ALICE PECK DAY MEMORIAL HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- ALICE PECK DAY MEMORIAL HOSPITAL (EIN 02-0222791)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-11
- IRS object ID
- 201131319349301418
- Schema version
- 2009v1.7
- 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 J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-11T12:11:47-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER NEWMAN & NOYES LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 650 ELM STREET SUITE 302 | AddressLine1 |
| City | MANCHESTER | City |
| State | NH | State |
| ZIP Code | 03101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020222791 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALICE PECK DAY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALIC | NameControl |
| Phone | 6034483121 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 MASCOMA STREET | AddressLine1 |
| City | LEBANON | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | EVALIE M CROSBY | Name |
| Title | VP FINANCE & CFO | Title |
| Phone | 6034483121 | Phone |
| Date Signed | 2011-05-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8002447444 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | HARRY G DORMAN III | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 MASCOMA STREET | AddressLine1 |
| City | LEBANON | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 44954543 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.alicepeckday.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1943 | YearFormation |
| State Legal Domicile | NH | StateLegalDomicile |
| Activity Or Mission Description | CRITICAL ACCESS HOSPITAL | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 18 | NbrIndependentVotingMembers |
| Total Nbr Employees | 480 | TotalNbrEmployees |
| Total Nbr Volunteers | 94 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 622434 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1029971 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48776296 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 42411307 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -246880 | InvestmentIncomePriorYear |
| Investment Income Current Year | 137115 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 50200 | OtherRevenuePriorYear |
| Other Revenue Current Year | 48297 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49202050 | TotalRevenuePriorYear |
| Total Revenue Current Year | 43626690 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21593020 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 23580477 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 248739 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 27577277 | OtherExpensePriorYear |
| Other Expenses Current Year | 17285987 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 49170297 | TotalExpensesPriorYear |
| Total Expenses Current Year | 40866464 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 31753 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2760226 | RevenuesLessExpensesCY |
| Total Assets BOY | 26231660 | TotalAssetsBOY |
| Total Assets EOY | 28392505 | TotalAssetsEOY |
| Total Liabilities BOY | 15916794 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 15278155 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10314866 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13114350 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF ALICE PECK DAY MEMORIAL HOSPITAL IS TO PROVIDE PATIENT-FOCUSED HEALTH CARE SERVICES THAT ARE RESPONSIVE TO COMMUNITY NEEDS, TO PROMOTE WELLNESS, AND TO CONTINUALLY IMPROVE THE QUALITY OF HEALTH CARE SERVICES IN THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37540598 | Expense |
| Revenue | 42325574 | Revenue |
| Description | Alice Peck Day Memorial Hospital is a community-based 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 forgone for services and supplies furnished under its charity care policy, the established costs of the services and supplies and equivalent service statistics. For the year ended September 30, 2010: charges forgone based on established rates were $1,198,647 with charity care AT COST OF $734,688. Estimated costs incurred in excess of payment for inpatient and outpatient services for Medicare and Medicaid patients in the year ended September 30, 2010 were $3.3 million.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. Services included community health services, health professional education, community building activities, and community benefit programs. Services ranged from community flu clinics, Upper Valley Smiles dental program, student and professional education, emergency pharmacy vouchers, and included countless other programs that contributed to and supported our community. As a local community hospital, Alice Peck Day works closely with community organizations to address community needs. Organizations that were beneficiaries of the Hospital's staff, time, and/or materials include Alcoholics Anonymous, AARP, American Legion, American Red Cross, Awake Support Group, Bonnie Clac, Brookside Nursing home, Childbirth Education and Postpartum Massage, Community Health Department, Dartmouth Medical School, Elmira College, Frontier School of Midwifery, Good Beginnings of Sullivan County, Good Neighbor Health Center, Grafton County Senior Center, Grafton County Senior Citizens Council, Lebanon Area Chamber of Commerce, Lebanon College, Lebanon Housing Authority, Lebanon School Bike Rodeo, Lebanon School District Nature Program, Over Eaters Anonymous, River Valley Community College, Rogers House, Savvy Seniors Exercise Program, Storrs Hill, United Valley Interfaith Project, Upper Valley Smiles Dental Program, Vermont Institute of Natural Sciences, West Central and West Central Behavioral Health. 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 its 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. | Description |
