2024-08-15T11:47:59-05:00 2023-09-30 010523282 Berry Dunn McNeil & Parker LLC 2211 Congress St Portland ME 04102 990 2022-10-01 020222152 Littleton Hospital Association LITT 6034449000 600 St Johnsbury Road Littleton NH 03561 Robert F Nutter President & CEO 6034449000 2024-08-14 1 1 Joseph R Byrne P01289281 2077752387 2024-08-14 2022 2024-08-08 14:25:15Z Littleton Regional Healthcare Robert F Nutter 600 St Johnsbury Road Littleton NH 03561 153201677 0 X www.littletonhospital.org X 1906 NH To provide health care services in Northern New Hampshire 16 12 685 63 0 0 2721351 7297380 106344174 107348233 1672313 4968423 250912 209411 110988750 119823447 287377 243905 0 0 56338958 55761732 0 0 0 52126381 61928967 108752716 117934604 2236034 1888843 115297202 123327936 56932469 61740548 58364733 61587388 X To provide quality, compassionate, and accessible healthcare in a manner that brings value to all. 0 0 88951551 243905 107348233 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. Littleton Hospital Association offers a full spectrum of services, including acute primary and selected secondary care; 24-hour emergency services; preventative diagnostic, therapeutic, and rehabilitative services on an outpatient and inpatient basis; continuity of care from preventive programs to coordination with home health services.Littleton Hospital Association provides these services without regard to race, religion, age, sex, income, creed, national origin, or disability.Littleton Hospital Association maintains a sufficient number and mix of medical staff who are competent, dedicated and community based, supporting them with the technologically up-to-date equipment and facility needed to provide these services competitively.Littleton Hospital Association creates a healthy, satisfying work environment for physicians, 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. 88951551 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 128 0 1 685 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 NH X D Chris Frauenhofer 6034449000 600 St Johnsbury Road Littleton NH 03561 Jeff Woodward Chair 1.00 X X 0 0 0 Dr Patrick Fitzpatrick Treasurer/Physician 40.00 X X 1080093 0 47118 Ashley Garrison Secretary 1.00 X X 0 0 0 Fred Chisolm Trustee 1.00 X 0 0 0 Dr Stephen Goldberg Trustee/Physician 40.00 X 358398 0 36504 Audrey Goudie Trustee 1.00 X 0 0 0 Richard Jesseman Trustee 1.00 X 0 0 0 Elizabeth Kunz Trustee 1.00 X 0 0 0 Robert MacLeod Trustee 1.00 X 0 0 0 Laurie Morgan Trustee & LRH Auxiliary 1.00 X 0 0 0 Stephen Noyes Trustee 1.00 X 0 0 0 Charyl Reardon Trustee 1.00 X 0 0 0 Paul Smith Trustee 1.00 X 0 0 0 Thomas Tremblay Trustee 1.00 X 0 0 0 Jennifer Lucas Ex Officio/Physician 40.00 X 439577 0 34416 Dr Richard McKenzie Ex Officio/Physician 40.00 X 359258 0 35454 Kathryn Fleury Past Trustee 1.00 X 0 0 0 Robert Nutter President & CEO 40.00 X 608272 0 292207 Steven Shaffer CFO 40.00 X 260588 0 24971 Koren Superchi COO/CNO 40.00 X 312739 0 10896 Dr Eric Mullins Physician 40.00 X 691719 0 39784 Dr Eric Emig Physician 40.00 X 871038 0 35681 Dr Jeffrey Kauffman Physician 40.00 X 644912 0 37348 Dr Anthony Salerni Physician 40.00 X 658367 0 28676 Dr Edward Duffy CMO 40.00 X 599999 0 38245 Leslie Walker Former VP of Finance 40.00 X 155077 0 30950 7040037 0 692250 109 1 1 0 The Alpine Clinic PLLC 1095 Profile Rd Franconia NH 03580 Physicians 2558994 AHSA LLC PO Box 670529 Dallas TX 75267 Contract Labor 1756492 C3 Revenue Cycle Solutions 4011 W Vasconia St Tampa FL 33629 Billing Service 1090769 General Linen Services 75 Centre Rd Somersworth NH 03878 Cleaning Service 436718 BE Smith Services LLC PO Bx 74007636 Chicago IL 60674 Contract Labor 421419 23 57437 6598827 641116 7297380 Patient Service Revenue 621110 218454082 218454082 Other Revenue 621110 4217724 3507266 710458 Contractual Allowances 621110 -115323573 -115323573 107348233 1448116 1448116 237610 0 237610 237610 237610 36861657 8681 33350031 0 3511626 8681 3520307 3520307 0 57437 28199 -28199 -28199 119823447 106637775 0 5888292 X 243905 243905 3900491 2390818 1509673 43272230 38395339 4876891 702704 702704 4993824 4520249 473575 2892483 2517164 375319 366030 366030 165029 76085 88944 85269 85269 22061066 10355082 11705984 294001 1693 292308 2229067 1126774 1102293 73371 1232 72139 5323270 2720912 2602358 126394 88976 37418 7320 7320 1394031 1394031 