Community Benefit Insight - Tax-exempt hospital

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Littleton Hospital Association

Littleton Regional Healthcare

600 St Johnsbury Road
Littleton, NH 03561

Bed count	25	Medicare provider number	301302	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 020222152

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

18.21%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 607,440 0.56 %
Medicaid as % of operating expenses	$ 7,635,839 7.02 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 85,653 0.08 %
Subsidized health services as % of operating expenses	$ 11,015,134 10.13 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 173,160 0.16 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 287,377 0.26 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 0 0 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 82241094 including grants of $ 287377) (Revenue $ 106344174)
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.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Littleton Regional Hospital
Part V, Section B, Line 5: In 2019, the Northern New Hampshire Region (Littleton Regional Healthcare, Ammonoosuc Community Health Services and Coos County Family Health Services) performed a Community Health NeedsAssessment 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 6b: LRH's (the Hospital) CHNA was conducted along with Ammonoosuc Community Health Services and Coos County Family Health Services.

Littleton Regional Hospital
Part V, Section B, Line 11: The Hospital is addressing the significant needs identified in its most recent CHNA as follows:- Drug/Substance Abuse: The Doorway at LRH is part of a statewide initiative to address the growing opioid crisis. Littleton Regional Healthcare serves as a HUB for Northern New Hampshire. Fire, police and first responders carry Narcan with them to administer during calls. LRH offers a women's health conference annually that attracts close to 400 women. The Conference offers education on drug and substance misuse.- Mental Health: Two contract providers were available and seeing patients at LRH to address mental health issues. LRH offers community education on topics related to mental health issues to raise awareness that mental health issues can happen to anyone or any family and should be treated with the same care as diabetes, cardiac issues, etc.- Obesity/Overweight: LRH's Registered Dietician shares health related information about healthy eating habits including healthy diets and recipes through North Country Nutrition & Wellness a Blog for visitors to the LRH website. LRH offers entry level fitness classes on campus including yoga, and Bone Builders. LRH's 43.6 acres makes walking on the campus a favorite for everyone to walk and run. This encourages staying fit and addresses the obesity/overweight community health need.- Accessibility (Transportation/Disability, Access to Care, etc.) LRH provided transportation to and from appointments and procedures at LRH through our Care-A-Van service. LRH invested more than $110,000 to cover the cost of this service to assist individuals who cannot drive or cannot afford a vehicle so that they can get to and from Littleton Regional Healthcare.- Alcohol Abuse: Due to Covid-19, LRH did not allow Alcohol Anonymous to host. LRH hosts Alcohol Anonymous weekly meetings at no cost to AA. Again, the Doorway at LRH offers drug/substance abuse treatment in the region we serve.- Affordability: In FY 2022, LRH provided $618,000 in charity care for individuals who are unable to pay for healthcare services. Our patient financial services staff works with patients who do not have insurance but want to be covered to help them make a selection that works for them. We work with patients to help them pay their healthcare bills on a monthly basis, at a level that works for their financial capabilities.- Dental: LRH does not address this need directly, but we do refer patients to Ammonoosuc Community Health Services who offers high-quality, affordable dental care that is open to everyone regardless of ability to pay. They accept Medicaid and most major insurances and work with uninsured through a sliding fee scale payment option.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
The Hospital determines its cost of charity care based on an overall financial statement cost to charge ratio applied against gross charity care charges.

Part I, Line 7g:
All costs reported on Part I, Line 7g are attributable to physician practices.

Part III, Line 4:
Please refer to pages 8-11 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 92,201 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 in New Hampshire. According to the United States Census, the Population estimates base in 2021 is 92,201 in Grafton County, New Hampshire. Persons under 5 years of age will make up 1.3% of the population. Persons under 18 years of age will make up 17% of the population. Persons 65 years of age and over will make up 20.5% and all females will make up 50.2% of the overall population. Median household income was $73,755. Per capita income in past 12 months (in 2021 dollars) 2017-2021 is $42,336. 9.4% of the population is considered at poverty level. For years 2017-2021 the percentage for individuals with a disability, under age 65 years is 9.9%. For people without health insurance, under the age of 65 years, the percentage is 8.4%.

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

Operating expenses	$ 108,752,716
Total amount spent on community benefits as % of operating expenses	$ 19,804,603 18.21 %