| Total Program Service Expense | 37540598 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 68 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 480 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 18 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NH | StatesWhereCopyOfReturnIsFiled |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETH LOUDERMILK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6034483121 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 MASCOMA STREET | AddressLine1 |
| City | LEBANON | City |
| State | NH | State |
| ZIP Code | 037662647 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|---|
| MICHAEL R HARRIS | ||||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| REV DR GUY JD COLLINS | ||||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | |||
| JUDSON T PIERSON | ||||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | ||
| KAREN G KAYEN | ||||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | |||
| BARBARA CALLAHAN CRNA | ||||||||
| MEDICAL STAFF PRESIDENT | 1.00 | X | 0 | 0 | 0 | |||
| JAMES R CALLAN PART YEAR | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MICHAEL J CRYANS | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| HARRY G DORMAN III | ||||||||
| PRESIDENT & CEO | 60.00 | X | X | 293463 | 0 | 25377 | X | |
| TERRI C DUDLEY | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| CLAUDIA C GIBSON | ||||||||
| AUXILIARY PRESIDENT | 0.50 | X | 0 | 0 | 0 | |||
| RICHARD S JENNINGS PART YEAR | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| BRUCE N JOHNSTONE PART YEAR | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| WILLIAM N JOSLER | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JENNIFER H JUDKINS PART YEAR | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| JOHN A KELLY MD | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| EDWARD T KERRIGAN | ||||||||
| TRUSTEE | 2.00 | X | X | 0 | 0 | 0 | ||
| SARA L KOBYLENSKI | ||||||||
| TRUSTEE, PAST CHAIR | 1.00 | X | 0 | 0 | 0 | |||
| MIRIAM M MAGUIRE | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| ANN E MARCHEWKA PART YEAR | ||||||||
| VP PATIENT CARE SERVICES | 60.00 | X | 135849 | 0 | 13066 | |||
| MARK E MELENDY PART YEAR | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| J TODD MILLER | ||||||||
| COO (part year) | 0.50 | X | 0 | 0 | 0 | |||
| SUSAN E MOONEY MD | ||||||||
| MEDICAL DIRECTOR | 60.00 | X | 237215 | 0 | 31258 | X | ||
| PATRICK J MORHUN MD | ||||||||
| TRUSTEE | 0.50 | X | 0 | 0 | 0 | |||
| MICHAEL PWH PAINE FRCS | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| EVALIE M CROSBY | ||||||||
| VP FINANCE & CFO | 60.00 | X | 112321 | 0 | 17032 | |||
| DOUGLAS CEDENO MD | ||||||||
| PHYSICIAN | 40.00 | 222102 | 0 | 20012 | X | |||
| CHRISTOPHER MAZUR MD | ||||||||
| PHYSICIAN | 40.00 | 204532 | 0 | 29767 | X | |||
| DAVID KRONER MD | ||||||||
| PHYSICIAN | 40.00 | 330652 | 0 | 25336 | X | |||
| SUZANNE SHIPMAN MD | ||||||||
| PHYSICIAN | 40.00 | 216620 | 0 | 30857 | X | |||
| KATHRYN VARGO MD | ||||||||
| PHYSICIAN | 40.00 | 239165 | 0 | 31540 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1991919 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 224245 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| AMN HEALTHCARE INC | |||||
| 26 CONNELL STREET | QUINCY | MA | 02169 | TEMP STAFFING | 413833 |
| SAGENT HEALTHSTAFF VA | |||||
| PO BOX 55553 | BOSTON | MA | 02205 | TEMP STAFFING | 320445 |
| TECHNICAL NEEDS NORTH INC | |||||
| 85 MECHANIC STREET | LEBANON | NH | 03766 | TEMP STAFFING | 303325 |
| LEADERS FOR TODAY LLC | |||||
| 38 RESNICK ROAD | PLYMOUTH | MA | 02360 | TEMP STAFFING | 203325 |
| VALLEY REGIONAL HOSPITAL | |||||
| 42 ELM STREET | CLAREMONT | NH | 03743 | LAB SERVICES | 148453 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| All Other Contributions | 1029971 | AllOtherContributions |
| Total Contributions | 1029971 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | 42123672 | 42123672 | |
| OTHER OPERATING REVENU | 621400 | 201902 | 201902 | |
| NUTRITIONAL REVENUE | 900099 | 85733 | $85,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 42411307 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 63502 | TotalRevenueColumn |
| Exclusion | $63,502 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 66361 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18064 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 48297 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48297 | TotalRevenueColumn |
| Exclusion | $48,297 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1383402 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1294245 | Securities |