4358307 3365979 992328 1830549 87810 1742739 Medical Supplies 16838693 16838693 Medicaid Enhancement Ta 5066252 5066252 Miscellaneous Expense 1471342 291445 1179897 Education and Training 238976 153119 85857 117934604 88951551 28983053 0 X 144066 168744 5938950 3027732 8829 0 13456183 30833742 2008161 2110578 2029717 921359 111939875 78713803 33403422 33226072 49103963 42639799 591877 525945 8612034 9873965 115297202 123327936 16427556 19525864 1337204 8561937 20046223 19115537 518742 6110915 18602744 8426295 56932469 61740548 X 55514259 58441127 2850474 3146261 58364733 61587388 115297202 123327936 X 1888843 1002038 331774 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14928 14928 0 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. 2386830 277727 40152 2624405 2757824 116439 -487433 2386830 2432225 29896 403922 108219 2757824 2374660 1058 129189 72682 2432225 2365387 1539 56233 48499 2374660 0.00000 0.77377 0.22623 0 0 1981468 1981468 43349397 29653119 13696278 1355697 445052 910645 59000565 46440063 12560502 6252748 2175569 4077179 33226072 Other Receivables 7550142 Estimated Third-Party Payor Settlements 2323823 9873965 Estimated Third-Party Payor Settlements 2398450 Deferred Compensation 5102123 Interest Rate Swap 354022 Reserve for Self-Funded Health Insurance 571700 8426295 120876818 1002038 359973 1362011 119514807 85269 223371 308640 119823447 117654163 28199 28199 117625964 85269 223371 308640 117934604 Part V, Line 4: All endowed funds are used based on the donors' wishes. The principal of the funds remains, and only the interest earned can be distributed. Part XI, Line 2d - Other Adjustments: Unrealized Gain on Interest Rate Swap 331,774. Fundraising Expenses 28,199. Part XI, Line 4b - Other Adjustments: Community Benefit Expense 223,371. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 28,199. Part XII, Line 4b - Other Adjustments: Community Benefit Expense 223,371. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments 4337386 0 0 0 0 0 0 4337386 0 4337386 0 0 1 0 1 0 Part III Accounting Method: Golf Tournament 57437 57437 8653 7450 8779 782 2535 57437 57437 8653 7450 8779 782 2535 28199 -28199 1 1 X 1 X 1 X 1 1 0 1 1 474766 474766 0.00400 22706842 13993532 8713310 0.07390 23181608 13993532 9188076 0.07790 165879 165879 0.00140 84220 84220 0.00070 27593643 20255634 7338009 0.06220 243905 243905 0.00210 28087647 20255634 7832013 0.06640 51269255 34249166 17020089 0.14430 1 0 24314936 24314936 X 1 1 1 1 Littleton Regional Hospital 600 St Johnsbury Road Littleton NH 03561 www.littletonhealthcare.org 02790 X X X X Littleton Regional Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X https://littletonhealthcare.org/about-lrh/ X 1 22 1 https://littletonhealthcare.org/about-lrh/ 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X https://littletonhealthcare.org/patients-and-visitors/my-bill/ X X X X X 1 X 0 X X X 1 X 0 0 Littleton Regional Hospital Part V, Section B, Line 5: In 2022, the Northern New Hampshire Region (Littleton Regional Healthcare, Ammonoosuc Community Health Services, Mid State Health Center, and Cottage Hospital) performed a Community Health Needs Assessment to determine the health needs of the Greater Northern New Hampshire Region.Data was gathered from multiple well-respected secondary sources to build an accurate picture of the community and its health needs. A survey of a select group of local Experts was performed to review the prior CHNA and provide feedback, and to ascertain whether the previously identified needs are still a priority. Additionally, the group review the data gathered from the secondary sources and determined the Significant Health Needs for the community. Littleton Regional Hospital Part V, Section B, Line 6a: The Northern New Hampshire Region Facilities ("NNHR or the "Facilities") performed a Community Health Needs Assessment (CHNA) in partnership with QHR Health ("QHR") to determine the health needs of the local community and developed an accompanying implementation plan to address the identified health needs of the community.The Northern New Hampshire Region Facilities include:- Littleton Regional Healthcare, Littleton, NH ("LRH")- Cottage Hospital, Haverhill, NH ("CH")- Mid State Health Center ("MSHC")- Ammonoosuc Community Health Services, Littleton, NH ("ACHS") Littleton Regional Hospital Part