employee, received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties. A Business Finance Authority of the State of New Hampshire 521304598 64468kbg0 2007-11-15 30000000 Refunded series 1998A and 1998B Bonds 0 0 0 A 2075000 30000000 274108 29725892 2012 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 1 Form 990, Part VI, Section A, line 2 John Starr (Trustee) and Maggie Starr (Past Trustee) have a family relationship. Form 990, Part VI, Section A, line 6 All persons making an annual contribution to Littleton Hospital Association or Littleton Regional Hospital Charitable Foundation, who are at least eighteen (18) years of age, or any legal adult resident of any town raising an annual appropriation to the Littleton Hospital Association shall thereupon, and without further election or action by the Association, automatically become a member of the Association. Failure to contribute to the Hospital or Foundation in the following fiscal year shall automatically terminate the membership. Form 990, Part VI, Section A, line 7a Each member of the Association shall be qualified to originate and take part in the discussion of any subject that may properly come before any meeting of the Association, to vote on such subject, and to hold any office in the Association to which he or she may be elected or appointed. Form 990, Part VI, Section B, line 11 The return was reviewed by the entire Board of Directors prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, Department directors and Auxilians complete a Conflict of Interest Statement each year, and any potential conflicts are reported to the Board of Trustees and to other places as required by law. In addition, front-line employees who don't normally make decisions for the facility are expected to report forward any conflicts they may have, should they ever be in a position to influence decision making. Quality Services queries these groups on an annual basis, and tracks down people until all statements are complete. Form 990, Part VI, Section B, line 15 Key employees complete self-evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations. The CFO's salary is approved by the CEO. The CEO's salary is approved by the Board. Form 990, Part VI, Section C, line 19 The hospital's governing documents and financial statements are made available upon request. The hospital's conflict of interest policy is not made available to the public. Other Fees Form 990, Part IX, line 11g Contracted Wages: Program service expenses 4,366,419. Management and general expenses 137,074. Fundraising expenses 0. Total expenses 4,503,493. Consulting: Program service expenses 71,526. Management and general expenses 292,579. Fundraising expenses 0. Total expenses 364,105. Laundry services: Program service expenses 7,290. Management and general expenses 144,027. Fundraising expenses 0. Total expenses 151,317. Purchased Services: Program service expenses 2,167,966. Management and general expenses 951,691. Fundraising expenses 0. Total expenses 3,119,657. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Unrealized Gain on Interest Rate Swap 1,508,446. Littleton Regional Hospital Charitable Foundation 600 St Johnsbury Road Littleton NH 03561 043750643 Charitable Foundation NH 501(c)(3) Line 7 Littleton Hospital Association 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Littleton Regional Hospital Charitable Foundation B 103734 FMV Littleton Regional Hospital Charitable Foundation C 114760 FMV Littleton Regional Hospital Charitable Foundation D 167427 FMV