| Other | 15544 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 89157 | Securities |
| Other | -15544 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 73613 | TotalRevenueColumn |
| Exclusion | $73,613 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43626690 | TotalRevenueColumn |
| Related Or Exempt Function Income | 42325574 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $271,145 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1062286 | Total |
| Program Services | 405985 | ProgramServices |
| Management And General | 656301 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18717484 | Total |
| Program Services | 17736652 | ProgramServices |
| Management And General | 826177 | ManagementAndGeneral |
| Fundraising | 154655 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 410200 | Total |
| Program Services | 388705 | ProgramServices |
| Management And General | 18106 | ManagementAndGeneral |
| Fundraising | 3389 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2071287 | Total |
| Program Services | 1942866 | ProgramServices |
| Management And General | 111765 | ManagementAndGeneral |
| Fundraising | 16656 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1319220 | Total |
| Program Services | 1215265 | ProgramServices |
| Management And General | 93665 | ManagementAndGeneral |
| Fundraising | 10290 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18206 | Total |
| Program Services | 3451 | ProgramServices |
| Management And General | 14755 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81509 | Total |
| Management And General | 81509 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3661333 | Total |
| Program Services | 3431725 | ProgramServices |
| Management And General | 195251 | ManagementAndGeneral |
| Fundraising | 34357 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 172028 | Total |
| Program Services | 4552 | ProgramServices |
| Management And General | 167432 | ManagementAndGeneral |
| Fundraising | 44 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1241714 | Total |
| Program Services | 938628 | ProgramServices |
| Management And General | 289815 | ManagementAndGeneral |
| Fundraising | 13271 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15840 | Total |
| Program Services | 15060 | ProgramServices |
| Management And General | 634 | ManagementAndGeneral |
| Fundraising | 146 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877978 | Total |
| Program Services | 680872 | ProgramServices |
| Management And General | 190082 | ManagementAndGeneral |
| Fundraising | 7024 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156780 | Total |
| Program Services | 137572 | ProgramServices |
| Management And General | 16840 | ManagementAndGeneral |
| Fundraising | 2368 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107489 | Total |
| Program Services | 83325 | ProgramServices |
| Management And General | 23250 | ManagementAndGeneral |
| Fundraising | 914 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1286182 | Total |
| Program Services | 1005666 | ProgramServices |
| Management And General | 280516 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 439578 | Total |
| Program Services | 430370 | ProgramServices |
| Management And General | 8860 | ManagementAndGeneral |
| Fundraising | 348 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES & EQUI | 4260353 | 4258523 | 1653 | 177 |
| BAD DEBT EXPENSE | 1931752 | 1931752 | ||
| MET tax | 1910835 | 1910835 | ||
| LOSS FROM DISCONTINUED | 486074 | 486074 | ||
| EQUIP RENTAL & MAINTENA | 383982 | 371874 | 11897 | 211 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254354 | Total |
| Program Services | 160846 | ProgramServices |
| Management And General | 88619 | ManagementAndGeneral |
| Fundraising | 4889 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40866464 | Total |
| Program Services | 37540598 | ProgramServices |
| Management And General | 3077127 | ManagementAndGeneral |
| Fundraising | 248739 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 992 | BOY |
| EOY | 1955 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5054967 | BOY |
| EOY | 4464824 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98655 | BOY |
| EOY | 8764 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4494556 | BOY |
| EOY | 6151124 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 985035 | BOY |
| EOY | 1158009 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192181 | BOY |
| EOY | 194503 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 34551439 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23151141 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11188524 | BOY |
| EOY | 11400298 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2579843 | BOY |
| EOY | 2555238 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8500 | BOY |
| EOY | 8500 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 158399 | BOY |
| EOY | 150291 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1470008 | BOY |
| EOY | 2298999 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26231660 | BOY |
| EOY | 28392505 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6018343 | BOY |