V, Section B, Line 6b: LRH's (the Hospital) CHNA was conducted along with Ammonoosuc Community Health Services, Mid State Health Center, and Cottage Hospital. Littleton Regional Hospital Part V, Section B, Line 11: The Hospital's most recent CHNA resulted in ten primary, significant identified needs. An implantation plan framework which organizes the needs by key groups was developed, allowing LRH to prioritize and address the identified needs with available time and resources.1. Mental Health: LRH's Emergency Department acts as a regional intake center for all patients with emergent behavioral health needs and contracts with Dartmouth Health's Connect Care to provide telepsychiatry in the Emergency Department. LRH is continuously enhancing its inpatient units to better accommodate the behavioral health needs of patients whose primary diagnosis is not behavioral who are placed on observation or admitted. LRH continues its efforts to embed behavioral health into its primary care clinic, including recruiting providers dedicated to behavioral health, and incorporates sharing mental health resources in the clinic and to the general public on an ongoing basis.2. Affordability of Healthcare Services: LRH's on-site urgent care clinic provides cost effective, accessible care as an alternative to the Emergency Department or for conditions too urgent to wait for an appointment. LRH also offers financial assistance to qualifying patients along with providing over a million dollars each year in Charity Care to those unable to pay for services. Established endowment funds help support patients needing assistance in specific health areas, such as those receiving cancer treatment.3. Access to Mental Health and Substance Use Disorder Services: The Doorway at LRH is part of a statewide initiative to address the growing need for SUD services. This clinic serves as a regional hub for patients throughout Northern and Central New Hampshire requiring these services. LRH understands the growing need for behavioral health services and is taking this into consideration as it prepares to embark on a complete Emergency Department renovation.4. Affordable Housing: LRH has joined nine other major area employers to address the lack of affordable housing in the area, which is impacting recruitment efforts for all major employers. The group is actively engaged with AHEAD (Affordable Housing Education and Development) to determine the feasible of constructing workforce housing in the near future on an identified parcel of local land. LRH keeps a running list of housing availability for new hires seeking housing in the area and owns a multi-unit property in Littleton that is used for on-call housing and longer term stays.5. Livable Wages: LRH is the largest employer in Northern Grafton Country and Coos County, and overhauled its compensation and benefits structure in 2022 to reinforce its position as the market leader. LRH is proud to say it achieves at or above the 75th percentile for all staff wages.6. Drug/Substance Abuse: The Doorway at LRH serves as a single point of entry for those seeking help for substance abuse. The Doorway providers resources, treatment, and other support and services to assist in long-term recovery, including peer recovery support services, coordination of placement in treatment centers, screening and evaluation, and medication-assisted treatment. LRH's Emergency Department coordinates emergent treatment for substance use disorders for The Doorway.7. Access to Senior Services: LRH provided a quarterly virtual health-related education session in 2022 on topics such as joint replacement, Medicare, among others. In the fall of 2022, LRH hosted a health and wellness fair, with nearly 50 health-related vendors providing education and resources. LRH has also launched a Mobile Integrated Health program which works closely with local EMS providers throughout the region. In September of 2022, LRH and other healthcare partners launched a mobile health clinic to address healthcare access issues throughout Grafton and Coos Counties. LRH collaborates clinically with a regional FQHC to bring specialty care closer to home for residents of Central New Hampshire through a visiting specialist program.8. Cancer: LRH shares resources with the public on services it provides such as skin cancer screenings, breast