Community Benefit Insight - Tax-exempt hospital

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Huggins Hospital

Huggins Hospital

240 South Main Street
Wolfeboro, NH 03894

Bed count	25	Medicare provider number	301312	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 020223332

Display data for year:

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

15.45%

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	$ 309,433 0.33 %
Medicaid as % of operating expenses	$ 6,721,367 7.18 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 423,528 0.45 %
Subsidized health services as % of operating expenses	$ 5,843,297 6.24 %
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.	$ 1,166,197 1.25 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 21,096 0.02 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
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	$ 21,096 0.02 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 21,096 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 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 $ 71772713 including grants of $ 229925) (Revenue $ 88614005)
Huggins Hospital is a non-profit Critical Access Hospital that provides medical services to the region's year-round population of 30,000 residents and approximately 120,000 seasonal residents and visitors. Our services include primary care, inpatient care, intensive care, surgery, medical imaging and diagnostics, gynecology, orthopedics, pediatrics, cardiology, infusion services, respiratory therapy, speech therapy, nutrition services, cardiac and physical rehabilitation, social services and emergency services.

Facility Information

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

Huggins Hospital
Part V, Section B, Line 5: In 2022, multiple organizations, along with community members, collaborated to build a comprehensive Community Health Needs Assessment identifying and defining significant health needs, issues, and concerns of Carroll County and other communities served by Huggins Hospital. The process included in-person focus groups as well as community surveys. The process centered on gathering and analyzing data as well as receiving input from persons who represented the broad interests of the community to provide direction for creating a plan to improve the health of local communities. Many of the community's social support service organizations and other healthcare agencies participated. Along with the direct feedback from community members, these organizations provided input through a viewpoint of the clients they represent. Many of the organizations who participated in Huggins Hospital's Community Health Needs Assessment employ people with special knowledge and expertise in public health issues.

Huggins Hospital
Part V, Section B, Line 11: Huggins Hospital's most recent Community Health Needs Assessment and Implementation Plan was completed in 2022. The Implementation Plan includes strategies to address Access to Care, Access to Mental Health Services and Social Determinants of Health Improvement. Huggins Hospital, along with its partners in the Huggins Community Health Network - a network of healthcare and social service organizations in southern Carroll County - work together to identify the gaps and barriers that exist to improving the overall health and wellbeing of the community. The group also improves connections, navigation and referral to all resources in the community.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Financial Assistance and Means-Tested Government Programs: The amounts reported on Lines 7a & 7b were computed using a cost-to-charge ratio.

Part II, Community Building Activities:
Huggins Hospital provides Community Building Activities to strengthen the community's capacity to promote the health and well-being of its residents. Community building activities include expenditures and in-kind donations for the development of programs, policies and partnerships intended to address physical and social economic determinants of health.Economic Development: Huggins Hospital is one of the New Hampshire Eastern Lakes Region's primary economic drivers as a large regional employer. The hospital provides assurance to year-round and seasonal residents and visitors that 24/7 access to health care is available every day of the year. The economic health and quality of life hinges on the financial strength and the ability of the hospital to provide healthcare in the region. Multiple Leadership Team members sit on local boards and assist with economic development initiatives with groups such as the Wolfeboro Chamber, the Wolfeboro Economic Development Corporation and the Eastern Lakes Region Housing Coalition. The hospital also supports these agencies with cash and in-kind donations listed in the hospital's Community Benefits Report.Community Support: Huggins Hospital works collaboratively with local resources to build and maintain a healthy community. The hospital maintains relationships with many organizations to promote and create better community health including Governor Wentworth Regional School District, Starting Point, Carroll County Coalition for Public Health, Central NH VNA & Hospice, Northern Human Services, local summer camps and many more. Huggins Hospital provides direct in-kind and cash donations to organizations who also strive to support a healthy community that you can find listed in the Financial Contributions section of the Community Benefits Report. As part of our community support, Huggins Hospital also provides paramedic-level services out in the community through the Paramedic Intercept Program. This program allows for a faster connection to a higher level of care that many rural areas do not have available. These quick connections to this high-level emergency care helps save lives and get people the care they need sooner. This program is counted on the Community Benefits Report under Community-Based Clinical Services.Coalition Building: Huggins Hospital staff members sit on multiple public health and regional health network groups to address healthcare concerns in multiple areas including chronic disease, substance misuse, mental health, behavioral health, elderly health, healthy childhood development and more.Community Health Improvement Advocacy: Huggins Hospital develops its Community Health Needs Assessment through comprehensive community outreach and involvement that creates a natural path to health improvement advocacy in our community. As mentioned before, employees at Huggins Hospital are involved in many community groups dedicated to the health of our community. Our employees are professionals in health care and are passionate about what they do. Not only do the employees sit on numerous health advocacy committees and boards, they also volunteer at other local healthcare organizations and support community healthcare initiatives. Emergency medical professionals at Huggins Hospital train local EMS for emergency preparedness and strive to improve the quality of emergency care. Huggins Hospital supports other local non-profits that provide needed support outside the hospital's scope-of-care including mental health agencies and agencies for domestic violence support. The support for these initiatives is represented in multiple categories of the Community Benefits Report. Workforce Development: As a rural hospital with rural primary care locations, Huggins Hospital needs extra support in finding healthcare providers to maintain local services. Huggins Hospital uses a support system to help recruit qualified providers to the Eastern Lakes Region community in order to provide the healthcare services the community needs.