| EOY | 6020355 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6492000 | BOY |
| EOY | 9021000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3331000 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75451 | BOY |
| EOY | 236800 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15916794 | BOY |
| EOY | 15278155 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8098613 | BOY |
| EOY | 11576659 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2189426 | BOY |
| EOY | 1509626 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26827 | BOY |
| EOY | 28065 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10314866 | BOY |
| EOY | 13114350 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26231660 | BOY |
| EOY | 28392505 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amt Of4955 Tax | 0 | AmtOf4955Tax |
| Amt Of4955 Tax On Managers | 0 | AmtOf4955TaxOnManagers |
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $10,458 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 10458 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| 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 | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 26827 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1238 | InvestmentEarningsOrLosses |
| End Of Year Balance | 28065 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 26456 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 371 | InvestmentEarningsOrLosses |
| End Of Year Balance | 26827 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 927577 | OtherCostOrOtherBasis |
| Book Value | 927577 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13995900 | OtherCostOrOtherBasis |
| Depreciation | 7417805 | Depreciation |
| Book Value | 6578095 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 179509 | OtherCostOrOtherBasis |
| Depreciation | 173716 | Depreciation |
| Book Value | 5793 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17217361 | OtherCostOrOtherBasis |
| Depreciation | 14771771 | Depreciation |
| Book Value | 2445590 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2231092 | OtherCostOrOtherBasis |
| Depreciation | 787849 | Depreciation |
| Book Value | 1443243 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11400298 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATES | 2103230 |
| OTHER ASSETS | 46517 |
| ASSETS WHOSE USE IS LIMITED OR RESTRICTED | 149252 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2298999 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED ANNUITY | $72,130 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $164,670 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 236800 | TotalOfAmounts |
| Total Revenue | 43626690 | TotalRevenue |
| Total Expenses | 40866464 | TotalExpenses |
| Excess Or Deficit For Year | 2760226 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 52297 | NetUnrealizedGLOnInvestments |
| Other | -$13,039 | OtherAmount |
| Total Adjustments | 39258 | TotalAdjustments |
| Excess Or Deficit Per FS | 2799484 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 43684012 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 52297 | NetUnrealizedGainsInvestments |
| Other Revenues | 5025 | OtherRevenues |
| Revenue Not Rptd F990 | 57322 | RevenueNotRptdF990 |
| Revenue Subtotal | 43626690 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 43626690 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 40398454 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 18064 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 18064 | ExpensesNotRptdF990 |
| Expenses Subtotal | 40380390 | ExpensesSubtotal |
| Other Expenses Not Included | 486074 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 486074 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 40866464 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | Alice Peck Day Health Systems Corp. and subsidiaries (the "System") adopted FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109, effective October 1, 2007. The System has evaluated its tax positions taken in accordance with FIN 48 and has determined that there is no impact on the System's current tax-exempt status, or financial position or results of operations for the years ended September 30, 2010 and 2009. |
| Part XI, Line 8 - Other Adjustments: | CHANGE IN INTEREST RATE SWAPS: 29044. CHANGE IN ANNUITY LIABILITY: -42083. | |
| Part XII, Line 2d - Other Adjustments: | rental expenses: 18064. CHANGE IN INTEREST RATE SWAPS: 29044. CHANGE IN ANNUITY LIABILITY: -42083. | |
| Part XIII, Line 2d - Other Adjustments: | rental expenses: 18064. | |