cancer screening, colonoscopies, cervical cancer screenings, prostate screenings, among others, and how to access these services. LRH also partners with Dartmouth Health's Norris Cotton Cancer Center to staff its on-site Oncology, Hematology, and Infusion Center. Through LRH's involvement in the visiting specialist program, many of these screenings are now available in central New Hampshire office locations.9. Obesity: LRH employs a full-time Diabetes Educator and a full-time Registered Dietitian who both accept referrals for patients requiring these services. LRH's Diabetes Educator offers a free, virtual support group once a month for patients and non-patients to attend. LRH encourages patients to see their provider on an annual basis to monitor health conditions, like weight concerns.10. Alzheimer's and Dementia: LRH shares resources related to Dementia and Alzheimer's, and encourages routine care to address any concerns related to these conditions. LRH also employs a Neurologist, contracts with Dartmouth Health for supplemental tele-neurology support, and is welcoming an additional Neurologist in summer of 2023 who focuses on cognitive disorders. 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 based on poverty levels determined yearly by the nation. The Poverty levels are decided federally and updated throughout the hospital policies. Part I, Line 7g: All costs reported on Part I, Line 7g are attributable to physician practices. Part III, Line 4: Please refer to pages 8-12 of the attached audited financial statements. 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. Part VI, Line 2: LRH takes a comprehensive approach to assess community health needs. We perform several independent data analyses based on secondary source data, augment this with local survey data and resolve any data inconsistency or discrepancies from the combined opinions formed from local experts. We rely on secondary source data and most secondary sources use the county as the smallest unit of analysis. Since the service area comprises parts of Grafton County, we asked local residents to note if they perceived the problems, or needs, identified by secondary sources to exist in their portion of the county. 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 defines its primary service area as Grafton County. Grafton County, New Hampshire's estimated population is 91,118 with a growth rate of -0.03% in the past year according to the most recent United States census data. Grafton County, New Hampshire is the 5th largest county inNew Hampshire. According to the United States Census, the Population estimates base in 2022 is 91,118 in Grafton County, New Hampshire. Persons under 5 years of age will make up 3.9% of the population. Persons under 18 years of age will make up 20.4% of the population. Persons 65 years of age and over will make up 21.9% and all females will make up 50.2% of the overall population. Median household income was $82,045. Per capita income in past 12 months (in 2022 dollars) 2018-2022 is $37,847. 11% of the population is considered at poverty level. Individuals with a disability is 15.5%. People without health insurance is 5.3%. Part VI, Line 5: Littleton Regional Healthcare is involved in several community building activities that promote the health and wellbeing of the communities it serves. We collaborate with a number of local agencies including the North Country Health Consortium, Littleton Area Senior Center, Ammonoosuc Community Health Services and others. These agencies share common goals that address access to healthcare, health improvement, health education and affordable healthcare services. LRH encourages senior management and mid-level management to be actively involved in the communities we serve. We work with area schools to address the health of our young students and we work with local safety providers to promote safety and help prevent injury. Part VI, Line 7, Reports Filed With States NH 1 Foundation for Healthy Communities 125 Airport Road Concord NH 03301 020275078 501(c)(3) 223371 0 Support Medicaid Expansion and Drug & Alcohol Commission. Boys and Girls Club of the North Country Inc PO Box 111 Littleton NH 03561 273653199 501(c)(3) 10600 0 Organizational Support 2 0 Part I, Line 2: Amounts were paid to organizations were required by the State