Part III, Line 4:
During 2020, the Hospital adopted FASB issued ASU No. 2014-09 and ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606) and Revenue from Contracts with Customers: Principal versus Agent Considerations, respectively, and related guidance, which provide guidance for revenue recognition. The standard's core principle is that a company will recognize revenue when it transfers promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. The most significant change from the adoption of the new standard relates to the estimation for the allowance for doubtful accounts. Under the previous standards, the estimate for amounts not expected to be collected based upon historical experience, were reflected as provision for doubtful accounts, and included within net revenue. Under the new standard, the estimate for amounts not expected to be collected based on historical experience will continue to be recognized as a reduction to net revenue; however, it is not reflected separately as provision for doubtful accounts. Under the new standard, subsequent changes in estimate of collectability due to a change in the financial status of a payer, for example a bankruptcy, will be recognized as bad debt expense in expenses. The adoption of this ASU in fiscal year 2020, and amounts recognized as bad debt expense and included in other expenses, did not have a material impact on the consolidated financial statements. As a result of the adoption of the rules described above, the Hospital is recording $0 of bad debt expense for fiscal year ended September 30, 2022.

Part III, Line 8:
The Organization used a cost-to-charge ratio as its costing methodology to determine the amount of Medicare allowable costs.

Part III, Line 9b:
As a not-for-profit, tax-exempt, and charitable organization, Huggins Hospital serves all in medical need regardless of ability to pay. The organization is governed by a volunteer Board of Trustees committed to balancing community needs with our available resources to meet those needs. As a hospital-employed medical staff, all twelve physician practices accept patients regardless of ability to pay.

Part VI, Line 2:
Please see Part V, Section B. The Huggins Hospital Community Health Needs Assessment and Implementation Plan can also be found online at: https://www.hugginshospital.org/assets/pdf/CHNA_and_Implementation_Plan_2022.pdf.

Part VI, Line 3:
Huggins Hospital provides a notice to all patients both in the hospital and its physician practices of the financial assistance programs available to them. There is a staff of financial counselors who work with the uninsured and underinsured to assist in qualifying for Charity Care or a sliding fee schedule depending on the family income. Financial counselors also assist those uninsured in applying for and receiving assistance through the Medicaid program. Information about our financial assistance programs can be found on our website and in print or in person at all of our locations.

Part VI, Line 4:
Huggins Hospital is a non-profit, rural, Critical Access Hospital. Our community's year-round population is approximately 33,000 citizens which expands in the tourist season to about 120,000 residents. Huggins Hospital is the largest employer in Wolfeboro. The primary service area for Huggins Hospital includes: Alton, Brookfield, Effingham, Freedom, Ossipee, Tamworth, Tuftonboro, Wakefield and Wolfeboro. Secondary service areas include parts of Barnstead, Gilford, Moultonborough and New Durham. These towns are located in Carroll, Belknap and Strafford Counties.

Part VI, Line 5:
Huggins Hospital has played an important role in the Eastern Lakes Region of New Hampshire for more than 100 years, enabling unwavering support to patients and their families, community members and employees. Gifts made to the hospital's annual giving program and special initiatives support programs that are important to the region.

Part VI, Line 6:
Huggins Hospital is part of GraniteOne Health, an affiliation with Catholic Medical Center and Monadnock Community Hospital. All three organizations are non-profit, charitable organizations focused on improving the health of their respective communities as well as all the communities served by all of GraniteOne Health organizations. The affiliation is collaborative, allowing the three organizations to maintain their own identities and strategies while offering support to one another to improve on community health initiatives already in place.

Part VI, Line 7, Reports Filed With States
NH

Operating expenses	$ 93,642,279
Total amount spent on community benefits as % of operating expenses	$ 14,463,822 15.45 %