| Part XIII, Line 4b - Other Adjustments: | LOSS FROM DISCONTINUED OPERATIONS: 486074. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 212.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 734688 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 734688 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01800 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5269409 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3075642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2193767 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05370 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6004097 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3075642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2928455 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07170 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 126776 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 126776 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 226728 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 226728 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00550 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 117284 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 117284 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 470788 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 470788 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6474885 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3075642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3399243 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08320 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 27160 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 27160 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 6500 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6500 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 33660 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 33660 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,184,031 | BadDebtExpenseAmount |
| Amount Attributable To | 100000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10014895 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11143679 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1128784 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
Form990 Schedule H Part V Form990ScheduleHPartV (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| ALICE PECK DAY MEMORIAL HOSPITAL | ||||||||
| 125 MASCOMA STREET | LEBANON | NH | 03766 | X | X | X | X | |
| ALICE PECK DAY EXTENDED CARE FACILITY | ||||||||
| 125 MASCOMA STREET | LEBANON | NH | 03766 | DISCONTINUED IN 2010 | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: N/A | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: N/A | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: Charity care and means tested programs use the cost to charge ratio as their methodology. Alice Peck Day Memorial Hospital calculates the ratio in a manner consistent with work worksheet 2, patient care charges to patient care expenses, to arrive at the ratio of costs to charges.Part I, Line 7, column (f): Bad debt expense reported on Form 990 Part IX, Line 25 was excluded from Total Expenses for the calculation of Net Community Benefits as a percent of Total Expenses. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Bad Debt expense is calculated using a cost to charge ratio using Worksheet B. In FY10, 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 denied due to lack of complete documentation. 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, payment programs or a combination of the above. Due to these efforts, we feel that amounts written off to bad debt that could qualify as charity care is minimal. Footnote 1 to the audited consolidated financial statements of Alice Peck Day Health Systems contains the following to address bad debt: ACCOUNTS RECEIVABLE - Accounts receivable are stated at the amount management expects to collect from outstanding balances. Management provides for probably uncollectible amounts through a charge to operations and a credit to a valuation allowance based on its assessment of individual accounts and historical adjustments. Accounts deemed uncollectible are written off through a charge against the established allowance. | BadDebtFootnote |
| Shortfall As Community Benefit | 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. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Our bad debt collections policy applies to all patient accounts in a consistent manner. The policy specifically indicates that, after a second patient 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 done 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 attain quality healthcare, regardless of ability to pay. Our financial assistance programs provide, 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 receiving services, at registration for services and during our billing process to ensure that any and all patients in need of assistance are provided the help the need. Brochures and signs are placed in high traffic areas such as the ER and Registration. Our staff is trained to identify patients during registration that may be in need of financial assistance and provide information and offer help in completing the necessary forms. During our billing process, calls are made to patients with outstanding balances. Our staff works with patient to identify problems they are facing in dealing with outstanding balances. Patients are again notified of the many types of financial assistance available that they may qualify for. 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 that may need financial assistance, very few qualifying patients patients reach the point of bad debt. Our collection policies and procedures in conjuction with our small size, allow our ogranziation to place great emphasis on helping all patients who may be in need apply for, and attain the appropriate level of financial assistance. | DebtCollectionPolicy |