of NH in order to support Medicaid expansion, as well as other nonprofit organizations. Therefore, additional monitoring of funds was not deemed to be necessary. X X X X 0 1 0 0 0 0 0 1 0 Dr Patrick Fitzpatrick Treasurer/Physician 536676 0 543417 0 0 0 9150 0 37968 0 1127211 0 0 0 Dr Eric Emig Physician 543159 0 327879 0 0 0 9150 0 26531 0 906719 0 0 0 Robert Nutter President & CEO 588772 0 19500 0 0 0 253342 0 38865 0 900479 0 0 0 Dr Eric Mullins Physician 647364 0 44355 0 0 0 4736 0 35048 0 731503 0 0 0 Dr Anthony Salerni Physician 632367 0 26000 0 0 0 0 0 28676 0 687043 0 0 0 Dr Jeffrey Kauffman Physician 642412 0 2500 0 0 0 9150 0 28198 0 682260 0 0 0 Dr Edward Duffy CMO 492104 0 107895 0 0 0 9150 0 29095 0 638244 0 0 0 Jennifer Lucas Ex Officio/Physician 418637 0 20500 0 440 0 9041 0 25375 0 473993 0 0 0 Dr Stephen Goldberg Trustee/Physician 319678 0 37400 0 1320 0 8400 0 28104 0 394902 0 0 0 Dr Richard McKenzie Ex Officio/Physician 348018 0 11240 0 0 0 9150 0 26304 0 394712 0 0 0 Koren Superchi COO/CNO 252564 0 60175 0 0 0 7695 0 3201 0 323635 0 0 0 Steven Shaffer CFO 240088 0 20500 0 0 0 0 0 24971 0 285559 0 0 0 Leslie Walker Former VP of Finance 150017 0 5060 0 0 0 4919 0 26031 0 186027 0 0 0 Part I, Line 4b Robert Nutter, President and CEO, participated in the Hospital's 457(f) plan. Littleton Regional Healthcare contributed $244,192 to Mr. Nutter's plan during calendar year 2022. Part I, Line 7 Dr. Patrick Fitzpatrick, Dr. Stephen Goldberg, Dr. Jennifer Lucas, Dr. Richard McKenzie, Dr. Anthony Salerni, Dr. Eric Mullins, Dr. Eric Emig, and Dr. Jeffery Kauffman all received bonuses during the year based upon their productivity using MGMA Standards by RVU and by their specialties outlined in their respective contracts. Robert Nutter, Koren Sperchi, Steven Shaffer, Dr. Edward Duffy and Leslie Walker received bonuses based and subject to achieving organizational quality and financial metrics developed with the Board Executive Committee and approved by the Board for fiscal year 2023. A New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 5331100 Refunded series 2007 Bond 0 0 0 B New Hampshire Health and Education Facilities Authority 020279866 2015-10-01 20753200 Refunded series 2007 Bond 0 0 0 A 1526723 5331100 41800 5289300 2015 1 0 1 1 B 5258116 20753200 162500 20590700 2015 1 0 1 1 A 0 1 0 0 0 0 1 B 0 1 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 1 1 Deutsche Bank AG 20.000000000000 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2022 Issuer Name: New Hampshire Health and Education Facilities Authority Date the Rebate Computation was Performed: 10/01/2022 Schedule K, Part III, Line 2, Lease Arrangements: The debt-financed property is leased to 3 physician practices which operated primarily for purposes related to the hospitals performance of its exempt purpose. Therefore, these leases are not considered to be private business use (Dartmouth Hitchcock (Derm and Cardio), Shippee/Eye Associates, Littleton Internal Med, White Mtn Family Health). Form 990, Part VI, Section B, line 11b The return was reviewed by the entire Board of Trustees prior to the filing. Form 990, Part VI, Section B, line 12c All Trustees, 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, 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. Form 990, Part VI, Section B, line 15 Key employees' have annual evaluation - HR Director prepares compensation surveys, reviews 990 of other organizations and market data. The CFO salary is approved by the President. The President/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. Form 990, Part IX, line 11g Contract Labor: Program service expenses 8,593,475. Management and general expenses 4,349,525. Fundraising expenses 0. Total expenses 12,943,000. Consulting: Program service expenses 1,440. Management and general expenses 673,226. Fundraising expenses 0. Total expenses 674,666. Purchased Services: Program service expenses 1,760,167. Management and general expenses 6,683,233. Fundraising expenses 0. Total expenses 8,443,400. Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: Littleton Hospital Association 600 St. Johnsury Road Littleton, NH 03561 EIN 02-0222152 Littleton Hospital Association is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). Form 990, Part XI, line 9: Unrealized Gain/Loss on Interest Rate Swap 331,774.