| Number Of Facility Type Expln | Part V: In addition to the hospital, there were 8 physician clinics in place at the end of FY 2010. | NumberOfFacilityTypeExpln |
| Needs Assessment | Part VI, Line 2: Due to our rural location and size, a collaborative effort between the United Way, Dartmouth Hitchcock Memorial Hospital and Alice Peck Day Memorial Hospital created the FY 2009 Community Benefits Plan. Priority needs and health concerns for our community were based upon information collected from community needs assesments and community surveys. Identified needs included: availability of oral health, availability of primary care, prescription assistance, transportation, availability of behavioral health and access to alcohol/drug treatment. Alice Peck Day Memorial hospital used this information to help focus their community benefit efforts to meet the priority needs identified in the community benefit plan. Of special note is the Upper Valley Smiles Program which has served a priority need for oral health within our local community. Upper Valley Smiles has touched the lives of many children in our community and provided much needed care for a very vulnerable population. | NeedsAssessment |
| Patient Education Assistance | 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 attain the care they need. We reach out to our patients in many different ways to ensure they are aware that help is available and to guide them through the process. Brochures and signage are posted in high traffic areas such as the emergency room, registration, and lobby. Registration staff is trained to identify patients who may be in need of financial assistance. Once identified, the staff notifies the patient that APD has various forms of financial assistance and explains 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 is trained to help identify and offer assistance to anyone who might require financial assistance. Patients with outstanding balances are contacted by our credit coordinator who works with them to clear up balances through the variety of programs that we offer. Depending on the individual situation, patients may qualify for free care, discounted care, payment plans or a combination of the above. Assistance is also provided in applying to federal/state programs for those who qualify. Specially trained staff guides 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. | PatientEducationAssistance |
| Community Information | 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 as well as Vermont. APD's service area in NH comprises fifteen 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. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Alice Peck Day Memorial Hospital actively promotes community leadership development. Staff members participate in two local Chambers of Commerce, Leadership Upper Valley, Foundation for Healthy Communities, the Rural Health Coalition and the Advocacy Task Force. As an active member of its community, Alice Peck Day works to be proactive concerning disaster readiness. Staff has participated in onsite training for disaster preparedness as well as offsite training with other regional hospitals. Collaborative efforts include all hazard regional planning, emergency response training and a regional mass casualty response program to help facilitate cooperative efforts if such needs arise. H1N1 planning included both vaccination clinics for staff and the general public, training of staff and stocking supplies that would be required if a pandemic were to arise. | CommunityBuildingActivities |
| Other Information | 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 the Board of Trustees are not employed by the Hospital, and include local government and business representatives as well as practicing non-employed physicians. Despite its small size, APD is committed to giving back to the community to the greatest extent possible. During FY 2010, cash donations were given to many programs that help provide to 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 over 36 local non-profit organizations with meeting space and refreshments. Although we are a small critical access hospital, Alice Peck Day recognizes that we are all part of the global community and have a responsibility to help others in need. APD supported the Haiti relief effort by providing staff, in-kind contributions and cash assistance to help the country of Haiti recover from the devastation it suffered as a result of the earth quake that hit in January of 2010. Alice Peck Day held community flu clinics, provided emergency prescription drug vouchers, subsidized senior exercise classes and worked towards expansion of local public transportation to ensure all those in need of medical care could receive it. One of APD's most exciting and celebrated programs is the Upper Valley Smiles Program. This program provides an oral health safety net for disadvantaged residents in its service area. In 4 different schools, over 728 students received oral health education. Dental screenings were provided to over 307 children of those children, with 203 receiving dental sealants and 159 of those were referred to dentists for restorative treatment. 36 children requiring urgent care were referred, case managed and paid for by Alice Peck Day. At WIC clinics within the area an additional 124 low income families received health education, 119 received dental screenings and 9 children were referred to local dentists for restorative treatment. Alice Peck Day hosted two free oral health clinics with 16 homeless children receiving a dental cleaning and fluoride applications. Individuals were provided with assistance in applying for NH/VT Medicaid to ensure increased access for medical care for this needy population. As a result a significant number of people were successfully enrolled and received ongoing care. To promote health professional education, APD provided clinical undergraduate training to Dartmouth Medical School, School of Midwifery, River Valley Community College, Elmira College and Lebanon College. Alice Peck Day annually sponsors district wide professional development for school nurses for in our area and others within the region. These initiatives and ongoing efforts continue to address several of the most pressing community health needs as identified in our community needs assessment. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
| Reports Filed With States | NH | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARRY G DORMAN III | |||||||||||||
| 235767 | 0 | 0 | 0 | 57696 | 0 | 10729 | 0 | 14648 | 0 | 318840 | 0 | 0 | 0 |
| SUSAN E MOONEY MD | |||||||||||||
| 221353 | 0 | 0 | 0 | 15862 | 0 | 9283 | 0 | 21975 | 0 | 268473 | 0 | 0 | 0 |
| DOUGLAS CEDENO MD | |||||||||||||
| 222102 | 0 | 0 | 0 | 0 | 0 | 7878 | 0 | 12134 | 0 | 242114 | 0 | 0 | 0 |
| CHRISTOPHER MAZUR MD | |||||||||||||
| 204532 | 0 | 0 | 0 | 0 | 0 | 7545 | 0 | 22222 | 0 | 234299 | 0 | 0 | 0 |
| DAVID KRONER MD | |||||||||||||
| 287317 | 0 | 43335 | 0 | 0 | 0 | 11546 | 0 | 13790 | 0 | 355988 | 0 | 0 | 0 |
| SUZANNE SHIPMAN MD | |||||||||||||
| 216620 | 0 | 0 | 0 | 0 | 0 | 8282 | 0 | 22575 | 0 | 247477 | 0 | 0 | 0 |
| KATHRYN VARGO MD | |||||||||||||
| 239165 | 0 | 0 | 0 | 0 | 0 | 9565 | 0 | 21975 | 0 | 270705 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 6 | ReturnReference |
| Explanation | Dr. David Kroner, a physician and one of the top five highest paid employees of the Organization, had an employment contract whereby he received a base salary and an opportunity for a productivity based incentive should net Professional service revenue from his practice exceed a pre-established threshold. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STATE OF NEW HAMPSHIRE BUSINESS FINANCE AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 521304598 | IssuerEIN |
| CUSIP Number | 64468KAY2 | CUSIPNumber |
| Date Issued | 2007-05-11 | DateIssued |
| Issue Price | 6925000 | IssuePrice |
| Description Of Purpose | ADVANCE REFUND EXISTING BONDS | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 6925000 | TotalProceeds |
| Amount Defeased | 6563296 | AmountDefeased |
| Issuance Costs From Proceeds | 111527 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 14112 | WorkingCapitalExpenditures |
| Capital Expenditures | 236065 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEUTSCHE BANK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 2.400000000000 | TermOfHedge |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 1 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Alice Peck Day Health Systems Corp, a charitable coporation, acting by and through its board of trustees, is the sole member of the Organization. | |
| Form 990, Part VI, Section A, line 7a | All trustees shall be elected by the board of trustees of the Member at the annual meeting of the Member. The board of trustees shall include at least a majority of the board of trustees of the Member. A nomination slate for the trustees shall be submitted by the governance committee of the Member. Any trustee may be removed at any time, with or without cause, by the Member. Vacanicies on the board of trustees due to death, resigination, or other cause except removal shall be filled by election by the remaining members of the board. Vacancies caused by removal shall be filled by election by the Member. Trustees elected to fill vacancies shall hold office until the next annual meeting of the Member, at which time successors shall be elected in the manner provided for in the case of original elections. Subject to the approval of the Member, the board of trustees shall selct and employ a president who shall be the chief executive officer of the Hospital. All other officers of the Organization, the Chairman, Vice Chairman, Secretary, and Treasurer of the board, are all to be elected at the discretion of the Organization's board of trustees. | |
| Form 990, Part VI, Section A, line 7b | The Organization's annual operating budget and all capital budgets shall be subject to the approval by the Member. Any overall strategic plan for the Organization, including the development of off-site facilities, the addition of new programs and affiliations with other institutions, shall be consistent with the strategic plan of the Member as determined by the Member. The borrowing of any sum in excess of $50,000 which has a stated term greater than one year or which is secured by a mortgage of all or any portion of the Organization's real property or by a security interest in the Organization's assets or revenues shall be subject to approval by the Member, provided, however, that the approval by the Member shall not be necessary for any borrowing to purchase or lease equipment or other personal property secured by a purchase money lien or title retention or security agreement except as incident to the review of the capital budget. Any voluntary dissolution, merger or consolidation of the Organization or the sale or transfer of all or substantially all of the Organization's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. The board shall select as certified public accountants for the Organization the firm which audits the books and records of the Member. The board shall select the president who must be confirmed by the Member. | |
| Form 990, Part VI, Section B, line 11 | The completed Form 990 is provided to all members of the finance and governance committees of the board of trustees in advance of the filing deadline to enable a detailed and conscientious review by all members of both committees. The completed Form 990 is also distributed to all members of the full board for review no later than the final regularly scheduled board meeting prior to the filing deadline. All questions and concerns are addressed by the Chief Financial Officer and incorporated into the Form 990 as deemed appropriate. After all input from the board, finance, and governance committees has been appropriately addressed and incorporated into the final Form 990, a vote of acceptance of the final document is required. The vote is recorded in the minutes of the board of trustees prior to the filing of the Form 990. Once approved, senior management files the final Form 990 with the Internal Revenue Service as required. | |
| Form 990, Part VI, Section B, line 12c | Alice Peck Day has a multi-faceted conflict of interest policy. Our board of trustees completes a conflict of interest questionnaire on an annual basis and any new members complete the questionnaire upon joining the board. Additionally, the board has its own board standard of conduct guidelines and statement of financial interest which are reviewed and signed by all board members on an annual basis. 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 to this, 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 New Hampshire and federal requirements for disclosure 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 staff upon hire and on an annual basis. The standard of conduct covers conflict of interest and other vital matters to ensure all business activity will be conducted in a manner consistent with the highest standards of honesty, integrity and fairness. | |
| Form 990, Part VI, Section B, line 15 | The compensation committee of the Alice Peck Day Health Systems board of trustees is responsible for determining the compensation of the Chief Executive Officer/President. The HR director 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. The CEO/President is responsible for reviewing the performamce of the senior management staff. The information is brought to the compensation committee of the board of trustees along with a recommendation for the salary of each individual. The compensation is determined through an analysis of salary data and performance. Individual salary increases are then based on overall performance, within budgeted wage increases for the Orgaization. The compensation 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 E | DR. SUSAN MOONEY IS A PRACTICING PHYSICIAN IN ADDITION TO BEING THE HOSPITAL'S CHIEF MEDICAL OFFICER. SHE WORKED AN AVERAGE OF 60 HOURS PER WEEK, OF WHICH AN AVERAGE OF 40 HOURS PER WEEK WAS SPENT ON EXECUTIVE MATTERS AND 20 IN HER ROLE AS A PHYSICIAN. | REPORTABLE COMPENSATION |
| FORM 990, PART XI, LINE 2C | THE ORGANIZATION DID NOT CHANGE ITS AUDIT OVERSIGHT PROCESS BUT DID SELECT A NEW INDEPENDENT AUDITOR FOR THE FISCAL YEAR ENDED 9/30/10. | OVERSIGHT OF AUDIT PROCESS |
| FORM 990, PART IV, LINE 34 | In addition to the organizations listed in Schedule R, the Organization is related to Alice Peck Day Realty Corp (EIN 02-0485369) and Alice Peck Day Health Management Services, Inc. (EIN 02-0485370) through the direct controlling parent, Alice Peck Day Health Systems Corp. Both entities are inactive and hold no assets. | INACTIVE ENTITIES |
| FORM 990, PART VII, SECTION A | J. TODD MILLER, WHO HAD PREVIOUSLY SERVED AS A TRUSTEE ON APD MEMORIAL HOSPITAL'S BOARD, WAS HIRED BY THE HOSPITAL AS CHIEF OPERATING OFFICER IN FEBRUARY 2010. HE DID NOT RECEIVE ANY REPORTABLE COMPENSATION FROM ANY OF THE ALICE PECK DAY ENTITIES IN 2009. | CHANGE OF ROLE FOR TRUSTEE |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| ALICE PECK DAY HEALTH SYSTEMS CORPORATION | |||||||||
| 125 MASCOMA STREET | LEBANON | NH | 03766 | 020479095 | PROMOTE HEALTH CARE | NH | 501(C)(3) | Line 11b, II | |
| ALICE PECK DAY LIFECARE CENTER INC | |||||||||
| 125 MASCOMA STREET | LEBANON | NH | 03766 | 020479094 | ASSISTED LIVING FACILITY | NH | 501(C)(3) | Line 9 | ALICE PECK DAY HEALTH SYSTEMS CORP |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| ALICE PECK DAY HEALTH SYSTEMS CORP | |
| D | 1177139 |
| ALICE PECK DAY LIFECARE CENTER INC | |
| D | 926091 |